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324777-Eng.Pdf (‎3.313Mb) World Health Organisation African Programme for Onchocerciasis Control Evaluation of the Sustainability of the Bench Maji CDTI project, Ethiopia January -February 2006 _[rb E.-- o,.udatt fX Dr E Nnoruka (Team Leader) l'o: Dr R Maggid CS\ Dr Y Saka co0h Mr K Tushune fiB? Mr W Musolo Mr W Kisoka i^ Table of Contents............. ..........2 Abbreviations/Acronyms .........3 Acknowledgements ..................4 Executive Summary .................5 {. lntroduction ..... 10 2. Methodology...... ............10g 2.1 Sampling .......... ..............1Q 2.2 Levels and lnstruments .1; 2.3 Protocol ......14 2.4 Team Composition............ .........15 2.5 Advocacy Visits and 'FeedbacUPlanning'Workshop........ ........ 16 2.6 Limitations ..................16 3. Major Findings, Discussions and Recommendations. ....18 _3.1 Zonal Level ....18 3.2 Woreda Level. ...............25 3.3. FLHF Level....... ........31 3.5 Community/Kebele Level ...............38 4. Conclusions ..........43 4.1 Grading the Overall Sustainability of the Bench Maji CDTI project.................43 4.2 Grading of Project as a Whole ........47 ANNEXES .............48 lnterviews ..............49 Schedule for the Evaluation, Advocacy.............. ...................52 Documents sighted. .......54 Feedback and Planning Workshop A9enda.............. ............55 Report of the feedbacUPlanning Workshop ..........60 Abbreviations/acronym APOC African Programme for Onchocerciasis Control CDD Community Directed Distributor (of Ivermectin) CDTI Community Directed Treatment with lvermectin EPOC Ethiopia Programme for Onchocerciasis Control FLHF First Line Health Facilig H/Q Headquarters H/C Health Centre H/P Health Post HSAM HealthEducation/Sensitization/AdvocacylMobilization IEC lnformation, Education, Communication MoH Ministry of Health NGDO Non-Governmental Development Organization NGO Non-Governmental Organization NID National lmmunization Day NOTF National Onchocerciasis Task Force PHC Primary Health Care REMO Rapid Epidemiologica! Mapping of Onchocerciasis REA Rapid Epidemiologica! assessment RHB Regional Health Bureau TCR Therapeutic Coverage Rate WHO World Health Organization WHD Woreda Health Desk ZHD Zonal Heath Desk r . ZOTF Zonal Onchocerciasis Task Force The Bench Maji Evaluation Team would like to express our gratitude and appreciation to APOC Management team for the opportunity given us to participate in the evaluation of this project. We appreciate all necessary travel and financial arrangements made by APOC management, WHO Ethiopia and NOCP Ethiopia. In particular we need mention ' the following persons and institutions for their help: . The Director of APOC, Dr Amazigo and other staff at the Headquarters of the African Programme for Onchocerciasis Control (APOC) in Ouagadougou. NOTF Chairman Ethiopia. ' WHO Country Representative and all stafl Ethiopia particularly Mr Tatek Mekonnen. The management of Jimma University, for the valuable support provided. The National Coordinator for Onchocerciasis Control programme, Ethiopia . The Project Officer Carter Center/Global2000, Mr. Abate Tilahun. Mr Hamus Mekuria, Bench Maji Programme Officer, WHO drivers and other staff from MoH, for undertaking all the necessary arrangements. Political and traditional leaders, health workers and community members of areas visited in Bench Maji zones as well as all political leaders at woreda/district level (Bench, Sheko and Guraferada woredas) . The scout, Mr. Korra Tushune, for having planned for the evaluation. Executive Summary Bench Maji is located at the South west of Ethiopia, bordered by Sheka in the North, South Omo and Sudan in the south, Kaffa in the East and Gambela in the West. CDTI commenced in Bench Maji in 2003 and mectizan distribution has been on going for the last 3 years in Bench, Sheko and Guraferda woredas. The prograrnme currently expanded to include an additional 6 woredas in the last two years. A mid-term evaluation was thus carried out in Bench Maji zone between the later part of January and early February 2006. The evaluation exercise was carried out at project (zonal, woreda, FLHF, Kebeles) level. Tables. I Scores on Sustainabitty indicators at Project level z o a a ilrd U1 & Fl q) t-l 3 (D nr & a ) ri ri q) a z= tr Q € O il L z rlr z r{l+i € er a E o o l- z N € rd tr a a ri rrlH l- U & ri rd (, t'r 0 il 3 U z o il z d & o (J z t.l il z (, frl F ri z a z il ri = z rd z rd n z a - ,\ z ts tr o z Fl ri ta & fr H) Fr z il a Fr Fr t*( (, ZONAL level I I I 1.8 3 0.7 0.5 I 2 4 1.6 WOREDA level 3 3 3 3 3.5 3 I 1.5 3 3 2.7 FLHF level 2 3 3 3.3 3.5 2 1 1.7 3 4 2.6 COMMUNITY 2 3 3 3 2 I 3.3 4 2.9 /KEBELE AVERAGE 2.5 2.3 2.5 2.8 3.3 1.9 0.9 1.4 2.8 3.8 AVERAGE FOR THE WHO ,E PROJECT 2.5 I Results of the evaluation were presented to a feedback and Planning meeting. Tablel above shows achievements (scores) for groups of indicators for different levels within the Zones. These scores show that the project has been making satisfactory progress towards sustainability. It is pertinent to mention at this point that a lot of structural reforms is currently on-going in the health section following the recent election. The zone apparently has borne the brunt of all this in recent times as reflected in table l. Coverage scored the most, followed by lVlectizan, then Human Recources and Monitoring and Supervision. Coverage was the most successful and the zone achieved 100 percent geographic coverage and therapeutic coverage well over 65 percent from its second year in all woredas visited. Both Zone and Woreda health staff believe cover4ge would be maintained once other aspects and indicators of sustainability are addressed accordingly by their policy makers. Mectizan@ collectioq storage, delivery to lower levels and control are carried out effectively and in an integrated manner within the government system. Mectizan@ is generally available in time but in excessive amounts. Staff at all levels were unable to establish the rationale behind the calculations of quantity of Mectizan required annually. There are huge amounts left over after each year's distribution. This partly is because zone has not been empowered to place orders. Data is forwarded to the regional offrce that do the calculations for mectizan required by the Zone.In all kebeles visited, census updates and Mectizan@ distribution were carried out at different periods. Monitoring and supervision by zonal oncho coordinator was carried out mostly in the month of Mectiz.an@ distribution. These supervisions although carried out mostly to all levels by the zone, emphasis was mainly targeted to Woredas/FLFIFs with low coverages. Visits to kebeles were carried out routinely. Supervision checklist exists, though no integrated supervisory check lists were available. Supervision at each of the levels was not integrated with any other programmes in the field. Human resources equally scored the same as monitoring and supervison. Staff interviewed (at all levels) had adequate skillq valued their work and expressed strong willingness to continue serving in their present position. Despite shortage of staff as expressed, majority of them were stable and salaries were paid regularly by governme Issues in this area included inadequate targeting and integration of training. It was clain that each program had its own funding source and timetable and thus there was no need integration. Also in some areas approach of FLIIF saffto CDTI is dampened because tl feel their money has been diverted, whereas on the otherhand CDDs with a few exceptit had all been trained. There were 2 CDDs to 20 houses and CDDS did not have to co' long distances Next were perficrmance for indicators on leadership, planning and integration which scored moderately with the exception of training/HsAM and transport which scored slightly. 'Finances' had the poorest score for all levels. On Leadership, there is a focal person for CDTI at Zone and Woreda but their roles for CDTI is unclear at the top. flocumentation and report writing has not been up-to- date and are pooly kept. Frequent change ofZonal leadership by politicians, poor handover of documents to successive leaders andlack of support from their administrators and policy makers, particularly at the Zone and woredas were some of the reasons given for this. NGDO partner has attempted to address this issue a couple of times. Similarly, the exact role of Region for Bench Maji zone has to be clearly defined particularly with the proposed phase out of zones. In addition, FLtIFs have not taken full ownership and responsibility for CDTI. Community leaders played leadership role in CDTI; they select CDDs and change them as necessaD/ and mobilize oommunities for CDTI. Planning, it was noted that activity plans of CDTI activities were found at the Zonal and Woreda levels, however health plans for the Zonal health sector lumped onchocerciasis under vector borne diseases and had not reflected CDTI on any of the 3 year strategic plans. Despite, CDTI activity plans being developed in a participatory manner at all levels, half of the FLFIFs visited had timetables for CDTI activities. Sustainability plans for CDTI activities had not yet been taken up by all levels including NGDO partner. On Integration at Zone progrwres were run as vertical progrirmmes, integration was mainly for transport and equipment. flowever, at Woredas and FLTIF because of staff shortage, programmes were integrated, though reports of integrated activities were not available at all levels. Training and HSAM were next and were carried out routinely without clearly addressing areas of need. HSAM materials were not adequate. HSAM activities have led to increased awareness / acceptance of CDTI within communities, but support from key decision makers in authorities and communities is still very poor.All individuals interviewed expressed their wish to take Mectizan@ for as long as it takes to get rid of the disease (a figure of 12 -l5years was often mentioned).
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