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The Federal Democratic Republic of EthiopiaMinistry of Health

COUNTRY/NOTF: ETHIOPIA Proiect Name: East Wollega

Approval vear: 2003 Launching vear: 2003

Reportins Period From: Februarv 2004 To: March 2005

(Month/Year) ( Month/Year)

Proiectvearofthisreport: (circleone) (} 2 3 4 5 6 7 8 9 10

Date submitted: 28 March 2005 NGDO partner: None

ANNUAL PROJECT TECHNICAL REPORTSUBMITTED TO

TECHNICAL CONSULTATIVE COMMITTEE (TC

DEADLINE FOR SUBMISSION:

To APOC Management by 31 Januarv for March TCC meeting

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AFRICAN PROGRAMMB FORONCHOCERCTASTS CONTROL (APOC)

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ANNUAL PROJECT TECHNICAL REPORTTO

TECHNICAL CONSULTATIVE COMMITTEE (TCC)

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

OFFICERS to sign the report:

Country Ethiopia

National Coordinator Name: Dr Daddi Jima

Sisnature:

Date:

Zonal Oncho Coordinator Name : M slaku..Tp.$g-e.rn...

Signature: /-,#or lqkl{

NGDO Representative Name: .Nqne.

Signature

This report has been prepared by Name : ..Melaku.T-e.s9e.r4........

Designation'. Zone

Signature , ...tiI

Date

Date

Coordinator

Date et )* li

ll WHO/APOC, 24 November 2004

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Table of contents

Acronyms

Definitions

FOLLOW UP ON TCC RECOMMENDATIONS

Executive Summary

SECTION I : Background information.

L 1. GeNpnal TNFoRMATToN........l.Z. Popur-erroN...............

SECTION 2: Implementation of CDTI

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.3

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.6

Ttuelme oF ACTIVITIES..............ADVoCACYMoeILIzetIoN, SENSITIZATIoN AND HEALTH EDUCATION OF AT RISK COMMUNITIES

CoHauuNrrY INVoLVEMENT

CeplclrY BUILDING...........TRsetNlpNts .....................ORDEPJNG, SToRAcE AND DELIvERY OF IVERMECTIN

CouuuNrry sELF-MoNrrozuNG eNo STRTBHoLDERS MEerrNc....SuppRvrsroN................

SECTION 3: Support to CDTI

2.1.2.2.2.3.2.4.2.5.2.6.2.7.2.8.2.9.

6

7

7

8

9

3.1

3.23.33.4

EeurpueNrFmeNcIRL CoNTzuBUTIoNS oF THE PARTNERS AND COMMUNITIES

OTHSnFoRMS oF coMMUNITY suPPoRTExpBNpnuRE PER ACTIVITY

SECTION 4: Sustainability of CDTI.

4.1. INreRNer-; TNDEnENDENT pARTrcrpAToRy MoNrroRrNG; EveluerroN............4.2. SusrerNesrlrry oF IRoJECTS: ILAN AND sET TARGETS (MANDATonv er YR34.3. INrecRerroN...............4.4. OpenerroNAL RESEARCH

SECTION 5: Strengths, weaknesses, challenges, and opportunities......

SECTION 6: Unique features of the projecUother matters

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lll WHO/APOC, 24 November 2004

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Acronyms

APOC

ATOATrO

CBO

CDD

CDTICSM

LGAMOHNGDO

NGO

NOTF

PHC

REMO

SAE

SHM

TCC

TOT

I.]NICEF

UTG

wHo

African Programme for Onchocerciasis Control

Annual Treatment Objective

Annual Training Obj ective

Community-Based Organization

Community-Directed Di stributor

Community-Direc ted Treatment with Ivermectin

Community Self-Monitoring

Local Government Area

Ministry of Health

Non-Governmental Development Organization

Non-Governmental Organization

National Onchocerciasis Task Force

Primary health care

Rapid Epidemiological Mapping of Onchocerciasis

Severe adverse event

Stakeholders meeting

Technical Consultative Committee (APOC scientific advisory group)

Trainer of trainers

United Nations Children's Fund

Ultimate Treatment Goal

World Health Organization

1V WHO/APOC, 24 November 2004

Definitions

(i) Total population: the total population living in mesoAryper-endemrc communitieswithin the project area (based on REMO and census taking).

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

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

(iv) Ultimate Treatment Goal (UTG): calculated as the maximum number of people tobe treated annually in mesoftryper endemic areas within the project area,ultimately to be reached when the project has reached full geographic coverage(normally the project should be expected to reach the UTG at the end of the 3'd

year ofthe project).

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

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

(vii) Integration: delivering additional health interventions (i.e. vitamin A supplements,albendazole for LF, screening for cataract, etc.) through CDTI (using the same

systems, training, supervision and personnel) in order to maximise cost-effectiveness and empower corrrmunities to solve more of their health problems.This does not include activities or interventions carried out by communitydistributors outside of CDTI.

(viii) Sustainability: CDTI activities in an area are sustainable when they continue tofunction effectively for the foreseeable future, with high treatment coverage,integrated into the available healthcare service, with strong communityownership, using resources mobilised by the community and the government.

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

WHO/APOC, 24 November 2004

FOLLOW UP ON TGG RECOMMENDATIONS

TCC session Not Ap le

Number ofRecommendationin the Report

TCCRECOMMENDATIONS

ACTIONS TAKENBY THE PROJECT

FOR TCC/APOC MGTUSE ONLY


Executive Summaly

1. Background on treatment and population data

East Wollega CDTI project is one of the four CDTI projects in Oromia regional state that has

started Mectizan distribution in2004. The project area is located in the western part of thecountry and bordered by West Wollega CDTI projects. East Wollega CDTI has totalcommunities (villages) of 3,678 that are dishibuted in eight Woredas namely Guta Wayu,Diga, Leka Dulecha, Sibu Sire, Jimma Arjo, Wama Buneya, Bako Tibe and Sasiga. In thefirst year the treatment was carried out in four woredas (Guta Wuyo, Diga, Leka Dulecha and

Sibu Sire) which has a total village of 2,166 and all the villages were covered with Mectizantreatment during the first year treatment period. The total population in the CDTI area is7 45,018 which make the UTG of 625,81,5. The population of the four woredas of the firstyear treatment was 368,261. The Annual Treatment Objective for the first year was 309,178out of which292,498 were treated with Mectizan, which gives the ATO coverage of 95o/o andUTG and therapeutic coverage of 39o/o and 47%o respectively. The geographical coverage forthe year is 59%o.

2. Background on population movements

The communities in CDTI areas are mainly settled farmers, daily laborers and civil servants.However, there is a resettlement program in one Woreda. Generally, there is no major type ofpopulation movement in the project area.

3. Training data

Training of Trainers (TOT) was given for 93 health professionals. Those who were trained as

trainers in turn trained 4,257 CDDs who were selected by the communities from 2,166

villages. Therefore, the average number of CDDs per villages is 2.

4. Challenges and how they were overcome

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

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

settlement programs.

Opportunities: The expansion of govemment structure down to village level "garee" and

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

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

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

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

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SECTION't : Background information

1.1. General information

1.1.1 Description of the project

East Wollega CDTI project is found in East Wollega zone, which is located in the westernpart of Ethiopia. It shares borders with West Wollega CDTI in the West, Illubabor CDTI inthe South.

East Wollega CDTI has total communities (villages) of 3,678 that are distributed in eightWoredas namely Guta Wayu, Diga, Leka Dulecha, Sibu Sire, Jimma Arjo, Wama Buneya,Bako Tibe and Sasiga. In the first year the ffeatment was carried out in four woredas (Guta

Wuyr, Diga, Leka Dulecha and Sibu Sire) which has a total village of 2,766 and all the

villages were covered with Mectizan treatment during the first year treatment period. The

total population in the CDTI area is 745,018 which make the UTG of 625,815. Thepopulation of the four woredas of the first year treatment was 368,261. The AnnualTreatment Objective for the first year was 309,178 out of which 292,498 were treated withMectizan, which gives the ATO coverage of 95o/o and UTG and therapeutic coverage of 39%and47%o respectively. The geographical coverage for the yeat is 59%o.

The topography of the zone is classified in to lowlands, mid altitude land and highland areas

widely ranging in altitude from 900 - 3178 m above sea level. The zone located incatchments drained by two perennial rivers namely Guder and Didessa.

The climate of East Wellega is characterizedby distinct rainy and dry seasons. The majorrainy season 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 1368 mm to 2400

mm. The mean monthly temperature of the zone differs widely from season to season ranging

from I I oc-38.8 oc. The area receives most of the rainfall (>80%) during the months of Maythrough September. Animal herding is a major farm activity in addition to seasonal activitiesof preparing the land for cultivation and harvesting. The months from January to April are

generally months of low agricultural activity and the period is conducive for the

implementation of mass treatment for Onchocerciasis control.

All weather road access is available between the capital town of the zone, Nekemt, and the

21 district capital towns. During months of heavy rains some access to some districts could

be difficult. All the CDTI district selected are accessible by road all round the year. The

capital town, Nekemte has also Air tuansport service to and from Addis Ababa. All the

districts have automatic and operator assisted telecommunication service and Postal Servicestations.

Beyond the district capital towns, most villages are accessed only on foot or on pack animalswhile some villages could be reached by motorcycle. During the rainy season supervisionand monitoring of CDTI may be difficult due to flooding of rivers and roads.

aJ WHO/APOC, 24 November 2004

'./ )

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

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

Table l: Number of health staff involved in CDTI

District Number of health staff involved in CDTI activities.

Total Number of health staff inthe entire project area

Br

Number of health staffinvolved in CDTI

Bz

Percentage

B:=Bzl Br *100

Guta Wayu 92 46 50.0Diga 28 t7 60.7

Leka Dulecha 20 t2 60.0

Sibu Sire 28 l8 64.3

Total 168 93 55.4

1.1.2. Partnership

Partnership is a principle of APOC as well as the government of Ethiopia which helps CDTIprojects for best achievement of their activities and gradually ensures their sustainability.Since the beginning of the project, there was strong partnership during planning, advocacy,mobilization, drug distribution, monitoring and evaluation of the CDTI activities amongdifferent partners. The main partners involved are Federal ministry of health, regional healthbureaus, zone health desk, Woreda health office, health facilities, the community,WHO/APOC and other government sectors.

Even if it is not the NGDO partner identified for this project, The Carter Center Ethiopia isgiving some technical support for the CDTI. The identification process for the NGDO partneris still going on.

4 WHO/APOC, 24 November 2004

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2.2. Advocacy

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

High-level political leaders and Onchocerciasis task forces at different levels particularly the

Zonal, and Woreda were involved in the advocacy to support the overall CDTI activities. The

members of the Task Forces at all level were officials from all sectors, which have relevance

for the CDTI activity. This political commitment helped the CDTI activities to be started and

successfully achieved its objective.

However, some of the sectors, which are members of the task force, were highly involved inthe ongoing restructuring of government organ, and other activities. This has to some extent

hampered the frequency of scheduled meetings. For the next treatment period the Task Forces

at all level will contribute their part as expected since the work loads they have because ofrestructuring and resettlement will be minimized.

2.3. Mobilization, sensitization and health education of at riskcommunities

Community mobilization was done at each village organizing community meetings. The

health workers at all levels have done their best in organizing the Task Forces and giving

health education for the task forces. The health workers working at front line health facilitylevel were responsible to organize the Kebele Task forces and giving health education for the

task forces, community supervisors and CDDs. The Task Forces at kebele levels which,

comprises of seven members and also responsible for all social, political and economical

activities in the kebeles have played major role in mobilization and sensitization of the whole

community at grass root level. Community Supervisors and CDDs were responsible in giving

health education to the community at village level including women and minorities.

The community mobilization has contributed a lot in awareness creation and as a result the

community involved in the first year CDTI activity with successful accomplishment. Thus,

for the next treatment community mobilization and health education will be shengthened.

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2.5. Capacity building

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

- Where frequent transfers of trained staff occur, state what the project is doing, or intends todo, to remedy the situation. (The most important issue to describe is what measures weretaken to ensure adequate CDTI implementation where not enough knowledgeable ntanpowerwas available or if staff arefrequently transferred during the course of the campaign).

There was a cascade of trainings on CDTI from the higher level to the community level inadequate amount to carry out the CDTI activities. However, there was a few situation where

there were turn over of trained staff particularly at front line health facility level which did notcreate any major problem on the project activity.

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

Any other comments

2.6. Treatments

2.6.1. Treatment figures

If the project is not achieving 100% geographical coverage and a minimum of 65%therapeutic coverage or the coverage rate is fluctuating, state the reasons and the plans

being made to remedy this.


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What are the causes of absenteeism?Most of the absenteeism was occurred because of the overlap of the farmingtime and the drug distribution. This unusual overlap has occurred because of late

commencement of the overall CDTI activities.

What are the reasons for refusals?The main reason for the refusal was fear adverse effects of the drug, which was

seen in some of the cases during the start of the treatment. Gradually the numberof refusals was decreased through continues health education campaigns.

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

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

No SAE case to report

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, r ..2.7. Ordering, storage and delivery of lvermectin

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

Mectizan@ delivered by - (please tick the appropriate answer)MOH M WHOtr UNICEFE NGDO EOther (please speciff)

Please describe how Mectizan@ is ordered and how it gets to the communitiesThe NOTF requests for Mectizan from MDP. After the drug reaches the country it follows the

existing drug and other medical equipment delivery system in the country. Then the drug isstored in MOH warehouse from which projects levels receive. From the project level (zone

level) the Woredas receive it and distribute to the health facilities. It is from the frontlinehealth facilities that the community supervisors get the drug to distribute to the CDDs forthem to distribute to the communities.

Table 10: Mectizan@ Inventory (Please qdd more rows if necessary)

How are the remaining ivermectin tablets collected and where are they kept?At the end of the treatment period, the CDDs were requested to return the remaining drugto their collection centers which are the health facilities. The health facilities, in turn, send

to the Woreda health office and finally from there to the zone health desk. Hence, the

remaining Ivermectin is kept at the project (zone) level.

List and briefly describe the activities under ivermectin delivery that are being carried out

by health care personnel in the project area.. Collection of ivermectin from the Woreda level. Distribution of ivermectin to CDDs. Training of community supervisors and CDDs

' Supervision. Recording and reporting of data

Any other comments

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

East Wollega 834,000 856,000 844,357 0 6,701 0 4,942

TOTAL

l5 WHO/APOC, 24 November 2004

n.) r)

2.E. Gommunity self-monitoring and Stakeholders Meeting

Has any training (of trainers) for community self-monitoring been done in the project area? No.If so, When?

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

Describe how the results of the community self- monitoring and stakeholders meetings have affectedproject implementation or how they would be utilized during the next treatment cycle.

2.9. Supervision

2.9.1. Provide a flow chart of supervision hierarchy

NOTF ) ZOTF) WOTF ) Health Facility ) Community supervisors ) CDDs

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

woreda and front line health facility levels properly.

2.9.3. Was a supervision checklist used? Yes

2.9.3. What were the outcomes at each level of CDTI implementationsupervision?Though the Finance officers have received proper haining on handling theAPOC/WHO fund utilization and liquidation system, still there was problem onliquidating of the used budget. Therefore, on spot training was given duringsupervision. The overall reporting of the CDTI activities was also corrected as

much as possible.

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

2.9.6. How was the feedback used to improve the overall performance of theproject?The good geographic and therapeutic achievement of the project performancesshows promising.

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

No of Communities thatcarried out self

monitorins (CSl{)

No of Communities thatconducted stakeholders

meeting (SHIVD

Guta Wayu

Drga

Leka Dulecha

Srbu Srre

835

4'11

356

564

0

0

0

0

0

0

0

0

TOTAL 2,166 0 0

t6 WHO/APOC, 24 November 2004

.{ i.

SEGTION 3: Support to GDTI

3.{. Equipment

Table 12: Status of equipment (Please add more rows if necessary)

*Condition of the equipment (F:Functional, CNFR:Currently non-functional but repairable,

WO:Written off).**The CDTI activities are highly integrated into the other health system and therefore the

available equipments at the MOH at different levels is used in an integrated manner.

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

The project expects APOC fund to maintain capital equipments that have been provided byAPOC for the first five years. The capital equipments thatare contributions of the government

will be maintained using the goverrrment money. The project is trying its best to perform wellso that APOC would replace these equipments after first five years while at the same time

efforts will continue to allocate budget by the govemment for smooth takeover of the projectgradually.

Source

Type ofequipment

APOC MOH * DISTRICT NGDO Others

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

l. Vehicle 1 F

2. Motor cycle(s) 3 F

3. Computer(s) 1 F

4. Printer(s) 1 F

5. Photocopier (s) I CNFR

6. Fax Machine(s) I F

7. Overhead projector I F

8.25" TV set I F

9. Deiesel Generator I F


)1,

)

3.2. Financial contributions of the partners and communities

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

* Indirect contributions such as staf salaries, ffice supplies, utilities, communication, etc.

**Contribution of CDDs and community supervisors converted in to monitory value

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

- Additional comments

3.3. Other forms of communaty support

Describe (indicate forms of in-kind contributions of communities if any)None

3.4. Expenditure per activity

Indicate in table 74, the amount expended during the reporting period for each activitylisted. Write the amount expended in US dollars using the current United Nationsexchange rate to local currency. Indictate exchange rate used here 1USD : 8.65

t

Contributor

Year I (2004)\ear 2 ('provide the

period')Year 3 ('provide the

period')

TOTALCash

Budgeted(US$)

TOTALCash

Released(US$)

TOTAICash

Budgeted(US$)

TOTALCash

Released(US$)

TOTALCash

Budgeted(US$)

TOTALCash

Released(US$)

MOH (Central + State) 17,000* 17,000

MOH (District * zone) 30,678* 30,678

Local NGDO(s) ( if any) 0 0

NGDO partner(s) 0 0

Communities 200,000** 100,000

APOC Trust Fund 85, I 54 69,200

TOTAL


ActivityExpenditure

($ US)Source(s) of

fundingDrug delivery from NOTF HQ area to central collection point ofcommunity

Mobilization and health education of communities

Training of CDDs

at all levels

Supervising CDDs and distribution

Intemal monitoring of CDTI activities

Advocacy visits to health and political authorities-

IEC materials

Summary (reporting) forms for treatment

Vehicles/ Motorcyc les/ bicycles maintenance

Office Equipment (e.g computers, printers etc)

Others

TOTALTotal number of persons treated

(( r."

Table l4: Indicate how much the project spent for each activity listed below during the

reporting period

*the CDTI activities are carried out in integrated manner

SEGTION 4: Sustainability of GDTI

4.1. lnternal; independent participatory monitoring; Evaluation

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

Year 1 Participatory Independent monitoring

Mid Term Sustainability Evaluation

5 year Sustainability Evaluation

Intemal Monitoring by NOTF

Other Evaluation by other partners

4.L.2. What were the recommendations?

4.1.3. How have they been implemented?

I


,'tl rll

4.2. Sustainabitity of proiects: plan and set targets (mandatory atYr 3)

Was the project evaluated during the reporting period? No

Was a sustainability plan written?

When was the sustainability plan submitted? No

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

4.2.1. Planning at all relevant levels

The CDTI activities are integrated with the other health activities at all health management and

health service giving levels. Therefore, the planning processes are also carried out in an

integrated manner through participatory methods, using bottom-up approach and

integrated with the basic health service.

4.2.2. FundsEnsuring the availabilify fund essential for the sustainability of the CDTI. The govemment willincrease the financial requirement for critical CDTI activities. In addition to this most of the

CDTI activities that are carried out in an integrated manner will receive resources from differentprograms.

4.2.3 Transport(replacementandmaintenance)The APOC donated vehicles for CDTI project are well functional at this time.Maintenance cost was covered from government. The government also uses othervehicles, in an integrated manner since the government uses pool system.

4.2.4. Other resources

4.2.5. To what extent has the plan been implemented

4.3. Integration

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

4.3.1. Ivermectin delivery mechanismsSince the beginning there is no separate Ivermectin delivery system to thelower level; it follows the existing drug delivery system in the country. Therequest for Ivermectin is to MDP is through MOH. As soon as the drug arrived,the same as all other drugs and medical equipments, the all the processesrequired are handled by a Pharmaceuticals Administration and Supply Servicein the MOH. The project levels, like any other medicines, receive and deliverto the respective levels following the existing delivery system.

4.3.2. Training :

CDTI is integrated with the Primary Health Care (PHC) from the beginning. Atthe National, Regional, Zonal, and Woreda levels, the Malaria and OtherVector-borne Diseases Prevention and Control Units are responsible.Therefore, all the staff of these units has received training on onchocerciasis.


No

i

t' \. t

.1..,r.6. Describe other health programmes that are using the CDTI structure andhow this was achieved. What have been the achievements?In some malaria endemic villages, the CDTI structure is used for malariacontrol program. The new structure of "garee" is also responsible for all healthactivities in the village.

4.3.7. Describe others issues considered in the integration of CDTI.The new government structure of "garee" (village) which has got a healthcommittee and the Health extension Package program designed to reach allKebeles with health posts, will play a major role for the integration and

sustainability.

4.4. Operational research

4.3.3.

4.3.4.

4.3.5.

4.4.t.

4.4.2.

Training of peripheral health workers has been carried out in integrated mannerwith other health issues.

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

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

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

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

SECTION 5: Strengths, weaknesses, challenges, andopportunities

Strengths: even though the CDTI activity is new, the project is able to accomplish the

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

coverage high above the minimum standard. This is due to high political commitment at all

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

Weaknesses: delay in reporting from the lower level, poor financial utilization and

liquidation

Opportunities: The expansion of government structure down to village level "garee" and

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

opportunity for sustainability of onchocerciasis control. The Health Extension Package

2t WHO/APOC, 24 November 2004

,ua

program in which there is a start of building a health post in each and every Kebele is also

another good opportunity.

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

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

settlement programs.

SEGTIOil 6: Unique features of the proiecUother mattersNone


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