Metekel annual project technical report submitted to technical consultative committee (TCC): Junuary 2010 to December 2010

l J The Federal Democratic Republic of Ethiopia Ministry of Health COUNTRYAIOTF: ETHIOPIA Proiect Name: Gambella Approval vear: 2003 Launchins vear:2004 Reportine Period: From: J.anuary.?012... To;......D.e.cp.mher.2gl?............ (MONTH/YEAR) MONTIL|TEAR) Proiectvearofthis report: (circleone) I 2 3 4 5 6 7 8 10 Date submitted : Dp.C.embgf 2012 NGDO partner: The Carter Center r iI December 30,2012 ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) DEADLINE FOR SUBMISSION: To APOC Management by Llesug1a for March TCC meeting To APOC Management by 31 Julv for September TCC meetingt@r AFRICAN PROGRAMME FOR ONCIIOCERCIASIS CONTROL (APOC) t December 30,2012 ! APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT UNICEF UTG wHo Acronyms African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Community-Based Organization Community-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 ) December 30,2012 Definitions (i) (ii) (iii) (iv) Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). Eligible population: calculated as 84o/o of the total population in meso/hyper-endemic communities in the project area. Annual Treatment Objective: (ATO): the estimated number of persons living in meso/hyper-endemic areas that a CDTI project intends to treat with Ivermectin in a given year. 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). Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). 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). (v) (vi) (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 they continue to function effectively for the foreseeable future, with high treatment coverage, integrated into the available healthcare service, with strong community ownership, using resources mobilised by the community and the government. (ix) Community self-monitoring (CSM): The process by which the community is empowered to oversee and monitor the performance of CDTI (or any community- based health intervention programme), with a view to ensuring that the programme is being executed in the way intended. It encourages the community to take full responsibility of Ivermectin distribution and make appropriate modifications when necessary. December 30,2012 I N N o an tr c)! oo(.) Ll c'oa.xssips\t-z\9()o EE ao .o8Htra(U0) i'l oE-c .= G) Eo) o)E EO '=9 9dao -o) PbO0)o4(J €,2E -en,Y,'C)E: T:i'oaUtrtra€ IJ6 e)(dH6EEEEE.6b 2=F9'E=c) s$Eb0=tr e; b -ddL*- t\ U k)\oEN lrl Nt\ xq z tN H! Fi r.A uo HU\ {:iU)(1)bI)(.)-qE.= '= f thiE 8 E .?.e E.EtjE hp6q ! a c)H.=>.EU^=.ooo2:'E Jy 'i4 (-) ir o.-qio v €.Hi€oo9 g'd E6E A dEtu:r:cE 6€€:9o)C)(g 'o5EC)o-q6qo',.: .s:6aF(h!!G)tr €€.2€9 e E d q I .HEH'E E.EE'HHE g iE E H!iKP9!-trhd6 E HE SorJ h '.E ..= olfitSolif, H E E= oho €L .d on, k-C()P .oE-q).6 929) =eo L(J ;iEUSo '=u)tr5o,E .* 'a 9; o=AvA)n-NCgE -8E€ * !u!oo.i. :E Iocu) )4 id .trN6.E'E>,E I bo aEtro.5a-E = so6roO :ci trtrocg'trE o€ aO.c) n ELi()OFO.o (d (.) o (.) k € thE ,tr o(t o o (B o o H tr() obo o) -otr -o$SE otr olg trq)otr\J A. .5U f^ uo\l\ x zl{ € 8 rrl r< U H bol.EE + 0.)(J6-)pEE Eu)E!-o4) ,.) (B a0 -(6\-Ctrfi.ep F .9-qtr(d;.e'E : Htr dtF 9'oou+r .-Jt = K 5€d.-q t €e€ eE EEF 9H tr9 8 d.94'; 'i6 *'; EEE E eotr= .2 qE a -oonr L L E E;:LH 'bo'trO '=-i3 '5tsE2 ah(n(D li € €(B (t 0)P C6 bo cn G) ; bo >t o (d (l) L< th U) s,h{G)tE (h o=HCd ,C) ob0 R _L' FC) =EA) () oo N Es bE E. h s{ E Et E {.s a z Fr aZH z -2 Ufr] ^&3UfUI Fl- ZSoF =..)A '- Qh ' ah\J C)1 ar) rlUOUfrF I Executive Summary l. Background on population and treatment data Gambella is one of CDTI projects of Ethiopia and it comprises five CDTI Woredas having a total of 369 villages. All the five woredas were targeted for the 8th year treatment cycle. The names of the woredas are Godere, Mengeshi, Gambella, Dimma and Abobo. Before starting treatment activitiy population census was conducted in all the five CDTI Woredas and the total population of the project area was 106,839. The Annual Treatment Objective (ATO) for the Sth year CDTI was 89,839. All the five CDTI woredas were covered with the treatment (100% geographic coverage). A total of 76,322 people were treated during the 7th year treatment cycle i.e;Tl.4ohthetapeutic coverage. 2. Background on population movements. The communities in CDTI areas are mainly farmers (change their villages for searching uncultivated land frequently), daily laborers and civil seryants. The population size vary from time to time based on the need for daily laborers for coffee, tea and cotton plantation specially in Abobo, Mengesh and Godere woredas and also gold mine workers in Dimma woreda. 3. Training data Training and refresher trainings were conducted before initiating other CDTI activities. The project was able to train (retrain) 40 health professionals, 146 community supervisors and 934 CDDs. 4. Challenges - Delay of the release of APOC budget - Shortage of vehicles for supervision & for distributing the drug to each endemic woredas 5. Opportunities: Planed resettlement program in this project areas in order to solve the migratory nature of the community members and bring dispersedly settled community in one area to live together. December 30,2012 SECTION 1: Background information 1.1. General information 1.1.1 Description of the project Gambetla National Regional State is one of the Nine Regional States of the Federal Democratic Republic of Ethiopia, and it is located in the western part of the country between 70 13.' N to 80 17" N latitude and 330 52" to 350 02" E longitude. The Region shares borders with the Sudan in the West, Oromia Regional State in the East, SNNPR (Southern Nation Nationalities Peoples Regional State) in the South and Benshangul-Gumuz Regional State in the North. Gambella Region has a total surface area of 25, 274.88 square kilometers. The total population of the region is estimated to be about 360,431 of which 74%o are rural and 26Yo are urban dwellers. The population is largely engaged in subsistence farming, animal husbandry, fishing and coffee and cotton plantations. The climate of the region is classified as tropical. Average annual Temp is 30.7o C. The annual rain fall ranges 800- 2100 mm. the altitude ranges 300-2400Mts above sea level. The region is classified as low land (82%), semi highland (10%) and high land (8%). Some of the perennial fast flowing rivers that cross the Agnuak zone include: Baro, Akobo, Gilo rivers. There are also quite numerous small rivers and streams, which are tributaries of the main rivers. There are two distinct seasons in the project area, i.e., the rainy season (April - October) and the dry season (November-March). Harvesting occurs from October to December, leaving January - March as the optimum treatment period. The Region is divided into three administrative zones (Agnuak, Nuer and Messenger Zones) and thirteen Woredas and one town administration. All the CDTI woredas (except Mengeshi which is difficult during rainy season) are accessible with all weather roads with the regional town. However, access to rural communities appears difficult during rainy seasons. The health infrastructure in Gambella CDTI project area consist I zonal hospital, 11 health centers (1 government and l0 NGO), 69 Government health posts and 10 private clinics. December 30,2012 Table l: Number of health workers involved in oroiect.2012 Table 2: Number of health extension workers involved in CDTI project. 2012 1.1.2. Partnership There was strong partnership during planning, advocacy, mobilization, drug distribution, monitoring and evaluation of the CDTI activities among different partners. The main partners involved are Federal ministry of health, Zonal Health Department, Woreda health office, health facilities, the community, The Carter Center, WHO and other government sectors. District Number of health worker involved in CDTI activities. Total Number of health worker in the entire project area Br Number of health worker involved in CDTI B2 Percentage B3=B2l Br *100 Abobo 46 5 11 Dimma 38 1l 29 Gambella 45 4 9 Godere 50 t2 24 Mengeshi 2l 8 38 Total 200 40 20 District Number of other health workers (health extension workers) involved in CDTI activities. Total Number of health extension workers in the entire project area Bl Number of health extension workers involved in CDTI Br Percentage B3=B2l Br *100 Abobo 28 28 100 Dimma 32 32 100 Gambella 2l 21 100 Goderie 29 29 100 Mengeshi 36 36 100 Total 146 146 100 December 30,2012 1.2. Population Table 3: Communities and population at risk in the entire project area whether they are treated or not durine the reporting period 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 reachedfull geographic coveroge (normally the project should be expected to reach the UTG ar the end ofthe 3'd year ofthe project). Was a census for the project done during the reporting period? Yes / No If yes, what is the source of the data in the table above? * Source: National census CDD ^/-Other source, specify: -Year :2012 4 CDTI Districts in the entire project area Total populatio n in the entire project area Number of communities/villages in Population of Meso- endemic zone in the project area A7 Hyper- endemic zone in the project area A2 Total in meso/hyper- endemic zone Aj: Aft A2 Meso-endemic zone in the project area Aa Hyper- endemic zone in the project area A5 Total in meso/h yper- endemi c zone Aa= A;+ As Ultimate treatme nt Goal (urG) Abobo 1 5,1 89 70 0 70 1 5,1 89 0 1 5,1 89 12759 Dimma t4,713 55 0 55 14,713 0 14,7 t3 12359 Gambella 10,705 50 0 50 10,705 0 10,705 8992 Godere 42,591 t26 0 126 42,591 0 42,591 35776 Mengeshi 23,641 74 0 74 23,641 0 23,641 r9858 TOTAL 106,839 375 0 375 l 06,839 0 106,839 89,745 WHO/APOC, 30 December, 2012 If you are using the term community or village, define what constitutes the community or village. This will help understand the profile of the project area. The term community or village is considered people who live in not more than 2 Kms rodius and who shared o common interest. In Godere and part of Abobo woredas where there was resettlement program the people live more closer ond have more than I50 households but in the remaining three woredas the community live very scattered and a village may constitute less than 50 households except in gold mine and cotton plantation areos where villages densly populated (daily laborers). Is there any other information of interest about the population in the project area? If so, include it here. In Godere there is coffee and tea plantation, in Abobo cotton plantation and in Dimma woreda there is manual gold mine. People travel to the above three mentioned woredas searchingfor occupation. Thus, the size and structure of the population in each woreda show /luctuation. December 30,2012 SECTION 2: Implementation of CDTI 2.1. Timeline of activities District LGA Mobilization of communities Training Censusfupdate Drug distribution Supervision Starting month Completio n month Starting month Completi on month Starting month Completi on month Starting month Comple tion month Starting month Completi on month Abobo March 2012 March 2012 April 2012 April 2012 April 2012 April 2012 May 2012 July 2012 March2012 July 2012 Dimma I bella March 20t2 March 2012 April 2012 April 2012 April 2012 April 2012 May 2012 July 2012 March2012 July 2012 March 2012 March 2012 April 2012 April 2012 April 2012 April 2012 May 2012 July 2012 March 2012 July 2012 Godere March 2012 March 2012 April 2012 April 2012 April 2012 April 2012 May 2012 July 2012 March2012 Iuly 2012 Mengeshi March 2012 March 2012 April 2012 April 2012 April 2012 April 2012 May 2012 July 2012 March2012 July 2012 2.2. Advocacy State the number of policy/decision makers mobilized at each relevant level during theyear; the reason(s) for undertaking the advocacy and the outcome. Describe difficulties/ constraints being faced and suggestions on how to improve advocacy. Because the involvement and support of the community leaders at all levels was minimal Advocacy meeting was held with decision makers (woreda council members and community leaders (Kebele leaders)) in respective woredas. During the discussion all participants promised to support the program and some improvement has been registered. But there is still a need of exerting fuither effort should to make them all fully involve and support the program. 2.3. Mobilization, sensitization and health education of at risk communities Community mobilization was done in each village by organizing community meetings. Kebele Task forces (that include Kebele administrative leaders, health staffs, health extension workers, and kebele elders) were responsible to organize the meetings and played major role in mobilization and sensitization of the whole community at grass root level. Community supervisors and CDDs were also involved in giving health education to the community at village level. December 30,2012 Table 4: Timeline of activities for the areas treated in Gambella. 2012 2.4. Communityinvolvement Table 5: ES participation in the CDTI proiect Comment on: - Affendance of female at community at health education meetings. The attendance of female members of the community at health education meetings shows some improvement. - 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). The participation of female members of the community is increasing from year to year. Incentives provided by communities for the CDDs Communities are not providing incentive to CDDs as they are treating their relatives and neighbors. Attrition of CDDs. Is attrition a problem for the project? If yes, how is it addressed? District/LGA Number of communities/villages with community members as supervisors Number of CDDs and the communities involved Number of communities /villages with female CDDs Total no. communities in the entire project area B4 Number with community members as supervisors Bs Percentage Bo= 85/ 84 +100 Male CDDs B? Female CDDs BE Total Bq: B7+ls Number of communities with female CDDs Bro Percentage Bu: Brr/Ba+ 100 Abobo 70 70 100 l3l )) 153 22 t4 Dimma 49 49 100 87 2l 108 21 Gambella Zuria 50 50 100 42 28 70 28 40 Goderie 126 126 100 371 32 403 32 8 Mengeshi 74 74 100 174 26 200 26 l3 Total 369 369 100 805 t29 934 129 t4 December 30,2012 I There is some attrition of CDDs and it is not a such significant and does not affect the projects activity. 2.5. Capacity building - Describe the adequacy of available knowledgeable manpower at all levels. The numbers of health workers are and in educational level are increasing each year - Where frequenttransfers of trained staff occur, state whatthe project is doing, or intends to do, to remedy the situation. (The most important issue to describe is what measures were taken to ensure odequate CDTI implementation where not enough lcnowledgeable manpower was available or tf staffs are frequently transferred during the course of the campaign). There are two health extension workers in each Kebele and they are responsible to train and supervise the CDDs working in their respective Kebele during transfer or and course of the campaign. 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Both the geographic coverage and therapeutic coverage are above the standard indicated above. Trainees Type oftraining CDDs Other Community members e.g Community supervisors Health Workers (FLHF) MOH staff or Other Political Leaders Program management How to conduct Health education Management of SAEs CSM SHM Data collection Data analysis Report writing 10 WHO/APOC, 30 December, 2012 N N d c-t Lr(.) -o E 0) C)q) F (€() (o o 0) L 0) B(t(d 0.) C'J o () o I 0) o. oa() Eq) ^,0)vt Lot e -l a)xl: -91 o.r Ul o tsl Iol a ot q,(.)l L El.8ol Erl 5 Pl tr )-l (! =t oZlt- olol -l o.rxl > EI E rYl () 9lx C)l ts Ql 0.)ol tr ot E0l'dt*l I :lt: .glE alc zl< (!() = o C) 'a :r a. C) fr.l& >. -o o ol Pol tr -l A)xlP El pIl -ul.ets|.= al C0)l 3Se JtE >l o >l c)ol c) .El tr =t 6 =lEtrl o 5l c) c..l I 9t-e6t> -ol ;trl o =l LZl+ Lro -o re (q F (n() Lr(u o() tr (.) 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Because of the detayed in Mectizan tablet shipment the treatment was given in the rainy season which some of the residence stays out of their village for farming for more than a month. In addition most of the people in the area are not settled in one area. They move from place to place for the number of reason and become in available during treatment period. 2.6.3 What are the reasons for refusals? Most of them consider themselves as healthy and do not need treatment and some others refused to take because of the fear that the drug may react with local alcoholic beverages, since a significant number of the people drinks local alcoholic in their daily life. In case the project did not have any cases of serious adverse events (SAE) during this reporting period, please tick in the box. 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Ordering, storage and delivery of Ivermectin Mectizan@ ordered/applied for by - Qtlease tick the appropriate answer) MOH EI WHO tr UNICEF tr NGDO N Other (please specify): Mectizan@ delivered by - Qilease tick the appropriate answer) MOH EI WHO ! UNICEF'E NGDO ! Other (please specify): Please describe how Mectizan@ is ordered and how it gets to the communities As usual Mectizan was requested to MDP by the NOTF. Then after drug arrived at the country it follows the existing drug and other medical equipment delivery system in the country. The drug was stored in MOH warehouse and then distributed to CDTI projects after the projects submitted a request paper. The Woredas received the drug after submitting the requisition latter to the zonal CDTI project health office and then distribute to the health facilities. It is from the frontline health facilities that the -ommunity supervisors received and the CDDs received the drug and distribute to the communities. Table 10: Mectizan@ Inventorv in Gambella 2012 How are the remaining Ivermectin tablets collected and where are they kept? The leftover Mectizan tablets are collected from the CDDs by the Front Line Health Facilities (FLHFs) and the FLHFs transferred the collected Mectizan and Albendazoleto the woreda Health Office and are stored at the Woreda Health Office. List and briefly describe the activities under Ivermectin delivery that are being carried out by health care personnel in the project area. . Training of community supervisors and CDDs about, the drug, its adverse effects and management. , Collection of Ivermectin from the Woreda health office store and then distribution to CDDs after checking the census (village register) ' Regular supervision with especial consideration to adverse effects during mass distribution. . Distribution of Ivermectin to CDDs and Supervision . Collecting of reports and the remaining drugs . Recording and reporting of data District Drug Balance from previous year Number of Mectizana /Albendazol tablets Received Used Wasted Expired Remaining Gambella Mectizan 43',74 250,500 228,874 300 0 25,700 Albendazol 8403 91,600 76,599 120 0 23,284 t4 WHO/APOC, 30 December, 2012 2.8. Community self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the projectarea? If so, When? Yes, It was provided in April 2012 incorporated with the last regular CDTI training. But CSM has not done because of time constraint. Table 1l: self-monitoring and Stakeholders Meetins in 2012 District/ LGA Total # of communities/villages in the entire project area No of Communities that carried out self monitoring (CSNI) No of Communities that conducted stakeholders meeting (SHM) Abobo Oimma Gambella 70 4g 50 126 74 0 0 0 0 0 70 49 50 r26 74 Goderie Mengeshi TOTAL 369 0 369 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. The SHM was conducted at woreda level and it was important to strengthen CDTI activities at woreda health facility and community level at large. 2.9. Supervision 2.9.1. Provide a flow chart of supervision hierarchy. NOTF )RHB) WOTF ) Health Facility ) Community supervisors ) CDDs 2.9.2. What were the main issues identified during supervision? ! Improvement has been observed in recording and handling of village register but still strict supervision and follow up should be strengthened. 2.9.3. 2.9.3. 2.9.5. Was a supervision checklist used? Yes What were the outcomes at each level of CDTI implementation supervision? . Handling of documents was relatively improved. Was feedback given to the person or groups supervised? Yes 2.9.6. How was the feedback used to improve the overall performance of the project? . After each supervision, Oral and written feedback was given. a December 30,2012 SECTION 3: Support to CDTI 3.1. Equipment Table l2: List and Status of equipment Source Type of equipment APOC MOH - Zone DISTzuCT NGDO Others No. Condition No. Condrtion No. Condition No Condition No. Condition 1. Vehicle 2 F NA NA NA NA 2. Motor cycle(s) 5 F NA NA NA NA 3. Computer(s) 1 F NA NA NA NA 4. Printer(s) I F NA NA NA NA 5. Photocopier (s) I CNFR NA NA NA NA 6. Fax Machine(s) 1 CNFR NA NA NA NA 7. Overhead projector I F NA NA NA NA Condition of the equipment (F:Functional, CNFR: currently non-functional but repairable, WO:Written off) NA-Not available How does the project intend to maintain and replace existing equipment and other materials? The project expects partner NGDO (The Carter Center) to maintain capital equipment that have been provided by APOC. Though there is no budget allocated for maintenance of the above materials maintenance is going on using government budget shifting from other programs. But the project is exerting effort to make the local government authorities to allocate budget. 3.2. Financial contributions of the partners and communities Table 13: Financial contributions all oartners for the last three years ontributors Year 8 Released NA 7,500.00 0 375.65 0 7 ,783.31 YearT(2011)Year 5(2009) Year 6 (2010)Year 4(2008) BudgetedBudgeted Release d Budgeted ReleasedBudgete d Releas ed Budgete d Releas ed 128,944 83 NANA NA NA NA 128,944 83 MOH (Central+ State) 4000 4000 7,500.004000 4000 0 00 0 NA NAMOH (District + zone) 0 0 0 00 0 0 0Local NGDO(s) ( if any) 0 12375.6s20,416 12,382 12,382NGDO partner(s) 16,089 16,089 21,816 0 0 0 00 NA NA 0Communities 0 14,114.5 5 t4,t 14.5 5 I l,l19.0 1 5857 4 100 0 0APOC Trust Fund 12,620 8834 30,994.6 6 16,382 16,382 74,114.5 5 14,114,5 5 32,709 28,923 27,691 24,561Total December 30,2012 27,658.96 If there are problems with release of counterpart funds, how they were addressed? The budget allocated from APOC released late after the treatment initiated. Additional comments -Keep on the availability of drugs at central level before the rainy season. -The allocated budget should be released as early as possible so that activities will run effectively as per the plan. 3.3. Other forms of community support a CDDs sometimes get lunch invitation during Mectizan distribution from the community 3.4. Expenditure per activity Table 14 indicate the amount expended during the reporting period for each activity and the amount expended in US dollars using the current United Nations exchange rate to local currency Exchange rate used here lUSD :18.00 Table 14 : Tlype of activit)r. expenditure and source of fundine during the reporting period of 20 I 2 Activity Expenditure ($ US) Source(s) of funding Community Mobilization, Advocacy and sensitization 762.75 TCC Trainings and HE 6,562.91 TCC Supervision and monitoring 4,710.63 TCC CDTI Activities 7,500.00 MOH CDTI Activities 7.183.31 APOC Others 339.37 TCC TOTAL 27,,658.97 Total number of persons treated 76,322 December 30,2012 SECTION 4: Sustainability of CDTI 4.1. Internal; 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 Internal Monitoring by NOTF Other Evaluation by other partners 4.1.2. What were the reconunendations? The project was evaluated as a project which is progressing toward sustainability. And the following recommendations were given: - Keep documents properly including financial reports - lncrease community mobilization in villages with poor treatment coverage. 4.1.3. How have they been implemented? - providing training and supporting Supervision document keeping has been improved in most of the project areas - Effort has been exerted to conduct community mobilization though the mobile nature of the people has negative effect. 4.2.1. Sustainability of projects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period? Was a sustainability plan written? Yes When was the sustainability plan submitted? Sept 2010 What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.2.1. Planning at all relevant levels Planning of CDTI activities were carried out through participatory methods. At woreda level woreda health office, woreda council members and health staffs discussed and plan when to conduct meetings with the communities. Then together with community members planning will be adapted when to conduct CDD training, when to conduct census and also when to start distribution of the drug. At community level community members made discussion together with Kebele task forces and plan all activities. The CDTI is integrated with Malaria control program and efforts will be made to integrate CDTI with other health programs. + December 30,2012 No 4.2.2. Funds The govemment is integrating all the basic health activities using all available funds. This integration approach will help to sustain CDTI after APOC funding cease. In addition to this, the NGDO partner is also expected to continue the critical funding support as it used to do previously. 4.2.3 Transport(replacementandmaintenance) The project expects that APOC will replace the vehicle and motorbikes and the government will be responsible for their maintenance. The project will also use other vehicles from other health programs to fill the gap, if any. 4,2.4. Other resources 4.2.5. To what extent has the plan been implemented The CDTI activities training, mobilization, census, etc. were done as planned but the drug distribution was not done in the date planed because of late arrival of drugs. 4.3. Integration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: CDTI is integrated with the Primary Health Care (PHC) from the beginning. At the National, Regional, Zonal, and Woreda levels, the Malaria and Other Vector-borne Diseases Prevention and Control Units are responsible. All prevention and control activities are included in the of health extension package at the grass root level. 4.3.1. Ivermectin delivery mechanisms Ivermectin delivery follows the existing drug delivery system in the country. The request for Ivermectin is made to MDP through FMoH. After arrival, all the processes required are handled by a Pharmaceuticals Administration and Supply Service in the FMoH. Then the CDTI projects receive the drug after submitting official letter to FMoH. Similarly woreda health offices submit request letter to the CDTI project. Ivermectin delivery system is handled in similar manner to that of other drugs and medical equipments in the country. 4.3.2 Training: Health staffs at the project woreda have received training/retraining on epidemiology of Onchocerciasis, Lymphatic Filariasis and CDTI principles. Efforts were also made to include other topics, such as measures to be taken on malaria prevention. 4.3.3. Joint supervision and monitoring with other programs The program is integrated in health promotion and disease prevention and control core process, most of the supervision and monitoring activities are carried out in integrated manner with other activities within the core process and regional health bureau. December 30,2012 4.3.4. Release of funds for project activities A fund from the NGDO partner was released on time to accomplish the CDTI activities December 30,2012 4.3.5. Is CDTI included in the PHC budget? Yes, as part of PHC, CDTI is one of the health activities at all levels and at grass root level and use the budget in the integrated manner. 4.3.6 Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? All the five woredas are malaria endemic. CDDs participate and support the community during bed net distribution and other anti-malaria activities. 4.3.7. Describe others issues considered in the integration of CDTI. The Health extension Package program is an important program that can help to sustain CDTI in the community. 4.4. Operational research No operational research undertaken in the project within the reporting period. December 30,2012 ) ISECTION 5: Strengths, Weaknesses, Opportunities and Threats Strengths:{ The project is able to accomplish the seventh treatment cycle with coverage. ,/ Therapeutic coverage is above the standard. ,/ The awareness of the community about CDTI has increased. Weaknesses: ,/ Poor document handling, at some of the woreda and health facilities{ Lack of supportive supervision at all levels 100% geographical Opportunities:/ Availability of Health Extension Workers in every Kebeles Threats: ,/ The far distance of Dimma and Godere woredas is a barrier for frequent supervision and close follow up. It demands additional cost for fuel and perdiem. December 30,2012