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World Health Organization African Programme for Onchocerciasis Control

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World Health Organization African Programme for Onchocerciasis Control World Health Organization African Programme for Onchocerciasis Control Evaluation of Sustainability of East Wollega CDTI Project, Ethiopia (Third Year) May, 2009 OLAMIJU FRANCISCA ABATE TILAHUN FIREW AYATEW 1 Acknowledgements The Evaluation team is grateful to the following persons and organisations for their cooperation, contributions and assistance towards the successful execution of this assignment • The Director, Dr. Mrs. Uche Amazigo,and staff at APOC Headquarters in Ouagadougou for making available the necessary financial and logistic requirements for the success of this assignment. • The WHO, Carter Centre and Light for the World offices in Ethiopia for providing support, which contributed to the smooth functioning of the Evaluation Team. • The National Onchocerciasis control programme staff for all the preliminary arrangements and facilitation. • Mr Ensermu Jeldu,the Zonal Onchocerciasis focal person for East Wollega CDTI project and his team, for all their the logistic support. • The Zonal Health Desk Head and his deputy for their kind support especially at ensuring that all the expected participants were around for the three days sustainability planning workshop. We equally thank Zonal Health Desk Head of the West Shoa zone for his participation. • A very special thanks to the Acting Zonal Administrator of the East Wollega Zone, and all the other Woreda Administrators for your time and commitment ,We appreciate the fact that you were present all through the four days planning meeting. • The Woreda Health desk Head and Onchocerciasis focal persons from the 10 CDTI Woredas of East Wollega and West Shoa. We thank you for your commitment. • The female Health Extension Health workers manning all the Health post visited, for their hard work and willingness to share their CDTI data with the Evaluators. • The CDDs, Kebele Administrators, community leaders and community members that provided very useful information that made this Evaluation possible. • The Evaluation team finally appreciates all the drivers and local guides that assisted through this exercise. 2 Abbreviations/Acronyms APOC African Programme for Onchocerciasis Control BPR Business Process Re-Engineering CDC Communicable Disease Control CDD Community Directed Distributor CDTI Community Directed Treatment with Ivermectin EPOC Ethiopia Programme for Onchocerciasis Control FLHF First Line Health Facility HQ Headquarters HC Health Centre HE Health Education HFs Health Facility staffs HEW Health Extension Worker HP Health Post HSAM Health Education/ Sensitization/ Advocacy/ Mobilization IEC Information, Education, Communication LFTW Light for the World MoH Ministry of Health NGO Non-Governmental Organization NID National Immunization Day NOTF National Onchocerciasis Task Force PHC Primary Health Care REM Rapid Epidemiological Mapping of Onchocerciasis RHB Regional Health Bureau TCR Therapeutic Coverage Rate WHO World Health Organization WOFP Woreda Onchocerciasis Focal person WoH Woreda Health Office ZHD Zonal Health Desk ZHDH Zonal Heath Desk Head ZOFP Zonal Onchocerciasis Focal Person 3 EXECUTIVE SUMMARY The East Wollega CDTI project was launched in November 2004 but actual reporting on distribution started in Year 2005.The 2007 updated census shows that the Zone has a total population of 1,175,853. The districts of the zone are sub divided into 367 kebeles, of which 339 are rural and 28 are urban. The kebeles are further divided into Gare (village).Each village consists of 30-50 households. Villages are responsible for all developmental activities including health. East Wollega CDTI projects has 10 districts (Woredas). They are Jima Ario, Leka Dhulecha, Diga, Guto Gida, Wayu Tuka, Sasiga, Sibu Sire, Bako Tibe,Boneya Boshe and Wama Hagalo. Recently the Bako Tibe Woreda was moved from East Wollega Zone to become part of West Shewa Zone.This therefore makes East Wollega Zone to have 9 CDTI Woredas while the West Shewa zone has 1 to give a total of 10 CDTI Woredas. In the 10 CDTI Woredas there are 4299 villages and 8478 Community Directed Distributors (CDDs).The Project has 419 trained Health workers involved in CDTI. APOC has been supporting the project since Year 2005, According to the East Wollega Zonal Onchocerciasis focal persons the project is its fifth year technically but financially they are in their third year. Considering the age of the project and the need to conduct midterm evaluation for CDTI projects by their third year, APOC decided to conduct an evaluation with the following objectives. The general objective of the evaluation exercise was to determine the sustainability potentials of the East Wollega CDTI project by its third year of operation and assist in developing a plan for sustaining the project post-APOC. The specific objectives are: To assess the performance of the different groups of indicators of sustainability of CDTI projects in the East Wollega CDTI project To identify the factors that may block or help the sustainability of the project Discuss the outcomes of the evaluation exercise with the relevant stakeholders in the East Wollega CDTI project Develop plans for sustaining the East Wollega CDTI project post APOC In order to carry out the above objectives, a team of three Evaluators was sent to the project. The Evaluation took place from the 18th – 23rd of May 2009,while the Feedback meeting and the development of sustainability plans took place from the 25th -30th of May 2009. In carrying out the Evaluation, two Woredas, 4 Health Facilities and 12 villages were randomly selected from all the 10 Woredas .One additional Woreda was equally randomly selected as a reserve one. 4 The evaluation was conducted using four types of instruments developed by APOC. Instruments were used at the 4 levels to access the projects performance regarding the routine activities and processes, there were 6 group of indicators to access this namely; Planning, Integration, Supervision and Monitoring, Mectizan supply, Training and HSAM. Resources provided for the activities were accessed using 3 groups of indicators namely; Financing / Funding, Transport and other material resources and Human Resources. The result achieved were measured using Coverage indicators, both Geographic and therapeutic. The performance of the above indicators as well as the various aspects of sustainability (Integration, Resources, Efficiency, cost-effectively, Simplicity, Health staff acceptance (Attitude of the health staff) and Effectiveness were used in grading the performance. In addition documentary evidence from CDTI data, reports and plans, inspection of capital Equipments, Verbal reports from persons interviewed, Community Meetings and additional insight during feedback meetings provided additional insight to the evaluation team. The five critical elements of sustainability (money, Transport ,supervision ,Mectizan supply and political commitment),the seven aspects of sustainability in the project were qualitatively discussed and results agreed to by the team. The project was graded using these aspects and elements following the Evaluation guidelines. Qualitative descriptions of problems were deliberated upon and recommendations made. The sustainability judgment about the sustainability potentials of the project was therefore based on the quantitative assessment of the average sustainability scores of the groups of indicators as well as the qualitative assessment of the critical elements and aspects of sustainability of the project. The following are summaries of the findings; Community Level The community level was judged to have high sustainability potential based on the insights below; The CDDs plan and manage CDTI activities in close collaboration with the Health Facility staffs, kebele leaders and village chiefs . The main activities enumerated by CDDs as their key CDTI activities were; Conducting census updating, Requesting for Mectizan based on census population, Informing communities the specific date of Mectizan distribution and reporting back on treatment to the HFs. The village registers were seen at the Health facility and confirmed that the above activities have taken place. Kebele leaders as well as village chiefs have impressive knowledge of CDTI activities. They know the impact of the disease, eligible population, as well as its benefits. Leadership and ownership of the programme are shown in various ways like selection of CDDs, initiating annual distribution activities, agreement on time and mode of distribution; they also participate in census updating, social mobilization and monitoring Mectizan distribution. 5 Community members have positive perceptions towards CDTI. They have given high value to Mectizan and wish they will be allowed to take Mectizan for unlimited number of years. All community members elaborated that Mectizan has multiple effects on their health. Besides Onchocerciasis, Mectizan kills lice, bugs, relief from persistent itching and expelling intestinal worms. It seems also that the communities decided not to provide any kind of support to CDDs because of the believe that it is a great honor to be appointed to serve their community. Community incentive to CDDs is also not common in communities visited even the CDDs do not expect it. CDDs are willing to continue to distribute Mectizan because they are happy to protect their communities from Onchocerciasis and other diseases Current CDD: Community member ratio is 1:80 CDDs are reporting their activities to health facility staffs, Some CDDs are literate enough to summarize their activities
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