Kaffa-Sheka annual project technical report submitted to Technical Consultative Committee (TCC): from April 2005 to October 2005

The Federal Democratic Republic of Ethiopia Ministry of Health Proiect Name: Kaffa-ShekaCOUNTRY/NOTF: ETHIOPIA Launchins vearz 2001Approval vear: 2000 Reportins Period: From:Ap.ri.l.2.Q0.5..To;.....Qstp.her..20..Q5........(Month/Year) ( Month/Year) Proiectyearofthisreport: (circleone) I 2 3 4Qj 6 7 8 9 10 Date submitted: 15 June 2006 NGDO partner: The Carter Center ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE For Tol aL @P Nil€ cfzV BFo FoDEADLINE FOR SI]BMISSION: To APOC Management by 3L Januarv for March TCC meeting forTor To APOC Management by 31 Julv for September TCC meeting AFRICAN PROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) I AO */*n ( I I I I -l ?. i JtJll,l 2006 WHO/APOC, 24 November 2004 c-,._- KS 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: Signature: Date: Date l! (t Zonal Oncho C oordinator Name : Ia.rsk-e. gn. Ma.tq....... Signature: h- out", .O//q.t it,/ NGDO Representative Name: .......T.e.qhsm.e..G.ebre Signature: Date:./.4 This report has been prepared by Name : ..Ia.rEkp.gn.Mate..t..N.AIE.... Designatio n : Zone onchocerciasis Coordinator Signature , /ff, tlu 1I WHO/APOC, 24 November 2004 I Table of contents DEFINITIONS.......... FOLLOW UP ON TCC RECOMMENDATIONS...... Exncurrve SuuueRv SECTION 1: BACKGROUND INFORMATION...... 1.1. GBNBRII-INFORMATION 1.2. Popur-RuoN SECTION 2: IMPLEMENTATION OF CDTI 2.I. TtMeLrNs oF AcTrvrrrEs.............. 2.2. AovocRcv 2.3. MosILIzeIIoN, SENSITIzATIoN AND HEALTH EDUCATION OF AT RISK COMMUNITIES v 1 2 3 J 5 6 6 7 7 82.4. 2.5. 2.6. 2.7. 2.&. 2.9. 3.2. 3.3. 3.4. CoruuuNrry INvoLVEMENT ........... CRpnclry BUILDINC... TRrarueNrs ................ ORDERING, STORAGE AND DELIvERY OF IVERMECTIN Cotrluuury sELF-MoNIToRING Ruo SraxrHoLDERS Meermc.. SupeRvrsroN................ FtueNctel coNTRTBUTIoNS oF THE pARTNERS AND coMMUNITIES ....... OTTmn FoRMS oF CoMMUNITY SUPPoRT ExpgNoTTuRE PER ACTIVITY 10 t2 16 t7 t7 3.1. EqununNr 18 t9 t9 19 SECTION 4: SUSTAINABILITY OF CDTI.. ...........21 4.1. INrsnNel; INDEpENDENTpARTICIpAToRyMoNTToRTNG; Evl1uertoN..................21 4.2. SusrerNeslI-rry oF IRoJECTS: ILAN AND sET TARGETS (ueNoeronv er YR 3)...........2L 4.3. INrBcRnrroN............... ................22 4.4. OpBnerroNAL RESEARCH ..................23 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AND OPPORTUNITIES 23 SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS..........23 lll WHO/APOC, 24 November 2004 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 Objective Annual Training Objective Communi ty-Based Organization Communi ty-Directed Distributor Community-Directed Treatment with Ivermectin Community Self-Monitoring Local Government Area Ministry of Health Non-Governmen tal 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 lv WHO/APOC, 24 November 2004 Definitions 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 847o of the total population in mesoftryper- 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 meso/tryper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage (normally the project should be expected to reach the UTG at the end of the 3'd year of the project). (v) Therapeutic coveraqe: number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) Geographical coverage: number of communities treated in a given year over the total number of mesoftryper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). (vii) Intesration: 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 modifi cations when necessary. (i) WHO/APOC, 24 November 2004 FOLLOW UP ON TGG REGOMMENDATIONS TCC session 2l"t Number of Recommend olion in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FORTCC.APOC MGT USE ONLY 18r (i) Resportd to all questions tn report; All questions have been answered in this ATR. 181 (ii) D e s c ribe ntethods and as suntp t iorts nnde for calculating community and MOH financial contributiotrs in table I. 3. The table asks for cash contributiotts. The report indicates that the contributions of tlrc c o mmunity w e re ruo rrctized w hil e the MOH contributiorts reflect indirect cont ribution s. Commwtities did not contribute in cash it is only the contributiotts of CDDs, community supervisors and the community that has been converted in to monitory value and assumed as the contribution of the communities Similarly tlrc MoH's contribution has been calculated considering the indirect contributions such as staff salaries, ffice supplies, utilitie s, communication, etc. and the program benefitedfornt other health program budget utilized in inte g ration. 1 WHO/APOC, 24 November 2004 Executive Summary 1. Background on treatment and population data Community Directed Treatment with Ivermectin (CDTI) has been successfully implemented in Kaffa and Sheka zones of South Nations Nationalities and Peoples Region (SNNPR) since May 2001, for five consecutive years. Kaffa-Sheka CDTI was the first ever CDTI which has started its activity in Ethiopia. Kaffa-Sheka CDTI is divided into 13 woredas and two administrative towns (Bonga and Tepi towns) that previously were pafls of the Gimbo and Yeki woredas. CDTI implementation was initiated in five woredas, during the first cycle of treatment. During the second round nine woredas were treated and in the 3'd year all woredas in the project area were treated with geographic coverage of 1007b. The therapeutic coverage of the project was also remarkable (see table below). YEAR Populatlon Total populatlon of the meso/hyper-endemrc areas Amual Treatment Obiective Number of persons treated Therapeutic coveruge (Vo) ATO coveruge (Vo) UTG Coverage (vo) 2001 902,687 306.297 233,309 26 76 31 2002 928,69r 654,250 516,217 56 79 66 2003 955.443 955,443 718,241 75 75 89 2004 981,198 824,206 768,@2 78 93 93 20p5 1,020,679 857,370 187,766 77 92 92 2. Background on population movements The communities in CDTI areas are mainly settled farmers, daily laborers and civil servants Generally, there is no major type of population movement in the project area. 3. Training data Training of Trainers (TOT) was given for 304 health professionals. Those who were trained as trainers in turn trained 6,765 CDDs who were selected by the communities from 3,277 villages. 4. Challenges and how they were overcome. Threats (Challenges): o Administrative & Financial problems related with pool system. o Lack of training to financial managers. o Delay of financial and activity reports from woredas. In order to overcome financial problems APOC has assigned one responsible person and he is doing his best in assisting CDTI projects and following up the process of fund utilization, liquidation and reporting activities 2 WHO/APOC, 24 November 2004 SEGTION {: Background information 1.1. Genera! information 1.1.1 Description of the project Geographic location, topography, climate Kaffa-Sheka CDTI is located abott 447 km from Addis Ababa south west of Ethiopia. The project is found in Kaffa and Sheka zones, which are two of the thirteen zones that constitute the Southern Nations, Nationalities and Peoples' Region (SNNPR). The project area constitutes 13 woredas and two administrative towns (recently formed). The area is 11,350.64 sq kms. 70olo of the area has moderate temperature,26.5 hot and 3.5 cold. Population: activities, cultures, language The communities in CDTI areas are mainly settled farmers (92.3Vo). The remainingT .7 %o are urban dwellers who are government employee, merchants, daily laborers etc. The languages of the community are Kaffinono and Shakinono, and also the people speak Oromifa and Amharic . The official language is Amharic which is also the national language. Communication system Ten districts have all-weather roads and the remaining 3 woredas have dry weather roads. Eight woredas have satellite telecommunication while 5 woredas have digital telecommunication service. Administrative Structures Even though Kaffa -Sheka is treated as a single project administratively they are two independent zones. Kaffa zone has ten districts and one town administration under it and the districts are divided in to 301 Kebeles (sub-districts) and Kebeles further divided into 2,984 villages. Similarly, Sheka Zone has three districts and one town administration under it and the districts are divided in to 72 Kebeles (sub-districts) and they further divided into 293 villages. Health system and health care delivery Kaffa zone has 26 Health stations, 26 Health Posts, 6 Health Centers and t hospital with a total of 403 health professionals. Out of which 304 have got training and involved in CDTL J WHO/APOC, 24 November 2004 District Number of health staff involved in CDTI activities. Total Nurnber of health staff in the entire project area B1 Number of health staff involved in CDTI Br Percentage Br=Bzl Br *100 Gewata 29 20 69.0 Gimbo 72 65 90.3 saylem 20 16 80.0 Menio 33 26 78.8 Gesha 36 34 94.4 Bitta 22 20 90.9 Chena 57 52 91.2 Cheta 18 15 83.3 Tello 26 16 61.5 Decha 55 40 72.7 Yeki 58 46 79.3 Andracha 27 24 88.9 Mesha 44 38 86.4 Total 497 412 82.9 Table 1: Number of health staff involved in CDTI 1.1.2. Partnership Partnership is a principle of the Ethiopia Government, which helps the Kaffa-Sheka CDTI projects for best achievement of its activities and gradually ensures its sustainability. 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. The FMoH, And Zonal Health Desks are involved in planning, and Supervision activities. The Carter Center involved in planning, Supervision and in providing financial and technical support. Woreda health Offices involved in training, community mobilization, supervision and follow up of the CDTI activities. The community involved in community mobilization, Health Education and in implementing the treatment activities. 4 WHO/APOC, 24 November 2004 s c-l Ho! o z *N O o B o o (.) oF a. 0) E (! (A o! =Eo. 9, oo)Ea 4 .2.}tr3 ()bo i66 t\n: o.l oh 6atr.h trooot o'= !5 Ro '59(r) - O't()e (!o}E !oili i.= O()co ud "i aoodo O HU)oE =0)cooHCd g't Ltro ao (L) botr 6li =3E(.)lr- Fr Cg I-< -oC) ^o)e;'a Its Etr C)oti) o U) lr C) l-t () E C) (r) an oo C€ o (! 4 Oo = o(h c) os(! 0) -od o E 0) (H o a)ok o(n C) (A (n B d z q-r o z € o li oa bo li oO.olr o oo li)! C) € (-) o 'a l-ra (.) lro an o o o(! (n(! B o H o 0)(! OH 0) H 0) 0) B CE 0) li Iq) q) tr 0) 0.) )a U) L ! (! oo oU E o .-fl o -fg oE aN ar (n\ (A o 6. o F .Y9 .=9 o N()(o- t.@ \t oio ${ @- @(r) !+ O) @- No F- o)- (o @@ c) FJ@ Ns- \t\t Nod) co- C\l O) o- @ o(D rt c') @Nod o,l N dN @ t arI: ct oE<N+ ErrEd o o 6 F N Lr) @il @ s oio $v @- @(7) t o, @- No F. o- @ (o @(r)il @ t..s-$$ ol(o O) odN O) o- @ o (f)- ro (f) (o N o- (Y) N o, dN @ s g\ F N 9E E9, 9€ E< OE HE N C\(olo @ ci) roo ol @lr) $ olN @(o lo @ ro (r) o) @(os o t @(") @t(') ot @ coo ro(o @F. t(t) NN t.F. r)(\l ot- { @@{ o)f.-$(?) ol € €F 6n c!o L o '= L o o I o o z o o, 8 N o)o o) c)$ oo F.. @ @ ro \tt { OJ(\llo(') (o N o) @ oJ (') N ol(o s|o\t ol co(r,N(o N o)t- @ Lr) o O)N ro @(\l ot @oN l.r g\ € a ! o ol .F o5 Lo z .o - b E< .=tNr s<'E< € EE,Itr tr< @t ol tr) t (')!c roF. (f, oloN O)NN o(r) lo OJ(\J OJ$ OJ oot @{ oF.. rof-- Fral .e .EEo' q,E Ed ':- 6 - otr { F-(7)N N@ $N Ns c.) No(") oN @(r) rosN .(f@ ot (t,rt a\o& o C! o '= o q o o z No @N @ @ @o @o) @(\l OI N ro sfo ro@ t(o oc) (\l(.) ao ! 6 oo: ?i 6.iE 3g 9'tsqi50 ot() @- f-.@ * oio $t@ odo @- No N Or- @ @@(7) Fi(o f.-sf{{ ot @ O) od CI c', o- @ o(7' d (f, (o No('t C\I 6J d(\I @ $ ar € cl 'FO6 .!E E ii"q 56o !E =z 6a 6 o(, oU o oF d o a !! ! d o E) Er F soo c.l o -o o z t c.l L,,q oE B Oo rh E E6 EE(, al 3 o o oal o -o I N o .o o oo N o -o o ol o -oo o o ooal o -oo o oN o o o o N o o oo6l o -o o o CN o -oo o o oo CI c..l o ol5 Eo.o ?E 6= oal o N o ol otr 6l o oo ol o oool o = oo C.l otr OO e{ o 8ei o o C{ o oo cl o" el C-l L OI o *E 5E O N bo ooN o -o o o.o CA ol b0 ool o -oo a o al o Eo o(n el b0 C.l o -o Eo o.o c/) a N o -o o o.o Ch o C{ o o oi o -oo o(J ol C-l ol Eo.o ?E a' oo e.l o el al >l o cl o c.t o C-l el a c.l O ol c..l oN d cq z, o c.l d z O 6' o() o 9:o= EEU C] cn ol c-l N o C{ oo c{ c.l ol cl IC-l d 8 cl 2 8 c.l 6 z HE !E oo ol o o N q) oo N q) ooi 0) o al o al o al o N o c-l 0) el o oo al G z I c.l d 2 ooN d 2 ctt F E I 8 a-l o 8 N o 8 C{ o 8 N o 8 al o o e.l o o al o o en o o C.l o 8 ol o a o al o. oo c.l oo c.l o U ?q 6=dE c.l o o ol o oo ol o o CI otr o ol o al o o ol o 6l o a c.l o o N o C.l o. o al o. o N o. o tr A N z o: 3EtEQ cl o o c.l o oN o o C.l o o ol o ol C) O c.l C) o cl o oN o oo e.l o o N o. 6l L a. o ol E'." ?E ;E ocl o ol o a al o o N o o c.l o 8 CI I oO C.l o ooN o N o c.l o 8 cl o. 8 c.l o. 8 N o. -I o o .o E (J o o o 2 d o d cq o C) d 0) O o oF Io IC) d 'o o 2 \o lid C) >, C)Lt< o C) E 0)(! ok O 0) li 0) li o o Io(!(lr o C) 0) F c.it d-)I -ol(nl FI o or. +.a- r- i.(, o h o o ,E -o EtF !F aN Fa C' E o E .9fl IEfl E o Eg c E tlN z o IF(, Uo 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/ constraints being faced and suggestions on how to improve advocacy. A total of 89 policy makers mobilized in all Ievels (seven persons from each zone and 5 from each woredas including Bonga and Tepi twons (theZonal Capitals). And 476 Kebele Task force members from72 kebeles have been mobilized at three woredas of Sheka Zone. The reason for mobilization is to involve policy makers in mobilizing communities and play significant role in CDTI. 2.3. Mobilization, sensitization and health education of at risk communities Community mobilization was done at each village by organizing community meetings. Frontline health workers, Community Supervisors and CDDs were responsible in giving health education to the community at village level. For health education manuals were distributed to each CDDs and community supervisors and also three types of posters also distributed to each villages and posted at different places where people look at and discuss it. The community mobilization and the Health Education activities have contributed a lot in awareness creation. 7 WHO/APOC, 24 November 2004 + ON oF Eo z '+N rJi B U) o(/) (n o(A € bo o .o C)Lr Cd o o ar.) o f- O o o bo oo oO C) (+r o (t) l-r C) -o o 0) a(rr z:ogtroOa '56(E .- .=o o= '5() ,o o9 s.E cde 6E >. P. oai -t<t(!oa -rIt tr o-bo .g O U) obo(! t- O o !o € lrg HLC)cdoc) -ox dE x0) .Y >' ox €,tOg EC)(!tro()l-r1 > -o Ldo.otr troo E>)-HO l.i -C5u) ^a o (!ar o- =boofi -q 0):> cd .rox bo9 13tr O,;L0.2 ao70) o.oQ.-a*oo!;!i dH F,P vCd o bo (.) C) o (! o € 0) o (n >l o o o (ntr c)s 0) o 6 o +r o '. () OGI oc) E< (-) r q) 4 L s,) U F U o o o oU +t ol -oldlFI fl E o E o .: o ,s := Ef E E o(, {N € tdN \ ro @ g N q(o(') st : lr ig.ii c:d c) ai N c\i F. \(, N o (fJ(') aN Io qCf) \@(r) $('i (')oiN t I EO qA .EU -o Lo z oEx Eo oo z NC! o) @ t@ \t @(o s o lo o)ot v oo d € a rqo FE OHFI (ot NC! o*ln 6J|o(o $@N o $ N @N C\I F- si @ (7) rn N ro € d cl 8 r @ 9-EO - t.N o)@ st(o sf@@ \t o lo o)(\J $ oo) cl I F € o '1, 0 H Q z le (-) o z t(r) \f @() o) (o Nt @ @ o) o @ o,l o $ Nf.- F. 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U O .^()aaXH o o -QI-.] .i O O \J=e LL L ,o ./) C) l- l-ro '= 0) (! p. o o F bb bO@ E.e A'- o.- oE )'a 6)u =soo= 0)E0.)ts >.c troo- 00 botrtr EO a= o'' .={i oe'5 ; '-=\J[ir I -AEo 'i.ooEl-oq Ue trbO'= UEU t!94dCgtr49ts HO:iJ O(.)rr >\dAo.- -o €F< !trA a(U- u o(J 'tO,r Or^L d.^ll 9AA EOO LrP=P €; FUXooE-c tr o\ 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 are frequently transferred during the course of the campaign). Well organized trainings have been given on CDTI at all levels in adequate amount. But there was high turnover of trained health staff particularly at woreda and front line health facility levels and we solved the problem by giving on job training to the new staff replaced the old ones.. l 10 WHO/APOC, 24 November 2004 q) 6 (t (J {) z o -: +L\J: .( {! Ev I .i =v (os c.)ON @ rON O) o, @N$ O)$ o$lJ) $s (o o) cr) sof.- @os (o o)N s @N $ @N o (f) lr) o O)(\ $N F- @ F* cf)t-(o $ NIr t O) @Ir s (o $ e)N o@ a) (r) lo Ir t-N c) @N$ o,N o\ o N ol\o a- c.t\n \n o\ O o co O d@ r r- ra ra F- €N r- o\ o\ o) o 0) s?aFQ rr)@$ oC\Io) osrO rOot- rO @N rr) cf)lr) o O)t- rr)N tr) @ lJ)loIr N N cl € o d a t, o .='th' cc F< lFrq): o9? l!g0Jr z 6ll I .O U zv a< O O o o o o O O o a o o o O o o o o o o o o O o O o O O o O o o O o o o o o o 6) q) 0) sULF o O O O o o o O o o o o o v) oa c) E,E90) =cEdh 3= i: q) z ( [vE,'i+F'd U Uz N Ir o o(o O@ o $ t o OJ ol NN o N(f) N a) o @ (o o @ .t @$ o cr) a) o $ $ o (o cr) @(r) o cai{ o.l c.l \o r- c.l r- oo @ c.) N o\ 6(.) \ott {.)CI o) O o) s(.)3 F- o@ $ NN Ncr) (o @$ (f) $r @e) c.it r-N oOca 6 q) G cg b I U) q) z lq ilvE,'i +F-d U s 0< z cr) (r) o lo lr) o N C! o s $ o C\t N o $ $ o s $ o N N a N c\l o $ s o t $ O c{ c.l o \f $ o N$ al$ t q) o q) s QLF c) rf) N $ N $ v N N s $ C.l $ olv () rl ql .2 a o s ri o c,/) o 0) (n (r) C) (! Eq (! o U o O oF (! o 0) a .v C) d o Lr € d th C) Fl F Er + 5 c{ r3 q) : z * C.l Q/.\ o B o C o s B B A c o 0o\ S \ o !' B B € ,r F i = - v, u, a,) U\) % > o\ p q) 4 \0[. o (! o C) a F nU o o C) q) ol-i ,o o oo dLF :l -ol cllt-l tI I Table 6: Type of training undertaken (Tick the boxes where specific training was carried out during the reporting period) - Any other comments CSM was not implemented as per the APOC guideline. But in most of the villages the supervisors have tried to accomplish the supervision and monitoring activities. The project has conducted SHM at zonal and woreda levels successfully. And it was found very instrumental for the success and sustainability of CDTI. It reviewed in detail the weakness and strength of the project and then proposed solution for the observed weaknesses and problems. 2.6. Treatments 2.6.1. Treatment figures If the project is not achieving l0o7o geographical coverage and a minimtm of 65Vo therapeutic coverage or the coverage rate is fluctuating, state the reasons and the plans being made to remedy this. Trainees Type of training CDDs Other Community members e.g Community supervisors Health Workers (FLffi) MOH staff or Other Polrtical Leaders Others (specify) Program management How to conduct Health education Management of SAEs CSM SHM Data collection Data analysis Report writing Others (specify) t2 WHO/APOC, 24 November 2004 t c\t !I 6) z +ol UoA co F (! oL oo 'd a. o >q C)H cg() 0)! o I c) o. >| a C) c) ot I -l ()xl o!l I9l c.r(!l -ot a5l Iol o. 51 6Ol rol a)Ll -o6l ELl 59l trEl= 5l ^zli d C)tr(n 9o c) 'a IHBa \(l) I oo.= 'dA LV H z,(l) rri -H =d '= -o P ,.9 0= oe- U H9 F9 looc)UHEtr ot tro ol 15! -l EE "l Ib El.gO. cdl E> sl d or I El E orOl o o{.' Ol;lE :lE rlgcl.! tl > ol'F frl H slE frlBtrt > '=t 6) trt i^ ul .l !l A ulV o->l - =l tr o-ll r-EIF EIH EIb EIE HI; EIE ql j ql '! ql !)ol* oltr ola!t u HL rt'q)l o. ol E (.)l- -ot - pt - -ot =trld trld trlHIJHI!HIH =lb Jlo =1trZl? Zll- Zl< al ol oodl!l 9l ol ol EI .91 -clol(dl $ ol 5 3l =lo Rt Lrlol -tr1 bd trl 3l EI ol ol "Elcl =l EI ol r!l h q 4\) Q \J (l.- 4 \J t S \)4 \) a. )4(A L (! O(! oH 6J J o l< aa E -o 0 E] a ! (n C) c0 C)EF :t -oldlFI € 0) 0) o (, F s o2 C)boNa oFV o F C) H obo Lr c) oo (-) -.E- b0 o C) c)2 C)bo H c) o()^ .E NQ C) o- k 0) F I : bE aab:8E; e< z<og o o o o o o o o o o o o Eer:aE'tr t 9< =9,8-a2z o o o o o o o o o o o o o bs!trEO abzd NN @ N @to @(f) 'oOI o)(r)lo(r) @tNcl tr,Nt O) @{ ot to .t O) lr,o O)o oq$ (,, t N @@ rc r 6d :€e- uiril e 4! E bo:d = 9a< IZB-Y- t-(r) tr) $ F- t.- (r) N ol @oo N$ @ oINs @(')$ @C, o@ oo(o. oco N €ra 6 o o ir^ t 9F-rl * U>vHH oo FH $(ot- F. N t^- (7) c\i @ u'l co (") $N f..$N ro c;t- ol .t F. otdt. oN d@ (r, dN oq o @ aF o 6_ 969+?6 = E-!z (r) F-- tr) rr)r) c) otN ro lO o)- c) @() @_ c) @ N o) @- o(o N c). o ro (Y) o o- o @ @$- OI N(') N. t-{ lJ) o, o. @o F.(o() oi O) (') o- o) (') F..(\t (') (7) \o\o\r €r E i.ZaE- :=o < 9€FU @N @(o ro @t..t-lo @ o) N @ N (f) (?) @N @@ o @ @(o to(o(o() @ rf) (Y) N @ ot (f,t(\J @ ro N lo (7) ro @- (?) ott(7)(?j o t(, o ol N o)to s r r € -i.Etsp 6< E =\ d *E:a d o! 'o (\J|o(o |.j(o t oio {{@ od (l) $ o, @. <\l o F- o- @ @o(') lj @ N s-st N E @ ol o) o- @ o(')-() c) (o N o- o 6J N @ ol @ { ar\o N E^ EQ aj.F-ll*E EN^'A Mav-- uq x()H O O o g o E O H'. :Y ! c:^' ';lr4 @tN lf, s c)$ lr)f-.(7) otr)(v o)NN o c) ro ot ot (\JtN o(o tf @t of.- tr)F. rFc| 2uE U.: c6Ya(Da' o+ N lr,{ ot rot-(r) orON O)(\tN o(olo otC! (\,1$(\I I<t @$ oN rr,t. tsrN 9.'3E: E.H - 6E.Y:d o> cH .6 goi b -Etr @$ OJ lr, $ (')$ loN(") o(o CV o,N C\T o(7) ro olN N{(\] o(r)$ @t oN loF- tsr6I .9<;v o\ 6 € E(, EI da o € lo 6 U o U o oF oo o 6 !! t o z G oF 2.6.2 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 has happened because of late commencement of the overall CDTI activities. 2.6.3 What are the reasons for refusals? Most of the refusals think that they are free of Oncho and are safe from contracting the disease as most of them are urban dwellers. 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 of serious adverse events (SAE) during this reporting period, please tick in the box. No SAE case to report ,/ t4 WHO/APOC, 24 November 2004 tr +o N Eo -o o z * e.l U 0. o B rr) ,; I v .-t) CE)I CEq) q) OD CEL o) A Q rt\JFD d .- li vI CE I .- I oLtrcE c)9E g I H93H aq)9L -r$.s!Hl.j ocEu)9€ vt .E.S;a. :' tt)H o)E96Jltrlil I!:lE6^lE.E EIarF'l .u rnlErs6lbHtii d) | .t GtE=l q,eg H -ail r9-lq,E csl q)q)el '=d -t vE4Lo!l A 00)boY .ll t!vg 9()trc,>-o 9UHtr o rhq)nY =2L 9!u-)CEa9:ylH-r)or)r=Ee9EE E.9.egFE a l'rL- -'l o) "! *l H\o *l q)6i rjl E 0) bI)I Es -o U co \o\o o\oo C-'o\ c.lo. o c0 a. o c I- i' = _t E] o oSoF 6E\ -o o \o t-- o,c- t-- ca o\ c.lo. ll* cr{ E) o '5o : bI)O d- PbEeiI>vooEOF \o e.l \o lr) c- oor- c-t-- ti ,o o6 .o oE4-FC =Az-i o, c-) co co c.] t-r(\ \o \a t c.l @ t-- Nt od\o t-- I\ F-@F- f.l :oE 6.2 =EUti5 F- o\ c.l\do c.) o c\{\a\o cot n o\ \co c.l{ c.l @ F- ca r- 00 aA.rd -oy 6.= .. >EH;€.:d ' 6. 39 o F- oo\o a o, o\ ooN o\ co$ * ,ri tr) o\ @ o\ @ o\ o\t--\o No. (.) bod o oU ll * El l{ ri oos^F bBS -o o E E E E E o.bo=9d-9q-ili Er 3 g Sr.ir.r- Oorrl 3 E E E liE=SEtr tr= ai >od so\$ @ co o.l r-r-(.l ca t-- a- c't ao rrr-a\ ca E =oE b.uatr? / 9.6 -FO $ o\t co @ o^ ol r-F- c..l c.i t-- t-- o{ c.) c-r- c.I cf) o0 € =6 _r6tst, E 9 +.u€ xI _E.: E *'= 14E; r uE EO o c- a-c! co t--|.-c{ co r-Fc! co ('- t-r c.l c.i r-r- .l c.) & rrl Ic.l NN coc{ $ooc{ \.) o c.l \o o c\l r- 8N @ o C-l o\ooci o N 2.7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - Qtlease tick the appropriate answer) MOH EI WHOtr UNICEFtr NGDO tr Other (please specify): Mectizan@ delivered by - Qilease tick the appropriate answer) MOH M WHOtr UNICEFtr NGDOtr 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 l0: Mectizan@ Inventory (Please add more rows if necessary) * The requested amount includes 170,572 tabs which were carried over from previous year. How are the remaining ivermectin tablets collected and where are they kept? At the end of the treatment period, the CDDs were requested to return the remaining drug to their collection centers which are the front line health facilities. The front line health facilities, in turn, 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. But there are woredas and Front Line Health Facilities which kept the remaining drugs in their store as they are remote and transporting the left over Mectizan to the zone is difficult and costy. 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 and follow up . Recording and reporting of data DistricVLGA Number of Mectizan@ tablets Requested Received Used Lost Wasted Expired Remainins Kaffa-Sheka 2,425,072 2,254,500 2,262,783 0 7,214 0 155,075 TOTAL 16 WHO/APOC, 24 November 2004 2.8. Gommunity self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? No. If so, When? Table 11 and Stakeholders Mee rows Describe how the results of the community self- monitoring and stakeholders meetings have affected project implementation or how they would be utilized during the next treatment cycle. 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? . Tumover of trained health workers especially at Woredas and frontline health facilities. r Delay in utilizing and liquidation of funds. . Delay in organizing the collected reports on CDTI activities especially ar some woredas and front line health facilities. ' Weakness in proper handling of documents 2.9.3. Was a supervision checklist used? Yes 2.9.3. What were the outcomes at each level of CDTI implementation supervision? . The overall reporting of the CDTI activities and document handling have shown some improvement but there is no significant improvement in timely liquidation of funds. And the turnover of health workers is still an outstanding problem. Distnct/ LGA Total # of communrtres/villages rn the entire prolect i[ea No of Commumtres that camed out self motutonng (CSM) No of Communities that conducted stakeholders meeting (SHM) 415 248 0 143 Gewata Gimbo .9gvtl-- - --- vpruo Gesha 415 248 143 375 zso 0 375 250 Brtta 229 0 229 Chena 530 0 530 0 122 0 242 4300 0 148Yeki Andracha Decha Cheta Tello 122 148 70 242 430 0 70 Masha 75 0 75 TOTAL 3,277 0 3,277 t7 WHO/APOC, 24 November 2004 0 0 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? . All project woredas and FLHF staff are now fully aware of the basic principles of CDTI and APOC philosophy. Efforts are being made to incorporate CDTI into the overall health plan of the respective woredas and health facilities. This progress is mainly attributed to the frequent dialogues and feedbacks provided by project coordinators and senior level supervisors. SEGTION 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 ofO. How does the project intend to maintain and replace existing equipment and other materials? The project expects APOC fund to replace all capital equipments that have been provided by APOC. The two vehicles provided for both Kaffa and Sheka zones are now completely worn out due to the bad roads and long period of service. Thus far, the maintenance of vehicles (the two cars and motor bikes) was taken care by the respective zonal health offices and the partner NGDO. Due to the nation-wide integration policy, the available office equipment and vehicles are used in the pool system at zonal, woreda and FLIIF levels. Source Type of eourDment APOC MOHI* DISTRICT NGDO Others No. Conditron No. Condition N o. Condrti on No. Conditron No. Conditr on Tovota Hilux 4W pickup 2 F 0 Motor cvcles storaqe boxes 14 l3 F& ICNFR 8 F Photocopier 2 F 0 Fax machine 3 F 0 VCR 2 F 0 Meqaphones 9 F Typewriter 1 F 0 Video proiector '| F 0 Stensrl Desiner 1 F 0 Desk top compuler 2 lF& ICNFR 0 LaserJet printer 2 F U Laotoo comouter .l F U Desktet printer 1 F 0 TV 2 F 0 Overhead proiector 2 F 0 Radio communication 2 F 0 Portable electric oenerator 2 F 0 18 WHO/APOC, 24 November 2004 Contributor Year 2 (2002) Year 3 (2003) Year 4 ('2004) Year 5 ('2005) TOTAL Cash Budgeted (us$) TOTAL Cash Released (us$) TOTAL Cash Budgeted (us$) TOTAL Cash Budgeted (us$) TOTAL Cash Budgeted (us$) TOTAL Cash Released (us$) TOTAL Cash Budgeted (us$) TOTAL Cash Released (us$) MOH (Central + State)* 0 0 0 0 0 0 0 0 MOH (Drstrict + zone)* 0 0 0 0 0 0 0 0 tocal NGDO(s) ( rf any) 0 0 0 0 0 (, 0 0 NGDO panner(s) tt2.425 112.425 84,846 84,846 84,846 84,846 15,980 28,068 Communities** 0 0 0 0 0 0 0 n APOC Trust Fund I 96,094 I 96.094 27.000 27,000 27,000 1s,000 12,882 0 TOTAL 308,519 308,519 111,846 111,846 111,846 99,U6 28,862 28,068 3.2. Financia! contributions of the partners and communities Table 13: Financial contributions by all partners for the last three years * The two z,onal health departments (Kaffa ard Shekn) have significant contributions for the CDTI project in their respective project areas. These include, indirect contributiorts such as staff salaries, ffice supplies, utilities, communication, etc. In addition, CDTI activities are carried out itt integrated manner and it v'as dfficult to quantify the MoH contributions and attach monetary values for each contponent of the project. On top of thar, it should be noted that this project did not receive funding from APOC for its 2005 CDTI acrivities due to late ftnancial liquidatiort. If there are problems with release of counterpart funds, how were they addressed? As mentioned above, the APOC fund itself was not released for 2005. The project managed to implement CDTI activities by integrating it with other programs and to some extent by means of NGDO partner's support. Additional comments 3.3. Other forms of community support Describe (indicate forms of in-kind contributions of communities if any) The sen'ice given by CDDs, cornnunity supervisors and the comnrunity ntembers is the nnjor contribution ofthe conununities. 3.4. Expenditure per activity Indicate in table 14, the amount expended during the reporting period for each activity listed. Write the amount expended in US dollars using the current United Nations exchange rate to local currency. Indictate exchange rate used here 1USD = 8.67 t9 WHO/APOC, 24 November 2004 Activity Expenditure ($ US) Source(s) of funding Drug delivery from NOTF HQ area to central collection point of community ? MOH Mobilization and health education of communities Training of CDDs 3,205 5,@0 NGDO NGDO Training of health staff at all levels ? MOH and distribution Internal monitoring of CDTI activities 7306 NGDO 581 NGDO Advocacy visits to health and political authorities ? MOH IEC materials Summary (reporting) forms for treatment r 955 NGDO 4958 NGDO Vehicles/ Motorcycles/ bicycles maintenance 3691 NGDO Office Equipment (e.g computers, printers etc) ? MOH Others 732 NGDO TOTAL 28,068 Total number of persons treated Table 14: Indicate how much the project spent for each activity listed below during the reporting period* *It is exffemely difficult to separately quantify the amount of money allocated for some of the activities mentioned above as it is carried put in an integrated manner. 20 WHO/APOC, 24 November 2004 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 x 5 year Sustainability Evaluation Internal Monitoring by NOTF X Ongoing monitoring by The Carter Center 4.1.2. What were the recommendations? The following actions are recommended to the zone 1. Solicit the collaboration of partners (including NGOs and APOC) for the provision of transport means for the health facilities in order to ensure a more effective communication. 2. Sustain current process of system structuring and upgrading of the health facilities, human resource development, integrated and intersectoral project implementation. 3. Develop partnership with the university in Jimma for research into some basic aspects of the project such as the added values of ivermectin delivery (ectoparasite reduction, intestinal helminth decline), which are so frequently mentioned by the health personnel and community members. The availability of records over a long period makes such study very appropriate at this time. 4.1.3. How have they been implemented? The recommendations mentioned above are in the process of implementation 4,2. SustainablllQl of prolects: plan and sct targcts (mandatory at Yr 3) Was the project evaluated during the reporting period? Yes Was a sustainability plan written? Yes When was the sustainability plan submitted? _2003 What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: All such issues were addressed during the previous ATR. 2t WHO/APOC, 24 November 2004 4.2.1. 4.2.2. 4.2.3 4.2.4. Planning at all relevant levels Funds Transport (replacement and maintenance) Other resources 4.2.5. To what extent has the plan been implemented As clearly witnessed by the APOC monitors, the sustainability plan was being implemented to the best of the project capacity. 4.3. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3.1. Ivermectindeliverymechanisms Since the inception of the project, ivermectin delivery has been fully integrated into the existing health service at all levels of the project implementation. 4.3.2. 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 Control Units are responsible. Therefore, all the staff of these units has received training on onchocerciasis. Training of peripheral health workers has been carried out in integrated manner with other health issues. 4.3.3. Joint supervision and monitoring with other programs As part of the system in the country, most of the supervision and monitoring activities are carried out in integrated manner with other programs. 4.3.4. Release of funds for project activities The project accomplished the 2005 Mectizan treatment activities by the fund released from The Carter Center and the MoH fund that is used in integrated manner with other health activities. 4.3.5. Is CDTI included in the PHC budgef Yes, CDTI is one of the priority activities for the malaria and other vector borne unit in particular. Although there is no specific budget line for CDTI, it is implicitly included in the department' s budget. 4.3.6 Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? In some malaria endemic villages, the CDTI sffucture is used for malaria control program. And also Polio Campaigns and vitamin A distribution are also using the same structure 22 WHO/APOC, 24 November 2004 4.3.7. Describe others issues considered in the integration of CDTI. The government structure of village which has got a health committee and the Health Extension Package Program designed to reach all Kebeles with health posts, may play a major role for the integration and sustainability. 4.4. Operational research 4.4.1. Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period. NONE 4.4.2. How were the results applied in the project? SEGTION 5: Strengths, weaknesses, challenges, and opportunities Strengths: The project is able to accomplish the distribution in short period of time with 1007o of geographical coverage and 84Vo of therapeutic coverage with out getting fund from APOC for the 2005 Mectizan treatment activities. Weaknesses: Weakness in supportive supervision at all levels, delay in reporting from the lower level, poor financial utilization and liquidation and turnover of trained health staff at woreda and health facility level. 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. Threats (Challenges): Involvement of health workers in a lot of health programs which make them overburdened, high turnover of trained health staff, making the finance office outside the control of the health offices at all levels. SEGTION 6: None Unique features of the project/other matters 23 WHO/APOC, 24 November 2004