Plateau State CDTII 7th year annual project technical report submitted to Technical Consultative Committee (TCC): from 1st Jan. 2006 to 31st Dec. 2006

PLATEAU STATE NOTF/WHO.APOG GDTI PROJECT Country / NOTF: NIGERIA Proiect Name: PLATEAU STATE GDTI PROJEGT ApprovalYear 1997 Launchinq Year: April '199E Reportinq Period: From: {rt JAN. 2OOG (Month / Year) To:3{"t DEG. 2OOG (Month / Year) Proiect Year of this Report:(Circle0ne) 12 345 6 I 910 Date Submitted: JAN.2007 NGDO Partner: GLOBAL 2OOO THE GARTER GENTER NIGERIA. 7TH YEAR ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNTCAL CONSULTATTVE COMMITTEE (TCC) AFRTCAN PROGRAMME FOR ONCHOCERCTAS/S CONTROL (APOC) WHO/APO C, 24 NOVEMBER 2OO4 >Eth- oE P ^lT Xt 0bEg e -&B {'lfePrl ANNUAL PROJECT TECHNICAL REPROT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) lEg'lDO(NEgrlEg,lT PIease confirm you have read this report by signing in the Appropriate Space. OFFICERS TO SIGN THE REPORT Country: NIGERIA National Coordinator: Zonal Oncho. Coord i nator: NGDO Representative: This report has been prepared by: Name: Name: i2*t i-*rC r+\ C.C-*i., ?r+*lc,r,.- signature.. .Poa.r. cc. Date .+l+ I 4t t t Name: frg r{e r,t ( CP, t, ftr\Llc tr sisnature *il,:*.r.!*.. Date t l *l ?:Pe f Name: T)v ' tP "t , E ''3t3< Signature.,, ... . ru.9.1?./f. Date. ...{:*,. }9,. ..?-..e.7...... .. JONATHAN A. KADIMBO Designation: ONGHO C0RDINATOR Signature Date,,. ,.,. ll TABLE OF CONTENTS ENDORSEMENT PAGE TABLE OF CONTENTS ACRONYMS., DEFINITIONS FOLLOW UP ON TCC RECOMMENDATIONS.. EXECUTIVE SUMMARY....... SECTION 1: BACK GROUND INFORMATIONS.1.1 GENERALINFORMATION. 1.1.1 Description of the project (briefly). 1.1.2 Partnership...... 1 .2 POPULATION.. SECTION 2: IMPLEMENTATION OF CDTI....... 2.1. TIMELINE OF ACTIVITIES. 2.2. ADVOCACY 2.3. MOBILIZAT]ON, SENSITIZATION AND HEALTH EDUCATION OF AT RISK COMMUNITIES... ...2.4. COMIVIUNITY INVOLVEMENT ii Iil v vi 1 3 5 5 8II 2.5. 2.6. 2.6.1 2.6.3 2.6.4 2.6.5 2.7 2.8. 2.9. 2.9.1 2.9.2 2.9.3 2.9.4 2.9.5 2.9.6 CAPACITY BUILDING TREATIVIENTS... Treatment figures 10 11 11 11 13 18 18 18 18 18 19 30 30 31 2.6.2 What are the Causes of absenteeism? What are the Reasons for refusal?...... Briefly described all known and verified Serious adverse events (SAEs) that. .. . .. .. Trend of treatment achievement from CDTI project inception to the current year.... ORDERING, STORAGE AND DELIVERY OF IVERMECTIN. COMMUNITY SELF _ MONITORING AND STAKEHOLDERS MEETING SUPERV]SION. Provide a flow chart of supervision hierarchy.. What were the main issue identified during supervision?.... Was a supervision checklist used?. What were the out comes at each level of CDTI implementation supervision? ... . Was feedback given to the person or groups supervised?...... How was the feedback used to improve the overall performance of the project?. 21 23 25 26 26 27 27 27 28 28 SECTION 3: SUPPORT TO CDTI. 3.1. EQUIPMENT... . 3.2. FINANCIAL CONTR]BUTION OF THE PARTINERS AND 111 3.3 3.4 COMMUNITIES. OTHER FORMS OF COMMUNITY SUPPORT. EXPENDITURE PER ACTIVITY. 32 33 35 35 35 35 35 35 SECTION 4: SUSTAINABILITY OF CDT!..4.1 !NTERNAL;INDEPENDENTPARTICIPATORYMONITORING; EVALUATION.. 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable) 4.1.2 What were the Recommendations?.... 4.1.3 How have they been lmplemented?.4.2. SUSTAINABILITY OF PROJECTS: PLAN AND SET TARGETS (mandatory at ..........Year 3) 4.2.1 Planning at all relevant levels. 4.2.2. Funds. 4.2.2 Transport (replacement and maintenance)...... 4.2.4 Other resources 4.2.5 To what extent has the plan been implemented4.3 INTEGRATION. 4.3.1. lvermectin Delivery Mechanisms... . 4.3.2. Training: 4.3.3 Joint supervision and monitoring with other programs. 4.3.4 Release of funds for project activities. 4.3.5 ls CDTI included in the PHC budget?...... Describe other health programmes that are using the CDTI structure 4.3.6 and how this was achieved. What have been the achievement?... 4.3.7 Describe others issues considered in the integration of CDTI.4.4 OPERATIONAL RESEARCH..... 4.4.1 Summarize in not more then one half of a page the operational research undertaken in the project area within the reporting period? 4.4.2 How were the result applied in the project? SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AND OPPORTUNITIES......... SECTION6: UNIQUE FEATURE OF THE PROJECT/OTHER MATTERS 35 36 36 36 36 37 37 37 37 37 37 37 37 39 39 39 40 42 IV ACRONYMS At Risk Mllages African Prograrnme for Onchocerciasis Control Communily Direc{ed Distributors Community Self monitoring Community supervisors Community Directed Treatment with lvermectin District Health Supervisors First line health facility Staff Global 2000 River Blindness Program Local Onchocerciasis Control Team Members Lymphatic filadasis Elimination Program Lymphatic filariasis Local Govemment Area Local Govemment Council Mectizan Donation Program Mectiza n Expert CommitteelAl bendazole Coord inati on Ministry of Health Merck Sharp and Dohnme Non Govemmental Development Organization National Programme on lmmunization National Onchocerciasis Control Programme National Onchocerciasis Task Force Project Administrator Primary Health Care Stake holders Meeting State Ministry of Health State Onchocerciasis Contml Team Members RollBack Malaria River Blindness Foundation Sentinel Mllage Evaluation State Project Officer State Project Coordinator United Nation lntemational children educational funds World Health Organization. 1 ARVs APOC CDDs CSM COM. S CDTI DHS FLHF GRBP LOCTs LFEP LF LGA LGC MDP MEC/AC MOH MSD NGDO NPI NOCP NOTF PA PHC SHM SMOH SOCTs RBM RBF SVE SPO SPC UNICEF WHO ' wno/Apoc, NovEMBER 2oo4 v (iv) (vii) Definitions (i) Total population: The total population living in meso/hyper - endemic communities within the project area (based on REMO and census taking) (ii) Eliqible population: Calculated as 84o/o of the total population in meso/hyper- ( iii) endemic communities in the project areas. Annual Treatment Obiective: (ATO); The estimated number of person living in meso/hyper-endemic areas that a CDTI project intends to treat with lvermectin/Albendazole in a given year. Ultimate Treatment Gqal (UlGl: Calculated as the maximum number of people to be treated annually in meso/hyper - endemic area within the project area, ultimately to be reached when the project has reached full geographic coverage (normally the project should be expected to reach the UTG at the end of the 3'd year of the project) (v) Therapeutic coverage: Number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) Geoqraphical coveraqe: number of communities treated in a given year over the total number of meso/hper - endemic communities as identified by REMO in the project area (this should be expressed as a percentage). lntegration: Delivering additional health interventions (i.e. vitamin A supplement, albendazole for LF, screening for cataract, etc.) through CDTI (using the same system, training, supervision and personnel) in order to maximize cost effectiveness and empower communities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTI. (viii) Sustainabilitv: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future, with high treatment coverage, integrated into the available healthcare service, with strong community ownership, using resources mobilized by the community and the government. (ix) Communitv Self-monitorino (CSM): The process 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 vl that the programme is being executed in the intended area. lt encourages the community to take full responsibility of lvermectin distribution and make appropriate modifications when necessary. ' wHo/Apoc, NovEMBER 2oo4 vll FOLLOW UP ON TGG REGOMMENDATIONS TCC Session 22 Number of Recommendation in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY (i) Document integration of neglected diseases into CDTI and use the results to advocate for funding at state and local govemment levels Documentation of malaria, Schisto, Trachoma and LF was carried out and the result was used for advocacy to state and LGAs. And the LGAs released Nl,225.000.00 (sus9,570.3l) (ii) NOTF and APOC Management should support the project on advocacy to state government for funding CDTI; Advocacy was carried out to state Government by NOTF and APOC, However government is yet to release her counter part fund. (iii) Review the UTG based on evidence; UTG has been reviewed through community census update by CDD's in 2006. (iv) Improve on geographic coverage in Bokkos and Jos East local government; There is great improvement of Geographic coverage in Jos East and Bokkos LGAs (see table 7). Jos East recorded 100% while Bokkos 96.4% as against 94%o and 94o/o respectively recorded last year. (v) Identify and address the reasons for poor therapeutic coverage in Kanke LGA; This has been identified and addressed. Kanke LGA recorded 75.5% of therapeutic coverage this year as against 63.4 % last year. (See table 7). (VD Disaggregate expenditure by NGDO partner (US$ 295,000) particularly for supervising CDDs and distribution; The said US$295,000 was mistakenly reported, instead of US$38,585.00. And NGDO partner expenditure has been disaggregated for supervision of CDD's and distribution. (see table 14) Number of Recommendation in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY (vrr) Train all health staff in the project area on CDTI; This was not done in the year; however plans have been made to carry out this exercise in the year 2007. (vrrr) Ensure communities carry out CSM and SHM to strengthen community involvement, participation, sustainability; 34 villages (115%) of 296 villages carried out CSM and SHM in December 2006, and more communities are on course. (x) Improve CDD/population ratio; There is reduction in the ratio from 1 to 378 Population as against I to 397 last year (Oncho/LF ratio). (x) Explain the high number of Mectizan tablets Ieft in the field; Mectizan was left in the field due to instability caused by massive health stafftransfers at the end ofthe year. However this was later recovered from field. (xD Outline progress on the implementation of sustainability plan Above 80% of major components of CDTI (Training, Mobilization/Health education/Advocacy, treatment, supervisiorVmonitoring and community support) has been implemented. 2 FOLLOW UP ON TGG REGOMMENDATIONS TCC Session 22 Number of Recommendation in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY (i) Document integration of neglected diseases into CDTI and use the results to advocate for funding at state and local govemment levels Documentation of malaria, Schisto, Trachoma and LF was carried out and the result was used for advocacy to state and LGAs. And the LGAs released Nl,225.000.00 ($us9,570.31) (ii) NOTF and APOC Management should support the project on advocacy to state goverrrment for funding CDTI; Advocacy was carried out to state Govemment by NOTF and APOC, However government is yet to release her counter part fund. (iii) Review the UTG based on evidence; UTG has been reviewed through community census update by CDD's in2006. (iv) Improve on geographic coverage in Bokkos and Jos East local government; There is great improvement of Geographic coverage in Jos East and Bokkos LGAs (see table 7). Jos East recorded 100% while Bokkos 96.4% as against 94Yo and 94Yo respectively recorded last year. (v) Identify and address the reasons for poor therapeutic coverage in Kanke LGA; This has been identified and addressed. Kanke LGA recorded 75.5% of therapeutic coverage this year as against 63.4 % last year. (See table 7). (VD Disaggregate expenditure by NGDO partner (US$ 295,000) particularly for supervising CDDs and distribution; The said US$295,000 was mistakenly reported, instead of US$38,585.00. And NGDO partner expenditure has been disaggregated for supervision of CDD's and distribution. (see table 14) 1 Number of Recommendation in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY (vrr) Train all health staff in the project area on CDTI; This was not done in the year; however plans have been made to carry out this exercise in the year 2007. (vrrr) Ensure communities carry out CSM and SHM to strengthen community involvement, participation, sustainability; 34 villages (11.5%) of 296 villages carried out CSM and SHM in December 2006, and more communities are on course. (x) Improve CDD/population ratio; There is reduction in the ratio from I to 378 Population as against I to 397 last year (Oncho/LF ratio). (x) Explain the high number of Mectizan tablets left in the field; Mectizan was left in the field due to instability caused by massive health stafftransfers at the end ofthe year. However this was later recovered from field. (xr) Outline progress on the implementation of sustainability plan Above 80% of major components of CDTI (Training, Mobilization/Flealth education/Advocacy, treatment, supervi sion/monitoring and community support) has been implemented. 2 EXECUTIVE SUMMARY The implementation of CDTI in Plateau State started when APOC's letter of agreement was signed in April 1998. The project completed the seventh year, (2nd year of post APOC sustainability period, Jan 2006 to Dec.2006 of CDTI). The project still maintains the 5 LGAs initially approved by APOC for CDTI (Bassa, Bokkos, Jos East, Kanke and, Pankshin) with 296 meso endemic villages. Activities under-taken in the seventh year are: * Advocacy visits to State / LGA officials and community leaders * Mobilization and Health education of LGA and community levels. * Mectizan distribution at community levels. * Monitoring and Supervision, submission of treatment reports and drug balances. The project in the Seventh year targeted an ATO/UTG of 346,282 and total population of 431,831and has achieved75.0o/o of its therapeutic and 93.5% of its UTG. A total of 293 villages were treated representing 99.0% of target villages (296), see detail on page 19. Also, the project received 1,648,434 tablets of Mectizan from Global 20001 The Carter Center Jos Nigeria, and used 1, 388,590 (930,067 tablets in the CDTI villages and 458,523 in LF only communities). A total balance of 259,844 tablets retrieved from field and stored in State store for eight year CDTI activities used. Training was carried out in all the LGAs. The following categories of staff were trained: 125 HFS, 1,141 Clan CDDs, 296 Community Supervisors, 10 DPHC/DDPHC and 25 LOCTS. The ratio of CDD to population in the Seventh year is 1 CDD to (378) population. Mobilization was carried out in all the 296 CDTI villages in the Seventh year of CDTI. 266 CDTI villages representing 89.9% showed high level of commitment to the programme by giving incentives to 522 CDDs amounting to N217,694.00 (US$1 ,700.73) at an average of N417.04k (US$3.26) per CDD, while 200 LF villages supported 229 CDDs with N120,810.00k (US$943.83) an average of N527.55k (US$4.12) per CDD. The Country Representative/Director/PA of the Carter Center and Project staff carried out advocacy visit to the 5 CDTI LGAs. During the period, N1,225, 000.00 ($9,570.31) was contributed by the 5 CDTI LGAs to 5 integrated 3 programmes: Oncho, LF, Schisto, Trachoma and malaria, using the CDTI strategy/structures the said amount contributed was used for training, mobilization, health education/ supervision/monitoring, treatment and distribution activities by the 5 integrated programmes mentioned above. Major constraint is the non-release of counterpart contribution by state government. With change of government and election coming up in 2007, in which new political leaders/executives will be elected, the project still needs a powerful advocacy visit by APOC/NOCP/NGDO to the state government come year 2007. lnclusion, the project performance is graded as fairly satisfactory and could reach higher height in the near feature if government counter part funds are readily paid. 4 SECTION: I Background information 1.1 General information 1.1.1 Description of the Project Geoqraphical loc topoqraphv. climate: Plateau state is located in the middle belt of Nigeria and is bounded to the South West by Nasarawa state, while to the North West and North East are Kaduna and Bauchi states respectively with Taraba state to the South. The terrain is rough, rocky and sometimes not motorable due to flood and lack of culvert and bridges. The rocky nature and terrain are sometimes serious impediment to effective transportation in some LGAs. People: The people of the state are predominantly farmers living in scattered nucleated hamlets, with some scattered dispersed population. There are over 50 different ethnic tribes in the state. Where CDTI activities are carried out, the major tribes are Ngas, Kulere, Buji, Ron, lrigwe, Jere, Amo and Jarawa, Mushere, and Rukuba to mention just a few. Communication svstem (Roads): The preferred channels of communication in the affected communities depend on the particular community structure. Where chiefs are significant, they are an important link with the state and local government structure. Communication down to the community is from the chiefs to the district heads to the village heads, to the ward heads, and to the heads of households. For mass community mobilization and awareness, Posters, Face to face and town criers are used. Climate: The state enjoys two types of seasons, the raining season, (May - October) and the dry season (Nov. - April). NIost treatmenUdistribution activities in the state are carried out during the dry season when farmers have less to do in their farms. Political: Politically the state is divided into lT local government areas but CDTI is carried out in only five. The five LGAs are further divided into Chiefdoms, chiefdoms into districts, district into villages and villages into wards and ward into hamlets (smallest unit) comprising of ten to fifteen households. The state is headed by a Governor, LGAs by Chairmen, Chiefdoms by Paramount rulers, and Districts by District heads, Villages by Villages heads and Wards by Ward heads. 5 Population: lmplementation of CDTI in Plateau started when APOC's letter of Agreement was signed in April 1998. The CDTI programme is being executed in five LGAs as follows Bassa, Bokkos Jos East, Kanke and Pankshin LGA. There are 296 meso endemic villages in these LGAs with population of 431,831 and ATO/UTG of 346,282 persons. (See table 2). Health svstem structure: The Plateau state health system is structured such that the Oncho control unit is under the directorate of the PHC/Disease control, headed by the SPO who is answerable to the Director PHC/ Disease control. All communications are passed through the Senior Medical Officer to the Director PHC/DC up to the commissioner. At the LGA each, there are Primary healthcare districts usually referred to as referral centers, and are headed by District health supervisors. Within each district are Primary health centers or first line health facilities (FLHF) headed by health facility staff (HFS) that oversees the activities of CDDs within their catchments area (See Table 2 on population of CDTI LGAs). A Primary health care director who supervises all health activities in the LGA heads each local government health department. The state ministry of health develops policies and sends to the LGAs through Ministry for Local Government for implementation. Each LGA has 38 staff that are involved in CDTI activities. At the state level, there are seven personnel who carry out Onchocerciasis control activities, they include the programme officer (SPO), 3 SOCTS, 1 Data clerk and (2) two drivers. The programme is integrated into the Primary health system at both the state and Local Government levels. 6 TABLE 1: NUMBER OF HEALTH STAFF INVOLVED IN CDTI The entire health staff working in the five CDTI LGAs (Bassa, Bokkos, Jos East, Pankshin and Kanke) is 1 ,057. Only 190 health staffs are involved in CDTI activities: Each LGA has 1 Primary Health Care Director,2 Deputy Directors, 5 LOCTs, 5 DHS and25 FLHFs. o o DistricULGA Total Number of health in entire project area (B1) Number of health staff involved in cDTr (B2) Percentage Bs=BzlBl*100 Bassa 227 38 16.70/o Bokkos 222 38 17.1o/o Jos East 178 38 21.3o/o Kanke 185 38 20.5o/o Pankshin 245 38 15.5o/o Total 1,057 190 18.0% 7 1.1.2. Partnership (Role of each Partner) state, LGA/Communities. Principal partners involved in CDTI activities in the state are NOCP (1998- Date), MSD (1998-Date), GRBP (1998-Date) and APOC (1998 - Date), the five LGAs, (Bassa, Bokkos, Jos east, Kanke and Pankshin) and the 296 Mesoendemic villages (1998 - Date) The state is the lmplementing agency and her major roles include Planning, staffing, Manpower development, Advocacy, counterpart funding, Mobilization/health ed ucation a nd supervision/d istribution. NGDO Provides technical assistance to the project, advocacy to high government functionaries, procurement of ivermectin tablets from MSD and development of Health education materials. While MSD provides Mectizan tablets, through WHO, Nigeria. The Local governments' roles include, Planning, Staffing, training, distribution, supervision, mobilization and health education. The roles of the communities include collection of Mectizan, selection of CDDs, provision of registration books and incentive to CDDs. Other partners in CDTI are community-based organizations (CBOs) such as Union of Road transport Workers, Churches and women organization e g women fellowship (Matan zumunta). Their roles include social Mobilization of people, supervising distribution and sometimes assist in providing materials and drugs to LGAs and villages when the need arises. Political/traditional leaders at various levels provide political will and conducive atmosphere for operations. 1.2. Population Plateau state has an estimated population of 2.7 million people out of which an estimated 431, 831 population are living in 296 villages of the five endemic LGAs namely Bassa, Bokkos, Jos East, Kanke, and Pankshin. This translates to 16.0% of the entire population. See table. 2 8 lolcd a l-C Ll- ol'o =l c) =li ElO- qIr Et=!l- g16 ol- O t- l-vlE e.td.! lo Etd f ,UE9ILgUIeERll.oo\OUH;h9. C ^E IE6tlool )kold: d a"(J !l E .;r-€ooN;(Jg6b):; Og.= '=dtroyo5() d>.E= O J. 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LbEO; n f 3EE8. .= ]8E gE L'=o o-EP.P 8 .= r- 'FooEo EFO I(\t F a U 0) q) N z -F U Eda a c .9 .9t o CL o o o =v_69OE (oo G' = (0o CL oo @o c, = (ooj oz (0o CL(, o E'ItrEEEg9AE (0oi(! .? (oo o -, (oo o .? (oo E;f (0o ? tr o tt .9,o E') o o o trE69OE (0e CL (0o 6 (0o CL (9o o o (.oo CLoo E"g.trEEg9AE (0o d olr (Doi -, (0o d olr (0o d, = (0 o 6' Gt, CLf o o oo tr .9 o 59(Jts (0e G E (0o (! = (oo L o = (0o L(E = (o0 L IE = E') EEG'OAE (9oi(E ('9o (E (o oi IE (0o G' @oi c, E'I .= '6 F .9 6) ;269C'E (oo G = (0o E; (oo oE @o () o (oo CL oo E'ItrEEE(lro AE (9e lll -, (.oo f .? (o 0 t! -) (0o Ei, = @o > ? oo o o= iE=Ntr ;o =o o o =269C)E (oo CL (.oo dt = (0 o CL (oo oo (o o CL oo E)C-CEE .99AE (ooi .U (o o o 5 (.ooi tll (0o cil5 ('oo > o Eo .9o U' U' tr o oYY ogl o ul U' oa LUYz v z U'Yz o- Advocacy STATE: LGA: 2.3 A team of APOC/NOCP management visited the state ministry of health, and made effort to meet with the Executive Governor, but it was not possible. However, they met with the Commissioner for health and Secretary to the state government, who, both promised to convey the team's message to the Executive Governor, and something positive, was to follow there after. But up to date nothing has happened. High management staff of Global 2000 and the project staff, carried out advocacy visit to ministry for Local Government and Chieftaincy Affairs, and Chairmen of the 5 CDTI LGAs. This yielded positive result, because the 5 CDTI LGAs budgeted the sum of N2,450.000.00 ($t9,140.63), but released the sum of N1,225,000.00 ($9,570.31) (50%) for the 5 integrated programmes: Oncho. LF, Schisto, Malaria and Trachoma respectively. The amount released was used for training, mobilization, health education, supervision/monitoring, treatment and distribution activities for the 5 programmes mentioned above. With election coming up in 2007 in which new political leaders will be elected, in the state, the project still needs a powerful advocacy to the elected Governor and LGA chairmen by APOC management team. This we believe will change the situation. Mobilization, Sensitization and health education of at risk villages The objective of the project was to reach and mobilized 296 villages concerning CDTI activities through faceto-face discussions and by the use of posters, pamphlets, brochures and film shows. The method mostly adopted during the period was the face-to-face methods: to community leaders/elders, women group, religious leaders and minority groups. ll Materials that were used to facilitate the mobilization were:- During the Seventh year (Jan. 2006 - Dec. 2006), the project was able to mobilized 296 villages, which represented 100% of our target (296). Out come of the mobilization was impressive. The Villages were able to This is indicated by geographical coverage of 99.0% and 86.9% of ATO/UTG coverage in the year. A total of 266 villages of the 5 CDTI LGA provided incentives in kind or cash to their CDDs representing 89.9% of the total villages (296). Financially, the sum of N217, 694.00k (US$1 ,700.73) was provided to 522 CDDs as incentive with an average of N417.04K (US$3.26) per CDD. (at N128.00 of US$1.00 exchange rate). Major constraint during the period was inadequate motorcycles for health workers to visit remote areas for mobilization and health education. The project intimated the LGA chairpersons to help refurbish broken down motorcycles and fuel other functional ones used in NPI for CDTI activities too, but due to lack of funds, they promised to look into in next year. 12 2.4 Communitylnvolvement. Table. 4 Communities participation in the CDTI * ln all the endemic communities, female CDD's were selected based on socio-cultural and religious beliefs, this is the basis of their acceptance to the communities. Comments on females performance on CDTI activities:- o Attendance of female members of the community at health education meetings: Attendance of females at community health education meetings was encouraging, because about 10 - 20o/o per village attend meetings regularly. . ln general, how do you rate the participation of females members at the community meetings when CDTI are being discussed (attendance, participation in the discussion e.t.c)? Generally, females are actively involved in community meeting when CDTI is being discussed. The asked relevant questions, and gave answers in respect to CDTI. l3 DistricULGA Number of comm./Vill. With Comm. members as supervisors N0. Of CDDs and the comm. involved N0. Of comm. /Vill. With female CDDs Total No. Comm, in the entire project area 84 No. with Comm. members as supervisors Bs Percentage 86= B5/84-100 Male CDDs B7 Female CDDs 88 Total 89 = B7+88 N0. of comm. /Vill. With female CDDs 810 Percentage 811 = 810/84-100 Bassa 70 70 100 286 18 304 18 25.7o/o Bokkos 83 83 100 215 8 223 8 9.6% Jos East 63 63 100 269 47 316 47 74.6% Kanke 17 17 100 56 3 59 3 17.6% Pankshin 63 63 100 230 9 239 I 14.3% Tota! 296 296 100o/o 1,056 85 1,141 85 28.7olo . ls incentives provided by communities to the CDD's? Yes, 266 (89.9%) villages supported 522 CDD's with N217,694k (US$ I ,700.73) in cash, and 399 CDD's (35%) were supported in kind e.g. farming, farm product, house construction e.t.c. o ls attrition a problem for the Project? With the adoption and used of Kindred CDD's, attrition is no longer a problem for the project dropped out CDD's are immediately and easily replaced with new CDD's (Kindred) by the communities. t4 2.5 Capacity building. Plateau CDTI programme targeted to train 1,627 personnel and had adequately trained 1,597 personnel at both the LGA and community levels, although capacity building at all levels is a continuous exercise. Training/retraining was conducted for both health staff, community supervisors and Clan CDDs. The trained 296 community supervisors and 1,141Clan CDDs was decentralized by FLHFs health staffs who were at LGA headquarters. Training of 25 LOCTS, 10 DPHCiDDPHC and 125 FLHFs staff were done by the SOCTs while, that of the CDDs by LOCTs and HFs staff. See table 5. Materials used for training of CDDs included: During training, emphasis was on the causes of the disease, signs and symptoms, drug administration using height, health education, programme management, exclusion criteria, early submission of reports, census up date and the management of adverse side reactions. All trainings where integrated with other programmes e.g. Roll back Malaria, Schistosomiasis and Lymphatic filariasis, where applicable. Selection of CDDs based on clan/kinship and the involvement of CDDs in other health related activities e.g. National Programme on lmmunization (NPl), Schistosomiasis control, LF and Roll back Malaria programme had reduce demand on incentive and attrition rate. Between January 2006 and December 2006, some health staffs were transferred by the Local government service commission, and this affected some trained staff involved in CDTI. Effort was made to ensure that all newly posted staff were trained on CDT to replace those transferred. (See table. 5 and 6). Longterm plan is to train all LGA Health workers on CDTI to enhance effective participation by all staff. 15 1l ()(J (!+6=F(J bPE<) E= z, () (J o F t, o,c ct ooo(, o (, I E z, te(? @ 1r) (o$ c,NN N (0 ct o) r()NN o) ro t-N N(r) o) c)(\t N @ tq s tq C') o Eo .9 (.) s G'olO ({)(9(o rfo c., o)t(\l (0 c, ot ro el,tN N _(JaErr=E 's <-rFo+ o L oE. o C) oo o F oo(l, c, G, L o o 6'E '6 (t, o o (,g E J z, ro N s CA N tr) lo N s cf) lr, 64' soo tr o E o .9 o s o ot l(, tO (Yi, rl, o oo CL L(l, E(l, o -c =(l,o J- o q, Er -ct o,E= 5aE ilod Glr OoF(J E(l)tsE<) o = (u z. ro ot o lr) N ro(\l @ t- ro ol o (. c! ro(\l N s rO(\t sf 1(,N soo ot lo @ o oEF rON rO(\t lO(\t rO(\ ro(\ roN Eo -6rLoF()+ o oE o = (l, z. o t-<o ts au U, tt, oJ art _ oo LL aa aE os o (t)I E J z. N(9 rr) N(Y' N 6t(Y' N $t(9 (o N C\ e, ro o(0 soe o E o .9 o s o(o t-N 6t co oN o{(9 o cf) (\t(9 (o (\t(9 t- (\t c, oo o(l, .3< E9o> r! .o oG trl o oJ .Y o trl o(! IIJ o o o .:<tr(l, Y .= os IE o- J F ot- \o i o +.(U +,e o E o CL E Fo o tF o o o o rF' F ot- or*rF E +,(E ct)tr tr '6 LF rfi o .cr(EF a ->> ri o) \)a trI (,,i15E oq)O. r.] ) L hi i: crUzE F(: FTa ) ) ) ) ) ) E!EE E ) ) ) ) ) ss!18 ) ) ) ) ) rt) U ) ) ) ao ioFr or o EC)d orJLrdo0codtuz eEoo !dE()o)oE, aO >e7: -Y();Ii -c (t () C) oo(S u)q irl €<2A F a cn a (d d d Cd oo L B Lr oa 0)& r- -glt(E .9 -cL CL il Ec o E') oJ q) liq) oo clL l11 o q) t'r \o o c{F 2.6 2.6.r Treatments Treatment figures. Total census population 431,831 persons Eligible population (UTG) 346,282 persons Treated population 323,695 persons (See table .7) Therapeutic coverage ----- 75.0% ATO/UTG coverage 93.5% Geographic coverage. (Villages) =99.0% 2.6.2What are the cases and causes of absenteeism? Absenteeism of 1978 persons reported during the distribution period accounted for 0.5% of the total eligible population. Reasons for absenteeism include: resettlements as a result of the crises in the state, and also temporary relocation for farming activities. 2.6.3 What are the cases and reasons for refusal? ln Bokkos LGA, 3,826 cases of refusals were reported by the CDDs during distribution. And reason is as a result of poor incentive to CDDs and non compliance by members of Christ Apostolic church (CAC) in Mushere and Butura districts respectively. 2.6.4 Briefly describe all non and verified serious adverse event (SAE'S) that occurred during the reporting period and provide in table 8 the required information when available. ln case the project did not have any (SAE's) during the reporting period please tick in the box. N0 SAE Case to report ( 18 b -otr6eEEBfi e9Y(6(,,k = e yEO()o=(6 o lJ-5eH .\!LJJ,CN e18 oo EE ELA EO[;CxEo L9t rc .9, .c =-oaooo3EEgE= : - co=63Eli +dE 4o=iq(D 6I]C a.;L;ee(o=v .Lo)o=(oPE E.=OLX<EPU,g d-* or dce(U0) -c (l -c65fi -J(E8 E 3 -Y=!lz -c o)oocoo= f E [U3 U = .gisR l--: ,\ -omY oZ E E o oE ; BITEE !r^=>l ;€H" e z z z z z z 6,3i6 z z z z z z o 6.$ .coo2,8 .E (9 \f o)N(o N r cf) (e o, @o$ oNoI o *s 5 3 E€Erz.o,'=cLt z (o N@ CO z z z @ ol o^ ct) o g CL o o- E= oi?,, ! E edRfi<-r o st- oit- s(o o,(o s@ cot- slr) rot- s o) .(rt\ so r.c, * 96O X.o a EE :Z B.E (o ro o) co O) Ns N @(o o,No o\r @t- (o CO (r) o)N -F- ro o,(l,^ (9$l(9 )i 'o(u =EEO s cf) cf)- o) o, c.)f.- s- o,t- (o r (a lr) s@ co(a lr)t- @t- N € c\{(ot co oob : CL.S2 O FEEE g --oEo,t E=EFE @(o .(r N (o r co o) (o o, (f) (o(o N(f) o, F-$ o) N [r) o) (9 cr^ (9 t oq) cDg 5 o o .E E E oo 6tto -o =ooFaf;<-et e6olo so oo s a(o o) so oo so oo so oo sq o) CD .gE 6Efi ei E.=z.Eo O(l,oE) ot- o@ cf)(o f.-r (r)(o (Y) G')(\ xFo -oIa*EO o f.- (o co CO(o F* CO(o (o o)6t E ..= 9 -qr.: E E $g;-E EP'= C b E oN (f)@ (f)(o t- (f)(o (oo)N oJ (J -9o o atao(D U'olzlz o(D a C, trJ oo - o) -:zc oY .c !o .)zc G o- FoF J o (E o(E o (u (u ;(9 JD o .9, o lt o UJ a E'tr(E g o E (U o F !-g .ct GF z z z z z o Eo _Eoo ->oo 12 =5<.= c z z z z z z b _E P.E' 8Eii.gaEo(, E CL= .9E6x o.=LIJ.]o z z z z z z z z z z z z z z U'9 'l',EOocaE)EO5b a z z z z z z z z b9eE:atE E;i ar'= o cEEgE b z z z z z z z z z t ct (Eru,o)b (,-e > * E sEdEE.E z z z z z z z z z .= Eo b'B = ->s'EE=SEEE z z z z z z z z z z z z z z u, ct =c(! -Y6sE -r 9, -N =€ET-E --cl= z z z z z z z art Eo CL E U' z z z z z z z z z z z z z z z z attFE66E -= a! e F8_8AS z z cE(l)(t,-YN.E -.'.= € -139(,iEqr(!oE 3 z z z z z z z z z z z z z z z z z z z z o o,trDc(o'6; >o (l) E' z z z z z z z z z z Cf) \r F- o) oc, z,(r, N rr) @ @ c.l (o oo(\l o .ct E o o oo Ii(E tr(E? ci o a, IJJ tL IJJ F(, z e. :) o o IUFt o(L IIJ u o 3 Fz lrJ UJ IUat ut o tt,f o e. lrJo o 4. ts (l, 'c, E(I) ooo (E o UJ C" cn (l, (l, (l,q, o E(E o o oU' o a o,a(so dd o,E(\,F oz 2.6.5 Trend of treatment achievement from CDTI project inception to the current year. Since treatment started in 1998, there has been a progressive increase in the number of persons treated each year. However, note that the marked increased during 200112002 to 200212003 was due to internal displacement of persons during crises, While 2006 is as a result of adoption of kindred CDD's See table 9 for details of treatment achievement from 1998 to December 2006. 2t (\ ol z o f o. o o- uj ='o6\o g '.[ .J uJ ollF st- d o, s(o $@ ss c"j o) s (f) d@ s\N o) s o) o o, s o, co o, s rr) CO o) €iE$=io >ulf8,, s(o (o F- s(o 1r-(o st- +F- s(o ot- sN +t- s @ c.it- sN rit- so rrit- * gfiO Xo -x6, = [E ooN[o @ r o,oN @@ o N $ N $o s_ @N o) \ ro(f) o)t-(9 c.it\N (o I\(a- @ N lr) o, @_(r) N(o ,a LE :LU G' ='= =o s(o$- CO o, r t-@ rO c.iNN o @N o,NN t-s@ co (r) t\ o,(o lo c!(o (o N r.c) o, o)N (oN rf) o, o)N N@N(os(f) .9 oEto :9 -o 6ut *eH *t aE EEr6' E (f) o) F-_ $N s(r) N @t-N oo(o- (o @ N (f) lf) 1r) co o, CO (o sf f.-(oo\t @o$- st-(9 @o\f-\rt-(o (.) @_ (f) tif o uJ o o LlJ 2f = =oo oi..o>Io8,fE o G'!u k -r.rr soo r soo soo soo soo soo s @ o, so o, o) Expo-;< *-!s -ul6d>I Eil soo soo soo soo soo soo s @ o) so o, o) E E=E, (o o,N (o o)N (o o)N (o o, c! (o o)N (o o)N o o,N (f) o)N E -o- E: UJ&T (0 o,N (o O)N (o o,N (o O)N (o o,N (o O)N (o o,N (o o,N rhE:= X o - .EiEEET E E = 3E iIFOqrdr.E(JE (o o,N @ o,N (o o,N (o o)N (o o,N (o o)N (o o)N (o o)N E trl t- o, o, o, o) o) @ O) o) oooN o, o, o, r ooN oooN NooN ooN (o ooN NooN sfooN (O ooN lr)ooN sooN (o oao!; o Gtr .9 s I G'() o E) G o oo o f G' '= o Gtr EO L9Eg.g EEe'gqrvcL =8e()0,ee5E!e.='o oE3EEE3,9,Qr=(o(J= -ENt yrjRl 8 -od:.e-g Eo-E(E;F0,:YR HE t(gEooO'=o .r-gN?cLb;iotrE5 E oLo .l)rFo =(90(JF.(sf(o E otor-N s-L(E';5-lEsr6= s:Glo.=-) 'c, oog_E FG (n rrtoqE(\tF 2.7 Ordering, storage and delivery of ivermectin. Mectizan ordered/applied for by: MOH(v) WHO( ) UNICEF( )NGDO(v) Other (please specify): FMOH (NOCP) Mectizan delivered by: MOH () WHO(v ) UNTCEF() NGDO(y) Other (please specify): Ordering: Before the procurement of Mectizan was done by the NGDO, each CDD calculated his Mectizan, requirement based on the eligible population registered multiply by average of 3 tablets. Together with FLHFS they arrived at their requirement for each village and DHS, which in turn did the same and sent to the focal person at the LGA to the SOCTs. The SPO compiled all requirements for the 5 LGAs and sent to the NGDO for procurement. Storaqe Deliverv: When Mectizan arrives in the country, WHO clears it from the Customs and stores it in their warehouse. The NGDO then collects the drugs to her store and then notifies the state: The State makes requisition from NGDO's store for LGAs ready to start treatment. When Mectizan is supplied to the SPO by NGDO, SOCTs collects for their respective LGAs and hands over to the LOCT team leader at LGA level. The team leader later hands over to the five DHS/LOCTs for allocation to the five FLHF or collection centers where CDDs come to collect for their respective communities. 23 $ c.l F(.J=8: og. rE 5Eo(trJ.= o o@ts LL IO9E oooE PLJotI o"= -c t\#o 90bNL L E;qd Oao:f c-. = o)E-U-o -99.9\.OEeiE;$ Pt@-a ,t O, O)Ytr)(Dg a,rzt a P 'x(EElgOC-OLGg€ EPqE =EoEoiuEo9o) -ot:_c(u-#EOEO PLLI8_b -l-e-b.Ox\yv =:foP€; '=a+ i: oos=b oo ! o fitE;3,A =5E';(Jp-CG o 0, E(E (E N o o =o oll E z E"E e. .E EoE (,(o 6 o @^ lo (.o o o- @(, $ a o) N t- G' ct \tt oq o)(, N E'o 'a x TU o o o o o o t,oE 6'E o o o o o o E' o, o(u = o o o o o o ooJ o o o o C' o J FoF o) @-(\(o ct ro @ ao^ o(0 N o^ ot @(o cr-(9(0N o o)^ (o(? o o) tr)^ @ @ eo- E'oo = LLJ (\t$t^ N € cc @(.o o @_o(o o) o- t ({) N lo^ @l{'t oIo z,o (e t_ o@N t(,, ot N o) o^ olll o)t^(\te @(\ €- t N t\(o o^ o 00 o) Eo .=o(, o,d, o rO- @fi, (0(9 or- rO(9 at lo d N @$^ t ra,(Y) o) (9^ oo\t \tg) .t G't(o- !o lto:, EToE o l4r^ @(9 @ @ o)^ lO (Yl, c, r(, d (\t @ -t_\t ro c) g) c'r- oot $(9t- G'$ @- o atl (t, o L .9, o t! oo tI, d! o o .YJ oo o .E lrJ o o? o .Y tr(l,Y .= o .Y fi, o- E oF (ooo ot o -o E o(J oo I .oooN e(! ftr(U ., b o tr o ;(E N o o =c; g tt(!F o List and briefly describe the activities under lvermectin delivery that are being carried out by the health care personnel in the project area. 1. Mobilization/Health education: Health staff mobilized and health educate community members on the important of CDTI activities, such as how to conduct CSM, Sustainability effort, selection of CDD's and CDD support. 2. Traininq: Selected CDDs by communities, are trained by Health personnel on CDTI activities and training is centered on how to conduct community census, update community registers, order/collect and distributes lvermectin tablets, keep good records, recognize and handle reaction, data collection and report writing. 3. Treatment: Health personnel collect lvermectin and supply to CDD's and CDD's distribute to their communities. The also manage side reactions referred to them. 4. Supervision: CDTI activities carried out by CDD's are supervised by Health personnel right from the beginning to the end of the activities, by checking their records, drugs, supplies, community support, e.t.c. . Any other Comment? Supervision is based on CDTI hierarchy: SPO - Supervised SOCT's at state level. SOCTs - Supervised LOCT's at LGA level. LOCTs - Supervised FLHFs at health facility level. FLHFs - Supervised community supervisors (Com. S.) at community level. Com. S. - Supervised kindred CDDs at kindred level. 25 2.8. Community self-monitoring and stakeholders meeting. The project carried out CSIVI and SHM in December 2006 in only 34 villages (11 .5o/o of 296) due to limitation in funding. Has any training (of trainers) for community been done in the project area? @ lf so when? In December 2006. Table 11: Community Self - monitoring and State holders meeting . .Describe how the results of the community self-monitoring and stakeholders meetings have affected project implementation or how they would be utilized during next treatment cycles. The 34 communities conducted CSM/HSM at the end of the year, the result of their finding and conclusion are expected in the next round of treatment (2007) 26 District/LGAs Tota! # of comm./villages in the entire project area N0. of comm.. that carried out self monitoring (CSM) N0. of comm../villages that conducted stakeholders meeting (SHM) 2006 Bassa 70 17 17 Bokkos 83 Nit 0 Jos East 63 17 17 Kanke 17 Nit 0 Pankshin 63 Nil 0 Total 296 34 34 2.9. Supervision The Plateau CDTI project is so designed that Supervision is carried out at six Levels, (Zonal, NGDO, SMOH, LGA District and FLHF). At the NGDO level, the Director Plateau and Nasarawa project, Global 2000 and the Project Administrator did periodic supervision. At the state level, the SPO/SOCTS supervised the activities of the LOCTs while the LOCTs/DHS supervised those of the HFS. HFS supervised Community supervisors/leaders and community supervisors/Leaders supervised CDDs/Community members. All the LOCTs and DHS were provided with Motorcycles by APOC, Carter center and LGA to facilitate supervision. Each LOCTs (DHS) is assigned five PHC or FLHF centers which serves as collection center for Mectizan while each FLHF supervises the activity of CDDs at the village level. 2.9.1 Flow chart of supervision NOCP ZONE'D' ZONAL COORDINATOR STATENGDO (Dir/PA) SPO/SOCT LGA I,OCT/DHS FLHF (clinic) HFS Communiry /Village. COMM. LEADERS/Supv 27 2.9.2 a. What were the main issues identified during supervision? Some CDDs used small exercise books that would not withstand repeated usage and therefore no track records of past treatment. Some communities supported their CDDs while others had difficulties in supporting them. Non-released of counterpart funds by state while the 5 CDTI LGA's released funds lnadequate logistics for supervision. lnadequate IEC materials Transfers of Health staff Adequate supply of drugs and materials b c d e t. g 2.9.3 Was a superuision checklist used? Yes The project within the period of reporting developed a checklist for supervision at various levels, SOCT check list, LOCTs Check list and CDDs check list. These checklists are available at LGA levels and the health facility staff uses them during supervision. 2.9.4 What were the out come at each level of CDTI implementation supervision? With close supervision at each level, records were properly kept and mistakes avoided. Results of supervision were used in addressing problem areas to prevent feature occurrences. , The 5 CDTI LGAs released counterpart funds. . 266 villages (89.9%) supported 522 (45.8%o) CCDs with N217,694.00k (us$1 ,700.73) . 23 villages and also among the 266 villages supported 399 CDD's in kind. . The 296 communities were mobilized and 293 (99.0%) treated. . Training Recorded = 1,597 (10 DPHC/DDPHC,25 LOCTs, 125 HFS,296 comm. supervisors and 1,141 CDDs). 28 2.9.5 Was feedback given to the person or groups supervised? Yes. 2.9.6 How was the feedback used to improve the overall performance of the project? Feedback was used for target training/mobilization/group discussion and supplies at various levels to maximize effort and overall performance. 29 SECTION 3: Support to CDTI. 3.1. Equipment. How does the project intend to maintain and replace existing equipments and other materials? Capital equipment and usage is properly integrated within the health system such that maintenance is done through the State and Local government system of operation. Existing equipment and other materials will be replaced or maintained by the state and LGA using their counterpart funds. Project staff and the NGDO may assist with simple maintenance where and when necessary. And APOC would support major repairs and replacements Table 12: Status of Equipments Source of equipment s/N Type of Equipment APOC MOH DistricULGA NGDO (GLoBAL 2000) Others NO Condition NO Condition N() Condition N() Condition NO Condition 1 Vehicle 1 CNFR 0 0 0 0 0 0 0 0 2 Motor Cvcles 10 8F2WO 0 0 0 0 10 4F6WO 1 1WO 3 Computers 2 2F 0 0 0 0 0 0 0 0 4 Printer 2 2F 0 0 0 0 0 0 0 0 5 Photocopier 1 1F 0 0 0 0 0 0 0 0 6 TV 1 1F 0 0 0 0 1 1WO 0 0 7 VIDEO REC 1 1F 0 0 0 0 1 1WO 0 0 8 GENERATOR 1 1F 0 0 0 0 0 0 0 0 9 Stabilizer 0 0 0 0 0 0 1 1F 0 0 10 Phone 0 0 0 0 0 0 2 2F 0 0 11 standing fan 0 0 0 0 0 0 2 2F 0 0 12 Refriqerator 0 0 1 1F 0 0 0 0 0 0 13 Tables 0 0 3 3F 0 0 6 6F 0 0 14 Chairs 0 0 18 18F 0 0 0 0 0 0 15 Cardboard 0 0 0 0 0 0 1 1F 0 0 16 File Cabinet 0 0 0 0 0 0 9 9F 0 0 17 P.A System 0 0 0 0 0 0 ,| 1F 0 0 18 Bicycles 25 25F 0 0 0 0 10 10F 0 0 19 Office safe 1 1F 0 0 0 0 0 0 0 0 20 UPS 2 1F 0 0 0 0 1F 0 0 30 Condition of the equipment (F - Functional, , CNFR - Currently non functional but repairable, WO - Written off). Maintenance - The state CDTI Project vehicle and other capital equipments are solely maintained by the Carter Centre (NGDO), while motor cycles/ Bicycles are maintained by 5 CDTI LGAs. However, when state government fund is released will be used as supplement. Replacemen!- ln December 2006, APOC replaced the state project computer (Flat screen and new version CPU), printer and UPS. And request has been made to APOC to replace the project 4 WD Hilux Toyota vehicle. Also there is move for the Carter Centre (NGDO) to replace some of the project motorcycles. 31 N ao a0o c,F1(to3Hr z E Ee €fi3 F z CO oNlr) o, z @ o! s t- lo r z (Y) N ooN. oo oo rr) l- N elo € .t t(v, Es sga sf f.* do(f) ro cr)(0 os o, z @ c! st rI- 'r)r z z oo rr) F* lf,q(9(o @- Nt roooN = $ooN uJzf - ('9 t IIJ gga gt3 F z o)q o(o t-_ z oo [r) @ rr) @ cf) z @ c! rO o)(o- N ooq N lO ul ot\(v)(o fit g9a CA o) +@ ryo sq cf)(o(r) r.c) z ood @ rr)_ @ cf) z z oo o)- sN Nq (v) co oiN (v)ooN = oloo(\t llJzfa ro t uJ gna (E of6E-F z tr) cf) N z Nq sN r o z (7) <.is o- o)q Noq (\t I\q rOo r(,- t *E,a E.e - (oq(o(o|f) o r NF- +$ o{(o z o(a F-(o(o- oN z z @q No - N coq @ tr)- @lO (\tooN = oo(\l IJJz3 tt IIJ TU ; G(#q-9(/) .e o=F Lv z N oq @ z o@ o(o 1r) NN z oq !t cf, -z -a|r) rr)s lo(o e1tq o)ol(- o(o 6o !t .9 Esg s(o o o) .l: t\ N oq @ z Nq o,Nt- o,s z z n ro\r\rlr) cf) o) at\t oq fi, o) oL o+,)lt L+,tr oo o o a o '6 C '= oL o- I o = oJ o .E ,9o T o E o = o oo(, z ooo -J ah L oCt o o- oo oz o q) .C o oo =c =E E oo Ec fII of Lt- oo o- J F oF oq @ .1,f l1 G'N z ri -9 -o(E F o Go r-O BE tv (g JC'arNtrV os o o o ocE G CL (E .o c o lt tr oo E(,g (5 ir- oo .E E E oo Ec(g o otrtr(E CL o o otr o flt o o (E '6 c(E c iE cY (i'l) lf there are problems with the release of counterpart funds. How were they addressed? o Advocacy visits were made to the relevant policy makers by NGDO, APOC and NOCP o NGDOs and add - on programme Funds are used where and when available. Additional Comments. High-power advocacy visit to the various government levels by NGDO, APOC, and NOCP is solicited, due to change of Government in the State. And come 29 May 2007, there will be another change in Government. 3.3. Other forms of community support During, training and distribution, communities provided feeding, transportation and registers to their CDD's. 3.4 Expenditure per activity. lndicate in table 14 the amount expended during the reporting period for each activities listed. Write the amount expended in US$ using the current united nation exchange rate to local currency lndicate exchange used here = N128 = US$ 1.00 JJ E oF lr)\ F-los t\ a(o CO ro ro o sN(o o{ s o) 1r) @ @_ @q O) @@ lr) s a cf)Ns (oq o(o_ N oo oo ro oo ooN @ o, loo\ CA oodo(o_ s o o, +(f) ryN lo c! lo (Y) o- N co o (,J .Es o .)l G o- o sf(o t-Nlr) (o (f)(fi o, F- alr)o N\(o @(f) CJ t-q (f)(o N o o oNd ro o lr)odN oq o) ro\ oLtr(U Y o q o,s@ (o c! NN(f) @t\ dt- (o @ cot-(o o ro a o)(f)s o o t\(o c"j(o N o @o lfioN @q o)N or- C\ oGt! a o COlr) ss(o s oq s N o, @Nr \t + o,s o t- c! NN co o o (o (f) c"j o, o O) c.) o 1r) tt6t (\T o oJJ oo o o)\ sl(o @odoN loo coN s a(at-N o (ot- F* F- o o NN @ CO o @ c? o,o C') N(fl 6,)- G o o(E o o (0 o $ Nt-(o(a (f)q N@ ro a!t (o o o,odoN o o \tI(o N o ot- ri o) CD t-(l' co- oEE UI o o o o o o o o o o o o o (J oL o oo Cfitr)t- oo oo o_ o ro c\i(o c.) o s a (f) Ns (oq r(os o o o oo o 1r)t- CO o oq oll,\(o ooo6l E0o(9 lr)F- r-ros so l'-o o- N s o o) N ro @ o$(o @s(ost\ CO o O) (f) 6i(ot- oo oo ro oo ooN o, o, o(f) @_ N ao co ro @ o(f) o,slo- t ol N \lo .= .= C' o (I, o>o.=Or=(E=JE C)EooEoo=o: -c =8_FC5.o EO >o) 98 EE oc,0) q) =c)o9 o Co (E o =E(D =(!oT E(go co) .9= 6= N= oo =O at,oo(J o o) .cc '(! F o(t) G) (o (E ts(E o E o)I o o) .C '(g F Co -o .oE E (\, at)ooO o c @ E(D o- =U) U)O ao '= o(I, Foo o(n c o =Co =E c (l) E Eo:oo- oc(! c =(!(D E o vt =o '= (J>AEXo -ra=<(E I(u (D (E =O LLl c(D E (I,(D o o E o oCEoo. o) .(\, E E =a tt, o)E .o cct E c(E tt,o o >ro 9ooo>Eb6o= t'<o>E o o o) C .E o qt o) =o Eoo o o) =o E .g =o o) ooE o o .9 o co (U o o o) =E co (J(g o) op U) Fo ai -o(! C)r t 0) a.x El o E c) o .s lz o o(O L() o. o)r ! C) o.X C) o() ,tiH z aq @ lt @ N ez RE o= €!,tsooocLoxO IIJ l(oe8tsNNd Eo =lrr (O -o ER,E: :>H8.,(Uo LOOEo- .t()E =o1G ELCOocL rs 8Ep'b nCL x+o;HE'd(ELF(L Any comments or explanations? Most activities were sustained by NGDO funding, supported by the 5 CDTI LGAs and good will from the communities. 35 SECTION 4: SUSTAINABILITY OF CDTI 4.1 lnternal, independentparticipatorymonitoring, Evaluation. 4.1.1 Was Monitoring/evaluation carried out during the report period? (Tick any of the following, which are appticable). NO Year I Participatory lndependent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation lnternal Monitoring by NOTF What were the recommendations? _ NIL _ How have they been implemented? _NlL Sustainability of Project: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period? _ No- Was a sustainability plan written? _Yes - 4.1.2 4.1.3 4.2. When was the sustainability plan submitted? _ 4.2.1 Planning at all relevant levels? Yes _ 2003 t200,5t2006 The project after the fifth year CDTI developed a three years sustainability plan for implementation by all the five LGAs and the State. These plans (2nd and 3'd year plan) were resubmitted in 2005 and 2006 all were signed by various key persons of the LGAs and state ministry of health ln the year 2006, the following activities were planned: State:- The state in her 2006action plan, budged N679,519.00 (US$5,308.74) and to carry out advocacy visiUmobilization/health education, training, treatment and supervision/monitoring, but there was no released of fund, and yet the activities were fairly carried out. LGA:- The 5 CDTI LGA's in their action plan of 2006, approved N2,450.000.00k (US$19,140.63) but released N1,225.000.00k (US$9,570.31) representing 50o/o, and planned to catry out community mobi I ization/hea lth ed ucation, train i ng, treatment and supervision/mobilization. And the activities were carried out. 36 Community:- ln 2006 action plan, the 296 communities of the 5 CDTI LGAs, planned to carry out stakeholder meeting, community self-monitoring, select Kindred CDD's, update community census, collect/distribute drugs and write report. And the activities were carried out, with exception of CSM and SHM which was only carried out in 34 communities of 2 LGAs. 4.2.2 Funds: The 5 CDTI LGAs provided counterpart funds for CDTI and 4 other integrated programmes. Using the CDTI structure. Project depended heavily on NGDO funding. 4.2.3 Transport (replacement and maintenance). Replacement = 1n2006, there was no replacement made. However, the project request APOC to replace and add more 35 motorcycles, but this was not accepted, instead, APOC advised for either replacement of 6 - 7 motorcycles or a vehicle, and the project has requested for replacement of 4 WD Toyota Hilux vehicle in 2007. Maintenance = State project vehicle maintenance is being done by the Carter Centre, while motorcycles and Bicycles are done by the 5 CDTI LGA's. 4.2.4 Other resources, _Nil 4.2.5 To what extent has the plan been implemented? At both the state, LGA and community level, all the activities that were planned to be carry out, has been fairly done, resulting to 75.0o/o therapeutic,99.0% geographic and 93.5% ATO/UTG coverage respectively. And also an ATO/UTG of 98.2o/o trained personnel involved in CDTI activities. The project recorded 50% of fund released by the 5 CDTI LGA's 100% by the Carter Center (NGDO), 80% by APOC and above average by communities of the 5 CDTI LGAs as incentive to their CDD's. 37 4.3 4.3.1 4.3.2 4.3.3 4.3.4 4.3.5 4.3.6 4.3.7 lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: lvermectin delivery mechanisms - lvermectin, Albendazole, and insecticide treated net (lTN) are distributed to the eligible persons simultaneously during treatment. Training: lntegrated into LF, Schisto and Roll Back Malaria Joint supervision and monitoring with other programs _ Yes -Release of funds for project activities, Yes a!! the 5 CDTI LGA's. ls CDTI included in the PHC budget _Yes _ Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? ln plateau state, programme that are using CDTI structure included: Roll - Back malaria, Trachoma, Schisto, LF and Vitamin A supplements. There is also move to NIP; measles etc to be fully use the CDTI structure. And this has been possible due to the effort of the Carter Centre - Nigeria (NGDO). The achievement has been so great to the extend that the manager of Roll- Back malaria programme in the state, was invited by WHO in 2005 to Ethiopia, in respect to the structure used that made the programme recorded above 80% coverage at the first instant, and all the programme using CDTI structure has been recording good coverage in geographical, therapeutic and UTG/ATO respectively, even when funds are limited. Describe others issues considered in the integration of CDTI. Logistics, Staff, Funding. LOGISTIC: Because of integration, the project is benefiting on other programme vehicles, motorcycles and bicycles. Like wise other sister programmes did enjoyed the same from the project. This makes the project personnel movement easier when CDTI activities are carried out. And cost less, than when individual programme are to use only their logistic. 38 4.4 4.4.1 4.4.2 STAFF: The health personnel and CDD's involved in CDTI are scars but when integrated. The few one gained more responsibilities, knowledge and skills, than when individual programme are to use different personnel. FUNDS: ln the scarcity of CDTI funds, other integrated programme (e.9. LF, Schisto, Malaria) supplement funds which are mutually used. This makes CDTI activities go on to an extent. Operational research Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period? There was no operational research undertaken in the project area within the reporting period. How were the result applied in the project? No operational research conducted. 39 SECTION 5: Strengths, weaknesses, challenges, and opportunities List the strengths and weaknesses of CDTI implementation process. 5.1 STRENGTHS The CDTI activities in Plateau state wishes to observe the following strengths of the project during the Seventh year of its activities:- LGA level helped to improve movement for supervision. 5.2 WEAKNESS / CONSTRAINTS LIST THE CHALLENGES AND INDICATE HOW THEY WERE ADDRESSED:. CHALLENGES: 1. Poor counterpart funding from state, and Local Government. 2. lnability of some communities to support their CDD's 3. Resistance to selection of clan/kindred CDD's by majority clans in some villages. 4. High cost of project vehicle maintaince because it is too old, and worsened by lack of funds. 5. To train more CDD's based on clan and the ratio of one CDD's to kindred population of 150, based on APOC request and also recruit more female CDD's Training of LGA staff/Directors of PHC and FLHFs on CDTI implementation due to constant transfers. 40 HOW CHALLENGES WERE ADDRESSED: 1. Advocacy visit was paid to state by APOC/NOCP and the 5 CDTI LGA's. by The Carter Center and project staff. And the 5 CDTI LGA's released the sum of N1.225, 000.00 (us$ 9,570.31). 2. 296 communities were mobilized and 266 supported 522 CDD's with N217,694.00 (US$ 1,700.73), and average of N417.03k (US$3.26) per CDD,23 and among the 266 communities supported 399 CDDs in kind. 3. As a result of intensive mobilization, 1,141 clan CDD's were selected by their communities and trained by LOCTs and HFS. 4. ln Plateau CDTI project revised 2007 budget, the project requested APOC to provide a new 4 WD Hilux Toyota vehicle. And awaiting approval. 5. The number of CDD's has increased by 559 (45.9o/o) as a result of kindred CDD's trained during the year. 6. The project trained all the 160 local government health staff in CDTI, representing 100o/o. 41 SECTION 6: Unique features of the projecUother matters. The project operations were integrated where the CDTI staff at the state, Local Government and community level were involved in LF elimination programme, Schistosomiasis control and roll back malaria activities together with other designated staff. The project had the following achievement during the period under this reporting period in addition to CDTI: ADD - ON ACTIVITIES TO CDTI IN PLATEAU. * Above Schisto. result is school based treatment (age 5 - l4 years) of 2 communities in Jos East LGA (Gada and Fusa). Entomological studies of Black flies and mosquitoes were also ongoing to monitor impact on lymphatic filariasis and Onchocerciasis. 42 VILLAGES POPULATION S/NO PROGRAMM E ATO NO.COVERED ATO % ATO NO.PERS TX'D. ATO % 1 Lymphatic Filarial 277 271 97.8o/o 171,069 156,678 91. 60/o 2* Schistosomiasis 2 2 100% 1,605 1,605 100o/o 3. RBM - lTNs Distribution 87 85 97.7o/o 23,572 22,739 96.5