Ethiopia NOTF annual NOTF secretariat technical report to Technical Consultative Committee (TCC): January 2007 - December 2007

NOTF ETHIOPIA The Federal Democratic Republic of Ethiopia Ministry of Health ANNUAL NOTF SECRETARIAT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) To APOC Management by 31 Ianuarv for March TCC meeting To APOC Management by 31 Julv for September TCC meeting AFRICAN PROGRAMME FOR ONCHOCERCIASIS CONTROL (APOC) tn..,,( lfr rlI\z Tcc t< p h ^n/dr csb fo? AHE Bfo f0 NOTF ETHIOPIA NOTFCOLINTRY/: ETHIOPIA Approval vear: 2001 Reportine Period (Month/Year): January 20O7-December 2007 Proiect vear of this report: (circle) 1 ffiz I s totrrz Date submitted z 15 /02/ 2007 ?i,irt0g' rt\/ Apoc/Dtlr RICU I.I: tl.B.Ko,-,e I : I I I I i I I I I tCo ANNUAL NOTF SECRETARIAT 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: untry: Ethiooia N ational Coord inator N ame : ...........Qp..1e....Ej.e.qa Date, .. NOTF Chair N ame' I D-r..D.a.dd.i..J.im.a. Signature: Date This report has been prepared by Nam Gole..Eic.ta D e s ign atio n : ............N a.t i p..n.aL.Q p. .q rd.in a.qa,r Signature: ... DateI I WHO/APOC, December 15,2004 TABLE OF CONTENTS FOLLOW UP ON TCC RECOMMENDATIONS VT EXECUTME SUMMARY ........8 SECTION 1 : BACKGROLIND INFORMATION ........ 1. 1. GrNpnal rNFoRMATroN................. l.Z. Popur,qrroN AND HEer-rH sysrEM SECTION 2: SUMMARY OF CDTI IMPLEMENTATION........ 2.7. Aovocecv AND SENSrrrzATroN 2.3. INrorurerroN, EnucATIoN AND coMMUNtcATtoN STRATEGv AND MATERIALS DEVELOPMENT 2,4. COI"II"IUNITIES, INVOLVEMENT IN DECISION-MAKING 2.5. Capecrry BUILDrNG... 2.6. ORoERTNG, sroRAGE AND DELTvERv oF TvERMECTTN ..... 7..1. DrsrzugurroN pERroD.... ............13 10 10 T3 l3 r4 t5 t5 t6 18 3l 3l 3Z 3?. 33 Z5 2.7. TRparuENTS....... 2.8. SupERvrsroN ....... ........19 7.9. CouvtuNrry sELF-MoNrroRrNG AND SrRrsrioLDERS MEErmc ?.8 SECTION 3: OTHER ACTMITIES OF THE NOTF.... .... ze SECTION 4: SUPPORT TO CDTI 31 4.1. FmaNcrel coNTRTBUTToNS oF THE pARTNERS 4.7. Orugn FoRMS oF coMMUNrfi suppoRT. 4.3. RpsouRcE MoBrLrzATroN EFFoRTS.............. 4.4. ExpENorruRE pER AcTrvrry By rHE NOTF sECRETARrAT.......... 4.5. EeurpuENr SECTION 5: EVALUATION FOR SUSTAINABILITY OF CDTI, INDEPENDENT MONITORING AND OTHER RE\ITEWS............ .....,.,.,. 3 4 5.1. INoEpTNoENT pARTrcrpAToRy MoNIToRTNo/Evru-uATroN... ...................34 5.2. SusrerNRsrlrry oF IRoJECTS: pLAN AND sET TARGETS (uaNonrony er YR 3) 36 5.3. INTEcRerroN . 37 5.4 OprnarroNAl RESEARCH ................39 SECTION 6: STRENGTHS, WEAKNESSES, CIIALLENGES AND OPPORTLINITIES 39 Acronyms APOC African Programme for Onchocerciasis Control ATO Annual Treatment Objective ATrO Annual Training Objective CBO Community'Based Organization CDD Communiry-Directed Dismibutor CDTI Community.DirectedTreatmentwith Ivermectin CSM Community Self'Monitoring LGA Local Government Area MOH Ministry of Health NGDO Non-Governmental Development Organization NGO Non-Governmental Organization NOTF National Onchocerciasis Task Force PHC Primary health care REMO Rapid Epidemiological Mapping of onchocerciasis SAE Severe adverse event SHM Stakeholders meeting Technical consultative Committee (APOC scientific TCC advisory grouP) TOT Trainer of trainers UNICEF United Nations Children's Fund UTG Ultimate Treatment Goal \7HO 'World Health Organization II WHO/APOC, December 15, 2005 ! Definitions (il Total population: the total population living in meso,/hyper'endemic communities within the project area (based on REMO and census taking). (iil Elisible population, calculated as 84o/o o{ the total population in meso/hyper-endemic communities in the project area. (ii1 Annual Treatment Obiective: (ATO)' the estimated number of persons living in meso,/hyper-endemic areas that a CDTI project intends to ffeat with ivermectin in a given year. (i"; Ultimate Trea t Goal (UTG), calculated as the maximum number of people to be treated annually in meso,/hyper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage (normally the project should be expected to reach the UTG at the end of the 3'd year of the project). (") Therapeutic coverage: 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). ("ii) Integrationt The bringing together of rwo or more health programs, removing barriers benveen/among them, in order to maximise cost- effectiveness and permit free and equal association. For example delivering additional health interventions (i.". 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 ourcide of CDTI. ,viii) Sustainabilityr 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, lll WHO/APOC, December 15, 2005 with strong community ownership, using resources mobilised by the community and the government. lv WHO/APOC, December 15, 2005 WHO/APOC, December 15, 2005 UX $B $s ^- i*< S,\&< IJJ Nl \* notr =NHB rT hl cr, (rj KHNC ue x^ O C.)w# ! - .E E cE t .E y B ti.!= tr s esi ?E zt .)cdY-c,gpFe gj_Bil,5EE c:>Ei r€ 3a di t 6i,.g d c!t = H;E i 3 *A 3I = b Y H:L.-CJ':\!.r!'c",-'EA5trhUpE.E E tr 0+*2iHsE€,gg E C)PI (-, UI vG) AA u)!4, t< Aq,qEIUP(Jcg >- $? = .iJ :: q))lr li (J <-6 R\Jr4 ,!*Nv! .iaLJ ID T<(.)C.J-(.)cDq: 2 ccrc, ri >-9AH\J\ts I l''lt H eo9! 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Ethiopia has got ninc GDTI projccLs; namcly Kaffa-shcka, Bench-Maji, North Gondar, Illubabor, Jimma, .Srest .Wollcga, East 'Wollega, Metckcl and Gambella. Thc first projcct is at 7th ycar of implemcntation, whcrc as thc next two arc at 5'i ycar and t6c last six arc in thcir 4'h ycar of implcmcntation. Orrt of 22,486 communities in all the projcct arcas, a total of 22,486 commtrnitics wcrc trcated making an ovcrall geographic coveragc of 100%. In 2007 rreatment pcriod a total of 4161462 peoplc are treated making a therapeutic covcragc of 78o/o. Each of thc projcct^s has achicvcd a good geographical as wetl as thcrapcutic covcragc scparatcly. A11 thc projcct-s havc achicvcd a gcographic covcragc of 100% ancl a therapeutic covcragc above 65% during this ffeatment period Z. Summary of training data of projects (nationally) for' .Projectofficer(mainingoftrainersand,/orotherspecifictraining), total number of CDDs and health workers trained, total population per active CDD trained. Trainirrg 6f traincrs wirs givcn to a total of 110 projcct lcvcl statT,2,777 hcaltft prgfcssictnals and 7,196 othcrs scctor staff. Thosc who w'crc tririnccl 8 WHO/APOC, December 15,2004 as trainers in tlrrn gave training tor a total o{ i4,979 Cl)Ds (29,558 neu' and 5,421 rcfrcshcrs). This mirkcs thc zrvcragc numbcr of Ol)l)s pcr villagcs to bc 1.7. 3. Extent of integration of CDTI projects into the health system. CDTI is intcgrated with thc Primary Hcalth Carc (PHC) from thc bcginning. At thc National, Rcgional, Zonal, and '$Torcda lcvcls, thc Malaria and Othcr Vcctor-bornc Discascs Prevcntion and Conffol Units arc rcsponsiblc. Thcrcforc, all thc staff of thcsc units has rcccivcd training on Onchocerciasis. Training of peripheral hcalth workcrs has bccn carricd out in integrated manncr with othcr hcalth issues. Ivcrmectin dclivcry starting from thc highcr to the lowcr lcvel is also intcgratcd into thc rotrtinc drug dclivcry systcm in thc country. As part of thc systcm in thc collntry, most of the sttpcrv'ision and monitoring activitics arc carried out in integrated manncr with othcr programs. Thc CDDs are involvcd in othcr hcalth activitics such as malaria prcvcntion. Gcncrally thc CDTI activitics arc givcn priorities as part of PHC. 4. Strengths and weaknesses of the national onchocerciasis control program; challenges and how they were overcome; and opportunities that will strengthen the program. The most important strength of the CDTI projcct-s was their abiliry to accomplish thc ivermcctin distribution with high gcographical and thcrapcutic covcragc. This was due to high political commitment at all lcvcl, intcgration of thc activitics to thc cxisting hcalth systcm and awarcness and active involvcment of health workcrs and thc communify at large. Incomplcte utilization and bcing slow in liquidation of APOC trust fund is onc of thc wcakness of the projccts. In addition to that dclay in strbmission of both tcchnical and financial rcports was a wcakncss. To ovcrcomc such problcms, thc projcct lcvels werc givcn on job trainings and advised durir-rg supervisory visits. Thc good opportunity for thc CDTI activitics to bc strcngthcncd I was thc expansion of govcrnmcnt strucfllrc down to villagc lcvcl and bcing taking the responsibility of dcvclopmcnt activitics as wcll as hcalth carc. Anothcr goldcn opportunity for CDTI was expansion and coveragc of primary 9 WHO/APOC, December 15,2005 health service coverage and health extension program through building of hcalth posLs at grass root lcvel. To implcment this program at house hold levcl thc govcrnment of Ethiopia traincd and deployed hcalth cxtension workcrs at this communiry levcl. These hcalth extcnsion workers sttpcwisc and dircct Cl)Ds for cffcctivc and timely implemcntation of CDTI 5. Key activities undertaken by the NOTF during this reporting period. Launching worksirop for all CDTI projects Training of traincrs at project lcvcls for new CDTI projccts Carry out National Annual Review Meeting Makc suppt-rrtivc supervision to the CDTI projccts Conduct Ongoing Monitoring CDTI activitics Conduct rcgular NOTF mcctings Assist projcct lcvcls in report writing 6. Progress on vector elimination activities (where applicable) Not applicablc SECTION 1: Background information 1.1. General information 1.1.1. Description of the country program -CDTI and vector elimination (brieflY) Status of National plan implementation, population at risk, number of projects being implemented, other relevant activities, and infrasffucture (eg. Adequate health facilities, is system decentralized or not, etc), logistics, administrative structure. Health system & health care delivery (state any problems related to health system that impede program implementation). Provide map locating all projects (CDTI and Vector Control, if any) within country. Thc lancl arca of Ethiopia is cstimatcd at about 1.1 million square kilomctcrs and thc total population at that time was approximately 70 million, of which more than 85. Pcrccnt livc in rr.tral arcas. Ethiopia is a Fcderal f)cmocratic Rcptrblic composed of 9 National Rcgional States, Tigray, Afar, Amhara, Oromia, Somalia, Bcnshangul-Gumuz, Sottthcrn Nations, Nationalitics and Pcoples Region (SNNPR), Gambclla and Harari, and two Adminisrrativc statcs (Addis Ababa ciry administration and Dirc l0 WHO/APOC, December 15, 2005 f)awa council). The regions and the city administrative councils are further dividcd into zones thcn worcdas and kcbelcs. An cstimatcd 60 to 80 pcrccnt of hcaltl-r problems arc drtc to infcctiotts and communicable discascs and numitional problcms. Thc hcalth care system was underdcvelopcd and only able to providc basic scrvicc to about 680/o of the population. Much of the rural poptrlation had littlc acccss to modern hcalth care that lcd to thc inability of thc health carc dclivery systems to respond both quantitativcly and qualitativcly to thc hcalth nccds of tl-re pcoplc bcforc the last two ycars of this rcporting pcriod. However in rcsponsc to this problcm thc health policy of the Fedcral Dcmocratic Rcpublic of Ethiopia was developcd based on thc critical examination of thc nattrrc, magnitudc and root catrscs of thc prcvailing hcalth problcms of the coul-rtry and it is dcccntralizcd and integrated. Sincc 1990, thc govcrnmcnt dcsigned a twcntyrycar Hcalth Sector Deveiopmcnt plan to rcalizc its health dcvelopmcnt objcctivc w,ith five-ycar rolling invcstmcnt programs. Morcovcr accelcratcd cxpansion of primary hcalth carc covcrage and hcalth cxtcnsion program wcre anothcr ground breaking innritivc to rcach rural community. Ethiopia has becn implemcnting ninc (9) CDTf projccts since the tin-re of inception in 2000; namcly Kaffa8heka, Bcnch-Maji, North Condar, Illubabor, Jimma, 'S7est'Wollega, East'lUollcga, Metckcl and Gambclla. Thc projccts are now found at diffcrcnt ycar of implcmcntation. Kaffa-Shcka ^.t,project is at 7"' year of implcmentation, whcrc as Bcncl-r-lvlaji, North Gondar are at 5'd ycar and Illubabor, Jimma, W'cst.V7o11ega, East Wollcga, Metckel and Cambella arc in their 4"d ycar of implcmcntation. Thc ninc projcct areas covcr a total of 22,489 communities/villagcs and a[ thcsc communitics wcrc treatcd during thc 2007 trcatmcnt pcriod making an ovcrall geographic coveragc of 100%. A total of 5357793 peoplc arc living in hyper/meso cndcmic arcas in thc above-mentioned CDTI arcas. In 2007 trcatmcnt period a total of 416L462 peoplc w,crc trcated making a thcrapctrtic covcragc of 78o/o. Each of thc projects has achicvcd a good gcographical as wcll as thcrapcutic covcrage separatcly. All the projccts havc achicvcd a geographic coverage of 100% and a therapeutic coverage above 65%. Mrp 1: Distribution of Onchocerciasis with CDTI Project Areas, Ethiopia, 2004 ll WHO/APOC, December 15, 2005 l. [orth Gondir CDTI 2. MctGkGl COTI 3.WG3tWollcg. CoTl l(. Ecrt wolle0. CDTI 5, lllub.bor CoTl 6. Grmbcll. COTI ?. Hdf.-Shck. CoTl i. Jimmr CDTI 9. Bcnch-M.ii CDTI LEGEND 1.1.2. Partnership Indicate the partners involved in project implementation at all levels (MoH, NGDOs -national, international) Describe overall working relationship among partners, clearly indicating specific areas of project activities where all partners are involved (planning, supervision, advocacy, resources mobilization, endemicity mapping / assessment, development of IEC materials, studies or surveys etc). State plans it any to solve any issues arising as regards CDTI implementation. As a principlc of APOC as wcll as thc govcrnmcnt of Ethiopia, the CDTI activitics havc bccr-r carried out with a partnership of different actors sttch as Ministry of Hcalth, trniversitics, rescarch organizations, rcgional hcalth blrcaus and NGDOs at national lcvcl. Thc partncrship extendcd to thc project lcvcls to community. The partncrship is strong during planning, advocacy, mobilization, drug distribtrtion, monitoring and evaluation of 12 WHO/APOC, December 15,2005 o .',,) o,, E] @o .ril fol o o i{## if the CDTI activities among different partners. The main partners involved are Fcdcral ministry of health, regional health burcatts, zonc health desk, 'STorcda health officc, health facilitics, thc community, thc cartcr ccntcr, 'WHO, Light for thc world and othcr governmcnt sectors. This string partncrship helped CDTI projects for best achicvcmcnt of thcir activitics and gradually cnsures thcir strstainability. 1,2. Population and Health system Table 1, Projects and population at risk in the entire country, whether they are treated or not during the reporting perio d. (Plr,ase ad.d more rows if necessary) Source: From Oncho Project reports: National censuss Other source, specify--- Year of sourcez 2007 UTG' Calculated as the maximum number of people to be treated annually in meso/hyper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage (normally the project should be expected to reach the UTG at the end of the 3'd year of the project). SECTION 2: Summary of CDTI Implementation 2.1. Distribution period Chart the actual distribution period for each CDTI Project in the country in the table below. 13 WHO/APOC, December 15,2005 Name of CDTI Project Total communities in meso/hypen endemic zone Total population in meso/hyper- endemic zone (Jltimate Treatment Goa[ (UTG) by 2010 Kaffa-Sheka 3726 1075607 978,426 Bench,Maji ttg5 59,3109 493,947 North Gondar 914 302604 235,046 Illubabor 3704 651399 673,734 Jimma 4123 848678 745,969 W. Wollega 4,034 883,829 881,332 E. Wollega 4298 735,lLl 742,914 Metekel 289 140L82 119,894 Gambella 403 93721 100,536 TOTAL 22686 4,731,131 4,973,808 X Project Name Distribution Period Ja n Feb Ma r Apt M"y J,r., J.rl Au db S"p Oct No V Dec KaffaSheka Benchr-Maji North Gondar I1[ubabor Jimma 'W.'!7o11ega E.'!ilollega Metekel Gambella Table 2, Overview of distribution undertaken by project (insert rows &s needcd) Briefly note any problems/issues (one paragraph). 7.2. Advocacy and Sensitization a) State the number and type of policy / decision makers mobilized at the national and lower (state and district level) during the current year; the reasons for the sensitization and outcome. Mobilization of decision makers was done before the start of the CDTI for ali projects in 2007 for national as well as project levels. The meml-rers of the Task Forces at all level were officials from all sectors, which have relevance for the CDTI activity. This political commitment helped the CDTI activities to be successfully achieved its objective. b) State progress made towards internal resource mobilization. The CDTI activity is included in the twenty year health sector development program. The CDTI activities are carried out in an integrated manner. Most of the resources are shared for health activities. Therefore, resollrces mobilized through different health programs also are used for CDTI activities. The NOTF was able to mobilize CDTI specific resource from 'SYHO, The Carter Center and light for the world t4 WHO/APOC, December 15, 2005 c) Describe any policy-related constraints being faced by any particular project and describe what was done to assist the project (outcome). Explain any plans on how to improve advocacy. Thc government has adopted a ncw financial system in which all thc donations are put into a common baskct. In addition to that differcnt scctors fir-rancial rcsourccs arc managcd by sir-rgle finance administration officcs by fcw accountants. This to somc cxtcnt crcatcd sort of dclay of APOC impresscs account managemcnt. To solvc this problcm thc APOC financial officcr has assistcd the projects and rcfreshcr trainings. 2,3. Information, Education and communication strategy and materials deve[opment Briefly describe the IEC strategy being used in the country for CDTI. Thc IEC stratcgy being used for CDTI is similar to thc sffategy for othcr major communicable health problcms. The major strategies arc usc of media (mainly radio), written matcrials (postcrs, information brochures) dircct communication dtrring meetings, health facility visit public gatherings, at school etc. the projccts are using thc standard IEC matcrials and no ncw IEC matcrials produced. Thc IEC matcrials arc producccl at thc projcct lcvcls through thc IEC officcs and distributed to lowcr levcls. Commtrnity mobilization was donc at cach village organizing community mcctings. The hcalth workcrs at all lcvcls havc donc thcir best in organizing thc Task Forccs and giving health cducation for thc task forces. The hcalth workcrs working at front line hcalth faciliry lcvcl wcrc rcsponsiblc to organizc the Kebclc Task forces and giving health cducation for thc task forces, and CDDs. Frontlinc health workcrs and CDDs werc responsible in giving hcalth cducation to thc community at village lcvcl. The community mobilization has contributcd a lot in arxrarcness crcation and as a rcsult thc community involvcd in the CDTI activity with succcssftrl accomplishment. 2.4. Communities' involvement in decision,making Comment on community participation making comparisons among projects The lowcr govcrnment strucftrrcs cspecially thc kcbclc lcadcrs bcing mcmbcrs of onchoccrciasis task forcc, arc rcsponsible for all social, political and cconomical activitics in thc Kcbeles, and havc playcd major rolc in mobilization and sensitization of the wholc community. Civil and traditional associations such as femalc, yollth etc are thc activc participants. l5 WHO/APOC, December 15, 2005 2.5. Capacity building Training of national, district [eve[ staffs in CDTI and general management skilts (computer applications, project planning, etc.) Briefly describe any training done by the NOTF for specific CDTI or Vector Control Projects (Objectives, participants, outcomes, xhY follow'up needed). Training of traincrs was given to a total of 24 projcct coordinators and decision makcrs for thc six ncwly launchcd CDTI projccts at the national lcvcl. Thc main objcctive of this training was to cnablc thc project coordinators to condtrct cascadcs of trainings to CDD lcvcls so that thc CDTI activity will be carricd out. Table 3, Typ" of training undertaken at national level by the GTNOr/NOTF (Tick tfu boxes where specific training was carried out dunng tlle reporting Deriod) Type of training Project staff MOH staff Opinion Leaders Others(speci fu) NGDO Program management x x x x How to conduct Health education x x x x Management of SAEs x x x CSM x x x x SHM x x x x Data collection x x x x Data analysis x x x x Report writing x x x x Others (specifi,) Briefly describe any technical assistance provided to the CDTI projects. The CDTI project coordinators were given brief training on the new annuai technical reporting format during supervisory visits. 16 WHO/APOC, December 15,2005 N -i L() -o oo 0) o O o E ts r- Eq) (! li rh a aO o lios F Z 6i -d [L.,+,) \oIIdO'= .O d d .F q) a< e q.) z o\rn @ Y o\ O, : ca\o € c-t O. \o\o rll : @ cn $ c-1\o : c-r- c-.1 : r-t ca r- c-.1 @@ U1 : \o -ica O o\t o\ @t\o ? c-..1$@ @O F< -: car-OO -: \o O co o\\o co\o tr- Y @ra c--.1 o+ @ o ot@ ca\o : (-.l\o :_ O o c- o rn \o o\N -f, + +\o o\\o E c)t d) o U A\ O cli t-{ o\$ o\ta r- -f $ e.l\o ca f-N@ @ O o\+ @t/)O c'.1O@ O$@ c'.t\o\o @ @ @o+ 90 .lo(! l-{rb L [-t .aJ (r,fEo.E tr !{P5E r+rEO z dll + +JNO f, c.l dio d d .ts, qJ a q.) z c- Lr) -: \-i\o : \o o\ O o O O O O O O O ? O O @O ca \o t-- -i C{ ca Fl t@ : \o L : t @ O @ O n-\oo ct o\ rn o\o -+ I o) E o.) 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D-o\o ra D- o_ O ca o\ r $o\o Gio cO o\ o\ cO rn\o @r-\o @$@ Nr-q (-.l(--l o\ r+ F{ ar1 .Or- c-.1o@O$ F{ -iN c- ca o\ U) C) P E F o O oll -'\ qdcii a o, q)kDo !'; N ^P.q bs6l l-rnU\r(J Oo oO oo oO Oo OOFl Oo oo oO a b Ej E €= E€ t, fl!\Jtr<a-b0ijrxqrF z 8:! p \o c.Ir- cO rn o\ + o\ tOr- cO cON + a -f,Ot @ e.l$ o\O e'l c.)o$ N -.16EH)-:ii.cJ6r? ii 65 >{F o \oND-ct rno\ +o\ $oD-cO cON+ OtO$ @o\C.l$ o\@(*.l aa\o$ ts: E *: * E> u+S€ saii -. .r !v - V) H .v.JsI \oN D- ct tn o\ $ o\ +Oc- cO cON + O+O+ @ (*.l$ o\ co c...1 caO+ P(J q) +rCi r, cds*d-.Y6 -tU.* frz lrd +(J Lr! zc ti cd -o cn d. cd OD C) .o dbo C) o Ei > o3 0) .u o<z d O -a \, A. oA ON ri o -o o(J() a Ota (-, N o O ra +ror\ rn N tn N+o@ N\o$ \o + o\ @ o\tr-$+o\ tn o\q cO\oq tn N o\\oNN crl o\\oNN N o\\oNN J f, F< N ri k() -o o(-)(.) IJ O o NN cF) o +r PO c) otia (.) l1 !J l-J ts C') (.,)tr C! o OEt q.) t\() A. U) F tr E C)!) 0)F!) (.)p oP q) o. C) A. \+i o li q.) -o E 6P oF z ll 0,) .ePUo C tJ d C) tr].J q) lrF c! i C)l-i d PO C) L.,/ *r A. C) p H o IJ.] d., -oto \.jr LJ a)t ct) ct)q) P t E oU(, E q,)t () nO A. o cn o E (J lrq) -o E t dP F X i cd(.) li d P(J C) Lia C) ! c tJ B cn c) lJ tr E tr oO U E(.) q,)I(.) O. I oa c) tr bo o P6 A. oa tJ oF OO Xt 0)P C)lrLJ c) o o c) o !+r o F() -o E z Eq) () o F) s C)P tr q) bo c! l.rI'r a u<- F C) +J lr obo cdlrI () L) Qo\ dv +r uo oO q) !J li c.)bodtr C,) oo U ! -^)rO0) o\ lr F If the projects are not achieving 100% geographical coverage and minimum of 650/o therapeutic coverage rate or if coverage rate is flucruating, state reasons and plans being made to remedy this. The geographic coverage of the CDTI projects was 100%. The therapeutic coverage of all projects was more than 65(% for all the projects. 2.7.2 In general, what are the causes of absenteeism and refusals and how is the NOTF dealing with them? The high number of refusals and absenteeism were seen in new CDTI project areas. This is attributed to low awareness of the communities to wards the treatment. This issue was especially pronounced in township areas where the community feels they are not sick. To solve this problem we have discussed with the project levels and planned to exempt big towns from the drug distribution through CDDs and instead passive treatment cases at health faciiity level will be usecl preceded with intensive mobilization. In some of the projects absenteeism was also due to overlap of farming season with actual dismibution time, and will be minimized by appropriately targeting the community preferred distribution time. 2.7.3.Briefly describe all known and verified serious adverse events (SAEs) and provide in table 7 the required information when available. Not applicable 2.7.4.In case the country has had no case of serious adverse event (SAE) during this reporting period, please tick in the box. No case to report x Table 7: Cases of Serious Adverse Events (SAEs) that occurred during the reporting period (Please add more rows if necessary) Name of project Number of verified* SAE cases reported Action taken Number of cases with squeal Number of deaths KaffaSheka 0 0 0 Bench-Maji 0 0 0 North Gondar 0 0 0 Illubabor 0 0 0 Jimma 0 0 0 23 WHO/APOC, December 15, 2004 !7. \7o11ega 0 0 0 E.'!7o11ega 0 0 0 Metekel 0 0 0 Gambella 0 0 0 . SAEs slwuld.be uerifiedby proiect coordinator Sequelea is de{ined as those cases that have not recovered {uIIy {rom the SAE and are le{t with lasting neurological or other debilitating ef{ects. 2,7.5. A summary of the trend of treatment achievement per project from inception of first CDTI project to the current year '!7hat is the ultimate ffeatment goal for the entire country? 4478t Table 8r Treatments and coverage's by calendar year for the entire projects areas. (Please fill in the required data {or the country as a whole - combine data {rom aII CDTI into a national YEAR 2001 ?,002 7003 2004 7005 2006 7007 2008 7.009 UTG Covetage (%) Annual Treatmcn t Objective E7 Therapetrt ic coverage (%) Es= Er/ E6*1oo Total pc-rpnlation of the rneso,/hyper' endemic areas E6 Geographic al covcrage (%) E+= Er/ Er*100 Total # of cornm./ villages in thc meso,/hyper-endemic ATCAS E1 26 3l306,297l5 902,6873,277 56 66654,250978,691641,277 78 1, 790,247 667,563,635815,2.44 60 7t 770,,035 3 )80 4,985,88220,368 68426976160 508304920699 444i907 695,290,36610020625 4478164 785290366100?.2486 2010 24 WHO/APOC, December 15, 2005 7.8. Supervision 2.8.1 Note the supervision that was undertaken by the NOTF (Project supervised, date, by whom, objective o{ supervision mission, outcome, follow,up needed) 25 WHO/APOC, December 15,2004 $ c.l ,ri L()p () o(.) o o o \o c\ -'> F+ q) Qq) a t- q)Fo .B I q) qJ n* IJiF o z C)i {-J -oi c) .V Pli C)E ! o cn tq) A. a qt -ol6t FI EoE c.) a.)t O. -t * € q) U +r C)<a .I c! 'r -u-,tv Hir ,.n Lrr > (+ .+?^ U i^-! q- ui,-:v -v ) * S": bn 6# :1^ t-va'i YY!ercE 8r! 9 P --!- tJ !9rJq.;l.Y0)'=pl-) .-r{Ud(, .. t l- N hd)v- U_Lr-YC.r.H= P HLi G C) o.! rl 9l 9 eVFLJT-iu(.) -. '21 - 63 ? F= Ct-:)EP.;r t-{-ct@(! H o a trO A. a O ]-J O C) -oC bo C5'J HAt- -6>.- O .a6 .! 9.EQ 6 ts?- o .Y >..^.,.iJ tJ :1'U ! rrc(J t4 /lv -HStrox iL)! 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U) d rir }Z d<A .J o EA !6 +,J|.i trooZO t< o -aCd -o N Vi L C) .o (.) oo a O o r-N O- Nal =ii - -Li ,'-/ IJi -cd LYbo(.) P '.) bD -E5 8.a.ro6!a.! cd Y^ 6J - .J J-: \J(Jp(J v tvc''- t4 )irr :1 o)/ui L! 11 H. >\ {-r lil-1 Cd d)rl o I\./ L rJ a\P-7o9tr€ H L) t A -.Yt.: L) .-!OO or< ^UtlbO !A .e ;n O!a:^ G) ti- -C,r- .! tr c(h uroat4)ou)! o. aO iJ,frcd q) u 8 H iit g [r-vV.- fi i= J-] LJ Y4 ..E* 9 E; E =.= a.!t dt< -1 (J .id<^od>l-Fi'4izatsQzr t I Y )1E $ sE 35 s?p:o ij b0EFiepf! .nrJqr!(1(JFE;EEPHuIJ o <at-t* \J *r^\rLLi9rarlA;H "lj F odxq!-iiu .) C ''/ !",| E i-E€ I E cr P; t--c = ? XEii 393r ^cgiIiuo.: a0-)- Ea -E g ,;i 8 H ;i e; tr+.9 t?.F ,,( = +l a.r Y .aU* g.E c, Utr.: p.!t 6 -E a-: i a = ar71+Ji!-\ * )i ;^ l-.i :- E go lc-r - rl il r\ ; 2cBouoC.=HTP.E o 9.E E':.E.E 90L!VU-iHiUTJE <nt+-d* ug a 6a 8 7, H ;€ s e \E '.E€ g'E Fr-zJ O Li Q X 7,. x* =3 dCU7 U05o9tr9u) OLgCJE i-l >c-dC) >R ir-!oTR - t-- .O Z c..l >. (--cso >S N>bi:o2 c.l c.l vct cg;-CcnlrA .d]ll-sF>i ,r-!JVvOCJ cit-Ct)H.^A -v Y r'r .dAt<H -.,1 -- O>FItrC cr.l .r \< lJi5v O cdcg ,-S A a=:d,c)<.l=.-v .cd^liSF>A /. # LJljv U 6 c,3 t-C aAL.aA J .CCAlr sE>i 6.1 -c}9 -:. c) ^\- tqYt B -G){:r)U /i * - ! .)( pc P . U . Fl<O!X -< zx -r ,v2l).e? d E F d bo c.) boO o r.i q)Jo! c,) 2 d (,) -o E 2.8.1. What were the main issues identified during supervision? Onc of thc isspcs identificd during the sttpcrvision period was dclay in utilizing and liquidation of funds in almost all CDTI projccts. Dclay in rcporting of CDTI activities cspccially at Woreda and front line hcalth faciliry lcvcls was also obscrvcd in somc CDTI projects. Participation of 'Womcn was low, .Unlecessary expiration of drug was observcd. 2,.8.2, Was a standard supervision checklist used? YES 2.8.3, What were the outcomes at each level of CDTI implementation supervised? Thc CDTI projccts wcrc ablc to finalize thc trcatmcnt of thc year with good gcographical and therapeutic coveragc. To solvc thc financial liquidation probicms, on job training was givcn to thc accountants during supervision. Thc overall reporting of thc CDTI activitics was also corrcctcd as much as possiblc. Unncccssary cxpircd drugs wcrc cxplaincd rcason for cxpiry. fu-rtcnsivc }-rcalth cducation was providcd to increase womcn participation. Z.8.4.Was feed,back given to the supervised, and how was the feedback used in improving the overall performance of the project? Fccdback is givcn in-rmediately after the supcrvision and all the concerned lcvcls arc informcd. This fcedback hclped in the projccts implemcnt cffcctivcly. Z,g, Community self'monitoring and Stakeholders Meeting Table 10, Community self-monitoring and Stakeholders Meeting (Please ad.d more rows if necessary) Project Name Total + of districts in the entire project area No. and o/o of districts that carried out self monitoring (CSM) No. and o/o o{ districts that conducted stakeholders meeting (SHM) Kaffa-Sheka Bench-Maji _ North Go_ndar Illubabor Jimqa 'W. \Tollega E. \7o11ega Metekel Gambella 13 10 ) t_z ) 11 t0 4 4 13 8 3 6 1 11 10 4 4 13 7 3 6 a) 11 10 4 4 TOTAL 70 70 70 28 WHO/APOC, December 15, 2004 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. 2.10 Compliance to long,term treatment with Ivermectin Mention specific activities in the Table 11 that the NOTF has done to ensure that CDTI projects comply with long-term mass treatment with ivermectin! (For projects 4 and above years old) Table 11r Activities that promote compliance to long-term treatment with ivermectin SECTION 3: Other activities of the NOTF Objective Specific Activities Project targeted 1. Promote Integration of CDTI with other health care servlces -Sincc the bcginning, the CDTI activitics are intcgrated in the existing hcalth systcm, - Allocation more fund for CDTI activities A11 projects 2. Maintain high therapeutic (>65%) and geographic (100%) coverage -Continuous rcfrcshcr trainings to FLH'S7, and thc CDDs -Strcngthcn commun ity owncrship Advocacy and sensitization of thc decision makcrs il 3. Promote strong community ownership -Allow and facilitate for the community to make decision ,lnvolve the community in planning, M&E n 4. Promote high government commitment -Conduct continuous advocacy and sensitization meetings at all levels 5. Support strong partnership Advocate for partnership, involve all parties, work in close collaboration il 6. Put in place a strong IEC strategy that encourages continued treatment -Messages through different medias - Advocacy and sensitization meetings -Use different formai ancl informal community gatherings to transfer health in formations il Other 29 WHO/APOC, December I 5, 2005 3.1 Describe any additional activities undertaken by the NOTF (REMO, RAPLOA, KAP studies, vector elimination where applicable, etc). Nonc in 7007 3.2 What was done to coordinate CDTI Project activities? Rcgular sLlpportivc supcrvision to thc projcct-s wcrc done, idcntifi' probicms and givc fccdback. Conduct annual rcvicw mecting to sharc cxpcrienccs among different CDTI projects and revicw thc achievcments, idcntifi, probtems and their solutions, challcngcs and opportunitics. 3.3 Note meetings convened for the NOTF. (Objective of meeting, issues addressed, date, participants, outcome, and constraints faced follow,up needed) The NOTF is mcctings cvcry quarter. Howcver, during this treatment pcriocl the NOTF met only one time Qan 2007 ) due tightcning and compcting priority. The main objectivcs of thc mcctings whcrc, to asscs.\ thc lcvcl of thc CDTI implcmentation, identifu any bottlenecks to provide doablc rccommendation and encouraging achicvcments madc so far. Thc outcomcs of thc meetings wcfc applied at thc project lcvcls. 3.4 Note meetings attended to provide technical input to other projects, other countries, or other sectors. h-r addition to Onchocerciasis malaria control is the rcsponsibility of tl-rc tcam in thc ministry of hcalth and down to thc community (hcalth post) lcvels. 3.5 Briefly state any administrative duties undertaken Number and type of reports reviewed (technical, financial), Reports forwarded to APOC management, Administrative assistance or trouble shooting for Projects Thc NOTF havc rcviewcd a total of 9 tcchnical reports and plan of action and strbmittcd to APOC managcmcnt. Thc projects wcrc rccciving differcnt administrativc and tcchnical supports espccially dr-rring sttpcrvisory visits' 3,6 Insert the Plan of Action for the NOTF activities for the current year indicating activities by month, which were implemented. 3.7 Insert the Plan of Action for next year. Sent to APOC Managcment 30 WHO/APOC, December 15, 2005 SECTION 4: Support to CDTI 4.1, Financial contributions of the partners Table 12' Summary of financial conrributions by all partners to all CDTI Projects for the year under reporting Note: figures should include contributions in kind such as salaries paid by the MOH, etc. If there are problems with release of counterpart funds, how were they addressed? No problem State the number of projects that had no funding from APOC Trust Fundl None State the number of projects that had no funding from any outside source? None State the number of projects that are late in submission of the financial reports to APOC? 9 4.2. Other forms of community support Name of project Contribution (money or items in kind released) Ministry of Health NGDO Partner Local CBO/ communities Distr ict Others Kaffa-Sheka 0 72970 0 2725 5 Bench-Maji t84377 28255 150,000 5928 North Gondar 0 8115 0 4683 Illubabor 0 30974 0 7076 Z Jimma 0 58?.87 438965 2586 0 W.'S7o11ega 13,983 154913 50,000 40,4 75 E.'!7o11ega 0 89827.74 0 0 Metekel 2000 tzz65 500 Gambella 3500 15T7O Total 203860 470726.74 638965 t25463 31 WHO/APOC, December 15, 2004 Describe (indicate forms of in-kind contributions of communities if any) T[e community has contributed towards the CDTI in different ways in most of the CDTI projects. Some of them are involvement in mobilization, training, CDD selection, farm work for the CDDs, supervision of CDDs. In few CDTI projects the community has also contributed money as an incentive for the CDDs. 4.3. Resource mobilization efforts - Describe activities undertaken by the NOTF to raise funds or mobilize in'kind resources and the outcome of those efforts. The NOTF has tried to mobilize financial contribtttion from donors and succeeded to get frorn !7HO country office. 4.4. Expenditure per activity by the NOTF secretariat - Indicate the expendirure on activities below in US dollars using the current United Nations exchange rate to local currency Table 13r Indicate how much the NOTF secretariat project spent for each activity listed below during the reporting period Activi of NOTF secretariat Expenditure ($ US) and ) of funding APO C MOH NGDO OTHER Drug delivery from NOTF HQ/entry point to projects, districts, etc** Monitoring and supervis ion of CDTI Projects Training of Project officers, TOT, NOTF staff, etc. Advocacy visits to health and political authorities at national level Annual leviqw workshops Bi annual NOTF meetings Fu"l u.,Jmaintenance of Vehiclls Maintenance of offpe equipmepg Stationery Others l,z5 4670 2,000 2,000 3,496 4500 4500 80 500 500 tz0 50 3,00_q 100 TOTAL 5125 t5920 6,496 Total number of persons treated 4L61462 7') WHO/APOC, December 15, 2005 ** The project level carries out these activities in an integrated manner. 4,5. Equipment Table 14: Status of equipment of NOTF Secretariat Project (Pl.ease ad.d more rows if necessary) *Condition of the equipment (Functional, Currently non-functional but repairable, 'l7ritten ofO. ALI tlrc equipments mentioned aboue were not functional. at that time. * *The CDTI actiuities are higllb integrated into tlle other lleal.th system and therefore tLle auailable equipments dt tlle MOH at different.leuels is used in an integrated m{Lnner. How does the project intend to maintain and replace existing equipment and other materials? The NOTF as well as the projects are expected to maintain moat of the equipments from the government in an integrated manner. However, few types of equipment wilt be expected to be replaced especially for CDTI projects by APOC after first five years while at the same time efforts will continue to allocate budget by the government for smooth takeover of the project gradtrally. The capital equipments that are contributions of the government will be maintained using the government money. 'V7e were expecting APOC to replace that equipmenLs obsolescec{. - Describe the adequacy of available knowledgeable manpower at all levels. Typ. of Equipment APO C MOH Other donors NGDO Private 1. Vchiclc Toyota Land Cruiscr 4\v 1 1 0 1 0 2. Desk top computer 4 1 0 1 0 3. Printers a.) 1 0 1 0 4. Photocopier I t 0 I 0 5. Fax machinc 1 0 0 1 0 6. LCD projector 1 1 0 1 0 7. Overhead projector 1 0 0 1 0 8. Slide projector 1 0 0 1 0 9. TV, VCR & stand 1 0 0 1 0 10. Scanner 1 0 0 1 0 11. Digital camera 1 0 0 1 0 12. Video Camera 1 0 0 1 0 33 WHO/APOC, December 15, 2005 , Where frequent transfers of trained staff occur, state what project is doing or intends to do to remedy the situation (The most important issue is what measures were taken to ensure adequate CDTI implementation wlwre not enough knowledgeable manpower was auailablB or staff often transfened dunng tlle course of thr campaign). At the NOTF secretariat level their adequate trained and knowledgeable human power. The turnover or the transfer of trained personnel is infrequent. As a matrer of fact all staff of the Malaria control programs in MOH have got enough knowledge regarding CDTI at all levels. Trainings were given in a cascade manner from the higher level ro the community level in adequate amollnt to the appropriate personnel. At 'lToreda and health faciliry levels, there were a few situations where there was rurn over of trained staff which however, did not create any major problem on the project activity as health extension workers are being dcployed to rural villagcs. SECTION 5: Evaluation for sustainabiliry of CDTI, Independent monitoring and other reviews 5.1. Independent participatory monitoring/evaluation 5.1.1 was any independent Participatory monitorin g and/ or evaluation carried out during the reporting period?NO Table 15: Overview of when monitoring and evaluation undertaken (Please add more rows if necessary) Project Name (After Year 1) participator v independen t monitoring Mid-term sustainabilit y evaluation (3'd year) Indepen dent monitori ng after 4tL year Evaluatio n for sustainab iliry (5'h year if necessary ) Internal monitori ng bv NOTF Other evaluati on by partner S Kaffa-Sheka X X X x Bench-Maji X X X North Gondar X X X Iilubabor X Jimma '!7. \Uollega E. Wollega Metekel 34 WHO/APOC, December I 5, 2005 Gambella 5,1,2 In general, what were the recommendations? The general recommendation made during the mid-term sustainability evaluation at its third year of implementation of Kaffa- Sheka was that the project is making satisfactory progress towards sustainabiliry with improvement on some of the key sustainability indicators. The preliminary findings of the ongoing internal monitoring by the NOTF also indicated that the projects marked "X" were carrying out the CDTI activities with high therapeutic and geographic coverage, and community involvement. 5.1.3 In general, how have they been applied/ implemented? The recommendation made during the mid-term sustainability evaluation was fully implemented ancl TCC members reevaluated its level of implementation during their visit to Ethiopia to attend the national annual review meeting conducted in February 2005. The recommendations made during the internal monitoring of the projects are discussed with the project coordinators and indicated for implementation. 5.1.4 Any other comments? 35 WHO/APOC, December 15, 2005 5.2. Sustainability of projects: plan and set targets (mandatory at Yr 3) 'What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: (ll)TI is progrcssing u,cll in all projccts in Ethit-rpia with a fcw challcngcs. Thc trcatnrcnr c()vcr?rgc of most projccts is satisfactory ancl CDTI is intcgratcd with ot[er available health i]ctivities, w'hile there is encouraging communiry- ou'nership. These all are good indic.ators to shou, the projects' prc,gress toward strstainability- Tfiird ycar sustirinability cvaluatiot't took placc in Kaffa Shcka Octobcr 2003, and in North Gondar alcl Bench Maji in 2006. The evaluators u'ere particularly impressecl u,,ith the level of integrlltion they w'itnessecl at all levels of the health crirc. Tirc Kaffa Shcka projcct was graclcd as "making satisfactory progrcss towards sustaina[ility". Thc pcrccirred bcncfits of Ivcrmcctin as cxprcsscd lry the commutrities themselves u'ere impressive. 5.2.1. Planning at a[[ relevant levels. Since the beginning the CDTI activities are integrated with the other health activities at all health management and health service giving levels. Therefore, the planning processes are also carried out in an integrated manner through participatory methods, using bottom'tlp approach and integrated with the basic health service. 5.2.2. Funds Ensuring the availability of fund is essentiai for the sustainabiliry of the CDTI. The government has already increased the financial conftibution for critical CDTI activities. In addition to this most of the CDTI activities that are carried out in an integrated manner wili receive resources from different pfograms. 5.2.3. Transport and equipment (replacement and maintenance) Thc APOC donatcd vchicles for CDTI project are well functional at this timc. Maintenancc cost was covered from govcrnment. Thc govcrnmcnt also trscs other vcl-riclcs, in an integrated manner since thc govcrnmcnt tlscs pool sYstem 5.2.4. Human resources 36 WHO/APOC, December 75, 2004 As mentioned above, the CDTI activities are carried out in an integrated manner. At thc national lcvcl, onchoccrciasis is in the division of malirria ancl otlrcr vcctor L',clrne cliseases prevention and control team. This clivision comn.lLlnicirtes with a sirnilar one at thc regional levcl, from there to the zonc, ulltil thc hcalth post levc1. A11 the other members of the team are also actively involved in CDTI activities. 5.2.5. Which projects have submitted sustainability plan? Kaffa^Sheka CDTI, Bench-Maji and North Gondar 5.2,6. To what extent have the plans been implemented? The fourth year and fifth Kaffa-Sheka the third year for Benchmaji and North Gondar sustainability plan is successfully implemented. 5,3, Integration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration. The government has inttoducecl the principle of coimplementation with malirria anc{ othcr control activitics to cnsurc cffcctivc utilizatiorr of rcsrrrrrccs. This startcd in partncrship u,ith Clilrtcr Ccntcr supl'rortcc{ CDTI projccts, which arc all implementecl together with malaria control (MALONCHO) program while the project in North Gclndat is integrated u.,ith both malirria ancl trachoma control (MALTRA) progranrs. [t is cxpcctcd that this will cxtcnd to othcr projccts supportcd by l-ight for thc \rVorld. 5.3. 1. Ivermectin delivery mechanisms Since the beginning there is no separate Ivermectin delivery system to the lower level; it follows the existing drug delivery system in the country. The request for Ivermectin is to MDP through MOH. As soon as the drug arrived, the same as all other drugs and medical equipments, a Pharmaceuticals Administration and Supply Service in the MOH handle all the processes required. The project levels, like any other medicines, receive and deliver to the respective levels following the existing delivery system. 5.3,2. Training CDTI is integrated with the Primary Health Care (PHC) from the beginning. At the National, Regional, Zonal, and 'lToreda levels, the Malaria and Other 37 WHO/APOC, December 15,2005 Vector-borne f)iseases Prevention and Control Units are responsible. Thcrefore, all thc staff of thcsc units has receivcd training on Onchoccrciasis. Training of periphcral health wc,rkers has bccn carricd out in intcgratcd manncr with othcr hcalth issttcs. 5.3.3.Joint supervision and monitoring with other progralns As part of thc sysrcm in thc country, most of thc supcrvision and monitoring activities are carricd out in intcgtatcd manncr with othcr programs. 5.3.4. Release of funds Thc govcrnmcnt allocatcd moncy cspccially for critical CDTI activities is rcleased ir-r timc. h-r addition to this most of the CDTI activities that arc carricd out in an intcgratcd manner and rcsollrccs rclcascd for other programs arc also used. 5.3.5.Is CDTI included in the PHC budget? Yes, as part of PHC, CDTI is onc of thc priority activitics at community lcvcl. 5,3.6.Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? In collaboration with thc hcalth cxtcnsion workcrs CDDs are uscd for malaria control program espccially community mobilization, Mosquito net distribution, cnvironmcntal control activitics and ctc. 5.3.7. Describe other issues considered in the integration of CDTI 5.3.8. Describe the integration of other programs into CDTI in your country and the results of this integration on CDTI (e.g. Is Vitamin A supplementation integrated and what are the results, is screening for cataract of primary eye care interventions integrated in all or some projects, if no integration has taken place, are there plans to pilot test a strategy, etc?) Nct In lithiopia, ODTI tras bccn intcgratcd into tl-rc hc:rlth systcn-I right from thc inccpriol of thc program ir-r tl'rc ycar 2000. CDTI has bccn part ancl parccl of thc Lrasic health serv,ice in dre malaria and other vector Lrorne cliseases contrcll ilepartrncnt. Tlle national hcalth policy of the Ethiopian governrnent doesn't plrviclc any r()om firr sctting up a vcrticrll structrrc for any program in thc cxisting hcalrh carc systcnt. 38 WHO/APOC, December 15, 2005 a5.4 Operational research 5.4,1. Summarize in half of a page the operational research undertaken in the country area within the reporting period. Nonc 5.4.2. Howwere the results applied in the project? 5.4.3,Note the issues that have been identified by the NOTF for future operational research. Factors affecting sustainabiliry of CDTI SECTION 6: Strengths, weaknesses, challenges and opportunities List the strengths, weaknesses, opportunities and threats of CDTI implementation process. Strengths: All thc projccts arc ablc to accomplish thcir Mcctizari distribrrtion with 100(/o gcographical covcrage and high thcrirpcutic covcrirgc. This is c{uc to thc awarerless and :rctive involvement of the health Extension u,orkers and the community at targe. Weaknesses: Thcrc is still poor clocumcnt hanclling in somc of thc projects, tlclay in licluiclating the utilizecl Lruclget, and also clelay in collecting leflover Mectizan tablets after trcatmcnt. There is sornctimes delay in starting Mectizan distribrrtion and rcp<-rrting OI)TI activitics on timc. Fcmalc participation as (ll)l)s is still n-rinimirl in almost all thc projccts. Threats (Chaflenges): L)verburdening of hcrrlth workcrs at 'Worec]a and hcalth faciliry 1c-vcls, as l-rcalth w'orkcrs irrc cng;Lgcd in cliffcrcnt compcting hcalth programs, thc continuolrs rcstnrcturing of u,orcclas arrJ villagcs and higl-r ttrrn over of health staff at all levels har,'e heen a continrrotrs problems fllr the projects. Thcsc cI-rallcngcs arc howevcr -surmor.rntablc. - List the strengths, weaknesses, opporrunities and threats of the vector elimination project (where applicable). No Vector control activity 39 WHO/APOC, December 15,2005 - Indicate how challenges were addressed Ily training and clcpkrvrncnt hcalth cxtcnsion workcrs and CDI)s accoml'ranicd with on Job training is action bcing takcn. - Indicate how opportunities can be utilized to improve CDTI. C)pportunities: Thc cx1-lirnsion of govcrnrncnt strucrurc down to villagc lcvcl and taking thc rcsponsilrilit,v for dcvclopmcnt activitics includir-rg health is a goocl opL'rortuniry fcrr sustainabiliry of Onchocerciasis control. The Healtlr Extension program ancl the builcling of a hcalth post in ezrch ancl every Kebclc is also anothcr geod opportuniry. Thc vcry smooth anc{ good rciation of thc partncrs ancl thc ftrll intcgrirrion of thc CDTI into thc existing hcalth scn'icc at all lcvels of the projecrs are also important opportunities tor the sttstainabiiity of the CDTI. 40 WHO/APOC, December 15, 2005