Jimma annual project technical report submitted to Technical Consultative Committee (TCC): from January 2009 to December 2009

IThe Federal Democratic Republic of Ethiopia Ministry of Health ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNTCAL CONSULTATIVE COMMITTEE (TCC) DEAI)LINE FOR S ON: To APOC Management by 31 January for March TCC meeting To APOC Management by 31 JulY for September TCC meeting AFRICAN PROGRAMME FOR ONCHOCERCTASIS CONTROL (APOC) \o gPI Br4 rA csO co?\o cAo cO 15|0-t-( bi n- I I COUNTRYAIOTF: ETHIOPIA Proiect Name: Jimma Approval vear: 2003 La vear:2004 Repo Period: From: .fan arv 2009 To ;.....D.esp..mhe.r..2 0..Q9...... ear Proi vear of this (circleone) I 2 3 4 5 78910 Date su itted: 25 October 2009 NGDO partner: The Carter Center RECU LE 2 5 JAl{. zoto RDCoPA WHO/APOC, 25 October 2009 I )ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: Country: Ethiopia National Coordinator Name Signature: Date Zonal Oncho Coordinator Name: Jihad Kemal Signature: ..... Date NGDO Representative Name : .....,....A.baI-e..fi.[a.hu.n.......... Signature: Date This report has been prepared by Name : Jihad Kemal ..t.Np.IH..... Designation:Z..qr.re.Qn-c.h9..Cp..qrdi.na.tqr Signature Date ll WHO/APOC, 25 October 2009 Table of contents Acronyms. Definitions FOLLOW UP ON TCC RECOMMENDATIONS. SECTION 1 : Background information......... l.l GENERAL INFORMATION 1.2. PoPULATION SECTION 2: Implementation of CDTI.... 2.I, TNvMI-rNP OF ACTIVITIES. 2.2. Apvocecv 2.3. 2.4. 2.5. 2.6. 2.7. ....'.......Iv .............v 6 8 ...8 .10 l1 .l I ...,..'.,..'..,,,.'12 MOBILIZATION, SENSITIZATION AND HEALTH EDUCATION OF AT RISK COMMUNITIES ......,I2 CouvnrNlrv INvoLVEMENT.............. ......13 CAPACITY BUILDING TREATMENTS ..................... ORDERING, STORAGE AND DELIVERY OF IVERMECTIN ................. l4 .................1 5 .......................20 ...,.'.'.,..,..,......,2| ,.,......'..........,22 ......,...,.,...,......22)l ....,,,.'...,25 ..,..,.......25 .27 .25 27 ,27 2,8, COVUTXITY SELF.MONITORING ANO STETEHOLDERS MEETTNG 2.9. SupeRvtsloN..... SECTION 3: Support to CDTI ....3.1. Equlrurur 3.2 J.J 3.4 FTNANCIAL CONTRIBUTIONS OF THE PARTNERS AND COMMTNITIES '...'..........'.... OTSpRTORIAS OF COMMUNITY SUPPORT EXPENDITURE PER ACTIVITY SECTION 4: Sustainability of CDTI..... 4.1. 4.2. INTenNaI; INDEPENDENT PARTICIPATORY MONITOruNC; EVATUATION SUSTATNABILITY OF PROJECTS: PLAN AND SET TARGETS (MANDATORY AT.................. Yn3) 26 4.3. INTEGRATION 4.4. OPERATIONAL RESEARCH SECTION 5: Strengths, weaknesses, challenges, and opportunities.... SECTION 6: Unique features of the project/other matters.. lll WHO/APOC, 25 October 2009 ...26 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 Ivermectin Community Self-Monitoring Local Government Area Ministry of Health Non-Governmental Development Organization Non-Governmental Organization National Onchocerciasis Task Force Primary health care Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Stakeholders meeting Technical Consultative Committee (APOC scientific advisory group) Trainer of trainers United Nations Children's Fund Ultimate Treatment Goal World Health Organization lv WHO/APOC, 25 October 2009 t Definitions (iD (iiD (iv) (v) (vi) (vii) (viii) (ix) (D Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). Eligible population: calculated as 84%o of the total population in meso/hyper- endemic communities in the project area. Annual Treatment Objective: (ATO): the estimated number of persons living in r*ro/hyp.r-endemic areas that a CDTI project intends to treat with ivermectin in a given year. Ultimate Treatment Goal (UTG): calculated as the maximum number of people to be treated annually in mesolhyper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage (normally the project should be expected to reach the UTG at the end of the 3'" year ofthe project). Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). 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). Intesration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) through CDTI (using the same systems, training, supervision and personnel) in order to maximise cost- effectivenest and empow"r communities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTI. Sustainabilitv: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future, with high treatment coverage, integrated into tfie available healthcare service, with strong community ownirship, using resources mobilised by the community and the government' Community self-monitorine (CSM): The process by which the community is .r"p""-"d t"-"*see and monitor the performance of CDTI (or any community- based health intervention programme), with a view to ensuring that the programme is being executed in the way intended. It encourages the community io Lt" full responsibility of ivermectin distribution and make appropriate modifications when necessary. v WHO/APOC, 25 October 2009 FOLLOW UP ON TGG REGOMMENDATIONS Using the table below, fi|| in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session 2gth 6 Number of Recommendation in lhe Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROTECT FOR TCC/APOC MGT USE ONLY 66, Report related i Reporting period should be coruected It was corrected ll Correct several errors in tables 4 and 13 Corrected project related i Increase the particiPations of females in CDTI Number of female CDDs showed progress and still needs more effort 11 Sustainability evaluation should be conducted The Sustainability 6valuation has been conducted and each CDTI woreda has develoPed its sustainability plan and submitted to APOC lll The project should be encouraged to undertake operational research Discussion has been conducted with Jimma University regarding imitating oPerational plan and it wil be practiced in the near future in cooPeration with The Carter Centre WHO/APOC, 25 October 2009 Ex6cutive Summary l. Background on treatment and population data Jimma CDTI project is located in Oromia Regional state which is found in the southwestern part of Ethiopia and has been started implementing CDTI activity since 2004. The Prof ect is on its sixth year treatrnent round. There arc a total of about 887,344 populations in the project area. The Annual Treatrnent Objective (ATO) for the ptoject for the year is 746,667 which are the same as the Ultimate Treatment Goal pTG). During the treatrnent round 728,477 people were treated which glve a therapeutic coverage of 82oh with 100% geographic coverage. There xe a total of 4,125 communities (villages) in the project atea, which are distdbuted in 4 Woredas namely Mana, Seka-Chekora, Shebe Sombo and Dedo. All the communities (villages) were coveted with Mectizafi treatment since the start of the project. 2. Background on population movements. The communities in Jimma CDTI project ^te s zte mainly farmers, traders, daily workers and civil servants .Overall; there is no majot type of population movement in the ptof ect area. 3. Training data The community have selected and reselected community superrrisors and Community Drog Distributors in the entire proiect xea. Fvery yeat, training of trainers has been conducted at project level for woreda focal person and woreda health exPerts. At each proiect woreda training and retraining of Health workers, Community supervisors and CDDs are conducted in the project area. During the treatment round training and retraining were given for 374 health workers, 390 community superwisors, and 2,453 new CDDs and 9330 CDDs. 4. Challenges and how they were overcome. Threats (Challenges :- High turn over of front line health workers and focal persons at all levels, overburdening of woreda health office focal persons and front line health workers in peripheral health facilities in different health programs. Opportunities:. The expansion of Health posts and the assignment of two female health extension workers in each and every Kebele during the year, the government structure down to village level "geree" and being taking the responsibility of development activities as well as health is a good opportunity for sustainability of CDTI. 7 WHO/APOC, 25 October 2009 SEGTION {: Background information 1.1. General information 1.1.1 Description of the project (briefly) Jimma CDTI project is located in Oromia Regional state which is found in the southwestern part of Ethiopia. According to the Government structure the zone is divided into 18 rural and one urban woredas which is further divided into small administrative unit kebels . .The Jimma CDTI project area bordered in the south with Kaffa CDTI project, in the west with Illubabor Zone, in the north east with Sheka zone. The project area consists of 4 Woredas namely Seka Chekorsa,shebe-Sombo, Mana and Dedo woredas The project woredas are further subdivided into 137 Kebeles and 4,125 villages "Geree" with the total inhabitants of 887 ,344. The "Geree" (Village) are the smallest administrative unit that consists of 25-35 nearby households that are responsible for all developmental activities including health. Climatically Jimma CDTI project is classified into three geo-climatic zones: highland, mid- land and lowland area. In the high land areas the mean annual temperature rages from 10 0C - 16 0C , in the midland 16 0C -26 0C and in the lowland 23 0C -330C. The total annual rainfalls are highest in the highlands reaching 2000mm. There are two rainy seasons in the area. The main rainy season is between June and October while small rainy season is from January to April. There are some perennial fast flowing rivers such as Gojeb, Ghibe, Gilgel Ghibe, Dedessa, and Kawa which cross Jimma zote. There are also a number of small rivers and streams, which are tributaries of the large ones in many places in the zone. The projectzone is connected to the capital city Addis Ababa with asphalted road which is about 345 Kilo meters .All project woreda capitals are connected to the Jimma town with all weather roads. However, with in the rural communities the roads are only for dry weather. Except Monday, there is a daily air flight to Jimma directly from Addis Ababa' 8 WHO/APOC, 25 October 2009 Jimma zone has one referral hospital, one district hospital, 26health centers, 54 health stations and over 200 health posts with each two health extension workers at the post. In the CDTI project area there are six health centers, 10 health stations and 125 health posts which gives a potential health service coverage of 95 %. Table 1: Number of health staff involved in CDTI (Please add more rows if necessary) District Number of health staffinvolved in CDTI activities. Total Number of health staff in the entire project arca Br Number of health staff involved in CDTI Bz Percentage Br=Btl B, *100 Seka-Chekorsa tt2 102 9l Shebe Sombo 96 66 68 Dedo 140 120 86 Mana 106 86 8l Total 454 374 82 l.l.2Partnership The main partners involved on CDTI activities are respective Woreda health offices, the Zonal health department ,Oromia Regional Health Bureau , the Federal Ministry of Health, , Health Facilities, front line health workers , The Carter Center, WHO and other Government sector offices and the affected Communities in the project zone. Since the beginning of the project, there was strong partnership during planning, advocacy, mobilization, drug distribution, monitoring and evaluation of the CDTI activities among all the partners. 9 WHO/APOC, 25 October 2009 o\ooN L o) -oo o o rn c.l Ci o Or o 'Jr O \n cft I\ndNgH E(llEE Es3 € d9>E; g e.ts I tE El '+iPtr o =CEe[^. B =$ €E8 E a! 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Advocacy State the number of policy/decision makers mobilized at each relevant level during the current year; the reason(s) for undertaking the advocacy and the outcome. Describe difficulties/ constraints being faced and suggestions on how to improve advocacy. Eight decision makers atzonal , 32 atworeda ard274 at kebele level were involved in the advocacy meetings. The reasons for undertaking advocacy meeting were to mobilize community leaders, different sector staffs, religious leaders and community elders to support the overall CDTI activities in the entire project area. The over burden of political leaders and other several competing priorities of the govemmental officials at high levels makes difficult to single out a control program and give attention in the project area. 2.3. Mobilization, sensitization and health education of at risk communities The front line health workers and Health extension workers at all levels play a great role in disseminating health information and follow up the CDTI activities. Political leaders, high officials and at risk communities were sensitized and mobilized in the entire project area. Task forces at zone,woreda ,kebele levels and community supervisors have played major role in community mobilization and sensitization of the whole community at grass root level .At village level , Community supervisors and CDDs were participated in delivering health information to the entire community . Generally, community mobilization and sensitization at all level has contributed a lot in awareness creation. The awareness, their involvement in the CDTI activities and interest of the community in getting Mectizan@ treatment has shown significant increase from year to year. As a result, therapeutic and annual treatment objective rate have been above the expected range during the period. t2 WHO/APOC, 25 October 2009 o\o c.l op o o o$ C\l q, o o co .!9o^E €.E g .E .=E E u) -.2 € AgE F A!.+ g (Jtrodk .o'5 v .oEE. V, E;; 4 PPE a S x; E E<a-., cl LarX 3 €-'t e H a s'H I i Eg€ A E EEg F E iiE 8 P E.:6 : ai= , E EE-g E e tr *E g E HEE E g Extr tr I E c'(\l()H.ZC)EEE b l-. g 9F,E.b H E ii UE ^?i E ? fr E€$EE E .E E .IS Esf i ; ; E? €EE c E E g# E€a H i q ;s EE€ E E * gE ;EE E *59 3E'E c€ 5EE;"E EsE EF5*EH€ €.E; E.gc; E E *cic i 3E :$Ep*g;Ed EE €{gE iEE l? 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(l !aoH 4q q) u a) q- 41 L q)i\ t 9 q) V) q) 5 F O() o (Bg o Ldq (/) C) 3 oU +t ol .ol(BI FI # E o E o2 o .= t Ef E E o(, {N o rr ao 6 c.l o\ co o\ t.tFrr c GItfl o\ (aiat al Su= Su' ooo N c.l 6o c.l oo t rr oNC'I s o\to o $ €o cn c.lo otr 6ltr qh ht aU L o z ooo ol c{ \o .t t-- o$ o ra) r-. co rao6 q) () 6) () -oc\ o\ o\ o +. q o ri =v o o o o o o o o o oo o o otr 0) .=c6l f-rLh, L t-ro: ?anoq) *.9 Lc{ol! z () o o o o o t{) () () I s Q U+.0( U"z E,I?F-(j co co o\ o$ co o\o o\N t--v c\ (a\o o \o r- \o\o (r) ol $(a 6 al q) aA gts !s 3H E>- zE €)I Q o (\lo c.lo\ oN \o00 o ! 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Pc-c o ti .r9-- EUo-rR =-q N -Er'Ei(!-.ia ai sEbqE9(li l'<- G) :a=9idE.SF*H; ft E HPH=EEE xBErE .= ^ tr (I)'5P9LVH 'trl2(,)EE = d qy biIE;Eo s/F o= rE H B HG'.-Eo .eHfl6€ s B *€ II X 68,.Y# x€ o o)F > (d-q-o Ie s\h; ;E E 8 sS ..Hi $tE€ I Bts-s s sL + 'c,C)-- Vr cd5Fa) €'i E$ .l A - Etr" Es E H f;* e,g €$E g >,^\Us E* uvd-H9 troUH'\E -Ayxgr ;; $E E$Eg €E;'a sP .V ^ H I *r x .d,sgH,. E= -og ^s #*E €s .A!E : N EEH $E il E E rS iee Eep Ff € 6 g$ *E 6 S*: $ci-iiSF EE HiE i sg [#Et-$* cd 0.,:) ' ,cd .= .i boEEBIEI.S-eiutbls 1r-'9 9 z:.oJb.Ei;e s i5sr8 3E SB16'aoo! x ( E*sEtSS s'F.E E,E .k Q EsgE$ti ?< E.T?€ S U, tr .IE - a- - -o +. a-(, (E c o(, a It) aN Trainees Type of training CDDs Other Community members e.g Community supervisors Health Workers (FLHF) MOH staff or Other Political Leaders Others (specif) Program management How to conduct Health education Management of SAEs CSM* SHM Data collection Data analysis Report writing Others (specifu) Table 6: Type of training undertaken (fick the boxes where specific training was carried out during the reporting period) - Any other comments * Training on community self monitoring is given for community leaders and health workers at each level. 2.6. Treatments 2.6.1. Treatment figures If the project is not achieving 100% geographical coverage and a minimum of 65% therapeutic coverage or the coverage rate is flucfuating, state the reasons and the plans being made to remedy this. The project is achieving l00oh geographical coverage since its inception and has high therapeutic coverage without out any fluctuation. l5 WHO/APOC, 24 October 2009 o\ooN ko -oo o o Tr) c.l d o Or{o !) s $ s ts E $!a \) OO .s q)tBU B{ .:\ (q €\)eJs!s 'Eo iCr\ :EEraJ q)S'OSs1^ .isEE3SES$s sp&B :hqr qJE 'Sii E 3.L .$ {x.\-.,'s ssH .Eq-a lo'u k!E B!s:i3 s+5 Et u Y! ':l..\ES Xq)S llqrs r:t $.: s !sS !q)E :*t Ss .s st!p 3P 'i ss :aS $!eE*S SEE es :' bd T EEit rE.ss sqE SEE .S'S. .s {\E Sss s5il rEP HS\ ag \o F do 6d Poo 'a o E .E; (h cd otr(d o C) C) IL()a ot) o : C) 6 ^,0) ol e -l orxl: EI IJ .91 o-rEIElil O -l ()9l o 5loC)l r ol, 0) ol I el E -81 tr'trlE =t 6z ? olol -t loxl > EI E cdl '= st6 el E otr c)ol tr(l)l .=ol irql g :IF9lE trl tr =l trzl< (!I €oo 'a .L6i^ C)k (l)CgF 9Poo.= 'A -rLV G) rr"l i5& '= -o ! v - qA.io= L .=(l)tr! d6 FA =o)()r o'E )tr ol tr(l) ol =E -l E6 xl 8 * El.e o- ill tr + €l EA olC3r 8d9 -1tr Sl6j; El * .El $ Bl€;xt .= ijt aEl.= 'El EC)l- =l L Hl F HILe+6 Elo EIE sI Eql = +il =ol ir- ol Erl6 rl3olo- olE -ot - !t -Els Els =l 'o =l ozl? zl? V) 0.) OI(6 l-r o) oo (B o EbI o C)bI .d (6 C) o Cgkq) bI tr P o H o() H € tr Lr ofri U1 T\ q)\ v t 4 q) .\l(A tr (d and o)lr CB cli .l () k u, € aH a ro d C) tr (B C)tiF II €() O O oF 5\ o CdL o 9p .bs oo F o cd C) bo(dL C)t o R^ .Y ro -o\E- 63L00 oo o)(ttr 0)bodLo oo oa !^\ oa Cd lio F o o o o o I s g( o='E3.0 [i9;t 35H*€Hsfz 9€ oa()o-OL O rrl ET2z o o o o a3 bE E9, zd o o o o z^ -E: .E E.et E ;r=EE o o o o \o ll r o ,o0()dPb ooEOF o\rr v? s oo c'') cn € c.l6 FT € t- = €clr- o.^ b EE Ebs = o.-z @ CDN o,@ o) t-_ o)o t-(a N F-@N F-rN. $ :od o.z =tro =: c)< 9€'FL,) oot o c.l \osN o € o o o\N rooo r$ F-\o\o \ot F-. o (! o o. .=.rdE, &H6-€ ?o d=oE E - E€ .6 E6F (o F o,(f, N ooF o)Nr o @N ro sf(9 (Y' c! @Nt- tt(t) Fr66 o\ ll r ^.4 (o o,r _c ooAG !€5 o0< oe oo oo oo oo c a E.9 .- r.E [ii?3 g sxtr tr= ii =c>-AO o co rno c\loo r.}r.) o\c.to\ ia al t =oE b.z2E-o < 9P'FU coiao c\oo ta) o\coo\ ia al ! U)(.) b{ cg t) O ) oU >9., p!.oE 6I sEcflE" . 8= E E cn rao c{6I.) in o\ co o\ iaN t .gEa)J= -qoCD V) oEo n (d tr GI Fl tr o Fr .9<L,;HV H G,6L .o cfl( 86 t2.6.2 What are the causes of absenteeism? No report on absenteeism from each level 2.6.3 What are the reasons for refusals? No report on refusals due to high community awareness about multiple benefits of the drug Mectizan@ .. 2.6.4 Briefly describe all known and verified serious adverse events (SAEs) that occurred during the reporting period and provide (in table 8) the required information when available. In case the project did not have any cases of serious adverse events (SAE) during this reporting period, please tick in the box. No SAE case report ,/ WHO/APOC,25 October 2009 o\ooN L(l) ,o o o ol O o Or{o E o l.oq trot (d oLi o b0 tr L E !q) qi o C) C)s(l)J (€ .otr tr() Eq) o U) o d =)g oo BO o o) € (\, oko B G, cl 'l3 C)t,(B c.)l-rOtr u)(D t H o(.) o kop z I EAz an o 6l I 6lI q) a0 6lLo o() rh t'r cl L o tr €) () U' ct C)L a0 rai 02 q) .a F-l\al\olJ\olr+l t-l 6lq) L c! q) q) oL q) L E() tr () q) GI tr o ar) q) Fr e €\UL tq) L :a)us :.1PNi\63 oq) .t! Frt! o GEg5cle+.o(,9C) Ei .ge q) 2() hi PUH o(BL o.) ->.eltrEtotlE5t(l)ol -Exesl IY C)rbotr(B9b g5 LE rE(d €Htr0) .flEF(€ . ,0)ui# \o oi o,l()l -ol cdlFI o bI) P ES -o(J c? r o\ q o\ o\ o\ € \ 00 o\ € o\ n r- o\ o d tg o o< ili kiH E] () 9 Sat: ()6\ < e-(,) ctl rn o\ q o\ o\ o\ € \ € o\ € o\ v? F- o\ ll + r.l l! El 6\ (JiE() :r ht)odg9 c)o -coF oi €r- c.l € r- cn€ ol to € c.l oo EI ! ,,o oa6 r9o52-Etr zE q $ rn € F-- € os\o o\ coo r- ta) co $or- o\r- €^ ia cnr- r-$ 00Nr- f.l :O d ().= =c'ot etrF\J oo roolt \o la) c.t6 .dt\o c{$r- =\o o o\ € c.l r- olt+\o ra) l.- r-\o\o" \ott.- Lqh.16 -oy - x qES'E <'r ho . ' a E9o dxq c\I € €sr- o c.) o" or-r- r-(\.lq oo oo 6r-\o^ €t € o\\o $ € € $$dI F- oo € a c) bo(d c) tr oO t lL *^ Hld f.l OoS-F 6X<. >v o oo oo oo oo o oo o.o0=!g-!q-il!' FB gdao ooH oo oo oo oo oo oo 1.1 ao)o= E_ E 5 PE tr ts= ii5Etts -, oa r-o \O^ ro F-o\o co r--o\o co co c.l s co e.l $ ra ol t ri ,oE 6.2 aEo 199' FU r-.o\o ?o r-o\o ca F-o\o ro co(\l $ ol t c.l = bod =q -r6!i.,5 ev a x o-:i + oE >.:: -'E - -tr .Sl .i € E E g€E '6 o r-. \o co rro\o to F-o\o co cn C\l $ cn c.l .+ a-.1 $ il sl C\ o c.l (\oo c\l oc.l <f N la)ooN \ooo c.l F-o o.l €oo at o\ c.l N 2.7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - (please tick the appropriate answer) MOH EI WHOtr UNICEII NGDC Other (please specify): Mectizan@ delivered by - (please tick the appropriate answer) MOH M WHON UNICEIE NGDC Other (please specify) : Please describe how Mectizan@ is ordered and how it gets to the communities The project level (Zonal) requests the amount of Mectizan@ required based on the target population to the Federal Ministry of Health .Based on the request from the project, the NOTF requests Mectizan@ from MDP. After the drug delivers the country it is stored in MOH warehouse and follows the existing drug and other medical equipment delivery system in the country. The project level receives the Mectizan@ from the National level through its delegates. From the project level (zone level) the Woredas health office requests , receive and store at woreda pharmacy store and distribute to the front line health facilities based on their request .At the health facilities the health extension workers may distribute indirectly to Community Supervisors or directly to the community Directed Distributors (CDDs) that distribute the drug to the communities. Table l0: Mectizan@ Inventory (Please add more rows if necessary) How are the remaining ivermectin tablets collected and where are they kept? The remaining Ivermectin are collected from all communities by front line health facilities workers and returned back to the woreda and kept at the Woreda pharmacy store. List and briefly describe the activities under ivermectin delivery that are being carried out by health care personnel in the project area. . Planning the amount required based on the target population. . Request of Ivermectin to the Woreda health office and zonal health office . Collection of Ivermectin from zonal health office according to their request . Collection of ivermectin from the Woreda health office . Distribution of ivermectin to Health facilities/health post . Distribution of ivermectin to community supervisors/CDDs Zone Number of Mectizant tablets Requested Received Used Lost Wasted Expired Remainin o Jimma 2, 183,954 2,193,954 2, 005,401 0 2,540 0 176,013 TOTAL 2, 183,954 2,183,954 2, 005,401 0 2,540 0 176,013 WHO/APOC,25 October 2009 . Training and re training of community supervisors and CDDs on Ivermectin distribution . Supportive supervision and monitoring of the over all CDTI activities . Collection of the remaining Ivermectin from supervisors ' Recording and reporting of data . Conducting review meeting . Community mobilization and sensitization 2.8. Gommunity self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? Yes ,Woreda task forces, kebele task forces, Commturity leaders and Community supervisors have been trained on how to conduct community self monitoring in their Communities . Stakeholders Meeting have been conducted at each project woreda for governmental organization, political leaders, religious leaders and community leaders. If so, When? June ,2009 Table I l: Community self-monitoring and Stakeholders Meeting (Add rows if needed) Describe how the results of the community self- monitoring and stakeholders meetings have affected project implementation or how they would be utilized during the next treatment cycle. Community supervisors and kebele task forces were trained on how to conduct community self monitoring system in their community. Then, Community self monitoring was conducted in selected communities by their community representative .Overall, the performance of the CDTI activities and the work of the CDDs are monitored in selected village by the trained community supervisors and kebele task forces. Community Self monitoring was implemented effectively in this project and has proved to be very effective in monitoring the performance of the CDDs and the therapeutic coverage at the community levels. 20 WHO/APOC, 25 October 2009 Any other comments DistricV LGA Total # of communities/villages in the entire project area No of Communities that carried out self monitoring (CSN[) No of Communities that conducted stakeholders meeting (SHIO Seka-Chekorsa Shebe Sombo 1,053 1,053 74 s82 s82 42 Dedo 1,551 1,551 108 Mana 939 939 50 TOTAL 4,125 4,125 274 At woreda and health facilities level stakeholders meetings have been conducted to support the CDTI activities. At the project level annual program review meeting were conducted to identi$ gaps, weakness, strength and to outline future directions. 2.9. Supervision 2.9.1. Provide a flow chart of supervision hierarchy. NOTF )ROTF) ZOTF) WOTF ) Front Line Health Facility ) Community supervisors) CDDs 2.9.2. What were the main issues identified during supervision?! Poor document handling and reporting . Lack of integration r Poor planning and no plan in some areas . Delay in the compilation of treatment reports r In adequate knowledge and information among newly assigned front line heath workers and health extension workers. r Poor drug inventory . Delay in utilizing and liquidation of APOC trust funds t Turn over offocal persons. 2.9.3. Was a supervision checklist used? Yes, a standard checklist was developed and used at woreda and health facility level during supervision .However rno standard and developed checklists at community level. 2.9.4. What were the outcomes at each level of CDTI implementation supervision? Most supervised woreda project have improved in document handling, recording and reporting CDTI activities. Also cases of absenteeism and refusal were reduced. There is an increase in therapeutic coverage in the most project areas 2.9.5. Was feedback given to the person or groups supervised? Yes, during the supportive supervision oral feedback were given immediately by the supervisory team. As soon possible, the Supervisory team has developed a written feedback and sent to the supervised areas. How was the feedback used to improve the overall performance of the project? Based on the oral and written feed back from the supervisory team the project woredas and health facilities showed an improvement in their document 2.9.6. 2t WHO/APOC, 25 October 2009 handling and reporting system, the appointment of focal persons who responsible for the CDTI activities in their catchment's ,improve in their drug management system ,maintenance of the 100% geographical coverage and the increasing tendency of therapeutic coverage shows promising trend. SEGTION 3: Support to GDTI 3.{. Equipment Table 12: Status of equipment (Please add more rows if necessary) *Condition of the equipment (F:Functional, CNFR:Currently non-functional but repairable, WO=Written off). How does the project intend to maintain and replace existing equipment and other materials? The Zonal health department does not have the capacity to replace capital equipment like vehicle and motorcycles. But, minor maintenance and repair for the existing vehicles, motor bicycle and other equipment of the project is being handled by the zonal health office. Source Type of equipment APOC MOH - Zone DISTzuCT NGDO Others No. Condition No. Condition No. Condition No. Condition No. Conditron 1. Vehicle 1 F I F 2 F 0 0 2. Motor cycle(s) J F 2 F 4 F 9 F 3. Computer(s) I F 2 F 4 F 0 0 4. Printer(s) 1 F 2 F 4 F 0 0 5. Photocopier (s) 1 CNFR I F 0 0 0 0 6. Fax Machine(s) 1 CNFR I F 0 0 0 0 7. Overhead projector 1 CNFR 0 0 2 F 0 0 8.25" TV set 1 CNFR 0 0 0 0 0 0 9. Deiesel Generator I F 1 F 1 F 0 0 22 WHO/APOC, 25 October 2009 23 WHO/APOC, 25 October 2009 o\o c{ q) !o o o(a ..* O o Or o 'l () o Fi tr odi € ,tr a) E (B an € ooot)(+r o .n(n E () o t, (g() o B € ,tr V) liF O o0i o CB O o rn C) .o -d9 =d li9 E<(B oLrPI C) bo lr E ahE ,tr Ed a.tio ) oo +i o (.) a G,o (D o tr Eo rE q) 'o osokq o z E(l) tt) a C)firO €d o) C)fiO B B o aE ,tr trd o.Lro o()(t.{ o() U) Cgo 0)t< B U) Eosoka() cl Ofr(,) q< q) ;! o q)t- q) u\ .j q)$E ': .is sq)E\ i$ b.o3f \J .S o'rg t:S x9i.\Bx ooUO * ** a a c.l \o r!q) ss$a r..o\q(\l -t N\o € c.tN ri rn ..1 N (\l oo oi\o6 ,ai c.i\o$ c- \o 'J c)^<-q :ii4' r-l P EbcabuE> c-o\aal+ o ol\o € a.l cn Gi q (\l € r-\o 6,1 c.l n \oN t \o a - N ra 6o gs$a O c.lN\ oorl F- c.i\o o\ \o6l tat c.t \o o oi a.l o\ FJ (D^tiBaboE> o Nt'-F- oo -f r- e.i\o o\\oN C\ t-- o\\o o\ o\ s s6f t 6 rt) gs$a crt o \o c.t oo *\ -l\o o\ @ -t o r} ri(\l t.- o\ o\s Fl c)^ *EE3bc.lE> o\-fN F- *tr)r:$\o o\ 6 c.t st o\r- c.I F- l'- lat 6S N (.) 6o EsEa cat:tFi c-l \o @t * \o oi6l * o 6l \o cor) od .Ei o)^4sx,6F I 5o9? -t r) E JFo $-F-6l \o €q 6 \o o\(.I$ t-q \o ci F-o 6l 6SSN GI 6'o ,=E EEgA \oN \or,- ,d F-\t (\l * ar o\ I ol t- o\ -l .E -.] o ^ *EBA9UE<) €\F- € cost F- ca o r..@ * al o o\ o!.| c{ c.Irt €\os L o E L A U cgl.i (.)() vc) iI; Cd l)a z+ o lr U)a^ -'o)'Fli !f 2+ +i U) Eo^8o h)z a U) x9 rFl E z8 ao tr) H oO a)LrF ONE <d Fl tr t'r U)L cdo >r x v) (n CB () lr € U)k o) L Cda ct >rp (n o)s t< troo CT, o tri :t ,l -ol(Bl FI o .!9 =Ef E E o t) ! E o oL o Et Gc os# la. o o E .9 *. -! a-Lg E o o -6 a- o E IE .=E "!o 3.3. Other forms of community support Describe (indicate forms of in-kind contributions of communities if any) The involvement of community directed distributors (CDDS ) in population census, in community mobilization, in conducting mass distribution , in returning back registration books and left over mectizan tablets to the health facilities .The community supervisors were involved in training CDDs , bringing drugs from health facilities ,involved on supervision during mass treatment by CDDs ,compiling CDDs report and submit to health facilities. Woreda and kebele task force members were also involved in CDTI activities at all levels considered as community support. 3.4. Expenditure per activity Indicate in table 14, the amount expended during the reporting period for each activity listed. Write the amount expended in US dollars using the current United Nations exchange rate to local currency. Indicate exchange rate used here 11.45 Table 14: Indicate how much the project spent for each activity listed below during the reporting period - Any comments or explanations? * The contribution of MOH (Personnel cost, capital equipment) are not included in the project spent. ActiviE Expenditure ($ us) Source(s) of funding Drug delivery from NOTF HQ area to central collection point of community 636.t0 NGDO Mobilization and health education of communities 7000 APOC Training of CDDs 0 Training of health staff at all levels 22,000+6319.82 NGDO +APOC Supervising CDDs and distribution 1,226+600 NGDO +APOC Internal monitoring of CDTI activities 0 visits to health and authorities 2000 APOC IEC materials 0 NGDO Summary (reporting) forms for treatment 0 NGDO Vehicles/ Motorcycles/ bicycles maintenance 7,345 MOH Zonal, Office Equipment (e.g computers, printers etc) 93s MOH Zonal Others 0 TOTAL 48,064.92 Total number of persons treated WHO/APOC,25 October 2009 SEGTION 4: Sustainability of GDTI 4.1 . lnternal; independent participatory monitoring; Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable) Yes. No Year I Participatory Independent monitoring Mid Term Sustainability Evaluation No _ 5 year Sustainability Evaluation No Internal Monitoring by NOTF No monitoring by the partner NGDO Other Evaluation by other partners 4.1.2. What were the recommendations? o The zone should develop detailed plan of action and use it to guide the day-to- day activities o Zonalstaff should spot check districts population figures to ensure updating of census includes eligible o Training of newly assigned member of CDTI team in Shebe Sombo and other health workers in all the four CDTI districts o Follow-up of the request for vehicles replacement to the region as none of the vehicles is likely to last for the next ten years. 4.1.3. How have they been implemented? Not yet addressed. 4.2. Sustainability of proiects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting Yes Was a sustainability plan written? Yes When was the sustainability plan submitted? Julv-2Q09 What arrangements have been made to sustain CDTI after APOC funding ceases in terms of? 4.2.1. Planning at all relevant levels Sustainability plan was developed at each woreda levels by woreda officials . 4.2.2. Funds The program was integrated into the PHC and budget was allocated for the implementation of the program Transport (replacement and maintenance) The project Requested for APOC for the replacement of vehicles 26 WHO/APOC, 25 October 2009 4.2.3 4.3. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.2.4. 4.2.5. 4.3.1. 4.3.2. 4.3.3. 4.3.4. Other resources The government was planned for replacement of other resources. To what extent has the plan been implemented The plan implementation will be expected for the coming treatment round. Ivermectin delivery mechanisms Based on the target population, the Federal Ministry of health of Ethiopia requests for Mectizan@ directly to the Mectizan Donation Program (MDP). As soon as the drug arrived the country, the same as all other drugs and medical equipments, all the processes required are handled by a Pharmaceuticals Administration and Supply agency. Since the inception of the program, the delivery of Ivermectin follows the existing drug system in the country, like any other medicines. The MOH receives and distributes to the respective project area. The project then distributes to woredas following the existing delivery system. Training: At the National, Regional, Zonal, and Woreda levels, the Malaria and Other Vector-borne Diseases Prevention and Control Units are responsible for the planning, implementing, monitoring and evaluating CDTI activities in their respective areas .Each year training and retraining for all front line health professional working in the project areas were conducted on Integrated CDTI implementation and other health activities. Joint superuision and monitoring with other programs During the mass mectizan@ distribution, their is a separate supervision and monitoring system that have been carried out by focal persons to tackle immediate solution. However, supervision and monitoring for general health activities are in an integrated manner. Release of funds for project activities APOC and NGDO partner Carter Center Ethiopia are the main sources of funding agents for the CDTI project activities in the area .However, there was a delay of release of fund from APOC during the year. However, the allocated funds are properly utilized for the project activities for the period. 27 WHO/APOC, 25 October 2009 a t Is CDTI included in the PHC budget? The CDTI is integrated into Malaria and other vector borne disease control and prevention unit at the project level and woreda level. There is no separate line budget for CDTI, since onchocerciasis is incorporated into malaria and other vector borne diseases. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? Malaria was integrated into the CDTI structure. Community Directed Distributors were involved in mobilizing community in Malaria prevention and control activities ,teaching and demonstrating communities on bed net use ( proper hanging , using net regularly ,washing nets , mending ) ,educate communities on early and prompt treatment, and recording and reporting the availability of bed nets in the community by using CDTI village register book. Increased community awareness to wards malaria control and prevention activities and reduced malaria mortality was observed in the project area. Describe others issues considered in the integration of CDTI. The expansion of health posts designed to reach all kebeles , the assignment of trained female health extension workers and the existing lower govemment structure the so called 'Geree' (village ) which is composed of 25-35 households is found important for integration and sustainability of CDTI activities in the project . 4.4. Operational research 4.3.5. 4.3.6. 4.3.7. 4.4.1. 4.4.2. Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period. Not done How were the results applied in the project? 28 WHO/APOC, 25 October 2009 tSEGTION 5: Strengths, weaknesses, challengesr and opportunities List the strengths and weaknesses of CDTI implementation process List the challenges and indicate how they were addressed. Strengths: The active involvement of front line health workers and Health Extension workers , community supervisors and community at large which leads to high therapeutic coverage with 100% geographical coverage since the start of the program. Weaknesses: Low attention of some front line health facilities and woreda health offices ,poor record keeping ,delay of treatment reports ,poor quality report ,delay in utilizing and liquidating financial resources, low support of different administration body in mobilizing communities Opportunities: The expansion of Health posts and the assignment of two female health extension workers in each and every Kebele during the year, the government structure and restructure down to village level "geree" and being taking the responsibility of development activities including health is a good opporhrnity for sustainability of CDTI. Threats (Challenges): High turn over of front line health workers and focal persons at all levels, transfer of health extension from one post to the other without full exchange of CDTI documentation, Government priority issues during the mass drug administration campaign at the project area, overburdening of woreda health office focal persons and front line health workers in peripheral health facilities in different health programs, SEGTION 6: Unique features of the proiecUother matters None 29 WHO/APOC, 25 October 2009