Year 2 Re-submitted activities report for community directed treatment with ivermectin (CDTI): Jigawa State Nigeria, May 2002

AFRICAN PROGRAMME, FOR ONCHOCE,RCIASIS CONTROL (APoC) Year 2 Re-submitted Activities Report for Community Directed Treatment with Ivermectin(cDrI) [:cr -/,ci C I L 1 I l, I o$ur, tit------ -i ' fa' - ".' ,"ir'')i r,2' l' t i]t)l Birniwa Kazaure Yan Sule Tankor M/ Maduri Guri na Babura Bosuna Gumel Hadejia Garki Kaugama Taura A Miga wHa Jahun Dutse Kiya Birin Kudu Jigawa State Nigeria * H s[F I0r]2 May 2002 rt 0t, UTIVE S MMARY Jigawa State was carved out of Kano State in September 1991. The State presently has a total number of twenty seven (27) Local Government Areas. Seventeen (17) of these Local Government Areas are endemic for oncho cerciasis. Eight (8) Local Government Areas namely Birnin Kudq Gwaram Dutse, Birniwa, K/FIausa, Kaugama, Ringim and Taura ate meso endemic, and are currently implementing CDTI. The remaining Nine (9) Local Government Areas are Hypo endemic. The state has been carrying out treatment in all the communities with the assistance from the state Government and the supporting NGO (CBM). It was a cheering news that APOC is disposed to the idea of supporting treatment in all hypo- endemic communities of the State. Jigawa State falls within the Sudan Savanna and Sahel zone. The terrain is either generally flat or slightly undulating with few rock out crops and hills particularly the southern part of the State bordering Bauchi State. The State is drained by some major rivers such as River Hadejia, River Chiyako and their tributaries. The tributaries are largely seasonal, while the main Rivers have water all year round. The flood plain of the River Hadejiah contains extensive wet land and swampy areas, and the presence of some man made dams in the state provides breeding sites for black flies. Ivermectin Distribution Programmes (IDP) started in Jigawa State in 1996, immediately after the memorandum of understanding was signed between Ministry of Health and Christpftel Blindenmission (C.B.M.) of Germany. _t Below are the results of IDP exercise since from the inception in 1996 to date YEAR TREATMENT FIGURES 1996 36,758 (8 L.GAS) t997 37,820 (8 L.GAS) 1998 t24,744 (17 L.GAS) 1999 t44,324 (17 L.GAS) 2000 188,153 (17 L.GAS) The main goal of the project is to treat a total number of 250,000 rural populace who are known to be infected or at risk of the disease in both the APOC supported and the Hypo endemic LGAs of the state, by the year 2003 through annual treatment with invermectin tablets. This task we hope to achieve in the 17 LGAs under treatment by establishing effective and sustainable community directed prograrnme, owned by the people through participation and effective implementation and support. The project has integrated its activities into the existing PHC services at both the state and the LGA levels in order to enhence sustainability. SOCT, LOCT and other Health workers are actively involved in the implementation of the programme. I SECTION I BAC ROUND IN RMATI 1.1 CO UNITIES IMPLEMENTING CIITI There are 99 oncho endemic communities in the 8 Local Government Areas qualified for CDTI in Jigawa State. The communities have a nucleated paffern of settlements. The average community size is approximately 2,500 persons. Most households in these communities have an ayerage of 5-10 persons each but some may have up to 20-30 members. ENDEMIC L.G.A.S WITH TREATMENT ROUND Shown bellow are treatment rounds for each endemic local government area. SAtO LOCAL GOVERNMENT AREAS (L.G.A) DISTRIBUTION ROTTND (2001) 1 BIRNIN KUDU 5 2 BIRNIWA 5 3 DUTSE 5 4 GWARAM 5 5 KAFIN FIAUSA 5 6 KAUGAMA 5 7 RINGIM 5 8 TAURA 5 3 CDII I TEMENTAII SEPIEMBER, 2000 - AUG 200r SN L.G.A NO. OF COMMU NITIES /VILLIA GES NO. OF COMMUNI TIES THAT SELECTf,,D CDDS NO. OF COMMUNITI ES THAT COLLECTED DRUGS NO. OF COMMI,]NITIES Df,CIDES ON MONTHOF DISTRIBUTION NO. COMMTINITIES THATDECIDf,S ON TIIE METHOD OF DISTRIBUTION NO OF COMMUNITI ESWITII TRAINOD CDDS NO. OF COMMUNITI ES PAYING CDDS IN CASH OR IN KIITD I BIRNIN KUDU 38 38 38 35 32 38 15 2 BIRNIWA 5 5 5 5 4 5 2 J DUTSE 7 7 7 6 7 7 5 4 GWARAM 20 20 20 20 20 20 12 5 KAFN HAUSA 7 7 7 6 6 7 J 6 KANGAW A 8 8 8 6 6 8 2 7 RINGIM ll il lt l0 l0 ll 5 8 TAURA 3 J 3 3 5 J TOTAL 99 99 99 91 88 99 44 TABLE 1 Getting to know the sort of support that CDDs receive is difficult because of conflicting claims between the CDDs and the community members. Our suggestion is that project implementers should not concern themselves with the support issue, but should only encourage community members during mobilzation activities. The above table should be revised by APOC to allow project share experiences more. Communities making decisions on the month of treatment in the project has not been too easy to report on, because of the differences in opinion from one village to the other. What has is more feasible to report on is the period A that the community members choose, which often is a range of months that they prefer to be treated. This suits the project's planned activities and the logistics that are available. The reporting table should permit for more discussion on some conflicting experiences. IRAINING OF DIFFERENT tEVEt OF SIAFF INVOTVED IN CDTI IMPLEMENTATION 2.1 Trainine Obiectives/Achievement The Annual Training Objective (ATO) was to train a total number of 300 personnel for the ivermection distribution progratnme using CDTI approach in the 8 APOC supported LGAs. Out of these, 294 progralnme workers (SOCT, LOCT, Health Workers and CDDS) were trained representng9So/o of the ATO. 2.2 Developed Trainine Materials Used. Training being an integral part of the CDTI process was given a due consideration during the period under review. Materials were developed in line with the NOTF instructions. Little modifications were made in some of the materials produced such as the posters and the T -Shirts. Inscriptions and messages were printed in Arabic so that non- English speaking persons in the community can understand the messages The English brochure has been translated into Hausa language and produced in order to make comprehension better. 2.3 Performance of CDDs The perforrnance of the CDDs during the exercise was good, but in some communities, it is difficult to have required number of CDDs. 5 This increases the work - load of the few cDDs during distribution activities. Many of them have demonstrated a good understanding of the CDTI concept during training and mobilization. Records were properly kept by most of the cDDs, and mectizan drugs well managed. 2.4 Imn the Oualitv of Trainins The quality of training has improved since more health workers have been trained to assist the LOCT in this task. The traditional Hausa Language has been the main means of communication during training. The Health education and training flip chart has been translated from English to Hausa language and this has helped to enhance understanding. TOT has been conducted for trainers in order to strengthen their abilities during training programmes. The very fact that the project conducted training and re-training in this past years, has made training activities more enjoyable for both the trainers and the trainees. As the projects starts activities for year three, we hope to devolve training responsibilities to the LGAs without compromising standard, putting more emphasis only on the new CDDs that inexperienced. To will increase the confidence level of the LGA PHC workers involved in the progralnme. 6 TABLE II GOFD VELS OF AFF NVOLYED IN CDTI IMPLENTATION S/N L.G.A NO. OF TRAINING UNDERTAKEN NO. OF TOT TRAIIYED NO. OF L.G.A DISTRICT STAFF TRAINED NO. OF HEALTH FACILITY STAFF TRAINED NO. OF CDDS TRAINED I BIRNIN KUDU 3(LOCT TyWORKERS & CDDS ) 4 l5 76 2 BIRNIWA 3(LOCT TVWORKERS & CDDS 2 4 4 l0 5 DUTSE 3(LOCT TVWORKERS & CDDS 2 4 7 t4 4. GWARAM 3(LOCT IyWORKERS & CDDS 2 4 l0 40 5 KAFIN HAUSA 3(LOCT FVWORKERS & CDDS 2 4 7 t4 6. KANGAWA 3(LOCT FVWORKERS & CDDS 2 4 5 t6 7 RINGIM 3(LOCT TyWORKERS & CDDS 2 4 8 22 8 TAURA 3(LOCT TyWORKERS & CDDS 2 4 J 6 TOTAL l6 32 59 198 1 *TAB E III MOBITIZAIION, AND EDUCATION OF IARGET COMMUNITIES The team visited all the communities to ensure that they were mobilized in readiness for the second year CDTI implementation exerclse. To guarantee success in the second year of the implementation period, the SOCT and the LOCT team carried out community mobilization activities twice during the period under review. It was a rewarding experience in preparation for the third year. To avoid duplication, the project did not present two separate tables for this activity. * 8 SA{ L.G.A NO. OF COMMUNITIES THAT RECEIVES H/EDUCATION ABOI,NTHE IMPORTANCE OF EXTENDED TREATMENT NO. OF ADVOCACY VISIST TO STATE OR REGIONAL DIRECTORS OF HEALTH. NO. OF COMMI.JI\IITI ES MOBILIZED NO. OF MOH STAFF NYVOVED IN MOBILIZATI ON NO. OF NGDO STAFF INVOLVED I BIRNIN KUDU 38 2 38 5 I 2. BIRNIWA 5 2 5 5 I 3. DUTSE 7 2 7 5 I 4. GWARAM 20 2 20 5 I 5. KAFIN HAUSA 7 2 7 5 I 6. KAUGAMA 8 2 8 5 I 7 RINGIM l1 2 l1 5 I 8 TAURA J 2 J 5 1 TOTAL 99 2 99 5 I 2.2.0 Advoca Visits Advocacy visits were carried out during the period under review to state and Local Government Areas (L.G.A) Chief Executives before and during the take -off of the project. The state has been able to carry out this exercise jointly with other opinion leaders, and prograrnme supervisors in the state ministry of health as well as ministry for Local Government and Chieftaincy Affairs. 2.2.1The Use of Media In mo tion Utilising the media for mobilrzation is very important to the success of the progralnme, but it is becoming very expensive these days, especially with the commercialisation of the media houses. They have been of great importance to the project in covering CDTI occasions of ceremonial nature, such as CDTI including. The project utilizes other means of getting the information to the people, mostly the face to face education and mobilisation. Communities were mobilized using the following channels of communication Traditional/Reli gions Leaders Face to Face discussion with community members Town criers t( * * A:\ 2.2.2 Result of Mobilisation Effort The mobilization effort carried out by the groups outlined above has greatly increased peoples' awareness on the need to take the drugs continuously for the next 10 - l5years. The community members are increasingly becoming aware of their roles and responsibilities in CDTI implementation. They also appreciate the involvement of community members in the planning and implementation process. 2.2.3NIobilization of Materials Used. During community mobilisation, posters and flip charts were used as IEC materials in creating awareness among the community members. The state government has recently procured more mobilization equipment being used during activities. 2.2.4 Response of the communitv The various communities have demonstrated their commitment to the implementation of CDTI. However, what remains contentious is the level and relativity of support to CDDs, which bears different definitions and interpretation on the part of the community members and the CDDS who are the recipient. To one group, they have done enough, and to the other, not much has been done. The project suggests to APOC to de-emphasise the issue of support and leave the matter to the communities. Keen interest should be paid to coverage, participation and CDD continuity to suggest that community and their CDDs doing well. t0 2.2.5 SUGGESTIONS TO IMPROVE MOBITISATION The quality of information that gets down to women in purdah is of serious concern in predominantly muslim communities. The project intends to address this problem by getting female members to be part of the teams at both the local goverrrment and the state levels to open up better and easier ways of interacting with this important group of people. The project will try to identify female community based organizations to work with in the implementation of the progralnme. This will go a long way in ensuring that drugs that are distributed are swallowed by all to make he control programme a success. The project intends to also target the men too to educate them on the need to have the women to be involved in the programme either as distributors or as mobilizers without contradictions. The information to be given to them will encourage participation and the need to take the drugs over the years by all without breaking the cycle- /l s/N L.G.A NO. OF TARGET COMMI,JNI TIES NO. OF PEOPLE TREATED COST PER PERSON TREATED NO. OF DISTRIBUTION SI.]PERVISED BY HEALTH WORKER NO OF COMM/VILL AGE IN WHICH CDDS ARE TU}VORKERS NO OF TREATED VILLAGERS WITH SUMMARY F'ORMS I BIRNIN KUDU 38 30428 + 1 0 38 2 BIRNIWA 5 3368 + I 0 5 3 DUTSE 7 1il08 * I 0 7 4 GWARAM 20 22304 * I 0 20 5 KAFIN HAUSA 7 8868 + I 0 7 6 KAUGAMA 8 14751 + I 0 8 7 RINGIM ll I l5l0 + I 0 1l 8 TAURA J 5268 + I 0 J TOTAL 99 107,605 * I 0 99 TREAIMENT FOR JIGAWA SIATE SEPTEMBER 2OOO - AUGUST 2OOI The cost per person treated has not been determined since the implementation of CDTI started in the state. This is because it will require intensive data collection of inputs (financially and materially) at atl the levels and then its analysis before arriving at the cost per dose. I think that projects need to be guided in this regard. o SEC N III 3.1 Treatment Coverage The treatment coverage for the Jigawa Sate during the last distribution is 80% (Therapeutic) t1- TABLE IV 3.2 T I Cens Po tion The total census population of treated communities was 135,177 persons.(Tft is answers the question of the TCC in the Year one report, requesting to know the treatment population of the CDTI LGAs) 3.3 Total lisible Population Total eligible population of treated communities was 118,455 3.4 Total Absentees/Refusals Total number of absentees and refusals is 10,852. For the second year running, the number of absentees seems high due mainly to foltowing problems indicated below which will also clarify ksues raised by the TCC in the year one reporL 3.5 Some Reasons for Absen sals (1) The people of Jigawa State are predominantly farmers and nomadic herdsmen who sometimes move away from their towns and villages to other areas during raining seasons. Some of them again are involved in dry season farming, taking them away during distribution activities. Whenever, treatment period spills over to the farming season, it tends to affect treatment coverage to some extent. This though has been given a serious consideration in our planning for subsequent years to ensure that we avoid such active period in the lives of farmers. 13 12 3 (1) Rural- Urban migration or movement to other localities outside where treatment with Mectuan of CDTI is being implemented, in search of greener pasture, especially when in the previous year, there was no adequate rain fall for the crops to yield bumper harvest. 3.6 Plans to Reduce Number of Absentees Intens ive community mobilization Advocacy visit to Emirs/district heads and religious leaders Advocacy meeting with L.G.A Chief executives on roles and responsibilities as project partners. Treating the people at the most appropriate time required by them. However, no time/period can ever be appropriate for every body residing in the villages. Organizing mop up treatment activities for communities with low treatment coverage. 3.7 Contribution of the Ministrv of Health The following are the contribution of the government of Jigawa State to the project. 3.5 million as counter part funding was approved as cash contribution to the project. As at the time of writing this report, the release has not yet been effected but there was strong commitment on the part of the govemment who are pleased with the CDTI implementation in the 4 5 I th 2. aJ state to release the money for activities soonest. The development shall be communicated to you in our next report. One electric typewriter. Purchase of office equiPments. STRENGHTS, WAEKNE SS, AND SUGG ESTIONS STR ENGHTS: Very high government commitment to the progralnme in the area of release of counter part funding to the project. A reasonably good community commitment and participation due to prompt mobilization. Prompt delivery of livermectin supplies and other logistics to the communities. Training of CDDs at their communities or centres closest to them has reduced the burden of travetling long distances, and this development has enabled community members to watch training events and gain more knowledge ofthe CDTI strategies. The programme enjoyed the services of a dedicated and committed SOCT and PHC staff. 1 2. aJ 4. 5 r5 WEAK ES c NSTRAI 1 2 Inadequate support to CDDs by the communities. This too is quite controversial and relative to the village in question. Determining accurate support data and its sufficiency is rather difficult. Low level of supervision by the LOCT/Health workers due mainly to the current political situation where almost all the LGAs are complaining about the zero allocation from the federation account, making it almost impossible for them to sponsor the LOCT during supervision activities. The progralnme plans to re-orientate the LOCT team on change of attitude. 3. Payment of incentives to village workers by other programes during activities has greatly affected the principle of CDTI. The culprit is the National Immunization prograrnme which seemed to have federal govemment commitment for the eradication of polio at the expense of other control programmes. ( This issue has been partly addressed, when LGAs see the CDDs as the most capable set of community workers to participate in NID activities. In the new dispensation, they are involved and activities are being integrated to ensure that both the health workers and CDDs elfectively distribute Mectizan and also get involved in the NID progromme. This has surely solved the concern we had in our lirst year report, which the TCC also observed) 4. Participation of women goup in the CDTI progralnme is still not encouraging. This has to do with the culture and religious believes of the people. \5 I5. Jigawa state witnessed one of the worst natural flood disaster in its history this year. This affected some communities where CDTI is implemented. Two communities cannot account for their treatment records which were destroyed in the process. The CDDs are being traced to conduct another census as well as update treatment records for the year. SUGGESTIONS: Advocacy meeting with L.G.A executives should be held at ministry for Local Government Affairs. This necessary because of the importance that LGAs attach to that office who are their immediate supervisors. Community Members, influential people and interest groups should be mobilized to support CDDs. The women group shall be targeted to get them participate more. (The proiect intends to reod and implement the findings in the report of the research conducted by Miss Badaki, and if possible seek for other professional and expert advise on how to get the women fold more involved without necessarily interfering with the peoples' culture and religious beliefs). LOCT/Health workers should participate fully in all the stages of implementation. This we intend to do by continuous devolvement of responsibilities to them, and encourage them through workshops on the need to change their attitude. 2 aJ It 4 The project appreciates moves at the highest level of government to stop the payment of all community progralnmes in the near future. This will help CDTI implementation, as there will be no longer basis for comparison. If this however fails, then beneficiaries should be the CDDs. APOC should harmonize the Technical and Financial period of operation of the projects to take effect from January of every year and to end in December. 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