4th and 5th year sustainability plan Tello Woreda (district) Kaffa-Sheka CDTI project period: 2004-2005

Ethiopian Program for onchocerciasis control community Directed rreatment with rvermectin(cDrr) 4th and sth Year Sustainability plan For Tello Woreda (District) Kaffa-Sheka CDTI Project Project Period: 2004-2005 r.Ea*?--.... +.. .s..... ..nr._.r,.i..r I!..i, l1iIrfi 0,DE[.200 JI fit{ .". n -* *r^-.fr J iiiJ ;'t '' II Table of Contents Part I 1. lntroduction...... 2. Background I"f";;;;.. Part II 1. Rapid Epidemiological Mapping of Onchocerciasis . Part III 1. CDTI implementation and Results 2. CDTI training achievements......... 3. Treatment coverage... Part IV I 2. REMO Maps of Tello woreda. Financial Management of APOC Trust Funds Part V Sustainability of Issues of Tello woreda CDTI. 1. Planning 2. Leadership 3. Monitoring and Supervision ...... Mectizan supply and distribution........... Training/FIESAM...... Project Budget Financing/Funding Transport and other Material Resource... Human Resources Coverage Sustainability plan frame framework for Tello woreda List of Available Resources for program support..... List of Materials, Supplies and Equipment Requiredfor GDTI Activities ... Part V L Budget justification (Explanation 2. Budget Summary Year IV..... 3.Budget Summary of Sustainability plan for year V .. 2 1 I 2 2 J 4. 5. 6. 7. 8. 9. 10. 11. 12. 5 5 5 6 6 7 n 8 8 9 11 t2 13 l5 16 > J 4 5 t- 1 Introduction Tello is one of the ten wordas (districts) of Kaffa zone, located about 495 kms away Southwest of Addis Ababa. Tello has a population of around 56,560. The woreda comprises 25 kebeles (smallest admin units), whose inhabitants mainly depend on subsistence agriculture. The climatic zones of the woreda, in most places, are that of highland with longer annual rainfall period (6-8 months). In this woreda, there is one health Center one health station, one health post. The infrastructure in the woreda is underdeveloped; no continuous electric power supply, poor telephone service, inadequate roads connecting the kebeles (rural communities) to the capital town, etc. The woreda is well known for its diversified cultural and ethnic composition, although Kaffecho is the most dominant one amongst others. Background Information Onchocerciasis control program was launched through community directed treatment with Ivermectin strategy in the year 2003. The project was initiated with a strong partnership between APOC, affected communities, regional, zonal, woreda admin councils and health departments, Federal Ministry of Health and an NGDO partner (The Carter Center). The program was initially designed and implemented as Kaffa-Sheka CDTI project with the overall coordination role assumed by the zonal health department. However, Kaffa- Sheka was later on split as two distinct zones and the leadership role was then shifted to each zonal health office. Again, very recently, in accordance to the decentralization policy of the government of Ethiopia, there was a paradigm shift of power and authority from zonal to woreda levels. It was at this juncture that the midterm CDTI sustainability evaluation of Kaffa-Sheka project undertaken. In line with this development, it was recommended that the CDTI plan be worked out at woreda level. After the midtenn evaluation of CDTI sustainability, there was SWOT analysis done for each level of health delivery structure. As a result, coverage, Mectizan order and supply, monitoring and supervision, as well as training and HESAM were considered relatively -'1" rBtt .!Ht 2as strong points at woreda and front line health facility levels. On the other hand, Financial Resources, Planning, Leadership, Transport and other materials and Human Resources were considered as weak points at this level. Efforts have been made to address these weak points in this action plan. Rapid Epidemiological Mapping of Onchocerciasis (REMO) The rapid epidemiological assessment carried out in selected communities indicated that Tello woreda as hyper and meso -endemic for Onchocerciasis. in 1997 t CDTI Implementation and Results Although the woreda was known for its endemicity of Onchocerciasis, there was no mass treatment activity conducted before the launching of CDTI. However, clinic-based treatments have been going on with diethylcarbamazine (DEC) in some of the health institutions of Tello Woreda. As mentioned earlier, CDTI was implemented for the first time in the woreda during the year 2003. The major partners were APOC, FMOH, respective health authorities, local goverrrments, affected communities, and the partner NGDO (Carter Center). The mass treatment had 100 percent geographic coverage of the communities in the woreda right from the beginning. CDTI Training in Tello Woreda, Kaffa zone Year Health Persomel Others CDDs 2001 NA NA NA 2002 NA NA NA 2003 t4 8 234 NA:Not Applicable JTreatment Coverage, Tello Woreda, Kaffa zone Financial Management of APOC Trust Funds Zonal health department carried out the financial management of each CDTI during the year. Accordingly, data that has been extracted from the zonal document shows the following financial information (see table). Year Funds Received Other Sources Comments APOC NGDO 2001 2002 2003 3061.6 679.7 None On the 1' advance was received from APOC Total 3061.6 679.7 New Leadership Role and Integration of CDTI ln view of the recent decentralization policy, devolution of power and authority has been made to the woreda level structure. As a result of this change, CDTI has been considered as integral part of the overall three-year strategic health plan for Tello woreda. During the CDTI sustainability-planning workshop, all stakeholders have participated and have expressed their commitment to assuming the leadership role in the implementation of CDTI in their respective areas. CDTI has been included in the malaria and other vector borne diseases prevention and control unit in the strategic woreda health plan. Year Total Mr. of villages ATO Nbr. of Villages Treated Geogra phic Coverag e (%\ ATO Coverage (%) Total Popn. ATO Nbr. of persons ffeated Therapeutic Coverage (%) ATO Coverage 200 l 2002 t!. 2003 242 242 242 100 100 56,560 45,248 41,360 73.1 9t.4 4REMO Map, Tello woreda, Kaffa zone q+_*.:. - rq[{!r )1 -.I. -f,t ,:I oJ: "it ,r:i. . '.lh [+:tyt]- r *,-..-, ,; 'th+litl I rl,,-ii., \ ,tJf,t;r.) "*ftf.t' 1, "-*-" *-" '.-.^-,;[ iV"r,tFrr. 5Sustainability Issues in Tello Woreda CDTI Planning This is an area identified as weakness during the midterm evaluation that requires immediate corrective action. The CDTI is incorporated in the overall three-year strategic health plan of the woreda. However, in the past,..the woreda health office and FLHFs were not actively involved in drawing up the CDTI proposal and annual plans of action. It was rnainly the zonal health department that was responsible for planning CDTI activities in particular. Following the midterm CDTI sustainability evaluation, however, it has been decided that all stakeholders at woreda and FLHF levels will assume the responsibility of working out their respective periodic plans of action from this time on. Short training course will be necessary to develop the planning skills of the health personnel working in these institutions. Efforts will be made to implement the bottom-up planning approach with the assistance of the NOTF in the remaining two project years. Leadership As introduced earlier, currently there is a paradigm shift in the admin structure and organizational set up of the overall management of health and other development programs in the country. The general trend is to empower the woreda level structures and build capacities in all aspects of program management. The CDTI, being one of the recognized and integrated health programs of the woreda, will receive leadership and close guidance from the woreda admin council and the taskforce organized at this level. Monitoring and Supervision Monitoring and supervision is verycritical to the success of CDTI if it is done in atimely and effective tranner. However, it was understood during the evaluation that the frequency and coverage was inadequate. Supervisory checklists were not used regularly and feedbacks 'uvere not communicated in writing. [n most cases, supervisory visits were not problem oriented and targeted to improving poor performance of FLHFs and CDDs. During the sustainability-planning workshop, it was agreed that the rveak points identified would be addressed very critically although shortage of health personnel and o)5 6other competing health priorities at both woreda and FLHF levels could be possible threats in the implementation process. Mectizan Supply and Distribution This activity is considered as a strong point during the evaluation process. Mectizan procurement and distribution is fully integrated into the government health care delivery system. Every effort will be made to maintain the good achievement obtained thus far. Ordering Mectizan in good time and in suffrcient quantity is indeed a commendable job favoring sustainability. However, there are areas that need fine tuning at FLHF and CDD Ievels, Minimizing wastage, proper record keeping and timely and cornplete reporting are some of the areas requiring attention in the remaining project period. Training/HESAM Organization and management of CDTI training programs were the responsibilities of the zonal program coordinator in the past three years. The woreda health office is not fully empowered to handle this responsibility. The future direction is however to build the capacities of the woreda health staff so that they can be in a position to plan and implement training sessions after carrying out needs assessment at FLHF levels. Efforts will be made to make CDTI training sessions focused on identified weaknesses of the health personnel and other partners including CDDs. Similarly, the woreda health office will be making proper use of its meager resources by integrating training programs to the best of its capacity. Health educatiol, sensitization and community mobilization has been very effective in enltancing CDTI awareness to the general public. The perceived benefits of Mectizan are foundational grounds for the sustainability of CDTI in the woreda. There will be a need to produce more powerful health education and sensitization materials in order to enhance further the active involvement of communities in decision-making process. Moreover, the beneficiary communities will need to be mobilized to provide effective support for the CDDs serving their respective villages. This is believed to be one of the comerstones for the effective sustenance of the proglam in the woreda. I 7Financing/Funding During the first three CDTI years, there has been no specific budgeting for onchocerciasis control activities in this woreda. Very.recently, however, the woreda admin council has started allocating funds in block for all health programs in an integrated manner' Obviously, the amount of money is much smaller.compared to the diverse needs of the woreda health office. Whatever the amount may be it is indeed a commendable start and it is hoped that it could be increasing over the remaining project period. Since the woreda health system functions in an integrated manner, it is hoped that CDTI could also benefit from funds coming from other sources like Global Fund, EPI, etc. At this rudimentary stage of the woreda, however, more support will be required from APOC' Transport and other Material Resources ln this woreda, at it is the policy of the Ethiopian government in general; available transport facilities are used in an integrated manner. In the midterm evaluation, means of transport is one of the most important limitations identified at both woreda and FLHF levels. Ideally, it would be appropriate if a pick up could be provided for the woreda health service and at least one motorcycle for each FLHF. This woreda has not receive any vehicle from APOC. The evaluation team has recommended immediate replacement of the motorcycles that are found to be worn out and non functional in the evaluated woredas. It is strongly recommended that each FLHF would need one rnotorcycle for effective monitoring and supervision of CDTI activities. At this juncture it is very important to underscore the need to consider building the capacities of the woreda and FLHFs in order to be able ensure the sustainability of CDTI in this particular woreda. This woreda health office lacks important office equipment like computer, printer, photocopy machine, etc. These deficiencies need to be tackled as soon as possible. Other CDTI material resources like treatment registers, reporting booklets, training manuals, posters, flip charts, T-Shirts, stationery, etc. should be supplied in sufficient quantities for the effective continuance of CDTI in the woreda. el sf Human Resources 8It is known beyond any grain of doubt that the availability of skilled and motivated human resource is very critical to the success of CDTI. The midterm evaluators noted that there was a very high turnover of health personnel at both woreda and FLHF levels. It was also noted that most of the FLHFs are understaffed. [n the coming couple of years, however, these shortcomings need to be addressed as much as possible. During the planning workshop, the woreda admin council and other authorities at higher levels promised to do their best in this respect. Plans have also been made to motivate health personnel and CDDs by means of rewarding best performing individuals and institutions. As stated above, training workshops will also be organized to fill the gap of knowledge, skills and competence of the available health personnel in planning and management of CDTI activities. Coverage This woreda has already achieved 100 percent geographic coverage and therapeutic coverage of well over 65 percent during the past three years. Participants of this planning workshop believe the fact that if all other aspects and indicators of sustainability are well taken care there won't be a problem to maintain the current geographic coverage and improve further the therapeutic coverage levels. 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N p o a C)o o ln C) @t--\ctr} 15 Bud et Summa for Year IV CDTI in Tello Woreda Kaffa zone a lnuoset Line ItemS.No APOC MOH Carter Center Total Allocation ersonnel1lP 0 I 1,000 79 11290 Equipm 10,500 0 0 1 0500 upplies 0 105 75 855 1865.97 87.32 sl.7 2004.99 toring and5 2072.4 230.82 0 2303.22 bilization urce 0 44.74 0 44.74 SAM 1,902.94 144.92 168.42 2216.t8 8lAnnual Review lMeeting 0 0 763.14 763.t4 vision of 0 180 180 BudgetI 16,34t.21 11,612.90 2,203.26 30,157.27 11 GDO overhead 1,225.59 0.00 0.00 1,225.59 I Grand total 17,566.90 11,612.90 2,203.26 31,392.96 13 tments 45,249 45,249 45,249 45,248 st per treatment1 0.39 0.26 0.0s 0.69 15 % Input of artners 55.98 37.00 7.02 i00.00 .s%) l6 Budget summary of sustainability plan for year v CDTI in TelloWoreda, Kaffa zone No udget Line Item C H Center otal Allocation I ersonnel I J 123 apital Equipment J upplies ll 81 I 9 t I 1 and on 150 1735 Mobilization 5 0 5 1,500.0 l5 r00 175 8 al Review Meeting 0 0 700.00 70 ion of Awards 0 1 II otal Budget 4,000.00 12,635.00 2,090. 18,7I5.0 11 GDO overhead (7.5%) 300,00 0.00 0.00 300I rand total 4,300.00 12,635.00 2,090.00 19,015. 1 timated Treatments 46,560 46,560 46,56 46,5 I per treatment 0.09 0.27 0.04 0.41 15 Input of Partners 22.61 66.45 10.94 100.00 al 0