Bench-Maji CDTI annual project technical report submitted to Technical Consultative Committee (TCC): January 2011 to December 2011

The Federal Democratic Republic of Ethiopia Ministry of HealthI COUNTRYAIOTF: ETHIOPIA Proiect Name: Bench-Maji Approval yearz 2002 Launchins vear:2003 To ;.....Desemhpr..?0.1- 1...... (Month/Year) From : J.en.ua.ry..?0I.[.......... ( Month/Year) Reportine Period: Proiectvearofthisreport:(circleone) l2 3 4 5 6 7 0 Date submitted: 30 January 2012 NGDO partner: The Carter Center 7 L I ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO , .&E __. .TECHNICAL CONSULTATIVE COMMTTTEE (TCC)| ;,,,i o ri n T':r:-i. 3l(.e qi t t I a ftsiltt ll.ff^ @,v DEADLINE FOR SUBMISSION: To APOC Management by 31 January for March TCC meeting To APOC Management by 3l Julv for September TCC meeting AFRICANPROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) IF+!\4l+{ -- ! Jid Hn L WHO/APOC, 24 November 20047 FEV TTJJ APOC/DIR RECU tE t-! i'C.{ ro? q/ I ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATTVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: Country Ethi IA National Coordinator Name. Mihret Hiluf Signature: Date Ls) 0r.l uolU Zonal Oncho Coordinator Name:- Teklit Tesfom Signature Date NG - Dr. Zerihun ature Lo l- I\Iihret Hiluf Nigu{ric(T.:r t" lll,'H) i n ' .;11 anil lJi+" 're llrci-:ri:.sLl -:'i--.'-'ratc, Dircctor 'r- | : =-------:'\. . U,.i ,/ .,,, i I -Y..&L-.i,i -15" rr'ii -' l'.,''. i** f' "i\ .l I I i d .i i;I i I I I I I ! I I i I I I I I i i i I i I i I This report has Name :- _ Teklit Tesfom Des ignati o n'. Zone Oncho cerciasis Coordinator Signature Date tlIIIt ll WHO/APOC, 24 November 2004 Acronyms APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT UNTCEF UTG wHo African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Commun ity-Based Organ ization Community-Directed Distributor Commun ity-Direc ted Treatment with Ivermectin Community Sel f-Mon itoring Local Government Area Ministry of Health Non-Govemmental Deve lopment Organization Non -Go vemm enta I O r ganization National Onchocerciasis Task Force Primary health care Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Stakeholders meeting Technical consultative commiffee (Apoc scientific advisory group) Trainer of trainers United Nations Children,s Fund Ultimate Treatment Goal World Health Organization f WHO/APOC, 24 November 2004llt a Definitions (i) Total population: the total population living in mesolhyper-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/tryper- 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 year. (iu) Ultimate Treatment Goal (UTG): calculated as the maximum number of people to be treated annually in meso/hyper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage (normally the project should be expicted to reach the UTG at the end of the 3'd year ofthe project). (v) Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) Geoeraohical coverage: number of communities treated in a given year over the total number of meso/hyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). (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. (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 modifi cations when necessary. , tv WHO/APOC, 24 November 2004 FOLLOW UP ON TGG REGOMMENDATIONS TCC session ) Number of Recommendat ion in the TCC TIONS ACTIONS PROJECT TAKEN BYTHE FOR TCC/APOC MGT USE ONLY T recommended that the reporting period should span through l2 months (January to Dec). The authors report compliance with this recommendation, however this repoft under review spans from January to October 2010. please clarift; TCC current reporl spans over a period of l2 months i.e. Jun_Dec 20r l. The Take steps to min wastage imize drug lloHos and ZHD to minimize drug wastage. However, due to delay of Mectkan shipment drug dislribution was conducted during the rainy season. As o resull the efforts made to minimize drug wostage was not Measures were taken by the 201 muchvery willThissuccessful. be ln 2improved provided thethat ornves3 action for community self monitoring The ect s mature andproJ ityet would seem no selfcommunity IS done. T,monitoring o ini tiate rep rese ntol ives of co mmu nit ies appraised the activities occ o mplis h ed t h ro u gh review meetings conducted ot kebele level. However, selfCommunity ,.tmonitoring not done m 201 OSI APOCper guideline. regards to timeliness of financial reporting; Improve on performance with oftinancialTimeliness reporting will be improved 5 reports expenditure $2000 for community self-monitoring, which conflicts with the information provided under section 2.8, Content under section 2.8 suggests that NO The project ofabout US CSM was done - Please The budget n'as utilizedfor kebele level review meetings rhat assessed the acco mpl ished activities. 6 prospect for reaching the threshold is promising. Aspects worth paying attention to increase coverage: Even ticthough Therapeu lscoverage srill below 80o/othe threshol thed, failure to meel the threshold is delay in the arrivol The therapeutic 'S stillcoverage thebelow 80% threshold. The mainly due to whichMectizan lablets + WHO/APOC, 24 November 2004 Treatment to be scheduled during Jan- April timeline, described as optimal timeline for treatment drug distribulion to be carried out during the rainy season.. Nevertheless efforts will be put forth lo improve the situation in the fulure. 7 In this regard, APOC and the Project should look into and address factors hindering timelY release of funds The project zone liquidsted the funds timely and looksforward for apt release offunds by APOC 2 WHO/APOC, 24 November 2004 Executive Summary l. Backsround on treatment and ponulation data Bench Maji is one of among the 14 SNNPR zones and its bounders are Kaffa zone in the North and North East, Sheka Zone in the North Wes! Gambella Region & the Sudan in the South West and South Omo Zone in the South East. The zone has a total area of 19,326.6 sq kms divided into l0 rural woredas and I town administration having 221 Kebeles. The capital of the Zone, Mizan Teferi, is 574 km south west of Addis Ababa and 849 km. from Hawassa which is the regional capital. Thecensusresultforthe20ll CDTIprojectshowsthatBench}y'rajiZonehaspopulationof 7l0,ll3.The annual therapeutic coverage is 73.3Yo and Annual Treatment Objective (ATO) is 92Yo. The project also has achieved I 00%o geographic coverage. 2. Backsround on population movements. The communities in the CDTI areas are mainly settled farmers, pastoralists, daily laborers, government employees and coffee plantation workers. The indigenous ethnic groups are Bench, Sheko, DLi, Meneat, Surima and Mezenger which occupy the entire Zone GuraFerda woreda has accepted new settlers from other zones of SNNPR. 3. Trainine data In 201I trainings were given for 180 health workers 484 Community Supervisors and G,Z|Z CDDs Challenses and how they were overcome. Challenges: . Most of the woredas are without specified focal persons . Woreda and kebele reports were not coherent. r Proper training was not given to CDDs by HEWs . Work overload to HEWs and HWs ' Delayed Mectizan distribution and report collection due to Impact Assessment done by APOC ' village register updating was not regularly done in some kebeles ' Regular and continuous supportive supervision is lacking at HFs and Woreda levels Solutions eiven for the Challenses ' The reports were compiled based on the village registers during the woreda review meeting sessions. ' Discussion held with the ZoneHealth Department so that specified focal persons could be assigned at each woreda ' HEWs were strictly told to train cDDs properly by the woHo officials , We have tried to collect reports even though it was a rainy season ' village registrations updating done during the review meeting sessions ' The WoHOs and FIEWs were advised to practice continuous and regular supportive supervision. r 3 WUO/APOC,24 November 2004 SEGTION 1: Background information 1.1. General information 1.1.1 Description of the project (Geographic location, topography, climate) The topography of Bench Maji Zone is classified as 52%o lowland, 43Yo Semi- highland and 5oh highland. The mean annual temperature ranges from20oc-25oc and the mean annual rainfall ranges from 400 - 2000, mm. The estimated altitude range is 500-3000 meters above sea level. Slopes, hills, fields with gorges and large river basins and streams dominate the landscape of the zone. About24yo of the area is covered with tropical rain forest. About gOJl% of the populations are rural and9.99Yo urban dwellers. Agricultural is the backbone of the zone's economy. Harvesting occurs from October to December, leaving January - April as the optimal Mectizan treatment period. Communication svstem Road transportation is one of the widely used modes of Communication in the project area. The main all weather road runs from Addis Ababa through Jimma to Mizan Teferi (capital of the project zone). The l0 woredas are accessible at present. Nine woredas do have wireless telephone lines; Mizan as well as Sheko towns are operating with digital telephone. At present the telephone communication system is improving and a network access is possible in almost all woredas. Health care deliverv svstem The zone has I Hospital, 34 Health Centers and 177 Health Posts having 421 health workers with different qualifications and 480 Extension Health Workers. The health center staffs do supervise and provide Mectizan to the HPs. The HEWs do provide Mectizan to the CDDs and carry out training as well as supportive supervision to CDDs. CDDs are responsible in distributing Mectizan.. Table l: Number of health staff involved in CDTI District Number of health staff involved in CDTI activities. Total Number of health staff in the entire project arca BI Number of hcalth stalf involved in CDTI B2 Pcrcentage Br=BrlBr *Ifi) Bero 40 24 60 GuraFerda 73 57 78 Maii 84 64 76 Meneat Goldia 97 77 79 Meneat Shasha 90 65 72 Mizan Aman 43 27 63 North Bench 116 87 75 Sheko 109 53 49 Shie Bench I l3 6L 54 South Bench I l8 103 87 ZHD 36 12 s7 Total 903 630 70 Health Efiension Yl/orkers and other Hll/sThe totol of health staff 903 includes the 4 WHO/APOC, 24 November 2004 I 1.1.2. Partnership Since the beginning of the project, there were strong partnerships in planning, advocacy, mobilization, drug distribution, monitoring and evaluation of the CDTI activities u-ong different partneri. The main partners involved are Federal Ministry of Health, Regional Health Bureau, Zonal Health Departments, Woreda Health Offices, frontline health facilities, the community, The Carter Center Ethiopia, WHO (ApOC) and other government sectors. APOC, The Carter Center, RFIB and the ZHD are involved in planning, trainings, monitoring and evaluation as well as allocation of funds and other supplies such us vehicie, motJrcycles, Jomputerr, piint"., and fax machines etc. The zonal and woreda task forces are responsible in the foilow- up oithe prolect and mobilizing the population, even though they are non-functional at present. The iront line health facilities dofacilitate trainings, conduct supervision, census updating, allocate Mectizanto each village according to the censuses. The community leaders do mobilize the population and fix the distribution date in agreemJnt with their community members. 5 6 WHO/APOC, 24 November 2004 a+ N 0) ,.o Eo oz + c.l O o0. > uttEI ol -slol c)l =lo -El hJ E1 'El ol -ol -Elbi ol EI lalql N(H o ! 0) rr) oo. o(-)() o0 6dLq) (d o) tro t', () tt)(o o (n 0) bod 't Lo tr o c) tr() c) F ci o)L(o o() 'a L o. c) (N o C) oL o.() (n lr')L C) !tr o. 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IJ. o c'l h c,aLo c)t& oN h rd .-oot\ O o.t >' c, L -oO Er oN >\ d -otuIL o EO Bq,) L U2 ht GIE (.) T&(, (J a) ca o U) E() (.) co() U) v C) U) o () EA Lo z c- L(g ox (n ch 0.)() o o. o 63 Fo() rt)(l) 63o ! () o (r) F q) o oQ () L o o =o)(! o) a/)(!(') L(! oo1o; fldJ .IEl,'5(,'< .u .=|}9od oo - Q.) t-.= Oc)EHL:- a.ll . crlF5l .(BlNFI F.o(J I- o tr oIIfl G{.tr o Eg c! taN z o -F(J ltJo ?- o.t >.(, 2. (\ (, z o.t d (\l >. c, o o.l G, 2 -l'81 >l (, !Eol *lGllolclol >I (ot clEa d(D tr(.) 2 E E iT = 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. Zone and Woreda Administrators were invited to attend the zonal and woreda CDTI trainings and review meetings. Most of Woreda Administrators have attended the meetings where as the Zonal people did not due to involvement of other emergency duties. 2.3. Mobilization, sensitization and health education of at risk communities Community mobilization was done at each village organizing community meetings. Health education and community mobilization was conducted to the community by CDDs and community supervisors (FIEWs). A newly set up structure called one to five (one community Ieader to five people in the community) was very helpful in mobilizing the community. Each one to five team leader was responsible to organize his/her people and make them ready for Mectizan d i stribut ion. 8 WHO/APOC, 24 November 2004 2.4. Gommunity involvement Communities in the CDTI add more rows neces, Comment on: - Attendance of female members of the community at health education meetings Even though female health education attendants are not as equalto that of male attendants, their number is increasing yearly. Female affendants are shy to ipeak in public unA ,oriof the timethey are overburdened with so many home and field tasks. . - In general, how do you rate the participation of female members of the community meetings when CDTI issues are being discussed (attendance, participation in thediscussion etc). - Their attendance. anllEit participation is increasing and are having quite fairparticipation in the CDTI discussions. -Incentives provided by communities for the CDDs They are sometimes being helped in their farms and are omitted from other community campaign activities during Mectizandistribution days. Even if the communities do notprovide incentives, they don't complain much for tiey are serving their relatives and neighbors of 20-25 households. The WoHOs some times involves them in vaccination campaigns and are being paid small amount of per_diem. -Attrition of CDDs. Is attrition a problem for the project? If yes, how is it addressed? cDD attrition is not a-problem for this project. If a replacement is needed, it isdone immediately and training is given-by-FlHw at their respective kebeles. Number of communities/villages with communlty mcmbers as supervisors Number of CDDs and the communities involved Number of communities /villages with female CDDs Totat no. communlties in the entire project aree B. Number with community members as supervisors Br Percentage Bo= By'B. *100 Mrle CDDs B? Br Female CDDs Be= Br+3, Total Number of communities with female CDDs B,o Percentagc I Brr= Bero 47 47 100 63 29 92 27 29 GuraFerda 120 120 100 412 73 485 35 7 Maji 95 95 100 z)3 50 283 36 13 Meneat Goldia 161 I 6 I 100 675 3s3 1028 87 8 Meneat Shasha l0l l0l 100 490 t2t 6tt 8 1 Mizan Aman 69 69 100 lr0 112 222 58 25 North Bench 202 202 r00 822 323 I 145 178 16 Sheko 138 138 100 409 87 496 62 13 Shie Bench t99 t99 100 754 167 921 105 11 South Bench 222 222 100 889 80 969 59 5Total 1354 1354 100 4857 1 395 6252 655 l0 -Other issues 9 WHO/APOC, 24 November 2004 t n District/LGA ] 2.5. Capacity building - Describe the adequacy of available knowledgeable manpower at all levels' The CDTI progru111iu, L".n implemented for th-e last nine years and every year trainings and review ,.rtingr at zone and woieda level have been conducted for all health workers who are involved in the program. Due to this every body is aware of the program. - Where frequent transfers of trained staff occur, state what the project is doing' or intends to do, to remedy the situation. (The most important issue to describe is what measures were taken to insure adequate CDTI implementation where not enough lonwledgeable manpower was *oilobl" or if staffs are frequently transferued during the course of the campaign). There was no transfer or shortage of staffduring the 20ll campaign period at each project woreda. l0 WHO/APOC, 24 November 2004 6ll i. o< = c.l o\ \o\o \o e.l oo .+ r-ta} oo c.t .+ co oo c.l vlr)(\ o\N aa oo c.l o c.t(\ r- \o \o o c.l o.l e.t ra) o\ a-N .+ ra) € $ o\N \o ca \o o\$ o\o :f, o o\ (\ o\ co oo o\\o o\ o\\o o\ o s(o @ C..l(.| C..l\o @@(elo ----l fc,q) G u)a oQ o q)& z N o'l @(n(o Fl Nfn oo No t-{ F{ F{(o <flr) ft1 la sf Fl Fl (o Olsl (o @Ol Or ro Ol rrt sf(o(o a) E(, a) I s vo\ .ll $ = o o O O O O o O o o o o o O o o a O O O o o o e N I oF oF q) o(u 6'tr o ()o z o v) (,) 6l tr(l) o ? o O O o O O o 6aia 1l]) E() a) 4e <l s E,'r, Q .S q a or r-l o Or F\ st N st tt m r-l r\t/) sf sf oN or\ ot1 O) rn (nln (o (n ri rt! o 00 r-l N Ol l'\ <f (\l rn rn F{ o sltn sf,(n @(o @ l/) o t-{ ;r{ F{ <f F{ lJ1 OrOl cn fo q) dL r-. fi o)0E9 E>* >E c)I ? or @st qt rn or\ Otu) mr-{ o@ Nsf fOln rnor msltn ra o\ E.'i sq = ia (n o o ('- r- o O r.. F- \o \o O v $ o F- c- \o \o oo ao ta) cO € (a) @(o oro @ !E G a) a) (.) ;U -6 o! q)& z ?F ra) ra) (n l-- \o !f r'. \o oo oo ri ro o (.) ca d 0.)IL6, c, '1' o o C) 2) (u -c ct .tr U) 6,otr 0) z (, E N =l otrq) p t L o z olzo C') od() ca o U) Eo () EA a oql c, F s .+ a-l I o oz$ c.l (-)(J o > bb o() qJ .a € .{ s)Lq) B q)\ % v .< a s o B go t o * Pr. () a) t oL\ s -o B v s Bt\- t' s< .q) .lf q B4 U2 \)q) S q: sL q) Lo N B qJ rtq) S tr .9 s (l) g o,trIF o(.) ({< qt o) o) o)tr .(DE 1' a) (U boc (t, LF ,rir o,l -oldlFI 6 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 75Yo therapLutic coverage or the coverage rate is fluctuating, state the reasons and the plans being made to remedy this. The project has achieve d IOO% geographic, 73.3% therapeutic and TUG 92o/o coverage in Z0l f. iherapeutic coverage was compromised in woredas such as Bero, Mizan Aman and South Bench due to inadequate number of and commitment by CDDs. Zone Health Department is taking measure to increase the number of CDDs and revitalizethe leadership in those poorly performing woredas. Trainees Type of trainins CDDs Other Community members e.g Community supervisors Health Workers GLHF) 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) t2 WHOiAPOC, 24 November 2004 .+ oN o -o () o z tf, c.l L.,/ o > co oF D (0 C)L(u oo 'a a. o B th(!(,)L(d o EoU o IL(") o. >.\o(r') C) d ;o H C)L ol ol€ol ol o) -l o, !l oxl>xlo -I .5 _I € .Ul s Eledl '- adl O-g16 gl I orl = o.rl 0 oI 0) dx olE olvgEgE :Itr 3l EPIE 9I E at ) rt-5lE5ls zl < zl,a ilil Cc() L(g (.) o) 'a L o. o .g o q.l & -o E C) rE o V)(g h C) =ol E "l 5Bl ., iRI E El bel !0lEol 6) 9fl ,.:.jl o) =l o.>l >, (t)l -\yl 6 '=l 6-) =t tsEl t*dl obl x 3t#ot tr ot tr .ol _trl d 5t 6zlt- (B(!) d oo 'a a. o (a() .E oo() o! oIt< C) o- -,otsl3 -l trxl - 'ol .!9l oodl cO)l .i .BI .>qrl: 8t.E 8lE(-l 5ol o. rl O3l o EIE zli -s. 4q q) q) .\ %: L P }l s qJ Va 0) a-\- .v(t) tr cd cr,(! 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Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - Qtlease tick the appropriate answer) MOH M WI{O[] UNICEil NGDd] Other (please speciff) Mectizan@ delivered by - Qtlease tick the appropriate answer) MOH EI WHOtr UNICEil NGDC Other (please speciff): Please describe how Mectizan@ is ordered and how it gets to the communities The NOTF requests for Mectizan from MDP. After the drug reaches the country it follows the existing drug and other medical equipment delivery regulation system of FMoH. The drug is stored in MOH warehouse from which the project receives. From the project level (zone) the Woredas collect the drug and distribute to the FLHFs. It is from the FLHFs that the community supervisors GIEWs) get the drug and distribute to the CDDs and the CDDs to the community. Table l0: Mectizan@ Inventory (Pleose add more rows if necessary) Note How are the remaining Ivermectin tablets collected and where are they kept? At the end of the treatment period, the CDDs are requested to retum the remaining drug to their collection centers which are the frontline health facilities GIPs). Then the frontline health facilities (HPs) sent to the Woreda health office where the remaining Mectizan is kept. List and briefly describe the activities under Ivermectin delivery that are being carried out by health care personnel in the project area. . Training of health workers, community supervisors and CDDs on handling, distribution, maintaining stock balances, recording and reporting . The Cafter Center Ethiopia delivers Mectizan to the respective project zones , The woredas collect their Mectizan from their zone . Collection of lvermectin from the Woreda level is done by the frontline health workers . Distribution of Ivermectin to community supervisors and CDDs ' Supervision . Recording and reporting of data . Conduct review meeting at keble and woreda level . Collect the remaining Ivermectin from the supervisors and CDDs and return to the WoHO - Any other comment District/ LGA Number of Mectizan tablets Remaining from the previous ycar (2010) Requcsted Receivcd (available) Used Transferred to Benshangul Gumi Wasted Expired Remrining Bench-Maji 242,183 1328000 1570183 t4t236t 21500 4t27 42017 90178 TOTAL 242,183 1328000 1570183 t4t236l 21500 4127 42017 90178 t6 WHO/APOC, 24 November 2004 2-8. Gommunity self-monitoring and stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? If so, When? Not done. Table I l: Community self-monitoring and Stakeholders Meeting (Add rows if needed) Describe how the results of the community self- monitoring and stakeholders meetings have affe.cted project implementation or how they would be utilized during the next treatment cycle. CSM is not done. 2.9. Supervlslon 2.9.1. Provide a flow chart of supervision hierarchy. zHD ) woHo) Health Facility ) community supervisors ) cDDs. What were the main issues identified during supervision? o Continuous and rdgular supervision is not done by the WoHOs and front line health facilities o Village registers were not properly updated o New comers to pick coffee and work in gold mines in some woredas have fluctuated the actual woreda population number o Delayed Mectizan distribution due to Impact Assessment 2.9.3. Was a supervision checklist used? yes (ZHD) 2.9.4 what were the outcomes at each rever of CDTI implementation? o Improvement in handling of documents 2.9.5.was feedback given to the person or groups supervised? yes District/ 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 meetins (SHM) Bero 47 0 0 GuraFerda t20 0 0 Maji 95 0 0 Meneat Goldia t6l 0 0 Meneat Shasha l0t 69 0 0 0 Mizan Aman 0 North Bench 202 0 0 Sheko 139 0 0 Shie Bench South Bench 199 222 0 0 0 0 Total 1355 0 0 17 WHO/APOC, 24 November 2004 tz 2,9.6. How was the feedback used to improve the overall performance of the project? t Proper documentation is implemented I More CDDs recruited r Village registers updated SEGTION 3: Suppod to GDTI 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, WO=Worn off). How does the project intend to maintain and replace existing equipment and other materials? In 20ll APOC has replaced I vehicle and a desktop computer with its printer. The zone is expecting 6 motor cycles, photocopier and a fax machine as a replacement. Source Type of equrpment APOC MOH -Zone DISTRICT NGDO Others No Condrtron No Condrtion No. Condrtion No Condttlon No Conditron Toyota Hilux 4W pickup 2 lF+lCNFR 1 2F F 0 0 0 0 Motor cycles 4 F 2 2F E F 0 0 0 0 Oesk top computer 1 F I F 0 0 0 0 0 0 LaserJel printer 1 F I F 0 0 0 0 0 0 DeskJet Printer 0 0 0 0 0 0 0 0 0 0 Photocopier 1 wo Fax machine 1 wo Overhead projector 0 0 0 0 0 0 0 0 0 0 Megaphones 0 0 0 n 0 0 0 0 0 n Radio Communications 0 0 0 0 0 0 00 0 0 w 1 F l8 WHO/APOC, 24 November 2004 t'OTAL 3.2. Financial contributions of the partners and communities Table l3: Financial contributions by all partners for the last three years DNA - Data not available. .Tle MoH budger includes running cost as well as sataryfor onchocerciasis focalFrsons at zonal and woreda level. - If there u." Problems with release of counterpart funds, how were they addressed? There is no problem in releasing funds from TCC and the Govemment, but ApOC,s fund always reaches late. AP0C's budget is released after all CDTI activities are carried on usingTCC and Govemment funds. - Additional comments At present, all health programs are integrated and the government is using its entire resourcesfor integrated health programs 3.3. Other forms of community support - Describe (indicate forms of in-kind contributions of communities o CDDs are supported in their farm fields and are omitted form other campaignsduring Mectizan distribution period. Contributor Ycar 6 (2009) ear Year8 ITOTAL Cash Budgeted (US$) TOTAL Cash Released (US$) TOTAL Cash Budgeted (US$) TOTAL Cash Released (US$) TOTAL Cash Budgeted (us$) TOTAL Cash Released (us$) MOH (Central+ State) DNA DNA DNA DNA DNA DNAMOH (District + zone) 49471.38 4947 t.38 82,067.52 82,067.52 85,000.00 85,000.00 Local NGDO(s) ( if 0 0 0 0 0 0 NGDO partners(TCC) 25571.46 25571.46 26,032.59 26,032.59 7,739.00 7,739.O0 Communities 0 0 0 0 0 0 APOC Trust Fund 34066.?s 34066.75 19,887.40 t9,803.97 45,455.60 t8,t68.92 109,1 09.59 109,109.59 127,987.51 127,904.08 t32,794.60 104,907.92 t9 WHO/APOC, 24 November 2004 lJ ) o) @_(, @ o_ N @v(o @ 'I, o k()q b0tr L oa 0.)! o b0 r< E Bo os 0) v) ()(d od(.) tr .a oa v) oo 'a tra C) o a o o Cdo +r ol -ol(Ul FI F o 0.) bo v) ofr(d o a o troaX c) o d (.) q) L{ ts .d (.) v) () cl o(d(l) l< € '1, o Lrq)& oo E oaot< o bo tr kt! o 'otr o)aX() o E Cd q) + - c.ll 6.' l1l5:l6te ll Idt .= olg i?l(UJt o-l 'olcl # II 5'(, G L ot - - .tsEg oc xtu at a(r) a I a I I I ( ( .! .l u I I I I oq ooo@ o eooo@ oq ooo rr) oo ooo() oq oootr) I I I I I I oo C;oort oq ooot oq ooo oq ooo oo ooo oq ooo(v, I I , oo ooo$ oq ooot oo ooov oo ooovl oq ooos I I I l I I I I I I I I I oo ooo@ oq ooo € oq ooolr) oo ooo rr) oo ooolf, oq o(\ oot oN oN o(\t oN oN oN oN o(\t oN oN oN e(\{ o(\I o(\ oN oN oN Go o soEs .NE .!: Goo b€oo c o .N i.EGQOoo =i{G o = N (9 tr o (u(, t,o E t!oE a G o Ia5q N o C" .s .E(E o CDtr '=o .=o EOFO o E,,tr E e,oJ o 3 t!o (E o EDtr .s(E F N N o o IaIq o GS G url (Y, tr .9 .9,t IE o JEG e o UJ oc(9 io ot a(, G o IaIq o o o .o EtG* =o E$ €cOGIE lc oo tg S o g o o Qo E G tr oo- EO 6,= -: -d .'tr t.9t, o tro Eo ED(E tr(! =cit o tro o o aD o tt .E o o oU' 6 'eq Bo.N := .U =(, tr o d! () tro @ !=t! = otro dt l! = otro @ t otroo G = otr o @ E(, o @ l! =totro @ Il! = otro @ :=(! =(, tro @ (E = oEoo t otro @ s oEoo = C)E o @ (,g o @ (,g o @ (U = oEo @ lor= otr o @ (E =G(, tr o @ Ftso =tsOlgoz .g EL o ut o u, o CL o UJ .9E IIJ l! o. o IIJ .g o. r.9 u, .E CL .9 UJ I I s UI SEGTION 4: Sustainability of GDTI 4.1. tnternat; independent participatory monitoring; Evaluation 4.t.t Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable) Year I Participatory Independent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation Internal Monitoring by NOTF -r/-1aeOC) Other Evaluation by other partners 4.1.2. What were the recommendations? 4.2. Sustainabitity of proiects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period? Yes Was a sustainability plan written? Yes When was the sustainability plan submitted? on the 3td year ofthe project What arrangements have been made to sustain CDTI after APOC funding ceases in terms of? 4.2.1. Planning at all relevant levels The CDTI activities are planned integrated with the other PHC programs at all levels. Therefore, the planning processes are carried out through participatory methods, using bottom-up approach und integrated with the basic health services. Resources are utilized to all health activities on integrated basis. 4.2.2. Funds Funds from the government and other donor agencies like TCC, APOC, UNICEF and WHO are utilized on integrated basis for all health programs. 4.2,3 Transport(replacementandmaintenance) APOC has replaced a vehicle and the zone is looking for 6 more motor cycles 4.2.4. Other resources - 4.2.5. To what extent has the plan been implemented The plan is well executed by the support of the government, APOC, The Carter Centre Ethiopia and the community atlarge. The CDTI activities are mostly incorporated and integrated with the other PHC programs, even though support from APOC and The Carter Center Ethiopia is highly demanded. This year Therapeutic and TUG coverage has reached 73o/o and 92%o respectively. 4.3. lntegration t I o 22 WHO/APOC, 24 November 2004 aoutline the extent of integration of GDTI into the PHC structure and the plans for completeintegration: All CDTI acrivities are integrated into pHC o Mectizan delivery o Training o MectizanDistribution o Supervision o Review meeting o Budget utilization 4.3.1. Ivermectindeliverymechanisms Since the beginning of the program, there is no separate Ivermectin deliverysystem to the lower level; it follows the existing a*g J"rir.ry system of thegeneral health service. In other words, Ivermectin delivery is fully integratedinto the existing drug delivery system of the country. 4.3.2. Training: tDfr hainings are integrated with the Primary Health care (pHC) program fromthe beginning at National, Region al, zona)., woreda and HF levels. The DiseasePrevention and Health Promolion iore Process is responsible in taking care ofthe program at all levels. The carte. center Ethiopia has developed modules,manuals and Fllip Charts to be used at zonal, woreda and kebele levels. 4'3'3' Joint supervision and monitoring with other programsAs part of the system in the countrl, ailrort, orrup;;;;; supervision andmonitoring activities of the CDTI i.ogrurn are caniid out in an integratedmanner with other pHC programs. 4.3.4. Release of funds for project activities The government, The Carter Center Ethiopia and Apoc have released fundfor the year 20ll CDTI activities. Tt" goui-rent is paying the salary of all itshearth personner and a[ocates. budget dr rupe*ision, fuer, stationary andvehicle maintenance, etc. AII healt[ activities are carried out on integratedbases using the allocated budget from ttre Ctvemment and NGDOs. 4.3.5. Is CDTI included in the pHC budgetr The budget itemized for Disease Pievention and Health promotion includesCDTI too. 4'3'6' Describe other health programs that are using the cDTr structure and howthis was achieved. What have been tne actrievements?CDTI structure is being used for -malaria p..u"riion, national vaccination programssuch as Polio, T! Measles and EoS. cDDs ;." "",y;;lpfuland highly involved duringthese campaigns.. . 4'3'7' Describe others issues considered in the integration otCDTI. 4.4. Operational research IJ WHO/APOC, 24 November 200423 4.4.1. 4.4.2. Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period. Not done How were the results applied in the project? SEGTION 5: Strengths, weaknesses, challenges, and opportunities Strengths: - Geographic coverage- 1007o - Therapeutic and TUG coverage 73%o &92% Weaknesses: - Continuous and regular Supportive supervision is lacking at Woreda & HF levels - Bulkof Mectizan tablets expired - Number of Absentees and Refusals is still high - Taskforces at all levels are inactive as usual Opportunities: o Accelerated expansion of PHC to village level. . Newly designed development scheme called one to five . Assignment of HEWs at kebele level. o Establishment of Health Development Army Threats (Challenges): o High tumover of health staffs especially at front line health facilities and woreda levels . Overlapping of other health campaigns during Mectizan distribution period. . Workload on health workers SEGTION 6: Unique features of the proiecUother matters q t t 24 WHO/APOC, 24 November 2004