Ogun State CDTI annual project technical report submitted to Technical Consultative Committee(TCC): January to December 2008

OGUN STATE CDTIPROJECT ORIGINAL : Engli$ Proiect Name: OGT'N STATE CDTI PROJECT t I ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO For TECHNICAL CONSULTATIVE COMMITTEE (TCC) Tot DEADLII{E SUBMISSION: To APOC Management by 31 Januarv for March TCC meeting To APOC Management by 31 Julv for September TCC meeting AFRICANPROGRAMME FOR ONCHOCERCIASIS CONTROL (APOq tor Tor COT NTRY/NOTF: MGERIA Approval vear: FEBRUARY, 2000 Launchins year: NOVEMBE\ 2001 From: January,2008 (Month/Year) To: December,2008. ( Month/Year) Repartins Period: Proiectvearofthisreport: (circleone) I 2 3 4 5 6 (7) 8 9 10 ILGDO partner: IINWA.Date submitted: December, 2008. Stn c$! coP c^o .T0 co &Fo ro brnoflon tQ- I. Bc\corip I ! , l0A0l,r2m oclDtRAP WHO/APOC, 24 November 20([ 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: Dr. Y. Fayomi Signature: . Date Zonal Oncho. Coordinator Name: Otunba A. Jaiyeoba Signature: .... Date NGDO Representative Name: Mr. M. Olu Taiwo Signature: Date This report has been prepared by Name : Mr. V. O. Osikoya Designation : Project Coordinator Signature Date ll WHO/APOC, 24 November 2008 Table of contents ACROI\-YMS v DEFINrTIONS......... .....................yI F'OLLOW UP ON TCC RECOMMENDATIONS .....-..I EXECUTIVE SUMMARY........... l.l. Gpuenel rNFoRMATroN............. l.l.l Desuiption of the project (briefly)... 1.L2. Partnership 1.2. Popur-nrroN SECTION 2: IMPLEMENTATION OF CDTI 2.1 TruelrNB oF ACTrvrrrES 2.2 Aovocecy 2.3. MoeLlznrloN, SENSITIZATIoN AND HEALTH EDUCATToN oF AT RISK coMMUNrrrEs. ll 2.4 Couuuqny II\n/oLVEMSNT................ 2 3 3 4 5 7 7 9 Nn. ..............12 ..............t2 .............. l32.5. CnpecrryBUrLDrNG... 2.6. TnrerueNTs.............. .....15 2.6.1. Treatmentfigures.......... .........-- 15 2.6.2 What are the causes of absenteeism?.......... ................. /82.6.3 Wat are the reasons for refusals?................ ............... 182.6.4 BrieJly descrtbe all lcnown and verified serious adverse events (SAEI that ... 18 2.6.5. Trend of treatment achtevementfrom CDTI project inception to the current yeu20 2.7. 2.8. 2.9. ORorRnic, sroRAGE AND DELIVERv oF IvERMECTIN .... Colrutxny sELF-MoNrroRING eNo STRTeHoLDERS MeErrNc ..... SupBRvrsroN ........22 ..,.,...23 ........ 23 2l 24 24 25 25 26 2.9.1. Provide aflow chart of supertision hierarchy. 2.9.2. 2.9.4. 2.9.5. 2.9.6. CoNotnoN oF THE EeurpMENT * PLEnse srATE.. 3.2. FrNeNcnl coNTRTBUTToNS oF THE pARTNERS AND coMMUNITTEs 3.3. OrHen FoRMS oF coMMUNrry suppoRT............... 3.4 ExpBNoIruRE PER ACTIVITY ... of the fo ll ow ing w hic h ar e appl ic ab le) ...........4.1.2. Wat were the recommendations? . 4.1.3. How have they been implemented? Wat were the main issues identified during supervision? ..........-- 23 Wat were the outcomes at each level of CDTI implementation supervision? 23 Was feedback given to the person or groups supervised? YES. ..-.. 24 How was the feedback used to improve the overall performance of the project? 24 SECTION 3: SUPPORT TO CDTI ...........-24 3.1. EqumurNr....... SECTION 4: SUSTAINABILITY OF CDTI....... .......-26 4.1. INreRNar.; TNDEIENDENT pARTICIpAToRy MoNIToRINc; EveluRTIoN.......... ..........26 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick ory ..........26 ..........27 ,....,....27 4.2. SusreNesrlrry oF rRoJECTS: ILAN AND sET TARGETs (MANDAToRv AT...... ..........27 ,,......,.,.......... 27 lll WHO/APOC, 24 November 2fi)8 The State government has a history of releasing counterpart contributions. This is expected to continue. Some LGAs have been releasingfunds but others have not. The Local Government Department has been mobilized to assist tn mobil,izing all LGA Chatrmen to release counterpart funds.4.2.3 Tronsport (replacement andmaintenance). 4.2.4. Otherresources.. 4.2.5. To what extent has the plan been implemented..4.3. INrpcnarroN 4.2.1. 4.2.2. 4.3.1. 4.3.2. 4.3.3. 4.3.4. 4.3.5. 4.3.6. Planning at all relevant levels........ Funds release 27 27 27 27 27 27 27 Ivermectin deltvery mechonisms .. Training Joint supervision and monitoring with other programs.... ...28 Release offunds for project activities . Is CDTI included in the PHC budget? Describe other health programmes that are using the CDTI structure and how thts was achieved. What have been the achievements?.. 28 Programme staffbenefitfrom joint training such as RBM, NPI, HIV/AIDS, TB/LEPROSY and Health Education Programmes.............. .............28 28 Some Community Based Organizations are using the CDTI structures to ossist in the Roll Back Malaria[RBM], TB/L and NPI. Following the conclusion of LF mapping in the country, the project will be joining afew others to commence Mass Administration (MDA) from 2009 ustng the CDTI structure. 284.i.7. Describe others issues considered in the integration of CDTI. ..... 2A 4.4. OprnerroNAl RESEARCH. 284.4.1. Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period. ........ 284.4.2. How were the results applied in the project?............. .................... 28 SECTION 5:.............. .....................28 STRENGTHS............ ....................28 WEAKNESSES ..........28 SECTION 6: UMQUE FEATURES oF THE PROJECT/OrHER MATTERS...........29 lv WHO/APOC, 24 November 2008 Drug Acronyms APOC African Programme for Onchocerciasis Control ATO Annual Treatment Obi ective ATrO Annual Training Objective CBO Community-B ased Organization CDD Community-Directed Di stributor CDTI Community-Directed Treatment with Ivermectin CSM Community S elf-Monitoring GCCC Government Cash Counterpart Contribution LGA Local Government Area MOH Ministry of Health NGDO Non-Governmental Development Organization NGO Non- Gov ernmental Or garization NOTF National Onchocerciasis Task Force NPI National Programme on Immunization OGRUMED Ogun State Rural Medical Scheme PHC Primary Health Care REMO Rapid Epidemiological Mapping of Onchocerciasis SAE Severe Adverse Event SHM Stakeholders meeting IBIL Tuberculosis and Leprosy Programme TCC Technical Consultative Committee (APOC scientific advisory group) TOT Trainer of trainers UNICEF United Nations Children's Fund UTG Ultimate Treatment Goal wHo World Health Organization v WHO/APOC, 24 November 2008 Definitions Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). Elieible population: calculated as 84Yo of the total population in meso/hyper- endemic communities in the project area. Annual Treatment Objective: (ATO): the estimated number of persons living in meso/tryper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. (iv) Ultimate Treatment Goal (UTG): calculated as the maximum number of people to be treated annually in meso/tryper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage (normally the project should be expected to reach the UTG at 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) Geoeraphical coverage: number of communities treated in a given year over the total number of meso/hyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). (vii) Inte8ration: 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 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 mobilised by the community and the government. (ix) Community self-monitoring (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 that the programme is being executed in the way intended. It encourages the community to take full responsibility of ivermectin distribution and make appropriate modifications when necessary. (D (ii) (iiD vl WHO/APOC, 24 November 2008 FOLLOW UP ON TGG REGOMMENDATIONS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session 28 1 Number of Recommendatio n in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROIECT FOR TCA APOC MGT USE OI\AY Include APOC in partner's list This is noted and has been done. Intensify efforts to improve women involvement in CDTI The project paid advocacy visit to the Ministry of Women Affairs, and through them has started mobilizing the women wings of the different Community Development Associations (CDAs). A retired female justice ofthejuvenile court and a retired police officer were mobilizpdto assist in mobilization of women particularly in Ifo LGA. These efforts have resulted in a slight rise in the number of female CDDs. These efforts will be pursued further in 2009 Update census This willbe done in2009, definitely. The project is concerned that for quite a long time census is yet to be thoroughly updated. WHO/APOC, 24 November 2008 Executive Summary Prepare an Executive summary of the report in not more than one page. Ogun State is one of the 36 States in the Federal Republic of Nigeria. Located in the South Western part of Nigeri4 it is made up of 20 local government areas with a projected population of 3.4 million. The greater proportion of the State lies in the tropical rain forest zone with a sizeable feature of Guinea Savannatr in the northem part. The people in the State are predominantly Yorubas of which there are Ijebus, Yewas, Egbas, Aworis, Eguns, and Remos.The prevalence survey of 1994 and the subsequent REMO refine of 1997 and 2000 revealed that the State is endemic for Onchocerciasis. Mectizan distribution in the State started in year 2001 with support form IFESH and APOC. CDTI is being implementedng52 communities in 8 LGAs. The total population of the endemic areas is 3I7,720. Population movements occur with the migration of young ones from the rural areas to urban centers in search of greener pastures. There are also movements when farmers and particularly fishermen move temporarily to new areas during particular seasons. Festive seasons (religious or traditional) provide opportunity for movement of persons from community to community and from urban areas to the communities, and vice versa. During the period being reported 837 communities were covered and207,549 persons heated thus achieving 88% Geographical coverage aad 65% Therapeutic coverage. The treahents also meant a coverage rate of 77Yo of the Annual Treatment Objective of 269,467 afi82%o of the UTG. The low treatment coverage was due to inadequate Mectizan obtained for the year. Following some misinformation from the supporting NGDO, MDP withheld the consignment meant for the State for 2008. When it was fully resolved it was already late to ship the consignment, and through the NOTF the project obtained loans from other States. 781 LGA health workers (301 new and 480 refresher), 609 front line health facility workers (321 new and 288 refresher), and 2495 CDDs (495 new and 2,000 refresher) were tained during the reporting period thus achievng 94% of ATrOs for health workers and 100% of CDDs ATrO respectively. 133 State and LGA Policy makers were mobilized as well as 358 Village Heads, 204 Women Leaders and263 Religious Leaders to support CDTI. The strengths of the implementation process include large numbers of trained health staff available for CDTI implementation, increased number of female CDDs, the involvement of religious organizations and churches in the CDTI process, high community awareness of the benefits of Mectizan treatment, and willingness of community members to comply with annual treatment. The major weakness experienced was the inadequate release of counterpart funding by LGAs. To this is the increasing complaints by CDDs over lack of incentives. The major challenge the project faced was late supply of Mectizan and inadequate numbers of quantities secured. Other challenges were instability of political appointees/caretakerltransition committees at the Local Government level, unsatisfactory quality in record keeping, inadequate number of CDDs in some communities and frequent change of LGA Coordinators. 2 WHO/APOC, 24 November 2008 SECTION 1: Background information 1.1. General information 1.1.1 Description of the project (briefly) - Geographical Iocation, topography, climate Ogun State, otherwise known as the Gateway State, was carved out of the defunct Western State on 3'o February, 1976by the Federal Military Government of Late General Murtala Ram at Mohammed. It lies within the tropics. Oyo and Osun States bound it in the West by the Benin Republic; in the south by Lagos State and the Atlantic Ocean; in the East by Ondo State and in the North. Ogun State occupies a total areas of 16,409,26 square kilometers. The climate follows the tropical pattern with the raining season starting about March and ending in November, followed by dry season. - Population: activities, cultures, language. The projected population from 2002 for the state is 3,262,889. The major ethnic groups are the Egba, Yewa, Awori, Egun, Ijebus and Remo; they belong in the main Yoruba ethnic group.Nigerians from other parts of the country as well as expatriates also live in the state. The languages spoken are mainly Yoruba (Languages of the predominantly majority) and English (Official languages). There are several dialects including Ijebu, Remo, Egba, Yewa, Awori, Egun, Ikale and Ilaje. The major occupation of the population is farming; fishing, Weaving of cloth (Aso-Oke), tie and dye (Kampala and ad ire) are practiced. Settlement pattern is largely dispersed. - Communicationsystems (roads...) Roads between major cities are in good conditions, but access roads to most of the endemic communities are in poor shape. Some are not possible during the rainy season. Despite this, transport by road remains a major means of communication among the communities. The electronics and print media are also veritable channels of communication. - Administrationstructure. The State consists of 20Local Government Areas with the political appointees being the Chairman. Legislative arm made up elected Councilors from various wards supporting the system. At the State level, the Executive Governor is the Head of administration. There are the Legislative and Judicial Arms. The capital of the State is located in Abeokuta. - Health system & Health Care Delivery (provide the number of health posts/centers in the project area if the information is available). There is an official PHC policy and structure in the Project area. It is a system of health care services where community participation forms the mainstay with support from the state, Local Govemment and NGOs. Level of functionality however varies across the state, the health facility in the State spread and located in various LGA, ranging from Health Posts to Hospital. There are 426 Health Clinic/Centers/ Posts and 8 Hospitals in the Project Areas. J WHO/APOC, 24 November 2008 Table 1: Number of health staff involved in CDTI (Please add more rows tf necessary) District/LGA Number of herlth staffinvolvcd in CDTI activities. Total Number of hcalth staff in thc cntire projcct arca Br Number of hcalth strffinvolved in CDTI B, Percentage Bs=Bzl Br rl(X) Abeokuta North 200 156 78% Abeokuta Souttr 270 249 92Yo Ewekoro 160 t49 92o/o Ifo 170 l6l 95o/o Imeko-Afon t70 145 96% Obafemi-Owode 200 l9l 85% Odeda 160 136 85% Yewr-North 200 182 9l%;o Total 1s90 r369 86Vo 1.1.2. Partnership The partner involved in project implementation in Ogun State are APOC, IFESIVUNIVA /FGN {NOCP-Natioml &Zonal Offices}, State Government, various Local Government and the Endemic Communities. Some Christians Organization is assisting in the distribution of Ivermectin being that, it comprises of both immediate and extended family living in a compound. APOC provides funding, technical guidance and logistics for project implementation. IFESIVITNIVA is mainly involved in planning, occasional advocacy and also assists in providing technical experts in Training, community mobilization, co-financing Prograrnme activities, monitoring, encouraging in Mectizan treatment. The NOCP zonalOffice is enabling a favourable environment for IFESIVUNIVA, supervision of CDTI in Ogun State. The State, LGA and endemic community carry out their various responsibilities under CDTI. Partners are working together in harmony to achieve a successful implementation of the Programme. However, a Field Officer was appointed by IFESIilUNIVA to supervise and oversee the fieldwork activities at all levels. Plan to orientate Community Coalition members i.e. Association of Local NGOs to develop each community. The meetings sensitize religious bodies (Christians and Moslems) in creating awareness to wanderer/strangers coming into the community. To also contribute incentives for CDDs and train Local NGO Coordinators as Monitors for effective distribution of Mectizan among the Community dwellers. 4 WHO/APOC, 24 November 2008 €ooN l<(l) -o E o) oz tNdo0r so €i 6lEe F) o ah E 6) U(n L clo .h o t!)q v, oo t<5 o v, to -c o c.(DtBlE>tG oxHIJ -o :^''cd t-.1 o sEl 'cJr/l9.d+itr -- 6)EO 8El.E-I E= o z c-.1 r, !l '-tsgts=loP i2.oEa>7 d z(!):i lt 3 bq) '8. 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Timetine of activities Fill in table 3, timeline of activities for areas treated in current year,indicating when the key activities were implemented by the month they began and the month they ended. 7 WHO/APOC, 24 November 2008 @ooN r<(.)p tr C) oz rt c.ldo o. o *r B Iilri\ -s 's ssi.f .S *)S{q) €st ,s\t\!S B$&s$r1 a; 'ii\ s *\.'\\) MT €$r ,9t,o\\sH'S ta - B"S ^.oo .NET -N\r\'S*. 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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. Below are the Tables showing: Number of Policy and decision makers mobilized et State and LGA level sal LGA VILLAGE HEADS WOMEN LEADER RELIGIOUS LEADER I Abeokuta North 80 39 30 2 Abeokuta South 74 40 50 3 Ewekoro 33 20 50 4 Ifo 27 20 30 5 Imeko/Afon 30 l5 29 6 Obafemi/Owode 38 t5 20 7 Odeda 40 20 33 8 YewaNorth 36 35 4l TOTAL 358 204 263 ADVOCACY AT STATE AND LGA LEYELS 9 N/s STATE # LGA # I Honourable Commissioner for Health I Chairman Local Govemment Service Commission. I 2. Chairman, House Committee on Health. I Chairmen of LGA 8 3. Permanent Secretaries: 2 HOLGA 8 a. Health. Treasurers I b. Hospital Management Board. Supervisory Councilors for Health. 8 4. Director: 7 Oncho Officers. t4 a. PHC & DC. Department. PHC Coordinators 8 b. Training. District Coordinators 40 c. Hospital Services Dept. WES Coordinator I d. Nursing Services Department. e. Planning, Research & Statistics Depart. f. Pharmacy Department. (} Finance and Administration t Principal: a. Schools of Nursing. 3 b Schools of Midwifery 3 c. School of Health Technology 1 d Reproductive Health Centre I 6. Programme Officers: 11 a. NPI unit b Roll Back Malaria unit c TB/L unit. d. HIV/AIDS unit. e Health Education unit. f. School Health Service unit. oF. Reproductive Health unit. WHO/APOC, 24 November 2003 h. Monilgring & Evaluation unit i Women - In - Health unit. i Environmental & Occupational Health. Total 30 Total 103 Reasons for the sensitization: o To establish their responsibilities for CDTI execution and sustainability. o To participate in Community Self Monitoring and attend Stake Holders Meetings. o To share ideas and encourage participation of the decision makers. o To determine appropriate incentive to be given to the CDDs. o To establish women involvement in CDTI activities. Outcome: - CDDs are now enjoying motivation from community members in some corlmunities. - Agreed to support CSM and SHM initiative. - Number of CDDs increase with Voluntary participation in drug distribution. - Women liberation and empowerment. Constraints: * Bad road and poor terrain experienced by the State and LG Supervisors especially smuggling route in Imeko-Afon and Yewa North and collapsed bridges in Odeda and Obafemi - Owode. * Climatic and Weather condition partially adaptable i.e. Flood disaster. To improve advocacy: o Sponsoring of Prograrnme segment (Media Chat and Press Conference) in media houses to solicit for support and create awareness.. o Marking of Oncho Day. o Showing documentaries of people affected with terminal complications of the disease. o Orgarization of drama and song festival to give orientation to Top functionary Officers for moral and approval support. o Production, Printing and Distribution of Souvenir such as Face-Caps, Stickers T-shirts and Pocket Calendars. 10 WHO/APOC, 24 November 2008 2.3. Mobilization, sensitization and health education of at risk communities. Provide information on I - The use of media and / or other systems to disseminate information. Use of Media Houses: The State Ministry of Health organizes regular Programme tagged 'karo o jire. Airing of this in GTV.GBC, Rock city F.M.NTA and FM News was regularly done. The Onchocerciasis Programme was aired in the following Media Houses: r' 'Eto flera ni Ipinle Ogun' in Paramount FM 94.5.{ GBC -'Healthy Living Segment'./ Mid-day News on Health and Environment [Oncho Day]. GTVAITA News in Yoruba, English and Egun. Few I.E.C materials were distributed to communities and religious organizations. The major medium was face-to-face discussions with community members by health workers. Some of these community discussion fora were organized through integration with other PHC Programrne such as AFP, NPI, RBM, .Health Education, RHP and HIV/AIDS training activities. Mobilization and Health Education of communities including women and minorities These are aimed at ensuring community involvement, participation and intensiff effort of numerous CDDs that are yet to be remunerated by the community. Mobilization meetings were also held with Religious Leaders for support in the aspect of giving incentives and negative attitude of CDDs towards Mectizan distribution. Mobilization of Community Development Association and Landlords Association meetings were carried out with Local Government Coordinators to achieve better coverage. Regular meetings with Chdstian Association of Nigeria {CAN} and this led some Churches to choose CDDs who in turn boost the CDTI distribution in Abeokuta North and South. 28 Churches being an Organization with complete household members agreed to carry out distribution,223 Chtxch Directed Distributors have been selected and trained while regishation and treatment was carried out and completed during the Health Week commemorated in various churches. Health Education Campaign in Churches and Mosques is in progress.. The project paid advocacy visit to the Ministry of Women Affairs, and through them has started mobilizing the women wings of the different Community Development Associations (CDAs). A retired female justice of the juvenile court and a retired police officer were mobilized to assist in mobilization of women particularly in Ifo LGA. Response of target communities/village: The various communities have responded by coming forth to take their drugs when these are made available. Accomplishments: . Level of acceptance by the opinion leaders and women fold is high. o Increase in the number of female CDDs Ways to improve mobilization and sensitization of the target communities: o Formation of Village Committee on Mectizan Distribution. o Involvement of more local NGOs and CBOs l1 WHO/APOC, 24 November 2008 2.4. Gommunity involvement Table 4: Communities participation in the CDTI (Please add more rows if necessary) Comment on: - Attendance of female members of the community at health education meetings is average. - In general, how do you rate the participation offemale members of the community meetings when CDTI tssues are being discusses: They were recognized and title holders were opportune to raise issue i.e. Iyaloja/Iyalaje. in the meetings. Participation in the discussion depends on what the male members says and agreed upon. Attrition of CDDs. Is attrition a problemfor the project? Ifyes, how is it addressed? There are problems of attrition but the rate is still minimal. With growing demands for incentives by cDDs this issue may become a source for high attrition rate in the project. Other issues Nil. DistricUlGA Numbcr of com muniticVviltagcs with community mcmbers es supcrvisors Number of CDDs end the communitics involved Numbcr of communities /villagcs with fcmale CDDs Total no. communitics in thc entirc project aree B. Numbcr with community membcrs as supervisors B< Perccntegc B; By' B. *100 Mrle CDDs B7 Fcmalc CDDs Br Total Bq= Bz+Br Number of communitics with femrlc CDDs Brn Pcrcentage flu= BrorB.*100 Abeokuta North ll9 67 56 320 100 420 28 24% Abeokuta South 110 48 44 119 105 224 45 4t% Ewekoro 88 54 6t 296 120 296 33 38% Ifo 110 6t 56 230 105 335 25 23% 390Imeko-Afon 92 33 36 185 95 280 35 Obafemi-Owode t76 89 5l 195 61 256 20 tt.3% Odeda 104 52 50 180 65 245 25 24% Ycwr North ts3 3l 20 175 58 233 28 18.3% Totel 9s2 435 46 1,574 709 2283 239 25.1o t2 WHO/APOC, 24 November 2008 2.5. GapaciQr building - Describe the adequacy of available knowledgeable manpower at all levels, Adequate trained staff is available. Where frequent transfers of trained staff occur, state what the project is doing, or intends to do, to remedy the situation. (The most important issue to describe is what measures were talren to ensure adequate CDTI implementationwhere not enough knowledgeable manpower was available or if stffi are frequently transfer1ed during the course of the campaign). Frequent transfer of health staff is a major issue, and the project has been handling this by training and retraining of those that come into the endemic area, and by training of other LGA health staff so that if they are posted to an Onchocerciasis endemic area, programme activities would not suffer much disruption. l3 WHO/APOC, 24 November 2008 cooe -o ozsc\ do Or o $ hi) o Q € € oE TI s P: a € 6 o B o boE No B L og + b\\ o * * E() A 6lL v, a aU o Lq) z E?[Q o-=+F v.i Sd lr *o o s ota c.l o\o ra o\ c.l o N ra)tf o 00N o raN o co olo c.t o ra) c.l N\.l c\ F.- c.l o rn c.l o.t c.l r- F--(\l o rr}N t-- c\ in ra) co o ra) c.l (n o tito rn oin c.l $(a la o\t+ ol oooN ia o\tc s(ao (u (u a) (J sIFd oot ooao oooc{ ooc.l N ola)c.l oinc.t ooti o n)rc N o q)L €) .=6alfr!o r. fro: TO:oq):-9 LC0J rr z =?llQia3 Su= io *o -'Js OI O t-,{ sooN o (,) o () -cc\(.) o F - -, - q) ai Gl lt f;E Eg E3E> 2E oI E*?F-d U U. +.q z r- \o cf) la) co € c.l \o co c-'l o\ \o\n \o co oN \o\o \o co co s\o \o co oo c-l €rr \o cn c.l$ o.l\o \o c.t \o c.l $ € \o co €$ o\o\o 66 al tl ra s € o\ t) EIo (l) I sU o F o€ o c.l o\o or- or- o€ o\o o € cl\o ct o tt) () iI .3le(J6J ;'e oe o L o& z E,'t?F-d o o *. q * @ o\o N o o\o o o\ o 00 o\o N (a oo \o ta) N @\o o\o 00 o o\o o ra) N o\ o\o o.ltl o\o €t- € = o n) so o\ o (u o o \co\ U o F o c..l o\n 6 oo o € o.l o ol oF-6 I Fl c) o n o z c, av o C)3 oa d lz o C)o oEo -vo Br! € tr -o Io ,vo () !o 3 oI .E q9(! ! (, o o oz ql!o Fl tr o I-{ i.cB4 a4q) oq) .S s oL q)\o NB \) V) s\) el co 63 (l) E(.) & E F a() +i o V) o () P 0.)Lr .(l)H €(l) ct bo tr tr (dLt- .iir ol -ol(6l FI * Table 6: Type of training undertaken (fick the boxes where specific training was carried out during the reporting period) - Any other comments Community NGOs are Marketers Association and OKADA (ACOMORAN) Riders. Religious Bodies such as CAN, Bible Society, NASFAT, DAWAH, YOUBAS, NAWA-RU- DEEN. 2.6. Treatments 2.6.1. Treatmentfigures If the project is not achieving 100% geographical coverage and a minimum of 65% therapeutic coverage or the coverage rate is fluctuating, state the reosons and the plans being made to remedy this. Treatment was not optimal in most LGAs because of the inadequacy of Mectizan tablets obtained. The project had to borrow from other projects through the NOTF intervention when MDP could not release the project's consignment following misinformation from the supporting NGDO - UNIVA. Additionally, MDP, APOC and the NOTF felt that the NGDO was not assisting the project enough, and there were some missions to resolve the issues. The State subsequently will be procuring their Mectizan supplies together with the UNICEF- assisted States. Trainees Type of training CDDs Other Community members e.g. Community monitors Health Workers (frontline health facilities) MOH staffor Other Political Leaders IFESH field Officer, Comm unity NGOs and Religious Leaders. Program management How to conduct Health education Management ofSAEs CSM SHM Data collection Data analysis Report writing Community Coalition l5 WHO/APOC, 24 November 2003 €oo o{ L(u .od (l) oz .tN C)o O. o > I \o cdEOC!E5o\/ 'A seCl,FP(1)c\' tloeGl-co s#q) .a.Eg'A r^ 6.LVa=s2 o7;]€ =4.=E5 EI.E.EE ;=g(l)=cg u .=ooE='E =ao)E(BEFEEv.;{o.=o(.)trP h or tr 'E € =l E EE il 8 Et EI : E5 iilE E sE PJ F s sE EI,1 EIg EI$EIE tlE El€ tlE ils8IH 8IE BIEEIUUA HE HEtsIE €lg €l; €le €l€ zl9 218 zle 21,3 o)il HO oob0 'rlEst 6 -g C)IclH o o0(d Lio oo R^ .Y rodo\av(!l b0 oo() o) (dL o a0(d Fr o) oo .9GEo\ oa(dL o) F o h( c0lro o() Gto a(! Li bI oo bI € (6 o oo GILrO hI tr)0 E oo l-< € (U L. ofrr ,l( an L cB an cl(l) lr cl c! tr \J FI I L u2 E(l) E Gq)L Fr illlil H A€E E E€EEE g z z z z z z z z z O rrl E3 ZO z z z z z z z z z cg EoSe?i*9- Ad i c.t I ol $ \o E. fir .E E.ct E Eg,EE z z z z z z z z z s C) u0d() oo o ao o.6l q) F \o6\$\o 6\al € x c- \o o\ @ t-- qO \o \o 6\ .o6\ o\\o \o5\ o\ sia\o Ee* o\o co N o o\ ot cn an ca c?) ol o\rt ra\i ol o\o \o c{ c{\o- \oN r.|r-oI co ol o\ € ra .d6l o\t ra r-o c-l tsc)? d.z =triJE E.S < g4'FU o\o ,.I € c\l cn .t$- rat co c.l co\o^ c.l r-F- ra oi c.l 00$ r- c.t ra ooq. \o .+ c.l .+ @- oo c\t o @ ra t- ci r-\ot- o\\oN o (g ao O{ .9 .,3 E-&Hi€ -?.g o:oE E 9€ _oF t-\oq c.l co \o rnvl o!+ $o ci a.| o o.l$ c.t al(q. cOt $ €\al c?)\a ra$ o\ CO ca o\ !+$ eNF F (fi (6 .9o =@A 6^ Ss58E s ca rn -o6\ o\ € \oo\r- o\ \o6\t o\ s$ o\ \o6\(r'l o o\ \o6\ .+ o\ \o o\ c.l o\ s6 € tsE.- r'E [i!Q # E3',fi5 E't 15 AO () co\o 00o\ \o@ so c- € o\ ra) €o\ c{ .t r-.(7) € tso d o.= r-Eo t.u Ft<v o\ o oo 00 o c.l o\ \o r-. !+o c.trat Nin o\ U)o b0 cl U' o) +) d E oO =E€ * t sEEfis . 8E E E o\ o € € o c.l o\ \o t-- .to co Nin o\ .9<gq o\ (t).1J.ti E2 ((, a.n *Eg3 oL oJo BH € 6ct€ E< 'i o-ltr.d *9Er^o- (B €o €o EE F1 H oH €oo c.l L C) -o E() oz$ c\ldo A<\o r- \J$ $ s Eg .i $ $\)!0 .t\ I E{ E 's s\\'s$s .asooi Ej .ss .stsErs3us EE BE E jr-s$ \JBEE .S 'Sci. E $$\ saJF SE|t ls' : EFr PXS:L % 'l^, E tt! E:t *;$ s:$ Es;s' rI 3 \sox t: .s sE o6 uiE 'S\ 't qs : u.ts E E$! r!t tEr :r\r tr E S$ 'r d\s s*S *lrtr t-r ='il ilsP PSt 5s 2.6.2 What are the causes of absenteeism? Some workers were transferred. Few went for community assignments in the city when distribution took place. Some were religious members that travelled to represent churches at Conferences, Retreat, Carnp and Mountain worship. 2.6.3 What are the reasons for refusals? They are mostly nomads 2.6.4 Briefly describe aII known and verified serious adverse events (SAEs) that occurred during the reporting period and provide (in table 8) the required information when available. No Serious Adverse Event recorded In case the project did not have any cases of serious adverse events (SAE) during this reporting period, please tick in the box. ./ 18 WHO/APOC, 24 Novemb er 2004 too c.l k o)p Eo oz$ c.t t,o Pr{o o\ q) B q) \.r o'\q)s B L -q)(t) * -.(' v v;q) uq) .S la L a)Lo t t3 q) qi q) 5 €o Lr C)o bo troa c)L c.) b0tr 'trt € o)L{Lr () oo Cd V)r! (n v)Itr(l) (l) (l) V)l.r(.) 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Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - (please tick the appropriate answer)MOHtr WHO N INICEFtrTJNIVA Other (please speciff): Mectizan@ delivered by - Qtlease ttck the appropriate answer)MOHtr WHO U INICEFN I]NIVA Other (please specify): _loan from NOTF Please describe how Mectizan@ is ordered and how it gets to the communities UNIVA ordered through NOTF, later supply MOH according to their request. UNIVA forwards completed Mectizan. Application form to Mectizan Donation Program through the NOTF. On approval, consignment is received through UNICEF and supply is made to the state Ministry of Health on request. IIow it gets to the communities. State Coordinator collect from Carter Foundation, Jos and Oyo State to replenish state store for Mectizan, LG Coordinator applies for total required by the Frontline Health Facility Staff, when CDD finally collect number demanded. Table 10: Mectizan@ Inventory for Year 2008 State/District/ LGA Number of Mectizano tablets Requested Received Used Lost Wasted Expired Remaining Abeokuta North 80,000 64,000 63,885 0 l3 t2 Abeokuta South 140,000 100,000 99,919 5 6 7l Ewekoro 100,000 70,000 69,963 4 7 28 Ifo 150,000 80,000 79,881 9 4 106 Imeko/Afon I15,000 80,000 '19,853 7 t2 128 Obafemi/Owode 150,000 80,000 79,934 8 56 Odeda 100,000 70,000 69,863 4 9 124 Yewa North 130,663 80,000 79,816 8 99 167 TOTAL 965,663 624,000 623,113 37 158 692 How Mectizan was procured - Left over from year 2007 - Loan from Carter Foundation Jos - Loan from CDTI Oyo State Total 24,000 350,000 250.000 624.000 '/ How are the remaining ivermectin tablets collected and where are they kept? LG Coordinator retrieve left over tablets and distribute to other communities, but state distribute to static centers for clinic base. WHO/APOC, 26 September 2003 / List and briefly describe the activities under ivermectin delivery that are being carried out by health care personnel in the project area. - Requisition, Collection and supply to endemic communities. - Keeping of Mectizan Inventory. - Updating Registers and supply of Mectizan. - Notification to the community of availability of drug. - Monitoring and supervision of Mectizan distribution. '/ Any other comments Nil 2.8. Gommunity self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? If so, When? (Between 29s October- 9'h November 2007) Table I l: Community self-monitoring and Stakeholders Meeting (Add rows if needed) District/ LGA Total # of communitieVvillages in the entire project area No of Communities that carried out self monitoring (CSID No of Communities that conducted stakeholders meeting (SHM) Abeokuta North 119 67 6l Abeokuta South 110 48 42 Ewekoro 88 54 50 Ifo ll0 6l 55 Imeko Afon 92 33 27 Obafemi Owode 176 89 78 Odeda t04 52 44 Yewa South 153 31 25 TOTAL 952 435 382 Describe how the results of the community self- monitoring and stakeholders meetings have affected project implementation or how they would be utilized during the next treatment cycle. 22 WHO/APOC, 24 November 2008 2.9. Supervision 2.9.1. Provide a flow chart of supervision hierarchy. 2.9.2. What were the main issues identified during supervision? ,/ Readiness to take the drug by community members although some feel it is not a priority for them. The latter was the position in Obafemi Owode LGA. r' Good level of awareness of the Mectizan distribution prograrnme r' Frequent change of LGA Coordinators/ Posting of new staff at health facility level to endemic areas. '/ Reluctance of CDDs to continue distribution due to inadequate or absence of incentives r' Lack of enthusiasm of health workers for activity implementation due to lack of counterpart funding from the government. 2.9.3. Was a supervision checklist used ? YES 2.9.4. What were the outcomes at each level of CDTI implementation supervision? Community mobilization to continue compliance with Mectizan treatment and to fulfill their roles under CDTI Training / Orientation of new health workers/LGA Coordinators newly posted a a 23 WHO/APOC, 24 November 2008 F ,Lr "ft , ,,] :l i .j' '. t' Ir I r_' _\\.. ' '(. .l ilr!. '. i, ,, i',.1ltr tn ul,'i . 'tq nr il' .:j .il f ('l ,'- r t1.,;i:,i, \. ', t,,. ,t'' "i,:.,' '..t,:'; L ' ', l .' !:rl ,t ,i'il 'r gI'llilIdl{s r-[(iii[-' liir!!) 'J- ,. i. r. -., . ^i,*4ujri',,,-,"' ,r .., I -' ,l r'[ ir i"i I 'r'i,i , lj . a2.9.6. Nil SECTION 3: Support to GDTI 3.{. Equipment Table 12: Status of equipment (Please add more rows if necessary) Status of equipment (Please add more rows if necessary) Encouragement of CDDs to continue distributing Mectizan in the absence of incentives 2.9.5. Was feedback given to the person or groups supervised? YES. How was the feedback used to improve the overall performance of the project? Source Type of Equipment APOC MOH DISTRICT/L GA IFESTV UNIVA Othe rs Condition of the equipment * Please state 1. Vehicle Stolen 1 old 2 Nil Functional 2 2. Motor cycle Functional 8 Nil Functional 8 Functional 3 3. Computers Functional I Functional 1 Nit 4. Printers Written I Functional 1 Nil 5. Fax Machines Functional I Nil Nil 6. Air Conditional Functional 2 Functional 3 Nil a) Lap Top Functional I Nil Nil b) Generator Functional I Functional I Nil c) Bicycles Functional Nil Functional Nil d) Public Address System Functional 4 Nil Nil e) Television 20" Functional I Nil Nil f) Money Safe Functional 1 Functional 2 Nil g) Refrigerator Functional 1 Nil Nil h) UPS Functional 2 Nil Nil i) Stabilizer Nil 2 Functional Nil j) Photocopier Functional I Nil Ni1 k) Slide Projector Functional I Nit Nil l) Storage Boxes Functional 4 Functional I Nil m) VCR Functional 1 Nil Nil n) Over Head Proiector Functional I Nil Nil o) Writing Board Functional I Nil Nil p) Information Board Nil Functional 2 Functional I 24 WHO/APOC, 24 November 2008 *Condition of the equipment (F=Functional, CNFR:currently non-functional but repairable, Wo-Writren off). How does the project intend to maintain and replace existing equipment and other materials? The project intends to maintain and replace existing equipment with the State Counterpart Contribution and support by IFESH/UNVA. 3.2. Financial contributions of the partners and communities Table 13: Financial contributions by all partners for the last three years '/ If there are problems with release of counterpart funds, how were they addressed? GCCC is often approved and release. Additional comments - APOC should not hesitate to release fund promptly. 3.3. Other forms of community support ,/ Describe (indicate forms of in-kind contributions of communities if any) - Release of members of the community as CDD. - Purchase of more register notes for registration of the population. - Venue allocated for training i.e. Palace, Town Hall. Contributor Ycer 3 Year 4 Ycar 5 TOTAL Cash Budgeted (us$) TOTAL Cash Released rus$) TOTAL Cash Budgeted rus$) TOTAL Cash Released rus$) TOTAL Cash Budgeted (US$) TOTAL Cash Released rus$) MOH (Central + ProvinciaVState) 52,860 52250 60,340 15,680 9,379 9,379 LGA 25,000 5,600 20,560 10,200 2,200 2,200 Local NGDO(s) ( Church Society) Nil Nil 0 0 IFESHA'NIVA 35,000 15,650 25,415 t3,250 16,020 16,020 Others Nil Nil Nit Nil Nil Nil a) Nil Nil Nil Nil Nil Nit b) c) Nil Nil Nil Nil Nil Nil Nit Nil Nil Nil Nit Nil Communities Not visible Not quantified Not quantified 50,000 l 1,200 APOC Trust Fund 57,415 25,000 82,030 52,445 25,465 TOTAL 170,275 98,500 188,345 39,r30 130,044 64,2U 25 WHO/APOC, 24 November 2008 3.4. Expenditure per activity r' 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 curency. Indicate exchange rate used here $ l:N126 Table 14: Indicate how much the project spent for each activity listed below during the reporting period r' comments SEGTION 4: Sustainability of CDTI 4.1. lnternal; 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 Internal Monitoring by NOTF Other Evaluation by other partners 26 WHO/APOC, 24 November 2008 Aqlivrtv Expenditure ($ us) Source(s) of funding Drug delivery from NOTF HQ area to central collection point of commllqry 280 MSII/UNIVA Mobilization and health education of communities 7832 IFESIYUNIVA ,MOH Training of CDDs 4859 APOC Iraining of health staff at all levels 4235 APOC Supervising CDDs and distribution 3938 LGA Internal monitoring of CDTI activities 1842 MOH,IFESH Advocacy visits to health and political authorities 4812 MOH,LGA IEC materials 0 APOC [ummary (reporting) forms for treatment 1463 LGA Vehicles/ Motorcycles/ bicycles maintenance 10,418 MOH.LGA,IFE SIIAIMVA. Maintenance of Office Equipment (e.g. computers, printers, Photocopier etc) 13,305 MOH,APOC, IFES[Y[.]NIVA TOTAL 52,lll Total number of persons treated 2s8359 4.1.2. 4.1.3. None wos carried out during the reporting period What were the recommendations? How have they been implemented? D 4.2. Sustainability of projects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period? N,o Was a sustainability plan written? Yes When was the sustainability plan submitted? July 2006 What arrangements have been made to sustain CDTI after APOC funding ceases in terms of? 4.2.1. Planning at all relevant levels. After the evaluation stakeholders were invited to a planning and debriefing meeting where tentative 3-year work plans were developed for both State & LGA levels. The annual work plans are refined for each year. The most important thing is that a culture of planning is being cultivated in health workers. 4.2.2, Funds release The State govemment has a history of releasing counterpart contributions. This is expected to continue. Some LGAs have been releasing funds but others have not. The Local Government Department has been mobilized to assist in mobilizing all LGA Chairmen to release counterpart funds. 1.2.3 Transport (replacementandmaintenance) Using the counterpart funds released by government transport will be maintained. There are instances where old vehicles in the department are released for CDTI activities. A replacement the project vehicle has been effected by APOC. 4.2.4. Other resources The project hopes to mobilize funds from government at all levels for the procwement of needed resources. The project intends to approach some local NGOs to assist in getting some of the materials needed, particularly at the LGA and community levels. 4.2.5. To what extent has the plan been implemented Over 80% of planned activities for the year have been implemented. 4.3. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3.1. Ivermectin delivery mechanisms There is a sharing of transport and storage facilities for Ivermectin. This is more pronounced at the LGA and health facility levels. 27 WHO/APOC, 24 November 2008 t 4.3.2. Training Programme staff benefit from joint training such as RBM, NPI, HIV/AIDS, TB/LEPROSY and Health Education Programmes. 4.3.3. Joint supervision and monitoring with other programs Usage of Programme logistics for other health activities and usage of NPI motorcycles for CDTI supervision are the vogue within the project area. This is more pronounced at the LGA and FLHF levels. 4.3.4. Release of funds for project activities Funds release follows the normal channels within the Ministry 4.3.5. Is CDTI included in the PHC budget? CDTI activities are reflected in the health plans for the State and LGAs 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? Some Community Based Organizations are using the CDTI structures to assist in the Roll Bac Malaria[RBM], TB/L and NPI. Following the conclusion of LF mapping in the country, the project will be joining a few others to commence Mass Drug Administration (MDA) from 2009 using the CDTI structure. 4.3.7. Describe others issues considered in the integration of CDTI. 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. No operational research was carried out during the reporting period. 4.4.2. How were the results applied in the project? N/A SEGTION 5: Strengths / Availability of large numbers of health workers available and involved in CDTI r' Increasing number of female CDDs being selected by the communities. ./ Involvement of churches and mosques in Mectizan distribution./ High community awareness of the benefits of Mectizan treatment r' Willingness of community members to comply with annual treatment Weaknesses ,/ Inadequate releases by LGAs and State of their counterpart funding. '/ Increasing complaints by CDDs over lack of incentives a 28 WHO/APOC, 24 November 2008 o h Ghallenges/ The major challenge the project faced was late supply of Mectizan and inadequate numbers of quantities secured. r' Instability of political appointees lcaretakerltansition committees at the Local Govemment level ./ Unsatisfactory quality in record keeping/ Inadequate number of CDDs in some communities'/ Frequent change of LGA Coordinators SEGTION 6: Unique features of the proiecUother matters Churches being household congregation accept Mectizan distribution by health committee.I a 29 WHO/APOC, 24 November 2008