Proceedings of the national annual review meeting on onchocerciasis control programme: 4th - 7th october 2011, Kereyu Hill Resort Hotel, Adama organized by WHO in collaboration with federal ministry of health (FMOH) and African Programme for Onchocerciasis Control

dtr PROCEEDINGS OF THE NATIONAL ANNUAL REVIEW MEETING ON ONCHOCERCIASIS CONTROL PROGRAMME. "''i'''' 4th - |h october 2o1l1, Kereyu llill Resort Hotel, Adama organized by wHo in collaboration with Federal ministry of health (FMOH)and African ProgrammeforonchocerciasisControlwHo/APoC) 1 tr '.i .! i4i .!.. l\ .a .(rrP 8S *'\ rl ,. i Ei 4 ?t. v ,:::. , .tl - ? ..ti -l a,\ Table of contents Topics l. Day one presentation 2. Day 2 presentation.. . 3. Day 3 presentation... 4. Day 4 Presentation.. . 5. Recommendations ... 6. Annexes List of participants . . . Schedule page 4 ,9 1l l4 t6 l9 l9 .20 2 List of Acronyms APOC Africa Programme on Onchocerciasis control CDD Community Drug Distributors CDTI Community Directed Treatment with Ivermectin HSDP Ilealth Sector Development Programme JAF Joint Action Forum NMP National Master Plan NTDs Neglected TroPical Diseases MDA Mass Drug Administration REA RapidEpidemiologicalAssessment REMO Rapid Epidemiological Mapping on onchocerciasis WCO World Health Organization Country Office 3 -- -r3' Proceedings of National annual meeting on onchocerciasis control programme. 4th - 7th October, 2}ll. Kereyu Hill Resort Hotel,Adama '[he annual review meeting was started after a welcome speech made by NTDs focal, Mr. Kadu Meribo. After his welcome speech, he invited Mr, Getachew Temeche to make Keynote address on behalf of WCO Mr.Getachew Temeche made a keynote address and on his speech he mentioned Onchocerciasis, one of the NTDs and transmitted to humans through the bite of black flies and endemic in 30 African countries where 120 million are at risk of infection. The disease causes severe unrelenting itching and can result in blindness if untreated. He also mentioned the socioeconomic impact of the disease such as reduction in agricultural productivity of affected rural communities He also mentioned scope of The African Programme for Onchocerciasis Control (APOC) and strategies of The Community-Directed Treatment with Ivermectin (CDTI and status and achievements made by the Ethiopian programme, good treatment coverage and lOOo geographic coverage, activities carried out including mobilization of the community members and training of health staffs, community supervisors and high number of Community Drug Distributors (CDDs). Rapid Epidemiological Mapping on Onchocerciasis (REMO) has been conducted to further refine and fully determine the intensity of onchocerciasis distribution in Ethiopia. 34 districts that constitute about 3 million populations were newly identified endemic for Onchocerciasis He also states that in the next four days of this meeting, it is expected to review prograrnme achievements made in 20l l activities and also the challenges you faced with possible solutions lt is also expected to discuss onthe Shift from onchocerciasis control to elimination and futureof APOC and onchocerciasis control in Africa. He expressed his hopes that the meeting will be fruitful that will end up with important recommendations to improve future programme implementations He finally thanks the ministry of health staffs, the NGDO partners and the community at large lor their contribution to protect the at risk population from this devastating disease from the country. Mrs.Mihret HiluC Agrarian Health Promotion and Disease Prevention Directorate Director made an opening remark During her speech she expresses her gratitude to make opening speech of this review meeting that conducting during a period where Guinea worm disease is approaching for eradication, a possible shifting of Onchocerciasis control to elimination and finalization of NTD's National master plan (NMP) taking place 4 On her speech she mentioned the Health policy of the country that emphasizes on prevention of disease and even distribution of health service delivery. In these premises, more than 14,500 health posts have been constructed and more than 34,000 Health Extension Workers deployed in rural areas to access all population of the country to the preventive and basic curative health services. The blue print of health poticy, Health Sector Development Program (HSDP) is implementing through health extension program that aimed to focus on house hold and community in order to reach all members of community and all corners of the country. As the result of this, reduction in child mortality has observed .in addition, reduction in number of death and morbidity due to malaria has also been achieved significantlY' She also explained on Health Extension program which is a comprehensive program that operates at households and community level through implementation of I6 heath extension packages, thus it contributes directly or indirectly for prevention and control of NTDs This will enhance the efforts of reducing burden of communicable diseases to level where they are not public health problems The Government of Ethiopia has been developing National Master Plan for NTDs which will be finalized soon. onchocerciasis is one of the NTDs that has got a consideration in National Master Plan (NMP) due to its Prevalence. onchocerciasis is prevalent in five National regional state regions with different prevalence rate' Among all regions the disease is widely distributed in western part of Oromia. Onchocerciasis control program has been implemented in Ethiopia since 2001 with support of APoc According to the 2010 report, of treatment targeted population, more than 4.8 million have received Ivermectin treatment Co-implementation, strengthening integration and partnership are the way forward to scale up control and then elimination of onchocerciasis Finally she thanked wHo/Apoc for supporting the meeting financially and technical for sending technical experts to facilitate the meeting. She welcomes all participants and declares the meeting has offrcially oPened. After the opening remarks, introduction of participants and adoption of the agenda was carried out The objectives, expected outcome and methodology of the overall four day agenda was presented by Mr Getachew Temeche from WHO country oftice' objectives: The meeting has the following major objectives: -. To review the 2010/l 1 CDTI Implementation in Ethiopia 5 . To discuss the shift from Onchocerciasis control to elimination and future of APOC and Onchocerciasis control in Africa . To review the results of the Epidemiological evaluation and treatment coverage surveys in Kaffa-sheka, North Gondar and Bench Maji CDTI Projects . To review the results of recent REMO Refinement in Oromia, Benshangul-Gumuz and Amhara Regional States . To set up TechnicalReview committee (TRC) in Ethiopia Expected Outcome . The 2011 CDTI implementation will be reviewed . participants will be oriented on the new shift of onchocerciasis control to elimination . A consensus will be reached on future of onchocerciasis control in Africa and future of APOC . The result of REMO, Epidemiological evaluation and treatment coverage survey result will be reviewed . A TRC will be established at national level MethodologY ' Presentation ' Discussion . Day I &2: Review CDTI Implementation . Day 3: Oncho Elimination, Future of Oncho and APOC and Epidemiological evaluation Results .Day4:SettingupTRC,therecommendationandwayforwardfor2012 Then after, the national onchocerciasis control implementation during 20r l was presented by the national focar person, Mr. Kadu Meribo. All the l0 CDTI projects coordinators present their project implementation during 20l l for two successive days on the first day of the annual review meeting 5 CDTI projects Kafa, Sheka, Bench Maji, Jimma and Ilubabora present their presentations Duringthenationalfocalpresentation,theissueofgovernmentfinancialcontributionstoCDTI activities was described. Although direct allocation of budget was not observed' indirect financial contribution was reflected in one or other ways like, participation government paid health workers during community mobilization, health education, training of CDDs and Health workers' utilizing thebudgetallocatedforotherhealthservicesintheformofintegration.Accordingtohis presentation there were some lessons learnt and few problems encountered during implementation Lesson learnt co-implementationishighlyrecommendabletocutdownresource(time' money. .)Extension workers and community is increasing program effectiveness' because 6 a tIEWs have been working for 75o/o of their time in community going from house to house, educating about onchocerciasis will increase acceptance and reduce refusal and absenteeism Problems encountered o Transport problem in some parts of program areas( seasonal road, shortage of vehicles...)Limited supportive supervision from FMoH and RFIBs, o I-imited joint monitoring and evaluation of projects, o Re-request for REMo: In addition to the 34 districts identified to have the disease some districts still requesting further refinements eg. East Wollega, West Wollega, HoroGuduru and Assossa, o Poor data management, delay in reporting " " Kaffa-shekka GDTI Project:The first presentation was made by Sheka zone GDTI coordinator' Sheka zone is included with Kaffa CDTI project and is the first and oldest CDTI project in Ethiopia' However, high refusal and absenteeism was observed during the presentation, especially in urban and semi_urban settings. In addition, a lot of Mectizan was also reported as wastage. A decline trend of treatment coverage was also observed in 201 1 compared with the previous year The second presentation was made by Kaffa CDTI project During the presentation, it was observed that the therapeutic coverage of ail CDTI woredas was less than S0%.Bongadistrict reported the lowest (60.z%)while Adiyo district reported with the highest (7g.9%)treatment coverage Although the project was the first in the country and accounts severar years of implementation, there is still high refusals and absenteeism especially at urban settings' 7 (,w ;,\- W EE v: I After the presentation of the 2 CDTI projects discussions were held participants raised some questions such as why a lot of Mectizan was wasted and factors for decline on treatment coverage in some woredas The participants forward suggestions and comments to improve implementation for the future Bench-Maji CDTI Project: The third presentation was made by Bench Maji CDTI project coordinator. Over all treatment coverage is less than the expected value by APOC (75Yo), ranging from 620/o to 79yo in Bero and Shasha /Golydiya respectively. There is also unacceptable number of refusals and absentees, According to the information provided from the project coordinator, the main reason for refusals and absentees were: o The high number of refusals could be related within appropriate timing MDA was conducted during Muslims fasting and people refuse to take drugs because of rumor that Mectizan Provokes hanger' o Absenteeism was explained by unstable settlement, Security problem and farm time. A stable treatment trend was observed since the inception of the programme except in 2010 and 201 I where a decline trend was observed due to the above mentioned high number of refusals and absentees. Ilubabora CDTI project: The fourth presentation was made by Ilubabora CDT'I project 'I'he result of the project area shows still the coverage is less than 80% with maximum 850% and minimum 67oh. lngeneral there was reduction in treatment coverage from 83%-780% when compared 2010 with 20l l Jimma CDTI Project: The last presentation for the day was presented by Jimma CDTI coordinator On his presentation it was observed that the result of treatment coverage of 2010 shows 84\Yo on average and all the cDTI woredas scored >807o.Trends of treatment coverage of the past Syrs(2004- 2010) shows >80% on average except 2006 which was 78%. During the discussion' wastage of drugs was raised as an issue since a lot of drugs have reported wasted (9148 tabs) and advised to improve in future based on the rule first in first out rule' Before the end of the first day meeting, participants discussed issue related with the role and members to be recruited for community self monitoring and community supervisors. ln some CDTI projects, Health Extension Workers were working as community supervisors and CDTI coordinators justify that community members were responsible to recruit members from the community to be trained as health Extension workers ln addition the health extension workers are fully engaged supporting all health related activities to the community including onchocerciasis So' it is 8 appropriate to assign the health extension workers as community supervisors on the other side, some CDTI projects oppose the idea of recruiting Health Extension Workers as community supervisors because they are government paid employees and we should not consider them as community members. After a long discussion the participants agree to recruit community supervisors based on their respective CDTI project situation. During the discussion, it was observed that participants were not clearly understand the role of community supervisor and community self monitoring. ApOC stafB provide detail explanation on the definition and role of the two concepts' Day-Two North Gondar CDTI project: on the second day, the first presentation was made by North Gondar zone CDTI coordinator. During his presentation, it was learnt that about 20,575(8Yo) people were not treated due to absenteeism and refusal. Majority of them (76%) were from Metema and Tachfumachihoworeda. However, the number of absentees and refusals reduced by (38'2%) in 20ll compared to the year 2010 (33,314).Trend of Ivermectin treatment was increased since the inception of the programme. The lowest achievement was attained in 2oo7 and the highest in 2009 Moreover, a decreasing trend of Ivermectin treatmentgOo/o and 87 6oh were observed in the year 2010 and 2011 respectively. After the presentation, discussion was held and participants raised questions such as why there is high number of absentees? What were your challenges not covering all CDTI communities? The presenter respond as treatment period started late (appropriate period to CDTI was october to February) because of the instruction given from APOC as there was irnpact assessment study and most farmers left their homes for agricultural activities to non-cDTI districts starting from March Gambelta CDTI Project: The second presenter was Gambella CDTI coordinator' on his presentation, it was observed that the achievement of the region is acceptabre in comparison with the standard set (glolo), but there are still high refusals. There is an increasing trend on therapeutic coverage in 20u compared with 2010 that will encourage for the future performance. During the discussion period, participants raised questions related with refusals and absentees and the coordinator reply few factors for absenteeism as daily labourers that were registered during village census left home during treatment time that leads an increase number of absentees 9 East Wollega CDTI Project: The third presenter was from East Wollega zone CDTI project as the Zone CDTI projects are administratively separated even though APOC does not recognize them. The three projects who presented were: East Wollega, West Shoa and HoroGuduru. The achievements of 2010 shows high treatment coverage(83%) but the data needs to be adjusted since the sum of absentees, refusals brings few expected eligible which may compromise the result. According to zonal focal person explanation lack of awareness and miss conception (Some people think that they don't have the disease) reasons for refusals and seasonal travel for agricultural activities to non-CDTI areas flor absentees. The focal person also highlighted not received all APOC approved capital equipment such as motor cycles. In addition he requested APOC to support the newly identified woredas with financial and capital support west wollega CDTI Project: The fourth presentation was made by west wollega zone coordinator. There were two CDTI districts in the zone and both districts achieve similar treatment coverage of g4oh, with still large amount of population not treated due to refusals and absentees. 'Ihere is increasing trend on treatment coverage in recent immediate years Then after, West Shoa zone that have one CDTI district presentation followed. On his presentation, it was observed that achievement of the treatment coverage was the best in compared with the intended standard' The last but not the least presenter for the 2"d day was Kelemwollega zone GDTI coordinator. The 6DTI project achieved treatrnent coverage of >80% but the issue of those who did not get treatment should be considered.There is a decline trend of therapeutic coverage in 2010 and 2011 compared with the previous years and it might be due to high absentees and refusals in 201I Before the end of the session, discussion was held and major issues, such as need to carry out REMO in additional districts, 3 in HoroguduruWellega (AbayChomen, Guduru and AmuruJarti)' 1 in west Shoa (Gindeberet), 4 in East wollega (GudayaBille),2 in west wollega (ManaSibu' Kiltu Kara, Begi and BureGechi) need to be refine to finalize mapping in Ethiopia Additional three districts from BenshangulGumuz(Kamashi, AgeloMeti and WomberaWoreda)was also suggested to be included in the REMO. tn addition due to administrative and other managerial problems such as drug supply and financial issue, west Shoa and Kelemwollega zones suggested to be considered as separate CDTI projects Earlier west shoa zone was included in East wollega cDTl project and Kelemwolega having 9 CDTI districts was incruded in west wo[ega CDTI project with only 2 CDTI projects 10 Day-Three -Ihe third day of the meeting was fully held by Presentation by staffs from APOC. The first presentation was made by Dr Noma, on conceptual and operational frame work of onchocerciasis elimination with Ivermectin. During his presentation, Dr Noma explained clearly that according to the decision of Joint Action Forum (JAF) in December 2009 which has directed APoc to determine when and where lvermectin treatment can be safely stopped and to provide guidance to countries on preparing to stop Ivermectin treatment where feasible. It was also described that APoc is following the direction given by JAF closely conducting: Epidemiological evaluations, designing conceptual and operational framework, National workshops to develop elimination plans' Preparation for stopping Rx in advanced projects. The issues of conceptual and operational document were discussed in detail. Finally he addressed the possibility of elimination by treating the disease with Mectizan without any vector control interventions by supporting with the study results found in other African countries Senegal and Mali. criteria to determine where to stop should be based up on the target set by wHO on disease prevalence and infected vector density has already been tested in the Senegal and Mari study. This test procedure wiil arso be used in Apoc countries. Following his presentation a question was raised if the program is shifting from control to elimination addressing the issue of untreated hypoendmic areas and APOC',s plan to include them Dr Noma has explained that with the new concept of transmission zone all areas that have local transmission will be incruded under treatment Fortunately Apoc identified those areas in a mapping analysis using trigging methodology and has compared it to the treatment areas under CDTI and found that most of those areas are already under treatment. However, if they are not already covered by CDT' APOC Management has decided that they will be incorporated in the CDTI project Next to this, Dr Afework present a topic entitred "Resurts of Epidemiological evaluation in Kaffa- sheka, North Gondar and Bench Maji GDTI projects" and on his presentation the result observed in most cDTr projects was satisfactory. He also highlighted all the epidemiorogicar evaruation that has been conducted since 2009 to date by Apoc in a number of African countries To date APoc evaluated 27 projects and 24 of them showing a very satisfactory result and with only four other with unexpected unsatisfactory result due to poor treatment coverage The result of North Gondar whichshowednoinfectionandKaffa-ShekaandBenchMajiCDTIprojectsveryhighreductionof 11 infection is highly satisfactory and commendable. After the presentation discussion was held on the topic. Before the end of the day, one more presentation was made by Mr Abate Tilahun. "Result of Treatment coverage survey in Kaffa-sheka and Bench Maji CDTI Projects". Mr. Abate started his presentation with the definition of therapeutic coverage as "the proportion of people accurately treated with Ivermectin in relation with the census population of treatment year. He also explained the two methods used for the survey l) survey within the community and 2) review of village register. Three CDTI projects, Keffa, Bench Maji and North Gonder were selected based on treatment regime (> 8 years)'The findings of the survey were: eligible population and some did not update it Finally the presenter forward the following recommendations receiveditfromtheCDDsforimmediatecorrection REMO Refinement Result of EthioPia Dr Afework presented the REMo refinement exercised in Ethiopia which was conducted in 201I with the financial and technicar support of Apoc. rn summary the study has identified 34 New CDTI woreclas endemic for the disease and approximately more than3.3million people live at ri sk of the disease in those woredas Following the presentation a number of concern were raise as to how to start implementation of CDTI in the new areas. one suggestion which was supported by the participants was to start semiannual treatment in those woredas to catch up on old projects and achieve oncho elimination in Ethiopia by 2020.In addition a number of participants raise the issue 12 of further refinement in some of the woredas and adjoin areas which were explained earlier under west Wollega presentation. Summary New endemic areas and their population Zones Number of woredas fit for CDTI Total Population 4Ytr g Oromiya IloroGuduru I 43,E71 36,852 I 10,555 East Wolleg4 5 390,294 327,847 983,54 I West shoa 2 196,109 164,732 494,195 West Wollega 1 6EE,E60 57E,642 t,735,927 Ilubabora 7 365,661 307,155 Jimma E 1,297,357 Amhara BenishangulGumuz r North Gondar Z.ane Assossa and Kamashi 2 2 310,645 61 199 334 At risk population Tablet requirement 3tab 921 466 780 3,269 782,1\25 __ll4z, 2,E17,357 154,221 TOTAL Future of Onchocerciasis Control in Africa and APOC Regarding future onchocerciasis in Africa and Apoc future, the four scenarios that were proposed by the advisory committee were presented to participants by APOC staffs The options were: I extend life of APoc ttll2o2o by transforming it to a technical body, 2 APOC extends its mandate and transform to NTDs hub in Africa, 3. keep and continue APOC as it is now and 4' close APOC by 2015. Thorough discussion was held and participants expressed their opinion on the issues Most of participants expressed that option 2 and3 were very appealing, due to the current health policy of integrated approach and co implementation of interventions and the development of national rnaster plan on NTDs F'inally, from the four scenarios all participants except two vote for the second scenario which states thar,,Apoc extends its mandate and transform to NTDs hub in Africa" of the two participants that remain abstain from voting one of them mentioned that it was good to have moreoptionsthanonlyfourscenariosthatiswhyheholdhisvote, oh 13 UO'I The next presentation was made by Dr Afework, APOC staff on setting Up Technical Review Committee (TRC) in Ethiopia. In his presentation issues like rationale for setting TRC and TOR of the committee were described, After the discussion, the participants proposed the following people as members for TRC Proposed Potential Members of TRC l.Mrs.MihiretHiluf,(FederalMinistryofHealth),Chair 2. Mr Kadu Meribo, (Federal Ministry of Health),Secretariat 3. professor Ahmed Ali and Dr wakgari Deressa (Addis Ababa University School of Public Health), member 4. Dr Daddi Jima ( Ethiopian Health and Research Institute), member 5. Mr. Getahew Temeche(WHo), member 6. Dr Zerihun Tadesse and Mr Assegid Taye (The carter center), member 7. prof Teshome Gebremikael ( Aklilu Lemma Institute of Pahtobiology),member S.DrTeshomeGebre(Regionalrepresentative'ITI)'member 9. I-ight for the World, member 10. Mr. Hailegerbriel Wolde(private) member I 1. Oromia Region Health Bureau as appropriate' observer It was explained that APOC will provide initial support, such as, to cover expenses for experience sharing in other APOC countries for TRC members, support the meeting cost and technical support with ApoC staff or TCC members attending the meeting. The NTD focal point will take the next step by inviting offrcially the proposed individuals to be part of the team as soon as possible Discussion on the topic was held and concluded the meeting for the day Day-Four on the fourth day, general discussion has been carried out The discussion was led by Mr, kadu Meribo, NTDs Focal at FMoH. Major issues discussed and consensus reached during the general discussion include REMO:cDTlzoneswhichhavestillquestionofREMOrefinementmustconductRapid Epidemiological assessment (REA) in collaboration with and presence of WHO and end this issue by sending result ofsurvey to APOC for verification Establishment of separate CDTI projects. some CDTI projects were separated into two This affects for the srnooth 2 administrative zones but CDTI project remaln as one l4 implementation of CDTI activities like drug supply, logistic, financial management and other administrative related activities. Those zones should need to be separated according to the government administrative structure. The participants agreed to have separate CDTI projects that will make l3 CDTI projects in number. The participants suggested that FMoH should request APOC the decision made by participants for approval. 3. Semi-annual treatment: The participants have agreed to conduct MDA twice a year in recently identified districts in order to catch up with the older projects in order to eliminate onchocerciasis from Ethiopia by 2A2O.In addition, baseline survey should be conduct in these newly identified districts before MDA takes place with technical and financial support from APOC. 4. Future of ApOC and Onchocerciasis in Africa: Ethiopia interest towards future of APOC is the extending of mandate's of Apoc to include control and elimination of other NTDs and transforming APOC to NTDs hub in Africa' 5. Government contribution: Government contribution should be calculated from time invested in control of onchocerciasis on key CDTI activities and equipment' money allocated for fuel, stationery etc. However, it is also important to consider all activities that is implemented in integrated manner with onchocerciasis as government financial contribution' 6. CDDs Training: Army of health development is composed of all community members in productive age group and can participate in health dev't programmes at community level directing by gov,t, so that, ln order to utilize army of health development and strengthen communityself-monitoringselectionofCDDsshouldfocusonleadersofone-to-fiveof health develoPment army 7 Crinic based Hearth facility onchocerciasis treatment: Hearth facilities in hypo endemic areas should start treatment for Onchocerciasis CDTI program officers need to conduct advocacyinhypoendemicdistrictstorequestlvermectinthatwillbeusedathealthfacility level. g. Supportive supervision: discussion was held on how to conduct supportive supervision and agreed to be carried out at all levels (FMoH, RFIB, ZHB and District health offices) during MDA Before concluding the annual review meeting important recommendations were forwarded 'fhe participants discussed on each recommendation and agreed to be carried out for necessary action 15 APOC RECOMMENDATIONS Provide Resources (financial, logistic) for newly identified endemic CDTI woredas to start semi-annual treatment by2012. Provide the necessary supports (financial and technical) to collect baseline data epidemiological (skin snip data) information in the newly identified woredas for before the commencement of CDTI in early 2012. Recognize the separate CDTI project into their respective zone according to their offrcial administrative set up for smooth implementation of CDTI (Kaffa/Shako, lYe st llto I I e g a/ K el e mWo ll e g a, E ast Woll e g a/w e st S h o a/H on o g u du ru Wo I le g a ) provide technical and financial support to carry out training for ZllD and RIIB officers on data management, recording and record keeping and other capacity building topics on onchocerciasis. Suppoft on revising reporting formats to include information on LF & Malaria or other NTDs Provide technical and financial support for local capacity building by providing training on epidemiological and entomological surveys for RFIB and ZHD staffs APOC needs to release fund on time to carry out training for all CDTI projects Provide support to replace capital equipment and provision of necessary logistic materials according to approved Plan of Action(PoA) by APOC Management Financial support to CDTI focal persons to conduct experience sharing with countries that achieve success on CDTI implementation' Recruit technical advisor at National Professional Officer (NPO) level to proactively support the implementation of CDTI especially in the areas where semi-annual treatment is commencing NGDO provide support to replace of some capital equipment and provision of necessary logistic materials camera and IT according to approved POA Communicate and consult Regional Health Bureau (RHB) Regularly Support on lmmediate auditing community registration book after census and drug distribution 16 a a a a a a o a ! Support on revising reporting formats to include information on LF & Malaria or other NTDs Scale up co-implementation intervention in all LF woredas. Support and monitoring of community register regularly Provide support to avail drugs on time at all levels Support to strengthening training for health workers & CDDs in all CDTI woredas Support to have training manuals available at all level Provide Resources (financial, logistic) for newly identified endemic CDTI woredas to start treatment semi-annually for 2012 Provide support for to conduct refreshment training on time at all levels Fund allocated by donors to CDTI projects should be informed to the RF{B and FMOH FMOH Separate CDTI project into their respective zone (Xa11atSna4a, llestll/ollega/Iklemll/ollega, East lYollego/west Shoo/Horroguduruwolleg*) Support to establish ZOTF in new CDTI Zones and strengthened in old CDTI zones' Supportive Supervision should be conducted from Top to bottom Review meetings should be conducted regularly Report formats should be revised to include information on LF & Malaria Scale up the LF intervention in all LF endemic woredas. Drug should be avail on time so that community can get on the preferable time Organize Mass Drug distribution by campaign, based on decision of the community' Improve recording and documentation of cDTI activities. REGIONAL HEALTH BUREAU (RITB) .Regionalonchocerciasistaskforcesneedtobestrengthened. . The RHB need to conduct supportive Supervision especially during MDA .RegionalReviewmeetingshouldbeconductedannually' . Strengthen recording and documentation of GDTI activities ZONAL HEALTH DEPARTMENT ' Budget should be liquidated on time ' Supportive Supervision should be conducted' .Zona|Reviewmeetingshouldbeconductedsemiannually. . Reduce drug wastage and monitor expiry date by regular supportive supervision t t a a a a a a a a a L7 a a a a Improve the quality, timeliness and validity of reports by regular feedback Strengthen documentation of CDTI activities WOREDA HEALTH OFFICE Supportive supervision should be conducted regularly Village register Reviewing should be conducted regularly Woreda micro-plan should include Onchocerciasis implementation activities. Budget should be liquidated on time Budget should be allocated for NTDs. Regular check up of village register should be done Reduce drug wastage and monitor expiry date by strict follow up Number of refusals and absentees has to be reduced by conducting appropriate advocacy and social mobilization Involve army of health development for all community based activities in the woreda Train model Households for cDD so that cDD per population ratio should not be more than I to 100 Improve the quality, timeliness and validity of reports by appropriate feedback Strengthen community ownership on CDTI program' Strengthen recording and documentation of GDTI activities at woreda and health facility level. a a I a a 18 a a t a a O| r{ v.I! E 6 caN t-- o oo 6l t--+O o\tr)\oOta) rr) c.)r-+ o\tn\o car-+O O\oOO oo ral r-+ o\ ra)(\ +$r-+O + O r) ra) r-+ o\ 00lr)(> O\o O €tri rrt t-- ( O ..1 c.l\o +O 00 6 ra ca F-+O co\o F- lrllr) c- ra) \o ra O r-F-F-lr)O N\o 0a +r- <f, O <l \o o\o ON F- €r- 00 o\O oo+ c.l\o =l o\ o'\o r-N6 F- o\O v o\ co F- O @d c'.1r-(.i +(\ o\O r-.Nr- o\ ot =lca a.l o\O 00 ( o\ o\ \o+ |r) N rcrr o\O \o + ra) oo F-' o\O * ca rr o\ o\ 00r-&o m o\o @(\I +(\.l O@ o \oo Or- rn r- o\O 00rn c- r- o\O o\ F- o\ c.) a.l r.) ( o\ <lo € tr- o\ |r) @ 00r-lr) c.l o\O oo o\$ O o\O \o(\l o\6ltrl o\ c-l@ 00 CN\o\o ala) cl tat v-) €lr)O .+ o\ *+r-+o o\ rat ta) ca r-.+O c.) *\oO t-- O o. *O 00 t-. o\O <f\oO r-+ \o @ rn r/) r- O O o\fa |r) c4 cat-'sO \o F- o (7) ra F- <f \ola) \ooO 00V.lr)f- O a o\@ cn r-tr} o o\ ral r-+\o a.) c.l o \o co o o\\o r.) \o c.) O r-r-r-lalo \o t-- c.tlr) rr)|r) c- rnO r-(\l\o rn rallri F-tr) O r- <l in r- lr) o\ ++F-+ r-)t'-\o!n n oq oo (! r-\\v, I C) d -o ocl d bo G)Nq.) >| as d oo oo d (B) OOO o.l 'a ts C) -o x oo o o cd G)\o ON od -o (n o c ht o i4 0) q) o E o() ..j(! bo c) () G) (! (!E E o Ll o o (! c)ooa ao o cl oo CC G) .li -o oo oo !d c) s) ,y(s B 0.) o -oC! tr o Ll s bo G)dEo o la oq oo !n ca) o b0k €oV d oo oo !! o O6l -o(! oq iE t oq oo d (B) 0 i C) (0 (!E Iljl oq o o (! G) !(!il o .o L 0) (! o -odp CO(! F oq o d c) d o Iq o d o ts oz a o o m (!)i C) a e o (.) l0 J4 a E Ji& .dEv t+i o 6 bD o Oi oo 0) o > II r! CdEao En c, bo(.) o o() V () () v ta Ji& TI oN !E o k o) E(,) C) o)E Cd(, &A zZa &trz za &AZza & zz U) d. o- zza N o o o o CC e o o o o (n o o c! o o (! 0)3 d o -or! e (n ok o *o u)tId o z Ir. z -v o t! CS F o d -o C) d(-t() bo C)q o(, o .o q(! z C! o ,c! 0.) Ho -o () -o0) -oo o (n & o- zza o ,tr (n a G) (dq 0) o bo 6)N (.) o 0)F 0.) -oq) o 0)qk 6) q)0)q o EIooq oJ N o o d () od q E(, (! 'd() C) rrl x(s p a (! C) -v 0)q o .o !() F C) d trl CCaq v (s m 0) -oo ! C)ll 0) d -o trq) o EL cq 0) (d E F C) H BI 7. o -o (.) z dv oN r.loo o\c.l o\00\o Ir-6l ca ? Yn q) c! I clg o tt U)() x o) trr oN \o+@ 00 =t o\ ra) \o|r) o\O o\O r.{ c- ra) ta) + o\o o\ o\\oN\o 6t o\o co o\ .+ od o\ =lo\ \t+t-. O 00r- o\ o\6l r- a f.t\noO o\ €|r)o ra\o € \o\o + cno € =f o\ <) sr.l rn o 6,1 o\o oq oo (! ro tn L c)N o() oo d (s) (n o(! -oN o oI as H o (B) o E G)k C) 00 ,n oq ooE(g (s'r .ngq d}Zo € €(! (! o -o(! -o E o 0) € 6tv c) .\l c) G) IJ< Oooi dAz2 U) o tf{ o (.)(J E() H k 0.) 6)O (.) l< O c0 d bo Ea Fo m .E Or Hd ti c :( .& o i a (s o z o 0.) o6) (,)F 0) o c! 0.) () (.) () ca k c! C)F (! () d co (c 6)J o C) 0) (! -o q c) () cd 0)t c) 0.) (!o 6)!!()t: E oNti o .E F G) ,o(,) -o a.lc)t-' a.l 6 c{ N6.1 @a.le.l no o c)o € -vq d (c) 0., -o0) oo 0) -o() o c! o (.)F H o NC.lc.l (! (!)4 C) €! ETHIOPIA ONCHOCERCIASIS CONTROL PROGRAMME National Annual Review Meeting 04 to 07 October 201 l, Kereyu hotel, Adama Topic Presenter Day I Rappourteur - Mr Getachew TAilHO Registration 04.45 05 15 Discussion znd daY- Ra pourteur: Mr 830-915 North Gonder CDTI 9 15 - 10 00 Gambella CDTI Presentatton l0 00 Tea break Partic nts l0 30 Metekel CDTI Presentatlon Metekel ll45 Discussion on the three Participants Modulator FMoH Mr Getachew T AVHO Dr'l.eshome- ITI Dr Teshome - ITI Organizers CDTI Dr Teshome- ITI i I Participants8:30 - 9 00 Time Mr KaduWelcome address Getachew iIVHOKeynote address 9:00- 9:15 9:15 - 9:30 Mrs.Mihret, Director,Opening address Mr KaduAdoption of agendas GetachewMrObjectives and exPected 09 30 09:45 1 00 o zetTea break National ProgrammeN status of Onchocerciasis CDTIShekaSheka CDTI Presentatton1 1 :15- 12:00 l0:l 5 l0:30 Kaffa CDTI Coordinator Bench Maji CDTI 0rganizers Kaffa CDTI Presentatton Bench Maji CDTI Presentatton Discussion bothon Lunch 2 00 02.45 12 00 0l:00 02.45 OrganizersTea break03:30 CDTIIlubaborllubabor CDTI entatlon04:00 Jimma CDTI resentatton North Gonder CDTI CDTI Participants Jimma CDTIGambella l2:30 Lunch Partircipants _ 71 East Wollega CDTI West Wollega CDTIWest Wollega CDTI02.45- 03:30 JWestShoa CDTIWest shoa presentation03:30 ParticipantsTea break04:00 K. Wollega CDTIKelemWollega CDTI Mr Getachew AMHO T ParticipantsDiscussion on all Presentations ModulatorPresenterTo rc 04.20- 05:00 05:00 Time Day 3 Rappourter Mr Kedir Conceptual and operational Dr Noma, APOC staff Discussion Dr Noma, APOC staff participants Conceptual and oPerational 8:30 - 9:15 9.15 - 09:45 09:45 l0:30 OrganizerTea breakl0:30 Results of EPidemiological evaluation in Kaffa-sheka, North Gondar and Bench Maji Discussion Mr Abate Tilahun ITCCResult of Treatment coverage survey in Kaffa-sheka, North Gondar and Bench Maji CDTI Projects OrganizerDiscussion 02 00 East Wollega CDTI Mr Getachew T. WHO l0:45 I l:30 Dr Afework, APOC staff Participantsll:30 1230 02:00 02.45 02'45 72 Setting up of TRC (technical review Committee) in Ethiooia 03 :30 04 15 Organizers04:15 -04:45 Tea break Dr Afework, APOC staff The Shift from Onchocerciasis control to elimination and future nf APOC and Onchocerciasis 04.45 05:30 nicnrrccinnn(.d5 4th day ParticipantsGeneral discussion08:30-10:00 ParticipantsRecommendationsl0:30 participantsLunch12.30 NTDs focal, FMoHClosing remark02:00 Dr Afework, APOC Mr Kadu Meribo 23 f}--oni-ors a