The Federal Democratic_Republic of EthiopiaMinistry of Heatttr.ah i ETHIOPIA Kaffa 2000 2001 thNea From:,L4nH.a.ry-.?0.1I....... oT, .D.e.c.p.m.h,.er. ?9.!1.... Month/Y I r tsI (circle one) t2 3 4 5 6 7 8 9I0 30 Janua 20I2ry The Ca rter Cen ter ANNUAL PROJECT TECHNICAL REPORT rE cHNr cA L . r,fr11TlTf,T,? ISrrrr rr. (rc c) c- i., ; i I t,f it : Itl {r1f" i ?(.0 f- l r.rJr D To APOC Management by 3r January for March Tcc meeting To APOC Management by 3l JulI, for September TCC meeting AFRICANPROGRAMME FORONCHOCERCTASTS CONTROL (APOC) I Ij, WHO/APOC, 24 November 2004 I I I I I I I Y-"r- r a 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: M..ihr..*.H.i.Luf Signature: .ffi.#}. Illihret Hiluf Niqirssie (RN, BSe, il[PH)l ",an Health Promotiou I)isease Prevention ..4 P Date. W Zonal Oncho Coordinator Name: Atirse Gebire Signature Date NGDO l[n-lvl::- t: '- TirF 16 r9 t-, I .:-iri ,,\ .t ,l )r This report has A07-- L012_ Name . ....Ati.ls.e.G..ebj.re Des ignati o n'. Zone Oncho cerciasis Coordinator Signature. Date .t,i i- Itttq .-.. -.1 ll WHO/APOC, 24 November 2004 f Table of contents ............IV DEFINITIONS FOLLOW UP ON TCC RECOMMENDATIONS... Expcurlvp SuuuaRy SECTION I : BACKGROUIID INFORMATION........ l.l. GeNsRalrNFoRMATroN............. 1.2. Popu1anoN............... SECTION 2: IMPLEMENTATION oF CDTI 2,1. TruellNe oF ACTIVITrES............. 2.2. ADVocACy 2.3. MostLtzartoN, sENSITIZATIoN AND HEALTH EDUCATIoN oF AT RrsK coMMUNTTES v I 2 3 3 5 6 6 6 7 7 8 2.4. 2.5. 2.6. 2.7. 2.8. 2.9. CovnauNrry INVoLVEMENT ........... Cepactry BUILDING... TRparveNrs ............... ORDERING, SToRAGE AND DELIVERY oF IVERMECTIN CouuumrY SELF-MoNIToRING aNo STaTEHoLDERS MperINc.... SuppRvrsloN..........., ...10++ ...t4+6 ...14+6 ...15# SECTION 3: SUPPORT TO CDTI=- ................16{8 EQutpvpNr .............16+g FtNeNcter- coNTRTBUTIoNS oF THE pARTNERS AND coMMUNrrrES ............. ........1J+g OrueR FoRMS oF CoMMUNITY SUPPoRT ............Ennon! BooxnrARK NoT DEFINED. ExpplotruRE pER AcTrvrry .... .. I g2e SECTION 4: SUSTAINABILITY OF CDTI 4.1. INToRNeL; TNDEIENDENT pARTICIpAToRy MoNrroRrNG; EvALUATroN............ ...lgz+4.2. SusrnlNasILITY oF PRoJECTS: PLAN AND sET TARGETs (uaNoaroRy AT yn 3) .192+4.3. INTpcRanoN............... .............2022 4.4. OpenarroNAL RESEARCH ...............20i#l SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AND OPPORTUNITIES ,20?3 SECTION 6: UNTQUE FEATURES oF THE pRoJECT/orHER MATTERS.......2I34 3.1 3.2 3.3 3.4 lll WHO/APOC, 24 November 2004 e Acronyms APOC ATO AtrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT UNICEF TUG wHo African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Community-Based Organ ization Commun ity-Directed Distributor Community-Directed Treatment with Ivermectin Community Self-Monitoring Local Government Area Ministry of Health Non-Governmental Development Organization Non-Govemmental 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 (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 Iiving 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 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 ofthe project). (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 identified by REMO in the project area (this should be expressed as a percentage). (vii) Integration: 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 "ornrnrnityownership, 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. WHO/APOC, 24 November 2004 FOLLOW UP ON TCG RECOMMENDATIONS TCC session 32th Number of Recommendatio n in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY I Train more CDDs; More CDDs were trained in 201 l. As a result the number of CDDs rvhich was 8,649 in 20 l0 have increased to 9, I 85 in 201 l. There is a plan to train more CDDs in 2012. 2 Retrain all involved in CDTI on record keeping All the HEWs were retrained in record keeping in 201 L However, due to other competing activities ferv HWs were retrained. 3 Explain how CSM was done without training Community self monitoring is not done in 201I as per APOC guideline. However, representatives of communities appraised the activities accomplished through review meetings conducted at kebele level. 4 Reduce number of wasted and expired drugs; Measures were taken by the WoHOs and ZHD to minimize drug wastage. However, due to delay of Mectizan shipment drug distribution was conducted during the rainy season. As a result the efforts made to minimize drug wastage was not very much successful. More efforts will be exerted to improve the situation in 2012. 5 Conduct Operational research on challenges; Due to absence of fund and other competing activities operational research on challenges was not conducted. Yet the zone will make efforts to conduct such type of operational researches in the future.. 6 Conduct sustainability evaluation and prepare sustainability plan. If this has not been done already. Sustainability evaluation was conducted and sustainability plan is prepared and submitted to APOC. WHO/APOC, 24 November 2004 Executive Summary . Background on treatment and population data Community Directed Treatment with Ivermectin (CDTI) has been successfully implemented in Kaffa zones South Nations Nationalities and Peoples Region (SNNPR) since May 2001. Kaffa CDTI project is divided into l0 woredas and I administrative town Bonga which was previously part of Gimbo. The project has achieved a geographic coverage of 100% and the consecutive therapeutic coverage of the project is so remarkable and is indicated below. Table 1: Treatments and coverage bv calendar year for the kaffa CDTI entire project area. YEAR atron Total popularton of the mesoftryper-endemlc areas Annual Treatment Oblectrve Number of persons treated Thdrapeutrque coverage (%) ATO coverage (%) UTG Coverage (%) 2001 902,687 306,297 233.309 26 76 3l 2002 928,69t 654,250 516.2t7 56 79 66 2003 9s5,443 955,443 718,241 75 75 89 2004 981,t98 824,206 768.642 78 93 93 2005 1,020,679 857,370 787,766 77 92 92 2006 1,012,6u 810,088 778, l 88 77 96 96 2007 1,075607 899325 843373 79 94 94 2008 tr43748 914998 85333 I 75 93 93 2009 lt6t273 975469 924979 79.6 94.6 94.6 2010 12't5404 972323 962256 79 99 99 20tt 1013706 8 r 0965 777507 77 96 96 Background on population movements. The communities in Kaffa zone are mainly settled farmers, daily laborers, civil servants, tea and coffee plantation workers. Yearly many people from all over thc country come to pick coffee and tea to this zone. The new influx usually does increase the number of population during Mectizan drstribution yearly. Challenges and how they were overcome Threats (Challenges) o Lack of continuous supportive supervision at all levels using checklists Woreda health office(WoHo) o The HP and WoHO repofts were not coherent to each other o High number of absentees and refusals o Delayed Mectizan distribution period due to Impact assessment done by APOC To solve this problem the following measures were taken:- ' Discussion was carried on with the WoHOs so that continuous and regular supportive supervision could be carried on r Reports were compiled during woreda level review meetings based on village registers. ' Woreda level review meeting was conducted to improve the challenges observed in 201I 2 WHO/APOC. 24 November 2004 SEGTION {: Background information 1,1. General information 1.1.1 Description of the project Geographic location, topography, climate A. Kaffa Zone Location:- Kaffa zone is located at the south West of the country and the capital of the zone, Bonga town is about 469 km. from Addis Ababa and 746 km. from Hawassa which is the capital of the SNNPR I(affa is considered as the birth place of Coffee and agriculrure is the main source of the zone's economy. Coffee & tea are the man cash crops of the zone. Its boundaries are Jimma zone on the rvest, Bench Maji zone and Konta special woreda on the east and north, Sheka zone and South Omo on the south. The mean annual rarnfall is 100l-2200 mm, Agro ecology Dega 7.30o/o, Woinadega 70.00o/o and I(olla 22.70o/o. Elevation 501-5300 meters above sea level. Population: activities, cultures, Ianguage The communities in Kaffa CDTI area are mainly settled farmers Sefflement of the population is 92.3% rural and 7.7oh urban dwellers comprises government employees, merchants, daily laborers, and tea and coffee plantation workers.A large number of daily laborers migrate to the Coffee and Tea plantation investment farms yearly and this cause's population increase during Mectizan distribution session. The languages of the community is Kaffinono and some of the people speak Oromifa, Amharic and other languages of the country. The Kafinano is a localofficial language of the Zone. Communication system Kaffa: - Road-All woredas do have all dry weather roads and 2 of the woredas are not accessible during the big rainy season (Saylem & Cheta). - Telecommunication: - All woredas do have a wireless telephone line and network access is available in some woredas too. Administrative Structu res o l0 districts o I town administration o 301 rural kebeles o 16 urban kebeles o 2572 Onchocerciasis villages J WHO/APOC, 24 November 2004 Table 2. 1.1.2. Partnership rh There is strong partnership which helps the Kaffa CDTI project for its best achievement andgradually ensures its sustainability. The main partners involved are Federal Ministry of Health,Regional Health Bureaus, Zone and Woreda Health Departments, Administration, Education,Agriculture, Finance, the community, The carter center Ethiopia and wHo (Apoc). The FMoH' The Carter Center Ethiopia and APOC are involved in planning, Supervision and inproviding financial and technical support. The ZIID and Woreda health Offices are involved in Pillq,community mobilization, supervision, monitoring and evaluation of the CDTI activities.FLHF do implement the CDTI activities and supervise the health posts. The community is involvedin supporting the CDTI activity by recruiting CbDs, as well as in fixing the Mectizan treatmentdates and sites. tn Number of health staff involved in CDTI ectivities.District Total Number of health staff in the entire project area Br _& Number of health staff involved in CDTI Percentage Er=Bzl Br *100Adi 77 70 98.s Bitta 7L 55 77.5 Bonga town 35 12 35 Chena 92 72 78.3 Cheta 42 26 52 Decha L23 95 77.2 Gesha 85 60 70.6 Gewata 85 69 80.2 Gimbo 95 91 92.8 lem 97 57 58.8 Tello 86 64 74.4 Total 883 728 82.5 4 WHO/APOC, 24 November 2004 <f N (,) ,o C) o z .+ c.l (-) o C) (* o 0) rrI o a. C) E (! U)L(.) !! =_Eo-o;a0()= -qo .- oo th! (-d oo(r9boL(g ra, =6J e a.l tra =(h 5o Yo c)- = (.) u)o -r!6A c6i €d otr ,E0(.)o .oo0 C' C!bo v>(o =o ,o =o)E bI)E(! 0J thec)(DP '-L E boc =ciO -.(l)(JHhe 5C)!2 ^(-)-;'d 9 --Atr '5 o th o)oL o(r) 0) o I I ah ooQ t(!(.) rh tt) o c) d .9 (o v G) C)L oa o z \ U7 C) c-. 'E c) o- ootc> PE[i or od €o oo -tr €s(,;)(d c! €E o(HC)o 'd crEeO.,I *t lr) g0) .o -q t^ .2 th= c)=o5(d^^ _^ (JYizBs o o o Eo c!oL C)L(g c) o q) c! Iq) o c) 0) .Y At L (! rc (d (n 0) E oO tr o I G fc otr N F E d c \o 6 D G @C (E E! =o -.L (o(i') @No r-'l <fr\Ol Ol(o cO(o fn Ol Fl @@o(.o (r') r-{ N O'loo(r1 rO @6l!i NFi ftl sft- O)N (o r-{ln @(o ao @r\(n @ or\ rn N ao @oN F{(.o r/)(.o olo Fl @ s< Ei !llE< t €o o q oF hs oo c\ @\o .f F- € =f N =fe.l oF- N\ot* ca a- \o o\F-\o o\ .+\o oo o\6t c-+ o\\or+ F-F- (o or\ ar.i F{o rl e '= .ek g: =- tgE >! !, -.E X E< F{r\(\ frlr\ r\ rn @ ol <l (O Otr\(n r-{ cft(oqlto Ol <l sf stt<(\ (O r'l <f(O 6 N ri @(O rn @ i.{ @@sl r.O Ol(D Ol l/) Ol(.o r\ ro(N r\(O Ol fO sf <l r-{ @NF|n oiNE E9 !c .lo8= 2.= =tr-C\ \o c- aa € .+O r-$ ao t-- r-r- \o o\ \o C.l\o oo N rf, t- c..l oo\o ca r.t aoo + sl o\ oN €\o ca N Ol6 r.r)(n <l .E IE! * E = E o L E] EI =lzl ! s< >,9 f_ --< E<5;^9 rtFEEe o\o c\ c.lc.l + co !f, N c.t c.t € r* $ \o oo ol \o o\N Or- c.I N ca c.t (\l r\ l/) N E 'a .:E E.: =t &g riE Ee Ot r-a F{ @(\ F{ Ol r-l rJt @ F{ N <f @fi1 GI sl Ol <fN ri Ol(o Fl stln rl ot @ r-{ (O (^o sl ri oqNE E9E.g Ao Es 4,.= a C') r\ Ol lr) F.l ol fO F.l rnfn Olr\ r-{ rir\ <lot r\GI r{ (o r-l F{ an sl r-{ r.O o r'l rl il .Eci =i E.Ei Po PFA!Q + oo c't €\otrr @ $oNs c.t r- N\or-(o r- \o o\F-\o o\ o\ $\o 6 o\ e.l tr-+ \o o\\o <t F-r- ro Or\ aO r-{o r{ .-" E .98L E.! Fdaeg9= r E (! m B o (o o0 o m cO o (J (g o) U 63 oo t-l (o ar', o O c((! B C)(, o -o C) (ga o c)F ,1 FoF It rf c.l 6) -o o o z v6t (-) (-) o c)0) e(i 4U j(u€ -(Ba' bI)H9ooo'o ILC! .Y o:ts!e 99bo .2cc .i \/d d=!U I F L _oN a I6'c vd c, a6h odEL Aa/ 9tL .^ ^ _L(JF6J d5g.gi EEs9du:eh)>vo it> o.> \- sL - - Cou) .E-H € x* --vo- >>i'o o-c .aa FLLVao9 >.8+G)u)LE 9oE - bo= .E3e9 oo, ,\9U PA(g .- qa xE> .X HH -9r! _o do=AFUX.= (nE c),;sEl-a -9 EE9'E 6rL- --.h dLF .96f. .2ac- ,\\.rY.r')e,U't.JE.= (d\HLA-- .<-t 5 c P^ -r--wAE d.E O EolsaG -€-EO PhEqo =; (gt E EH E ()( o aiS EE Et\ o) ^F!v-lN :g-*c,i #3. h 0') E oF J r()EC)b€(, .E rhEOEtrgO2 a- !Y+rgG(!g() 5.0 I? sdl Ll6o 5€ 3HEErr9r Oi ooN .S.EZEE 9 ,E.EF F+'O . o.rl H iEI ilql c.l =lal EEoC\JE N oC\l c.l c.l >' e{ >. c.^l >r c..l >t o.l >. a a.l (..l N oo LE6tO U)E a.lj C) fJ. N d OJIL (\j otu a.l -oo fJ. N lj 0) fJ. c.l olL a.lj o tJ. N d c) fJ. N oE. c.lj q)Ir 6lj()E I .9 0 -o-EEEoo e.l N N a.l N >' c.t >' c.l N >. c.l x oN a] b, LE cEo ChE N otr c\ c.) c! o c.l o) c.l C) (\ o o.l C) c.l 0) C.l o (\ o a.l C) I E€ EEoO!/ E 6l o d z a.l oE z, c..l -tro(! c.l o d2 e.l (,) Ld 2 a.l (.) L(, c.l o c! z c.l -tro d (\ o z e.l (J z 6l o d z, o 00 Eq, U) N o(l (..1 C,) cd a (\ o d c! (,) z c.l o d 2 c{ o(! z N o c! 2 c.l (,) d c.I oL6 c.l oLd N (.) c, UI nL g =aEtrooL,)E e.l >r c'l >.(6 e.l (, z e.l >l c! z N >'(! z e.l x(! 2 N cO 2 N (o c.t 2 a.l (! 2 UD do U)E N >. z, N d z (\ >r c, (\ 2 c.l d 6l a-l >. C6 c.l (! z N z c.l >' z. c.l >rd z lo E o o CI NI -alol 2l =EEEOQUE N d e -oo& c.l (d =!!q) 6l >r(! E -o(.)E C.I >r aL -oC)IL ON >r d e -oq) IL N t'(! e -oo a.l (! L -ool& O6l >. =L -oq) c{ >. 6 L -ooq. a.l e -ooIL c.l >.L(! E ol\ o B! L 6' (n 61 Ld -oof! e.l da -o() l& a.l d e -oc) E. N d -ooh c.l xrd e -o0) lJ. e.l >r .d -ool& N xL d L -o C) fJ. e.l L Co e -oolL oN 6t e -o0)q. e.l >' (6 e -oq) f! e.l (t e -oo r& J .9 .2 d $- EE C€ o U cg q) U d oo (o (n C) O (!(! ()(, o -otr C) cOa o C)F t N o -o E C) o zq a.t (J o o q: L p o -x Fo(J C) (t) C) oQ {a E o E o : o .= =c) E E o(, () ^Li'()u7Qa 'i o) v- )9n ^U6P td8 0) +E u) c, >':9L !-L ;vx.rH9tr(0 =o\)=(Je ^c)AaL+o=fz(ob#) ! d_) --o Rq)O -Ec> ro:iJ F\V -.-- -t E>E 9HE !:. ;'.L.!o g).'Eo H= .Y EEo oxcvLLC;) n bgaE 'Eth =oO E:tr E.0 .9 3HE P:tl 's6 = 'A-c,9E sE H s O-qUE >, boEi-ocEO o.r'I d .,g -E'&#E .' EH -GlJi; t qp"itr 3 =>O H=:E^-fl c)+ Ia! E9-N IJtrH fl,^Hl '6 s;5E tE.:o F.'6 .2O .Y tr-o -)Ua E .N #qo E 9,':5 * o-rX$ E gE>\/ >\! -- i' .JV)U! EOro =o e = E() EL-*o>Zg)d uEa c.i r r- U- Er_ 9il< A.lete (o N rlsf @(o sl!-l OlN rnN rJ.)rl (Y)(\l rnFl ot\ Ot FlN , U € a o o s,! a EG =Eze .9 .: Ex q(J vG LE:E z>a ro ro (f) O) (f) N ros sN $o r $N olr) lr)s $rr) cf) @strn + =A Fla GI r-{ <f ri rn @N ol @ O r/) + r-l r\(.o rO Ot ot Fl Fl sf c\lor{ t-t r..tr\ t ri @ cO u) t) Fl st N rJt @ ri Ol \o c.l co cn $ 00 .+ aa oo$ co c-t.+ r- s @ca (no @ ! E o 6 & aU o z I U I6 -d .9E: frUlQ \o oo(\ cn\o \o \oc.t c.)cac.t a.to\o\ oot-- $-tF- N c.tt'- N oo co @ cooDo €-Er9.r l il- oo oo oo oo oo oo \o o\ e.t oo o\O c.l oo E_ $ oo ;\o € cl 6 -o E E E o E ! Iu6 o o a? o 4e 7; 2aE! 7.? EI EO2q >a LL l9 -z EA. -=- _-- '8, EIleEEEo' ocio E.- C9E g "lk=c6 I o\ c.l [-'C\ c..l oo (\ c.l $ ca oo * c.) $N $N ca N oo N oo r- =f ta)\o 6 c.l \o o\N r- a1 -. r-N N c.t co C.l aa ao r-{ ri Nr\ l,(\ N r- r/) N J >' E ad o (g bo oo d o O d o Q c, oo (l o d Cd oo o -o 0) (! a o 6F ( F Comment on: ' Attendance of female members of the community at health education meetings Even though the female health education attendants are not equal to that of male attendants, their number is increasing from year to year. Female attendants are shy to speak in public and most of the time they are overburdened with so many tasks at home and in farm fieids. ' 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 attendance and participation of female members on CDTI discussion during community meeting sessions is less than that of men attendants. Culturat barriers do play a major roll for their low participation. Their participation is rated as fair. ' Incentives provided by communities for the CDDs CDDs provide free service to their respective communities. The community members sometimes help the CDDs working on their farm fields and do supply them ctffee drink and food during Mectizane distribution sessions. The woreda health offices and FLHF do assign CDDs to participate in other health activities such as Polio, measles, TT and EOS campaigns so that some amount of per-diem could be paid for them as an incentive when these campaigns are carried on. ' Attrition of CDDs' Is attrition a problem for the project? If yes, how is it addressed? I CDD attrition is not a problem .for the project. If a replacement is needed, it is done immediately and training is given by FLH* at their respective kebele. 2.5. Gapacity building - Describe the adequacy of available knowledgeable manpower at all levels. ' The staff members who have served long time in the project area are having good knowledge and the newly assigned health workers are given training yearly Where frequent transfers of trained staff occur, state what the project is doing, or intends todo, to remedy the situation. (The most important issue to deicribe is what-*rrrur"r r"r" token to enlure odequa!-e CDTI implententation where not enough knowledgeable manpower was available or if staffs are frequently transferred during the ciurse of theiampaign). This problem has been solved and there was no transfer of trained health staff during theMectizan distribution session. 8 WHO/APOC, 24 November 2004 l t-- ooN (t-t $ € c.t o\r- c\ $ r-. o\r-\o c.l\o Fll/l N <l t-{ @ (r.) l/)ln c.tlr} rat a.)trl la) (otr\ u) @ r< Ol @N6l @ r\ LN Ot <f sl @@ ; q) q) €) o\ q,) c! 0 a aI o c)& z ! _9 €'!*= :YY qU <U (\ $ $ N 6 r a! F{ st Fl v$ r/') @r\ tn oo(-- tr- a ra!$ f---- ra) c! aa N (.o sl <t F.{ r-.\o c.) r-\o cO -'-l o lNI(ot rnl o\ o\ $ co ta) N rJ1o ri $6l co sfN c.l oo $o c.l o o O q) q) () v o q) cC lEL^CB .I-0 EY > evGtEsE! E.E E iE2ir U o<u ZU E,L*. -i ddd o o "l o o o o o o o o o o o o o o o o o o o .l o o o o o o o o o o o o o o o o o o o o o s@ $lr) o (t) @ (O @ Ntr) or, N N rr) o rO F- O(o(o ft1o(o F t.n !t N rr) rr) o rr) rr) N 1r)(o .t$ 1r)lf) rlo)N o q) () -oo\ f.) € O q) 4)I CB() Otr .tE =6tzz U U-a Q ? U +o 'i. @o $@ F.- rr) N|r) olr) N .q (f) (o o, o, o lo (o @ @@ @ NN NN o @ * @ ro o, (oN lo N @ (o o |f, lr, v t (o (o .t $ lr, lf) rr) lr) lr) lr) O @ @ lf) lo F- F.- o(o o(D d * U ?dE IL+-l:: 6l 0 o() 0 o (,) !Eo) 3Ctzf, U- o F (o lr) $ @ s lo rr, rr) @ rf) F- a(o (€ oo m cd C) U 0) U cB o C) n cd th C) o (n (o ' o o -o (, C) (!a o (,)F Fl F F oo -] o E (! e s c.l () o z st al (-) o o o o -\r I B o B o Eo o * o \l o\ o_ a q b o s e ; %q q) Qq) .S q > \. \ o i q) 4 q) s o d C) c) a. F U o ar7 C) () o ,E(ir '(,() (0 oo (s LF riir 6)l -ol(glFI o\ o\ oo s co rrl Ol@ o o Table 7: Type of training undertaken (Tick the boxes where spectfic training was carried out during the reporting period) Any other comments! 2.6. Treatments 2.6.1. Treatment figure If the project is not achieving 100oh geographical coverage and a minimum of T5Yotherapeutic coverage or the coverage rate is fluctuating, state the reasons and the plans being made to remedy this ' Kaffa has achieved 100% geographic and 77yo and therapeutic coverage. Trainees Type Of training CDDs Other Community 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 (specifu) l0 WHO/APOC, 24 November 2004 t C-l 0) -o o o z + c.l O J 5 g (€ P() 0) 'a L(tA 0)L0)6- 99o(J.= 'AA kv 0-) rrl !d HAE-o U>0) - t-Io()= .=ocE a 6trcB Fb =c)c)Po'E )tr ot trC) ol =E -l H6 "l 3J. El ,-,8- El'E c- el E ^ alC ot ; ()l 0.) ol =l g _81 * el "l ; =l * xl pI r ,:IE f;I!l .;- =l c elsl; El; el8t.e El I Et81H 8lE 8l(*l = q.l = ql olo- oltr ol rlO rlA pla)lo- C)lc C)l -ol -ol _ .oltrl d trl cd trl JI -o =l o flzl- zlt- zl alol o0 cdlLI 6Jl el C'J 3l -clol(dl LI bo ol ol od sl (Bl ,rl '.=lil c.)l o.t cdlLI ol -ct 00 .gt =lol EI ol :l €l dt EILI olt!l q v) uq) S q o P E ! q)q 5 ido L (! o cd C)L cd c0 J o L C) 'o 'o(r) g.l a 1' (o C) cd o L<F ddr orl -ol(dl FI () dL qJ bo(U c) oo IJF () (B (.) b0 Cd C) ooE^ o.- CB 00 ooo () cd!() bod() oo(.) - 0) o-(dko F o ;=E ded^ 9(;9 E#E "Ezd9.5A o o o o o o o O o o o o o "v.s8^; tr o o iH = c > o< ; @P >a o o o o o o o o o o o o o LE Oo t= -8 EE PE32E :8_Eg r- € + a.) o\oN € c.) c.l $ o\o 00 o c.l\o No) F.l @ 9g =cEO \o ca o\r- ra) c.lo a.l s a.l\o F- o oo aa h oo c.l a.l c.l\lt.- \o o\s(\ o N c.l €\o Nr- c\ ro(\t o F{ a! cl ol dl =lOJ ol o-l Oa 9?dHS x o;-ll \f AX,{A o@ Olr\ o(o @r\ Olr\ OlN OrN otN ft')(o @r\ otr\ rO(n6 x ct a oa)Ea=rhU z 6-E o F- c.lo ao o\ €\o 00 t-- =f No c..l a.) co oo o\N N oo a.t o\ aor- oor- t-- o\t-\o o\ h\o \o oo\o\o a.t € \o \o No rr) Nr\N co 6 E: =86 =u:iti5 r.o fi') @Not-l <tr\ OlOl(o on(o (O Ol Fl @ €o(o on F{ r\ Oloo co (o @6l r-{(\l F{ cOtN OrN (^o F{tn @(o (n @N cn @ or\ lJ)r\ rn @oN r-{(^o st(o Olo !-l @ ob -oYEE> 3 ag E8- g F= OH !f, € c{ oo\o + c- @ I C'l sf c.l t-- N\orr co t- \o o\r-\o o\ o\ \t\o € o\N F-\tO o\\o <f c-t a-.r\ (o oN(r1 r-.,|O Ei a& = o E E] EIolUI E 9O =d;DH 6I >-[ \ r\ v 6\ A A Oo E O E g E g O oo o oo oo F{ , OE =EOsEd!r?g =Ed = o @i o\ N NN + c.l +a{ c.t a.l € r- $ \o oo C.l \o o\N Or- N N ca ca NN Ln N EO d E: =dF<ao o\ C\ (\ N $ ca +N c.l c.l oo t-- s \o oo N \o o,N or-N N ca co (\ N rn N Po * a a= -m^o-^q d ;E eX= o d c O -F >= tr Y dH o\oN (..lN =lc-l $N c.t N oo t-- + ra)\o ao C..t \o o\N F-(\ c'lc.tc.t NNrnN 9V o .b! (g o o (l, b0 ca d C) (J G, c) Q (q oo t-.1 (, t) o (! (g B C) o -o (, q) 6a o o)F 6l oF $O c.l Lo Eo o z <f(..l o o > c\ () q) t- I q,) q) o E-}. .gH o'-o Bi 15: (.)F8trseg I o-r EE Eq)o)boE(! oc) oo (, ('l ctX Q)rE= ri Cllfit .,o),=LE trQo hr' o'- F ud' \o at i o (.) vo c) U)(d C) o. L o o. bo 1i o. C) (/, bo L IJ.] a C'1 O) 0) o v1 o a,(d (h tr o(h(: o ah() C) o (B o (n o C) 'd L o oq cldo (n o C,) € - C) U) -o(o olr(!gE! Pq)O .lJ G -rr 'I\-=(.) -r o.R af Eg rJtr .93 <g i6. a= 2l)vL; sa EoEo'e2 €r= E ->-G,O 6.rc N o fr.= d Yo >g =.=rY>E6aOo =tr (\! oq :o '* 'E'r: .=Y !l= L ..E U' E €AE EE E?:=3 '5h 9,7d cn .oD 60 a oo o! aA = trE.eo Ff.;3 --AqJ, iT E E iTEiV> t e 1'";1cEJ E-s<Gl>:T'Eca0q)caq,, ?- o E.E-:;+ f E:fiE e? - 5€ oeo 9- 0rt,5 c)L:-O-'Eq)6rc)a:u-r;o IE= E!Ei -YrOsE O 'E ': cB o -. c)lJd 9 a6l (\ U \JA -o os A I € o E .h(a oIA(t) d €o(B .4. 'otro.= 'Es Qql 5! e^ AJ -_9i5 l: r- 7) ariEE = A .? g- Q E.N 9 = :P_= Ei O.J !wo o X+E r< += ,Qr<< )G.c I IL€.* ^'- ^ sY jt oo ir-f\39,eY s g€ i9 ooa It.tr .g f,o C= tr-t- F= orlG.o o s) !kE'- -Eb e y?ia o-= o) -.!€ELr-c) .l 9.E.8900< 6l (, F (tr oLd (-) c) 'a H o. (.) (n(E o)r (.) E(.) C) IL() o. oa c.) o(! o) C) -o o (.) o. o o. C) -o E or- olol -tC)t>xl 8El '= cdlx9l Eq)l()oltrol .5 C)lar oi9el r- el 'sl =ol:v -otEEIc3l<zl t () C) c5 -(,F yO o\ I \ f o. C)L o C) <r1 ado r! a oz il TI:l <f c-l L() -o 0) o z +N O - o co G q) a .c! V C) cl oQ o q) a) o ar) ol q) gl o c! c! q) a I .c! cq v 0) c!(, oq) .YN EG()!E ;id;Vo.o= os!>. -=qDD 6l: tr61 TIi F o GI (') c! <) o a06 (') () l- c! q) ci c)OE v)!cqEe tA0qE 9u) og9= h3ld orl .ol = r<lu@l >\ -t clt =l c) :lt d -el E(gl 0) -t o .6lE 9ry U!()L Orr o rh EF 9q) c):tr q,) id cgai9 - ,E' o'l .()l u) =l cEHIFI cr o dt) d rt (l) V >a F Orc>o9 o \o\o o\6 o\ 6lo\ r-o\ to\ o\ rao\ o\o\ \oo\ trlol (Bl o-toltul 8 lt r.l Ii t: o ol)6ou^Faro'< 59 \ot- o\r- rAt'- ?a)o\ 6lo\ t-o\ to\ (t)o\ r.rto\ o\o\ \oo\ L) ll- e r-I .9 9? ooqd agLOe iGL Xc' \o FT \o rA rar- €r.- r-F. ar- o\r- rI) € o\tr Frr- r{ o 6o iq do !azo. o\ (.) ?a)6l r- al \o ra tal € r- 6t!+\o 6\o r- \o\o FT Fr 6t- 6 ao 6r-t- r 6 r rI,(t(, lO @ o\r- o\i al o\ @ rf) N c.i(o O) o ro r{l'. rd co =*u= o'Fti5 tr o\ al \o rA GI tc iA\o ?t ta rA o\ \o N i FT6 F. t- ra6 66 6 m d o\a € c, C')(Dt o, lO CD (, N(v) c.i o) tn(o or o a aa rEe o=O P:: c <trE5 96E 8g EE .F o.:il tr o El r- €\o alo o\ o\\o 6 cl o\ =!f, ra ra o\ 6 o\ 6 o\ o\r-\o o al \o 6l r €|ar @t (Y)$ ?or-6l \o tot- r,l,l) N (O ot.- ci, o- () bos .9 .= E E oO t (,lt- lI1EI o oo oE^F iro< 3e) o oo oo o co oo oo iioE i:6rbD !r .-i ,E= 5al,;l, o o<./llE ra t\o o t oo e oo f-l ^O LEoo = b0- =ii>aiz6>}J i o\t 66 FT F. F- .l r.) r-t.-(\I t-t- al t-, r-t- GI tr) \o alt- 6to(O 6.) aloal f.) GI6lGI(.) t\rr rA6t r.] EOa> =EE o'RiE6 t o\!c 6 €o 6l r-t-6l r-F. al ?n r-rr al F-t-6l c) \o GilF- No(o(v) f.fo6lf') al6l6l(.l 6lr-ta G{ oOO, dL =qI hg8= U o'E 9. + J tr'= --FarEd =i o: E !E -e O a C-=F o.= oE r- F- a{ r-r- cil(r) r-r- .* r- t-- FI ?al ttrt- al ra', t-r- a.l \o alr- c) No(O .,, GI t\ at GI al ttl GI t-- raFI & sH at aleo al {r) o ar ! al rao cl \o a N r-ooN 6o al o\ t\ o o6l oal 2.7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - Qtlease tick the appropriate answer) MOH M WHOtr UIIICEil Other (please specifu) Mectizan@ delivered by - Qtlease tick the appropriate ansuer) MOH M WHOtr UMCEil NGDC NGDC Other (please specify) Please describe how Mectizan@ is ordered and how it gets to the communities The NOTF requests Mectizan from MDP. After the diug reaches the country it follows the existing drug and other medical equipment delivery system of FMoH. Then the drug is stored in FMoH store from which projects zone receives. From the zone the Woredas receive and distribute to the frontline health facilities. It is from the frontline health facilities that the community supervisors get the drug and handover to the CDDs making it ready for commun ity distri bution. Table l0: Mectizan@ Inventory (please add more rows if necessary) How are the remaining ivermectin tablets collected and where are they kept? At the end of the treatment period, the CDDs return the remaining irug to Hps and the HEWs to the HCs which are the front line health facilities. The front line health facilities,in turn, send to the Woreda health offices and finally from there to the zone health department. Hence, the remaining Mectizan is kept at the ZHD store. But sometimes there are woredas and Front Line Health Facilities which keep the remaining drugs in their store as they are remote and transporting the left over Mectizan to the zone is sodifficult for them during rainy seasons. List and briefly describe the activities under ivermectin delivery that are being carried out by health care personnel in the project area. . Training of HWs, community supervisors and CDDs . Woreda health offices collect Ivermectin from the Zone ' Frontline health facilities collect Ivermectin from the woHos . HEWs receive Mectizan from FLHFs ' cDDs get their Ivermectin from Hps and distribute to the community . Supervision and follow up . Recording and reporting . Return the left over Mectizan CDDs >Hp > HCIWoHO>ZHD District/LGA Number of Mectizano teblets Remaining from 2fi) Requested 2010 Rcceived (available) Used Wrasted Transferred to Remaining Kaffa 166,014 2,099,500 2,254,514 2,060,079 3985 59,000 131,446 Total 166,014 2,099,500 2,254,514 2,060,079 3985 i 59,.ooo 131,446 t4 WHO/APOC, 24 November 2004 ! D 2.A. Gommunity self-monitoring and Stakeholders Meeting Has any training of trainers(TOT) for community self-monitoring been done in the project area? If so, When? Training was not conducted. self-mon and Stakeholders Meet 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. . Training was not conducted on SCM and SHM 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? . Ownership of the program by the health workers is not seen . CDDs were not properly trained ' Village registers updating is lacking . WoHOs did not conduct continuous and regular supportive supervision. . Woreda level and front line HF reports were not coherent 2.9.3. Was a supervision checklist used? Yes 2.9.4. What were the outcomes at each level of CDTI implementation supervision? . Review meeting conducted at woreda level. . Village register updating training was carried on . Reports were compiled during the review meeting session 2.9.5. Was feedback given to the person or groups supervised? Yes - at the spot during review meting time. 2.9.6. How was the feedback used to improve the overall performance of the project? It is to be seen in 2012 Mectizan distribution period No of Communrtres that carried out self monltorrne (CSM) No of Communrtres that conducted stakeholders meetrng (SHM) Drstnct/ LGA Total # of communrtres/vrllages rn the entlre prolect area 44vq Bitta Bonga town Chena 0 0 0 0 34 82 324 202 225 0Cheta 0 0 0 0 0 0 0 Decha 417 Ggshq Gewata Gimbo 165 218 296 0 0 0 Saylem 270 0 0 0 0 0 0 Tello 332 0 0Total 2572 0 l5 WHO/APOC, 24 November 2004 SEGTION 3: Support to GDTI 3.1. Equipment Table 12: Status of equipme nt (p rease add ntore rows if necessary) *Condition of the WO:Worn off). equipment (F:Functional, CNFR :currently non-functional but repairable, How does the project intend to maintain and replace existing equipment and other materials? Government budget is used to maintain existing equipments and other materials.Replacement is also done by the government and other NGDOs such as The Carter Center,WHO and UNICEF. Source Type of equlpment APOC MOH** NGDO No Condrtion No Condrtron N o Conditi on No Condrtlon No Condrtr on Tovota Hrlux 4W pickup 1 INF 2 F Motor 3 wo 0Motor 5 NF 5 F I NF 1 NF I F 0 Fax 1 INF I F 0 VCR 0 ones 0 0 0 Video 0 0 1 NF I F 0 1 NF I F 0 1 NF 0 1 wo 0w 1 NF 0Overhead 0 0 Portable electric generator 1 NF 0 l6 WHO/APOC, 24 November 2004 Photocopier Stensil Desiner Desk top computer Radio communication 3.2. Financial contributions of the partners and communities Table l3: Financial contributions by all partners for the last three years MOH contribution is for Focal person's salary- ond running cost. lf there are problems with release of counterpart funds, how were they addressed - APOC's fund reached late. Trainings and review meetings were conducted by the budget allocated from The Carter Center/Ethiopia and the Government. Describe (indicate forms of in-kind contributions of communities if any) . The community leaders and elders do waste much of their time in mobilizing the community during the Mectizan distribution period. Some times the community members do assist CDDs in their farm. 184 0 Contributor Year 8 ('2008) Year 9 ('2009) Yearl0 ('2010) Year l1 ('201 l) TOTAL Cash Budgeted (US$) TOTAL Cash Released (us$) TOTAL Cash Budgeted (us$) TOTAL Cash Budgeted (us$) TOTAL Cash Released (US$) TOTAL Cash Budgeted (US$) TOTAL Cash Budgeted (US$) TOTAL Cash Released (us$) MOH (Central + State)* DNA DNA DNA DNA DNA DNA DNA DNA MOH (District + zone)* 299s.00 27255.00 27255.00 2995.00 88,447.76 88.447.76 47,851.8L 47,857.87 Local NGDo(s) ( if any) 0 DNA DNA DNA DNA DNA DNA DNA NCDO partners(TCC) 38346.00 72920.00 72920.00 38346.00 39,077.08 39,077.08 5,r84 Communities* 0 0 0 0 0 0 0 APOC Trust Fund 7200.00 0 0 7200.00 0 0 62757.97 43679.92 TOTAL 75496.00 100175.0 0 100175.0 0 75496.00 I10,324.88 I10,324.88 175,793.72 95,775.73 t7 WHO/APOC, 24 November 2004 ! N\N@(o(9 o, o)(e (f) c! N @o sc! N lo_ N (\l ril(\ N\N@(0 (f) N\(\t @(0(, I I v a @$ CO O) o, a o, o,(o(o o) a(D o) aY)(9 o oq NF- (f) g, llo-SE B (E oF (, o o otr oN (! tr .9 t!z Eo o ,C,,t =o o tr o E o o o E" ; o o o G Eo g, Il .9t I (U o oN o(\t oN o(\t oN oGToN o(\ oN oN oN oot o(\ o(\t oNo(\ o(\ o$t luJ =Jl- tu(, of @ IC Go io osEO .N dE Ts\ G.SEQ O.E Aoooo =i 5€{$oo tr o G .N lt o = E o t! .N oc oo .i o(! o o E' "i o t!(, 3Eo (! o t G o Ia5 .4 lo EI' .E .E(E o El)tr .'E I 6i g6F(J o E" .-tr .9n Eggi r E! rE$ G o tast4 c o tDtoaS c4 o GS g l{ o (9 tr .9 lcDlc L o =tr o = a-.i (v) Itr o (l, a! IJJ c,i (v, Itr oo E 3 .g otr a(v, G o aa5q o o oto o co ooo G P .sE e€gs IS o o o o Eo E G .E C'o-Eo o= .:.d .'tr +.9t, oOo 'g'5 o-N IE|!Y lE GY G GY lE r!Y (! GY l! GY IE(! Y lE t!Y (E GY (! (!Y (E (E Y (! GY (E GY G (l,Y t! l!Y G oY (! (E Y l! lEY btso :rts olt,tJz (! CL o LlJ r! CL o E uJ (! CL o UJ .E CL .9t IIJ a! CL .9 UJ (E CL o -ci uJl G CL o UJ l! o. o UJ G EL o lrJ G CL .9t trJ .g CL o -cl uJl .ll CL o UJ (, CL o UJ .g CL o uJt .E CL o -cl url G, CL o I! G CL o UJ E co o) c.i oq oo 05(o o, t(oa(o F-(r) o ooo(, z alu t( o Lro a. bo tr o (.) Lr C) bo L o 0) (,) t) >\ o o(n o l< .o oq(r) o() 'a tr o. o (.) o o(!(.) #r -l()l -oldlFI E o 0.) b0 U) ch Ld o! a q) '13 C) a.x 0) o E(c C) (.) L -.:0) v) >. o o(s(.) k .o o Ho a. oo L oq q) l-r C) bo tr '(, 'o C) (.) P.X o) o + o -od 0) o c.l v?l \ol il 0 r tr({(I o r()o 9(f, o, I I Ij IJ # t- .I *t(, G L oc oL =a:! E og x uJ 1 0r) a t6 $ a co\t ec o) SECTION 4: Sustainability of GDT! 4.1. !nternall 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 I Participatory Independent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation Im pact assessment was done in 20ll 4.1.2. What were the recommendations - not yet delivered How have they been implemented?4.1.3 4.2. 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? Yes When was the sustainability plan submitted? on the 3'd and 5th years What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.2.1. Planning at all relevant levels - Yearly integrated plan is prepared including CDTI at all levels and all health activities do share funds allocated from the government and other NGDOs 4.2.2. Funds - The government, NGDO and APOC are allocating budget for the integrated health activities including CDTI. 4.2.3 Transport(replacementandmaintenance) - The government APOC and NGDOs are replacing and maintaining Vehicles and motor cycles to be used for integrated heath services including CDTI. 4.2.4. Other resources - The government does get additional resources from WHO and LINICEF to execute all integrated health activities including CDTI. 4.2.5. To what extent has the plan been implemented - The plan is fully implemented yearly in an integrated manner including CDTI. 19 WHO/APOC, 24 November 2004 4.3.1. Ivermectindetiverymechanisms Since the inception of the project, Ivermectin delivery has been fully integrated into the existing PHC drug delivery system of the country 4.3.2. Training: CDTI trainings are integrated with the Primary Health Care (pHC) program from thebeginning at National, Regional, zonal, wored-a and HF tevels. Disease Prevention and Health Promotion core process is responsible for the CDTIprogram. Therefore, all the staff who are responsible at Zone, woredas and FLHWslevel have received CDTI trainings 4.3.3. Joint supervision and monitoring with other programs As part of the system in the country, all suf,ervision andmo"nitoring activities are donejointly on integrated manner for all health piog.u- assisted by checflist. 4.3.4. Release of funds for project activities The 2011 Mectizan treatment ictivities were accomplished by the fund released fromThe Carter Center Ethiopia and MOH. As usual ApOC's fund has arrived after allCDTI activities were accomplished 4.3.5. Is CDTI included in the pHC budgetr o Itemized budget for Dp&Hp includes CDTI too 4'3'6 Describe other health programme that is using the CDTI structure and howthis was achieved. what have been the achievement-s? ' Campaigns such as malaria prevention, Polio eradication, T, Measles vaccinations and EOS do use the CDTI structure. CDDs are always involved in these activities and the achievements are very remarkable 4.3.7. Describe others issues considered in the integration of cDTI. 4.4. Operational research 4'4'l' Summarize in not more than one half of a page the operational research undertaken in the project area within ttre repoitirg p.iird. Epidemiological evaluation of onchocerciaisis transmission was conducled. But the data analysisand results of the study is not yet releasedl 4.4.2. How were the results applied in the project? Nor yer applied sEGT!oN 5: strengths, weaknesses, chaileng€sr and opportunities Strengths: 4.3. lntegration outline the extent of integration of CDTI into the PHC structure and the plans for completeintegration: All CDTI activities are integrated into pHC o Mectizan delivery o Trainings o Distribution o Supervision o Review meetings 20 WHO/APOC, 24 November 2004 . Geographic coverage- 100%o . High therapeutic (77%)and (96%)TUG coverage Weaknesses: ' Continuous and regular Supportive supervision is lacking at WoHO and HF levels . Number of Absentees and Refusals is still high . Woreda and Kebele level reports were found incompatible . Village registers were not properly updated . Ownership of the program is weak - by health workers Opportunities: o Accelerated expansion of PHC to village level. o Assignment of HEWs to kebele level. o Establishment of Health Development Plan Threats (Challenges): o Overlapping of other emergency programs during Mectizan distribution period o Work overload to health staff SEGTION 6: Unique features of the project/other matters o APOC's ATR format is so laborious, please try to revise it and make it simple and appropriate . The ZHD has so many reports to deliver to the government and its other partner NGDOs. 21 WHO/APOC, 24 November 2004 The Federal Democratic Republic of Ethiopia Ministry of Health COUNTRYAIOTF: ETHIOPIA Pro Name: Sheka Approval vear: 2000 Launchins yearz 2001 ReportinsPeriod: From: J,enU.?.ty..ZgJ.t. ......... To ;.....Dp.c.e.m.b.e.r, ?.0. 1.1.... n Month/Y Proiect vear of this report: (circle one) I 2 3 4 5 6 7 8 910 I Date submitted: 30 Janu ary 2012 NGDO partner: The Carter Center ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) DEADLINE FOR SUBMISSION: To APoc Management by 3l Januarv for March rcc meeting To APoc Management by 3l July for September TCC meeting AFRICANPROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) i Ta I I _i u*'l r\ i '- , i!' ,/(/ ,,\ i + 2Z ,*grE_lI J WHO/APOC, 24 November 2004 .L.i 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: Ethiooia National Coordinator Name: M.ihs.t.Hi.luf Signature Date Zo nal O ncho C o ordinato r Name : A.dam.u..Aypnq.\y Signature Date NGDO Representative Name: .........Dt,.Zstihsn.Iadp.s.sg... Signature Date: This report has been prepared by Name : ....Adam.u.Ay.s.new.... Designation : Zone Onchocerciasis Coordinator Signature: Date ll 2:5 WHO/APOC, 24 November 2004 I I I I I I sANNUAL 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 Ethiop ta National Coordinator Name: M.ihr.ql.H.iLq.f S ignature :,.:tr[.T&h. * Date .....]-il.d I\Iihret Hiluf Nigfssic (RN, BSc, MPH)I zul 1- f-.tvu rti. riln' Health Pronotion Prevention ahd Disrase "Director '.il a., i Zonal Oncho Co o rd inator Name : A..damu..A>rsn.e. ril Signature Date: 'ii -! 't I .i : ,-s ." i, ', -il -r," l. ' l,li N Name i I I ! I I : I ! I I I I i I I ! ! I I ThiS report Signature: C". Date: . ?{lpa l+p r+ by Name : ....Adam.u.Ay.e.np.w........ Des ign ati o n'. Zone Oncho cerciasis Coordinator Signature: Date 2 tt *t' ll WHO/APOC, 24 November 2004 d }.t1 eoa.
Table of contents ACRONYMS... DEFINITIONS ry FOLLOW UP ON TCC RECOMMENDATIONS... ExEcurrvp SuuuaRy SECTION l: BACKGROUND INFORMATION l.l. GeNenalTNFoRMATToN............... 1.2. Popu1erroN............... SECTION 2: IMPLEMENTATION OF CDTI 2.1. TruelrNe oF ACTIvruES.............. ...................... 62.2. Aovocacy ...................62.3. MostltznttoN, sENSITIZATIoN AND HEALTH EDUCATIoN oF AT RISK coMMuNrnEs.. 6 CouuuNrry rNVoLvEMENT............ ......,....72.5. Cnpaclry BUTLDTNG ........................ g 2.6. TRparvpNrs................ 2.7. ORDERING, SToRAGE AND DELIvERY oF IVERMECTIN2,8. CouuuNITY SELF-MoNIToRING nNo SrerceHoLDERS MpprINc...... . TRnrrurruc wAS Nor coNDUCTED oN SCM %SHM...............2.9. SuppRvrsroN. SECTION 3: SUPPORT TO CDTI........ 3.1. EeurpueNr 3.2. FrNaNcraL coNTRTBUTToNS oF THE pARTNERS AND coMMUNrrrES3.4, ExpeNoITuRE PER ACTIVITY SECTION 4: SUSTAINABILITY OF CDTI. 4.1. IurpRNeL; TNDEpENDENT pARTrcrpAToRy MoNrroRrNG;EvaluntroN .............4.2. SustatNaulrry oF pRoJECTS: pLAN AND sET TARGETs (vaNoeroRy AT yn 3)4.3. INrpcRarroN............... 4.4. OpenerroNAl RESEARCH SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AND OPPORTUNITIES .uz+ ....21 4 WHO/APOC, 24 November 2004 V I 2 3 3 5 6 SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS lll .10 t4 ..... t4 .....15 ..... l5 t6 t7 l8 Acronyms APOC ATO AtrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT UNICEF TUC wHo African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Commun ity-Based Organization Commun ity-Directed Distributor Community-Directed Treatment with Ivermectin Community 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 2.f WHO/APOC, 24 November 2004lv Definitions (i) ( ii) ( iii) (iv) (v) ("i) (vii) (viii) (ix) Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). Eligible population: calculated as 84o/o of the total population in meso/hyper- endemic communities in the project area. Annual Treatment objective: (ATo): the estimated number of persons living in meso/hyper-endemic areas that a CDTI project intends to treat with ivermecti; in a given year. Ultimate Treatment Goal (UTG): calculated as the maximum number of people to be treated annually in meso/hyper 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 jd year ofthe project). Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). Geograohical coverage: number of communities treated in a given year over the total number of mesolhyper-endemic communities as identified bv REMO in the project area (this should be expressed as a percentage). Inteeration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) through GDTI (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 CDTL Sustainability: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable fi:ture, with high treatment coverage, integrated into the available healthcare service, wiitr strong .o.nrrnity ownership, using resources mobilised by the community and the government. community self-monitoring (csM): The process by which the community is empowered to oversee and monitor the performance of CDTI (or any co.runity- based health intervention programme), with a view to ensuiing that the programme is being executed in the way intended. It encourages the communityto take full responsibility of ivermectin distribution and make appropriate modifi cations when necessary. 4 WHO/APOC, 24 November 2004 FOLLOW UP ON TGG REGOMMENDATIONS TCC session Number of Recommendati on in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY I Train more CDDs; The number of CDDs is increased in 201I and more will be done in2012 2 Retrain all involved in CDTI on record keeping HEWs and HWs were trained in record keeping in 201I and we hope to see the changes in 2012 J Explain how CSM was done without training CSM was not done 4 Operational research on challenges; Due to shortage of fund and other competing activities operational research is not carried out in 201 t. However, will try to conduct in the future 5 Reduce number of wasted and expired drugs; Measures were taken by the WoHOs and ZHD to minimize drug wastage. However, due to delay of Mectizan shipment drug distribution was conducted during the rainy season. As a result the efforts made to minimize drug wastage was not very much successful. More efforts will be exerted to improve the situation in 2012. 6 Conduct sustainability evaluation and prepare sustainability plan. If this has not been done already. This has been done already t WHO/APOC, 24 November 2004 2-?- Executive Summary . Background on treatment and population data Community Directed Treatment with Ivermectin (CDTI) has been successfully implemented in Sheka zone of South Nations Nationalities and Peoples Region (SNNPR) since May 2001. Sheka CDTI project is divided into 3 woredas and 2 administrative towns ( Masha and Teppi) which were previously part of Masha and Yeki woredas respectively. The project has achieved a geographic coverage of 100% and the consecutive therapeutic coverage of the project is so remarkable and is indicated below. Tablel. Treatments and coverage by calendar year for the kaffa CDTI entire project area. YEAR Total populatron of the meso/hyper-endemlc areas Annual Treatment Oblectrve Number of persons treated Thirapeutrque coverage (V:o) ATO covenge (%o) UTG Coverage (%) 200 l 902,687 306.297 233,309 26 76 3l 2002 928,691 654,250 5t6,2t7 56 79 66 2003 9s5,443 955,443 7 t8,241 75 75 89 2004 981,198 824,206 768,642 78 93 93 2005 1,020,679 857,370 787,766 77 92 92 2006 l,012,6ll 810,088 778, I 88 77 96 96 2007 t,075607 899325 843373 79 94 94 2008 11437 48 9t4998 85333 I 75 93 93 2009 lt6t273 975469 924979 79.6 94.6 94.6 z0t0 1215404 972323 962256 79 99 99 20tt 2l9,4tt t75,520 166,474 76 95 95 Background on population movements. The communities at Sheka zone are mainly settled farmers, daily laborers, civil servants, tea and coffee plantation workers. Yearly many people from all over the country come to pick coffee and tea to these zones.. The new influx usually does increase the number of population during Mectizan drstnbuuoo yearly. Challenges and how they were overcome Threats (Challenges) o Lack of continuous supportive supervision at all levels using checklists Woreda health office(woHo) . The HP and WoHO reports were not coherent to each other . High number of absentees and refusals ' Delayed Mectizan distribution period due to Impact assessment done by APOC To solve this problem the following measures were taken:- ' Discussion was carried on with the WoHOs so that continuous and regular supportive supervision could be carried on r Reports were compiled during woreda level review meetings based on village registers.r Woreda level review meeting was conducted to improve the challenges observed in 201I WHO/APOC, 24 November 2004 28 2 SEGTION {: Background information 1.1. General information 1.1.1 Description of the project Geographic location, topography, climate A. Sheka Zone Masha, the capital of Sheka zone is located 680 kms from Addis Ababa situated in the South Western part of the country. The zone's boundaries are Illubaborzone in the north and west, Bench NIaji zone in the south,Kaffa zone in the east and Gambella region in the south east. The total surface area of the zone is 2175.26 sq. kms and its annual rainfall, ranges from 1000-2200 mms. Agnculrure rs the backbone of the zone's economy Population: activities, cultures, language The communities in CDTI area are mainly settled farmers Settlement of the population is92.3Vo rural and 7.7%o urban dwellers comprises government employees, merchants, daily laborers, and tea and coffee plantation workers. A large number of daily laborers migrate to the Coffee and Tea plantation investment farms yearly and this causes population increase during Mectizan distribution session. The languages of the community is Shakinono, and some of the people speak Oromifa. Amharic and other languages of the country. The official language is Amharic which is also the national language of the country. Communication system lheka: - There is road communication to the 5 woreda capitals throughout the year. Telecommunication- wireless telephone line and network access is available too Ad ministrative Structu res Sheka: - Has three rural and two urban districts Table 2. Total health workers and the health workers involved in the CDTI includes HEWs and WHO/APOC. 24 November 2004 zI3 Number of health staff involved in CDTI activities.District Tota! Number of health staff in the entire project area Bt B, Number of health stalf involved in CDTI Percentage B.=Brl B' *100 Andracha 77 41 57.7 Masha 7L 45 63.4 Masha Town 35 11 31.4 Tepi 72 10 13.9 Yeki 52 42 80.8 Total 301 L49 49.5 1.1.2. Partnership There is strong partnership which helps the Sheka CDTI projects for its best achievement and gradually ensures its sustainability. The main partners involved are Federal Ministry of Health, Regional Health Bureaus, Zone and Woreda Health Departments, Administration, Education, Agriculture, Finance, the community, The Carter Center Ethiopia and wHo (ApoC). The FMoH, The Carter Center Ethiopia and APOC are involved in planning, Supervision and in providing financial and technical support. The ZHD and Woreda health Offices are involved in training, community mobilization, supervision, monitoring and evaluation of the CDTI activities. FLHF do implement the CDTI activities and supervise the health posts. The community is involved in supporting the CDTI activity by recruiting CDDs, as well as in fixing the Mectizan treatment dates and sites. WHO/APOC, 24 November 2004 3d4 s 6l o -o Eo o z$al O (J > a E o (') a bo L -o oo o (..I I C\ o q1 a oo o () o ct) C) E 0) o ho (g lr) C) U)(! o U) q) oo(u o ar1 C) CdUG'OL-CdF oc)()e '= 0) a.F 0) t;lol6) lcloILlo- Ilo) l€l'olcldl€lalbl! '6 o.96 o=gB t.=thE LfrC)' .= o)(J bo ,(Bt-I.-t:lot- lcl= NE 11tr C)t!le laI 6.)l=IJl.=lel6lcIOl(Jt-lcgl-EI> lo-, (') L1,(E .o.t oi ,. bo(B t- l>l-lolalct,A,E a) l-g5 dF !o) EgzF .. bo C) .LOa =)oc)(,H 9.. (! *r I I I I 'l t) !) ! o Lo o- oo'o.ltr> PE[i o-r ()(d -ooo.q !s 6)(iq! €E o(*oo 'd aras ol +(, p() avl 3E 8E c!, l"frzB= 0) L L o E(.) C)L 0)L L 0) o c!q) Cg qJ c) q) 6) q) tr iZ ch (t o (! ! (n ahq) E E O tr o I r! fc or N F oz I q s a FD ( oE .i6 =o NNooN sl ri ao Ol(\ sl @@ r.D @Ol@aN (o o <f @Ol Ol(\ tn rriNFl S< 'Ei !tE< t 8 $ cOO ra) c.l c\ .{F\o\o a.) ral \o oo cON \o N F- c.t(\ r.l ti <f ot r< N -9. '= .:E Ee9 =r!.stg E Ol(O(\ st Fl (o @@o(\ rno ott oOl@ <f F.l <t r'{Fior\ sl(o o rJ.)N r-.1 OCNg EQ!:q EO 6aAo 2. -= \o r-o \o t-- o t- ca ca coN ca o\ oo(..l r) N <t fO st Ol n 6Ad ol =lEI rl .$ EI zl E 3< >.9 +* -= E<s;: rr FEEa \o oo c.t r- co la) \f, $ co o)(n(o 'a .:E E €-E tgriE F;. Ol sf rnN r-{N ro(\ slOr ri Ln(o(o a SE Ca\q EO AoAoit 2.= Nfn (O rn (o F{ Ol r< (o <f r-{ <ll\(\ C .:Ea =i E.iE 3c IFO.=tr s aa tr) c\l c.ls\o\o aO r.r) \o oo ca6l \o c.I r-oO c.l o.l Fl r{ =lOl r-{ N 0 '= .9 o. L FC oo9 U= 6 o(! E (! t't c, 2 tr BoF(! (n(€ z 'a oF ! C) F B,iI LC(.)gi AU) ;q) >=LE 8"9 J<a_ -9arC €A L- J^ L9E(d!o(J'o ^c)crt aL*a)= -sz d!oUF ? -E dJ a-o FoO -Eo, J()::J F!vE .== = ts>E EaEE2.L-€o s'Eo H= .Y EE6 ()Xe9LE() s >rC)iu .E€ rF=oo E: ,,-A .E s'Eg ^^9iE E": J '7-c,9E $EF - o-<U = >r ho!i -O c'qE $:AJ -?E EEI,.T - (E-J- G E 99uiE E:iElJ tB='r, 'E ar4 oG E9:NVEH .ae-.Yfi (;E - >= l- -!Po *.'a .2O .Y cE - a! ii.lJtr .N H.Eo E 9.':E f o.rXS E gF = .D;.eA EO=o =o pE EU E =E iiVaYrI)JArr, - * *al Cti t o € 'o (g (.) 9=s, L, 'o(!- !Eb ! bo \J L at:v-GG) t-o-:Y UEE)U ^?(EEOE L o(!thtr UgN og& ! .. >\EL()0) !s cd -O9C)c>.O oe)tsEE '!9do.r =9i(J^F .,Lv^A €F> bo'- -iF^E '5;e n Q,esr: E6 bga -itr Etrl(B 9+r >'E *rG) (,F-E 8oa^; TiO(haE=F Ed; 4usx o.=IE€5 oodotr(!E'6 H ,^-o E LraUc)€*> *HE'E'r,EEq.> cPEo=oo 'a 59 ,\\vU ??1J 9'rL\P^ a<.- .=o(B -r-LAF!X= ta O E c.,'iG -! E ,i C)'='O =-oo<d; EEEE EA A( o aiN -qEo!LF . "r OEN =g'rlY-N 6d. N tf, c.l c) -o (.) z + e.t Q { > \o =EEEoOar E 00 L 6t (t) L O O(\ >t C\ N >' N N -d(.) IL (\ -o(,) lL N 0.)l& (\ .oog- N ljq)f! ZE EEoOQE o!E- LE(o .tE N >. a.l o.l N N ON 0) o c.l o c\ o c! 0) O C..l (,) o oI u0 LE!.o U)E a.l (.) Ld c.l oLd z C'l o N o 2 c.l o(! a.t ord 2 c.l o(, z N o d z 6l o z (\ o(! z OI c! E€ OO IJE c.t >' a0 2 e.l (! 2 c.t (l z N d z c.l cO z BD LE cto AE e.t (! 2 a^l <d z, a..t (! z O c.I >t c, z N 2. Ilo l= o o 6t o 2 o =EEEoo l./E N d .ooE. N >. 6 e -oC) c.l x d =L -o(.) lL N 60 aL o N >' tn e -oC) E. o E B! L CE a 6t x d e -oC)l& a.l >' GI =L!() l& c.l (, -o(.) I! (\ (, e -o 6JlJ. C.l >r e -o c)a J .9 A (! o(! -d (! cn(o 2 (B -ctr(d< e? oF Jo L o (.) l- o C) C) d C)L at)(! C) cd C) .o ah o) o(! (H () o E F vl orl -ol(dl FI Fo o {r o tr o .Ifl IE E.uat, L\tr ,=:qr FTrO .rON.5ZE 9,EFF(, lll -g,-ci v $ al Lo -o E 0) o z sf a.l a o o F- q) oco r\Ia Orr{ 6NUXg= 9il(: a.6 ca r-N (\ o@ ri U6 o OH LU EN zc .9 .: Ex OHeu :!Yd .rEEt z >a aa c.l t- ca F- o\ le + =d:i Il Fla <l ot r-.1 t-r\N F{rf) anfn r-l (D(n Ol Fl Ol rn Fl \o c.l $ r-- c..l It- t-- !it(\I ! c E C A oU o z co A HU a ?.kEH EEs 6\o aO\o c! + c\ \oI'* o\ co o r/)fn r{ 90U6 €-ErEdLil-. A.lQle oo \o @ C L E o tr 8U6 8 E o oo ;Pca 7= l> l'E p t:.EIE El; c_ lE0 l-- 6l> GlZe t6 -o !9-zE6 .s 8cE9 Ed =-EE EO8:_ lo E.E 60 lE;;I \o @ oo cO aO oo I'r ca rr ca oo rns tr)s oo $ ca t ca O) 01(.o oo rn Ot rn(o (! o(! L! (g an(! tr Bo (c (n c, z Bo 0.)F ! C) oFI q: q) T\ tR q) Fa q) F IJ O c) an(.) oO I E o E o : o .E =E =E E o(, A Comment on: ' Attendance of female members of the community at health education meetings Even though the female health education attendants are not equal to that of male attendants, their number is increasing from year to year. Female attendants are shy to speak in public and most of the time they are overburdened with so many tasks at home and in farm fields. ' 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 attendance and participation of female members on CDTI discussion during community meeting sessions is less than that of men attendants. Cultural barriers do play a major roll for their low participation. Their participation is rated as fair. . Incentives provided by communities for the CDDs CDDs provide free service to their respective communities. The community members sometimes help the CDDs working on their farms and do supply them coffee drink and food during Mectizane distribution sessions. The woreda health offices and FLHF do assign CDDs to participate in other health campaigns such as Polio eradication, measles, TT and EOS so that some amount of per-diem could be paid for them as an incentive when these campaigns are carried on. Attrition of CDDs. Is attrition a problem for the project? If yes, how is it addressed? I CDD attrition is not a problem .forthe project. If a replacement is needed, it is done immediately and training is given by FLHW at their respective kebele. 2.5. Gapacity building - Describe the adequacy of available knowledgeable manpower at all levels. ' The staff members who have served long time in the project area are having good knowledge and the newly assigned health workers are given training yearly Where frequent transfers of trained staff occur, state what the project is doing, or intends to do, to remedy the situation. (The most importanl issue to describe is what *eosrrr, *ery taken to ensure adequate CDTI implementation where nol enough knowledgeable manpower was qvailable or if staffs are frequently transferred during the course of the campaign). There was no transfer of trained health staff during the Mectizan distribution session 8 WHO/APOC, 24 November 2004 3.r .d- a.l a) -o () o z !f, 6l O o - o\ bo o € o !{ s > o 5 o ! o * !t € C tr B o UtS ,r .. a ; ca co oo ao o\ oo o\ ca ra) ooc.l q) G q I q) z 6 E IL+.F99 ? <U (i-o $o\ c\ € c.l tOl ri t-r('r C.l r\r\(\ r- r-.(-.l lat oo ca aa r_{tn Fl Ol tJ') r< t/) 6 <l r'{ (o o e{ Fl CD u') Fl o q) Q) v (n an r-{ (o(n Ol a, () cl lrl-^6l EY > :FEvv6t zaE! E.E E r= 2zS E'!*= =F999 I c< L,) YF C:EU o o o o o o o o o o o o o o o o o o o o o o o o q) () q) Y 0 o q)() CEq) Otr 9i: E!H =(!Z -n, ?dE IL+.FUU a<9 U. U ?F t-(f) tJ) ct, tI)(e o @(o @(f, o @(f, N (r) ; t- (o (O o (O N$ N$ r,(f) N o on d @6l Fl ri ri ri N Fl rA ci o\ il) q) () o\ d U 6 F Uil+ UU \o o a- c- o * rf, o s + o o Flfn F{(r1 O G o 0() O ()! E() =6tZE I o cr <t $ Fl(r') o o. o)F .Vo -] l'( F o I -oo\ o rl a (! o(d E ta(c B (B (r', (B 2 4q AJ() .S a v i u q) 4 !q) S o cd (.) C) o- E F o(-) qi at) o () c) ,0.) () bo cd F rbl ,l -ol(gl FI (. o4 Trainees Type Of training CDDs Other Community 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 (speciS) Table 7: 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 figure lf the project is not achieving 100%o geographicalcoverage and a minimum of 75%o therapeutic coverage or the coverage rate is fluctuating, state the reasons and the plans being made to remedy this Sheka zone has achieved l00o/o geographic and 83Yo therapeutic coverage where as Kaffa has achieved 100% geographic and 78o/o and therapeutic coverage. l0 WHO/APOC, 24 November 2004 l( +6t q) -o E() z v c.l o B ()E r'1dv;FoD0.)v 'd(o L(l)6AE0)dto(E-c<.l eO ()d'=().=ts 'dno- LV (.) il =d,.= Ito.ln>EU 6L .=o.9tr-oc LE3#E?Eo.g.ioi6o'Ea '==>rF at F -C() ot = d 'O -l ts qtr -l O (JI :l o EE gl : =5 UlE E3r $r st sts;lE fle ;e;13El.= <l a ol f; 'ol e9l oo El= gl Ugl ;EI= ET flFEItr;l= =l E ;l; ;l EEE EIE EEEtEE 8lg g{x4lHa EIE rl8tslEkl (, rl J El ' Ll = "813 -81 - _8lE -81 iEIS EIS EIE EIS =lb =lo =1tr=lozt? zfi- zt< zt? o 6d C) bo(d 0) o o- q) a.(U C) F 6l 6)l bo ctlLIol >t ol ol dlol -clAI CBILI s ol o0 altrl sl !l dlOI ctlLIol -cl ;J trl ol EI ol :l €l .gl 5l EI!t olfr.l a 4q q) (.) q) v) q)\ t U q) a S) 5 .V an (o (n C)ti cn oJ o L U' -o ar)t! a (q (.) (n o F cidr orl -.oldlFI r ll (L}- i!()r>()q)9pE u9s O\Ja(-e5 C) (d o oo Cd() o N^ 'F o\ d bo o C) r{ra, o ;==6=9o E:jO =qts +5?E - A zd Y.E L o o o o o o .r.-OX=6ab E O o e* = c > o<; o-9 >a o o o o o o aEo?3E-. u 9E a E E,3 Ei8.Eg oo st o\v O\ov € \o or\(n ri o6 EO @r- F- <t a.l r- t +st co $F-$r+ O) <fN(\ ri 12d o;-ll -t ^\e - FF U:]OA A 9'2paouc6= z 6-E Ee GE: :EU =o=ti5 -q E> p =qudP E8"etr 7 uE - tn @ (o r\ (or\ or\ rJ)N (ot- c-N c.l st @r- c.l oo \o € @ €\osN o\ $F- a.(o(o r\(\ oo c\l <l r{(n ot c\l <l @ co(o @ O) ooo6l roo sl co Ol OlN rn ,ri F\ F{ $ cao C'l c.t .f,\o\o ca (n \o oo cO c.l \o c! r- c.) o.l t-{ Fl sl Ol r{(\ E9= d9- IduH OSXGrr->oSaao 9o+ o a= -;o >6.-d ;! d:= o o E O - - >= tr Y 6H , OEEEg = o d,i cQ) d t: =oFtf5 O E g 6 o6 oo F.l \o @ co r- aa r$ O.f, ca O) fi.)(o \o € a.) t--ca rasf $ cO Olfn ro \o oo co t-r aa ra\f $ ao Ol(r1 ro =<2W ^J (! odLE (! cn(B oF (d v1 cd !)F .8,o GI F il \t O(\ c) -o E C) o z + a.l O c..l L cllo q) L q, c) q)(, !xL)-o: 'g g. Qs rOF3o9 rt/ B ,.: 6 tr()oboE(! oo oo '=()(, r'lcx G)r Eqai (g61,.6J .=L= t-9 o;- F lf;I 96l io -o C) ; .9 c)(h I a. .h "?q).9 OL 1J C)LO- o,aoo 6 €= t- oEo.(!G) oLthlo 9.-9d z. B.;E (g! C co ^c9 0 'E O01 =e^4.,\U= .i[ ?s E tr.r' 3Ov-Ee|,FAFvtr = ii,^c - Eoo S .3At 3e ; Ee gl o-o o > rrc|olc6 G _ 9-J L o-- >v c) : O €E, N E .9 ! ,n'i bo (dHvt =-o .= 2\IVVLLJ'iiE 'io- i .9 !-)-9L9R thY E oFE 'ok 6 .t') ^.H5 ,q; I ts?i=' 6 = 6 9 ;EE{ T[ ! A5.EA Ep =t ;,IF: ;E*$ F €=6 It-83 9 .-^6U.r.-^)iE> E:Sri iXEr! -Y(s< : Ei AT T-EE? :gytj t'Etts ! -v_r\,rJFqP;q5 ri,.Eb IEbg !EEs 'aT!LJ\L-!L : !! >, 5'= tr ar O-EE! EE€i € ,tsE.6oE3 !, -YE .9 Hn38 Y b 9qJd *i a € Gl C..l o(! .E o C) ! >' I (.) o L I l; C)h o C) U) o L (h IJ .o o c) o. o 'E +..9 oc 6) -.Yo.= E()GJO(, r<AZ cll -qlr.: o> 0 -lq) trlJo ota u g< 9 ooh or'E 9r-F! .! .E ii c!(ts =lr-()t *E '-=7) ,(h .l999o rN I \ t- o o-(l) L o o ah(o o t! a oz 91 I tI s a] C) -o (, z '+ c..l o o a.l c,i o a .c! 6 v C) CE q) U) q) 0) (J o v) C! e(\l c) () o rh 6l ea 6i .:( o CN I clH cl V Eq) cl() ir 0) .EESt\ .E c{o .:!U2 Q) y(h o.o= o-El 3s, v=ql hD 6l: E6l i=frF ,; o s q, c!I 4) oo G 0) (J F D CE o q) 'q)cq .E6)!6fr Ep oa0 at .2 Eq)ot2 Ov € o'tgNl € u?l '- rath r-l()FIlir =l o.) =l cq _Et ;(Et c) -to _6t :. 9rg u!0)L>oo9ro rl 2ra(gDj3 q) o:E6)EeidGo9 "lt'iAl u) €t-gFIA L n1 obo(d rt OY>^ \o\o o\ € o\ C.lo\ t'-o. +o\ c.)o\ o\ o\o\ o\ o (n o. o I ilH E] E1 o bI) Hia< u9 \or- o\r- r- o\ e.lo\ r-o\ !to\ o\ o\ o\o\ o\ 8 E)il- r.l ri '5 dE"SElr9^ 'E 6S \o e.l \o F- oo F- F-r- €F-- F- F- @ o\c- \or- lll a o a9 EA -:oz. o- o\ e.l r- c.l \o $N @ rr c.ls\o od\or- \o\o a* ri € a- @ @ oo r- c- c-dI v oo oo o\r- o\$ c'l o\ N c.l\o $t\n\o\o Ll c -o) E E'; =6o = '=tE6 r- o\ .l \o e.l$ \o cA sf+ \o c{ + al @ c- r- oo €a oo c.l m o\ o\ oo oo o\ o\ =t c- F- a- o\ N a} c.lt- o\ o\ clvl r- di9EO= .9 Ho d+F E 6 a; .o 59I E eF O= E ots r- €\o o.i o\ o\\o 6 c.l c.t$a o, @ o\ 00 o\ o\ c-\o e.l \o c.l a- r- 00 .+t- t r\ c.l \o <t .+ 6l + c'l o bo : o .E E E o(-) t til- ri El o bn ^LLJO-F a'-o'< 3a ,= *oE i:crgo .b^, '.iEE sE,5B t\o ri -EEo5u- =X>oiz 6> b t o\$ @ € o- N F- c- c.l cO F-r-c\ co r-r- a{ r-F- c\ ca \o a.lr- N o.l at N c.l C.l \o Ll tr -cJEE: =oo = '= <Fo $ o\ =f 00a a.l F-r-c\ a- F- c.l a- t-- c.l t-- Frc\ a'lr\ (..l c.l N c.) c.l6l6l c-) o\ o oIJ ,6L -Y >E d .q> s o'E 9 -+5tr= q E€€ .vOtC =F q.= ots F-r-(.{ tr-r- o* a-r- e.l r- F-a\ r- t'.. .* t.- r.. ..I \o C.l c- N a.l c.l c.l a.l a.l o\ c.)\o & rl.] N C-l c.l (\ -l a.l O N \o N a- o.l oo c.l o\ c.l N c.l 2.7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - Qtlease tick the appropriote answer) MOH M WHO! UNICEil NGDC Other (please specifu) Mectizan@ delivered by - Qtlease tick the appropriate answer) MOH M WHOtr UNICEil NGDC Other (please specify) Please describe how Mectizan@ is ordered and how it gets to the communities The NOTF requests Mectizan from MDP. After the drug reaches the country it follows the existing drug and other medical equipment delivery system of FMoH. Then the drug is stored in FMoH store from which projects (zones) receive. From the zone the Woredas receive and distribute to the frontline health facilities. It is from the frontline health facilities that the community supervisors get the drug and handover to the CDDs making it ready for community distribution. Table l0: Mectizan@ Inventory (Please add more rows if necessary) District/LGA Number of Mectizano tablets Remaining from 2010 Requested 201 I Received (total aveilable) Used Wasted Remaining Sheka 53,277 441500 494,777 454,754 3136 36,888 Total 53,277 441500 494,777 454,754 3136 I l0,ag8 How are the remaining ivermectin tablets collected and where are they kept? At the end of the treatment period, the CDDs return the remaining drug to HPs and the HEWs to the HCs which are the front line health facilities. The front line health facilities, in turn, send to the Woreda health offices and finally from there to the zone health department. Hence, the remaining Mectizan is kept at the ZHD store. But sometimes there are woredas and Front Line Health Facilities which keep the remaining drugs in their store as they are remote and transporting the left over Mectizan to the zone is so difficult for them during rainy seasons. List and briefly describe the activities under ivermectin delivery that are being carried out by health care personnel in the projectarea. . Training of HWs, community supervisors and CDDs . Woreda health offices collect Ivermectin from the Zone . Frontline health facilities collect Ivermectin from the WoHOs . HEWs receive Mectizan from FLHFs . CDDs get their Ivermectin from HPs and distribute to the community . Supervision and follow up . Recording and reportingI Return the left over Mectizane CDDs >HP > HC) WoHO>ZHD 2.8. Gommunity self.monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? If so, When? Training was not conducted. a t4 WHO/APOC, 24 November 2004 'to Com self-monitori and Stakeholders 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. . Training was not conducted on SCM %SHM 2.9. Superwision 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? . Ownership of the program by the health workers is not seen . CDDs were not properly trained . Village registers updating is lucking . WoHOs did not conduct continuous and regular supportive supervision. . Woreda level and front line HF reports were not coherent 2.9.3. Was a supervision checklist used? Yes 2.9.4. What were the outcomes at each level of CDTI implementation supervision? . Review meeting conducted at woreda level . Village register updating training was carried on . Reports were compiled during the review meeting session 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? It is to be seen in2012 Mectizan distribution period Drstnc, LGA Total # of communrtres/vrllages rn the entlre project area No of Communrtres that canred out self monrtorrns (CSM) No of Communrtres that conducted stakeholders meetrne (SHM) 0Andracha Masha Masha Town 0 0 J"pi Yeki 86 l3l 37 45 340 0 0 0 0 0 0 0 Totrl 639 0 0 l5 WHO/APOC, 24 November 2004 + SEGTION 3: Support to GDTI 3.1. Equipment Table 12: Status of equipment (Please add ntore rows if necessary) Source Type of equrpment APOC MOH+* DISTRICT NGDO Others No Condrtron No Condrtron N o Condrtr on No Condrtron No Condrtr Tovota Hilux 4W Dickuo 1 INF I F Motor cycles storaqe boxes 0 wo 0 Motor cycles 5 NF 4 F I NF Photocopier 1 NF I F 0 Fax machine ,| NF I F 0 VCR 0 Megaphones 0 Tvpewriter 0 0 Vrdeo proiector 0 Slensrl Desiner 0 Desk top computer 1 NF I F 0 LaserJet printer 1 NF I F 0 Laptop computer 1 NF 0 Deskjet printer 1 wo 0 w 1 NF 0 Overhead proiector 0 Radio communication 0 Portable electric generator 1 NF 0 * Condition of the equipment (F:Functional, CNFR:currently non-functional but repairable, WO:Worn off.; How does the project intend to maintain and replace existing equipment and other materials? Government budget is used to maintain existing equipments and other materials. Replacement is also done by the govemment and other NGDOs such as WHO and UNICEF. t6 WHO/APOC, 24 November 2004 i2 on Contributor Year 8('2008) Year 9('2009) Year 10 ('2010) Year ll ('201l) TOTAL Cash Budgeted (us$) TOTAL Cash Released (us$) TOTAL Cash Budgeted (us$) TOTAL Cash Budgeted (US$) TOTAL Cash Released (US$) TOTAL Cash Budgeted (US$) TOTAL Cash Budgeted (us$) TOTAL Cash Released (us$) MOH (Central + Sate)* DNA DNA DNA DNA DNA DNA DNA DNA MOH (District + zone)* 2995.00 27255.00 2725s.00 2995.00 88,447.76 88,447.76 27,426.42 27,426.42 Local NGDo(s) ( if any) 0 DNA DNA DNA DNA DNA DNA DNA NGDO partners(TCC) 38346.00 72920.00 72920.00 38346.00 39,077.08 39,077.08 2,t27 2,127 Communities* 0 0 0 0 0 0 0 0 APOC Fund Trust 7200.00 0 0 7200.00 0 0 13,850.51 99s2.97 TOTAL 75496.00 100175.00 100175.00 75496.00 110.324.88 r10.324.88 43,413.93 39,505.39 3.2. Financial contributions of the partners and communities Table l3: Financial contributions by all partners for the last three years MOH contribution is for Focal person's salary- and running cost. . If there are problems with release of counterpart funds, how were they addressed APOC's fund reached late. Trainings and review meetings were conducted by the budget allocated from TCC and the Government. Describe (indicate forms of in-kind contributions of communities if any) . The community leaders and elders do waste much of their time in mobilizing the community during the Mectizan distribution period. Some times the community members do assist CDDs in their farm. I l7 WHO/APOC, 24 November 2004 vl lf (.o\t (o (Y) F- c! @ o(f) O) s @ O) ro stq (9 tN sq cf)$N ooo(9 z J( koa oo c li oq oL C) b0 fr E 3 o o! o!th >\ o(s o(! q) Lr € oa V) (J o 'a trq q) O 0) o irt ,l -ol CBIt-l Lli o o bo (/) lr) Lr a3 a r5 o (.)aX() o (! 0.) o t-r -.io v) x (.)(! o(d o L. .oH o Lo bo L o O.(.) Lr o b0tr tr E 0) oP.xo o tr CB o + - C7) o.)tl =\oCd *ll .=A aa(gJ o- tl cl I *, a- l-fl o G L oc oL) +,lrE E oc x UJ a\t a co ( I ! ( ( I( 1( ( t( ( g oN o o tr o El(l, (E =c!t (! Jo o o CL o uJ too = .cl .o :XE E ,oF o@ sNo c., o oqt(\t o- ct (o CO f- N (0(9 i- 6t o o o o aN ro s@ oi $N t oq o) tN o aN rr) c o 'troN (o o) +e(0 (oq) +o(o @(D +o(0 @ o) so(o t o,; P,, =tt o. It o Ei o E Lo g EDE '= e o oE GI Etr o (! z ,t tl'- !,{, o E,,t, @ lEo oN oN oN 0N oN oN oN oN oN oN oN oN oN oN oN oN oN oN IJJz J Go iooq E rtsOO.EGooo9 =i 5E{o(4o o G N tt o = tr o t! N o e, oo N olg o o t, "i tr o (! o =E'o =t! 6,t tt o o IaSq p s(! 1- o E') .EE .E o E) .'E I -. IUAt\l l; r+l-(J o E') .s .Ao sgo!;i i E! o o IaIt4 o GSiEo> .D rlJ 'Fs o.-\ 3_E?r .= so r-E tr .9 ,9 (, CL) -(9 E) o c o =N(9 tr o (Eg(! TU ri(t ED e, oo E =.g o E, a(e (! o Ia5q eg oto sE!f; E.E B A EE p$i* Ei tr (Jo-Eo o= >-6 .'tr{.9E' l!J o o 65 o) o t!J oEo (, .ge e6GN GJ o o G'J o o oJq) o (!Toso |!J o3o r!J oEo t!J o o a!! o o |!J o U, l!J oto |!J o o r!JoEo (! Joto (EJo o G --o ,Eo aEofEOl!oz .g CL .9E UI aI' EL o IIJ a! CL o UJ TE CL o uJ .g CL .9t u, .g CL o ul (! IL o LlJ G CL o uJ (! CL o uJ o CL o IIJ r! CL o IJJ (! CL o UI G CL o UJ G CL o uJ lE CL o UJ |! CL o lU (! CL .9 ul +1 SECTION 4: Sustainability of GDTI 4.1. lnternal; independent participatory monitoring; Evatuation 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 Im pact assessment was done in 20ll 4.1.2. What were the recommendations - not yet delivered 4.1.3. How have they been implemented? 4.2. sustainability of projects: ptan and set targets (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? _on the 3'd and 5th years What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.2.1. Planning at all relevant levels - Yearly integrated plan is prepared including CDTI at all levels and all health activities do share funds allocated from the government and other NGDOs 4.2.2. Funds - The government and NGDOs are allocating budget for the integrated health activities including CDTI 4.2.3 Transport (replacement and maintenance) - The government and NGDOs are replacing and maintaining Vehicles and motor cycles to be used for integrated heath services including CDTI. 4.2.4. Other resources - The government does get additional resources from WHO and UNICEF to execute all integrated health activities including CDTI. 4,2.5. To what extent has the plan been implemented - The plan is fully implemented yearly in an integrated manner including CDTI. 4.3. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: All CDTI activities are integrated into PHC o Mectizan delivery o Trainings o Distribution o Supervision o Review meetings 19 WHO/APOC, 24 November 2004 1t t f h a4.3.1. Ivermectin deliverymechanisms Since the inception of the project, Ivermectin delivery has been fully integrated into the existing PHC drug delivery system of the country 4.3.2. Training: CDTI trainings are integrated with the Primary Health Care (PHC) program from the beginning at the National, Regional, Zonal, Woreda and HF levels. Disease Prevention and Health Promotion core process is responsible for the CDTI program. Therefore, all the staff who is responsible at Zone, woredas and FLHWs level has received CDTI trainings 4.3.3. Joint supervision and monitoring with other programs As part of the system in the country, all supervision and monitoring activities are done jointly on integrated manner for all health program assisted by checklist. 4.3.4. Release of funds for project activities The 20ll Mectizan treatment activities were accomplished by the fund released from The Carter Center Ethiopia and MOH. As usual APOC's fund has arrived after all CDTI activities were accomplished 4.3.5. Is CDTI included in the PHC budgetr o ltemized budget for DP&I{P includes CDTI too 4.3.6 Describe other health programmed that is using the CDTI structure and how this was achieved. What have been the achievements? . Campaigns such as malaria prevention, Polio eradication, TT, Measles vaccinations and EOS do use the CDTI structure. CDDs are always involved in these activities and the achievements are very remarkable 4.3.7. Describe others issues considered in the integration of CDTI. 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. Epidemiological evaluation of onchocerciasis transmission was conducted. But the result of the study is not released by APOC 4.4.2. How were the results applied in the project? Not yet applied SEGTION 5: Strengths, weaknesses, challenges, and opportunities Strengths: . Geographic coverage- 100%o . High therapeutic (76%)and (95%)TUG coverage Weaknesses: . Continuous and regular Supportive supervision is lacking at WoHO and HF levels . Number of Absentees and Refusals is still high . Woreda and Kebele level reports were found incompatible . Village registers were not properly updated . Ownership of the program is weak - by health workers WHO/APOC, 24 November 2004 ,f6 a a 20 Opportunities: o Accelerated expansion of PHC to village level. o Assignment of HEWs to kebele level. o Establishment of health Development Plan Threats (Challenges): o Overlapping of other emergency programs during Mectizan distribution period o Work overload to health staff sEGTloN 6: unique features of the project/other matters o APOC's ATR format is so laborious, please try to revise it and make it simple and appropriate. The ZHD has so many reports to deliver to the government and its other partner NGDOs. WHO/APOC, 24 November 2004 1T a Y 2t