The Federal Democratic Republic of Ethiopia Ministry of Health COUNTRY/NOTF: ETHIOPIA Proiect Name: Kaffa Approval vear: 2000 Launching vear: 2001 Reportins Period From: Januarv 2011 To: December 2011(Month/Year) ( Month/Year) Proiect vear of this report: (circleone) I 2 3 4 5 6 7 8 910 l1 Date submitted: 30 December 2006 NGDO partner: The Carter Center \ ulaAA I i h ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO CAL CONSULTATIVE COMMITTEE (TCC) DEADLINE FOR SUBMISSION: To APOC Management by 31 Julv for September TCC meeting t(-\ lr. rI l-ri -fllc tr lu( fi, !4-L. To APOC Management by 31 Januarv for March TCC meeting-t- (9l AFRICAN PROGRAMME FOR ONCHOCERCTASIS CONTROL (APOC) 0 5 JUIL. 2012 APOC / RECU LE Dlt, WHO/APOC, 24 November 2004 *'1r" ?RD 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: Mrs. Mihret Hiluf.... Signature: ... Date: Zonal Oncho Coordinator Name: Atirse Gebire Signature: Date NGDORepresentative Name Signature This report has been prepared by Name : ...Alir.se.Gebire Designation'. Zone Onchocerciasis Coordinator Signature u. ') .t'c h. 4- o Date ll WHO/APOC, 24 November 2004 C ,t * n
Table of contents DEFINITIONS ............. FOLLOW UP ON TCC RECOMMENDATIONS............ Execurtve Suuunnv.. SECTION I: BACKGROUND INFORMATION l.l. GeNeRalINFoRMATIoN......................... 1.2. Popu1ettoN................ SECTION 2: IMPLEMENTATION OF CDTI 2.1. 2.2. 2.3. 2.4. 2.5. 2.6. 2.7. 2.8. ry .v I 2 3 aJ 5 6 Ttuer-rNp oF ACTIVITIES............... .....................6 Aovocecv ..................6 MOEILIZATION, SENSITIZATION AND HEALTH EDUCATION OF AT RISK COUITINITTBS.T Couuuxny INVoLVEMENT............ ..................7 Cepeclty BUILDING .......................8 TRrRrvENrs................ . ........ ...10 ORor,RruG, sroRAGE AND DELIvERY oF IVERMECTIN......... .. ................14 CovuuNtry sELF-MoNIToRING RNo StnrcpHoLDERS Meerruc.... .......14 2.9. SupeRvtsloN............... SECTION 3: SUPPORT TO CDTI=::: 3.1. EeutpuENr .......'........16 3.2. FrNeNclnr- coNTRIBUTIoNS oF THE PARTNERS AND coMMI-,TNIITIES ...."....'..'. .......-...17 3.3. Oruen FoRMS oF CoMMLTNITY SUPPoRT ENNON! BOOrcTARX NOT DEFINED. 3.4. ExprNolruRE PER ACTlvlrY SECTION 4: SUSTAINABILITY OF CDTI 4.1. INrenNnI-; INDEPENDENT PARTICIPATORY MONITORING;Eva1uertON...............,....19 4.2. SustaNestllTy oF rRoJECTS: ILAN AND sET TARGETs (ueNoeroRY AT Yn 3) ..... 19 4.3. INtEcR.artoN..........,..... ................20 4.4. OprnartoNAl RESEARCH.. .................21 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES' AND OPPORTUNITIES 2t SECTION 6: UNIQUE FEATURES OF THB PROJECT/OTHER MATTERS...........21 .................. l5 .................. l6 llt WHO/APOC, 24 November 2004 Acronyms APOC ATO AtrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT LINICEF TUG WHO African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Communiry-Based Organization Commun ity-Directed Distributor Community-Directed Treatment with Ivermectin Community Self-Monitoring Local Government Area Ministry of Health Non-Governmental Development Organization Non-Governmental 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 lv WHO/APOC, 24 November 2004 Definitions (i) Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). (ii) Eligible population: calculated as 84%o of the total population in mesoftryper- endemic communities in the project area. (iii) Annual Treatrnent Objective: (ATO): the estimated number of persons living in meso/hyper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. (iv) Ultimate Treatment Goal (UTG): calculated as the maximum number of people to be treated annually in meso,/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 ofthe project). (v) Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) Geographical coverage: number of communities treated in a given year over the total number of meso/hyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). (vii) Integration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) through CDTI (using the same systems, training, supervision and personnel) in order to maximise cost- effectiveness and empower communities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTI. (viii) Sustainability: CDTI activities in an area are sustainable when thev continue to function effectively for the foreseeable future, with high treatment coverage, integrated into the available healthcare service, with strong community ownership, using resources mobilised by the community and the government. (ix) Communitlz self-monitorine (CSM): The process by which the community is empowered to oversee and monitor the performance of CDTI (or any community- based health intervention programme), with a view to ensuring that the programme is being executed in the way intended. It encourages the community to take full responsibility of ivermectin distribution and make appropriate rnodifications when necessary. WHO/APOC, 24 November 2004
FOLLOW UP ON TGG REGOMMENDATIONS TCC session Number of Recommendatio n in the Reporl TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY I Train more CDDs; The number of CDDs has increased in 201 I by 536 CDDs 2 Retrain all involved in CDTI on record keeping HEWs and HWs were trained in record keeping in 201 I J Explain how CSM was done without training Orientation was given during the CDTI training session at each woreda, in 2010, but CSM was not done as it out to be. 4 Reduce number of wasted and expired drugs; We have discussed seriously on this issue with WoHOs but still the condition needs further follow up. 5 Conduct Operational research on challenges; The ZHD has identified its gaps and is trying to find a lasting solution to the identified challenges. 6 Conduct sustainability evaluation and prepare sustainability plan. If this has not been done already. This has been done already WHO/APOC, 24 November 2004 Executive Summary Background on treatment and population data Kaffa zone of Southem Nations and Nationalities Peoples Region (SNNPR) of Ethiopia is located in the southwestern part of Ethiopia. The project zone is divided into l0 woredas (districts) and I town administration which are further subdivided into 2,572 villages. Kaffa is one of the first CDTI zones in the country and has been successfully implementing ivermectin treatment since May 2001. The Annual treatment objective (ATO) of Kaffa CDTI project for the year 2011 was 851,513 out of which 777,507 people were treated. The overall therapeutic coverage was 77o/o and the geographic coverage was 100%. Consecutive therapeutic and ATO coverage of the project zone over the years is indicated below. YEAR Population Total populatron of the meso/hyper-endemic areas Annual Treatment Obtectrve Number of persons treated Iherapeutrc coverage (%) ATO coverage (o/o) UTG (%) Coverage 200 I 7 t6,599 r00,820 96,244 80 95 t6 2002 731 ,7 56 36s,852 3s8,996 79 98 58 2003 763,582 610,866 567 ,37 6 '74 93 93 2004 795.352 668.096 620,t82 '18 93 93 2005 830,360 691,502 635,995 77 9t 9l 2006 816,1 1 3 652.890 623.786 76 96 96 2007 817,490 '737,092 689,566 79 94 94 2008 930,584 78t,691 69t,439 74 88 88 2009 948,859 199,143 753,8 r l 79 94 94 20t0 1,001,055 840,844 184 ,'7 l6 '78 93 93 201 I 1 ,0 1 3,706 851,513 777.50't '7'7 9l 9t Background on population movements. The communities in Kaffa zone are mainly indigenous and new settled farmers, semi-pastoralist, daily Iaborers, civil servants, tea and coffee plantation workers. Yearly many people from all over the country come to pick coffee and tea to this.zone. The new influx usually does increase the number olpopulation during Mectizan distribudon session and some times it decreases if we are late to srarr rrearmenr on trme (before the rainy season for people move out of the area once the harvesting season is over). Challenges and horv they were overcome Threats (Challenges) . Lack of continuous supportive supervision at HF and WoHO levels using checklist. o Inability to increase female participation in CDTI and the number of female CDDs o High turnover of frontline health workers at all levels . Overburdening of woreda health offices due to competing activities o Delayed Mectizan distnbution period due to Impact assessment done by APOC To solve this problem the following measures were taken:- . Feedback was given to the WoHOs to undertake continuous and regular supportive supervision and recruit more female CDDs to increase females involvement in CDTI . Preparation of integrated plan that include onchocerciasis control ' New CDDs were selected and trained to fulfill the set standard 2 WHO/APOC, 24 November 2004 SEGTION 1: Background information 1.1. Genera! information l.l.l Description of the project Geographic loc ation, topography, c limate A. Kaffa Zone Location:- Kaffa zone is located at the south West of the country and the capital of the zone, Bonga is about 469 km. from Addis Ababa and746 km. from Flawassa, which is the capital of the SNNPR Kaffa is considered as the binh place of C-offee. C-offee and livestock are the main economic sources. Its boundaries are Jimma ,on. o., the east, Bench lvIali znne on the south and south west, Konta special woreda and South Omo on the south and south east, Sheka zone on the north east and Illuababora zone on the nonh. The mean annual rainfall is 1001-2200 mm, Agro ecology Dega 7 .30o/o, \Woinadega 70.Oo/o and Kolla 22.7o/o. Elevation is 501-5300 meters above sea level. Population: activities, cultures, language The main language of the Zone is Kaffinono. It is also an official language of the zone. Some of the inhabitants speak Oromifa, Amharic and other Ianguages. Communication system:- o Transportation: - All woredas do have all dry weather road o Telecommunication: - All woredas do have a wireless telephone line and network access Administrative Structures . l0 rural districts . 1 town administration . 301 rural kebeles o l6 urban kebeles c 2572 Onchocerciasis villages J WHO/APOC, 24 November 2004 District Number of health staff involved in CDTI activities, Total Number of health staff in the entire project area Br Number of health staff involved in CDTI Br Percentage Br:Brl Br *100 Adiyo 77 70 7t Bitta 7t 55 7t Bonga town 35 12 35 Chena 72 92 72 Cheta 42 26 42 Decha 95 123 95 Gesha 85 60 85 Gewata 85 69 86 Gimbo 95 91 95 Saylem 97 57 97 Tello 86 64 86 Total 835 718 85 Total health workers and the health workers involved in the CDTI includes HEWs and other health workers 1.1.2. Partnership The main partners involved are Federal Ministry of Health, Regional Health Bureaus, Zone and Woreda Health Departments, Administration, Education, Agriculture, Finance department, Communities, The Carter Center Ethiopia and WHO (APOC). There is good relationship between partners,which helps the Kaffa CDTI project for its best achievement and sustainability. The FMoH, The Carter Center Ethiopia and APOC are involved in planning, Supervision and in providing financial and technical support. The ZHD and Woreda health Offices are involved in training, community mobilization, supervision, monitoring and evaluation of the CDTI activities. FLHF do implement the CDTI activities and supervise the health posts. The community is involved in supporting the CDTI activity by recruiting CDDs, as well as in deciding Mectizan treatment dates and sites. 4 WHO/APOC, 24 November 2004 $ o e.l C)p 0) z <f, c'l () o ts o , t-.1ENou =o) (.) -o o i:th?oo()tr :q) a 71_cYo =B?'13 .2E AC)ta orv oo.qCn r) 6l L e6l =u)EAHC 5o o. :o.l cho ot-o6 (tln -cU>- oF ,E0 Oa eO0 ()Lv ooa 63 >(! .o O cr) trooc(d Eq)0)aeo 6i aooc 'aH3do ..()q) EdF Joo -()-;'a 9 = o.F B o C) o. v) doL oa Ho o L d 0) 6 a () O d .9 (o 7 ooL oa 0) o z o o C) C)l< otr l< C) 0) 6q) q) c,) o -Va (n C') a aO ra) aq) c.. .9ti C) o- oo ti 9JC od bo.q -os ocotr-oo o:r v! O(Hoo 'd qr Lc])OL o-r 2 uo) o.a2- =(d0)=o5 c0 .i aZdA)t* C trEO'tUtrr!= JCcxO.:o. :. 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O () -o F t-- (o N rlsl @(o <tFl O)N r.r)r\,1 rJ')ri rnr! r.r)r-l oc! ot rlNM=5= 6.^? s Lt o.lala $N olr) ros $rJ) @ <l r/) U6 o EO rU c -. ze =^ e9 :U zra lr) rr) (r)O) ceN lr)$ $N $or st Fl @ rn rn rn Fl stt- rn6 Fl Ol (\ Ft sl Fl rn @r\ ot 00 o rn sl Fl r\(o co O) O| r_{ r_{ tNO r{ Fl rnr\ o + ? Fla aas t-r s ooao cnO @ \o N co a.l $ 00 $ c.l @$ co ?:EH lr(JlQ @ F- $$ c- c.l lr) r-- N @ cn @ \o oo N cA\o \o rn \o\o co co ca cO |r) coo\ o\ o I ! z a o I 9 d - oo oo OO Oo Fl Oo oo Oo oO oo Ooeouo :r sd L[.- LCOCO Oo \o o\N F-c\ OO - co cO c!N rr)N $ $ c.] ao c{ @ tr- s r)\o @ c\I 2o =0 !o -= 2o LL a@ ^zefr ON NN \o N Or- c\ c! ca c!NIr)N NN $ $N ca c.l 00 r- s \o co N o u € o? zj, E ( n 'e L o\ c..l () c0a oF C F cg (.) O (, o O rg o() cn (.) (! all o o -o J o d @ (! 00 oo Comment on: . Attendance of female members of the community at health education meetings increase their participation the women organizations should play the major roll. In general, how do you rate the participation of female members of the community meetings when CDTI issues are being discusses (attendance, participation in the discussion etc). Incentives provided by communities for the CDDs CDDs provide free service to their respective communities. The communify members sometimes help the CDDs working on their farm fields. The woreda health offices and FLHF do assign CDDs to participate in other health activities such as Polio, measles, TT and EOS campaigns so that some amount of per-diem could be paid for them as an incentive when these campaigns are carried on' Attrition of CDDs. Is attrition a problem for the project? If yes, how is it addressed? , Some times there is an attrition of CDDs due to personal seasons. If a replacement is needed, it is done immediately and training is given by FLHW at their respective kebele. 2.5. GaPacitY building o Describe the adequacy and availability of knowledgeable manpower at all levels' manuals. Theiefore, everybody is well aware of what is expected of the CDTI program. Where frequent transfers of trained staff occur, state what the project is doing, or intends to do, to rarady the situation. (The most important issue to describe is w'hat n'te7sures Ytere taken to ensLr-re adequate CDTI implementation where not enough htov'ledgeable manpov;er was available or if itaffs arefreqt,irrtly transferrecl dtrring the cottrse of the cantpaign)' problem. 8 WHO/APOC, 24 November 2004 I c) cl 0 Q q) z ! I(il + F(JU d! 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B 0) o -o .E ri 0) (B a o 0)F ,.] F F $ a.l o -o (.) o z $(\ Q t o bo o a o\ o B 3 o o b{t a a. t o \ o s* a €! s o B\S r -q ; qq a,)(J q) U\ a,)\ \ q o* o co () E 0) a tr F IJ Uq- o (n 0) () o! .0)c (.) Cq o0 '6 F ,ii1 dJl -l_ol FI o, ! Table 6: Type of training undertaken (Tick the boxes where specific training was caruied out during the reporting period) Any other comments 2.6. Treatments 2.6.1, Treatment figure If the project is not achieving 100% geographical coverage and a minimum of 7 5o/o therapeutic coverage or the coverage rate is fluctuating, state the reasons and the plans being made to remedy this . Kaffa CDTI Project has achieved 100% geographic, 77o/o,therapeutic and 9l% ATO coverage. Trainees Type Of training CDDs Other Community members e.g Communrty supervlsors Health Workers (FLHF) MOH staff or Other Politrcal Leaders Others (speciff) Program management How to conduct Health education Management of SAEs CSM SHM Data collection Data analysis Report writing Others (specify) 10 WHO/APOC, 24 Novernber 2004 $ c..t () .o o oz$ a.l o ^aL' > (! C) (n oo H C) zr! p !o c) o a 0.) o O o! 0)ol 0)Pxl +. ()l ^elrgltrol :6.t -olb9l --o .'1c:lL9t col orlFZI () (d O 'a ! a. 0) 0o oo o trotOOI 'o -lc .-l !1 o O.(! Yd)[ig tr> oo3 ac ,i: u o.oOLO_() dF iz O x 0) dor o o oo o Lo .o E z al(.)l$ bl !l(ol ot -clo.t EI coAI d)lM -lcl cdl OI .-l dl s.tLI()I -cl $ ,-l :t)t 5l ot -lal sl )l EI EI -, a qj Q AJ V) > oL a)L U \ a,)a \) 5 -va a C)L(! ; J (.) a -o aq.l O 'o o E CN() LF :t -t -oldlFI 0) c6 o oo d L.. YP2c6oroo) oo o'^ L =N C)g OO /1()F C) q) o0 L C) oo o.: o o. (.) F v -:6 6-= 9o oYo E?& "?zd Y.E A o O o o o o o o o o o o o is9^a ES9E?: ap >aAqdA! 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'=0ycq 9= :lE6.2 oE .0 Ei/I slli (ot:'i orl;cl ,-l 5ldlEl d!=l q, ol li -l q!GIul z >l c, -ol 'a(JL o0a9iq, U.o tr1,c!30D tr q,)q,E E! .: c) -i .yFE ?l '; .gt 0Al C(l?t -eFl or 2.7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - (please tick the appropriate answer) MOH M WHON UNICETI NGDC Other (please specifo) Mectizan@ delivered by - Qtlease tick the appropriate answer) MOH M WHOD UNICEil NGDC Other (please specifo) Please describe how Mectizan@ is ordered and how it gets to the communities follows the existing drug and other medical equipment delivery system of FMoH. Then the drug is stored in FMoH store from which projects zone receives. From the zone the Woredas receive and distribute to the frontline health facilities. It is from the frontline health facilities that the community supervisors get the drug and handover to the CDDs making it ready for community distribution. Table l0: Mectizan@ Inventory (Please add more rows if necessary) How are the remaining Ivermectin tablets collected and where are they kept? At the end of the treatment period, the CDDs return the remaining drug to HPs and the HEWs to the HCs which are the front line health facilities. The front line health facilities, in turn, send to the Woreda health offices and are kept in the WoHO store. 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 ' Community mobilization and health education . Population census b1'CDDs . Woreda health offices collect Ivermectin from the Zone . Frontline health facilities collect Ivermectin from the WoHOs . HEWs receive Mectizan from FLHFs ' CDDs get their Ivermectin from HPs and distribute to the community . Collecting and compiling reports ' Supervision and follow up . Review meetings . Retum the left over Mectizane CDDs > HP > HC ) WoHO District/LGA Number of Mectizan@ tablets Number of Mectizano tablets Remaining from 2010 Requested 201 I Received (available) Used Wasted Transferred to Benshsangul Remaining Kaffa 166,014 2,088,500 2,254,514 2,060,079 3985 59,000 131,450 I I t4 WHO/APOC, 24 November 2004 B District/ LGA Total # of communitres/villages rn the entlre proiect area No of Communities that carried out self monrtorins (CSM) No of Communities that conducted stakeholders meetrng (SHM) 0 0 0 0 q 0 0 0 0 0 0 Adiyo Bitta Bonga lqwn 9beqa Che,ta Decha Gesha Gewata Gimbo Saylem Tello 417 165 218 296 270 332 209 225 34 324 82 0 0 0 0 _0 0 0 0 0 0 0 02572 0Total 2.4. Gommunity self-monitoring and Stakeholders Meeting Has any training (of trainers) for communily self-monitoring been done in the project area? If so, When? Orientation was given during the CDTI training to HEWs and HWs.. Communi self-monitori and Stakeholders Meeti dd rows 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. o The HEWs and HWs have received orientation on how to conduct CSM and SHM, but they did not report. their achievements. 2.9. Supervision 2.9.1. Provide a flow chart of supervision hierarchy. NOTF ) ZOTF) WOTF ) Health Facility ) Community supervisors ) CDDs The flow chart is not always complete for most of the time the NOTF did not conduct supportive supervision. 2.9.2 What were the main issues identified during supervision? . CDDs were not properly selected and trained . Village registers updating was lacking . WoHOs and HFs did not conduct continuous and regular supportive supervision . Report fallacy . Document handling problem 2.9,3. Was a supervision checklist used? Sometimes Yes 2.9.4. What were the outcomes at each level of CDTI implementation supervision? . Review meetings were conducted at woreda level and village register updating was done as well as repots were compiled from the village registers. . Training on proper record keeping and handling was given to HWs and HEWs . CDD training manual provided and more CDDs trained l5 WHO/APOC, 24 November 2004 a2.9.5. Was feedback given to the person or groups supervised? Yes it was given during the supervision session. 2.9.6. How was the feedback used to improve the overall performance of the project? o The HEWs and HWs have seen their gaps based on the supervision. o The village registers were updated o Document handling has improved SEGTION 3: SuPPort to GDTI 3.1. Equipment Table 12: status of equipment (Please add more rows if necessary) *Condition of the equiPment (F:Functional, CNFR=currentlY non-functional but rePairable, WO:Worn of0 How does the project intend to maintain and replace existing equipment and other materials? o Government budget is used to maintain existing equipments and other materials' o Replacement is also done by the government' Source Type of APOC RICT NGDO Others No. Conditron No Condition N o. Conditi on No. Condrtron No. Condrti Hrlux 1 NF 2 F Motor boxes J wo 0 Motor 5 NF 5 F I NF 1 NF I F 0 Fax machine 1 NF I F 0 0 ES 0 0 0 0 Desiner 0 Desk I NF I F 0 Laser 1 NF I F 0 com 1 NF 0 et 1 wo 0 Overhead 1 NF 0 0 Radt 0 ratorPortable 1 NF 0 l6 WHO/APOC, 24 November 2004 on 3.2. Financial contributions of the partners and communities Table 13: Financial contributions by all partners for the last three years Contributor Year ll ('201l) TOTAL Cash Budgeted (US$) TOTAL Cash Released (US$) MOH (Central + State)* DNA DNA MOH (District + zone)* 47,851.81 47,857.87 Local NGDo(s) ( if anv) DNA DNA NGDO partners(TCC) 22,575.26 22,57s.26 Communities* ,t 0 APOC Trust Fund 62757.91 43679.92 TOTAL 133,184.98 114,106.99 MOH contribution is for Focal person's salary- and running cost. If there are problems with release of counterpart funds, how were they addressed o APOC's fund reached late. Trainings and review meetings were conducted by the budget allocated from The Carter Center/Ethiopia and the Government. o Describe (indicate forms of in-kind contributions of communities if any) o Some times the community members do assist CDDs in their farm' 11 WHO/APOC, 24 November 2004 0 a E a) aD !!i a Et c tUTF o eF 9o G, <E N. N. o N. c? o- N o ts oiF @- e! 6 ! a , E E oo -6!loEO)z o6 oz o. ts ! o- o- N q .! ts N c0 t! E o FzU -2du o o ! ! ao .! ! :( l! ! o ,E]I o E E a o l! l!lo oF N $ ts o- q N F a. a ts N 6i riN c o o ! .q N q o o o o d !c o z E oE ,6 N N N U2) u oof @ o ! = c ot t6 lt t- IE IIl5lo t: lEla ln lo l- t: o @ t< l: .9 , ! t Ir lr lo lF t-- oo lu t6 IE IE l!l@IE t._c t: e o , = o i c z lF l6ll* c o t l{ c; o = o E i e g d t-{ I lEls l> ldt, l; o o =c o - q t, IU lc lEt: IElr l3 ld l: t:l!lo IAl5 lq e o 6 E lrlcl! l:lo t: t:li IEt: li E 9 ! I ! E t2 I t: E o e lo l3 t:lc IElo IE l* l: l>t\ l6lrlslq q I Itltl<lr c E t,trlu la l6 li lL l> lq l* ! olitftq IJt< l5 l: l3lo E gE EN Y Y x v Y v Y Y v Y Y v n x v Y Y Y Y Y Y Y !v E z a o o q ot U o U !o .9E U o o U !o 9 ! U ,!o .9E u d ot u .!q .9 U .!!o .9t r o o E U .!o 9E U o o u .!!o -9t u -t!q .9E u .!A .9t U o E u o o u .!oI u !o .9E U .!! dIE U e o a .!o .9E U c o E U o o E u o o U o L o EI ; o 6 o bo 6 a o 9 6z !o: c E o o oE 50 c a a s o rc a E c o o- o a o E 9* -U oSo il o! o ao :€ o!Y 6v v> -^ o- LO Yt^ a): -h E> co tOo !9 C-, L, 9;HU > ?q ?' !L9:uu6 ib =O !a 9 e "9 =a=trorE--L-42 Jto: -E o$ YE !c i:o s! =q, c-o ;x -4 -r! 9: crdv-t =)1 ql! u: =lq 5= a(.t .: Fl SEGTION 4: SustainabilitY of GDTI 4.1. lnternal; independent participatory monitoring; Evaluation 4.1.1 was Monitoring/evaluation carried out during the reporting period? (Tick any of the following which are applicable) Year I Participatory Independent monitoring Mid Term Sustainability Evaluation 5 year SustainabilitY Evaluation assessment was done in 2011 4.1.2. What were the recommendations - not yet delivered 4.1.3. How have they been implemented? 4.2. Sustainability of proiects: ptan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period? Yes Was a sustainability plan written? Yes When was the sustainability plan submitted? -on the 3'd and 5th years What arrangements have bien made to srstain CDTI after APOC funding ceases in terms of: 4.2,1. Planning at all relevant levels o Yearly integrated strategic plan is prepared by the government inclu.ding CDTI at all levels and all heaith activitles do share funds allocated from the govemment. t 4.2.2. o 4.2.3 o 4.2.4. 4.2.5. o Funds The Government, NGDO and APOC are allocating budget for the integrated health activities including CDTI. Transport (replacement and maintenance) The Government and APOC are replacing motor cycles to be used for the integrated heath service activities including CDTI Other resources To what extent has the plan been implemented The plan is implemented 8b-90% in an integrated manner including CDTI' 19 WHO/APOC, 24 November 2004 4.3. !ntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: All CDTI activities such as:- o Communitymobilization o Mectizan delivery . Trainings o Mectizan distribution o Supervision o Review meetings are integrated into PHC 4.3.1. Ivermectindeliverymechanisms Since the inception of the project, Ivermectin delivery has been fully integrated into the existing PHC drug delivery system of the country 4.3.2. Training : CDTI lrainings are integrated with the Primary Health Care (PHC) program from the beginning at National, Regional, Zonal, Woreda and HF levels. Disease Prevention and Health Promotion core process is responsible for the CDTI program (NTD). Therefore, all the staff who are responsible at Zone, woredas and FLHWs level are getting CDTI trainings every year. 4.3.3. Joint supervision and monitoring with other programs As part of the system in the country, all supervision and monitoring activities are done jointly on integrated manner.. 4.3.4. Release of funds for project activities The 2011 CDTI activities were accomplished by the fund released from The Carter Center Ethiopia and MOH. As usual APOC's fund has arrived after all CDTI activities were accomplished 4.3.5. Is CDTI included in the PHC budget: o Allocated itemized budget for DP&HP includes CDTI too 4.3.6 Describe other health programme that is using the CDTI structure and how this was achieved. What have been the achievements? . Campaigns such as malaria prevention, Polio eradication, TT, Measles vaccinations and EOS do use the CDTI structure. CDDs are always involved in these activities and the achievements are very remarkable 4.3.7. Describe others issues considered in the integration of CDTI. l a 20 WHO/APOC, 24 November 2004 4.4. Operational research 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. Operational research was not done in this Fiscal year.o a 4.4,2. How were the results applied in the project? SEGTION 5: Strengths, weaknesses' challeng€sr and opportunities Strengths: ' Geographic coverage- 100% . High therapeutic (77%)and (91%)TUG coverage Weaknesses: . Continuous and regular Supportive supervision is lacking at WoHO and HF levels ' Number of Absentees and Refusals is still high . Village registers were not properly updated . Documentationproblem Opportunities: o Integration of all health activities . Assignment of 2 HEWs per kebele level. o Establishment of Health Development Army (l to 5 connection at each village) Threats (Challenges): o Overlapping of other emergency programs during Mectizan distribution period o Work overload to health staff o Increasing attrition rate of HEW SEGTION 6: Unique features of the proiect/other matters o If possible APOC's ATR should be reduced in size for t he ZHD has so many reports to deliver to the government and its other partner NGDOs' 2l WHO/APOC, 24 November 2004 t