FY2014 Annual Project Report: Project code 3028
January to December 2014
Project Title / Establishing Comprehensive Rural Eye Health in Two Districts and Jinka Town of South Omo Zone of SNNPR, Southern EthiopiaProject code / 3028
Reporting period / January 2014 to December 2014
Section 1:
project Objectives
By the end of the 4 years project period:
1. Reduce blindness caused by trachoma in South Omo Zone
a. By the end of the project, the prevalence of Trachomatous trichiasis will have reduced from 1.14% to less than 0.1% from the total population in the two districts of South Omo Zone.
b. By the end of the project, the prevalence of infectious trachoma will have decreased from the existing level of 28% (in the 2 woredas of North Arii and South Arii) to <5% in children 1-9 years.
c. By the end of the project, 80% of the population in the two intervention woredas will be aware of and implementing improved hygiene practices to reduce infectious trachoma.
d. By the end of the project, the adequate availability of clean water will have increased from 12% to 56% and sanitation coverage will have increased from 8% to 54% in the targeted kebeles.
2. Reduce blindness and visual impairment through strengthening refractive error and cataract services
a. By the end of the project, eye health services for cataract, TT, refractive error and other eye diseases will be established at one SECU and 25 PECUs.
b. By the end of the project, 50% of patients operated for cataract will have corrected vision of 6/18 or better on the operated eye within 3 months follow-up after surgery.
c. By the end of the project, 100% of patients presenting with refractive error will receive refraction, a prescription for spectacles and 100% of children with refractive error will receive free spectacles.
Section 2
1. Progress for the past 12 months against the annual implementation plan
Key project strategies;
· Capacity-Building through Training
· Strength the only SECU at Jinka
· Establish 10 new PECUs in two woredas and Jinka city administration
· Strengthen the newly established PECUs and SECU with the necessary supplies and equipment
· Establish Eye clubs in all schools of the project districts.
· Health Communication (advocacy)
· Implementation of SAFE Strategy
· Developing partnerships with other organizations in the project area
Table showing the annual activity targets and achievements
S.N / Activity / Planed / Achieved / Percentage (%) / Justification for over/under performance1 / Training of new nurses in PEC and TT surgery / 10 / 10 / 100
2 / Refresher training of IECWs / 10 / 10 / 100
3 / Training for new health extension worker on PEC / 143 / 162 / 113
4 / Basic refraction training for IECWs / 10 / 10 / 100
5 / Training for CHA on PEC, cataract and TT identification and referral system / 184 / 178 / 97
6 / Training for new teachers on school children vision testing and referral / 140 / 148 / 106
7 / Training of Trainer for woreda health office staffs / 10 / 9 / 90
8 / Screening of patients for cataract, trachoma trichiasis and other eye conditions at health facilities and out reach / 9600 / 5882 / 61 / Limited number of PECU
9 / Screening of school children for refractive error / 2500 / 2748 / 110
10 / Number of adult persons provided with eye glasses / 75 / 120 / 160 / Increase demand for eye glasses a
11 / Number of school children provided with eye glass / 100 / 121 / 121 / Well-coordinated school outreach program contributed for the achievemant
12 / Number of people treated with 1% tetracycline eye ointment (including children) / 5700 / 7574 / 133 / The coverage of TEO during MDA was improved
13 / Number of adult people treated with Zithromax / 165,744 / 156,011 / 94
14 / Number of children treated with Zithromax / 146,987 / 138,349 / 94
15 / Number of TT surgeries done / 475 / 599 / 126
16 / Number of cataract surgery done / 250 / 112 / 45
17 / Number of people educated / 1950 / 2058 / 105
2. Project management’s assessment of the past 12 month’s project progress in relation to the overall multi-year objectives.
Discuss continued relevance of project objectives and design, appropriateness and sufficiency of planned activities to achieve goal & objective and present status in achieving the multi-year objectives.
As an initial year of the project implementation in the zone, we learnt a lot while striving to achieve the goals and objects of the project.
With few exceptions like patient screening and cataract surgery, almost all the targets were met successfully which ranges between 90 - 160%. Specially all the training components of the activity has been accomplished successfully, this would definitely build the capacity of local partners and would contribute a lot towards achieving the project objectives in the fourth coming years and later for sustainability of eye care in the zone.
Mass drug administration is one of the key activities of the project in the fight against trachoma. In this regard, the project accomplished remarkable achievements in which 301,934 children, pregnant mothers and elder residents were treated and or protected from trachoma with zithromax and tetracycline eye ointment.
This year through the training of 10 IECWs and equipping of 10 health institutions, the project established 10 new PECUs (now nine of them functional) and have carried out 599 TT surgeries which is 126% achievement in comparison to the plan. Currently all the established PECUs are providing comprehensive primary eye care service to the community at the static and outreach based programs except one PECU where the trained IECW left the facility. Apart from the establishment of the PECUs, we managed to establish 62 new school eye clubs in all schools of the two woredas and Jinka city administration. The established school eye clubs are addressing issues of face washing, personal hygiene and environmental sanitation.
The SECU in Jinka Zonal hospital was strengthened with different medical equipment ranging from ophthalmic operating microscope, biometry machines to consumables and post-operative medications. The cataract surgeon was only able to operate 112 cataract surgeries which is 45% achievement compared to the plan.
The low achievement is related to shortage of supplies and drugs occurred as a result of lengthy and delayed international procurement took place in the year. Though the performance for the year is low, it is believed that the SECU has improve a lot in terms of providing its service regularly and the number of cataract surgery has increased significantly from six surgery per annum to 45. In this regard the service has improved as compared to the period where Orbis support was non-existent.
A. Major cumulative achievements by objectives from start to Dec 2014 (results):
i. The opening of ten new PECUs (nine of them are functional now) in two districts which is helpful in improving accessibility of eye care and reduces travel time. Moreover the establishment of these PECUs gives chance for the local residents to seek eye health care and increases their awareness as the assigned trained IECWs provide eye health education regularly.
ii. The training of more than 527 eye health care cadres (new and refresher IECWs, basic refraction trainees, HEWs, HDAs teachers…etc) that ensures the accessibility of PEC service and sustainability of the project.
iii. 62 new school clubs were established in all school of the project implementation districts.
iv. 2748 school children were screened for refractive error and 120 school children with refractive errors received free corrective spectacles.
v. The SECU of Jinka Zonal hospital was strengthened through provision of high tech medical equipment like operating microscope, A-Scan, keratometer, ophthalmoscope, trial sets, tonometer and several consumables and supplies.
vi. 112 patients with cataract received cataract surgical service.
vii. The project has been able to treat 301,934 eople with Zithromax and tetracycline eye ointment for the reduction of active trachoma. This achievement will contribute a lot in reducing the prevalence of Active Trachoma.
viii. Key trachoma message is being broadcasted in eleven local languages through local FM radio.
ix. 9 woreda health office officials (woreda focal persons) received TOT training for the purpose of capacitating them to provide training for HEWs, CHAs and Teachers.
x. We established strong partnership with local partners. The project usually goes forward in consultation with the two districts concerned offices and their support has grown from time to time.
xi. Orbis Ethiopia in collaboration with AMREF Health Africa is implementing “SAFE” strategy to tackle trachoma in South Omo project. In this regard the two organization shared the componenets of SAFE stategy where Orbis is addressing the “S” and “A’ component and AMREF is implementing the the “F” and “E” component. The following are activities performed by AMREF in the year.
· conducted one project launching in collaboration with Orbis international
· - established and provided training for 14 woreda WASH team members
· - provided training for 30 woreda WASH committee members
· - rehabilitated 2 water schemes
· - constructed 2 new water schemes
· - provided training for 14 HEW on PHAST integrated with MDA
· - constructed 2 school VIP latrines with separated male and female rooms and with hand washing facility
· - established and equipped 8 school hygiene and sanitation clubs with CHAST
· - celebrated world hand and face washing days in collaboration with Orbis International and zonal partners.
· - produced different IEC/BCC materials (100 T shirts and capes for participants of world hand washing day)
· - provided 2 motor cycles for partners
· - purchased and provided seed spares for WASH committees
b. Quality of clinical outcomes measure for Cataract: VA measurement, what percentage of total patient restored sight (revert blindness), improved sight by the project? Provide a table of VA after treatment/surgery following WHO standard criteria of outcome measures.
Though the clinical quality outcome is not done this year, the SECU is regularly implemented the keratometer and A-San measurement to calculate the IOL strength for individual patient and uses ranges of IOLs that contributes to the quality surgical outcome.
c. Follow up of training program: Provide a table with list of all training (fellowship and HBPs) completed during the past 12 months in FY2014: doctors, nurses, technicians, managers. Give a follow-up note on each fellow about their performance after training. Provide any Cyber-Sight activity by trainee surgeons.
s.no / activity / Planed / achieved / percentage / Follow up1 / Training of new nurses in PEC and TT surgery / 10 / 10 / 100 / PEC service increase ever since the trainings
2 / Refresher training of IECWs / 10 / 10 / 100
3 / Training for new health extension worker on PEC / 143 / 162 / 113 / Patient flow increased
the trainees assisted for good coverage of MDA
4 / Basic refraction training for IECWs / 10 / 10 / 100 / Availability of refraction service improved
5 / Training for CHA on PEC, cataract and TT identification and referral system / 184 / 178 / 97 / Patient flow increased the trainees assisted for good coverage of MDA
6 / Training for new teachers on school children vision testing and referral / 140 / 148 / 106 / School children screening has improved greately, from observation , number of children with clean face has improved
7 / Training of Trainer for IECWs, CHAs and HEWs trainers / 10 / 9 / 90 / Improved quality of training based on knowledge
As Primary Eye Care Service started immediately following the first round training for IECWs on PEC and TT surgery, the community started using the service in the nearby facilities. The training has also put its positive influence in reaching remote areas where there were no eye care services. The newly trained IECWs on basic refraction are now providing screening of patient for refractive errors.
The flow of patient has relatively increased in PECUs and SECU after the newly trained IECWs been employed and after trainings were provided for CHAs and HEWs. Through the trained teachers, school clubs has been established in all schools of the 2 districts and Jinka town and the performance of the teachers in screening of school children for refractive error has been enrmous.
The provision of TOT training for woreda health office officials for the provision of trainings for CHAs, HEWs and teachers training had served as a source of trainers in all districts which made the trainings of CHAs, HEWs and teachers to be provided by a trained man power who knows the local context very well.
As this is a rural project, there was not cyber sight activity
D. Constraints encountered to project implementation, if any
· Malfunction of operating microscope in the mid of second quarter and this has resulted in low cataract surgery performance.
· Delayed provision of internationally procured ophthalmic equipment, instruments and supplies to the project. This has happened due to a very protracted procedures and processes of international procurement