s..: t ,'- The Federal Democratic Republic of Ethiopia Ministry of Health COUNTRY/NOTF: ETHIOPIA Proiect Name: Illubabor Approval vear: 2003 Launchins vear:2004 Reportins Period : From: Jnn.ufl.ry...?0..L1...,..... To;....Des.Q.mhs.r.20,1 1...... ear Month/Yea Proiectvearof this report: (circle one) I 2 3 4 5 67 8 910 Date submitted: January 30 2012 NGDO partner: The Carter Center ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) DEADLINE FOR SUBMISSION: To APoc Management by 31 Januarv for March rcc meeting To APoc Management by 3l July for september TCC meeting AFRICANPROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) i :l PRO ! i rr jI i 'rcL I i €o .--."_u,1_tJ 34 AA i .E!*-##+'a l;N:**:,tiftn 'i .Lr tl t: L.s ,']i"rnr i lrb ePI Lt- .t i { ! iI t t , ftt' - WHO/APOC, 8 August,20l I I ,- ) tiil,i Ii i - ,-,,_,-_t Ttt 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 Ethio IA National Coordinator Name:......M..ihitgt.H.ilU.f Ntihrcr Hiluf Nfgussie - (RN, BS"' UI'q) Signature. ...../.V-.ffi\,:.-rirun ;,^ ,l' l:,;'. Lioniand I- Prevsttiun l-'iiec"orate iDirector f;o Date ame: .........p..J, o- o Signature Date l1- -t Zonal Oncho Coordinatof Name: Husen Abate {,i';,, Signature Date :l ,l I il t , 'i ri F .;1. a N 4. Iz R\--- This report has been prepared by Name : ....H.usen.A..b.aJe...t.N.9.TF......... D es i gn ati o n'. Zone oncho cercias i s C oordi nator Signature tttI*f ll WHO/APOC, 8 August, 201 I =si '*;T' i I t ,"\ Date DEFIMTIONS......... FOLLOW UP ON TCC RECOMMEI\DATIONS... EXECUTIYE SUMMARY.............. SECTION I : BACKGROLIi\D INFORMATION l. l. GeNen-a,L INFoRMATIoN... 1.2. Popur-anoN...... SECTION 2: IMPLEMENTATION OF CDTI Table of contents TtuEt-nre oF ACTIvITIES .................. Aovocacy MontltzenoN, SENSITIZATIoN AND HEALTH EDUCATIoN oF AT RIsK coMMUNITIES CouuuNlty II.woLVEMENT ............ CRpactty BUILDING... Tnrerupr.rrs ............... ORoeruNc, sroRAGE AND DELIvERv oF TvERMECTIN Corvruuury sELF-MoNIToRING aNo SrarsHoLDERS Mnprruc.. SupgRvtstoN SECTION 3: SUPPORT TO CDTI............. ry v I 2 3 J 6 7 7 8 8 l0 t2 2.1. 2.2. 2.3. 2.4. 2.5. 2.6. 2.7. 2.8. 2.9. 3.1. 3.2. 3.3. 3.4. ,,,.,. |4 20 2t)) 22 Equrruexr... FrueNcIaL CoNTRIBUTIoNS oF THE PARTNERS AND CoMMUNITIES Orgpn FoRMS oF coMMUNITY suPPoRT ExperotruRE PER ACTIvITY 22 24 25 .....25 26SECTION 4: SUSTAINABILITY OF CDTI. 4.1. INrrRNar-; INDErENDENT pARTrcIpAToRy MoMToRING; EveluartoN .................. 4.2. SustnrNeslLrry oF rRoJECTS: rLAN AND sET TARGETs (uaNoaroRy AT Yn 3)......... 4.3. INrpcnarroN 4.4. OpenauoNAL RESEARCH 26 26 26 27 28 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AlrlD OPPORTUNITIES 28 SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATT8RS..........28 1- lll WHO/APOC, 8 August, 201I Acronyms APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT TINICEF UTG wHo African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Community-Based Organization Community-Dru g D istributor Community-Directed Treatment with lvermectin 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 Emergency Fund Ultimate Treatment Goal World Health Office lv WHO/APOC, 8 August,20l I Definitions (i) Total population: the total population living in meso/tryper-endemic communities within the project area (based on REMO and census taking). (i i) Eligible population: calculated as 84Yo 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 mesofttyper-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/ttyper 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/lryper-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 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 (viii) Sustainability: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future, with high treatment coverage, integrated into the available healthcare service, with strong community ownership, using resources mobilised by the community and the govemment. (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. ) v WHO/APOC, 8 August, 20l I
FOLLOW UP ON TGG RECOMMENDATIONS TCC session Number of Recomme ndalion in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BYTHE PROJECT FOR TCC/APOC MGT ASE ONLY I TCC 29 recommended that the reporting period should span 12 months (January to Dec). The authors report compliance with this recommendation, however the report under review spans from January 2009 lo November 2010. - 23 months. No justificationfor this is provided Accepted and it has been adjusted to the correct period of the reporting time (i.e. January to December). lt The annual training objective for health workers to be trained tallied with the actual number trained; that is 537. Yet the percentage achievement was computed as 84.8%o. The reason for this is not it should be l00o/o Exactly it should be 100% and it has been corrected According to table 7 in the report, there are no refusals or absentees. Yet in the narrative it is implied that somepotential beneficiaries skipped treatment because the period of distribution coincided with other activities - farming, trade etc. Others refused treatment because of minor side effects The absentees and refusals were not properly reported from the respective health facilities. Their number was mixed with number of people not treated because of the known selection factors such as age, height, etc lv There is need for further clarification on the content oftable 7 - All RB endemic villages planned to be treated were covered with 100% GC, - >78o/o of population in endemic areas were treated with 83%o average TC, - Number of absentees & refusals were not separately reported to complete in the table, - No case of SAE this It would appear that all 3,894 communities carry out self-monitoring. But it is not clear, what is involved. How was monitoring done? What kind of information was found? How was information channelled back to health authorities? What corrective actions were taken? The review meetings held at each kebele level were considered as part and parcel of community self monitoring. Similar meetings have been conducted at Woreda (district) level to discuss the information obtained from the lower community and solve the problems encountered. 4 WHO/APOC, 8 August, 201 1 lll I Executive Summary l. Background on treatment and population data Illubabor CDTI project is one of the project found in the Oromia Regional state which is located in the Southwest Ethiopia. T\e Zone is sub-divided into 24 woredas with about 7,432,607 populauons. The project consists of twelve CDTI woredas namely Ale, Alge Sachi, Becho, Bedele rural, Bilo Nopa, Dabo Hana, Darimu, Didu, Doreni, Hurumu, Mattu rural and Yayo. There are 33 health centers, l4 health stations and243 communiry health posts (CHPs) in the CDTI project area. The CDTI woredas are furthet divided into kebeles, sub kebeles (so called zones in which each kebele rs subdivided in to 3 zones) and 'Garees' which is the smallest administration unit. There are 3,943 vdlages whose local name is called 'Garees' rn the project areas. The Illu Aba Bora CDTI project has been started since the year 2004. All the targeted villages (with 100 Yo of geographical areas) were covered with Mectizan treatment since the start of the programme. The total population for the project area for the year was 735,536 with the Annual Treatment Objective (ATO) of 617,850 out of which 597,399 were ffeated with Mectizan@ for this year which gives 8l o/otherapeutic coverage. 2. Background on population movements. Most of the Communities in CDTI areas are settled farmers, Merchants, daily laborers and civil servants. Overall, there is no major population movement that affects the project program. 3. Training data Training and retraining were given for health ptofessionals, Community supervisors and CDDS every year .During the treatment period 135 front line health workers, 675 community supervisors and 7,827 CDDs were trained and retrained which gives the average number of CDDs two and above per villages. 4. Challenges and how they were overcome Challenges: . Frequent restructuring and reshuffling of administrative levels (districts and kebeles) has been a major challenge in using constant denominators to calculate certain coverages and achievements or follow the progresses. The change in number of village during the campaign was the result of this restructuring. 2 WHO/APOC, 8 August, 201 I ..-: Opportunities: . The availability of health facilities and health posts and the existence of health extension workers in each of CTDI kebeles are good opportunities for CDTI implementation. SEGTION t: Background information 1.1. General lnformation 1.1.f Description of the project Illubabor zone is one of the 24 administrative zones in Oromia Regional State .Metu, Zonal capital is 600 kms away from Addis Ababa .The Illubabor CDTI project is one of the project located in the western part of Ethiopia. The project is bordered with Gambella regional state in the west, West and Kellem Wollega CDTI in the Northwest, East Wollega CDTI in the North and Kaffa-Sheka CDTI in the South and Jimma CDTI zone in East. The Illubabor Zone is sub-divided into 24 Woredas. According to the government structure woreada is subdivided into Kebeles and the Kebeles are further subdivide into 'Zones '.The 'zones ' are further subdivided into "Garee" (villages) which is composed of 25 - 35 nearby households and responsible for all development activities including health. The Illubabor CDTI project consists of twelve woredas namely Alle, Alge-sache, Becho, Bedele, Bilo- Nopha, Dabo- Hana, Darimu, Didu, Dorani, Hurumu, Mettu and Yayu. There are a total of 273 kebeles in the CDTI woredas which are subdivided into 3,943 Garees (villages). The CDTI project area has very complex terrain with altitude ranges between 1,000-2,576 meters above sea level. Ecologically it is a tropical rain forest. Climate in the area shows great seasonal and inter-annual variations which is traditionally classified into three broad geo-climatic zones, i.e. cold highland (160 ), sub-humid mid-land (61%), and hot lowland (23%) area. The mean annualtemperature ranges from 10 oC to l6 0C in the highlands, l6 0C -260C in the midlands, and 230C - 33 0C in the lowlands. The annual rainfall totals ranges from 1,000 millimeters in the lowlands to 2,200 millimeters in the highlands. Sor, Geba, Birbir Dedessa, Offa, Sesie, and Gumer rivers are among the perennial fast flowing rivers that cross the zone. There are also many numerous fast flowing small rivers ) 3 WHO/APOC, 8 August, 201 I and streams, which are tributaries of the main rivers in many areas in the zone. The project Zone is covered with big land mass of forest and coffee plantation .The zone is well known with two distinct seasons that is the rainy season (April - October) and the dry season (November-March). There is a mono-modal rainfall pattern in the zone. Agricultural activities (clearing, farming, and herding) occur all year round in the project area, but are most intensive during the rainy season. Harvesting occurs from October to December, leaving January - March as the optimum treatment period. There are about 576 kilometers dry weather roads that connect woreda centers with Mettu town. The main road that runs from Addis Ababa to Mettu, the zonal capital town, passing through Jimma zone is partially Asphalt road and woredas alongside of the road are connected with Mettu town. All the CDTI woredas have all weather roads that connected with Mettu town. However, access to rural communities appears very difficult during rainy seasons in the project areas. Generally, in all Ilubabor zone there are one referal hospital, one general hospital, one Fistula center, 48 health centers, 30 health stations and 488 health posts making a total of 569 health facilities. The potential health service coverage of the zone is 82.9%. Table l: Number of health staff involved in Illubabor CDTI project area,20ll District Number of health stafl involved in CDTI activities. Total Number of health staffin the entire projcct trea Br Number of hcalth staff involved in CDTI B, Percentage B"=B,/ B' *100 Alle 4l t2 29 Alge-Sache 59 l6 27 Becho 33 1l 33 Bedele 36 15 42 Bilo -Nopha 29 9 3l Dabo-Hana 27 8 30 Darimu 50 22 44 Didu 28 11 39 Dorani 2t 6 29 Hurumu 29 8 28 Mattu 42 1l 26 Yayu- 36 6 t7 Total 431 135 3l 4 WHO/APOC, 8 August, 201 I 1.1.2 Partnership The Ethiopian Federal ministry of health, Oromia Regional health bureau, Illubabor zonal health Department, respective project Woreda health offices, health facilities, the affected community, The Carter Center Ethiopia , WHO/APOC and other government sectors in the zone are the main partners involved in the Illubabor CDTI project . There has been strong partnership during planning, advocacy, mobilization, drug distribution, monitoring and evaluation of the CDTI activities among all partners in the project area. 5 WHO/APOC, 8 August, 201 I a.l bo) 00() o 0<{o ci() ((, o C) o.() i! o() rE 0) ! (o () 't,) o. 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Describe difficulties/ constraints being faced and suggestions on how to improve advocacy' During the treatment period more than 242 political leaders at Woreda & Kebele were mobilized. The purpose of the mobilization was for the improvement of the treatment coverage, reduce the number of absentees and refusals and as well on sustainability of the program. .However, some competing activities limited the contribution of political leaders on the CDTI activities. 2.3. Mobilization, sensitization and health education of at risk communities The health professionals working at woreda health offices, front Line Health Facility workers, Health extension packages and Developmental workers were the major role player in the community mobilization and sensitization. Community Supervisors and kebele leaders were also involved in the mobilization activities. Community mobilization, sensitization and health education was conducted at each level during the treatment round. Health extension workers and CDDs were responsible in giving health information to the community at kebele and village level. The Community sensitization and dissemination of health information have contributed a lot in the awareness creation of the community .As a result of which the Eighth year CDTI activities was successfully accomplished with high therapeutic coverage(8lYo) and 100% geographical coverage. 8 WHO/APOC, 8 August, 201 I 1 NbI) 00 o" ri o P a a o ) 5 E o A >i do U;ou d o 8. E o oE c 3 o 6 o o Eo q.l o ao Ljo ooa a -o E d @ E E o o o o F oq rn N c.l N \o c\ \o \N o\ F-\o \o ,r.'l N n ra) \f o\ \o ttt c.t o\ <rN 6aa t-.ca ctl6I cot r- ra) r o\ olra| coco c-l \o in o EI6y oZ I z tr + ae il6 6t oF \o(r)\o r-ca @N crt $$$ co$ co \o o\ Olrl \o o\r- O\oo or- @ =fra) €ca $$ € lq 9o EEOr\ eo o\ $6l @ao r-ao NC\i co$ r- ra) rr)o\ c\(a) caco ol \o in EAI c z ro\o ra) r- * cn o o\ c.l r-o+ e.lco c.t t-- oo co oos \osF- r,^r\o o\ o\ -f,\o r.) rf) o\\o ca €Niar- E* ,o o.9o>DDL6lI .=5 <O .96P? =o EE 9= ZZ q ll * EEtq EA o u! n 0 o oO O Oo oo OO OO o oo oo O O e le Eas e i ET i EE E'A o\o co \o o\ aA@ co c.l car- r\r-s rcl o\o oo +$ r- co cn € @c! r- o\ <to\ aa la .=E E:E E" E =.!:FE6ooeE o\o ca \o o\ cn@ cOC\ cat'- t'-r-$ ra)N o\ @ sf$ F- co an €aN l'r o\ =fo\ c.) .l () o C)o FA (0 ao zIo EA o ! o () o)Eo FA (! (o o -o(! o L(\l o (.) o a Io o0 I >r(g Jr dLo 6 oF 44p U a) U) p -x q q) v(- O o +r€ -O.= E5O '.= o'5 L(d a.o J= EtrEELAOrI(, :.. .U{ -olt (glNFI aComment on Attendance of female members of the community at health education meetings o There is no significant improvement in the attendance of female community members at health education meetings. Usually because of pervasive tendency of the community letting females to accomplish the major roles they have at home .this is what the community assign to them. o In general, how do you rate the participation of female members of the community meetings when CDTI issues are being discussed (attendance, participation in the discussion etc). About less than a quarter of female members have been participated at the community meeting when the issues related to GDTI program are being discussed. o Incentives provided by communities for the CDDs The CDDs in this project area are serving their neighbor hoods (25-35) households voluntarily. No incentives (in cash or material based) were provided so far. Attrition of CDDs: Is attrition a problem for the project? If yes, how is it addressed? Attrition of CDDs is not considered as a problem because of immediate replacement of very few drop outs. o Other issues ll WHO/APOC, 8 August, 201I 2.5. Gapacity building - Describe the adequacy of available knowledgeable manpower at all levels. There is availability of knowledgeable man power at the higher levels. However, there is shortage of man power having adequate knowledge about CDTI principles at lower health facilities like Health centers and health posts. This gap is filled by conducting training and refresher haining of all staffs at lower health facility level that involved in CDTI program. - 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 implementationwhere not enough knowledgeoble manpower was available or if staffs are frequently transferred during the course of the campaign). The project has provided training and retraining for the new comers and the existing health workers at each levels every year on the CDTI principles to ensure adequate implementation of the program. Training and retraining were also given for the community supervisors and CDDs. t2 WHO/APOC, 8 August, 201I @t CD(o to Nto \€)\o c.l r\ RI co o\ G'(\I a, CDN a9 ..,t a)t (o t c) G'(v, C" o) o) ..,qt (n .,, oo ooto N t 6N (o o) tt, Nt oo t o) F' o) o) ro(o N ro(o 6ttlo ;(Y,t ;l N €(t o) .v, (g, o o o ;r-Nt- 6r-F- t-- (\I rn I? q) G t, Q o o! z l= il 9- a oF U a< (D(o oo\o co @N a) rolot ro(, (0 (D !t ro (o o) @(r)o o)lo(o (o lo No .Y' o rc? 6 (,) q,) il) o <l slvl F- o\ 6l c\ N o C\l 6t N N 6l o N N o N N a-l c.l o C\ .----l N o N N -----l 6l ca ca r\N c.)N $ O () .=G c[r LFr(u: oc)lF9 L 9!l z ? il d U z a o +.q c\ c! 6I o.l N N c.i C\ c! c\l c.l N c.) r- c\l l) C) () E \0o'l oo N\n c\lla) o co ca ca co o\6l o\N o c\ aa r\ co tat N r c\l c! oo N oo o oo6l oo c-l o f----. ----i ls r-r- o lorl(a c\ia F--- s co $ ca oo N oo N ra c-l 6l N ia al rf) ta oIF t Ilq lq L__ t> 6l 0 o t)o-> E r-I c! !r. jrU .6q)-= z lt(J l oola) cOc.l Oc-t $ o\N 6l€ c.) $oo c.l\o +co oc.t \ar! tr-rain I c) {) 1C {') o\ c! o\ o o\ r\ N cn C-l o\ O ta) N aO oo oo c.t c.l c! c\t O I - :l 'l \o $ c\ oo \o c! \o \o tr G a) O o a 90 .9e!'F o q) z ? ol 6q i z E,'tY c.t c-l oo .f, o.t oo c..lc! \o \o o \o IJ a) a () =z o ooo (€ o 1o ca C) E () c)Eoo (! (!l A o -o(d o H 0.) o(o a I 0) 00 I >.(g L d oa o N s N I F oF ia TQ i6 o (9 o o\ \o N q oo € O > -\ ! V1q q) Uq) q: v \)r. a -x q) Fs!q) s o cg o) o o. F oU({< o U) c) o 0)L . (.) Hr () cg o0 c, F .iir o:l -ol cdlFI bo o a € o E I s caa B o bo t o$ n;s aq a o tS F I < c\t I I l I I I l I Table 6: Type of training undertaken (Iick the boxes where specific training was carried out during the reporting period) Any other comments; - HEWs have been considered as community supervisors. 2.6. Treatments 2.6.1. Treatment figures If the project is not achieving 100% geographical coverage and a minimum of 65% therapeutic coverage or the coverage rate is fluctuating, state the reasons and the plans being made to remedy this. All projects are above the lower limits set for the performance Trainees Type of trainins 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 (specify) t4 WHO/APOC, 8 August, 201I ac\ o oo oo (-) o O{ o rr1 A u q q) u .\ ? \ p -N q) qj s JZ(n (6 ch(!(l) L(B (n J o L (n E >.! U) r! a ! d o (d C)LF rrf o-)l -ol(dl FI : 8€E r g H6€* IEHi€Hg;Z HE E o o qElt< = (r) AO o o O o o o b93EE9 =9z$ ll)NN o F- ro G. lr) c!(o roN o.l F- ro@ r- Or_ (o @lr) l.r)(o(O (o r-t- oia! in : e- s Hsi E E['€E @ @r- Nlr) G. @(A @(O o N o, C\l l.()(o o$ (o@ rr)o\o e ik A A d o\ E8E?F85 E-1,z !od o.z3trr{ :r= o} iJF .9 .,8ti 59E o f Ell€ F.e a.=oEa'E€ .6 E5F o '5o =bnodgg 38f- \t oo € o\F- Na a^l€ 00 c.t € oo t- e{F- oo +a 6 o\00ri $ca \o oo F- rd a-l 4.. st \o c.) a.tt- o\\o o\\o t 00 N \o \ 4.. tt c.t$ o \o 6i ca € € r.-N o\ o\(.I F. o\ia c.l c-l -t c.t oo 00 F- \oN \o * \o F- c.l00 oi 00o o^\tN NN t--r- o c.)t €o ..t 00 o\N o ra € r-. \o @ o\vl \o F- € .+ + € €^ e.lF- o\ 6 I o\ -t: \o co *q oo c.l(\l F- .+ ooN \O- rJv o\N o\ o\ o\ \o 00 -f lf o\ \o \o f.)ia ia l.- t ll r -!i d d sEf=$E * \oo\ tsB s.= a'i ! E 58fi3E's5 ao o tso? 6.> =E-^!!= o < 9€'F\J G -9o -Eb0o9s!d5 5b> 6o U'(.) tr o(J o oo o 6 O\o cO \o6 cO@ coN c.)t'- tt-(--$ rnN Oro oo +$ I r- c-l aO € oo c{ r- o\ {.)no\ ra O\o aa \o Or c.t oo aO c.l c.t t-r t--t'-$ la)N o\a@ $* rr c.) eO oo oo6t trr o\ ?al =o\ ao O\o ca \o o\ cOoo a.) c\ cal'- ln a-l l-- c--s \r$ o\ € r- co co t- o\oooo c\l t o\ .9< uq o z o o(u ca ca g o .o o ca 15 (! d ols(! I L(B o I o o(!a A cBL o a 6l F Formula for computing therapeutic and geographical coverages Therapeutic coverage rate Number of people treated x 100(%) Total population living in meso/hyper-endemic communities within the project area Geographical coverage rate Number of communities/villages treated x 100(%) Total number of meso/hyper-endemic communities as identified by REMO in the project area ATO coverage rate (%) Number of people treated x 100 Annual Treatment Objective %UTG achieved : Number of people treated x 100 Total number of people to be treated in meso/hyper-endemic areas within the project area (UTG) ATO = The estimated number of people living in meso/hyper-endemic areas lhut a CDTI projecl intends to treut with ivermectin in a given year. UTG = The maximum number of people to be trested in meso/hyper-endemic areas within the project area, ultimalely to be resched when the project has reachedfull geographical coverage (normally the project should be expected to reach the UTG at the end of the 3'o year of the project). t6 WHO/APOC, 8 August, 201 I 2.6.2 What are the causes of absenteeism? Some absenteeism was recorded due to the overlap of work activities such as movement of community members for trading or agricultural activities at the period of drug distribution . The large number of absenteeism is mainly due to the fact that some CDDs poorly mobilized the community and did not let them to decide on time and system of the Mectizan distribution. As a result, they carelessly considered any one who missed the drug as absentee or refusal. 2.6.3 What are the reasons for refusals? Most individuals refused because they considered themselves as healthy and others refused because of minor side effects. Poor mobilization and education in some places brought about significant number of refusals.. 2.6.4 Briefly describe all known and verilied serious adverse events (SAEs) that Occurred during the reporting period and provide (in table 8) the required Information when available. In case the project did not have any cases of serious adverse events (SAE) during this reporting period, please tick in the box. No SAE case to report l7 WHO/APOC,8 August, 201 I Noo 00 O o a. s Fri @ d t o 9 6l -e) 6lI o o0 c!t- C) oI rhv F.) = I L I I L .L(t0oc LL() c(61 !0):AEE -trO'0)9Ld LC' =9!?.Edov iH 99u) ^H!? t- .EXeAHo)OUC) 9Laoo-oq.)(B E-O ;=ot6 rr)l 'ee@l t- = i\lqLrl .o @l FAEr\ () :h;iE=l oeil H :61 EE(ql 4)(Dol '= -t vEaltrq)nt E oboz EE9oc)r- L 9c (J rioEY 5(0D 6lb9==LL-!c)9 rFtoOET ,o33 L9F= t- .l'r!- o)ir; 9l kqit PI\ FI Fr( obor't cl ^F 9;< O o o\ o\oo F-oo c? \o o\ @ o\ \oo\ o\o' F-o\ o (l, oo tIi k5 r.1 f-l o 9HeF Oo\f >v -o o o, o\ € F-6 cr') \o o\ 6 o\ \oo\ o\o\ F-o, t ll r fi r.l tl a o5o3ADo(€g9 ooEOF Frt.- r- r*F- 00 o6 oo € 00 E] E ,o o(€ .o o5 -o .^ FC =6z9 'o o c- 6 N * c.t ..i\ot o\ o\F-t s c- oo al \o sf o\ tst oi o\ o\ F- o\ EI :o d O.= aEo .535 Fq, \o\o 00 a.l € co 00 €q O) @!t 1^() ooq F-\o r- <t st @ r- \o : .,8vxo tr XE d.= .. ^ -. ,EEE<Ed - e rr o. c.l+\o F-\o \o c- \o +N\o o\ o\ c.I \o o\ 6l o\\o F- cq Nr-r- \o co v) F- q) bo cd e () c oO t ll t 1.1 tl ld o ^oo9 EG.r oo\ o o EOll a.bo= $E gslr{ Oolrl Oo o O o r-l qo o:E 3* E E SE c tr= ii =tr>k2Od o\ co c.) c.) $ o\tr- o\F- c.t \t o\ oo $ o\ rI1 E E.g aEo c €.= <.sA' FV o\ co co * F- st o\r- o\r- co sl o\6 <to\ bI)6 = '8r>xof B€ *F € E E E€E tr6 o o\ Ori ca m + r- + o\F- o\r- \f o\6 t m & rl] c.l c.l e.l o(\ ooa\l <f N o.l \o N t-- O c{ a o e.l o\ N c.l N c.l I o0a 00() 0. o > o\ r 2.7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - Qtlease tick the appropriate answer) MOH EI WHOf] TINICEil NGDC Other (please specifu): Mectizan@ delivered by - Qtlease tick the oppropriate answer) MOH EI WHOtr T]NICEil NGDC Other (please specifu) Please describe how Mectizan@ is ordered and how it gets to the communities The Ministry of Health together with NOTF requests for Mectizan from MDP. After the drug reaches the country, it follows the existing drug and other medical equipment delivery system in the country. Then the drug is stored in MOH warehouse .The project request for Mectizan@ from the MOH, following the existing drug distribution system. From the project level (zone level) each project Woredas receive the drug and distribute to the frontline health facilities. Then the frontline health facilities distribute the Mectizan@ to the community supervisors' The CDDS directly receive from their respective community supervisors and they distribute to the communities. Table l0: Mectizan@ Inventory (Please add more rows if necessary) How are the remaining ivermectin tablets collected and where are they kept? The remaining Mectizan @ tablets were collected by frontline health facilities from CDDS and returned back to the woreda focal person and stored in the woreda pharmacy store. List and briefly describe the activities under ivermectin delivery that are being canied out by health care personnel in the project area. . Training of community supervisors and CDDs . Request of Mectizan @ from different levels . Collection of Mectizan @ from the Woreda Pharmacy store . Distribution of Mectizan @ to Front line health facilities . Distribution of Mectizan @ to community supervisors . Distribution of Mectizan @ to CDDs . Supervision and follow up of treatment operation . Management of severe Adverse effects . Recording and reporting of training and mass drug distribution data District/LGA Number of Mectizan@ tablets Requested Received Used Lost Wasted Expired Remaining Illubabor zone 1,712,000 1,712,000 1,679,006 0 2359 0 30,635 Total 1,712,000 1,712,000 1,679,006 0 2359 0 30,635 20 WHO/APOC,8 August, 201 I Any other comments 2.8. Gommunity self-monitorlng and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? No. If so, When? Proper and formal training on community self monitoring was not given. As a result, none of the communities carried out the CSM. However, the review meetings held at all CDTI kebeles were considered as Stake Holders Meeting in which at least individuals from all communities, community leaders, CDDs and health extension workers have participated and thoroughly reviewed their performances. During the discussion they raised the major successes and failures in CDTI activities and recommended accordingly. Table I l: Community self-monitoring and Stakeholders Meeting (Add rows if needed) 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. In each village the community supervisors and community leaders have supervised and monitored the implementations and the performance of CDTI activities. The Stakeholders at each level have supported the implementations and the performance of CDTI activities. As the result the number of absenteeism and refusal were reduced and the therapeutic coverage showed increment during the period. District/ LGA Total # of communities/villages in the entire project area No of Communities that carried out self monitoring (CSM) No of Communities that conducted stakeholders meeting (SHM) Metu 360 0 360 Becho Bilo-Nopha 196 183 0 0 196 l8J Alle 231 0 231 Didu 173 0 173 Bedele 477 0 477 Dabo Hana 251 0 251 Darimu 809 0 809 Alge-Sache 441 0 441 Yayu- 337 0 337 Hurumu 288 0 288 Dorani 197 0 197 TOTAL 3943 0 3943 2t WHO/APOC, 8 August, 201 I 2.9. Superwision 2.9.1. Provide a flow chart of supervision hierarchy. NOTF )ROTF) ZOTF) WOTF ) Health Facility ) Community supervisors ) CDDs 2.9.2. What were the main issues identified during supervision? . Though some improvement have been observed further improvement is still required. 2.9.3. Was a supervision checklist used? Yes, supervision check lists were used at all levels. 2.9.4. What were the outcomes at each level of CDTI implementation supervision? Some improvement was seen for the year. 2.9.5. Was feedback given to the person or groups supervised? Yes, verbal communication during the field visit and written feedbacks were Given for each level 2.9.6. How was the feedback used to improve the overall performance of the project? High th"rapeutic coverage and l00o/o geogtaphic coverage is due to the continuous supervision and feed back. SEGTION 3: Support to GDTI 3.{, Equipment Table l2: Status of equipment (Please add more rows if necessary) +Condition of the equipment (F:Functional, CNFR:Currently non-functional but repairable, Source Type of equipment APOC MOH - Zone DISTRICT NGDO Others No Condrfion No. Condrfion No Condrtton No Condition No. Condrtron l. Vehicle 2 F 0 NA 0 NA 0 NA 0 NA 2. Motor cycle(s) l2 F 0 NA 0 NA t9 F 0 NA 3. Computer(s) 2 F 0 NA 0 NA 0 NA 0 NA 4. Printer(s) 2 IF 0 NA 0 NA 0 NA 0 NA 5. Photocopier (s) I CNFR 0 NA 0 NA 0 NA 0 NA 6. Fax Machl4q$f I CNFR 0 NA 0 NA 0 NA 0 NA 7. Overhead projector I F 0 NA 0 NA 0 NA 0 NA 8.25" TV set I CNFR 0 NA 0 NA 0 NA 0 NA 9. Deiesel Generator 1 F 0 NA 0 NA 0 NA 0 NA NA:Not Applicable). 22 WHO/APOC, 8 August, 201 I How does the project intend to maintain and replace existing equipment and other materials? The project office and its partner's were effectively repaired and maintained the existing Capital equipment and other materials provided by APOC. The project is trying to handle and to improve the overall performances of all activities by integrating to the existing government system. At the same time efforts will continue to allocate budget by the government for smooth operation and management of the project by integrating into the existing health programme. 23 WHO/APOC, 8 August, 2011 q \o 6 a.l o s a.l o.l bo € O $N () L € {t) o E(,)(n C) o E oo c) o c) ot) :X o)69o-E .o. c!c\.otrEtrO6.:)5()3E9,9ii..r €.sE I: EEf RE +tG)(D tidC,LEb 6= -oir7 7 € e.b ^rj .9oE v€!JtrN <9!i(trd= 0Je L)cg >rO. cd' ob E go €v !t)UOY9i EEvaa _qqrE o7a L-0)!u t XE .E\1C2?3e r.E6: -oAXe E-SAV 6)=c)L_oLL(giaE -6) (1)(g:\ t,9_9(! lJ - ir(E I o d (t) t, o th l+ Fl F oF t^ LF UAE <r! ano oO rh iiE z 'd.(! (h oEO() ;Fiov)Z C) oN + o Ynza (D d a + 6 L 3g o L U (ssn) peseeleu qsES l?loJ a.l 6 do pela8png qsuc .IVJOJ o o{ \o .o \o € a.l \o c.t € (ssn) paseeleu qsec IsloJ € \o o r-.VI \o6l r-q a.l o a.l t\ V? o\g\ tt) rtc a.l r- GIo pere8png qsBc .IVJOJ € \o rr\o 6l cl c- a.l al6l ior- N \o ra ($sn) pesBeleu qsBS .IVJOJ o oo\o \o\o (\ la F-ia F-6o\ a.l \o €I ($sn) pele8png qsBS .IVJOJ 6 \o \o\o ol 6 \o iaia € r) o\ ($sn) pasealeu qSBJ .IVJOI \oq o 9s r o\6l o *\o\o =l' i \o\o\o o\@ a.l r.) 6o (ssn)pele8png qsEc .IVJOJ o\q \o oo\ €" GIt o\o\o r o\G \o (ssn) pesBeleu qSEf, .IYIOJ N oo + oo\vl t*. * o € rr) t- o\otr- 6l ! 6to ($sn) palaBpng rlsBS .IVJOJ N o\ rr o o\vl 6lF o <t r- a.l o\ \o o GI ! \o (ssn) pesEeleu qseJ "IVJOJ \oo 6l c (ssn) palaBpng qseJ .IVJOJ o r !+ o\ \o o oo\o6I oot \o ol o .gI E J E E?OEo9, Eq - q.) o€oaLfrIo- -O)ttt! .6ce (hob .ttr+,E|r.xo5OE -o-o J= JOlt '.= L=fl= OFo3 G.g oOtr -(gG;i Eii #r -l ."1N -ol .(BloFt Additional comments Integration of Malaria and Onchocerciasis control programme (MALONCHO) play a great role in the implementation and good performance of the CDTI activity for this year. 3.3. Other forms of communlty support Describe (indicate forms of in-kind contributions of communities if any) The services provided by the Community Drug Distributors(CDDs) and Community supervisors are considered as the major community contributions for the effective accomplishment of CDTI Projects. .In this treatment round ,8,p44 CDDs and 675 community supervisors are involved in 3,943 communities. 3.4. Expendlture per activity Indicate in table 14, the amount expended during the reporting period for each activity listed. Write the amount expended in US dollars using the current United Nations exchange rate to local currency. Indicate exchange rate used here I USD = 16.8 Table l4: Indicate how much the project spent for each activity listed below during the reporting period Any comments or explanations? The budget assumed from MOH is not considered as expense (budget item as personnel cost, capital equipment), that leads to the difference of expenditure and expense in the listed above (table 13 &.14\. Assumption of the exact budget for CDTI is not an easy due to the pooled finance management system and the integrated nature of the CDTI project to the existing health program. !a:tjvity Expenditure ($ US) Source(s) of funding Drug delivery from NOTF HQ area to central collection point of 0 Mobilization and health education of communities 6,886.28 TCC Irg!,fne_gf CQD9 of health staff at all levels 0 13,915.44 0 NGDO 7,145.28 APOC 4,486.97 NGDO SIng and Mop4q{qg CSM 3002.82 t964.t8 APOC APOC Vehicles/ 0 Others 1,281.96 TCC TOTAL 38,682.83 Total number of rsons treated 25 WHO/APOC,8 August, 201 I community Supervising and Monitoring bicycles maintenance SEGTION 4: SustainabilitY of GDTI 4.1. tnternat; independent participatory monitoring; Evaluation 4.1,1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable) None -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? 4.1.3. How have they been implemented? 4.2. Sustainability of proiects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period? NO Was a sustainability plan written? NO When was the sustainability plan submitted?-NA- What anangements have been made to sustain CDTI after APOC funding ceases in terms ot 4.2.1. Planning at all relevant levels -CDTI iJ insisted to be included in annual plan of action and prepared yearly and communicated from top to bottom with follow up for its proper implementation. -The one to five structure established by the government is also very promising for community ownership and sustainability of CDTI' 4.2.2. Funds Utilize common budget allocated for the PHC. 26 WHO/APOC, 8 August,20l I aTransport (replacement and maintenance) APOC has replaced vehicles for zone and motor cycles for woredas. Locally available means of transportation has been used at kebele levels. 4.2.4. Other resources contribution of the communify in kind can be considered as potential resources 4.2.3 4.3.1. 4.3.2. 4.3.3 4.2,5. To what extent has the plan been implemented It is in a good Progress 4.3. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: Ivermectin delivery mechanisms The ivermectin delivery system is very well integrated into the MOH structure right from the onset. There has been no separate Ivermectin delivery system in this project; it follows the existing drug delivery system in the couniry. The project will be normally notified to collect the drugs as soon as it has been cleared by the wHo clearing agent in close collaboration with the MoH. The project coordinator will then allocate the drug to the respective project woredas and FLHFs. Training: Health professionals in the entire project were trained and retrained on community Directed treatment with Ivermectin (cDTI) every year. GDTI is integrated with the Primary Health Care (PHC) particularly to Malaria and other vector borne diseases from the beginning. Therefore, CDTI is part and parcel of the health care delivery at all levels. t Joint supervision and monitoring with other programs Primary health care activity in the project area are supervised and monitored in an integrated manner. Also CDTI and malaria activities are supervised in an integrated manner. 4.3.4. Release of funds for project activities For the treatment period the APOC Trust Fund was delayed .However the fund from NGDO was released on time. 4.3.5. Is CDTI included in the pHC budget: Yes, CDTI in this project area is an integral part of the malaria and other vector bome disease control unit at all levels and have similar budget. 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? The CDTI structure is used for malaria control program particularly for bed net distribution, for follow up the utilization of bed nets, in expanded program on Immunization (EPI) and for TB default rracing. 27 WHO/APOC, 8 August, 201 I I- 4.3.7. Describe others issues considered in the integration of CDTI. The Health Extension Package program which include many other health programme designed to reach all Kebeles that will play a major role for strong integration and sustainability of CDTI in the project area. 4.4. Operationa! research 4.4.1. 4.4.2. Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period. Not done How were the results applied in the project? SEGTION 5: Strengths, weaknesses, challenges, and opportunities Strengths: The project is successfully accomplished the distribution of Mectizan@ for the Eighth round within the given period of time with high therapeutic coverage (81%) with in 100/o geographical area. This great performance is due to the active involvement of the health workers, community supervisors, partners and the community atlarge. Weaknesses: Delay in liquidating the utilized budget from partners. Opportunities: The commitment and availability of Health Extension Package program and the increased numbers of Health extension workers is an opportunity for the programme. The government structure down to village level "Geree" and being taking the responsibility of development activities as well as health is a good opportunity for sustainability of Onchocerciasis control. Threats (Challenges): The high turn over of health professionals at all levels, and overburden of other activities, the continuous restructuring of woreads, kebeles and villages. SEGTION 6: Unique features of the projecUother matters None i a 28 WHO/APOC, 8 August, 201 I