ENVISION | ENVISION - Standardization of NTD … · Web viewThe FMOH is following the 2020...

ETHIOPIA Work PlanFY 2017Project Year 6

October 2016-September 2017

ENVISION is a global project led by RTI International in partnership with CBM International, The Carter Center, Fred Hollows Foundation, Helen Keller International, IMA World Health, Light for the World, Sightsavers, and World Vision. ENVISION is funded by the US Agency for International Development under cooperative agreement No. AID-OAA-A-11-00048. The period of performance for ENVISION is September 30, 2011 through September 30, 2019.

The author’s views expressed in this publication do not necessarily reflect the views of the United States Agency for International Development or the United States Government.

ENVISION Project Overview

The U.S. Agency for International Development (USAID)’s ENVISION project (2011-2019) is designed to support the vision of the World Health Organization (WHO) and its member states by targeting the control and elimination of seven neglected tropical diseases (NTDs) including, lymphatic filariasis (LF), Onchocerciasis (OV), schistosomiasis (SCH), three soil-transmitted helminths (STH; roundworm, whipworm, hookworm) and trachoma. ENVISION’s goal is to strengthen NTD programming at global and country levels and support Ministries of Health (MOH) to achieve their NTD control and elimination goals.

At global level, ENVISION –in close coordination and collaboration with WHO, USAID and other stakeholders- contributes to several technical areas in support of global NTD control and elimination goals, including:

Drug and diagnostics procurement, where global donation programs are unavailable, Capacity strengthening, Management and implementation of ENVISION’s Technical Assistance Facility (TAF), Disease mapping, NTD policy and technical guideline development, and NTD monitoring and evaluation (M&E).

At the country level, ENVISION provides support to national NTD programs by providing strategic technical and financial assistance for a comprehensive package of NTD interventions, including:

Strategic annual and multi-year planning Advocacy Social mobilization and health education Capacity strengthening Baseline disease mapping Preventive chemotherapy (PC) or mass drug administration (MDA) Drug and commodity supply management and procurement Program supervision M&E, including disease-specific assessments (DSA) and surveillance

In Ethiopia, ENVISION project activities are implemented by RTI International (RTI), the Fred Hollows Foundation (FHF), and Light For The World (LFTW).

ENVISION FY17 PY6 ETHIOPIA Work Planii

TABLE OF CONTENTSPage

Acronyms List...............................................................................................................................................v

COUNTRY OVERVIEW..................................................................................................................................7

1) General Country Background...........................................................................................................7

a) Administrative Structure..............................................................................................................7

b) NTD Program Partners.................................................................................................................8

2) National NTD Program Overview...................................................................................................11

a) LF...............................................................................................................................................11

b) OV..............................................................................................................................................13

c) SCH/STH.....................................................................................................................................15

d) Trachoma...................................................................................................................................17

3) Snapshot of NTD status in Ethiopia................................................................................................21

PLANNED ACTIVITIES.................................................................................................................................22

1) NTD Program Capacity Strengthening...........................................................................................22

a) Strategic Capacity Strengthening Approach..............................................................................22

b) Capacity Strengthening Interventions.......................................................................................23

c) Monitoring Capacity Strengthening...........................................................................................24

2) Project Assistance..........................................................................................................................27

a) Strategic Planning......................................................................................................................27

b) NTD Secretariat..........................................................................................................................29

c) Advocacy for Building a Sustainable National NTD Program......................................................30

d) Social Mobilization to Enable NTD Program Activities...............................................................30

e) Training......................................................................................................................................34

f) Mapping.....................................................................................................................................37

g) MDA Coverage and Challenges..................................................................................................37

h) Drug and Commodity Supply Management and Procurement..................................................39

i) Supervision................................................................................................................................40

j) M&E...........................................................................................................................................41

3) Maps..............................................................................................................................................43

Appendix 1. Work plan Timeline...............................................................................................................48

Appendix 2. Table of USAID-supported Provinces/States and Districts.....................................................53

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TABLE OF TABLESTable 1. NTD partners working in Ethiopia, donor support, and summarized activities..............................9

Table 2. LF endemic woredas by region after 1% remapping exercise......................................................12

Table 3. OV endemic Woredas by region..................................................................................................15

Table 4. SCH and STH endemic woredas by region....................................................................................17

Table 5. Number of woredas that fall into each treatment category and their progress toward elimination in 2020....................................................................................................................................19

Table 6. Snapshot of the expected status of NTD program in Ethiopia as of Sept 30, 2016......................21

Table 7: Project assistance for capacity strengthening..............................................................................23

Table 8: Social mobilization/communication activities and materials checklist for NTD work planning...33

Table 9: USAID-supported coverage results for FY15 and FY16** and targets for FY17............................39

Table 10. List of PFSA branches allocated by training cluster and region..................................................40

Table 11: Planned Disease-specific Assessments for FY17 by Disease.......................................................42

LIST OF FIGURES

Figure 1: 2016 OV Disease Distribution and Biannual vs. Annual treatment.............................................14

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ACRONYMS LIST

ALB AlbendazoleAPOC African Programme for Onchocerciasis ControlAmref African Medication and Research FoundationBCC Behavior Change CommunicationCDD Community Drug DistributorCIFF Children’s Investment Fund Foundation CNTD Centre for Neglected Tropical Diseases, Liverpool School of Tropical MedicineCY Calendar YearDFAT Department of Foreign Affairs and Trade (Australia)DFID Department for International Development (U.K.)DQA Data Quality AssessmentsDSA Disease-Specific AssessmentEND Fund End Neglected Tropical Disease FundEOEEAC Ethiopia Onchocerciasis Elimination Expert Advisory CommitteeEPHI Ethiopian Public Health InstituteESHI Enhanced School Health InitiativeF and E Facial Cleanliness and Environmental Improvement (part of the SAFE strategy)FHF Fred Hollows FoundationFMOH Federal Ministry of HealthFPSU Filariasis Programmes Support Unit, Liverpool School of Tropical Medicine (formerly known

as CNTD)FOG Fixed Obligation GrantFY Fiscal YearGTM Grarbet Tehadiso MahberGTMP Global Trachoma Mapping ProjectHDA Health Development ArmyHEW Health Extension WorkerICT Immunochromatographic TestIEC Information, Education and CommunicationITI International Trachoma InitiativeIVM IvermectinLF Lymphatic FilariasisLFTW Light For The World M&E Monitoring and EvaluationMDA Mass Drug AdministrationMEB MebendazoleMfM Menschen für MenschenMMDP Morbidity Management and Disability Prevention ProgramMOH Ministry of HealthMOU Memorandum of UnderstandingNGO Nongovernmental OrganizationNTD Neglected Tropical Disease

ENVISION FY17 PY6 ETHIOPIA Work Planv

OEPA Onchocerciasis Elimination Program for the AmericasOCSSCO Oromia Credit & Savings Share CompanyOV OnchocerciasisPCR Polymerase Chain ReactionPC Preventive Chemotherapy PFSA Pharmaceutical Fund and Supplies AgencyPHCU Primary Health Care UnitPZQ PraziquantelREMO Rapid Epidemiological Mapping of Onchocerciasis RHB Regional Health BureauRTI RTI InternationalSAC School-Aged ChildrenSAE Serious Adverse EventsSAFE Surgery-Antibiotics-Facial cleanliness-Environmental improvementsSCH SchistosomiasisSCI Schistosomiasis Control InitiativeSNNPR Southern Nations, Nationalities, and People’s RegionSTH Soil-Transmitted HelminthsTAF Technical Assistance FacilityTAS Transmission Assessment SurveyTF Trachomatous Inflammation–FollicularTIPAC Tool for Integrated Planning and CostingTOT Training of TrainersTT Trachomatous TrichiasisUIG Ultimate Intervention GoalUSAID U.S. Agency for International DevelopmentWASH Water, Sanitation, and HygieneWHO World Health OrganizationZTH Zithromax®

ENVISION FY17 PY6 ETHIOPIA Work Planvi

COUNTRY OVERVIEW

1) General Country Background

a) Administrative Structure

Ethiopia is a federated nation comprising nine autonomous regions (Afar; Amhara; Beneshangul-Gumuz; Gambella; Harari; Oromia; Somali; the Southern Nations, Nationalities, and People’s Region [SNNPR]; and Tigray) and the two city administration councils of Addis Ababa and Dire Dawa. Each region is constitutionally allowed self-determination; the federal government is responsible for the military and foreign affairs, international treaties, and other overarching issues of interest to the entire nation. The nine regions are further subdivided into 68 zones, which consist of 839 administrative woredas (districts). Each woreda has an average population of 100,000 people. The woredas are further divided into 16,523 kebeles. The kebele, which is the smallest unit of local government, consists of 5,000 people on average.

The Ethiopia Federal Ministry of Health (FMOH) focuses on eight priority neglected tropical diseases (NTDs): lymphatic filariasis (LF), onchocerciasis (OV), trachoma, soil-transmitted helminths (STH), schistosomiasis (SCH), podoconiosis, dracunculiasis, and leishmaniasis. Ethiopia has witnessed a tremendous scale-up in NTD activities since the official launch of the National Master Plan for NTDs (2013–2015) in June 2013. In November 2013, the Minister of Health established an NTD team and appointed an NTD team leader to accommodate this scale-up. NTD mass drug administration (MDA) treatment results were also added to the National Health Management Information System as an indicator, and the FMOH has integrated NTD program planning into the existing platform of annual, woreda-level micro-planning for health initiatives. In May 2015, the FMOH updated the National Master Plan to incorporate the strategies and implementation plans for all eight NTDs from 2016 until their elimination and control goals are reached (by 2020).

The FMOH oversees the coordination and implementation of Ethiopian health programs on a national level, and the Regional Health Bureaus (RHBs) do so on a regional level. RHBs follow countrywide, health-related initiatives issued by the FMOH but also maintain a large degree of autonomy in determining their priority health intervention areas and implementation timelines. RHBs also must approve mapping and disease-specific assessment (DSA) results before the FMOH can declare them official. In terms of NTDs, RHBs have developed their own Regional NTD Master Plans within the framework to complement the National Master Plan and other key NTD documents, such as Regional Trachoma Action Plans. Currently, RHBs split the efforts of NTD focal persons with other disease initiatives (e.g., malaria and HIV/AIDS), though ENVISION and other NTD partners are strongly advocating for dedicated NTD teams because the other, larger disease initiatives, such as malaria, tend to take precedence in terms of actual program time.

The FMOH and RHBs currently conduct various health initiatives at three levels: Primary Health Care Units (PHCUs), the Health Extension package, and the Health Development Army (HDA). PHCUs are woreda-level medical clinics, and on average, each woreda contains five PHCUs. The Health Extension Program, which was created to address medical intervention needs at the community level, consists of an integrated set of 16 health packages, including NTD intervention through MDA. The FMOH has trained and deployed approximately 38,000 health extension workers (HEWs) across the country to implement these health packages. They are government-salaried, trained, community-based health workers. Finally, the HDA is a community-level cadre composed of six women health volunteers per

ENVISION FY17 PY6 ETHIOPIA Work Plan7

community. Each member of an HDA is assigned five households. The HEWs lead groups of HDA members in forming health development teams. Overall, an average of 30 development teams exist in each kebele.

b) NTD Program Partners

As one of the most NTD-endemic countries in the world, Ethiopia has witnessed an exponential increase in the number of donors and implementing partners since the launch of the NTD Master Plan in 2013. Largely as a result of FMOH leadership, donors and implementing partners now recognize that with coordinated efforts, a substantial impact can be achieved in terms of the size of the population treated, progress toward 2020 elimination and control goals, and sustainable capacity building. Table 1 presents an overview of each partner’s roles and responsibilities.


Table 1. NTD partners working in Ethiopia, donor support, and summarized activities

Partner Location Activities

Is USAID providing financial support to this partner?

Other donors supporting these partners/activities?

FMOH Federal level - Coordinate all NTD activities at the national level and provide technical assistance to the regions, zones, and woredas during supervision

- Facilitate drug supply management in the country

- Provide support for TT-related training through the Hon. Minister’s TT initiative

Yes World Health Organization (WHO), SCI

EPHI Federal level - OV delineation mapping- OV/LF/trachoma impact assessments- Collaborating with SCI and Evidence Action to

conduct the monitoring and evaluation (M&E) components of the STH/SCH pooled funding initiative

No SCI, The Carter Center

RTI Federal level, Beneshangul-Gumuz, Gambella, Tigray and Oromia

- Provide capacity building and technical support at the federal level, including implementation of the integrated NTD database, the Tool for Integrated Planning and Costing (TIPAC), and technical secondments at the federal and regional levels

- Provide direct implementation support to the Beneshangul-Gumuz RHB for OV, LF, and trachoma and to the Gambella RHB for trachoma

- Through MMDP Project, provide TT surgery quality assurance activities and LF morbidity activities (hydrocele and lymphedema training, LF morbidity burden assessments, and situational analysis)

Yes No

FHF Oromia - Support the full SAFE strategy in 44 woredas (5 zones) with funding from ENVISION and the Australian Department of Foreign Affairs and Trade (DFAT);

- Support 112 woredas (8 additional zones) for MDA and TT surgeries by ENVISION and MMDP Project

- Support the full SAFE strategy for 18 woredas (1 zone) in Oromia through DFID SAFE support

Yes (ENVISION and MMDP)

DFAT, DFID, private donors

LFTW Tigray and Oromia

- Implement MDA in 10 LF-endemic woredas, 36 OV-endemic woredas, and 42 trachoma-endemic woredas in Oromia with ENVISION funding

- Obtain support from ENVISION and MMDP Project for MDA and TT surgeries in 22 woredas (3 zones) and 1 LF woreda in Tigray

- Support a SAFE strategy in 9 woredas (1 zone) in Tigray with funding from DFID SAFE

Yes (ENVISION and MMDP)

DFID, Austrian Government, private donors

ORBIS SNNPR Support a SAFE strategy in 67 woredas in SNNPR with the DFID SAFE grant and additional funding

No DFID, private donors





from OrbisThe Carter Center

Amhara, Oromia, SNNPR, Beneshangul-Gumuz, and Gambella

Implement a SAFE strategy in 152 woredas in Amhara with a DFID SAFE grant and funding from the Lions Club and additional sources.Implement MDA for LF and OV in 97 woredas in Amhara, SNNPR, Oromia, Gambella, and Beneshangul-Gumuz with funding from the Lions Club and other funders

No DFID, Lions Club, private donors

GTM Oromia and SNNPR

Implement the full SAFE strategy in 10 woredas in Oromia

No Private donors

MfM Oromia and Amhara

Implement the full SAFE strategy in 11 woredas in Oromia and Amhara

No Private donors

FPSU Federal level and Oromia and SNNPR RHBs

Implement MDA in 20 LF-endemic woredas in Oromia and SNNP regionsProvide support to LF MMDP activities in Amhara and SNNP

No DFID, Liverpool University, Numerous smaller donors

END Fund FMOH Address all STH/SCH in Ethiopia as part of a joint fund. The END Fund may look to support other diseases as the need arises.

No Numerous private business donors

Evidence Action FMOH Receive funding jointly with SCI from CIFF over five yearsWork with SCI to coordinate the M&E component of the SCH/STH pooled fund

No No

CIFF FMOH Apply the five years of funding acquired to address STHAllocate 85% to the governmentProvide the remaining funds to the END Fund to leverage matched funds and to SCI and Evidence Action over five years (as noted immediately above)

No No

CARE Amhara and Afar

Utilize funds donated by Johnson & Johnson to conduct a pilot cost-benefit analysis of adding NTDs to existing WASH programsFocus the pilot activities 12 kebeles in 4 woredas (3 kebeles per woreda) in South Gondar, Amhara

No Johnson & Johnson

Partnership for Childhood Development

SNNPR Implement the ESHI project in SNNPR: combine STH/SCH MDA with a complete package of WASH interventions (e.g., latrines and running water) along with WASH BCC integrated into the curriculum in 30 schools

No Imperial College

Amref Afar Conduct trachoma MDA in the 4 woredas with prevalence exceeding 10% in Afar with support from the END Fund

No END Fund

Peace Corps Amhara, Tigray, SNNPR, Oromia

Place Peace Corps volunteers in woredas with a high trachoma prevalence to improve facial cleanliness and environmental improvement (F and E) in the communitiesUse volunteers to assist with MDA for all targeted NTDs

No (Though RTI does facilitate in-service trainings for Peace Corp trainees on

Peace Corps





NTDs)

2) National NTD Program Overview

a) LF

As stated in the revised National Master Plan (2016‒2020) and in accordance with the WHO Global LF-Elimination Strategy, the FMOH is targeting LF for elimination by 2020. In compliance with Lymphatic Filariasis: A Manual for National Elimination Programs,1 the national program uses an MDA strategy combining IVM and ALB in entire at-risk populations. MDA coverage must be at least 65% of the total population in an endemic area for at least five years before conducting transmission assessment surveys (TAS) to determine whether MDA can be stopped. In the 46 LF-endemic woredas that are co-endemic with OV, ALB can be added to the existing IVM MDA. Currently, the triple drug administration of ALB, IVM, and PZQ is not used in practice, although this strategy may be considered by the FMOH in some co-endemic areas after one to two years of separate treatments, according to WHO guidelines. In areas targed for LF MDA, SAC are not specifically targeted with a separate MDA for STH unless the woreda has a prevalence >50%, and bi-annual treatment is required. It is important to note that Loa loa is not endemic in Ethiopia and, thus, does not present a barrier to using IVM.

The FMOH has also stated in the National Master Plan that by 2020, the estimated hydrocele and lymphedema burden within the 70 endemic woredas must be established through burden assessments. Furthermore, according to the National Master Plan, all those living within these woredas should have access to hydrocele surgery within their zonal hospitals, and those in need of lymphedema care should have access to that care within a 10-kilometer radius of their home.

The initial LF mapping in Ethiopia occurred in CY08—113 woredas were surveyed in the regions of Gambella, SNNPR, Beneshangul-Gumuz, Amhara, and Oromia by The Carter Center using immunochromatographic tests (ICTs). Of the 113 woredas, 34 were found to be endemic for LF. MDA was immediately initiated in all 34 of these woredas, again with the support of The Carter Center. Starting in June 2013, Ethiopia targeted 571 additional woredas for mapping through a nationwide initiative led by EPHI and the FMOH NTD team with funding support from DFID through FPSU (known as CNTD at the time). The 2013 mapping was conducted using current WHO guidelines for initial LF assessments: In each implementation unit, two sites were selected based on the high likelihood of ongoing transmission, and in each site, a convenience sample of 100 adults aged 15 years or older was tested for antigenemia by ICT. During this 2013 mapping initiative, podoconiois mapping was also conducted by identifying woredas as endemic for podoconiosis if lymphedema cases were found but exhibited negative ICT results.

In 45 of the 113 woredas found to be endemic for LF, a single ICT-positive case was found in one of the selected villages (1% prevalence). The FMOH was hesitant to designate these woredas as endemic and, as a result, commit to beginning a costly five-year treatment plan. At the request of the FMOH, the Task

1 http://apps.who.int/iris/bitstream/10665/44580/1/9789241501484_eng.pdf


http://apps.who.int/iris/bitstream/10665/44580/1/9789241501484_eng.pdf

Force for Global Health supported EPHI in implementing a more robust LF mapping methodology based on targeting older SAC, also called the ‘mini-TAS’. According to this methodology, if three or more antigen-positive children were found, then the woreda was confirmed as endemic. EPHI completed this remapping initiative in February 2015. The results revealed that only 3 woredas (2 in Amhara and 1 in SNNPR) out of the 45 woredas remapped were endemic for LF, corresponding to a 53.6% reduction in the number of people at risk for LF (Table 2). The official number of endemic woredas stated in the National NTD Master Plan is now 70. Note that two woredas in Oromia and one woreda in SNNPR had already implemented one round of MDA with funding from FPSU before being assigned a new non-endemic status. The FMOH ceased all future rounds of MDA within these three woredas.

Table 2. LF endemic woredas by region after 1% remapping exercise

Region

No. of endemic Woredas before 1% remapping

No. of endemic Woredas with remapping results

Initial population at risk

Population at risk after remapping

Year in which MDA began: number of Woredas

Year of the fifth round of MDA: number of Woredas

Afar 1 0 73,006 0

Amhara 19 8 2,830,444 986,3692012: 32015: 21

2016: 32019: 2

Beneshangul-Gumuz 13 13 586,323 603,913

2013: 11 2012: 2

2017: 112016: 2

Gambella 7 7 218,919 227,8942009: 5 2015: 2

2020: 5 2019: 22

Harari 1 0 18,549 0

Oromia 36 17 3,836,933 1,838,892 2015: 143 2016: 4

2019: 122020: 4

SNNPR 30 24 3,174,335 2,289,927 2012: 82015: 114

2016: 8 2019: 10

Tigray 5 1 590,952 135,511 2016: 1 2020: 1

TOTAL 113 70 11,329,461 6,082,506(53.6% reduction)

1 Three woredas in Amhara will begin treatment in the remainder of CY162 In CY15, sentinel and spot check Pre-Transmission assessment survey (TAS) failed in the five woredas that began treatment in 2009. Five more years of treatment are currently planned unless sentinel and spot check assessments conducted every two years reveal that a TAS is appropriate. 3Two out of 14 woredas treated in 2015 were categorized as non-endemic after the remapping. The FMOH decided to stop MDA. One additional woreda, Kofle, is proposed to start MDA in October FY17 within this workplan 4 One out of 11 woredas treated in 2015 categorized as non-endemic after the remapping. FMOH made the decision to stop the MDA. Six woredas will begin MDA in the latter half of CY2016 with support from FPSU and The Carter Center

USAID support for LF began in FY15. LFTW targeted seven woredas with MDA in Western Oromia and one woreda in Tigray. RTI targeted 12 woredas in Beneshangul-Gumuz. All 23 woredas targeted have achieved greater than 65% coverage in both FY15 and FY16. Through the USAID-supported MMDP


Project, RTI conducted an LF morbidity situational analysis in five hospitals in Oromia, Tigray, and Beneshangul-Gumuz to assess the abilities of these hospitals to provide hydrocele surgeries. RTI also co-supported a hydrocele surgery training of trainers (TOT) for 14 surgeons together with FPSU in November FY16 and adapted the WHO LF toolkit and a hydrocele surgery training manual to the Ethiopian context. Also in FY16, with support from the MMDP Project, RTI trained 104 clinical health workers from LF-endemic woredas on lymphedema and adeno-lymphangitis management. RTI also trained 84 zonal and woreda supervisors and 882 HEWs from 12 woredas in Beneshangul-Gumuz, 1 woreda in Tigray, and 7 woredas in Oromia on how to conduct LF burden assessments within their catchment areas. After the trainings, RTI successfully supported the implementation of burden assessments in all 20 woredas. The 15 remaining woredas in Oromia are targeted in July and September FY16. Once these assessments are complete, estimated LF morbidity burdens will be available for all of the endemic woredas in these three regions.

b) OV

In 2013, Ethiopia declared that the country’s National Master Plan was shifting from OV control to OV elimination. OV elimination is defined by WHO and FMOH as follows:2

Interventions have reduced O. volvulus infection and transmission below the point where the parasite population is believed to be irreversibly moving to its extinction.

Interventions have been stopped. Post-intervention surveillance for an appropriate period has demonstrated no recrudescence of

transmission to a level suggesting recovery of the O. volvulus population. Additional surveillance is still necessary for the timely detection of recurrent infection.

In 2014, national and international experts, including experts from the ENVISION project, formed the Ethiopia Onchocerciasis Elimination Expert Advisory Committee (EOEEAC) to help guide the FMOH in implementing this strategic shift. In October 2014, the committee held its inaugural meeting, with support provided by The Carter Center, which focused on creating the national OV elimination guidelines. The creation of the document was based on the WHO Geneva 2001-approved guidelines and the 2013 WHO/NTD Strategic and Technical Advisory Group draft guidelines, with consideration of the experiences of the Onchocerciasis Elimination Program for the Americas (OEPA), APOC, and in the Sudan (focused on Abu Hamad) and Uganda. The guidelines propose several strategies, including bi-annual MDA, transmission zone mapping, and targeted vector control. The overarching theme for interventions described by the guidelines is that each OV-endemic area requires a tailored approach rather than the one-size-fits-all interventions practiced by the APOC model.

Based on the successes of OEPA and in Uganda and Sudan, the guidelines recommend bi-annual MDA with IVM as the main strategy for interrupting transmission. The FMOH currently endorses bi-annual treatment for newly endemic areas that are IVM naïve or any annual treatment area that is not on track to end MDA in 2020. The elimination guidelines stipulate that moving woredas from an annual to a bi-annual treatment schedule should be dictated by the following indicators:

The positive skin snip rate among adults in any community is >2%. Skin snip-positive children <10 years of age are found in any community. The OV-16 rates in children <10 years exceed >0.1% (95% confidence interval). The PCR infectivity in flies exceeds >1/2,000 (95% confidence interval).

2 http://apps.who.int/iris/bitstream/10665/204180/1/9789241510011_eng.pdf?ua=1


http://apps.who.int/iris/bitstream/10665/204180/1/9789241510011_eng.pdf?ua=1

The seasonal transmission potential (as calculated by PoolScreen®) exceeds 20 L3/person/year (95% confidence interval).

As of May 2016, 153 of the 188 of the woredas endemic for OV are on a bi-annual treatment schedule (Figure 1). The guidelines stipulate that impact assessments will be conducted in these woredas after five years of bi-annual treatments.

Figure 1: 2016 OV Disease Distribution and Biannual vs. Annual treatment

24%

40%

36%

2016 OV Disease distribution

Hyper -endemicHypo-endemic Meso-endemic

35

153

Biannual vs Annual Treatment by Woreda

Annual Biannual

In 1997 and 2001, rapid epidemiological mapping of OV (REMO) was conducted in the western part of the country, and 78 woredas were found to be endemic in SNNPR, Amhara, and Oromia. Subsequent REMO mapping in 2004, 2011, and 2012 revealed additional endemic woredas in western Oromia, SNNPR, Beneshangul-Gumuz, and Amhara. In 2014, as the Ethiopian program shifted from a control strategy to an elimination strategy, hypo-endemic delineation was performed throughout the western part of the country. The cumulative mapping results identified 188 endemic woredas, including more than 17 million people at risk and 5.8 million living in hyper- and meso-endemic areas (Table 3).

The number of endemic woredas increased by nine relative to the 179 reported in FY16. These 9 additional woredas are urban centers surrounded by OV-endemic woredas. Because these urban centers experience seasonal population fluctuations from the surrounding areas, the national OV technical working group decided to target them for bi-annual MDA.

Whether or not mapping is “complete” is technically difficult to determine. For a long time, the FMOH and APOC have assumed that only the western part of the country would have OV because the vast majority of fast-flowing rivers are found in this area. However, recent mapping in arid countries found OV in areas previously thought to be environmentally unsuitable. Although understanding the OV situation in the eastern part of the country is important, currently, the FMOH is not suggesting that a full mapping initiative is required. Instead, in CY16, the FMOH plans to conduct a targeted entomological evaluation to determine the occurrence of OV transmission before confirming that eastern Ethiopia represents a “gap” in mapping. The FMOH is also targeting these remapping efforts based on the OV-16 serology of 60 hypo-endemic woredas in the western part of the country. At present, only REMO results


are available for these woredas, and because of the inaccuracy of the REMO method, the FMOH is uncomfortable with initiating any treatment schedules without confirmatory mapping.

Table 3. OV endemic Woredas by region

RegionNo. of Endemic Woredas Population at risk

Amhara 19 2,317,146Beneshangul-Gumuz 21 1,085,676Gambella 8 288,562Oromia 105 11,002,173SNNPR 35 3,295,080TOTAL 188 17,988637

In Ethiopia, controlling OV through IVM MDA began in the Kaffa-Sheka zone of SNNPR in 2001. In 2001‒2013, APOC, The Carter Center, the Lions Club, and LFTW were the major supporters of the FMOH in this OV-control effort. Scale-up to other parts of the country continued in 2004, and another wave of expansion was implemented in 2014. Until 2013, Ethiopia’s OV-control program only supported MDA in meso- and hyper-endemic areas with REMO results exceeding 20%. Hypo-endemic woredas were not targeted as part of the control strategy.

In FY15 and FY16, through ENVISION, USAID supported bi-annual MDA in 14 woredas in 2 zones of Beneshangul-Gumuz via direct implementation through RTI. In Oromia, ENVISION funding was provided to LFTW to support the Oromia RHB in conducting bi-annual MDA in 42 woredas. In terms of funding gaps, as noted in the OV Partners section, the FMOH has approached the END Fund to address the 23 woredas that constitute the remaining gap in the country.

c) SCH/STH Though not stated in the WHO NTD roadmap, Ethiopia has taken the initiative to eliminate SCH and STH so that they will no longer represent public health problems by 2025. This goal will require the repeated treatment of at least 75% of SAC (enrolled and non-enrolled) in Ethiopia. According to the National STH/SCH Action Plan, the long-term goals associated with this control program are as follows:

Eliminate STH-related morbidity in children by 2020 Eliminate SCH-related morbidity by 2020 Reduce the mean intensity of infection with Schistosoma mansoni by 65%‒80% in sentinel sites

following four rounds of treatment Reduce the mean intensity of infection with S. haematobium by 75%‒90% in sentinel sites

following one round of treatment Reduce the proportion of individuals harboring heavy infection with S. mansoni by 60% Reduce the proportion of individuals harboring heavy infection with S. haematobium by 70% Reduce the proportion of individuals harboring heavy infection with STH by 60% Ensure that treatment coverage is expanded to pre-school children in the future

STH/SCH mapping has been ongoing since December 2013. The Carter Center led a mapping effort in conjunction with ENVISION-supported trachoma impact assessments in Amhara in 2013. However, this mapping only included S. mansoni and STH because of the lack of urine dipsticks. In a separate initiative


that lasted from December 2013 to April 2014, EPHI led STH/SCH mapping (including both S. haematobium and S. mansoni) in all nine regions with funding and technical guidance from SCI.

140 woredas were then mapped in the Somali, Afar, and Fin-Fine Special regions with separate funding from WHO Afro and the Bill and Melinda Gates Foundation. These woredas were originally omitted from the mapping targets because they were believed to exhibit below-treatment-threshold prevalences for both diseases. However, targeted sampling in these areas revealed higher-than-expected infection levels; thus, mapping was conducted in CY15. Currently, 80 woredas—18 in Afar and 62 in Somali—still have not been mapped because of security issues. The FMOH is currently mobilizing funding with WHO to map these woredas as they become more secure. Amhara is also being targeted for remapping to capture the S. haematobium prevalence in this region.

According to the current national situation, intestinal SCH, S. mansoni, is far more prevalent throughout the country than uro-genital SCH, S. haematobium, which is generally isolated in the Rift Valley region (predominantly in Oromia). According to the STH/SCH action plan, at least 39 million people are estimated to be living in the 347 SCH-endemic woredas. The government of Ethiopia’s Growth and Transformation Plan II (CY15-20) plans for massive expansion of irrigation schemes and an exponential increase in sugar cane fields, both of which provide ideal conditions for the endemic vectors: Biomphalaria pfeifferi and Biomphalaria sudanica for S. mansoni and Bulinus abssynicus and Bulinus africanus for S. haemotobium. The FMOH is open to performing vector control via the application of molluscides, but no funding for this work is currently available.

STH infections are distributed very widely throughout the country, and more than 58 million people are estimated to be living in the 477 STH-endemic woreindas (Table 4). It is important to note that final mapping results have not yet been made available for parts of Afar, Somalia, and Amhara. Some discrepancy exists between the targets determined based on the known mapping results, which are used in this work plan, and the targets listed in the STH/SCH Action Plan, which assumes that all woredas in which mapping remains ongoing will be endemic. This assumption was used for planning purposes by the FMOH and to ensure that sufficient funding would be secured CY16 and CY17. Additionally, it should be noted that the FMOH plans to treat hypo-endemic woredas for SCH every two years rather than every three years because of the logistical constraints involved in successfully implementing a program with such a long interval between treatments. The FMOH will also most likely distribute MEB with any SCH MDA—regardless of whether the woreda in question is above the 20% threshold for STH—to maximize logistical and cost efficiency of SCH treatments.


Table 4. SCH and STH endemic woredas by regionRegion/Administrative Council

SCH Endemic Woredas Population at risk for SCH

STH Endemic Woredas

Population at risk for STH

Afar 3 149

3 with mapping pending in some

woredaa (18) 189,934

Amhara 94 14,042,213 125 18,308,947

Beneshangul-Gumuz 19 949,016 6 399,747

Dire Dawa 9 440,984 0

Gambella 14 477,460 14 477,460

Harari 6 171,366 2 45,381

Oromia 95 11,880,435 171 20,489,379

SNNPR 60 7,099,805 138 18,354,760

Somali 5 434,380

9 with mapping pending in some

woredas (62) 823,831

Tigray 42 4,238,298 9 1,265,772

Total 347 40,230,651 477 62,269,469

In past years, SCH and STH MDA were performed intermittently by various NGOs and government initiatives on small, targeted scales. In CY07, Ethiopia treated approximately 1 million SAC for SCH and STH with support from Save the Children. These treatments were part of a one-time campaign, and no funding was provided for future years. CY13 represented the first implementation of a sustained national STH/SCH MDA strategy. Ethiopia secured 3.5 million tablets of PZQ (sufficient to treat approximately 1.4 million children) and 6.8 million tablets of MEB through WHO, Merck Serono, and Johnson & Johnson drug donation programs, and SCI provided financial and technical support for the distribution of these treatments. In CY14, the FMOH distributed approximately 7.8 million STH treatments across 236 woredas to SAC in Amhara, Oromia, and SNNPR, leveraged by a donation from the END Fund. These treatments focused on woredas that were not captured in the CY13 distributions because they were above the treatment threshold for STH but were not SCH endemic. In CY16, the FMOH will attempt to scale up to the national level by targeting all 347 SCH and 477 STH woredas.

USAID support for STH/SCH is provided primarily as an ancillary benefit, treating STH through the LF MDA regimen. In FY16, the ENVISION project treated 298,000 people living in the six ENVISION-supported woredas that are LF endemic and have an STH prevalence exceeding 20%. Members of the ENVISION team also are members of the STH/SCH working groups and ensure that the ENVISION work plan is closely aligned with that of the STH/SCH implementing partners.

d) Trachoma

The FMOH is following the 2020 elimination goals set forth by WHO which state that clinical signs of active trachoma (TF) should be found in less than 5% of children aged 1–9 years, and TT cases, unknown to the health system, occur in less than 1 per 1,000 people living in a woreda.3 With more than 83.2 million people currently requiring intervention through MDA and an estimated TT backlog of 880,317, achieving these goals by 2020 represents a great challenge for Ethiopia.

3 http://apps.who.int/iris/bitstream/10665/208901/1/WHO-HTM-NTD-2016.8-eng.pdf?ua=1


http://apps.who.int/iris/bitstream/10665/208901/1/WHO-HTM-NTD-2016.8-eng.pdf?ua=1

The impressive feat of mapping the entire country for trachoma began with the National Survey on Blindness, Low Vision, and Trachoma (2005–2006). The results from this mapping exercise indicated that Ethiopia is the most endemic country in sub-Saharan Africa, with an average, countrywide prevalence of active trachoma of 40.1%. After this national survey, through support from The Carter Center, the Amhara RHB completed baseline trachoma surveys for all 10 Zones (152 woredas) in the region in 2007. The next major step forward in the collection of epidemiological data by the trachoma program in Ethiopia was the GTMP funded by DFID. With the GTMP, trachoma surveys throughout the country are now complete, except in some zones affected by the insecurity in Somali and Afar. The results of all of these mapping efforts revealed that 575 woredas (68% of the woredas in the country) have trachomatous inflammation–follicular (TF) prevalences at or above 10%. However, with the availability of Pfizer-donated Zithromax for one round of MDA for woredas with baseline TF prevalences of 5%‒9.9%, 94 additional woredas will require support for a single round of MDA and the subsequent impact assessment; this will bring the total to 669 woredas.

As mentioned in the partner section, 88% of the woredas with TF exceeding 10% have support for MDA. Additionally, 42 woredas with TF of 10%‒29.9% have no support. However, the 34 woredas with TF exceeding 30% in Somali, Tigray, and SNNPR that have not initiated an MDA schedule and have no support available in the immediate future to do so are particularly concerning. It is important to note that these 34 woredas are the last implementation units in the world without security issues that require five years of treatment and have not yet started MDA. As such, they constitute the greatest obstacle toward achieving global elimination goals (Table 5).


Table 5. Number of woredas that fall into each treatment category and their progress toward elimination in 2020 Regions # of Woredas

with 5%‒9.9% TF(1 year of MDA

# of Woredas with 10%‒29.9% TF(3 years of MDA)

# of Woredas with 30%‒49.9% TF (5 years of MDA)

# of Woredas with ≥50% TF

(7 years of MDA)MDA Start date required to achieve elimination by 2020*

2020 2018 2016 2014

Oromia 21 109 118 2Beneshangul-Gumuz 7 4 0 0Gambella 0 13 0 0Tigray 3 23 20 0SNNPR 6 78 53 2Afar 19 3 0 0Somali 22 18 4 0Amhara 17 68 51 9TOTAL 95 316 246 13On track for 2020? Not yet started

nor does support

currently exist

NOMust start soon:24 in SNNPR18 in Somali

NOMust start 2016: 24 in SNNPR4 in Somali6 in Tigray1

Yes, all started in 2011 or 2012

*Assumes that in the final year of treatment, MDA and the impact survey will occur in the same CY (a 6-month delay is required between MDA and the impact survey).1 These six woredas were identified in Mekele Zuria, Tigray, after GTMP conducted belated mapping in December 2015.

ENVISION currently supports 201 woredas in Oromia for trachoma MDA through partners LFTW and FHF. Because ENVISION can only support the “A” component of the SAFE strategy, RTI has drawn together a consortium of support which includes the MMDP Project, DFAT, DFID, organizational funding from FHF and LFTW and the National “OneWASH” program to achieve the full SAFE package in almost all 201 woredas (WASH support still needs additional funding in some of these woredas).

In Ethiopia, the addition of 95 additional woredas which need one round of Zithromax treatment represents a dramatic increase in the denominator when trying to achieve 100% geographic coverage for the country. When these 95 woredas are added to the 575 woredas above 10% prevalence, the percent of woredas addressed with partner support falls from 88% to 75%. ENVISION proposes the following strategy over the next three years to provide a single round of MDA to the 31 woredas that are between 5-9.9% in the ENVISION-supported regions. This strategy will address 33% of the 5-9.9% woredas in the country. Note that all of the woredas detailed below for ENVISION support were mapped in 2014/15 as part of the nationwide GTMP mapping project and therefore represent a prevalence based on an up-to-date and technically sound methodology.

In the FY17 work plan below, ENVISION will propose expansion to the seven woredas in Beneshangul-Gumuz and seven woredas in Oromia. These woredas are targeted in FY17 because they currently fall within zones in which ENVISION is already providing trachoma MDA support. As MDA trainings are cascaded from the zone to the woreda to the kebele, these additional woredas will be captured within the cascade strategy at a relatively nominal cost.


In FY18, ENVISION will support impact assessments in all 14 woredas treated in FY17 as well as one round of MDA in the remaining 17 woredas, which are found in western Oromia and Tigray. While trachoma MDA is not currently supported in these two zones, ENVISION does support OV/LF MDA in them and will look for operational synergies for cost-saving opportunities.

In FY19, ENVISION will support impact assessments in the 14 woredas treated in FY18 and address any remaining 5-9.9% woredas in other regions that other partners have not yet addressed on a case by case basis.


3) Snapshot of NTD status in Ethiopia

Table 6. Snapshot of the expected status of NTD program in Ethiopia as of Sept 30, 2016

Columns C+D+E=B for each

disease*Columns F+G+H=C for each disease*

MAPPING GAP DETERMINATION MDA GAP DETERMINATIONMDA

ACHIEVEMENTDSA NEEDS

A B C D E F G H I

Disease

Total No. of

Woredas in

Ethiopia

No. of Woredas classified

as endemic**

No. of Woredas classified as non-

endemic**

No. of Woredas in need of initial mapping

No. of Woredas

receiving MDA

as of 09/30/16

No. of Woredas expected to be in need of MDA at any level: MDA not yet started, or has prematurely stopped as of 09/30/16

Expected No. of Woredas where criteria for stopping district-level MDA have been met as of 09/30/16

No. of Woredas requiring DSA

as of 09/30/16

USAID-

fundedOthers

LF1

839

70 768 0 22 47 1 0 Pre TAS - 102

OV3 188 531 120 50 138 0 0 0

SCH4 347 364 128 0 347 0 0 0

STH 477 234 128 4 473 0 0 0

Trachoma5 679 132 28 240 249 181 9 896

1 45 woredas were remapped, and 43 woredas were negative for LF; the total number of endemic woredas decreased from 113 to 70. 2 Of these, 8 were in the Bench Maji Zone, SNNPR, and 2 were in North Gondar, Amhara.3 60 woredas in western Ethiopia are hypo-endemic based on REMO data; FMOH decided to remap these woredas before classifying them as endemic.4 In 128 SCH- and STH-endemic woredas, mapping was delayed because of security issues in Somali and Afar region and because the budget allocation for Amhara expired.5 The 28 woredas requiring mapping are in the Somali and Afar regions. GTMP has the necessary funding but is waiting until the region’s securitiy improves.6 The following regions require impact assessments in 2016: Amhara (61), Oromia (10), and SNNPR (18).


PLANNED ACTIVITIES

1) NTD Program Capacity Strengthening

a) Strategic Capacity Strengthening Approach

Standardization of NTD Tools and Protocols

Since the launch of the NTD Master Plan in 2013, the FMOH has endeavored to create a national NTD program in which all regions and implementing partners adhere to the same standardized protocols, tools, and best practices. If different regions and partners are using their own tools and protocols for supervisory visits, coverage assessments, social mobilization, DSAs, and the organization and storage of treatment data, then the national program does not have a common standard with which to evaluate programs. The FMOH sees this standardization across all regions as crucial to the preparation of their elimination dossiers and eventual WHO validation of elimination for LF, OV, and trachoma.

Integration of NTD Drugs into the National Supply Chain

The FMOH believes that incorporating NTD drugs into the country’s current supply chain system will create less dependence on implementing partners and a more sustainable program in the future. In the past, implementing partners were responsible for collecting NTD drugs from the central storage hub in Addis Ababa and ensuring that they were transported all the way to the community distribution points. This system operates completely outside of the national supply chain system, which relies on the Pharmaceutical Fund and Supplies Agency (PFSA) to deliver all medical consumables to the health post level throughout the country. In CY16, the government expanded the number of PFSA hubs in the country from 11 to 16 to better facilitate the delivery of medical supplies to every corner of Ethiopia. Upon completion of these 16 hubs, the FMOH stated that one of the primary capacity building goals of NTD partners should be to support the PFSA to manage all NTD drug distribution. Although NTD supply management is new to the PFSA, the organization already has experience with the requirements of “campaign-style” supply chain activities through the vaccine programs they support.

Strengthening of NTD Program Management and the HEW Workforce

While the FMOH has developed a strong capacity for managing NTD programs, the sub-federal health offices have more of a challenge in general NTD program management and monitoring of program funds. In addition, much of the drive to address 2020 NTD elimination and control goals dissipates with each descending tier in the health system. The FMOH recognizes the need to bolster the regional and zonal offices’ ability to conduct successful NTD programming given that each zone represents several woredas and an average of more than a million people.

With more than 80 million people at risk for at least one NTD, the investment of time and human resources to conduct all of the necessary MDAs is massive. Every region currently follows its own MDA schedules determined by drug availability and the schedules of other community health initiatives. With MDA often required twice a year for OV, once a year for LF, possibly twice a year for STH/SCH, and once a year for trachoma, NTD interventions are quickly becoming one of the greatest demands on the community health infrastructure. HEWs, the backbones of the MDA mechanism, may be called out of their health post to attend woreda-level NTD trainings and post-MDA reviews four or five times a year


within a single district, meaning that the community is left without their healthcare provider. In response to this, the Hon. Minister has mandated that all MDA in the country occur on an exact distribution schedule during a two month window twice a year (see Country Overview section). In addition to this formalized MDA schedule, the FMOH has also mandated that all HEWs will be trained during a four-day period in October on all facets of NTD prevention and management. This four-day training is meant to serve all training needs for the entire year. These new requirements will begin for the first time in October 2016 (although the MDA schedule was proposed in CY15, CY16 will be the first time that this will be enforced).

ENVISION Strategy to Support FMOH Capacity Building Plan

When assessing which programmatic areas need capacity building, the ENVISION project finds itself in an advantageous position in Ethiopia in that the FMOH has already identified its largest obstacles toward creating a self-sustaining NTD program (detailed above). The FMOH has already taken decisive action in addressing these obstacles through mandates from the Hon. Minister and, in a series of strategic meetings with RTI, has very specific requests for support tailored to fill the technical and financial gaps in its strategy. It is important to note that the FMOH is well aware of ENVISION’s preference to build a consortium of funding across multiple partners and therefore has been engaged in meetings with all Ethiopia NTD partners to gather pledges of support for these capacity building initiatives. See Table 7 for details on project assistance for capacity strengthening activities.

b) Capacity Strengthening Interventions

Table 7: Project assistance for capacity strengthening

Project assistance area

Capacity strengthening interventions/activities

How these activities will help to correct needs identified in situation above

a. Strategic planning

Rollout of the NTD Integrated Database at the Regional level

FMOH capacity building focus addressed: Standardization of NTD tools and protocols

Provide uniform indicators across the country Enable regions to store and track their own data to make

evidence-based decisions Ensure the consistent update of the National database for the

eventual preparation of elimination dossiers

b. NTD secretariat Engaging Peace Corps FMOH capacity building focus addressed: Strengthening NTD program management and the HEW workforce

Providing a community-level perspective of the success of the Integrated NTD training including the memory retention of important MDA protocols by the HEWs.

FMOH Technical Advisor Secondment


Preparing/adapting national guidelines according to WHO recommendations

Technically advising on the NTD research working group terms of reference and NTD research symposium

Co-facilitating many of the of standardization workshop listed in the work plan


Project assistance area

Capacity strengthening interventions/activities

How these activities will help to correct needs identified in situation above

FMOH M&E officer (and data manager) Secondment


Maintaining NTD database and TIPAC and training FMOH staff on these tools

Conducting RHB-level database trainings Leading M&E standardization workshop

Pharmaceutical Fund and Supplies Agency (PFSA) Secondment

FMOH capacity building focus addressed: Integration of NTDs into the National Supply Chain

Building NTDs into current PFSA supply chain mechanisms Liaison between FMOH, PFSA and implementing partners Co-facilitate the NTD PFSA and Implementing Partners

Coordination training

Regional Health Bureau Technical Advisor Secondments

FMOH capacity building focus addressed: --Standardization of NTD tools and protocols; --Strengthening NTD program management and the HEW workforce

Assist with adapting the Integrated NTD database to the regional level

Assist with rollout of Integrated NTD training of HEWs

d. Social mobilization

Standardization of information, education, and communication (IEC) Materials Workshop using “Toolkit for IEC and Social Mobilization for NTDs”


Create a standardized selection of regional-level IEC materials of high quality and proven effectiveness

e. Training (please see the Training section for specific Training activities.)

h. Drug supply management & procurement

NTD PFSA and Implementing Partners Coordination training

FMOH capacity building focus addressedIntegration of NTDs into the National Supply Chain

Create a linkage and common understanding between the PFSA, FMOH and Implementing partners

i. Supervision

MDA Supervision Workshop FMOH capacity building focus addressedStandardization of NTD tools and protocols

Create national MDA supervisory guidelines

c) Monitoring Capacity Strengthening

Together with the FMOH, ENVISION has created specific monitoring activities to evaluate each of the capacity strengthening activities proposed. These activities are in addition to the standard supervisory activities detailed in the Supervision section. The annual review and post-MDA review meetings detailed in this work plan will also provide opportunities to discuss the results and findings of these tools and adapt activities accordingly. Once again, each activity is grouped by one of the three capacity strengthening foci stipulated by the FMOH.


Monitoring Standardization of NTD tools and protocols

Integrated NTD database rollout (See Strategic Planning): ENVISION will support the initial training in the remaining regions without an integrated database. Once the database is complete, the FMOH will require quality monthly reports from the regions produced by the regularly updated database. ENVISION will also provide support for the seconded FMOH M&E officer to return to the regions three to six months after the training to provide on-site mentoring and troubleshoot any problems that arise.

Standardization workshops: The ENVISION project will ensure the uptake of all the standardized tools in all four ENVISION-supported regions after the standardization workshop takes place. Together with the FMOH, ENVISION will also work with other non-ENVISION partners in the regions to advocate for this uptake. This is further detailed under the following activities: MDA supervision workshop (see Supervision section); M&E standardization workshop (see M&E section); Standardization of IEC/BCC materials workshop (see Social Mobilization section).

Monitoring Efforts to Increase Capacity of NTD Program Managers and the HEW Workforce

Integrated HEW NTD Training: In the past, HEW refresher trainings have been conducted immediately before MDA to ensure that all the information required to conduct a safe, high-quality MDA was re-emphasized and fresh within the minds of the HEWs. With the new Integrated HEW NTD training, the government has mandated that only one MDA training will be allowed—in October. This means that for the MDA conducted in April and May, HEWs will need substantial reference materials as well as reminders of the most pertinent MDA-related information. ENVISION will implement the plan detailed in the Training section to address these concerns.

WHO Integrated NTD Zonal Program Managers’ Training: Each of the zonal program managers trained in Oromia, Tigray, Beneshangul-Gumuz, and Gambella will be assigned a mentor during the training to help actualize the topics discussed in the training with the realities encountered during implementation of NTD activities in a program manager’s specific zone. The mentor will have time after each training module to conduct one-on-one discussions with program managers to brainstorm on practical applications for the information presented. In Oromia and Tigray, ENVISION partner zonal staff will be paired with the government zonal focal person to serve as a mentor and to ensure that the zonal NTD microplan created during the training is implemented. In Beneshangul-Gumuz and Gambella, which have far fewer zones, the NTD advisors seconded to the RHBs will serve this function.

Monitoring Integration of NTDs into the National Supply Chain

The PFSA seconded staff, together with the FMOH NTD logistics officer, will act as the liaison among the PFSA, the FMOH, and implementing partners. They will keep partners updated as to


drug shipment schedules and directly address any issues with delays or logistics challenges as early as possible to allow partners to adjust their MDA plans accordingly.

In addition to the role served by the PFSA secondment, one of the results of the PFSA partner coordination training will be to create a system by which partners can track their shipments via contacts established with local PFSA hubs.


2) Project Assistance

a) Strategic Planning

FMOH

NTD Annual Review Meeting (RTI). The FMOH has requested this meeting be held once annually for three days because it allows the FMOH to interact with the regions and zonal representatives on national NTD matters. ENVISION will fund the per diem and travel costs for government representatives from ENVISION-supported regions, and WHO has agreed to support all venue, refreshment, and stationery costs. Other partners will support attendees from their respective operational areas. ENVISION will also provide logistic and technical support to the FMOH in preparation for the meeting, including assistance to create graphs and tables to better illustrate important discussion points. Four RTI staff will participate in this review meeting to make presentations and serve as moderators for different presentations and discussions.

NTD Midterm Review Meeting (RTI ). RTI will cover the per diem costs for representatives from ENVISION-supported regions and the WHO will cover the costs for venue, and travel costs for government refreshment and stationery costs. ENVISION program staff and secondments from all of the ENVISION partners will also technically support the FMOH in preparing presentations for the meetings including tables and graphs. The midterm review meeting will be held for three days.

National NTD Task Force Meetings (RTI). National NTD Task Force members come from the FMOH, universities, select RHBs, nongovernmental development organizations (NGDOs), and select international experts, as necessary. In FY17, ENVISION will fund the per diem of the same government participants. Other partners will be expected to support participants from their perspective regions. Travel will not be included here because those costs will be covered under the NTD annual and midterm review activities. The WHO will support venue, refreshment, and stationary costs. ENVISION will also provide technical support by assisting the FMOH to prepare any documents and reports to be shared, as well as attending the meeting to provide any updates from the global NTD community and technical guidance, as is required.

NTD Scientific Symposium (RTI). RTI will cover per diem and travel costs for participants and the WHO will cover the costs for venue, refreshment, and stationery. TIPAC Maintenance (RTI). Note that the TIPAC is regularly updated by the FMOH NTD program manager (seconded by RTI) and the FMOH NTD team. It is a fully functioning tool used by the FMOH for fiscal year planning and to complete the WHO Joint Request for Selected Medicines (JRSM). This process will continue throughout FY17 and does not require an any additional budget from ENVISION.

FY18 Planning Workshop (RTI). In the latter half of FY17, RTI will hold a planning workshop with the FMOH, USAID representatives, ENVISION partners, and the Regional Health Bureaus in order to plan for FY18. The workshop will include a brief technical review of successes and challenges in FY17 that will be used to inform the FY18 plan. Budget sessions will also be included in order to build strong budgets based on uniform unit costs across all of ENVISION’s partners in Ethiopia. The workshop will last for five days. ENVISION will support the venue and per diem of RHB participants.


Oromia

Oromia Regional Annual Review Meeting (RTI). Given the size and unprecedented scale-up of NTD interventions in Oromia—including MDA for trachoma, OV, LF, and STH/SCH for more than 25 million people; the region-wide TT surgery initiative; and hydrocele/lymphedema interventions—this meeting is crucial to ensure that goals are being met and zonal offices are successfully coordinating multiple disease interventions. This review meeting will also be an opportunity to continue ongoing efforts to coordinate NTD WASH activities in the region. RTI, LFTW, and FHF staff will assist the Oromia RHB with presentations and data analysis. ENVISION will support the per diem, venue, and participants’ travel from ENVISION-supported zones, as well as act in a technical advisory role to the meeting. Participants from the region and zonal health departments will attend the two-day review meeting.

Woreda-level Post MDA Review Meetings (FHF). One-day post MDA review meetings are held in each district to share, compile and analyze treatments reports as well as reflect upon success and challenges regarding the recent MDA distribution. ENVISION will support the participant per diem and travel costs for these meetings.

Zonal Post MDA Review Meetings (FHF). One-day Zonal Post MDA Review Meeting in each zone build upon the woreda-level post MDA review meetings and allow an opportunity for compiling woreda MDA reports for each of the zones. ENVISION will support participant per diem and travel costs as well as the venue for these meetings.

FY18 planning Workshop (LFTW). The workshop will develop strategies to address any low coverage areas in FY17 and will incorporate results from any M&E activities conducted during the year to ensure that FY18 activities are data driven. This workshop is included in the FY17 plan in order to be more prepared for the FMOH-mandated October/November MDA schedule in FY18.

Tigray

Woreda-level Post MDA review meeting (LFTW). After MDA, there will be a one day LF MDA performance review meeting, which will be held at implementing woreda level. Participants will include representatives from HEWs, Kebele leaders, Health center staff and district office (NTD focal and head/deputy head), TRHB, zonal field project coordinators and Zonal LFTW program officers. This activity has the same goals and objectives stipulated in the Oromia section.

FY18 planning Workshop (LFTW). As indicated above for the Oromia region, a five day planning workshop will be organized that will be attended by participants from zonal and regional offices with the aim of enhancing joint planning and building a sense of ownership. ENVISION will support the per diem and venue costs for this training.

Beneshangul-Gumuz

Beneshangul Gumuz Regional Annual Review Meeting (RTI). ENVISION will support a two-day NTD Regional Annual Review meeting after all MDAs are complete to help the RHB assess the success of the MDA expansion, review its data, and evaluate the progress of the three priority capacity building foci as they pertain to Beneshangul-Gumuz. RTI’s regional secondments and technical staff will attend the meeting to assist with presentation preparation and data analysis. ENVISION will support the per diem, venue, and the travel of all participants.


Zonal-level Post-MDA Review Meeting (RTI). Zonal-level Post-MDA Reviews were carried out in Beneshangul-Gumuz in FY16. The meetings created an opportunity for the Woreda health officers to discuss challenges and best practices with their zonal-level counterparts to adjust microplanning for future MDAs. The same zonal level post-MDA review meeting will be held in FY17. These post-MDA review meetings will also be used to collate and clean reports. ENVISION will support the per diems and travel expenses for participants for this one-day meeting.

Gambella

Gambella Regional Annual Review Meeting (RTI). The Regional Annual Review Meeting will be an opportunity for the RHB to discuss areas of improvement with the woreda-level health office, align SAFE activities, and discuss the roll out of the Integrated NTD training of HEWs (see Training section). ENVISION will support the venue and per diem for participants for this two-day meeting.

Zonal-level Post-MDA Review Meeting (RTI). These meetings will serve the same purpose as has already been described in the other regional sections. ENVISION will support the per diems and travel expenses for participants during this one-day meeting.

b) NTD Secretariat

Engaging Peace Corps (RTI). In FY17, Peace Corps volunteers will also play a role in the FMOH capacity building plan by providing community-level insights into the new Integrated NTD training of HEWs, which is one of the cornerstone activities of the “Increase capacity of NTD program managers and the HEW workforce” focus.

RTI is working with Peace Corps and regional partners to identify ideal sites and strategies for volunteer placement (e.g., multiple volunteers in one heavily endemic woreda, possible scope of work for the volunteer, etc.) The availability of the health volunteers by region is as follows:

Amhara: 10 volunteers Oromia: 10 volunteers SNNPR: 10 volunteers Tigray: 10 volunteers

In FY16, RTI and The Carter Center co-facilitated two in-service NTD trainings and linked volunteers to the major NTD partners in their region. These activities will continue in FY17. No funding is required for these activities except for the travel and per diem of RTI technical advisors to attend the Peace Corps pre-service training.

FMOH

FMOH Technical Advisor Secondment (RTI). In FY17, in accordance with the FMOH capacity building strategy, this position will focus more on documenting evidence for elimination dossier development, standardizing M&E tools and assisting with the roll-out of the Integrated NTD training of HEWs. This person also will lead the development of the National NTD Research Advisory Group and assist in preparation for the NTD research symposium (see Strategic Planning). Note that this position splits its level of effort with the MMDP project as outcomes of the postion also include some MMDP project deliverables.


FMOH M&E Officer (RTI). In FY17, in support of the FMOH capacity building plan, this position will continue all of the aforementioned duties including expanding the roll out of the database to the regions of Amhara, SNNPR and Gambella. In an expansion of his role, he will also help facilitate the M&E standardization workshop and participate in the trachoma impact assessments detailed in the M&E section. Note: This person was nominated by the FMOH to participate in the Tropical Data training in Tanzania in June 2016.

PFSA Secondment (RTI). In Fy17, in support of the FMOH capacity building strategy, this person will liaise among the PFSA, FMOH, and implementing partners concerning NTD drugs, and he will co-facilitate the NTD PFSA and implementing partners coordination training (see Supply Chain section). He will also co-facilitate the Ethiopia supply chain forum. His other duties will include the distribution and stock replenishment of PC-NTD medicines to targeted woredas through PFSA hubs, assisting with port clearance of Zithromax® (ZTH), IVM, ALB, and tetracycline eye ointment, and the subsequent entry of these drugs into the PFSA health center management information system.

Beneshangul-Gumuz

Technical Advisor Secondments (RTI). RTI will continue to support two NTD technical advisors seconded to the RHB who began in January 2015 to build the RHB’s capacity in the implementation of OV/LF, STH, SCH, and trachoma MDA throughout the region.

Gambella

Technical Advisor Secondment (RTI). The Gambella RHB currently has one government-employed NTD staff person who manages the OV, trachoma, STH, and SCH MDA activities. In the latter part of FY16, ENVISION placed one RTI-supported seconded staff within the Gambella RHB to build the RHB’s capacity to conduct evidence-based, high-quality MDA for these NTDs. In FY17, this position will be continued.

c) Advocacy for Building a Sustainable National NTD Program

Tigray

Project launching and sensitization workshop (LFTW). In FY17, five new woredas in Mekele Zone will be targeted for MDA for the first time. LFTW will conduct a one-day project launching and sensitization workshop within these woredas before MDA commences. ENVISION will support the per diem and venue rental for this activity.

d) Social Mobilization to Enable NTD Program Activities

FMOH

NTD IEC/BCC Evaluation Exercise (RTI). A Toolkit for IEC and Social Mobilization for NTDs, created by Sightsavers, was recently presented to RTI headquarters and USAID in June 2016 as a tool to analyze the effectiveness of IEC/BCC to influence MDA uptake. In FY17, RTI will bring RHB representatives from Tigray, Oromia, Gambella and Beneshangul-Gumuz to a workshop in Addis Ababa. The workshop will use the toolkit to analyze all existing social mobilization materials and alter them in ways that may prove more effective. RTI will support the venue and per diems for participants in FY17.


Standardization of IEC Materials Workshop using “Toolkit for IEC and Social Mobilization for NTDs” (RTI). This workshop is essentially a scaled-up version of the NTD IEC/BCC evaluation exercise. RTI will support the venue for this one-day workshop.

Oromia

Community Sensitization Meetings (FHF). In FY16, the three woredas reported unfounded rumors during the trachoma MDA which resulted in a coverage below the WHO recommendation of 80%. In FY17, FHF will undertake community sensitization and advocacy meetings within these woredas to ensure that this low coverage does not occur again.

Testing of IEC/BCC Materials (FHF). The Oromia RHB has requested tee-shirts for the MDA teams as a means of incentive, identification, and as a general health education tool as the shirts will have SAFE-related messaging printed on them. Banners created in FY16, which contain messages on SAFE and indicate the date of the MDA week, will be displayed in each woreda. As per requests from the FMOH and RHB, posters with trachoma MDA messaging will also be produced. These posters will complement the MDA social mobilization efforts after they have been vetted during the standardization of IEC materials workshop.

MDA Mobilization- Dissemination of Health Messages (FHF). In order to assist with MDA social mobilization, FHF has created trachoma awareness messages to be broadcast via radio and television both before and during the actual MDA.

Pre-testing Radio message and IEC/BCC materials (LFTW). In FY17, radio messages and IEC materials (posters and brochures) will be pre-tested. The main purpose of the pretest is to evaluate how the messages fit with the target community culture, community languages like local naming, wording etc. and knowledge level. The pretest will be implemented in sample selected communities and schools.

IEC/BCC Materials (LFTW – Social Mobilization). In FY17, IEC materials such as posters and brochures will be reprinted in Afan Oromo for trachoma, OV and LF and will be distributed to implementing woredas to reach the local community, create awareness on the project and enhance project implementation. LFTW plans to make IEC/BCC materials more inclusive and disability-focused in FY17.

MDA Mobilization- Dissemination of Health Messages (LFTW). To disseminate MDA information on MDA dates and delivery areas, LFTW plans to broadcast a 30-second television message for three consecutive days before MDA and a total of 18 radio spots (30 seconds each) during the distribution period. In addition, local FM radio stations will broadcast regular messages to raise awareness on these three NTDs (trachoma, OV and LF). A 10-minute airtime message with the focus on causes, prevention, and treatment of these NTDs will be broadcast in Afan Oromo twice in a week for 6 weeks in western Oromia.

Tigray

Pre-testing Radio Message and IEC-BCC Materials (LFTW). As indicated above for Oromia region, radio messages and IEC materials (posters and brochures) will be pre-tested in Tigray region. The pre-test will be implemented in a sample of selected communities and schools.

IEC/BCC Materials (LFTW). In FY17 IEC materials such as posters and brochures will be reprinted in Tigrigna for trachoma, OV and LF and will be distributed to implementing woredas to reach the local


community, create awareness on the program, and enhance project implementation. LFTW plans to make IEC/BCC materials more inclusive and disability-focused in FY17.

MDA Mobilization- Dissemination of Health Messages (LFTW). Similar to the Oromia region, with the aim to disseminate MDA information, LFTW plans to broadcast a 30-second television messages for three consecutive days before MDA and a total of 18 radio spots (30 seconds each) during the distribution period. In addition, local FM stations will broadcast regular messages to raise awareness on three NTDs (trachoma, OV and LF). A ten-minute radio message with the focus on causes, prevention, and treatment of these NTDs will be broadcast in Tigrigna twice a week for four consecutive weeks in Tigray region.

Beneshangul-Gumuz

MDA Mobilization: Dissemination of Health Messages (RTI). In Beneshangul-Gumuz, teaching materials, posters, and brochures will be produced by RTI to mobilize the community and provide health education during MDA activities. ENVISION will support the printing of the materials and the distribution of brochures while mobilizing targeted communities via town criers and public address systems. ENVISION will also adapt BCC and IEC materials from FHF, The Carter Center and LFTW for trachoma in 11 woredas (seven new woredas) that are above the treatment threshold for trachoma. The Beneshangul-Gumuz RHB has also successfully established an agreement with the local radio station to announce the date and location of MDA-- both before and during scheduled MDA-- at no cost to the project. IEC materials such as posters, flipcharts and brochures will be developed in FY17 with different health messages based on the results of the workshop to standardize IEC materials.

Gambella

MDA Mobilization: Dissemination of Health Messages (RTI). RTI will use the same strategy in Gambella as will be used in Beneshangul-Gumuz, but with a greater focus on the behavioral change aspect of the SAFE strategy in all 13 trachoma endemic woredas. The current situation with radio broadcasts and the languages of the broadcasts is still being explored during the writing of this work plan. In FY17 IEC materials with different health messages will be developed for MDA mobilization, based on the results of the workshop to standardize IEC materials.


Table 8: Social mobilization/communication activities and materials checklist for NTD work planning

Category Key Messages

Target Population

IEC Strategy (materials, medium, activity etc.)

Where/when will they be distributed

Frequency

Is there an indicator/

mechanism to track this

material/activity? If yes, what?

Other Comments

FHF

MDA Participation

-MDA will take place at x location on x day

-The drugs provided are free and safe

-Includes additional messaging on the SAFE strategy

Community members

Posters Put in Clinics/schools/local office buldings one weeks before MDA

Once Annually

% of audience who recall seeing the poster and message – in coverage survey, or at point of MDA

Community Members

Radio 6 days before the MDA campaign

Once Annually

% of audience who recall hearing messaging during post-coverage assessments

LFTW

MDA Participation-MDA will take place at x location on x day



Community members

Posters Put in Clinics/schools/local office buldings one weeks before MDA

Twice Annually for OV MDA and once for trachoma

% of audience who recall seeing the poster and message – in coverage survey, or at point of MDA

Community Members

Radio and TV

6 days before the MDA campaign


% of audience who recall seeing and hearing messaging during post-coverage assessments

Community Brochures Will be Twice % of audience who


Category Key Messages

Target Population

IEC Strategy (materials, medium, activity etc.)

Where/when will they be distributed

Frequency

Is there an indicator/

mechanism to track this

material/activity? If yes, what?

Other Comments

Members handed out during integrated MDA trainings so that HEWs can then disseminate to communities

Annually for OV MDA and once for trachoma

received the brochures, or received messaging due to the during post-coverage assessments

RTIMDA Participation

-MDA will take place at x location on x day



Community members

Posters Put in Clinics/schools/local office buildings one weeks before MDA


% of audience who recall seeing and hearing messaging during post-coverage assessments

Community Members

Radio 6 days before the MDA campaign


% of audience who recall hearing messaging during post-coverage assessments

Community Members

Flipcharts Integrated MDA trainings for HEWs

Once Annually

% of community members that received health education via the flipcharts from HEWs and who recall the messaging

e) Training

Integrated NTD Training Partner Coordination Meeting (RTI). In September of 2016, ENVISION will meet with all the major partners from each of the four regions it supports to hold informal coordination discussions. These discussions will largely center on the budget contributions of each partner and align schedules for the October trainings.


These four meetings will be held at the ENVISION office and only involve refreshment costs.

WHO Zonal Program Managers Integrated NTD Training (RTI). (Note that this training is not a part of Integrated HEW NTD training cascade. While the cascade training focuses on how to teach HEWs about NTDs, this training focuses on how to manage an NTD program from the perspective of a zonal program manager.) In accordance with Ethiopia’s NTD capacity building strategy, the FMOH has requested RTI to conduct a WHO Zonal Program Managers Integrated NTD training in FY17. ENVISION will roll this training out in the regions of Oromia, Tigray, Beneshangul-Gumuz and Gambella. The training will take place in the regional capitals and will include one zonal NTD officer from each zone.

Oromia

Zonal Health Officer TOT on Integrated NTD Training of HEWs (RTI). The TOT targeting zonal officers will start the actual training cascade. This five-day training will take place in Addis Ababa (also the central administrative hub for the Oromia regional government) and will target the zonal health officers of all 17 zones in Oromia. RHB, FMOH and some implementing partner staff will also attend. ENVISION will support the per diem and venue costs for three of the five days for this activity because ENVISION supports the majority of the NTD activities in Oromia.

Woreda Health Officer TOT on Integrated NTD Training of HEWs (FHF). In 12 zones of Oromia, ENVISION will support the woreda health officer TOT through FHF. These health officers will be the key facilitators for the Integrated NTD training of HEWs. ENVISION will support the per diem and travel costs for woreda health officers to travel to the zonal capitals and the venue costs of the training.

Integrated NTD Training for HEWs (FHF). In the 160 woredas of the 12 zones, ENVISION will support the integrated NTD training for HEWs through FHF. FHF and RTI staff will supervise these trainings randomly together with zonal and regional-level health officers. As with the woreda health officer TOT, FHF will support the venue and per diem costs for only one day of this four day training.

Woreda Health Officer TOT on Integrated NTD Training of HEWs (LFTW). In four zones of Oromia, ENVISION will support the woreda health officer TOT through LFTW. Because LFTW is supporting both OV/LF (Rounds 1 and 2) and trachoma MDA in these zones, ENVISION will support the venue and per diem costs for all four days of training.

Integrated NTD training for HEWs (LFTW). In the four zones where LFTW operates, ENVSION will support the integrated NTD training for HEWs in each of the 43 OV/LF-endemic woredas and 42 trachoma-endemic woredas in Western Oromia. ENVISION will support the venue and per diem costs for all four days of the training.

Disease-Specific NTD training for HDAs (LFTW). As detailed in the Country Overview section, HEWs directly distribute Zithromax during trachoma MDA as an antibiotic is involved. However, for OV/LF MDA, the HEWs may rely upon members of the HDA to distribute IVM and ALB. Volunteers from each community (Gare) will be trained by HEWs at their village centers to distribute OV/LF drugs. HDA members will be trained for one day during OV and LF MDA.


Training of Supervisors (LFTW). This training will target Woreda MDA supervisors. The core curriculum will be based on the “MDA supervision workshop” (see Supervision section) and will focus on best practices to ensure quality MDAs with sufficient coverage. The training will last for one day and will take place in woreda capitals. ENVISION will support the per diem costs for this activity.

Tigray

Zonal Health Officer TOT on Integrated NTD Training of HEWs (RTI). This five-day training will take place in Mekele, the capital of Tigray. TRTI staff will also co-facilitate the training with the FMOH and LFTW. ENVISION will support the per diem and venue costs for three of the five days for this activity.

Woreda Health Officer TOT on Integrated NTD Training of HEWs (LFTW). In three zones of Tigray, ENVISION will support the four-day woreda health officer TOT through LFTW. ENVISION will support the venue and per diem costs for two days of the four-day training.

Integrated NTD training for HEWs (LFTW). In the three zones where LFTW operates, ENVISION will support the integrated NTD training for HEWs in each of the 27 trachoma-endemic woredas and one LF-endemic woreda in Tigray. The same supervisory strategies and technical support detailed for the Oromia woredas will be applied for the Tigray woredas. ENVISION will support the costs for two days out of the four day training.

Disease-Specific NTD training for HDAs (LFTW). As detailed in the Country Overview section, HEWs directly distribute Zithromax during trachoma MDA as an antibiotic is involved. However, for OV/LF MDA, the HEWs may rely upon members of the HDA to distribute IVM and ALB. Volunteers from each community (Gare) will be trained by HEWs at their village centers to distribute OV/LF drugs. HDA members will be trained for one day during OV and LF MDA.

Training of Supervisors (LFTW). Similar to the activity description in the Oromia section, this training will target Woreda MDA supervisors. The core curriculum will be based on the MDA supervision workshop (see Supervision section) and will focus on best practices to ensure quality MDAs with sufficient coverage. The training will last for one day and will take place in woreda capitals. ENVISION will support the per diem costs for this activity.

Beneshangul-Gumuz

Zonal Health Officer TOT on Integrated NTD Training of HEWs (RTI). This five-day training will take place in Assosa, the capital of Beneshangul-Gumuz. ENVISION will support the per diem and venue costs for three of the five days for this activity.

Woreda Health Officer TOT on Integrated NTD Training of HEWs (RTI). Woreda health officers will gather in each of the three zonal capitals for this four-day training. RTI will support the costs for one day out of the four.

Integrated NTD training for HEWs (RTI). ENVSION will support the integrated NTD training for HEWs in each of the 11 trachoma-endemic woredas and 14 OV/LF-endemic woredas where RTI is implementing MDA. The same supervisory strategies and technical support detailed for the Oromia woredas will be applied for the Beneshangul-Gumuz woredas. ENVISION will support the venue and per diem costs for three days of the training in seven of the trachoma-endemic woredas because they have not conducted


MDA before FY17. For the remaining 14 woredas, ENVISION will support costs for two out of the four days of training.

Disease-Specific NTD training for HDAs (RTI). As detailed in the Oromia section, volunteers from each community (Gare) will be trained by HEWs at their village centers to distribute OV/LF drugs. This will be part of the HEW’s duty and will come at no extra cost to the project because the HDA members will be trained within their respective communities.

Training of Supervisors (RTI). Similar to the Oromia activity description, this training will target Woreda MDA supervisors. The training will last for one day and will take place in woreda capitals. ENVISION will support the per diem costs for this activity.

Gambella

Woreda Health Officer TOT on Integrated NTD Training of HEWs (RTI). Gambella region does not have a strong zonal structure. Therefore, woreda health officers from all 13 woredas will gather in Gambella Town for this four-day training. ENVISION will support the costs for one day of this four day training because it recently supported a regional TOT for trachoma in FY16.

Integrated NTD Training for HEWs (RTI). Through a FOG, ENVSION will support the integrated NTD training for HEWs in each of the 13 trachoma-endemic woredas where RTI is implementing trachoma MDA. ENVISION will support the per diem costs for two days of the four day training in each woreda.

Training of Supervisors (RTI). Similar to the Oromia activity description, this training will target Woreda MDA supervisors. The training will last for one day and will take place in woreda capitals. ENVISION will support the per diem costs for this activity.

f) Mapping

As detailed in the National NTD Program Review section, while Ethiopia does still have mapping gaps due to myriad issues including insecurity (for trachoma and STH/SCH) and evolving technical protocol surrounding elimination efforts (OV), these gaps do have funding and therefore are not addressed within this work plan.

Coordinated NTD Mapping of Refugee Camps (RTI): This activity was originally included as an addendum to the FY16 work plan. It included mapping ten refugee camps (six in Gambella and four in Beneshangul-Gumuz) for all five PC-NTDs in a coordinated fashion using the national standard mapping methodologies for each disease. As of the end of the FY16 fiscal year, 5 camps are still remaining. As the camps have been combined into one evaluation unit, it is necessary to map all ten camps in order to calculate the overall prevalence of the camps. Therefore, the cost for the remainder of this activity has been included in the FY17 work plan.

g) MDA Coverage and Challenges

Oromia

Trachoma MDA Campaign Week (FHF). In FY17, ENVISION will support the Oromia RHB through FHF to address the same 167 trachoma endemic woredas in 12 zones. For the woredas targeted for TIS in FY17


through ENVISION support (see M&E section), MDA will discontinue in each woreda with TF<5%. Where warranted, FHF will continue to conduct MDA in April 2017 in order to continue the treatment cycle. These woredas include the 160 woredas targeted in FY16 and additional seven woredas with TF prevalence between 5 and 10% targeted for the first time in FY17. ENVISION will support the per diem for the HEWs and supervisors traveling outside of their duty stations for this activity.

LF MDA Week (FHF). ENVISION will support the Oromia RBH through FHF to conduct MDA in one new LF-endemic woreda in FY17. ENVISION will support the MDA logistics, dose poles, and production of MDA reporting forms and writing materials for HEW supervisors where gap are identified.

Trachoma MDA (LFTW). In FY17, ENVISION will support the Oromia RHB through LFTW to conduct MDA in 42 woredas in Western Oromia addressing 4.6 million people at risk. ENVISION will support the MDA logistics, dose poles, and production of MDA reporting forms and writing materials for HEW supervisors where gaps are identified.

OV/LF MDA (LFTW). In FY17, ENVISION will support the same 43 woredas that it supported in FY16 as well as an additional 3 town administrations that the FMOH has declared as endemic due to the fact that they are located in the middle of OV endemic woredas. ENVISION will support the MDA logistics, dose poles, and production of MDA reporting forms and writing materials for HEW supervisors where gaps are identified.

Tigray

Trachoma MDA (LFTW ). In FY17, ENVISION will support the Tigray RHB through LFTW to conduct MDA in 27 endemic woredas. Five of these woredas will be targeted for the first time in FY17. ENVISION will support the per diems of HEWs and supervisors traveling outside of their duty stations and MDA logistics such as dose poles, registers, and reporting forms for the new woredas and areas where gaps are identified.

LF MDA (LFTW). ENVISION will continue to support the treatment of the one LF endemic woreda in Tigray through the same mechanism mentioned in the Tigray Trachoma MDA section.

Beneshangul-Gumuz

OV and LF MDA (RTI). In Beneshangul-Gumuz, ENVISION will continue to support MDA in 14 OV-endemic woredas, 12 of which are also endemic for LF. In November of FY17, RTI will support Round 1 of IVM treatment in all 14 of the OV woredas, together with administering ALB in the 12 woredas co-endemic with LF. Six months later, in May of FY17, ENVISION will support Round 2 of IVM treatment to all 14 woredas. ENVISION will support the MDA logistics, dose poles, and production of MDA reporting forms and writing materials for HEW supervisors where gaps are identified.

Trachoma MDA (RTI). In FY16, RTI targeted the only four woredas in Beneshangul-Gumuz with a trachoma over 10% prevalence for Zithromax targeting more than 266,000 people at risk. In FY17, ENVISION will target an additional seven woredas whose prevalence rates are between 5 and 10%. These seven woredas are in the same zone as the four woredas targeted in FY16 so addressing them is strategically and financially advantageous. Supplies needed for the MDA, dose poles, registers, reporting forms will be produced through ENVISION support.

Gambella


Gambella Trachoma MDA (RTI). In FY17, ENVISION will support the same 13 woredas for trachoma MDA that were targeted in FY16. HEWs will be used as team leaders and community volunteers were used as social mobilizers. After the refugee camps in the region are mapped, RTI will target these additional populations if found to be endemic. ENVISION will support the MDA logistics, dose poles, and production of MDA reporting forms and writing materials for HEW supervisors where gaps are identified.

Table 9: USAID-supported coverage results for FY15 and FY16** and targets for FY17

NTD# Rounds of annual

distribution

Treatment target

# DISTRICTS

# Districts not meeting

epi * coverage target

# Districts not

meeting program* coverage target

#

Treatment targets PERSONS

# treated

PERSONS

%

of treatment target met

PERSONS

FY17 treatment targets

# DISTRICT

S

FY17 treatment targets

# PERSONS

LF FY 15 1 18 1 852,807 724499 84.9%24 1,651,945FY16 23 0 1,368,680 403,247** 29.5%

OV FY 15 Round 1 37

1

1,969,281 1,866,161 94.8% 52

3,453,983

Round 2 1,983,360 1,942,886 97.9%

FY16 Round 1 50 _

3,192,042 476,312** 14.9%Round 2 3,192,042

STH FY 15 Round 1 6 1

335,617 298,022 88.8%

4 279,204 Round 2 - - - -

FY16 Round 1 1 22,522 22,738 100%Round 2 3 246,745 52927** 21.5%

TRA FY15 1 85 1 8,592,474 4,896,791 57% ***260 30,452,401FY16 240 3 27,862,994 5,372,691*

* 19.3

*Epi and Program coverage as defined in the workbooks** FY16 data includes woredas were MDA report is received: LF 12 woreda, OV 14 woreda, STH 1 woreda, trachoma 46 woredas report received *** FY17 targeted number of districts includes the 10 woredas that will conduct an impact assessment in FY17; if TF <5% is found, MDA will not be conducted in FY17.

h) Drug and Commodity Supply Management and Procurement

NTD PFSA and Implementing Partners Coordination Training (RTI). The FMOH and the PFSA have requested support for a training that would introduce all 16 branches of the PFSA to NTDs. In FY17, RTI will support a two-day training in NTD supply chain management to PFSA staff, regional and zonal logistics focal persons, and the logistics and program management staff of implementing partners within the regions. ENVISION will support the per diem and venue costs for all four trainings.


Table 10. List of PFSA branches allocated by training cluster and region

Training Session

Name of PFSA Branch Region Addressed

1

Addis Ababa

Adama (Oromia and Somalia)AdamaDire DawaJijiga

2

Hawassa

Hawassa (SNNPR and Southeast Oromia)Arbaminch

Negelle

Borena

3

Jimma

Metu (Western Oromia, Beneshangul-Gumuz, Gambella)

Gambella

NekemetAssosa

4

Gonder

Bahir Dar (Amhara and Tigray)

Bahir DarDessieSemeraShire Mekelle

Transporting of Drugs from the Central Store to Woreda Health Centers (RTI). As of May 2016, the FMOH has piloted management of transporting and distributing integrated NTD drugs to districts via its regional hubsAs mentioned in the supply chain description above, the PFSA delivers all drugs to the woreda-level health center. There is a small charge for this service which the FMOH is currently in the process of standardizing for all partners. RTI will cover this charge for all four regions through a direct payment to the PFSA. Other implementing parnters will cover this cost for regions of support.

Transporting Drugs from the Woreda Health Center to the Distribution Points (RTI, FHF, LFTW) In all four supported regions, the ENVISION project will support either the procurement of fuel for woreda-level health post vehicles or, if vehicles are not available, ENVISION will support the rental of a vehicle. Whenever possible, ENVISION will ensure the drug deliveries are carried out in conjunction with other activities such as MDA training supervision.

i) Supervision

For any drug distribution program strong supportive supervision is mandatory during three phases of drug distribution, which are:


1. Pre drug distribution (MDA) supervision: Woreda health offices and zonal health departments will conduct supervision to ensure all logistics are in place and ready for the actual distribution.

2. Supervision during drug distribution: This stage requires intensive supervision from the regional, zonal, woreda, kebele and HEW work force. The aim of this supervisory stage is to make sure the MDA will take place as per the standards and to provide appropriate support required at field level. Particularly attention will be put towards the assuring the collection of accurate data according to the FMOH protocols.

3. Post drug distribution supervision: District supervision teams and district MDA coordinators are highly engaged during this stage. The aim of this supervisory stage is to evaluate if the intended coverage is achieved or not, assess the quality of the data, and to collect all supplies and reports for compilation. Feed-back is provided during post-MDA meetings at the woreda and zonal levels (see Strategic Planning section)

MDA supervision workshop (RTI). In July 2016, the FMOH nominated a member of its own NTD team and RTI’s ENVISION program manager to attend an MDA supervision workshop conducted by KCCO with support from ITI. In FY17, ENVISION will support an MDA supervision workshop in Ethiopia that will disseminate the lessons learned from the Cape Town workshop to the major implementers in the country. RTI will support the venue and per diem costs for this event.

j) M&E

National M&E Standardization Training (RTI). This workshop will target the standardization of the following activities:

All DSA protocols MDA coverage assessments using segmentation and Task Force for Global Health

Coverage Assessment Tool Rapid Coverage Assessment Tool (now called Coverage Supervision Tool) Data Quality Assessment

RTI will provide technical guidance to create modules highlighting all of the WHO-endorsed M&E best practices. RTI will support the venue and per diem costs for this activity. WHO Integrated NTD Database Regional Rollout (RTI). The Integrated NTD Database is an important component of the FMOH’s push to standardize reporting and tools in Ethiopia (see Capacity Building section). In FY17, ENVISION will support the continued roll out of the database to the regions of Gambella, Amhara and SNNPR in order to ensure that all regions are using the database as per the FMOH’s desire to standardize tools. ENVISION will support the travel of the data manager to the regional office both for the five-day initial training and a two-day follow up three months later. No venue or per diem costs will be necessary because the training will be held within the regional office.

Trachoma Impact Survey (RTI). With support from ENVISION, RTI will target ten woredas in North Shoa and Finfine Zuria zones with a 10%-29.9% prevalence to conduct trachoma impact surveys (TIS). The WHO simplified trachoma grading system (and Tropical Data) will be used for the assessment. As per the direction from the FMOH that all impact assessments must be implemented by an organization other than the implementing partner, this assessment will be conducted by an external third party and will


also include the newly trained FMOH trachoma grader and recorder (detailed in the Capacity Building section).

Table 11: Planned Disease-specific Assessments for FY17 by Disease

Disease No. of endemic districts

No. of districts planned for

DSA

Type of assessment

Diagnostic method (Indicator: Mf, ICT, hematuria, etc)

Trachoma 670 10 Impact Survey WHO, Trachoma simplified grading system

Post-MDA Coverage Survey (RTI, FHF, LFTW). In FY17, post-MDA coverage surveys will be executed by RTI, FHF and LFTW in their respective implementation areas. ENVISION partners and the relevant RHB will visit any woredas in which reported coverage differs from surveyed coverage to troubleshoot causes with the local health offices.


3) Maps


*Please note that the white areas do not “require mapping” but are an artifact of the shape files used to create this map. We are working to correct these shape files together with the FMOH to ensure that everyone continues to use the same versions.

FY17 DSAs indicated in the map reflect all planned DSA which may include DSAs supported by other partners in addition to those supported by USAID ENVISION's project.


*Based on data collected as of June 2016. Still collecting updated reports from partners and FMOH on some impact assessment information.


APPENDIX 1. WORK PLAN TIMELINE


`

Capacity Strengthening StrategyQuality Assessment of HEW Integrated MDA training (RTI). Project AssistanceStrategic PlanningFMOHNTD Annual Review Meeting (RTI). NTD Midterm Review Meeting (RTI).National NTD task Force (RTI).NTD Scientific Symposium (RTI). TIPAC Maintenance (RTI).FY18 Planning Workshop (RTI).

OROMIAOromia Regional Annual Review Meeting (RTI).Woreda-level Post MDA Review Meetings (FHF and LFTW). Zonal Post MDA Review Meetings (FHF and LFTW).FY18 planning Workshop (LFTW).

TIGRAYWoreda-level Post MDA Review Meeting (LFTW)FY18 planning Workshop (LFTW).

BENESHANGUL-GUMUZBeneshangul-Gumuz Regional Annual Review Meeting (RTI).Zonal-level Post-MDA Review Meeting (RTI).

GAMBELLAGambella Regional Annual Review Meeting (RTI). Zonal-level Post-MDA Review Meeting (RTI).

NTD SecretariatFMOHEngaging Peace Corps (RTI).

FMOH Technical Advisor Secondment (RTI).FMOH Data Manager Secondment (RTI).PFSA Secondment (RTI).

BENESHANGUL-GUMUZTechnical Advisor Secondments (RTI).

GAMBELLATechnical Advisor Secondments (RTI).

Advocacy for Building a Sustainable National NTD Program

APPENDIX 2. TABLE OF USAID-SUPPORTED PROVINCES/STATES AND DISTRICTS

No. RegionHealth Districts

LF Pre-TAS TAS1 TAS2 TAS3 TIS TSS OV Mapping OV Epi Surveys

1 Beneshangul Gumuz Asosa Asossa

2 Beneshangul Gumuz Asosa Assosa Town

3 Beneshangul Gumuz Asosa Bambasi

4 Beneshangul Gumuz Asosa Homosha

5 Beneshangul Gumuz Asosa Kurmuke

6 Beneshangul Gumuz Asosa Menge

7 Beneshangul Gumuz Asosa Oda bildigilu

8 Beneshangul Gumuz Asosa Sherkole

9 Beneshangul Gumuz Kamashi Agalometi

10 Beneshangul Gumuz KamashiBelo Jegonfoy

11 Beneshangul Gumuz Kamashi Kamashi

12 Beneshangul Gumuz KamashiSedal (Sirba Abay)

13 Beneshangul Gumuz Kamashi Yasso

14 Beneshangul Gumuz Metekel Dangure

15 Beneshangul Gumuz Metekel Dibate

16 Beneshangul Gumuz Metekel Bullen

17 Beneshangul Gumuz Metekel Guba

18 Beneshangul Gumuz Metekel Mandura

19 Beneshangul Gumuz Metekel Pawe

20 Beneshangul Gumuz Metekel Wombera

21Beneshangul Gumuz Tongo Sp. Wereda MaoKomo

22 Gambella Agnua II Abobo

23 Gambella Agnua II Dimma




24 Gambella Agnua II Gambella

25 Gambella Agnua II Gog

26 Gambella Agnua II Jor

27 Gambella Itang Itang

28 Gambella Mejang Godere

29 Gambella Mejang Mengeshi

30 Gambella Nuer II Jikawo

31 Gambella Nuer II Akobo

32 Gambella Nuer II Lare

33 Gambella Nuer II Makoy

34 Gambella Nuer II Wanthuwa

35 Oromia Arsi Amigna

36 Oromia Arsi Aseko

37 Oromia Arsi Bale

38 Oromia Arsi Chole

39 Oromia Arsi Digelu & Tijo

40 Oromia Arsi Diksis

41 Oromia Arsi Dodota

42 Oromia Arsi Enkelo Wabe

43 Oromia Arsi Gololcha

44 Oromia Arsi Guna

45 Oromia Arsi Hetosa

46 Oromia Arsi Jeju

47 Oromia ArsiLimuna bilbilo

48 Oromia Arsi Lode hetosa

49 Oromia Arsi Merti

50 Oromia Arsi Munesa




51 Oromia Arsi Robe

52 Oromia Arsi Seru

53 Oromia Arsi Shirka

54 Oromia Arsi Sire

55 Oromia Arsi Sude

56 Oromia Arsi Tena

57 Oromia Arsi Tiyo

58 Oromia Arsi Zuway dugda

59 Oromia Bale Agarfa

60 Oromia Bale Barbare

61 Oromia Bale Dawe Kachen

62 Oromia Bale Dawe sarar

63 Oromia Bale Delo Mena

64 Oromia Bale Dinsho

65 Oromia Bale Gasara

66 Oromia Bale Ginir

67 Oromia Bale Goba

68 Oromia Bale Gololcha

69 Oromia Bale Goro

70 Oromia BaleGura Dhamole

71 Oromia Bale Harana Buluk

72 Oromia Bale Lege Hida

73 Oromia BaleMada Walabu

74 Oromia Bale Rayitu

75 Oromia Bale Sawena

76 Oromia Bale Sinana

77 Oromia Borena Abaya




78 Oromia Borena Arero

79 Oromia Borena Bule Hora

80 Oromia Borena Dhas

81 Oromia Borena Dillo

82 Oromia Borena Dire

83 Oromia Borena Dugda Dawa

84 Oromia Borena Gelana

85 Oromia Borena Melka Soda

86 Oromia Borena Miyo

87 Oromia Borena Moyale

88 Oromia Borena Teltele

89 Oromia Borena Yabelo

90 Oromia E. Shewa Adama

91 Oromia E. Shewa Adea

92 Oromia E. Shewa Boset

93 Oromia E. Shewa Fentale

94 Oromia E. Shewa Gimbichu

95 Oromia E. Shewa Liben

96 Oromia E. Shewa Lome

97 Oromia E. WellegaBoneya Bushe

98 Oromia E. Wellega Diga

99 Oromia E. Wellega Ebantu

100 Oromia E. Wellega Gida Ayyana

101 Oromia E. Wellega Gubu Sayo

102 Oromia E. Wellega Gudaya Bila

103 Oromia E. Wellega Guto Gida

104 Oromia E. Wellega Haro Limu




105 Oromia E. Wellega Jima Arjo

106 Oromia E. Wellega Kiremu

107 Oromia E. Wellega Leka Dulecha

108 Oromia E. Wellega Limu

109 Oromia E. WellegaNekemte Town

110 Oromia E. Wellega Nunu Kumba

111 Oromia E. Wellega Sasiga

112 Oromia E. Wellega Sibu Sire

113 Oromia E. WellegaWama Hagalo

114 Oromia E. Wellega Wayu Tuka

115 Oromia Finfine Zuriya Akaki

116 Oromia Finfine Zuriya Bereh X

117 Oromia Finfine Zuriya Mulo X

118 Oromia Finfine Zuriya Sebata Awas X

119 Oromia Finfine Zuriya Sululta X

120 Oromia Finfine Zuriya Welmera X

121 Oromia Guji Adola Wayyu

122 Oromia Guji Anna Soraa

123 Oromia Guji Bore

124 Oromia Guji Dama

125 Oromia Guji Girja

126 Oromia Guji Goro Dola

127 Oromia GujiHambala wamana

128 Oromia Guji Liben

129 Oromia Guji Odo Shakiso

130 Oromia Guji Qerca

131 Oromia Guji Saba boru




132 Oromia Guji Uraga

133 Oromia Guji Wadera

134 Oromia Horo Guduru Abay Comen

135 Oromia Horo Guduru Abe Dongoro

136 Oromia Horo Guduru Amuru

137 Oromia Horo Guduru Guduru

138 Oromia Horo GuduruHababo Guduru

139 Oromia Horo Guduru Horo

140 Oromia Horo Guduru Jardega jarte

141 Oromia Horo Guduru Jimma Ganati

142 Oromia Horo Guduru Jimma Rare

143 Oromia Illu Aba bora Ale

144 Oromia Illu Aba bora Alge Sachi

145 Oromia Illu Aba bora Becho

146 Oromia Illu Aba bora Bedele

147 Oromia Illu Aba bora Bilo Nopa

148 Oromia Illu Aba bora Borecha

149 Oromia Illu Aba bora Bure

150 Oromia Illu Aba bora Chewaka

151 Oromia Illu Aba bora Chora

152 Oromia Illu Aba bora Dabo Hana

153 Oromia Illu Aba bora Darimu

154 Oromia Illu Aba bora Dega

155 Oromia Illu Aba bora Didu

156 Oromia Illu Aba bora Diediesa

157 Oromia Illu Aba bora Doreni

158 Oromia Illu Aba bora Gechi




159 Oromia Illu Aba bora Hurumu

160 Oromia Illu Aba bora Meko

161 Oromia Illu Aba bora Metu

162 Oromia Illu Aba bora Nono Sale

163 Oromia Illu Aba bora Yayo

164 Oromia Jimma Chora

165 Oromia Jimma Deddo

166 Oromia Jimma Gera

167 Oromia Jimma Gomma

168 Oromia Jimma Gumma

169 Oromia Jimma Kersa

170 Oromia Jimma Limmu Kossa

171 Oromia Jimma Limmu Seka

172 Oromia Jimma Manna

173 Oromia Jimma Nonno Benja

174 Oromia JimmaOmmo Nadda

175 Oromia JimmaSaka Chekorsa

176 Oromia Jimma Satema

177 Oromia Jimma Shabe Sombo

178 Oromia Jimma Sigimo

179 Oromia Jimma Sokoru

180 Oromia Jimma Tiro Afeta

181 Oromia North Shoa Zone Abichugna X

182 Oromia North Shoa Zone Aleltu X

183 Oromia North Shoa ZoneDebre Libanos

184 Oromia North Shoa Zone Degem

185 Oromia North Shoa Zone Derra




186 Oromia North Shoa Zone Girar Jarso

187 Oromia North Shoa ZoneHidhabu Abote

188 Oromia North Shoa Zone Jidda X

189 Oromia North Shoa Zone Kimbibit X

190 Oromia North Shoa Zone Kuyu

191 Oromia North Shoa Zone Were Jarso

192 Oromia North Shoa Zone Wuchale

193 Oromia North Shoa Zone Yaya Gulale

194 Oromia S.W. Shewa Ameya

195 Oromia S.W. Shewa Becho

196 Oromia S.W. Shewa Dawo

197 Oromia S.W. Shewa Elu

198 Oromia S.W. Shewa Goro

199 Oromia S.W. Shewa Kersa Malima

200 Oromia S.W. ShewaSeden Sodo Rural

201 Oromia S.W. Shewa Sodo Dachi

202 Oromia S.W. Shewa Tole

203 Oromia S.W. Shewa Woliso

204 Oromia S.W. Shewa Wonchi

205 Oromia W. Harerge Ancar

206 Oromia W. Harerge Boke

207 Oromia W. Harerge Burka dhintu

208 Oromia W. Harerge Chiro

209 Oromia W. Harerge Daro Lebu

210 Oromia W. Harerge Doba

211 Oromia W. Harerge Gemechis

212 Oromia W. Harerge Guba Koricha




213 Oromia W. Harerge Habro

214 Oromia W. Harerge Hawi Gudina

215 Oromia W. Harerge Mesela

216 Oromia W. Harerge Mi'eso

217 Oromia W. Harerge Tullo

218 Oromia W. Shewa Ade'a Berga

219 Oromia W. Shewa Ambo Zuria

220 Oromia W. Shewa Bako Tibe

221 Oromia W. Shewa Chelia

222 Oromia W. Shewa Dano

223 Oromia W. Shewa Dendi

224 Oromia W. ShewaDire Inchini (Tikur Inchini)

225 Oromia W. Shewa Ejere

226 Oromia W. Shewa Elfeta

227 Oromia W. Shewa Ilu Gelan

228 Oromia W. Shewa Jeldu

229 Oromia W. Shewa Jibat

230 Oromia W. Shewa Meta Robi

231 Oromia W. Shewa Mida Kegn

232 Oromia W. Shewa Nono

233 Oromia W. Shewa Toke Kutaye

234 Oromia West Arsi Adaba

235 Oromia West Arsi Dodola

236 Oromia West Arsi Gadeb Asasa

237 Oromia West Arsi Kofele

238 Oromia West Arsi Kokosa

239 Oromia West Arsi Kore




240 Oromia West Arsi Nensebo

241 Oromia West Arsi Shala

242 Oromia West Arsi Shashemene

243 Oromia West Arsi Siraro

244 Oromia West Arsi Wondo

245 Oromia West Wellega Ayira

246 Oromia West Wellega Babo Gambel

247 Oromia West Wellega Begi

248 Oromia West WellegaBodji Chokorsa

249 Oromia West Wellega Bodji Dirmeji

250 Oromia West Wellega Genji

251 Oromia West Wellega Haru

252 Oromia West Wellega Jarso

253 Oromia West Wellega Kiltu Kara

254 Oromia West Wellega Kondala

255 Oromia West Wellega Lalo Asabi

256 Oromia West Wellega Mene Sibu

257 Oromia West Wellega Nedjo Rural

258 Oromia West Wellega Nedjo Town

259 Oromia West Wellega Nole Kaba

260 Oromia West Wellega Seyo Nole

261 Oromia West Wellega Yubdo

262 Tigray Central Tigray Ahferom

263 Tigray Central Tigray Geter Adwa

264 Tigray Central Tigray Kolla Temben

265 Tigray Central TigrayLaelay Maichew

266 Tigray Central Tigray Mereb Leke




267 Tigray Central Tigray Naeder Adet

268 Tigray Central TigrayTahtay Maichew

269 Tigray Central TigrayTanqua Abergele

270 Tigray Central Tigray Werehilehi

271 Tigray Eastern TigrayAtsibi Wonberta

272 Tigray Eastern Tigray Erob

273 Tigray Eastern TigrayGanta Afeshum

274 Tigray Eastern Tigray Glomekeda

275 Tigray Eastern Tigray Hawzien

276 Tigray Eastern Tigray Kilte Awlaelo

277 Tigray Eastern TigraySaesi Tsaeda Amba

278 Tigray North West TigrayTahtay Koraro

279 Tigray North West Tigray Tselemti

280 Tigray Mekele Adihaki

281 Tigray Mekele Ayder

282 Tigray Mekele Hadnet

283 Tigray Mekele Hawelti

284 Tigray Mekele Kuha

285 Tigray Mekele Semen

286 Tigray North West TigrayAsgede Tsimbla

287 Tigray North West TigrayLaelay Adyabo

288 Tigray North West TigrayMedebay Zana

289 Tigray North West TigrayTahtay adiabo


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