Metekel annual project technical report submitted to technical consultative committee (TCC): January 2013 to December 2013

.l The Federal Democratic Republic of Ethiopia Ministry of Health ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TBCHNICAL CONSULTATIVE COMMITTEE (TCC) DEADLIIIE FOR SUBMISSION: To APOC Management by 31 Januarv for March TCC meeting To APOC Management by 31 Julv for September TCC meeting\9y AFRICAII PROGRAMME FOR ONCHOCERCIASIS CONTROL Proiect Name: GambellaCOUNTRYAIOTF: ETHIOPIA Launching vear:2004Approval Year: 2003 Fro m : J.a.nuary. 2 0 11.., To ;......D..e.cem he.r. 201 J............ (MONTH/YEAR) MONTH/rEAR) Renorting Period Proiectvearofthis report: (circleone) I 2 3 4 5 6 7 8 0tl12 The Carter CenterNGDODate submitted : F.Q[;g3ry 2013 I ! I (APOC) I I I I 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 Oumer Shafi Signature: ..... Date: Regional Oncho Coordinator Name: MLBtqaEleqh Signature: .... Date NGDO Representative Signature Name: Dr. Zerhiw Tadesse Date This reoort has been DreDared bv Name : Mr. Saimen Lul+ NOTE Designation : Regional Onchocerciasis Coordinator Signature: I Date ll 3 Contents FOLLOW UP ON TCC RECOMMENDATIONS.. SECTION I : BACKGROUNG INFORMATION.......... l.l. GENenet.INFoRMATIoN............ 1.2. Popu1RrtoN............... SECTION 2: SUPPORT TO CDTI......... 2.3 2.4 2.5 2.6 2.7 2.8 2.9 MOSILIZETION, SENSITIZATION AND HEALTH EDUCATION OF AT RISK COMIVIUNITIES CovrrauNrry INVoLVEMENT ........... CnpRcrrv BUILDING TRearurcNTS .............. ORDERING, sroRAGE AND DELIVERY oF IvERvecrtN .............. CovvuNtry sELF-MoNIToRING nNo SrercpHoLDERS MpErlNc... SuppRvtstoN .............. SECTION 3: SUPPORT TO CDTI........ 3.1. EeutplrrpNr 3.3. OrHen FoRMS oF coMMUNITY suPPoRT..... 3.4. ExppNotruRE PER AcrlvtrY.. I 1 2 4 13 .6 .6 .7 .8 1l t2 t2 .13 . 13 .14 .14 SECTION 4: SUSTAINABILITY OF CDTI ..................... 15 4.1. INreRNal; INDEPENDENT PARTICIPATORY MoNITORINC;Eve1unTION......................... 15 4.2. SusrerNesrLrry oF IRoJECTS: ILAN AND sET TARGETs (vaNoaroRY AT Yn 3) .......... 15 4.3. INrecRartoN............... ........ 16 4.4. OpEnnrroNAL RESEARCH. .........l7 SECTION 5: STRENGTHS, WEAKNESSES, OPPORTUNITIES AND THREATS ........17 lll Acronyms APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT UNICEF UTG wHo African Programme for Onchocerciasis Control Annual Treatment Ob.i ective Annual Training Objective Community-Based Organization Community-Direcled Distributor Community-Directed Treatment with Ivermectin Comrnunity Sel l-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 1V Definitions (i) Total population: the total population living in meso/hyper-endemic communities (i i) within the project area (based on REMO and census taking). Eligible population: calculated as84%o of the total population in meso/hyper-endemic communities in the project area. (iii) Annual ent Obiective (ATO): the estimated number of persons living in nreso/hyper-endemic areas that a CDTI project intends to treat with Ivermectin in a givcn year. (iv) Ultimatq Treatment Goal (UTG): calculated as the maximum number of people to be treated annually in meso/hyper endemic areas within the project area, ultimatcly to be reached when the project has reached full geographic coverage (normally the project should be expected to reach the UTG at the end of the 3'd year of the project). (v) Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). (ri) Geographical coyqragqi 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 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. V O ai o. (J q o ux IE Pg FU t\ U k) q\ ta Xq za vs l^ oF U\ -*P .; L' -6tr6'0 L)k t .LHr-o0(d^()^5o'd'7,7F"a!2o*6 o'E'oo''o A .r IC-jrc)9 U B€ Htroo-Yo2-oxLtr 9UAA 'o cg (Jg-c.-q.! r<trt=c AHJd €.; E H NYc0boc'5L I a)ootrYd -Ootr;oO =0)rscaH.jdg-tro0v) -tr.=g'E3 PEEhtrC,o)Yd-) ^i tn 6r HEq.2itrH(Ub9=u)!2 opd9-6f gg H'EFio)()oFp..oEo za O oo o o o 'oo !<(n a a 0) o -oC) -v o cO 0) (d >. oo 0) F 0JthOq)gbEE *\)V =l<etng; E c)c'-cd-c 9 cd thEc.99P", -et0)al -: .9"i'5='5p; d g E - .-\ (UlJ.l t e L d -t\JoolU)(5oo(U() -o(')-C-0.)) -t- --UC6 '*(ol=X!i-Cd3a)\(g(E.L-O(J-:oJo)o Y, -(:6 99(gBu)vOret U €= .q(,o.- ^?v€+?t L/ E# ts.9 Etrtr'=.iEq)0rO=l-C, oLtr!lto0trc,c)9!-q';e - r.i \-,, c, raf<(uv.;.,i\-/ V') eo\t-i A er{ a\ 8 rrl F( U P o d o a.h o(!L bo *a(H(i o)q<bo 9) b!p>.=ooo, =o) E(n ao E E oo zaQ o o() C) E E o o bo =LUq: E- eO. o._Qo) ao 6,) =L)E5a _ot o.l .E(d+:()aoa !E *EH s.si F Bfr F I rr) v)q) an U UF az F z frl ETa 2 U tr]&(J U t-, z P.p B o Fl Fl fr Executive Summary 1. Background on population and treatment data Gambella Regional State is located in south west Ethiopia, 776 kilometers away from Addis Ababa. The Region has a total area of 25,802.01 square kilometers. The Region is boarding Oromia Region in the North & East, Southern Nations, Nationalities and Peoples Region (SNNPRS) in the South & East, & Sudan republic in the West. It has three administrative Zones (Nuer, Agnwua, Mejang) and one special woreda (ltang). The major ethnic groups found in the Region includes; Agnwua, Nuer, Mejang, Opwo, Komo and people from Amhara, Tigray, Oromiya and the SNNPR. Based on the REMO conducted in 1997,2001 & 20i0 Gambella was found to be hyper-and meso endemic for Onchocerciasis. And CDTI program was initiated in five Woredas in2004. In the reporting year-2013, all the five CDTI woredas were covered with the treatment (100% geographic coverage) md75.4 oZ therapeutic 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 servants. Due to unstable movement of people to neighboring woredas for business related activities,, population size in CDTI areas vary from time to time. 3. Training data Training and retraining of 191 health workers,l82 community supervisors and 1,098 CDDs was conducted. 4. Challenges - late arrival of Mectizan - Delay of the release of APOC budget 5. Opportunities: Resettlement program implementation is going on in a satisfactory manner by the government in the CDTI program areas. I SECTION 1: Background information 1.1. General information 1.1.1 Description of the project Gambella 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 (Southem 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 371,424 of which 74o/o are rural and 26oh are urban dwellers. The population is largely engaged in subsistence farming. animal husbandry, fishing and coff'ee 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 Q.{ovember-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 area consists of 13 health centers and 75 health posts. 2 Table 1: Num of health workers involved in oroiect.2013 District Number of other health worker involved in CDTI activities. Total Number of health worker in the entire project afea BI Number of health worker involved in CDTI B2 Percentage Br=Bz/ Br *100 Abobo 46 8 fl.1 Dimma 38 17 44.7 Gambella 45 4 8.9 Godere 50 t2 24 Mengeshi 2t 6 28.6 Total 200 47 23.5 1.1.2. Partnership The Federal ministry of health, Regional Health Bureau, Zonal Health Department, Woreda health office, health facilities, the community, The Carter Center, WHO and other government sectors are tha main partners in Gambella CDTI project. There has been strong partnership during planning, advocacy, mobilization, distribution, monitoring and evaluation of the CDTI activities among all partners. J District Number of health extension workers involved in CDTI activities. Total Number of health extension workers in the entire project area Br Number of health extension workers involved in CDTI B1 Percentage Bs=Brl Br *100 Abobo 36 36 100 Dimma 25 25 100 Gambella 24 24 r00 Goderie 29 29 100 Mengeshi 35 32 9l Total 150 144 96 Table 2:Number of health extension workers involved in CDTI project.20l3 1.2. Population at risk in the entire ect area or not during the reportine period UTG : calculated as the maximum number of people to be treated annually in meso/hyper endemic areas within lhe project area, ultimately to be reachedwhen the project has reachedfull geographic coverage (normally the project should be expected to reach the UTG at the end ofthe 3il year ofthe project). Was a census for the project done during the reporting period No If yes, what is the source of the data in the table above? * Source: National census CDD {-Other source, specify ? Yes '/ 4 Year :2013 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 Hyper- endemic zone in the project area A7 A2 Total in meso/hyper- endemic zone Aj: Aft A2 Meso- endemic zone in the project area A.1 Hyper- endemic zone in the project area As Total in meso/hy per- endemic zone A6: Par+ A5 Ultimate treatme nt Goal (urG) Abobo t7,531 66 0 66 t 7.531 0 I7.531 14,726 Dimma 14.2t5 55 0 55 14.2t5 0 t4.2t5 13,621 Gambella I I .177 40 0 40 I I,177 0 I | .t'77 9,389 Godere 46573 126 0 t26 46s73 0 46573 39,121 Mengeshi 2598t 74 0 74 2s981 0 2s981 21,824 TOTAL I17,477 361 0 361 117,477 0 117 ,477 98,68 r WHO/APOC, 30 December, 2013 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 v,ho live in not more than 2 Kms radius and v,ho shared o common interesl Is there any other information of interest about the population in the project area? If so. include it here. In Godere there is cof.fee and tea plantation, in Abobo colton plantation and in Dimma woreda there is manual gold mine. People travel to lhese v,oredas searchingfor occupalion. Thus, the size and struclure of the population in each u,oreda shou'.fluctuation. SECTION 2: Implementation of CDTI 2.1. Timeline of activities Table 4: Timeline of activities for the areas treated in Gambella,2013 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. Advocacy meeting has been conducted 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. 5 District LGA Mobilization of communities Training Census/Update Drug distribution Supervision Starting month Comple tion month Starting month Completio n month Starti ng month Completi on month Stafting month Completi on month Starting month Completi on month Abobo June 2013 June 20t3 June 2013 June 2013 June 2013 June 20 I 3 Julv 2013 July 2013 June 2013 July 2013 Dimma June 20t3 June 2013 June 20 I 3 June 2013 June 2013 June 20 I 3 July 2013 July 2013 June 2013 July 2013 Gambella June 2013 June 2013 June 20 I 3 June 2013 June 2013 June 20 I 3 July 2013 Julv 2013 June 2013 July 2013 Godere June 2013 June 2013 June 20 I 3 June 2013 June 2013 June 20 I 3 Juli, 2013 July 2013 June 2013 July 2013 Mengeshi June 2013 Iune 2013 June 2013 June 20 I 3 June 20t3 June 2013 July 2013 July 2013 June 2013 July 2013 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. 2.4. Communityinvolvement Table 5: Communities participation in th Comment on: - Attendance of female at community at health education meetings. The attendance of female members of the community at health education meetings has been improved. - 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 very encouraging. Incentives provided by communities for the CDDs No incentives were provided so far. Attrition of CDDs. Is attrition a problem for the project? If yes, how is it addressed? There is some attrition of CDDs and immediate replacement of drop outs was made. Perccntagc Brr- B * 100 6 District/LGA Number of communities/villages rvith communitl' members as supervisors Number of CDDs and the communitics involve d Number of communitrcs /villages u,ith female CDDs Total no communities in the entire projcct area B4 Number with communitl, rnembers as superv i sors B, Percentage Bo: 85/ Br + 100 Male CDDs B7 Female CDDs BE Total Be: Br+Bt Number of communities wrth female CDDs B,u /IJ Abobo 66 66 100 t23 117 240 66 r00 Dimma 55 55 t00 93 50 143 55 100 Gambella Zuria 40 40 100 42 25 67 40 100 Goderie 126 126 t00 340 ll9 459 126 t00 Mengeshi 74 74 I00 137 57 194 74 100 Total 361 36r 100 138 368 I 103 361 100 2.5. Capacity building - Describe the adequacy of available knowledgeable manpower at all levels. The govemment has assigned 2 well-trained Ilealth Extension Workers in each Kebeles - Where frequent transfers of trained staff occur, state what the project is doing. or intends to do, to remedy the situation. (The mosl imporlanl issue to describe is v,hat measures Ytere token to ensure adequate CDTI implementalion u'here nol enough knou,ledgeable manpou'er y,as available or if staffs are.frequently lransferred during lhe cottrse o.f the campaign)- Adequate number of health workers from HFs was trained. Table 5: Trainins of durins CDTI implementation in the proiect area of Gambella.20l3 District/L GA Number of Districts/ staff trained Number of Health cen terlpost staff traincd Number of other trainers of trainces ( TOTs) Number of CDDs trained ATr o CI Nev C2 Refr C3 Tot al C4= C2+ C3 AT rO C5 Netv C6 Ruf r C7 Total c8= C6+ C7 ATrO C9 New c10 R"f r cil Total Cl2= cl0+ cl1 ATrO cr3 ,\Iey cl4 Rof r CI5 Total cr6: Cl4+ cl5 Abobo 6 4 2 6 28 0 28 36 240 t17 123 240 Dimma 2 6 8 38 l0 l9 29 138 66 72 138 Gambella 4 4 0 4 2l 10 l4 24 67 25 42 67 Godere 5 I 4 5 36 0 36 36 459 t07 3s2 459 Mengeshi 3 3 0 3 39 t9 t6 35 t94 ll0 84 194 26 t4 l2 26 162 39 l13 160 1098 425 673 r098 100 7o Achievement 100 7o Achievement 100 TOTAL 7o Achievement Table 6: Tvpe of undertaken in 2013 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 l 8 2.6 Treatments 2.6.1. Treatment figures If the project is not achieving 100% geographical coverage and a minimum of 650/o therapeutic coverage or the coverage rate is fluctuating, state the reasons and the plans being made to remedy this. . The geographic and therapeutic coverages were 100% and I5Yo respectively Table 7: Treatment and SAEs bv district/L in all oroiected areas in Gambellain2013 District ILGA Communities/Villages Population Numb er of person s refuse d lreatm ent Number of absente es Num bcl of SAE S 'l-otal # of communiti es/ villages in the meso/h1,pe r-endenric areas Dr Annual Treatm ent Objecti ve D: Numbe rof commu nities/v i llages treated Dr Geograp hical coverag (%) Dr: Dt/ Dr* 100 Total populati on of the meso/h1' per- endemic areas Ds Annual l'reatme nt Ob.;ectr VC Dr Numbcr ol' persons treatcd Dz -l-hcrapc utrc covcraS c (',',) Dr: Dt/ Ds* 100 Abobo 66 66 66 100 ll ,531 14,126 13918 19.1 5 t46 0 0 Dimm a 55 55 55 t00 14,215 13,621 1 14s5 80.6 I 060 2530 0 0 Gamb ella 40 40 40 100 I I ,177 9,399 7734 69.2 132 576 0 0 Goder e 126 126 126 100 46513 39,121 349s6 7 5.1 59 3910 0 0 Menge shi 74 74 74 100 25981 21,824 20460 78.8 736 1695 0 0 Total 361 361 361 r00 t17,477 98,681 88,583 75.4 1992 8857 0 0 Numbcr of seri ous adversc evenls (SALs) referred to the health Post/hos tal Forurula for computine ther Therapeutic coverage rate (%) communities within the project area Geographical coverage rate ATO coverage rate (%) Number of people treated x 100 Total population living in meso /hyper-endemic Number of communities/villages treated x 100(%) Total number of meso/hyper-endemic communities as identified by REMO in the project area Number of people treated x 100 Annual Treatment Objective %UTG achieved Number of people treated x 100 Total number of people to be treated in meso/hyper-endemic areas within the project area (UTG) ATO: The estimaled number of people living in meso/hyper-endemic areas lhol o CDTI project intends to lreal wilh ivermeclin in a given year. UTG = The maximum number of people to be lreated in meso/hyper-endemic areas within lhe projecl orea, uhimatel! lo be reached when lhe project has reached full geographical covetage (normally lhe project should be expecled lo reach the UTG at the end ofthe 3't year ofthe projecl 8 2.6.2 What are the causes of absenteeism? Late arrival of Mectizan tablet forced us to carry the MDA campaign in the rainy season, where some conununity members were leave their village for business related reasopn. 2.6.3 What are the reasons for refusals? Migrant setteled for gold mining and coffee harvesting activities in the CDTI areas refused to take Mectizan, 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 9 WHO/APOC, 30 December, 2013 tr c.l (.) -o E 0) o o tJ c.) (-) (J o- o > :l alNl dl 0-)LI(! o C) .i oL -10)! 6 0) L € C) Cd obI(n L o) oo cd C) (_) 0) o c) CdoLF O. 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ON 2.7. Ordering, storage and deliverA of Ivermectin Mectizan@ ordered/applied for by - Qtlease tick the appropriate answer) MOH M WHO tr UNICEF tr NGDO N Other (please specify) Mectizan@ delivered by - Qtlease tick the appropriale ansv,er) MOH M WHO tr UNICEF tr NGDO tr 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 letter to the zonal CDTI project health office and then distribute to the health facilities. It is from the frontline health facilities that the community supervisors received and the CDDs get the drug and distribute to the communities. Table 10: Mectizan@ [nventory in GambellL29l3 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 drugs to 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. . Sentisize and mobilize political leaders and community members . 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 dishibution to CDDs after checking the census (village register) ' Conduct supportive supervision and follow up to confirm the proper accomplishment of Census activity, CDDs training,drug distribution, proper handling of drugs, data compilation, and report writing activities. ll WHO/APOC, 30 December, 2013 District Drug Balance from previous year Number of Mectizano /Albendazol tablets Received Used Wasted Expired Remaining Gambella Mectizan 26309 259000 248,032 650 0 36627 Albendazol 23284 I 19,500 88583 231 0 53970 2.8. Community self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? If so, When? Yes, Zone and rvoreda level training conducted on June 2013, before the treatment period. Table I l: Communi tv self-monitoring and S takeholders Meeting in Gambella. 2013 District/ LGA l-otal # of communities/villages in the entire project area No of Communities that carried out self monitoring (CSM) No of Communities that conducted stakeholders meeting (SHIVI) Abobo Dimma Gambella Goderie Mengeshi 66 55 40 126 74 18 18 l3 t4 18 18 18 l3 l4 18 TOTAL 361 81 8t Describe how the results of the community self- monitoring and stakeholders meetings have affected project imptementation or how they would be utilized during the next treatment cycle. The SHM was conducted at woreda level to discus and make the stock holders involve and supporl the CDTI activities. The participants also review the last MDA activities and planned for the nexl MDA activities. The result was found successful. 2.9. Supervision 2.9.1 . Provide a flow chart of supervision hierarchy. NOTF )RHB) ZHD)WOTF ) Health Facility ) Community supervisors ) CDDs 2.9.2. What were the main issues identified during supervision? r Village registers were not properly updated 2.9.3. Was a supervision checklist used? Yes 2.9.3 What were the outcomes at each level of CDTI implementation supervision? ' CDDs were trained on how to record data in village registers and good improvement has been observed. 2.9.5. 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? . Oral and written feedback has been given to overcome the gaps identified. quality service was observed t2 SECTION 3: Support to CDTI 3.1. Equipment Table 12: List and Status of equipment +Condition of the equipment (F:Functional, CNFR: currently non-functional but repairable, WO:Written of0. NA-Not available How does the project intend to maintain and replace existing equipment and other materials? Efforts will continue to allocate budget by the goverrrment for equipments maintenance. 3.2. Financial contributions of the partners and communities Table 13: Financial contributions by all partners for the last three years If there are problems with release of counterpart funds, how they were addressed? No Additional comments Source Type of equipment APOC MOH - Zone DISTRICT NGDO Others No Condition No Condrtron No Condrtion No Condrtron No Condrtron l. Vehicle 2 F NA NA NA NA 2. Motor cycle(s) 5 F NA NA NA NA 3. Computer(s) I 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 1 F NA NA NA NA Conffibutors Year 6 (2010) Year 7 (2011) Year 8 (2012) Year 8 (2013) Budget ed Releas ed Budgeted Budgeted Released Released Budgeted Released MOH (Central+ Srate) NA NA 128,944.83 NA NA 128,944.83 NA NA MOH (District + zone) 4000 4000 0 7,500.00 7,500.00 0 7,500.00 7,500.00 Local NGDO(s) ( if any) 0 0 0 0 0 0 0 0 NGDO partner(s) 12,382 t2,382 12375.65 12,37s.6s 21,240.00 21,240.00 Communities 0 0 0 0 0 0 0 0 APOC Trust Fund 0 0 14,114.55 I l,l 19.01 7,783.31 14,114.55 8,056.00 8,056.00 Total 16,382 16,382 14,114.55 30,994.66 27,658.96 14,114.55 36,796.00 36,796.00 l3 3.3 3.4 Other forms of community support 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 IUSD:18.00 Table l4 : Type of activi tv. expenditure and source of fundine during the reoortins period of 2013 Activity Expenditure ($ US) Source(s) of funding Trainings and HE 1 1,055.00 TCC Supervision and monitoring 2,319.00 TCC CDTI Activities 7,500.00 MOH Mobilization, Advocacy and intervention 4,414 TCC CDTI Activities 8,056 APOC Others 3,452.00 TCC TOTAL 36,796.00 Total number of persons treated 88,583 l4 SECTION 4: Sustainability 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) Year I Partici patory Independent monitoring --Mid Term Sustainability Evaluation __- _ 5 year Sustainability Evaluation Intemal Monitoring by NOTF Other Evaluation by other partners 4.1.2. What rvere the recommendations? 4.1.3. How have they been implemented 4.2.4. Other resources 4.2.5. To what extent has the plan been implemented The CDTI activities training, mobilization, census update, etc. were done as planned. But, though treatment geographic coverage was maintained at l00yo, therapeutic coverage (75%) was not satisfactory. 4.2. Sustainability of projects: plan and set targets (mandatory al Yr 3) Sustainability of projects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period ?NO 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 levelsYearly integrated plan is prepared including CDTI at all levels. 4.2.2. Funds Govemment budget allocated for the integrated health activities including CDTI. This approach will help to sustain CDTI after APOC funding cease. 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 vehicles from other health programs to fill the gap. 15 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. All prevention and control activities are included in the 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 FMOH>TCC/E >ZHD>WHOs>HC>HP>CDDs> community. 4.3.2 Training: Health staffs at the project woreda have received training/retraining on epidemiology of Onchocerciasis, Lymphatic Filariasis, and CDTI principles. 4.3.3. Joint supervision and monitoring rvith 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. 4.3.4. Release of funds for project activities Fund from the NGDO partner was released on time to accomplish the CDTI activities l6 4.3.5. Is CDTI included in the PHC budget? Yes, 4.3.6 Describe other health programs that are using the CDTI structure and how this was achieved. What have been the achievements? Malaria control and Lymphatic Filariasis elimination programactivities were accomplished in integration with CDTI. 4.3.7. Describe others issues considered in the integration of CDTI. No. 4.4. Operational research No operational research undertaken in the project within the reporting period SECTION 5: Strengths, Weaknesses, Opportunities and Threats Strengths: ./ The project is able to accomplish the ninth treatment cycle with 100% geographical coverage. ,/ Community awareness on CDTI philosophy has increased. Weaknesses: ./ Poor document handling and recording, at some of Front line Health facilities ,/ Supportive supervision at all levels by Health personnel is not covered./shortage of manpower. Opportunities: / Avallability of Health Extension Workers in every Kebeles / The government structure organized up to the grass root level Threats: The far distance and inaccessibile woredas (Dimma and Mengesh) is a barrier for frequent supervision and close follow up. t7