Gambella annual project technical report submitted to Technical Consultative Committee (TCC): January 2011 to December 2011.

COUNTRY/NOTF: ETHIOPIA Proiect Name: Gambella Aporoval vear: 2003 Launchinq vear:2004 Reoortinq Period: From: J.a nuary. 20.r. 1......... Tq1..... Pec emhe r. 20 I 1...... (MONTrr/rEAR) MONTH/rEAR) Proiect vear of this report: (circleone) 1 2 3 4 5 6 8910 Date submitted : November 2011 NGDO partner: The Carter Center The Federal Democratic Republic of Ethiopia Ministry of Health ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNTCAL CONSULTATTVE COMMTTTEE (TCC) DEADLINE FOR SUBMISSION: To APOC Management by 31 Januarv for March TCC meeting To APOC Management by 31 Julv for Seotember TCC meeting ''i ! i I i ! I l ! ! I i I I I I I I I I I I ! I I I @,v AFRICAN PROGRAMME FOR ONCHOCERCIASIS CONTROL (APOC) I ----!-..- (,'( i"ol 3p TCL AOP : )i 'fid#{t}flf+ttfi ir:q \ n f\* inrl,".'*T [-J I EPJ L -\{"'J'{G0 ANNUAL PROJECT TECHNICAL RBPORT 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 Mibret Hitu.f lHi:rltj]{ ,iliil""Signature: N-.#-\........ A,,vr,.,, " *1.," pror:ror,on and Ili Iattrt0 I ri Date. }fl) sr-l zo lr- Prer':,ttion T)i-eclorate Direr:io Regional Oncho Coordinator Name. Signature Pr.Q a'(r.f + ;c \'N, g$' ."3' Cl %,,* ah t. I i It ,1, Irt' I i ! i, I I 'i i I i I i i I i i I I ; I I I ! ,\ !. ) rl r; A.I Date: 15/9/2011 l=* \'*, \ I Name: Dr. Zerihun Tadesse ", I n n I F*,t0.).j z<l o- l'ot t ature Thi p Date s repoff- been prepared by Name .MTE Designation . Regional Onchocerciasis Coordinator Signature Date 2 I I I I I I I I I I I I I I i I l I I I I I I Table of contents ACRONYMS............... ...... ERROR! BOOKMARK NOT DEFINED DEFINITIONS ..... ERROR! BOOKMARK NOT DEFINED.S SECTION 1: BACKGROUND INFORMATION l.l. Gpupnel INFoRMATIoN............... 1.2. PopuLlrroN............... SECTION 2: IMPLEMENTATION OF CDTI Truer-tNE oF ACTIVTnES .............. ADVoCACY MoslLtzatloN, sENSITIZATIoN AND HEALTH EDUCATION oF ATCouvuury rNVoLVEMENT ........... Capacny BUrLDrNG... Tnrarururs ............... ORoeruNG, STORAGE AND DELIVERY oF IvERMECTIN CoruuuNlry sELF-MoNrroRrNG aNo StareHoLDERS Mpprnc RISK COMMUNITIES 13 z3 4s 56 k 51 64 6+ 2.1.)) 2.3. 2.4. 2.5. 2.6. 2.7. 2.8. 2.9. 3.1. 3.2. ....78 ,.9]4 l3+4 14-ls t4+5SupenvrsroN.......... EqurnueNr FrueNcw- coNTRTBUTIoNS oF THE pARTNERS AND coMMUNITIES ....3.3. OruBn FoRMS oF coMMUNITy suppoRT3.4. ExpeNo[uREpERACTIVTTy SECTION 4: SUSTAINABILITY oF CDTI.. I q3. INrpcnerroN I q.q.oppRarroNALRESEARCH ................ l516 ................ I 5-16 ................ 168 ................ l6{+ 4.1. IurERuaL; TNDErENDENT pARTrcrpAToRy MoNrroRrNG; Eva1uatroN............... l71{ 4.2 SusratNaullTy oF pRoJECTS: pLAN AND sET TARGETs (uauoeroRy AT ........ u+8 ........181e ........ l92e ::::::):: ::Y-::::i Y:::llll:*:::)::: *:::::: ilff SECTION 6: UNIQUE FEATI REs oF THE pRoJECT/orHER MATTERS .......202+ 3 Acronymes 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-Govern mental 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 4 Ddfinitions (i) Total population: the total population living in meso/tryper-endemic communities within the project area (based on REMO and census taking). Eligible population: calculated as 84%o of the total population in mesoftryper-endemic communities in the project area. (ii) (iii) Annual Treatment Objective: (ATO): the estimated number of persons living in meso/hyper-endemic areas that a CDTI project intends to treat with Ivermectin in a given year. (iv) (v) (vi) (vii) Ultimate Treatment Goal (UTG): calculated as the maximum number of people to be treated annually in meso/hyper endemic areas within the project a.ea, 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 ofthe 3'd yeai ofthe project). Therapqutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). Geographical coveraqe: number of communities treated in a given year over the total number of meso/hyper-endemic communities as identifiea Uy netr4O in the project area (this should be expressed as a percentage). Integration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) through GDTI (using ih. ,um. systems, training, supervision and personnel) in order to maximise cost-effectiveness and empower communities to solve more of their health problems. This does not include activities or interventions carried out by .ornrunity distributors outside of CDTI. (viii) Sustainability: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future, with high treatment coverage, integrated into the available healthcare service, with strong community ownership, using resources mobilised by the community and the government. (ix) Community self-monitoring (CSM): The process by which the community is empowered to oversee and monitor the performance of CDTI (or any community- based health intervention programme), with a view to ensuring that the'programme is being executed in the way intended. It encourages the community-to take full responsibility of Ivermectin distribution and make appropriate modiications when necessary. 5 !u sN:!\\J()O H: -og(! o o o ()(J bo o () L o. () oN o() 'a o.() o (n o. oo.i}IqoEtr bI) :' E.r o€tr, H Ul{ qq lA TH\q e kJ vs rr\ z U\ !o a. ooo(, (.) o () () ciok> o.= <! q, a Q,)!-o9O .2 rz )gLdB-q qO AE tro =o -d 66 oEC cd> 6o) .9 'to E- dd)E=tro o= 0.) o c) d o o 6) L C) () d o! hI) Q oo, d ! 0.) o ! o aQ lo o tdlc 1oq9\r .lJ tr o.l5 dq= z! o.r I ..tr cl 6) ok >y Oo !9Q 'ooEE OEx,oo- o.l! o--]Yo ,aS _ouHO c)oco. .99 (d!E-+o=tro Erc -o6) r\ oo .9 .J6 >L O ,: o!o\I&U IEtol>l0)l> iI Lo E o. ! cd o o.tr!xc) \J G' B ()6)E>.>r 1i 9o.l 6() -c!'Euo. c,E o.rOE(!'= o.o oci j:3 r\ o AY s=3'*; E aooNEs:E .-'6ogIJJE .= L c)E€E o\,/= -oo -L:dtr5Q E2oa o>,;ia-odo9-6CA- rr30 ccc,cod6 Farg -c)ooEqz€5R5E d.^Z o iooLtsctr ^'E .!JOo --=Lac'EtgE o; o0 '.:5.8 fi,; eE-+ CdO!Y e.2 g 9 E: [E lLloo.(! >. .o(u cg v1 U) L(o 0) ra) oo Bo € C) a. C' C)(* o troitro(!) .-9E o-=oXe6 EiF z >' -o u0 L o (B Lo L € E C) c) z c) C) C) !o o C) o -o ar') o (g o o o. L o (n ri oo C) E oo o L\to H A zkl oUl{q U H za(-) o ro oo o E bo (! LF o (gL Q c) d C)tu ti Cd z o 0) o S EEE ss: o z o -F( o z lu =E o() ulE o3lo{lF '>l z .ElOFIFIfr -, I =.23sJUOUILF ,6 Executive Summary l. Background on treatment and population data Gambella CDTI project comprises of five Woredas having a total of 339 villages. All the five woredas were targeted for the 7th year treatment cycle. These are Gambella, Godere, Mengeshi, Dimma and Abobo. Census was conducted during the 7s year treatment cycle and the population of the five CDTI Woredas constitutes 103,896. The Annual Treatment Objective (ATO) for the 7th year CDTI was 87,273. All the five CDTI woredas were covered with the treatment (100% geographic coverage). A total of 84,929 people were treated during the 7th year treatment cycle i.e; 82 oZ therapeutic coverage. 2. Background on population movements. The communities in CDTI areas are mainly farmers (change their villages for searching uncultivated land frequently), daily laborers and civil servants. The population size vary from time to time based on the need for daily laborers for coffee, tea and cotton plantation specially in Abobo, Mengesh and Godere woredas and also gold mine workers in Dimma woreda. 3. Training data Training and refresher trainings were conducted before initiating other CDTI activities. Gambella CDTI project was able to train (retrain) 96 health workers, 174 community supervisors and 1,041 CDDs. 4. Challenges and how they were overcome. Threats (Challenges): - Delay of the release of APOC budget - Shortage of vehicles for supervision & for distributing the drug to each endemic woredas. Opportunities: The involvement of Health Extension Workers is increasing from year to year in the treatment activities. I T SECTION l: Background information 1.1. Generalinformation 1.1.1 Description of the project Gambella National Regional State is one of the Nine Regional States of the Federal Democratic Republic of Ethiopia, and it is located in the western part of the country between 70 13" N to 80 17" N latitude and 330 52" to 350 02" E longitude. The Region shares borders with the Sudan in the West, Oromia Regional State in the East, SNNPR (Southern Nation Nationalities Peoples Regional State) in the South and Benshangul-Gumuz Regional State in the North. Gambella Region has a total surface area of 25, 274.88 square kilometers. The total population of the region is estimated to beabout 360,431 of which 74%oare ruraland 26%oare urban dwellers. The population is largely engaged in subsistence farming, animal husbandry, fishing and coffee and cotton plantations. The climate of the region is classified as tropical. Average annual Temp is 30.7o C. The annual rain fall ranges 800- 2100 mm. the altitude ranges 300-2400Mts above sea level. The region is classified as low land (82%), semi highland (10%) and high land (8%). Some of the perennial fast flowing rivers that cross the Agnuak zone include: Baro, Akobo, Gilo rivers. There are also quite numerous small rivers and streams, which are tributaries of the main rivers. There are two distinct seasons in the project area, i.e., the rainy season (April - October) and the dry season (November-March). Harvesting occurs from October to December, Ieaving January - March as the optimum treatment period. The Region is divided into three administrative zones (Agnuak, Nuer and Messenger Zones) and thirteen Woredas and one town administration. All the CDTI woredas (except Mengeshi which is difficult during rainy season) are accessible with all weather roads with the regional town. However, access to rural communities appears difficult during rainy seasons. The health infrastructure in Gambella CDTI project area consist I zonal hospital, I I health centers (l government and l0 NGO), 69 Government health posts and l0 private clinics. Table l: Number of health staff involved in CDTI 2 District Number of health staff involved in CDTI activities. Total Number of health stalI in thc entire project area B, Number of health staff involved in CDTI B, Percentage B.=8,/ B, "100 Abobo 46 9 20 Dimma 38 10 26 Gambella 45 5 11 Godere 50 37 74 Mengeshi 21 21 100 Total 200 82 41 Table 2: Number of health extension workers involved in CDTI 1.1.2. Partnership There was strong partnership during planning, advocacy, mobilization, drug distribution, monitoring and evaluation of the CDTI activities among different partners. The main partners involved are Federal ministry of health, Zonal Health Department, Woreda health office, health facilities, the community, The Carter Center, WHO and other government sectors. ( J Distrlct Number of other health workers (health extension workcrs) involved in CDTI activitics. Total Number of health extcnsion workers in the entire project area B, Number of health extension workers involved in CDTI B, Percentage Br=Brl Br *100 Abobo 31 31 100 Dimma 42 42 100 Gambella 22 22 100 Goderie 30 30 100 Mengeshi 33 33 100 Total 1s8 1s8 100 1.2. Population Table 2: Communities and population at risk in the entire project area whether they are treated or not during the reporting period. UTG = calculated as the maximum number of people to be treated annually in meso/hyper endemic areas within the proiect area, ullimately to be reachedwhen the project has reachedfull geographic coverage (normally lhe project should be expected to reach lhe UTG at the end ofthe 3* year ofthe project). Wasacensusfortheprojectdoneduringthereportingperiod?Yes_-L- No If No, what is the source of the data in the table above? * Source: National census Year CDD_Other source, speciff : 4 CDTI Districts in the entire project area Total populatio n in the entire project area Number of comm unities/villages in Population of Meso- endemic zone in the project area Ai Hyper- endemic zone in the project afea A2 Total in meso/hyper- endemic zone Aj= Aft A,2 Meso-endemic zone in the project area Hyper- endemic zone in the project area A5 Lt Total in meso/h yper- endemi c zone Aa= A7* A5 Ultimate treatme nt Goal (UTG) Abobo 16,797 69 0 69 t6,797 0 t6,797 14,109 Dimma 12,3t2 30 0 30 12.3t2 0 12,3t2 t0342 Gambella 10.86r 49 0 49 10.861 0 10.861 9123 Godere 40.630 t23 0 123 40.630 0 40.630 34,129 Mengeshi 23,296 68 0 68 23,296 0 23,296 r9569 TOTAL 103,896 339 0 339 103,896 0 I 03,896 8'.7,273 WHO/APOC, 24 November 2004 If you are using the term community or village, define what constitutes the community or village. This will help understand the profile of the project area. The term community or village is considered people who live in not more than 2 Kms radius and who shared a common interest. In Godere and part of Abobo woredas where there was resettlement program the people live more closer and have more thon t 50 households but in the remaining three woredas the community live very scattered and a village moy constitute less than 50 households except in gold mine and cotton plantation areas where villages hwe concentrated individuals (dai ly laborers). Is there any other information of interest about the population in the project area? If so, include it here. In Godere there is coffee and tea plantation, in Abobo cotton plontation and in Dimma woredo there is manual gold mine. People trovel to the above three mentioned woredos searchingfor occupation. The size and structure of the population in eachworeda/luctuate, based on the agriculturol activities. SECTION 2: Implementation of CDTI 2.1. Timellne of activities Table 3: Timeline of activities for the areas treated in the current year District LGA Mobilization of communities Training Census/Update Drug distribution Supervision Starting month Completio n month Starting month Completi on month Starting month Completi on month Stafting month Complet ton month Starting month Completion month Abobo March 201I March 2011 April 2011 April 201 1 April 201I April 201I May 201I July 201 I March 201I July 201 I Dimma March 2011 March 2011 April 201 I April 201I April 2011 April 201 I May 20II July 201I March 2011 July 201 I March 201I March 2011 Aprll 201 I April 201I Aprll 201I Aprll 201 I May 20Il July 201I March 20lI July 201 I March 2011 March 201I Aprtl 201 I April 201 I April 201I April 201 I Moy 201I July 201 I March 201I July 201 I Mengeshi March 20ll March 2011 April 201I April 201I Aprll 201 I Aprll 201 I May 201I July 201 I March 2011 July 201 I Gambella Godere Comments 2.2. Advocacy State the number of policy/decision makers mobilized at each relevant level during the current year; the reason(s) for undertaking the advocacy and the outcome. Describe difficulties/ constraints being faced and suggestions on how to improve advocacy. Because the involvement and support of the community leaders at all levels was minimal Advocacy meeting was held with decision makers (woreda council members and community leaders (Kebele leaders)) in respective woredas. During the discussion all participants 5 '1 promised to support the program and some improvement has been registered so further effort should be exerted to make them all fully involve and support the program. 2.3. Mobilization, sensitization and health education of at risk communities Community mobilization was done in each village by organizing community meetings. Kebele Task forces (that include Kebele administrative leaders, health staffs, health extension workers, and kebele elders) were responsible to organize the meetings and played major role in mobilization and sensitization of the whole community at grass root level. Community supervisors and CDDs were also involved in giving health education to the community at village level. One of the reason of the increment treatment coverage in this treatment period can be the impact of the community mobilization and sensitization. 2.4. Communityinvolvement Table 4: Communities participation in the CDTI (Please add more rows if necessary) Number of communitics /villages with female CDDs Comment on: - Attendance of female members of the community at health education meetings. The attendance of female members of the community at health education meetings is improving compared with the previous years. - In general, how do you rate the participation of female members of the community meetings when CDTI issues are being discusses (attendance, participation in the discussion etc). The participation offemale members of the community is increasingfrom year to year. Incentives provided by communities for the CDDs 6 District/LGA Number of communities/villages with community members as supervisors Number of CDDs and the communities involved Total no. communities in thc entire project area Number with community members as supenisors B. B. Percentege Br= B./ B. *100 Mele CDDs Bz Female CDDs Br Total Br= f,r*$t Number of communities with fcmale CDDs B,o Perccntage Blr= Bro/8.*100 Abobo 69 27 40 135 10 146 11 l6 Dimma 30 33 ll0 106 45 151 15 50 Gambella Zuria 49 21 43 57 26 83 26 53 Goderie 123 50 4l 379 48 427 48 39 Mengeshi 68 29 43 176 74 250 30 44 Total 3 39 160 48 853 203 1 057 130 38 Communities are not providing incentive to CDDs as they are treating their relatives and neighbors. - Attrition of CDDs. Is attrition a problem for the project? If yes, how is it addressed? There is some attrition rate of CDDs and it is not such significant and does not affect the projects activity. - Other issues 2.5. Capacity building - Describe the adequacy of available knowledgeable manpower at all levels. The number of health workers are increasing in number and in educational level from year to year. - Where frequent transfers of trained staffoccur, state what the project is doing, or intends to do, to remedy the situation. (The most important issue to describe is what meosures were taken to ensure adequate CDTI implementation where not enough lcnowledgeable manpower was available or if staffs are frequently transferred during the course of the campaign). There are two health extension workers in each Kebele and they are responsible to train and supervise the CDDs working in that respective Kebele and their tum over is very minimal. /s 7 q) clt o a (J o eE z = 6 -: +t<v: s.:qv }Y zv o(O N@ (Y) tt r{) (\l o o,$ (O @ (o r() NN F-N$ ct)(o(o @@ olr,N o o$ !to $ o, : Ns(r) r.) o\ tro (, q) sa Q oLF c.l 6 € sl N t.) at \8 :q, :.= Oefi r-!h A ??E0) z'e ?tt +- F o-ou &'\ d i. *G I1o () rE cl -l- Eg 0)q -aP E:- '2, P q)() E.t+F-d U \J t' z (o N t t- o a- N (Y) o cn o(Y) o co (ot- ?alt- (O t- o\ tro 6) €J \oo\U? (o F- CO (r) cf) @F* ts cl 0 q o x.= -G oe q)E z (J + U 6 6 il U C t' o< E c.t c{ c.l c.t tl o \o t cl \o ! o 19 Eo o s U o F c.t co \o 6l II (J a o -6 .o tra o -o Ed o oEo o bD o Fl F oF v e..l () .o E() o z + e'l (-, o bb o u s -a o\ 4 s) qJ L q) ,t e >. h o bo -E o a-qs\\ q, q)\ \ qt .o s o t s .. s a q4 a0U S 4 rr p +: q)q Uq) 5 o ad o o o- F IJ(,) o t)() (.) C)L -oqr 0) c! bo (n LF ,; o -o(nF € 2.6.2 What are the causes of absenteeism? Because of the deloy of Mectizan tablet shipment the treatment was given in the rainy season. This time some of the residence stay out of their village for farming for more than a month. That is the major reasonfor the absenteeism. What are the reasons for refusals? Most them feel they are healthy and no needfor treatment and some others refused to take because of the fear that the drug may react with local alcoholic beverages, since some of the people used to local alcoholic drinks on daily bases. But the number of refusals hos significantly decreased compared to the previous years. 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. lr 2.6.4 In case the project did not have any cases ofserious adverse events (SAE) during this reporting period, please tick in the box. No SAE case to report ll WHO/APOC, 24 November 2004 fl +a.I o -o () o z st a.l (t.l -U) E .9vs -g clI o oo clfrq) IIIF) =6l : .; o - =c!o.= != IE5 v io)I o.eEtBu2!(l)d ^L9(Uq) EO= € 5tra=.r)E TE;! 'E o)9Ear)9(I)=qrv '= I .oliEr-ltrL k c.ll - dl r-lLa.€lbFt7i y I\J -)r-l ctE(gI O)EEI HtF()l sEEI Eo:l '= ^9E.OI IBbe L!E9!Ig,,ts o!2Ytr(Bt- :aJUE9Li\-a-Y!tEtr6) o={aE9U .-IL;0)t9LEL. A'r 6)u;91 2e €l .!iGi Fl tr 0)bor'1d^ F ON U o\ oo@ o\ \oa c.)o\ \o@ F- o\ o d oo rLi dET ri c) 9 taF (lJ o\ <. >v -o o o\ oo@ o\ \o00 o\ \Ci € F- o\ oo ll * a€td ti ri \o o 'E c)5bood *bi:>ootoF r- @ F- € e.ltr @r- \NF- al€ ri o-^ b 5E!odEbg = o!z o =f\o \o a.l 6l 0) >. E 6.) o !tr o C) o (! 0) z t \o \o o\ t-rr- N .o- \o\o a,l =tq t\-F- st F- o\ a.t o\tf € rH :q) d O.=5tr? ) tr)n o\\o F- \o oo\o c.l e..t \o @ $ o\ F- rr o\ c.t oo @$ oo ca F- e.lrr @ c 9<:8.9.. *'E r .EEE<gELY -E EE* st N N \o F- @ e.l\ o\ \o €rr c{ o\ F- c.t o\ o\ ca O \o o\ € co G) ood () a O oo * ri,ji "it 0)9tei C)o:<,>v -o o o o o o Bg'& di ri b= rL c bo!o5do = E= Q5E*Eaoa) o\ @ N $ o+ Nc.t \o\o \o o\ ri ts o.r cd O.=2E5 i -o -o' -Fo o\ €N t t N \o\o \o o\c.t =q3 e t Fv ot o-:l{t'5 ^ >'--: .95irbE-3 E YoEgtr.-Etro()o t 6 =t =l O e.l \o\o \o c.) o\ d E] s N e.l \o (\ a- c.t 00 a.l o\ N N N Table 6: Type of training undertaken (Tick the boxes where specific training was carried out during the reporting period) - Any other comments Communities did not conduct CSM. 2.6 Treatments 2.6.1. Treatment figures If the project is not achieving 100% geographical coverage and a minimum of 65%o therapeutic coverage or the coverage rate is fluctuating, state the reasons and the plans being made to remedy this. Both the geographic coverage and theropeutic coverage are above the standard indicated above. 9 Trainees Type of training CDDs Other Community members e.g Community supervisors Health Workers (FLHF) MOH staff or Other Political Leaders Others (specify) Program management How to conduct Health education Management of SAEs CSM SHM Data collection Data analysis Report writing Others (specify) l2- WHO/APOC, 24 November 2004 Y" E\ .qJ s\ s .\ $ bo y" .S\ri\F-i (JJA;r()3h-iES .sl '-9's\3\S € $s .= 'aE * q3\ 'r :* H Eih s3 .e ls ;.-a f '=s C} ql'TJ. T\o\ * :N5 !EB SsH t$Sf $*RH \s q,x Nss ot 9 S': ts' =l ; !eH:l: s B=xgl! 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T/NICEF tr NGDO tr Other (please specifu) Mectizan@ delivered by - Qtlease tick the appropriate onswer) MOH M WHO f] UNICEF tr NGDO tr Other (please specify): Please describe how Mectizan@ is ordered and how it gets to the communities Mectizan was requested to MDP by the NOTF. Then after drug arrived at the country it follows the existing drug and other medical equipment delivery system in the country. The drug was stored in MOH warehouse and then distributed to CDTI projects after the projects submitted a request paper. The Woredas received the drug after submitting the requisition latter to the zonal CDTI project health office and then distribute to the health facilities. It is from the frontline health facilities that the community supervisors (CDDs) received the drug and distribute to the communities. Table l0: Mectizan@ Inventory (Please add more rows if necessary) After application additional people have been treated with mopping up. During the opplication the treated population were 81,020. How are the remaining lvermectin tablets collected and where are they kept? The leftover Mectizan toblets are collectedfrom the CDDs by the Front Line Health Facilities (FLHFs) and the FLHFs transferred the collected Mectizan and Albendazole to the woreda Health Office and are stored at the Woreda Health Office. List and briefly describe the activities under Ivermectin delivery that are being carried out by health care personnel in the project area. ' Training of community supervisors and CDDs about, the drug, its adverse effects and management ' Collection of Ivermectin from the Woreda health office store and then distribution to CDDs after checking the census (village register) ' Regular supervision with especialconsideration to adverse effects during mass distribution . Distribution of Ivermectin to CDDs and Supervision . Collecting of reports and the remaining drugs . Recording and reporting of data District Drug Balance from previous year Nu m ber of tvtectiianMts Received Used Wasted Expired Remaining Gambella Mectizan 62,953 171500 229,303 714 0 4,374 Albendazol t2378 77100 84929 304 0 4245 r) l3 WHO/APOC, 24 November 2004 - Any other comments 2.8. Community self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? No. If so, When? Table I l: Community self-monitoring and Stakeholders Meeting (Add rows dneeded) DistricV LGA Total # of communities/villages in the entire project area No of Communities that carried out self monitoring (CSM) No of Communities that conducted stakeholders meeting (SHM) Abobo 69 0 69 Dimma 30 49 0 30 49Gambella 0 Goderie Mengeshi 123 68 0 0 t23 68 TOTAL 339 0 339 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. The SHM was conducted at woreda level and it was important to strengthen CDTI activities at woreda health facility and community level at large. 2.9. Supervision 2.9.1, Provide a flow chart of supervision hierarchy. NOTF )RHB) WOTF ) Health Facility ) Community supervisors ) CDDs 2.9.2. What were the main issues identified during supervision? Improvement has been observed in recording and handling of village register but still strict follow-up and supervision should be strenglhened in this regard. 2.9.3. 2.9.3. 2.9.5. Was a supervision checklist used? Yes What were the outcomes at each level of CDTI implementation supervision? . Handling of documents was relatively improved. Was feedback given to the person or groups supervised? Yes 2.9.6. How was the feedback used to improve the overall performance of the project? . Oral and written feedback was given after each supervision. I4 SECTION 3: Support to CDTI 3.1. Equipment Table 12: Status of equipment (Please add more rows if necessary) Source Type of equipment APOC MOH - Zone DISTRICT NGDO Others No Condrtron No. Condrtron No Condrtron No Condrtron No Condrhon l. Vehicle 2 F NA NA NA NA 2. Motor cycle(s) 5 F NA NA NA NA 3. Computer(s) I F NA NA NA NA 4. Printer(s) I F NA NA NA NA 5. Photocopier (s) I CNFR NA NA NA NA 6. Fax Machine(s) I CNFR NA NA NA NA 7. Overhead projector I F NA NA NA NA *Condition of the equipment (F:Functional, CNFR:Currently non-functional but repairable, WO:Written off). NA-Not available How does the project intend to maintain and replace existing equipment and other materials? The project expects partner NGDO (The Carter Center) to maintain capital equipments that have been provided by APOC. Though there is no budget allocated for maintenance of the above materials maintenance is going on using government budget shifting from other programs. But the project is exerting effort to make the local government authorities to allocate budget. 3.2. Financial contributions of the partners and communities Table l3: Financial contributions by all partners for the last three years Contributors Year 3 (2007) Year 4(2008) Year 5(2009) Year 6 (2010) Year 7 (201l) Budgeted Released Budsercd Released Budseted Released Budseted Released Budseted Released MOH (Central + State) 3500 3500 4000 4000 NA NA NA NA I 28,944 83 I 28,944.83 MOH (District + zone) 0 0 0 0 NA NA 4000 4000 0 0 Local NGDO(s) ( ifany) 0 0 0 0 0 0 0 0 0 0 NGDO partner(s) t 2,500 t5t70 16,089 t6,089 2t,8t6 20,4 t 6 12,382 t 2, i82 1,48 t I,48 t Communities 0 0 0 0 NA NA 0 0 0 0 APOC Trust Fund 16,000 84 l9 t 2,620 8834 585 7 4t00 0 0 t4,l 14.55 14,1 14.55 Total 32,000 27,089 32,709 2E,923 27,691 24,561 16,382 16,382 I 44.540.38 I 44,540 38 r4 15 If there are problems with release of counterpart funds, how were they addressed? Delay to release the budget allocated from APOC. The budget allocated from APOC was released late after the treatment initiated. - Additional comments -Keep on the availability of drugs at central level before the rainy season. -The allocated budget should be released as early as possible so that activities will run effectively as per the plan. 3.3. Other forms of community support - Describe (indicate forms of in-kind contributions of communities if any) In some communities people invite CDDs to have lunch during Mectizan distribution. 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 l,Ugtl##..iitiffi0 Table l4: Indicate how much the project spent for each activity listed below during the reporting period Activity Expenditure ($ US) Source(s) of fundins HSAM 1,078.05 APOC Trainings Health workers 6,330.00 APOC S qpery 11"199 ?_!4 trqt49.t' n g Intervention and distribution 2,567.10 APOC Others 4,139.00 APOC TOTAL 14,114.55 APOC Total number of persons treated Any comments or explanations? l6 SEGTION 4: Sustainability of GDTI 4.1. Internal; independent participatory monitoring; Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable) Year I Partic ipatory Independent monitoring Mid Term Sustainabi lity Evaluation 5 year Sustainability Evaluation 4.1.2. What were the recommendations? The project was evaluated as a project which is progressing toward sustainability. And the following recommendations were given: - Keep documents properly including financialreports - Increase community mobilization in villages with poor treatment coverage to achieve ATO - Woreda staff to increase number of visits to health facilities 4.f3. How have they been implemented? - Document keeping has been improved - Community mobilization was increased in villages which have poor treatment coverage - Woreda staff increased the number of supportive supervision 4.2.1. Sustainability of projects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period? Yes Was a sustainability plan written? When was the sustainability plan submitted? Seot 2010 What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.2.1. Planning at all relevant levels Planning of CDTI activities were carried out through participatory methods. At woreda level woreda health office, woreda council members and health staffs discussed and plan when to conduct meetings with the communities. Then together with community members planning will be adapted when to conduct CDD training, when to conduct census and also when to start distribution of the drug. At community level community members made discussion together with Kebele task forces and plan all activities. The CDTI is integrated with Malaria control program and efforts will be made to integrate CDTI with other health programs. + rt- t7 4.2.2. Funds The government is integrating all the basic health activities using all available funds. This integration approach will help to sustain CDTI after APOC funding cease. In addition to this, the NGDO partner is also expected to continue the critical funding support as it used to do previously. 4.2.3 Transport (replacement and maintenance) The project expects that APOC will replace the vehicle and motorbikes and the government will be responsible for their maintenance. The project will also use other vehicles from other health programs to fillthe gap, if any. 4.2.4. Other resources 4.2.5. To what extent has the plan been implemented The CDTI activities training, mobilization, census, etc. were done as planned but the drug distribution was not done in the date planned because of late arrival of drugs. 4.3. Integration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: CDTI is integrated with the Primary Health Care @HC) from the beginning. At the National, Regional, Zonal, and Woreda levels, the Malaria and Other Vector-borne Diseases Prevention and Control Units are responsible. All prevention and control activities are included in the health extension package at the grass root level. 4.3.1. Ivermectin delivery mechanisms Ivermectin delivery follows the existing drug delivery system in the country. The request for Ivermectin is made to MDP through FMoH. After arrival, all the processes required are handled by a Pharmaceuticals Funding and Supply Agency PFSAof FMoH. Then the CDTI projects receive the drug after submitting official letter to FMoH. Similarly woreda health offices submit request letter to the CDTI project. Ivermectin delivery system is handled in similar manner to that of other drugs and medical equipments in the country. 4.3.2 Training: Most health staffs at the project woreda have received training/retraining on epidemiology of Onchocerciasis, Lymphatic Filariasis and CDTI principles. Efforts were also made to include other topics, such as measures to be taken on malaria prevention. 4.3.3. Joint supervision and monitoring with other programs The program is integrated in health promotion and disease prevention and control core process, most of the supervision and monitoring activities are carried out in integrated manner with other activities within the core process and regional health bureau. 4.3.4. Release of funds for project activities A fund from the NGDO partner was released on time to accomplish the CDTI activities 18 4.3.5. Is CDTI included in the PHC budgetr Yes, as part of PHC, CDTI is one of the health activities at all levels and at grass root level it is under immediate supervision of the health extension workers at grass root level. 4.3.6 Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? All the five woredas are malaria endemic. CDDs participate and support the community during bed net distribution and other anti malaria activities. 4.3.7. Describe others issues considered in the integration of CDTI. The Health extension program is an important program that can help to sustain CDTI in the community. 4.4. Operational research 4.4.1. Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period. No operational research undertaken in the project within the reporting period. 4.4.2. How were the results applied in the project? SECTION 5: Strengths, weaknesses, challenges, and opportunities Strengths:/ The project is able to accomplish the seventh treatment cycle with l00Yo geographical coverage. ,/ Therapeutic coverage is above the standard. ,/ The awareness of the community about CDTI has increased. Weaknesses: '/ Poor document handling, at some of the woreda and health facirities ,/ Lack of supportive supervision at all levels Opportunities:/ Security situation improved./ Availability of Health Extension Workers in every Kebeles Threats (Challenges): r' The far distance of Dimma and Godere woredas is a barrierforfrequent supervision and close follow up. It demands additional cost for fuel and perdiem. t6 l9 SEGTION 6: Unique features of the project/other matters Compared with most of the projects found in the country, Gambella CDTI project is found in remote area. The temperature that exceeds above 490c during February to May is unique feature of the project area that affects CDTI activities to run smoothly. Apparently the project area is in savanna vegetation area that needs further investigation on the clinical monifestation of onchcerciasis in the region. 20