Metekel annual project technical report submitted to Technical Consultative Committee (TCC): January 2011 to December 2011

The Federal Democratic Repubtic of Ethiopla Ministry of Health C9UNTRY/NOTF: ETHtOptA Prolect Name: Metekel taunchins vear: 2004 (Month/Yeor) (Month/Yeor) Reportine period: From: Lansarr.?011. ......... ro;......penemD.er .?gtt, 910Proiect vear of this reoort: (circleone) L 2 3 4 S G Date submitted : January 2012 NGDO partner: The Carter Center .6.6 -.4,(#.@. r t.t.,, 'il mCI AA +rw l, -'rri.;3rq,;.+;i..r ' -'I'iil t n-Sc,&rt.e *$L ii -----*"_! I irJ !: -r it,- WHO/APOC, January 2Ol2 {, Nf-{' ANNUAL PROJ ECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT PIease confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: Signature: ..N..*.y. Ifihldt Hiluf Nigusaiq Date: -l-,8) rn )>dt,r:,';,,., (RN, BS", N'iI'H) i IIcr,i*'-r irrnr";tv,,n nrrl f)i*e'ig0 Zonal Oncho Coordinator Name A,; B"*"" Jrra P Country: Ethiopia National Coordinator Name: Mihret Hiluf Signatu re ,i. * Date: January 2072 NG '}.ei eulic:r l-l :'ce ?t ta atrf t/6tr ,c il 'tlo6o .,Dr. Zerihufi\Tadesse ;":;;,. %dl{ d,r(:v' 'tl i i( ,I i"n te: This report has been prepa red by Na me : .....A.tq.B.e.y.en.e J.?.fA Designation : Zon e onchocerciasis Coordinator Signature: Date January2072 WHO/APOC, Januwy 2012 I \- IANNUAL PROJECT TECHNICAL REPORT TO TECHNTCAL CONSU LTATIVE COMMTTTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: Country: Ethiooia National Coordinator Name: Mihret Hiluf Signature: ... Date Z o n a I O n c h o C o o rd i n a to r N a m e : ....... A.tg. B.g.y.e. n e. J.a f.e.......... Signature Date: January 2012 NGDO Representative Name:.........Dr. Zerihun Tadesse Signature: Date This report has been prepared by Name :,....A.t9.8.e.y.ene.j.?.f.? Designation: Zone onchocerciasis Coordinator Signature: Date January 201,2 3 WHO/APOC, January 2012 ! i : I I I I I I I I ! I I I I I I I Table of contents Acronyms FOLLOW UP ON TCC RECOMMENDATIONS Executive Summary SECTION 1: Background i nformotio n ............. -....... 1,1. GrnrRatTNFoRMATToN 7.2. Popuuroru SECTION 2: lmplementation of CDTI 2.7. Trn,trlrrue oF AcnvrrEs 2.2. Aovocacv.. 2,3, MOBITIZNTIOI'I, SENSITIZATION AND HEALTH EDUCATION OF AT RISK COMMUNITIES .... Coruuururrv TNVoLVEM ENT .... Cnpacrw BUTLDTNG TREATMENTS 2.7. OnoERrruG, sroRAGE AND DELTvERv oF rvERMEcnN.... 2.8. CourraururwsELF-MoNrroRrNG AND SraxEnoloEns MEETTNG 2.9. SupERvrsroru SECTION 3: Support to CDTI 3.1. Eeutpuerur 3.2. Frrurucral coNTRrBUTIoNs oF THE pARTNERS AND coMMUNtlEs 3.3. OrHen FoRMs oF coMMUNtry suPPoRT 3.4. ExpEruorrunE PER AcrvrrY SECTION 4: Sustoinobility of CDTI .. 4.!. lrurrRrual; TNDEpENDENT pARTrcrpAToRy MoNrroRtNG; Evnlunloru 4.2. SustatNnsrLrry oF pRoJEcrs: eLAN AND sET TARGers (unruonroRY AT Yn 3)....... 4.3. lNrecnnroru 4.4. OpenarroNAL RESEARCH:- NoruE SECTIO N 5 : Stre ngth s, weo knesses, cha I le nges, a nd op portu n ities.......... SECTION 6: lJnique feotures of the project/other motters....... ..........5 .,,..28 .... . z8 .... 1011 .....10-l+ .....)4+5 ... u18 .....12-13 .....lE1e .....1E+e .....19?s .....21?J. .....Dzs .....27D .....2830 .....2$e ....3932 3032 ,3)43 3 133 3 133 3234 ,3234 333s ,3436 353+ w7 381 2.4. 2.5. 2.6. A WHO/APOC, January 2012 Acronyms APOC ATO ATrO CBO CDD CDTI csM HEW LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT UNICEF UTG WHO ZHD African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Com m unity-Based Orga nization Com m un ity-Directed Distributor Com m u nity-Directed Treatment with lvermectin Com m unity Self-Monitoring Health Extension Workers Local Government Area Ministry of Health Non-Governmental Development Organization Non-Govern menta I Orga nization 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 Zone Health Department j WHO/APOC. lanuary 2012 Definitions (i) Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). (ii) Elisible population: calculated as 84% of the total population in meso/hyper- endemic communities in the project area. (iii) Annual Treatment Obiective: (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/hyper 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 of the project). (v) Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) Geographical coveraqe: number of communities treated in a given year over the total number of meso/hyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage), (vii) lntesration: 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 maximize 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) Sustainabilitv: 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 mobilized by the community and the government. (ix) Communitv self-monitorins (CSM): The process by which the community is empowered to oversee and monitor the performance of CDTI (or any community-based health intervention programme), with a view to ensuring that the programme is being executed in the way intended. lt encourages the community to take full responsibility of ivermectin distribution and make appropriate modifications when necessary. 6 WHO/APOC, January 2012 FOLLOW UP ON TGG REGOMMENDATIONS TCC session Executive Summary The project named "Metekel Zone Community Directed Treatment with lvermectin,, (cDTl) is funded by the African Program for Onchocerciasis Control (APOC) and its partner The carter center. cDTl was initiated in 2004 and has g years project life. There are 365 communities in four meso/hyper endemic woredas. The 2011 updated census figure indicates there were a total of 1,56,942 people in the communities. Training of traineers (ToT), training of health workers, recruiting and orientation of CDDs and community supervisors were some of the activities accomplished prior to drug distribution. ToT was given to 11 zone and woreda management staff. Cascade trainings I WHO/APOC, lanuary 2012 Number of Recommendalion in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY I Involve kebeles leaders in uU CDTI uctivities at kebeles levels Kebele leaders were involved in the CDTI activities, including the selection of CDDs and follow up of Mectizan distribution 2 Conduct advocacy al kebele level Advocacy before MDA and during MDA has been conducted using existing opportunities like: Social meetings, Religious gatherings, Market places and community based development areas. 3 Use checklist for supervision at all levels Standard checklist for supervision of CDTI activities was the tool used at all levels 4 Implement recommendations from monitorl ng and evaluation Recommendations from monitoring and evaluation is the instrument used to improve the CDTI program 5 Conduct CSM and HSM I Community self monitoring is nor done in 20ll as per APOC guideline. However, representatives of communities appraised the activities accomplished through review meetings conducted at Kebele level. were also organized to 213 health workers and 13 district staff. A total of 1413 CDDs and 133 community supervisors participated after they had received orientation. Out of the 366 communities, 5 villages are not treated. Treatment is given to 7L2,227 persons making the therapeutic coverage 72%. Table lTtreatment summary over the years, Metekel zone 2011 The project didn't attain good result in terms of therapeutic and geographic coverage. Absentees and refusals together were also significant (12o/ol. High number of absentees and refusals together with missed villages were the basic reasons of low therapeutic coverage of this year. Late arrival of iveremctin influences the achievement by affecting the commencement of the distribution time. A22% CDD attrition is documented this year making the CDD population ratio to be 1:111. The reason for high attrition is not well understood, but inconvenient of the time for them is believed to be the possible cause. 1. Overview of the population Based on the 2OO7 National Census, the entire zonal population is projected at 309, 851 in 2011. Nearly half of population lives in four Meso/hyper endemic woredas. Agriculture, hunt and trade are common practices of living. A number of day laborers (tens of thousands) migrate from the other areas of the country to these areas. These people have the potential to contract the disease when the treatment coverage doesn't meet the minimum requirement. t WHO/APOC, lanuary 2012 YEAR Total population endemic areas Annual Treatment Objective Number of persons treated Therapeutic coverage ATO covera ge UTG Coverage 2004 L20,234 LOO,997 65,9L4 55 65 65 2005 2006 LLB,42L 99,474 79,7L3 67 80 80 2007 740,t82 7L7,753 99,660 7t 85 85 2008 L42,056 1L9,327 100,149 7t 84 84 2009 L47,524 L23,920 104.363 7t 84 84 2070 t57,284 L27,O78 t27072 80 84 84 20L7 L56942 131,831 1L2,227 72 85 85 2. Training data Similar to the previous years, two days TOT was organized for persons recruited for zone health department and woreda management health office. Overall, 11 health staff (2 per woreda three from ZHD) have attended the training, The training was given collaboration with by The Carter Center staff. Similar trainings were also organized in each woreda. A total of 2L3 health workers 56 (26%l of them have received for the first time while the remaining 157 received the previous trainings. The number of health workers who received the training is higher than the previous year. This is related to expansion of health facilities and deployment of new health workers. The training is given by persons who have taken the TOT. Zone health department and The Carter Center staff have given assistance and played the facilitation role. Reportedly, one day orientation (half day for malaria and half day for Oncho) was given to 1473 (743, new and 727O refresher). Similarly, 133 community supervisors, (majority of them new) have the orientation. Both the number of CDDs and community supervisors involved this year is less by 394 and 64 persons from last year respectively. 3. Challenges and how they were overcome Mectizan shortage was reported form all woredas. Unwillingness of some CDDs and community supervisors to continue working was additional challenge to access the service. The underdeveloped infrastructure (road access) made conducting supportive supervisions difficult. Drug shortage was partly addressed by mobilizing it from other CDT; projects (oromia and Southern regions). ln those areas where there are no functional community supervisors, health extension workers have played the role of community supervisors besides to their task. Opportunities: The ever expansion of basic health service and the deployment of health extension workers who can work at lower health facility level is an opportunity for the program. These people are directly supporting the program in many ways. I WHO/APOC, January 2012 SECTION 1: Background information 1.1. Generalinformation Description of the Project Metekel zone is located in the North-west part of Ethiopia. Metekel is one of the three zones in Benshangul Gumuz People's Regional State. Gilgel-Beless is the capital of the zone where the zonal onchocerciasis control coordination office is based. The zone is divided administratively into seven woredas and 727 kebeles known as the lowest administrative units of the government structure. The zone has a surface area of 22,028 square km, The climate of the zone is classified as tropical. There are two distinct seasons i.e rainy and cool weather from June - October and hot and dry weather from November to May. The temperature ranges from 25 cs - 42 ce. The topography of the land is classified as 82%low land, TOYo semi highland and 8% highland. The total population of the zone was estimated at 309, 851 in 2011. Agriculture is the main source of income for the vast majority of the zone population. Unofficial reports indicate that a number of day laborers (tens of thousands) visit for agricultural activities. This group people have likely to contract onchocerciasis as there is no system in place to access the service. Health Service The zone has one district hospital that serves the entire zone population. The majority (93%l of the population has access to primary health services by seven health centers and ninety-one health posts. The health posts and health centers are the ones providing primary health service to the community. Health posts are the lower health service units and staffed by health extension workers. These workers are meant for providing basic health service including providing education to the communities. The HEWs are contributing a paramount role in the CDTI activities: involve actively in recruiting, CDDs and community supervisors, giving orientation, supervise the drug administration, collect, compile and submit reports. Therefore the health extension program is taken as the opportunity to enhance implementing the CDTI activities to the grass root level. (16 WHO/APOC, lanuary 2012 Map of Benshangul Gumiz Region Dangu C,ilba Lhnfirth ll \\'ourllera Dp-keZatt SUDAN zI o IJJ d, =ot oOROMIYA R REGION la l.h.bDorw.ca. tdrt.t thans trnt nrrtDtrDEtdrtraAchott&. N W E+ s z o 6 lll tr( t r E \\'or' 0 sclt-El trt0,000 80 (iberhrs - LEGEND Townt M.,or R otds tn 8G MaJor R uars Eounda.y lnl.rnalpnal boundiry ll WHO/APOC, lanuary 2012 l 1.1.1 CDT!woredas As it is shown in the above map, the CDTI woredas are situated in Metekel zone. The 2003 REMO has labeled Dangur, Pawi, Guba and Mandura as endemic for onchocerciasis. The CDTI was launched in 2004 following the approval. Thus far, seven rounds of drug distribution have taken place. The zone had failed to perform second treatment round therefore the number of treatment rounds is less by one year. Eighty six kebeles and 366 villages are available in the CDTI woredas. The number of villages has increased by 59 from the previous year. The additional villages are reported from Dangur woreda. Though remarkable progress is being made in infrastructure development, majority of the kebeles have still no road access. This makes provision of support to health facilities and CDDs difficult. The census update done in 2011 revealed that a total of 155, 942 people live in the CDTI woredas, The census result of this year is lower than the previous year. This is due to unavailability of reports from 6 villages located in Pawi and Mandura woredas. woredas. The Annual Treatment Objective was set as 131,831 of whom L72,227 persons have been received ivermectin making a therapeutic coverage of 72%. The project hasn't treated the entire villages; therefore the geographical coverage is reduced from 100% in the previous years to 97o/o. Table 1: Number of health staff involved in CDTI District Number of health staff involved in CDTI activities. Total Number of health staff in the entire project area B1 Number of health staff involved in CDTI Bz Percentage Be=Bz/ Br *L00 Dangur 704 69 65 Pawi 79 51 65 Guba 43 43 100 Mandura 65 50 77 Total 290 273 73 Not all health staff involved in the CDTI activities. Health workers working at health centers mostly don't involve in the activities whereas health extension workers and nurses who work at health posts usually involve. Woredas having relatively small number of health workers involve all of them. tL WHO/APOC, lanuary 2012 L.L.z. Partnership The CDTI activities are being implemented with the financial, logistics and technical support from WHO/APOC, The Carter Center, CDDs and entire communities. The health staff and other sector offices (schools, training institutions) have shown their partnership by providing tra ining halls, tra nsporti ng mectizan. +3 WHO/APOC, lanuary 2012 e.l L d -$- E L,) o. oz !qJ q) o(.) oc aJ oi o ! qJ Bl s NH q) o aJ E q,(J cqJ qJh! €. l-tS PB qJ 0J GAa! 4., qJs.Ebs Ef,qJ v) XoIS qJ q) Q-< \!SEdo3t t4EOB !=Pa-oroaa-tr .Uu '=il EEts!9\o\obN bB at4E s oJa t-*\ *t+a aa 3H o\ *'o 5botstss- =pdqrq, ar EE OPo-f, ar q, !! '=u '- qJt\ H:r\ 0JG .tJ\J(JAJE*AJ AJpar bab=S6 t\ (^ a\!H8so' qO- SSB :GBs EOqJtr 8ebE,3! s8 fl€ E.g!+- OO' ar\Gl3=tr\\rst tr(J\G: 4.,ts\ EE - t-) 9qJ *.d 3b. Estr c1} =qJ(JE}'Fu! nllP^rt"ti5 E6 '(, o o o- boc .F oa OJ L q) E P ooc f ! oc o io oP(o oL o (I, (L, E L o Po 3(! o o IJ o o CL o .= tr o (u -c. .E J P(o c o fI, f o- o a- !c fE o .E f E E oU c.; qJ -o(oF c .9 s =CL o o. ..i \ 6 o r!.! o '= o o- so ti ?o: -clii- ooo .E o.EEPPo, OO-LU '5 .= E(o(l.,itr L -9; -.c(J ._ .qE9o)a9 EB soJO-c9p C(oo<e3 (o qO(sZ3= og o s CL oG (, D s5qE hv- .=l!r!!oof!to r! LN co CN <t @tn rO sf <t 00r\ t.r)N Fl sf sl rn r-l cO F{(O @ r-{(n r-{ rn + il \o .Eo LLooCLN >lJ \F E flgOZtrFtrO Oto\o r-{ Lo No0oN Lo N ol\t H NtotoN(n N\i or(o h o ..c lr, P r'E.strIT H F E 9I o5E .9c(! y sE E I o O)o(o rl tn r\o@N tJ1 o o <rN Olsl rl o oq, N rn ln md <to Nln tnN cn .s ta o o0g 15 .g .tc E E o(, o o .Et E z \ lt tr -oicooCLN -a .:\F E ffgo=trFEO tnrnr-l O)sl tnsl r-FlFl *(o lD(n c! .egcE3E E'=f;lH $ -XcL o O)t o o ol<l oEE .gtr(! st Eg rJ1rnF.l o t/)sl r\FlF.l m EEPE:6 ===of r='sF CL.= GL Olo\o r.i Lo Na 0o tn N Ot\t H NtotnN cn * *N\tgi(o ro EO -E(J(UIE 'tro +,Lral!oE G'Eoo-IJ?L9E GL L f boc(o o '= G, o- (o -ol(, (I,) Ec(! o a.t N d O U { L^* .i ttlE os OJ J o o st I tn b,0 ,E L CL E otJ o f (J fL (o obo(o o .9 v_g J E E o(J E o (u F o o o o CL os !,c o oT'tr J -CLos '= .g q; oog o .gc E E o o ta o J .E ta tr oI l! 3 oE oT' q, bos o .ttrJ E E oI E (u ot a0c 5l! -oq,LLt!(!P =o =e 'o (U o. 6 ot(J f o o o L(o o ooU I) ? o(J Ec o P(o =o e =ott * ls there any other information of interest about the population in the project area? lf so, include it here. Some communities are settlers/seasonal workers coming from highland areas of the country. These groups of people usually leave the area when they finalize harvesting their crops usually after February. Commencing mass administration before February will maximize annual therapeutic overage t6 WHO/APOC, JanuarY 2010 o.l cd d Q L-r > ;(lJ(U *-c-c YPP s8b -e-- =h 9L.Le6 oo:.= =_ gE 6 F# [F .oEcE co.Y!s,! 5 ;o bD-cl (U -o='trLL P o, E .1 , YL(U(ueP3fEE rr!uo' EeEro '--ElJo PLLEE:9(J 9E g*Jsi= :iEE E8H= '89-'- :o I3 =OYboE;s+ ---?x ETET .=95;(oo(lJtr9Eo6;ge!6) cEoE;3b :=#8.8. .:PEPHdE= ?EOaEc'=qr .IBP6 =f 3 3;EFP>9,!'=E!oPALqY;fEE: .EH;Ev-3=U i:Pf8..E.s E(l,!-s LJ-ScLo.Y !!};E ?gts oES so.E 3(r-)pEPt-33 ebEtt d5 E =aigrIEE (o o c o f(J o P .g Eo l! o P t! o) (o o o .o :=P(J(! o o .s E Ei: #r o.,l -olflrlFI IA o .E t, .! o o .5 o E .j N trot, o tr .9 l! tr o E .E CL E N z o Et!th tr .9 .i .E o CL ta g .9 o o.EE=:o(JE o -o E o oo ./l oo o (J o o -o E o o o a/l L o! o Io b/0E.CEErEO tt tr Lo o o- =o c .9 lr L .gT' o0 =o E .9 q, o.Etrc =oL'E o! E o) o- OJtt L o -oo oo oo E o o o) tt1 qJ -oo Io aocEEE(!O tatr =Lo Lo- o. =o o l!t, CLD tn tag o(J cL -nEO: Iv u(.) il, E -c(JL(o ! (J t! (J (o -c.IJ L(o 00E-trEEl!O ttt E L) (o -cU (o ! () (! s,I (! !,cl! o 1A ag l! os o o0c .=s6F(J E o -9o.Etrtr59L'E -(o) L -cro u- L(o =L!(u u- (!) -o OJl! L rE f, -ooII ooCEEEl!O .rt tr (o =L! qJ lJ- (o J ! olJ- l!) -oq, t! (! :, -ooII o .EE l!tr .N= rl=OE Eo cLE =cLotr:90E -c.(JL(! ! (J (I, I (! s,(J (o aog-cEE|!o tt tr s(J (D ! (J (! lJ (o EIL(o (, IJ .9o L =ooE(E o 't (o o- (!o f(, (!L fE L(! 2.2. Advocacy Though not intensive as the previous year, officials at zone and woreda levels have been communicated and sensitized on the program. lt is believed that year round advocacy would help getting the full support of leaders, sector offices for smooth implementation of the CDT|. The other importance of conducting advocacy is to harmonize the activities with the government developmental activities. The government has in most of the case schedule with the community and sector offices, Making advocacy helps harmonizing activities and avoids conflicts, Advocacy should be done on yearly basis to address newly assigned officials or decision makers. Accordingly, 7 officials/delegates from ZHD, woreda health offices, woreda administration have been mobilized. Officials who were mobilized had supported by giving directions to sector offices, kebele leaders. Some officials provided vehicles for transportation drugs, supervision activities. Few leaders visited CDDs during other community visits. ln most of the time, zone and woreda officials have busy schedule. As a result repeat visit or phone contact is mandatory. Non functional or absence of onchocerciasis taskforces or at zone and woreda levels continued to be a problem to access these people easily' Re- establishing the taskforce at zone and woreda levels would facilitate communication. Z.l. Mobitization, sensitization and health education of at risk communities Mobilization and sensitization of communities were carried out mainly by CDDs and health workers (HEWs). lnformal reports show that communities' perception towards the drug reaches the highest level. Communities have understood that the drug has additional side benefit of deworming and effects on other ectoparasites . Despite this fact, maintaining community mobilization is very important. Reportedly, level of active community participation varied depending on how intensively mobilized and sensitized'. IE WHO/APOC, JanuarY 2010 bo E(o oL o. -o Eq, Ec) o o- E o(J OJL)!)(J E -o L P @tF tor;5 oO''lo-E: 5 .=(oE .Z oo P -(J.=l)(oe 6t,.EcrO. .E 6= o6 ok S-= o L -'9E6i) CCc(oEoinEXor!.=cH E:L!rxoo i=E0J(! vgIrE== .g TUf; zELi €q 'E =i =c.=EqoE HJi8 ;FLts +rruq,E H5rn .E';. .g !.8E EE0,FLE UX -g :;tu;-ctrc 6A o9{ S!eou6 o?=9 6qL(t,L l!(J tr-6:Jo ol:a Ec] P(! P f o o- oL .Tf, oI c o (o o L(o(u E oc .9 o o) F -j.(o L Ec(! P o- o(J xo (oEoL o 3 oo t E o -> .c(o E !o roo E oI L(o(u .2 Eo o o- u rrlqc o ob 'E .go Eg o.c OLug >Rt r'{ = <€ ooc ta .g t^ i8EO El!otru6 trto.E 3 oolt botrlg :i. oo r{ *a6 dcl @co o a0l! tr otrt oG o g tnEOE 'Eo tr E olt E z z z z z. t,o o .s ]A .g tr E !trl! 1Ao o(J o olt E = € @ +N ro il Or co E o r\r- Fl (\ tn(o o @ r-.1 slo sf (n F{ st F{ o @ g Ot,troAoII IJ r\ or\ oF{ (Y)<t orn ts6 1A oo(J -go = o r/) ti N @ rJ1 oN Fl t-l(D(n m(o N IAOvtrE =.9\s=8A .Ed =vlJIU EO EO oIleF o stro; .= o5lt= E=is 3 oo * rt co @6co@ o ool! g oI oG N sf r\st (oFl r\(\l rn(n lo EEgTE EEEI lA(o fnN r\ (r1 N l! 0,(! (., o o o E o o ..c 1A .9OP C'E rnln F{ or sf tnst N F.l ti (o(o(n (, .9 .a o ) ooc(o o .; (o o- (! -of(, (o =Ec(o Eo E ot6(a AJ(J AJsb(ai o 0, o Ett tr a,q o 0, o- oL' o .g g .9 l! .9 .9t o CL th o .E E =oI If o ll o c o E o o .E .E f E E o(J aN e.l N >. ,Q3\E O oA > ;(J l! E O)c o .F c o, E o o -o 11, o oP oa! c '6 o- -c. c o c(u E E ou oz I t, otn lJ .9 E' bo .g o .ct o (l, (u =ti .9 o(J tr o .E 3 ooc o o E ?-g E E oI oE o olt E o E o(! E o o C(\. .9G rE(u CL .e .9 EEe6 IAtE ,b, oOE(!tr c o.=>E CL Et9 AEt o (!Ebs sg tr(! lncentives provided by communities for the CDDs. No any form of incentive given to CDDs by the communities Attrition of CDDs: ls attration a problem for the project? tf yes, how is it addressed? As it is mentioned above, this up to ZLYo attrition is reported from three woredas. Compared to the previous years, this year attrition is significant. There are no clear reasons the attrition, however; inconveniency of the distribution time may be attributed to high number of CDD attrition. 2.5. Capacity bullding - Describe the adequacy of available knowledgeable manpower at all levels: - The government is aggressively working to access basic health services to the communities with particular emphasis to deprived communities like B/Gumiz region. The number of health staff available in project woreds is increasing from time to time. All new health workers receive training every year to ensure the availability of knowledgeable staff at all levels. Therefore, it is believed that there are adequate staffs who can support the CDTI activities. - 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 whot meosures were token to ensure odequate CDTI implementotion where not enough knowledgeable monpower was avoiloble or if staffs are frequently tronsferred during the course of the campoignl. Compared to theprevious years, the staffs in the project woreds are becoming stable and the number of health workers leaving the area becomes low. Whatever the case, health workers and management staff receive training yearly. Accordingly, of the total health staff, 73o/o of them had been trained in 2011 or retained on integrated activities of Malaria and CDTI activities. tl WHO/APOC, January 201I .E' o .E l! oo(J o oll E z Er+ =osogHddFu9(J r,tI tt LI u 5q = qJ z o r\ r- : q)o : @(O (o <t rn NtnI N rn : o N rnro o@ .: rno : lnr\ r\l r.o N slo : slo st o sfo sf an r+ : o N : fn <f <f ro(o xln6 c o E o o EIJ N o IA o .=l! Etn oo o- oo,lt (ucc, =ozts Er+E T9:F9(J(, 6u brTU Sd ko i : o N : : o N r-{ Fi N o c! CN -T o c{ 1 o o s 1 c o E o .gs TJ s s U9 o r-l!ot ta oLCLo> =o2s il+60ts(J(JL' (J €(, l! o i_ L 0J'q 3 q.) z o)(o \o : (n ri r\F r-l rn sf sl N t'l rn CO st (o rl r\N O) sf otn ti : o) sf sl O o o o tYt N rn (o tn NN \oo\ ro CN g o E o .Etu x(Jko tso IA to .9 ti o o OElroctr =(!zts 6(J L.r U I It(J E o .F- bq = qJ = o F T cn o (n : sl o co (n co o CO i rn o fn m fn o r{ rl xq, o tr o E o .gE(J s I .9 .2 o L a o0c(o o '= (o d (o -of(9 (o f !c(! (I, o -N oF c.l >.L cU (! (, o - J c.,l Ot !cf, ol-) q, af o! os AJ q) ! G q) AJ{B >. so G! o! Blq Bc o a_t4 AJ o() qJ ! AJt o\ o_ q.i aB G o ! os G OJB(L 0J' s< = qJ 3 * s oh qJ u OJ S i o qJ oE E! o qJ G 4., a- C o v(!Pc o E o) o- E tro(J oI o o c o o ! o)t (o bo .g .E(o F rrit orl -ololFI N N N Table 5: Type of training undertaken (Tick the boxes where specific training was carried out during the reporting period) Any other comments No additionalcomment 2.6. Treatments 2.6.L. Treatment figures lf the project is not achieving LOO% geographical coverage and a minimum of G5% therapeutic coverage or the coverage rate is fluctuating, state the reasons and the plans being made to remedy this. Twelve villages (six from Pawi and another six from Mandura) are omitted from drug distribution. Pawi woreda failed to provide the service due to shortage of drugs where as reluctance of the woreda health office management body was reason for failure. 19 WHO/APOC, January 201I Type of training CDDs Other Community members Community supervisors Health Workers (FLHF) MOH staff or Other Politic al Leader s Others (specif v) Program management How to conduct Health education Management of SAEs CSM SHM Data collection Data analysis Report writing Others (specify) 6l d.- r NJC d -F qri .E +.- E'$Eits +Str\A,B\0) qJ\aI o(n *.q)\s OrL ET+, q, s q,, clrEEB(5Eh0J \) '6' qr Ef,et:!B O.rtr\Se'=t HEbr .C a,Ea0Jt U9 8.r -< 'dgh. q, q, tr\ TE BEbs.3$ ebgB qlJ EEra .=tE 3Btr4, =orsi.St .EeiHtr\ e8F€ Ir l.) P$5E ttr AJ tr a, Er B s tr (J a,tr a) € 3 E A) o t trq, c U a, '6. a tr oQ G B 14 B 0) tr E AJttr a, I q, a s. o.(aq, tr Els AJ a. oq) a.t a,a ESs! a) B .E qJ q, tt o = o 0JoqJ cb i o qJ o E EB G qJ o qJ o_ .v, L P(o (! oL(o (! .c (9 J PIJ L P .2E ! UJ tlt lCc(! Pc o E Pt! o)LF l- o -o(I,F 6oJLt-5 [3''E =5L P >E.tuEZ_f*HoJoro z o Y E -c. cL.= o o o o o 3E 3 r {a9OoJcuJ i L gE o dO o o o o o b9 -oc =oJ =tiJr_O6Zo(!o rlN OrN r-{ F\(Y) st (o Flo Fl t-{ O)Nti C'l CNln C'T bPEq,43gEE?or(!2zg€E#g-. @tnosf @sfOrCN oNor-{ r\tn@ (no6C'T c o s) o- o o- 9epoIl roruLoi: OJ F{ -c,'! O>RoNhr-=Uo9OOO stN Olln r{oo Floo NF- tso 3b H;uE?(o5d9 ZLO-{= fn(n CN 00(O sfl'- Fl Fl cn Fl F\ N N rl ol st slofn NNN F{ @o PcoJ (8tr: v =b(uF 95' N tn(n ro st @ tJ) CN <f sl @r\ rnN F-{ <f sf rn !-'l(O F{(n @ Fl(r) Fl o (L)L - -C, OJ .E P 9.gE €E -=a-(l)6(!l ;.1f,(I,l*oJcoUVSaTLFo-OtrY(o Oto\o r-l Lo Na 0o N Ln N Ot\tt! N LotnN cn N\t('r(ot,l o bo(! o =L) E E oU oo amdooo ""$Fb3E eS oorl @00 ooF.l rn@ or o .: o, . c ooEnf(ooJ lltr'=(oFE<OJ2*ob.A: r/)rnFl rnst tn<f r-Ftr-l o(o(n do tutrf, =bo&tsE6o lntJ)rl or<t l/tsf F\FlFl (D(orYl Eg.s iYqtO+t E.0r^ >.9)! (E\-F Es:ee;gd rnLNr-.1 Olst lnst FFl!-'l (o(orn (J -qgi5< :, ooc t!o =(oo- (! -of(, t! f E' L(E fo 2,6.2 What are the causes of absenteeism? The coincidence of the distribution period with farming period was the cause absenteeism. lt was identified that some villages started lately even after they had received the drug. 2.6.3 What are the causes for refusals? No known. 2,6.4 Briefly describe all known and verified serious adverse events (SAEs) that occurred during the reporting period and provide (in table 8) the required information when available ln case the project did not have any cases of serious adverse events (SAE) during this reporting period, please tick in the box. No SAE case to report L' WHO/APOC. January 201I N >. (o DJ,a > oo(o L G, 5goE oqr I o@ @@ @co a@oo rnOl ln@ c o s =o oo oo 't-.fd6ts LlJ lr, LrJ bo 11, otr, \k g,E r-@ I o@ @@ @oo a@@ rno) tJ)@ oo F{ oo€ uJ I r' 8$ r!LL(U -c '{= o >RFJ(JU rnln r-(o Flr\ or\ r-{r\ o€ N u') r-.1].\ €lrl o b 2p -o=(uvts9iE =69ZO-{: st r{ Or l.r')(O (O Fi F{ oi F- o(O(o oi O) ot sf rido rl (n(O(nto r< Nr\o rl(\l F{ r\ r! c{N rl Fl h l! PcoJ rEtrf,. lbc, :9-o- rJ') Ol r.o lriN (n r\q Ol Ol ln st(o N r-l r< ln sl r.o cfi Fl Fl stNt,)r\t rl Olr-o r\N ri r-l ro @ -i cO r-l ooJXso-(J .=P>\-P?E .E 9P 36o*9EEeFo-Otri(ouJ sl CNNdN Fl rlN sl oo' r-l Fl r.oo@d st r-l ro rJ1o(\l sf Fl st a{ rJ1 ra sf Fl sl @(\,1j rn Fl c\t st o)(o ln Ft vt o oo l! tJl .o .:c) E E o(J ooFl 6mNuJ lrt uJ (u u0(! (ULr>^k eE otn ooFl ooFl oor-{ ooFl oori n@Ol E-F'eF= b I sE 4,8,lt,.fl-b s rJ1 lJ1 Iotn oo Fl oo rl oo r{ oo t-{ oo F-{ n 00 O) 6 LU -fO(lJf=E, -otr.>oE\P EEt^--a!2z 8:E sg rnstr'l o'l@N o)@N Ot@N oOtN or\cO o(ocO UJ C(u gEE li!(u elY-Oatro rnsfFl Ol00N or@N O)@N oOtr! r\orn (o(o cO !--(lrVIJIE .oPd P +C>-(J J6! .EF3.EH5 E= 9 E E H rnstr-l Or@N Ol00f! O)oON oqrN r\oan (.o(ocO E IJ.J sfooN tJ.|ooN (O OoN r-ooN @ooN qlooN o Fio N r-{ F.{oN ttg .9 .g J JJ|!IJ o aol! o o(J(, (E .E o (E .5 E oE o .E' o ttl l! o =oo .9s o = tYtq, tn (E o (! IJ o o CL oE o (, ) o ! o(! .9E' .= oIA o o c o o t! IJ o o CL o g o o o l!o rl flrl Erl cl o,l .!llJl >llll o oo(! o oI E'c o IA tro E o o oig It r! l! o tr o I ot o tr .9 CL o rJ .= o o CL olJ E o c o E o ,gs o tr o E o o o !,g o ,iIN I I 2.7. Ordering, storage and delivery of ivermectln Mectizan@ ordered/applied for by - (please tick the appropriote answerl MOH g WHo E UNtcEF E Other (please specify) Mectizano delivered by - (pleose tick the appropriate onswer) MOH V WHo f] UNIcEF f] Other (please specify) : Please describe how Mectizan@ is ordered and how it gets to the communities Mectizano ordering and distribution was done as per the existing government drugs and supplies management system. The Zonal health department submitted a request paper to FMoH the total amount based on the woredas requirement. Shipment of drugs and other supplies from FMoH to zone warehouse was facilitated by the ZHD. Similarly, woreda health offices transported to woreda and some times to health facility levels (depending on the accessibility and availability of vehicles. For most communities, the CDDs or community supervisors collected the drug from the FLHF. Only in a few cases did the FLHF staff deliver the drug to the communities during their visits for other health programme activities. Table 10: Mectizano lnventory @lease odd more rows if necessary) lnformation was not available on the amount of Mectizan expired until this report time. The assumption there could be expired drugs. How are the remaining lvermectin tablets collected and where are they kept? ln principle the remaining drugs have be collected and stored at woreda health office in woreda pharmacy store and will be used in the next distribution schedule. However, it is known that some health facilities haven't yet transported the remaining drugs to woreda. List and briefly descrlbe the activities under lvermectin delivery that are being carried out by health care personnel in the project area. . FLHF responsible staff formally requests the woreda health office staff (pharmacy technician or person in charge of doing this section) transports to FLHF level when deemed necessary. r Transportation and/or distribution of lvermectin to CDDs NGDO tr NGDO District/LGA Number of Mectizan@ tabtets Requested Received Used Lost Wasted Expired Remaining MetekelZone 371500 339422 315358 0 705 NA 23053 ?-+ WHO/APOC. January 201I . Collect the left over drugs from CDDs or community supervisors and transport to woreda warehouses. . Audit and assess the condition of remaining drug , Facilitate disposal of expiry or damaged drugs Any other comments none 2.8. Community self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring done in the project area? The agenda is addressed during the two days zone level ToT which was organized in April 2071. Table 11: Community self-monitoring and Stakeholders Meeting lAdd 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. CSM is not yet implemented in the all program woredas, hence unable comment on this area. There was a single attempt in 2010 treatment year in which few communities had conducted reviewed the activities with health workers and leaders. 2,9. Supervision 2.9.L, Provide a flow chart of supervision hierarchy ZHD/NGDO) WHO ) Health Facility ) Community supervisors ) CDDs "tb WHO/APOC, lanuary 2012 District/ LGA Total # of communities/villages in the entire project area No of Communities that carried out self monitoring (CSM) No of Communities that conducted stakeholders meeting (sHM) Dangur Pawi Guba 155 49 45 0 0 0 0 0 0 Mandura L77 0 0 TOTAL 366 0 0 ZHD staffs, worda health office staff together with The Carter Center have made joint supervision. The supervision covers all the entire process (trainings, distributions, health educations). 2.9.2. What were the main issues identified during supervision? Woreda health office level 1. Woreda health offices were not able to provide assistance to health workers and down to community supervisors due competing activities. 2. Data discrepancy between woreda and Zone 3. Malaria was not properly integrated and no document on it. 4. Mal distribution of mectizan resulted in temporary shortage of drug. Health facility level 1. Similar to woreda, frequency of visits/support to supervisors and CDDs were minimal 2. Missing CDD registers 3. Similar to woreda health offices, distribution of mectizan was not based on population data. Some health facilities added contingency to the farthest villages. This resulted in temporary shortage of mectizan with in the woreda. 2.9.3. Was a supervision checklist used? Yes, 2.9.3. What were the outcomes at each levelof CDTI implementation supervision? o Data discrepancy corrected . The frequency of visits increased . Missing registers replaced by new ones o ShortaBe of mectizan solved by mobilizing from village to village o Health workers motivated 2.9.5. Was feedback given to the person or groups supervised? lmmediate feedback is given to all supervised 2.9.6. How was the feedback used to improve the overall performance of the project? The lesson learned from the repeat visit is that gaps identified during the previous supervision were corrected and adhered. rq 19 WHO/APOC, lanuary 2012 SECTION 3: Support to CDTI 3.1. Equipment Table 12: Status of equipment (Pleose odd more rows if necessary) *Condition of the equipment (F=Functional, CNFR=currently non-functional but repairable, WO=Written off, NA data not available) Replacement of the items is done in 2011. Replaced items are highlighted blue How does the project intend to maintain and replace existing equipment and other materials? Maintenance APOC donated vehicles is done according to government regulations. Unless there are financial constraints, vehicles especially the car receives regular service depending on the mileage. Regular service is not common for motorbikes. Replacement would seem difficult for zones and woredas, nonetheless vehicles and office equipment donated by other programs will be utilized whenever necessary since APOC donated vehicles and equipment are supporting other programs. 3c WHO/APOC, January 2012 Source Type of equipment APOC MOH ** DISTRICT NGDO Others No. Condit ion No Condit ion No Condit ion No Condit ion No Condit ion Toyota pickup I NF 1 F 4 F Motor cycles 5 NF NA Desk top computer 7 F NA LaserJet printer t NF NA Photocopier 7 NF NA Fax machine 1 CNFR NA Overhead projector 7 NF NA Megaphones 2 NF NA TV 1 F NA VCR 7 F NA Generator 3 F NA 2 F i3.2. Financial contributions of the partners and communities Table 13: Financial contributions by all partners for the last three years - lf there are problems with release of counterpart funds, how were they addressed? ln most cases, release of APOC fund is not flexible and doesn't arrive timely. Rather the fund from TCC is fast and flexible. - Additionalcomments CDTI activities have been implemented with integration of other health programs; however, lack of appropriate documentation usually posses difficulty to clearly put explicitly and might underestimate government contribution. 3.3. Other forms of community support - Describe (indicate forms of in-kind contributions of communities if any) Few communities assisted drug transportation from woreda health office to kebeles. 3.4. Expenditure per activity - lndicate 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. lndicate exchange rate used here 1USD = 15.32 Birr 3t WHO/APOC, lanuary 2012 .j,,,0,., Year (2009) Year (2010) Year (2071) TOTAL Cash Budgeted (uss) TOTAL Cash Released (uss) TOTAL Cash Budgeted (uss) TOTAL Cash Released (uss) TOTAL Cash Budgeted (uss) TOTAL Cash Released (uss) MOH (Central+ State) 0 0 0 0 0 0 MOH (District + 2sng; 5000 4408.7 5500 3789 4892 2737 LocalNGDO(s) (if any) 0 0 0 0 0 0 NGDO partner (The Carter Center) 7000 5009.5 12,000 7L743.25 2,776 2,L76 Communities 0 0 0 0 0 0 APOC Trust Fund 5551.11 3955.77 L5242.85 14808.73 18,331 12,832 TOTAT 77651.1,1. 14373.97 32742.85 30340.98 25,399 t7,L3g Activity Expenditure (S us1 Source(s) of funding Drug delivery from FMoH area to central collection point of community 834 GOV & TCC Mobilization and health education of communities (HSM) 2806.02 APOC TCC & Training of CDDs 0 Training of health staff at all levels 11583.1 APOC+ TCC Supervising CDDs and distribution 3283 APOC+TCC CSM 6921 APOC lnternal monitoring of CDTI activities 564.3 TCC Advocacy visits to health and political authorities 670 TCC IEC materials 0 Summary (reporting) forms for treatment 774 GOV Vehicles/ Motorcycles/ bicycles maintenance 2732 GOV Office Equipment (e.g. computers, printers etc) Other miscellaneous expenses L74.5 TCC 1099 GOV TOTAL 30340.92 Tota! number of persons treated = L2tO72 Table 14: Indicate how much the project spent for each activity listed below during the reporting period Cost treatment = 0.30 USD SECTTON 4: Sustainability of CDTI 4.L. lnternal; independent participatory monitoring; Evaluation 4.t.L Was Monitoring/evatuation carried out during the reporting period? (Tick any of the following which are applicable) Year 1 Participatory lndependent monitoring Mid term Sustainability Evaluation X- 5 year Sustainability Evaluation WHO/APOC, January 2012 4.L.2. a a a a a a lnternal Monitoring by NOTF Other Evaluation by other partners What were the recommendations? Training should be targeted Government budget should be explicitly spelt out at all levels lmprove therapeutic coverage to highest level lmprove documentation of cDTl activities especially at worda level Mectizan should be available at the appropriate time The need to plan for vehicle and equipment replacement 4.L.3. How have they been imptemented? The ZHD and woreda health offices are trying to address the recommendations 4.2 sustainability of projects: pran and set targets (mandatory at yr 3) Was the project evaluated during the reporting period? _ _no Was a sustainability evaluation_)_- When evalua plan written? yes_(during 5 ys project was the sustainability plan submitted? _yes_(during 5 yrs What arrangements have been made to sustain CDTI after ApOc funding ceases in terms of? 4.2.!. Planning at al! relevant levets 4.2.2. Funds 4.2.3 Transport(replacementandmaintenance) 4.2.4. Other resources 3) WHO/APOC, lanuary 2012 4.2.5. To what extent has the ptan been implemented t + 4.3. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3.1. lvermectin delivery mechanisms lvermectin and delivery mechanism is integrated into the existing government drug procurement and distribution system. Zone health department is responsible to transport lvermectin from the Center until zone level. Each health office has transport its own share to woreda level and when necessary to FLHFs. The woreda plans to execute CDT activities by integrating with other health programs. , 4.3.2. 4.3.3. 4.3.4. 4.3.5. Training: The CDTI activities including training of health workers are integrated are being implemented with other activities. The budgets from other sources are helping to train health workers and vice versa. Joint supervision and monitoring with other programs One of the directions of the government is to conduct joint supervisions and address related activities together. Health facility supervisions, drug collections and the likes were done along with malaria control activities (lRS spray, outbreak investigation and control. Health extension workers were assisting CDDs and community supervisors during door to door visit for routine health activities. Release of funds for proiect activities Release of funds for project activities is done based on the proposal prepared by appropriate person and presented to the zone or woreda head. Effecting payments or purchase of materials is done after it gets the approval of the head. The Carter Center manages its fund by its own. Training and other expenses are either effected immediately or reimburse based on the receipt or approved documents. ls CDTI included in the PHC budget? Yes As clearly mentioned earlier, CDTI is part of Malaria and Other Vector Borne Diseases. One can not find earmarked budget for Oncho specifically' The money allocated under this budget line includes CDTI activities' 4.3.6. Describe other health programs that are using the CDTI structure and how this was achieved. What have been the achievements? Though difficult to measure the achievements, health programs such as lmmunizations and malaria control activities use the structure. CDDs also support malaria during drug distribution. >1 WHO/APOC, JanuarY 2012 a , s 4.3.7. Describe others issues considered in the integration of CDTI. No further comment 4.4. Operational research:- None 4.4.1. Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period. 4.4.2. How were the results applied in the project? SECTION 5: Strengths, weaknesses, challenges, and opportunities Strengths: o Willingness and CDDs o lntegration of CDT| with other programs o The positive attitude of communities towards the drug ievermectin o Relatively stable staff Weaknesses: o Reluctance of some woreda health office such as Mandura to support the activities o Data inconsistency at different levels o Weak document and missing registers o Absence of document on government financial contribution o Presence of omitted villages Challenges: Problems related to transportation o Poor infrastructure to reach CDT villages o High fuel and maintenance cost o Mobile nature of some communities o Late arrival of drugs from the Center o High rate of CDD attrition SECTION 6: Unique features of the project/other matters A mega project is underway in Guba woreda on Blue Nile riverbank. An estimated 15-20 thousands of laborers have been working. The project will stay for the next five years. As these groups of people living in endemic areas, there are possibilities of contracting the disease. Guba woreda health office has made an official request how to handle the issue, 35 WHO/APOC, lanuary 2072