Report of country support mission of TCC/APOC to Ethiopia: 10 to 20 September 2009

WORLD HEALTH ORGAIIZATION AFRICAII REGION @ ORGA}ISATION MONDIALE DE LA SANTE REGION DE L'AFRIQUE Report of Country Support Mission of TCC/APOC to Ethiopia l0 to 20 September 2009 AFRTCAN PROGRAMME FOR ONCHOCERCTASIS CONTROL (APOC) PROGRAMME AFRICAIN DE LUTTE CONTRE L'ONCIIOCERCOSE Prof. Eka Braide, former TCC member, University of Catabar, Nigeria Mrs. Francisca Olamiju, TCC member & MITOSATH, Nigeria Dr Afework Hailemariam, Epidemiologist, APOC k l.Mhffi*dll effiOn !.tkH.SOTl + [d tirdq. Con chE@rt tmd.COn ?,If.tr.On a.lIIm@n tacmh{Jimil LEGEHD 1 Summary of Mission Report to Ethiopia 9- 21 August 2009 Background of the Mission The Technical Consultative Committee (TCC) of APOC during its 28th session held in Ouagadougou from 9-14 March 2009 had made a number of recommendations regarding CDTI Projects in Ethiopia including a mission to the country, lead by Mrs Franca Olamiju and Prof Eka Braide. The purpose of mission involves: . Conducting orientation training to Ministry of Health newly assigned staff after the new reform, o Conduct advocacy visit to high authorities of the Ministry of Health, and a field visits. o Provide Technical assistance as needed by the NOTF The TCC proposed dates of the mission, 10-21 August 2009, were accepted by the Ministry and the training has been conducted from l4-16 August 2009 inNazareth. Below is the summary of the mission report including the detailed CDTI training report. I. Training on APOC Philosophy and CDTI Strategy The Ethiopian Program for Onchocerciasis Control (EPOC) conducted training on APOC Philosophy and CDTI strategy on 12 - 14 August 2009. The participants were drawn from all the CDTI projects working at regional and zonal levels, FMoH, The Carter Center Ethiopia officials, NOTF members, WHO, Light for the World, APOC. (See Annex 1 for participants list). The objective was to build national capacity on APOC philosophy and CDTI strategy in order to deliver ivermectin to all meso and hyper endemic communities in Ethiopia. Main Objectives of the Workshop To build national capacity on APOC philosophy and CDTI strategy to deliver ivermectin to all meso and hyper endemic communities in Ethiopia To inform leaders on their roles and responsibilities in Onchocerciasis control Specific Objectives of the training: r To train and orient health workers on the principles and practices of CDTI r To train health workers on how to '/ Approach and mobilize communities for CDTI ,/ Train community-directed distributors (CDDs) ,/ Monitor and supervise implementation of CDTI ,/ Recognize side-effects from ivermectin and manage it accordingly Expected Outcomes of the Conference: '/ Program managers at all level will be oriented on APOC philosophy and CDTI strategy for the control of Onchocerciasis/ All partners working on Oncho control will recognize their roles and responsibilities in Onchocerciasis control ll I I Health workers will be able to: ./ Give health education on Onchocerciasis to the communities{ TrainCDDs ,/ Monitor and evaluate CDTI implementation ,/ Recognize and manage side-effects of ivermectin Methodology r Presentations ' Plenary discussion . Video show . Group discussion . Role play and practical exercise Pre-test examination A pre-test was administered on participants to access their knowledge on Onchocerciasis and the current control strategy. Result showed an average score of 79%o.Lowest score was 27%o while the highest was 100%. FMOH participants scored an average of 560/o,lowest score of 27%o and highest score of 87%o- Others (Region, Woreda and NGDO) had an average score of 93'%.Lowest was 67%o while the highest was 100%. Post -test examination A post test was administered to 26 participants at the workshop. Result showed an average score of 93oZ.Lowest score was 73 %o andthe highest was 100%. FMOH participants scored an average of 92%o' lowest score was 73%o and highest score was l00o/o. Otheis (Region, Woreda and NGbO) had an average score of 96o%.Lowest was 87%o while the highest was 100%. Workshop Evaluation An evaluation of the workshop was done by administering post workshop questionnaires. Rating the overall evaluation of the workshop based n the queitionnaire administere d, Tgyo of theparticipants rated it very good (>75yo), l5oh rated, it Good (65-75%). Therefore the participantsgenerally have been satisfied with all components of the presentation, organization, iiming and duration of the workshop. The Way f,'orward Discussions were held on all the presentations and some NorF review issues. At the end the meeting agreed to come up with key recommendations listed below Trainings should be replicated at the lower levels o., Annual Technical Reports for Kadressing the comments given ,,ffi.East Wollega and West Wollega projects Consultative Committeeby Technical Sustainability plans. for Rapid Epidemiological refinement. all projects shouldJejnalized and be should (TCl)27 and?8, submitted to HQ Assessment (REA) should be conducted in areas that need tw a a NorF should sort out funds utilization and liquidation problems. lIl 5 o Persons handling APOC funds should be adequately sensitized and invited to trainings/meetings. II. Advocacy meeting to the regional Health Bureau The team visited the Oromiya Regional Health Bureau office and was received by Mr.Taye Tolora who is the Deputy Regional Head of the ORHB also present. Others present were Mr. Kedir Gobena, the Regional Onchocerciasis Coordinator, Mr. Temirat, Dr. Afework and Mrs. Francisca Olamiju. Points used for the advocacy were regional post Evaluation recommendations and issues that came up during the training namely: o Development of an integrated work plan. o Facilitation of approval of duty except status for Light for the World . Documentation of integrated support activities. o SupportivesuPervision . Ensuring that Government allocates fund for CDTI In response the region promised to address the above issues and requested for APOC support in the following areas: . Release of financial support to the region to enable them provides effective, supportive, monitoring and supervision through field visits and Evaluation. . Provision of funds for replication of training at the lower level. ilL VISIT TO THE WR of WIIO The team also visited the WR Dr Fatoumata Nafo-Traoe. Presents at the debriefing was Dr Daniel Argaw the Disease prevention and control cluster team leader. She was debriefed on the training objective; the outcome and the recommendations made at the end of the workshop. ln response she thanked the team for the visit and apologized for her inability to receive the team before the workshop. staff turnover at the FMOH and that: of support that can support of CDTI program especially in the face of the staffturnover challenge Dr Daniel was requested to present her a short on the mission to enable hera take action while the complete report rs finalized. IV. Visit to NGDO Partners 1. Light for the World Ethiopia The team met with Mr. Getachew Abera the coordinator, based in Addis Ababa and Mr. Dubiwak program and field Oncho Focal Person based in Nekemte - ---- -1fuaEast and W.esr-Woll-ega proj-ecfl for hghffurthe woflat. We had learnet ttaf Light ft.tte in different health andWorld (LFUD is intemational donor NGO funding other local NGOs lv blindness related issue. The LFW is under registration in Ethiopia and has no full legal entity to operate as it wishes. The registration took long time because it was discontinued because of the new legislature proclaimed by the country National Assembly in 2009. It is expected to resume soon in September and hope the NGDO partner will get its full legal status. This partner NGO have been supporting the East and West Wollega CDTI project since 2005 mainly on technical assistance by recruiting one field oflicer for both projects based in Nekemte. However the officer is constrained because of logistics and transportation reason as he has no vehicle assigned for him 2. The Carter Centre Ethiopia A fruitful discussion has been made with the Country representative Mr. Teshome Gebre. The Carter Centre is the leading NGDO partner in the country co-financing and supporting 7 of the 9 projects in the country. The Country representative is the NGDO coordinator and secretary of the NOTF. They have stafl even at project level and are very much address a number of gaps which the government could not fill. They are optimistic in continue supporting the program and making sure all the projects sustain themselves to take over from APOC. III. Technical Assistance provided to NOTF Ethiopia During the CDTI training issue related to finalization of REMO and complaints from different CDTI project focal points was raised regarding communities with high burden of the disease but which were not included as REA was not done. Therefore the FMoH requested APOC to help in the preparation of the Development of proposal for REMO Final refinement, Development of proposal for geographical coverage and village identification and sharing of various Project documents and Reporting with the newly assigned FMoH staff. Those documents were prepared in collaboration with FMoH and the Carter Center with assistance from APOC technical staff Dr. Afework. Acknowledgment The team is grateful to the WR, the FMOH, The Carter Center and Light for the World for the hospitality accorded them during the mission and equally grateful to APOC for the opportunity given to them to serve in this capacity. v ETHIOPTAN PROGRAM for ONCHOCERCIASIS CONTROL (EPOC) REPORT ON APOC PHILOSOPI{Y AND CDTI STRATEGY WORKSHOP I{ELD ON TIm 12 to 14 August 2009 AT ADAMA GERMAN HOTEL, ADAMA. vl I ','il,fs ;il rq. *j n f?al \, :q' 'g,,r & ;{ I ti \u \ L tQ -.+ -E- -: i '\,"',*\ A\ t\ -f.a,-"-lil$,ffi-q:AsL "-.r I t i t r Table of Content PREAMBLE 1. Opening Session 2. Objectives and Expected Outcomes of the Workshop: 2.1. Main Objectives of the Workshop: 2.2. Specific Objectives of the training: 2.3. Expected Outcomes of the Conference 2.4. Methodology: 2.5 Pre-test examination 3. Session 1-Partnership and Country Experience 3.1-Partnership 3.2 Experience of Ethiopia on Onchocerciasis control 4. Session II and III 4.1 Session II: Rapid Epidemiological Mapping of Onchocerciasis (REMO) Status of REMO in Ethiopia 4.2 Session III: APOC Philosophy and CDTI strategy 4'2.1 Session III.I: APOC Philosophy and Community Directed Treatment with Ivermectin 4.2.2 Session IIL2: CDTI strategy: Community participation 4.2.3 Session III.3: CDTI strategy Management of stocks of ivermectin by communities 4.2.4 Session III.4 NOTF concept and responsibilities 5. Session IV: Ivermectin procurement and the new delivery system 5.1 Delivery of Ivermectin in the context of the new pharmaceutical Logistic Management System 6. Session V: Integration of Community-directed treatment with ivermectin (CDTI) in the national health system. 6.1 Implementation of GDTI in the context of the new Health Reform in Ethiopia 6.2 co-implementation of different intervention to strengthen the health system 7. Session VI: Administration, Budget and Finances 8. Session vii: Introduction to Health Educationllnformation Education and Communication materials 9. Session VIII: Data collection, transmission and reporting 9.1 Annual technical report format 10. Session IX: Sustainability of Community-directed treatment with ivermectin (CDTI): Issues of Sustainability in CDTI Projects 11. Session X: Monitoring and Evaluation of ApOC projects 12. Session XI: Evaluation of the workshop & post -test Annexes vll Acronyms APOC CDD CDTI EPOC IEC MDP MOH MOVDPC NGDO NOTF OCP REMO RHB ROTF SNNPR TCC TOT wHo WOTF ZHD ZOTF African Program for Onchocerciasis Control Community Drug Distributor Community Directed Treatment with Ivermectin Ethiopian Program for Onchocerciasis control Information Education and Communication Mectizan Donation Program Ministry of Health Malaria and Other Vector-borne Diseases Prevention and Control Non Govemmental Development Organizations National Onchocerciasis Task Force Onchocerciasis Control Program Rapid Epidemiological Mapping of Onchocerciasis Regional Health Bureau Regional Onchocerciasis Task Force Southern Nation Nationalities and Peoples Region Technical Consultative Committee Training of Trainers World Health Organization Woreda Onchocerciasis Task Force Zonal Health Depafiment Zonal Onchocerciasis Task Force vlll PREAMBLE The Ethiopian Program for Onchocerciasis Control (EPOC) conducted training on APOC Philosophy and CDTI strategy on 12 - 14 August 2009. The participants were drawn from all the CDTI projects working at regional and zonal levels, FMoH, The Carter Center Ethiopia officials, NOTF members, WHO, Light for the world, APOC. (See Annex I for participants list). The objective was to build national capacity on APOC philosophy and CDTI strategy in order to deliver ivermectin to all meso and hyper endemic communities in Ethiopia. 1. Opening Session Mr. Abate Tilahun, The Carter Center and NOTF member welcomed all the participants and gave briefing on the purpose and agenda of the three days training (See Annex 2 for the Agenda) and then Dr Afework Hailemariam, APOC and Mr. Teshome Gebre, The Carter Center - Ethiopia Country Representative gave keynote addresses. Then, Dr. Keseteberhan Admassu, Disease Prevention and Health Promotion General Directorate, General Director, MoH and NorF chairman officially opened the training at the end of his opening remarks. APOC representative Dr. Afework in a keynote address noted the achievement of APOCA{OTF partnership in the control of Onchocerciasis in Ethiopia, starting in year 2000 in Kaffa and Sheka Zones of SNNPR, and the expansion to Bench Maji and North Gondar Zones in Year 2001, and by 2003 it expanded further to Illubabor, Jimma, West Wollega and East Wollega Zones in oromia region, Metekel Zone in Benshangul-Gumuz region and Gambella Region. He ended by thanking the FMOH, members of the Technical Consultative Committee members who are external facilitators, The Carter Centre, WHo/Ethiopia, intemal facilitators and all participants for honoring the invitation to the workshop. The Country Representative of the Carter Center Ethiopia Mr Teshome Gebre also expressed his appreciation for the opportunity given to Ethiopia to host this training workshop, stressing its importance especially as a result of high staff turnover. He thanked, on behalf of the NGDO coalition, all participants adding that the meeting will provide an opporhrnity for the NOTF/Ethiopia to address some pressing CDTI issues. In an opening speech, the Director General of Health promotion and Disease prevention General Directorate Public Health, Dr Kesetebirhan Admasu appreciated the opportunity given to the Government of Ethiopia to hold the training workshop at this time. He said it was timely because of high staff turnover due to the restructuring in Government policy regarding Health Care. He also added that the Ministry of Health being in a planning stage for Health activities the timing was good. He ended his speech by encouraging participants to be attentive as TOT given the fact that Health programmes are no longer vertical but integrated. I 2. Objectives and Expected Outcomes of the Workshop: Dr. Afework Hailemariam, Epidemiologist, APOC. Dr Afework Hailemariam, from APOC presented the objectives, expected outcome and the methodology for the training. 2.1. Main Objectives of the Workshop: . To build national capacity on APOC philosophy and CDTI strategy to deliver ivermectin to all meso and hyper endemic communities in Ethiopia . To inform leaders on their roles and responsibilities in Onchocerciasis control 2.2. Specific Objectives of the training: ' To train and orient health workers on the principles and practices of CDTI . To train health workers on how to:{ Approach and mobilize communities for CDTI '/ Train community-directed distributors (CDDs) '/ Monitor and supervise implementation of CDTI ,/ Recognize side-effects from ivermectin and manage it accordingly 2.3. Expected Outcomes of the Conference:t Program managers at all level will be oriented on APOC philosophy and CDTI strategy for the control of Onchocerciasis ,/ All partners working on Oncho control will recognize their roles and responsibilities in Onchocerciasis control . Health workers will be able to: ./ Give health education on Onchocerciasis to the communities '/ Train CDDs '/ Monitor and evaluate CDTI implementation '/ Recognize and manage side-effects of ivermectin 2.4. Methodology: r Presentations . Plenary discussion . Video show . Group discussion ' Role play and practical exercise 2.5 Pre-test examination A pre-test was administered on participants to access their knowledge on Onchocerciasis and the current control strategy. Result showed an ayerage score of 79o/o.Lowest score was 27%o while the highest was 100%o. FMOH participants scored an average of 56%o,lowest score of 27%o and highest score of 87o/o. Others (Region, Woreda and NGDO) had an average score of 93olo.Lowest was 67Yo while the highest was 100%' 2 3. Session 1 3.1-Partnership Two presentations were given during this session. They were: Introduction to Onchocerciasis and APOC partnership by Dr Afework and Experience of Ethiopia on Onchocerciasis control by Mr Teshome. The first presentation captured the following major points: Onchocerciasis disease overview, mode of transmission & the vector, global geographical distribution. [n addition history of Oncho control in Africa highlighted the following: history of OCP its objective, strategy and achievement (1974-2002). History of APOC and its set up, the APOC Objective which is to establish within a period of 12 to 15 years, effective and sustainable, community- directed treatment with ivermectin throughout the endemic areas within the geographic scope of the programme, and, if possible, to eradicate the vector in selected and isolated foci, by using environmentally safe methods). Additional areas covered by this presentation include: APOC areas of operation, APOC CDTI strategy, partnership, structure financing and countries criteria for participation. Lastly he highlighted APOC's achievements, challenges like conflict areas, Government ownership (finance) of control programmes, weak health system, macrofil research and surveillance still exist. 3.2 Experience of Ethiopia on Onchocerciasis control Mr. Teshome Gebre shared the experience of the country and highlighted the following major points: distribution of the disease, numbers of project, and major achievements of the program. He raised issues related to Mectizan utilization and wastage as a key challenge and stressed its persistence as a problem even though the extent of the problem is minimized. 4. Session II and III 4.1 Session II: Rapid Epidemiological Mapping of Onchocerciasis (REMO) Status of REMO in Ethiopia-Presented by Dr Afework Highlights from the presentation: Historical account on Ethiopia Onchocerciasis documentation and research that oncho was first reported in 1939 in Elibabur, Kaffa, Wollega and Gamogofa and in 1977 in N.Metema. The Onchocerciasis cases in different times and population at risk of the disease, classification of endemicity based on the presence of nodules into hypo, meso and hyper endemic if the percentage of nodules <lgoh, bln 20-39% and >40Yo respectively. He also explained the need for REMO Mapping tool which is used to identiff the endemic communities where mass Ivermectin treatment is to be done. Detailed account on stages of REMO, methodology, the current distribution and existing gap were also presented. He indicted the need refinement in the following areas: Chilga, Alefa, Takussa, Jimma, Illubabur and E & W Wollega needs REA. However, it was learnt that REMO has been completed in the following CDTI areas: Keffa, Sheka, Benchmaji, Metekel, and Gambella 3 4.2 Session III: APOC Philosophy and CDTI stratery III.I: APOC Philosophy and Community Directed Treatment with Ivermectin-presented by Prof Eka Braide Highlights from the presentation: Overview on Onchocerciasis and its socioeconomic consequences, control effort and achievement of OCP and its achievements. APOC was set up in 1995 with HQ in Ouagadougou, Burkina Faso. APOC's objective which is to establish within a period of 12 to l5 years, effective and sustainable, community-directed treatment with ivermectin throughout the endemic areas within the geographic scope of the programme, and, if possible, to eradicate the vector in selected and isolated foci, by using environmentally safe methods. She discussed APOC strategy of Community Directed Treatment with Ivermectin (CDTI) which is intervention directed by communities. She explained the reason for adopting CDTI and implication of the strategy ie communities decide on period/mode of distribution and select CDDs. She indicated that CDTI is a (Community Directed Intervention (CDI) strategy. The strategy enhances community empowerment, community ownership of project, sustainability, and achievement of ideal treatment coverage. She highlighted achievements of APOC which include: remote communities reached, entry point for other intervention, health staff trained, health system strengthened, community empowered and conflict areas reached. Session III.2: CDTI strategy: Community participation Approaching community, Community responsibility, Community mobilization and participation presented by Mrs. Francisca Olamiju. Highlights from the presentation: Community definitions and definition in the context of CDTI, background information required for community entry for CDTI activity (endemicity local name of the disease, vector and common signs and symptoms, community structure, major occupation etc).She stated manner of approach of communities, composition of team points to be explained to the community, role, responsibilities and the type of program to the community. Participants were reminded that no two communities are the same and understanding each community is important for CDTI. They were equally advised to study the CDTI practical guide for trainers of CDDs produced by APOC/WHO. Discussion points on the presentations . It was pointed out that Onchocerciasis Control Program strategic plan from 2000-2005 exist but there is no strategic plan for 2006-2010, but Oncho program has included in the health sector plan of HSDP II & ilI . Participants remarked that therapeutic coverage of 80% looks high and said it may need to be reviewed by APOC /HQ. . In order to strengthen the program and improve coverage follow up visit, time of distribution and accurate data management are important. . In the future involvement of model families of Health extension Program in CDDs should be taken as an option . Corrective measures towards the reduction of Mectizan wastage were advised. . The problem of HEWs supervisors should be solved accordingly . Ethiopia has a very well established structure to implement community program, harmonization and integration of tVE and strategy is important 4 Community conversation should be taken as a means to strengthen CDTI Day Two 4.1.4, Session III.4 or v: CDTI strategy Management of stocks of ivermectin by communities-presented by Mr Abate Tilahun Day two started with a recap of day one proceedings by Tsegaye after which there was a group work/role play on approaching the community, community mobilization and sensitization. The class was divided into two groups and there was interaction and practice of day one lessons. Detailed report on the two groups is attached as annex 2. Highlights from the presentation: NOTFA4OH will submit application to Mectizan donation program. WHO country office is the consignee for all Mectizan donated drugs ensuring that all donations are tax exempted. Each CDTI project requests for its share of Mectizan and gets the amount approved by MDP. Department drug store. Each Woreda takes its share of Mectizan (calculated on the basis of population size) from the respective zone. Each Health Facility takes its share of Mectizan from the respective Woreda based on population size. CDD registers Challenges Method. villages. Session III.4 NOTF concept and responsibilities- This was presented by Mr Teshome.Highlights were: APOC's a global partnership, NOTF structure and composition of NOTF - National Onchocerciasis Task Force, the different level Oncho coordination units. He also highlighted roles and responsibilities, modes of operation of NOTF which include: Advocacy, training, resource mobilization, planning, and implementation. 5. Session IV: Ivermectin procurement and the new delivery system 5 a Mectizan procurement, Mgt & delivery presented by- Mr. Abate Tilahun and he highlighted the following maj or points : o Disclosed reasons why CDTI started.... i.e. Mectizan given free and is the safest for Onchocerciasis control o Purpose of Mectizan donation ... to make the treatment ready and available for the needy. o How to calculate/estimate drug requirement. . WHO imports the Mectizan and handovers to MOFVintegrated into procurement and distribution systemt Expiry .... '1" expiry 1" out'principle is not abided o Some CDDs may not submit leftover drugs after treatment o Error in calculations o Poor record keeping .... Stockbalance o Lack of motivation ....from the side of CDDs 5.1 Delivery of Ivermectin in the context of the new pharmaceutical Logistic Management System A New Health Commodity Supply System (HCSS) for Ethiopia and Mectizan Procurement, supply and Delivery-presented by- Dr Afework Hailemariam. He highlighted the following major points: Principles of Health and Commodity Supply System, the existing situation of the system in Ethiopia which was lengthy and inefficient. He also explained what the new proposed system including how it differs from the old one, proposed location of new hub warehouse, proposed way it will work. Finally he discussed the implication of the new system on the Ivermectin supply chain management. He indicated that project areas need to get prepared ahead of time to ensure sustainable delivery when the new system started implementation. 6. Session V: Integration of Community-directed treatment with ivermectin (CDTI) in the national health system. Introduction to the integration of CDTI in the national health system: Prof Ekanem Ikpi Braide The presentation began with a background Primary Health Care (PHC), Alma Atta declaration on Piimary Health Care and present status of PHC. She stressed that Health is central to the MGDs and other development plans because it is central to poverty reduction and development' For health to be adequately and cost effectively addressed, interventions have to be implemented in an integrated manner. The ability of communities to have integrated perception of their problems is a critical potential for integration! APOC is now a proactive advocate for facilitating, catalyzing, enabling and promoting the appropriate use of CDTI (a CDI strategy) to increase access to health services. The strength in this derives from the availability of human and material resources CDTI has brought to countries. This has made it easy to add on to CDTI, Lymphatic filariasis control, Schistosomiasis control, Vitamin A supplementation, Immunization, Distribution of Insecticide Treated Bednets (ITNs) and others. In developing countries about 80% of all disease results from a combination of poor hygiene, contaminated water and poor sanitation...inadequacies which hinder socio- economic development. It would be cost effective to tackle this group of diseases by providing 6 the missing facilities in an inter sectoral integrated manner. Neglected Diseases which include onchocerciasis can be similarly handled. Shift towards integration within health sector should be done cautiously to allow the following is sues " be addresl' w"l#m;;;;:*,"-Concerns on drug interactions 6.1 Implementation of CDTI in the context of the new Health Reform in Ethiopia - presented by Dr Kesetebrehan Admassu Highlights: sector. disease by 2020. Presently: trachoma program was managed at the federal level by Malaria For the future: resulted in new process based organizations. Rationale is for integration: comprehensive care Directorate with three subdivisions: Pastoralist, Agrarian and Urban The benefits of this organization F Client oriented service FAddress the specific health related needs of the pastoralist, agrarian and Urban FIn line with the government's developmental strategy D Cost savings by reducing duplications F Fewer wastage rates of drugs etc 7 Potential challenge The way forward F Address the challenges D Enhanced integration with the HEP D Strengthen the community involvement 6.2 Co-implementation of different intervention to strengthen the health system (Dr. Afework) The presentation captured the following: CDTI strategy and the fact that those community ."-b".. collectively: Plan how, when, where and by whom ivermectin will be distributed discuss results and adjust approach as required. That from monitoring CDTI implementation a CDI study was carried out. He shared the result of the study and their findings. He explained that CDI provides opportunities to combine preventive chemotherapy and opportunities of delivery methods at community level. He also identified the challenges in combining preventive chemotherapy as including the following: combinations urban settings. The presentation covered other challenges like convincing the policy makers, Lack of intersectoral collaboration, financial resources and Low population coverage by health system. 7. Session VI: Administration, Budget and Finances Presentation on APOC's Financial & Administrative Rules and Guidelines by Mr' Tamirat Belete Highlights transferred to WHO Country Ofhce Imprest Bank Account to the respective CDTI Project Bank Accounts 8 shall be justified on a monthly basis by a set of financial documents upon signature of both by WHO-APOC FMoH and/or NGDO Coalition besides the DFC Agreement also specifies when to release the 2"d installment Country Office within three month of completion of the activity. receive their funds through their respective bank accounts. Accordingly, the DFC Agreement has a section to fill bank details such as: Bank Account Name, Bank Name, Bank Account Number, Bank Branch Address, Bank Account Currency, and the Bank's Origin of country o Reportingrequirements . Key challenges Discussions and issues at the end ofpresentations: I Mectizan management as it's facing problems in some districts during distribution and storage2. Record keeping/filling and reporting 3. NOTF was not strengthened at lower levels4. Liquidations were not being done on time 5. Zones and woredas were not appropriately indicating money used for the program weather it is from Govt. budget or donors' Day Three 8. Session vii: Introduction to Health Education/Information Education and Communication materials- Mrs. Francisca Olamiju Recap of day was presented by: B. Temesgen Highlights . Why do we have to Health Educate the communities? o How to fill the knowledge gaps (IEC) materials. . When IEC materials are needed facility, strategic places in the community) o Available IEC materials were shared and practical discussions on their use o Participants were equally reminded that Health Education is a continuous process therefore effort should always be made to: 9 What to do when IEC do no longer meet your need: 9. Session VIII: Data collection, transmission and reporting CDTI Data Collection-by Dr. Afework and Mr Abate Highlights basic information about dat4 its importance components of good data, level of data g.r".uiion in CDTI including Finance data is equally important in CDTI. At the end of this iession a practical demonstration on the use of available Management Information System forms was introduced by Mr Abate. 9.1 Annual technical report format by Prof Ekanem Ikpi Braide Highlights The presentation began with a background on Technical Consultative Committee of APOC, its composition, meetings and functions,. TCC provides technical guidance to APOC by{ vetting new national plans and CDTI project proposals '/ Reviews operational research proposals and reports ,/ Reviews Technical Reports{ Provides technical advice on other issues as necessary Procedure for reviewing was explained: r Two reviewers review each report independently and thereafter both reconcile their reports o First reviewer presents report to TCC in session o Final decision is taken by TCC in session o Report of TCC communicated to projects Using reviewed l]ench Maji report as example, Prof Braide took the participants through the format for Technical reports explaining information required for each indicator. 10. Session IX: Sustainability of Community-directed treatment with ivermectin (CDTI) Issues of Sustainability in CDTI Projects-Mr Teshome o Sustaibility was defined resources and those from outside - provided both, in particular government resources are dependable" (APOC Management, April 2003) o Aspects of Sustainability were highlighted o Indicators of Sustainability were highlighted o APOC sponsored evaluation was conducted o APOC criteria for funding projects post Evaluation was highlighted o He ended with a key note that ownership of CDTI by the communities and its integration into the health service are foundational steps to achieving sustainability. a l0 11. Session X: Monitoring and Evaluation of APOC projects Monitoring of CDTI Projects by Mr Teshome Highlights: o Defined Monitoring as the systematic collection and analysis of information as a project progresses. organization. going wrong. used well and whether we are doing what we planned to do. annually in the CDTI projects since 2004. o He ended by showing that result of APOC evaluation confirmed earlier findings in the projects evaluated. The last presentation on Evaluation of sustainability of CDTI Project and post APOC sustainability plan was presented by Mrs Francisca Olamiju r Sustainability was defined r A lot of reference was made to earlier presentation on sustainability o An evaluation process, methodology and key finding at the different levels in Ethiopia were highlighted. o Process of developing a Sustainability plan was taught o APOC's criteria for funding projects in third and fifth year was explained . The presentation ended with a way forward for NOTF/Ethiopia annual estimates. stakeholders Discussions were held on all the presentations and some NOTF review issues. At the end, the meeting agreed to come up with key recommendations listed below: o Trainings should be replicated at the lower levels o Annual Technical Reports for East Wollega and West Wollega projects should be re submitted taking the comments given by Technical Consultative Committee (TCC) 27 and28. o Sustainability plans for all projects should be finalized and be submitted to APOC- HQ ll o Rapid Epidemiological Assessment (REA) should be done in areas that need refinement. o NOTF should sort out funds utilization and liquidation problems. . Persons handling APOC funds should be adequately sensitized and invited to trainings/meetings. Post -test A post test was administeredto26 participants at the workshop. Result showed an average score of 93%o.Lowest score was 73 o/o and the highest was 100%. FMOH participants scored an average of 92o/o, lowest score was 73oh and highest score was lOOo . Others (Region, Woreda and NGDO) had an average score of 96%.Lowest was 87Yo while the highest was 100%. 11. Session XI: Evaluation of the workshop An evaluation of the workshop was done by administering post workshop questionnaires as shown in Annex..... OEr all eEl@tron of the rcrkshop a OEr all eEl@trm of the workshoP Ery good (>75%) g@d (65 - 75%) far (50'65%) p@r (40 -sOYo) wry poor (< 40%) so 80 70 60 50 & 30 20 '10 s E o t2 , i, OTIIER ACTIVITIES CARRIED OUT Advocacy meeting to the regional Health Bureau The team visited the Oromiya Regional Health Bureau office and was received by Mr. Taye Tolora who is the Deputy Regional Head of the ORHB also present; others present were Mr. Kedir, the Regional Onchocerciasis Coordinator, Mr Temirat, Dr Afework and Mrs. Francisca Olamiju. Points used for the advocacy were regional post Evaluation recommendations and issues that came up during the training namely: o Development of an integrated work plan. . Facilitation of approval of duty except status for Light for the World o Documentation of integrated support activities. . SuPPortive supervision . Ensuring that Government allocates fund for CDTI In response the region promised to address the above issues and requested for APOC support in the area of o Supportive supervision like field visit o Provision of fund for training VISIT TO THE WR of WHO The team also visited the WR Dr. Fatoumata Nafo-Traoe. Also present at the debriefing was Dr Daniel Argaw the Disease prevention and control cluster team leader. She was debriefed on the training objective the outcome and the recommendations made at the end of the workshop. In response she thanked the team for the visit and apologized for her inability to receive the team before the workshop. She was also concerned about the high staff turnover at the FMOH and requested that: o The team let WHO know the areas of support that can be provided in support of CDTI program in the face of the staffturnover challenge. That a short summary report on the mission be submitted to her to enable her take action while the complete report is being finalized. a IV. Visit to NGDO Partners 3. Light for the World Ethiopia The team met with Mr. Getachew Abera the country program coordinator, based in Addis Ababa and Mr. Dubiwak Gemeda, program officer and the field Oncho Focal Person based in Nekemte (for East and West wollega project) for light for the world. We had leamed that Light for the World (LFVD is international donor NGO funding other local NGOs in different health and blindness related issue. The LFW is under registration in Ethiopia and has no full legal entity to operate as it wishes. The registration took long time because it was discontinued because of the new legislature proclaimed by the country National Assembly in 2009. It is expected to resume soon in September and hope the NGDO parbrer will get its full legal status. 13 This partner NGO have been supporting the East and West Wollega CDTI project since 2005 mainly on technical assistance by recruiting one field officer for both projects based in Nekemte. However the officer is constrained because of logistics and transportation reason as he has no vehicle assigned for him 4. The Carter Centre Ethiopia A fruitful discussion has been made with the Country representative Mr. Teshome Gebre. The Carter Centre is the leading NGDO partner in the country co-financing and supporting 7 of the 9 projects in the country. The Country representative is the NGDO coordinator and secretary of the NOTF. They have staff; even at project level and are very much address a number of gaps which the government could not fill. They are optimistic in continue supporting the program and making sure allthe projects sustain themselves to take over from APOC. III. Technical Assistance provided to NOTF Ethiopia During the CDTI training issue related to finalization of REMO and complaints from different CDTI project focal points was raised regarding communities with high burden of the disease but which were not included as REA was not done. Therefore the FMoH requested APOC to help in the preparation of the Development of proposal for REMO Final refinement, Development of proposal for geographical coverage and village identification and Sharing of various Project documents and Reporting with the newly assigned FMoH staff. Those documents were prepared in collaboration with FMoH and the Carter Center with assistance from APOC technical staff Dr. Afework. Acknowledgment The team is grateful to the WR, the FMOH, The Carter Center and Light for the World for the hospitality accorded them during the mission and equally grateful to APOC for the opportunity given to them to serve in this capacity. l4 WORKSHOP ON APOC PHILOSOPHY AND CDTI STRATEGY 12to 14 2009 Wednesday 12 August 2009 08H30 - 09H 00 Registration of the participants & Arrival of invited guests and officials 9H 00 - 09H30 Opening Session Welcoming address by NOTF Keynote Address by the Carter Center Ethiopia Keynote Address by the Representative of TCC/APOC Keynote Address by the WHO Representative, Official opening by the Honourable Minister of Health or his Representative I ntroduction of participants Election of Chair persons and Rapporteurs for the 3 days (10 minutes) - Mr. Teshome Adoption of the Agenda (5 minutes) - Mr. Teshome Group Photo IOHOO _1OH3O TEA BREAK Objectives of the workshop and expected outcomes (5 minutes) - Dr. Afework Pre-test (20 minutes) - Facilitators Session l: Partnership 10H30 -13H00 lntroduction to Onchocerciasis and APOC Partnership(Presenter: Dr Afework: 20 minutes); Experience of Ethiopia (presenter: Mr. Teshome : 15 minutes) ; Discussions (30 minutes) Session ll: REMO current status of Rapid Epidemiological Mapping of onchocerciasis (REMo) in Ethiopia (20 minutes) - Dr.Afework 13H00 -14H30 Lunch Break 14H30 -16H00 Session lll: APOG Philosophy, CDTlstrategy and implementation process Session !11.1: APOC Philosophy and CDT|strategy APOC Philosophy and Community-directed treatment with ivermectin (CDTI) concept (20 minutes) - Prof Ekanem lkpi Braide Discussion ( 10 minutes) Session ll!.2: CDTI strategy: Community participation 16H00 -16H15 16H15 -17H00 Approaching communities (15 minutes ) - Mrs. Francisca Olamiju Responsibility of communities (10 minutes ) - Mrs. Francisca Olamiju Community mobilization and sensitization (15 minutes) Mrs. F. Olamiju Coffee Break Management of stocks of ivermectin by communities (15 minutes) - Mr Abate Tilahun l5 Discussion (20 minutes) Thursday 13 August 2009 08H00 - 10H00 Session lll.3: CDTI strategy: Responsibility of other partners (MOH, NGDOs, NGOs, Donors, WHO country Office, Merck & Co.lnc) Report on the previous day (10 minutes) - Rapporteurs NOTF concept and responsibilities (5 minutes) - Mr. Teshome Approach and responsibilities of other partners (10 minutes) - Mr. Teshome Working groups and role play on community mobilization and sensitization and approaching communities (45 minutes) - Prof Ekanem lkpi Braide 10H00 - 10H15 Coffee Break 10H15 - 12H30 Session lV: lvermectin Procurement Delivery of lvermectin in the context of the new pharmaceutical Logistic Management System (15 minutes) - Mr. DanielTadesse Procurement and delivery of ivermectin up to the port of entry in the country (15 minutes) - Mr. Abate Tilahun Experience of the country in the procurement of drugs (10 minutes) - Mr Abate Tilahun Discussions (20 minutes) 12H3O - 14H30 Lunch Break 14H30 - 16H00 Session V: lntegration of Community-directed treatment with ivermectin (GDTI) in the national health system lntroduction to the integration of CDTI in the national health system: Prof Ekanem lkpi Braide lmplementation of CDTI in the context of the new Health Reform in Ethiopia (10 minutes) - Dr Kesetebrehan Admassu Co-implementation of different intervention to strengthen the health system ( Dr. Afework) Discussions (1 5 minutes) Video film on CDTI & discussions (10 minutes) 16H00 - 16H15 Coffee Break 16H15 - 17H00 Session Vl: Administration, Budget and Finances Presentation of country financial flowchart (15 minutes)- Mr. Tamirat Belete Steps leading to disbursement of APOC funds (10 minutes)-Mr. Tamirat Belete Discussions (20 minutes) l6 Friday 14 August 2009 08H00 - 10H00 Session Vl!: Training and Health Education Report of previous day (10 minutes) - Rapporteurs lntroduction on training and health education (20 minutes) - Mrs. Francisca Olamiju Presentation on IEC (15 minutes) - Mrs. Francisca Olamiju Discussions (20 minutes) Session Vlll: Data collection, transmission and reporting lntroduction to collection and transmission of data (10 minutes) - Dr. Afework Utilization of data in planning and management of CDTI projects (10 minutes) - Dr. Afework Discussions (1 5 minutes) 10H00 - 10H15 Coffee Break 10H15 - 10H35 10H35 - 13H00 Session lX: Sustainability of Community-directed treatment with ivermectin (CDT!) Sustainability of CDTI: country experiences (15 minutes) - Mr. Teshome, Strengthening community ownership of CDTI (10 minutes) - Mr. Teshome, Discussions (20 minutes) 13H00 - 14H00 Lunch Break 14H00 - 16H00 Session X: Monitoring and Evaluation of APOC proiects Monitoring of CDTI projects (10 minutes) - Mr. Abate Evaluation of sustainability CDTI project and post-APOC sustainability plans (15 minutes) - Mrs. Francisca Olamiju Country experiences of evaluated projects (10 minutes) Mrs. Francisca Olamiju Discussions (30 minutes) Post-test (20 minutes) - Facilitators Session Xl: Evaluation of the workshop 16H00 -15H10 Evaluation of the workshop (15 minutes) Synthesis, conclusions and recommendations (1S minutes) Reading of the draft final report (30 minutes) Distribution of the draft recommendations (10 minutes) End of the workshop at 15H10 Annual technical report format (20 minutes)-Prof Ekanem lkpi Braide t7 WORKSHOP ON COMMT'NITY DIRECTED TREATMENT WITH IVER]VTECTIN ADAMA, 12 - 14 August 2009 Dear colleague, to help us assess the outcome of this workshop kindly complete the anonymous questionnaire by allocating scores to your answers. Please return completed forms to Facilitators. Thank you. Scores l-5 are to be given. I : very good (>75%)' 2: good (65 - 75%); 3 : fair (50 - 65%) 4 = Poor (40 -50%) 5 : very poor (< 40%) Please fill in the table and provide responses to the questions hy allocating scores of 1 lhrough 5. 2. Rate the that were made in each of the 2. Please score the idea of group work and role play that was used for this workshop. 3. Rate the degree to which your expectations were satisfied by the workshop? 4. How well were topics in general (presentation, plenary and group work) covered? 5. Do you think the number of days allocated to the workshop is:(i) Enough, (ii) Not enough, (iiD Too much areas: Clarity Content Approach Quality Subjects Opening session Introductlon to Oncho and APOC partnership Philosophy of APOC, CDTI strategy and rmplementatron process REMO status Integration of CDTI sustainability of CDTI procurement andMectizan distribution Frnance and APOC financial management Training and Health education collectionData transmission Monitoring and evaluation of CDTI projects 18 12 3 4 5 of Works Evaluation Very good (>75o/o) Good (65 -75o/o) Fair (50 - 65%) Poor (40 -50%) Very poor (< 40o ) 4 5 TotalS. No. Subjects I 2 3 80 10 7 3 0 1001 Opening session Introduction to Oncho and APOC partnership 86 11 4 0 0 1002 0 0 1003 Philosophy of APOC, CDTI strategy and implementation process 83 13 3 87 7 7 0 0 1004 REMO status 5 Integratron of CDTI 73 13 10 3 0 100 3 0 1006 sustainability of CDTI 77 7 13 67 20 13 0 0 1007 Mectizan procurement and drstributron 8 Finance and APOC financial management 60 23 17 0 0 100 13 7 0 0 100I Training and Health education 80 73 13 13 0 0 10010 Data collection transmission 10011 Monitoring and evaluation of CDTI projects 80 13 7 0 0 67 20 7 7 0 10012 Group work and role play 13 Satisfactron of expectations 87 13 0 0 0 100 0 0 10014 Over all evaluatlon of the workshop 87 13 0 67 33 0 0 0 10015 Duratron of the training 77 15 7 1 0Overall evaluation ofthe workshop l9 Name Region u)ne Pretest questions l. The disease Onchocerchiasis (river blindness) is caused by round worm, nematode parasite called a. Plasmodium flalciparum b. Onchocerca volvulus c. Loa loa d. Wuchereria bancrofti 2. The vector that transmit the disease Onchocerciasis is a. Anopheles mosquito b. Culex mosquito c. Sand fly d. Black fly e. None ofthe above 3. The major strategy of controlling Onchocerciasis is a. Vector control using Larviciding b. Insecticide treated mosquito nets (ITNs) c. Mass drug distribution d. Indoor residual house spraying 4. Community directed treatment with Ivermectin (CDTI) is a unique strategy because a. The community owns the program b. The community decide on mode and time of treatment c. The community plan and execute the program d. All of the above 5. What are the common clinical manifestations of Onchocerciasis? a. Blindness b. Acute papular dermatitis c. Skin depigmentation d. Hanging groins e. All of the above 6. What is the drug of choice for Onchocerciasis Treatment? a. Diethyl carbamazpine (DEC) b. Mectizan c. Suramin d. Macrofil e. Nodulectomy 7. What is the major disadvantage of Ivermectin? a. It does not kill adult worms b. Does not kill microfilariae c. It does not reverse blindness or Leopard skin d. The treatment should be taken for more than 12 years e. All of the above 8. One of the following is not the principle of African Program for Onchocerciasis Control (APOC). a. Community ownership and empowerment b. Sustainability c. Partnership d. Evidence based decision making 20 e. Centeralizedfinancialmanagement 9. In Oncho endemic community, treatment of Onchocerciasis using Ivermectin should be given for _Years. a. One year b. More than 12 years c. One time only d. Three years 10. Onchocerciasis treatment with Ivermectin should not be given to the following members of the community a. Pregant mothers b. Under five children c. Lactating mothers till seven days d. Very sick people e. All of the above I l. The community directed distributions (CDDs) administer the drug Ivermectin and determine the dosage (number of tablets) using a. Weight b. Height c. Age d. None ofthe above 12. What is the ultimate goal of APOC? a. Treat Oncho cases yearly b. E,limination of Onchocerciasis as a disease of public health and socio economic importance through out Africa. c. Eradicate Onchocerciasis from Africa d. None ofthe above 13. Which of the following is the major Objective of APOC? a. To establish, within l2-14 years, effective and self-sustainable community Directed Ivermectin Treatment throughout the endemic areas. b. To increase the capacity of the health institution to effectively treat the community with lvermectin. c. To strengthen the capacity of the health institutions to own the program and take the whole responsibility of Ivermectin treatment. d. None ofthe above 14. Most of the clinical manifestations of Onchocerciasis is caused by a. Macrofilariae b. Microfilariae c. Adult worm d. Noneoftheabove 15. Which of the following level of onchocerciasis endemicity will not be considered for Onchocerciasis mass drug treatment using CDTI strategy? a. Meso endemic areas b. hyper endemic areas c. Hypo endemic areas d. Holo endemic areas 2t Report on Role nlav on communitv mobilization and sensitization Group -L The group was considered as a village having .f. One chief of the community .t Two other community leader .1. One health worker and .i. Other community members The health worker met the chief of the community and discussed on the issues of Onchocerciasis its causes, methods of transmission, prevention including its treatment. The chief of the kebele took turn and thanked the health worker and he started to elaborate the major problems created in the village due to the disease. Both after discussing and arriving at consensus on the issue, the chief gave on appoint to ready other community leaders and the whole community for discussion. Next Day Two community leaders and chief of the community were discussing while the health worker arrived at the chief s house. After they all welcomed her, she greeted all of them and thanked them for their punctuality. The two other community leaders asked her some questions including{. What Oncho is .t Mode of transmission .1. The need for intervention and how to do so. After she cleared any doubt raised the chief of the community and the after two community and the other two community leaders along with the health worker went to meet the community Meetins with the communitv The chief of the community introduced the health worker to them and explained reasons for which she, the health worker, was there the health worker took her turn to discuss about Onchocerciasis. ?Who were unable to be gathered accordingly, the CDDs collected the drugs and started distribution. With the community accordingly the community, turn by turn, asked the following questions i. What Onchocerciasis was ii. Was totally new term for them Mode of transmission iii. Number of CDDs to be selected iv. If the Rx period overlaps with their farming times. The health worker made brief explanation on the questions raised. She explained that the local name for the disease was "Waashoo" after all, the community selected 2CDDs it was a village of about 42FIHS, the CDDs got training by the health worker they mobilized the community, registered and up dated census. Financially by facilitation by the CDDs, Rx period the community will be waiting for the Rx by being gathered under a tree. The community also added the importance of House to house distribution for those. 22 A summary Renort of Role nlav on communitv mobilization and sanitization. Group work GROUP II Before the practice of the role play, the entire participants were to be divided in to two groups namely, G-l and G-2 by the day workshop facilitator accordingly, this summary report concerns for role play group work of G-2. First of all before proceeding to the actual group work; the group (nG-2) selected its representative facilitator to manage the group discussion and a recorder to keeping down recorded on what took place during the discussion of the group. The group selected its social actors: chief community leaders, two religious leaders, kebele leaders, women affairs and two health worker and a professional health extension worker and a professional health worker (as of from MOH) and respective roles assigned to each members. Then after, the actual exercise of a role play was held as follow: 1. Approachins the communitv chiefs and leaders At the degging kebele FIEW and the health worker started discussions with these local chiefs and leaders on general health problems visible in that local areas chiefs and leaders mentioned that malaria , HIV/AIDS, Onchocerciasis and other as out most and common top disease to the community. Next to this the discussion shifted to the sessions main agenda on Onchocerciesis and disease sanitization in particular. The local leaders/ chiefs were asked how the disease happens to occur to the socio economics impacts in the area. They responded that the disease (locally termed as yemasakik Beshta) already exists in the area and it has been affecting the community. After this discussion the health workers requested the local leaders should inform the entire local community for there would be community meeting with health workers on the problems of the disease and on how to be solutions. The community meeting period/ time was fixed to be on the occasion of community's spiritual date (on the event of St.? Marry) near next future. 2. Meeting the entire community Based upon the fixed date for meeting the entire community approach of the community or social mobilization was started. Their health workers, asked (again as of local chief leaders and the community participants on this meeting to raise their main health problems. Onchocerciasis was mentioned out the hot. 3. Selecting communitv Directed Distributors Health workers extensively gave awareness to the community about the disease and on how to tackle it. Health workers recommended (on the basis of lobby and Diplomacy- total community) the community if they would select CDDs from themselves so that these selected distributors would distribute the tablets to their immediate population 23 4. Selectine tment neriod and mode of treatment By the consent and decision of the community from the meeting should take place at the end of fasting period of that community it was decided that mode of decrement to be held at the fixed ; it was agreed that the treatment (that is to be after a week). Also place of the villages where the community practice social affairs like "Iqub" After all the session reached as promised conclusion remarks by the religious leader and kebele leaders of the community is that they would follow up and take the program as their own part of activity. Finally at the end those honorable religious leaders closed it by their rue spiritual blesses 24 List of Participants on APOC Philosophy and CDTI principles held at Adama German Hotel From 12-14 Aueust 2009 S. No. Name Region/ Organization Responsibility I Dr Kesetebirhan Admasu FMOH Disease Promotion and Prevention Programme Directorate General 2 Dr. Tizita Hailu FMoH Pastoralist Health Promotion and Disease Prevention Directorate J Mihiret Hiluf FMoH Agrarian Health Promotion and Disease Prevention Directorate 4 Sileshi Yitagesu FMoH Health Officer 5 Kebede Mengistu FMoH Health Officer 6 Temesgen Barba FMoH Health Officer 7 Teshome Regasa FMoH Health Officer 8 Kasech Sintayehu FMoH Health Officer 9 Abrham Lilay FMoH Health Officer l0 Abebaw Asnake FMoH Health Officer l1 Tilaye Gudina FMoH Health Officer t2 Haregewoin Kiflom FMoH Health Officer 13 Eskedar Ameneshewa FMoH Health Officer t4 Tsegaye Bedane FMOH Health Officer 15 Yiblet Dagnew North Gondar Office Health Onchocerciasis Focal Person l6 Kedir Gobena Oromia Health Bureau Onchocerciasis Focal Person 17 Osman Ibrahim Sheka Zonal Health Office Onchocerciasis Focal Person 18 Bekele Kindane Kaffa ZonalHealth Desk Onchocerciasis Focal Person t9 Tigist Tafer Benshangul G. Regional Health Bureau Regional Oncho. Coordinator 20 Sr. Yealemfikir Hika Metekel Zonal Health Desk Onchocerciasis Focal Person 2t Tibebu Amente Illubabor Zonal Health Office Onchocerciasis Focal Person 25 22 23 Ensermu Jeldu Alemu Biru East Wollega Health Desk Kelem Wollega Zonal Health Office Onchocerciasis Focal Person Onchocerciasis Focal Person 24 Gudisa Deyas West Shoa Zonal Health Office Onchocerciasis Focal Person 25 Jihad Kemal Jimma Zonal Health Desk Onchocerciasis Focal Person 26 Demissie Uykab Bennch Maji Zonal Health Office Onchocerciasis Focal Person 27 Hailu Turura Gambella Regional Health Bureau Onchocerciasis Focal Person 28 Wondimu Tesgera TCC Pro ect Advisor 29 Ambaye Areru TCC Proiect Advisor 30 Birhanu Melak TCC Proiect Advisor 31 Getachew Abera LFW Programme Coordinator 32 Dubiwaq Gemeda LFW Programme Officer 33 Tekalign Mamo TCC 34 Ashenafi Tadesse TCC lan 35 Engidawork Mamo TCC Logistician 36 Mr. Teshome Gebre TCC Country Representative 37 Mr. Abate Tilahun TCC Officer 38 Mr. Tamrat Belete WHO-APOC Admin. & Finance Assistant 39 Amsalu Gurmessa Metekel Zonal Health Desk Driver 40 Dhaba Gallu East Wollega Zonal Health Office Driver 4t Bekuma Abdeta FMoH Driver 42 Belete Shiferaw FMoH Driver 43 Seid Adem FMoH Driver 44 Birhanu Kebede Oromia Health Bureau Driver 45 Tieistu Woldemariam FMoH Driver 26 Losistician