Ethiopia NOTF annual NOTF secretariat technical report to Technical Consultative Committee (TCC): January 2004 - December 2004

^t- I NOTF ETHIOPIA The Federal Democratic Republic of Ethiopia iVlinistry of Health ANNUAL NOTF SECRETARIAT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) To APOC Management by 3l Januarv for March TCC meeting To APOC Management by 31 JuIv for September TCC meeting AFRICAN PROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) Y/: ETHIOPIACO NOTF ETHIOPIA NOTF Approval vear: 2001 Renorting Period (Month/Year): January 2004 - December 2004 Proiect vear of this report: (circle) I 2 456789101112 Date submitted: I 5/08/2005 IIr 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: Country Ethiopia National Coordinator Name: Dr .J.ima... Signature: . t, /{ Date I J NOTF Chair N ame : . ...... .. .D...r..A.lem.ay.p.hu. S.ei fu...... l Signature: ... Date: . ... t.6.1. oso This report has been prepared by Name: .......Dr..Dadd.i.J.im.a.......... Designation : ......... Signature Date lpo JL..-_,_ ___._ -_._ WHO/APOC, December 15, 2004 t I .sL , -v q' o 1\ i\{.& a q ,.&6 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-Directed Distributor Community-Directed Treatment with [vermectin Community Self-Monitoring Local Government Area Ministry of Health Non-Govemmental 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 ll WHO/APOC, December I 5, 2004 I ,'t r r 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 mesoAryper- endemic communities in the project iuea. (iii) Annual Treatment Objective: (ATO): the estimated number of persons living in mesoAtyper-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/tryper endemic areas within the projict 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 j'd year ofthe project). (v) Therapeutic coverase: number of people treated in a given year over the total population (this should be expressed as a percentage). GeoEraphical coverage: number of communities treated in a given year over the total number of meso/ttyper-endemic communities as identified by RIUO in ttre project area (this should be expressed as a percentage). Inteeration: The bringing together of two or more health prograrns, removing barriers betweer/among them, in order to maximise cost-effeitiveness and permii free and equal association. For example delivering additional health interventions(i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) thrgugh GDTI (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 distnbutors outside of CDTI. (vi) (vii) (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. rri WHO/APOC, December I 5, 2004 ,\ t( FOLLOW UP ON TCC REGOMMENDATIONS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session (Please add more rows if necessary) Number of Recommendalion in the Report TCC RECOMMENDATION ACTIONS TAKEN BY THE NOTF SECRETARIAT FOR TCC/APOC MGT USE ONLY tv WHO/APOC, December 15, 2004 it r( Executive Summary Prepare an Executive surnmary of the report in not more than one page. L Summary of heatment and population data comparing projects, trends in treatment over time i.e.- Total number of communities, communities' treated, total population, UTG, ATO and persons treated. Ethiopia has got nine CIDTI projects; namely Kaffa-Sheka, Bench-Maji, Norrh Gondar. Illubabor. Jintma, West Wollega, East Wollega, Metekel and Gambella. 'fhc Frrst project is at fourth year tlf iurplementation, where as the ne.\t two arc at seconcl year ancl the last six are in their first year of implementation. Out of 20,368 cottlt'nunities in all the project areas, a t<ltal of t6,36.1 cr)mnrunities wete treated making an overall geographic coverage of 80%. A total of +.gss.atz people ar.c Iiving in [ryperirueso endenric areas in the abclve mentionecl CDl'l areas and this makes a tJl'Ci of r.taa.t+t trefltments by the time allthe project reach l00ozi) geographic covcrage. In 2004 trcatntcnt pcriod a total of z.gzO.oas pcoplc are trcated making a thcrapeutic coverage of 6092i,. Each of the projccts has achicvcd a good geographical as well as therapeutic cor.eragc separately. All the proiccts exccpt four have achieved a geographic covcragc of lOOuzir and a thcrapcutic coveragc above 6502. 2. Summary of training data of projects (nationally) for: - Project Officer (training of trainers and/or other specific toaining), total number of CDDs and health workers trained, total population per active CDD trained. 'l'raining of trainers was givor to a total of I l0 project level stafT. 2,177 hcalth prol'cssionals and 2,196 others sector stafT.'fhosc who wcre h'ained as trainers in tum gavc training for a total of' 31.979 CDDs (29,558 new and 5.421 tefi'eshers). 'l'his makcs thc avcragc numbcr o1'('DDs per villages to be 1.7. 3. Extent of integration of CDTI projects into the health system. CD'l'l is integrated rvith the Primary Flcalth Care (PHC) fionr the bcginning. At thc National. Regional, 7.onal, arrd Woreda levels. the Malaria and Other Vector-borne Diseases Preventiott and C'trntrtrl [.lnits are restrronsible. Therefore, a]l the staff of these units has received training tln C)nchocerciasis. Training of peripheral heallh w.orkers has been carried out in integrated nlanner with other health issues. Ir,.enlectin deliverl starting from the higher to the lower level is also integrated into the rourine druif delii,ery system in the country. .\s part of the systenr in the country, most of the supervision and monitoring activities are carried out in integrated manner witli otherprograms. The CDDs are irrl,olve,J in other health activities such as malaria prevenlion. Generally the CDTI activities are given priorities as part of PHC. Strengths and weaknesses of the national onchocerciasis control program; challenges and how they were overcome; and opportunities that will strengthen the program. 4 WHO/APOC, December 15, 2004 It Tl.re most important strength of the CDTI projects is their ability to accomplish the ivemlectin distribution rvith high geographical and therapeutic coverage. This is ,lue to high political comnritmetrt at all level, integration of the activities to the exisl.ing health system and arvareness and active involvement of health workers ancl the cornmunity at large. Incomplete utilization and being slow in licluidation of APOC trust fund is one of the n'eakness of the projects. In acldition to thatdelay in submission of both technicalancl tjnancial reports is a weakness. -lo overcome such problems, the project levels weregi'en on jotr trainings and ad'ices tluring supervisory visits. l'he good oppornrnitl'tirr the (IDTI activities to be strengthene,J is the expansion 6fgovernment structure clotvn to v'illage level and being taking the r-esponsibilitl, of development actil'ities as w'cll as health care. Througtr ttr. Health Sen,ice Ertension Program in which there is a start of'building a health post in each ancl el'ery Kcbclc is also another good opportunit).. 5. Key activities undertaken by the NorF during this reporting period. Launching workshop fbr n*r, ('D'l'l projects 'l'raining of traincrs at project levels fbr nerv cD'il projects Carry out National Annual Rcview Meeting l\{ake supporlive supervision to thc CD.t'l projccts C'onduct Ongoing Monitoring CD.I'l activitics Conduct regular NOTF meetings Assist project levels in report ',vriting 6. Progress on vector elimination activities (where applicable) Not applicable. vl WHO/APOC, December 15, ZOO4 SECTION {: Background information 1.1. Genera! lnformatlon l-1.1. Description of the country program -CDTI and vector elimination @riefly) - Status of National plan implementation, population at risk, number of projects being implemented, other relevant activities, infrastructure (eg. Adequate neattl facilities, is system decentralized or not, etc), logistics, administralive 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. 'l'hc land area of Ethiopia is cstinrated at about 1.1 million square kilonrcters and the currcnt population is approrimatcly 70 nrillion, of which nrore than [i5.0 pcrcent livcin rural arcas. Ethiopia is a Fcdcral Dernocratic Itepublic composed otrg Natiolal I{cgional States: 'l'igray. Afar, Amhara, oromia, Somalia, IJcnshangul-Gumuz. Soutlrem Nations. Nationalitics and pcoples Rcgion (SNNPR), Gambclla and Hararr. and two Administrativc statcs (Addis Ababa city administration and and Dirc Darva council). 'l'he regions and thc city adnrinistrative councils arc turther dividecl into zoncs thcn woredas and kebelcs. AIt estimated 60 to 80 percent ol health problems are due to inf'ectigus anrl comnlunicable diseases and nutlitional problems. The health care system is underdeveloped and only able to provide basic service to about 6l,t/o ol the pJpulation. Much of the rtrral population has little access to modern health care, that lead to theinability of the health care clelivery systenrs to responcl both quantitatively andqualitatively to the health rrecds ol'the people. 'l'hc health policy of thc Fcderal Denrocratic Republic of Ethiopia w,as developcd basccl on the critical exatninatiorr of thc naturc, magnitudc and root causes 6f the prevailing health problems of the country and it is declntralized anil integrated. Since 1990' tlre gol'ernment clesigned a twenty-year Flealth Sector Developmerrt plarr 19 realiz,e its health developmetrl. objective with five-year rolling investmerit pl.ograms. Iithiopia has been implementirrg nine (9) CIDTI projects since rhe rirne of inception in2000: namely Kaffa-Sheka, Bench-Maji. North Gondar, Illutrabor, Jimnra. wesrWollega, East Wollega, Metekel and Gambella. The projects are now lilrnd atdifferent year of implementation. Kaffa-Sheka project - is ar lbyrt6 year ol intlrlementation, where as Bench-Maji, North Gondar arqat second year and Iliubabor. Jimma' West Wollega, East Wollega, Metekel and Gambella are irr their lirst year of irnplementation. T'he nine project areas cover a total of zoJo communities/villages. Out of this a total of 10.:0't communities were treated rturing the 2004 treatment p.iioa nraking an ov,er.allgeographic coverage of 80ozi,. A total of r.gas,stz people aie living in irypel1es.-, ettdemic areas in the above-mentionecl CIDTI u..ur und ihis makes a tlTCj oti+.r88.1.1r treatnlents Lry the time all thc project reach lOOoh geographic covcrage. In 2004 t'reatlnent period a total of z.szo.6.1s people are treatecl making i theratrrcuticl.lveragc ,rf 6{)",o. WHO/APOC, December I 5, 2004 Ilach of the projects has achieved a good geogSaphical as well as therapeutic coverage separately. AII the projects except fcrur have achieved a geographic coverage of 100'/o and a therapeutic coverage above 65,/o. Map l: Distribution of onchocerciasis with CDTI project Areas. Ethiopia. 2004 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 parhrers are involved (pianning, sulervision, advocacy, resources mobilization, endemicity mapping / assessment, development of IEC materials, studies or surveys etc). - State plans if any to solve any issues arising as regards CDTI implementation. As a principle of APOC as well as the governmenr of Ethiopia. the CDTI activities are carried out with a partnership of clifl'erent actors suoh as Ministry of HealtS. univcrsities. research organizatiorrs. regional health bureaus and NCjDOs at national Ievel. the partnership extencls to the project levels to community. rhe partnership is strong during planning, advocacy, nrobilization, dmg distribution. monitoring and cvaluatit'rn of the CD'l'l activitics among clifferent partners. 'l'he mairr ;,ritn"r,involrcd alc Fedcral ntinistr-r'of health, regional hcalth burcaus. zonc hcalth desk. lVorcda hcalth ofllcc, hcalth facilitics, the conrmunity, thc carter ccnrcr, W[{O antl othcr govcmmerlt sectors. 'l his string parlnership will help CD'l'l projccts tirr bc.sr achicvcmeltt of thcil activitics and gradually cnsurcs their sistainatritity. 2 l. ]{oflh con(,.r COT| 2. Mct"kd COn 3. WG3t Wo[cg. CDn 4 E.nWohO. CoTl 5. Itub&tr COTI 6, Gmbci. CDTI I. l(lf.-Shel(. Coft a..lilrmCltTl I tcrEt.M.I COn LEGEI{D WHO/APOC, December I 5, 2004 o o o oc o 6 o o {' 1.2. Populatlon and Health system Table l: Projects and population at risk in the entire country whether they are treated or not during the reporting period. (Please add more rows if necessary) Source: From Oncho Project reports: National census: Other source, Year of source: UTG: Calculated as the maximum number of people to be treated annually in meso/tryper endemic areas within the project area, ultimately to be reached when the project has ieached full glpgraphic coverage (normally the project should be expected to reach the UTG at the end of the 3'd year of the project). J Name of CDTI Project Total communities in meso/hyper- endemic zone Total population in meso/hyper-endemic zone Ultimate Treatment Goal (UTG) by 2010 Kaffa-Sheka 1.27 t- 98r,r98 973.116 Bench-Maji I.0-53 495..r46 493.947 North Gondar ql4 235.7t2 235.046 Illubabor .t.590 675,642 67 3.7 -\1 Jimma .1.607 748,082 715.969 W. Wollega 3.703 883,E29 88 r,332 E. Wollega _1.678 745.01 8 '742.9t4 Metekel 141 120.234 I r9.894 Gambella .103 100.821 100..s-16 TOTAL 20,369 4,985,992 4,973,809 X WHO/APOC, December 15. 2004 SEGTION 2: Summary of GDTI lmplementation 2.1. Distributlon perlod Chart the actual distribution period for each CDTI Project in the country in the table below Overview of distribution undertaken ect rows as Briefly note any problems/issues (one paragraph) 2.2. Advocacy and $ensitization a) State the number and type of policy / decision makers mobilized at the national and lower (state and district level) during the currentyear; the reasons for the sensitization and outcome. Mobilization of decision nrakcrs $'as done befbre the start of thc ('Dll espccialll,fbr thtrsc projects that has startcd clistribution in2004 for national as lvell as projcct ler.els. 'l'lte ntembers of the 'l'ask Forccs at all lcvel rvcrc of'ficials from all scctons. *.hi.h llor,. rclcvance for thc CDl'l activity. 'llis political commitment hclpecl thc CD'l'l activitics to be successlirlly achieved its objective. b) State progress made towards intemal resource mobilization. The CDTI activity is included in the twenty year health sector development prog.am. Tlre CDTI activities are carrietl out inan integrated manner. Most of the resourcis are shared for lrealth activities. Therefbre, resources mobilized through difterent health programs also lre used lor CDTI activities. The NOTF was atrle to motrilize CDTI specific resource fiom WllO and The Carter Center. c) Describe any policy-related constraints being faced by any particular project and describe what was done to assist the project (outcome). Expiain any plans on how to improve advocacy. l-hc govemtrtent has adopted a uew financial system in which all the donations are put intrl a cotrlmon llasket. In adclitiou to that different sectors financial rcsources are managed by a single flnance adrninistration tlflces by ferv accountauts. fhis to some cxtcllt crcated sort of delay of'.\POC imprest account nlanagement. 'l-o solve this problems the APOC tlnancial trfTicer has assisted the projects and refiesher tr.ainings. 4 Distribution PeriodProject Name Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Kaffa-Sheka W,i * Bench-Maji ffii.': North Gondar ffi" lllubabor 1*jJil ,.i]!.1 t*jJ Jimma .i,ir;'la- | )4 t W. Wollega d'tll; ;lf, i.i,r -i E. Wollega ffii$'ii' - Metekel l.:1.r,.'+: Gambella ,re'$'$ 5]'t'$i WHO/APOC, December 15,2004 2.3. lnformatlon, Educatlon and communrcailon strategy and materials development Briefly describe the IEC strategy being used in the country for GDTI. 'l'hc IEC strategy being used lor CD'l'l is sinrilar to thc strategy for other major conrnrunicable health problems. The major stlategics are use of media (mainly radio). r,vritten materials(posters. infbrmation brochures) direct comntunication during meetings, health facility visit public gatherings, at school etc. the projects are using the standard IEC materials and no nc\\' IEC nratelials produced. 'Ihe IEC materials are procluce<l at the project levels through the IEC officcs and distributcd to lorvcr lcvels. C'onrnrunity mobilization was done at "aih uillog"organizing commttnily ntcctings.'the hcalth workers at all levels have done their best in organizing thc '[-ask Forccs and giving hcalth education for the task forces. 'I'hc hcalth workers u'orking at frottt linc health facility level were responsible to organizc thc Kcbcle 'Iask fbrccs and gi"'ing health education tbr the task forccs. and ClDDs. [,'rontline health workcrs and CDDs \\'erc responsiblc in giving hcalth ctlucation to thc community at villagc lcvel. 'l'hc community nrobilization has contributed a lot in awarcness crcation and as a result the conrnruniry involvcd in the ('D'l'l activiry with successful accomplishmcnt. 2.4. Gommunitlest involvement in dectslon.making comment on community participation making comparisons among projects The Iou er government stnrctures cspecially the kebele Ieaders being members of onchocerciasis task force. are responsible fbr all social. political and economical activitics in the Ketrcles, and have played major role in mobilization and sensitization of the u,hole comnlunity. C'ivil associations such as f'emale, youth etc are the active participants. 2.5. Gapacity buildlng Training of national, district level staff in CDTI and general management skills(computer applications, project planning, etc.) Brigfly describe any haining done by the NOTF for specific CDTI or Vector Control projects(Obj ectives, parricipants, outcomes, any follow-up needed). Training ol'trainers was given to a total of 24 project coor<Jinators and decision makers lor the six nervll' launched CDTI pnrjects at the national level. The main objectir.e ol- this training was to enable the project coordinattx-s to conduct casca<Jes of trainings to CDD |evels so that the (IDTI activity will be carried out. Table 3: Type of training undertaken at nationar revel by the GTNoaIorF(Tick the boxes where specdic training was carried out during the reporting period) Type of training Project staff MOH staff Opinion Leaders Others(specify) NGDO Program management x .x. x x 5 WHO/APOC, December I 5. 2004 nHow to conduct Health education X X x x Management of SAEs x 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 (speciff) Briefly describe any technical assistance provided to the CDTI projects. The CDTI project coordinators werc given brief training on the new annlral techrrical reporting lormat during supervisory v,isits. .J 6 WHO/APOC, December 15, 2004 s a.l ri L() _o E 0) o() ! 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FI 6l 6t@ ra ?rle ot'- F{ F) trooE bo - o *6FF€gOE9H E L'€ .oF II o (g o 'Eo500O G^gEE ooEOF o --bFE4rE 5 BEz =oEEi €.9I € -:oc o^ N oo oo$F- \o =t _,. o\ Nq t- N r ,;, at al00 €^ ta6ql nl 6l t'.- e6 l-l=l'l 6 t-.d1 -t t\ a--w f-. aa o, rt\a \o @at a] t$ \o=t O\f co F- 6\oq 6t= $ F -qa E o(, o)l< o) o) ul \Oq:.Us; E;E5*i -=q8.9 E Eg}5 o>-5 f\ I\ a! t\r\6t (n t\ F- .J cAo tr Q il E3s Ebsboa- d; qo EE.L.= {i ! # EE'fi = ='F F ao o Eo d O.a =EEE E.O <_9*'F\/ -f t'.- -i o, t-- oq) a o. x o!a (! oY o a o() cE o .= o E Eo L o) c0 (D o) o) 3 = o -o(E - = (u E E - v O o. '+o\ * F\F. r\ -oo -t , -t vi @ a s t-- co o' -J at et € .; .A % a.lta @ N :f t-- oo o\ rf6t '1-a.l o\ a.l CA c.ia oo @ $c- - If the projects are not achieving 100% geographical coverage and minimum of 65% therapeutic coverage rate or if coverage rate is fluctuating, state reasons and plans being made to remedy this. 'l'hc gcographic covcrage of sonre of the CD'l'l projccts is not 1Oo%.'l-his is bccausc thc projccts did not rcach at their tull UTG coverage. 'l'he NOTF togcther with the projcct coordinators hope that all thc projects will reach at its full UTG during the 2005 fi-eatnrenr period. The low thcrapeutic co\crage is ath'ibuted to the low gcographic cor-crage.'l'he therapeutic coveragc out of A't'o is more than 65% fbr all the projects. 2.7.2 In general, what are the causes of absenteeism and refusals and how is the NOTF dealing with them? The high nunttrer ol refusals and absenteeism were seen in new CIDTI project areas. This is attributed to lorv awareness ol' the communities to wards the treatmeni. thi, issue rvas especially prcxlounced in to$'nship areas where the community l'eels they are not sick. To solve this problem rve ha'ue discussed with the project levels and planned to crempt bi.u tou'ns liom the drug distribution through CDDs and instead passive treatment cases at health faciliN' level will be used llreceded with inlensive rnobilizarion. In some ol't6e projects ztbsentceism rvas also due to overlap ol farming season with actual disrribution time. indr.rill be nrinimized by appropriately targeting the community prefened distribution tinrc. 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 add more rows * SAEs should be verified by project coordinator Sequelea is defined as those cases that have not recovered fulty from the SAE and are teft withlasting neurological or other debilitating effects. Name of project Number of verified* SAE cases reported Action taken Number of cases wrth sequelea Number of deaths Kaffa-Sheka 0 0 0 Bench-lVaji 0 0 0North Gondar 0 0 0lllubabor 0 0 0 Jimma 0 () 0 W. Wollega 0 0 0E. Wollega 0 0 0 Gambella Metekel () 0 0 0 0 0 l0 WHO/APOC, December 15, 2004 ll 2.7.5. A summary of the trend of treatment achievement per project from inception of first CDTI project to the current year What is the ultimate treatment goal for the entire country? 4.188,140 Table 8: Treatments and coverage by calendar year for the entire project area. (Please Jill in the required datafor the country as a whole - combine datafrom all CDTI projects into a national Jigure) YEAR Total # of commu/ vrllages rn the meso4ryper+ndemrc areas EI Ceographical coverage (%) Er= Ey' Er*100 Total population of the meso/hyper- endemic areas Er Annual Treatment Objective E; Therapeutic coverage (%) Er= Ey' E.il00 UTG Coverage (%) 200r 3.277 l-s 902.687 306.297 26 -il 2002 6rl 928,69 I 654,250 56 6(r 2003 5.244 8t l._s63,635 1,290.247 (r(r 2004 20.368 EO 4.985,882 3,270,035 60 1t 2005 2006 2007 2008 2009 2010 lt WHO/APOC, December I 5, 2004 I Ir 2.E. Supervision 2.8.1 Note the supervision that was undertaken by the NOTF (Project supervised, date, by whom, objective of supervision mission, outcome, follow-up needed) undertaken the NOTF add more rows 2.8.1 S What were the main issues identified during supervision?()ne of the issues identified during the supervision periocl was tlelay in utilizing and liquidation of funds in almost all CID'l'l projects cxcept wcst wollcga. Delay in rcporling of CID'l'l activitic's cspccially at Worcda and fiont linc hcalrh f'acility l6,cls rvas also obsen'cd in sontc CD I'l projects. 2.8.2. Was a standard supervision checklist used? yES 2.8.3. What were the outcomes at each Ievel of CDTI implementation supervised? 'l'hc CD'I'l projects arc able to flnalize the heatment of the ycar with gootl geographicat ancl thcrapeutic coveragc. to solvc the financial liquidation problems, on job training lvas gil'cn to thc accountants during supcn'ision. lhe ovcrall rcporting ,rf th" CD'll acti\ ities was also ctrrrected as much as possible. 2.8.4. Was feed-back given to the supervised, and how was the feedback used in improving the overall performance of the project? Irecclback is giren inrmediately alter the superv'ision and all the concernecl levels are inbrmed. This I'eedback helped in the projects to achieve good coverase. Project Name Supervisor Date Objective of supervision Outcome/follow-up needed Kaffa-Sheka Dr Daddr .lrrna ( l) Mr Abatc. lrlalrurr 1l) Tatck !lc.konrrcrr (2) Dcc2004, Scpt ()-1, Aprrl 05 T() ssscss the ovcrall actrr rties of (-'DTI at prolcct. [{F ancl conrnrunrty lcvels including fi nancral rrn lrzatton and reporttng) Ihc ('l)TI pro;ects ,rrc chlc to Iinllrze thc Irc:rtnrcnt \\rth good gcographtcal anti therapeuttc co\ ('rJsc lt,llo\\ - up rs strll nccdcrl tln the' scllrnr up oi tinancrll rttrl rzatrtn Bench-Maji Dr Daddr ltnra ( I ) Mr. ..\hrte 'f rlahtrrr { I ) Tatek \'lckonncrr 12) Scpt 2(Xlil, ,\ prrl 0-5 North Gondar \,lr Abarc'fllehutr 1 l)I'atc'k \lcl<onncn (2) [)ec 2()0.1. .l:rn 2005 lllubabor Dr Dacldr .hnra ( l) Nlr. Aharc'frlahun (l) 1'atr'k \lcJcolrnc-n 1 I 1 iVlr. Adtfis l\tckasha Scpt 2004 Dcc20(,4 Jimma Dr Darldi Jirna ( I ) Mr Abatc Tilahun ( l) Tatel Mekorrnen (21 Mr. Addis Mekasha Scpt 20()4. Dcc2004. Aprrl 05 W. Wollega Mr Atldrs Mekasha Mr. l'atek Mckonnc.n Mr Addis Mekasha May 2004, Nttv 2004 toThc (''DT1 pio,dcts arc tlnllrzc'thc trcanrcnt $ rth good geognlphrcal and E. Wollega lVlr Atldrs Mekasha Mr. 'l'atck Mckttunen l\{r Atldis Mckasha Llal 20{)4. Nor 2004 Metekel \,lr T.rtcl \4ekonncnMr Abr'ra Asegre \r'pt 200.1 Dec 200.1 Gambella Mr Ahrrrcd lhrahhrnr .luli.'2t)04.Scpt 2004 t2 WHO/APOC, December 15,2004 t. 2.9. Gommunity self-monitorlng and $takeholders Meetlng Table 10: Community self-monitoring and Stakeholders Meeting (Please add more rows if 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-tenn mass treatrnent with ivermectin? (For projects 4 and above years old) Table 11: Activities that promote compliance to long-term treatment with ivermectin Objective Specific Activities Proiect targeted L Promote Integration of CDTI with other health care services -Srncc thc bcginnrng. thc CDII acfivitres arc rrrtcgnrtcd rn thc cxrstrng hcaltlr system, - r\llocatrrtrr nrorc fund tbr CDTI actrvrties Kafta-Shcka CDTI 2. Maintain high therapeutic (>65%) and geographic (100%) coverage -C'ontrntrous retieshcr trarnings to Ft.HW. and thc ('l)Ds -Strcngf hcn cornmun ity orv nership -Arlvocucr and sensitizatron olthe decrsiorr nral<crs Kal'l-a-Sheka ('DTI 3. Promote strong community ownership -Allow' and lacrLtatc tbr thc cornmunitv to rnakc dccisron -lnvolvc thc conrmunity'rn plannrng, M&t, Kalta-Shcka CD'l'l 4. Promote high government commitment -Conduct cotlttnuous adxrcacy and sensr trTatr()n nreetillgs Kal'l-a-Sheka CDTI 5. Support strong partnership -Advoc.rtc tbr partncr-shrp, rnvolve all llirtrcs. rrorl< in closc collaboratrcln Kaffa-Shcka CDTI 6. Put in place a strong IEC strategy that encourages continued treatment - N4cssagcs tlrroirgh drt-fercnt mcdras - {dvocacy and scnsrtrzatron mcctlngs -Usc drlfcrcrrt lbrnral and rnlbrrral c()nrmun l1v' galhefl ngs to lransfer r n form at r ons Kalta-Shcka CD'l I Other Project Name Total # of districts rn the entire pro1ect area No. and % of districts that carried out self monitoring (CSM) No. and o% of drstricts that conducted stakeholders meetins (SHM) _Kaffa-Sheka 9-9!9!,'--tYrti North Gondar ittro"oo,. lTrrna W. Wollega E. Wollega Metekel Gambella 1 3 6j 7 8 I3 4 /1, l3 3 7 8 n+ 7 J 6 4 3 1 8 ,l+i l-t 1 3 6 TOTAL 55 55 55 l3 WHO/APOC, December 15, 2004 r /(l '' I t SEGTION 3: Other activities of the NOTF Describe any additional activities undertaken by the NOTF (REMO, RAPLOA, KAP studies, vector elimination where applicabte, etc). Nonc in 2004 What was done to coordinate CDTI Project activities? Supportive supen'ision to the projects were done, identily problems and give f-eedback. C-onduct annual review meeting to share experiences anroTlg ditfbrent CDTI ;rrojects and review the achievements, identify problems and their sol utit'rns, challenges and opportunities. Note meetings convened for the NOTF. (Objective of meeting, issues addressed, date, participants, outcome, constraints faced follow-up needed) 'rhe NOTF is meetings every quarter. [-lowever, during this treatnrent period the No'l'F nrct only'threc times (Jan 2004. Nov 2004. l-eb2(x)5) due to ttnforeseen problems. 'fhe main objective of the meetings rvhere to assess the progress ol' the (lD'l-l activities, and identify any bottlenecks as early as possible. The outcomes of the meelings are applied at the project ler-els. Note meetings attended to provide technical input to other projects, other countries, or other sectors. In addition to Onchocerciasis n-ralaria control is the responsibility of the team in the ministry of health and down to the Woreda levels. 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 The NO'I'F have l'evicrved a tcltal of 9 technical and 14 financial repons ancl submitted all the technical and l0 financial reports to ApoC management. The projects were rcceiving different administrative and technical supports especially cluring supen,isory visits. 3.1 3.2 3.3 3.4 3.5 3.7 3.6 Insert the Plan of Action for the NOTF activities for the current year indicating activities by month, which were implemented. Insert the Plan of Action for next year. Sent to APOC' Vlanagcrncnt 14 WHO/APOC, December 15, 2004 a tA J I J SEGTION 4: Support to GDTI 4.1. Financial contributlons of the pailnets Table 12: Summary of financial contributions 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 countelpart funds, how were they addressed? No problcnr State the number of projects that had no funding from ApoC Trust Fund? None State the number of projects that had no funding from any outside source? 4 State the number of projects that are late in submission of the financial reports to APOC? 8 4.2. Other forms of community support - Describe (indicate forms of in-kind contributions of communities if any) 'I'hc contntunity havc contributed towards the CDTI in difl'erent rvays in most of thc CD'l I pl'o.iccts. Sornc of thcm is involvemcnt in mobilization, training, CDD sclection. famr rr,'ork fbr the CDDs, sttpcrvision o{'ClDDs. In t'erv CDTI projects thc conrmunity has also confibutcd nlortcy as an inccntivc fbr 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 NO1'F has tries to mobilize tlnancial contribution from dtxrors and succeeded to get lrom \\'llO courrtry office. It is also possible to involve an NGDO callcd Liglrt lor the lVorltl as metrttrer ol'NO'[F ancl an NGDO parlner for East and West Wollega CDTI projects starting fi'ont 200-5 trcatllte n1 periotJ. Name of project Contribution (money or items in kind released) Ministry of Health NGDO Partner Local CBO/ communities District Others Kaffa-Sheka -15.0(x) 8-1.3.16 300.00() 7-5,()7-1 Bench-Mall 12,000 tE7,25 r 150.000 i0,000 North Gondar r4.000 I ()().63 I Ls0.000 27._i00 lllubabor 13.98_l (t7,970 200,900 40.175 Jimma t.l,e43 ,"3.2.)0 r 7 r,680 :i5.8 23 W. Wolleqa I 3.qS3 () 50.000 .10.47-s E. Wollega t7.0()0 0 100.000 30,678 Metekel l-i,983 () 85,000 12,47 5 Gambella I 3,q83 () 85.000 _13.470 Total r 50,875 582.988 t,292,580 375,970 l5 WHO/APOC, December 15, 2004 I l' "' r ) 4.4. Expenditure per activity by thc NOTF secretariat - Indicate the expenditure on activities below in US dollars using the current United Nations exchange rate to local currency Table 13: Indicate how much the NOTF secretariat project spent for each activity listed below the Activity of NOTF secretariat Expenditure ($ US) and Source(s) of funding APOC MOH NGDO OTHER Drug delivery from NOTF HQ/entry point to projects, districts, etc** Monitoring and supervision of CDTI Projects Training of Project officers, TOT, NOTF staff, etc. Advocacy visits to health and political authorities at national level IEC KAP studies, materials development Annual review workshops Bi annual NOTF meetings Fuel and maintenance- of Vehicles Maintenance of office equipment Stationery Others 7,000 1 500) 2,000 2,000 3.196 80 500 s00 120 50 TOTAL 8,500 2,250 6,496 Total number of persons treated 2.970645 *" The project level carries out these activities in an integrated manner t6 WHO/APOC, December 1 5. 2004 a F ,rr { ) 4.5. Equipment Table 14: Status of equipment of NOTF Secretariat Project (Please add more rows tf neces, *Conditton of the equipment (Functional, Currently non-functional but repairable, Written off). /ll thc eqttipnten.ts rnerttiorrctl ubtn'e ure' filnr:ttorrul ut thi.s titne. **'flx'(-l)t't crctititie's ure highlt'iutc.qruted into the olher healtlt s.t;.stt,rtt tmcl thara.fitra tlte ut,uilnltlc (qttipntents ilt the !v{OII ut dr,llerent l<:vels is used in an integt'oterl munner. How does the project intend to maintain and replace existing equipment and other materials? The n'O'['l:as rvell as the projects are oxpected to maintain moat of the equipments from the govcrnmeltt in an integrated manner. Hou'ever, few types of equipment will be expected to be replaced especially tbr CDTI projects by APOC after first five years w4rile at the same time efforts rvill continue to allocate budget by the govemment tbr smooth takeover of the project gradualll'. 1'he capital equipments that are contributions of the government will be maintained using thc government lnorley. - Describe the adequacy of available knowledgeable manpower at all levels. - Where frequent transfers of hained 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 where not enough knowledgeable manpower was available or staff often transferred during the course of the campaign). At the NO IF secretariat level their aclecluate trained and knowledgeable human po,uver. fhe tuntover ot' the transfer of trainecl pcrsonnel is infrequent. As a matter of fact all staff of the Malaria eontrol progran.rs in IVIOFI harc got enough knowledge regarding CID'I't at all lcvels. 'l'rainings rverc givcn in a cascade m?rnncr tiom the higher leve I to the communi6' lcvel in aclcquatc amount to thc appropriatc pc-rsonnel. At worcda and health faciliry lcvels, thcrc rvcrc a f'erv sitttations u,hcrc therc u'cre turn ovcr of trained staff which howevcr, did not create any major problcnr on thc projcct acti\-ity. Type of Equipment APOC MOH Other donors NGDO Private 1. Vehicle Toyota Land Cruiser 4W 1 1 0 1 0 2. Desk top computer 4 1 0 1 0 3. Printers 3 1 0 1 0 4. Photocopier 1 1 0 1 0 5. Fax machrne 1 0 0 1 0 6. LCD projector 1 1 0 1 0 7. Overhead projector 1 0 0 1 0 8. Slide proiector 1 0 0 II 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 '1 2. Video Camera 1 0 0 1 0 17 WHO/APOC, December 15, 2004 rt, r/ t ) sEGTloN 5: Evaluation for sustainability of GDTI, Independent monitoring and other reviews 5.{. Independent participatory monltoring/evaluation 5.1.1 Was any independent Participatory monitoring and/or evaluation carried out during the reporting period? NO Table l5: Overview of when monitoring and evaluation undertaken (Please add more rows ,f 5.1.2 In general, what were the recommendations? 5.1.3 Thc getteral recomnrcndation made during the micl-tcrm sustainabilitl. cr-aluation at its third year of implementation of Kaffa-Sheka \ .as that theprojcct is making satisfactory progress towards sustainability w.ith improvcment ou somc of the kcy sustainability inclicators. 'rhc preliminary findings of the ongoing internal monitoring by thc NO]IF also indicatcs that thc projccts nrarkcd "X" wcre carrying out thc CDI'I activitics with high thcrapeutic and gcographic coverage, and conrmunity involvcment. In general, how have they been applied/ implemented? '['hc rccommcndation made during thc mid-tcrm sustainability craluarion w.as fully ip1P1.nlented and TCC menrbers reevaluated its level oi implenrentation cluring their visit to Ethiopia to altend the national annual ."rie* meeting conducted in Februarl 200-5. The recommendations rnade during the internal monitorirtg of the projccts are discussed rvith the projecl coorclinat6rs ancl ind icated lirr i rnlllcmcnta ti()n. Project Name (After Year l) particrpatory independent monitoring Mid+erm sustainability evaluation (3'd year) Independent monitoring after 4h year Evaluation for sustainabilit y (5s year if necessary) Internal monitoring by NOTF Other evaluation by partners Kaffa-Sheka x x Bench-Ma;r X North Gondar X lllubabor X Jimma W. Wollega E. Wollega Metekel Gambella 5.1.4 Any other comments? 18 WHOiAPOC, December 15, 2004 tln t i r 5.2. Sustainability of profects: plan and set targets (mendetory et yr 3) What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 5.2.1. Planning at all relevant levels. Sirlce the begtrtrring the CD'l'l actrvltrL's are rntegrated rvrth the other hc'alth activrties at all healtli lllanlgetllellt aurd health scrv'ice uivrng levels. 'lherefore, the plarrning processes are also cartied ottt in an itttcgt'ated manner through participatory methods. using bottonr-up approach and integrated rvith the basic health sen,ice. 5.2.2. Funds [:nsuring thc availability' ol tirud rs esseutial for the sustainability of the CDTI. Tlre gorernrnent has already ttrcreased tlte financral contribution for critical CD]'I actrvitres. In adcliticln to this rttost of the ('DTI activities that are carriec'l out iu an integrated marner will receive rL'sorn.ces tlorrr tli ft-erent progranls. 5.2.3. 5.2.4. 5.2.5. Transport and equipment (replacement and maintenance) 'l'hc APO(I donated rchiclcs fbr CD'II project are well tunctional at this timc. Maintcnance cost was covered fiom government. 'l-he govcmment also uscs other vehiclcs, in an integratcd mauner since the government uses pool system Human resources As ntentioncd above. the CD'l'l activitics are carried out in an integrated manner. 'l'hc responsible pcrson lbr C)nchoccrciasis control is also rcsponsible fbr othcr tliseases control pr()grams such as malaria control and is usually the head of rnalaria and othcr vcct()r bonc discases control team. All the other nrcmbers of thc team are also activclv inr olr ed in CDTI actii,iries. Which projects have submitted sustainability plan? Kalla-Sheka CDTI 5.2.6. To what extent have the plans been implemented? -I'hc lirurth year Kafla-Sheka sustainability plan is successlully inrplemented. 5.3. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration. 5.3.1. Ivermectin delivery mechanisms Since the begirrning there is no separate Ivermectin delivery system to the lorver level; it fbllo*'s the existing drug delivery system in the country. The request fbr Ivermectin is to MDP through MOH. As soon as the drug arrivecl. the same as all other cltrgs and medical ecluipntents, a Pharmaceuticals Administration and Supply Service in ttre l,toff han6le alt tlte proccsscs rcquited. 'l'hc projcct levels, like any other mcdicincs. rcccive ancl clcliver to the rcspcctive lcve Is fblltrrr in_u the cristing dclivcry system. 5.3.2. Training CD'll is integrated rvith thc Prirrarv Hcalth Care (PHC) from thc bcginning. At t6c Natiottal. Rcgional, /,ttnal. and Worcda lcvels, the Malaria and Othcr Vcctor-borrc L)jsear.-'s Pt'evcntion and ('ontrol tjnits alc rcspollsiblc. 't'hercforc. all thc stafl'of thcse ttnits has rcccivcd lraining on Onchoccrciasis.'l'raining of periphcral health u.orkcrs has bee n curncd out in inlcgrarccl mar)ncr uith other healtlr issucs. l9 WHO/APOC, December 15, 2004 - t . rt ^ 5.3.3. Joint supervision and monitoring with other programs As part oIthe system in the country, nrost of the supervision and moniloring activities are carriecl rlut in intcgrated manner rvith other programs. 5.3.4. Release of funds -[hc govcmment allocatcd rroncv L'spcclally for critical CDTI activ"itics is rclcasetl in tiruc. ln adriltron to this urost of the CD'l I actrvities that are cirriecl clut ilr an rntegrated nranuer and l'csourccs releascd tbr other prograuls arc also uscd. 5.3.5. Is CDTI included in the PHC budget? Yes. as part of PHC, C'DTI is one of the priority activities. 5.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? In somc malaria endernic villagc-s. thc CDDs are uscd for nralaria control program cspcc iall-v in nrobi I ization. 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?) No 5.4 Operational research 5.4.1. Summarize in half of a page the operational research undertaken in the country area within the reporting period. Noue 5.4.2. How were the results applied in the project? 5.4.3. Note the issues that have been identified by the NOTF for future operational research. F actors a ffecting susta i nabilitl' ol' C'DTl SEGTION 6: Strengths, weaknesses, challenges and opportunities List the strengths, weaknesses, opportunities and threats of CDTI implementation process. Strengths: .,\lmost all the projects are able to accomplish the distribution in the intended period ol time r,vith good geographical and therapeutic coverage high above thc minimunr standard lin- ..\PO('. fhis is due to high political commitnlent at all level, aw-areness and active involvcment <lf health u'orkers ancl the community at large. The integration of the C'D'II actir.ities to the existing health system is the strength that helps tirr sustainability. Weaknesses: Delay in rept>rting from the lower level, poor f-inancial utilization and liquidation Opportunities: l'he e.xpansi<ln of govcrnment structure down to village. 'l'hc nerv government healtlr p,rliuv of Flcalth Scn'icc Iixtcnsion Package program 20 WHO/APOC, December 15,2004 T aaI Threats lOhallenges): Overtrurdening of health workers in peripheral health facilities in dill-erent health programs such as malaria epidemic conftol, EPI, measles & polio campaign' - List the strengths, weaknesses, opportunities and threats of the vector elimination project (where applicable). No Vccttlr cotrtrcll acti!'ity - Indicate how challenges were addressed' - Indicate how opportunities can be utilized to improve CDTI' 'l'he erpansion 6f governrnent structure clown to village level and being taking the ,.rpunribility of devllopment activitics as well as health related activities rvould enable the overall coordination of the CD'tl activities at the community levels' The new government health policv of Health Servicc Ertcnsion Package progmm in which there is a start of builciing a lealtl1 post in each and *'cry Kebele assigning a trained/qualit'ied health service extension l,orkers is also another goocl opportunity tbr close supervision of CDTI activities at thc crxlr1unitv levcl. ancl cnhancc thc rcporting and Mcctizan delivcry to the C'DDs. 2l WHO/APOC, December 1 5, 2004