Gambella CDTI annual project technical report submitted to Technical Consultative Committee (TCC): January 2011 to December 2011

The Federal Democratic Republic of Ethiopia Ministry of Health COUNTRY/NOTF: ETHIOPIA Proiect Name: Gambella Approval vear: 2003 Launchinq vear:2004 Reportino Period: Fro m : Ls pgnry. 20.L 1......... To,1..... Peaemher. A0 1 1......... (MONTrr/rEAR) MONTTT/rEAR) Proiect vear of this report: (circle one)l 2 3 4 5 6 7 8910 Date submitted : November 2011 NGDO partner: The Carter Center I I I I I I I I I I I I I I I I I I ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNTCAL CONSULTATTVE COMMTTTEE (TCC) DEADLlNE FOR SUBMISSION: To APOC Management by 3l Januarv for March TCC meeting To APOC Management by 3l Julv for Seotember TCC meetingII I I I I I I I I I I I I I I I I I I @,v AFRTCAN PROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) ilr %u iItI{ i II I r--=-- ._ _ q t' /.\_ " r. i I .'ol 3 TCL i PAo Y AA ia' rndrr*ta{icfl n fro \i hJ i*F 6P7 L G ^\n{ 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 Signature: Name' Mihret Hiluf N_d+........A,,,., I\tihret Hiluf Nigusaiq (RN, BSc, iUl'II) *t:n Heatth Pronrol.orr and lli'rtrrr0 g.,f ,s*? a17 ! + r< rt Go.'6 v Date. rA\ ul-lzolu Prevention I)i..cr:Iorate Direr:tor i Regional Oncho Coordinator Name Signature: a-r: h * Date: 15/9/2011 N ve Name: Dr. Zerihun Tadesse I R \ ) t. l, I -eOrr, F*,tC..).J zg1 o- lrott 'r:r t ic fi';5r'.r,rIIti lgnature Date been prepared by Name . Mr. Hailu Turura + NOTE Designation' Regional Onchocerciasis Coordinator Signature: ... Date This 2 I I I .t 't l I I I I I -t. i I i I ! I I I I I I i I ,1 Table of contents ACRONYMS ERROR! BOOKMARK NOT DEFINED DEFINITIONS.......... ...... ERROR! BOOKMARK NOT DEFINED.S FOLLOW Up ON TCC RECOMMEI\DATIONS... ......................1 EXECUTIVE SUMMARY......... L2 SECTION 1: BACKGROUND INFORMATION........ ................ 13 Grupnel rNFoRMATroN. PopuLattoN .................. EqurvENr FmnNcteL coNTRIBUTToNS oF THE pARTNERS AND coMMUNITTES . OruBn FoRMS oF CoMMUNITY SUPPoRT ............... ExpeuortuRE pER ACTTvITy SECTION 4: SUSTAINABILITY OF CDTI INrpnNel; INDEpENDENT pARTrcIpAToRy MoNrroRrNc; EvaruauoN .... SusratNaaILITy oF pRoJECTS: pLAN AND sET TARGETs (uaNoaroRy AT INrpcRatloN ........... I q.q.oprRauoNAL RESEARCH...... l.l. 1.2. zt 4s .... l5t6 SECTION 2: IMPLEMENTATION OF CDTI ......... s6 2.1.)') 2.3. 2.4. 2.5. 2.6. 2.7. 2.8. 2.9. 3.1. 3.2. J.J. 3.4. 1516 t6# 16+1 17+8 t7+84.t. 4.2. 4.3. .. 171+ ..lEle ..1224 ::::::) l: llY-llll*:T:llll illl:T:: T::::::: t;'ff SECTION 6: UNIQUE FEATURES oF THE pRoJECT/orHER MATTERS .......202+ J Tttrael-np oF ACTIvITIES ... ADVocACy........ MoBILIZATIoN, SENSITIZATIoN CovrvruNtty INVoLvEMENT .... AND HEALTH EDUCATION OF AT RISK COMMUNITIES Clpacrty BUrLDrNG.... TREATMEMTs .............. ORoezuNc, sroRAGE AND DELIVERv oF IVERMECTIN CouvuNtry sELF-MoNITozuNG aNo SrarpHoLDERS MpenNc..... SuppRvtsroN....................... ....28 ..9t4 t3+4 l4-ls l4+5 Acronymes 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 Community-Based Organization Community-Directed Distributor Community-Directed Treatment with Ivermectin Commun ity Self-Monitoring Local Government Area Ministry of Health Non-Governmental Development Organization Non-Governmental Organization National Onchocerciasis Task Force Primary health care Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Stakeholders meeting Technical Consultative Committee (APOC scientific advisory group) Trainer of trainers United Nations Children's Fund Ultimate Treatment Goal World Health Organization 4 D6finitions (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 Treatm.ent Obiective: (ATO): the estimated number of persons living in mesolhyper-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/hyper endemic areas within the project u..u, uiti.rtely 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 yeai olthe projlct). (v) Therapeutic coverage: 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 meso/hyper-endemic communities as identifieA Uy nffr,fO in the project area (this should be expressed as a percentage). (vii) Integration: delivering additional health interventions (i.e. vitamin A supplemenrs, albendazole for LF, screening for cataract, etc.) through CDTI (using ih. ,u1n. systems, training, supervision and personnel) in order to maximise cost-eifectiveness and empower communities to solve more of their health problems. This does not include activities or interventions carried out by .orn.rnity distributors outside of CDTI. (viii) Sustainability: CDTI activities in an area are sustainable when they conrinue tofunction 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 uny .o..unity- 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 maka appropriate modiications when necessary. 5 !qr FE35 E$EB P> o o o d c) o. c6 o o. =6) -Yo\J co o oo >.: o., :d h() uo.t dE(.)()E o.o()cd io. or\ o -.Y s=3'*; E aoONEtrI s'E t Egs o\,/= -(.)OEEEEQ E9(.)a = !!6I)9-6EA; ! ?oE ET lL!g -q)6)o6qz€5s5E =o; .E.sEiooLYcc ^'E;oo >.E.8i3Eg;€ 7Cq ='=9,;eqoo€GrO!tsP.s g 9 cYiitciatrtg.loQd 0.) do oLo 0)(.) o0 L o () o. () N oo 'd o-() (! c .' '; !?o dE bo ii Y, t-3 t\ U lr) A trq l.l !{' x na e H\( s ft\to E U\ OEE6J -o-OE ,;o aqqQ)9'E O.- 9c 9Y{6. s [-EE<6o .:6A *.E-9 O)q L6Y &q lOo L-)0)arEo-.=cCO420Eq-E E.HI66 €i9c:tr 36i aq)6.e't CeO) Fd zFo ch:q lJo= oo Eo\ , !.1 <t .9E ooE,:ZEO,)BE6, 0) ok O.o CH H9O !0)gE otrx.()6)- o! 9", ,50 oS _oo90 o (.) co'90(reE.>o=tro)c,3 90UP (D rl oo .9 .J6 ,"oA,i o!o\EU o (g L t-.1 Q c) olL ii <rz o C) o o. -o(g (o U7 tJ7 L c0 C) >. la) botr o .o o o. o) (H of tro -q'E o-= EB trrF z -o bo !o o Cd li(.) € E C) C) z o() o E c) o(B C) () -o (n o d o. o o. bo (6 L oo E o ! oo =t\ xekl e 8t{( U! 2aU o E oo Bo o oo cULF rEs ss: 6 o z o -F( a z uI =E o o lut o3lo{lF '>l Z .EI :fr J4 =.29sJUOUILF Executive Summary l. Background on treatment and population data Gambella CDTI project comprises of five Woredas having a total of 339 villages. All the five woredas were targeted for the 7th year treatment cycle. These are Gambella, Godere, Mengeshi, Dimma and Abobo. Census was conducted during the 7ft year treatment cycle and the population of the five CDTI Woredas constitutes 103,896. The Annual Treatment Objective (ATO) for the 7th year CDTI was 87 ,273. All the five CDTI woredas were covered with the treatment (100% geographic coverage). A total of 84,929 people were treated during the 7th year treatment cycle i.e; 82 Yo therapeutic coverage. 2. Background on population movements. The communities in CDTI areas are mainly farmers (change their villages for searching uncultivated land frequently), daily laborers and civil servants. The population size vary from time to time based on the need for daily laborers for coffee, tea and cotton plantation specially in Abobo, Mengesh and Godere woredas and also gold mine workers in Dimma woreda. 3. Training data Training and refresher trainings were conducted before initiating other CDTI activities. Gambella CDTI project was able to train (retrain) 96 health workers, 174 community supervisors and 1,041 CDDs. 4. Challenges and how they were overcome. Threats (Challenges): - Delay of the release of APOC budget - Shortage of vehicles for supervision & for distributing the drug to each endemic woredas. Opportunities: The involvement of Health Extension Workers is increasing from year to year in the treatment activities. I 7- SECTION l: Background information 1.1. Generalinformation 1.1.1 Description of the project Gambella National Regional State is one of the Nine Regional States of the Federal Democratic Republic of Ethiopia, and it is located in the western part of the country between 70 13" N to 80 17" N latitude and 330 52" to350 02" E longitude. The Region shares borders withthe Sudan in the West, Oromia Regional State in the East, SNNPR (Southern Nation Nationalities Peoples Regional State) in the South and Benshangul-Gumuz Regional State in the North. Gambella Region has a total surface area of 25, 274.88 square kilometers. The total population of the region is estimated to be about 360,431 of which 74Yo are rural and 260/o are urban dwellers. The population is largely engaged in subsistence farming, animal husbandry, fishing and coffee and cotton plantations. The climate of the region is classified as tropical. Average annual Temp is 30.7o C. The annual rain fall ranges 800- 2100 mm. the altitude ranges 300-2400Mts above sea level. The region is classified as low land (82%), semi highland (10%) and high land (8%). Some of the perennial fast flowing rivers that cross the Agnuak zone include: Baro, Akobo, Gilo rivers. There are also quite numerous small rivers and streams, which are tributaries of the main rivers. There are two distinct seasons in the project area, i.e., the rainy season (April - October) and the dry season (November-March). Harvesting occurs from October to December, leaving January - March as the optimum treatment period. The Region is divided into three administrative zones (Agnuak, Nuer and Messenger Zones) and thirteen Woredas and one town administration. Allthe CDTI woredas (except Mengeshi which is difficult during rainy season) are accessible with all weather roads with the regional town. However, access to rural communities appears difficult during rainy seasons. The health infrastructure in Gambella CDTI project area consist I zonal hospital, I I health centers (l government and l0 NGO), 69 Government health posts and l0 private clinics. Table l: Number of health staff involved in CDTI 2 District Number of health staff involved in CDTI activities. Total Number of health staff in the entire project area Br Number of health staff involved in CDTI B2 Percentage B.=B,/ B, *100 Abobo 46 I 20 Dimma 38 10 26 Gambella 45 5 11 Godere 50 37 74 Mengeshi 21 21 100 Total 200 82 41 Table 2: Number of health extension workers involved in CDTI 1.1.2. Partnership There was strong partnership during planning, advocacy, mobilization, drug distribution, monitoring and evaluation of the CDTI activities among different partners. The main partners involved are Federal ministry of health, Zonal Health Department, Woreda health office, health facilities, the community, The Carter Center, WHO and other government sectors. t District Number of other health workers (health extension workcrs) involvcd in CDTI activitics. Total Number of health extension workcrs in the entire project rree B, Number of health extension workers involved in CDTI B2 Pcrcentage Br=Bzl Br *I00 Abobo 31 31 100 Dimma 42 42 100 Gambella 22 22 100 Goderie 30 30 100 Mengeshi 33 33 100 Total 158 158 100 J 1.2. Population Table 2: Communities and population at risk in the entire project area whether they are treated or not during the reporting period. UTG = calculated as lhe maximum number of people to be treated annually in meso/hyper endemic areas within the proiecl area, ultimately lo be reachedwhen the project has reachedfull geographic coverage (normally the project should be expected to reach the UTG at the end ofthe jil year ofthe project). 10342 9123 Was a census for the project done during the reporting period? Y No If No, what is the source of the data in the table above? * Source: National census CDD_Other source, speciry: Year es 4 CDTI Districts in the entire project area Total populatio n in the entire project area Number of com m u nities/villages in Population of Meso- endemic zone in the project area A1 Hyper- endemic zone in the project area A2 Total in meso/hyper- endemic zone Aj= Aft A2 Meso-endemic zone in the project area At Hyper- endemic zone in the project area A5 Total in meso/lr yper- endemi c zone Aa= A.1+ A5 Ultimate treatme nt Goal (urG) Abobo t6,797 69 0 69 16,797 0 16,797 14,109 Dimma t2,312 30 0 30 12,312 0 12,312 Gambella t 0,861 49 0 49 10.861 0 10,861 Godere 40,630 123 0 123 40,630 0 40,630 34,r29 Mengeshi 23,296 68 0 68 23,296 0 23,296 19569 TOTAL 103,896 339 0 339 103.896 0 l 03,896 87,273 WHO/APOC, 24 November 2004 If you are using the term community or village, define what constitutes the community or village. This will help understand the profile of the project area. The term community or village is considered people who live in not more than 2 Kms radius and who shared a common interest. In Godere and parl of Abobo woredas where there was resettlement program the people live more closer and have more than I50 households but in the remaining three woredas the community live very scattered and a village may constitute less than 50 households except in gold mine and cotton plontation areas where villages have concentrated indiv iduals (daily laborers). Is there any other information of interest about the population in the project area? If so, include it here. In Godere there is cffie and tea plantation, in Abobo cotton plantation and in Dimma woreda there is manual gold mine. People travel to the above three mentioned woredas searchingfor occupation. The size and structure of the population in eachworedafluctuate, based on the ogricultural activities. SECTION 2: Implementation of CDTI 2.1. Timeline of activities Table 3: Timeline of activities for the areas treated in the current year District LGA Mobilization of communities Trrinins Census/Updete Drue distribution Supervision Starting month Completio n month Starting month Completi on month Stailing month Complcti on month Starting month Complet ton month Starting month Completion month Abobo March 201I March 20lI April 201 I Aprll 201 I April 2011 Aptil 201 I May 2011 July 201 I March 201I July 201 I Dimma March 20lI March 201I Aprtl 201I Aprtl 201 I April 201I Aprll 201I May 20lI Iuly 201 I March 2011 July 2011 March 20ll March 20lI Aprll 201I April 201I April 2011 Aprll 201 I May 20II July 201 I March 2011 July 201 I March 20lI March 20ll Aprll 201I April 2011 April 201I Aprll 201 I May 20lI July 201I March 2011 July 201 I Mengeshi March 201 I March 201I April 201I April 201 I April 201I April 201 I May 20II July 201 I March 2011 July 201 I Gambella iodere Comments 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. Because the involvement and support of the community leaders at all levels was minimal Advocacy meeting was held with decision makers (woreda council members and community leaders (Kebele leaders)) in respective woredas. During the discussion all participants 5-l promised to support the program and some improvement has been registered so further effort should be exerled to make them all fully involve and support the program. 2.3. Mobilization, sensitization and health education of at risk communities Community mobilization was done in each village by organizing community meetings. Kebele Task forces (that include Kebele administrative leaders, health staffs, health extension workers, and kebele elders) were responsible to organize the meetings and played major role in mobilization and sensitization of the whole community at grass root level. Community supervisors and CDDs were also involved in giving health education to the community at village level. One of the reason of the increment treatment coverage in this treatment period can be the impact of the community mobilization and sensitization. 2.4. Communityinvolvement Table 4: Communities participation in the CDTI (Please add more rows if necessary) Number of communities /villages with female CDDs 38 Comment on: - Attendance of female members of the community at health education meetings. The attendance of female members of the community at health educotion meetings is improving compared with the previous years. - In general, how do you rate the participation of female members of the community meetings when CDTI issues are being discusses (attendance, participation in the discussion etc). The participation offemale members of the community is increasingfrom year to yeor. Incentives provided by communities for the CDDs 6 District/LGA Number of communities/villages with community memberc as supervisors Number of CDDs and the communities involved Total no. communities in the entire project area B. Number with community members as supervisors Br Percentage Bc= BJ B. *100 Mele CDDs B? Female CDDs Br Total Bo= Br*Br Number of communities with fcmale CDDs B,n Percentage Brr= B,n/B.* 100 Abobo 69 27 40 135 10 146 11 l6 Dimma 30 33 110 106 45 151 15 50 Gambella Zuria 49 2t 43 57 26 83 26 53 Goderie t23 50 4t 379 48 427 48 39 Mengeshi 68 29 43 176 74 250 30 44 Total 339 r60 48 853 203 1057 130 Communities are not providing incentive to CDDs as they ore treating their relatives and neighbors. - Attrition of CDDs. Is attrition a problem for the project? If yes, how is it addressed? There is some attrition rate of CDDs and it is not such significant and does not affect the projects activity. - Other issues 2.5. Capacity building - Describe the adequacy of available knowledgeable manpower at all levels. The number of health workers are increasing in number and in educational level from year to yeat. - Where frequent transfers of trained staffoccur, state what the project is doing, or intends to do, to remedy the situation. (The most important issue to describe is what meosures were taken to ensure adequate CDTI implementation where not enough lmowledgeable manpower was available or if stafft are frequently transferued during the course of the campaign). There are two health extension workers in each Kebele and they are responsible to train and supervise the CDDs working in that respective Kebele and their turn over is very minimal. 7 irs () G 0 a Q o o! z o .: + .s .:qv (jie o(r) r-@ (v)$ |r, No o,s cf)@ (o to trN F*N .+ o,(o(o @@ otoN o o$ so $ O)I N$(o (.I o\ q) ru q) \o U LF a.l 6 00 O + a.l ?o6l :-' ol =o?.= L!A .Q raF EO z'e ?n+- € oou &'\ d ir *G (Jk- q) =c!g Eg .tE tr ---:()ZE q)() I +d U d rL U ( F i z (o N =l F. o rr N (O o o(o o c.l (o N r- (Y) r- o\ o E 6) a) \oU?F @ t* (o (r)(o @rr G 0 0 o ;U A.=H6! oe () z E.'iY \) s \ a< z N c.l co c.t \o \o o $ 6l \o t oo () 4) o () \o U 6 co \o oN Fl a -oo -o E E H s 3t d(, o o E o bD o 2 Fl F t'r \t N 3 o oz .+ o.! O A 50 u e -o 4 $\q) $\ 4$ -a s o uo -E \ s o q) t oL q; -o B o t\- i$' a< q) 44q)() q) (r_ q: \ \) U t \) dq) E o () C) o. F O(! o(h o 0) C)L .o q-i E o (n bI) LF ,; 0) -odF oo 2.6.2 What are the causes of absenteeism? Because of the delay of Mectizan tablet shipment the treotment was given in the rainy season. This time some of the residence stay out of their village for farming for more than a month. That is the major reasonfor the absenteeism. What are the reasons for refusals? Most them feel they are heolthy and no needfor treotment and some others refused to take because of the fear that the drug may react 'tryith local alcoholic beverages, since some of the people used to local alcoholic drinlu on daily bases. But the number of refusals has significantly decreased compared to the previous years. 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 l1 WHO/APOC, 24 November 2004 +c..l 6.) -o E(J o z =ta.l O {o > a.t oE o G, o clI c) a0 €Lo o Fr 6g L CE o (t) ah cl (l)L u0 U2 q) an t-- a\ t'-l ool Cll c)L cll I o) o) € tr (u o G(,) o U) clq) Cr L clq) q) L o oE(!!(lJ) ok E() a6.) 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Treatments 2.6.1. Treatment figures If the project is not achieving l00o/o geographical coverage and a minimum of 65% therapeutic coverage or the coverage rate is fluctuating, state the reasons and the plans being made to remedy this. Both the geographic coveroge and therapeutic coverage ore above the standard indicated above. 9 Trainees Type of faining CDDs Other Community members e.g Community suDeryisors Health Workers (FLrrF) 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) t2- WHO/APOC, 24 November 2004 $u) E- t sq) hO\\ONF-i UJB 'vU d\()3 l-: oio's A'.\I Sa,r !,s € $s .= 'A:* * cl*E .sS - s9H HNH Ss rr q, A -= >\i.\1g Et (.) !Ej. 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Ordering, storage and delivery of Ivermectin Mectizan@ ordered/applied for by - Qtlease tick the appropriate answer) MOH M WHO tr TJNICEF tr NGDO N Other (please specifu): Mectizan@ delivered by - Qtlease tick the appropriate answer) MOH M WHO tr UNICEF tr NGDO tr Other (please specify) Please describe how Mectizan@ is ordered and how it gets to the communities Mectizan was requested to MDP by the NOTF. Then after drug arrived at the country it follows the existing drug and other medical equipment delivery system in the country. The drug was stored in MOH warehouse and then distributed to CDTI projects after the projects submitted a request paper. The Woredas received the drug after submitting the requisition latter to the zonal CDTI project health office and then distribute to the health facilities. It is from the frontline health facilities that the community supervisors (CDDs) received the drug and distribute to the communities. Table Mectizan@ Inventory (Pleose add more rows if necessary) After opplication additional people have been treated with mopping up. During the application the treoted population were 81,020. How are the remaining Ivermectin tablets collected and where are they kept? The lefiover Mectizon tablets are collectedfrom the CDDs by the Front Line Health Facilities (FLHFs) and the FLHFs transferred the collected Mectizan and Albendazole to the woreda Health Office and are stored at the Woreda Health Office. List and briefly describe the activities under Ivermectin delivery that are being caried out by health care personnel in the project area. ' Training of community supervisors and CDDs about, the drug, its adverse effects and management r Collection of Ivermectin from the Woreda health office store and then distribution to CDDs after checking the census (village register) ' Regular supervision with especialconsideration to adverse effects during mass distribution. . Distribution of Ivermectin to CDDs and Supervision . Collecting of reports and the remaining drugs . Recording and reporting of data District Drug Balance from previous year Number of Mectizanq /Albendazol tablets Received Used Wasted Expired Remainins Gambella Mectizan 62,953 171500 229,303 714 0 4,374 Albendazol 12378 77100 84929 304 0 4245 r) l3 WHO/APOC, 24 November 2004 - Any other comments 2.8. Community 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 I l: Community self-monitoring and Stakeholders Meeting (Add rows if needed) District/ LGA Total # of communities/villages in the entire project area No of Communities that carried out self monitoring (CSM) No of Communities that conducted stakeholders meeting (SHM) Abobo 69 0 69 Dimma 30 0 30 Gambella 49 0 49 Goderie Mengeshi t23 68 0 0 123 68 TOTAL 339 0 339 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. The SHM was conducted at woreda level and it was important to strengthen CDTI activities at woreda health facility and community levelat large. 2.9. Supervision 2.9.1. Provide a flow chart of supervision hierarchy. NOTF )RHB) WOTF ) Health Facility ) Community supervisors ) CDDs 2.9.2. What were the main issues identified during supervision? Improvement has been observed in recording and handling of village register but still strict follow-up and supervision should be strengthened in this regard. 2.9.3. Was a supervision checklist used? Yes 2.9.3. What were the outcomes at each level of CDTI implementation supervision? . Handling of documents was relatively improved. 2.9.5. Was feedback given to the person or groups supervised? Yes 2.9.6. How was the feedback used to improve the overall performance of the project? . Oral and written feedback was given after each supervision. t4 SECTION 3r Support to CDTI 3.1. Equipment Table 12: Status of equipment (Please add more rows if necessary) Source Type of equipment APOC MOH - Zone DISTRICT NGDO Others No Condifion No Condition No Conditron No Condrtron No Condrtron l. Vehicle 2 F NA NA NA NA 2. Motor cycle(s) 5 F NA NA NA NA 3. Computer(s) I F NA NA NA NA 4. Printer(s) I F NA NA NA NA 5. Photocopier (s) I CNFR NA NA NA NA 6. Fax Machine(s) I CNFR NA NA NA NA 7. Overhead projector I F NA NA NA NA *Condition of the equipment (F:Functional, CNFR:Cunently non-functional but repairable, WO:Written off). NA-Not available How does the project intend to maintain and replace existing equipment and other materials? The project expects partner NGDO (The Carter Center) to maintain capital equipments that have been provided by APOC. Though there is no budget allocated for maintenance of the above materials maintenance is going on using government budget shifting from other programs. But the project is exerting effort to make the local govemment authorities to allocate budget. 3.2. Financial contributions of the partners and communities Table l3: Financial contributions by all partners for the last three years Contributors Year 3 (2007) Year 4(2008) Year 5(2009) Year 6 (2010) Year 7 (201l) Budgeted Released Budgeted Released Budeeted Released Budeeted Released Budgeted Released MOH (Central + State) 3500 3500 4000 4000 NA NA NA NA t 28,944.83 128,944.83 MOH (District + zone) 0 0 0 0 NA NA 4000 4000 0 0 Local NGDO(s) ( ifany) 0 0 0 0 0 0 0 0 0 0 NGDO partner(s) t 2,500 t5t70 16,089 t6,089 2I,8t6 20,4 t 6 I 2,382 I 2,382 I,481 I,48 t Communities 0 0 0 0 NA NA 0 0 0 0 APOC Trust Fund 16,000 84t9 t 2,620 8834 5857 4t00 0 0 14, I t4 s5 14,1 14.55 Total 32,000 27,089 32,709 2E,923 27,691 24,561 16,3E2 16,382 I 44,540.38 144,s40.38 r4 l5 lf there are problems with release of counterpart funds, how were they addressed? Delay to release the budget allocated from APOC. The budget allocated from APOC was released Iate after the treatment initiated. - Additionalcomments -Keep on the availability of drugs at central level before the rainy season. -The allocated budget should be released as early as possible so that activities will run effectively as per the plan. 3.3. Other forms of community support - Describe (indicate forms of in-kind contributions of communities if any) In some communities people invite CDDs to have lunch during Mectizan distribution. 3.4. Expenditure per activity lndicate in table 14, the amount expended during the reporting period for each activity listed. Write the amount expended in US dollars using the current United Nations exchange rate to local currency. Indicate exchange rate used here IUSUFYi;Ultffi0 Table l4: Indicate how much the project spent for each activity listed below during the reporting period Acllyrty Expenditure ($ US) Source(s) of funding HSAM 1,078.05 APOC lainlngs Health workers 6,330.00 APOC S_uperv i s i on ql4 [qdlgt]4:s Intervention and distribution 2,567.10 APOC Others 4,139.00 APOC TOTAL 14,114.55 APOC Total number of persons treated Any comments or explanations? t6 SEGTION 4: SustainabilitY of GDTI 4.1. Internal; independent participatorymonitoring; Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable) Year I Participatory Independent monitoring +-Mid Term Sustainability Evaluation --: - 5 year Sustainability Evaluation Internal Monitoring by NOTF Other Evaluation by other partners 4.1.2. What were the recommendations? The project was evaluated as a project which is progressing toward sustainability. And the following recommendations were given: - Keep documents properly including financial reports - Increase community mobilization in villages with poor treatment coverage to achieve ATO - Woreda staff to increase number of visits to health facilities 4.1.3. How have they been implemented? - Document keeping has been improved - Community mobilization was increased in villages which have poor treatment coverage. - Woreda staff increased the number of supportive supervision 4.2.1. Sustainability of projects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period? Yes Was a sustainability plan written? When was the sustainability plan submitted? Sept 2010 What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.2.1. Planning at all relevant levels Planning of CDTI activities were carried out through participatory methods. At woreda level woreda health office, woreda council members and health staffs discussed and plan when to conduct meetings with the communities. Then together with community members planning will be adapted when to conduct CDD training, when to conduct census and also when to start distribution of the drug. At community level community members made discussion together with Kebele task forces and plan all activities. The CDTI is integrated with Malaria control program and efforts will be made to integrate CDTI with other health programs. li- t7 4.2.2. Funds The government is integrating all the basic health activities using all available funds. This integration approach will help to sustain CDTI after APOC funding cease. In addition to this, the NGDO partner is also expected to continue the critical funding support as it used to do previously. 4.2.3 Transport (replacement and maintenance) The project expects that APOC will replace the vehicle and motorbikes and the government will be responsible for their maintenance. The project will also use other vehicles from other health programs to fillthe gap, if any. 4.2.4. Other resources 4.2.5. To what extent has the plan been implemented The CDTI activities training, mobilization, census, etc. were done as planned but the drug distribution was not done in the date planned because of late arrival of drugs. 4.3. Integration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: CDTI is integrated with the Primary Health Care (PHC) from the beginning. At the National, Regional, Zonal, and Woreda levels, the Malaria and Other Vector-borne Diseases Prevention and Control Units are responsible. All prevention and control activities are included in the health extension package at the grass root level. 4.3.1. Ivermectin delivery mechanisms Ivermectin delivery follows the existing drug delivery system in the country. The request for Ivermectin is made to MDP through FMoH. After arrival, all the processes required are handled by a Pharmaceuticals Funding and Supply Agency PFSAof FMoH. Then the CDTI projects receive the drug after submitting official letter to FMoH. Similarly woreda health offices submit request letter to the CDTI project. Ivermectin delivery system is handled in similar manner to that of other drugs and medicalequipments in the country. 4.3.2 Training: Most health staffs at the project woreda have received training/retraining on epidemiology of Onchocerciasis, Lymphatic Filariasis and CDTI principles. Efforts were also made to include other topics, such as measures to be taken on malaria prevention. 4.3.3. Joint supervision and monitoring with other programs The program is integrated in health promotion and disease prevention and control core process, most of the supervision and monitoring activities are carried out in integrated manner with other activities within the core process and regional health bureau. 4.3.4. Release of funds for project activities A fund from the NGDO partner was released on time to accomplish the CDTI activities. t l8 a4.3.5. Is CDTI included in the PHC budgetr Yes, as part of PHC, CDTI is one of the health activities at all levels and at grass root level it is under immediate supervision of the health extension workers at grass root level. 4.3.6 Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? All the five woredas are malaria endemic. CDDs participate and support the community during bed net distribution and other anti malaria activities. 4.3.7. Describe others issues considered in the integration of CDTI. The Health extension program is an important program that can help to sustain CDTI in the community. 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. No operational research undertaken in the project within the reporting period. 4.4.2. How were the results apptied in the project? SECTION 5: Strengths, weaknesses, challenges, and opportunities Strengths: '/ The project is able to accomplish the seventh treatment cycle with 100%o geographical coverage. ,/ Therapeutic coverage is above the standard. ,/ The awareness of the community about CDTI has increased. Weaknesses: '/ Poor document handling, at some of the woreda and hearth facirities ./ Lack of supportive supervision at all levels Opportunities:/ Security situation improved.{ Availability of Health Extension Workers in every Kebeles Threats (Challenges): '/ The far distonce of Dimma ond Godere woredas is a barrierforfrequent supervision and close follow up. It demands additional cost for fuel and perdiem. t6 19 a SEGTION 6: Unique features of the project/other matters Compared with most of the projects found in the country, Gambella CDTI project is found in remote area. The temperature that exceeds above 490c during February to May is unique feature of the project area that affects CDTI activities to run smoothly. Apparently the project area is in soyanna vegetation area that needs further investigation on the clinical manifestation of onchcerciasis in the region. a a 20