I I 4OqRESER VED FOR PROJECT LOGO/HEADING i ORIGINAL : English COUNTRY/]T[OTF: ETHIOPIA Proiect Name: East Wollega CDTI Approval vear: Launchins vear: 2005 -Reportine Period Month/Year): Proiect vear of this report: (circle one) 1 45678910 Date submitted NGDO partner: !!ght for the World I I I I I I I I I ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) DEADL FOR To APoc Management by 31 Januarv for March rcc meeting To APoc Management by 31 Julv for september TCC meeting AFRICAN PROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) For To ll t ij For To, R 'ij -{ I I BIM CaP- *tfc tstu@ fl I A0|JI 20n7 WHO/APOC, 24 November 2004 I L, I It I rl I ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: Country: Ethiopia National coordinator Name: Dr. Afework Hailemariam Signature: ..4*. # D Zonal Oncho Coordinator Name: Insermu Jaldu Signature Date: NGDO Representative Name..Dubiwak Signature Date. This report has been prepared by Name: Insermu Jaldu + NorF Desi Signature: Date u WHO/APOC, 24 November 2004 _t
Table of contents ACRONYMS.. DEFINITIONS ......... VI FOLLOWUPONTCCRECOMMENDATIONS ERROR! BOOKMARKNOT DEFINED. EXECUTIVE SUMMARY .......... I SECTION 1: BACKGROUND INFORMATIONERROR! BOOKMARK NOT DEFINED. v 1.1. GeNeRelrNFoRMATIoN....................... I .1.1 Description of the project (briefly) 1.1 .2. Partnership 1.2. PopuLerroN ;;: ; ;;: ; ;; ;: ;: ;; ;; ; ;;;; ; "ru;;. .............3 ..,..,..'...,4 SECTION 2: IMPLEMENTATION OF CDTI...ERROR! BOOKMARK NOT DEFINED TtugLrNe oF ACTIVITTES .............. .... Ennon! Booxrrmnx Nor DEFTNED. Aovocacy ...................7 MoslltzertoN, SENSITIZATIoN AND HEALTH EDUCATToN oF AT RISK coMuutitttps..T CovuuNrry rNvoLVEMENT............ ........,..........8 CePRCITy BUILDING ...... ERnoR! BooK}IARK NoT DEFINED. 2.6. TnenrnrNrs...................... 2.6.1. TreatmentJigures....... 2.6.2 What are the causes of absenteeisrn?.................Eruor! Bookmark not delined, 2.6.3 What are the reasons for refusals? ....................Error! Bookmark not deJined.2.6.4 BrieJly describe all known and verified serious adverse events (SAEs) that Eruor! Bookmark not defined. 2.6. 5. Trend of treatment achievement from CDTI project inception to the current year 1 42.7. ORDERINc, SToRAGE AND DELIvERY oF IVERMECTIN ..,...... 15 2.8. CoHauuNtrY sELF-MoNIToRING nNo SrereHoLDERS MperrNc EnnoR! BooxnraRx NOT DEFINED. 2.9. SupeRvrsloN............... .. ... ..........16 2.9.1. Provide aflow chart of supervision hierarchy. .......... 16 2.9.2. What were the main issues identtfied during supertision? ................. . ........16 2.9.3. Was a supervisiort checklist used?......... ....................16).9.4. What vvere the outcontes at each level of CDTI intplementatiort supervision? l6 2.9 5 Was feedback given to the person or groups supervised? . .,........ 162.9.6. How wos the feedback used to intprove the overall perJbrnrunce of tlrc project? 16 SECTION 3: SUPPORT TO CDTI ....... l6 3.1. EquPneNr 3.2. FINANCIAL CoNTRIBUTIoNS oF THE PARTNERS AND CoMMUNITIES...... 3.3. Orsrn FoRMS oF coMMUNrry suppoRT 3.4, ExpeNoITuRE PER ACTIVITY SECTION 4: SUSTAINABILITY OF CDTI 19 4.1. INrenNel; TNDEnENDENT pARTrctpAToRy MoNTToRING; EvALUATToN ................... 19 4.1.1 Lf/as Monitoring/evaluation carried out during the reporting period? (tick any of thefollowing which are applicable).............. ..... tg 4.1.2. What were the recommendations? .......... 20 2.1. 2.2. 2.3. 2.4. 2.5. ll 11 & I l I{ lll WHO/APOC, 24 November 2004 .......... t6 .......... l8 .......... l8 ..........18 4. 4.2. 1.3. How have they been implemented? ................... SusreNestllry oF rRoJECTS: ILAN AND sET TARGETs (ueNolrony AT...... 20 20 20 20 20 20 20 20 z0 20 20 20 20 20 Yn 3) 4.2.1 . Planning at all relevant levels 4.2.2. Funds........ 4.2.3 Transport (replacement andmaintenance) 4.2.4. Otherresources... 4.2.5. To what extent has the plan been implemented............. 4.3. INrecnerroN ............... 4.3.1. Ivermectin delivery mechanisms 4.3.2. Training.... 4. 3 . 3 . Joint supervision and monitoring with other programs . 4.3.4. Release offunds for project activities4.3.5. Is CDTI included in the PHC budget? 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? ............. ..................20 4.3.7. Describe others issues considered in the integration of CDTI. .....20 4.4. OpenerroNAl RESEARCH.. ..................20 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..... .....................21 4.4.2. How were the results applied in theproject?............. ....... ..........21 SECTION 5: STRENGTHS, WEAKNESSES, CIHLLENGES, AI\D OPPORTUNITIES..... ....21 SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS ...........21 iL =T II * Iil" lv WHO/APOC, 24 November 2004 Acronyms APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT UNICEF UTG wHo African Programme for Onchocerciasis Control Annual Treatment Obj ective Annual Training Objective Community-Based Organization Community-Directed Distributor Community-Directed Treatment with Ivermectin Community Self-Monitoring Local Govemment Area Ministry of Health Non-Governmental Development Organization Non-Governmental Organ ization National Onchocerciasis Task Force Primary health care Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Stakeholders meeting Technical Consultative Committee (APOC scientific advisory group) Trainer of trainers United Nations Children's Fund Ultimate Treatment Goal World Health Organization t, 1 Iit ti WHO/APOC, 24 November 2004 Definitions (i) Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). (ii) Eligible population: calculated as 84o/o of the total population in meso/hyper- endemic communities in the project area. (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 -vear. (iv) Ultimate Treatment Goal (UTG): calculated as the maximum number of people to be treated annually in mesoAryper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage (normally the project should be expected to reach the UTG at the end of the 3'd year ofthe project). (v) Therapeutic coverase: number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) Geographical coverase: number of communities treated in a given year over the total number of meso/hyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). (vii) Integration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) through CDTI (using the same systems, training, supervision and personnel) in order to maximise cost- effectiveness and empower communities to solve more of their health problems. This does not include activities or interventions carried out by community 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. (rx) Community self-monitorine (.CSM): The process by which the community is empowered to oversee and monitor the performance of CDTI (or any community- based health rntervention programme), with a view to ensuring that the programnle is being executed in the way intended. It encourages the community to take full responsibility of ivermectin distribution and make appropriate modifications when necessary. i '4" T J,. i I& vl WHO/APOC, 24 November 2004 Executive Summary Prepare an Executive summary of the report in not more than one.page. 1. Background on treatment and population data East Wollega CDTI has 3545 communities /villages that are distributed in 9 districts. Due to restructuring the number of districts has increased from seven to nine and the number of villages also increased relatively. In the first year, based on the recommendation and advice given from APOC management and MDP to start from few districts and expand to the whole project area , and during treatment period , all districts are covered. The total population, in the CDTI area is 636,511 which make a UTG of 526,066. The Annual Treatment objective (ATO) for the year was 526,066 out of which 479,662 were treated Mectizan, which gives the ATO coverage of 91.2% therapeutic coverage of 75.4 o/o and geographical coverage 100%. 2. Background on population movements. The communities in CDTI areas are mainly settled farmers, daily laborers and civil servants. 3. Training data Training of Trainers (TOT) was given for 182 health professionals. A total of 6931 CDDs were selected by the communities from 3,545 villages of which 5544 are males and 1389 females. And all of them have properly trained. The average number of CDDs per village is 2.8. 4. Challenges and how they were overcome. Threats (Challenges): Over burdening of health workers in peripheral health facilities by different health programs such as malaria epidemic control, EPI, measles campaign and settlement programs, supported by shortage of health man power. Opportunities: The expansion of govemment structure down to village level 'garee' that is responsible for the development activities as well as health service is good opportunity for the sustainability of onchocerciasis control, which helps to overcome the above mentioned challenges. The expansion of health post to each kebele is also another good opportunity I * 1{ .L WHO/APOC, 24 November 2004 1.1. General information 1.1.1 Description of the project East Wollega is one of the 17 zones of Oromia regional state. It is located in the Western part of the country. The capital town of the zone is Nekemte which is located at the distance of 3 3 I kilometers from Addis Ababa the capital city of the county. Recently the former East wollega zone is divided into two zones namely East Wollega and Horo Guduru Wollega. East Wollega extends from Gibe river to Didesa river occupying wider areas of varied topography. It is bounded by Amahara regional state and Horo Guduru wollega in the North,West Shoa in the East, Jimma zone in the South East, Illubabor in the South West and West Wollega tempretaure zone and Benishangul Gumuzu regional state in the West. The altitude ranges from 500 to 2600 meters above sea level. Agro ecologically, it is divides into lowland, middle land and highland. Annual rainfall various from 1200- 2500mm. The temperature reaches a daily maximum of 280c. At present the total population of the zone is estimated to be about 1,175,853 of which 71o/o are urban and 89%o are rural dwellers. It is sub divided in to seventeen districts.The districts are further subdivided in to 367 Kebeles of which 339 are rural and 28 are urban. The kebeles are further divided in to Gare (village) that is composed of 30 - 50 households and responsible for all development activities including health . East Wollega CDTI project comprises 9 woredas> They are Jimma Arjo, Leka Dhulecha, Diga, Guto Wayu Sasiga, Sibu Sire, Boneya Boshe and Wama Galo. The CDTI project area has got a total of 3545 villages. The climate of East Wolloga is characterized by distinct rainy and dry seasons. The rainy season is from June to September. Harvesting is from November to January. Thus, the optimum time for mass treafinent will be in the months of February and march There are four big rivers in the zone, namely Gibe which is between West Shoa and East wollega zones, Didesa, Anger and Uke. The zone has many other small rivers and streams that drain into the basin. There are good service of telecommunication and all whether road. However, most of the villages could be accessed only on foot or on back of animals while some villages could be reached by motorcycle. 2 & T 'lit -t-t WHO/APOC, 24 November 2004 Table 1: Number of health staff involved in CDTI Number of health staff involved in CDTI ectivities. Total Number of heelth staff in thc entire projcct erea Bt Numbcr of heelth staff involved in CDTI B2 Percentage Br=Bzl Br *100 Guto Wayu 23 23 100 Diga 27 27 100 Leka Dulecha l5 t5 100 Sibu sire 39 39 100 Wama Hagalo l3 13 100 Boneya Boshe 24 24 100 Jima Arjo 32 32 I00 Sasiga 35 35 100 Total 185 r82 100 1.1.1 Partnership Parlnership is a principle of APOC as well as the government of Ethiopia which helps CDTI project for best achievement and gradually ensures their sustainability. There was cooperation during planning, advocacy, mobilization drug distribution, monitoring and evaluation of the CDTI activities among different partners. 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Et (D lr (Dr (D !, u)o ox A' o !t .D D' tD TD v) o -l -o N)5 z o 3 o I N) o(, N I Table 6: Type of training undertaken (Tick the boxes where specific training was carried out during the reporting period) Any other comments 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 rnade to remedy this. i ), 1l J,. -T .l rL Trainees Type of training CDDs Other Community members e.g Community supervisors Health Workers (frontline health facilities) MOH staff or Other Political Leaders Others(specifo) Program management ^/ { ./ How to conduct Health education { ./ { ^/ ^/ Management ofSAEs ri ./ CSM SHM Data collection { ^/ ./ { Data analysis { ./ { ^/ Report writing ^/ { ./ ^/ Others (specif,,) ll WHO/APOC, 24 November 2003 EEEg;ss* {EEE*9E o69 a 9 o q)q o C) -o E z o o o o o o 9rI]ts< =(nzz o O O o oE €H =-ozd o e.l \o @ cf) @ NF- co o\ o\r- a.l c.l$N$ N\o$tt \o r-\o t)rr r.) tos\o = vq tstr .E E.et E EE.}EE (\l o O{ ll rix H \o o 'Eo , bI)o6 =oooEOF \o r- v1 t-. N + q 00 n a- \q e.l F- n o\F- r- ! rA F- EcYc65Ebs = o-ez o\ € c.l N\o$\or+ oo a.l $ c.l @ F- $c]o t'- 'i. 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N hJ o\o tJ o@ t9Oo{ NJ o o\ tJo tJ s N)oo(, \o\o -l lr, F o os- t i1"X ^ 3 -loiii;EoI O --5 fg,X'>i, a:= ^-< ao:ttHE a 5qB,' = p ga o o 3 o E' 0qoq ^d "*'8 i z'E !ro= lr! @o4 r'3.J 5is =J +F# E TU s.o oi E l'toO\OQ!"trR6 sfi+ ll</6i;ai =tiq! N) \o oo- \oG -leEo o It' n,H *ll o\ o\ tJJ @5 @{5 O* EU E. Ed-\*N o;'o .7 5 F.S s* I -@:!Dr'9a- o FO o NJ o\ 6, o\ 0a5 N) ^JY;'> =oP_d= E' 5 -J o\ o\tJ t) oo\o o\ oaz OE5tw-6 to DO o' F1 \t 5 { i., .lo=oo 6€DO0qtr oa o o\ FI lrl F, 'r ft \o ie oo- ^<,\oo JeE cj o F' S' o -l 5 { i.) o OAa5: :iI.i 0qo A € o "o N)s z (D 36ot N 5 2.7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - Qtlease tick the appropriate answer) MOH D WHOtr IJNICEFtr NGDOtr Other (please speciff): Mectizan@ delivered by - Qtlease tick the appropriote answer) MoH tr WHOtr UNICEF! NGDOE Other (please specifr): Please describe how Mectizan@ is ordered and how it gets to the communities Zone health offices collect from MOH and distribute to the respective districts according to their need. Then the districts distribute to the near by health facilities from where it is given to CDDs according to the result of the survey. Table l0: Mectizan@ Inventory (Please add more rows if necessary) [{ow are the remaining ivermectin tablets collected and where are they kept? List and briefly describe the activities under ivermectin delivery that are being carried out by health care personnel in the project area. r Identify the number of old and new health staff r Prepare training proposal. o Collect training materials. o Conduct training for health professionals and others. o Carrying out evaluation on the result of the census to know the amount of Mectizan required. o Check the amount of over left Mectizan. {. rl 1 c" ;r State/District Number of Mectizan@ tablets Number in stock Requested Rcceived Used Used/Pers on treated Lost Wasted Expired Remrin tng Guto Gida 399000 381673 I 533 15794 Diga 170000 140000 500 29500 Leka Dulech I 75000 t21425 5 53570 Sibu Sire 256500 245132 2007 9362 Wama Hagalo 97500 89572 500 7428 Boneya Boshe 120000 102285 156 17559 Jimma Arjo 211500 195800 1000 14700 Sesiga 193000 179873 r000 12127 Total 1622000 r.155259 6701 160040 l5 WHO/APOC, 24 November 2004 a o Distribution of the drug. o Conduct intensive supervision before and during distribution. o Collect and analyze report at all level. Any other comments 2.9. Supervision 2.9.1. Provide a flow chart of supervision hierarchy. NOTF ZOTF WOTF Health Facility community Supervisors CDDs 2.9.2. What were the main issues identified during supervision? Poor record Loose s keeping supervision to the lower level Poor reporting system delay rn liquidating the budget 2.9.3. Was a supervision checklist used? Yes 2.9.4. 2.9.5. 2.9.6. How was the feedback used to improve the overall performance of the project? Civing feed back is found to be very important because people learn from their mistake. SEGTION 3: Support to GDT! 3.1. Equipment Table 12: Status of equipment (Please add more rows if necessary) *Condition of the equipment (F:Functional, CNFR=Currently non-functional but repairable, oWO:Written off). What were the outcomes at each level of CDTI implementation supervision? Improvement was observed Was feedback given to the person or groups supervised? Yes Source Type of equipment APOC MOH DISTRICT/ LGA NGDO Others No Conditron No Conditron No Condition No Condrtion No Condrlron 1. Vehicle I F 2. Motor cycle(s) 7 F 3. Computer(s) 1 F 4. Printer(s) I F 5. Photocopier (s) I CNFR 6. Fax Machine(s) I F 7.over head projector I CNFR 8. 25"TV set I F 9.deiesel generotor I F 16 WHO/APOC, 24 November 2004 How does the project intend to maintain and replace existing equipment and other materials? The above mentioned equipment was given to the former west wollega which has at present only one CDTI district. Kelem wollega which has no any equipment and other materials except few motor cycles 3.2. Financial contributions of the partners and communities Table 13: Financial contributions by all partners for the last three years If there are problems with release of counterpart funds, how were they addressed? There is delay in sending the money from oromya health bureau to the respective zones. Additional comments 3.3. Other forms of community support Describe (indicate founs of in-kind contributions of communities if any) 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 i 3 -tit l Contributor Ycar I ('provide the period') Ye* 2 ('provide the oeriod') Year 3 ('provide the period') TOTAL AMOLINT (cAsH) Budgeted (US$) TOTAL CASH Released (us$) TOTAL AMOUNT (cASH) Budgeted (us$) TOTAL CASH Released (us$) TOTAL AMOUNT (CASH) Budgeted (us$) TOTAL CASH Released (us$) MOH (Central * Provincial/State) MOH (DistricVLGA) Local NGDO(s) ( if any) NGDO partner(s)light for the world 16157 Others a) b) APOC Trust Fund 40954 25000 481t0 20000 TOTAL 40954 25000 481 l0 36,137 t7 WHO/APOC, 24 November 2004 3.2. Financial contributions of the partners and communities Table 13: Financial contributions by all partners for the last three years If there are problems with release of counterpart funds, how were they addressed? There is delay in sending the money from oromya health bureau to the respective zones. Additional comments 3.3. Other forms of community support Describe (indicate forms of in-kind contributions of communities if any) 3.5. Expenditure per activity Indicate in table 14, the amount expended during the reporting period for each activity listed. Write the amount expended in US dollars using the current United Nations exchange rate to local currency. Indicate exchange rate used he.e_ a T{ \ I & Contributor Year I ('provide the period') Yer,r 2 ('provide the period') Year 3 ('provide the period') TOTAL AMOUNT (cASH) Budgeted (us$) TOTAL CASH Released (us$) TOTAL AMOUNT (cASH) Budgeted (us$) TOTAL CASH Released (us$) TOTAL AMOUNT (cASH) Budgeted (US$) TOTAL CASH Released (us$) MOH (Central * Provincial/State) MOH (District/LGA) Local NGDO($ ( if any) NGDO partner(s)light for the world r 6,1 37 Others a) b) APOC Trust Fund 40954 2s000 48t r0 20000 TOTAL 40954 25000 48r l0 36,t57 l8 WHO/APOC, 24 November 2004 Table 14: Indicate how much the project spent for each activity listed below during the reporting period. N.B From the government side -U281.06 $US APOC& Light for the World -28f30 $US - Any comments or explanations? SEGTION 4: Sustainability of GDTI 4.1. lnternal; independent participatory monitoring; Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable) Year I Partic ipatory Independent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation Intemal Monitoring by NOTF Other Evaluation by other parbrers 19 WHO/APOC, 24 November 2004 {t I I 3, al s& Activity Expenditure ($ us) Source(s) of funding Drug delivery from NOTF HQ area to central collection point of com411{ty Mobilization and health education of communities Training of CDDs Training of health staff at all levels Supervising CDDs and distribution !1t9rn4l mgn_itgring of CDTI activities Advocacy visits to health and political authorities IEC materials Summary (reporting) forms for treatment Vehicles/ Motorcycles/ bicycles maintenance Office Equipment (e.g computers, printers etc) Others supplies 490.67 5230.6 qqir.ai 12546.55 14729.55 2530.48 313 5t38.72 Government Government Government and light for the W"orl9 APOC&LFW Light for the Wortd and govemment APOC APOC APOC TOTAL 45411.06 Iqtal number of persons treated a 4,1.2. What were the recommendations? 4.7.3. How have they been implemented? 4.2. Sustainability of projects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period? Was a sustainability plan written?_ When was the sustainability plan submitted?_ What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.2.1. Planning at all relevant levels 4.2.2. Funds 4.2.3 Transport(replacementandmaintenance) 4.2.4. Other resources 4.2.5. To what extent has the plan been implemented 4.3. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3.1. Ivermectin delivery mechanisms Training Joint supervision and monitoring with other programs Release of fuhds for project activities Is CDTI included in the PHC budget? Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? Describe others issues considered in the integration of CDTI. 4.3.2. 4.3.3. 4.3.4. a a 4.3.5. 4.3.6. 4.3.7. t tI! 4.4. Operational research 20 WHO/APOC, 24 November 2004 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. 4.4.2. How were the results applied in the project? SEGTION 5: Strengths, weaknesses, challeng€sr and opportunities List the shengths and weaknesses of CDTI implementation process. List the challenges and indicate how they were addressed. STRENGTHS Despite the scarcity of health personnel at district health offices and work overload the performance achieved was very good. WEAKNESS Poor record keeping. Poor census sing system. Delay in reporting. Delay in liquidating budget. Inability of increasing female participation in CDD. CALLENGES Most of the health workers who are trained and have valuable experience in under taking CDTI activities were sent to be upgrading from health Assistant to Nursing and from Nursing to Health Officer. Opportunities -The expansion of health facilities. -The number of health extension packages workers is increasing from time to time -The need of community is increasing from year to year. -The ability of the drug to expel different intestinal parasites. -The reduction of mectizan side effect. I SEGTION 6: matters Unique features of the proiect/other I * : * fi 2t WHO/APOC, 24 November 2004 aI j