Kaffa-Sheka CDTI annual project Technical report submitted to Technical Consultative Committe (TCC): January 2010 to December 2010

tThe Federal Democratic Republic of Ethiopia Ministry of Health Launching year: 2001 Rerrorting Period: F ro nr : Ja.[. s.a r]:.2.-0. 1 0.......... To.1.... Qs tq hs r. 2.0.1.Q..(Month/l'car) IVIon th/Yea r)---. Proiect year of this rerrort: (circle one) t z 3 -r s e i-s e-frol\_-/ Date submitted: 30 December 2006 NGDO partner: The Carter Center ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) DEADLTNE FOR SUBMISSION: To APOC Management by 3l January for March TCC rneeting To APOC Management by 31 Julv for SeptemberTCC meet rng AFRICAN PROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) R.ECiJ I-E t- ---i o t rr l 1r 'if'it r. LUll ,C. {, -_-f.-€86-r,,I<r* Per .,qsl;os { &o A+ ' ;' fnfd-on.:tior, r.,5t( n-Ba^t^; I I I I I t I t A, i-;C i UiR Project Name: Kaffa-ShekaCOUNTRYA{OTF: ETHIOPIA Approval year: 2000 I i I , l !I i 1 I I I tI I ! i( I I I I ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT I'lease confirm you have read this report bl,signing in the appropriatc spacc OFFICERS to sign the report: Country Ethiopia Tizjtr Iir,iru GrJ, r:r (Dr.) National Coordinator N a I n c . . .P_,1 Ll.V.,:,1 j.,.., i.,.i j.-: .,.1.,,i 1,. J.,;....,., u j . Urr.+c' l)i,:t r.r.lr.:u iJ Sirnature : l$#ry I)ate q$ {'i'i,.4" ?r.T" 1/c l rL) 'srrj of Date Z onal O n c ho C o ord i n ator N a m e : N i gu.s.q i.e..B.rrh.ans. I Signature ( /\ 'ql'- --/ q t)/- I I(,, * e' ... ..lanuarr lUl 1..... . \1home_ Gebre (phD)Uountry Representahve 'N(iDOl{eprcsentative Nanre Dale Signature r' 'fhis report has been prepared by Narnc : NigLrssie llirhanc.t.N.e.l.li Desiglratio n : Zone Oltchoccrc iasi s Coordi nator Signature Januarl 201 I II Date W'HOiAPO( . 2.1 Nor enrbcr 2()().1 a 1Q 35 ta Table of contents ACRONTYMS DEFINITIONS FOLLOW UP ON TCC RECOMMENDATIONS Exr:cUTI ve S un,ttnla,RY SECTION I: BACKGROUND INFORMATION GrNrn at- r NIroRN,tA.noN Popt u-,t'f ION SECTION 2: IMPLEMENTATION OF CDTI......... ....6 l-ttt,tt,l.lNt oF AC I't\/tI'il:s ........... AllVot..\t Y lVlOutt-tz,rltoN. sENSIIZ/\ftoN,\ND HET\L t'H Et)UC,\ il()N ()t ,\t IUSK ('()NIt\lLrNIt'ilrs CoHtHtttNt'rY IN\/ot-\/tiNlEN'l' ..... Cl,lt,,.rct I'\' ntIII-DING .................r Tnt,rtNlINIS ORllLtUNt;. srol{A(iE AND DEI-l\/hlt\'()tr t\ t.t(NIIcilN........ .. ..., Crtlr t Ht uNl'tY strt-tj-NIoNI]-ORING r\Nt) S I-A KE r t( )t.r )E ns N{ t.r L t Nr; Supt,nvtslttN ............... SECTION 3: SUI'PORT'rO CDTI::: l.l. Eqt,leHlt,Nt ................ 3.2. FIN,TNCInL coNTIUBui-toNs or t HE pARt'Nr:RS AND ('ot\'tN,luNITIES 3.3. Olm-n FoRlvts oF coMl\,ruNIt-y sr.Jpp()RI 3.4. Expr-.Nort'uRt pER Ac-t'tvtTy................ SECTION 4: SUSTAINABILITY OF CDTI......... -1.1. INt'lrttNnL; INI)[pENDEN'f pAIutctp,\'t'ot{\'NIoNtfoRINCl: E\,,,\Lt],AI'toN.. ... 1.2. Sus'l.,rlN,tBILITY OF t,Ro.tE('t-s. pt-AN AND sF. I fARGE I-S (tvtANDi\1'()Rv A I Yn 3) .. l.l. IN rLUR.r ruN............ -1.4. Open..r'rr()NAr- nrsDAr{cr I SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, ANT) OPPORTUNITIBS SECTION 6: UNIQUE FEATURES OF THE PROJBCT/OTHER MATTERS 2.1 2.2 _. ) 2.1 2. _5 1.6 2.1 2.8 2.9 6 7 1 8 0 22 23 lll \ /l IO/AP(X'. 2-1 Nor enrber 2001 t8 l9 l9 20 20 2l 2l)) .............20 Acronyms APOC ATO AtrO CBO CDD CDTI CS]VI I-GA MOI_I NCDO NGO NO'fF PHC REMO SAI] SHM TCC TO'f UNICEF LITG WHO African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Com m un ity-Based Organization Cont munitl'-Di rected Distributor Conrm un itt,-Di rected -lreatment n, ith Ivermect i n Communitr Sel f-Monitoring l-ocal Governntent r\rea N'l in istrl' o f' llealth Non-CovcrnnrcntaI DeveIoputcnt Organization Non-Ciovenrnrental Organization Natronal Onchocerc iasis -l'ask lrorce Prinran' health care Rapid Epidemiological Mapping olOnchocerciasis Severe adverse evertt Stakeholders nreeting I-echnical Consultative Cornrnittee (APOC scientifi c advisory group) l-rainer of'trainers United Nations Children's Irund Ultirrate'lreatment Goal World Hcalth Orgarrization lv WIIO/APOC. 2.1 Norenrber 2(Xl.l Definitions (i) Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census). (ii) Elieible lation: calculated as 84%o of the total population in rneso/hyper- endemic communities in the project area. (iii) ual Treat (ATO): the estimated number of persons living in meso/hyper-endemic areas that a CDTI project intends to treat rvith iverntectin in a given vear. (iv) Treatment calculated as tlre rnaxirnum nurlber of people to be treated annually in rneso/h;'per endemic areas rvrthin the prolect area, ultimateh to be reached rvhen the pro;ect has reached full geographrc col'erage(norrnallv the project should be c.rpcctcd to reach thc LITC at the end ol-the j"r -\'c-ar ol- the project). (v) 'l'hcrapcutic coverage: nurnber of'pcople treatcd rn a givcn vcar ovcr thc- total popLrlatron (this should be cxpressed as a pr.r'ce ntage). (,'i) Geortraplttcal coveragc: nutnbcr of cornrnrrnrties treatcd in a given 1.ear over tltc total ttLttttbcr ol'nteso/hvper-endernrc conrrnunitic-s as identifiecl by RENIO i1 the pro-ject area (thrs should be expressed as a percentage). (vii) [rltegratrttlt: deliverirtg additional health intervcntions (i e. v'itarnin A supplernepts, albendazole fbr LF, screenitrg for cataracl. ctc.) through CDTI (using the sarne s-\'stenls. trairting, supervision and personnel) in order to ntaxirnrse cost- efl-ectiverlc'ss and entporver colnnrunities to solve ntore of their health problents 'l'his does not include acltvities or interventions carried out bv conlnunitv clistributors outside of CDl'I. (viir) Sustai abilitl, GDTI activities rn an arca are sustainable rr'hen thev'contirruc ttr (ix) firrlction e flf-ectivelv fbr the fbreseeable firturc, rvith high treatlncnt co\ erasc, irltegrated ittto the available healthcare scrvlce. rvith strong cornrnupit_\, o$ ne rship. using resources nrobilised b1, the comnrunltv and the govenrnrcnt Cornrnutrit-r' self-rnonitoring (CSM): The process by rvhrclr tlre cornnrunitl, is enlporvered to oversee and monitor the performance of CDTI (or any cornrnunitr- based health intervention programme). rvith a vierv to ensuring that the progralnlne is being executed in the waf irttended. lt encourages the cornlnunitl, to take full responsibility of iverrnectin distribution and nrake appropriale rnodiIlcations rvhen neccssar\/. WHO/n PO('. 2-1 Nor crnbcr 2ll0l FOLLOW UP ON TCG RECOMMENDATIONS TCC session Number of Recommendation in lhe Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY I P rov rd e t n-fornt at i on o n conlrtbuttotl of ?overnmertl lO tntprovc table ll c&ll lt is indrcatcd lor thc vcar 2009 2 -) + ) Erplurrt rtotte rnc'luston of' dt.srt'rt't f urul rn toblt, I l It rs rncluded lbr the vear 20()9 It rovr tl c t ttfot'ttt ttl t on o n I 1 n l) I L' nt t' il t Lt t t | )t t ( ) f 5 I t \ | Lt t n d h r I r t.l Sustarnabilrtr plan is bcrng tnrplcrne nteJ usrnq (ior cr nnrL-nt .ln\l N(iDO lirntlslutl P t t tt'r,l t' t tt/( )n)t(tI t( )n rttt .\ l( ) I L ,/t.sIrt, t.,trtJ \'( ] I)( ) t'qttt|)tnL'ItI I-![uInrcDts arc rrtrIrzcrl rn inLcr:r.rte,l nr.inncr ( \ ehtr Ic:. i\lotorrr e lc:. I)hrrtocoprer l-ar rlirchrrrc & c()nl tcrs ) -1rlrlre.s.s lr (,(/k/7r'.\.r tdutlr/ir'tl t e tlr'lot',s ttt 1'cl)r.)t'tutg dt !o\1 er ! aya I \,tL'L ( ) u tt t r tt t! / t tr /) t ttLl.s I lck ol'crpe ne nuc l)\ thc hc.rltlt uorker:.rt tlrc lori'cr lcrel u.rs thc L,ru\( I,,r .icl.t-r' ut tr'Prr11i11,1 toula,l . I drl t-.'.t \ t'c rt \( )n I r tr lt t elt lilrn()r'tt' t-tttd ol lteulth,:to[/ ut I hc re tnotencss urtd harrishrlts ur llrc 1-()ncs Jre bclrcr cd to bre thc rc.lson\ ftrr thc hieh turno\ er ol hcaltlt stat'lti'0rcdd und heultlt litc'rlr lcve I 6 WIIO,AP(X'. 2-1 Nor cnrbcr 2()0{ ( Executive Summary . Background on treatment and population data Itnplementation of Community Directed Treatment with lvermectin (CDTI) had been underway in Kalfa and Sheka Zones olSouthern Nations Nationalities and Peoples Region (SNNPR) since lvla-,- 2001. Kaffa-Sheka CDTI project is divided into [3 Woredas and 3 administrative torvns (Bonga. Masha and Teppi) which were previously parl of Gimbo, Masha and Yeki Woredas respectively,. The pro-iect has achieved a geographic coverage of l00oh and therapeutic coverage of Jgot'o as indicated belorv in the Table. Y I,,\ R I)opu latr on nnual dctrve Nurnber ol' pcrsons (redteJ -fhe rJ pcut rquc eovcrage (o u) 100 I I06.29 7 2I l. i0(, 26 5(r 75 78 71 77 -79 7,S 7t) (t 29!l loo l l(,xl.l l()0_i l()06 1)51.2 5 0 f-i-i.-1.11 lll1.20(r .il(r.217 7 I ri.2l I 7 68.6J? lJ -5 7.170 8 I ().()8ti 78,1 .166 77ft. ISlJ 100 7 20()ti 8q9i 2-5 9 tl99ti li-l.l -.r 7 l u-i.t.l,l I 91 5169 t)21979 972323 962256 I otal populalron ol- .\ ro LI'f G('") Cor crpcr-endernrc area-s 901. (rl.l7 corcraqe ("o) 7(, ll ()a ,3.()(,) I l9 7-i,)5 5.ll l ( r/r li,/ _e8 l. lgtt l. (r10.679 9i f.i ()l l.tl Il6ll l.07i607 ()( ) 9(l (/ -l 9-l I lJ-17{lJ 9l 9l 2(Xl9 l0I0 Il(rll7j 9-1 (, 9J /) 1215404 lt) 99 99 Background on population movcments Thc cotntrunitics in both Kellh and Sheka Zones are ntainlv settled f'arnrers. claili labcrrcrs. civil servaltts attd tea and cotl'ec plantation rvorkers. There is a continLtous irrflux ttf-pcttple. cornilrg to the Zorles to u'ctrk irt tlrc cttfl'ce and tea platttations contributing to the increasc in the ntrrnber ol' 1ropulation during annuaI lVlectizan distribution Challenges and hort thcl't'ere overcome Threats (Challenges) . High turnover ol'health \\/orkers o I-ack olcontinuous strpporlive superl'ision at all levels using checklists lWot{O) . Dela) and discrepanc),of repons . High nurnber of absentees ancl ref usals . Dela)'ed Mectizan arrival To solve this problem the follou,ing measures were taken:- ' Recruitnrcnt ot'neu health stafl's to deal rvith the problern o1'turn tti,er . Repeated visit to the WollOs to irnprove their supervisorr, skills ' Zonal Ievcl revie* rnccting uas conductcd to irnprove the challcnges obscrved in 2010 ) \\'l IOlAl']Oc. 24 Nor cntbe r 200.1 9l SECTION {: Background information 1.1. General information l.l.l Description of the project Geographic location, topography, climate Kaffa Zone Kaffa CDTI Zone is located in the south Western part of the countr),, rvith the capital Bonga situated at about 469 Krn from Addis Ababa. Co[fee & tea are thc'nrarn caslr crops of tl.re area Its boundartcs arc,ftnrrna zonc on thc rvest, Bcnch I\lalt zonc and ](onta spccral uroLccla on thc cast and nortlr. Shcl<a zonc and Sotrth C)nio on tlre sor,rth It has nrean annual rarr-r[all rangc,rI l(X)1 22( )0 rnr]r an.l trlutude rlngc c.,f 5()(l 53()i) nrcters irb,-lr'c scrr lclc'I. It hris tlrrce:rgro ccologlc r()nes; t[rc hrghlancl 1'7'' ,,) tltc scntt htglrlrrrrd (l()0i,) ancl tht' kr,,r'l,tntl (23r' ,,) Sheka Zone i\frt.ir.r. llre c;rPrt,rl ,r[ 5hck:r rs l<,c.ttc,-l trr r]rc Si,Lrth \\ c:tt'rn P.rrl of tlrt' c,>rrntn' ,ir (,St t lint. t-r, rrrr \tl.lt. -\l;rrlr.r S[rcka Z-ont'slrrrres lrorclcls rr-ttlr Illultrrtrt\''1.or)c rrt thc nolllt ,trr.l t-cst, LJcrrrir NIllt /-,,nc Lrt tht' s,rrrth. [.,:r[t:i /.orrc rn tlr,-'c:rst lntl (].rrnbclla rcgrt,n tn the s,ruth casr 'l'hc torrl sLtrt,rct'.11'1.1 ,ri tht'zottt' rs l l - i 36 s.1 I<r-n. ,rn.l 1ts :tllllu2ll lrrrntnll r.rn.qc\ l-l-()nr l()( )0 2"01 1 nrtn. -\grtcttltLrt'c t. tlte tttrtttt ('c()n()lt)tc- :i)Lll-c(' ,;t- litt' .trctt. l-hc cottlrtlrrrlities in ('D'l-l arcas ol both Sheka and Kaf la lones arc lllailll\ (92 -l')o) f a.rtters li'itlg irr rLrral areas. -l-hc urban dw'ellers, constituli-tg 7.79/o o1'thc total population arc qo\enlntcnt entplol,ees. nrerchalrts. daill' laborcrs and tea and coff'ec plantation u,orliers. Population: activities, cultures, language The communities in CDTI areas of both zones are urainlv sc-tIled tarmers Settlenrent of tlre population is 92.3o/o rural and 7.7o/o urban drvellers u,ho arc- governrnent etrpkrl,ees. Ilerchants, daily' laborers, 1ea and coffbe plantation u,orkers. The languages ol' the cornrnunitv are Kaffluono and Shakinono. and sorne of the pcoplc speak Oromifa. Arnharic and other lanquages of the countr\,. -l'hc ofllcial language is Arnharic rvhiclr is also the national Ianguage oltlte countn,. Com mu nication sy'stent Kaffa: - 'l'his CD-il Zone has ll Woredas ol- ivhich 8 havc all rr'cather roads sith three being inaccessible during the big rain)/ season. All rvoredas do have a rrireless telephone line nith net\\,ork access in some. Sheka: - This Zone has five Woredas all of'u,hich have road conrrunication throughout the vear and rvireless tclephonc' line and ttetrvork access. Ad min istratiye Structu res Kaffa: - Ila' lo rirrrl end 1 t()\\-n \\irrc'da.tclrtttrtlstrattort Sheka: - Has three rural and t*o urban districts ) WHO/APOC. 24 Novenrbcr l0()-1 Districl Number of health staff involved in CDTI activities. Total Number of hcalth staff in the entire project area Br Number of health staff involved in CDTI B2 Percentage Br=Bz/ Br *100 Adiyo 82 52 bJ Bitta 74 43 58 Bonga town 5 5 100 Chena 121 43 137 85 70 Cheta Decha 31 72 116 85 74Gesha 55 Gewata oa 68 to Gimbo Sa;,lcnr Tellcr Andracha 99 bJ 77 63 47 77 42 64 AE 100 8152 59 1a 29 64 Nlasha 44 't8 20' CA 75 82 69 84 IVlasha I'on'rr f-"!i Yeki Total 1 088 820 75 Tatrle l: Number of health staff involved in CDTI 1.1.2. Partnership 'fherc is strong partnership irhich he'lps the Kafla-Sheka CDTI pro-iects fbr its besl achio,cmcnts and qradually ensures its sustainabiliw. 'l-he mairr partners involved are Federal lvlinistrl ol t{ealth. Regional t{ealth Burear.rs. Zone and Woreda Health Departments. Adrrinistration. EdLrcatiorr. Agriculture. Finance, the cornmurritl'. 'fhe Cafter Center Ethiopia and WI'{O (APOC). 'l-he lrMoll, The C'arter C'cnter Ethiopia and APOC are involved in planning, Supervisiorr and in providirrg flnancial and technical support. The ZHDs and S/oreda health Offices are involved irr training. comrnunit.v nrobilization. supcrvision. rnonitoring and evaluation of the CD'f l activities. FI-HIr do irnplernent the CDTI activities and supervisc the health posts. The cornmunitf is involvecl in supporling the CDTI activity br recruiting CDDs. as wellas in fixing the Mectizan trL'atnrent dates and sites. 4 WI IO/APOC'. 24 November 200.1 -fC c a] u E a CZ -f c.1 a c- A T , q -g a a)q) = -= at) ='- s !r = al l cl =) .a u L O =L a 0) c (_, o cJJ a q ,J C () 0L) =':- o C, .O .: C =o ,J =L u uE 0) I -.ctPl(Llo I| (-)lclolLl^t,l-ct"l-o ldtp lL ..' or *- 'J= u^ ne) a)- '/. ==r,)/ 1.7 a= =-- -ul.D t-t; >lt: l- = \-, O a) =l!I' u,lut- le l()l*lcd le l't(J .. ,= (-) u .'.)- oJl c3l=t'-l-l-I .,t: lPi'=l-q' F, aE a6 -tr !(J 'E qr . . cI) a.t .! 'Jq du9. 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Y o, o.l-ojj Uitv-p--- L ! * r) .-.-(-).-ra; .NolI-'cg_Y '= L.= _I-Oa,eOaY 5Do:1e-ii-!. c Y E ),cr eJV-ELQ.- Ldb'frUJE=i/]J * : 0j rr .; -olto j:s =6,=.El:\r-doJ:Y =-io-.=ortC2__.L.- a) - v L ". al -.C n :- C'= 'Y ; lo-€ = e -vr,a.^aa'--,.Pv: Yl - _..!ro'olId;Z?'= oJ E Xl u o.I Y co3-YOEr=-c -i-gee-- =56.9E8ftril tr o - F o > T '. '!: u N -@rv NI VL;: o (U.- -'-F ea-^!e-H?1 0 \ -X N(Et'rrr .- (u u .- .. v = ( E L 3 3e -oxcu<-^eo=o7Z?^cL v: ts U >,E'; >i>\o d 9 a oJ ,P4".=.-'- LL:}LL- <-U ^!Nr!-pe::F L ts (d u€ ? tr vvs(J\, Itl--'.2 o o .9 E tr E E o o J o +, G l- o tr o a, G o t, o t! G os t, tr t! tr .9 +,(! .! .: o tr o o tr .9 +, G T -o o E ri N \--L 9-:(-)o(!v tvu!-9 coy(J()-_= I cd '-C:E- d) -7.v)-- -at) oo iE: 4 9r= E or !.Yu oao: -(JN! LV! * cO COU q--a- - (1 ., - Q_''U 4tDi-_ \r,>,?C'-ttYO/,_ t) t, - - ->ar-! .. .fi - - J oi ,9T I p I 'U tr - L a) N -O ELI i- - = :=-:'?. - _.-UU ec=zY- a)-^tn - > cje - -/a V-,4: ol r .i =S - iL^v-- - 7), u nt7).Y2e> >P=7 , ilE 3YOAn-hE 6ijll I rd=L== >qa-:7,ocli9:-r: dfLL_:: -oZEE -n'--a(J q.).= u'uCJU-(J-u .cJ ='- -q d aL- ij i li9U;U -:! \ a aI! S => aJ) cJ) ^;2--E s-c ct'l u 6 q u a'E L ,/ - Lc)-L-s *-9i,,-EOitr€ Ueu'- d.-q-OL9._:t_ -__>q .-J---+0oexo gts-n,L()=:: OJ -v'c, L- !i o, G'..31 .e € = :P-c Q 5N';996.!AE 9:U!.^F: :r di I >,-;<-cl(J@ -: c bno ot O o o'<,^ = 9; ?z- )D or o ^ X-:'-=J..y-''u0) -Y,jo>(-) E-o!C(r(!. o G o o E "iN r- -t cl - - at Z 1 al /i U= cro-: o N Os F- c.) (oN @N f.rN (.) .(r (o @ Oc.) OO o@ N O)U E - E E oLU n= ze Eaio c- =.-- . $ C\l $N O N cf)o, (r) otr) cf).f @N(oN \Dcl CI Nal =f --f l x ,a al r r cl .c ?. -f -j cl rrr l rl\' r\.f I --l 'fcl -f tr- ,r r J cl al x T -t < c. a -fT cl o) oo l .ol o, Iolol o E c o tr z l)I& + :ll t-' 6 o v 2 z Jr al - 1 €r .c -a N \o \.c clcl aCr .?-t a.l @r .c rr\o @r cl cl € ^ i -t 6 (")(,$ O) oo € ? E E E u =.; I E E t E E o o a E r E z. E = o q ?t EA ca {o 3 co-Lil- O o. c.l o'o CJ r a- N rr al l O Oo =t -t oo --f -f € & O O o\ ai o\ CI o 9 \o oo rO ol a-Ocl oO r a-- r- cl r- N oO oO cl a..l oo \c € \, € Oo -j- -t I oO c.l cl cl CI € O O -f O =f -e.l o{N co N(\(\ fo () -.) .2 a o >r € (6 : ca G bo 6 0)E O oE(, dso 0.) o -c6O(, 6 d o O o -o E o Eo cJ U) o 6F (-) cd 'IJ o Cd Z. c o 'a ()F '.4, (J o \.) U v i \ I\ \ t- Q o (n 0) U +, E o E o o .s E E E E o o co Comment on: ' Attendance of female members of the communiry at health education meetings Even though the lernale health education attendants are not equal to that of male attendants, their trurnber is increasing yearll'. Fernale attendants are shy to speak in public and lnost of the time thev are overburdened u,ith so manv tasks at home and in fields. I IIt general. hou do 1,ou meetings rvlrcn CD'f I discussion etc) rate the participation of fernale members of the cortrntunil\, issues are being discusses (attendance. parlicipation in thc. ! '['he atletltlltllee arttl participation ol'fL'nrale t]'lL'ntt)ers on C'L)T-l discussir, cltrrrrrg cottttttttttitr tllectitlg sessiotts is lcss than that trf rnen attendants. ('ultLrr.al bar.rier: cl. ytlar It ttlltlot'rrlll li,r thcir lori pal'ttcipation.'flteir;tar{ icrpation is ratcd as luir. lrrcentivcs ltror rdcd b,r cttr.rinturtrtics fiir the C'DDs ('l)t)s llror itlc ll.cc scrt iec to lheit' rcspective corrrrlunities. I'hc conrrnirrrit_r rnenrbe rs s()ltlctllllcs hclP thc C'l)Ds rr'itrking on therr liirrns and ilo supp[-r rhenr col'lLje upcl l'tr6d clLtt'inu N'leetizaltc distribtrtiort se-ssions. fhe \\"ttrecja heulth cilllces and FLIJF tl. assigrrCDDs to partreipatc ilt ol.her health canrpaigns such as Polio cradicalion. rneasles. l-J arrcj IIOS so that sotllc atnorttlt olper-clienr could be paid fbr theur as an incentive wlrep thesc canrpaigns are carried orr ,'\ttrition of c'DDs. Is arrririon a problenr fbr the project? If 1es, hou,is it addressed,/ ' CDD attrition is rttit a problenr .fbr the pro-lect. Il-a replacernent is neecjed. it is clopeirnnlediatelt' atld training is given b1 Irl-LIW at their respective kebelc. () WHO,'APOC. 2.1 Nor,ernber 2004 2.5. Capacity building - Describe the adequacy'of available knowledgeable manpower at all levels ' The staff members rvho have served long time in the project area are having good knowledge and the newll,assigned health rvorkers are given training l,early Where frequent transfers of trained staff occur, state rvhat the project is doing, or intends to do, to remedy the situation. (The ruosl itnporlant issue to describe is y,hat nleast4re.\ y'ere lakerr lo ensure adecluale CDTI implententalion where not enough knrnt,ledgeable manpott,er v,o,s av'orlable or rJ'stoffs urefrequenlll'lron.sferrad during the c'our.se of the c'umpargn\ For the 2010 CD'l'l acti\it\ period'I'hc CarterCcnter Ethiopia Iras designed diflcrent trainitig rrodulcs. nrarruals and Fillip charts fbr l-lealth rrtrrkers, FIE\\/s and C'DDs. Bascd ttn the designed nrodules and nranuals cl'l'ectire trairrinrt rrus given at Zonal. \\/oretla irnd Kebele lcvcls. Thc training irrcludcd topics r)n transnrission ol'Onchtlccrciasis. iLs consequences. htl$ t() nreasurc clients & closaqc ol'Mectizan on the biisrs ol'thc nteasrtrement. \'ector tlrat transnrit the discase. cligibilitv tbr Nlectizan urrd httu to ntanuqe SAlr il'it.occurs. l0 WIJO/APOC. 2-1 Novcmbcr 2004 a cl =t Z -f al c- T=a s c -: C\ :I a / o o 3 5t e\ e o a- i !! c - .. q a a _(,<tl +E:lFUU qU - .f o) L U L -o z @\o : $ c- = s o, @(o N (\ co ; Os(\ -N co a- O$ r.- aa : t--\o A \o oo\o c9 u-)(o C. oo ca = tr) LO co $ c.] O al oo T .1- $N a- trr (r- F- \o O\o f.-t- f-- \os oo o\ co c-\o co(o rf ; F- r- \o v ca coN c.) tr) \o$ t-- c.) ro r.o <J' r- v \o O s r.- (\ N NN O tr) NN O O C O c9 o\r € ; O)t- € : f-o. =fs € $N cf)o N$ c9 @ N c.)o N t..- f.- ceO o\ O. o\ o o \o r- o\f @(9 c9tt.. O) C! N O c{(\ NN - ir L o (_ 5tLL^al E- > 7-.! L9'- Zc-) O) N O o) c! O)(\ @ N O @ N @ N o) @ O) s O s s N O c! (\ cO O o) O) co (o N O (r) N (r) N N o C! N tr co O l-- co N c.) C! O N N (o O (o (o (o C! O ro N (o N O) O O) O) N o N N o) O O) o) s(o co c,(o co v(o co o E o\ -ll + ! U \ F L c, (, Otr ZZ @ o) () O) (o O) t-t\ sN cr) f.-f.- C, s NN F-|.- o f.* F- o) C! (o N Cr) o)N (r) tr) o tr) (r) f.r s (r) N(o C.l(o o (o(o (r) tr) O (r) (o (o$ O v N(o N(o (o N(o (') co O) C7) O O) C, O Os o Os (o (\ s o)N O)N O o,N t--(O f.-(o O f.-(o o o, o)o O) C! s o) o o o\ AU o t a i) -L -ll + FQ! Qa< L -O q) ZI O) o, O) $ O v C @ @ O @ O tr) ro O s v O (o (o O (o O (o O o o O O o .? -+ O J O CI C1 o c.l C O 3 F-l-- l'-f.- o It- N o E o .9 o\ tr) s J .9 L o .-' -IJ a o oo o a C)(, (U o U oO o (! -qq C) o cd (.) O o _o E c E 0) V) o 6F CO (-) -o C q CJ o q cO O 'a 0-)F , 0) -l F F U iJ \J \J \J (! q) q) .) q) o) q) 6 o! - rr)l orl .ol _(!1 -l Table 6: Type of training undertaken (Tick the boxes v,here specific training v'as caruied out durmg the reporting period) Anr other conrnrents. 2.6. Treatments 2.6.1. Treatment figure Ifthepro.iectisnotachieving 100%geographicalcoveragcandaminimunrolT50%therapeuticcoveragct.rrthe coverage rate is fluctuating. state the reasor.ls and the plans being made to rernedl'this Sheka Zorre has achicved 100% geographic and 830'o tlrerapeutic coverage and Kaffa 1-orre has achieved 100% geoglaphic and 7892o therapeutic covcragg" I Trar nees Typc Of trarnrng CDDs Other Communrty members e g Communrtl superyrsors Health Workers (trLHF ) MOII staff or Other Polrtrcal Leaders Others (specr I)') Program management Horv to conduct l-lealth education Managernent o{'SAEs CSIvI SHIVI Data collection Data anal;'sis Reporl rvriting Others (speci{l ) t2 \\/llO/A I'}OC. 24 Nor,ember 2004 dO N L 0) -o E o c z .t al C oT a l,JU 1J r J : q a 0) rr G J l- 0 (a rrl a (! q) 6q)tF r-.1 o,l -olclFI EI=EA f,i5S z;eL O o O O O o o o O O o o o O o o o o ve?,^; tr o a c- =; > uq:aP>6Lbdu- O O O O o O O O O O O o O O O o O aL! U !!oE z'F-?t E € @ r- o\\o r- N <t d \o{ o O O € €$N @@o@ r-.r- o. t!r $ol alr o\-f ol -j- o\o\ O c.l N o\ O+ O o o,o] c'l N F -@ o) o a o oL O)O n-@ @ O@ O@ o,N f--F- N F- l'- O@ LO N O) f.- @ C\t- @ rr) @ o)t- a r ocr € ?. o.r -j ! cl € c. C) r o. r ,-t r r a cl -t nr o. .o :i € o, c.l clC cl -f c o. a.l c.l -l- :)' a) cl cl =C (o r{) c\I(\{(.o o) zEa =il74-a cO$t- O)(o o @ @ O) caoN O) CO O) Cf)(r) CO s O) O) C.t N @o N (o o co O)N N @(\ @(o o NNN@ ON r.r co @oN (o ro(, so C\l @ @s @ N (o(o O C,ON N CO(o tr) o) (v) ot(9^ c{i- O) =l oEu E! o.r c- € OOO : tCO a cl -f N o.\o \. c.lsr -f : o\ o. r CI rc rr C]c <= \ot rr -t -$ cl O r .o N € r € c.l O -f to .({ |o(\ d + q c E E o(, E =urry X! _, - OI - l =il oCal t--f-. c.l -f <f € a N \o a-o c.l r Or al N T \o @ a'.1 a.l € O -f N(\(\I(e ?tr! <rO o.Ool r(--(\ t <t- @ c,al \.c rCC! F- t--6l al \c€ -t clCJ € C{ C{(\(\(e Ee nOo{ 6 a= -@f, d ;! -7= u L c il , F >= tr; da o,O c.l r-r N =$ 'f @ o. N \o rO ol t- Ct- al ct \o @ t CI(\ @ o+ C\6t(\t(o a ;O o: ! c0 o .- -o o oo o a 0) Q q) Q (n o o o (! 0)(] c( 0lc o _o E(] E OJ ;^ a s()F (! (.) L -o a oF a o-(-)F _9,(.) F. -j- O N o -C E U oZ + c1 Q c- c = I o -o() ;(_) -() {.) c- -o 2 u c- oJ.) =.; L c_ aD L .a .E at) '- -!f UI (fi C(J u r.) a L a) -o a o L() 'n a q()q C () CN o ='o U OJ a L o- o q CJ(.) ! Cjr -a t-1) ^9(JOQ) r-tl-: a4Q'; a7 7:Y2@ ;LV 6,J Cq -\ 4., 7. o:- :>oz 9v tY) aoo oQot -9oJe:q; L! 'U 9F ,EoD crXU, -> -o!o N1lO.lC -^-O -grvu ^ V.a --9LR- 4O)-'a*< ClLrl =!E<c! boo(, !'i = g 'C=-9 ,.-H.Uva^-h .,-'-O EocgoL-q>,L E !: q J - _-qr 9.o+ t-.X c "cov- E o '- =f6 .i L/j 6i tt ^)U =, 'tL E ,) L u , -c u o- O L -a -a) tJ, N: ()- s;z._tJ(JEOJ ec oo (J,^ a :: ,)e '* F u.- Le -a) a. (u:i O(! u.< a>! --^r- 0-I 9(, -a_ :qc (Fe'" 2 U<H-5U Ui'i b-UiI- .Y OJ -, qE v-! tOYa\ ,. (J 6Q Y .^* c!iol= ! 9= >cqr9<;;>a r}'+ -U -I -^,4 " c+ -:Zdu n U-o O 9JJc- al !() (n 6) -o o q) ! = I() C c =L c* I i cf tr- =o ,: "g u '= 'r, .9 = -o .I G i5 -o .9 L C) o- =o = -o 'x +. .= qC cJ -rl(, .{\ 6J OJa< ^Z-c! -E aq)C ao ;:(J !-=qr E=r-F< cq(F (5 ) o-E/oN a, O .{ ; 4, 'oc>6i (, FD (!() L \ 9(.) nt aL u = .= E '- () E 1) = i) () o- E o () = .= ! 0) d ^,O o-l I > xl ! I El ; -o ;:t oA-l ^'-l U = uto- u olatr ol oi0l g id ol ol0l cl -O t= E 9l c -F/ 6LJ] O<z- (! d) L(n (J 0) L o- 0) = c z L!d -o -a u ,.= .Z =o ; a OJE '= = = =o o o E 0,) -o (JO 0J'-O-I =0J9dre E6J -C -o;k lqc() .o FZ _ ,r!(J L c3 oq) 'e L o- (J -c = = = 0) .: = E E otJ .9 E(] c 0) L 0) o- o 0) tr ;c .z 2 =o- o (! oF OO x !o d C) 0) o o 0)o o L 0) -o E z .a( C C Dj t U C; =i c C c L(. , Z .l()L>(-)() :l -c.ir 't <;(f ^-- cd>i- a I-')oF -J o CJ 0) ar) cl q) oo =^(.)^ dL 50 o 0) L e o- u L c aa .) LT .a) cZ o (n L() oo dL o o(-) o-l 'E -r" ="-6) d OJ F () OI 0) oo (-) o bI o() OI ! d o C)o 0) OI .; o E oo _o E! o LL a vOON L(.) -o E O o z $ cl o c- o :E (h q) o0 qJ F D () a.) q a) :- 0! q) c., I Grl colJNI F*lol : o 0) q, Fp 0) 0,) C!q) OJ !- 0.) OJ L .o L(d() (c 0-) o o oo(0q 0) oo -o q 0-) E 0) LF o.f ,l 5t(dt FI q.) q,) :. a (,) q) !A O'(Jl- >1 Qp f< cJo !.,U;C ^Or G(! -E ooo q)O q)o Q ('lc(- O- O, .= qq ^u -cdEh o);' ,?' 6i o oo6 a't o \, o.,6 c!o. t-o. $o\ o. o.o, o ., ) a, a-l ,, (, (,GJ o! d a rG<;a .o f-- F-. r o\ No. (-- o\ o. o\ o,o. Irlil- G.l L.l E 3*6; o2 >': F u--- I ol \o r-- @r rr @r- o'\t- tr)N O€ o'r- 3.1 o T l- L= =t =|:/-a 3. ,^| c1 r al -t al € r N -t 9r Cr .c\.r: rxr - -;rr r f) a € tr) co co(r) @ o.r o. -t- C] 3'. (o to ry N(o O) GJ =L-<!c r ct ,7, cl J --t ?. al --f clT r r - Tr T o, o,$ O) N(r) F-N o) N co^ N F- O) r €I cl c ;9& al -t --t. r a r CI - .o cl r- cI r : @ F- c.) $ r cl \c $ $-(r) N - o oo = o .= E a E E Q t!ti- r! G) a i-i= C c - = C CC -lC O c <) = OC E] =r)P 2 ?!e -! trji o Lon= To -f rc €? cl rr cl rr at rr al rr al. \D atr C\o(o cr) C!O c.l cl a.l N tr9 GE; c Yi<;o o. .J & hq al t-r- cl rr al rr cl r F- CI \o clr\ c! (o c, N C N cl c{N =9 e69 ^=u +lE= 6 -C U F; ! ilbl rr c! rr cl rr cl rr cl tr-r al rr ai \o clr- (\ (o cO clo c.l N N CJ CON clOO c.l a-O cl -f C,O c! OO al .oOC c! rOO6l @CO cl c. O cl c o C1 2.7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - Q:lease tick the appropriate answer) MOH M WHOf] TINICEil NGDC Other (please speciff) Mectizan@ delivered by - Qtlease trck the appropriate anstver) MOH M WHO[] UNICEil NGDC Other (please speci[') Please describe how N4ectizan@ is ordercd and hou,it gets to the cornmurrities The NOTF requests Mectizan from MDP. After the drug reaches the coLrntrr it lirllous thc existing drug and other nredical ecluiprnent deliverl'systelx ol IrMoll. Druss arc storerl in FN{oH store lionr tr,hich pro-iects (Zorres) receire and pass onto tlte \\'orcdas reccivc t() distribute to the liontline hcalth tacilities. It is fionr thc fiontline health tacilitic's that the cclnrrnurritl supcrl'isors gct thc drtrr: ancl handor,er tcl thc ('DDs nrakrng it leaiil firr cornnrunitv distributron. Table l0: Mectizan@ Invcntory (Plcuse udd ntorc row,s if ttecassary,) Horv are the remaining ivermectin tablets collected and rvhere are thet, kept" At the end of the treatment period. the CDDs return the rernaining drug to H[)s and the HEWs to the I"lCs rvhich are the front line health facilities. The fiont lirre health facilities. in turn. send to thc \\/oreda health offlces and linalll tronr there to the Zone hcalth department. Hence, the rerraining Mectizan is kept at the ZI-ID store. But stttlelitne: there are Woredas and F'ront Line Health Facilities rvhich keep the rcntainittg druss in their store as they are rctnote and transporting the left over Mectizau to thc zonc is st, dilficult fbr thern during rainy seasons. List and briefly describe the activities under ivermectin delivery that are being carried out by health care personnel in the project area. . Training of HWs. community supervisors and CDDs . Woreda health olfices collect Ivermectin liom the Zorre . Frontline health facilities collect lvermectin frorn the WoHOs . HEWs receive Mectizan fiorn FLHFs . CDDs get their lvermectin fiorn I-lPs and distribute to the cornrlunitl, . Supervision and fbllorv up . Rccording and reportirtg . Return the leli over N4ectizane CDDs > HP > HC) WoHO>ZHl) I District/L(lA Nunrber of I\lectizane ta blcts Renraining fronr 2009 Rcqucsted 20 l0 Received (availa ble) I Ised [,os( \\'as tc d Ii r pire d I{crn:tining Kaffa 127,760 2,189,000 2,316,760 2,14'.7,309 0 3,473 0 I (r6,01.{ Sheka 47,396 490,000 537,396 48,337 0 782 0 I 53,277 Total 175,156 2,679,ooo 2, 854,156 2, 195,646 0 4,255 0 219,291 t6 WI IO/APOCI. 2.1 Novenrbcr 200-l I No of Communrtres that conducted stakeholders meetrns (SHM) Drstnct/ LGA Total # of communrtres/vrllages rn the entrre prolect area No of Communrhes that carrred out self monrtonng (CSM) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 C) 0 0 0 0 0 0 0 0 0 0 0 0 t) 0 0 (.) 0 Adiyo Bifta Bonga torvn Chena Cheta Decha ci'[i Gelr'ata Girnbo Sat'lent -l'e lkr Andracha N'lasha N'lasha 'forr r'r -fepi Yeki 209 2'77 34 I r.1 a'i I 329 165 201 357 270 332 lJ6 14 t ?2 5rJ j-10 0 0'l'otal 3222 2.A. Gommunity self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? If so, When? frairring r.r'as rtot concluctecl. Table ll: Commun self-monito and Stakeholders Meetin dd rows Describe horv tlre results of the conrmunity sell- rnonrtoring and stakeholders r.ncetings hitre- affected project iruplementation or horv they rvould be utilized during the next trcatment cvcle. . Training was not conducted on SCM %SHM 2.9. Supervision 2.9.1. Provide a flo*'chart of supervision hierarchy' NOTF )'lOTl:) WOI-I" ) Ilealth Facilitl ) Comtnutritr.'supervisors ) C'DI)s 2.9.2 What n'ere the main issues identified during supen'ision? . High turnover oltrained health tr'orkers especialll'at Woredas and FLIIFs level is seen 1'early . 'fask fbrces alZone and Woreda are inactivc and their participatiolt in the supervisitlrr process is verl' lirnited. . Shortage ol Villagc rcgisters 2.9.3. Was a supen'ision checklist used? \'es 2.9.1. What lvere the outcomes at each level of CDTI implementation supervision? . 'I'he reporting systenr olthe CDTI activities is inrprovine. IIou,o,e r. tltc high turnover ol'health rr'orke rs is still the tnajor unsolved problcttt. . Village rcgister updating training rvas carried out tl \\'l{O,'APO('. 2{ November 200.1 2.9.5 . Village registers were printed Was feedback given to the person or groups supervised? Yes NCDO 2.9.6. How was the feedback used to improve the overall performance of the project? Based on the supervision findings, the record keeping. document handling, village register updating and proper reporting is showing some improvelnent in both zones. Therapeutic and UTG has increased SECTION 3: Support to GDTI 3.1. Equipment Table l2: Status of equipment (Please add nutra row,s if nec'essury) Otltcr' ('ondrtr0[ li e orrd rtr ull +Condition of the equiprnent (F=Functional. CNFR-curlently' non-flnctional but repairirble, WO:Worn off) How does the project intend to maintain and replace existing equipment and other materials? Governnrent budget is used to maintain existing equiprnents and other ntalerials Replacerneut is also donc bl the government and other NGDOs. Stiutce frpc ol' cLlurl)[]cil1 ,\ P( )( I\1()ll** DIS fI{IC I N Cord rlr oll No Condrtron No Cond r 1r on 2 Ntr 0 No Ioyg!qt!!. l_w_p,c!!p Motor cycles sloraqe boxes ,| 3 CNFR \\'o ullgl rvslel Photocoprer 5 3 F lli t 2CNFR l) Fax machrne VCR 1 0 CNFR 0 0 Meqaphones 6 CNFR 0 0Typewrrler 0 Vrdeo proJector 1 wo 0 Stensrl Desrner 1 CNFR 0 Desk top computer 1 ICN}'R 0 LaserJet pnnler Laptop computer CNFR 0 1 F 0 DeskJet pnnter w 2 wo 0 1 CNFIi 0 Overhead proJector CNFR 0 Radro communtcatton 2 CNFtt 0 0Portable electilc generator 2 CNF R r8 \ /HO/APO('. 2-l Nor cmbcr 2004 I-' a3.2. Financial contributions of the partners and communities Table 13: Financial contributions by all partners for the last three years \l()Ll c'onlrrhulrott t.r'for l:otul parson s tolor'.t- 23952 96 dnl rwuung c'rnt 5],019 ,\l ' I1-therc are problents with release olcounterpart funds. hou,n,ere thev addressed The trvo Zones \\,ere not able to liquidate the 2009 APOC's fund and they u,crc no1 ablc ttr get linancial supporl fiom APOC. The Carter Cc'nter and the governtnelrt have contribLrted their share on tirnc'. Describe (indicate forms of in-kind contributions olcornmunities if an1,) . -fhe cornrnuuitl, leadcrs and elders do lvaste rnuch ol their tinre in mobilizing the comrnur.rity during the Mectizan distribution periocl. Some times Ihe cornrnLrnitr rnembers do assist CDDs in their larnr. Contributor Year 7 ('2007) Year 8 ('2008) Year 9 ('2009) Year l0 ('2010) TOTAL Cash Budgeted (us$) TOTAL Cash Released (us$) TOTAL Cash Budgeted (us$) TOTAL Cash Budgeted (us$) TOTAL Cash Rele ased (usl;) TOTAL Cash Budgetcd (us$) TOTAI- Cash Budgeted (USS) TOTA L Cash Releascd (r rss ) MOH (Central + State)* DNr\ DNN DNN DN.A DNA I)NA DNN I)N,,\ MOIJ (District + zolre)+ 27155 0() 21255 0() 2995 00 21255.00 27255 00 299-5 r)0 titi.l17 76 8ti.lJ7 76 DN.\ t)N \ 19.()77 ()lt l().|77 ()g (l () () () Local NCDO(st t rl anr ) f)N.\ 71910 0() 0 DN,A 71910 0(l () t)N,,\ () llilJ6 0o 71910 ()0 DN,\ 71910 00 DN.\ NCiI)O partners{ 'f('(') .lti..l-1tr t)() l) 72()() 00 Corn tr ttlt ttr cs i () () 7l{x) (x) -1- I o () ,,\l)OC' - l rust l'und () () l) TO'tA I 100 I 75.00 r 00175.00 75496 00 t00 t 75.00 | 00 r 75.00 7_,196 ()() r r 0.J2{.88 I 10.J2{.88 l9 WllO/APOC. 24 November 200-1 a 3.4. Expenditure per activity Indicate in table 14, the amount expended during the reporling period lor each activitv listed. Write the amount expended in US dollars using the current United Nations exchange rate to local currency. Indictate exchange rate used here IUSD: I3.65 Table 14: [ndicate horv much the project spent for each activity listed belox' during the reporting period* SEGTION 4: Sustainability of CDTI 4.1. lnternall independent participatory monitoringl Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (Tick any r,rf the follorving which are applicable) Year I Participatory lndependent ntonitoring Mid T'ernr SustainabiIity Evaluation 5 y,ear Sustainabilitr F.r'aluation a Activity Expenditure ($ US) Sou rce(s) funding oI Drug delrvery' lronr NO-fF I-lQ area t() central collcctron pornt rrl eornntunitr NIobrIization and health educatron trl-conttlunrttes lr;inrng o1- CDI)s TC( Taa TCC N,IOFI IVIOII NIOII N4OH a aa1 aa l-r.rrnrng o['hellth \tr1'1'at irlI I!-\cls Supervrstnp ('L)Ds and dtstributttlrr lrrtr'rnal nronrt()r'lng ol ('D-l'l acttVrtlcs r\dvocacl \ istts to hc.rlth artd politrcal attthortttcs ["ocal I)ersons salarr Vehrclcs/ Ntotocr c lesi brcr cles lrar ntenatlce Oifice Equiprnent (e q conrputers. prtnters ctc) Statronarl and prrrrting t8.i75 _19 6 003 97 18439 00 il.6 l7.lr, 15691 l0 l9l1 00 Rcvicrv mectrngs Fuel and oil TOTAL Total number of persons tre{g{ 102,023.44 20 WllO/APOC', 24 Novcmber 200.1 I 4.1.2. What were the recommendations 4.f .3. How have they been implemented? 4.2. Sustainability of proiects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period? NO Was a sustainability plan rvriften? -\'es- a .-on the 3'd and 5tr' 1'ears \\/hen u,as the sustaiuability'plan subnrrtted'l\\/hat arrangenrcnts ltar'e been tttade to sustllill CD'fl aflcr APOC funding ceascs in terms ot-: 1.2.1. Planning at all relevant levels - \'earl1 intc-gratcd plarr is preparcd inclLrilins C'D-l-l at all leve ls iirld all Ilealth actrvitie\ di) sharc tirrtcls allocated lrtlttt tlle govcrnl'rle nt attd othc-r NCiIX)s 1.2.2. Funds - -fhc grlycrnrncnt ancl rrtlter NCIX)s irre allocatirtg btrclgct firr the intcs,ratecl hcrrlth actir ities inclucling C I) ll. 4.2.3 Transport(replacement and maintcnancc) - The qovernr.rrenI and other NGDOs is replacing and tnaittttiirling tratlspt)l'[ l]lcalls (o be uscd fbr integrated hcirth services including CDTI 1.2.4. Other resources - Tle govc-rnrnent does get additional resources fiom \\/HO and tINICEF to execute all integrated health activities including CDI-1. 1.2.5. To rvhat extent has the plan been implemented - The plan is fulll irnplerneltled 1'earlr in an integrated tlratttler irrcltrdirlr-l CDl-I. 4.3. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans fbr coniplete integration: All ('DTI activities are integrated into PI'{C o Mectizan de livery o Tra in ing . Distributiorr o Supcrvision 4.3.1. h'ermectindeliverymechanisms Since t[e iuception of the project. lvernrectin dclivcn'has beetr f ullf intcgrated irrto thc existing PHC drtrg deliverv svstellr. a 2l \ /HO/APOC. 2-1 Novernbcr 200.1 4.3.2. Training : CDTI training is integrated with the Primary Health Care (PHC) program from the beginning at the National, Regional, Zonal- and Woreda levels' Diiease prevention and Heatth Promotion core process is responsible for the CDl-t program. Therefore. all the staff at this unit at Zone, Woredas and FLHWs have received CDTI training 4.3.3. Joint supervision and monitoring with other programs As part of the ryri"* in the country, atl supervision and monitoring activities are done jointlf in an integrated manner. 4.3.4. Release of funds for project activities The 2010 N4ectizap treatmept ictivities \\'ere accornplished b1 the tirrtd rcleasecl fiorn The Carter Certter Ethiopia and MOH. 4.3.5. Is CDTI included in the PHC budget? Itenrized butlgct I'r-rr DI'}&HP includes CDTI 4.3.6 Describe other health programme that is using the CDTI structure irtttl hou this n'as achieved. \\/hat ltave been the achicvements? . ('ampaigus suc.h as ntalaria preventiott. Ptrlio cradicatiott. l-T' N'lcaslcs vaccinations and EOS clo use the CDI-l structtlrc. CDDs are alnavs itlvtilved i, thcse activitics ancl their achievenrents in thc assistatlcc tltei pror idc is Vcrr rettlarkable .l.3.T.DescribcothcrsissuescottsitleretlintheintcgrationofCl),Il 4.4. Operational research 4,4.1. sunrmarize in not more than one half of a page the operational research undertaken in the project area rvithin the reporting period' . OPerational researclt was not done in this Fiscal year' 4.1.2. Ilort' r+'ere the results applied in the project? SEGTION 5: strengths, weaknesses, challeng€s, and opportunities Strengths: ' Geographic coverage- 100% . High therapeutic (79o/o)and (99%1UTG coverage Weaknesses: . Lack olcontinuotts and regular Supportive supe rvision at all ler'cls ' High number of absentecism and refusals . -l'ask forces at all levels are itlactive as usual Opportunities: . Accelerated erpartsion ol'PHC to village level o Assigttttte nt ol HEWs to kehele [evel' a t 22 WI IO/APOC. 24 Nor enrbcr 200'1 aThreats (Challenges): o Overlapping of health related programs during Mectizan distribution period o High stafTturn over(health rvorkers) SEGTION 6: Unique features of the proiect/other matters . Project rvoredas are very rernote . Health staff unu,illing to sta), in the area. . The A f R fbrmat is so laborious. and in our opiniorr needs revision to rnake it sirnple and appropriate. -fhe ZHD has so nran\'reports to deliver to the governnrcnl attrl its other partncr NGDOs. l. I 23 \\/l IO/APOC. 2.1 Novcrnbcr 200-1