Illubabor annual project technical report submitted to Technical Consultative Committee (TCC): from December 2006 to November 2007

.Qr t I The Federal Democratic Republic of Ethiopia Ministry of Health { I ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) DEADLINE FOR SUBMISSION: To APOC Management by 31 Januarv for March TCC meeting To APOC Management by 31 Julv for September TCC meeting AFRICAN PROGRAMME FOR H. ONCHOCERCTASTS CONTROL (APOC)" - Fcr Jo: ri tce26 For l.: To, b R ke Proiect Name: IllubaborCOUNTRY/NOTF: ETHIOPIA Launching year: 2004Approval vear:2003 From:P..e.q.em.b..er.2..00..6......To;.....Np..ys.mhsr..20.4.7.....(Month/Year) ( Month/Year)Repo Period: Proiectvearofthisreport: (circleone) I 2 3(r5 6 7 8 9 10 NGDO partner: The Carter CenterDate submitted: September 2007 7 t .it 0 6 FEV 2008 WHO/APOC, 24 September 2007I ;;,-.:ilon ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSI.JLTATIVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space' OFFICERS to s the report: Country Ethiopia National Coordinator Name .Dr. Signature / Date Zonal Oncho Coordinator Name: .. Date NGDO Representative Name : .........A.b.a.tp..T.il.ah.un Signature l)ate This report has been prepared by Name ...Ti.bebu. AmsnjP... t .N QITF. Designation chocerciasi s Coordinator Signature S i " l. ii: '1 -i-,; t! ll " \' t, { -:t Date WFIOiAPOC. 24 SePtember 2007 rt ) 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 Dadi Jima Signature: ...... Date Zonal Oncho Coordinator Name: Tibebu Amante Signature Date NGDO Reoresentative Name: Abate Tilahunl. Signature Date This report has been prepared by Name : ....T,iheb.u..Am.q.n1e..t.N-O.f[ Designation : Zone onchocerciasis Coordinator Signature Date ll WHO/APOC, 24 September 2007 )Table of contents FOLLOW UP ON TCC RECOMMENDATIONS I EXECUTIVE SUMMARY ...........2 SECTION 1: BACKGROUND INFORMATION....... .....................3 1.1 GpNpRer TNFoRMATToN ......... Popu1artoN............... 4 t.2 7 SECTION 2: IMPLEMENTATION OF CDTI .............9 2.1. Tnrmrnw oF ACTrvITIES............. ........ 9 2.2 Aovocecv. l0 2.3. MosnzeroN, SENSITZATTON AND TIEALTTT EDUCATToN oF AT RISK COMMUNITIES l0 Comvtxnv TNVoLVEIVIENT ...2.4. 2.5. 2.6. 2.7. 2.8. 2.9. 3.1. 3.2. J.J. 3.4. Capeclry BUILDING.. TRremrBurs.............. ORIERnIG, SToRAGE AND DELIVERY OF TVERMECTIN ColryruNrrv sELF-MoNIToRINc eNo SrerrHoLDERS MEETNG SuprRvrstoN ............... ....,,....,..12 ....,.,..,.,.14 ............. l6 ....,....',..21 ...,...,.,...22 .,..,.,,,,.,.23 SECTION 3: SUPPORT TO CDTI EeupunNr FuveNcnl CoNTRIBUTIoNS OF T}IE PARTNERS AND COMMUNITIES. Orrun FoRMS oF coMMLTNITY suPPoRT ExppNnm.nE PER ACTIVITY... 24 24 25 25 25 26SECTION 4: SUSTAINABILITY OF CDTI 4.L. INrrRNer; INDErENDENT pARTICIpAToRy MoNIToRINc; EveruerloN ......... 4.2. Susrenqnsrr-rry oF rRoJECTS: rLAN AND sET TARGETS (uaNoeroRY AT............... Yn 3) 4.3. INrpcRerroN ............. 4.4. OprneTIoNAL RESEARCH SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AND OPPORTUNITIES ......................28 SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS ..........28 26 21 27 27 28 llt WHO/APOC, 24 September 2007 Acronyms i APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT IJNICEF UTG wHo African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Community-Based Organization Community-Drug Distributor Community-Directed Treatment with Ivermectin Community S elf-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 goup) Trainer of trainers United Nations Children's Emergency Fund Ultimate Treatment Goal World Health Office IV WHO/APOC, 24 September 2007 Definitions (i) Total population: the total population living in mesolhyper-endemic communities within the project area (based on REMO and census taking). (iD Eligible population: calculated as 84o/o of the total population in mesofttyper- 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, (iv) Ultimate Treatment Goal (UTG): calculated as the maximum number of people to be treated annually in meso/tryper 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 coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). ("D Geographical coverage: number of communities treated in a given year over the total number of mesolhyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). (vii) lnteeration: 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) Communitv 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 prograrnme 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. WHO/APOC, 24 September 2007 FOLLOW UP ON TGC RECOMTENDATIONS TCC session 2sth Number of Recommendation in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROTECT FOR TCC/APOC MGT USE ONLY t99 Avoid distribution activities during the rainy season with the resulting absenteeism The distribution period was adjusted accordingly (March -May) Ensure advocacy is carried out to political leaders Political leaders and religious leader were advocated and sensitized in the Project area. Improve on the number of female CDDs The project has tried to increase the number of female CDDs every year and continue its effort. This year some improvement has been shown. Improve on liquidation of funds utilized to reduce delays in release of APOC funds ln-service training were given for financial workers on how to utilize funds and timely liquidation of funds, however no significant improvement seen. Continue to address reporting and document handling during training. It is well accepted Improve on calculation of number of tablets needed to avoid excess and expiry It is well manged. I WHO/APOC, 24 september2007 IExecutive Summary 1. Background on treatment and population data Illubabor Zone is one of the CDTI project found in the Oromia Region and it is located in the Soudrwest of F,thiopia. The total population of the zone is about 1.2 Million and it is sub- divided into 23 woredas . 'Ihere are 'Iwelve CDTI woredas ( Mattu, Darimu, Alge-Sache, Yayu,Hurumu, Dorani ,Alle,Didu,Bacho,Bilo-Nopha,Dabo-Hana and Bedele) in Illubabor CDTI project .There are 7 zonal hospital, 6 health centers, 47 heakh stations and 47 community health posts (CHPs) in the CDTI project area .'llr:.e CD'II woredas are further divided into kebeles, sub kebeles and 37 04' G arees' with the smallest administration unit. The Illubabor CDTI project was started in the year 2004. Right from its starting all the targeted villages (100 percent of geographical areas) were covered with Mectizan treatment. The total population for the project area was 651,399 with the Annual Treatment Objective (ATO) of 534,147 out of which 528,754 were treated with mectizan for this year which gives 81 % therapeutic coverage. 2. Background on population movernents. There is no major type of population movement in the project area. Most of the Communities in CDTI areas are settled farmers, Merchants, daily laborers and civil servants 3. Training data Training and re ttaining were gi.ven for health professionals, Community supen isors and CDDS for this ycar .During the period 290 health workers with different categoties,342 community supen isors and 8,827 CDDs selected from the project villages were trained and refreshed rvhich gives the aver ge number of CDDs two and above per villages. 4. Challenges and how they were overcome. Threats (Challenges): o Frequent restructuring at all administrative levels has been a major challenge. . High turn over of health workers atZonal, Woreda and peripheral health facilities 2 WHO/APOC, 24 september2}}7 Over lap of several health programs and work overload of health workers that delayed the distribution and reporting period of the CDTI activities. Opportunities: o The expansion of health posts and the increased number of health extension workers in the project area is a wonderful opportunity for CDTI implementation. o 3 WHO/APOC, 24 september2007 ISEGTION {: Background information 1.1. Genera! information 1.1.1 Description of the project Illubabor CDTI project is located in the western part of Ethiopia. It is 600 kms away from Addis ababa.The project is bordered with Gambella regional state in the west, West and Kellem Wollega CDTI in the Northwest, East Wollega CDTI in the North and Kaffa-Sheka CDTI in the South. Illubabor zone is one of the 25 administrative zones in Oromia Regional State .The Zone is sub-divided into 23 Woredas. According to the govemment structure woreada is subdivided into Kebeles and the Kebeles are further subdivide into 'Gots '.The 'Gots ' are further subdivided into "Garee" (villages) which is composed of 25 - 30 nearby households and responsible for all development activities including health. The Illubabor CDTI project consists of twelve woredas namely Mettu, Darimu, Alge-sache, Yayu, Hurumu, Alle, Didu - lalo, Becho,Bilo- Nopha, Dorani, Dabo- Hana and Bedele. There are a total of 267 kebeles in the CDTI woredas which are subdivided into 3,704 Garees (villages). The CDTI project area has very complex terrain with altitude ranges between 1000-2576 meters above sea level. Ecologically it is a tropical rain forest. Climate in the area shows great seasonal and inter-annual variations which is traditionally classified into three broad geo-climatic zones, i.e. cold highland, sub-humid mid-land, and hot lowland area. The mean annual temperature ranges from 10 0C to 16 0C in the highlands, 16 0C - 26 0C in the midlands, and 23 oC - 33 0C in the lowlands. The annual rainfall totals ranges from 1000 millimeters in the lowlands to 2200 millimeters in the highlands. Sor, Geba, Birbir Dedessa, Offa, Sesie, and Gumer rivers are among the perennial fast flowing rivers that cross the zone. There are also many numerous fast flowing small rivers and streams, which are tributaries of the main rivers in many areas in the zone. The project Zone is covered with high forest and coffee plantation .The zone is well known with two distinct seasons that is the rainy season (April - October) and the dry season (November- March). There is a mono-modal rainfall pattern in the zone. Agricultural activities (clearing, farming, and herding) occur all year round in the project area, but are most intensive during 4 WHO/APOC, 24 september2D07 athe rainy season. Harvesting occurs from October to December, leaving January - March as the optimum treatment period. The main road that runs 600 km from Addis Ababa to Mettu, the zonal capital town, passing through Jimma zone is partially Asphalt road and woredas alongside of the road are connected with Mettu town. There are about 576 kilometers dry weather roads that connect woreda centers with Mettu town. Except Lalo-Didu woreda all the CDTI woredas have all weather roads and are connected with Metu town. However, access to rural communities appears very difficult during rainy seasons. The potential health service coverage of the zone is 650/o. There is one zonal hospital, 6 health centers, 47 health stations and 4l health posts in the CDTI project area. There will be construction of new community health posts with the assignment of health extension workers in each Kebele . Table 1: Number of health staff involved in Illubabor CDTI project,2007 District Number of health staff involved in CDTI activities. Total Number of health staff in the entire project area Bl Number of health staff involved in CDTI Br Percentage B"=Brl B, *100 Matu 35 27 77 Darimu 52 28 53.8 Alge-Sache 50 43 86 Yayu- 29 27 93 Alle 32 22 69 Becho 23 23 100 Hurumu 25 23 92 Didu t6 15 94 Bedele 40 38 95 Dabo-Hana l8 l8 100 Dorani 9 8 89 Bilo -Nopha 2t 18 86 Total 345 290 84 5 WHO/APOC, 24 september}DD7 1.1.2 Partnership The main partners involved in the Illubabor CDTI project are Federal ministry of health, Oromia Regional health bureau, Illubabor zonal health office, respective project Woreda heatth offices, health facilities, the community, The Carter Center, WHOiAPOC and other goverrrment sectors in the zone. Since the initiation of the Illubabor CDTI project, there has been strong partnership during planning, advocacy, mobilization, drug distribution, monitoring and evaluation of the CDTI activities among all partners. 6 WHO/APOC, 24 september2}}7 F- o(\l C) .o C) a(,) o .f c\l o< o lr< 4B U s) v q) \) > \) () s\)L q) "o o \) B r8 E's:.t P :\v$ 9!: .:a q- o' o'\E$9 -sA\\ s9 5$ la O' 9: tJ$UU'is t* -iB sH $\J *p\* qu PS $ts$i:E s*Bo\s,8-a ss\Idt ^.ulY ':a *\P\\9\:r v:{ssr. \R sbo .FL 59 rE *s .Y $E Ng.(Jq) \b0st ildr: .s\J (JtrB\q) q) r- o L{ oEo ol< ok lr() q) B clq)fr I 6) 0)L q) o .v U) ! Cd o z (n q) o Lq)q b0 L oa o) t< C) b0 tr Lr o o oo 'a !a o L{ .o v) v) (.) o(! v)d B d U)o ) o ? E or-#t!Efc oE IN I F o o cl a o nr o F. 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(d 0)H rndq)L Cd 0) r< € U)q) O(6(ri o q) o E F ..i r o-rl -olCBIFI o o!rfl IIfl(, IE 5 o o tr a- -o EarF I F IN F o(, E o tr .9fl E{. tr o E .gc E tlN - o IF c, ul o o\ 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. During the current year 120 political leaders at each relevant levels were mobilized .The putpose of the mobilization was on the improvement of the treatment coverage and prograrnme sustainability .However, other competing activities limit the contribution of political leaders on the CDTI activities. 2.3. Mobilization, sensitization and health education of at risk communities Community mobilization, sensitization and health education was conducted at each level. The health professionals working at woreda health offices and front Line Health Facility levels, Health extension workers and Developmental workers were the major role player in the community mobilization and sensitization. Community Supervisors and kebele leaders were also involved in the mobilization activities. Health extension workers and CDDs were responsible in giving health information to the community at kebele and village level. The Community sensitization and dissemination of health information have contributed a lot in the awareness creation of the community .As a result of which the fourth year CDTI activities was successfully accomplished with high therapeutic coverage . 10 WHO/APOC, 24 september2007 o 6 e g uoc ?Q .=a '= \,, E o q) E z ilF ^io" d q) b0c 0) ogr oq ca cn \$ ra! tr) oi $c.l \oc\l rr) ca cn $c\ r.) c.) ra) \c, ra r*(\t le I'i I 9'El, i=E a i-(, +$ ca\o ca catr) t (r}(\ cO sf,o\ \ocora) ca Ot (a\ao\ o o Q) -{)tr=6!i -a U o () z +Ftr il le c oF \o oor- ca\o ca € ca ca \r) 6 ca N\o + \o$ o\ N c-t$ r- € r-. Ot*. oo oo ca\o \o ootrl $ cn o.l F-N €a lq 9-EA fle $+ co\o c.l c.)lrt $ (a)N co +o\ \o cnrn c.) o\ Ot (f)\o o\ F la o U q) cl 2 N$r- Oca (n c-) a-t N co c.) ct ot$ No\ o\ c.lv aa o.\o s ca ca oo ca\o co o\$ ta) onN $\o6r- 8'Fa0x6L >0 Be EO EEE9Otr(, >: o= z.) o ll * laca o) oo c, () q) O O o lq E >,2 y, ,'ze2! 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Lr(s >.o t- (h o F oo r< o o ,.li V)O q) c)i E() La €o (.)lr c) B t) () d9u) €*tr(n I l-JEO ou)u1 d 2(hd9 .nd €Eb0& (t)o -O€e8 !vH(/) 0.) oo FfrOEUCU c.) o= 1!CUt! c^Fboy -o c)(,) sEt: .: c)ta =()li Lr =oli .- o.n og €7iltr AHh 9Ei -o=ou.nHHbn9 d=* ) v)06)(hH U H.8E 6e a uo(H5.=O ocEOE s =-B9r,)i€cg5!ao.2.o .-(,AH I HPAELocoa9 ,o 'EAvSH.i -P'! F -t i.s E e -Oatrli E st x H 4 V H L6.2,9 o. ?X€E E =oqo': d!{j s E EEaOcdl6:€ 3 !? +il<6.-a ^V.r! b &E o .:l'-lW-9.I I" = UdCtr+a<.i ti gr t- th >. E Eoo C) Cd 0) (€ aa C) cn o Cg o O (s(') l.r rdA A\9X Es9Htr0)d>r otr i! .iO) (lr !!Ug a(B =9(dc)oc sC)(ob t?i3 ;E X 6-) OF9x (!E o= vtELr;otrpotro 0)O tsgotrEEtrc* ,OUI o.ll:oeE .. I € od() ctrcgOOartr!-EE<F oOr 2.5. Gapacityr building - Describe the adequacy of available knowledgeable manpower at all levels - Where frequent transfers of trained staff occur, state what the project is doing, or intends to do, to remedy the situation. (The most important issue to describe is what measures were taken to ensure adequate CDTI implementation where not enough lcnowledgeable manpower was available or if staff are frequently transferred during the course of the campaign). High turnover of health workers and the assignment of new health workers in the project area is a great challenge each year .The project was provided training and retraining for health workers at each levels every year to ensure adequate CDTI implementation. Training and retraining were given for community supervisors and CDDS. t4 WHO/APOC, 24 September 2007 f- oo \o oo co co\o co ca\o ra) \o oolr) o\ oo$ r-- o\ t caN + cn C.l r-(\l6 € ia r* \o ?a Uq o .: +L\J: .O i: *o \o oor- trl €\o ca\o c.) cn\o co oo ca co oo c-) co rn oo cn NN ca cn\o N\o$ c..I\o$ \o$ o\ sN o\ NN N en$ s oo $ r- oo t'-. t-- oo r-- o cn\o c.) oo ca co tr} @ cn N\o =f \o$O, N ca$ F oo r-- r-. oo oo ca\o \o oo[a $ cn c..l r-Na6 oo q) () q) <, s c) clL 0 a a(.) o frq) ! z ?rFU \oooF- rr\J = S.i i. *d (D 0) o o s o OL() .a'ra'Cltkrri rr t-ro): oq) .. c) rr c!oLr z (.) o F 6t(\I o\ o\ €\t c.tN co c.l (t- ca $ r-. r-. @ s + ca ca rr) oo trl $ cn co cil ol s c.l \o \f,N oo N \o N s Ua< = FU& 6$(\l q) q) q) I sca C.l c.t t @ co ca h caN -t +ol N \o c) dL !.5 .BE E> ZE 0)o Q oIF + $ ca N .+ co $ sf $ N N (n (n ca ca ra c.) N c.) N c.t N N N c.l (\ (a (\r .+ Q 6z E,'i +F-d o)tr dL cg 0 O o L O a o q) z (JF $ ca $ $ .+ tri cn (a) ca co N ot (\ts dtr o (d a L. C) o a0a I(.) o0 I x CC HH Lr (B l-r o a '-l Fr otr o c) o () s F] o O o () z o ooa d aoz I o m o o q,) 0) (.) m F-Oo c..l () 0) a 0)a $6l (J oA o *i B r bO o -o \ o{ \ o o\ o \' 14 h\)U\) q- + S p o \ \)t4 q) s tro (g tq) tr o a tr F oU CH o U1 (.) O trok - (.)tr E O bo CdkF .iir ol -olcdlFI Table 6: Tlpe of training undertaken @ck the boxes where specific training was carried out during the reporting period) Any other comments ;- No more comments 2.6. Treatments 2.6.1. Treatment figures If the project is not achieving I00% geographical coverage and a minimum of 65Yo therapeutic coverage or the coverage rate is fluctuating, state the reasons and the plans being made to remedy this. The geographical coverage for the project was I 00% and the therapeutic coverage is above 65Yo. 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) t6 WHO/APOC, 24 September 2007 r-oo6l o -o o 0.(l)q *N A o r- (0 0')L(d oo 'a L{p. o) i z r!& hp E c) C) rt) Cd t)o =t Exl 8Hl c> xl'E Pl 6el E utl dot oOOI sl E '51 x El= el 6 '=l o) 5t E El .". Et 9ot itol-5 ot trrl 3ol E €l= =l oZll- (B o L<(d o 0) 'a !a o i U) o I E E oo o H C)! 0.) ILr(l) o.x ot9ol G) :I Eil.s9l oo cdl C et't o->l - 51.9 BIE(HI JOl O.r.l O3|a. -trlE =t 6ZI? o (dk o bo(0 *i C) oo 3a .t \- =v(U l< 00 oo o C) ! C) bo(o l< C) oo oa Eo\ og(g Lo F q di € !!I g 9( 0<'6. f E{?EE#z tE a o o o o o Qr! ..ir <Ea2z o b9 E9 =9zG O o.l \at \ O oo c.) \oo\ la)ca \n N [.) ra-) c.l ca o.l+ =iA = = 9*v6 IC ,E H.gt E ;['Ec \ot-- rnN cAcn N c.l O o\ \or- \n(-- (n c.l o\ * (n(n t ?a 00N € Cd o o o< lL *.QA o '5() ,oood sb ooEOF rn o\r- $ € N oo 9 oo F- oo 9N@ r-t. Noo Noo € raf- \of- 6 a o --EEE ,Ll@dEb9 = o.!z ooN =l: r* oo N cO o\\o v} $ c.l oo \o c.) (.I\oc{ o\ c.l rJ\o c.ll/) co co @ o. \o co CO o,\o ao .+ o\+rI N co o\ tr) t Ir1t- € clin :o? 6.2 itri) < 9P'F'J o, (a slr) N co (f) o,(o ro N N o)(o^ F-(9 s (o- o,N N- @(o (o(oo co cf) oNlJ) oo F- ot- CO @(o c.i$ o, 1r)(9- (o(o rr) ro t-_ N ol- @\tlO .=.'d E " &H4€ -?.gE.=b E a - E€ _oF (a)\o \o" $\o ra rr) o\ @ ca cA\oq o\N f-@ st$ C-llr) \o^ c.t ca :f, C..l @ r- ca rn + r-\o\o o\ @ $@ \olr} + ra) =fooC\ cn$ (a 00 rn o\ o\(f) ta\o U) 0)b{(d q) o oO ll *dd A d :M F-bs50>v do OO o oo O O oO O o O a E.9 .- r.E fi! -8 5 PXtr tr= o =tr>!zd o r\ .f, co \o r- NN .+ rn c.)\o$ CI o\ oo \o ca$ Or cO No\ on r- = F-(f) a :o? d.: , tr .r-r t etrF\J t. * cA \o r- NN +\n ca\o =l' \o N o\ oo \o ca$ Ot ca N o\N r-- t r-(., ?:= E 9.ei ESE€5 r. u E:.E r 6 6FEE ET t--+ ca \o r- NN \f, rn c.)\o+ \o N o\O oo \o cO+ 6 cO No'N t-- = r-t) .9<;v Q< o z o o 0) m G, ozI o ca () ) € () c)E G) ca (Bi FH o -od t<(! o (.) C) Cda Io o! I) li rJi Cdko 6toF :\n V1 vjq) uq) s o\ q)\ o \ a) U1 Bq) s J4 .n tr (d a dq) L<(d d tr (, rl o 'tr (n Xp (n rI] a q) (d o)kF c-f o.ll -l -ot(dt FI illt r-oo on o -o E C) a.(l) o \f N O{ o oo E{ q) s' =\\*Ss .isoo ISB*l'ls siS Ys'.F S$'Y \.Si sE .X Fr - <rpErfE 'Esip !E b-\ sll!\ $\6\-E XPt .N,{Ybrr=B SSP\ iDF S.$H i*rv a9B SUs:vL =clS\h; .!xB SS$$q.)\ E& .t ?ts E.ss ah TN\$ >s{ ;S$ q5{\S?21\r E r$T }\i N* bnqJ\s- €=' ':l^B .= Ss : $IU\^ = a-:B. S-g .i s$" -Lt)\$> :q'QSE S; -\-v\-t\ si!s =$s E*3 E3o s sB r lSs l)tFilrrB\ bI () F doL(B o C) 'a Lr o. G) B (t)(! C) li(! o E o d 0) ILro o,x o ah o 0) (n ot I ol ! -l c>xls *lO 9l c-> EIE"rl I9l a al !=ot eOl p0loul -Ool ELl d _gl n Ht 6 5t 6zt? ol -l o.rxl > EI E sls ol : ol 0)ot trol ,:ol i€ Elt €lEJl d zl< il EO o o(€ oF s 0) (dL o bo !d^ 9E oo oF 2.6.2 What are the causes of absenteeism? Most of the absenteeism was occurred due to the overlap of certain movement activities during the drug distribution. 2.6.3 What are the reasons for refusals? Most individuals refused because they considered themselves as health and Others refused because of minor side effects. 2.6.4 Briefly describe all known and verified serious adverse events (SAEs) that occurred during the reporting period and provide (in table 8) the required information when available. In case the project did not have any cases of serious adverse events (SAE) during this reporting period, please tick in the box. No SAE case to report ,/ 19 WHO/APOC, 24 November 2004 a o ol ko -o tro o z tN O o. o > oN -an tr o .t +a 6l -- -(.) -6lo q) b0 clLo oI() Er) -GI tr .l L o +a cll tr .l .Lcto0)trh h3(D!3.AEEo'oE:crirj 0)a9!e.=aeE8"i5oo .l!,1 t) -E;tr;o(Jq *J ! ---i o-o9cdl-o o=G)rl 'ae5l ttcol5.5 3l -:AEii o -r GtEHI q)o-ut !LAILY+i i'fl ! +. =l cJE sl .tt rt IEalrrq) J-rl or 6)oo= dlvg Hc,0)L +rOr:E () ri9EitrHi-9(U-)Cqr',gEi +rot)t:tro oE! hr Gl €iia H_9F=F oil '; ui91 2e€l u ".i Fl er o b0 P Bs Po O o\ o\oo F-€ ctl \o o\ o (€)ao o rr i tria H 0) e s:;ti Oo\4 >v -o o o. o\ 00 r- 00 oo o\ ll r rllrd rd \o o '5() ,bnod Bb oo -coF r-r- r- F-F- € ri ,o oi! .o 4-FC5oAb o r- c.lN $N cl\o$ o,o olr-$ s \ € c.l l{ :oE 6.> itra)!:ot uFFl, \o\o oo" N € tat ca c-) € a.) €$ tr) r) r.r)t\ lt-!tlr) Gq ^.rd -ov - x sa .S'E o )o,o dE<'=El . A EPO c:o. "6 Nt .o^ ral Fr\o \o r- \o ao $N\o o\ o\ co \o o C) o0(B q 0) c oU o ll + td l{ B1 6.) o Fo-. F Oo\ -o o o O O o o.o0=O- Ss,:il iF3 95;a Oorxl O O ri qO o' q! u 5 Pg tr E= U5 Ei bz8- o.ta) co coOvl co cO co cao to I-l :c)E 6.2 iEo::ot uFFU O o\ co c.to v'l c.| c-) c.) $ r- c.) bod =q .r6ts* g IH+ ot >.:: oS9Pqn)F E - EEE '6 o o o\vI co coO co c.)Ov} co $ r- co & gr o(\l O (.I N (\l c.t oN \looN rr) o(\l \ooo at r-oo6l @ N o\ooN o o6l 2.7. Ordering, storage and deliveqy of ivermectin Mectizan@ ordered/applied for by - (please tick the appropriate answer) MOH EI WHOtr UNICEFE NGDC Other (please specify): Mectizan@ delivered by - Qtlease tick the appropriate answer) MOH EI WHOtr UNICEFE NGDC Other (please specify): 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 system in the country. Then the drug is stored in MOH warehouse from which projects levels receive. From the project level (zone level) the Woredas receive it and distribute to the health facilities. It is from the frontline health facilities that the community supervisors get the drug to distribute to the CDDs for them to distribute to the communities. Table l0: Mectizan@ Inventory (Please add more rows if necessary) How are the remaining ivermectin tablets collected and where are they kept? The remaining Ivermectin tablets were collected by focal persons and kept at zonal pharmacy store. List and briefly describe the activities under ivermectin delivery that are being carried out by health care personnel in the project area. r Collection of ivermectin from the Woreda Pharmacy store . Distribution of Ivermectin to Front line health facilities . Distribution of Ivermectin to community supervisors . Distribution of ivermectin to CDDs . Training of community supervisors and CDDs . Management of severe Adverse effects . Supervision and follow up of treatment operation . Recording and reporting of training and mass drug distribution data District/LGA Number of Mectizant tablets Requested Received Used Lost Wasted Expired Remaining Illubabor zone 1,543,896 r,544,000 1,421,016 0 8,528 0 114,456 TOTAL 1,543,896 l, 544,000 1,421,016 0 8,528 0 114,456 Any other comments 2t WHO/APOC, 24 November 2004 2.8. GommuniQl self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? Yes If so, When? March,2007 The community self monitoring training has been given for health workers and community leaders, So that most communities have carried out self monitoring in their respective villages (communities) Table I l: Community self-monitoring and Stakeholders Meeting (Add rows if needed) Describe how the results of the community self- monitoring and stakeholders meetings have affected project implementation or how they would be utilized during the next treatment cycle. Stakeholders meetings have been conducted at each woreda of the project. In each village the community supervisors and community leaders have supervised and monitored the implementations and the performance of CDTI activities. As the result the number of absenteeism and refusal were reduced and the therapeutic coverage showed progress. District/ LGA Total # of communities/villages in the entire project area No of Communities that carried out self monitoring (CSN[) No of Communities that conducted stakeholders meeting (SHIvf) Metu 347 347 160 t70 221 t54 463 Becho Bilo-Nopha Alle Didu Bedele 160 170 221 t54 463 I I I Dabo Hana 2t6 216 I Darimu 809 809 I Alge-Sache 436 436 I Yayu- 3t9 3t9 I Hurumu 292 292 I Dorani tt7 tt7 I TOTAL 3704 3704 t2 22 WHO/APOC, 24 september2007 I I I 2.9. Supervision 2.9.1. Provide a flow chart of supervision hierarchy. NOTF )ROTF) ZOTF) WOTF ) Health Facility ) Community supervisors ) CDDs 2.9.2. What were the main issues identified during supervision? . Delay in starting training and retraining of CDDs, health workers and community supervisors . Delay in starting of Ivermectin distribution and per long the time of Ivermectin distribution . Most woredas were staffed with few health workers and luck of focal person that leads to poor coordination . Weakness in proper handling of documents and poor reporting in the front line health facilities. 2.9.3. Was a supervision checklist used? Yes, supervision check lists were used at all levels. 2.9.4. What were the outcomes at each level of CDTI implementation supervision? Significant improvement was registered for the year. 2.9.5. Was feedback given to the person or groups supervised? Yes, verbal and Written feedbacks were given for each level. 2.9.6. How was the feedback used to improve the overall performance of the project? Significant improvement have been observed in the over all performance of the project this year due to the continuous supervision and feed back. 23 WHO/APOC, 24 september20O7 t SEGTION 3: Support to GDTI 3.{. Equipment Table 12: Status of equipment (Please add more rows if necessary) *Condition of the equipment (F:Functional, CNFR:Currently non-functional but repairable, WO:Written off). How does the project intend to maintain and replace existing equipment and other materials? For the time being existing Capital equipment and other materials provided by APOC were effectively repaired and maintained by the project office and its partner's .The project is trying to handle and to improve the overall performances of all activities by integrating to the existing government system. It's expected that APOC would replace these equipment by the end of the hfth year and at the same time efforts will continue to allocate budget by the govemment for smooth operation and management of the project. Source Type of equipment APOC MOH - Zone DISTRICT NGDO Others No. Condition No. Condition No. Condition No. Condition No. Condition 1. Vehicle 1 F 2. Motor cycle(s) 6 F 3. Computer(s) I F 4. Printer(s) I F 5. Photocopier (s) I F 6. Fax Machine(s) I CNFR 7. Overhead projector 1 F 8.25" TV set 1 F 9. Deiesel Generator I F 24 WHO/APOC, 24 september20}7 3.2. Financial contributions of the partners and communities Table 13: Financial contributions by all partners for the last three years Year I (2004\ Year 2 (2005) Year 3 (2006)) Year 3 (2006)) Contributor TOTAL Cash Budgeted (us$) TOTA L Cash Release d (us$) TOTAL Cash Budgeted (us$) TOTAL Cash Released (us$) TOTAL Cash Budgeted (us$) TOTAL Cash Released (us$) TOTAL Cash Budgeted (us$) TOTA L Cash Release d rus$) MOH (Central + State) 13,983 13,983 14.983 14,983 0 0 0 0 MOH (District + zone) 40,475 40.475 42,475 42,475 45,575 27,040 20,762 20,762 Local NGDO(s) ( if any) 0 0 0 0 0 0 0 0 NGDO partner(s) 67.970 67,970 66.59 I * 17,25t+* 16,393 16.393 30,974 30.914 Communities 0 0 0 0 0 0 0 0 APOC Trust Fund 64,175 35.000 50, I 96 20,000*** 48.268 20,000 15,000 8,000* TOTAL 186,603 157,428 174,245 94,709 110,236 63,433 72,590 60,415 *only first installment from APOC trust fund - If there are problems with release of counterpart funds, how were they addressed? Delay of release of APOC trust fund that may lead to the loss of second installment - Additional comments Integration of Malaria and Onchocerciasis control programme (MALONCHO) play agreat role in the implementation and good performance of the CDTI activity for this year. 3.3. Other forms of community support - Describe (indicate forms of in-kind contributions of communities if any) The services of Community Drug Distributors and Community supervisors are considered as the major community contributions for the CDTI Project. Overall, there are 8,827 CDDs and342 community supervisors are involved in the entire project this year. 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 exchangerate used here IUSD:9.03 25 WHO/APOC, 24 september2}O7 aTable 14: Indicate how much the project spent for each activity listed below during the reporting period Any comments or explanations? Assumption of the exact budget for CDTI is not an easy due to the pooled finance management system and the integrated nature of the CDTI project to the existing health program. SEGTION 4: Sustainability of GDTI 4.1. lnternall independent participatory monitoring; Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable) None Year I Participatory Independent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation Internal Monitoring by NOTF Other Evaluation by other partners 4.1.2. What were the recommendations? , Activity Expenditure ($ us) Source(s) of funding Drug delivery from NOTF HQ area to central collection point of community Mobilization and health education of communities Training of CDDs l.elLrye of health staff at all levels Supervising CDDs and distribution Internal monitoring of CDTI activities Advocacy visits to health and political authorities IEC materials Summary (reporting) forms for treatment Vehicles/ Motorcycles/ bi_cycles maintenance Office Equipment (e.g computers, printers etc) Others I 330 I 360 2,040+25031. 1500+6953 MOH APOC APOC +NGDO APOC +NGDO APOC+NGDO NGDO NGDO NGDO Apoc +NGDo APOC+NGDO 2,000+1329 0 3325 3,166 1,713 700+554 400+398 0 TOTAL 51,799 Total number of persons treated 26 WHO/APOC, 24 september2}}7 4.1.3. IIow 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?NO Was a sustainability plan written? NO 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. !ntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3.1. 4.3.2. Ivermectin delivery mechanisms The ivermectin delivery system is very well integrated into the MOH structure right from the onset. There has been no separate Ivermectin delivery system in this project; it follows the existing drug delivery system in the country. The project will be normally notified to collect the drugs as soon as it has been cleared by the WHO clearing agent in close collaboration with the MOH. The project coordinator will then allocate the drug to the respective project woredas and FLHFs. Training: All health professionals in the entire project were ffained and retrained on Community Directed treatment with Ivermectin (CDTI) every year. CDTI is integrated with the Primary Health Care (PHC) from the beginning. Therefore, CDTI is parl and parcel of the health care delivery at all levels. 4.3.3. Joint supervision and monitoring with other programs Primary health care activity in the project area are supervised and monitored in an integrated manner. 4.3.4. Release of funds for project activities The fund from partners such as The carter Center is released on time However, funds from APOC Trust Fund is delayed. t 27 WHO/APOC, 24 septemberZ007 t1a 4.3.5. Is CDTI included in the PHC budget? Yes, CDTI in this project area is an integral part of the malaria and other. vector borne disease control unit at all levels and have similar budget. 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? The CDTI structure is used for malaria control program particularly for bed net distribution, for follow up the utilization of bed nets, in expanded program on Immunization (EPI) and for TB default tracing. 4.3.7. Describe others issues considered in the integration of CDTI. The Health Extension Package program designed to reach all Kebeles that will play a major role for strong integration and sustainability. 4.4. Operational research 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? l SEGTION 5: Strengths, weaknesses, challenges, and opportunities Strengths: The project is successfully accomplished the distribution of Ivermectin for the fourth round within the given period of time with 100% geographical coverage and high therapeutic coverage. This great performance is due to the active involvement of the health workers, community supervisors, partners and the community at large. Weaknesses: poor document handling and reporting, delay in liquidating the utilized budget, delay in starting Mectizan distribution, weakness in collecting leftover Mectizan tablets after treatment from CDDs and storingatZonal Health office. Opportunities: The govemment structure down to village level "Geree" and being taking the responsibility of development activities as well as health is a good opportunity for sustainability of Onchocerciasis control. The expansion of Health Extension Package program and the increased numbers of Health extension workers is an opportunity for the programme . Threats (Challenges): The high turn over of health professionals at all levels, the continuous restructuring of woreads and kebeles , overburdening of health workers in peripheral health facilities, in different health programs such as malaria epidemic control, polio campaign ,etc. SEGTION 6: Unique features of the projecUother matters None 28 WHO/APOC, 24 september2}OT