West Wellega Zone Oromia Regional State FEDERAL DEMOCRATIC REPUBLIC OF ETHIOPIA
Project Period: Year Z0W-2A07
For Action., Submitted to To: African Program for onchocerciasis Control TCCIT (APOC) faurlrJu.:r,9 COOf ! CSD CLV Btrr toP blo Revised July 2003
fior lt*fiorrnut{orr SECTION 1: BACKGROUND INFORMATION
1. INFORMATION ON THE PROJECT AREA FOR CDTI...... I l.l. Geographical and administrative areas...... I Topography, | ? CIimare, Access ') 1.3 OnchocerciasisEndemicityLevels 8 1.4 CommunityStructure 9 2. PAST AND CURRENT STATUS OII CDTI IN PROJECT AREA .ll SECTION 2: PROJECT EXECUTION OUTLINE II 3. DESCRIPTION OF PROPOSED CDTI ll 3.1. Outline PIan and Timing ... lr 3.2.HealthEducationandCommunityInteractionandParticipation...... ri 3.3. Local Operational Research ...... l(r
SUPPLY, IMPORTATION, STORAGE, INVENTORY AND DELIVERY MECTIzANTABLETs...... OF
5. SUPERVISION,MONITORINGANDEVALUATION...... r8 during : I -Supervision Evaluation t8 5.2. Monitoring CDTI 19 2t SUSTAINABILITY OF THE CDTI AFTER THE WITHDRAWAL OF EXTERNAL FUNDING ...... 2I g Integration of GDTI into other community pHC I Based of Systems ...... 23 6.2. Cost Recovery System during CDTI ...... _...... 25 6.3. .Other Issues 26 6'4' Methods of Measuring the progress Towards sustainabirity. ... 27 7. CROSS BORDER CONSIDERATIONS 28 8. SPECIAL RISK ISSUES 28 S ECT I ON 3 ADM I N ISTRATI O N/F INAN C IAL
9. ADMINISTRATION 'tg 9.1. Organisational Structure for CDTI 29 9.2. FinancialAdministration 3t 9.3. Timed Plan of Action i-;
BUDGET IO. .'t / 10.1. Budget Estimate 37 10.2. Budget Justification 4U 10.3. Current Resources available in CDTI 4t
LIST of MAPS: MAP 1: Onchocerciasis CDTI Zorrcs in Ethiopia (A?OC 2003) -) MAP 2: Oromia Regional State, Etltiopia 4
MAP 3 lltesr Wellega Zone, Orotria Regiort .5 MAP 4: Districts Selected for CDTI Project 6 MAP 5: Distribution of Health lnstituriorts & popuration Density (199a 1 Census) Wesr Wellega Zone
LIST of FIGURES:
FIGURE 1: Organisational Stntctttre of National Onchocerciasis Contrctl Program 2L)
FIGURE 2: Recluest cutd Disbur's'entent oJ'APOC Fund FIGURE 3: Budget Input of Partners for rhe Project Years 4i FIGURE 4: Annual Treatment Objective b), Endemicity Level 44 LIST of 'IABLES
Table I. Estimated Nuntber of Populariott, ATO and Status of REMO b1,
District, West Wellegct Project Arect I Table 2. Classification Criteria of Endenticity Levels in Rural Communities ...... 8 Table 3. Criteria Issues in the Developntent of Health Education.for CDTI l4 Table 4. I mp le nte nt at i on T i nte F rct ne 3(r Table 5 Year one sumnrury Budget for onchocerciasis contor in ruest Wellega Zone 38 Table 6 Five Year Budget Suntntary for Onchocerciasis Control 39 LIST of APPENDTCES
APPENDIX I: ESTIMATED NUMBERS OF COMMT]NITIES AND PERSONS TO BE TREATED EACH YEAR BY ENDEMICITY LEVEL ... 42 APPENDIX 2: I N D I CATOR.S FOR EVALI]ATION, S U STAINAB I LIY /INTEGMTION OF CDTI 4.5 APPENDIX 3.I: Budget Line ltent - Persontrcl 46 APPENDIX 3.2: Ihdget Line ltent - Capiral Ecluipment 17 APPENDIX 3.3: Budget Line ltem - Sttpplies J9 APPBNDIX 3-4: Budget Line ltem - Training 50 APPENDIX 3.5: Budget Line ltent - Health Educatiort & sociar Mobilizltrion .5t APPENDIX 3-6: Budget Line ltent - Travel .il APPENDIX 3.7: Budget Line ltenr - Comnrunicatiort .s3 APPENDIX 3.8: Budget Litte ltem - Consultants -5.:l APPENDIX 3.9: Budget Lirrc ltem - Recapitulatiort .55 APPBNDIX 3-10: Budget Lirte ltem - Operating Expenses -56 LIST OF ACRONYN{S
APOC African Program for Onchocerciasis Control ATO Annual Treatment Objecti ve
CDC Communicable Diseases Control CDD Community Drug Distri butor
CDTI Community Directed Treatment rvith Ivermectin DHO District (Woreda) Health Office
DOTF District Onchocerciasis Task Force EPI Expanded Program of Imnrunization
GIS Geographic Information System KAP Knowledge, Attitude, practice.
MIS Management Information system MOH Ministry of Health IVIO\/DCD Malaria & other vector-borne Diseases contr.or Department MOVDPCT Malaria & other vector-borne Diseases pre'ention & Contror ream NGO Non Govemmental Organisation NOCP National Onchocerciasis Control program
NOTF National Onchocerciasis Task Force PHC Primary Health Care
RAPLoa Rapid Assessment Protocol for Loasis REA Rapid Epidemiological Assessmenr
REMO Rapid Epidemiological Mapping of Onchocerciasis RHB Regional Health Bureau ROCP Regional Onchocerciasis Control program
ROTF Regional Onchocerciasi s Task Force TOT Training of Trainers ZHD Zonal Health Department SECTION I : BACKGROLIND INFORI\{ATION
1. INFORN,IATION ON THE PROJECT AREA FOR CDTI
1.1 Geographical and administrative area(s) Please tlescribc tlrc area(s) of the countr)' itt tryhich the proposecl CDTI u,,ill be carried out. (List the administrative units or parts thereof e.g., Lctcal Gorternrnent Areas, Districts, Arron disseruents, Health areas etc. that y'ill be coverccl atrcl provide a mop showing their lay-6y11
Oronria Regional State is one of the 9 National Regional States in the Fecler.al Democratic Republic of Ethiopia (Map l). West Wellega zone. tocated ar 80 l2r - 100 03t N latitucle and 340 08r- 360 t0rE longitude, in the *.ri..n part of Ethiopia, is one of the l2 zones in the Oromia Regional State (Map2). Based on the 1994 national census, the projecterl population of the zone in the year 2003 is estimated to be 1,941,430. The zone has a roral surface area of 23,980 sq. krn and is further divided into 20 districts and i4l villages. One district natnely Gidame shares a 76 km border area with the Sudan and the zone is also bordered by the Benshangul-Gumuz and Gambella National Regional Srate and East Wellega and Illubabor zones of the Oromia region. About 90.3 Vo oithe population lives in rural areas atid 9.7Vo live in urban area. The zone has a population density of 80 persons per square km. The zone is identified as Onchocerciasis endenric area and districts r.r'ith hy'per and meso levels of endemicitl' are proposed for the inrplemcntatigrr of CDTI activities. The project objective for Year-One is to conduct CDTI in six priority districts. The Annual Treatment Objective (AfO) for year-One is 563,909 and the Ultimate Treatment Goal (UTG) will be determined u,lren REMO refinement is completed in November 2003, in the other srx districts ol'East Wellega projecr area.
Table 1: ' Estirnated Nunrber of Population, ATO and Status of REMO b1, District, \Vest \\/ellcg:r Proiectroiect area.area- 200200i S. No Estimated Total Annual Treatment REIr(0 Starus \\foreda CDD \rillages Population Objective (ATO)
I Gimbi 521 130.327 104262 Year CDTI Arer 2 Gawo Dale 559 139.789 1 1 1831 Year CDTI Area 3 Dale Lalo 476 1 19.064 95251 Year CDTI Area 4 Anfilo 282 70,499 56399 Year CDTI Area 5 Hawa Welel 409 102.'t38 81710 Year CDTI Area 6 Sayo 572 143.070 1 14456 Year CDTI Area Subtotal 2819 704,887 563,909 7 Yubdo 144 36.008 28806 To be refined 8 Nole Kaba 538 134,529 107623 To be retined o Lalo Asabi 297 74,150 s9320 To be refincd 10 Haru 268 66,937 53550 To be retined 11 Aira Guliso 407 101.798 8't438 To be retined 12 Jima Horo 197 49,224 39379 To be rctined Sub Total 1 851 462.646 370.116 Grand Total 4670 1,167.533 934.025 L.2 Topography, climate, access.
1.2.1. Please describe the type of countrl, or bio-climatic zones that will be coverecl by rhe CDTI (e.g., rain forest, forest-savanna mosaic, Guines savatuta, sudan savattne, mountainous or flat), providing maps, t!' appropriate.
The topo-eraphy of the zone is donrinated by hills and gorges that range in altitude from 600 m in the extrenre Western end to 2100 m above sea level in the eastern part of rhe zone. The zone has three big rivers namely Didesa, Birbir and Keto rivers tlrat drain in to the Blue Nile. The area has many other small rivers and srreams that drain in to rhe basin (Map 3).
l'2'2' Cive the approximate tintes of the rainy and dry seasons and the monrlts covered by the fanning season.
The climate of West Wellega is characterized by clistinct rainy ancl clry seasons. The major rain1, ss25.n months are from June to September with short rainy season from February to March. The mean annual rainfall varies from area to area ranging from g00 mm to 2000 mm. The mean annual temperature of the zone ranges from l0oc-30oc. Farming activities (clearing, farming, and herding) occur ail year round, but are most intensive during tlie rainy season. Harvesting occurs from November to January, leaving February - May as the optimum trcatment period.
1.2.3. Provide inJbrmatiort on the state of rhe roads and tlrc effect oJ'this on the ntovements of CDT\ persorutel in the area at difJ'eint tiies oJ'tlrc year. (A map nlay be usefut)
The zone capital Gimbi is connected to 17 districts by all weather roacls while the three otherdistricts are only accessed during the dry season. All the CDTI districts selected are accessible by road all round the year. Two district, Dembidello and Begi are also linked by domestic aii transport service to Addis Ababa. All the districts have automatic and op"ruto, assisted telecommunication service and l0 of them have also postal Service stations.
Road transportation is one of the wiclely used and most important mocle of transpoftation in the zone. The roads provide access to l7 districtcapitals, however most villages could be accessed only on foot or on pack animals while some villages could be reached by motorcycle. During the rainy season supervision and monitoring of CDTI may be difficllt due to flooding of rivers and roads. Thereiore, conducting Mectizan distribution during the dry season (February-May) is advisable. aeo 6l U o t-(
cg o lrl
U) C) o N FH U- U) U) 6n () ()l- oI I oL r-{ L' cq at- MAP 2. OROMIA REGIONAL STATE, ETHIOPIA
- -f- ! ( -t _-1
I
! Oromia Region MAP 3. West Wellega Zone, Oromia Region Map 4. Districts Selected for CDTI Project
f]Districts for REMO Refinement in Year Trvo MAP 5. west wellega 7'one Population Density (1994 Census) and Health Facility Distribution
lJ HOSPrat + F; mr[lHCE&]IERCtflc + F; HtrllHfTmd{ + Irr ?ofu-rToYocnatr vaot Ls: tl$ 6 6.O il- r0 t0) lot'l- . t50 ffi ar.po E t.^:1,.,. f-._- I t,.0, I ,L t I * Llmma ordamt ( lo, \ Onchocerciasis endemicity levels.
The levels of onchocerciasis enderniciq, in communities in the GDTI area must be assessed bl',simple merhocls before treatment starts.
For tlrc prffpose of this proposal, the ret,er of endenticiry in a commurit1,s1, a group oJ'similar contmunities is defined on the basis of the prevalenc'e oJ. rtodule carriers (see table I ). TABLE 2: Classification criteria for endemicity levels in rural communities
ENDEMICITY LEVEL and Percent of nodule carriers in Esti mated prevalence ot' recommended type of trcatment REA sample O. volvulus in the (minimum sample 50 adult Whole community men) HYPER-ENDEMIC Community Treatment greater (uRGENT) than 39Vo greater than 59Vc MESO-ENDEMIC Communi ty Treatment (DESIRABLE)
HYPO-ENDEMIC less than 207o (NON-URGENT)
1.3.1. Based on rhe system in Table I anc{ usirtg the format in Appendix l, pleuse indicate ilrc estimated numbers of comniunities at each eidemic level arrcl the nuntber-s of persorts irt tlrcm.
1.3.2. complete Appenclix I Jbr each area covering the ne_rt 5 years of tlte project. (See Appendix l)
1.3.3 ruetlrcds If of assessing endemici4, thresholds other than nodule prevalence were used when your endemicity data were collecterl, please indicate ilrc method used. The levels of endemicity in communities of the selected districts in thrs zone was done based on nodule prevalence obtained by REMO exercises conducred in 2001. The results indicated that out of 33 villages surveyed in rhe zone 5 hyper-endemic, 3meso-endemic were identified in 6 districts. For the other villages, refinement of REMO will be done.
I.3.4. For areas still to be covered, wlrc.re endenticity levels are not yet known, please tlescribe the metlod lou rli// use to collect the necessctrY endenticiry data.
NOT APPLICABLE
1.4 Community Structure.
Provide bctckgrowtd infornution on the socictl organilations of contmunities in tlrc C.D.T.[. areas. This may include informat,ott on: Settlenxent pattent of tlrc corumuni\, (e.g. harulets, seasortal farntstertds, dispersed populatiott, etc.)
The population in the CDTI project districts is settled farmers and the settlement density differs from place to place as can be seen on Map 5.
. The ethnic groups in the comntunity.
The population is composed of different ethnic groups. The majority of the community members belong to the Oromo (96.17o) and the rest belong to Amhara (2.27o),Mao (0.9Vo) and others (0.47o).
. Please provicle infunnation ctbout tlrc area covered by CDTI indicating vthetlrcr they are ntigrants, nomads, refitgees or intenrully displaced populations.
The community included in the proposed CDTI project area is composed of settled subsistence farmers, government employees, and merchants engaged in small-scale businesses. o Community leadership structure.
The zone is inhabited by an estimated of 1.9 million people in 20 districts and 741 kebeles (administrative villages). Out of this, 704,887 people living in 6 districts and 2819 villages (CDD villages) are included in this CDTI proposal for the first project year. The community leadership structure in the zone is organised around zonal administrative councils, District (Woreda) Administrative Council, which consist of elected members from each village. The District Administrative Council is responsible for giving guidance and leadership to the community for all socio- economic activities. Each District has kebeles (administrative villages) with their own village committee. The number of CDDs will be determined based on the size of the kebeles (using 250 peoples/2 CDD as a guideline). 1''
The Administrative Structure below shorvs the comnrunity leadership system:
7-one Adnrinistrative Council )District Council Chairman ) Kebele Chairnran ) Elders/Religious/ Opinion Leaders ) Household Head
. Main occupalictn of contntunity and periods oJ'nrujor communal actit,ities.
The main occupation of tlie community is farming and small scale business on cash crop such as coffee. The urban population is engaged in small scale business, civil service and manual labour. Farming activities is low during from January through April. During these months, there are traditional religious celebrations such as Gena (Christmas), Timket (Epiphany), Id Al-Adha and Id-Al-Fetir.
c Prelbrred charurcls of contmunicatiort in the comrnmtit,v. .
The preferred channel of communication by the community is from the local fanners or' urban dwellers association chairmen to the village chief to the head and members of the households. No forms of mass media are easily accessible to these rural communities.
o Existirtg active conurtunity association/groups in tlrc area (e.9. social, religious, etc.)
The existing and active community associations/groups include the farmers associations in the rural areas and the urban dwellers associations in towns. In addition the churches and mosques also have dominant roles to play in community mobilization.
o Establislrccl clistribution s)tstems in the coruntunity.
There are some existing distribution systems, such as polio immunization, malaria control, vitamin A distribution, and family planning services that are organized through the social and religious associations mentioned above. It is also through these organizations that community mobilization and health education will begin for CDTI. Since the accessibility of existing health facilities in the project area is Iow, enrolling community health agents needs to be strengthened in the context of CDTI sustainability. o Social commuttal activities and months during which the activities take place.
There are various social and communal activities. Prominent among these are traditional religious celebrations such as Gena (Christmas), Timket (Epiphany), Id-Al- Adha and ld-Al-Ferir, which take place from January to March.
. An! previous experience of the community with development/health projects.
l0 Most communities in the zone have been involved in EPI, family planning, well construction and spring protection activities. There are also communiiy healtf, posts managed by community health agents and traditional birth attendants in iome communities. The communities therefore have well-established systems of mobilization to enhance participation in health projects.
' Description of other anthropological characteristics of the comtnunities. The people in the zone are followers of dift'erent religions. The most dominant religions are protestant, orthodox and catholic Christians and Moslems. priests, shekies and traditional leaders possess strong influence in decision-making and health-related behaviours. Planning lvermectin distribution cycles during reti-gious and public holidays can be important to access most community members.
2. PAST AND CURRENT STATUS OF CDTI IN PROJtrCT AREA.
2.I Please indicare if ttrc CDTI is an expansion of an existing )DTI.
No, this site is selected for the first time.
2'2 State the number years of the programme lns been operating, ctncl if possibte ettcpt.;e previous statistical, financial and annual reports.
NOT APPLICABLE
2.3 state the nuntber of perso,s treated each year for tlrc lasr 5 years:
NOT APPLICABLE
2'4 List the organiTatiott(s) involved in the programnte, the sources antl an.tolu-tt of furtds usecl each yearfor the ktst 5 years.
.IOT APPLICABLE
SECTION 2: PROJECT EXBCUTION OUTLINE
3. DESCRIPTION OF PROPOSED CDTI
The main strategy of the project wiil be to deverop and estabrish contmunirv-busecr iventtectitt treatment systents, which can be sustained by the endemic cornmunities thentselves wirhout external iupport after the S'year project period. This section should describe how the N1TF pl.ans to develop ancl implement CDTI in all high-risk communities in the project area. The plan should take into account the need to clevelop approaches to CDTI, which are appropriate, the for dffirent local situations, and the neecl to carefully evaluate the implementation of the selected approaches and. adjust rhem when required..
il The project objective for Year-One is to conduct CDTI in six priority districts. The Annual Treatment Objective (ATO) for Year-One is 563,909 and the Ultimate Treatment Goal (UTG) rvill be determined when REMO refinement is completed in November 2003, in the other six districts of East Wellega project area. Outline of the activities rhar will be carried during the first year is described in rhe following table.
3.1 Outline PIan and Timing of Activities for the Period 2003 - 2004
A ctivi tylJ ustificatio n Length of Tim+ Advocacy and sensitisation at the regional level - emphasis will be placed on introducing the 4 weeks APOC CDTI strategy, and enlisting the support of the regional level with the participation of the NOTFAIOCP, regional ad mi nistrati ve counci I offi ces Agreement on the definition of roles and respottsibilities of all participanrJ - through MOH with the 4 weeks region based on APOC guidelines, Pr Action Plan for the next year 2 wecks t2 3.2 Health education and Community Interaction and participation 3.2.t Hotv will you approach and interact wifu rhe community There are already existing systems of communication rvith the proposed project area through othe.r health programs as described earlier. Hovvever, thg following strategy will be implemented to maintain good relations with the communities: a) Discussions with District administrative council chairn:en and social affairs heads and then with local farmers and urban dwellers associations, religious leaders, community elders and opinion leaders to better understand community protocol b) Focus group discussions with social and religious groups to further mobilise the community with the support of the community leaders c) Focus discussions u'ith the community members as appropriate (separating men and women, or not, depending on the community traditions). The commrnity *"1y1bers will also be encouraged at this point to take owneiship of the program, defining their roles and distri bution mechanisms 3.2.2. Health educatiott Healilt educatiott and comntunity ntobilizariotr tvill continue be an integral parr oJ'all apprortches to CDTI. He.alth education actit,ities should ensure conrii-uous exchange with regards to htovvledge, awareness, perception and observable anitudinal clrung"es abour dirchocerciasis aid its treatment. Appropriate ltealth educcttion messages in the of posters, form pamphlets and verbal presentations will need to be developid ancl tested. Health education should address the Jbttowirtg issues (Table 2): l3 -Yil I l I Table 3: Critical Issues in the Development of Health Education for CDTI ISSUES Health Education Messages Knorvledge of the disease a Local name of the disease a Symptoms a Causation/transmission (si mple) Knowledge of trearment Previous experiences with Diethylcarbamazine (DEC' Introduce Mectizan@ (iverntectin) Dosage Exclusions Reactions Beneficial side effects Attitude to treatmenr Advantages of Treatment: . Free . Yearly treatment . Possibilit-v of self treatment at community Ievel . Importance of maximal coverage Attitude to disease . The disease can be controlled a Onchocerciasis blindness & skin changes can be prevented Attitude to good record keeping a Minimum requirements for record keeping a Records are confidential and strictly for health use a Records required are for subsequent drug supply a) Have attv KAP sun,el,s been done in the project area ancl dso, wltat were the results? No KAP studies have been carried; however. there is a need for KAP in sample villages. This will be done in collaboration with other parrners. b) What metltods v;ill be u.sed to develop health educatiort nrurerial for the conurtutities and the agetils for who will be respottsible for ivennectin treatntent ? Health education materials such as posters, Ieaflets and flipcharts will be developed in local languages by the project and submitted to NOTF for standardisation. These materials rvill be field-tested and refined/adjusted as necessary prior to mass production. Video films will be produced and utilised as a mobile video film show. c) What ntetltods will be used to provide health educatiott to the endenzic communities and to the agents responsible for treatment? The zone has used several media in the past for providing health education to endemic communities. Such methods have included face to face discussions with health workers, use the of village mobitizers, traditional birth attendants, community health agents and t4 rviil participate and the use of posters and other associations and faith-based institutions playing in local plays)' flipcharts in local funguug"t, and drama'(role the disease and the necessity for regular community leaders will first be informed about leaders will serve as agents for the treatment with ivermectin. These community to comply with ivermectin treatment' program, encouraginicommunity members Allcommunitymemberswillbeengagedindiscussionsaboutthehealtheducatiortaspect to ait< qLrestions they may have regarding any messages, anA giuen the opportunity also provicie valuable input into the healtlt of the program. Co*rnunity members wili education messages and materials 3.2.3. CommunitY ParticiPation Incommrutity.directedivermectittdelivenlsysle,ns,tnentbersoftheendemiccommunities Trained persorutel' krtowtt ct's rlo tlrc execuliort of ivernrcctin treat,tiril llternselt'es' wlto sltottlcl be supported b)' the Comntuniry-oirect-id Di"tributors (CDDs) futty Tlrc cornrtuutity should be responsible for the contnrunitl, itself nuy provile treotttlett' ntinirnttm bttt e'ffective ntedical supervisiott' orgartizatiort ,nd ,ilrlrri",, CDTI with "t'tlu ancl training' various organizational once it ltas received tlte trccessary mfornruriort cooperative to traditionctl comntuttiry level, ringing front Y)ot'ne:l's structures at tlrc of tlte sustainin{ o,i,l" the support network structures, orc in po,ri:ont 7i, """gthening CDDs. a)Explaitttlteorganizationoftheintenc]edconltruuity-directedivennectintre(ltnletililt tlrc project. Theformationofanonchocerciasistaskforceatalllevelsisessentialinorderto control in all endemic areas' At promote coordinated activities of onchocerciasis Diseases Prevention and Federal level the Malaria and other vector-borne for-routine program management and Control reum irtrovppcT) is responsible as rvell as with NGO partners within the acrs as the liaison between MOH, ifgg, the governing body for Onchocerciasis counrry unJ oririO.. The NOTF will be this unit will act as NOCP control activities in Ethiopia. A senior staff from coordinator. Diseases Prevention and At regional level, Malaria and other Vector-borne for program implementation at control D;;;;";t (MOVDCD) is responsible ROCP Coordinator' Similarly' at that level. The head of MOVDCb will utt ut a (DOTF) will be District level District onchocerciasis control Task Forces for program implementation at this established. The DOTF will be responsible level.(enzure.selectionofCDDs,supervisionoftreatmentactivities,record keePing etc). Also,localhealthinstitutionsunclertheDOTFwitlberesponsibletoco-ordinate' monitor and supervise CDTI at each locality' r5 I' For ivermectin treatment pur?oses the number of CDDs will be determined based on a guideline of 50 households or 250 people per two CDD. Once communities select their CDDs, they will be trained in the CDTI APOC srraregy for ivermectin distribution. CDDs and other local primary health care rvorkers wilt then provide health education to communities on Onchocerciasis (its cause, transmission. control and preventive mechanisms). Prior to the distribution exercise, registration of all households will be carried out and non-eligible individuals identified. After registration, ivermectin distriburion will begin. The CDDs will follow up defaulters based on their treatment registers. Both District and Regional health staff will carry out supervision and monitoring activities. b) Hotv will ivermectin distributors be selected? The selection of CDDs will be the responsibility of the communiry. This will be done under the guidance of the village leaders. The CDDs will be expected to be honest, dedicated, Iiterate and permanent residents in the village. c) How, will rnrt-eligible be identified and defaulters followed-up? Non-eligible are mainly identified by having a complete household registration census and defaulters are identified by referring to distribution rccord or house hold catds. Defaulters, upon identification, will be treated by the CDDs. This is also done after previously non-eligible (such as pregnant women) have delivered, and therefore now eligible for treatment. 3.3. Ldcal Operational Research Are there any plans to conduct local operational research? ./ YES NO If yes please give details Operational research will be conducted on issues that will be identified in the course of the implementation of the project in the first year. These research activities will be carried in collaboration with research institutions and partners. a) What training will be provided to ensure the development ancl sustainability ol' the CDTI? Training of CDDs to operate CDTI is very vital to the program. To ensure sustainability of the CDTI program, Training of Trainers (TOT) sessions will be conducted by the NOCP. Those trained here will represent both regionat and Di'strict levels. These individuals will in turn train ,.pi.r.ntutives from District l6 and health facilities. These will in tum train CDDs. The training sessions will focus on the following topics: o Basic CDTI principles . Village census : il::Tl :"'d Tff i,X'rffLI' ll? ff"' iH,,l3" ad v e rse e rre c t s a n d management of its adverse reactions o Inclusion and exclusion criteria for ivermectin treatment . Dosing of Mectizan : ["J::.'i.j,,#ffi::H[ b) Indicate criteria for selecring trairrces (supervisors and conmrunity-directed distributors). I) Criteria for selecting CDDs: (i) Literate if possible (ii) Resident in the community (iii) Willing ro serve rhe communiry (iv) Must be honest (v) Must be selected by community II) Criteria for selecting supervisors: District Surrervisor: pHC (i) Must be a staff selected by the state RHB (ii) Must be knorvledgeable and honest (iii) Must be interested in helping rhe community (iv) Must be stable rvith relatively low turn_over Indicate -. nuruber, type and cluratio, of training courses intended Regional Training District Training CDD Training Trainin_g_ in subsequent years will be focused, targeted and integrated with other PHC rraining. t7 I' DBLIVERY 4.SUPPLY,IMPORTATION,STORAGE,INVENTORYAND OF MECTIZAN TABLETS tlrc suppb', importatiort'. storage, inventorY This section is oril1, a reminder ancl concents l'lerck & Co' who v'ill ulso pay hamlling anrl delit'ery oi i,i,'*"in tcblets' ,onaru! bt' accretlited Qgetis' cfutrge s for ivernrcctin to their wHo and stored in the MOH Mectizan@ consignments will be received through centralstoresinAddisAbaba.Itrvilltlrenbetransportedbyroadtotheregional health office' The District health health bureau, and from there to West Wellega to the health facilities' (In some office will be responsible for deliveri,g the dlug the communities' In this case' areas the District health office is locatid far from point)' CDDs will then.collectthe health facilities rvill serve as the final collection A report showing the use drug from the District health office or health faiilities. Committee (TMEC) at the end of the drug will be sent to The Mectizan@ Expert ofeveryyear,bytheNoTF,withthesubsequentapplication.-Copiesofthe sent to APOC' Drug delivery' application and t'he report of its use u'ill also be drug management system and distribution una ,"p*ing will follorv the existing by the respective health units at reporring ;;g;;s oiactivities rvill be done .uth of level"" of the health service delivery system. every year by the end of An application for Mectizan@ tablets rvill be submitted of TMEC' This application September to the NOTF, using the standardizedform rr,illthenbeforu,ardedtoTMECinAtlantaforreviewandapproval. 5. SUPERVISIONA{ONITORING AND EVALUATION 5.1 Supervision during Evaluation However' APOC funded Projects are required to be supervisecl and monitored' effective but minimum projects will need to be deiignecl to function with iupervision compatible with its objectives' you yott consir)er will be requiredfor the CDTI a) Plc.tse describe tlte supervisory arrattgenrcnts rhe cessatiott of APOC support? Iropose how will this continue at program, especia.lly during the There will be intensive supervision at all levels of the Malaria and Other Vector early years. Since the program will be integrated into will be staff of these Bome Diseases Control units, the superviJors and monitors will also be responsible for units. The District health workers trained to train cDDs complete census enumeration' supervising their activities (proper record keeping, during the actual distribution Mectizan@ inventory ana Oosag", and monitlring be responsible for process). The supervisory ,"u-*, at the District level will effects, Mectizan@ supervising healtir institutions (management of side Most important will bp accountability, and reporting on treatment coverage). activities are carried supervision ui tf,. communiiy level where most treatment ivermectin' Findings our, and cDDs are responsible for proper distribution of l8 from supervisory visits will be reported along rvith monthly treatment data, and reporting on adverse reactions. There will be a feedback on the findings of the supervision and follow-up of implementation of recommendations. As the program matures, the community will assume more and more responsibility, including deciding on methods of supervision, and those rvho rvill carry them out. This process may involve community, opinions, and religious leaders. b) Describe lrcw vou tvould ensure that superuisiort will be carried out so as to: o fall withirt tlrc requirement accoutltitry for iverntectin use To ensure that the above requirements are met, the program will support regular monitoring during the actual distribution process to ascertain that correct dosage is being administered, exclusion criteria are being observed, and the collection and proper storage of unused drug is properly practiced. . be sustaitted wlrcrt tlrc progranx ends irt 5 years The government is implementing Onchocerciasis control activities integrated with in the Health Service delivery system and has indicated on the financial plan that government expenditure incrcases year by year. The Regional Health Bureaus rvhere the CDTI projects are located has also committed to allocate budget for Onchocerciasis control as a component of the Malaria & Other Vector-Borne Diseases Prevention and Control Budget. . ensure ntaxinturtt itwolventent of the conmtwities in the process The program rvill support advocacy visits to the Woreda and villages by MOH, regional, and Metekel Zone representatives of the Onchocerciasis tasl< forces at each level to encourage the active support of the community. 5.2 Monitoring of CDTI It is importatxt to collect infurmation to monitor the progress of tlrc CDTI. Wlrut indicators will be used to monitor: o lvennectindistribution? o Health educatiort and community participation? c ManaSentent s),stenxs? l9 The following indicators will be considered: I v e rm e ctin D is trib utio n o Numbers of communities and persons treated with ivernzectin o Treatment Coverage o Regularity of treatment exercise . Compliance o Reporting adverse reactiotts H ealt h Educatio n and Communitv Participatio tr c Numbers of communities participating in the project c Evidence of impact of lrcalth education Manaqeruent . Are activities being carried out according to plan and on schedule? c Inventory control, . Are recordforms accurate ond contpleted on tinte? . Numbers of persons trained . .. Balance of genders in staff of rlte progrant The project will consider the following indices for monitoring the program of CDTI I ve rme ctin Distrib ution : Since Ethiopia has already been conducting Onclrocerciasis control activities fbr the last three years, there is an established Health Management and Information System (MIS) including for Onchocerciasis control acriviries. The NOTF will ensure continuity of this system prior to the beginning of treatment in the new project areas. These will enable the NOTF to monitor the communities and persons treated with ivermectin, treatment coverage, and regularity of treatment, treatment compliance, and drug reactions. In addition, the project will monitor the following rates and percentages using Annual Treatment Objectives established at the beginning of each year: . Annual treatment objectives (ATO): At risk villages (number at risk villages targeted for treatment) Estimated at risk population (total population at risk in the region) o Treatment coverage (geographical and therapeutic coverage): Treatments (number of persons treated) At risk villages (number of at risk villages targeted for treated) 20 o Cost per person treated o Tablets distributed r Number of ivermectin tablets in store at MoH, in the field, on order, or to be ordered The degree of community participation in mobilization activities will be used as an indicator of community mobilization. In addition, the support of the leaders and key opinion leaders in the communities will be indicative of successful mobilization as well. The impact of health education messages will be measured through periodic focus group discussions and will be assessed in relation to the baseline kae rinolng, that rvill be carried in coilaboration with other partners. Manasenrcnt The project will develop, through the integration of Onchocerciasis control to the MOVDPCT, a regional and District *unug.r.nt/ supervisory system that monitors: The planning ' and implementation of activities according to a timeline o Mectizan@ inventory levels o Monthly reporting of treatment indices . Numbers ' of personnel trained . Atrempt to balance gender in staffing 5.3 Evaluation of CDTI Annual extenrul review incorporating field visits will be und.ertakert to ensure that projects are nteeting target indicatioits outlinecl in this proposal. Such reviews will provide TCC with the assurartce that each proiect is movirtg toward its long term srate4 goal and if approprictte nxake recommenditiois about any deficiencies or nt,diJiccttiott.s to this proiect' Such reviews will draw on the indicators iveloped by TCC as a guide. 6. SUSTAINABILITY OF THE CDTI AFTER THE WITHDRAWAL OF EXTERNAL FUNDING The concept of sustainabitity refers to the ability of countries and affectel communities following initial external investment io maintain the viability and continuity of the ivermectin treatment process without external support. ro, Apoc projects, funded such support will iormalty last 5 years, as the Apoc donrrs demand that there shall be a visible and achievable end. point the external donation aspect for of the proSra,mme, and thar the community based clistributiott 2t -ty.tre,,rs establishe.d shall thereafier be sustainable bt' the goventments ot' the endemic cotmt ries conce nted. Progress and plans towards sustctinability, i,rr,,rrrng the plrusing out c['extertrctl and NGO? support, must be reported aruruall1' and satisfactory progress in tlti:; directiort will be a condition for each succeecling year's funding installment. Please address the following areas that relate to sustainabitity: integration inro priruary health care, cost-recover)t, and other sustainability issues. Efforts rvill be made to ensure post-APOC sustainability of the program according to the sustainability indicators shown belorv. Planning: CDTI will be integrated with the Primarl'Health Care (PHC) from the beginning. Ar the National, regional, zonal, and woreda levels, the MOVDCU will be responsible to, prugru,, implementation. Onchocerciasis taskforces will be established at all levels. planning would be canied out through participatory methods, using bottom-up approach and integrated wiih the basic health service. Leadership: taskforces will be emporvered and community leaders rvould be encouraged to be activelf involved in CDTI implementation. Involving communities in deciding time anJmode of N{ectizan distribution, CDD selection, etc rvould ensure community orvnership of ttre program. Monitoring and evaluation: will be carried out regularlv rvith proper checklist by the MOH srafl in additron to the Community Self Monitoring, which rvill be conducted by trained commLrnrrv members. Trairling' Health Education, Social nrotrilization, Advocacy and Sensitization: would be undertaken in such a way that sustainability of the CDTI project rvould be ensured after the termination of external funding. In other words, all these efforts should lead to empowering the communities so that they can assume orvnership responsibility. Finance and Funding: Short, medium, long-term (posr-APOC) financial sustainability plans rvill be prepared at Woreda (district) and regional levels. Budger line will be created for CDTI activities by the respective Iocal government. Transportation: The respective health offices at each level will provide transportation tacilities for Onchocerciasis control activities according to the need. Human Resource: Existing health workers in the system will spend a portion of their working time for Onchocerciasis control activities in their respective work areas. Treatment Coverage: Effort to achieve alOT%o treatment coverage in the targeted areas will be ensured through continuous health education and mobilizat-ion cluring the implementation of community-directed treatmenr activities."orn*unity Mectizan Procurement, Storage and Distribution: Mectizan availability will be ensured through timely procurement, storage and distribution sysrem that will be further strengthened to meet the demand. 22 6.1. Integration of the CDTI into other community-basecl or primary Health Care (pHC) systems. The principal goal of the AP)C is to establish cost-ffictive ivermectin-basecl corttrol for Onchocerciasis, which can be sustained by the endemic communities and cotuttries. one way to ensure sustainabilitl, is to'integrate the GDTI into the PHC system of the country, which medns ntore than juit using the system for iv e rme c tin di s t ri b: o io n. pHC 6.1 .1. ls there ,n fficiar poticy ancr struct*-e in the country? ,/ YES NO lf yes, please give a brief outline of what it is: There is policy and structure for Primary Health Care (PHC) in Ethiopia. The pHC system is used to achieve full integration of health related activities at all levels. A Primary Health Care Unit (PHCU) in Ethiopia has one health centre and five satellite health posts serving an estimated 25,000 population. Trained community health workers and traditional birth attendants ui. utro serving the community the support and supervision lnder of the health posts. Therifore, there is a functional Primary Health Care delivery system ihat implements preventive, curative and promotion of good health practices. This system is currenily capable of implanting Onchocerciasis control activities. In summary, the PHC structure is as follows: FEDERAL MINISTRY OF TIEALTH ) REGIONAL HEALTH BUREAU) ZONAL HEALTH DEPT.) WOREDA HEALTH DEPARTMENT/PHCU ) COMMLINITY HEALTH POSTS (CFIWs & TBAs) a) Howfunctional is the primary Heahh Care systent? - Fullyfunctional - Partlyfunctional The system from the National level is fully functional until the Health/health facility level. However, at the community level health coverage is limited. - Nonfunctional (please specrfy) b) Does it cover the whole project area? ./ Yes No If no, in what part(s) of the project area is there afurtyfunctionar pHC structure? c) percentage Wat of communities where Onchocerciasis is endemic, and which are eligible for community-based treatment, have an existing and functional PHC system. 23 All communities in the onchocerciasis endemic area have an existing functional Primary Health care System (PHC). But as the health service coverage in the country is accessible to 6Lvo of the population some communities could still be very far from the PHC unit but accessed by trained CFIWs and TBAs. d) what organizations are supporting the development of PHC in your project area? Government of Ethiopia (Ministry of Health), WHO, I-INICEF, USAID, Ireland Aid, Italian Cooperation and other civil societies and research and academic institutions are active participants in the development of the pHC. e) Is there any past experience in the country of a programme integrctting with the PHC? If so, what programnxe was it and how successjful was the integration? Program such as the EPI, Malaria control, and family planning are iritegrated in the PHC and the planning, implementation and evaluation of activities and use of organizing and concefted resource utilization approach is being implemented. f) Are there any plans to integrate otlrcr rural health programmes, such as the Expanded Programme of Immunization, Maternal and Child Healtlt Programmes or programmes for the control of other parasitic diseases, with the PHC system? EPI, maternal and child health program are already integrated. IMCI that focuses on the integrated management of childhood illnesses, especially malaria and pneumonia is also being strengthened. g) Describe how the CDTI will be itxtegrated into the PHC system; the wav the PHC systent will be used to achieve integration and the key persons in the PHC system that will be needed to achieve the integration. At the Federal level MOVDPCT will be responsible for routine program management and act as the liaison between MOH, RIIB, as well as with NGO partners. Members of the team share responsibilities among themselves and hence a separate entity of vertical program nature will not be established. The head of this team will act as NOCP coordinaror. At regional level, MOVDCD will be responsible for program implementation (contacting community leaders, explaining the program objectives, discuss issues related to Mectizan@ security, at regional Ievel, including monitoring and supervision). The head of MOVDCD will acr as 24 a Regional Onchocerciasis Control Coordinator. Similarly, at the District levels will establish corresponding Onchocerciasis Control Task For-ces ( DOTF)' The DOTF will be responsible for program implementarion ar rhe District Ievel (ensure selection of CDDs, supervision of treatment - activities, record keeping etc). In areas where access to the District health office is restricted, locai health institutions will coordinate, monitor, and supervise CDTI activities h) Indicate how early in the CDTI the process of integration will be introduced; how it will continue thereafier, and after how many years within the externally supported lifetime of the CDTI it will be completed. CDTI activities in Ethiopia will be integrated from rhe very beginning. The establishment of the program will rely on existing systems oi health service delivery at all levels. 6.1.2. If there is at present no PHC systenx in operation or in those areas where these structures are non-fut'ctional, describe how the CDTI may be used to initiate and expand into such a system, giving a time frame for intended progress. . NQT APPLICABLE 6.1.3. In which way(s) can communi4,-directed ivermectin treatment initiarc or strengthen PHC? CDTI is likely to encourage and facilitate the acceptance of new health initiatives in the community. Also, through the new CDTI strategy, the community will likely play a greater role in the support and ownership of the PHC system. The structures aheady pur in place would be utilized by the PHC to enhance effective planning and implementation of the projeci. For example, the CDDs will develop capacities and skills, wtriln wil strengthen other programs such as health education, other drug distribution. 6.2. Cost-recovery Systems during Community-based Ivermectin Treatment Cost recovery for Primary Health Care is mandatory in some countries and it may be one means of sustaining a CDTI after APOC funding ceases. However, please note well that since ivermectin is donatedfree, there can be no cost recovery in respect of the value of the drug itself; cost recovery can only relate to the costs of distribution. 6-2-l- Please state whether there will be any system of cost recovery (such as is recommended in Initiative) to help cover outlays on the distribution oJ' ivermectin in the present CDTI. NO. 6-2.2. State exactly how any such system witl be organized, including answers to the questions listed below. Whctt charge will be made per person or perfamily? NOT APPLICABLE 25 Which groups of persons will be exemptedJrom paynxent? NOT APPLICABLE will payments be in cash or in kind? If h kind how wilr this ensure sustainability? NOT APPLICABLE whctt provision will be made to ensure that ctll those eligible to take ivermectin, but who are unable to pay, will also receive treatment? How will it be determined who is unable to pay? NOT APPLICABLE who will collect the payntents? How witl this person safety tratxsport funds to a place of safekeeping? NOT APPLICABLE Where and by whom will any funds collected be safely kept? NOT APPLICABLE what systems wili be put in place to ensure the proper use ctncl management of collectedfunds? NOT APPLICABLE For what purpose(s), including defrayment of distribution costs, will the funds collected be used? NOT APPUCABLE What role will Village Health Committees play in the managemetxt atxd allocation of the funds raised? NOT APPLICABLE 6.3. Other issues Please provide information on other issues and constraints relating to sustainability of CDTI you anticipate and identifi how they will be overcotne. For example: the mobilization of endemic communities the maintenance of adequate supervision and monitoring inadequat e human re s o urc e s lo gistic s and communications s o cial/c ult ural fac t o r s declining c ommunity c ompliance I ) Mobilization of endemic communities: Experience from the Bench-Maji and Keffa-Sheka CDTI projects indicate that sometimes minor problems of mobilization such as misconception and misinformation regarding the use of ivermectine in new CDTI area can be obstacle at the early phase of implementation of the CDTI. This can be solved through sustained advocacy visits, by assigning individuals with good communication skills and expertise in conducting mass health education meetings to increase awareness of the community, surveys to monitor belief systems. 26 Obviously there will be a need to estabtish good relationships with the community leaders in order to have increased access to the communitiei at times like these. (2) Maintenance of adequate superttision ancl monitoring Meciizan@ distribution should include community leaders to further increase acceptability and sustainability of the program. AII records will be verifiecl during supervisory visits, and informal discussions will be encouraged ro determine community perceptions regarding the importance of the Mectizan@. (3) Inadequate Hunran Resources Inadequacy of trained health staff and PHC units are expected to be constraints in implementing supervision and monitoring. These can be overcome by allocating adequate time for supervision, in addition to training additional supervisors fi-om health facilities and community members. In absence of roads in some remore areas, mules and horses can be used. (4) I-ogistics.andCommunicatiotts: During the rainy season in June to September travel to the endemic areas may be restricted. Proper planning (Mectizan@ drug orders etc) will focus on providing all high-risk villages with their drugs during the dry season (prior to rhe Jan- March distribution window), and encouraging completion of aistriUution before the rains if convenient for the communities. (5) Social/Culturalfactors: So far constraints related to social and gender differences in relation to the use of Ivermectin have never been observed. However, careful attention will be paid to cultural and social factors such as: the appropriate gender for CDDs especially in Muslim communities, respecting the tradiiional religion, and selecting supervisors and distributors who speak the local languages. (6) Declining C.ommunity Compliance: Declining community compliance will be avoided through conrinuous mobilization activities prior to each treatment period. Community"members could be interviewed to determine the reasons for the non-compliance, and corrective measures taken where possible and appropriate 6.4. tvtetfgal of Measuring the progress towards sustainability (See Appendix 3 for a list of possibli indicators of sustainabiliry)? Progress towards sustainability can be monitored and measured by evaluating the project in terms of financial managemenUcontribution, communications, training and capacity building. This will hJIp enhance integration. Financial managemenr 27 l't a should be incorporated into the usual government financial administration. Financial florv in the CDTI project should comply with government financial management procedures so that there will be safe resource management. Regional and District health office heads, and administration/finance managers at each level will be accountable for proper utilization of CDTI resources. The ability of managers at different levels to familiarize themselves with financial and human resources in the project can also be used to measure and monitor the progress of CDTI towards sustainability. In addition, the ability of community members to understand the cause and effects of Onchocerciasis, and the mechanisms for its control can be considered indicators of progress of CDTI to sustainability. The success of the program will depend on the attitudes and practices of the community towards the disease. 7. CROSS.BORDER CONSIDERATIONS Where an endemic erea extends across the borders of nuo or more adjacent States, special problems of cooperation between the respective country CDTI may-arise. In the event that there are (treus to be coveresl g1t your propos.etl CDTI wlrcre the endemic zone extends across the Jrontier into one or more neighbouring countries, and where there are likely to be transitory or even large-scale migrations of Onchocerca-infected persons either way across the border. 7.1 Please describe the particular situation, as it is tikely to affect ivermectin treatment, and the methods you will use to deal with it. The Jima Horo districts of the West Wellega project selected for REMO refinement is bordered to the Sudan. Therefore, working with the neighbouring country during village visits for REMO activities on issues elated to security and other cross border collaboration requires attention. 7.2 Include pertinent observations on current political and health relations with the neighbouring State(s). There is a strong collaboration through an Intergovernmental commission established by both countries that assess and address cross-border issues. 8. SPECIAL RISK ISSTJES In some areas of some countries there may be special risks, which could hinder the smooth running of a CDTI. Security and other issues related to landmines in border areas could be considered as special risk. However, the problem can be identified and tackled in collaboration with the bordering provinces of both countries. 28 8.1 Please describe the situation in any areas covered by your proposed CDTI were this factor may interfere with the program, and assesifuture prospects. At the moment, there are no factors that are feared to interf'ere with activities in the. CDTI areas and we believe that such issues are unlikely unless otherwise. SECTION 3: ADMINISTRATION/FINANCIAL 9. ADMINISTRATION 9.I. Organizational structure for CDTI 9.1.1 Please prov-ide an organogram for the CDTI showing the organizational structure responsible for implementing the proposal. Fig.l. Organizational Structure of National Onchocerciasis Control program 29 9.1.2 Membership of Taskforces 1. Regional Level -. Regional administrative council - Malaria & Other Vector-Borne Diseases Control Head - Regional capacity building department (education and health desks) - Regional Planning and Economic Department - Regional'Rural Development Office - Regional Finance Office 2. Zonal level - Zonal Administrative council - Zonal Capacity Building coordination department (education & heath desks) - Planning and Economic Development Department - Rural Development Office F]nance - Office 3. Woreda level - Woreda Administrative council - Woreda Capacity building coordination office (health &education ottices) - Planning and Economic Department - Rural Development Office - Finance Office - Religious Leaders - Famous personalities 4. Kebele (community) Ievel - Chief of Kebele administrative council - Kebele capacity building office - Religious leaders - Influentialpersonalities - Representative of women's association - Representative of youth association 30 9.2 Financial Administration Mechanisnrs of disbursements and transfer of funds from the World Bank to countries Funds from the World Bank APOC Trust Fund will be transferred to the WHO country office account in Addis Ababa. On request through the proper channels by authorised officer of the MOH, WHO Addis Ababa will transfer the fund directly to the bank account of the respective Regional Health Bureaux (RHBs) according to the approved CDTI project proposals. The signatories of the bank account into which APOC funds will be transferred at the regional level will be the head and the administration and finance officer of the regional health bureau. All the imperest returns will be submitted monthly by RHB to WHO country office in Addis Ababa that will forward them to APOC headquarters in Ouagadougou. Monthly reconciliation statements will be forwarded to the central MOVDPCT (acting as the secretariat of NOTF) for follow up. APOC will issue checks (advances) in accordance with WHO rules and the previously agreed project documents and/or plans of operations. When the total payment in cash required for the project exceeds $ 100,000, the payment must be made in instalments. The first instalment/advance could cover 3 months or 6 months of activity depending on the duration and magnitude of the project. Management of funds by projects and WHO/APOC mechanism for monitoring The size of the project will determine which of WHO's contractual systems is used, e.g. Technical Service Agreement, Irtter of Agreement, Contractual Service Agreement or Agreement for the Performance of work. A document on administrative and financial procedure will be made available to project being funded by APOC. Built into this documenr is an imprest mechanism, whereby the project will report its expenditure on a quarterly basis and receive further advances on that basis. Each project funded by APOC will require a periodic external audit at projecr expense. Each project must have one senior staff member who is accountable for the management and control of project funds. Standard internal financial checks and balances must be incorporated into each project's financial management plan. 3r Fig. 2 Reguest and Disbursementof APOC Funds Disbursement Financial Report 3l 9.2.1 Input from the Ministry of Health a) Indicate resources that will be provided by tlrc Ministry of heatth ancl otlrcr government agencies. The FederalMinistry of Health o Personnel, e Logistics-and provision of additional vehicle, . Office accommodation o Running cost for Vehicles maintainace and Office Utilities o Training, Supervision and monitoring, o Clearing, storage and transportation of Mectizan Regional Health Bureau/Zonal Health Desk . Personnel, o Logistics and provision of additional vehicle, o Office accommodation ' Running cost for Vehicles maintainace and Office Utilities t Tiaining, Supervision and monitoring, o Storage and transportation of Mectizan District (Woreda) Health Office o Personnel, . l,ogistics and provision of additional vehicle . Office accommodation o Running cost for Vehicles maintainace and Office Utilities o Training, Supervision and monitoring, . Storage and transportation of Mectizan b) Please provide a list of personnel assigned by the MOH to this project, ilcluding their name and proposed time (State irrrrriog, of time allocaied-to the prctject) the proiec.t for and where appropri.ass thiir ixperience in onchocerciasis . control through iverunectin treatmefi. This project is new for the District so that none of the personnel has had any prior experience i n onchocerci asi s control through i vermecti n d'istribution. 33 Regional Health Bureau: Name Position Region Vo Tlme Mr. Dereje Olana Head, MOVDCD Orormia Regional lOVo Health Bureau Mr. Shelleme Chibsa Head, MOVDCT Orormia Regional l0Vo Health Bureau Mr. Addisu Mekasha REMO (CDC report) Oromia Regional I0Vo Health Bureau Mr. Tadese Hundie Vector Control Oromia Regioonal I0Vo Expert Health Bureau West Wellesa Zone Health Department: Name Position ZonelDistrict 7o Time Mr. Abraham Rumicho Department Head West Wellega 25Vo Mr. Olana Ayana Zone CDC expert West Wellega 207o Mr. Kedir Gobena MOVDC Experr West Wellega 20Vo Mr. Teshome Kene Healtth Programs West Wellega 20Vo Coordinator Mrs Eshete Negasso Head, District Health Seyo District 20Vo Office Mr. Denu Fite Head, District Health Hawa Welel 20Vo Office District Mr. Mihretu Tarekegn Head, District Health Gawo Dale 20%, Office District Mr. Negaso Kinfu Head, District Health Anfilo District 20?o Office Mr. Bayisa Gemeda Head, District Health Dale Lalo 207o Office District Mr. Sisay Ashena Head, District Health Jima Horo 20Vo Office District Mr. Tafese Terefe Head, District Health Gimbi District 20Vo Office Mr. Abose Waqwoya Expert, District Health Gimbi District 20Vo Office Mr. Jemal Beshir Expert, District Health Gawo Dale 20Vo Office District * 4 additional staff members from each CDTI district will also be participating in the CDTI activities for 25 -30Vo of their working time. 34 9.2.2 Input from the partner NGDO(s) a) Please provide a letter from the Executive Director or the Director of Onchocerciasis programmes of each participating NGDO stcttirtg their intentions to participate in ancl support the National Onchocerciasis Control prograntme. b) Give infonnation of the input front each NGDO participatirxg irz this project. Please c) provide also a nominal list grading and post description the personnel for to be provided by partner NGDO(s). Indicate clearty what wil be their functions itt the program and their experience in Onchocerciasis control thro u gh iv e rme ctin dis t ribution. There are no partner NGOs in the area that can participate in the project Therefore, all the contributions will be met by the government and communlty. g.23 Inputs from other agencies. Please list any other agencies or parties tlmt will be ilwolved, in the running or financing of the CDTI, and indicate clearly their roles, functions and. contributions. WHO: WHO Ethiopia will assisr rhe project ln the procurement and clearance of Mectizan@ imported into the country by using its diplomatic status. 9.3 Timed plan of action Provide a time chan(s) showing how the various activities of the CDTI will proceed over the course of the proposed program. Numerical ainual targets for all planned activities should be providedfor each time point. The time charts should also indicate how external support will be phased, out over the 5 year period. 35 \ \ \ \l\ \ \l\ 00 rr (.t \ \ \ \ \ \ \ \ \ \ \ \ \o N \ \ \ \ \ \ \ \ \ \ \ \ rn N \ \ \ \ \ \ \ \ \ \ \ \ \ ! (.I \ \ \ \ \ \ o) \ \ \ \ \ \ \ \ \ 6n (-, Lr \ \ \ \ tu () 6t \ E-( a o C! .9 (n a o o0 o o L L U Itr q) I () o o lo o 0) I = (go (i o ! o oI) q qJ o a) E c5 o 'd C) () o o o C) o o € O o. 'd 'd (g o -o ,rt o. o a o a 'E a) .3 () () d oo o o o o o q) rf, 9 a qoo o o0 N o= o0 o0 (! o. o (.) q) o c)J .o a oo q) qy()= '=o o -o ci L> L o co v) o d 'o() '=o b0 U C! :j- !so {.) a o" L E G d! o -tr !)_ CI (.) Ead O6 t A F F-{ -o Oe 9E M cl no @ o0 tro x (JE o o0: 63 o0 o o dq E C): b6 rll o o 9tr oo O" o .= oo s E o(,) N o (! > 86 o cn 'o (J qQ oo a) .=9 o. o o Os oo o o0 (g ru qo-o.o o-?; o 9.4 io o o 0) o o lf<() & (/) o>\ o 10.1 Budget Estimates Budget must indicate total funds to undertake the project. The amount of funding requested from APOC, and the amount provided b), the MOH, NGDO(s) aia othi, partners. AII must be made in US dollars. Each budget must inclitde at least the foltowing ntajor categories (see appendix 2) indicating t the contibution of the partners to reJleci susiainability of CD.TI. o Personnel (services) o Capital equipment . Supplies Training o Healtheducation/mobilization o Travel o Communication . Consultant . Operating expense o External audit 3'7 38 Table 5. YEAR oNE suMMARy BUDGET FoR oNcHocERctASts coNTRoL,2003 ATEGORY APOC MOH TOTAL Personnel 0 96,009.20 96,009.20 Capital equipment u4,170.00 18,778.10 132,948.10 Supplies 59,267.00 0 59,267.00 Training 20,299.50 6,380.00 26,679.50 Health Education/mobi lizatio 34,896.6s 7,625.00 42,52t.65 Iravel 8,800.00 1.964.00 10,764.00 Communication 2,520.00 2,520.00 Consultants C External Audit 0 0 Recapitulation 9,600.00 0 9,600.00 Operating expense 14,370.00 14.370.00 Total u7,033.15 147,64630 sgq,oq.qs Estimated No. Treatments 563,910 s63,910 563,910 Vo input 62.6 37.4 100.0 Cost per treatment 0.44 0.26 0.70 o c oo T s(, (, o o (,, otr o ct (t, o o .2 lJ. d g lt FG, 10.1. BudgetJustilication Plt'tt.tt' lit'rtt tLlt ,t nttt t-tlIul tlt'.tt t'tltliqttt ttf lltt' l'(,(l\()n\ l(tt'(,(ttll 1tt-1t1t11.1.',i itt;t tlc,Dt-s ttl tlte budgt't ( I ) I)e rsonne I The budgct sccn urtdcr-lrrtc itcnr l)ersonncl rcl'lccts the necd tbr stal'l'lrt thc lcrcl.s ol' N'IOH. RI-lB .ttttl [)rstrrct hc'llth office to l'acilitate tlie CDTI ucrrr rtic's ut thc' 'l-lic conrnrunltY lcrcl. \4OIl rirll prtlVidc sul)Pol't ln thc lorrn ol': o l\IohrIr'rrru ;.tLrtIrtlrrtres lutcl colntnLutitv IelrdL-t's . Olgunr:rns r.rrrcl leitchng thc drstl'ibution prour';rnt o 'l'rarnrng ol'supen,isors lnd CDDs o Gctting ancl supPlyins ivermectin o'l'l'unslti)r'ti.rtlon o1'essentral supplies o Regulur sLrPsn lsjsn o r\ccoullLlns 1'or l'Lrnds slte nt (both APOC and others) . Pt'ogt'atn erulruttron (2) Capital er;uillnteltt For the- prosl';1111 tr) l'unctlon properll,, the RIIB. Drstnct health ot-llce uncl sonre health l'acrlrtrcs ntusI L)e rr cll equipped u,rth the necesstu'1, rr-raterrals (3) Supplics: Offrce supplrcs are c'ssential for the smooth runnrns of daily prosram operatlons. Since this is thc lrcernning of the program, APOC rvill be reqLrestecl ro provrde all essential offrce sLrppl res. (4) 'l'raining: Training ls essentlal to the implementation and success of the prognrnt. and it is an activity that is canled oLlt on il continuous basis, rvith training and re-training at all levels as ne\\/ personnel join the program. Training is also very importanr for the supervisorl/ actlvrtie s of the program. These activities rvill be supported by APOC. (5) Healtli Ectucation/N,Iobilization: Communttt't.t-tobtltzutton and advocacy activlties are requlred to bLrrlcl the support needed to ensure progrant sustainability. MOH personnel lrom the National, Regional, ancl District levels rvill mobilize communities throueh advocacl, campaigns, information packet and visits to the communitl'. General public awareness can also be supported by such techniciues as the distribLrtion of posrers, brochures, stickers, and T-shirts etc. 40 (6) Travel: TraVe I ls reQLlu'c'd t'rlr uclvocr.rcv visrts. lrurnrnS. r-clriunrng. sLlpcr.\ lslol.r and mclnrtoring.. and eVirluutl()n :.lctrr rties arc- all inrportlurt li)r. ct'ttctrrL- pl.ogrurnr r rnplemerrtatiorr. APoc $'rll bc rcsponsrblc tbr supporting tr.ur cl r-\l)e nsL-s nL-cL-ssar.\.. (7) Contnrunication: At lhe Nittttltlltl. Rt'qiottitl. ltncl Distl'ict lcrcls. tclcphonc. c()sr-ir'r'uncl .tlrer.nre.,s ol collllllLltll('Lttlt)ll \\ rll bc ttsccl itt'ttttns pl'r).lcct r)l)crirl()rs r\t thc cortrrlupr{.t, lcr,cl, cotttntuniclttloll \\rll be rnainly tlrrough the usc ul'r'uclros anci ntegaphones. ApOC is Iequestecl to support expenses associated n'ith cornlnunications including courier serv i ces. (8) Consultants: Consultants ri'oLtlcl be required to conduct KAP stuches (ro hclp ln the dei,elopment and rcfinement of healtlr education and other materials), p,.,rgrrn-, evalultions, computer maintenance and other aspects of conrplltcr uork. to ensur.e total quality manasement of the program. APOC is requestecl to support the costs of these consultants. (9) External Auclit: External audit u'lllensure proper accountabrlrtr. Since APOC uill supporl t5e costs of extenral audrting specil-rc budget is not indicated in rhe bucleer cietarls. (10) Operating Expenses: This lnclude costs such as utrlities, costs of quarterly meeting (NOCp), developrnent"vill and maintenance of MIS. Also includecl in this line item is the cost of operatronal tesearch, printing of essential reporting fornrs (treatment summary forms for community' Dtstrict, and Regional staff). household carcls, loni*unit1, registers. These "na expenses rvill be supportecl by APOC. NGOs and MOH rvill share some costs such as office utilities. 10.3. Current resources available in CDTIs Existirtg CDTIs (for continualiott or e.rpcutsiott)will have resources alreacly available. Plense provide a detailecl list of att existittg personnel, ecluipnte'nt attd supplies (including vehicles, etc'.) belonging ro ilrc'progrcutt, iniicaring tlteir ott'nership (MoH, NGD), other Agency, etc.) and thiir rever of fu.nctiortctlitl'. NOT APPLICABLE 4L APPENDIX I: ESTIMATED NUMBERS oF COMMUNITIES AND PERSONS To BE TREATED EACH YEAR, BY ENDEMICITY LEVEL AREA CO\/ERED: COMMUNITY ENDEMIC HYPER- HYPO-ENDEMIC I. LEVEL ENDEMIC TYPE OF TREATMENT Community-based No. of communrties to be treated Total popularion in above 47 5,370 267,174 1,245,796 communities yEAR 2** - (2004) No. of communities to be treatecl Total population in above communities 455,593 1,281,914 YEAR 3** (2005) No. of communities to be treated Total populatron in above communitres \/[df{ {x* - (2006) No. of communities to be treated Total population in above conrmunities YEAR 5x* - (2007) tlo. of communrties to be treated Total population rn above contmunities +Ortcltocerc'irr.sis is ttol cottsidcrerl art itrtltortattt Ptblit' Heolrh problertr in h1,po-ettdetric. t'ttttttrtttttities attl APOC t'ill ttol ttonttrtllt' .ftttttl cottuttttttin,-bosed lrartrttrcnt itt s1c/r t'ttttttrtttrtitias. 'l'lrc irxltt.st **lt is ttrultrstoocl thot tlrc Jigtrras Jbr t'curs 2-5 ttrt, likLlt' tr-t be estirtmtes tltut rtuty, clurtt.gc tts tltt, project prosresscs. 12 % lnput N O) @ o N.) o o o P O o b b b O t) t) o o o O o If! s, 1' o o o cTD (oo. o 13 o 3'8r (rl T' f0, o o o o -o e. o o o o, an s Ivernrectin Treatments reflected in Appendix I n'ere obtained as follon's: Total population in the 20 districts in the zonc- itt tlte vcar 2003 is: 2,012,741 (r of the 20 distncts are hlper or mesoendcntic qtralill'ing lbr CDTI All the six districts ir ill be treated in year one artd REi\{O rc-finenrent rvill be done in othcr 6 districts. Year-One Total population in the 6 districts targeted for Year-One,704,887 Total number of persons to be treated in year one: 563,910 On the consecutive )/ears the program will still cover 100o/'o EARP of the treatment objective tvith natural grorvth at a rate of 2.9oh per year in the fii,e districts selected for year two inten'ention. Fig 4. Annual Treatment Objective by Endemicity Level 450000 40000c 350000 300000 250C00 F 200000 1 50000 100000 50000 0 44 .{PPENDI\ 2: I\DICATORS FOII E\ {l_L'.{t'to\. SLTSTAINABILITY /INTEGRATIO.\ OF CDTY Proict't liyoluutiort lllanagcment Financial ntanaqement El'll'ctr vcncss ol' communicatrons 'l-rarnrng ;.rncl cupacitv building Iltstrt utronal cornnrrtment Fulfrlntcnt ol' other relevant sectors Problcm sol vurs capacity Inte gration of operational researclt Project eJJbctiveness Result of KAP Studies Treatment coverage Follorv-up of non-eligible and tibsenrees N4anagement of adverse reactions Rel iabi lity of reporring S u s ttri n ab i li ty / I nte gratio rt Pol rt it'al x, i I I o.f' ltost govenunetil Polrtrcal rvrll as shorvn in polrcy statenrents ancl apparent conrmltment of high-level Offrcials Officral action assiening personnel. funds, r,ehrcles to program Lottg-tarnt plaruirtg Is there a long-term plan for sustainrng the financing and the management of the program? P r o g re s s t ow ard.financial s ust ctina b il it t, If program sponsors cannot continue their cunent level of commitment for at least another five year, rvhat percentage of running costs is no\ / paid for host govemments or fees? P ro g re s s toward int e g ration To u'hat extent has ivennectin distribution been integrated rvith other health service programs? evidence of community empowerment and orvnership change in KAP over time exten( of involvement of both genders and non-li(erate. 45 a 'u c F (h .I) c o l= o o a o o m t> l g o to I = o c o o o- x la(, o o (t I :l =. o E (c ar, l- o g 9 I c 3 (D o a a I o o o o I 6- I - 5' o r o 0 o, A) c o o il + 6- g o o :, o 3 € € I 6' o (oo o o q a o o o, r(] J a o- o o o o @ f o o o o d 6' ; o 5' E 0 (D l o :I 0) o a l ? o o € 6' o f ID o o o o o d <. E= o a o 6' o l, o= a 6- o l I o a L lo o 0, (D o{ a o o a g (t a o o f = o f, o o, !) o a. -o o o- o o a 6" o C tr o U) a c o N N N N o n ll f) I I I 3 I o I I I a o I I I I c o C \J I I I I I I I r I ac o o U U o xl tI] @ m CE (D t! @ ! o o o t> lf :, J f :,f c c c o g o U' a o o oa 6- ID a a 6 (, D e o o D l f o N) N) o f N N o (^) @ Co @ O) O) Or co N N) o (, N N) (n o, O) @ (, (o UI o u (,r (rl (,r (n (, o o ! o 5 A o o o A o o o o o o o N z z z .o .o C p f o o o o lh o (D !, o O) @ o !t ! o co l @ -o o o-l { o O) o o a (, o) o -@ -O) --.t o l (, --] 'o -5(o .5 !0 { -.J o o ! o N) (.) :l 5 N) (! o (r) G) o N a o o co o o o_ o O) o) co (,I (o P P P I P 9 P o 9n ID o o o o d !t sr! !n !n s, s) I .5 6 o o o o o o o o o o o o o o o o N) T o o o o o e ) o o o o o o O o ? @ ta G) tot> a o ilr ls l3 a l8 f, 12.18 o ls rI & lil$ t3 g ;lj 3. ;'l! o 6 e lz l;li IOli l+ EE i l.t I5' { i le t-to t lm n Io o l=l*li l:- lx ls * lalf )l:lli lm lo lo rc, 9lz 9kc it: tx tol- lo j l-o t; t; l:l l= o-' 9lS o 5 illf ,r :, f lr laJ sl o 6la =o ol )t olo l il 6' olo t; f f Sllel a ll f o lo I ol o 3= slil o ;l;l 3 ll$l'l o -r $ U' lxtm l3 @ 5 'n D l< lo c l> m 218 l(D q IE lo u € IT ! lo l5 xJlI lg o ! lo l- o , o o o lo o s l6 t o lr ld m o lo) 3ls lx q tr fl o l6 o 0, o p. a Eli ro 1' o o o A' C o o -{ I\rl9 c c sl= o lo ], rc x 6lo o= 9. o l! lo o o o a o t- o : l-- f, @ c I I (D c q g f, lo 6 o E { o E =lcll o c 3 = 3 3ls q o l: 3 o t FH s : E o= r ql3 s la E b c c o I o , c ta c c :f g m o (D 6' o 0 s. Q a o ,o t; I o 6 :1 -{. g o. z o 6 :, o 3 o o, o o o o u o a G o r o o o u I o= (D o m o : E E= a o o r o= o o :, =. o= { {-t ao f - 0) q, x F C q, o 7t f o m o. € c 0, o) o o u -n "Tl TI T -n -n -rI a :D fl n o o -o -o -o .D U. T I I c 3 ! ! ! n ! -0 ll -o T 1! co g) ul q) o o o= o o o o o o o o o c o o o o o o (D I I I I I I I I o o o 3 o o o o o o o o o o .D c C t 5 c 3. o o o o o o o t,o o o o o o 3 o 3 3 f,r $ o N) o (l) o '(,l -(n _(, -o) -(,) .C,J .. !^, lrt @ o ! o, o (, o (, o o o o) (, o o o (, o o o o (n o o o N) o o o o o p o o o o o o o o o o o o o o o o 3 z z z 9 o 0) o 9 D o o = C C 8r :. C m a -o o =6 o D. 3 @ N) 5 o) d) t\) l { a o o o g o, 0, o o N o o tu (n o N o -o .(o o l\) $ o i., lu o o) (, l (n 'o 'o _(,) -(, ,o '(, !,' ,h co (,l o ! o ur o t\) o) o o o { Ol co o o) (,t o ! (rr o o o N o o o o o o o o 9 I I sl) 9 ;.J I I I I o o b o o o (Jr I 9 9 I I 9 9 P 9 I P P $ o o o o o o o o () o (> o o o o c o C) o o o o o o o o o o o o o o o o o o o o c o o o o E l(,rl(,r l6 o l(,r TO o o 1' o o TI U o l-o o o o 3 o o f l+le l;e I$l s slx Lo\ ;e s N N € o (D: olo lo * s o o o € € t; o. Ie c o o o ) ;o=9 f o o lf o o clc c 9L !, o Io o o lc 6lA c C o o :: ll lfi la I;I o ln 6 D a o. t- 5' 3 ol6 o BA o- 6- o o D' D o E o o o o D l3 l3 lo 1(D (! 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D 0 1, o l) x r1 t o) 5 o o o) o= 5f DI ) ;l @ o 9. ol Fq So' rl t sl o ir o, oJ fl T'IE f (D o o f o o 0, =l !n: DI--l ) ol 0) 0) 0, o)t =o )l ) ol :l ol 3 ;el 3c (Dl 3 J= o=. D;< DI J @l o 6qi ]' ol q, ru'l :tl-t l z al ol .DI:] 3l :r r dl-l ol o 3 o,-l I rl o col='l (olal il01 o a o-l (Dl Z ! (O cr- d! II -{ J = r:f o oi'5o o^lJa "El) -{c E.A:r(D ,6o o P_ ! -n -Tt o_ 'Tt 0) o o -.loo @ l 53 O< - 6 (i O) ; A);i-= o a- o: A, 0) rX 5' 5'(, o f IO- o 3:g E (o5' o o (D='cod [83 o- g. o. 0) 6=. q) aa f 93* o (D o)6 N) fo6'(o .?q)= o E oo.t @ 5 C a 5' (rr a O) 4 3s 6 E c -io. I9; o i, U) o @ 6' 3;E (f e 6 b1 E a of, ctr3 o-t J o rl a fl ooo=o -. 0) ol aoo o D EI I t o :l < J(D q ;l d:; ol ol P =:o)i= (Dl f 5'l 5o ol (D o,al I 9l D 3E o ol o-:)l o- e"E O) el o=- 5 (D (, o tI t< o)n lm ! cl lc lo ^Y EN o lx ! o lq 4ls i o lE E'dl: l< 115 o tb El: lc lr o5'5+ e.6 o lo o o 5 IC l{ q)- F'E o o { lg gl3 C. g t! lo O^ ot at= o i o. l3 :l: lc { 9A o o { o q'l! F 6'(o e r si Jo) 0, o r ! o.o :, 3 0, 3 q :, s a 3 ot (,)l(IIti sE o a t.t c N o o o 9.1: d.e o J *. rFIs; I a =.o o s. 8 et; o):N(o o=. 0, l F' o:l=. A) o, o g,gl: d' o HI.E a f 6' o i o f o o o qlE '13 o=. 0) i :f ot 3 610, fl 6 o 0,= ol o' o f I f oo) fllfi o O) 3l f, o_ u .o ll r0 tl T o o o o c c o o o o o :E I o o C J o Ito C o o6f,i I o oo I 3 ::f l\) (Jl (n l, i, Jo- z mt' o o. G) o 5h 6) g.@ (, lo ut o) 5 oc o o (^) @ Ot J lo- o o o 5 N) (,J o o o o a) (, o qoo=3 o{ :(D G) lJ o, 5 .o N c.rr Ior l\) us co 'o (^)l(o J -cn -o 6'o (o o CD O) O) o f o o OIN { N o t\) o o) o o 919 I u! I (n o b, b b olo o) b o Or o o olo (rr o o ob J (JI lcn a lo ot gc]| oo le- o c lo a9r 0ro o- o Ir: l:r. Q cY =of OA' o l- a, etrr A ff)A, (,r t3 laD l= lc Ib- lo lc lo ll l- lo o= Ir lI lo flE + lo, la lct; o to -l I!r lo 4l; I lo l(D o l{ r t? t6' II; c, lo ilo ;= a R !0 { ils- m :o 6' :_l !, o {o alN 6 E 6 il5 z m T r 9. o il - I- g 1l 4 o )l o-7t -i { TI I =, !0 o oc C m f, o m c o o x I C J o o o o o(, o I\) o 3 z I C o f C o (D N) f\) = {l o- o, @ G N o, o o 5or N N) o o o P i o o o o ob o tJ I Ct) tolo x 3 D rN 3 eg aio ol 9o nl \i' IqE lco { oxo9 0 0 oU, I r o o o o ,c o= o o o (, o 3irt o 3 z a-E 9 5'E o o9 C d3 i'l (j O:J N 5 6= 9o o- c(oJo- ! 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(rl (rl lml= 4ld u I a f, o o I I I U. o= T c o u, (I, @ o 4 o o I o o N N N o :f r r o c c) c] o :1. f C f o o o o o o ,n o o o o o (, o o t- o) :l (, (, o 5' o = A N ,r N (D o (n ) oC 3l z z (D I 9 o l o o o Do C (D C c :. f. :t 0) o) th tn l\) t\) (, o (o=' o m .5 o x (.) J.t J\) o) o E 9r 9, -co Ju o { o) o) o o A (Jl N g l P o o oo (, o a o 9 o o o o o (D o ob o o o o oI I I I o o o o o o o o lg> o l@ r>l l=c- c Edlls= 16'u) a =e.a E,S 16 ee @ E lol(, (,l iEI lo o E isl6l (D ;l 3 lo if,fl*s li f,l $l 6 I i ol-t 'g rl il$l: l*l il nt o ;l N flElil 3 o f oJ o q,lil /+ l? I ?2,EtLtr artlot lldbaq*, hr\{t @T'tt"+ THE GAMBETIIT PEOPIAS NATIONAL REGIONAL STATE mf (Le HEALTII BUREAU 2f fi;tr GAMBELI.A Disease Prevelrtion and Control Department F MinistyofHealth Addis Ababa. I Dear Sir/ Madam Subject- Approval of the New CDTI Proiect Proposal. According to your letter Ref. No aorn | 1491451956 dated llll/1995 E.C. We learnt that you need our interest on the New CDTI project proposal. For your information our region has highly accepted the New CDTI project Proposal. Hencgwearegoingto implement this project inthe yearof 2003. Your cooperation is highly appreciated. *w{; ,rffi *$,fl"#*f#akt,.$,p ' rrzoo+ n OA4J-:36 ?+o,,t.G 4 r',O*/l!kl= (.|.(at Oa hq A a Planning & Programming Servic.e :t' c4.@t :,ttt : +'t ...-9..21,.t t- a Malaria & Other s Y lBtD lP I CtDepartnent (ro +.r.c.-.-. rrrrt Tel. 51 01 38 Fax 5t 02 14 51 0r 41 5l 02 15 51 0l 42 .r4n&f I ,rqhP? ,t.R{l.tG aAfi JLrlc. ex{i,qwT?t +fc .ef+.} 5r 05 36 Ptease guote our refereuce number in reply. f h..)'f A'.e &.y- /-qT &fh /- il! q, i' r.fi tLh 9nut',r09 "Ztn.fc Federal Democratic Republic of Ethiopia Ministry of Health Dr. Azadigo Sek6t6li Director, African Program for Onchocerciasis Control Ouagadougou 0l Burkina Faso Tele: (226) 34 29 60 134 29 59 I 34 29 53 Dear Dr. S6k6t6li, Subject: Submission of Six Revised CDTI Project Proposals of Ethiopia It is to be recalled that NOTF of Ethiopia had developed and submitted six new CDTI project proposals to APOC for possible approval and funding in order to initiate Onchocerciasis Control Programme through Community Directed Treatment with Ivermectin (CDTD in three National Regional States, namely Oromia, Benshangul- Gumuz and Gambella. However, TCC in its sixteen session has rejected all the proposals and recommended the proposals to be revised. As a follow up of its recommendation, TCC mission visited Ethiopia to give a technical advice to NOTF from 16-19 July 2003. Based on the issues raised by TCC 16 and the technical advice extended by the mission, the NOTF has revised the proposals thoroughly. We hereby enclosed: For Actr;^r 1. Revised CDTI Project Proposals for: Illubabor, Jimma, East Wellega, West Wellega, Metekel and Gambella project areas To: 2. Signed endorsement letter from the Ministry of Health/ NOTF and NGDO T(+ commitment letter for the Revised CDTI Project Proposal for the years 2003- noS.- *ta,n$ 2007. r &DAo csD 3. Commitment letters of Regional Health Bureaus from areas where no partner CEt/ NGDO is available, so that 25% of the contribution is going to be met by the - Btn C^? government for the first year and the government's financial support will tlF! increase from year to year to ensure sustainability of the programme after the withdrawal of external support. For lnformotlon To, b la- Please be informed that Illubabor and Jimma projects do have NGDO partneg the A. Center. The rest do not have NGDO partner for the time being. AlemaYehu Seifu Solomon HECU Prewntion control 'ffin !3ttcr63 ili*.*' -a'od PePartmed' tleaA 3 I JUIL. 2C03 APOC/DIR Minister'soffice FaxNo.25l-l-519366,MCH5t 6677,PPD51269lDCPD527033,534867,Procurement535l66 E- mail [email protected] a t234'telex 2t8444ET $ srzorr, sn3w,st783t5t762t, 517923,517818 @AA 01nrr}n,l.?.tr fhT', f.,fl4(L *fc r,f4,ft In reply Refer to our Ref. No. This is, therefore, to kindly request the management of APOC to approve the project proposals. We would like to take this opportunity to thank APOC Management and TCC for extending their unreserved support towards the realization of Onchocerciasis Control Program in Ethiopia. We also appreciate the support and input given by the TCC mission of 16-19 July 2003 to NOTF. Sincerely yours, Seifu Solt'1"''rr lEnou"o andControl DcPafinc8t, Head Cc a H.E. Minister's Private Office a H.E. Vice Minister's Office o Planning and Programming Department a Diseases Prevention and Control Department a Malaria and Other Vector-borne Diseases Prevention and Control Team Ministryof Health Dr. Angela Benson WHO Representative, a.i., Addis Ababa Mr. Teshome Gebre, Country Representative The Carter Center Addis Ababa Oromia Regional Health Bureau Addis Ababa Benshangul- Gumuz National Regional State Health Bureau Assossa Gambella National Regional State Health Bureau Gambella Letter of Endorsement from the Government of Ethiopia to The African Programme for Onchocerciasis Gontrol (APOC) for Support of the Proposed Onchocerciasis Gontrol Project ln accordance with the memorandum of agreement for the APOC: l. The Ministry of Health, on behalf of the Government of Ethiopia, herby endorses the attached project proposal to be submitted to APOC for financial support. 2. This proposal reflects the collaboration between the members of NOTF and APOC with a view to conduct an onchocerciasis control project in Ethiopia. 3. The NOTF is a partnership of the government, NGDO's and other participating parties which will be responsible for the implementation of this project 4. The government shall assure free entry of Ivermectin into the country for delivery to the applicant without imposing duty, tax or other costs. 5. The govemment of Ethiopia pledges its full collaboration with the APOC in the expectation of acceptance of the present proposal. tr*: January *1nei,r, 30,2003 i{ffi ffiqH#*i"#1" 93". ffi *wName and Title of signatory National Onchocerciasis Task Force of Ethiopia Application for Support from APOC ln accordance with the memorandum of agreement of APOC: l. The NOTF on behalf of the Government of The Federal Democratic Republic of Ethiopia, (a partnership of government, the NGDO's and other partners) hereby express its wish to enter into collaboration with the APOC and the MEC with a view of conducting Onchocerciasis control project in Ethiopia. 2. Onchocerciasis in Ethiopia is considered by the health authorities as a problem of sufficient importance to warrant the implementation of a control project in the endemic areas with the aim of eliminating as a public health and socio-economic problem throughout the country. 3. It is estimated that out of the total population of 65 million there are 2 million people infected with the parasite, Onchocerciasis volvulus, causing blindness, serious visual impairment and debilitating skin diseases. 4. The proposed control project will rely on community directed treatment with Ivermectin (CDTD as its main intervention tool. 5. The NOTF has scrutinized the criteria and conditions for application to the APOC and is satisfied that the proposed projects meet all the criteria and fulfill the conditions established by the APOC. 6. Details of the project proposals for the control of Onchocerciasis in East Wellega, West Wellega, Metekel, Illubabor and Jimma zones and Gambella region in Ethiopia, including the support requested from APOC to successfully implement the project are provided in the enclosed proposal. 7. The NOTF of Federal Democratic Republic of Ethiopia pledges its full collaboration ion ofacceptance ofthe present proposal. Tailesse'@r.) 30, 2003 Place, Date, ', Rep. of Government Name and Tile of the Signatory tbt".opt "l,rriiro kj-'erorr+ j& THE CARTER CENTER February 28,2003 Dr Azodoga Seketeli Director WHO African Program for Onchocerciasis Control 8.P.549 Ouagadougou 01 Burkina Faso Dear Dr. Seketeli, The Carter Center has been working in Ethiopia collaborating with the Ministry of Health in the Guinea Worm Eradication Program and the Ethiopian Public Health Training Initiative since 1993 and 1997 respectively. In 1999, the Center expanded its health activities to assist the Ministry of Health in establishing a river blindness program. As stated in the proposal submitted by our representative in Ethiopia, Mr. Teshome Gebre, The Carter Center confirms its intention to be a parhrer with the Ministry of Health in implementing the CDTI projects in Illubabor andJimma. After reviewing the project proposal, I would like to confirm full technical assistance based on the activities listed in the proposal and financial support not to exceed the budget as stated in the proposal. I look forward to a successful collaboration. Sincerely, ?-,^...#I*- Donald R. Hopkins, M.D. Associate Executive Director Mr. Teshome Gebre, The Carter Center/Ethiopia Chair, National Onchocerciasis Task ForcelEthiopia ONE COPENHILL . . 453 FREEDOM PARKWAY ATLANTA, GEORGIA 3O3O? . (404',) 470.3837 . FAX (404) 874.5sr5 I I I, '".: l'r t" illtfr*.' 'd, *al.e tlait zaTr) rS 0.f Date O trrlrLrulul Gumru Nati Disease Prevention and Control Deparfinent Fa:r: (01 )52 -7 0-331 5348-67 MOH Sub: Program for onchocerciasis program ) We have received your fax message of letter dated l/ll/95 with reference No. oomll49l45l956. We appreciated the procedures undertaking to start with conhol program of onchcerciasis in our region. As the survey conducted indicates onchocerciasis is serious problem in Benishangul- Gumuz Regional State. Hence the regional health bureau would like to confirm that it is ready to implement the control program with existing resources and would provide any necessary support for the achievement of the control program throughout the project life as well as to sustain the program after the termination of the program. With Resards- y'nl',hrnr m,ffii tar'(trqG[ tElet':r. ,'ekelc/egerc JebirtoJetir/ro (MD.MPIII,MnMpE CC: - -^i-aSL >.lrEEUrAAffiI'raHh adr.s.o.P.C Tearn MOH RHB '.a I -t ', N" _Rer. oen/ -Zo/az ' Date *,iroc Er!:._..._ .. 4_ rr_ ?f , ;-: .i.:. , ...: !--.; -r.;* t"' and ilil,T;';'ffi::in @il"uPulg&qt' Addis Ababa Subject: - onchocerciasis is one of the most prevalent communicable diseases in oromia regional state' Five out of fourteen zones. of the region (35.7%) ure endemic ror onctrocerciasis. The result of REMo conducted with- the supp* rro^ yo* orr,.. and Apoc clearly indicated that significant proportion of the fiu" ron"s, though there are differences among them' are meso and hlpeieniemic for the disease. residing in these *:* continually exposed flse "J1u"1 "ii"pulations -u.t" to infection. Hence, onchoceiciasis is considered as one of the big health and socio-economic challenge in the region. how to confront-this we were thinking ) challenge..But.to start the on our lack frogr*." own, on one hand we experienced he-alth professionals with onchocerciasis control anJ on the other hand there is shortages of fundi and logistics rike a*gs to b" rs"d for the ol programme. "orrt It was juncture at this that we heard of good news from MoH. onchocerciasis Apoc is ready to support control program in Etliiopia. REMO was done meso-endemic in bromia. Hyper and areas, which are eligible to be included identified, in the program, are though some areas still need to be refined. proposal"ont.ot submitted were prepared and to APoc based on the REMO result. we were looking forward to start the progralnme' Still we hope that the proposal will be approved with some amendments. nrojgcl-i1 approved the oromia Health Bureau is committed 'lt" to cove r at least 25%o of the total CDTI cost starting from the initial p.o;ect y.-.-ln.r"uses the budget allocated for this programme with in cinsecutive year: -a i, ready to over take the whole project at the end of the fifith year. we also try to do our best to create a budget line for SDTI integrated within malaria control programme. for%f&"c,{qapproval of the project I"":*:::.y:lYl*tingexposed communities. for the benefit of the ,{.ifffi .; Withbest-regards, it7 .: '. d '' ' '1 -' i-;"'lY HEAI-T]I Head, oromia Health B,r#" "': ' ''*-T9-"IA Deputy H*;orili""r#ifu",,.;-'- EUREaU Malaria control service OHB NOTF- Ethiopia Addis Ababa