Delta CDTI project technical report submitted to Technical Consultative Committee (TCC): January 2007 to December 2007

,4/C;-TR(4 [6t,',,,'' BqF,,'r T-Cr !']- fi"v' &I oo+ DELTA STATE CDTI PROJECT ORIGINAL : English * tt * 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 31 July for September TCC meeting AFRICAN PROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) t Proiect Nanoe: DELTA CDTI PROJECT COUNTRYAIOTF: NIGERIA Approval vearz 1999 Launchinq year: 1999 From: JANUARY 2007 To: DECEMBER 2007(Month/Year) ( Month/Year)Reportinq Period: Proiect vear of this report: (circle one) l' 2 3 4 5 6 ? E 910 Date submitted: roNUARY 2008. NGDO partner: GLOBAL 2OOO/THE CARTER CENTER NIGERIA R"* frlc;/oe WHO/APOC, l0 April2003 II I I I ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: Country: NIGERIA National Coordinator Name: MRS. P. OGBU PEARCE Signature Date Zonal Oncho Coordinator Name: OTI-INBA A.O. JAIYEOBA Signature Date: ... NGDO Representative Name: MR. J. O. EGUAGIE Signature: ... Date This report has been prepared by Name: DR. P. A. YINKORE Designation: STATE COORDINATOR Signature: .. Date 1l WHO/APOC, 24 November 2004 Table of contents Acronyms v Definitions vi FOLLOW UP ON TCC RECOMMENDATIONS vii Executive Summary ix SECTION 1: Background information I 1.1. GeNERal rNFoRMATIoN................ 1 .1 .1 Description of the project (briefly) 1.1.2. Partnership 1.2. Popu1nrroN............... SECTION 2: Implementation of CDTI 6 2.L Tnraer.mp oF ACTIVITIES 2.2. Anvocecv 2.3. MostI,rzerroN, sENSITIZATIoN AND HEALTH EDUCATIoN oF AT RIsr VlllecEs.... Wevs ro IMpRovE MoBILIZATIoN oF THE TARGET vILLAGES:................. 2.4. Vrllece rNVoLvEMENT............. 2.5. CnpacrrvBUrLDrNG.. 2.6. TRearvpNTS.............. 2.6.1. Treatmentfigures.......... 2.6.2 What are the causes of absenteeism?. 2.6.3 What are the reasons for refusals?.....2.6.4 Briefly describe all lcnown and verified serious adverse events (SAEs) that ... I5 2.6.5. Trend of treatment achievementfrom CDTI project inception to the current year I7 2.1. ORoERTNG, sroRAGE AND DELIVERy oF IVERMECTIN ........... 18 .1 .1 ,2 .4 .6 .8 .8 .9 10 2.8. Vrllacp sELF-MoNrroRrNG eNp StersHoLDERS MepuNc 2.9.1 Provide aJlow chart of supervision hierarchy . . .. . . ............ 1 I ............13 ............13 ............1s ............15 ............19 ,.....,.'.'. 20 2.9.2 Wat were the main issues identified during supervision? .............................. 20 2.9.3. Was a supervision checklist used? Yes............ ............21 2.9.4. What were the outcomes at each level of CDTI implementation supervised? . 21 2.9.5. Wasfeedback given to the person or groups supervised?................................ 21 2.9.6 How was the feedback used to improve the overall performance of the project? 21 SECTION 3: Support to CDTI 22 3.1 EqunurNr .....................22 3.2 Orsen FoRMS or VtllecE suppoRT. ..................24 3.4 ExppNorruRE pER AcTrvrry .............25 SECTION 4: Sustainability of CDTI 26 4.1. INrenNer-; TNDEIENDENT pARTICIpAToRy MoNIToRINc; EvaluerloN......... ...........26 4.1 .1 Was Monitoring/evaluation caruied out during the reporting period? (tick any of thefollowingwhich are applicable)........... ............26 4.1.2. Wat were the recommendations? ............. 26 4.1.3. How have they been implemented? ............. ................. 26 4.2. SusrarNaerr-rry oF IRoJECTS: ILAN AND sET TARGETS (ueNoaroRy AT................27 Yn 3) .......27 4.2.1. Planning at all relevant levels.. .................. 27 4.2.2. Funds....... ............... 27 4.2.3 Transport (replacement and maintenance).... . . . ... .... 27 4.2.4. Other resources ...... 27 4.2.5. To whot extent has the plan been implemented............... ............... 27 4.3. INrecRerroN............ ......27 111 WHO/APOC, 24 November 2004 4.3.1. Ivermectin delivery mechanism.t ............... ................... 27 4.3.2. Training.... ..............28 4.3.3. Joint supervision and monitoringwith other programs........... ...... 28 4.3.4. Releose offunds for project activities ........ 28 4.3.5. Is CDTI included in the PHC budgetT Yes............ .....................28 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements?............. .................... 28 4.4. OpenarroNAl RESEARCH 4.4.1. Summqrize in not more than one half of a page the operational research undertaken in the project area within the reporting period. 4.4.2. How were the results applied in the project?.... SECTION 5: Strengths, weaknesses, challenges, and opportunities 30 SECTION 6: Unique features of the project/other matters 31 29 29 29 1V WHO/APOC, 24 November 2004 Acronyms wHo APOC ATO ATrO CBO CDD CDHS CDTI CSM DHS DSN FMOH G2000 HFS LCI LCIF LGA MOH NGDO NGO NOCP NOTF NPI PHC PMRC PHCDA RBF REMO SAE SHM SPIC TCC TOT UNICEF UTG World Health Organization African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Village-Based Organi zation Village-Directed Distributor Village Directed Health Supervisor Village-Directed Treatment with Ivermectin Village Self-Monitoring District Health Supervisor Disease Surveillance Notifi cation Federal Ministry of Health Global 2000 lThe Carter Center Health facility staff Lions Clubs International, District 404 Nigeria Lions Clubs International Foundation Local Government Area Ministry of Health Non-Governmental Development Organization Non- Governmental Organization National Onchocerciasis Control Programme National Onchocerciasis Task Force National Programme on Immuni zation Primary health care Project Management & Review Committee Primary Health Care Development Agency River Blindness Foundation Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Stakeholders meeting State Prograrnme Implementation Committee Technical Consultative Committee (APOC scientific advisory group) Trainer of trainers United Nations Children's Emergency Fund Ultimate Treatment Goal v WHO/APOC, 24 November 2004 Definitions (i) Total population: the total population living in meso/hyper-endemic Villages within the project area (based on REMO and census taking). (ii) Eligible population: calculated as 84%o of the total population in mesofttyper- endemic Villages in the project area. (iii) Annual Treatment Objective: (ATO): the estimated number of persons living in mesoftryper-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/hyper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage (normally the project should be expictLd to reach the UTG at the end of the 3'd year ofthe project). (v) Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) Geographical coverage: number of Villages treated in a given year over the total number of mesoftryper-endemic Villages as identified by REMO in the project area (this should be expressed as a percentage). (vii) Inteqration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) through CDTI (using the same systems, training, supervision and personnel) in order to maximise cost- effectiveness and empower Villages to solve more of their health problems. This does not include activities or interventions carried out by Village distributors outside of CDTI. (viii) Sustainability: 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 Village ownership, using resources mobilised by the Village and the government' (ix) Village self-monitoring (CSM): The process by which the Village is empowered to oversee and monitor the perforrnance of CDTI (or any Village-based health intervention programme), with a view to ensuring that the programme is being executed in the way intended. It encourages the Village to take full responsibility of ivermectin distribution and make appropriate modifications when necessary. v1 WHO/APOC, 24 November 2004 FOLLOW UP ON TCC RECOMMENDATIONS Using the table below, fiIl in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session 25 Number of Recommend ution in the Report TCC RECOMMENDATIONS ON 2006 ANNUAL REPORT FORDELTA STATE ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY 218 Suggestions for improving report further: Zonal coordinator to promptly review and sign report when submitted by the project. Cross check the Mectizan@ figures in view of high number of tablets used per person as in TCC 21 recommendations. This recommendation is being complied with The usage of Mectizan tablets is meticulously cross-checked at all times. 219 Suggestions for improving project: Advocacy to LGAs to encourage them to give counterpart funding Advocacy visit is a vital component of the programme and this is prominently being carried out. Project to facilitate introduction of CSM and SHM as recommended in TCC 23. A plan will be made and submitted for approval by the State PHCDA to enable the thorough mobilization, sensitization and campaign to be carried out in all endemic villages for the conduct of CSM and SHM in the 2008 operational year. Train more CDDs to increase the CDD/population ratio as in TCC 21 recommendations. A proposal for funding has been submitted to APOC for the training of more CDDs in order to reduce CDD/population ratio and enhance the participation of more female CDDs. vll WHO/APOC, 24 November 2004 Train more female CDDs. lmplementation of the proposal for training more CDDs already submitted to APOC, will feature increased number of female CDDs. (Please add more rows if necessary) vlll WHO/APOC, 24 November 2004 Executive Summary 1. Background on treatment and population data Delta State CDTI project started in June 1999 and covers nine LGAs out of 25 LGAs in the State. In 2007, which was the eight CDTI treatment year, 460,700 persons were actively treated out of a UTG of 461,277 persons against a population of 568,064 persons. Passive treatments of 99,233 persons were equally carried out. For both treatments, a total of 1,683,979 tablets of Mectizan were utilized. The geographic coverage was 100%; therapeutic coverage was 8l .l%o, and UTG coverage of 99.9% respectively. Refusals and absentees accounted for 2.2oh and 2Yo respectively during the treatment. Within the reporting period, 470 villages were mobilized and advocacy visits made to the nine endemic LGAs. 2. Background on population movements. There was no serious population movement that could significantly affect overall treatment activities. However, serious attention will be paid to population census update in the 2008 operational year. 3. Training data - CDDs, health workers, Total population (Village) per CDD trained. Training was conducted for different categories of staff that were involved with IDP activities. According to section 2.5 - Capacity building, targeted training was conducted for 27 LGA staff, 48 Health centre staff, 9 ToTs and 56 new CDDs. Out of the 376 staff on ground in the Local governments, 243 of the health staff were involved in CDTI activities. A proposal for funding has been forwarded to APOC to enable the training of more CDDs using the kinship system. 4. Sections 2.4 and 2.8 show level of Village involvement in CDTI activities. 79 villages out of the 470 villages had female CDDs. No CSM or SHM activities were conducted during the period. 5. Challenges and how they were overcome: The NGDO and the State Primary Health Care Development Agency provided needed logistics for the prosecution of Mectizan distribution activity during the year. On their part, the respective Local Government Councils also provided financial and logistic support for field activities in their respective domains. Although no CSM and SHM activities were carried out in 2007, there is hope that these will be conducted in 2008 based on the dogged implementation of the new plans of integrated primary health care. lx WHO/APOC, 24 November 2004 SECTION 1: Background information l.l. General information 1.1.1 Description of the project (briefly) Geo graphical location. topo graphy. climate. population. etc. Delta State was created in 1991, out of the former Bendel State. There are 25 Local Government Councils in the State, out of which 9 were identified through rapid assessment, as mesolhyper endemic for Onchocerciasis. The State has a population of 2.8 million with a land area of about 29,600 square kilometers. However, the latest population figures available has raised the State's population figure to about 4.1 million persons (2006 census). Delta State is bounded by Anambra and Kogi States to the north, to the West by Edo State, to the East and South by Rivers and Bayelsa States with the Bight of Benin on the Atlantic coast. The State lies approximately between longitudes 5o East and 60o 45' East and between Latitude 5o North and 7o 30' North. The area is generally low lying except towards the North, where there are some highlands. The coastal belt is interlaced with rivulets and channels that form the Niger Delta. The existence of many rivers in Delta State like rivers Jamieson, Ethiope, Niger and Koko to mention but a few, provide fast flowing rivers and streams that is ideal for the breeding of blackflies. The vegetation varies from the impenetrable mangrove swamps along the cost, relieved Northwards by a wide belt of deciduous and evergreen forest and terminated by Savannah in the North. The State has a tropical climate of two distinct seasons of dry and rainy seasons. Dry season is from November to April, while the rainy season is from April to October. During the rainy season, some of the rural roads leading to at risk villages are inaccessible and therefore makes implementation of Onchocerciasis activities difficult to carry out. The project area spans the Northeast and South parts of the State. The major occupations of the inhabitants are farming, fishing, trading and office work. The indigenes live in permanent settlements. Nonetheless, during farming seasons, some live nomadic lives as seasonal migrants. The people practice a communal system of life. Authority is vested on any person chosen by the entire people of the environment. The person so chosen becomes their leader. Communication. road network and administrative structure: The road networks in and out of the State are good. The communication system boasts of digital telephone system through Nigerian Telecommunications PLC with other parts of Nigeria and internationally. There are radio and television facilities in the State. There are also facilities for e-mails and internet browsing. The postal system operated by Nigerian Postal Services and other Courier service companies, are also reliable and efficient for delivery of mails. With the CDTI structure in place, even hard to reach Villages have either CDD or HFS carrying out drug distribution. But the lack of finance and difficult transportation occasionally hamper the progress of work. In Delta State, the establishment of The Primary Health Care Development Agency has greatly assisted the proper functioning of the CDTI project unit. Other health programmes have been integrated under her supervision. The State is gradually witnessing an integrated Primary Health Care delivery and management system. 1 WHO/APOC, 24 November 2004 Table 1: Number of health staff involved in CDTI (Please add more rows if necessary) DistricULGA Number of health staff involved in CDTI activities. Total Number of health staff in the entire project area B1 Number of health staffinvolved in CDTI B2 Percentage Br=Bzl Br *100 Aniocha North 48 31 64.5% Aniocha South 32 21 65o/o lka Northeast 30 22 73% lka South 51 28 55o/o Oshimili North 40 25 62.5% Oshimili South 55 27 49o/o Ndokwa East 45 32 71o/o Ndokwa West 33 25 760/o Ukwuani 42 32 76% TOTAL 376 243 64.6% Note: During the year, 243 LGA staff were involved in CDTI in Delta State. 1.1.2. Partnership Indicate the partners involved in project implementation at all levels MoH, NGDOs (nationaUinternational), Villages, local organizations, etc.J Describe overall working relationship among partners, clearly indicating speciJic areas of project activities (planning, supervision, advocacy, planning, mobilization, etc) where all partners are involved. State plans, tf any, to mobilize the state/region/district/LGA decision-makers, NGDOs, NGOs, CBOs, to assist in CDTI implementation. Between 1992 afi 1994, the River Blindness Foundation (RBF) funded the programme in collaboration with the State Ministry of Health and the benefiting LGAs. Between January 1995 and May 1999 funding was provided by the Lions Clubs International, District 404 with the Technical support of Global 2000 /The Carter Center, in collaboration with the State Ministry of Health. From June 1999 to-date, WHO/APOCAIOTF took up sponsorship of the prograrnme in collaboration with LCIF, Global 2000/ The Carter Center, the Ministry of Health and the benefiting LGAs. 2 WHO/APOC, 24 November 2004 The partners involved in the project's implementation at all levels are the NGDO, APOC, MOH, LGAs, Villages/Village. The working relationship among partners has been very cordial as it relates to planning, supervision and advocacy visits/mobilization. During the year: l. APOC Trust provided Sustainability funds and capital supply in2007 to the tune of $30,094.00 2. a) b) c) Global 2000lCarter Center provided funds for: drug distribution and retrieval of data carrying out advocacy visits, monitoring and supervision research and surveys for add-on programmes e.g. Schistosomiasis and others State Ministry of Health and LGAs provided funds for: integrated monitoring and supervision of field activities IEC materials mobilizationlhealth education through T.V., radio jingles, Oncho day celebration; office accommodation and operational imprest; maintenance of vehicles and equipment. Training of CDDs and HFS Drug distribution/supervision at the village level. 3. a) b) c) d) e) 0 s) J WHO/APOC, 24 November 2004 $ (\.l L 0.) -o o z t c{ d o o crl G) iv,^!;!h =tr E' = rsvyr '5 e- I iJr-o* $ q. @s soN. 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Advocacy State the number of policy/decision makers mobilized at each relevant level during the current year; the reason(s) for undertaking the advocacy and the outcome. Describe dfficulties/constraints beingfaced and suggestions on how to improve advocacy. At the State level, the Honourable Commissioner, Permanent Secretary, Director and Deputy Director of PHC/DC, LGA Chairmen and some other key players were mobilized during advocacy visits in respect of creating more awareness and release of counterpart cash contribution. The outcome of the visits revealed that the State and LGAs are willing to make some commitments. Delta State Oncho prograrnme has always been included in the year's budget plan, covering Training, Oncho day celebration, public awareness campaigns, provision of IEC materials etc. At the LGA level, key policy makers, notable politicians and newly appointed Chairmen were visited. The major objective was to create awareness, sensitize and health-educate them on the disease pattern; re-emphasize the need for LGA support to the programme especially as APOC sponsorship had ended. While some LGAs claimed to be handicapped, some provided funds for training, Village mobilization and drug distribution. Already, the State Primary Health Care Development Agency (PHCDA) is making impact on the CDTI prograrnme. Indications point to the imminent creation of Primary Health Care Development Authorities in each Local Government Council area. 2.3. Mobilization, sensitization and health education of at risk Villages Provide information on: - The use of media and/or other local systems to disseminate information - Mobilization and health education of Villages including women ond minors - Response of target Villoges/villages - Accomplishments - Suggest ways to improve mobilization and sensitization of the target Villages. a) The importance of the broadcast media or other local systems to disseminate information cannot be over emphasized, as it remains the best way of reaching the people especially in the rural Villages. Public address system was used for the people that could be gathered on market days or those living in densely populated areas. b) Posters and handbills depicting the signs and symptoms of Onchocerciasis and the use of Mectizan in the treatment of the disease were also distributed. Apart from these, local town criers/announcers were employed to inform the people about CDTI activities. c) The response of the people in many endemic Villages was impressive. There were expressions of delights in being better educated on Onchocerciasis control as well as add-on programmes like Lymphatic filariasis, Schistosomiasis (terminal blood in urine). People got reassured that they would not get blind of Onchocerciasis; and that the signs and symptoms of the disease would heal provided they took Mectizan at least once every year for up to 15 or more years. 8 WHO/APOC, 24 November 2004 f) d) During health education sessions, the relevance of women and minors being recorded in village register was also emphasized. Again it was explained that women stand good chance to play active roles in CDTI activities. Some women have become CDDs and they have been part of the opinion leaders in some Villages. e) The outcome of these activities resulted in good level of Mectizan distribution, compliance and acceptance of CDTI. The pledges to support CDD with incentives were not reahzed. Mobilization and sensitization of target Villages can still be improved upon by: Placing TV and radio broadcast and jingles; Carrying out high powered advocacy visits to Village heads and opinion leaders; Training more personnel (e.g. CDDs) especially in areas of poor drug distribution and low awareness; Improving our logistic support (field vehicles, motorcycles and bicycles).. Accomplishments: The 470 meso/hyper endemic villages in the State were fully mobilized during the seventh year operations. Weaknesses/ Constraints : a) Some villages are complaining that the burden of the progralnme, which they perceive as government responsibility, has been placed on them; b) Conduct of Mectizan distribution activity in some villages was seriously delayed by some CDDs because of socio-cultural differences. c) Fuel scarcity and the consequent high cost of purchasing it in some areas; e) Lack of commitment by some field staff; 0 Frequent transfer of trained health staff. Ways to improve mobilization of the target villages: - Continuous mobilization would be intensified provided logistics are available or provided by the appropriate quarters/stakeholders. - Putting up frequent TV and radio broadcast and jingles; - Carrying out high-powered advocacy visits to Village heads and opinion leaders; - Training of more CDDs especially in areas of poor drug distribution and low awareness - Continual provision of IEC materials - Improving material and logistic support. Note: A new vehicle has been approved by APOC for the State but is yet to be supplied. 9 WHO/APOC, 24 November 2004 2.4. Village involvement Table 4: Villages participation in the CDTI (Please add more rows if necessary) Comment on: - Attendance offemale members of the Village at health education meetings - In general, how do you rate the porticipation offemale members of the Village meetings when CDTI issues are being discusses (attendance, participotion in the discussion etc). - Incentives provided by Villages for the CDDs - Attrition of CDDs. Is attrition a problemfor the project? If yes, how is it addressed? - Other issues Supervision / monitoring of CDTI activities is done by the Village Health Committee that has been formed in some villages. 4. 2. J 1 In male dominant Villages some women actively participated in CDTI activities as CDDs. Attendance by female members at health education meetings is encouraging. Information about decisions taken is quickly spread round to those who did not attend such meeting. The female groups were also addressed during mobilization. Attrition is a problem in the project area, because it amounts to retraining of CDDs However, affected villages are quickly remobilized to select a replacement. In recognition of this problem, it has been decided that many CDDs would be trained henceforth to absorb any vacuum created by a withdrawing CDD. District/LGA Number of Villages/villages with Village members as supervisors Number of CDDs and the Villages involved Number of Villages /villages with female CDDs Total no. Villages in the entire project afea B1 Number with Village members as supervisors Bs Percentage Be= BJ B. *100 Male CDDs Bu Female CDDs Br Total Bq= B?+Br Number of Villages with female CDDs Bro Percentage Brr= Brry'B.*100 Aniocha North 50 50 t00% 93 r6 109 10 t4% Aniocha South 62 62 t00% 92 13 105 9 r4% Ika Northeast 46 46 r00% 99 18 tt7 T2 17% Ika South 65 65 100% 96 I4 110 t2 r2% Ndokwa East 54 54 r00% 95 13 108 13 11 % Ndokwa West 4l 4t r00% 89 15 104 7 t2% Oshimili North 57 57 t00% 95 15 110 10 17% Oshimili South 46 46 100% 88 t2 100 18 39% Ukwuani 49 49 100% 94 t6 110 10 t6% Total 470 470 100', 841 132 973 101 21.40 10 WHO/APOC, 24 November 2004 ro |r) ro lr) ro ro ro lo lr) ro ro |r) \oin \oia @ @ o o @ @ N(o N o(o N o(o N o(o N $N(f)N s =N () q) q) I s e) clL ah Q o 0) z rt UF ?! oro N o rO N o(o N o(o N N(o N o\ o\ o *-r a<v =v €\ o\ () () () q) s o o .a'o'((trt- h, L-6): o0) .o) Lc! otr z (,) ra) ta) tr) rr) ra) ta) 6 = 6 = Uq z Ei:+ \o \o \o ta) (a (r) ra) \o \o (n ra) tr) ta) lara s U? ia m 4) q) q) I sQ rn (n ra) ra) n ra) ta) o 0) 6)E(JC) U.- Lq) z co ca ca N c.) cO ca N aa) ca ca co r-6I o\ € c.) N c.) N c.) c.l c.) cn co ca ca co aa ca r*N - o t) Fl3e90) a!Y L 0) z II UF Q -s ca .\ 0) q) o 9 .\ a d .v (n CB rl] (d tsIo z cn() (g BI o z ir o z E t) oa cr) (6 B .V D 3 Fl o tr o z (d o o a (s o U) (.) L z .54 $ N L C)! c) o z +N O o \-, Jr rt s -a o\ o p p o s o M o * o t a\ o Bt\ .r F z; eqq)G' D.E h\ .E; 'E) s:\G$* \tla \) UheSsp+ v\\F.Pv+ L A ^ +U ts' SRt\=s\\^. b\ ^: *aUN\H1 \ Hr- *rv\) Q)q,l\. e ssa$ \) -:\\sa a-\< ::_s 3 ^A^h ^w^iv \ vSOYlls .s+3: ':' Ss, R .EU v>obax s .S.E Ni-R s B Yalqrs; x tsr[t d:is vI }S 5 vi(-.il}\QF EREU.T' E$:E$ E +ES.E 3i:"?SP .=u-v\q) L ^..t i-si si. E *tsFB ()SIa 6 a +i ^L)\!b)a \\hyu) *<.a_9= ^.<\^.uf Nts -a:'=\ooPbSiP.S E .s Gbxs &ti>',.,."J =E i*x i Ea s s 34. tj B$i E s $8r $E$ FG $.X." S rI(l*:q, tb xs v ?ld.qs ut fl0{lTt \ fil $ c-l Lop q) o z$N 0.{ o c-n oo '=9trc6 €.= 0)H o -q (JC)H 8H IL o!trs EJ -(JE'5L()(d ()hE!?b8 cr7 ch b-E *8pE .CE iOall 5=E,tO!?EraE &s sxfx trll5!HLs;QE O6t=O ts E: .B"t s E E; o"tHdU)-.,&:E =X-r, .3'o i =E.\E so C.)EDO .N .9 ,a c! >dO0.- u) l-i-F "(t!g HE5 o.c) -^l,l.E H(B=Ea 9'0 H96":E O.v'^ o o6-C Cq = o-o '5-= o(!L, ca Fr= APU) ''ll I *; dE = (,ErJ g t:.E (.)! ) U) C)I cgt-i bo oHq o I (g CB oo LO U) o C) O oH 9() =>"c)v)- 'ootrbo cg(6 a)s 9'btrbo ecB .9a9.e 0)e(c o6 'rE 6)(sNtr vr'E C.)HEo)PLr cBh 0)ij}E9E CA xnI5 (tr oslooa u.9 >() l) c- }1 .(.) .=Eoootrb'E F() t) l-1O 0) trQ= (B(€ -btr :O oEl .9, a.ro'o li-a.€ 0)() ()tr E(B troo'E o'E OO CB .=o li (-) .= cd =oi.*.E 0)= Enboa EECtrc)Eai \JO tE oo €h 9lr u) (h -c)h bI)(.) -= 3> -co o!i .zE .EE Eor tro JA oidug cdL '59 Ptja'6jc) eEEo q) 7) trft =53UE xE.tFEE =J 0)H- C) < b.E (.)p U) O olro C6 o () (h -o o\ nN i! oo > .!: ch,1 >tr ..a oo +i ER 'E o.ts< 0)Ebo c)str9trb€o) 6o- -C -r'PE a(dEoP o!v i- cd od+ 'ag So. E#Lr. .N El -vE ecB(.)c)tr>rUt' -9(dll}E aQ OX -c) or)-c -ti sdrEC) 0., .Es(trt-Hrhq) Q +cnc\.1 Table 6: Type of training undertaken (fick the boxes where specific training was carried out during the reporting period) 2.6, Treatments 2.6.1. Treatment figures If the project is not achieving 100% geographical coverage and a minimum of 65% therapeutic coverage or the coverage rate is /luctuating, state the reosons and the plans being made to remedy this. The Project achieved 100% geographic and 81 .lYotherapeutic coverage during the year. A thorough population update is planned to be carried out in 2008 in the State to enable the determination of more realistic ATO. Trainees Type of training CDDs Other Village members e.g Village supervisors Health Workers (frontline health facilities) MOH staff or Other Political Leaders Others {specifu) Program management ,/ How to conduct Health education ,/ ,/ ,/ ,/ Management of SAEs ,/ ,/ ,/ ,/ CSM ,/ ,/ ,/ ,/ SHM Data collection ,/ / ./ ,/ Data analysis ,/ ,/ Report writing ,/ ,/ Others (speci[,) 13 WHO/APOC, 24 November 2004 $ o.l 0) .o q) o z tN O o o. o $ ;E€:EE= E*mtr od2d . cr) -0)x0) ="9z€ o @ @o @- f- co- o) o) (o N o- rOs co_ Ns o) (o o) n" @s rr)- o)(r) @- g*ErE,E LUi-\.J-9 z B.'P g ro !o NN\ cf)o s- O) o) l-(o l()_ (o O) cr- l-f- r()o @_ N co- N c) ro- N - o C6 o u: gseAetrge q @ q N @ q @ dO) c! oo (a (o l- n O) @ q s(o q @ I rF @ r L.^o =E -oEo -9v9EO5/)Q = 6g z Q'ij (o @ @s @(o or- f-s @s NN ry6 r() (o(o co rJ) Nf- O)(o$ s o) @ lt-s o)(f) lr)(os ss(o- @ rO oo\o(0t Eard o.= 7 !).o', FU s ry6$ so6{ f-$ oo rO- @s oo ry6 rJ) cf)o(f)_ @ l.() O)N @- l-s l()l- ryos (o C\ ry @s (o(o(o^ @ rO NN(\{ -COt -Lb 8-.9EE.TEH re .oE;>t gF o.o; tr cso oc) *F O)(f)o o,|.r) cf)o rO @ rO (o o o, rO o rO(f) o, r() (f)s rO- C\l- N(a rO_ (o o o) r()- (f) lr) rr) f- o- Nf- $- Nt- t(0 o^ €(0 rO o o 0cs CA obt ll * ooE!p !s C) lo'F^)o\ :3ovuo L./ (c soo soo soo soo soo soo soo soo soo soo rF o.. ,AU'\,?()6)og.l -o o0 bo]=ESS e ---lJ.-z> o rr) N(o (os rr)(o slr) s l-rO (o$ o)$ oNrf E q.r d ().= ==o)i 9-o' o rO N(o (os lo(o srO f-rO (o$ o)s oNt E > '= E-.g *g$ei€ E; h.--aLwt:>= E e o rO N@ (os rO(o slo s Nlr) (os o)s oN\t (, rl o 'i .2 o t- z (B o o d ()d <d C')(B() tr z CB ! oa d J1 cn(g trl cB B}1 o z cn(.) CB BI z f5oz 6A Bs) CE E-t 44q)() a) q: o\ \)\ t 9 q) 4 9q) 5 tr () >) F- N ao Li t) fr CC U)(t() l-r(t (t J o U) s cr) tr.l a (B () CB C)trF c-1 6)t .ol(tl FI 2.6.2 What are the causes of absenteeism? a) Farming and fishing activities which takes the people away from their habitat for several months b) Academic pursuits by "still active people". c) Search for "greener pastures" outside the Villages d) Better medical treatment in urban centers e) Migration of inhabitants in times of communal clashes/conflicts. 2.6.3 What are the reasons for refusals? Refusal of Mectizan could simply be a human reaction to the kind of information or mis-information received from those who experienced mild reactions to treatment. However, increased and improved mobilization, health education and sensitization for awareness and reassurances about the safety and efficacy of the drug, will continue to help in reducing the level of refusals in the project. 2.6.4 Briefly describe all known and verified serious adverse events (SAEs) that occurred during the reporting period and provide (in table 8) the required information when available. 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 V 15 WHO/APOC, 24 November 2004 s N k 0.) -o 0) o z$N Ci p.{ \o q) q) Lq) *a !\ Siq IC -:. 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'iaa g qiO c: o r--r-q ta) r-.tr) (a) € ra) \o o\ ra} € ra) (n t--t.- o\ ta) ca o\ r\ ootr) ra) tr) \o o\ cnq N\otn $\o €\o ta) s\o od\o(n ll * kl El ti o ^doU FJ- F o6\ <,>! o s+ o\ o\ -oo\ .oo\ o\ .oo\ o\ -oo\ -oo\ o.bo=g= EGtL*- loU 9gtrird Ookl -o o\$ o\ .o o\ o\ o\ ^\ \oo\ -oo\ -oo\ .oo\ l.l o;g oYio € Yo!trcBa z5 $ +$ r-+ r-.+ t-+ r-+ r--+ r-.+ r-+ t-+ ri :o)E E.Z } UB Pv r-+ r-$ r-+ t-+ r--+ r--$ r-$ t-.+ r-$ ^,6:rd(r- = X oo R c f,E+ 5o'l ho - E=!,EE >-o r-$ f-s r-+ trr$ r-+ t*-$ r--$ t'-$ t-.$ & trl o\ o\ o\ N C.l N c..l cn c..l $ N (n N \o c..l r- c.l $ O cl H C) .o C,) o z$ c.l o > f- o,)lro ()E OX c,) 0)fr (h oLr bo H o 0,)li o at) H .; ri Fr z B a.) Srq) a) * g) lt 59)?) !SI o6iEq)r!- Oc!\t:=EBX9.- 9VA :L.-*:- o L'r pt)?9trLI jJ t)e)t-86e .-x v _c, r- =+it- -tr(\r-O;T.:hHYr\ C) .l c!Eet ItrYl 6tciiilg !-Yl IECul q)(.)el '= - \tEall- c)IJI gBSrP -Ei:! <)0)L eOr-t o rt6)il!,EEFt)9lu-) Gt chEEiii6)trEtrq) 5 't: dE;:9 ;./L9F=LI iAtLo)dsl 2G€I E e.i Fl Cr 2.7. Ordertng, storage and delivery ol ivermectin Mectizan@ ordered/applied for by - Qtlease tick the appropriate answer) MoH tr wHo tr uNrcEF tr NGDO EI Other (please specify) Mectizan@ delivered by - (please tick the appropriate answer) MoH tr wHo tr uNICEF n NGDO EI Other (please specify) Please describe how Mectizqn@ is ordered and how it gets to the Villages The Oncho Coordinators in the Local Government areas make their requests for Mectizan after getting CDD requirement through the FIFS, based on census updates in village registers. This application is forwarded to the State Coordinator through the SOCT in charge of such area. The sum total of the estimated number of people to be treated from all LGAs are collated and multiplied by 3 to arrive at the approximate number of Mectizan tablets needed. This final figure is forwarded to the NGDO project office for further action. On arrival of the tablets from Mectizan Donors, they are allocated to each LGA based on the original application. The tablets are delivered to the LGA and it follows the same process down to the Frontline health facility, and finally to the CDD with the consent of the Village leader. Table 10: Mectizan@ Inventory (Please add more rows if necessary) Note: I . Twenty one (21 ) tablets of Mectizan were damaged in the course of treatment activities How are the remaining ivermectin tablets collected and where are they kept? LGA Number of Mectizant tablets Requested Received Used Lost Wasted Expired Remaining ANIOCHA NORTH 145,000 145,000 144,998 0 2 0 0 ANIOCHA SOUTH 145,000 145,000 145,000 0 0 0 0 IKA NORTHEAST 145,000 145,000 144,994 0 o 0 0 IKA SOUTH 175,000 175,000 174,995 0 5 0 0 NDOKWA EAST 175,000 175,000 175,000 0 0 0 0 NDOKWA WEST 145,000 145,000 145,000 0 0 0 0 OSHIMILI NORTH 145,000 145,000 145,000 0 0 0 0 OSHIMILI SOUTH 140,000 140,000 139,998 0 2 0 0 UKWUANI 176,000 176,000 175,996 0 4 0 0 Treatment in 16 Hypo LGAs 293,000 293,000 292,998 0 2 0 0 Total 1,6g4,ooo 1,684,000 1,683,979 0 21 0 0 r8 WHO/APOC, 24 November 2004 1. There were no tablets remaining unused at the end of the reporting period List and brie/ly describe the activities under ivermectin delivery that are being carried out by health care personnel in the project area. a) The movement of Drug delivery start from SOCTs to LOCTs, then to DHS, HFS and to CDD. b) Monitoring / supervision of drug distribution were duly carried out. Other activities closely related to drug delivery in which the health workers were involved were: c) Training of CDDs d) Conduct of CSlWStakeholders' meetings e) Mobilization and advocacy visit to LGA policy makers. 2.8. Village self-monitoring and Stakeholders Meeting Has any training (of trainers) for Village self-monitoring been done in the project area? If so, Wen? Yes it was done in 2004. Table 1 1: Village self-monitoring and Stakeholders Meeting (Add rows if needed) Describe how the results of the Village self- monitoring and stakeholders meetings have afficted project implementation or how they would be utilized during the next treatment cycle. 1. To a large extent, Village self-monitoring is quite useful to the programme, in timely resolution of operational and logistic problems. It is the Village Health Committees of which CDDs are members that should organize it, but there are no formal reports that such exercises were conducted during the period of reporting. DistricV LGA Total # of Villages/villages in the entire project area No of Villages that carried out self monitoring (Csntq No of Villages that conducted stakeholders meeting (SHIvf) ANIOCHA NORTH 50 0 0 ANIOCHA SOUTH 62 0 0 IKA NORTHEAST 46 0 0 IKA SOUTH 65 0 0 NDOKWA EAST 54 0 0 NDOKWA WEST 41 0 0 OSHIMILI NORTH 57 0 0 OSHIMILI SOUTH 46 0 0 UKWUANI 49 0 0 Total 470 0 0 t9 WHO/APOC, 24 November 2004 APOC FMOH; NOTF/ZOTF NGDO - The Carter Center SMOH : DIRECTOR OF PHCDA 2.9. Superuision 2.9.1 Provide a flow chart of superuision hierarchy. The Director of Primary Health Care Dev. Agency and the Project Administrator of the Caner Center/Global 2000, jointly or separately at different times, carried out monitoring visits to LGAs, following the above flow chart. They selected some villages in the LGA for scrutiny when distribution was ongoing. Occasionally too, the SOCT and LOCTs carry out spot checks in some villages at least twice during Mectizan distribution activities. It is the DHS and HFS on ground that actually supervise such activities, using the approved checklist. What were the main issues identified during supervision? a) Some CDDs were not committed b) Minimal LGA support c) LOCTs were not showing the desired commitment and drive I STATE COORDINATOR SOCTs LGA; PHC COORD; RD; LOCTsLOCT DHS HF'S CDDs / VILLAGES 2.9.2 20 WHO/APOC, 24 November 2004 d) The DHS and HFS equally complained that the means of movement to supervision sites were not available; hence they could not walk the long distance to supervision sites. e) The bicycles that were provided have proved inadequate while the motorcycle assigned to each LGA is being used by the LOCT. 0 Some of the LGAs are riverine in nature, e.g. Ndokwa West and Oshimili South. There is need for boat to carry out CDTI activities in these LGAs. 2.9.3. Was a supervision checklist used? Yes. 2.9.4. What were the outcomes at each level of CDTI implementation supervised? The outcomes of supervision carried out were normally discussed at the State / LGA review meetings. Some of the outcomes are as follows: 1. LGA level: Though fund released were inadequate in many LGAs, a few of them did well. Staff carried out CDTI activities while awaiting reimbursement from their LGAs. Frequent supervision was limited by fund availability. The effect of staff transfer posed a little problem here but training is continually conducted to cushion the effect of staff transfers. 2. FLHF level: Inadequate bicycles constitute a problem as there is need for more bicycles for new health centers that are opening up in the LGAs. Transfer of staff is also a problem here; but training is done to cushion the effects. 3. Villaee level: Willing and functioning CDDs maintain good records and distribute Mectizan. CDD attrition due to lack of incentives remains a problem although there is increasing awareness of Village ownership of CDTI. There is need to train more CDDs using the new kinship method. 2.9.5. Was feedback given to the person or groups supervised? Feedbacks were always given to the people supervised at the end of supervision. Sustainability of the programme is the all-time message. The peoples' response is good and there is hope for improvement with time. The feedbacks were also further discussed at State and Local government review meetings. 2.9.6 How was the feedback used to improve the overall performance of the project? The feedbacks are passed down the line to CDDs with instructions that improvements should be effected in the identified areas of shortcoming. a. There are better drug delivery methods now; improved drug storage and administration. b. There is hope for improved Village participation. c. There is hope for improved release of LGA fund to support CDTI implementation. 2t WHO/APOC, 24 November 2004 SECTION 3: Support to CDTI 3., Equipment Table 12: Status of equipment (Please add more rows if necessary) NOTE: Information is not available to the project about LGA equipment set aside for Oncho activities. *Condition of the equipment (F:Functional, CNFR:Currently non-functional but repairable, lV'O:Written offl. How does the project intend to maintain and replace existing equipment and other materials? The MOH and the NGDO will be relied upon for maintenance of existing equipment and other materials. It is our recorlmendation that NOCP/APOC undertakes a high powered advocacy visit to the State to clearly define the responsibility of the State and/or LGAs, in maintenance and./or replacement of bad equipment. Describe the adequacy of available lcnowledgeable manpower at all levels Available knowledgeable manpower is relatively adequate. Source Type of equipment APOC MOH DISTzuCT/ LGA NGDO LGA Functi uonal Non functio nal Fun ctiu onal Non functi onal Fun ctiu onal Non functiona I Fun ctiu onal Non functi onal Fun ctiu onal Non functi onal 1. Vehicle I 0 0 0 0 0 1 0 0 0 2. Motor cycle(s) 10 1 0 0 0 0 4 0 0 0 3. Computer(s) 2 0 0 0 0 0 2 0 0 0 4. Printer(s) 2 0 0 0 0 0 2 0 0 0 5. Photocopier (s) 2 0 0 0 0 0 I 0 0 0 6. Fax Machine(s) 1 0 0 0 0 0 2 0 0 0 7. Bicycles 90 0 0 0 0 0 0 0 0 0 8. Generator 2 0 0 0 0 0 1 0 0 0 9. Overehad proiector 1 0 0 0 0 0 1 0 0 0 10. Radio/Tape recorder 1 0 0 0 0 0 0 0 0 0 1 1. Television 1 0 0 0 0 0 0 0 0 0 22 WHO/APOC, 24 November 2004 sl O c.l Lq) -o 0) z t c.l d o /1 aoN N.E $o. p; Gs)\oo s'q $-\$Xo 5(g - c,) .kE s8\oo it>$o so. =oVLua!be Xo dH :r 6) -so s_ s a)sxu-i * o.r \b ^, u) qrE I o.r *Sc6 SF- c, C) tF N o\ o\ o\ ,a! (h Lr() lidg >'p cA o -o Lr o (! o Cd l+r ..ir#l G)t -ot(dt FI €i . €4. O !a>s ts rs$= CON @_ sf(f) s(o F*(os o sf sf s_ (f) o s o)o o CO |o6tg)d rs$a rr) o) sf_(o$ (o (f) @ c., ro o sss-(o o st o,o o(f) (t)(o @_(?(r) r-- L c!q) ,E O :{(a(E @ 63383F)E tr)s @ @ o o o)lr) o)- N o ON @ co(o -tO(0^ o(0 r;q sa ,d] (o NN NN s@(o ',() o o,|o o) N o No @ co (f) ac- CD \o t- CE o rs$a (9 rO (o o, o, o No F-(f) o o rO(? od u:, r.sg? (ot-o coN sl@ (f) lr) o No F-(o o (o Gl @(o CDN(0- (Y) m L o E-,s$'q (o N@ t\o(o F- o oo,N lr)N @(o\N srot- F-N N6l @_(9(0 Eo^ E3Elfv(D t; E3 o (f) N o, o)(ot\ l.() o o,oN ro N o ro$ t-_ NN c)lo cD- @ d c!q) E-,8$eQF uro = o t\o CO F* o -l:(.)_ F- co o)(o oo, $s tNt_ ct) 00 rxegF-6o @ c.) l.r) ooq lo t\ cf) F-(f) o t\ ss (t)^ N@ (a L c) E-,s$'q o (o rolo cO o N(O|r) |r)N @@ Or- (f) l- @ s$ ot CD. ro ss$gF-6u o o o (oNlf, r.r)N o @(olr,(o$ tf C') o- N .I cl 0) E-'s$'q o (f)l{)lr) CO o o) l\ Or_ o iit @o, r() t'-sl roo ro-(\t(o ru9? o o o o, l- o, o o @o)lo c")l{) (0@ rO +(0 Gq) E-spe3 @ cf)(o F- o t\@ o, o(o cf) o) o)o l{)(o ot CD. € rxea -6 o o o t\@ o, o o, o)o l.c)(o (0 G'6{ tt I L r-- 6lEoo -e-=IE>-O -02 I -o->srd6 oJ o rE ^a =o^ o.^ _o =oo k E9= a ob -rEoE z. a- Ep,o);+c6:: >'= o =F o_OH(L5( tt- oF o $ a] L C)s q) z +N (-) { $N 9, oA Lr) loos'E \!< qa: qJMX $9\t,;s. .H\A\) taq .^\JE =eEE E9,os -=: $ E -E jioi x E;gS; E EE s H -E =te 5-E?L.-rv\ s ox trO !UH =o\si E S fiEE 5EEEEEh€Ea; S.X E E io u66o ,$ ^^^N L''1 cs 'o oFi, 3.4 Expenditure per 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 rate to local currency. Indicate exchange rate used here: N125 to US$1.00 Table 14: Indicate how much the project spent for each activity listed below during the 2007 year. Any comments or explanations? Cost per treatment was $0.25 per person treated in2007 Activity Expenditure (s us) Source(s) of funding Drug delivery from NOTF HQ area to central collection point of Village 325 STATE / NGDO Mobilization and health education of Villages 27,191 APOC / STATE / LGAs Training of CDDs 1,743 APOC / State Training of health staff at all levels 1,358 STATE / NGDO Supervising CDDs and distribution 7,908 STATE / NGDO Internal monitoring of CDTI activities 1,909 STATE / NGDO Advocacy visits to health and political authorities 4,752 APOC / STATE / LGAs IEC materials 0 STATE Summary (reporting) forms for treatment 1,103 STATE / NGDO Vehicles/ Motorcycles/ bicycles maintenance 1,800 STATE / NGDO Office Equipment (e.g computers, printers etc) 450 STATE Salaries/overheads 41,386 State / LGAs Others (Capital equipment) 25,000 APOC TOTAL s114,925 APOC / STATE / LGA / NGDO Total number of persons treated (active) 460,700 persons 25 WHO/APOC, 24 November 2004 SECTION 4: Sustainability of GDTI 4.1. lnternali independent participatory monitoring; Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable) Year I Participatory Independent monitoring Mid Term Sustainability Evaluation '/ 5 year Sustainability Evaluation Intemal Monitoring by NOTF Other Evaluation by other partners 4.1.2. a. b. c. d. e. f. ob' What were the recommendations? Improved and integrated PHC planning for CDTI. Develop short and long term sustainability plans. Strong advocacy to the State to convince Govemment to approve funds for programme implementation. An MoU was advocated. Improved Monitoring and supervision. Provision of transport and other materials resources at State and LGA levels. Conduct training need assessment and focus future plans for training on such needs. Improper training of CDDs Provision of IEC materials Village yet to grasp the philosophy of APOC.. 4.1.3. How have they been implemented? The recommendation of independent monitors is already being implemented regarding the initiation of Village self-monitoring (CSM) and Stakeholders meeting (SHM), as means to overcome some of the problems that were identified in the Villages. 2. Restructuring of training curriculum and the methodology of training. a) CDDs are henceforth to be trained along family lineage from village to village by DHS and HFS; b) Increased mobilization and sensitization of villages/stakeholders, thus improving their participation and an opportunity to solve other problems c) More IEC materials are to be produced and provided to the appropriate places by Delta State as was done in 2006. 26 WHO/APOC, 24 November 2004 4.2. Sustainability ol projectst plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period? -Yes Was a sustainability plan written? Yes Wen was the sustainability plan submitted? In 2005 What arrangements haye been made to sustain CDTI after APOC funding ceoses in terms of: 4.2.1. Planning at all relevant levels The monitors found some reasonable level of planning at the State and LGA levels. They recommended that Planning should be embraced as an important tool for effective prograrnme implementation. Delta State is embracing integrated planning for all PHC components following the existence of Primary Health Care Development Agency in the State. 4.2.2. Funds The provision of funds was recognized as a problem at State and LGA levels. However, more awareness and enlightenment will continue to be created at the various levels for improved compliance. In Delta State, the government has been providing financial and logistic support in the form of imprest for the Oncho department as well as the production of IEC materials. 4.2.3 Transport(replacementandmaintenance) The Ministry of Health and the NGDO will be depended upon for maintenance of existing equipment and other materials. However, replacement will not be easily reahzed due to paucity of financial resources. The solution is to get an MoU signed with the State to overcome this problem. 4.2.4. Other resources Efforts will continue to be made to attract support and provision of other resources from the NGDO, as required from time to time. A clear definition of the State's responsibility towards CDTI will solve this problem; though the State provides IEC/FIealth education materials plus public enlightenment campaigns. 4.2.5. To what extent has the plan been implemented The plans are faithfully being implemented subject to available resources. 4.3. Integration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3.1. Ivermectindeliverymechanisms CDTI has been fully integrated into the Primary Health Care structure in the State, such that Ivermectin delivery flows unhindered from the State office to Villages. Apart from LGA programme officers coming to collect the drugs, the State Medical Stores or the Primary Health Care Development Agency programme officers deliver the drugs to the Villages alongside other activities. The drug consignment for any LGA is safely 27 WHO/APOC, 24 November 2004 adelivered and proper inventory taken on its arrival at the LGA offrce. Each consignment is packaged and moved according to requisition to each FLHF and subsequently to designated Villages. 4.3.2. Training The trainings are fully carried out for staff that have no previous knowledge of CDTI and targeted or according to need for the old CDTI staff. The training is usually conducted by the next higher officer in hierarchy to the one immediately below. With the existing Integrated primary health care system in the State, more officers in other prograrnmes are continually being trained and involved in CDTI activities. 4.3.3. Joint supervision and monitoring with other programs Supervision and monitoring of CDTI activities are usually carried out side by side with other diseases such as Schistosomiasis control, Lymphatic filariasis elimination, NID, etc. The program officers at State and LGA levels are involved in more than one prograrnme based on the integrated approach of Primary health care implementation. 4.3.4. Release of funds for project activities The release of fund at LGA level is still a bottle neck to effective implementation of CDTI. However, much improvement has been recorded in the State since the sixth year The State is involved in production of IEC/health education materials and carries out public enlightenment with TV jingles and broadcasts. Also, the State now provides her Oncho project office with monthly imprest and there is inclusion of CDTI in the budget for forthcoming years. 4.3.5. Is CDTI included in the PHC budget? Yes 4.3.6 Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? So far no other programme uses the CDTI structure wholesale, but officers involved in CDTI activity are entitled to take part in other prograrnmes such as NID, Health education in HIV/Aids, IINFPA surveys, LF survey, etc. The officers have always performed well. The plans to integrate Schistosomiasis and LF programmes have begun to yield fruits. In Delta State, treatment for Schistosomiasis was launched in October 2004 and it has been added to the CDTI structure. Treatments have been carried out in Ndokwa East, Patani and Oshimili South LGAs with Praziquantel tablets sponsored by Chevron Nigeria Limited. The treatments will continue and would be extended to other oncho endemic LGAs. 4.3.7. Describe other issues considered in the integration of CDTI. Other issues considered in the integration of CDTI are joint and multipurpose training. Officers assigned for Disease surveillance and notihcations as well as other programme officers are going to be involved in monitoring and supervision, plus retrieval of data from the field. 28 WHO/APOC, 24 November 2004 a 4.4. Operational research 4.4.1. Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period. Not applicable during the reporting period. 4.4.2. How were the results applied in the project? Not applicable. t 29 WHO/APOC, 24 November 2004 a at SECTTON 5: Strengths, weaknesses, challenges, and opportunities List the strengths and weaknesses of CDTI implementation process. List the challenges and indicate how they were addressed. Strengths APOC's continued support to achieve sustainability Availability of Mectizan drug. Some CDDs are committed to high productivity The financial supports by some LGAs enhance CDTI activities in such LGAs. Some LGA policy makers demonstrate desired interest towards the programme. The motorcycles provided by APOC & NGDO enhances monitoring and supervision of CDTI by the LGA staff. Some villages are appreciative of their involvement / ownership of the programme. The NGDO is committed and dedicated to a successful program implementation. The political and financial backing from the State Primary Health Care Development Agency has boosted the CDTI progralnme in the State. Delays in release of fund slows down progralnme implementation. Lack of commitment by some LOCTs to the prograrnme. Non-initiation of CSM and SHM in some LGAs/villages. Fuel scarcity and its high cost following government's deregulation of the oil sector. CDDs' regular comparison of Onchocerciasis progtunme with other health prograrnmes where incentives are paid and govemment recognition is accorded to participants. Some Villages/villages are paying lip service to their involvement and ownership of the prograrnme. Constraints 1. High cost of fuel and vehicle maintenance. 2. Some villages are yet to come to terms with the call for their ownership of the programme. 3. Some CDDs are completely uninterested in the programme irrespective of whatever motivation is put in place. Challenses 1. Intensification of advocacy I mobilization to the States and LGAs for counterpart fund to the programme. 2. Intensification of Health education and Village mobilization. 3. Empowerment of LGAs to initiate and execute programme activities without the involvement or prompting of the State Oncho team members. 4. Intensive distribution of Mectizan tablets in all the endemic LGAs / villages in the project area. 5. Inauguration of CSM and SHM in all LGAs and Villages. 6. Conduct of population update in all endemic LGAs. 7. Increased monitoring and supervision of targeted LGAs and Villages by the relevant field staff. 8. Continuation of targeted training and retraining of LOCTs, HFS and CDDs. 1. 2. J. 4. 5. 6. 7. 8. 9. Weaknesses: I 2 J 4 5 6 a 30 WHO/APOC, 24 November 2004 How to address the clalleueet j I Continuous mobilization, advocacy and sensitization at all the levels : Village/Community, LGA and State levels. This also involves regular review and restructuring of styles, methods of work and strategies to meet with the evolving challenges of sustainability. Continue to work closely with the Budget Department of the Ministry of Finance for the inclusion of Onchocerciasis budget line in the State's yearly budget. Provision of more motorcycles, bicycles and replacement of project vehicle. APOC, NOCP and the supporting NGDO are being requested to carry out a high powered advocacy and sensitization visit to the State to fuither encourage the State to improve on its counterpart cash support to the progralnme. SECTION 6: Unique features of the projecuother matters Integration of Onchocerciasis control into the PHC/DC structure. Budgeting for Onchocerciasis at State level (especially for training materials and Oncho day celebration). Integrated service delivery. The proposal to establish the Primary Health Care Development Authorities at each LGA is at advanced stages, as the State Primary Health Care Development Agency has been doing well in this direction in her role of supervising all primary health care activities in the State. 2. 3. 4. t , 1 2 J 4 a 31 WHO/APOC, 24 November 2004