Bench-Maji annual project technical report submitted to Technical Consultative Committee (TCC): from February 2004 to March 2005

CThe Federal Democratic Republic of Ethiopia Ministry of Health ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) DEAD FOR SION: To APOC Management by 31 Januarv for March TCC meeting To APoc Management by 31 Julv for september TCC meetin! AFRICAN PROGRAMME FOR ONCHOC ERC IASIS C O\qERCL 1 2-ArR 700t i A)1il-, I a D t 6/ t N, &u t lW€ cl. ii I / I I q! (EV .Brn rl ff€ Jtro t4."9 @,y For lnlorrnotlon To, brp- ln lftu 'Ynu,* I I Y/N ETHIOPIA Proiect Name: Bench-Maji Approval vearz 2002 Launching vear: 2003 Reporting Period: F r o m : Hsh r.u. a.ry .2A.,P.4..... T o ;.. .. M e.r.-c.h..? 0..Q 5.. . .. .. .. ... Month/Y Proiect vear of this report: (circle one) I 345678910 Date submitted: 28 March 2005 NGDO partner: The Carter Center I r - j (l-^. ,rrr; a^-4 t'"//r./K h*/ t/"4J,( lb^, ,*'{ # ,:rilo lfi il4lt N,r-,rr"r-, k i'fC'q. fik k WHO/APOC, 24 November 2004 t-,____--_., iA\ i: -_.*._*.J aANNUAL 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: Dr Daddi Signature Date: o Zonal Oncho C o ordinator Name : N.ege.ri..Kq s.tab.... Signature NGDO Representative Name : .......T.e.qhsm.e..Q.ehr-e........... Date t" t- atulail6{ %;e Signature: Date: ..... Date This report has been prepared by Name : ..NEge..ri..kes.teh...t.N.Ql[...... Designation'. Zone Signature ku" p5. Coordinator I ll q1,L 0.1,{. WHO/APOC, 24 November 2004 I I i;;l- d: +rrai-itrE;r ",r r, F ti trE = EEiltilin.Lr E i,EiI-i E,EfI+i=s + ,-i {'.*; + Ei d r; rd i Iffi E =l{tl{J ad C)$i |)O C) 'e $i Fr l-lF RO ()(- z() -'l F-., aa 6i .-g -rv .- -r f +) E1 I Table of contents Acronyms iv Definitions v FOLLOW UP ON TCC RECOMMENDATIONS 1 Executive Summary 2 SECTION l: Background information 41.1. GeNenelrNFoRMATroN............... 1.2. Popu1erroN.......,....... SECTION 2: Implementation of CDTI 72.1. Trurrlme oF ACTrvrrrES.............. 2.2. Aovocacy 2.3. MogtltzerloN, sENSITIZATIoN AND HEALTH EDUCATIoN oF AT RISK coMMUNrrrES .2.4. CorrlvuNrry rNVoLVEMENT........... 2.5. CnpncrryBUILDrNG... 2.6. TRsarueNrs ................ 2.7. ORDSRING, SToRAGE AND DELIVERY oF IVERMECTIN 2.8. Courr,ruNrrysELF-MoNIToRrNGeNo StarpHoLDERS MperrNc 2.9. SupsRvrsroN................ SECTION 3: Support to CDTI 193.1. EqurrveNr 3-2. FtttnNcreL coNTRIBUTIoNS oF THE pARTNERS AND coMMUNITTES .................3.3. Orsen FoRMS oF coMMUNrry suppoRT 3.4. ExpgNortuRE pER AcTrvrry SECTION 4: Sustainability of CDTI2I 4.1 . INrenNel; TNDEpENDENT pARTrcrpAToRy MoNrroRrNC; EveLuertoN . .. . .. .. . . . .4.2. SusrelNnslLITY oF PRoJECTS: eLAN AND sET TARGETs (ueNoerony ar yR34.3. INrecRarloN............... 4.4. OppnarIoNAL RESEARCH SECTION 5: Strengths, weaknesses, challenges, and opportunities 23 SECTION 6: Unique features of the project/other matters}4 l0 1l 13 l7 l8 18 4 6 7 8 8 I9 20 20 20 2l 22 22 23 ul WHO/APOC, 24 November 2004 Acronyms APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT I.INICEF 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 Sel f-Monitoring Local Govemment 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 evenl 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 November 2004 Definitions (vii) (i) Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). (ii) Eligible population: calculated as 84%o of the total population in meso/hyper- endemic communities in the project area. (iii) Annual Treatment Objective: (ATO): the estimated number of persons living in meso/hyper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. (iv) Ultimate Treatment Goal (UTG): calculated as the maximum number of people to be treated annually in mesoftryper endemic areas within the projict area, ultimately to be reached when the project has reached full geographiC coverage(normally the project should be expected to reach the UTG at the ind of the 3'd year ofthe project). (v) Therapeutic coverase: number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) Geosraphical coverage: number of communities treated in a given year over the total number of mesoAtyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). Integration: dehvering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) through CDTI (using ihmur:r" systems, training, supervision and personnel) in order to maximise cost- effectiveness and empower corrrmunities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTI. (viii) Sustainabilrty: 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, wiifr strong .o**urity ownership, using resources mobilised by the community and the govirnment. (ix) Communitlu self-monitoring (CSM): The process by which the community is empowered to oversee and monitor the performance of CDTI (or any .o--unity- based health intervention programme), with a view to ersuiirg that the programme is being executed in the way intended. It encourages the iommunityto take full responsibility of ivermectin distribution and hake appropriate modifi cations when necessary. I v WHO/APOC, 24 November 2004 FOLLOW UP ON TGG RECOMMENDATIONS TCC session r8,n Number of Recommendation in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY ro0 (i) Provrde all mrssrng information on UTG, ATO, integration, and community involvement in decrsron makrng All the pornts are well taken and addressed in this report r00 (ii) Correct the calculation of geographical & therapeutrc coverage using all vrllages and total populatron of CDTI priority area as denominator All the pornts are well taken and addressed in thrs report 100 (iri) Ensure that residual tablets are used before expiry Those tablets not used at the end of the 2003 treatment cycle was expired in January 2004 & destroyed 1 00 (iv) Ensure that future reported are endorsed by the specified authorities Accepted, & addressed in this report I 00 (v) Find ways of addressrng the difficulties encountered in thrs treatment cycle especially the high refusal and absentee rate, during the next cycle The program managed to decrease the number of refusals. However the number of absentees rs still high 1 / WHO/APOC, 24 November 2004 Executive Summaly 1. Background on treatment and population data Bench Maji is one among the l3 SNNPR zones and it is bordered to Shaka zone in the North, to South Omo in the South &Sudan, to Kaffa zone in the East and to Gambella in the West. The zone has a total area of 19,326 sq kms divided into 10 woredas, 230 Kebeles and 965 villages. The zone has t hospital,T Health Centers, 3l Health stations, 18 Health posts and 2T6health workers with different qualifications. There are six woredas that started CDTI activities in 193 kebeles and 965 villages. Theyhave I Hospital,2 Health Centers, 23Healthstations, l6 Health Posts and 32health workers that are involved in the CDTI activities. Bench Maji CDTI has total communities (villages) of 1,053 which are distributed in seven Woredas (Bench, Sheko, Guraferda, Meanit-Shasha, Meanit-Goldya, She-Bench and Maji) and all the villages were covered with Mectizan treatment during the treatment period except the villages of Mizan Woreda. The total population of the CDTI was495,346. The Annual Treatment Objective (ATO) for the year was 382,491 out of which 308,165 were treated with Mectizan which gives the therapeutic coverage of 62%. About 92oh percent (six woredas out of seven) of the project area (geographical coverage) was covered by the treatment. 2. Background on population movements. The communities in CDTI areas are mainly settled farmers, daily laborers and civil servants. However, there is a resettlement program in the neighboring Woreda, Generally, there is no major type of population movement in the project area. 3. Training data Training of Trainers (TOT) was given for 108 health professionals. Those who were trained as trainers in turn trained 2,027 CDDs who were selected by the communities from 965 villages. Therefore, the average number of cDDs per villages is 2. 4. Challenges and how they were overcome. 2 WHO/APOC, 24 November 2004 Threats (Challenges): Overburdening of health workers in peripheral health facilities in different health programs such as malaria epidemic control, EPI, measles campaign, settlement programs and high tumover of coordinators and health workers that were involved in the CDTI. Opportunities: The expansion of govemment structure down to village level and being taking the responsibility of development activities as well as health is a good opporruniff for sustainability of onchocerciasis control, which helps to overcome the above mentioned challenges. The Health Extension Package program in which there is a start of building a health post in each and every Kebele is also another good opportunity. J / WHO/APOC, 24 November 2004 SEGTION {: Background information 1.1. General information f .1.1 Description of the project Bench-Maji CDTI ptoject 1s located in the southwestern part of Ettuopia in Bench-M aJi zone admirustration which is one of the zones that constirute the Southern Nations, Nationahties and ieoples Regron (SNNPR). T\e Zone is furthet divided rnto 9 admrrustrative Woredas. The CDTI project area covers 7 out of the 9 Woredas found in the zone and has a total population of 495,346.The project area shares borders with The Sudan rn South Gambella CDTI in the West, and Kaffa-Sheka CbTI in the North. The climate of the CDTI project area is classified as tropical and the weather is cold and raining from May through September and hot from October to April. The mean annual temperature ranges from20oc-25oc and the mean annual rainfall ranges from 400 - 2000, mm. The estimated altitude range is 500-3000 meters above sea level. Slopes, hills filled with gorges and large river basins and streams, dominate the topography. Estim ated 24%o of the area is covered by tropical rain forest. About 90% of the population lives in rural areas depending on agriculture. There are two distinct seasons in the project area: Rainy season (April - September) and dry season(October - March). Agricultural activities (clearing, farming, and herding) occui all year round in the project area, but are most intensive during the rainy season. Harvesting occurs from 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. The main all weather road runs from Addis Ababa through Jimma to Mizan Teferi (project area) extending to the capitals of two project woredas (Bench and Sheko). The rest four woredas are accessible through dry weather roads. The zonal capital city Mizan Teferi is located 555 kms south west of Addis Ababa. In addition to road hansportation, there are twice a week flights to Mizan Teferi and Tum (capital of Maji woreda). The indigenous ethnic groups of Bench, Sheko, Dizi, Meinit, Suri and Mezhenger occupy the area. The health service coverage of the zone is 54%oandhas I hospital,6 heaith centers,22 health stations and l1 health posts. Table 1: Number of health staff involved in CDTI District Number of health staff involved in CDTI activities. Total Number of health staff in the entire project area Bl Number of health staff involved in CDTI B2 Percentage B3=B2l B1 *100 Bench 96 39 40.6 Sheko 48 20 41.7 Guraferda 40 t4 35.0 Meanit-Goldya 37 l2 32.4 Meanit-Shasha 30 10 33.3 She-Bench 25 t2 48.0 Total 276 107 38.8 4 I WHO/APOC, 24 November 2004 1.1.2. Partnership Partnership is a principle of APOC as well as the government of Ethiopia, which helps CDTI projects for best achievement of their activities and gradually ensures their sustainability. Since the beginning of the project, there was strong partnership during planning, advocacy, mobilization, drug distribution, monitoring and evaluation of the CDiI activities among different partners. The main partners involved are Federal ministry of health, regional health bureaus, zone health desk, Woreda health office, health facilities, the community, the carter center, WHO and other government sectors. 5 / WHO/APOC, 24 November 2004 s c..l (,) .o E o z$ a-t Qo o. of -oL o ra) I ceqr o C)a p. () a E C)Lr5 O t< a 0) tr .A ;6;9 trbootrtrr ()O>tr ooa -c) 0)'= cgo at9(Bp 0Jx o): -c9 ao .- FIJ o- €E()* A,9 l.! 0) F! '46C)trb000i o_ ;F 6) >}r HA 6) Cll =9Aeo3a HF 8,i H-c .Yoao= (.) 0) 'a lrp. 0) qi q) oL o (€ aLr c)E a. C) B a t< 0.) oo CN l-r o (-) C) rh o (h o(.) c,3 o C) C) bo lr >. oo li(.) (.) 00 U) !) ^o+rHH(Il 0) L C) cg(.)tr C)Lr li C) o B cq a) cq L.l t-.,1() I I I I -l @ (I) o '5 4.. ooLL =cgh0) cn> q) q) q) JZ U) li c0 aq) oQ N o CdF tr o g o -3c oE aN aF ! o z \o .b ooatt) op o(h k C) \J \ an 0) o !o Qct.bootr> 9cd o(o €() boE Es o(€trE 'oi O+roo '5- o.>ag o)< 4A LC) -ot au) =63o+o, cd; o:dA Fq- tF I + lls r v- L l.'=!d *E i s + 'r.6E9'Na ;:E6r EEd .o -(uo .= oN? >.eii< c F 8d €: k F;E 9N:2 rr)- .t(o rO$ o,- @ rO o-\t cf) (os rr) Co @ o) O)@(o Lr) rO F- ro- sN oo(o- (f) cf) o\o \o = (o$ @^ rO O) $ rO lr)- NN $ O)$- o$ O)lo$- o) O) f.-(o F-_ f.- @ @ rO ry O)N oo o- o$ \o!edI ra o\v @N: $ (o cf) r-- $ .to tr)- @ (O @ @- oN l.r)Nol $ ss @ oo$- @ t)6lo v @ t- slr) @ @_ N O O) O)- c) (o N rO @ F.- N ro- c) ro N cON oo @- c.) ?.)al c.) o\(.) +_ il c!q) 6t €: h FIE OYLF'- a2 t q) >-: ON?u trE cto F o o C) q) oN q) q) IoO o q) z @t rO .+ $o) N$ \tlr) $(o @@ ?a) ra N O) O) ON CO N(f) CO @ (\lal s@ cf) @ cf) st- (o NN lr) oN ?o(fl € .i C!E9 .=trcB9.- -g:E? j 6.1r -E 39 P' -A-^ @t @_ lr) O) $ rO rtr)_ NN .t O)$_ o * O)lo t- o) o) N(f) N F-(o (o rr) o{ O)N oo o- o$ \o$t) ta o\i U) I '-9!1 o'E ,iitr61 t-,'. ; .9,A!o !oc o cD oEL(I, o (, oj o !o ocq) € o !o .go E(, I = o c) o .C o(E !o I =c o o 'a I F o t'r (, F $ a.l o -o E o oZ$ c.l (J o o I cn q) a o 3E EE U $ cl $ o.l N ! N I o.l 9 N ADiE Ptr !i- c.l + (\ 6 <. ct d $ a{ (n s N d $ N; d ta od 0 i=trE o Q $ N $ N s c.l $o c.l !t N s o.l EDEE({:(t) - o N t,o fJ. s o1 ogi $ (\j o rli $ c.1 -doII $ c.lj o r& $ N do q) 6, \a a1 ol "l o o-= trEo U .f, c.tp o rL $ c.lj oIL v (\ .doIL s e.l oIL o o.lj o ti N .do OD a- c.l -ou t N l'oE $ a.l .do !t e.l A ot\ $ o.l -cio Irr .i. e.t o frr OI cl t'r o 9: EEoU $ N + N; d $ (\ d v N d t N; d t N; d dD1E cn: <i' N d s N !i' N) sf cl; 6 $ N I (\; 6 -O) .= .;r rJE s= -otrooH.Jz 3EtrE Q $o N j s N i6 $ a.l; d .t N d $ N $ N a0 Lh- s e.l; $ oN <f a.l d s N cg <fo C.l s N () F] I U) o C) ca Cg Fr edl-r o o .V o V) o C) m I C) V) d o I d C) (! a(n a I d(.) 4 F] F F r- 3 th C) O t lr(€ 0.) (.) tr o o C) olr a oLr(n C) k tt) o odqi o C) 0) F ".iro.)l dlFI o o a-flar IIg(, G lF o o E a- -o E .IF t F aN F o(, h o E .9f ofl E o Eg c E alN - o IF(, uI o / 2.2. Advocacy State the number of policy/decision makers mobilized at each relevant level during the current year; the reason(s) for undertaking the advocacy and the outcome. Describe difficulties/ conshaints being faced and suggestions on how to improve advocacy. High-level political leaders and Onchocerciasis task forces at different levels particularly the Zonal, and Woreda were involved in the advocacy to support the overall CDTi activities. The members of the Task Forces at all level were officials from all sectors, which have relevance for the CDTI activity. This political commitment helped the CDTI activities to be started and successfully achieved its objective. However, some of the sectors, which are members of the task force, were highly involved in the ongoing restructuring of government organ, resettlement and other activiti.i. f-t i. has to some extent hampered the frequency of scheduled meetings. For the next treatment period the Task Forces at all level will contribute their part as expected since the work loads ihey have because of restructuring and resettlement will be minimized. 2.3. Mobilization, sensitization and health education of at risk communities Community mobilization was done at each village organizing community meetings. The health workers at all levels have done their best in orginizing ttre task Flrces and giving health education for the task forces. The health workeri working at front line health facility level were responsible to organize the Kebele Task forces and giving health education for the task forces, community supervisors and CDDs. The Task Forces at kebele levels which, comprises of seven members and also responsible for all social, political and economical activities in the kebeles have played major role in mobilization and sensitizationof the whole community at grass root level. Community Supervisors and CDDs were responsible in giving health education to the community at ;illage level including women and minorities. In addition information regarding the CDTI project was further disieminated through local radio station. The community mobilization has contributed a lot in awareness creation and as a result the community involved in the first year CDTI activity with successful accomplishment. Thus, for the next treatment community mobilization and health education will be strengthened. 8 WHO/APOC, 24 November 2004 I $ (\ L(.) ,o E C) oz + c.l O o- r- f q, o CN <, o t) C)aa () U) E bI) o ,.o oL(! a o (n a F O (.) a oo C) 0.)sA.Hro .EZtrc)a4 kbo= 'octrE ! F o=Pox (h H0)E€ B a, !^db"<)?6 J^\U v6 u -dL =o) -sdtr !jo,,o *- s(!'F \vH! x.6 X a.!H!-, 'E<- YHI5 I r\ P d - v !E X o.o EP-jrUCdF?.3 .5 0U,\-i *'-A^ -H.9L o Eg.E a taarO!'u EE T E 8E g.i E:Eliiio-lrHi:idE o 9.:i5'cE ?Xst-9YOrn .6Etj=6 E E E ER -t tr HY a !? --:.9 ;: IEsBHdi=d(6 l1x>\a I-.i!-=chocjjFO Xn'S o,r'tr q €w!.\9*H-iY!!<,! ii.,: < o C) Q $ t-- 9 o\ n c\l 9 ooN @ c'- ta .iN \o Nce o\ $sl t--ca F-6t 6 o 1F 9- EA o r\ I o o -9:> 6y o.= I o z (\ e.l o\ oo € oo e'l $N 6 c.) (n o\ \o N o\ ts F- F- 6l t- rO @ (o rO @ @O) o roN t-N a.) r- ,2 boi6: |;oOE Eo t=q EQ otr9- o= ze lt i lara oo €E o ' >.= ? : EE iU zeE- o ?ed r.: L oE.E::r=:;a 3 E!'- (os [f)s $O) t-.t s() v(o lO(oo) ,.1 o o ca d 'o .o d E q) o .\1o rr) o ca o U) o rr) 6o 2 G d a 6o 2 F 6 N 6k Qq)\S 4 ;v q)L * R q)q G qJ a- ! F t-.] O o9-qE=o.: =c-o'E .u g-O'I -l-t-E gc) s.= --)-EEEELO(:(r: VI . o.rlr5l$i f;l T 2.5. Gapacity building - Describe the adequacy of available knowledgeable manpower at all levels. - Where frequent transfers of trained staff occur, state what the project is doing, or intends to do, to remedy the situation. (The most important issue to describe is what measures were taken to ensure adequate CDTI implementation where not enough knowledgeable manpower was available or if staff arefrequently transferred during the course of the campaign). There was a cascade of trainings on CDTI from the higher level to the community level in adequate amount to carry out the CDTI activities. However, there was a few situation where there were turn over of trained staff particularly at front line health facility level which did not create any major problem on the project activity. 11 t WHO/APOC, 24 November 2004 q) cg O Q q) z dill, trg/: .LJ U i .r s a< ..l e.t N c.l o\ oo @ oo @ o\ @ N @ 6l <f, o\N $o\6l @ O oo o ?a) o\ t\ rnr- oo q) e () .\ F C\N o\ 00 oo o\ @ c.l $o\(\ rc (.)o\ O q) .a'q ctL LFr6)' o 9.1 LF6)r z Fv-9 S .:-tv "=l= O O O o e o o q) q) \o UF o cql- ql! o)oEQE.P zE (,) I U + U Q u"l E,'.: +. a< i = v -----t o\ ca C.l N s $ N N O O c.l (\ tro a\o o\ ?a) () c) q) -o .\(JF c.l $ a.t c.l r- cl O 0 q) .22 -cE 0) z IE.".Y \)a( = C\ c..l a.l c.l c.l (\ a\t (\ GI c.l 6l c'l 6l o al o q) q) q) .\ UF al N N N N c.l cl IJ o o o m L _() H U .5zq) a o C) ca I o a >. o I C) a ad a I (n C) a F] 3 F v a.l Lo -o Eo z$ c.l O o c.l .: le \ tr 5 o o $4 qj Qq) d oIr \ o q)q \J E (! C) o p. F nOqr th C) C) C)Lr _():n o (€ b0 liF ,;i1 ol7l FI t p a. o = (, Trarnees Type ol training CDDs Other Communiry members e.g Community supervisors Health Workers (FLHF) MOH staff or Other Political Leaders Others (specify) Program management How to conduct Health education Management of SAEs CSM SHM Data collection Data analysis Report writing Others (specify) Table 6: Type of training undertaken (Tick the boxes where specific training was carried out during the reporting period) Any other comments 2.6. Treatments 2.6.1. Treatment figures If the project is not achieving 100% geographical coverage and a minimum of 650% therapeutic coverage or the coverage rate is fluctuating, state the reasons and the plans being made to remedy this. 13 WHO/APOC, 24 November 2004 $ c-l L 0) -o Eo o z $ a.l (-)(., o '1- > $ d9a(! PFoDC)v 'Ad .sXg(.) (n!o .'-c9EEB LV ^();i€iHE&= .= a, .= € Ur,gHo=9 .=ooE€E =LEH€ENEOoro'5L:EHE orE .e' E -l E 6q j8 Hb El.g qo- El c5 gI E E slE Sr st as;t: fle ;g ;13 EI 3, EIE EIg EIE clE El€ =lE =lt8lE 8lg tsl slqqt , et '- -t y qt +ol+ olE ol. olEblE blE bl; bl= -ol -ol _ -ol = -ol - EIE ;IE EIE ;IE al()l bll(Bl LI 0)l >l !t(gl OI al cdl!t bd 8l s trl(ol ,->l el -l o)l ol(Bl bl .ql $ '.=l 5l ol EI :l €l .gl -l EI btEl q 4q) Qq) S q p q)\. o ! q q) Ej1 o L (n otr(! (! 11 o L (h an IJ] o (! o () LrF r-1 d)l -ol(!l FI (.) 0) od rFl F) yA o\ o !() oo!n^ --ol/ o\ o F (.) (B () b0 k() oo d t 9'. (gH bo a)(./ () cdH (.) bo(!kq) oo O,^ o a.d() F -oe ,YlS d ;!Ete€* EEI-H€ , -e 9t! 'E<\(n2z b9!trCO zd o\ € € .o] N N (\ e.t v} c.l F o\ co s k 9-i;:iE Er=Ec vri -5x rt--@ €r r- N rc N rn il aEO =boO 6^gIE -s3F o b_bEE trF.o = o.-z =o? 6.> c G.Y49s' -Fo .9 .,r < O P€ +€ -3.go=oE ? o€ F .l .f,r f: Nr o\ .o cl N 6 rr N\o =] .+i .{ N,i l $ol -i(\ o\ $ v F- N a.l rn\o @o rr)- 3 rJ)$ O)- @ lr) o-$(o (ort ro-(o @ O) O) @d rf) rr) F. rO +N o\ N € l Sir €l * l .t O) s- os O) rr)$- O) O) F- (f) t-- N(o rrj ry O)N oo o- os \o! ra o\ II :Bt r $ +'=.= * I €E$}E o>-6 d .9 p^ ii 9o\60<- E.9 .-E.= [i !q tr boIJf =s 3 =;rEz6 o :o 'd O.a =LU < 94',FU a C) oO o o 6lo\ rJ)$@st sO) F.$ slr) s ra\o o\ ro$(os sO) N$ tlr) 3 ta\oo\ lr) .n-$ $O) t-s E 3 @@ (, rOq E<;q o{ d L -o d l!, I o ca o J1o U) I o ca o (r) Jo 3: >d Uqza .F C! F il a (! o. o d l rn() b{(€ I2.6.2 What are the causes of absenteeism? Most of the absenteeism was occurred because of the overlap of the farming time and the drug distribution. This unusual overlap has occurred because of late commencement of the overall CDTI activities. 2.6.3 What are the reasons for refusals? Most of the big town dwellers who do not feel sick were not voluntary to have the medication. 2.6.4 Briefly describe all known and verified serious adverse events (SAEs) that occurred during the reporting period and provide (in table 8) the required information when available. In case the project did not have any cases ofserious adverse events (SAE) during this reporting period, please tick in the box. No SAE case to report 15 WHO/APOC, 24 November 2004 .f, 6t () E(,) o z $6l O o ^\U I (r, o cl () I o AD 6lLq) I Frp ct L €l q) q) o cg q) oo U) 4)(t) o\ \o t c! c)fr cl () q) q) trp c) q) c!o c)t) clo Fr cll 0) c) <) o6l!0) c! =q)9.- oroc) E6 H.O '^L r) (D of,lt- =lrr 6l E(nloolEat c) '!Jl ooo o() tro()fr Etrai (g600)urrtr!0) ntr oFr F ortU;slG*l 6l Fl o60(! !o O oF $rr ll * ,-i rIJ ti o H ES<'>v o o\ @ ll + Bl r.'i El o\ o 'Eo500od E!ooSoF \ov c.l ti ,o OG .o oE9_a =6a6 o\ NN \o od E] :oE 6.2 =EE < 9*'FV o\ dl co cON o\ s^ N@ cO a@ ^-rd: be - *dd.= ", >6Ei€.9l-= - o b' -d 89 o \o oo d} oo .f \o riF d) o\$ bo = 6) E E o(-) ll * Ii li l{ o ^ooP E:}tl Oo: < >v -o o o '=,,oESooE= EG'[ * lo U 9 adr,i6o\Oord' @ c.l o\ li qoo:= B_b E gpd E ! ;r 9) TOti \o o\ ri :o d O .a E E.CT < 9P',FU \o o\ bod =a .,6E{ o Q I+.9€ $I 8 E E Eg EO oI & rI] O e.l c.] N co N v N oci \oO N r-o c.l ooo C\ o\ c.l oa{ 2.7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - Qtlease tick the appropriate answer) MOH M WHO tr UNICEF tr NGDO tr Other (please speciff) Mectizan@ delivered by - @lease tick the appropriate answer) MOH M WHO D UNICEF f] NGDO D Other (please specify) Please describe how Mectizan@ is ordered and how it gets to the communities The NOTF requests for Mectizan from MDP. After the drug reaches the country it follows the existing drug and other medical equipment delivery system in the country. Then the drug is stored in MOH warehouse from which projects levels receive. From the project level (zone level) the Woredas receive it and distribute to the health facilities. It is from the frontline health facilities that the community supervisors get the drug to distribute to the CDDs for them to distribute to the communities. Table 10: Mectizan@ Inventory (Please add more rows if necessary) *From the remaining 25,107 tablets are transfered for other CDTI projects were shortage suspected. How are the remaining ivermectin tablets collected and where are they kept? At the end of the treatment period, the CDDs were requested to retum the remaining drug to their collection centers which are the health facilities. The health facilities, in tum, send to the Woreda health office and finally from there to the zone health desk. Hence, the remaining Ivermectin is kept at the project (zone) level. List and briefly describe the activities under ivermectin delivery that are being carried out by health care personnel in the project area. . Collection of ivermectin from the Woreda level . Distribution of ivermectin to CDDs . Training of community supervisors and CDDs . Supervision . Recording and reporting of data Any other comments District/LGA Number of Mectizan@ tablets Requested Received Used Lost Wasted Expired Remaining Bench-Maji 970,000 763,229 0 2,832 0 203,939* TOTAL t7 WHO/APOC, 24 November 2004 2.8. Gommunity self-monitoring and stakeholders Meeting l{-as 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 if neeclecl) Describe how the results of the community self- monitoring and stakeholders meetings have affectedproject implementation or how they would be utilized duriig the next treatment cycle. 2,9. Supervision 2.9.1, Provide a flow chart of supervision hierarchy. NOTF ) ZOTF) WOTF ) Health Facility ) Community supervisors ) CDDs 2.9.2. what were the main issues identified during supervision? , Delay in utilizing and liquidation of funds. ' Failure to organize the collected reports on CDTI activities especially at woreda and front line health facility levels properly. 2.9.3. Was a supervision checklist used? yes 2.9.3. what were the outcomes at each level of cDTr implementation supervision? Though the Finance officers have received proper training on handling theAPOC/WHO fund utilization and liquidation system, still theie was problem onliquidating of the used budget.. Therefore, on spot haining *u, gir.n during supervision. The overall reporting of the CDTI activities *as also-corrected as much as possible. 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 theproject? The good geographic and therapeutic achievement of the project performances shows promising. District/ LGA Total # of communities/villages in the entire project area No of Communities that carried out self monitoring (CSIvf) No of Communities that conducted stakeholders meeting (SHIvt) Bench Guraferda Sfr.t" She-Bench Mearit-Goldya Meanrt-Shasha 461 45 94 147 154 u 0 0 0 0 0 0 0 0 0 0 0 0 TOTAL 965 0 0 t8 WHO/APOC, 24 November 2004 7 tSEGTION 3: Support to GDTI 3.{. Equipment Table 12: Status of equipment (Please add more rows if necessary) *Condition of the equipment (F:Functional, CNFR:Currently non-functional but repairable, WO:Written off). How does the project intend to maintain and replace existing equipment and other materials? The project expects APOC fund to maintain capital equipments that have been provided by APOC for the first five years. The capital equipments that are contributions of the government willbe maintained using the govemment money. The project is trying its best to perform well so that APOC would replace these equipments after first five years while at the same time efforts will continue to allocate budget by the govemment for smooth takeover of the project gradually. Source Type of equipment APOC MOH - Zone DISTRICT NGDO Others No Condition No. Condition No. Condrtron No Condition No. Condition Toyota Hilux 4W pickup ,| F Motor cycles I F Desk top computer 1 F LaserJet printer I F DeskJet Printer 1 F 1 F Fax machine 1 F Overhead projector 1 F Meqaphones 5 F Radio 1 F TV 1 F VCR 1 F Generator 3 F 19 WHO/APOC, 24 November 2004 Photocooier 3.2. Financial contributions of the par{ners and communities Table l3: Financial contributions by all partners for the last three years * Indirect such as staf salaries, office supplies, utilities, communication, etc. **Contribution ofCDDs and community supervisors converted in to monitory value *** Donot include capital equipment If there are problems with release of counterpart funds, how were they addressed? Additional comments 3.3. Other forms of community support - Describe (indicate forms of in-kind contributions of communities if any) None 3.4. Expenditure per activity - Indicate in table 14, the amount expended during the reporting period for each activitylisted' Write the amount expended in US dollari using ihe current United Nations exchange rate to local currency. Indictate exchange rate used here IUSD : g.65 Contributor Year I (2003) Year 2 (2004) Year 3 ('provide the penod') 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) I 0,800* r 0,800 12,000 12,000 MOH (District + zone) 2l ,000* 2 | ,000 50,000 50,000 Local NGDO(s) ( if any) 0 0 0 0 NGDO partner(s) 80,000 80,000 187,251 t87,2st Communities 200,900** 100,000 200,900 150,000 APOC Trust Fund 160,62s 50,000*** 80,830 51,500 TOTAL 473,325 261,800 530,981 450,751 20 WHO/APOC, 24 November 2004 Table 14: Indicate how much the project spent for each activity listed below during the reporting period *The CDTI activities are carried out in an integrated manner SEGTION 4: Sustainability of GDTI 4.1. lnternall independent participatory monitoringl Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable) _Year 1 Participatory Independent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation Intemal Monitoring by NOTF Other Evaluation by other partners 4.1.2. What were the recommendations? 4.1.3. How have they been implemented? Activity Expenditure (s us) Source(s) of funding Drug delivery from NOTF HQ area to central collection point of community Mobilization and health education of communities Training of CDDs f rel",,Lg*_o*Lb.-qlthstaff_atallleve-ls- Supervising CDDs and distribution Internal monitoring of CDTI activities Advocacy visits to health and political authorities IEC materials Summary (reporting) forms for treatment Vehicles/ M9!olgy,cl9s/ bicycles m_aintenance -- - Office Equipment (e.g computers, printers etc) Others TOTAL Total number of persons treated 2t WHO/APOC, 24 November 2004 ,rlr 4.2. sustainability of proiectsr plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period? NO Was a sustainability plan written? NO When was the sustainability plan submitted? What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.2.1. Planning at all relevant Ievels The CDTI activities are integrated with the other health activities at all health management and health service giving levels. Therefore, the planning processes are also carried out in an integrated manner through participatory methods, using bottom-up approach and integrated with the basic health service. 4.2.2. Funds Ensuring the availability fund essential for the sustainability of the CDTI. The govemment will increase the financial requirement for critical CDTI activiiies. In addition to this most of theCDTI activities that are carried out in an integrated manner will receive resources from different programs. 4.?:3 Transport(replacementandmaintenance) The APOC donated vehicles for CDTI project are well functional at this time. Maintenance cost was covered from government. The government also uses other vehicles, in an integrated manner since the governm.rir.". pool system. 4.2.4. Other resources 4.2.5. To what extent has the plan been implemented 4.3. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3.1. 4.3.2. 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 tlhe tountry. The request for Ivermectin is to MDP through MoH. As soon as the drug arrived, the same as all other drugs and medicar equipments, all the processes required are handled by a Pharmaceuticals Administration and supply service in theMoH. The project levels, like any other medicines, receivi and deliver to the respective levels following the existing delivery system. Training: CDTI is integrated with the primary Health care (pHC) from the beginning. At the National, Regional, zonal, and woreda levels, the Malaria and other vector-borne Diseases Prevention and conhol Units are responsible. Therefore, all the staff of these units has received haining on onchocerciasis. 22 WHO/APOC, 24 November 2004 I/rl) 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 new structure of village is also responsible for all health activities in the village. 4.3.7. Describe others issues considered in the integration of CDTI. The new government structure of village which has got a health committee and the Health extension Package program designed to reach all Kebeles with health posts, will play a major role for the integration and sustainability. 4.4. Operational research 4.3.3. 4.3.4. 4.3.5. 4:1 6. 4.4.1. 4.4.2. Training of peripheral health workers has been carried out in integrated manner with other health issues. 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 manner with other programs. Release of funds for project activities Activities which were not funded by APOC have received the amount of money required in time to accomplish them. Is CDTI included in the PHC budget? Yes, as part of PHC, CDTI is one of the priority activities. 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? SEGTION 5: Strengths, weaknesses, challenges, and oppoltunities Strengths: The project is able to accomplish the distribution in short period of time with l00oh geographical coverage and therapeutic coverage high above the minimum standard. This is due to high political commitment at all level, awareness and active involvement of health workers and the community at large. Weaknesses: Delay in reporting from the lower level, poor financial utilization and liquidation Opportunities: The expansion of government structure down to village level and being taking the responsibility of development activities as well as health is a good opportunity for sustainability of onchocerciasis control. The Health Extension Package program in which there is a start of building a health post in each and every Kebele is also another good opportunity. 23 WHO/APOC, 24 November 2004 aThreats (Challenges): Overburdening of health workers in peripheral health facilities in different health programs such as malaria epidemic control, EPI, measles campaign and settlement programs. $EGTloN 6: unique features of the proiecuother matters None 24 WHO/APOC, 24 November 2004