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

F+r r\cii_, \ 1 .a Io: TetlSI 5 ulr 2007 SO The Federal Democratic Republic of Ethiopia Ministry of Health For lnfornoflon To, 5'1q AO *hltwa n.sdffil a ANNUAL PROJECT TECHNICAL REPORT rE cHNrcAL c of#i#ffi?? l3,r*rrrEE (rcc) 't I I I I I : ! I I RE o a To APOC Management by 31 Januarv for March TCC meeting To APoc Management by,3r Jurv for September TCc meeting L I I I ! i L ffi AFRICANPROGRAMME FORONCHOCERCTASTS CONTROL (APOC) # caP AtltBrufa : ETHIOPIA : Bench-Pro ame A 002roval vear:2 u )003 J.an.u :I) 9.c..-e.m.h.e.,tFrom T,o .?9..0.6..... ear Month/Year rti P ectP r t is rt: (circle one) 123 56 78910 uS m 30 Dec berem 2006 NGDO partner : The Crarter Center I 5 JUIN 2007 WHO/APOC, 24 Novernbe r 2004 IANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATWE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the rePort: Country: National Coordinator Name: Dr Afeworek Signature: .. Date: >\e\ol .s nlhl ,2 o1 f. r,? t4-f: Zonal Oncho Coordinator Name: Date Zfi, r*"1 NGDO Representative Name: Abate Tilahun /rtPlrr i' * I a) ji^,^ Signature: Date: . *( f?n E.ho.e.f,.. . This report has been prepared by Name , Ait:.a{..k:rozl,.ka.\ ' 4 Designation , /.fu2:.t.(------ .- sis;MixezW.... ktnSr.l&d Date ?..$.t. i?l 4fl ', 2, a9' I' R or a, + v t, d- (o -,a5 o^> + l'11 4. ,r fl.'l' Inh. ll WHO/APOC, 24 November 2004 I IANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: Country: Ethi National Coordinator Name: Dr Afework Hailemariam Signature Date: Zonal Oncho Coordinator Name: Asrat Banzikes Signature Date: NGDO Representative Name bate lah Signature: Date This report has been prepared by Name: _Asrat Banzikes + NOTF Desi gnati o n : Zone Onchocerci asi s Coordinator Signature : Date WHO/APOC, 24 November 2004 t a ll Table of contents Acronyms. Definitions FoLLow up oN icC necouH,reNoaiioNi ............. SECTION I : Background inform"ti"r......... ..............................'...'...'..'.......................'...'............1.2. popur-e1oN............... SECTION 2: Implementarion of CDTI .. .. . ... 2.2. Aovocacy 2'3' MoBlLtzauoN, 'ENSITIZATI.N AND HEALTH EDUCATI.N oF AT RISK ..MMLTNITIES2.4. CovuuNtry rNVoLVEMENT........ 2.6. TnearunNTS................... 2.7 2.8 2.9 onopRr,rc, rro*ori*; r;;,;;-, oiiri*ru.;^ ................COUUUNITY SELF-MONITORING ENO SrE TTHOLDER S MTETNCSuppRvrsroN ............... SECTION 3: Support to CDTI3.1. EqunveNr3.2. FmeNcrel coNrRrBUrroNS oF THE pARrNu*, o*, .orr. ;;il............3.3. OIHER FoRMS oF coMMrrNrry suppoRT............... SECTION 4: Sustainability of CDTI_..4.1. rNreRNar-; TNDE.ENDE*, oo*ii.i;;;;*; ;.ir"-i"", Er^;r;;;o* ...... *'", ::::i::BILITY oF pRoJECrs: 'LAN AND sEr rARGErs (vaNoeroRy Ar.. 4.3. t*rucnoiio* ......................... 4.4. OppnarroNAl RESEARCH SECTION 5: Strengths, weaknes;";, ;ilii.rg"r, ."0 "pp"n;,;r,;;;...........................SECTION 6: Unique features of the froiecUottrer matters ........ ill WHO/APOC, 24 Novemb er 2004 ... I I l5 16 .........16 .........17 .........17 ......... t8 ...18 ...18 ...19 ... 19 ..20 ..20 ..20 ..21 ..21 ..22 iv V I 2 J J 5 6 6 Acronyms APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT LINICEF UTG wHo 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 Govemment Area Ministry of Health Non-Govemmental Development Organization Non-Govemmental Organi zati on 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 1V WHO/APOC, 24 Novemb er 2004 Definitions (i) (ii) (iii) (iv) (v) Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO und."n.r, tafingy. Eligible population: calculated as g4o/o of the total population in meso/hyper_ endemic communities in the project area. Annual Treatment objective: (ATo): the estimated number of persons riving inmeso/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 tobe treated annuaily _in mesorhyper endemic areas within the project area,ultimately to be reach:d y!g, thi project has reached fulr geographic coverage(normally the project should be expectld to reach the urG at the end of the 3dyear ofthe project). Therapeutic coveragci-lumber of people treated in a given year over the totalpopulation (this should be expressed u.-u percentage). Geqgraphical coverage:. number of communities treated in a given year over thetotal number of meso/hyper-endemic communities as identified by REMo in theproject area (this should be expressed as a percentage). Inteqration: delivering additional health interventions (i.e. vitamin A supplements,albendazole for LF, screening for cataract, etc.) through CDTI (using the samesystems, training, supervision and personnel) in o-rder to maximise cost-effectiveness and empower communities to solve more of their health problems.This does not incrude activities or interventions carried out by communitydistributors outside of CDTI. Sustainability: GDTI activities in an area are sustainable when they continue tofunction effectivery for the foreseeabre future, with high treatment coverage,integrated into the available healthcare service, *itt strong communityownership, using resources mobirised by the "o--rrity urJ th" government. (vi) (vii) (viii) (ix) The process by which the communi ty isempowered to oversee and monitor the performance of CDTI (or any communify-based health intervention programme), with a view to ensuring that theprogramme is being executed in the way intended. It encourages the communrtyto take full responsibility of ivermectin distribution and make appropnatemodifi cations when necessary, V WHO/APOC, 24 Novemb er 2004 ?FOLLOW UP ON TCG REGOMMENDATIONS TCC session 23'd Number of Recommend ation in the Repofi TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY 184 Select and train more CDDs Because the health workers. community supervisors and community leaders were overburdened with several activities selection and training of additional CDDs could not be practical. But arrangement has been made to implernent it next year Train all health staff done Encourage more women to participate in the project The project has tried its best to increase women pamicipation but no improvement seen. Agree on treattnent period with comrnunities Agreement was reached with the community members on treatment period but because of overburdening ofhealth staff community supervisors and conrnrunity Ieaders the treatrnent was given after the agreed time. Intensifu Health Education Done. The availability of Health Extension Workers has created a good opporn:nity to intensifu Health Educarion. WHO/APOC, 24 November 2004I Executive Summary l. Background on treatment and population data Bench Maji is one among the 13 SNNPR zones and it is bordered to Kaffa & sheka zone in the Norlh' Garnbella Region & Sudan i, the South, Kafra zone in the East and Sheka and south omo Zones in the East. The zone has a total area of 19,326 sq kms divided into 9 woredas and230 Kebeles' The capital town of the zone.MizanTef'eri, is located 565 km farfrom Addis Ababa. Bench Maii GDTI has total communities (villages) of 1,053 which are distributed in eight woredas (Bench' Sheko, Guraferda, Meanit-Shasha, Meanit-Goldya, She-Bench, Bero andMaji' The total population for the CDTI was 555,293. The A,nual Treatment objective(ATo) for the year 2006 was 444,234 out of which 403,744 were treated with Mectizan whiclr gives amual therapeutic coverage of 73%o. The project also has achieved geographic coverage of l00o/o. 2. Background on population movements. The communities in GDTI areas are mainly settled farmers. daily laborers and civil servantsRece,tly, there is no known major popuration movement in the project area. 3. Training data Trainings and refresher trainings were given for 202 health professiona ls, 2l6community Supervisors and 2'316 cDDs who were selected by the communities from l ,053 villages. 4. Challenges and how they were overcome. Threats (Chaltenges): High turnover of trained health staff and program coordinators at arllevels' low participatio, of Zonal and woreda Task Forces in community Mobil ization, overburden of health workers and poor document handling are among the major challengesfacing the CDTI project in Bench_Maji. Prompt actions were taken to tackle these problems. In some instances, discussions were held with concemed authorities to resorve trre probrems observed. 2 WHO,/APOC, 24 Novemb er 2004 SEGTTON {: Background information 1.1. General information 1.1.1 Description of the project Rench-Maji GDTI project is one of the thirteen zones of Soutl-rern Nations Nationalities and peoplesRegion (SNNPR)' The Tone is di'ided into 9 Adminisr'auve woredas. The GDTI project area covers gout of the 9 woredas found in the zoue and.has a total poprlrtion of 555,293.The project area sharesbordcrs r'vrth 'I'he Suda-. in thc Soudr, Garnbella n"goi ii.;" west, and IQffa-Slieka cD.I.I in thcNorth' The climate of the CDTI project area is classified as tropical and the weather is coldand raining frorn May thl9y,gh s^enteqb-er and dry rro* o.touer to April. The mean annualtemperature ranges from 20oc-25oc and the mean urnruiruinfall ranges from 400 - 2000, mm.The estimated altitude range is 500-3000 meters "b;;;-sea level. Slopes, hills filled withgorges and large river basins and stt€ams, dominate the topography. Less than 24yoof thearea is covered by tropical rain forest. About 90% of the population lives in rural areas depending on agriculture. There are twodistinct seasons in the project area: Rainv_ g.urorr]ap.ir - september) and dry season(october - March)' Agricuitural activ.ities -(clearing, IJ.-irg, and herding) occur all year,ound in the project area, but are most intensive;;#;;. .uiry ,.uron. riarresting occursfrom october to December, leaving January - March as the optimum treatment period. Road transportation is one -of widely used mode of transportation in the project area. Themain all weather road runs frorn Addis A^baba through Jimma to MizanTeferi (capitar of theproject zone) extending 1o the capitals of two p.oj.li *or.au. (Bench and Sheko). The restsix woredat utt utttssible through dry weatheriouar. MizanTeferi is located 555 kms southwestof Addis Ababa' In addition to road transportaiion, tr*r" is once u -""k nigrr,, to Mizan The.indigenous ethnic groups of Bench, Sheko, Dizi, Meinit, Suri and Mezhenger occupy the The zone has I Hospital, 8 Health centers, 5 de_veloping Health centers, g2 Health posts andThere are 233 health workers with different qualificatiois and 157 Health Extension workers.There are eight CDTI woredas and all have started CDTI activities in all 1,053 villages. I J WHO/APOC, 24 Novemb er 2004 Table 1: Number of health staff involved in CDTI 1.1.2. Partnership Since the beginning-of the project, there.was strong partnership during planning, advocacy,mobilization' drug distribuiion, monitoring and ";"i;;i;, of the cbtr u"iiriti", amongdifferent partners' The main partners involved ar" fede.ai ministry of health, regional healthbureaus' zonal health desk, woreda health office, fi";; il. health facilities, the community, il:,.T[?center' wHo and other gor".,r*.nt sectors like Admin councils, Education and nvolved in CDTI activit[s.Number of health staff iDistrict Tota.l Nu mber of health staff in the entire project area Number of health staff involved in CDTI Percentage * 100Bench 181 1 8 I 100Sheko 42 42 100Guraferda 22 22 100Meanit-Gold 35 35 100Meanit-Shasha 20 20 100She-Bench 24 24 100I JJ JJ 100Bero 18 t8 100Total 375 375 100 4 WHO/APOC, 24 Novemb er 2004 s ON () -o () o zs a.t O l, o.F() U' 0)ta \a) I ca(H o () a p. 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O N L o- \o oN o- \oo a.l =Lo- \oo N ! o- \o N H o. o h.0 u)- c) U (!3 Fr \o ON o. \oo N =La- \oOON L o. \o O N L o. \o a c! L o- \o OON o- ouD .= .i!EI 6lr N= oo|<{ (.)2 \oOON 'r o- \ooO c! o- \oO N L o- \o O N ! o- \oO c.l =Lo. (l)9 tr= () ON L o. O c.l o-4 \o N o- \ooo ol o- \oO N o- \o O N L o- O N L o- \o 6t =Lo- a0 tg!(n- \o O N L o- \o ON o- \o O c! L o. >a o I cd 0) z o () co I(.) U) o!o a (B -d Li .0) (B L so 0.) ca F] I U) a F] Ei Fr o r< 0) co 'a 2 lo ta cd a I 0) 2 \o (/) o U L cd o 0)F o 0) E(.) (d 0) li a(s ot- cd a) l- an a) C) q< o () F c"ir 0)l+l -ol(!I FI o o a-g a- a-I ot! h o o E -o E F IF aN F a(, Its o tr .9fl IE +, tr o Eg c E ltN z o -F(, ut o O N bo N bo c! bo \o a.l =bo 2.2. Advocacy State the number of policy/decision makers mobilized at each relevant level during the currentyear; the reason(s) for undertaking the advocacy and the outcome. Describe difficulties/ constraints being faced and suggestions on how to improve advocacy. Task fbrces had been established. The members of the Task Forces at all level were officialsfrom all sectors' which have relevance for the CDTI activity. Though- the political commitment helped the CDTI activities to be started and successfully achieved its objectivebut their support became insignificant in 2006 as they were in their own activities. AdvocacyForum has been organized by the NorF which invtlves all political leaders and concemedofficials and stakeholders responsible for national, regional and zonal levels to discuss aboutthe problems observed and the decline of commitmeniof poriticar leaders. 2'3. Mobilization, sensitization and health education of at risk communities Community rnobilization was done at each village organizing community meetings. Forhealth education manuals were distributed to each cnnJana cJmrnunity ,.ri.*iror. and alsothree types of posters also distributed to each villages and posted at differelt places wherepeople look at and discuss it. The community mobilization has contributed a lot in awareness creation and as a result thecommunity involved in CDTI activitv. 7 WHO/APOC, 24 November 2004 2.4. Gommunity involvement Table 4: Communities participation in the CDTI (Please atld more rows if necessary) Comment on: Attendance of female members of the community at health education meetings In almost all health education sessions the attendance of women has shown improvement compared with the previous years. In general, how do you rate the participation of female members of the community meetings when CDTI issues are being discussed (attendance, participation in thediscussion etc). Though, attendance and participation of women has shown improvement compared to theprevious years the attendance in general is very limited. women are very busy in theirhome and some of them could not attend most of the Health Education sessions Incentives provided by communities for the CDDs communities do not provide incentives to the cDDs. Actually this is not a problem in ourcase as cDDs are serving their neighborhoods (30-50 households). Attrition of cDDs- Is attrition a problem for the project? If yes, how is it addressed? CDDs attrition is not a big problem in our case. when there is attrition the communities select other CDDs and the respective Front Line Health Workers provide trainingimmediately. Other issues 8 District/LGA Number of communities/villages with community members as supervisors Number of CDDs and the communities involved Number of communities /villages with female CDDsTotal no. communities in the entire project area B1 Number with community members as supervisors Bs Percentage Bo: Bs/ 84 *100 Male CDDs B7 Female CDDs B8 Total Be= BTtBg Number of communities with female CDDs Bro Percentage Brr= Bro/84*100 Bench 461 264 57.3 987 64 l05l 64 14 Guraferda 45 45 r 00.0 130 22 152 22 49 Sheko 94 94 r 00.0 256 36 292 36 38 Shc-Bench 147 144 98.0 311 21 332 2t 14 Meanit-Goldya 154 154 100.0 112 42 154 42 27 Meanit-Shasha 64 30 46.9 101 J 104 J 5 Maji 68 68 r 00.0 '133 l6 149 l6 24 Ilero 20 20 r 00.0 41 4t 82 20 100 Total 1053 819 77.8 2071 245 2316 224 21 WHO/APOC, 24 November 2004 2.5. Gapacity building - Describe the adequacy of avairabre knowledgeable manpower at ail levers. - where frequent transfers of trained staff occur, state what the project is doing, or intends todo' to remedy the situation- (The most tmportant issue to describe is what measures weretaken to ensure adequate :DTI implemenrafion where not enough lorcwledgeable manpowerwas available or if staff arefrequently transferred during the riur* oyti"'"o-paign). There were trainings on CDTI from the higher level to the community Ievel in adequateamount to carry ottt the CDTI activities- There were situations where we had turn over oftrained staff particularly at woreda and front line health facility levelsThis problem has bee,solved by giving training immediately for the newry urrig*o hearth staff. 9 WHO/APOC, 24 Novemb er 2004 o) cl O U q) z ! dll\J o.T + r-lJ: .Q U i.tu- q :f, co o' N \o $N F- co a\ \o N o N @ C-l o\ ol oo N c.l oo \o \o N $ $ o\ ci \or- t-- \o \o ?a) N o\ lar ol r.- rA al ?a) € c) c) o g) o\L! @co \o N 00 o\(\ $ o\ (-.1@ € o\r- al IA o .a'o'cEti o' oq) .q) ,- Cll oL. z =Eilq) o .. + L\,, = .O UI zv o< O O O O O O O O q) C) () o\(JLF o) dh o)0AO tr ':- zE q) c) E.l?F"d USo< =z r- co \o (.) N oo .i- N oo ca c\ o\ |,- \o oo .i- c! (o \o @ ca N \o € F-t o\ 0) q) q) \oo\U LJLF @oo \oat cl N O oo r- .I cq O O (.) A.= -cB o: o z Err Q 6 f i +F-d G \);z c.l (.l N c\l O ct c{ ol N c-l N O N ol O c.l N O N ol O \o 0) 0) q) o s ULF al N N N a.l ol c.l N \o rI q o () EO tr ,C)H ii o (.)Ea o o c0 I() a >. o I (.) z a CB a I od(.) Z 'a z lio c0 j Fr 3 vO N k() -o (.) z v c.l U(J A o HIMt.:t\ lalu 6! o a $ s 5 o o ga o\ LLI lu : I A- s_ -a o \ .a\. !< 3 ; -:\ ! V') V') a,)() AD S h L \)L. o \\R q)q \) E o (s q) () a. F ,-.,1(J qr o tl) 0) 0.) 0) Ii .q)}HH () oo ($trF .ii1()l -ol cdlFI - Any other comments The cornmunity self monitoring was not done in the way Apoc designed it to be done but it ;:,ll[r:" a modified wav. ih. co*-unitv Superuiro^ have do-ne the self monitoring SHM has been conducted at zonal and w'oreda levels and its contribution w-as significant inidentif ing strength, weakness of the programs urJ p.opo..a solutions and divideresponsibilities among stack holders. Table 6: Type of training undertaken (Tick the boxes where specific training was carried out cluring the reporttng periocl) 2.6. Treatments 2.6.1. Treatment figures - If the project is not achieving 100% geographical coverage and a minimum of 65%therapeutic coverage or the coverage rate is fluctuating, state the reasons and the plansbeing made to remedy this. ffi,:l*,""t is doing well in terms of both geographic and therapeutic coverages as shown Tratnees Type of trarn CDDs Other Communrty members e.g Communrty sors Health Workers (FLHF) MOH staff or Other Political Leaders Others (specify) Program *urug"-er1 How to conduct Health education Management of SAIs CSM SHM Data collection Data analysis Report writing Others (specify) 1l WHO/APOC, 24 November 2004 $ ON kop E C) z .i- N (-) oA{ L., ts N tF) 0) Lr o() 'a ! a. o ch(d 0)L o tr o C) Itrog o U)() 0.) CO() li C) o o a.o() (H o l-< 0) -o E (B oF olol ;l EIol €l(€l(Dl :l E] ol 0)l ol tsl bl €l trI 2l olol tc)xl.z EI E EIH ,l ;Ol oJol tr el tt4(dLl ()dl .L.pl - EIEtrl tr zte cn()L(d o ! a. o IJ a rr.l >' .o () 0) t) c0 cn 0) o() E C) o It< 0)g o chq) qr L 0.) (B F a (s G)tr(d o c) 'a F. (.) an c.) o o 0) () IHog a() oo (d p. (! oF olol -.t xl T'I 0.)l HI(-) | i5l ol ol ot 0)lft ol bl €l 2l o ilil q) 0.) o 6J oF \o 0) (d Lr C) b0 !u^6S O oF (.) (o li o bo(n li !.) o o o.1\ (! L bo o(.) 0) ! o bo lio o o-\ €^\ () (n li C) F (n a9E]t NB( ps 6- *6 -, @I -'E,; oi o !J ii.E '" 0e 3 ,o6OL o Lo Eo -o E z O O O F O rr) €?la Ao C o r-\o bs!trco 3-Oz6 r- c.l oc c.l o\ o\o' + o\ r- o. € t-- oo r-\oN e.l E- .3 : -E^O €fEEE =a d9)'7 0E € \o\orl ir_$ \oN r- oo f.* N lr) @ Nlr) cr)N o II oto3 br)o d^ E.! Eoo ..C oF o --q5q.l -!q6 5 [sz tso6oa =F?EE9T < EP'F(-' oa 6o9 - o ts61€ F.g o-:oL G o-5 .o Lbt-- .l r- .1 r F- od F- \q f- al =\ooir- c- 6it-r;a c.l <. o\ N F-.@F- t--r-\c o\ =rf, F- '"t!f, N v (o N!t o, cr)N(o_ (o o) @ o !t N l.r) cr)ss N @(o o) O) s_(o N O)No NN $Nf.- $N (f) O)N lr) ro ro @ N(.) O = (o v (o$ (o s il E .9oEbo Ebsboa-33 rF) E.9 -3 = t,9 5E;bAo o 6 o-a =F?E E,9T < EP'FI,, \o@ t.oi b u +--!'- - 5 o.c.o6 - O> -E = 9p3 FL c: O: o>-6 U)o O o f.-$$o)lr,$ ttr) ..toc$@ ia F.v$o)tr)$ v|r) GIoc\ov@ (.) m N .tso)(r)v str) oN@@v(o (v) ro o- o =o c0 o .41 6Y t co cn o -aa oE a Ee cd = .=S o= >o oca .F z2a 6l F tu .\ C') qj (..) AJ .S C) \ p o \)q q) E J<ta L cd(b(g a) *<(g (s (, -.1 o Lr (n >' -o a E] a d 0.) cd a)!F r-- | o-)l _ol(€I F.l il O oo 2.6.2 2.6.3 2.6.4 What are the causes of absenteeism? This year. the major cause of absenteeism is due to the overlap of the farming season with Mectizan treatment period. The drug distribtilion period w-as pushedfurther to the rainy season. I Briefly describe all known and verified serious adverse events (SAEs) that occurred during the reporting period and provide (in table s; itre requiredinformation when available. In 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 What are the reasons for refusals? S9-1lt of the people who consider themselves free of Onchocerciasis are not willing to take the drug. 13 WHO/APOC, 24 Novemb er 2004 vOoN o -o C) z .i- N opr o '{B \t q) o G I cq() c) oo cq o C) (J F cn L o o q) C) (a q o0 U) c)q) o\ q) G q) c) '= q) .o 3 q) c) () c)q) q) t- cllo c) q) c)i ,l:U! ,.. ocg l)! CJ =(uI9V al-ei a.(rcu !l- 9!L)tr(l)(D u -d A .o -eraLi-l <su9. li LtH)t v 'ol .r FlLHI!qltr(slo)olE>lo -ol qJ hn LQa) sO o !(€8s !o)l.< Cojj or- F orr rri ql\Et €l6l Fl 0) oo!J E,:F 0)>< $F- o\ o\ il ri o oP^F bsd>v -o o o. @ oo o\ H lt T{ o 'Eo :J ooo d^ sgEoo rEoF r- oo\o caoo r-- ,o O6pS) oEPaEC =oz?o o- \c ca N \o @O co an @ F- t $sF- coO .f, ta -Ee604 =EEE ST <-gP'F\J ca caN €ca N cr) F- \o w $ .fii.$ aqo,,(€ - 69 : o t+cB :E-e€eF= - O E+ q€E EE @$ o\\f, @\o o\$ c.) O)N il II1 o (-J r!^F bs -o o o O :z'rr i a r; r,j Eoo- o0 bo :'i oo->oooo q t-t \ o\ o O = a c.) oE@ - - O-I = Hq) trts-9 -7oti ._o \o \Do\ ca o ca O t{ 6oa =EoEHSTd g-o', -FO \c o\ O 3 0) ho d = a 0) o(-) l.l bo6 =b<, E U v, - qi *.:!A -!-Ee .lic-AtrO=@6hf- - a o; LO oo aa OO e{ C\oON co N .+ (\ N OON t--OON @ O(\ o\oO C\l o N Please describe how Mectizan@ is ordered and how it gets to the communitiesThe NorF requests for Mectizan from MDP. After the"drug.eaches the country it follows theexisting drug and other medrcal equipment delivery system in the country. Then the drug isstored in MoH warehouse from whlch the proje.t ....ir.r. From the project level (zonelevel) the woredas collect the drug and distribute to the FLHFs. It is from the FLHFs that thecommunity supervisors get the drug to distribute to the cDDs for them to distribute to thecommunities. Table l0: Mectizan@ Inventory (prease add more rows if necessory) 2'7- ordering, storage and derivery of ivermectin Mectizan@ ordered/applied for by - Qtlease tick the appropriate answer)MOH M wHon UNICEFD Other (please specify): Mectizan@ delivered by - (please tick the appropriate answer)WHON UNICETT]MOH EI Other (please specify) NGDC NGDC From the above remaining tablets a total of250,,500 tablets (95,500 to Jimma and 155. 000 to Illubabor CDTIProjects. Thus the project has 92,04g tablets in its store. How are the remaining ivermectin tablets collected and where are they kept?At the end of the treatment period, the CDDs were requested to return the rem air-ring drugto their collection centers which are the health facilities. The health facili ties. in tum, sendto the Woreda health office and finally liom there to the project coordination offi ceHence, the rernaining Ivermectin is kept at the project office level (Bench-Maj i ZoneHealth Dept.). List and briefly describe the activities under ivermectin delivery that are being carried outby health care personnel in the project area. . Collection of ivermectin from the Woreda level ' Distribution of ivermectin to community supervisors and cDDs ' Training of community supervisors and cDbs on handling, distribution andmaintaining stock balances . Supervision . Recording and reporting of data Any other comments District/LGA Number of Mectizan tablets uested Received Used Lost Wasted Ex ired Remainllench-Maji 1,403,927 1,404,000 1,092,034 0 3,775 0 342,549TOTAL 1,403,927 _L404,000 1,092,034 0 3,775 0 342,549 t5 WHO/APOC, 24 Novemb er 2004 2-8- Gommunityr serf-monitoring and stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? No.If so, When? Table I 1: community self-monitoring and Stakeholders Meeting (Add rows tf needed) 2.9. Supervision 2.9.7. provide a flow chart of supervision hierarchy. NorF ) zorF) worF ) Health Facility ) community supervisors ) cDDs 2.9.2 Describe how the results of the community.self- monitonng and stakeholders meetings have affectedproject implementation or how they wouli be utilized drd;;ir; next treatment cycle. The.community supervisors conducted supervision is not in exactly similar manner with cSMbut in a slightly modified way. on the other hand, sHM has been conducted at zonaland woreda levels and was veryinstrumental in identifying strengths, weaknesses, opportunities and challenges and ways ofaddressing them accordingly. what were the main issues identified during supervision? . Delay in utilizing and liquidation of funds. ' Though there is some improvement, there is still weakness in organizing and proper handling of documents. . Delay in starting mectizandistribution. Was a supervision checklist used? yes DistricU LGA Total # of communl ties/vi llages ln the entire pro;ect area No of Communities that carried out self (csM) No of Communities that conducted stakeholders (sHM)[]ench Gurafcrda Sheko Shc-Bench Meanit-Goldya Meanit-Shasha Maji Bero 461 45 94 147 154 64 68 20 461 45 94 147 154 64 68 20 461 45 94 147 154 64 68 20 TOTAL 1053 r 053 I 053 2.9.3. 16 WHO/APOC, 24 Novemb er 2004 2.9.3. 2.9.5. what were the outcomes at each revel of CDTI implementation supervision? Document handling has shown some improvement but it still needs additional effort by training health workers and conducting targeted supervision. There is still problem on liquidating the utilized project funds because of thepool funding system as there is problems in it management. was feedback given to the person or groups supervised? yes 2'9'6. How was the feedback used to improve the overall performance of theproject? The good geographic and therapeutic coverages are indicators of the encouraging perfonnance of the project. In addition, some improvements have been observed in timeliness of reporting of activities and in piop., handling ofCDTI documents. SEGTION 3: Support to GDTI 3.{. Equipment Table 12: Status of equipment (please add more rows if necessary) *Condition of the eq WO=Written off). uipment (F=Functional, CNFR:Currently non-functional but repairable, How does the project intend to maintain and replace existing equipment and other materials? The project would need APOC funding to support maintenance of vehicles that have beenprovided by APOC for the first five years. The pioject is trying its best to perform well so tharAPOC would replace these equipments after the i'n y.u, *tit" at the same time efforts willcontinue to allocate budget by the government for smooth running of the project gradually. Source Type of equlpment 4W APOC MOH - Zone DISTRICT NGDO Others No. 1 Condrtron F No Condttion No Condrtion No. Condrtion No. Condrtton Motor cycles Desk to LaserJet DeskJet Printer P 8 5F&3CNFR F F F F Radio Communtcatons 1 1 5 1 1 CNFR F F VCR Generator 3 F F t7 WHO/APOC, 24 November 2OO4 1 Fax machrne TV 3.2. Financial contributions of the partners and communities Table 1 Financial contributions by all partners for the last three years DNA - Data not available as it is done in integrated manner - If there are problems with release of counterpart funds, how were they addressed? No - Additional comments The MoH is contributing in mobilizing their staff and other stakeholders, coordinating project activities. procuring. storing and distributing Mectizan, providing trainings, covering communication costs, offering office premises for CDTI coordination and rnanagement. managing project funds, providing other logistical support. soliciting financial support in the absence of counterpart funding, record keeping and reporting, etc. Obviously, it isvery dilficult to quantify and attach monetary values to such kinds of contributions. The financial management pool system is still a serious impediment for the effective utilization and reporting of APOC and other counterpart funding. 3.3. Other forms of community support - Describe (indicate forms of in-kind contributions of communities if any) CDTI communities have done their best in mobilizing the communities for treatment, recruiting and training CDDs, conducting mass treatments, record keeping and reporting. A1l CDDs and community supervisors were fully supported by their respective communities. 3.4. Expenditure per activity Indicate 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. Indicate exchange rate used here lUSD:8.67 Contributor Year I (2004) Year 2 (2005) Year 3 (2006) TOTAL Cash Budgeted (us$) TOTAL Cash Released (us$) TOTAL Cash Budgeted (us$) TOTAL Cash Released (us$) TOTAL Cash Budgeted (us$) TOTAL Cash Released (us$) MOH (Central + State) 12.000 12,000 DNA DNA DNA DNA MOH (District + zone) 50,000 50,000 DNA DNN 5,000 5.000 Local NGDO(s) ( if any) 0 0 0 0 0 0 NGDO partner(s) r87,251 187.251 26,312" 13,8 l8** 14,937 14,937 Communities 0 0 0 0 0 0 APOC Trust Fund 80,830 5 r,500 34.854 I 5.000* * + 3 r,852 r 5,000 TOTAL 530,981 450,751 67,166 28,818 51,789 34,937 l8 WHO/APOC, 24 Novemb er 2004 tf Table 14: Indicate how much the project spent for each activity listed below during the reporting period The Carter Center i contribution as it is s the NGDO partner for this project carried out in an integrated manner It is difficult to show the MoH Year 1 Participatory Independent monitoring _ Mid Term Sustainability Evaluation 5 year Sustainability Evaluation Internal Monitoring by NOTF Other Evaluation by other partners SEGTION 4: Sustainabitity of CDTI 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) Activity Expenditure ($ us) Source(s) of funding Drug del ivery from NOTF HQ area to central collection point of community Mobilization and health education of communities Training of CDDs Training of health staff at all levels Supervising CDDs and distribution Internal ng!{orilg of CDTI activities Advocacy visits to health and political authorities IEC materials Summary (reporting) forms for treatment Vehicles/ Motorcycles/ bicycles maintenance Office Equipment (e.g computers, printers etc) Others I ,513 5,154 1,282 902 8,1 55 4,885 2.205 9,213 608 1,020 MOH NGDO MOH APOC NGDO APOC MOH APOC NGDO NGDO TOTAL* Total number of s treated 19 WHO/APOC, 24 November 2004 ! I 4.1.2. What were the recommendations? 4.2. sustainability of projects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period? Was a sustainability plan written? When was the sustainability plan submitted? What alrangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.2.1. Planning at all relevant levels The CDTI activities are integrated with the other health activities at all health management and health service delivery levels. Therefore, the planning processes are carried out through participatory methods, using bottom-up approach and integrated with the basic health service. 4.2.2. Funds Ensuring the availability funds is essential for the sustainability of CDTL IT is expected that the govenlment contribution will increase for the irnplementation of core CDTI activities. In addition to this most of the CDTI activities that are carried out in an integrated manner will receive resources from different programs. The NGDO partner is also expected to continue its critical funding support for the same. 4.2.3 Transport(replacementandmaintenance) It is expected that APOC will . provide replacement of the vehicles (car and motorbikes) by the end of the 5th year. The local govemment doesn't have the capacity to replace such capital items as vehicles but would definitely support the use of other project vehicles as appropriate and as available from its vehicle pool system. 4.2.4. Other resources 4.2.5. To what extent has the plan been implemented The preparation of sustainability plans has just been completed. The implementation is underway in most project woredas. It is too early to report the progress made. 4.3. !ntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration 4.3.1. Ivermectin delivery mechanisms Since the beginning there is no separate Ivermectin delivery system to the lower level; it follows the existing drug delivery system in the general health service. In other words, CDTI is fully integrated into the existing health service structure from the central level all the way down to the peripheral or FLHF levels. 4.3.2. Training : 20 WHO/APOC, 24 November 2004 ? i t CDTI is integrated with the Primary Health Care (PHC) fiom the beginning. At the National, Regional, Zonal, and Woreda levels. the Malaria and Other Vector-bome Diseases Prevention and Control Units are responsible. Therefore, all the staffs of these units have received training on Onchocerciasis. Training of peripheral health workers has been carried out in integrated manner with other health programs. 4.3.3 Joint supervision and monitoring with other programs As part of the system in the country, most of the supervision and monitoring activities are carried out in integrated maru1er with other programs. 4.3.4. Release of funds for project activities APOC (first installment) and The Carter Center have released fund on time for this year CDTI activities. 4.3.5. Is CDTI included in the PHC budgetz CDTI is part and parcel of the malaria and other vector borne diseases control program activities. Onchocerciasis control is clearly indicated as a priority progriun in the country's third five year health sector development plan (HSDPIID. Following this comprehensive document, the Bench-Maji zone health department has also included CDTI in its overall strategic health plan. 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? In some malaria endemic villages, the CDTI structure is used for malaria control program. The CDTI structure and the CDDs were in particular very helpful during the recent community based bed net distribution exercise. 4.3.7. Describe others issues considered in the integration of cDTI. The govemment structut'e of village which has got a health committee and the Health extension Package designed to reach all Kebeles with health posts, will play a major role for the ir-rtegration and sustainability of CDTI. 4.4. Operational research 4.4.1. 4.4.2. Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period. NONE How were the results applied in the project? a SEGTTON 5: Strengths, weaknesses, chaflenges, and opportunities Strengths: The project is able to accomplish the distribution in short period of time with 100% geographical coverage and therapeutic coverage high above the minimum standard. This is due to active involvement of health workers and the community at large. 21 WHO/APOC, 24 November 2004 ) r a Weaknesses: There is sstill weakness in proper document handling and delay in liquidating and leporting the utilized fund. Opportunities: The accelerated expansion of PHC structure down to village level is a good opportunity for the sustainability of CDTI. The Health Extension Package in which at least two health extension agents (mostly women) will be deployed at community levels lbr a population of about 5,000 is also another good opportunity fbr the effective implementation of CDTI and other PHC programs. Threats (Challenges): High tumover of health staff especially at front line health facility and woreda level, overburdening of peripheral health workers with various regular health programs are still found to be a continuing threats of the project. sEGTloN 6: Unique features of the proiecuother matters The Bench-Maji CDTI project area is one of the remotest parts of the country with very backward and underdeveloped infrastructure. Some of the CDTI woredas are very in accessible by car particularly during the rainy season. The communication network is very poor and most of the woredas can't be reached by phone. Some of the communities have a nomadic character. Due to such obvious reasons, health workers do not stay longer in those places of assignment. Such high turnovers would for sure make it difficult for us to build capacities and establish sustainable programs. a 22 WHO/APOC, 24 November 2004 t