FY2014 ANNUAL PROJECT REPORT: Project CODE 3025

January to December 2014

Project Title / Strengthening Cataract, Trachoma and Refractive Error Services in Kembata Tembaro Zone and Halaba Special Woreda, Southern Ethiopia.
Project number / 3025
Reporting period / January 2014 to December 2014

Section 1:

project Objectives

By the end of the 6 years project period:

  1. Accessibility will have improved from an average of 6 hours travel time to two hours for cataract surgery and refractive error services in Kembata-Tembaro zone and Halaba special woreda.
  2. 80% of patients operated on for cataract will have corrected vision of 6/18 or better in the operated eye using WHO criteria -1-3 months’ follow-up.
  3. 80% of patients will purchase the low cost spectacles that are issued after being fitted by an optical workshop organized at nearby Wolalita Sodo Hospital SECU and other dispensing units.
  4. Primary eye care services, including TT surgery, will be available to 100% of Kembata-Tembaro zone and Halaba special woredaresidents.
  5. The prevalence of TT will be reduced from 2.9% to less than 1% while the prevalence of active trachoma will be reduced from 34 % to below 10%.
  6. The SECU will generate revenue enough to cover 30% of their annual budget for supplies and consumables.

Section 2

  1. Progress for the past 12 months against the annual implementation plan

Key project strategies;

  • Capacity-Building through Training
  • SECU Sustainability
  • Strengthen the existing PECUs and SECUs with the necessary supplies and equipment
  • Health Communication (advocacy)
  • Implementation of SAFE Strategy
  • Partnership Development

Table shows the annual (2014) activity targets and achievements

Activity / Planed / achieved / percentage
Training of new nurses in PEC and TT surgery / 16 / 16 / 100
Refresher training of IECWs / 40 / 38 / 95
Refresher training for HEWs / 448 / 412 / 92
Basic refraction training for IECWs / 6 / 6 / 100
Refresher training for IECWs trained on basic refraction / 8 / 5 / 63
Training for CHA on PEC, cataract and TT identification and referral system / 448 / 446 / 99
Refresher training of teachers / 362 / 354 / 98
Screening of patients for cataract, trachoma trichiasis and other eye conditions at health facility and out reach / 20,000 / 34,048 / 170
Screening of school children for refractive error / 20,000 / 19,113 / 96
Number of persons provided with eye glasses / 1500 / 1553 / 103
Number of people treated with 1% tetracycline eye ointment(including children) / 39,000 / 38,308 / 98
Number of people treated with zithromax / 929,545 / 902,508 / 97
Number of TT surgeries done / 3100 / 3515 / 113
Number of cataract surgery done / 450 / 550 / 122
Number of good visual outcome of patients operated for cataract (not routine) / 80%
Number of people educated / 26,000 / 30,146 / 116
School toilet construction / 2 / 2 / 100
  1. Project management’s assessment of the past 12month’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.

The past twelve months was a time where we learned more in terms of achieving the overall/ multi-year project goals and objectives.

The set targets were met successfullyfor most of the activities throughout the year. All trainings were implemented in a range between 63-100%. This will build the capacity of local partner and would contribute to the project sustainability as reflected in the objectives of the project. Other activities which relates with service delivery to the community by SECU and PECUs attained in a range of 96-170%.

Mass drug administration is one of the key activities of the project in thefight against trachoma. In this regard, the project has accomplished a remarkable achievement in which over 921,427 residents- were treated or protected from trachoma. The project also can be evaluated as to be in the right path as it addressed one of the major objectives in terms of reducing the trichiasis backlog. In the FY,the achievement of the project for TT surgery has been 113% of the plan.

Existing 180 school eye health clubs continually addressed issues of face washing, personal hygiene and environmental sanitation by trained teachers. In this year the project also constructed two school toilets at Kembata Tembaro zone and Halaba special district in the effort to implement the “SAFE” strategy in its full scale.Probably the project may need more commitment and investment to address the “F” and “E” component of “SAFE’.

With regard to addressing the first objective of the project, increasing accessibility of eye care for the population at the project area, the facilities providing eye care services in 2014 has reached to seventeenwhich was nil in 2011, this has enabled the project to reach all the districts of the project area and will further continue to expand in the years to come. The refractive error management service also geographically covered all districts ofthe zone.A trained IECW in basic refractive error is assigned toeach PECUs found in each district.. Students with refraction problem were also reached during school outreach and refraction program conducted by anoptometrists from Durame SECU.

In terms of achieving objective 2, providing quality cataract surgery, though a routine cataract surgical audit has not been employed, the cataract surgeon in Durame SECUhad the skill of sutureless manual small incision cataract surgery which is known to be one factor for a better quality cataract surgical outcome .The optometrist in the SECU also undertake a routine post-operative refraction to correct residual refractive error and provide them appropriate spectacles or prescriptions for that.

The service uptake for cataract surgery has increased as compared to previous years, this was mainly due to regular outreach program to reach beneficiaries at their vicinities and also due to increased community mobilization using trained health cadres.

With regard to financially sustain the SECU, some efforts are underway; the SECU is collecting revenues from patients from cataract surgery provided at base facility aiming to financially sustainthe unit including refilling of the necessary supplies and drugs. But this need to be further strengthenedin consultation with Durame Hospital to create a more meaningful financial sustainability.

  1. Major cumulative achievements by objectives from January 2014 to Dec 2014( results):
  2. The opening of 4 PECUs in new districts which is helpful in improving accessibility-reduces travel time.
  3. Each woreda accessed refractive error service.
  4. The training of 1,277eye healthcare cadres that ensures the accessibility, service utilization and sustainability of the project.
  5. About 19,113school children were screened for refractive error.
  6. The project has been able to treat 921,427 people with zithromax and tetracycline eye ointment during MDA for the reduction of active trachoma. This achievement is considered to contribute to the overall objective of the project to reduce the prevalence of active trachoma from 34% to less than 10%.
  7. The construction of two school latrines in two schools
  8. Key trachoma message broadcasted through local FM radio for more than two weeks through local language.
  9. Training was provided for partners finance staffs from each districts and zone to strengthen their skill of managing the transferred budget as per Orbis’s financial breakdown and procedures.
  10. We established strong partnership with local media organizations.

Quality of clinicaloutcomes 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 me

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.

  1. Follow up of training program: Provide a table with list of all training (fellowship and HBPs) completed during the past 12 months inFY2014: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
1 / Training of new nurses in PEC and TT surgery / 16 / 16 / 100 / PEC services have increase ever since
2 / Refresher training of IECWs / 40 / 38 / 95
3 / Refresher training for HEWs / 448 / 412 / 92 / Patient flow improved and MDA coverage was assisted
4 / Basic refraction training for IECWs / 6 / 6 / 100 / Refraction service availability improved
5 / Refresher training for IECWs trained on basic refraction / 8 / 5 / 63 / same
6 / Training for CHA on PEC, cataract and TT identification and referral system / 448 / 446 / 99 / Patient flow improved
7 / Refresher training of teachers / 362 / 354 / 98 / Screening of school children helped to identify student with refractive error that couls assist for early detection

The trichiasis surgery, the medical treatment, the screening and other planned activities were relatively increased since the new and refresher training of nurses on PEC and TT surgerywas given.

The flow of patient has relatively increased in PECUs and SECU after the training of CHAs conducted.

The teachers training has contributed significantly tothe increased performance of school children screening in the project

The newly trained IECWs on basic refraction now are providing screening of patient for refractive error and provide treatment or referring them to the nearby SECUs for further examination by an optometrist.

The IECWs training has also put its positive influence in reaching remote areas where there were no eye care services through expansion of PECUs. In this year alone, fourprimary eye care units established and outreach program also increased than ever before. The number of PECUS has grown to 32 and out of these 26 of them are providing regular outpatient and outreach service.

  1. Constraints encountered to project implementation, if any
  • Turnover of trained eye care workers (IECWs). In this year alone five trained IECWs stopped
  • Delay of zithromax shipment created difficulties in setting the date for MDA and as a result the distribution program pushed forward to the end of November
  • Solutions found/proposed to constraints encountered, if any
  1. Orbis frequently requested and closely followed to obtain the required Zithromax dose from ITI and FMOH. We have also carried out early preparations with partners to conduct MDAs immediately after obtaining the drug. .
  2. ORBIS Ethiopia has continued to advocate for eye care to be a priority health agenda in the zone.
  3. We have been trying to train more eye care workers to compensate turnovers.
  4. Visit by any senior ORBIS staff, donor, media representative,etc..,

In this physical year,rural program manager and project manager visited the project three times. The purpose of the visits were to monitor the project half year performance with partners, to conduct joint project midterm evaluation with regional signatories (Finance and Economic Development, Helath and Education bureaus )and to discuss with partners on the implementation of project activities like latrine construction, budget settlement and to set MDA micro plan.

  1. Need for adjustment/project amendment , and new opportunities, if any

(If project activities, outputtargets and strategies should be adjusted, please state it here, including justification. Amendment, if proposed, should be submitted by latest Feb 15thfor approval. This section can also include any new opportunities that may be included, and the justification. )

  • Targets for refresher training for IECWs trained on basic refraction training need revision from 56 to45.

Justification: refresher training will be considered for those IECWs who are actively working in the PECUs or for those who need skill update based on recommendation of joint Supportive Supervision.

  • Pre-fitted eye glass treatments for adults and children to be reduced from 3800 to 1100

Justification: The project budget for procurement of spectacles can only accommodate procurement of glasses for 1100 beneficiaries in 2015.

  1. Key lessons learned and other relevant aspects.

(Key lessons learned, from any evaluations, review,and other aspects deemed important by the project staff/ partners)

Bi-annual project monitoring

  • In collaboration with zone and special district health sector, bi-annual project`s performance was reviewed in the presence of the districts health office heads, IECWs and head of HCs were PECUs and staffs from SECU. The performance was reviewed district by district and unit by unit to identify gaps, strength and way forwards. As a result, follow up of the performance of the various eye units from districts and zone officials increased; the performance of units with low uptake in the previous quarter has demonstrated an increased service output.

Project midterm evaluation

The Midterm evaluation of the Project was also conducted in this year. The evaluation team was comprised of regional signatory bureaus, zone line departments and representatives and heads of the respective district offices as well as staffs from facilities in each districts.

The evaluation team concluded that Orbis has laid strong foundation for eye care in the project area. It was identified that the project owns several strengths including the high relevance of the project to the felt needs of the community, the very good achievements exhibited for some crucial targets (TT surgery, MDA, refractive error management and accessibility). This need to be replicated to other areas where Orbis is not operating.

Some shortcomings identified during the evaluation were lack of projects based audit report, short of human resource and lack of office at the regional capital were among iterated few.

  1. Implementation plan for next 12 months (FY2015)

(List key activities planned for next 12 months, their link to the project objectives, expected timeline, and annual targets to be entered in iPDMS)

Activities in 2015 / link to project objectives / expected timeline / annual target
Training for New nurses on PEC + TT surgery / For service expansion & increase accessibility of basic PEC including TT surgical service relates to objective one and five / Qtr1 / 16
Refresher training for IECWs / To meet objectives I, IV and V / Qrt1 / 45
Refresher Training for HEWs / Meets objectives four and five / Qrt1 / 448
New basic refraction training for IECWs / possible service expansion & increase accessibility of basic PEC service relates to objective three / Qrt.1 / 6
Refresher training for IECWs trained on basic refraction / possible service expansion & increase accessibility of basic PEC service relates to objective three / Qrt.1 / 14
Refresher training for CHAs / Meets objectives four and five / Qrt1 / 448
Refresher training for Teachers / Meets objectives five / Qrt1 / 362
Screening of patients for cataract, trachoma, trichiasis, and other eye diseases at health facility and outreach sites / Reduces blindness caused by trachoma to the level that it will not be a public health importance and reduction of RE. Relates to objective 2 and 5 / 1-4Qrts / 25000
Screening of School Children for refractive error / Addresses the problem of low vision caused by refractive error. Relates to objective three. / 1-4Qrts / 20000
Number of Persons provided with Eyeglasses / Addresses the problem of low vision related to refractive error. Relates to objective three. / 1-4Qrts / 1100
number of adult people treated with 1% tetracycline eye ointment / Reduces blindness caused by trachoma to the level that it will not be a public health importance. Relates to objective 5 / 1-4Qrts / 14000
Number of adult People treated with Zithromax / Reduces blindness caused by trachoma to the level that it will not be a public health importance. Relates to objective 5 / Qrt4 / 505,468
Number of children treated with mass distribution of Zithromax (it is estimated that 45% of those to be treated would be children) / Reduces blindness caused by trachoma to the level that it will not be a public health importance. Relates to objective 5 / Q4 / 448,245
Number of children treated with 1% Tetracycline eye ointment (it is estimated that more than 90% would be children) / Reduces blindness caused by trachoma to the level that it will not be a public health importance. Relates to objective 5 / 1-4Qtrs / 16,700
Patients operated for trichiasis / Reduces blindness caused by trachoma to the level that it will not be a public health importance. Relates to objective 5 / 1-4Qtrs / 3000
Patients operated for cataract / provision of quality cataract surgery service to the residents of the project and restores good sight relates to objective two. / 1-4Qtrs / 500
Number of people educated / Reduces blindness caused by trachoma and other causes. / 1-4Qtrs / 16000
Section 3.
Attach an Excel summary of key project results for all past project years. Note: This need to include more than the summary core indicators already in iPDMS year by year and total, i.e. - include results: outputs, outcomes that are related to this particular project. Provide a brief narrative to comment on achievements over life of project to end of 2014.
KAT project cumulative activity plan and performance 2011 to 2014
Summary activity and target of FY 2011 and2014 / Plan 2011-2014 / out-put 2011-2014 / percentage / outcome
Summary activity and target of FY 2011 to 2014
Training of new nurses in PEC and TT surgery / 62 / 62 / 100 / improved accessibility of PEC service including TT surgery
Refresher training of IECWs / 55 / 53 / 96 / improved accessibility of PEC service including TT surgery
Training for new health extension worker on PEC / 420 / 392 / 93 / promotion of good eye health care and increased uptake of TT and cataract surgery
Refresher training for health extension worker on PEC / 448 / 412 / 92 / same as above
Basic refraction training for new IECWs / 12 / 12 / 100 / provision of refractive error correction by trained personnel
Refresher basic refraction training for IECWs / 8 / 5 / 63 / same as above
New training for CHA on PEC, cataract and TT identification and referral system / 420 / 453 / 108 / promotion of good eye health care, strengthened referral system and increased surgical output
Refresher training of CHA / 548 / 533 / 97 / same as above
Training for new teachers on school children vision testing and referral / 360 / 362 / 101 / identification and referral of students with refractive error by trained personnel
Training of Trainer for IECWs, CHAs and HEWs trainer (TOT) / 0 / 16 / Quality delivery of trainings
Screening of patient for cataract trachoma trichiasis and other eye diseases at health facility and out reach / 79,000 / 80,580 / 102 / increased service utilization and restoration of vision as well as reduction of active and blinding trachoma to less than the level of public health importance
Screening of school children for refractive error / 36,000 / 23,543 / 65 / identification and referral of students with refractive error
Number of persons provided with eye glasses including children / 4250 / 2513 / 59 / improved vision
Number of adult and children treated with 1% tetracycline eye ointment including the treatment on MDA / 78,298 / 89,787 / 115 / reduction of active trachoma to less than the level of public health importance
number of people treated with zithromax / 1,835,534 / 1,788,412 / 97 / reduction of active trachoma to less than the level of public health importance
Number of TT surgeries done / 14,602 / 10,544 / 72 / prevention of further blindness from complication
Number of cataract surgery done / 1450 / 1331 / 92 / Vision restored
Number of people educated / 61,630 / 92,827 / 150 / increased awareness and promotion of good eye health
Prepared by / Mulatu Gebre
Reviewed by / Tezera Kifle and Dr. Yeneneh Mulugeta
Date submitted

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