Jimma annual project technical report submitted to Technical Consultative Committee (TCC): from January 2006 to December 2006

Ifi o:; For Action Tol iqMnr?0[}7 30 The Federal Democratic Republic of Ethiopia Ministry of Health 4eb UP Ailsgtu rc gJr/t for hfurnoilon To' DiR rt L0 MI QTF: ETHIOC Y PIA ame: JimmaProiect N Approval year: 2003 earz 2004Lau nchins v F rom : Jn n.ue.r.y..29.8f .......... T o ;.. . . p s.c. .e. .;1Lb.er .?.QQf.Period:Renortins Month/Y ear rt:Proi r of thisect yea (circle one) I z 4s678910 Date submitted: 20 May 2006 The Carter CenterNGDO partn I ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) D FOR SUBMISSION: To APoc Management by 3l Januarv for March rcc meeting To APoc Management by 3r Jurv for September TCC meeting AFRICANPROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) ( I | 5 JUIN 2007 WHO/APOC, 24 November 2004 i.'- '-'--'- I LI 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: Signature:. 4&( Date tA"d,,ra Zonal' O nc[o C o o rdi nator Name : .........N.as.i.r..A. b.dp-..... signature: I'P Date: ....._lrloj flo aoo"7 NGDO Representative Name : ..........A. haLe..TiLa.hun.......... I lr Signature:.. Date: . . /.1..ft/-,c- . 3.e.d(. . . This report has been prepared by Name : ..........N.as.ir.A.b.dp...*.N.QT4........IILJ Designation:Z..q.nE.Qns.hp..Cp..qrdinatp..r Signature Date ll v ,lt. (\ d- -rl o.= () (D o/ :B v, .t' WHO/APOC, 24 November 2004 I t T 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: Ethi ta National Coordinator N am e : ...... .. ...Dr..A.fe w. .q r.k..Hai.lp.m.ari.am Signature : ............. Date: Zonal Oncho Coordinator Name: .Nasir.A.bde.. Signature: Date NGDO Representative Name : .......... Ab..a.te. Ti.lahun ......... Signature: .... Date: ... This report has been prepared by Name : ...........Nasir.A.bd.q..J.NgT8........ D e s i gn ati on : 29,p.9. g..n gh.q..C. .q p..rdi.n a.tqr Signature : ..... Date II WHO/APOC, 24 November 2004 I I lTable of contents Acronyms' ............... ivDefinitions ............... vFOLLOW UP ON TCC RECOMMENDATIONS .......6SECTION I: Background infonnation......... ................. g].L GpNeRel rNFoRMATroN............. ........ g1,2. PopulnloN.............'. '.................'..... 9 2.1. Trvpr_rNe oFACTrvrrrES............. ...... l02'2' Aovocacv .....................r22'3' MostLtzarloN, 'ENSITIZATI'N AND HEALTH EDUCATI.N oF AT RrsK coMMLrNrrES12 2.4. Covuuqrry rNVoLVEMENT........ 2.6. TRBarupurs.............. 2 7 ORoeRnrc, sroRAGE AND DELTvERv oF TvERMECTTN2,8. COUULXITY SELF-MONITORING ENO STATEHOLDERS MPETNqC2.9. SupeRvlsroN............... ^SECTION 3: Support to CDTI3.1. Equ1rueNT............... 3.2. FNqENCIEI CONTRIBUTIONS OF THE PARTNERS AND COMMTINIT'".............3.3.olrpnFoRMSoFCoMMLrNITYSUPPoRT............... SECTION 4 : Susrainability of CDTI.............. 4.1 - INrenNeL; TNDE.ENDENT pARTrcrpAToRy M.NIT.RTNc; EvaluarroN ... .. .4.2. SusreNeer,-rry oF PRoJECTS: PLAN AND sET TARGETs (ueNoaroRy AT..Yn 3)......:........... 4.3. INrpcRerroN............ SECTION 5: Strengths, weaknesses. challeng.r, ,rJ "pp"nunities.....................SECTION 6: Unique features of the project/othe. matieis ......14 ...... 16 ...... t8)) ......22 ,..,..23 24 lll WHO/APOC, 24 Novemb er 2004 .25 26 26 27 27 27 28 28 28 ...,.,.25 ...2s )Acronyms APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT LTNICEF UTG wHo African Programme for Onchocerciasis Control Armual Treatment Objective Annual Training Objective Community-Based Organization Community-Directed Di stributor Community-Directed Treatment with Ivermectin Community Self-Monitoring Local Government Area Ministry of Health Non-Governm ental Devel opment Organization Non-Govemmental Organization National Onchocerciasis Task Force Primary health care Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Stakeholders meeting Technical consultative committee (Apoc scientific advisory group) Trainer of trainers United Nations Children,s Fund Ultimate Treatment Goal World Health Organization IV WHO/APOC, 24 Novemb er 2004 Definitions (i) (ii) (i ii) Total population: the total population living in meso/hyper_endemic communitieswithin the project area (based on REMO und ".r,ru, tu[ing). Elieible population: calculated as g4%o of the total population in meso/hyper_ endemic communities in the project area. Annual rreatment objective: (ATo): the estimated number of persons riving inmeso4typer-endemic areas that a CDTI project intends to treat with ivermectin ina given year. (iv) (v) (vi) (vii) (viii) (ix) calculated as the maximum number of people tobe treated annually meso/hyper endemic areas within the prolect area,ln Therapeutic coveraqg:. number of peopre treated in a given year over the totalpopulation (this should be expressed ur-u percentage). Geoqraphical coveraqe: number of communities treated in a given year over thetotal number of meso/hyper-endemic communities as identified by REMO in theproject area (this should be expressed as a percentage). Integration: delivering additional health interventions (i.e. vitamin A supplements,albendazole for LF, screening for cataract, etc.) through CDTI (using the samesystems, training, supervision and personnel) in oider to maximise cost_effectiveness and empower communities to solve more of their health problems.This does not incrude activities or interventions carried out by communitydistributors outside of CDTI. Sustainabilitv: GDTI activities in an area are sustainable when they continue tofunction effectivery for the foreseeabre future, *r,r, rrigr, treatment coverage,integrated into the availabre hearthcare service, *iIn strong communityownership, using resources mobilised by the "o--unity unJ,h" government. 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'dyear ofthe project) The process by which the communi ty isempowered to oversee and monitor the performance of CDTI (or any community-based health intervention programm e), with a view to ensuring that theprogramme is being executed in the way intended. It encourages the iommunito take full responsibility of rvermectin distribution and make appropriamodifi cations when necessary ty te v WHO/APOC, 24 November 2004 FOLLOW UP ON TGG REGOMMENDATIONS Using the table below, fill in the recommendations of the last TCC on the project and describehow they have been addressed. TCC session TCC rd Number of Recommendation in the Report TCC RECOIIMENDA TIONS TAKEN BY THEACTIONS PROJECT FOR TCC/APOC MGT ASE ONLYr9r ore accurate calculation of the quantity of future mectizan needs of the project. M trainings and the review meetings conducted have focused on this issue and it has been corrected. The corrected UTG in table 2, and everywhere else in the report. Inclusion of Corrected comm un rtSr supervisors rs commended, but SHM is still recommended for implementation The use of SHM training conducted. has been o indicate gor".,rmerrt contribution which is indeed very significant T, are done in integrated manner and is difficult to identify the exact amount spent for the CDTI, we tried to estimate the MOH contribution which is Though, the health activities indeed si ficant. ancial returns to ApOC promptly to avoid delay in transfer of funds. To make fin officers On b trainJo was forng glven cefinan dan CDTI coordinators 6 WHO/APOC, l0 February 2004 Executive Summary l. Background on treatment and population data Jimma zone started irnplementing CDTI acuviq' in 2001 and this year ls the third year o[ the trearment lretiod. In 2t)0(r there were a total of 800,927 people in the project area .1r;th 610.742Annral Treatmenr ()biectrve (i\TO) for the year rvhich is the same as the U fG. The total number of people rreated were 571,039 urth a therapeutic coverage of 71o/o and 100% geographic covefage. The project area has total communitjes (vrllages) of 3607, rvhicl-r are distributed in -1 Woredas (Mana, Seka-Chekora, Shebe Sombo and Dedo) artd all the villages were co\,'ered with Mectizan treatment since the start of the fteatlnent. 2. Background on population movements. The communities in CDTI areas are mainly settled farmers, daily laborers and civil servants. Flence, there is no rnajor Wpe of population movemcnt in thc proicct arca. 3. Training data This year, training and refresher raining were given for 106 health professionals, 114 communirv superwisors and 10'874 CDDs selected by the communities from 3,607 villages. Therefore, the average nurnber of CDDs pcr villagcs is now threc plus (3+). 4. Challenges and how they were overcome. Threats (Challenges): Overburdening of health workers in peripheral health facilities in different health programs such as malaria epidemic control, EPI and campaigns like Enhanced Outreach Strategies for child survival. Multiple responsibilities over coordinators and poor recording and repofiing at health facility levels are also additional challenges. Opportunities: The government structures that are now stretching down to village level called "Garee" are taking the responsibility of managing several development activities, in which health is also a major component. This is a good opportunity for sustainability of CDTI in this zone- The expansion of Health Extension Package program to establish health post in each and every Kebele is also another good opportunity. 7 WHO/APOC, 10 February 2004 SEGTION i: Background information 1.1. General information 1.1.1 Description of the project (briefly) Jimma CDTI project is located in the southwestern part of Ethiopia in Jimm a zoneadrninistration' which is one of the zones that constitute the southern o.o,,iu Regional State.The Zone is further crivided into l6 administrative wor"aur. The cDTI project area covers 4 woredas which have a total population of 710,030. Theproject area shares borders with Kaffa-Sheka cDTt i; th" south. The 4 woredas are furthersubdivided into 137 Kebeles which, is further aivioeJln t o 3,607 ,,garee,, (village) composedof 25 - 35 nearby households and responsible for all development ac-tivities'including health. The climate of the GDTI project is classified into three geo-climatic zones: highland, mid-landand lowland area' The mean annual temperature rages f."; j; h ;; i?? t, in. high ra,d, r 60c -26 0C in the midland ""a z ic -ij bc in illiJ. i"rr" *nrul rainfall totats are highest inthe highlands of the zone reaching 2000mm. There are- two rainy seasons. The main rainyseason is between June and octobei while small .r; ;;;ron is from January to April. Some of the perennial fast flowing rivers that cross Jimma zone include: Gojeb, Ghibe, GilgelGhibe' Dedessa' and Kawa' TherJ are also a number oir*att rivers and streams, which aretributaries of the large ones in many places in the zone. There is a main asphalted road about 340 Kms rhat connects Addis Ababa with the capital ofthe zone' Jimma town' Each cDTI woreda capitats a.. connected to Jimma town with allweather roads' However, within the rural communities the roads are only for dry weather.There is also 3 times a week flight to Jimma town directry from Addis Ababa. The health infrastructure in the Jimma project area is relatively good. The zone has I zonalhospital' I district hospital, 15 health centers, 64 heatthstations and 46health posts. There area total of 127 hearth facilities in the CDTI project areas. - -" Table 1: Number of health staff involved in cDTr (please add more rows if necessary) 8 Number of health staff involved in CDTI activities. District Total Number of health staff in the entire project area Number of health staff involved in CDTI Percentage *lSeka-Chekorsa 15 12 80Shebe Sombo 27 25 93Dedo 25 24 96Mana 46 45 98Total l13 I06 94 WHO/APOC, t0 February 2004 s c{ x d .o 0.) lli O Q o Ar o +{ l4Ill () q) L\$ ,s : lr) co I n ciN()q< dv 83 'Fotro-o.tr()= <* UDo.H9.trrtEocad 9 ^q,EqJ €: (B\J ba rJ q) J(g Qo6g HC) '5^ *i .2 u)Fo>F> .P- o !E=bo5=(g(,:y -rru'- ri ,l- :dbo6€.s x(B-d!H .-P- Fd4 )V- ddHFH!- EE3Y 0)'-q 5'Stj bo'E .>9aaP(L)pIctr .= - (.) HpE5 or€ +, C0)GU\ -q(sr,B,at C) o_ ,=e(gE.= =E o.i# o.i I o>PU5 = rn'6 >-( x -.Zrn>, 0)!'C.) l.'E uOa H (g.r C;_; P tr>tr 35", L{(B 0.) o z \ l,(.) o soq) o'L\ AJ -s q)\I q) -s \) q) -t oF- q) -Ro UL o \) q) * q) q) -o -eVl U$ P'\ q) s q) 60 q) U o 's\ bo ou b0 q q) -tU q) L lq) (J q)L q) .o o AJ ll q)L u a) \ls) *E l v) q) qJ q)$\o4q) q) q)L a) -o o AJ sq) ,\ q) -s H(l lq) -t 4s q) p u lt(5\ -jo 'r 0) o) o L{o C) cd o)L{ 0.) li(B t<(.) 0) o)Li ct e) 6.)l ()fr (l) o I .t) li (g o CB o\ a) L<(.) q) o o cnqi (u ol< 63 o o) 'a Hp. G) o (d a.o o. (.) o cd (/) q) t< a.) qi o o (g L .o Lro d o)l< c) U) Fgf ar ErE *Eo oo=-qtrEa) '6a9 5C);J 9 E€(gri- =96>'x (B e l! OilF E 6 o(.) .l) (.) oLr o(n t-r(D o li0)lo-Ibot IEB Il<^lo= IB; I 'E a' _3sE * o-r ii bO -C vrc€l 'trtr I I)tE'C!I I0)(!ltr<, I €€ H €-d8t q 'd o-r -IE.g E o)io I.DE * Q'z arn9, oE 3 8E6 (d n2 F<r -;)* o\ @ o\ F- ol N @ !i- o\ \o C\ $\c) N (.Iv r-- !+\o F- oo o\ =c.l (.1 o\F- c.io N .i-q c\l ca Or- h F-N]O\l ol =l \o $ o, co ca CO N$q oo\o \o r- .t a.) F- -. cl L.;t:9Ec.i hx€;E< 'r6EP'N= F il o o cg cl og(, Gte .= q) +jE q) (, 'Eo91 E! 5E.=ur6)C)o tr.= SNi. r(u aOO .= o.N; -i".:Ec- E l-q4)L (DE r-vI N o oo$" o\ ca O N oo Oo .o^ ot oo Vt r-.Nv .eE €atro9I9E Ei-d0)t= >: e)lrr E N + a il I o) oO(D fil F Q) oN(J q) q) I o Ir c) zl I 'EgS €: H E.=urq)q) Z\o' SFa @\o .+ N N a- cn o\ t-.o .o- c.) \o s \ot'-\o c-'lNv rl ^rl c-O \oN oo r) (f) € o\ cltr9o9= .FLL$ Gt ij !'a -- E Y6 E o.:aF 3e e'!^E:L- x! E r* 00q$ N o\\(.Io N w =1.N co c.) ot--d : F.6lq o -/ (n q)Es8(,'5 thr:cEHc)rieE Q-9\J .= a, ld L o o) .EQ d .Y c) a o -E o U) o -o0) a o o) o (! (! Fl F F. F 'o t)) L (L)Os{.trtE= -)<JFCEo-r: IN I F a U)t- 0) G C( 6t rd c)(do N oo 11 0 Ya) .i t< o-o ;E "ibe3 JA- _bxo 'EErE'iDg15 ar- O'QTO acI)i- rH!JPL €E eUF ^-c ;ti (!, Lio^o) '5->d >.oN.=OO -v)L'='= o)!H-(JdPctroL _Hr V ^LU-}E Ex uo5 rr. iE € eB(s(s L ^15 c)co0)E .Ei b E 9aa s * +,< v ^i-*3 E co 0) r) .-F0) - (Bi '13qF F -^o-.= a' '= (g.= tdd c,)Q= -Pc)(JEdrHEF tscdoO-(, o,L boP_3qEP -rLE 0d rzrt; q.9!p Lr)k-(B o'-\LV> -0-).(g!H*orH=b'o = -q ooF 9doE(/)o c'J -o? O <ht- E.3 E cr'S -cpo(g q*.69 Fccoo^'(J c- 0) F o.r 'Y 'a€ 5 (D(!.S -oo5 6r!H _-E I ,l' 'j'*= U ccs(d:r>c)V) OE SECTION 2: tmplementation of GDTI 2.1. Timeline of activities Fill in table 3' timeline of ac-tivities for areas treated in current year, indicating when the keyactivities were impremented by the month they began ,.rJ th. month they ended. 10 WHO/APOC, 10 February 2004 r $ O c\ xr(6 E -ooI! O O op. 5 v1q AD\Jq) .S k \ q)\ o \.{ \D C) q) a_\_. L(!()x ot o q) q) (t() t< (n (.)tr o) t< (n o) o(!qi o() (.) E F e.i r ol -ol l-l (n a o Q \oo c\ P o- 0)a \c) 6l 9o. OJa \o C\ o-() a \o c.l 9 o- 0)a aI) 6rx \oO(\ 0.) \o o c!() \o c! 0) \ooo c..t o o E L t) Li a o 6Jg EE oI \c)O c{ o \o Oo C.l 0) \oOocl o O cn() H= Ptr ct= \o O c! CO \oOoN x(t \coO(\ (! \o o c.l (s 2. o c( U) .a Q) U o Etr L) \o oN x(B z \oOoN (g z \o (..l (s 2 \ooo ol cd a 0.0EE C{: u)- \o c.t (\, 2. \o O ot \oOOC! (d 2 \o o'l d 2 a0 6lIl-l ,.l (ur e Etr Q \o C\ (d \co c! x cU \o N z, \c)oON (g z ADtrS :tr CE:(n- \o Oo N (d \oo O N G \oooN (u z a.l (6 OuD .= .;-PEGl{N= oo =q)a o U \o N (o 2 \o N 2. \oOO c! x6 \o o a..l (B z bn cY(n- \ooo c.l \o O ol (E OON (B \o O on (B z () Fl (.) L U) a< (o r Jo (J CO -v(.) CN o -o E oa 0) -oq) U) o 0) o (g (B 2, Fl F o t-r 2.2. Advocacy State the number of policy/decision makers mobilized at each relevant level during the currentyear; the reason(s) for undertaking the advocacy and the outcome. Describe difficulties/ constraints being faced and suggestions on how to improve advocacy. Political leaders and onchocerciasis task forces at different levels particularly Woreda andKebele levels were involved in the advocacy meetings to suppoft the overall CDTI activities.The biggest challenge in the area of advocacy is-that theie are several other competingpriorities in the project woredas which makes it very difficult for the policy makers to singleottt such a control program out of the many so called "major killers" that are causing a lot ofdevastation to the communities. Community mobilization was done at each village organizing community meetings. Thehealth workers at all levels have done their best inlivini'treatttr education and follow up theactivity' Task Forces at kebele levels have playea m-aior lole in mobilization and sensitizationof the whole community at grass root ievel. community Supervisorc und cDDs were responsible in giving health education to the community at viilageievel. The community mobilization has contributed a lot in awareness creation. The awareness ofthe community, their involvement in the CDTI activities and their interest in getting Mectizantreatment has shown significant growth. As a result therapeutic and annual tre"atment objective rate have been above the expected range. 2.3. Mobilization, sensitization and health education of at risk communities t2 WHO/APOC, l0 February 2004 .t3 a Oc! k o) .o E(l) z tc! U o H o B $ o C) O a0C ?A :-9 o L o ! E z o Ii let d EO 0 L Ov \oc-l coN L't x L 0-95tJ =fdZEE N O r-oo co 6lo $al € ! 6 U L 3z la + c0 II G oF o\$ co @ ooq \oo cooo o'.i !c r-- € t0 2-so E! N c.| F- co N !+ al € t0 H U 3( \o co oor-q $a-.\c o.i co co r-- c.i ia Lq E !8 U.L )ooi o L E E z o I+ co tri E c oo d L Oo o O Oo f,arr 5 = !'3-E tr= !!gtrtrEY r9:! ZeEo \oO oo N\o No 3 F- c.) r- \o lY, la EE .cq =oo lc.= E -E=EFtrqJ Ee \o @ C.l\o a-) N F- CO o\ r- \o J L cd :1 0) (-) I CE -v,oa o .o o(t) o {) =a o c) o (d (s cg oF ?) bqj Uq) .S U1: p q)\ o S q) va q) s F L.lO() o a. o P(tl (r) C) (-) =tt o.)l -.ol -(qlFI I E o E o .a o .E fa- tr -J E E o(, at IN A. g 0)@Ca;;9.; V L 'O i{ ru (B .!n t-a@4, .H t-.1 BUoo ^rlaXU€ >a cdq6 c.. FE6o-x O,Qx Eat-l v;!-Hii E Cgv a\ o.l hriE v, qi'=:o tr Fo .o o 6';;U E X .9o gI ePaH )dJH;i Cgod.X F 3Ebo .tso =ch .-5 5a;9 Ef -o 'r= .q E - ! €Yo() -YorD0")9ts4!- ':. .= l-.1 O'aAr< ^ d U ^YZ ai * *s i€(1)t E E EE8E ,E g al^!JEZ t f oion v g P CB\/ (t) (D U)(Atdou) -9i' oo$)tr -'6 a F(D Ud a3qu)d ara H^FUa €uEltr P Cd-Ou)Elobr) '= I>Ijo)t^ 'ia)x € FI ,>\ u[i .ts .g ui<g :i .:boc = chtri^- tr a .i .U!9HLEr 5 ALic)oc) trq,qH .i LU !* f ideec) ohtD= -=H b 'dV Lc)(u*(d6() H trE.q o .= H€(d.tr.=3E O E;'i g >. "(rilX .i€ € v n<.(!AE:.E50)eHA E 50Ee'E €Pocuo)e-o p. c)9E '5 E L.^ts tr x6.E g.= ql u ioc €trts .O3-OEFE $EHFUX'trirxOEq - -o .2'- = o >r1, HEE -e 9',E(1)(E e= (g9rO>_O. ts ; a'=:0 - -F!oY-=L ,\ L ^ v d vL-'i= -E g H 3-;-H = F'5 Ig R eE E<d E 3.> tf ON dat-p 0.) Irr O (J o {(J +{ ra) t I 2.5. Gapacityrbuilding - 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 todo' to remedy the situation' (The moxt important issue to describe is what measures weretaken to ensure adequate 1DTI implementation where not enough knowledgeable manpowerwas available or if staffarefrequintly transferred durin[ the course of theiampaign). Trainings on GDTI from the higher level to the community rever has been given in adequateamount to carry out the CDTI activities. However, there were a few tum over of trained staffparticularly at the woreda and front line health f;.iiit i"r.tr. This effect of turn over wasalleviated by on job training of the n"*ty assigned staff at all levels. t6 WHO/APOC, 24 Novemb er 2OO4 q) cq O a U c) z Flr-: S,:qu G ise o\ .ir \o co o.l oo oon @ o^ Os \o l,-lco c\ t c.l 6 c.i $N oo- O rf, t-- € io €t- F. O\l6l ol "l o\ o\ q) q) o) .o o\ FU O o\ .i- Ot-- o- .$ @ (-.t o\ o 0 0) .=Gdt< qJ: oq)!9 LcloL z Fe_= Sd (j]z o o O O q) o 0,) (, soL O c) cll li o) ta -oQtrg >; 0)(.) Q + Q (J bl I L)o S s a F- ----1 .1- N co l- t: l- N\i- cn N € o\ oll.-l I -l fO o\ o) 0,) c) e soLF co c! (\ s ia q) G GI ar) a) c) U) o) z ;,dE.l +F-d Gisq > * l_ c\ ..l c.l ca o co I -il 00 (JF N N co Fl g) q C6I -vq) O (g .Y 0) <n o -o oa() .o c) (/) o q) IJ CO z, -l t'r o F{ $O c.l F(.) .o E 0) zs ol a\ UA o +r ts i * * v1qq) Uq) .S 4 o\ q)t\ \ q)q q) E o (€ 0.) () a. F a(J(* o .t) C) (D o)L .(D !H E o) oo cdLF .Ar o-rl -ol(dl FI bO a o o p s{ { I r- IU l o bO o\ p t \ o a\s ,..\' A< I oo q) qJ c) 9 s L) O IThere was no special training organized.on cSM using the Apoc manual. However, thattask was taken care by community supervisors which weie trained by the respective FLHFs. Table 6: Type of training undertaken (Tick the boxes where specific training was carried out during the reporting period) Any other comments 2.6. Treatments 2.6.1. Treatment figures If the project is not achieving roo% geographicar coverage and a minimum of 65%therapeutic coverage. or the *u".ugJrate is fluctuu,irg, ,?u," the reasons and the plansbeing made to remedy this. Trainees Type of CDDs Other CommunE members e.g Communrty supervisors Health Workers (FLHF) MOH staff or Other Political Leaders Others (specrfy) Program management How to conduct Health education Management of SAEs CSM SHM Data collection Data analysis Report writing Others (specify) 18 WHO/APOC, 24 November 2004 sO NxLr d Es o)t\ U o. oH B o\ q) 0O sl I E(){i$L uosa 0O .srh\vrt-S\.s)qVB(dP 9q(uc 6Eoa) .R .8. Y.\a:3(.)Yn .F .a .E;oaa .=E1B.sS2.S 3 :Y )! q)Ud\: s3 'ZlsgSE. =:cth:E E TE5: E -\13lly,SE ,r s $E .S 's='s; -E $$E P- S\!-l \ lar'= \ '=.s3g F EB -l o,l v ",5xl! : ${!l I s ai' xla H i!flI 5 tBElf H iE()l p ! *qrQl o = tE'.=tsIE T E! xl E s sREIE I T:zlt i t:r f t h;bo qrdi ,Q\ 'i so \Ell : st E E"t !* \,{i' ist E:= : TQ Hx \ try s :8o s .s'iE9L -q r udI 3 Er$ $tI f EsI rr ttS;J o t>!\o t\ SSo\ \ aS: ad 0.)li(s Po C) 'a .gX()h-3 99o(l).= 'a L \./H2.9ElE& .tr;.;j-o P -u) .;o= L .= c)tr'o EHEaA G,) o+jo'E tr ot co ol !E -l EE "l gb El.ga. 'dl trF gIEI 3l E o,(.) o,0 ,r oltr Sl 6 Hl ,,; EI$ TIE30 ul: gl E! :l3 Elf .- Ft F !t v; EIE el ; .e Et 9 ElH = ol |r C)l E -: ol X Ol 'cd5 (*l = el c) o- ol E ol ,lO ulf 'l-O. (,l tr C)l=E €lr €liHI!HIHo =lo =1trF Zt? Zt< x E(.) cn C) ti o er 0) ol c-l ol r-l 0-rl -ol EI ft zl o ll o(! t< o) ooF^()X o F (L) dL 0) bo(\lL(.) o o (Boa crl ti bo o 0)(, 0)(!L o bo(! l< c) C) o /:. 0.) + Lo F k €(! : EE E;9 B( q= a O=E6-4q -o.Y o v'o; OEH*EH:fZ gqY o6g o O O rrl €?>a2z o e bsotrcG) 3.o zd oN € od O ol oo c.) o\ .d sol a.) r,o N €in E- -B; ,E E.gE BEg>o= rA qi9) c\ N O$ c.ls o\r- a! OI o (! q op< o ll r cta A o\ o!ofbood =ooo -EoF o\\o oot-. t-- @t-- r- a o -*o=o -!l@dEh$) :6-!z {-r- o^ o\s N o\ .o^ o oo $ oo o^ ca NN o, @ @ o\ a r- ra o =odo= =E6E 8.9< 94'FU o. oo o\ r-- ca c.J N co $q \o c.l s\o v1 N N{r- t\o a .= dolu - O F€5--c i o o-:oE _'tao oF t-* ooq =c\ co o\ t-t ..i Nv =r:N ca ca O Frd F-N o\ oO co (,(.) oo 63 U)o o() a ll + =9ol -h0o- ss9uE5o: uo o O o ru -g.E U!o c M92 -o = d-;;tr tr= ii =E'EAO \oo co c{\o r.) olOv] t.-o\ r* \o aO =od o.a2EEE H.O "t6' \oo @ c.t\o clO ") F-.o. r-- ?al \o@ :.8€ b S :.: tr f E *C-A-- -=a,c.Yig EsEs- o>*6 \oO@ (..l\o co NOvi F. o. r- \o ?o .E< EAo- (q : -rzi>O o!ta(J ,Ps-=(uEtoa c/) oo (! c! z tl F t-r ) (\ q qj Uq) \- U}. q)\ o \\ U V) q) U JZ(n (d a(! 0)L(c cd o --l C) IA -o (n rI] a (! 0) (g 0.) tiF rrf ,l _ol(6l FI 2.6.2 2.6.3 2.6.4 What are the causes of absenteeism? Most of the absenteeism was occurred because of the overlap of the farmi,gtime and the drug distribution. This overlap t u, -o".r.."a because ofoverburdening of hearth workers and community supervisors. What are the reasons for refusals? Most of them consider themselves as healthy and were not willing to takeMectizan. No SAE case to report Briefly describe all known and verified serious adverse events (SAEs) thatoccurred during the reporting period and provide (in tabre g) the."qri".oinformation when available. In case the project did not have any cases of serious adverse events (sAE) during thisreporting period, please tick in the box. 20 WHO/APOC, 24 November 2004 soo N H(I) ,o G) z tN (-) A. i< ts N ta o ct C.) G(, q) a0 cll q) o CJ() t'{ cg l- o G o o () q) G oIr oo (h o)(t) c{lvlt-J OI .+l -l c{oL cl ()(u 'a ti (u lr .o l-r q) Q) GIq) q)(r, Gq) iYbBx LSq)\\t S.p .\ =aJUS :.S6\Fq. =9 q (l)\) -\I!\ O\J! -Gl vt- aj Gt x!(l)c) oo) H I eLq)a .gL c) o' li !A Hq) -o)x-cli€UI .UAq oe -L o) ! .lEStvlEtrIe'9la cdtq)olE>l(J -olGo) thn!t E'or<tr9 o (E CB El 69rtr Fod .ora .L \o .i oil 0)l -ol(dl FI 0_) 60o tr^F 6S '- ><-() CO o\ o.o' o\ oo oilr rri rr1 o oP^F US o c1 6 o\o\ o' oo o il t-l o r=o5boO d^ sgEOO .EoF c.l oo t-- @ r- -oq9O6 ueots PatrE3Oz?o o- $ 00 F- oo .tr\o o\ ca F- Eod o-a =tr: .l I .o' -F:O oo(o c.l \f, \c ol oo6v\o c.lrf, F. $\o =: Ig EEsSE H ET N@ odsF- O F- t'- F- No\dO oo o lt t{ f.l o ^bo(-J cd^F bs 'o o o o oEoO- brJ E d L .o lIbo;\ o o\ .:O - >vEooar1 0 OO OO O qo O'E @ '- o-I 5 E's E F'= 9)J tr< i '706 t--o ,o- co t--o \O- r-O rc^ co Ti ?o 6 o.i =c! ==o<, I -o' -io F- \o c.) t'- o F.- q o oo d q trotOI b/)(! .= .'KEi o Q I +t.Uf ql E v-=s E.=> EErOaqi;ii.-F F o 9-6E EEool t'-O\o- ca r*oq ca l-- \o^ aa & rr) oo(\ OoN N e\l ON tOON OO a.t \oOO(\ t- N ooooN o\o N O OC\ I I I Please describe how Mectizan@ is ordered and how it gets to the communitiesThe NorF requests for Mectizan from MDP. After tlr""d*g reaches the country it follows theexisting drug and other medical equipment.delivery system. in the country. Then the drug isstored in MoH warehouse from which projects levels r4,:,. From the project level (zonelevel) the woredas receive it and distribute to the healtn ru.iti,i", and the health facilities to ;,:ilT,H,ll :.T:il::il,ll.lj. frorn the communiry supervisors that the cDDs get the drug and Table l0: Mectizan@ Inventory (prease add more rows if necessary) 2'7' ordering, storage and derivery of ivermectin Mectizan@ ordered/applied for by _ Qtlease tick the appropriate answer)MOH EI wHon UNICEFEOther (please specify) NGDC Mectizan@ delivered by - Qttease tick the appropriate answer)MOH g wHotr UNICET[Other (please specify): NGDC How are the remaining ivermectin tabrets coilected and where are they kept?No tablets remained. List and briefly describe the activi ties under ivermectin delivery that are being carried outby health care personnel in the prolect area. Collection of ivermectin from the Woreda levelDistribution of rvermectin to community supervisors/CDDs Training of communl ty supervisors and CDDs Supervision Recording and reporting of data Any other comments Gommunity serf'monitoring and stakehorders Meeting Zone Number of Mectizans tablets Jimma I,456,500 1,456,500 1,609,735 13,784 419,726 0 TOTAL 1,456,500 I,456,500 1,609,735 13,794 419,726 0 2.9. 22 WHO/APOC, 24 Novemb er 2OO4 Requested Received Used Lost Wasted Expired Remaining -Has any training (of trainers) for community self-monitoring been done in the project area?No. If so, When? Table 11: 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 utilLed during the next treatment cycle. As explained above, CSM was implemented in a slightly modified manner by way of training a new cadre of monitors called 'community superviso.ri. Th. idea came from the NOTF andit was implemented effectively in this project area and have proved to be very effective in monitoring the performance of the CDDs at the community ievels. Mo.eover, the NGDOpartner has conducted what is called "ongoing monitoring exercised" in randomly selected 30 communities to validate the treatment activities. Findingi were more or less in agreement with reported figures. Annual program reviews were also conducted involving all stakeholders at zonal,woreda andFLHF levels. Program achievements and weaknesser.i... identified and future directions outlined. The SHM is conducted at zonal and woreda level. 2.9. Supervision 2.9.1. Provide a flow chart of supervision hierarchy. NorF ) zorF) worF ) Health Facility ) community supervisors ) cDDs 2.9-2. what were the main issues identified during supervision? . Delay in utilizing and liquidation of funds. . Delay in Metcizan treatment period. . Lack of proper document handling 2.9.3. Was a supervision checklist used? yes District/ LGA Total # of communities/villages in the entire project area No of Communities that carried out self (csNr) No of Communities that conducted stakeholders meeting (SHIVD Seka-Chekorsa Shebe Sombo Dedo Mana 806 362 1,502 937 806 362 1,502 806 362 I,502 937937 TOTAL 3,607 3,607 3,607 23 WHO/APOC, l0 February 2004 Iwhat were the outcomes at each lever of CDTI imprementation supervision? Because of the s ,pervision projects rrave prepared to start the Mectizandistribution for 2007 exactry on the ti-e p.ere.r.o-b, the community anddocument handling has shown some improvement. Was feedback given to the person or groups supervised? yes How was the feedback used to improve the overail performance of theproject? The good geographic and therapeutic achievement of the project showspromising trend. SEGTION 3: Support to GDTI 3.1. Equipment Table 12: Status of equipment (prease add more rows if necessary) *Condition of the equipment (F=Functional, CNFR:Currentl y non-functional but repairable,WO=Written of0 2.9.4. 2.9.5. 2.9.6. How does the project intend to maintain and replace existing equipment and other materials? The project is currently.in-its third year.- Minor repair and maintenance of existing projectequipment is being handled by the zonal healtrr ornce rrre project doesn,t have the capacity Hr:ti:ij big capital items like vehicles. The computer and photocopier are not cu,entry Source Type of equipment 1. Vehicle 2. Motor S 3 S 4 S 5 ler S APOC MOH - Zone DISTRICT NGDO Others No I J I I I Condition CNFR F CNFR F CNFR No. Condition No. Condition No. Condrtion No Condition 6. Fax Machine(rs) 7. Overhead projector 8.25" TV set 9. Deiese lGenerator I I [- ll F F IF I F Fl 24 WHO/APOC, t0 February 2004 I3'2' Financiar contributions of the partners and communities Table l3: Financiar contributions by ail partners for the Iast three years The prc1iect did rtctt ttse APOC.fund as it was nol available on time. If there are probrems with rerease of counterpart funds, how were they addressed? Additional comments 3.3. Other forms of community support R::fte (indicate forms of in-kind contributions of communiries if any) 3.4. Expenditure per activity - Indicate in table 14, the amount expended gTng the reporting period for each activitylisted' write theamount expendedin US dollars using the current United Nationsexchange rate to rocar currency. rndictat" exctrang".i,.'r."0 here g.65 Contributor Year I Y ear 2 ('provide the Y'ear 3 ('provide the TOTAL Cash Budgeted (us$) TOTAL Cash Released (us$) TOTAL Cash Budgeted (uss) I rornrI ca.t', Released __{qss) TOTAL Cash Budgeted (us$) TOTAL Cash Released _(us$) 1s,823 14,943 MOH (District + zone) 37,096 3s.823 27,435 27,435Local NGDO(s) ( if any) 0 0 0 0 0 0NGDO partner(s) 73,290 73,290 54,387 2t,471 3 t,486 31,486Communities 0 0 0 0APOC Trust Fund 56,090** 30,000 56,949 30.000 36,971 20,000TOTAL 353,979 325,736 I11,336 51,471 95,992 78,921 25 WHO/APOC, 10 February 2004 MOH (Central + State) aa a Table 14: Indicate how much the project spent for each activity listed below during the reporting period Any comments or explanations? SEGTION 4: Sustainability of GDTI 4.1. Internall independent participatory monitoring; Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable) No. Year I Participatory Independent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation Internal Monitoring by NOTF Other Evaluation by other partners Expenditure ($ us) Source(s) of funding Drug delivery from NOTF ffQ area to central collection point of community Mobilization and health education of communities Training of CDDs Training of health staff at all levels Supervising CDDs and distribution Internal moni 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 2.406.34 8,304 13,402.57 1,035 7,507.27 4,845.95 12,096 10,319.1 g 1,871.6 4,553 ist 1,469.47 3,285.99 1,043.62 APOC MOH APOC & Carter Center MOH APOC & Carler Center APOC & Carter Center MOH Carter Center APOC Carter Center Carter Center APOC APOi' Carter Center TOTAL 78,921.00 Total number of treated 26 WHO/APOC, l0 February 2004 f ' !,l a 4.7.2. What were the recommendations? 4.1.3. How have they been implemented? 4-2. sustainability of projects: plan and set targets (mandatory atYr 3) Was the project evaluated during the reporting period? Was a sustainability plan written? When was the sustainability plan submitted? NO What alrangements 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 pran been impremented 4.3. lntegration 9l]'::,t} extent of integration of GDTI into the PHC structure and the plans for completelnlegratlon: 4.3.1. 4.3.2. 4.3.3. Ivermectin delivery mechanisms Since the beginning there is no separate Ivermectin delivery system to thelower level; it follows the existing trug delivery system in ihe tountry. The request for Ivermectin is to MDp is through MoH. As soon as the drug arrived,the same as all other drugs and medical equipments, all the processes required are handled by a Pharmaceuticars Administration and Supply Service in theMOH' The project levels, Iike any other medicines, receive and deliver to the respective levels following the existing delivery system. Training: CDTI is integrared with the primary Hea-rth care (pHC) from the beginning. Atthe National, Regional, zonal, and woreda levels, ih" trtul*ia and othervector-borne Diseases prevention and control Units are responsible.Therefore, all the staff of these units has rcceived training on onchocerciasis. Joint supervision and monitoring with other programs As part of the system in the country, most of the'sup-ervision and monitoring activities are carried out in integrated manner with Lther programs. 27 WHO/APOC, 10 February 2004 &'T' * 4.3.4. Release of funds for project activities This year APOC and The Carter Center have released the 2006 flind on tirne and there was no shortage of money for the CDTI activities. Is CDTI included in the PHC budgetz Yes, as part of PHC, CDTI is one of the priority activities. Describe other health programmes that are using the CDTI structure and how this was achieved. what have been the achievements? None Describe others issues considered in the integration of GDTI. The structure called "garee" (village) which has got a health comrnittee and the Health extension Package program designed to reach all Kebeles with health posts is found important for integration and sustainability. 4.4. Operational research 4.3.5. 4.3.6. 4.3.7. 4.4.1. 4.4.2. I t summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period. NONE How were the results applied in the project? sEGTloN 5: strengths, weaknesses, challeng€sr and opportunities - List the strengths and weaknesses of GDTI implementation process. - List the challenges and indicate how they were addressed. Strengths: The project has accomplished the distribution in shon period of time with 100% geographical coverage and therapeutic coverage high above the minimum standard. This is due to the awareness and active involvement of health workers and the community at large. Weaknesses: delay in starting Mectizan distribution, delay in getting report from the lower level, poor financial utilization and liquidation. Opportunities: The government structure down to village level "garee" and being taking the responsibility of development activities as well as health is a good opportunity for sustainability of onchocerciasis control. The Health Extension Package program in which the building of health post going on to each and every Kebele is also another good opportunity. Threats (Challenges): Sortage and overburdening of health workers in peripheral health facilities in different health programs such as malaria epidemic control, ipf una measles campaigns. sEGTloN 6: unique features of the proiecuother matters None 28 WHO/APOC, I 0 February 2004