FY2013 Annual Project 3006 Report

Project Title / Elimination of Blinding Trachoma Project-Gamo Gofa Zone, Konso, Derashe and Alle Woredas.
Project number / 3006
Reporting period / January 2013 to December 2013.

Section 1:

Project Objectives:

  • Reduce the prevalence of active trachoma to less than 10% among 1-9 years old and
  • Reduce the prevalence of Trachomatous trichiasis to below 1% from Gamo Gofa Zone, Konso, Derashe and Alle woredas.
  1. Progress for the past 12 months against the annual implementation plan

1.1. Partner capacity building training

Training is the key project strategy to build the capacity of local partners to be able to provide preventive and curative eye health care services. In 2013 almost all the major planned trainings were completed successfully with more than 95 % achievements. Twenty new (20) nurses were trained on primary eye care including trichiasis surgery. The training has both theoretical and practical demonstration part. The practical demonstration part of the training was organized in rural health centers after announcement of the community with problem called Trachomatous trichiasis .Before the training the selection of trainees was jointly done with partner woredas so as to identify the active long time serving Integrated Eye Care Workers(IECWs).To keep the quality of the training pre and post-testwere given and during the practical demonstration of the training it was expected that each IECW should do minimum of 30 TT lid surgery before they graduate as an IECWs. After the training all the necessary supplies and ophthalmic equipment were provided to health facilities in order to establish and provide regular eye care services. As a result of this training some of them were assigned in health facilities where IECW left and the others at the new health centres where there is no trained nurses in the health centers .

IECWs trained with pre, post -test and number of TT surgery performedduring the training in 2013.

S.No / Name of Trainee / Woreda / HC / pretest % / Posttest % / Total BTR done / No. screening & Medical Rx / Remark
1 / Jomo Sitota Sinta / M/Abaya / Wajifo / 58 / 95 / 32 / 32
2 / Yonas Buta Buya / A/Z/woreda / Gatse / 52 / 95 / 34 / 123
3 / Melese Meleta Tamo / Melo koza / Gaysa / 52 / 77 / 34 / 23
4 / Enderyas Erase gELEBO / Konso / Fasha / 52 / 76 / 32 / 87
5 / mALDAYE kORKE WOLKA / Kemba / Bolanko / 61 / 93 / 30 / 95
6 / ADMASU BARZA BARANA / Dita / Woyza / 52 / 82 / 33 / 63
7 / BIHON BIREGA BIBISO / Melo Koza / Balta / 81 / 86 / 34 / 91
8 / DESALECH GETACHEW SHIBIRU / Kemba / Kara ossa / 45 / 96 / 33 / 89
9 / ASHENAFI AMSALU ABEBE / Derashe / Busa Killa / 45 / 83 / 29 / 88
10 / GETACHEW MELESE Mereko / A/M/Zuriya / Mayzo doysa / 52 / 83 / 31 / 120
11 / HAILU MAMO SHERBO / Boreda / Zefano / 48 / 90 / 33 / 81
12 / TEKALIGN TAMENE ASSEFA / Bonke / Gezeso / 81 / 84 / 32 / 67
13 / MESKEREM LEMMA GODANA / Zala / Galma / 55 / 87 / 30 / 32
14 / BIRHANU YELEA BUNDURE / Demba Goffa / Laymatsala / 68 / 90 / 31 / 68
15 / ABRAHAM AGAMA ALBE / Chencha / Zolo / 65 / 87 / 30 / 25
16 / TIGIST ABATE HABTAMU / Sawla Town / Sawla Hospital / 29 / 72 / 30 / 31
17 / MESERET MENZA MESA / Bonke / Deshkele / 45 / 79 / 30 / 34
18 / ADANE AYSA AZIZA / Kucha / Morka / 55 / 62 / 30 / 78
19 / TARIKU TADESSE KANA / Boreda / Menuka / 32 / 65 / 30 / 89
20 / TEKA TENTO TEMA / Chencha / 31 / 90 / 31 / 82
629 / 1398

22 (95.6%) (16 refresher and 6 new) IECWs were trained on basic refractive errors for two weeks, 5 days theoretical and 10 days practice demonstration in Arbaminch hospital. The plan in 2013 was to train 2515 different categories of health workers and community volunteers but 2345 was trained and this was 93% of total plan.Hence from these different categories of the health workers and community volunteers, a total of 605 (more than 100% ) of Community Health Agents(CHAs), 989(90% ) of Health Extension Workers (HEWs), 685 (almost 98% ) of teachers ,73(91%) community influential and religious leaders , 20 mass media peopleand 10 women group leaders in one of partner woredas received refresher training on how to produce soap from locally available materials. Particular emphasis was given on the F and E components of the SAFE strategy through the training of teachers, health extension workers and community health agents. Health extension workers (HEWs) are responsible to make house to house visits and educate mothers on personal and environmental sanitations. Community health agents (CHAs) were trained to identify and refer cataract and trichiasis patients to health facilities. Trained teachers were able to test vision of students and identify those with refractive errors and refer for better refractive error management to selected health facilities. In addition, the trained teachers establish/strengthen school eye care clubs through which the importance of face and hand washing and use of pit latrines is transmitted to communities through students to prevent trachoma infection.

Moreover,more than4,844 Zithromax distribution team members, supervisors, zonal and woredas higher officials who were participated in Zithromax distribution campaign in 16 woredas were trained on Primary Eye Care (PEC) and the importance of taking in Zithromax drug in prevention and control of trachoma.

four days Training of Trainers(TOT) was given for 52 (87%) focal person from health sector, one of the trainees was senior IECW and the other two were senior nurses working in each woreda health offices of the project area. This training was given by consultant from Hawassa University who has experience in such trainings to keep the quality of the training .During the training particular emphasis was given on basic trachoma prevention and control, regular monitoring, teaching methodology, documentation (recording and reporting) and strengthening of school eye health care clubs. Besides to these, the trainees gained adequate training skill how to deliver basic training to trainees at woreda level .

The whole purpose of training for the different stakeholders was to disseminate the required information to all sectors of the community so that awareness and eye care service utilization particularly about trachoma could be improved.

1.2 Provide primary eye health care service

During this year , the plan was to screen a total of 32,000, it was able to screen 35517(111%) people for various ocular problems, mainly for trachoma and cataract by health professionals at both base health facilities and outreach program . . However, the achievement was more than the planned target. This was due to the increased number of primary eye care units established, increased awareness of the community to seek medical care for eye health problems and the improved access to service providing units. Trained religious leaders and community influential elders who have been participating in raising the community awareness towards trachoma prevention and control was also a contributing factor for the increased number of people examined.

Again14691(98%) school students were screened for refractive errors by trained teachers in the project area. Of these, students with refractive errors problem referred to PECUs where trained IECWs and optometrist to better manage with eye glasses

A total of74,386 more than 100% against the annual planof adults and children were treated medically. Medical treatment includes treatment with 1% Tetracycline eye ointment (TTC), for children and adults with active infections; spectacle provision for students with refractive errors and woreda based mass antibiotic distribution of Zithromax for prevention and treatment of trachoma infection and transmission. Sixteen woredas were covered with mass antibiotic distribution based on trachoma baseline findings (Arbaminch Zuria, Bonke, Kemba, Dita, Chencha, Boreda, Konso, Derashe, Alle, Kucha, Zala, Ubadebretsehay, Geze Gofa, Demba Gofa, Oyda and Mellokoza). One million Nine hundredSixty Eightthousand and FourhundredThirty Six (1,968,436) with 97% achievement people were treated with Zithromax tablets and syrups in the aforementioned woredas. Impact survey was conducted in this year in six woredas of the project area and these were Konso, Derashe, Kemba , Bonke, Arbaminch Zuria and Deramalo . the results of the impact surveys have showed that the prevalence active trachoma and TT has significantly reduced below WHO cut point and trachoma is no more a public health problem in Deramalo woredas and therefore, the woreda is excluded from Zithromax distribution. The prevalence of active trachoma and TT was also significantly reduced ( more than 50%) from the base line in the remaining 5 woredas .According to the impact survery results, MDA should be conducted in the remaining 5 woredas and hence , 6th round MDA was conducted in four woredas ( Konso, Kemba, Bonke and Arbaminch Zuria ) and fourth round MDA in one woreda ( Derashe). Three woredas ( Chencha, Dita and Boreda and ) completed fifth round, seven of the last mentioned woredas of Gofa area conducted MDA for the third round. In 2013, the distribution went very well with average coverage of 97%. The success was due to the application of multiple advocacies and other community sensitization and mobilization strategies like involving influential community elders, politicians, religious leaders and broadcasting the information through local radio stations using four local languages. In addition to this the community awareness about MDA at community level was really changed to positive attitude towards the benefit of the drug to cut the circulation of causative agent of trachoma.

Seventy ThreeThousand One hundred Eight Four (73,184) people, mainly children with active trachoma infections were treated with 1% Tetracycline Eye Ointment (TTC)in health facilities and outreach program and during MDA. Spectacles were provided to 1,375 school children with refractive errors by trained IECWs and consultant optometrists. Overall achievements of medical treatment (MDA, TTC eye ointment and eye glasses dispensing) activitieswere 99 % in average from the planned.

1.3. Establish and strengthening of PECUs to provide regular trichiasis surgical services

Reducing the prevalence of Trachomatous trichiasis to below 1% by the end of the project life in all woredas is the key objective of the project. Attaining this objective needs a very efficient communication and advocacy within the different stakeholders (Zone and woreda health officials, community volunteers, IECWs etc.), well established referral system, well equipped health facilities with the necessary equipment and supplies and committed TT surgeons. Hence much attention has been paid to disseminate information about the prevention and treatment of trachoma, to mobilize community, identify and refer patients with TT to have the lid surgery. All possible efforts have been made to bring a change in increasing TT surgery service uptake at health facilities and their corresponding outreach sites. The overall achievement for total surgeries (both trichiasis and cataract) performed was 6,229(99%). Of this, 5,966 (99%) patients were operated for TT and 263 (88%) patients for cataract. The services utilization of surgery greatly improved compared to the last year performance specially the uptake of cataractsurgery. The cataract surgeon left the Sawula SECU in June of 2013, however, we were able to mobilize cataract surgeons from different SECUs working in the country by contractual agreement to come to this achievement of cataract surgery service.. Reasons for improved service uptake were massive mobilization of TT and cataract patients by trained community elders, the involvement of religious leaders, IECWs and woredas higher officials, mobilization of patients with cataract by cataract surgery service beneficiaries and above all transport support provided by ORBIS for those selected cataract patients to and from Sawla SECU and motivation for the IECWs who screen and refer the cases. The involvement of the community leaders particularly the chief administrates of the woredas was resulted in increased number of the cataract and TT service up take. The screening of cataract patients primarily made by IECWs in each woreda of Goffa area and then rescreening (confirming) made by cataract surgeon before transporting to SECU. Such decision (logistic support including transport) was reached on the last year based on the problem of service utilization. During annual and biannual review meeting with partners the service up take issue and its short comings was discussed detail and the new strategy was designed to motivate IECWs per number of cataract cases referred as matured cataract case surgery be done .This improved service utilization believed to be continued in the coming years as well and agreed during the annual review meeting.

1.4. Advocacy on primary eye care services

Public awareness and education activities is a key part in changing the health seeking behaviour of the community, improve the demand and utilization for eye health care services. In this regard, in 2013 different advocacy activities were conducted to increase the community awareness towards trachoma prevention and control methods. Regular trachoma prevention and control messages were disseminated through local radio using four local languages of the area. Three dramas on trachoma prevention and control were conducted in three woredas schools by school eye health care club members where all school community members attended. Again small version of Ethiopian Great run concerning trachoma (with message about trachoma) in Arbaminch town created and important message disseminated for those who attended during the run.In general the school eye clubs created informative events at schools which include song in local language concerning SAFE strategy, and the great runwas also attended by visiting team from Irish board memebers and it was a colourful and attractive.

1.5. Construction of model communal latrines

As per the 2013 annual project plan two communal latrines were constructed in Konso woreda at community site and at school which has active eye health club with problem of school latrine. The construction sites were selected by the woreda health offices and the community. ORBIS supported the cost for the construction materials and cost for the hired builders. The community contributed by providing water, sand and the labor cost. This collaborative effort, as shown in previous years, has brought strong community ownership. As a result of communal latrine constructions in Konso woreda, open field defecation has reduced and is becoming unacceptable by the local communities and at the same time there is increased community demand for more communal latrines.

Besides to above mentioned constructions, two block latrine in Arbaminch zuria woredas was constructed at school and water scheme development was also made in two woredas in partnership with Water Aid and catholic church. ORBIS has made a financial contribution of 1.9 million birr for the above WASH partnership development in the specified woreda. Moreover, 486,000 birr was invested in the school and public latrines construction and water point development in Deramalo woredas in collaboration with Gamo Gofa zone water and energy, and finance and economic development departments

1.6. Procurement and distribution of ophthalmic equipment and supplies to PECUs and SECU

All the necessary ophthalmic equipment and supplies for the secondary and primary eye care units were procured domestically and a repeated procurement of these supplies were made based on the demand raised and provided to the partner woredas (primary eye care and secondary eye care units). All supplies were purchased in sufficient quantities and were distributed to all the functional PECUs and SECU. Based on demand from PECUs, the supplies were distributed as necessary.

1.7. Other project related activities

  • Annual review meeting on the 2012 achievements and 2013 planning was conducted with implementing partners from all woredas (IECWs, head of health centers, woredas health, finance and education offices heads ) including Gamo Gofa and Segen Area People zones health, finance and education departments was conducted successfully. Based on the review on the achievements of 2012, participatory planning for 2013 activities was made
  • Biannual review meeting was conducted with IECWs, health center heads, and woreda health PEC focal persons where 6 months activities achievements presented and discussed by partners. Strengths and limitation during the implementation of activities identified and follow up action points developed. Here during this biannual review meeting the target plan was revised per woredas and each IECW was planned his/her own plan for the rest months of the year. This new way of planning created conducive environment to share responsibility and accountability for high and low performance respectively.
  • Refresher training with IECWs was also conducted. Success stories, best practices and other encouraging achievements were presented by IECWs. Challenges were also discussed in detail particularly on how to increase TT uptake and increase the cataract surgery service utilization in line with the annual plan.
  • Hands on training on lid clamp was given for senior 13 IECWswho then can transfer the skill the trainees gained to junior IECWs .
  • Joint supportive supervision to PECUs was made by field coordinators, project manager in collaboration with Gamo Gofa zone health and education departments and respective woredas health and education offices. Such supervision has brought a change in conducting and providing eye health care services regularly in the outreach and static sites. The joint supportive supervision and monitoring also conducted with zonal finance and economic development sector . In addition to the above activity ,students with refractive errors were screened and given eye glasses by trained IECWs and consultant optometrists in strong collaboration and support from respective woredas and zone education offices and department respectively. As result, the services of screening students with refractive error and distributing eye glass for those students with the problem successfully completed in the year 2013.
  • Attending in annual review meetings of education and health sectors at zonal level in two zones of project area(Gamo Gofa zone and Segen area people’s zone) and the progress of eye health care in the project area and challenges during the implementation of Primary Eye Care were presented to participants of the meeting .
  • More than 10,000 IEC/BCC materials, mainly focusing on trachoma, in the form of leaflets were distributed to community members through IECWs in different health facilities.
  • In collaboration with WaterAid Ethiopia, Expansion of WASH (water, sanitation and hygiene) project to Arbaminch Zuria Woredahas started in 2013. This WASH project was implemented by a local faith based NGO named Catholic Church in collaboration with the local government. ORBIS Ethiopia (through its Gamo Gofa project staff) and WaterAid Ethiopia have provided continuous technical backup and close monitoring. As a result one school communal latrine and one latrines in the health post were constructed; one motorized water source and one on spot spot spring recappingwere constructed.

The annual achievement against plan of year 2013