Gambella annual project technical report submitted to Technical Consultative Committee (TCC): January 2012 to December 2012

The Federal Democratic Republic of Ethiopia , Ministry of Health et' 'i COUNTRY/NOTF: ETHIOPIA Proiect Name: Gambella Approval year: 2003 Launching year:2004 Reporting Period: F ro m : J.anu.ary.?.0I 2... To ;......Dec.am h er..? Q l?........ .... (MONTH/YEAR) MONTH/YEAR) Proiect year of this report: (circle one) I 2 3 a s O 7@ tO Date submitted : .D9.q9.m.[.9p 2012 NGDO partner: The Carter Center { t, )t .xo ForAction To: PRo Aklry For 'ots,R e9\[ ! S,.Bn"kou*a WHO/APOC, l0 April2003 ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) DEADLINE FOR SUBMISSION: To APOC Management by 31 Januarv for March TCC meeting r (P To APOC Management bv 31 Julv for September TCC meeting I aFRrcAN pRocRAMME FoR oNCHocERCTASIS coNTRoL (Apoc) December 30,2012 t1 ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) EI\DORSEMENT | *r"u." confirm you have read this report by signing in the appropriate space. j , OFFICERS to sign the report: Country: Ethiopia National Coordinator Name: Mihiret Hilu-f Signature: Date: Regional Oncho Coordinator Name: Mr. Saimen Lul Signature: Date: NGDO Representative Name: Dr. Zerhiun Tadesse Signature: Date: I This report I I i has been prepared by Name : Mr. Saimen Lul+ NOTE Designation : Regional Onchocerciasis Coordinator Signature: lll December 30,2012 Acronyms APOC African Programme for Onchocerciasis Control ATO Annual Treatment Objective ATrO Annual Training Objective CBO Community-Based Organization CDD Community-Directed Distributor CDTI Community-DirectedTreatmentwithlvermectin CSM Community Self-Monitoring LGA Local Government Area MOH Ministry of Health NGDO Non-GovernmentalDevelopmentOrganization NGO Non-Govemmental Organization NOTF National Onchocerciasis Task Force PHC Primary health care REMO Rapid Epidemiological Mapping of Onchocerciasis SAE Severe adverse event SHM Stakeholders meeting TCC Technical consultative committee (Apoc scientific advisory group) TOT Trainer of trainers UNICEF United Nations Children's Fund UTG Ultimate Treatment Goal WHO World Health Organization IV December 30,2012 Definitions (i) Total population: the total population living in mesoAryper-endemic communities within the project area (based on REMO and census taking). (ii) Eligible population: calculated as 84o/o of the total population in meso/hyper-endemic communities in the project area. (iii) Annual Treatment Objective: (ATO): the estimated number of persons living in meso/hyper-endemic areas that a CDTI project intends to treat with Ivermectin in a given year. (iv) Ultimate Treatment Goal (UTG): calculated as the maximum number of people to be treated annually in meso/tryper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage (normally the project should be expected to reach the UTG at the end of the 3'd year of the project). (v) Therapeutic 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) Inteqration: 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 communify 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 communiry ownership, using resources mobilised by the communify and the govemment. (ix) Communiqv 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 communify to take full responsibility of Ivermectin distribution and make appropriate modifications when necessary. December 30,2012 FOLLOW UP ON TCC RECOMMENDATIONS TCC session: - Thirty Two Number of Recommendilion in the Report TCC RECOMMENDATIONS - (i) There is still a need ro pur in @ migratory population which has been causing high absenteeism during treatment- NorF to work with Apoc management and MDP to resolve the issue of late drug arrival. ACTIONS TAKEN BY THE PROJECi FOR TCC/APOC MGT USE ONLY2t8 r ne govemment has designed resettlement program in this projeci areas and implementation has been started. Thus, it is believed this settlement program is expected to significantly decreases the migratory nature of the population and contribute in increasing Mectizan treatment cov erage. \,., r\urroer or rerusals ls reratlvely hrgh. Investigate and address the underlying causes. This problem is not yet solved U.. people are used to drink alcohol and refused to take the drug considering taking Mectizan with alcohol is dangerous. (ru., \-unrrnue ro loooy government to allocate funds for vehicle and equipment maintenance. The government has allocated budget fb. ffi the budget amount could not be enough because the vehicles are old they need frequent maintenance service. December 30,2012 /:::\ r\^.^ al Executive Summary 1. Background on population and treatment data Gambella is one of CDTI projects of Ethiopia and it comprises five CDTI Woredas having a total of 369 villages. All the five woredas were targeted for the 8th year treatment cycle. The names of the woredas are Godere, Mengeshi, Gambella, Dimma and Abobo. Before starting treatment activitiy population census was conducted in all the five CDTI Woredas and the total population of the project area was 106,839. The Annual Treatment Objective (ATO) for the 8th year CDTI was 89,839. All the five CDTI woredas were covered with the treatment (100% geographic coverage). A total of 76,322 people were treated during the 7'h year treatment cycle i.e;71.4 oh therapettic coverage. 2. Background on population movements. The communities in CDTI areas are mainly farmers (change their villages for searching uncultivated land frequently), daily laborers and civil servants. The population size vary from time to time based on the need for daily laborers for coffee, tea and cotton plantation specially in Abobo, Mengesh and Godere woredas and also gold mine workers in Dimma woreda. 3. Training data Training and refresher trainings were conducted before initiating other CDTI activities. The project was able to train (retrain) 40 health professionals, 146 community supervisors and 934 CDDs. 4. Challenges - Delay of the release of APOC budget - Shortage of vehicles for supervision & for distributing the drug to each endemic woredas. 5. Opportunities: Planed resettlement program in this project areas in order to solve the migratory nature of the community members and bring dispersedly settled community in one area to live together. SECTION 1: Background information December 30,2012 1.1. General information 1.1.1 Description of the project Gambella National Regional State is one of the Nine Regional States of the Federal Democratic Republic of Ethiopia, and it is located in the westem part of the country between 70 13" N to g0 17" N latitude and 330 52" to350 02" E longitude. The Region shares borders with the Sudan in the West, Oromia Regional State in the East, SNNPR (Southern Nation Nationalities peoples Regional State) in the South and Benshangul-Gumuz Regional State in the North. Gambella Region has a total surface area of 25, 274.88 square kilometers. The total population of the region is estimated to be about 360,431 of which 74o/o are rural and 26%o areurban dwellers. The population is largely engaged in subsistence farming, animal husbandry, fishing and coffee and cotton plantations. The climate of the region is classified as tropical. Average annual Temp is 30,7o C. The annual rain fall ranges 800- 2100 mm. the altitude ranges 300-2400Mts above sea level. The region is classified as low land (82%), semi highland (lO%) and high land (8%). Some of the perennial fast flowing rivers that cross the Agnuak zone include: Baro, Akobo, Gilo rivers. There are also quite numerous small rivers and streams, which are tributaries of the main rivers. There are two distinct seasons in the project area, i.e.., the rainy season (April - October) and the dry season (November-March). Harvesting occurs from October to December, leaving January - March as the optimum treatment period. The Region is divided into three administrative zones (Agnuak, Nuer and Messenger Zones) and thirteen Woredas and one town administration. All the CDTI woredas (except Mengeshi which is difficult during rainy season) are accessible with all weather roads with the regional town. However, access to rural communities appears difficult during rainy seasons. The health infrastructure in Gambella CDTI project area consist I zonal hospital, ll health centers (1 government and l0 NGO), 69 Government health posts and l0 private clinics. December 30,2012 Table l: Number of health workers involved in CDTI project. 2012 District Number of other health workers (health extension workers) involved in CDTI activities. Total Number of health extension workers in the entire project area Br Number of health extension workers involved in CDTI Bz Percentage B3=82/ B1 *100 Abobo 28 28 100 Dimma 32 32 100 Gambella 2t 2t 100 Goderie 29 29 100 Mengeshi 36 36 100 Total 146 146 r00 1.1.2. Partnership There was strong partnership during planning, advocacy, mobilization, drug distribution, monitoring and evaluation of the CDTI activities among different partners. The main partners involved are Federal ministry of health, Zonal Health Department, Woreda health office, health facilities, the community, The Carter Center, WHo and other government sectors. District Number of health worker involved in CDTI activities. Total Number of health worker in the entire project area Br Number of health worker involved in CDTI B, Percentage B3:B2l 81 *100 Abobo 46 5 1l Dimma 38 ll 29 Gambella 45 4 9 Codere 50 t2 24 Mengeshi 2t 8 38 Total 200 40 20 December 30,2012 Table 2: Number of health extension workers involved in GDTI project. 2012 1.2. Population Table 3: Communities and population at risk in the entire project area whether they are treated or not during the reporting period 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 reachedfull geographic coverage (normally the project should be expected to reach the {JTG at the end ofthe 3'd year ofthe project). Was a census for the project done during the reporting period? Yes / If yes, what is the source of the data in the table above? * Source: National census CDD !:Other source, specify: _Year :2012 No CDTI Districts in the entire project area Total populatio n in the entire project area Number of communities/villases in Population of Meso- endemic zone in the project area A7 Hyper- endemic zone in the project area A2 Total in meso/hyper- endemic zone A3: A'7+ A2 Meso-endemic zone in the project area A.t Hyper- endemic zone in the project area A5 Total in meso/h yper- endemi c zone Aa: Aa+ As Ultimate treatme nt Goal (urG) Abobo 1 5,1 89 70 0 70 1 5,1 89 U I 5,1 89 t2759 Drmma t4,7 t3 55 0 55 14,7 t3 0 t4,7 t] t2359 Garrbella I 0,705 50 0 50 10,705 0 10,705 8992 Godere 42,591 126 0 126 42,59t 0 42,591 35776 Mengeshi 23,641 74 0 74 23,641 0 23,641 I 9858 TOTAL r 06,839 375 0 375 106,839 0 I 06,839 89,745 WHO/APOC, 30 December, 2012 If you are using the term community or village, define what constitutes the community or village. This will help understand the profile of the project area. The ternt communitlt or village is considered people who live in not more than 2 Kms radius and who shared a common interest. In Godere and part of Abobo woredas where there was resettlement program the people live more closer and have more than 150 households but in the remaining three woredas the community live very scattered and a village may constitute less than 50 households except in gold mine qnd cotton plantation areas where villages densly populated (daily laborers). Is there any other information of interest about the population in the project area? If so, include it here. In Godere there is coffee and tea plantation, in Abobo cotton plantation and in Dimma woreda there is manual gold mine. People travel to the above three mentioned woredas searchingfor occupation. Thus, the size and structure of the population in each woreda show fluctuation. 6 December 30,2012 SECTION 2: Implementation of CDTI 2.1. Timeline of activities Table 4: Timeline of activities for the areas treated in Gambella . 2ol2 District LGA Mobilization of communitres Training Census/Update Drug drstribution Supervision Starting month Cornpletio n month Starting month Completi on month Starting month Completi on month Starting month Comple tion month Starting month Completi on month Abobo March 2012 March 20t2 April 2012 April 2012 April 2012 April 20t2 May 20t2 July 2012 March2012 Ju,ly 2012 Drmnra March 2012 March 20t2 April 2012 April 2012 April 2012 April 2012 May 2012 July 20t2 March2012 July 2012 Gambella March 20t2 March 20t2 April 2012 April 2012 April 2012 April 2012 May 20t2 July 2012 March2012 Iuly 2012 Godere March 2012 March 20t2 April 2012 April 2012 April 2012 April 2012 May 2012 July 2012 March2012 Iuly 2012 Mengeshi March 20t2 March 20t2 April 2012 April 20t2 April 2012 April 2012 May 2012 July 20t2 March2012 luly 2012 2.2. Advocacy State the number of policy/decision makers mobilized at each relevant level during theyear; the reason(s) for undertaking the advocacy and the outcome. Describe difficulties/ constraints being faced and suggestions on how to improve advocacy. Because the involvement and support of the community leaders at all levels was minimal Advocacy meeting was held with decision makers (woreda council members and community Ieaders (Kebele leaders)) in respective woredas. During the discussion all participants promised to support the program and some improvement has been registered. But ihere is still a need of exerting further effort should to make them all fully involve and support the program. 2.3. Mobilization, sensitization and health education of at risk communities Community mobilization was done in each village by organizing community meetings. Kebele Task forces (that include Kebele administrative leaderi, health staffs, healih extension workers, and kebele elders) were responsible to organize the meetings and played major rolein mobilization and sensitization of the whole community at grass root livel. Community supervisors and CDDs were also involved in giving health education to the community at village level. 7 December 30,2012 2.4. Communityinvolvement Table 5: Communities participation in the CDTI project Comment on: - Attendance of female at community at health education meetings. The attendance of female members of the community at health education meetings shows some improvement. - ln general, how do you rate the participation of female members of the community meetings when CDTI issues are being discusses (attendance, participation in the discussion etc). The participation of female members of the community is increasing from year to year. - Incentives provided by communities for the CDDs Commur,ities are not providing incentive to CDDs as they are treating their relatives and neighbors. - Attrition of CDDs. Is attrition a problem for the project? If yes, how is it addressed? There is some attrition of CDDs and it is not a such significant and does not affect the projects activity. 8 December 30,2012 Distnct/LGA N umber of communities/villages with communiry members as supervisors Number of CDDs and the communities involved Number of communrtres /villages with female CDDs Total no communrties in the entrre project area B, Number with communify members as supervlsors B. Percentage Bo: 85/ 84 *100 Male CDDs B, Female CDDs R. Total B.: B"+B" Number of communities with female CDDs Bro Percentage Brr: B rolBa+ 100 Abobo 70 10 100 131 22 153 22 t4 Drmnra 49 49 100 87 2t 108 2I l9 Gambella Zuna 50 50 100 42 28 70 28 40 Godelre 126 t26 100 31t 32 403 32 8 Mengeshr 74 74 100 t74 26 200 26 l3 Total 369 369 100 805 r29 934 t29 l4 2.5. Capacity building - Describe the adequacy of available knowledgeable manpower at all levels. The numbers of health workers are and in educational level are increasing each year. - Where frequent transfers of trained staff occur, state what the project is doing, or intends to do, to remedy the situation. (The most important issue to describe is what measures were taken to ensure adequate CDTI implementation where not enough lonwledgeable manpower was available or if stffi arefrequently transferred during the course of the campaign). There are two health extension workers in each Kebele and they are responsible to train and supervise the CDDs working in their respective Kebele during transfer or and course of the campaign. 9 December 30,2012 District/LGA Number of Districts/ staff trained Number of Health center/post staff trained Number of other trainers of trainees ( TOTs) Number of CDDs trained ATrO C1 New, C2 Rnf,' C3 Total C4= C2+ 63 ATrO C5 Nev, c6 Refr C7 Total C8= C6+ C7 ATr o C9 New c10 Re fr C1 I Total C12= Cl0+ cll ATrO c13 New c14 Ruf," c15 Total Cr6= Cl4+ c15 Abobo 5 2 J 5 28 0 28 28 153 54 99 153Dimma 5 I 4 5 38 I 37 38 108 0 108 108Gambella 4 4 0 4 2t 0 2t 2l 70 0 70 70Godere 5 I 4 5 36 0 36 36 403 t7 386 403Mengeshi 5 3 2 5 39 0 39 39 200 10 190 200 TOTAL 24 11 13 24 162 I 16r 162 934 81 853 934 %o Achievement r00 7o Achievement 100 7o Achievement 100 l0 WHO/APOC, 30 December, 2012 Table 6: Type of training undertaken in 2012 2.6. Treatments 2.6.1. Treatment figures If the project is not achieving 100% geographical coverage and a minimum of 65%o therapeutic coverage or the coverage rate is fluctuating, state the reasons and the plans being made to remedy this. ' Both the geographic coverage and therapeutic coverage are above the standard indicated above. ll Trainees Type oftraining CDDs Other Community members e.g Community supervisors Health Workers (FLHF) MOH staff or Other Political Leaders Program management How to conduct Health education Manasement of SAEs CSM SHM Data collection Data analysis Report writins WHO/APOC, 30 December, 2012 al Table 7: Treatment and SAEs bv district/LGA in allpro_iected areas iri Gambella in 2012 Formula for computinq therapeutic aod seographical coveraee Therapeutic coverag€ mte = Number of people teated x 100(%) Total population living in meso /hyper-endemic commudties v/ithin the proje.t area G€ogaphical coverage rate = Numb€r of communitievvillaees tr€ated x 1OO(y"') Total number ofmesoAlper-€ndemic commuities as identified by REMO in the project area ATO cov€rage rute = Number ofpeopl€ trealed x lOO(Y"\ Annual Treatrnent Objective 7o UTG achieved = Nurnber ofpeople teat€d x 100 Total oumber ofpeople to be treated in meso/hyp€r-endemic areas within the project area ([ITG) lro=7h..sti^at4ltuibqofp.orkbnqbt.sdhwHndzhi.dtu@ttataCDTIprojectinEnllsrottatnithiwedinlso8i|.nlAol VfG- Th. icbu dwb.rolpcopLtob.ttuEniawto/htrer4.lnk:.r8fithinth.prol.dorea,dti n d! tn h. Mchcalehd h. Wl.ct has tuch.ttfulr g.ographi.ot @wge(^qdaty &. proJet shoru b. q.de.l to @h th. UIO dt th. alt ofth. 1d rw ofrh. ptujed, District /LGA Communities/Villases Population Number of persons refused treatment Number of absentees Number of SAEs Number of senous adverse events (SAEs) referred to the health post/hospital Total # of communrties/ vrllages rn the meso/hyper- endemic areas D, Annual Treatment Ob.;ective D. Number of communrties/ villages treated Dr Geographrcal coverage (%) Dr-- D3/ Dr*100 Total population of the meso/hyper- endemic areas D. Annual Treatment Oblectrve D" Number of persons treated D, Therapeutrc coverage (%) Dr= Drl D<*100 Abobo 70 69 69 99 1 5,1 89 1 2,15 1 l 1571 76.2 327 1278 0 0 Dimma 49 30 30 6t.2 t4,7 t3 1t,170 8509 58.0 673 2753 0 0 Gambella 50 50 50 100 r0,70s 8,564 6101 57.0 412 1657 0 0 Godere t26 r26 126 100 42,59t 34,073 328s7 77.t 58 1096 0 0 Mengeshi '74 74 74 100 23.641 I 8,913 r7284 73.1 900 1694 0 U Total 369 349 349 95 r06839 85471 76322 71.4 2370 8478 0 0 t2 December 30,2012 2.6.2 What are the causes of absenteeism? Because of the delayed in Mectizan tablet shipment the treatment was given in the rainy season which some of the residence stays out of their village for farming for more than a month. In addition most of the people in the area are not settled in one area. They move from place to place for the number of reason and become in available during treatment period. 2.6.3 What are the reasons for refusals? Most of them consider themselves as healthy and do not need treatment and some others refused to take because of the fear that the drug may react with local alcoholic beverages, since a significant number of the people drinks local alcoholic in their daily life. ' In case the project did not have any cases of serious adverse events (SAE) during this reporting period, please tick in the box. No SAE case to report 13 WHO/APOC, 30 December, 2012 Z 2.6.4. Trend of treatment achievement from CDTI project inception to the cument year Table 9: Treatment objective and coverage rate for the entire project area in 2012 YEAR Comn.runities /Villages Population Total # of communitres/vi ll ages in the meso/hyper- endemic areas E1 Annual Treatment Objective E2 Number of communiti es/villages treated E3 Geographic al coverage (%) Er= E3 Er*100 ATO coverage (%) Es= Er E2*100 Total population of the meso/hyper- endemic areas E^ Annual Treatment Objective E7 Number of persons treated Eo Therapeutic coverage (%) Es: E8/ E6*100 ATO coverage (%) Ero= Es/ E?*100 UTG Coverage (%) 2004 t45 289 289 50 50 120,234 7 569s 6s640 87 90 90 2005 No treatment conducted in this year (2005 2006 403 403 403 100 100 8s765 68,603 60654 7t 88 88 2007 403 403 403 100 100 93.721 86,223 71,90t 83 90 90 2008 320 320 320 100 100 92,786 71,940 66,652 72 86 86 2009 366 366 366 100 100 99.037 83,19 l 71,442 78 93 93 2010 356 3s6 356 100 100 l0l.0l3 84.851 73,435 72.7 86.5 86.s 20tt 339 339 339 100 100 103896 87273 84929 82 97 97 2012 369 369 369 100 100 106839 8547 | 76322 71.4 89.3 89.3 t4 WHO/APOC, 30 December, 2012 2.7. Ordering, storage and delivery of Ivermectin Mectizan@ ordered/applied for by - Qtlease tick the appropriate answer) MOH M WHO f] UNICEF D NGDO E Other (please specify): Mectizan@ delivered by - (please tick the appropriate answer) MOH M WHO E UNICEF E NGDO tr Other (please specify): Please describe how Mectizan@ is ordered and how it gets to the communities As usual Mectizan was requested to MDP by the NOTF. Then after drug arrived at the country it follows the existing drug and other medical equipment delivery system in the country. The drug was stored in MOH warehouse and then distributed to CDTI projects after the projects submitted a request paper. The Woredas received the drug after submitting the requisition latter to the zonal CDTI project health office and then distribute to the health facilities. It is from the frontline health facilities that the community supervisors received and the CDDs received the drug and distribute to the communities. Table l0: Mectizan@ Inventory in Gambella 2012 - Horv are the remaining Ivermectin tablets collected and where are they kept? The Ieftover Mectizan tablets are collected from the CDDs by the Front Line Health Facilities(FLHFs) and the FLHFs transferred the collected Mectizan and Albendazole to the woreda Health Office and are stored at the Woreda Health Office. - List and briefly describe the activities under Ivermectin delivery that are being carried out by health care personnel in the project area. ' Training of community supervisors and CDDs about, the drug, its adverse effects and managenlent. ' Collection of Ivermectin from the Woreda health office store and then distribution to CDDs after checking the census (village register) ' Regular supervision with especial consideration to adverse effects during mass distribution. . Distribution of Ivermectin to CDDs and Supervision ' Collecting of reports and the remaining drugs ' Recording and reporting of data District Drug Balance from previous year Number of Mectizana /Albendazol tablets Received Used Wasted Expired Remaining Gambella Mectizan 4374 250.500 228,874 300 0 25,700 Albendazol 8403 91,600 76,599 t20 0 23,284 l5 WHO/APOC, 30 December, 2012 2.8. Community self-monitoring and Stakeholders Meeting Has any trainrng (of trainers) for community self-monitoring been done in the project area? If so, When? Yes, It was provided in April 2012 incorporated with the last regular CDTI training. But CSM has not done because of time constraint. Table l1: Communitv self-monitorins and Stakeholders Meetine in Gambella. 2012 District/ LGA Total # of communities/villages in the entire project area No of Communities that carried out self monitoring (CSM) No of Communities that conducted stakeholders meetins (SHM) Abobo Dimma Gambella Goderie Mengeshi 70 49 50 t26 '14 0 0 0 0 0 70 49 50 t26 74 TOTAL 369 0 369 Describe how the results of the community self- monitoring and stakeholders meetings have affected project implementatron or how they would be utilized during the next treatment cycle. The SHM was conducted at woreda level and it was important to strengthen CDTI activities at woreda health facility and community level atlarge. 2.9. Supervision 2.9.1. Provide a flow chart of supervision hierarchy. NOTF )RHB) WOTF ) Health Facility ) Community supervisors ) CDDs 2.9.2. What were the main issues identified during supervision? . lmprovement has been observed in recording and handling of village register but still strict supervision and follow up should be strengthened. 2.9.3. Was a supervision checklistused? Yes 2.9.3. What were the outcomes at each level of CDTI implementation supervision? . Handling of documents was relatively improved. 2.9.5. Was feedback given to the person or groups supervised? Yes . 2.9.6. How was the feedback used to improve the overall performance of the project? . After each supervision, Oral and written feedback was given' 16 December 30,2012 SECTION 3: Support to CDTI 3.1. Equipment Table l2: List and Status of equipment Source Type of equipment APOC MOH - Zone DISTRICT NGDO Others No Conditron No. Condition No Condrtron No Conditron No Condition 1. Vehicle 2 F NA NA NA NA 2. Motor cycle(s) 5 F NA NA NA NA 3. Computer(s) F NA NA NA NA 4. Printer(s) F NA NA NA NA 5. Photocopier (s) CNFR NA NA NA NA 6. Fax Machine(s) CNFR NA NA NA NA 7. Overhead projector F NA NA NA NA *Corditio,l of tf," .q.rip*"nt 6:fr*,tional, CNFR: currently non-functional but repairable, WO:Written off)' NA-Not available How does the project intend to maintain and replace existing equipment and other materials? The project expects partner NGDO (The Carter Center) to maintain capital equipment that have been provided by ApOC. Though there is no budget allocated for maintenance of the above materials maintenance is going on using government budget shifting from other programs. But the project is exerting effort to make the local government authorities to allocate budget' 3.2. Financial contributions of the partners and communities t7 December 30,2012 Contributors Year 4(2008) Year 5(2009) Year 6 (2010) Year 7 (20 I Year 8 (20 2) Budgete d Releas ed Budgete d Releas ed Budgeted Release d Budgeted Released Budgeted MOH (Central + State) 4000 4000 NA NA NA NA 128,944. 83 t28,944. 83 NA MOH (Drstrict + zone) 0 0 NA NA 4000 4000 0 0 7,500.00 7,500.00 LocalNGDO(s) ( if anv) 0 0 0 0 0 0 0 0 0 0 NGDO partner(s) r6,089 16,089 21,816 20,4t6 12.382 12,382 12375.65 12,375.65 Communities 0 0 NA NA 0 0 0 0 0 0 APOC Trust Fund t2,620 8834 5857 4100 0 0 r4,114.5 5 14,114.5 5 I1,119.0 I 7,783.31 Total 32,709 28,923 27,691 24,561 16,382 16,382 14,114.5 5 14,114.5 5 30,994.6 6 21,658.96 I I 1 I I Released NA If there are problems with release of counterpart funds, how they were addressed? The budget allocated from APOC released late after the treatment initiated. Additional comments -Keep on the availability of drugs at central level before the rainy season. -The allocated budget should be released as early as possible so that activities will run effectively as per the plan. 3.3. Other forms of community support r CDDs sometimes get lunch invitation during Mectizan distribution from the community. '' 3.4 Expenditure per activity Table 14 indicate the amount expended during the reporting period for each activity and the amount expended in US dollars using the current United Nations exchange rate to local currency. Exchange rate used here IUSD :18.00 Table I 4 : Type of activit)2. expenditure and source of funding during the reporting period of 2012 Activity Expenditure ($ US) Source(s) of funding Co mmun ity Mob i li zati on, Advocacy and sens i tization 762.75 TCC Trainings and HE 6,s62.91 TCC Superv ision and monitoring 4,71,0.63 TCC CDTI Activities 7,500.00 MOH CDTI AC vrtres 7,783.31 APOC Others 339.37 TCC TOTAL 27,658.97 Total number of persons treated 76,322 18 December 30,2012 ! I SECTION 4: SustainabilitY of CDTI 4.1. Internal; independentparticipatory monitoring; Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (Tick any of the following which are aPPlicable) - Year I Participatory Independent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation Internal Monitoring by NOTF Other Evaluation by other partners 4.1.2. What were the recommendations? The project was evaluated as a project which is progressing toward sustainability. And the following recomntendations were given: - Keep documents properly including financial reports - Increase community mobilization in villages with poor treatment coverage. 4.1.3. How have they been implemented? - providing training una suppo.ting Supervision document keeping has been improved in most of the Project areas - Effort has been exerted to conduct community mobilization though the mobile nature of the people has negative effect. 4.2.1. Sustainability of projects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period? No Was a sustainability Plan written? When was the sustainability plan submitted? Sept ZO1O What arrangements have been made to sustain CDTI after APOC funding ceases in terms ofl 4.2.1. Planning at all relevant levels planning of CDTI activities were carried out through participatory methods. At woreda level woreda health offi.., woreda council members and health siaffs discussed and plan wherr to conduct meetings with the communities. Then together with community members planning will be adapted when to conduct CDD training, when to conduct census and also when to start distribution of the drug. At community level com-munity members made discussion together with Kebele task forces and plan all activities. The GDTI is integrated with Malaria control program and efforts will be made to integrate CDTI with other health Programs. 19 December 30,2012 o a e t Yes 4.2.2. Funds The government is integrating all the basic health activities using all available funds. This integration approach will help to sustain CDTI after APOC funding cease. In addition to this, the NGDO partner is also expected to continue the critical funding support as it used to do previously. 4.2.3 Transport(replacement and maintenance) The project expects that APOC will replace the vehicle and motorbikes and the government will be responsible for their maintenance. The project will also use other vehicles from other health programs to fill the gap, if any. 4.2.4. Other resources 4.2.5. To what extent has the plan been implemented The CDTI activities training, mobilization, census, etc. were done as planned but the drug distribution was not done in the date planed because of late arrival of drugs. 4.3. Integration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: CDTI is integrated with the Primary Health Care (PHC) from the beginning. At the National, Regional, Zonal, and Woreda levels, the Malaria and Other Vector-borne Diseases Prevention and Control Units are responsible. All prevention and control activities are included in the of health extension package at the grass root level. 4.3.1. lvermectin delivery mechanisms Ivermectin delivery follows the existing drug delivery system in the country. The request for Ivermectin is made to MDP through FMoH. After arrival, all the processes required are handled by a Pharmaceuticals Administration and Supply Service in the FMoH. Then the CDTI projects receive the drug after submitting official letter to FMoH. Similarly woreda health offices submit request letter to the CDTI project. Ivermectin delivery system is handled in similar manner to that of other drugs and medical equipments in the country. 4.3.2 Training: Health staffs at the project woreda have received training/retraining on epidemiology of Onchocerciasis, Lymphatic Filariasis and CDTI principles. Efforts were also made to include other topics, such as measures to be taken on malaria prevention. 4.3.3. Joint supervision and monitoring with other programs The program is integrated in health promotion and disease prevention and control core process, most of the supervision and monitoring activities are carried out in integrated manner with other activities within the core process and regional health bureau. 4.3,4. Release of funds for project activities A fund from the NGDO partner was released on time to accomplish the CDTI activities. 20 December 30,2012 a I 4.3.5. Is CDTI included in the PHC budgetr Yes, as part of PHC, CDTI is one of the health activities at all levels and at grass root level and use the budget in the integrated manner. 4.3.6 Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? All the five woredas are malaria endemic. CDDs participate and support the community during bed net distribution and other anti-malaria activities. 4.3.7. Describe others issues considered in the integration of GDTI. t The Health extension Package program is an important program that can help to sustain CDTI in the community. 4.4. Operational research No operational research undertaken in the project within the reporting period. 2t December 30,2012 a I SECTION 5: Strengths, Weaknesses, Opportunities and Threats Strengths: ,/ The project is able to accomplish the seventh treatment cycle with 100% geographical coverage. "/ Therapeutic coverage is above the standard. ,/ The awareness of the community about CDTI has increased. Weaknesses: ,/ Poor document handling, at some of the woreda and health facilities , '/ Lack of supportive supervision at all levels - Opportunities:t / Availability of Health Extension Workers in every Kebeles Threats: ,/ The far distance of Dimma and Godere woredas is a barrier for frequent supervision and close follow up. lt demands additional cost for fuel and perdiem. 22 December 30,2012 I ,