FCT CDTI annual project technical report submitted to Technical Consultative Committee (TCC) : January-December 2005

) \ Lq r$ll I ORIGINAL: English COUNTRY/NOTF: NIGERIA Proiect Name: FCT CDTI PROJECT Approval vear: 1998 Launching ILear: 1998 Reportins Period (Month/Year): JANUARY -DECEMBER 2005 (circteon.) t 13 4 t-C[s s toProiect vear of this report: bmitted: FEBRUARY 2006Date su NGDO partner: CBM ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) DEADLINE FOR SUBMISSION: To APOC Management by 31 January for March TCC meeting To APOC Management by 3l July for September TCC meeting AFRICAN PROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) ; )-*' i' i ,r, il ! I "" $-th [],$t, ' {'}F'?'t L,.r l\ ,' Irr6hl ,' f5l i ,,,, |*;l ' i:' t' *'l ' : l,- '.. . . .,I f\-1 1 rt- i ,r -- -t t t^,i ,! r rI /'llr :B pl ,lt- - .-t.+, t' .-,1 '. {- ktt( ,-1 (.u\ \ "l{t r/n( "LA h *rlto*ul1*1 ,'l-n/h/-, ,4&tl lv'l t{,tAt' ,t l,*lo 4;t'" ,!u,"- WIIO/n P()('. 2.1 November 200.1 (L I Yl" /t- tl c clbT4 ry" q )tt altfot I ANN TIAL I'IiOJEC'['TE(JI IN ICAI, Ii.E,P0II'I' TO fEcI INICAL ('oNsul-'l'n-l'lvlr ('oMN,{l',i' I'lllt ( l'('c') trNDO[RStrh4EI\T Pleasc confirm you hitve rc:td tliis rellort by siglling ilr the appropriatc spzlcc. OI"F ICIIIS to sigrr thc re;lot't: N IGETIIA/LEBIi,I{IA Nlttitlltal Coordil',atol' Nlntc: I)r \, runtryo 'fi rtaIttt'c I)atc f).^ )-tr-c( Zotral ()ncito Coord i t-r,. |oi' Nttitr..:: ill" l:t.l '{Nlll S igttxttttrc I)atc: .I b 'l'his rcpoft lias bectr prcplticd lly Ntrnrc'. ilf ulluttt 'lltltut !)ul I tt sis I)t'signal.itril Si:ltltlLtt r I )ittc l! r r tj t ft$ t t, !,t' *fi t rt I t t t' / / l(,i;zittu:, 'iz/af torL \t, I i{ ) \l}( )( -r6',11'11 1111'1',1 ,]r),)lt Table of contents ACROIYYMS............... """""""v DEFrNrrroNs......... """""""' vr FOLLOW t]P ON TCC RECOMMEI\IDATIONS .......1 EXECUTTVE ST]MMARY ........2 SECTION 1: BACKGROUI\D INFORMATION...."""" """""""'4 l.l. GBuenal INFoRMATIoN 1. 1.1 Description of tlrc project (briefly).....-...- 1.1.2. PartnershiP 1.2. Poput-arrox SECTION 2: IMPLEMENTATION OF CDTI........ """""""""""8 .................... 82.1. TttuBr-wp oF ACTIvITIES ........-. 2.2. AovocacY ... l0 2.3. MOSTLZATION, SENSITZATION AND HEALTH EDUCATION OF AT RISK COMMI.JNITIES ENNON! BOOKMARK NOT DEFINED. 2.4. CounauunY INvoLvEMENT.......'.... 2.5. CapecruY BUILDING 2.6. TRsarrrleNrs................ 2.6.1. Treatmentfigures................... 2.6.2 What are the causes of absenteeism? --...-.---- 2.6.3 What are the reasons for refusalsz ..'............. 2.6.4 Briefly describe all krnwn andverifud serious adverse events (SAEI) that.... 2.6.5. Trend of treatment achievemenlfrom CDTI project irrception to the current year How was the feedback used to improve tle overall pedonnonce of tlrc pmiect? Enor! Bookmark not deftned '20 2t2.7 - ORDERING, sroRAGE AND DELIVERY oF IvERMECTIN 2.8. CoutvruNny SELF-MONTTORTNG AND STAKEHOLDERS MeBrrNC ...........22 2.g. SuprnvtstoN """""""'22 2.g.1. Provide aflow chart of supervision hierarchy. ..Enor! Bookmarh not deftned 2.g.2. What weri the main issues ifuntified during supervision? .....Efior! Bookmark not defined 2.g.3. Was a supervision checHist used? ...Enor! Bookmark not deftned 2.g.4. What were the outcomes at eoch level of CDTI implementation supervision? Enor! Bookmarh not deJined 2.g.5. Wasfeedback given to tlrc person or groups supervised? Etor! Bookmark not deJined 2.9.6. SECTION 3: SIJPPORT TO CDTI 3.1. 3.2. 3.3. 3.4. EeurpupNr FnqeNCIAI CONTRIBUTIONS OF THE PARTNERS AND COMMI.,NITIES........ Olupn FORMS OF COMMI.]NITY SUPPORT E>oeNotruRE PER ACTIvITY .......... 23 23 25 25 25 SECTION 4: SUSTAINABILITY OF CDTI.. """"""'26 4-1. tNrenNAI-; INDEPENDENT PARTICIPATORY MONITOnTC; EvaI-UATION-..... ..............26 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick ary of thefollowingwhich are applicable) ...........- """"26 lll WHO/APOC, 24 November 2fi)4 ......Error! Bookmark not defined 4 7 4.1.2. What were the recommendations? 4.1.3. How have they been implemented? """"""" 4.2. SuSTRNaSILITY oF PRoJECTS: PLAN AND SET TARGETS (MANDATORY AT"""""""" Yn 3) .. 4.2.1 4.2.2 Planning at all relevont levels Funds........ 4.2.3 Transport (replacement and maintenance) 4.2.4. Otherresources... 4.2.5. Bookmarh not defined 4.4. OpENAUONAL RESEARCH.. 4.3. INrecReuoN .'............."ERRoR! BooxrumxNorDEFINED' 4.3.1. Ivermectin delivery mechanisms -.....0nor! Boohmark not deftned 4.3.2. Training.... ..Efior! Bookmark not deJined 4.3.3. Joint supervision and monitoringwith other programs--. Enor! Bookmark not deJined 4.3.4. Release offundsfor project activities................Error! Bookmark not deJined 4.3.5. Is CDTI irrcluded tnine pUC budget? ...............Error! Boohmarh not defined. 4.3.6. Describe other heatth progrommes that are using the CDTI structure and lnw this was achieved. What have bienttrc achievements? .....Enor! Bookmark nol deftned 4.3.7. Describe others issues considered in the integration of CDTI. Enor! ............. EnnoR! BooKMARK Nor DEFII\IED- 4.4.1. Summarize in not more than orc half of apage tlrc operdional rcsearch undertaken in the proiect area within the reporting period.."""""' Enot! Bookmark not dejined 4.4.2. How were the resulrs applied in the project? .....Enor! Bookmarh not deftned SECTION 5: STRENGTHS, WEAKIYESSES, CHALLENGES' AI\D OPPORTTJNITIES....... .....ERROR! BOOKMARK NOT DEFINED. SECTION 6: LMQUE FEATT RES OF TIIE PROJECT/OTHER MATTERS.------....30 IV WHO/APOC, 24 November 2004 Acronyms APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT UNICEF UTG wHo African Programme for Onchocerciasis Control Annual Treatnent Obj ective Annual Training Objective Com munity-Based Organization Community-Directed Dishibutor Community-Directed 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 goup) Trainer of trainers United Nations Children's Fund Ultimate Treatment Goal World Health Organization v WHO/APOC, 24 November 2004 Definitions (i) Total population: the total population living in mesolhyper-endemic communities within the project area (based on REMO and census taking). (ii) Eligible population: calculated as 84%o of the total population in mesoftryper- endemic communities in the project area. (iii) Annual Treatment Objective: (ATO): the estimated number of persons living in meso/hyper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. (iv) Ultimate Treatment Goal (UTG): calculated as the maximum number of people to be treated annually in meso/tryper 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 tt e end of the 3d year ofthe project). (v) Therapeutic coverage: number of people heated in a given year over the total population (this should be expressed as a percentage)- (vi) Geographical coverage: number of communities treated in a given year over the total ntrmber of meso/hyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage)- (vii) lntegration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for I-F, screening for cataract, etc.) through CDTI (using the same systems, training, supervision and personnel) in order to maximise cost- effectiveness and empower communities to solve more of their health problems. This does not include activities or interventions carried otrt by community distributors outside of CDTI. (viii) (ix) Sustainability: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future, with high treaffnent coverage' integrated into the available healthcare service, with strong community ownership, using resources mobilised by the community and the government. Communiff self-monitorine (CSM): The p(rcess by which the community is empowered to oversee and monitor the performance of CDTI (or any community- based health intervention programme), with a view to ensuring that the programme is being executed in the way intended. It encourages the community to take full responsibility of ivermectin distribution and make appropriate modifications when necessary. vl WHO/APOC, 24 November 2004 FOLLOW UP Oil TGG REGOTTE]IDATIOIIS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session 19 I Number of Recommendation in the Report TCC RECOMMENDATIONS ACNONS TAKEN BY THE PROJECT FORTCC/APOC MGT ASE ONLY I Project to perform operational research on incentive options for CDDS So far we are consulting with NOCP and Sociologist to draw up aproposal forthis study 2 Assess Onchocerciasis endemicity in FCT satellite communities. A research group will be submitting a proposal to determine the transmission potential in the FCT satellite communities soon. J Continue !o increase number of CDDs We plan on increasing the number of CDDs as part of our training proposal to APOC 4 Train MOH staffat all levels on management of SAEs Already we have a plan to conduct training and re training of all the workers in the programme. 5 Strive to reduce the number of refusals and absentees The project is working hard at sensitizing the community members to comply with treatment and for CDDs to be more committed to their duties of getting the community members treated. 6 Integrate program activities into PHC and into other health programs for the sake of sustainability. Yes there is already emphasis on this as conscious effort to re- train all the PHC staff on CDTI and using this level effectively. 7 Submit 3 year post APOC sustainability plan to APOC management as soon as The project had submitted this WHO/APOC, 24 November 2004 possible. proposal on two occasions, but have been recently intimated that such has not been found. We are re-submitting it again to APOC. l0 No expenditures were described for the available APOC tunds. It was an oversight. The table presented was meant for APOC and CBM and not MOH. Executive Summa4Y The Federal capital territory GCT) was created from the gerographical centre of Nigeria to serve as the new capital of the Nation. The area occupies about 8, 000 sqkm and divided into 6 administrative Area councils. prior to the creation of Abuja as the new Federal Capital Territory in 1976 the whole area was infested with black flies vector of Onchocerca SPP. The results of Rapid Epidemiological mapping of Onchocerciasis (REMO) Conducted in 1995 in the area demostrated hyperendemicity. Mectizan distribution was started in 1995 in collaboration with christofell Blinden Mission (CBM), an NGDO supporting Onchocerciasis control in FCT A total of 56, 083 people were treated in 178 endemic communities during the period. African programme for Onchocerciasis control programme (APOC) approved proposal sent by FCT in 1998 for 5 -years support (1995-2002). The FCT has assumed full responsibility oisustaining the programme by providing the enabling enviroment. Under APOC support, the treatment coverage has increased from 56,083 to 234,895 and from 178 to 559 endemic communities. Training was conducted in a targeted manner for all categories of staff involved in the programme. The local Oncho control Team (LOCT) identified priority needs of the personal it tfie first line Health Facility (FLHF) and the community Directed Distributors (CDD) who were trained. A total of 860 programme workers were trained. Health Education and Mobilization was also carried out in the communities in a targeted manner. Advocacy visit to politically electoral Chairmen of the Area councils was also carried out to solicit for support. 2 WHO/APOC, 24 November 2004 capital Equipment and counterpart funds provided by FCThry been of tremendous assistance to it " COff project in the implementation of the scheduled activities. FCT has released 5 million last year and again 5 million this current year 2005' During the year under review, the project has treated 261, 728 people in 559 communities' thus achiev ing r7%.Therapeutic and I 00% Geographical coverage' s. Major challenges remained the population explosion of the satetlite and urban centres as well u, ior*opolitan nature of the residents. This issue is addressed in the sustainability plan. 3 WHO/APOC, 24 November 2004 SEGTTON {: Background informdion 1.1. General inf,ormation 1.1.1 Description of the project (briefly) Geograp hical location, topography, clirMe theieteral Capital Terriiof lies-in the centre of Nigeria, just north of the hot and humid low lands of the Niger/Benul Trough, but south of the drier areas to the north. It lies north of the wide alluvial plains formed by the confluence of the Niger and Benue Rilers- The Jama'a Platfornu a continuation of the Jos Plateau, extends well into the middle of the FCT' It comprises 8,000 square kilometers. Four major rivers flow through the area, all of them flowing roughiy from north to south, and draining into the River Niger. The rivers often now siitt/tfriough rocky gorges, providing an ideal habitat for the Simulium fly. The FCT itself ;onsists of a tilted plain, rising from an elevation of 300 fe€t in the south-west' to above 2,000 feet at the North-East corner. Rising out of this plain are numerous rocky outcrops and inselbergs. The predominant vegetation type is park savannah. River banks are typicaily heavily foreited wiitr tatt trees and thickets, and there are occasional patches of rain forest r*t"r"d throughout the FCT. Rainfall averages l622mm annually- The rainy s&ason begins in April and ends in mid October. The dry season lasts from late October to March. Pop ulotion: activities, cultures, lang utge Before the construction of Abuja the capital city, the estimated population of the area comprising the FCT was about j00,000. With the construction, populations have exploded in ait thJ settlements. The indigenous ethnic groups in the FCT include the Gbagi, Gwandar4 Gade, Koro, Ganagana, Bassa, tgbirr4 Fulani and Hausa. With the influx of people into the capital tenitory almost all major ethnic groups have representatives in the tommunities. Therefore, most settlements are muhi-ethnic, and many are multi-lingual. Most rural communities depend on farming andlar pastoralism. Other occupations include farming, fishing and pastoralism. Traditionally many crafts are practiced, including iron smelting, pottet making, etc. Setlements may be either nucleated or dispersed. There are also numerous nomadii Fulani settlements, which may be either seasonal or semi- permanent. C o mm unic dio n sy stem (road.. ) There is a good network of roads leading to the major towns, particularly Area Council headquarters. In the past few years there have been considerable improvement in road construction, and some communities with poor road network have had their access roads improved considerably. However, some roads to the smaller settlements are at best rudimentary. A few of these rmds are not accessible during the rainy season. There is a multiplicity of channels of communication. The most commonly used in governmental circles is through the traditional political and community leaders, council of "tO".r, religious leaders, youth and social groups. Town criers are often used at the community level to communicate information to the public. Radio (and TV where available) is also effective. A dministrot io n str ucl ur e The FCT is treated as one of the Federal Minishies, under the coordination and supervision of a Minister appointed by the President and ratified by the National assembly. The Minister is assisted by Directors who oversee different departments. The FCT is divided into six administrative areas (Area Councils), under the leadership of an elected Chairman. 4 WHO/APOC, 24 November 2004 Health system & health care delivery @rovide the number of health posts/centers in the project area if the information is available). R Frimary Health Care System is in place within the project are4 although the level of functionality differs from place to place. This system of health care services ensures community participation as the mainstay with the support of the local govemment/area council. In this regard, some health care activities have been hansferred to local govemmenVarea councils for adequate sustainability. Table l: Number of health staffinvolved in CDTI @lease add more rows f necessary) District/LGA Numbcr of hcrlth strff involvcd in CDTI rctivitics Totrl Numbcr of hcrhh strfr in thc cntirc project rrcr Br Numbcr of hcrlth stefr involvcd in CDTI B, Pcrccntegc B3=B2l 81 *lfi) AMAC 50 25 50o/o ABAJI 30 25 83% BWARI 35 25 7lo/o KWALI 37 25 680/o KUJE 45 25 68% GWAGWALADA 46 25 62% Total 237 150 630/" 1.1.2. Partnership Indicale lhe parlners involved in project implementation at all levels (MoH, NGDOs - nat io nal, inter notio nal) The FCT project is a partnership involving APOC, NOCB CBM, State Government, the Area Councils, and the endemic communities. Describe overall worhing relationship omong partnerc, clearly indicating specilic oreas of project activitics @lnnntng, supervision, advococlt, planning, mobilizfiion, etc) where all partnerc are involved APOC provides financial and logistic assistance, and conducts monitoring/evaluation of the project activities. NOCP coordinates the control efforts and provides guidelines. It also supervises and monitors implementation of programme activities, advocates for support and provides technical assistance through the Zonal Office. The State and Local Governments through the SOCT and LOCTs conduct training of all levels of personnel involved in programme implernentation, collects and deliver mectizan to endemic communities, collects and collates reports/data on CDTI, mobilization and health education of communities, and supervision/monitoring of CDTI activities. The community selects its distributors, decides on mode and period of distribution, and provides support for dnrg dishibution, census update, and recording and reporting of treafinent activities. The assisting NGDO - CBM - assists in advocacy, provides technical assistance and logistic support. It also assists in provision of tEC materials and funds for various CDTI activities. 5 WHO/APOC, 24 November 2fi)4 Overall relationship among partners has been cordial. State plans tf any to mobilize the state/region/district/LGA decision-makers, NGDOs' NGOs, CBOs, to assist in CDTI implementation. As a routine SOCTs and LOCTs Carry out advocacy visits to policy makers at State and Area Council level before the commencement of the dishibution exercise. This becomes all the more necessary in view of the fact that elections into the area councils are expected to hold by March 2004 andnew policy makers will be in place- 6 WHO/APOC, 24 November 2004 +6l o -o o o z + c.l U o 0.4 o (.) o 'a *<o (l) (H o C) otr o. q) 'o (n P v,L 0.) ) a. (l) (t) F CJ bI) GI L o tr oo C) 6o cntr oo CO B o)tr (l) E () bo(o t<o tr oo F () o ootr 0 C)L Cg o >. +i I I I I I I g' I * do) 9 k0) o I I I I c.. I(I)l ol -O a' TE (o G)l -ql;l(t!l9tdlrl a9 =(,tsE 8=L Erati oo -Hi( #4 .. .e3 EEEEa> dzH* o z I .l(D 'oo L C)a hI) tr ir, og o t< o) bI)tr !:)E o)troE o(D 'a l<p. 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Timeline of activities Insert Plan of action indicating activities by month, which were implemented' SAI Activities Time Implemented I J' 2005 2 Review January 2005 3 February 2005 4 Mectizan February 2005 5 of PHC Staff February 2005 6 Mobilization February - March 2005 7 of CDDs - March 2005 8 Census U March - 2005 9 Mectizan Distribution April - May 2005 10 May - June 2005 1l Treatrnents June 2005 t2 collection & Collation June 2005 l3 Feedback Workshop 2005 8 WHO/APOC, 24 November 2004 Advocacy Monitoring & Supervision + (\ o -o q) o z + c.l (.) o o\ T, 6) oI L o)5 L trI .!l axq) q) (n 6loq o cl q) 6l q 4) cl c)u 6l 6) oL 0); ar)q) I 6l (l) cl c) o)o 6l(l) FiI -:.A Bq hq)() s) ? L q)L EB q) U) Sq)g t.r((t(;) >. tr(D E o (l) tr E(l) (B G)tr9 (A d o)L cl (l) l< .o V)(I) o(llqi o o C)tr F ".iro)l -oldtt-l tr o q, Loq a tro E6 EEU (l)g ()tr o) (l)tr otr = (l) tr = .E',eftr Gt= T\H ct =a >. CO RI 2 cl z cl z >.(6 z Eo E L t) UI L a Eo 'c5 EE Q (g z cl a (d z cl >.Gt cl a a0_E+IPtr 6=aa o La Lo *<o t-A k& (l)i GIEItrlD\a ur, (l)(J Eo a6 EE O l<0. l-o. L0. t<o. r<o. L& .i'e1|.E 6= a;a oLd z tokd z oL c,gz -qoL Gt z oLd z ol<$ o3 .E GI li Fr Eo =E*o EE Q oLd E <)t<d z .Eok(! to l-<(n 2 oL ct ot< GI A .Ht .t!. El d= aE tr(o LI C) frr t- cl Ls(l) trr L cl t-3(l)t\ >.tr Rt t-I(l) 14 L cl .o c;)t! L a{ L -o(l) tL vuD -o) E.E6l=Ni -atrooET C'a tro -9:a6EEo() ti c,5t< -o o)t\ L6 Lp(u tJr h GI LI o) frr L Gt t-s o) tri >rkcl L -oq) f! hd =Lp o frr Enottr 6= L d tr GIl- k ct5tr(g l- hd =g(€ l- r,(B =c(€ l- L cl tr c, r. GI tr C(l I{ c) L .2 a O z l- o & o J v Hi- v A Fl B(, Bo Fl F o t'{ State the number of poticy/decision mokerc mobilized at each relevant level during the current year; tie- ,i^o^ for the sensitizltion and outcomc' Descrtbe dilliculfie;/constraints beingfaced and suggestions on how to improve advocacy' At the State level the Hon. Minister, Permanent Secretary, Director Health Service, Deputy Director Public Health, Director of Finance were sensitized. At the LGA level the Hon' Chairmen, Council Secretaries, Council Treasures (CT), HODs Chieftaincy Affairs, and HODs Health of the six area councils were sensitized. This was done to ensure political commitment to the programme, release of counterpart funds, and logistic support' With the advocacy and sensitLatlon approval was secured for the released of funds. This was followed up with ihe actuat releases aiCouncil levels. To achieve this there was need for repeated visits and fottow up as politicians could be very diflicult to deal with. 2.3. tobilizdion, scnsitizati.rn ard healllr Gducatiorl of at risk Glommunitiea Provide information on : The use of media and/or other local systems to disseminde informalion FCT being the seat of the federal government as well as the HQs of most companies it is difficult to utilize the mass media without adequate funding. The project therefore could not make use of the mass media for mobilization and health education of, communities, as it is expensive. The traditional systems employed for mobilization include: Direct contact with the community members. Use of town criers Services of information unit of LGA/Area Councils with vehicles mounted with public address system. Utilization of the departnent of chieftaincy affairs of LGA/Area Councils to mobilize officially community leaders and opinion leaders who then mobilized their communities. Mobiliztfion and heahh education of women and minorities - method and response The FCT being inhabited by peooni from diverse cultural and religious backgrounds which provides the Jnabling "nri**ent for easy mix of men and women when the occasion iemands. During treatttr education and mobilization women do not find it difficult to participate with ihe men and to make contibutions. There are however families that are Muslims who do not allow their women to freely mix. For such families a female health worker is usually assigned to health educate and mobilize them. As a result of womert participation **, "ori*unities have female CDDs who had been found to honest and io-.itt"d to the work. However, women do not participate in the decision-making apparatus of the communities. Most decision-making meetings take place at an elder's forum at the chiefls palace. Women are conspicuously absent at such palace meetings. It is at such meetings that community decisions on time and mode of treatment are usually taken. Response of target communitiestTilloges fne Uenefiiof tiking Mectizan in previous years has made communities to respond positively to health education messages and created a high demand for the drug. However, most communities are still reluctant in supporting CDDs. 2.2 AdvocacY Accomplishmerds l0 WHOiAPOC, 24 November 2004 All communities have been health educated and mobilized. They have accepted CDTI as their own although there are problems of giving incentives to CDDs. ll'ea k nes s e s/C o nst r ai nts The FCT is a commercial center and seat of power of govemment. Several things are monetized, and people expect benefits in monetary terms. Communities ane being encouraged to do what they can for their CDDs. There is however need for gleater interaction with the communities. Suggest wuys to improve mobilization of the target communities. At the moment the communities in FCT require general mobilization and sensitization. This will be useful to discuss compliance, community participation and support to the programme. rherorrowinswavsy",;Hff '"J,li'f, 3'ffi lH#it*rHffi f,ff ::.T#'il:"lna"-i" communities. o Mobilizing the entire communities at the villages o Talking to the people in the churches and mosques. : i*:"'il: i:flffiil';Ti#:,'H"HI*unity Serr Monitoring (csM) l1 WHO/APOC, 24 November 2004 c.t O c.l Lq) -o 0) z tf, c.t O E o c.l o (t)(l) o (t) U) c) rn U)o P tr oo a o F tro Cd r). o t Cda o) (6 o €d(t o o (l) o o o0 o0 -o bI) a tr o C) l- COo h CT o) o)t) A) t q.) aq) U) v, (J € Oo q)s q) B ?) a) U) .3 F{t\ a\) q) *i 3 u) Oo a)q) b S() q){ S' k\) € q) q) s ,q) B .s (3A\t3q) \)trs s)':. s3 -9l'S aQtEs3sS'Ess -$.s EEs.s$.:ooE rn o .EooLa o.(! -4. .9P .2 q) .9 s *< ooBs; 'F 0-) s€ IEAE ql> SE $.= 'ss (!-{e ll(B .E^'ts =os= Sov>qJc$ iE -q :''.t:olE3sSEgos,Sa'co .$c\5bs$E ..qotreoO Elets-o9SH E\ts o(Jr od .E IJl-9 Ed 5e EE rBtaEb0 ZF il I', .ii d' I EO c I I Fr so \oo\F- o\ \o .+ \o o\ o\ s € FE =.9 c i EEEZ?, c.I + <t c t- t n (J o E z FE + te Io FN C o Fr o,o + + c.) o GTt-- Eq 9oCOE;d (\ c.l o\ O(\ +c-l e.l t FE aA(J cl 2 a.l + € $ o\ oo\ F- o{@ a\t-la t- >o o?bo ^-6= >o)oo€ EoEE E9 otr e= =oze o ll * EEE tr o o0qt I r e O O O c FE Eae r ?'E z .2r;3 i EEE+ Zeeo o o o o Fq d.E.i Etr'==c -59:.?E E€.5 o c.) \o \o € o\r- o c.l \o r-- o\ ra ra IJ a ca a ra = v r4 D v F1 F. oF -\ s va U)q)()p %: L P o t q) riq) e-v F oQ()n€Lo.=EtrLOO '.= o'6 -LLd )tu) -()E.E J5EEEE o-C' :.st .olt -ol . (lllNFI +c-l C)! o o z + c.l O {o aa 9e og; c!o .tr 6O. r-EEo. bI) *;cl+(t) hE(: -i 0r epEL N.E -8Etroo+g .*;(B F>,# HE s o,i-..'(r) t (DPF(J cEEr.-aF ai)B/\qE HO € oe t(DEb0 E <r. t.v I a^OOOE E H":E .x ki.as5- SHEGoeYslrE; :iaET :.E EE <S ts -.9.-ct?-a, E hE sY^Po)H '{ >r.!$ $Ei s H $Eqa.9 s€:!n &.H;FE s"7E .si s aEF; E€!S-*LP 'i ( ci €.e =6 Sq-S; E* ;: g E E-X S€ se *E *s Bii : E: - x s.- bo 8.3 3 H..E "ae'- t s'.= .,iE; SEE sgE$3: 2.5. GapaciQr building The project intend to train within the year 8 SOCTs, 3l LOCTs, 150 PHC staff and 720 CDDs. At the close, the project was able to train 8 SOCTs ,24LOCTs 120 PHC staffand 720 CDDs. t4 WHO/APOC, 24 November 2003 oGIr- ra(.)\o GI\o O o. + o\ -----l cll I t.:qv f .ie,v a.l aq o\ o\ o. oclr- tr a) E It) q) o s F- o\ o. + Eq) ct oa (.) o q,) ! z I I I I 6ll v L9 = S.ra<v c .iev tr a) q) €) C) \o o O q) .EaGfr t- [rerl -i6oq) .o r- Gl c.h z Q?F eal ocl t c.l c.l c..l a-l c.l c.l c.t c.l a.t c.l Ua S. E.t+F-u' ...l a.l GT Eo E(D e) I s oo c.l a.l c.l o a-.1 o a.l c.t (D =6dlg; !s oqle3E>- ZE o() Q o fr t- t .I r- + a.l + L) E53 +. A< i t .+ a.l 6l ?a \o 6l o o ()I$eo(D Eo o q)E E z I ?F Fl t{ o t-,i a a) E a) €) <, s \a6 (J rl (, o o C) Jz a ts ra o H J t o IJ]p v 5 54 C.l o -o Eo o z <t c.l O oA la) l'r I ah(l) L L q) E 6l otr cil q) o t E gll x o) oo e!()q o) clL o c) B Oo(l) E 6L o lt)Lo GIL L o) bo a e t o p s I * $ o € 7 a B F -\ v1 v)q)() q) aa 1 o q) -E q) vq) s E o d tr o) E(l) o FoU(H o (n o (l) (l) t< .c)HH 'o o e6 bI) tr cl F ,iir o,l -olcllFI I I Table 6: Type of training undertaken (Tick the boxei where spectfic training was carried out during the reporting period) Any other comments 2.6. Treatm,ents Total Population 297, 491 Number Treated 261,728 Mectizan Used 733,474 Coverage 88%o Total communities - 559 Number of communities Treated - 559 Geographical Coverage- 100% Trainees Type of training CDDs Other Community members e.g Community supervisors Health Workers (frontline health facilities) MOH staffor Other Political Leaders Others(speci$) Program management { How to conduct Health education { ./ ./ Management ofSAEs ./ CSM ./ { SHM ./ ./ Data collection ./ ./ { Data analysis ./ ./ Report writing ./ { Others (specifo) l6 WHO/APOC, 24 November 2003 +c.l Lo -o C) z + c-.1 O 4{ >r1 r= $"ql Lql I !t E a.B $q) Oo \9EF* U -) ltvqr rd\o3hi68(l)'59's\f x.I €isE 3: 'E.sS u6.=l!EETH S3 .93Si €EE (1)ciEiP: o.sqtFE S ^sFy,SUI .S 'FaiHr\.8 .E s sg\\\H a, Eq,E E SS ot 9 F 'Its ol * \J q!;13 : Ex -l o -: Bi cIB s Ei()l o. .x t\Er S \S .Hl H $ S': :IE b Sl' il E S IS EIE E S*Zlt- I is .= cY 5a Sgs €\ .l ss ,, _! *.8 E i*qr- lo _r EtE SE = s.s t-6Y ! \rE E E$ -c s ela.3 s s*!, E tsFrrttSP s pFS \ SE (dg c! E(l) 'g 3o.r< o) c!d €9()d(l).= 'a^ LV 9r!rd =-o.!v -td q6 oP- .=oCE4AAtrd F6 =o)oe .98A)ts ot E(1) ol =E -l EI "l 8il Et :F sl€3r &3 8l;lE #lE Ilg gI.g, tIE tIB ol- =l e o)lE =I E EIH EI bEIE EI E EI€ r*l 'j r*l i ql Pol ir. ol tr ol -ulo rl5 rl' -813 3l tr -8lEqq qE qE zli zli zl< al0)l orl cllLI6)l >l olol dl()l -clol cll s(ul .5 trldt ol 9l (1)I 9IdlLI cll ,ql acl 9l =lo EIol :l €l .cl 5l EI ol rI.I -\(r B ca U)q)() q) .\ w2 o T\p o .x G q) 6q) S JZ .t) k GI qt doL cl (€ tr (, -] o tr (t) E >.s o rq a Ec(d (l) tr (B c)LF r'-t arl -olcllFI (l) dL() o0!d^ 9E o C) oF o)#6L(l) bI)((lk o) oo G! .9G .c 9t- d o0 o(l) o o) clk(l) o0dLo oo C) /:\E5(I)q(ok c) F e BEEe a o <l a -'Ag a Bo;E eEH*EH3; >ooOE #HEc) Ao vobg!EEga.a z<o o o O O o E_ 3; EaEEE o\rr o\N t- \o c-\o \o C.l .+ o\Otr \o \o c- 6lo\ tro I(! =oo c &h o5o ,ooodFb ooEOF t-€ o\a \o€ 66 a €6 tr€ a o -- -EEgEbs = o€z e.l e.l F-F- + 6 \o\o \oo * CN +t e.l o\ r- c.) $\o € c?) € c.lr- \o(..l Eo? 6.2 lEo E H.SI<86 +c.)$ €\o (\o <f\o (\oo\o ce c.l o\ @ t €++\o $ o(.It c.t\o a.l\o\o c.l a .9 ,3 E " EH BF €:o:oE u - E€E tsEF F-F- € € F- c.lF-o!f sf <t\o 6 ca * o oNt(\ <l € t-ta o\s F.- o\ e{ <t, Ic)l ood ;o E tr tr oU oo ltr a=d a 6\ 6 EF !dE bDa Ei e(, Oo o oO oo o O a E.c .- -.= [i 9 .3 E SHE E= O ,tr>€ AOq c.) \o @ \o o e.t o\ Fr \or- o\r) A Eo? 6.> ,EA xE8 m \oa \o c.t o\r- \or- o\ >9.,3q o= x ooE c EH 3 E$E.;^ . 3E E E co \o € \o oN o\ F.. \or- o\r) .E<L.lt;q E, m o rI] v = V o J o J F oF il I 2.6.2 What are the causes of absenteeism? Temporary relocation by farmers to virgin areas Movement back to schools" Travel outside the community during distribution Employment in the citY 2.6.4 N/A In case the project did not have any cases of serious adverse events (SAE) during this reporting period, please tick in the box. No SAE case to rePort I I I 2.6.3 What are the reasons for refusals? The number of people refusing to take the drugs is almost non existing, but what we have at the moment is absenteeism due mainly farming activities population movement and lack of CDD motivation. Briefly describe all known and verified serious adverse events (SAEs) that occuried during the reporting period and provide (in table 8) the required information when available. l8 WHO/APOC, 24 November 2004 I $ (\ L c) -o Eq) o z * e..l U o o. o\ q) a, s) Lq) .a r. -qJv) * (\ q V)q) $I S vj: P a t q) j uq) U !o t<(l)r o0tr Eo o. C)rr (l) e o0tr l< E E() LL ooo I(o 0 rq a (n tr o) o) (l) U)Lr c.) ! 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D ID - rlr I -i H -GtI 9'oq-q qD ^! u'u' i. .= 0)()-q tr&96 ht I - ;6 L;;()-6 o.a -3 O E E;e L L.-60a9OE,Ee llDi,T - )I ( ( I o =o>V AEP = E cd':idESC I-(l.: (E ) D D dN oO z €-999 E gEE I I - a o. :ra trE;Xc)jy r aY o) a h- 3 o c)b0E -il >o 0)I () 6 H dN o 6) z I C) a () bo * 4a -> c) bora Gl ^F Us/o (J \o o\F-+ -o6\r) @ \oo\ r- \o6\ o\F- -o o\\o € \oo\+ o\ \oo\ € o\ \oo\o o\ tr o GI g op< llr Ei r.l E] o _oo9 g.;F O6\4',>! -o I 1Oo\ €r- -o o\o o\ 1Qo\ o\ € \oo\ € o\ -oo\\o € 1Qo\+ o\ yO o\ @ o\ \o o \o o I ll r- r-i ri rIl o\ a '5o 500o6gE oo .EqF \oo\\o ra) \oo\t- c- \o6\r-t- \oo\ ra) 6 \o o\ € -o o\r- € \oo\\oa \o c- € s € € f-l t .o o(€ .oOE4- EEz* 'o g o\ C' t* o\ F- o.t\o o\\o r-tr 6 @ F.- \o o\ o\s c.l o\ € +o c.r F- c.t -i+ c.l o\\o €- + c.l o\ <t \o(\ Ti Ua? 5.2IE6 5ga ooq Olal ooq oa oo o^ oocl oao c.l oo o^ O ra cl ooq d ra)N oq o c.l ooq o1r)(\ ooo- o ra)(\ _: ilHgE€€EN ' d. 39o c-q r-+ ao c.l tatso c.l(\ ocidI o c.tcl 6 rrl(\ \o co(\ 6 ra)(\ .d c.l \o(\ OF- c.t ra)lr) cl iat €(\ o ra) al o\ c.l o\+ r- o\ c.l c) o0d q() tr E (,) a ll r rd El r.l o -boH ES<\>J -o o o\oo \oo\ o -oo\oo \oo\oO o\oo \o oo o\oo o\oo o\oo .co-aoo=E= E::'tt i- Ho gc,iE()orrl 1Oo\oo \o o\oo \oo\oo \oo\oO \oo\oo o\oo \oo\oo \oo\oo -o o\ o rd qoO.E ts*g =-sgE E= o;E-arrz3- Oc'l+ @$t cosf$ o\lat ra o\ ra) ra) o\ ral r/) o\ h ral o\lr, r o\la)r) r-1 *a? 6.22EA TE8 o o.l * €s €$s o\ lr) o\ ra) lar o\ ral r.) o\ rat rat o\ rat ra) o\ ral rat oo d = ,Bq>Hof ts€ *F EE E€ Ed T E 6 EIEAoo o(\s €*+ €++ o\lalrr) o\rn o\ta) ra o\ ra) ra) o\ rat ral o\ h lal & trl r- o\ o\ € o\o\ o\ o\ o\ c.l o(\ c.lo c.l c.t O e.l +oO e.l O c.l \o O a.t r- N 6 O et o\ (\ e.l + O c..l !o -o c) o z + a.l -1 op. :\ tTr C\t ,; .9: s -I cll c) q) ul) 6lLo o c)I ts) =c ^EIt' '-b *o!9IE .s 'E$ELGrE8Se : 'S qr)iE TL -- tr c) -e3;o odlE €N.Zv -{:.3 cl o)592Ecl{<trLrlocJl c)(l)l .El vtEil .gelo.=tta,iItrLEI r-{(DlH9tatlQbl(HlEHI rr(Dl : il i,i'iEt I9el e6gt E .e 9t 'a6-6t LI &.sr!e:96L a. a lri8fotsEt-r rEclD 9a vEEEE(l):Otr€)Iii-!g<Ecl '(l)qJViA'E .L\0 -=ci o\l o,(l)l 0t =l GlHeFl Fr 2.7. Ordering, storage and dclivery of ivcrmectin Mectizan@ ordered/applied for by - Qtlease tick the appropriate answer) ./uon tr Btro uflcnr NGDO Other (please speciff) Mectizan@ delivered by - Qtlease tick the appropriate answer) MOH tr WHOtr T]NICEFtr {NcoC Other (please specifu) Please describe how Mectizan@ is ordered and how it gets to the communities Information generated from census update by the CDDs is used to estimate the number of Mectizan tablets that would be needed for the next treaffnent cycle. This information is made available to CBM by the FCT team who applies to Merck, Sharpe & Dohme (MSD)' Once the drug is made availa-ble through the NOTF itore to CBM, the FCT Team is contacted to fetch thei requirements. The SOCT on collection requests the LOCTs to pick up their consignments for their respective area councils. The LOCTs present the consignments to the Area Council Chairmen tosignal the commencement of the distribution exercise. The LOCTs asks the FLHF staff to pick irp their drug needg and these make the tablets required for the communities to the CDDs. Table l0: Mectizan@ Inventory (Please add more rows if necessary) Sfate activities under tvermectin delivery lhat are being carried out by heolth care personnel in the proiect areu The Health Care Personnel uses the data generated by CDDs through Census update to apply for Ivermectin based on the population figures- The health staffs collect the supply of Ivermectin from the appropriate point, (the State from CBM, the Area Council stafffrom the State and the Health facility staffcollects from Area Council). The health staffalso store Mectizartfor safety at all levels. Mectizan inventory are also kept by health Staffat all levels for record purposes and ensure accountability. Monitoring and supervision /Health Education at community level. State/District/LGA Numbcr in stock Rcqucstcd Rcccivcd Uscd Used/Pcrson trcetcd Lost Westcd Erpircd Rcmeining AMAC 0 250,000 203,000 2r1239 77122 ABAJI 0 97,000 106,000 101840 36 166 BWARI 0 I10,000 106,000 103,744 35 140 KWALI 0 100,000 106,000 106,339 37 902 KUJE 0 I14,000 132,000 123,265 44534 GWAGWALADA 0 98,000 90,000 87047 30 864 TOTAL 770,fl)O 743,4m 733474 261 728 2l WHO/APOC, 24 November 2fi)4 Number of tablets - Any other comment 2.8. GommuniQT self-monitoring and $takeholdenr illeeting Has any training (of trainerc)for community self-monitoring been done in the proiect area? No training has been done, but we are requesting that APOC fund this activity to enable us introduce the concePt in 2006. Table 1l: Community self-monitoring and Stakeholders Meeting (Add rows if needed) Describe how the results of the community self- monitoring and stakeholders meetings have affected project implementation or how they would be utilized during the next treatment cycle. 2.9. Supervision 2.7 .l Provide a flow chart of su hierarchy 1.8.1 What were the main issues identified during supervision. Issues identified in the process of supervision include: District/ LGA Total # of communitieVvillages in the entire project area No of Communities that carried out self monitoring (CSM) No of Communities that conducted stakeholders meeting (SIIfvD rln00fl I TOTAL N-- DD/PH COORDINATOR SOCTs LOCTs DHS FLHF STAFF CDDs/Comm unities 22 WHO/APOC, 24 November 2004 . Poor record keeping ' Lack of logistics at lower level ' Non support of CDDs by communities . Low involvement of FLHF staff ' Delay in funds release to LOCTs . Lack of documentation of supervisory visits . Few health staffhanding several PHC activities SEGTION 3: Support to GDTI 3.{. Equipmert 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;. IIow does the project intend to maintain and replace existing equipment and other materials? Funds have been set aside for the maintenance of vehicles motorcycles from the counterpart funds made available by the Government. It is expected that this will continue. The project will be requesting APOC management to replace existing transport and other capital equipment. For other materials the assisting NGDO is willing to assist, and efforts will be made to get other groups to support. Meanwhile efforts will continue to get government to fund the replacement of these materials when necessary. Describe the adequncy of available hnowledgeable manpower at all levels. Source Type of equipment APOC MOH DISTRICT/ LGA NGDO Others No Condrtion No Condition No. Condition No. Condition No. Condition l. Vehicle I F I CNFR 2. Motor cycle(s) 20 CNFR 5 wo 3 F 3. Computer(s) 1 CNFR 4. Printer(s) I CNFR 5. Photocopier (s) I F 6. Fax Machine(s) 7. Others a) Generator I F b) Television I CNFR c) Video I wo 23 WHO/APOC, 24 November 2004 Manpower though few compared to overall population of FCT are adequate for CDTI implementation if all that are trained will be committed. Where frequent transfers of trained staff occur, state what project is doing or intends to do to ."."dy the situation' (the most important issues is what measures were taken to ensure adequite CDTI implementation where not enough knowledgeable manpower was available or staffoften transferred during the course of the campaign)- Efforts are made to train new staff whenever transfers occur. But the transfers can be quite rapid, and sometimes there are delays in re-orienting the new ones. The solutions in the near future is to consider the training of all PHC workers which could be expensive. 24 WHO/APOC, 24 November 2004 Contributor Ye* I ('provde the period') Yerr 2 ('provde the pernd') Ycat 3 ('provide the period') TOTAL AMOUNT (cASH) Budgeted (us$) TOTAL CASH Released (us$) TOTAL AMOUNT (cASH) Budgeted (us$) TOTAL CASH Released (us$) TOTAL AMOUNT (cASH) Budgeted (US$) TOTAL CASH Released (us$) MOH (Central + ProvinciaUstate) 50,000.00 0 5s,000.00 50,000.00 s5,000.00 50,000.00 MOH @istrict/LGA) 31,000.00 8,000.00 3s,000.00 t 2,000.00 36,000.00 14,000.00 Local NGDO(s) ( if any) NGDO partner(s) 34,000.00 I1,000.00 20,000.00 10,000.00 35,000.00 21,000.00 Others a) b) APOC Trust Fund 0 0 0 0 0 0 TOTAL 84,000.00 19.000.00 l 10, 000.00 72,000.00 126,000.00 85,000.00 3.2. FINA}[CIAL CONTRIBUTIONS OF TIIE PARTIYERS AND COMMT'NITMS Table 13: Financial contributions by all partners for the last three years If there are problems with release of counterpart funds, how were they addressed? Before the current administration headed by Matlam El- Rufai, release of counterpart fund was a big problem, but with continuous advocacy and sensitization, budgetary allocation has been considered yearly for the project for CDTI and Blindness Prevention Programme of the FCT. This is a welcome development and is highly commendable. 3,3. ()ther forms of community support - Describe (indicate forms of in-kind contributions of communities if any) Different communities have one form of support or the other which can be considered relative to the people of the area. 3.4. Expenditurc pcr activitY - Indicate in table 14,the amount expended during the reporting period for each activity listed. Write the amount expended in US dollars using the current United Nations exchange rateto local currency. lndicate exchange rate used here 25 WHO/APOC, 24 November 2004 Expenditure ($ us) Source(s) of funding Drug delivery from NOTF HQ area to central collection point of community Mobilization and health education of communities Training of CDDs Training of health staffat all levels Supervising CDDs and distribution Internal monitoring of CDTI activities Advocacy visits to health and political authorities IEC materials Summary (reporting) forms for treatment Vehicles/ Motorcycles/ bicycles maintenance Office Equipment (e.g computers, printers etc) Others 4,200 7861 5,100 3,221 3,000 3,891 6,971 10,473 6,921 6,411 CBM/MOH MOH CBI\4/MOH MOH MOH CBM/MOH MOH MOH CBM/MOH CBM/MOH TOTAL 50,000 Total number of persons treated 261,728 Table 14: Indicate how much the project spent for each activity listed below during the reporting period. Any comments or explanations? SEGTIOII + Sustainabilitt/ of GDTI 4.,1. Internall independent pailicipatory monitoring; Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable) N/A Year I Participatory Independent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation Internal Monitoring by NOTF 26 WHO/APOC, 24 November 2004 Activitv Other Evaluation by other partners 4.1.2. What were the recommendations? 4.1.3. How have they been implemented? &2. Sustainability of proiectsl plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period (NO) Was a sustainability plan written (YES) When was the sustainabiliry plan submitted (YES) What arrangements have been made to sustain CDTI after APOC funding ceases in terms of, 4.2.1. Planning at all relevant levels Representatives from the state and Area Councils have developed realistic 3 years sustainability plans based on basic CDTI activities and recommendations made by the evaluators. 4.2.2 Funds: In the past 5 years of CDTI implementation, the Government released funds for 3 years. As a result of continuous advocacy and the adding on of the Primary Eye Care Programme, the FCT authority has released 5m Naira for 2005 activities. At the Area Council level there was release each year, although the levels were fluctuating. The project intends to build on this release to continue advocating for continuous funding of CDTI activities. The project will also approach philanthropic organizations such as Rotary Club to fund aspects of the project. In the meantime the assisting NGDO has expressed readiness to minimally support CDTI but in an integrated manner with PEC activities. 4.2.3 Transport @eplacement and Maintenance): The available transport has been in the Area Council for the pastT years and require at the moment replacemeng while the existing ones can be maintained to complement. The FCT project has in the light submitted proposal to APOC for replacement of existing capital equipments. 27 WHO/APOC, 24 November 2004 4.2.4 OthersResources: There is presently renewed commitment in the additional PEC programme recently introduced which is also attracting support from both the CBM and the government. This is a welcome idea as it will greatly support the monitoring and supervision of CDTI. 4.25. To what extent has the plan been implemented? The plan was implemented from 2004, and extent of implementation reported in this technical report. Integration: Outline the &ent of integration of CDTI into the PHC structure and the plans for complete integration CDTI is part and parcel of PHC structure but exist as vertical programme because of its strategies and technicalities. As long as the health worker are involved, its indeed an integrated programmme. 4.3 4.3.1 Ivermectin Delivery Mechanisms: The LGA focal persons who are part of PHC deparfinent normally come to collect the ivermectin whenever they come to collect NPI vaccine or other PHC logistics for their area councils. Also at Council level Mectizan collection is within PHC structure because LOCTs and first line health facility staffare all within PHC deparftnent. 4.3.2 Training: CDTI training has not been integrated with any other training activity or other programmes. This activity is being carried out in a targeted manner, but reasons suggest that the quality is reducing, requiring full scale training and re-training activities for all programme workers in 2006. 4.3.3 Joint Supervision And Monitoring With Other Programs: There is joint supervision and monitoring since the LOCT and FLHF staffs are charged with different activities to execute. 4.3.4 Release of Funds: Release of funds pass through the same channels within the PHC structure. At LGA level some impress is made available to PHC Coordinator and from here some 28 WHO/APOC, 24 November 2004 amounts are given to the LOCT leader for routine supervision. Funds are not combined and release for two different programmes at a time. 4.3.5 Is CDTI included in the PHC budget? CDTI activities are included in PHC budget. 4.3.6 Described other health programmes that are using the CDTI structure. What has been the achievement? The newly introduced Primary Eye Care programme is utilizing the CDTI structure. So far, some LOCT and CDDS have been trained in PEC. 4.3.7 Describe other issues considered in the integration of CDTI. CDTI can be utilized for programme like malari4 guinea worrn, polio etc. 4.4 OperationalResearch 4.4-l Summarize in not more than one half of a page the operation research undertaken in the project area within the reporting period. Presently the Kinship study is being undertaken, as preliminary data has been collected already. 4.4.2 How were the results applied in the project? N/A SECTION 5: Strengths, Weakness, Challenges and Opportunities. - List the strength andweakness of CDTI implementation process - List the challenge. "Andindicate how they are addressed". STRE,NGTHS: * The release of counter part fund forthe year 2005 t?. Availability of Mectizan and its wide acceptability * Continuous release of counterpart funds by most Area Councils {. Availability of some, CDD that are dedicated to the programme * Introduction ofthe Primary Eye Care Programme. 29 WHO/APOC, 24 November 2004 WEAKNESS: .3. Declining morale of some LOCTs/FLHF staff due to irregular or lack of support from Area Council executives- * Delay in release of counterpart funds by Area councils * Most communities do not support the CDDs Leading to CDD athition * Massive transfer of trained health staffat the Council level {. Unstable FCT population particularly at the satellite towns due to urbanization CHALLENGES: * Need to redefine satellite towns in FCT where the disease is endemic, and where treatments can continue * Nonchalant attitude of the health staffparticularly at the LGA and FLHF level * Demand of some CDDs for incentives before carrying out CDTI activities in their communities * Sustained and regular, release of counterpart funds from state and LGAs * Replacement of old vehicle(s) and motorcycle * Sourcing of funds other government in case of shortfall or non release of counterpart funds. To address the challenges faced the project has done the following: .E Re-organized the LOCTs and tried to ensure that committed FLHF staff ate appointed to handle the programme * Sensitized communities to select persons that are really willing to work for them {. Continued advocacy with policy makers to ensure sustained and early release ofcounterpart funds {. Plans are being made to approach relevant organizations to support CDTI within the project area. SEGTIOII 6: Unique featutes of the proieeUother matters This unique feature of the project is that it is a very fast growing city, that is fast diluting the original endemic communities' around the capital city. 30 WHO/APOC, 24 November 2fi)4