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

Ethiopian Program for Onchocerciasis Control Community Directed Treatment with Ivermectin(cDrI) 4th and 5th Year Sustainability Plan For Saylem Woreda (District) Kaffa-Sheka CDTI Project Project Period: 2004-2005 Part I Part II Table of Contents 1. Rapid Epidemiological Mapping of Onchocerciasis 1 . Budget justification (Explanation ..... .. . .. .. .. . 2. Budget Summary Year fV..... 3.Budget Summary of Sustainability plan for year V ....... .,.......2 Part III 1. CDTI implementation and Results 2. CDTI training achievements ............. 3. Treatment coverage... Part IV l. Financial Management of APOC Trust Funds............... 2. REMO Maps of Saylem woreda Part V Sustainability of Issues of Saylem woreda CDTI Planning....... Leadership Monitoring *a sup.*;;i;; :...... Mectizan supply and distribution TrainingAIESAM...... Project Budget FinancinglFunding ...... Transport and other Material Resource Human Resources Coverage 10. Sustainability plan frame framework for Saylem woreda I 1. List of Available Resources for program support 12. List of Materials, Supplies and Equipment Required for CDTI Actrvities ............... 12 Part V 2 2 J J 4 5 5 5 5 6 6 7 7 8 8 9 11 I 2 J 4 5 6 7 8 9 13 15 16 ll 1 Introduction Saylem is one of the ten wordas (districts) of Kaffa zone, located about 700 kms away Southwest of Addis Ababa. Saylem has a population of around 36,000. The woreda comprises 22 kebeles (smallest admin units), whose inhabitants mainly depend on subsistence agriculture. The climatic zones of the woreda, in most places, are that of highland with longer annual rainfall period (6-8 months). In this woreda, there is only one health station in Saylem woreda. The infrastructure in the woreda is underdeveloped; no continuous electric power supply, poor telephone service, inadequate roads connecting the kebeles (rural communities) to the capital town, etc. The woreda is well known for its diversified cultural and ethnic composition, although Kaffeclrc is the most dominant one amongst others. Background Information Onchocerciasis control program was launched through community directed treatment with Ivermectin strategy in the year 2002. The project was initiated with a strong partnership between APOC, affected communities, regional, zonal, woreda admin councils and health departments, Federal Ministry of Health and an NGDO partner (The Carter Center). The program was initially designed and implemented as Kaffa-Sheka CDTI project with the overall coordination role assumed by the zonal health department. However, Kaffa- Sheka was later on split as two distinct zones and the leadership role was then shifted to each zonal health office. Again, very recently, in accordance to the decentralization policy of the goverrrment of Ethiopia, there was a paradigm shift of power and authority from zonal to woreda levels. It was at this juncture that the midterm CDTI sustainability evaluation of Kaffa-Sheka project was undertaken. ln line with this development, it was recommended that the CDTI plan be worked out at woreda level. After the midterm evaluation of CDTI sustainability, there was SWOT analysis done for each level of health delivery stnrcture. As a result, coverage, Mectizan order and supply, monitoring and sr-rpervision, as well as training and HESAM were considered relatively fir 1 2ts4 as strong points at woreda and front line health facility levels. On the other hand, Financial Resources, Planning, Leadership, Transport and other materials and Human Resources were considered as weak points at this level. Efforts have been made to address these weak points in this action plan. Rapid Epidemiological Mapping of Onchocerciasis (REMO) The rapid epidemiological assessment carried out in selected communities in 1997 indicated that Saylem woreda is hyper and meso-endemic to Onchocerciasis. CDTI Implementation and Results Although the woreda was known for its endemicity of Onchocerciasis, there was no mass treatment activity conducted before the launching of CDTI. However, clinic-based treatments have been going on with diethylcarb amazine (DEC) in some of the health institutions of Saylem Woreda. As mentioned earlier, CDTI was implemented for the first time in the woreda during the year 2002. The major partners were APOC, FMOH, respective health authorities, local govemments, affected communities, and the parlner NGDO (Carter Center). The mass treatment had 100 percent geographic coverage of the communities in the woreda right from the beginning. CDTI Training in Saylem Woreda, Kaffa zone Year Health Personnel Others CDDs 2001 2002 7 28 150 2003 9 2t 150 JTreatment Coverage, Saylem Woreda, Kaffa zone Financial Management of APOC Trust Funds The financial management of CDTI projects used to be carried out by zonal health departments in the past two years. It was, therefore, not possible to come across correct figures for each woreda by year. Moreover, due to the restructuring process in the country (which is still underway) and frequent change of staff (CDTI coordinators), it was not easy get access to the financial documents. However, efforts were made to extract some data from the existing financial documents at zonal levels. Year Funds Received Other Sources Comments APOC NGDO* 2001 2002 DNA** ,f None 2003 911 430 None -onty tne t advince was received frory 4199. Total 911 430 * NGDO support was mainly througlr material and technical support *r Data Not Available New Leadership Role and Integration of CDTI ln view of the recent decentralization policy, devolution of power and authority has been made to the woreda level structure. As a result of this change, CDTI has been considered as integral part of the overall three-year strategic health plan for Saylem woreda. During the CDTI sustainability-planning workshop, all stakeholders have participated and have expressed their commitment to assuming the leadership role in the implementation of CDTI in their respective areas. CDTI has been included in the malaria and other vector borne diseases prevention and control unit in the strategic woreda health plan. * Year Total Nbr. of villages ATO Nbr. of Villages Treated Geogra phic Coverag e (%\ ATO Coverage (%) Total Popn. ATO Nbr. of persons treated Therapeutic Coverage (%) ATO Coverage 2001 2002 r43 t43 t43 100 100 34,795 21,836 27,622 79.4 99.2 2003 143 143 143 100 100 36,000 28,801 29,360 8 r.6 102 #l 4REMO Map, Saylem woreda, Kaffa zone t :i.lr ''li I ! i. l: .\..,]!l.- t. 'ttl).Iitt, i' ,:r'1rr iF, 1'I llir r;, I 5Sustainability Issues in Saylem Woreda CDTI Planning This is an area identified as weakness during the midterm evaluation that requires immediate corrective action. The CDTI is incorporated in the overall three-year strategic health plan of the woreda. However, in the past, the woreda health office and FLHFs were not actively involved in drawing up the CDTI proposal and annual plans of action. It was mainly the zonal health department that was responsible for planning CDTI activities in particular. Following the midterm CDTI sustainability evaluation, however, it has been decided that all stakeholders at woreda and FLHF levels will assume the responsibility of working out their respective periodic plans of action from this time on. Shorl training course will be necessary to develop the planning skills of the health personnel working in these institutions. Efforts will be made to implement the bottom-up planning approach with the assistance of the NOTF in the remaining two project years. Leadership As introduced earlier, currently there is a paradigm shift in the'hdmin structure and organizational set up of the overall management of health and'other development programs in the country. The general trend is to empower the woreda level structures and build capacities in all aspects of program management. fhe CD{I, being one of the recognized and integrated health programs of the woreda, will receive leadership and close guidance from the woreda admin council and the taskforce organized at this level. Monitoring and Supervision Monitoring and supervision is very critical to the success of CDTI if it is done in a timely and effective mamer. However, it was understood during the evaluation that the frequency and coverage was inadequate. Supervisory checklists were not used regularly and feedbacks were not communicated in writing. In most cases, supervisory visits were not problem oriented and targeted to improving poor perfonnance of FLHFs and CDDs. During the sustainability-planning workshop, it was agreed that the weak points identified wor"rld be addressed very critically although shortage of health personnel and tl 6other competing health priorities at both woreda and FLHF levels could be possible threats in the implementation process. Mectizan Supply and Distribution This activity is considered as a strong point during the evaluation process. Mectizan procurement and distribution is fully integrated into the govenrment health care delivery system. Every effort will be made to maintain the good achievement obtained thus far. Ordering Mectizan in good time and in sufficient quantity is indeed a commendable job favoring sustainability. However, there are areas that need fine tuning at FLHF and CDD levels. Minimizing wastage, proper record keeping and timely and complete reporting are some of the areas requiring attention in the remaining project period. Training/HESAM Organization and management of CDTI training programs were the responsibilities of the zonal program coordinator in the past three years. The woreda health office is not fully empowered to handle this responsibility. The future direction is however to build the capacities of the woreda health staff so that they can be in a position to plan and implement training sessions after carrying out needs assessment at FLHF levels. Efforts will be made to make CDTI training sessions focused on identified weaknesses of the health personnel and other partners including CDDs. Similarly, the woreda health office will be making proper use of its meager resources by integrating training programs to the best of its capacity. Health education, sensitization and community mobilization has been very effective in enhancing CDTI awareness to the general public. The perceived benefits of Mectizan are foundational grounds for the sustainability of CDTI in the woreda. There will be a need to produce more powerful health education and sensitization materials in order to enhance further the active involvement of communities in decision-making process. Moreover, the beneficiary communities will need to be mobilized to provide effective support for the CDDs serving their respective villages. This is believed to be one of the cornerstones for the effective sustenance of the program in the woreda. I 7Financing/Funding During the first three CDTI years, there has been no specific budgeting for onchocerciasis control activities in this woreda. Very recently, however, the woreda admin council has started allocating funds in block for all health programs in an integrated manner. Obviously, the amount of money is much smaller compared to the diverse needs of the woreda health office. Whatever the amount may be it is indeed a commendable start and it is hoped that it could be increasing over the remaining project period. Since the woreda health system functions in an integrated manner, it is hoped that CDTI could also benefit from funds coming from other sources like Global Fund, EPI, etc. At this rudimentary stage of the woreda, however, more support will be required from APOC. Transport and other Material Resources In this woreda, at it is the policy of the Ethiopian goverrlment in general; available transport facilities are used in an integrated manner. In the midterm eValuation, means of transport is one of the most important limitations identified at both woreda and FLHF levels. Ideally, it would be appropriate if a pick up could be provided for the woreda health service and at least one motorcycle for each FLHF. The evaluation team has recommended replacement of the motorcycles that are found to be'worn out and non functional in the evaluated woredas. It is strongly recommended that each FLHF would need one motorcycle for effective monitoring and supervision of CDTI ictivities. At this juncture it is very important to underscore the need to consider building the capacities of the woreda and FL,HFs inorder to be able ensure the su$tainability of CDTI in this particular woreda. This woreda health office lacks important office equipment like computer, printer, photocopy machine, etc. These deficiencies need to be tackled as soon as possible. Other CDTI material resources like treatment registers, reporting booklets, training manuals, posters, flip charts, T-Shirts, stationery, etc. should be supplied in sufficient quantities for the effective continuance of CDTI in the woreda. p I' ra* 8Human Resources It is known beyond any grain of doubt that the availability of skilled and motivated human resource is very critical to the success of CDTI. The midterm evaluators noted that there was a very high turnover of health personnel at both woreda and FLHF levels. It was also noted that most of the FLHFs are understaffed. In the coming couple of years, however, these shortcomings need to be addressed as much as possible. During the planning workshop, the woreda admin council and other authorities at higher levels promised to do their best in this respect. Plans have also been made to motivate health personnel and CDDs by means of rewarding best performing individuals and institutions. As stated above, training workshops will also be organized to fill the gap of knowledge, skills and competence of the available health personnel in planning and management of CDTI activities. Coverage This woreda has already achieved 100 percent geographic coverage and therapeutic coverage of well over 65 percent during the past three years. Participants of this planning workshop believe the fact that if all other aspects and indicators of sustainability are well taken care there won't be a problem to maintain the current geographic coverage and improve further the therapeutic coverage levels. Efforts will need to be intensified to reduce the cunent rates of absentees and refusals to the best rninimum levels. o) OI FE q) cll U) lrl o() L oa ,l-i6a LliCE(l)OQ O o o< H o OoA Eo\<rA U o .Lrli ()H E i-l(, ()xUOz () o Or o do o @\ r- .ir \o ol(n @ v') rn o\ coq c-r- t--q \o(r}\o (a) r- q r\o r.1 O\r-(aAr- c.t N eA q) =o0o=FCa n c.l o\ t-- t rar- \\n ca\o ,a? @ \t U) o () tt)0q) c,)(,) v) tA :0) E'Ec)() ^H boE - lo8r Eo.=.= tr o c) * r*E $BY.-Cv^q, a.-- 1 d V) e .= E ( 6O F E E:3 38E XSEEEE ,; (n ,L vE : E.E :o€irx ":Ei:EESiXtEtg..8'EfbEBgETE:iI8E:I; 0 3 ? 5 6 4.93 6I3'* +9 b :H-!FtvL^e ^ H L s(! E Ug g€ I 3 E qid<c Oi(J.t1E ErE. g9 EEEE'E\ ) 4 - I : ;E * H g9z.8EEFH c co'= co o iiJ 9q ETE€T .Fv-!v!-FL'it^tg sE "EU }E.HEIJ(!tro- lJ0)(ds{r\ = t-.- v;v9,\r-I'lt*otYoioro.r € 6E EE = a =9 r2849,3 q) cq q) !o - !2co >dR hTEotr> (cs7I-O H Oc{ hIE E qON Oo] t< -v(do5()cBS3 E $rOce ON () (a) t' Z atLta)Ioa)J I ^ c€-U29-o '5 E u! 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(, > &Es Ha E= a-aF:d.oACESR5 Lr r(\JH o ts^ 5E.35 oN il o c.t G) (A o t-.1(-) b0 ti _o Lrq)a (h C) -o\o ct) li B a 0.) 0)o (H o o a oLr Ifr t-- oo t 15 Bud et Sum for Year MDTI in Sa lem Woreda Kaffa zone S.No Budget Line ltem APOC MOH Carter Center Total Allocation I Personnel 0 11 290 11290 2 Capital Equipment 9,000 0 300 9300 J Supplies 0 70 500 570 4 Training 1977.27 95.58 70.5 2143.35 5 Monitoring and Supervision 2826 70.5 0 2896.s 6 HESAM r,526.04 95.58 170.18 1792.4 7 Annuai Review Meeting 0 0 667.78 667.78 8 Provision of Awards 0 0 t20 r20 9 Total Budget 15,329.31 1 1,331.66 2,119.06 28,780.03 10 NGDO overhead (7.5%) 1,149.70 0.00 0.00 1,149.70 11 Grand total 76,479.0t 11,331.66 2,179.06 29,929.73 t2 Estimated Treatments 29,665 29,665 29,665 29,665 13 Cost per treatment 0.s6 0.38 0.07 1 0 1 14 % hput of Partners 55.06 37.86 7.08 100.00 fi ,000 I6 Budget Summary of sustainability plan for Year V CDTI in Saylem Woreda, Kaffa zone S.No Budget Line Item APOC MOH Total Allocation I 0 12,500 300 12800 2 Capital Equipment 0 0 3 Supplies 0 80 s00 s80 4 Training 1000 100 100 1200 5 Monitoring and Supervision 1 500 80 0 I 580 6 HESAM 1,000.00 100 100 1200 7 Annual Review Meeting 0 0 700.00 700 8 Provision of Awards 0 0 t20 t20 9 Total Budget 3,500.00 12,860.00 1,820.00 18,180.00 l0 NGDO overhead (7.5%) 262.50 0.00 0.00 262.50 1l Grand total 3,762.50 12,860.00 1,820.00 18,442.50 t2 Estimated Treatments 30,525 30,525 30,525 30,525 13 Cost per treatment 0.t2 0.42 0.06 0.60 14 % Input of Partners 0.20 0.70 0.10 1.00 lCarter Center lPersonnel