Ethiopia Ministry

The Federal Democratic Republic of EthiopiaMinistry of Health

ANNUAL PROJECT TECHNICAL REPORTSUBMITTED TO

TECHNICAL CONSULTATIVE COMMITTEE

DEADLINE FOR SUBMISSION:

To APOC Management by 31 Januarv for March TCC

To APOC Management by 31 Julv for September TCC meeting

5*\):

(20C

L.i)

?

',;'lior

i\S\\

!

I

I

I

I

I

I

I

I

I

t._

r\0 ,

hAlfl\]o i.AFRICAN PROGRAMME FOR

ONCHOCERCTASTS CONTROL (APOC)

COUNTRYAIOTF: ETHIOPIA Proiect Name: Illubabor

Approval year: 2003 Launching vear: 2003

From:D.essmher..?0..q3,...To;....I$.qy..cmb..p.r.2.Q0..4....(Month/Year) ( Month/Year)

Reportins Period:

Proiectvearofthisreport:(circleone) (J2 3 4 5 67 8 910

NGDO partn€r: The Carter CenterDate submitted: 20 January 2005

3 I JAit. 2005

WHO/APOC, 24 November 2004

l

&!*!ffi

ANNUAL PROJECT TECHNICAL REPORTTO

TECHNICAL CONSULTATIVE COMMITTEE (TCC)

E,NDORSE,MENT

Please confirm you have read this report by signing in the appropriate space.

OFFICERS to sign the rePort:

Country rhioDla

NationalCoordinator Name:....p.r.

Signature: .......

/ 0J0Date

Zonal Oncho Coordinator Name

Signature

rv{Xlo{Date:

NGDO Representative Name: ........Tesh.q.m.e..Gehrs..........

Signature: /++.--........Date: . |il.a@

This report has been prepared by Name : .Ti.b.q.b.U

Designation :

Signature

oii,'joo

,,,Qv

,

t

a

:!

TI

?"1,/1,+ t.rtoo fl' c

l1

Date


aJ

Table of contents

v

FOLLOW UP ON TCC RECOMMEI\DATIONS...... ...................1

EXECUTIYE SUMMARY

SECTION I : BACKGROUND INFORMATION........

l. 1. GrNrnel rNFoRMATroN...............1.1.1 Description of the project (briefly) .

1.1.2. Partnership1.2. Popur-RrroN...............

SECTION 2: IMPLEMENTATION OF CDTI

2

3

3

345

6

67

78

9

2.1.2.2.2.3.2.4.

TIUBLINB oF ACTIVrrrES.....,........AovocacvMosILIzeTIoN, SENSITIZATIoN AND HEALTH EDUCATION OF AT RISK COMMUNITIES

Cotrluuuny INVoLVEMENT ...........2.5. ClplcrryBUrLDrNG......2.6. TRretunrrs................ ................ I I

2.6.1. Treatmentfigures............. ..... ll2.6.2 V[hat are the causes of absenteeism? .......... .............. 13

2.6.3 What are the reasonsfor refusals?................ ............ I32.6.4 Briefly describe all lcnown and verified serious adverse events (SAEs) that ... l32.6.5. Trend of treatment achievementfrom CDTI project inception to the current year 14

2.7. ORDERTNG, SToRAGEANDDELTvERyoFIVERMECTIN ......... 15

2.8. Couuuxrry sELF-MoNrroRrNc Ruo STITBHoLDERS MBBrnrc... ........ l62.9. SupenusroN................ ................. 16

2.9.1. Provide aflow chart of supervision hierarchy. .......... 162.9.2. What were the main issues identified during supervision?............................. 162.9.3. lV'as a supervision checklist used?......... .................... 162.9.4. What were the outcomes at each level of CDTI implementation supervision? I62.9.5. Was feedback given to the person or groups supervised? ............ l62.9.6. How was thefeedback used to improve the overall pedormance of the project? 16

EqureunNrFINRNCIaT CONTRIBUTIONS OF THE PARTNERS AND CoMMUNITIESOtsBR roRvs oF coMMUNITy suppoRT .............

3.4. ExpBNorruRE PER AcrIVITy...

SECTION 4: SUSTAINABILITY OF CDTI .. 19

4.1. INrnmtu; INDEIENDENTpARTTcIpAToRyMoNIToRTNc; EvaruATIoN................... l94.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick anyof the following which are applicable) .... ... . . ... .. . . .. .. I 94.1 .2. Vfthat were the recommendations? . .......... 194.1.3. How have they been implemented?.............. .............. 19

3.1

3.23.3

t718

18

l8

1lr WHO/APOC, 24 November 2004

4.2.Yn3)

4.24.24.24.24.2

SusrarNeuI-lTy oF IRoJECTS: nLAN AND sET TARGETS (utlNoeroRY AT

l. Planning at all relevant levels.....2. Funds........3 Transport (replacement and maintenance), . ...

4. Other resources5. To what extent has the plan been implemented.........

202020202020202020202t2t2t

2t

4.3. INrBcRerroN...............4.3.1. Ivermectin delivery mechanisms.....4.3.2. Training.....4.3.3.4.3.4.4.3.5.

Joint supervision and monitoring with other programs .

Release of funds for proj ect activities ....Is CDTI included in the PHC budget?......

4.3.6. Describe other health programmes that are using the CDTI structure and howthis was achieved. Wat have been the achievements?............. .................. 21

4.3.7. Describe others issues considered in the integration of CDTI. ...................... 21

4.4. OpenerroNAl RESEARCH

4.4.1. Summarize in not more than one half of a page the operational researchundertaken in the project area within the reporting period. .. .. . . 2 I4.4.2. How were the results applied in the project?............. ..........,....... 21

SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, A]rlDOPPORTUNITIES 2t

SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS...........22

1V WHO/APOC, 24 November 2004

Acronyms

APOC

ATOATrOCBO

CDD

CDTICSM

LGAMOHNGDO

NGO

NOTF

PHC

REMO

SAE

SHM

TCC

TOT

TINICEF

UTG

wHo

African Programme for Onchocerciasis Control

Annual Treatment Objective

Annual Training Objective

Community-Based Organization

Community-Directed Di stributor

Community-Directed Treatment with Ivermectin

Community Sel f-Monitoring

Local Government Area

Ministry of Health

Non-Governmental Development Organization

Non-Governmental Organ izationNational Onchocerciasis Task Force

Primary health care

Rapid Epidemiological Mapping of Onchocerciasis

Severe adverse event

Stakeholders meeting

Technical Consultative Committee (APOC scientific advisory group)

Trainer of trainers

United Nations Children's Fund

Ultimate Treatment Goal

World Health Organization

v WHO/APOC, 24 November 2004

Definitions

(i) Total population: the total population living in meso/hper-endemic communitieswithin the project area (based on REMO and census taking).

(ii) Eligible oopulation: calculated as 84o/o of the total population in meso/hyper-endemic communities in the project area.

(iii) Annual Treatment Objective: (ATO): the estimated number of persons living inmeso/h1per-endemic areas that a CDTI project intends to treat with ivermectin ina given year.

(iv) Ultimate Treatment Goal (UTG): calculated as the maximum number of people tobe treated annually in meso/hyper endemic areas within the project area,

ultimately to be reached when the project has reached full geographic coverage(normally the project should be expected to reach the UTG at the end of the 3dyear ofthe project).

(") Therapeutic coveraqe: number of people treated in a given year over the totalpopulation (this should be expressed as a percentage).

(vi) Geosraphical coveraqe: number of communities treated in a given year over thetotal number of mesoftryper-endemic communities as identified by REMO in theproject area (this should be expressed as a percentage).

(vii) Integration: delivering additional health interventions (i.e. vitamin A supplements,

albendazole for LF, screening for cataract, etc.) through CDTI (using the same

systems, training, supervision and personnel) in order to maximise cost-effectiveness and empower communities to solve more of their health problems.

This does not include activities or interventions carried out by communitydistributors outside of CDTL

(viii) Sustainabilitv: CDTI activities in an area are sustainable when they continue tofunction effectively for the foreseeable future, with high treatment coverage,

integrated into the available healthcare service, with strong communityownership, using resources mobilised by the community and the govemment.

(ix) Community self-monitorine (CSM): The process by which the community isempowered to oversee and monitor the performance of CDTI (or any community-based health intervention programme), with a view to ensuring that theprogrzunme is being executed in the way intended. It encourages the communityto take full responsibility of ivermectin distribution and make appropriatemodifi cations when necessary.

v1 WHO/APOC, 24 November 2004

FOLLOW UP 01{ TGG REGOUTENDATIOilS

TCC session Not

Number ofRecommendationin the Report

TCCRECOMMENDATIONS

ACTIONS TAKENBYTHE PROJECT

FORTCC/APOC MGTUSE ONLY


Executive Summaly

1. Background on treatment and population data

Illubabor CDTI has total communities (villages) of 3,590 which ate diskibuted in six

Woredas (Matu, Darimu, Alige-Sache, Yayu-[-lurumu, Alle-Didu and Bedele) and all the

villages were covered with Mectizan treatment during the treatment period. The total

population, which is the same as the UTG, of the CDTI is 675,642. The Annual Treatment

Objective (ATO) for the year was 582,866 out of which 523,171 were treated with Mectizan

which gives the therapeutic coverage of 77%. Hundred percent of the project area

(geographical coverage) was covered by the treatment.

2. Background on population movements.

The communities in CDTI areas are mainly settled farmers, daily laborers and civil servants.

However, there is a resettlement program in the neighboring Woreda. Generally, there is nomajor type of population movement in the project area.

3. Training data

Training of Trainers (TO1) was given for 113 healthprofessionals. Those rvho werc trained

as traincrs in tum trained 8,021 CDDs rvho wcre sclected by the communities from 3,590

villages. T'hcrcfbre, the average number of CDDs per villages is 2.

4. Challenges and how they were overcome.

Threats (Challenges): Overburdening of health workers in peripheral health facilities in

ditlbrent health programs such as malaria epidemic control, EPI. measles campaign and

settlement programs.

Opportunities: The expansion ol govemment structure down to village leveT "Garee" and

being taking the responsibility of development activities as well as health is a good

opportunity for sustainability of onchocerciasis control, which helps to overcome the above

mentioned challenges. The Ilealth Extension Package program in which there is a start of

building a health post in each and every Kebele is also another good opportunity.

2 WHO/APOC, 24 November 2004

SEGTION'l : Background lnformation

11.1. Gencral information

1.1.1 Description of the project

lllubabor CDTI projcct is fbund in Illubabor zone, which is located in thc wcstern part ofEthiopia. lt shares borders with Gambella CD1'l in the west, West Wollega CDTI in theNorthwcst, East Wollega CDTI in the Nofth and Kaffa-Shcka CIDTI in the South. Illubaborzone is one of Lhe 72 administrative zones in Oromia Regional State. It is sub-divided in 13

Woredas. The zone is one the areas where settlement program canied out and hence, there isa new Woreda added for settlers which has a population of 83,195. The Woredas are furthersubdivided into 505 Kebeles. The Kebeles, according to a new government structure realizedthis year, is further divided in to "Garee" (village) that is composed of 30 * 50 nearbyhouseholds and responsible for all development activities including health.

Illubabor CDTI project comprises six Woredas. These are, Matu, Darimu, Alige-sache, Yayu-Hurumu, Alle-Didu, and Bedele. The project encompasses a total of 227 kebeles which are

subdivided in to 3,590 Garees (villages).

The CDTI project area has very complex terrain with altitude ranges between 1000-2576meters above sea level. Ecologically it is a tropical rain forest. Climate in the area showsgreat seasonal and inter-annual variations which is traditionally classified into three broadgeo-climatic zones, i.e. cold highland, sub-humid mid-land, and hot lowland area. The meanarurual temperature ranges from l0 t'C to 16 t'C in the highlands, 16 oC -26 0C in thenridlands, and 23 0C -33 0C in the lowlands. The annual rainfall totals ranges from 1000millimeters in the lowlands to 2200 millimeters in the highlands.

Some of the perennial fast flowing rivers that cross the zone include: Sor, Geba, BirbirDedessa, Offa, Sesie, and Gumer rivers. There are also quite numerous small rivcrs andstreams, which are tributarics of thc main rivers in many places in the zone. There are twodistinct seasons in the project area, i.e., the rainy scason (April - October) and the dry season(Novcmbcr-March). 'lhere is a mono-modal rainfall pattcrn in the zone. Agriculturalactivities (clearing. fanning, and herding) occur all year round in the projcct area, but aremost intensive during the rainy season. Harvesting occurs from October to December,lcavirrg January - March as the optinrum treatment period.

The ntain road that r"uns 600 km from Addis Ababa to Mettu, the zonal capital town, passingthrough Jimma zone is Asphalt road and worcdas alongside of the road are connected withMettu town. There are about 576 kilometers dry weather roads that connect woreda centerswith Mettu town. All the CDTI woredas have all weather roads and are connected with Metutown. However, access to rural communities appears very difficult during rainy seasons.

The health infrastructure in the Illubabor CDTI project area is relatively good. The zone has7 z,onal hospital, 11 health centers, 63 health stations (59government,4 NGO) and 38 healthposts. Out of these health facilities a total of 32 health facilities (1 hospital, 6 health centers,12health stations and 13 health posts) are found in the CDTI project area.


I

The new government health policy of Health Extension Package (HEP) demands

construction of new health posts in each Kebele and staff with health extension workers inthe next 5 years.

Table 1 : Number of health staff involved in CDTI

District Number of health staff involved in CDTI ectivities.

Total Number of healthstaff in the entire project

areaBr

Number of health steffinvolved in CDTI

Bz

Percentagc

Br=Brl Br *100

Matu 185 36 19Darimu l8 18 100Alge-Sache 34 r6 47Yavu-Hurunru 27 19 70Alle Didu 35 1l 3lBedcle 44 13 30

Total 343 113 33

1.1.2. Partnership

Partnership is a principle of APOC as well as the government of Ethiopia which helps CDTIprojects fbr best achievement of their aotivities and gradually ensures their sustainability.

Since the beginning of the projeot, there was sffong partnership during planning, advocacy,

mobilization, drug distribution. nronitoring and evaluation of the CDl'l activities among

difl'erent partners. The main partners involved are l.'ederal ministry of health, regional healthbureaus. zone health desk, Woreda health office, health facilities, the community, the cartercenter, WHO and other government sectors.


+oc{ko

-o0)

oz$NUA

B

o.:lr)o'Lrl&OocoE(H

OEo9

s6C)()€.e€.=.sE'a=

€r,tr0))H-+oo:

€=c)a(oa o

^iFgE!(.)P

"i-rrFH €o-=.F Ee Bb sE 'i!Ub .9s 6

'= li b0 qiL.id)F.Ftr 5'c] +'!:==cllE ;E 9H itr €v€oFr,O-c=oc)'{j ts'.= 'RE 9:E I=

V,o 6)€w-9{9v) 5=E 9b .=i ;[ Ed7)^'5_C o0= dB cg 7o Ho,l +,E 3Y H.H!€ -8s -E^-Eeo .aE =s g* :

= dfi (lt

5 .24 Eh !Eii g.= trg) Htr .ii- .o^.9 !E E"c :t-=csxE '5T Etr b; H

L!g .qtr €9 '=; .=

,! -'U Hqp Ee n.! tr'li =3 EE ;9 Zi Ect E: c)6r A !? .r=-o c)

3.8 p H €(! lrl- qri cBF tr =

r.}

g'o0)at)ctoL

?o

o

oz

I

I

aoO

.l

Ed

o(d

4..ooLH

EEci>

tdl.stul$)t'\to'ILt\lul.ct-t9

tila)(J

q)

nJ.a

q)

!s's -<S9

sP'!\-qr9t$t\bu!u-S -'

SSbo'9:Bq)()q)'nttssr\aJ<L\qJ!*ElauPSsxl.:sB<s$s*\J*u.:s=p-E

o)

olroEq)

C)Lr

!)€

lrc)

G)

B6l0)Lctq6)

o)L

q)

C)

.5dt)L

cl

of

U)()

'ootroAct.b0 c)tr>'EOOEEg(D crl

Eo)bot

Eso:l cBtr'o€3o(Hoo'd

o,r

EeoI,-+ (,!()€Eq.29E6)+o,cd;azB=

ot:s.E*Lts\.a. p\rr$dsss!t!

=hn.st{9s9qrlt.:ri E'

s$tv.IEil\'r: .st\B\q)

at.t)o

oO

EoarflIE-fcoE

aN

a

F

oll

6l

!r

FP

9i!E o-

= 3e

@car

F-o\

N

c-l@.

oo

Nt.*

t.-

(\$t--

st--Noiafi

al!+\oviF-\o

+

il5

.oitr-oo.= aNE e.:r aE

o\oo^aalaa

t--

al

[email protected].)co

Nr-qF-O

attr-\oo\

$r-ola.t

6l$\ornr-\o

-,d. L)E Ei'=! 6&8.=;;>.EoO*EEEg

oor-$c.tco..l c.l

(--

\0t--\o\

;alc.loo

co.fa]

r.oo,.!tt-ra

.9E9U:5 h

Fisgsi

o\F-

N

\c$od

$F-v?a.t

\oo\\o d

$@

F-=(t)o

qD(DOT6l

ah0)

()

olrq)E

z

+

il

Iq)

ONo.=

Gt €)

F

t--c.)@ <f

c'lar\oo

'rfa-'lNl-..

oo,l,nca

.:.qE9:a:-.cl9E Eiect(l)E

>>oFEN

c-\o \o\o

ooo\ =l

\oa/^)

ar)

'Egsg= kFisgsi

+ C-l ,\or-

t*-m o\(.)

ra

trGIE9.egH

cle=? = 6.1lX Bor 9'-fv-xtsai5a

co

co

t--o\al

c.i@.

cn

c.lr-t--

a.l-{tt-r\o

$r-ctat

Nqrac-\o

(n

I'Fc)CigE s5EEliq)!

E.g.qArjO9.= a

ecn

a

EL

o

o0aC)EO

E

xao

oooo

Fl

Er

Fr

It

$oc{HG)-oFq)

z$NQA

B

(A

L4)oa

og:s0trEQ

rf

c.l

o

aoloIo

<J-

N

oz

$

6l

7

=f

N

7

<f

N

oz

E'O+.EG!=aE

\f,

a.l

3

!t

o.l>.=

a(\{)-o

sf

6lo

oo

t

^lo

ao

NEooo

Ltt)

atLn

o

=tr=9trEo(J

$

o]o

$

a.lo

+N

o-oo

o

aNoeoo

<.

GItso-o

o

<t

N

o-ooOo

E'.clitr6!=arE

te.lo

$

a.lo

aa.lLo,oooo

-f,

6l

o-oo

o

<f

Nt--oooo

$

c.ltso

o

0)

6l

g

aD

0q)

U

o9:e0trEU

$

N

6z

aold2.

v6Itroa

.t

c.l

Ua

sNot)a

$

.lp.oa

.E'e+,E

aE

$

N

z

n6l

:f

at

oa

$

c.l

ooa

t

..1

oa

-f,

NctJa

AT

GLFr

o

AEtrEoU

$

N

6,z

<t

cld2.

$

ol

br)

$

6l

o0

ii-

N

b0

"f,

N

boa

Er.=ftrd=aE

$

N)r

z.

ac-l

d

I

N

oo

=t

N

oo

$

N

o0

.f

N

oo

r(D

E.Es=-otrootsr()a

oQ)

aoQ

IoI'tra

<t

6l

o.

ao]Iu0

$o.l

b0

sal

br)

$

a.l

bD

.E'.e+Jtr6r,=atr

$

a]or(!t

aa..l

or(!2

$

ol

b0

ta-.t

b0

<.

6l

bD

+..1

br)

rhFl()L(h

H 2

E

do

o

dt/)obr)

ad

IJo

ooo

c0

Fl

t'r

F

\o

.n

C)

oO

Hdo>.trc)L!)oo

E0)

c)trU)(d(.)li(d(.)

Fr

€U)o

(_)(d

(H

C)trC)

EFc.ito-rl

.oldtFI

oo

a-gII

.Ifl(,6tFooE

I-

-oE

II

F!

FI

N

Fa(,5oEo

IIflEgEoEo

Ic.Ell

N-oIl-(,ulo

2.2. Advocacy

State the number of policy/decision makers mobilized at each relevant level during the currentyear; the reason(s) for undertaking the advocacy and the outcome. Describe difficulties/constraints being faced and suggestions on how to improve advocacy.

HighJevel political leaders and Onchocerciasis task forces at different levels particularly theZonal, and Woreda were involved in the advocacy to support the overall CDTI activities. Themembers of the Task Forces at all level were officials from all sectors, which have relevance

for the CDTI activity. This political commitment helped the CDTI activities to be started andsuccessfully achieved its objective.

However, some of the sectors, which are members of the task force, were highly involved inthe ongoing restructuring of government organ, resettlement and other activities. This has tosome extent hampcrcd the frequency of scheduled meetings. For the next keatmcnt period the

Task Forces at all lcvel rvill contribute their part as expected since tlrc work loads they havebecause of rcstructuring and resettlement will bc minimized.

2.3. Mobilization, sensitization and hcalth education of at riskcommunities

Community mobilization was done at each village organizing community meetings. Thehealth workers at all levels have done their best in organizing the Task Forces and givinghealth education for the task forces. The health workers working at front line health facilitylevel were responsible to organize the Kebele Task forces and giving health education for thetask fbrces, community supen isors and CDDs. The Task Forces at kebele levels which,comprises of seven members and also responsible for all social, political and economicalactivities in the kebeles have played major role in rnobilization and sensitization of the wholecommunity at grass root level. Cornmunity Supervisors and CDDs were responsible in givinghealth education to the community at village level including women and rninorities. Inaddition information regarding the CDTI project was further disseminated through local radiostation.The community mobilization has contributed a lot in awareness creation and as a result thecommunity involvcd in the first year CDll activity with successful accomplishment. T'hus,fbr thc next treatment community mobilization and hcalth cducation w,ill be strengthened.


$ooc.l

0)-o0)

oz$c{

A

orJi

>

Cio(o

Eo(d

t)C)ct)C,2

oa€botr0)

0)lrclU)c))acn

FOoBrh9p

o)(D

HT!o (h

.'- atro)f"= €c'tr E.;-E(d'oii€c)xtvatr o.:r

trt a.4il 9,:or.ioQ636 I'9A()= L

-Et-i- - A.cBtri-0)..o-cjg o-(B'F(uH!

>,.6 X o.ET H 9= 6 iiE=-Vptr H o.:.OFV:-ts!'4)88. xEA.5 GE

s.t a'A.E'VL

L I ,^.F AH X o.E *Y *€ ! ranrOH'v*: -adPE X H OE !2'E EEEE38EErO-Cl, 6 .3 -8;a

=are-HosE;.betjpoE A: E8

.. tl r.9 ;ts Ic-!BECD-7,os 6 E.= 5.e

UVF'F€.i.

EEtso'EHE-EE f s 8.E { 6Urrrrr

oO

.Eu,gE!6C=-rlBaEED=6zE

oo[]dE

d

oOD6t

c)

o+ c\

c.l@ \o o.

a.t

tr

E.E *

i EIEz e'i\o \t $N

o\a-.tc.l

F..N sf

€(.)o

0o

A

o0E-

EI6ya.=UooE

z

le+F

leil

tr

6t

oFcl

@al\oco

oocAo.

N

€

tr9-EEOa)

\o $ {a.]

o.c.]a..l

t--a.l

Oscotl

Ftr

AUocla

o\F-

o\ o.\o\o

fn6o\\o

>os'lH! :'lctX

>o}:oEi 6t'Eo

EEEOotr9-rCo=EEtrE-ozo

Pll rtrla

tr

6Jo!6l

{)

oti

O

E

EaH r

EEE iEeaT

r-@ *f

a.t@tr-

oo\o$

olc.ltr-

eo\mc.)

tr

?odr.: L oE.EE E

5E9E-H-P

t.t oa.l6 $

N@Ir-

a+

o.lc-'lt--

o\lr)(.)

rl

a 2 6,

oocn

(hooo >-

d

oo?

ooEom

6toF

qqj(.)q)

oLq)\

a)4t3s)

EFo(J0)flEE:o.HEcLAo.;

r l.trc'6,.EE:rrX

J()rr 'tsE.E-H-iEtrLEEHLAor-(, :.

+#l6i ffl

@

2.5. Gapacity building

- Describe the adequacy of available knowledgeable manpower at all levels'

- Where frequent transfers of trained staff occur, state what the project is doing, or intends todo, to remedy the situation. (The most important issue to describe is what measures were

taken to ensure adequate CDTI implementation where not enough knowledgeable manpower

was available or if staffarefrequently transferred during the course of the campaign).

There was a cascade of trainings on CDTI from the higher level to the community level inadequate arnount to carry out the CDTI activities. However, there was a fbw situation wherethere u,,ere turn over of trained staff particularly at front line health facility level which did notcreate any major problem on the project activity.


Ut.A<

.io .i +.(J

ir*$

N

Naa)

oo

oo

6l\ooo

c.]\ooo

@

@

\oo\

\oc.l

.I

a

(\l

6

otrCBL0aU

6)E

z(J

oF

Oa-lc'I @

at\ooo

@ca \o

coo\

G,I

a

(D

(D

(D

o

s

Q+-()

il

rin

F

,L'b'A<

is*d

t

$ao

N

ol

<t

:t

t--ao

t.-

$F-

+Ir-

i\oN

o

$\o6l

cl + t*-co

<f,t--

i\6N

o

q)

q)

q)

(J

s

oO

o.=GcltFr

LFT(l)'

.oEL!Eo-

z U t

=

glhYF-d

Ge-u

\c

\o

€

oo

\o

.\o

o\

c\

ao

co

c.)

(.)

o)

=!ri:!

!g€c2E

0)() OoF

\ocr)

@ U ao (i

Eo€)q)

s

o

$q

U3

*

,!Ei':+F-d a,l

c.l

N

c.l

c.l

c-l

N

c..l

c.1

a'l

N

c'l

al

a.l

o

N e.l ol a'l .I

q)

c!

00(J

O

q)

zO ct a-.1

-]q)

0a

€2

'trda

oo5dao50

=

d

uo

ooEoo

F]

Fot-r

q)

q)

q)

(,)

s

o

$

N(.)

-o0)

oz$(\l

QA

oo

I{{s)

s

oBobO

a.d

o

{.:Ia.ni

B

E

\'.L

g

!

=*

-\at;q)aq)

b4}Lpo

tq)qq)

Eod

ooA

FUqioa0)

o

C)

-0)EEo

(d

h0

(dLrF

.ii16)l

-olcilFI

Trainees

Typeof trainins

CDDs

Other Communitymembers e.gCommunitysupervisors

HealthWorkers(FLHF)

MOHstaff orOther

PoliticalLeaders

Ottrers(specifr)

Program management

How to conduct HealtheducationManagement of SAEs

CSM

SHM

Data collection

Data analysis

Report writing

Others (specify)

Table 6: Type of training undertaken(Tick the boxes where specific training was carried out during the reporting period)

Any other comments

2.6. Treatmcnts

2.6.1. Treatment figures

If the project is not achieving 100% geographical coverage and a minimum of 65yotherapeutic coverage or the coverage rate is fluctuating, state the reasons and the plansbeing made to remedy this.


aoNr3ooz$NUo.

EB

U

$q)

IB

Ea.

U\)bo

tU{BqJ

E*e)

$s{sSE!. q).a{EoiB\!.ss.EEq, -.!.8!s{t'.EEf€PEss€fS!iqlYs 's..l.i E..Ei *{\ s$r ssFlts'

c FFS i=xo '!-lE !:s ssr E*.s ]iE CSt *;It !lt'si EiS :EB !ui $s.i s:$ sI:i ss

EEB\ GsP €IE SE=

E{

t sp!l !'S

€ T\I ssE ES[ [:R PE\ ag

N

F

cl(,)

do(.)'aL(go

'=

tad(l)

HoE(.)

C)I

Lo)go(t(.)

E0)d

ot 9ol e-l o.l

xl P-l oEI ;EIEtsl Ial qpl tiol u()l !ol 0)ol !ol ELl -3l tr'dE

=t 6Zll-

olol-l oxl.LEIEEIR!t;oloot trot EolbElgLl '

EIEtrt tr=t trzl<

d(l)tr(gPoo'a

ctX(.)H-tP9()s'AALVo i,i€aH'=-o€8.9 qo.;.9E.= tiE=EHE-^0)5'EHEtr ol tro Ol |r! al H

E :I Bb El.eo. dttrF g-q\IYa 6tcot - aloel P Hl 'l

"l ! =l ts€l.H <l h

fil i' 'glELt>-tuut-- lt sol- =l

tr-l

F XIGEP El e8l.E 8l E(!l 5 (rl

=old oltr-lb ul5tit o- ot c€l= €l==l

-o =l bZI? ZI?

a0)b{dl-l6)

oo(so

(dLbIoc)b{E(B

o

o0cltrC)

OI

ooolr€GI

trotr

1\r-\

V)

qjQq)

S

p

t\Jq)qq)

gvU)Lr

drhcllolrcll

(n

(5F1

oLo€>,pt)E]

a€tr

C)

(BoFn-f,l-oldtFI

oC)

o(d

F

s

oclH(l)bo!!a6Soo

F

C)(Bl.r(l)o0cll<(l)

oof,^-.co\'Q.

-(s

so{,)o

C)clH()o0Looo(),

.H \oECC)aclLc)

H

qAgEJ c 9< os'6.

i a€*EE*z tE &

o

qql{J<Eaa.o

o

vob9'cq

zd

<lr-a.l

9t--

tr-co6l

@trrooa'l

\oo\\o

o\GT

ail

(H o..o--==EE.'O

€BEEE2" EE

oo\oq o\crl@

00$

Olr-C.I

t-rc.l$^c.l

\oF-oaa

od

oA

A3o\

odo6ooo

o

oo.d

oF

F-F-F-

o\f-.

r-r-.

o\tr-

r-t-.

r-F.-

EEEEE9= o!z

\o €^ ot\c

$=taO€

st

\ot..

a.l

(\F-

(nG{\a

=o.e 6.:l=of uFFl,

\o

t--

\o<tol

ooF--

F-

.la.lo\

o\ca@

-f \o\oaal6ra

.9 'EE " BH4€ -?.et-!'b EE 9t

ots

o\ood;

oF-o\c..l

e.loo^

co

c-lF-qF-

N<-\\oO)

sa-.a.la,i

alif,\orarr\o

an

oo0(d

rh0)

troO

ll *

a

d.9 e^

F'b sEol-uo

O

tsE.^u.ts fi!o c bolt.o=6dtr q= o=E>!AO

o

F-6 $

c.lcot--

oo.+

c.lcta-

o\raca

=oE E.:=EEEgt

tr-a4@ -t

a.l@r--

@\o$

c.lc..lF-

o\ra(.)

\OqF OE X Oo.E e EErr ts'- h., -E EsEE". 3E E E

t--@ $

NooF--

6$

o!c{r*o'ra(n

a)4

;vd2

do

o

ao60

J

e

!IJo

ooo

EO

.loF

I

2.6.2 What are the causes of absenteeism?Most of the absenteeism was occurred because of the overlap of the farmingtime and the drug distribution. This unusual overlap has occurred because of latecommencement of the overall CDTI activities.

2.6.3 What are the reasons for refusals?Most of the big towns, such as Matu, dwellers who do not feel sick were notvoluntary to have the medication.

2.6.4 Briefly describe all known and verified serious adverse events (SAEs) thatoccurred during the reporting period and provide (in table 8) the requiredinformation when available.

In case the project did not have any cases of serious adverse events (SAE) during thisreporting period, please tick in the box.

No SAE case to report r/


sooNo-o()oz$ol

or

o

=

\r

-an

Ho./+)cl

-q)

-GIc)c)a06lLrq)

oort\JF,,6la./Lo+a6lI

.ltU

LEcl c)(l)Eh6)

!-E!gZLLUAo)()L.sE.s+. L laio cg .t)!!?'= viHc)ro.E.-AaJ :- aAE-CJE(.)olELI

ci.-l !l

:,161.:. -- 6llE.E €IErrdlI .o F-lFi : \ol

RE Ivh-EEI E.i El c!

-oil !!-l r)4ql q)e3l 'eEfllio*rl qagre.--

!v€Ho(l)lr6rx€E o rtronYtrEts5(!DclagE.E*roItEtr6)o El +,f

Efi8H-9F=-

isl s

F--r-

(.)

--qptr bs'\ >:-

U

ll r

l-T hr

ri

e$s< a-

t'.l-to\

oll- *.r{ ld

ri

o'5o=o0o6*bi:>oosoF

ti

.oO6,,oti E,Eo5Ezfi

o

t--

aa|a-l

@N@

ti=oEEi

c 6.4<86

Ns.r--\o

o(o

aaopr

h .,8_; gH

EEs€8"' a 8"9r E6

ll +

ri tiFT

oo &o-.r Oa\

o

'o. oo =d- A^ri,

F 3 E E;';-(Jotrl

t{

AOo'u aUE*E? E= EEtr>L>o6

o\

o\trl

=oE E.:,troE E.q}9.o'

F9

o\

0)bo

qC)

oO

00(!

= .,3q>Ho

i}E *Er:E.= { E oi

E E g EEEOoo

o\oN

O

N

ilH

OOoa.l c.l

9!oc.l N

aal

oN

\o

N

\o6l

@ooN

I

2.7. Otdering, storage and dclivery of ivermectin

Mectizan@ ordered/applied for by - (please tick the appropriate answer)MOH M WHOtr UNICEFE NGDO trOther (please specify)

Mectizan@ delivered by - (please tick the appropriate answer)MOH M WHO! UNICEFtr NGDOtrOther (please specify)

Please describe how Mectizan@ is ordered and how it gets to the communitiesThe NOTF requests for Mectizan from MDP. After the drug reaches the country it follows theexisting drug and other medical equipment delivery system in the country. Then the drug isstored in MOH warehouse frorn which projects levels receive. From the project level (zonelevel) the Worcdas receive it and distribute to the health facilities. It is from the fiontlinehealth facilities that the conrmunity supervisors get the drug to distribute to thc CDDs forthem to distribute to tlre communities.

Table l0: Mectizan@ Inventory (Please add more rows if necessary)

How are the remaining ivermectin tablets collected and where are they kept?At the end of the treatment period, the CDDs were requested to return the remaining drugto their collection centers which are the health facilities. The health facilities, in turn, sendto the Woreda health office and finally from there to the zone health desk. Ilence, theremaining Ivermectin is kept at the project (zone) level.

List and briefly describe the activities under ivermectin delivery that are being carried outby health care personnel in the project area.

. Collection of ivermectin from the Woreda level

. Distribution of ivermectin to CIDDs

. Training of community supervisors and CDDs

. Supervision

. Recording and reporting of data

Any other comments

District/LGA Number of Mectizant tabletsRequested Received Used Lost Wasted Expired Remaininq

Matu 374,000 321,470 0 2,111 0 50,419Darirnu 252,500 239,460 0 1,795 0 tt,245Alge-Sache 185,000 180,447 0 1,707 0 2,851Yayu-l lurumu 232,000 225,433 0 2,089 0 4,478Allc Didu 221,000 203,057 0 t.525 0 16.418Bcdelc 374,500 276,485 0 2,148 0 95,867

TOTAL 1,639,000 1,446,352 0 11,370 0 181,278


2.E. Gommunity self-monitoring and Etakeholdenr Meeting

Has any training (of trainers) for community self-monitoring been done in the project area? No'

If so, When?

Table 1 1: Community self-monitoring and Stakeholders Meeting (Add rows if needed)

Describe how the results of the community self- monitoring and stakeholders meetings have affected

project implernentation or how they would be utilized during the next treatrnent cycle.

2.9. Supcrvision

2.9.1. Provide a flow chart of supervision hierarchy.

NOTF ) ZOTI.) WOTF ) Health Facility ) Community supewisors ) CDDs

2.9.2. What were the main issues identified during supervision?. Delay in utilizing and liquidation of funds.. Failure to organize the collected reports on CDTI activities especially at

',voreda and front line health facility levels properly.

2.9.3. Was a supervision checklist used? Yes

2.9.3. What were the outcomes at each level of CDTI implementationsupervision?Though the Finance officers have received proper training on handling the

APOC/WHO fund utilization and liquidation system, still there was problem on

Iiquidating of the used budget. Therefore, on spot training was given during

supervision. The overall reporting of the CDTI activities was also corrected as

much as possible.

2.9.5. Was feedback given to the person or groups supervised? Yes

2.9,6. How was the feedback used to improve the overall performance of theproject?The good geographic and therapeutic achievement of the project pertbrmances

shows promising.

DistricV LGA Total # of communities/villagesin the entire project area

No of Communities thatcarried out self

monitoring (CSM)

No of Communities thatconducted stakeholders

meeting (SHM)

Matu 357 0 0

Dalimu 830 0 0

Alge-Sache

Yayu-Hurumu

Alle Didu

431

782

468

0

0

0

0

0

0

Bedele 722 0 0

TOTAL 3,590 0 0

t6 WHO/APOC, 24 November 2004

a

SEGTIOil 3: Support to GDTI

3.{. Equipment

Table 12: Status of equipment @lease add more rows if necessary)

*Condition of the equipment (F:Functional, CNFR:Currently non-functional but repairable,WO:Written off).

How does the project intend to maintain and replace existing equipment and other materials?

1'he project expects APOC fund to maintain capital equipments that have been provided byAPOC for the first five years. The capital equipments that are contributions of thc govemmentwill be maintained using the government moncy. The project is trying its best to perfbrm wellso that APOC would rcplace these equipments after first five years while at the same timeeflbrts will continue to allocate budget by the government fbr smooth takeover of the projectgradually.

APOC MOH - Zone DISTRICT NGDO Others

No. Condition

Source

Type ofequipment

No. Condition No. Condition No. Conditron No. Condition

1. Vehicle I F

2. Motor cycle(s) 4 F

3. Computer(s) 1 F

4. Printer(s) I F

5. Photocopier (s) 1 F

6. Fax Machine(s) 1 F

7. Overhead projector 1 F

8.25" TV set 1 F

9. Deiesel Generator I F

III


,

3.2. Financial contributlons of the partners and communlties

Table 13: Financial contributions by all partners for the last three years

* Indirect contributions such as stalf salaries, office supplies, utilities, communication, etc.**Contribution of CDDs and communi\t sr.tpervisors converted in to monitory value*'r'F Do not include fttnd.for capital equipnrcnt

- If there are problems with release of counterpart funds, how were they addressed?

Additional comments

3.3. Other forms of community support

Describe (indicate forms of in-kind contributions of communities if any)

None

3.4. Expenditure per activity

Indicate in table 14, the amount expended during the reporting period for each activitylisted. Write the amount expended in US dollars using the current United Nations

exchange rate to local currency. Indictate exchange rate used here 1USD:8.65

Contributor

Year I (2004)Year 2 ('provide the

period')Year 3 ('provide the

period')

TOTALCash

Budgeted(us$)

TOTALCash

Released(us$)

TOTALCash

Budgetedrus$)

TOTALCash

Released(US$)

TOTALCash

Budgeted(us$)

TOTALCash

Released

rus$)MOH (Central + State) r3,983* r3.983

MOH (District + zone) 40,475* 40,47s

Local NGDO(s) ( if any) 0 0

NGDO partner(s) 67,970 67.970

Communities 200,900** 200,900

APOC Trust Fund 64.175*** 3s.000

TOTAL 387,503 3s8,328


a

Table 14: Indicate how much the project spent for each activity listed below during thereporting period

Any comments or explanations?

SEGTIOil 4r Sustainabillty of GDTI

4.1. lnternal; independent participatory monitoring; Evaluation

4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tickany of the following which are applicable)

Year 1 Participatory Independent monitoring

Mid Term Sustainability Evaluation

5 year Sustainability Evaluation

Intemal Monitoring by NOTF

Other Evaluation by other partners

4.1.2. What were the recommendations?

4.1.3. How have they been implemented?

ActivitvExpenditure

($ us)Source(s) of

fundingDrug delivery from NOTF HQ area to central collection point ofeollnulIvMobilization and health education of communities

Training of CDDs

Training of health staff at all levels

and distribution

Internal of CDTI activities

Advoc and authorities

IEC materials

Summary (reporting) forms for treatment

Vehicles/ Motorcycles/ bicycles maintenance

Of-lg_-e-Eqqipment(egc.ompqlgls,pllllellglg)

Others

TOTALTotal number of persons treated 523,171


o

4.2. $ustainability of proiccts: plan and set targets (mandatory atYr 3)

Was the project evaluated during the reporting period? NO

Was a sustainability plan written? NO

When was the sustainability plan submitted? NQ

What arrangements have been made to sustain CDTI after APOC funding ceases in terms of:

4.2.1.

4.2.2.

4.2.3

Planning at all relevant levelsCDTI activity is part of the Health Sector Development Program. Therefbre the

planning activity is carried in an integrated manner at all levels. Thegovernment policy of empowering the woredas, the communities and Health

Extension Packagc will also ensure the sustainability of the CDT[.FundsShort, medium, long-term (post-APOC) financial sustainability plans will be

prepared at worcda and rcgional levels. Budget line will be created fbr CDTIactivities by the respective local governmentTransport (replacement and maintenance)Efficient use of APOC vehicles will be ensured as long as they in a good

condition. Budget for maintenance will tre allocated and other vehicles fromMoH and other parlners will also be mobilized.

4.2.4. Other resources

4.2.5. To what extent has the plan been implemented

4.3. lntegration

Outline the extent of integration of CDTI into the PHC structure and the plans for complete

integration:

4.3.1. Ivermectin delivery mechanismsSince the beginning there is no separate lvcrmectin delivery system to the

lower level; it follows the existing drug delivcry system in the country. 'lhe

rcquest for Ivermectin is to MDP through MOH. As soon as the drug arrivcd,

tlre same as all other drugs and medical equipmcnts. all the processes rcquired

are handled by a Pharmaceuticals Administration and Supply Service in thc

MOH. 'lhe project levels, like any other medicincs, receive and deliver to thc

rcspective levels following the existing delivery system.

4.3.2. Training:CIDTI is integrated with the Primary Health Care (PHCI) from the beginning. Atthe National, Regional, Zonal, and Woreda levels, the Malaria and Other

Vector-borne Diseases Prevention and Control Units are responsible.

Therefore, all the staff of these units has received training on onchocerciasis.Training of peripheral health workers has been carried out in integrated manner

with other health issues.


{ Joint supervision and monitoring with other programsAs part of the system in the country, most of the supervision and monitoringactivities are carried out in integrated manner with other programs.

Release of funds for project activitiesActivities which were not funded by APOC have received the amount ofmoney required in time to accomplish them.

Is CDTI included in the PHC budget?Yes, as part of PHC, CDTI is one of the priority activities.

Describe other health programmes that are using the CDTI structure andhow this was achieved. What have been the achievements?In some malaria endemic villages, the CDTI structure is used for malariacontrol program. The new structure of o'Garee" is also responsible for all healthactivities in the village.

4.3.7. Describe others issues considered in the integration of CDTI.The new government structure of "Garee" (village) which has got a healthcommittce and the Health extension Package progtram designcd to reach allKcbeles with health posts. will play a major role for thc irrtegration andsustainability.

4.4. Operational researeh

4.4.1. Summarize in not more than one half of a page the operational researchundertaken in the project area within the reporting period.NONEHow were the results applied in the project?

4.3.3.

4.3.4.

4.3.5.

4.3.6.

4.4.2.

SECTIOil 5: $trengths, weaknesses, challenges, andopportunities

Strengths: Even though the CD'l'l activity is new, the project is able to accomplish the

distribution in short period of time with 100% geographical coverage and therapeutic

coveragc high above the minimum standard. 1his is due to high political commitmcnt at all

level, awareness and active involvement of health workers and the community at large.

Weaknesses: Delay in reporting fiom the lower level, poor financial utilization and

liquidation

Opportunities: 'l'he expansion of government structure down to villagc level "Garee" and

being takirrg the responsibility of developmcnt activities as well as health is a good

opportunity for sustainability of onchocerciasis control. The Health Extension Package

program in which there is a staft of building a hcalth post in each and every Kebele is also

another good opportunity.

2t WHO/APOC, 24 November 20M

)

Threats (Challenges): Overburdening of health workers in peripheral health facilities in

different health programs such as malaria epidemic control, EPI, measles campaign and

settlement programs.

SEGTION 6: Unique features of the proiecUother matterlsNone

A


Ethiopia Ministry

Documents

Transcript of Ethiopia Ministry