Nasarawa CDTI (7) year annual project technical report submitted to Technical Consultative Committee (TCC): from 1st January 2006 to 31st December 2006

COUNTRYNOTE:NIGERI1 Approval yearzl997 Launching vearz 1998 Reportinq Period From: l't January 2006 - December 2006 (Month/Year) (Month/Year) Proiect year ofthis report: (circleone)l 2 3 4 56(7) 8 9 10 Date submitted: s /1/2007 NGDO partner: GlobqL2000/ THE CARTER CENTER NATIONAL ONCHOCERCIA,SI,S TASK FORCE NIGERIA. (7) YEAR TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) AFRICAN PROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) uz c$b coP AH6 SFo fur tJ p. ,',-\1R. rcAP**: I WHO/APOC, 24 NOVEMBER 2OO4 'cEv Bin Tce+ A*lnt6e \ u Proiect Name: Nl SARAWA 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 National coordinaror Name: {Jftf*..',.*+ LA..LG-tL-tt - /e-r+*::ra' Signature: .ffi-Ov..r..!i- Date: ..I-' r...3.i.:;.,.=.-"t 7' z o nal o n ch o C o o rd i n at o r N ame : . Pn: * a * ( * . . C G-t) t. - { ?u- r1r1c e---- Signature: W; s.1. .t.qj - Date: ..,T.*.tr..,1.i ij..e"-"+ NGDO Representative Name:.Dr,. .0911., €':)y Signature: .,4K(*.. .: : Date: . .(r'*,.. 32, . . )o*t.l. This report has been prepared by Name: A.A. UMAR Designation.' Signature:. . . Date:... TOR LL ( lt. Table of Contents DEFINITIONS:...... FOLLOW UP ON TCC RECOMMENDATIONS..... 1 EXECUTIVE SUMMARY...... 2 SECTION I : BACKGROUND INFORMATION.... 3 VI t.t l.t I 1. t.2 1.2 GENERAL INFOR]zIATION Descri ption of t he proj ect (briefly)... . Parlnership... POPULATION... ... ... INTERNAL; INDEPENDENT PARTICIPATORY MONITORING; EVALUATION Was Monitoring/evaluation carried out during the reporting period? (tick any of the Foll owing w hic h are appl icable) ... Whal were the recommendations? ... How have they been implemented? 25 ) -43. 5 8 SECTION 2: IMPLEMENTATION OF CDTI..... 2.1 TIMELINE OF ACTIVITIES............. 2.2 ADVOCACY 2,3 MOBILIZATION, SENSITIZATIoN AND HEALTH EDUCATIoN oF AT RISK CoMMUNITIES 2.4 COMMLTNITY INVOLVEMENT........... 2.5 CAPACITY BUILDING... 2.6 Training... TREATMENT............... 2.6.1 Treatment figures... ...2.6 Whal are the cases of absenteeism?......... 2.6 3 What are the reasonsfor refusal?... 2.6.4 Briefly describe all known and verified serious adverse events (SAEs) that... ... ..... 2.6.5 Trend oftrealment achievementfrom CDTI project inception to the current year.. 2.7 ORDERING, STORAGE AND DELIVERY OF IVERMECTIN 2.8 COMMUNITY SELF-MONITORING AND STAKEHOLDERS MEETING........ 2.9 SUPERVrSrON............... 2.9.1 Provide aflow chart of supervision hierarchy... 2.9.2 What u,ere the main issues identified during supervision?... 2.9.3 Ll/as a supervision checklist used?... 2 9 4 llhat vtere the outcomes at each level of CDTI implementation supervision?..... 2 9.5 Wasfeedback giyen to the person or groups supervised? 21 2 9.6 How was the feedback used to improve the overall performance oflhe project? SECTION 3: SUPPORT TO CDTI.... 3.r EQUIPMENT 3.2 FINACIAL CONTRIBUTIONS OF THE PARTNERS AND COMMUNITIES 3.3 OTHER FORMS OF COMMUNITY SUPPORT............... 3.4 EXPENDITURE PER ACTIVITY... SECTION 4: SUSTAINABILITY OF CDTI. 9 9 l0 l0 ll ll t2-13 14 t4 t4 t4 15 t6 18 t9 20 20 2t 2t 21 4.1 4.r.1 4.1.2 4.1.3 2l 22 22 23 23 24 25 25 25 25 rii WHO/APOC, 24 November 2004 4.2. t 4.2.2 4.2.3 4.2.4 4.2.5 4.3 4.3.l 4.3.2 4.3.3 4.3.4 4.3.5 4.3.6 25 25 25 26 27 1a 27 27 27 27 27 27 28 28 28 28 )R 4.2 4.4.2 4.3.7 4.4 4.4. t SUSTAINABILITY OF PROJECTS: PLAN AND SET TARGETS (MANDATORY AT Yr 3)... ... Planning at all relevant levels... Funds... Transport (replacement and maintenance)............ Other resources...... ... To what extent has plan been implentented... INTEGRATION....... Ivermectin delivery mechanism... Training... Joint supervision and monitoring with other progrants...... Release offunds for project activities.. ls CDTI included in the PHC budget?... Describe other health programmes that are using the CDTI structure and how this lVas achieved. llhat have been the achievements? Describe other issues considered in the integration of CDTI ... OPERATIONAL RESEARCH... ... Summarize in not more than one half of a page the operational research undertaken in The project area within the reporting period... How were the results applied in the project? 28 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AND OPPORTUNITIES.. 29 Section 6: Unique feature of the project/other matter 30 it V WHO/APOC,24 November 2004 lV ACRONYMS At Risk Villages African Programme for Onchocerciasis Control Community Directed Distributors Community Self monitoring Community supervisors Community Directed Treatment wtth lvermectin Dristrict Health Supervisors First line health facility Staff Global 2000 River Blindness Program Local Onchocerciasis Gontrol Team Members Lymphatic fitariasis Elimination Program Lymphatic filariasis LocalGovemment Area Local Govemment Council Mectizan Donation Program Mectizan Expert Committee/Albendazole Coord inatio n Minislry of Health Merck Sharp and Dohnme Non Govemmental Developrnent Organization National Programme on lmmunization National Onchocerciasis Control Programme National Onchocerciasis Task Force Project Administrator Primary Heafth Care Stake holders Meeting State Ministry of Health State Onchocerciasis Gontrol Team Members RollBack Malaria River Blindness Foundation Sentinel Mllage Evaluation State Project Officer State Project Coordinator United Nation lntemationat children educational funds World Heatth Organization.l ARVs APOC CDDs CSM COM. S CDTI DHS FLHF GRBP LOCTs LFEP LF LGA LGC MDP MEC/AC MOH MSD NGDO NPI NOCP NOTF PA PHC SHM SMOH SOCTs RBM RBF SVE SPO SPC UNICEF WHO ' wno/APoc, NovEIvIBER 2oo4 v Definitions (D Total population: the total population living in REMO/tryper-endemic communities within the project area (based on REMO and census taking). (ii) Eligible population: calculated as 84%o of the total population in mesofttyper- endemic communities in the project area. (iii) Annual Treatment Objective: (ATO): the estimated number of persons living in meso/hyper-endemic areas that a CDTI project intends to treat with Ivermectin a given year. (iv) timate Treatment 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 fuIl geographic coverage (normally the project should be expected to reach the UTG at the end of the 3d year of the project) (v) Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) Geoqraphical 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) Integration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, e.t.c) through CDTI (using the same systems, training, supervision and personnel) in order to maximize cost-effectiveness and empower communities to solve more of their health problems. This does not include activities or interventions carried out by communify distributors outside of CDTI. (viii) Sustainabilitv: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future, with high treatment coverage, integrated into the available healthcare service, with strong community ownership, using resources mobilized by the community and the government. (ix) Communitv self-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 I,YHO/APOC, 24 November 2004 vl FOLLOW UP ON TCC RECOMMENDATIONS The recommendations ofthe last TCC on the project and how they have been addressed TCC session 18 Number of Recommendatio n in the Report t 20: TCC RECOMMENDATION ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY FOLLOW UP ON TCC RECOMMENDATIONS Recommendations of the last TCC session on the project, and how they have been addressed TCC session 22 Project related: Number of Recommendat- ion in the Report 120: TCC RECOMMENDATION AND QUERIES RE S PO NSE S/A C TIO NS TAKE N BY THE PROJECT FOR TCC/APOC MGT USE ONLY 2 Project related J EXBCUTIVE SUMMARY Nasarawa State came into being on I't October 1996, when it was carved out of the old Plateau State by administration of General Sani Abacha. The State took off with 13 Local Government Areas. Nasarawa State has a population of about 3.1 million with about 30 ethnic groups and diverse cultures, with 80% of them in ruralareas and practicing subsistent farming. The implementation of CDTI in Nasarawa State started when APOC's letter of agreement was signed in April 1998. The project is in its 6'h year (2ndyear of post APOC period I't Jan. 2006 to Dec.2006. The project still maintains the old 7 LGAs initially approved by APOC for CDTI (Akwanga, Karu, Kokona,Lafra, Nasarawa Eggon, Toto and Wamba) with 589 meso endemic villages. Activities undertaken in the 7th year include the following: o Advocacy visits to State/LGA officials and community leaders o Mobilization and Health education of LGA and community levels o Mectizan distribution at community level o Monitoring and supervision, submission of treatment reports and drug balances. During the period under review, we targeted to train 2851 CDDs,48 LOCTs,30 DHS, 175 HFS and 45 TOTs. At the end of the year the people actually trained came up to 1808 old CDDs, 1043 kindred CDDs, 175 HFS, 48 LOCTs 30 DHS and 45 TOTs, This represented 100% achievement for CDDs HFS, LOCT, DHS and TOTs. A total of 723019 persons out of 988,161 were treated representing 73.1% therapeutic coverage in 589 villages were treated representing 100% geographicalcoverage. The ratio of CDDs to the population is 1:347 for oncho. Also the project received 2,840,000 tablets of Mectizan from the Carter Center, Jos and used2642482 atotal of 197518 tablets were returned. In 2001 to 2003 there were influx of people into the State due to communal clashes in Sanga LGA in Kaduna State and Shendam in Plateau State accounting for high total population and persons treated. By 2004/2005, peace had returned and most people had returned to their various homes/States resulting in reduction in number of people treated and total populations. Local Government Areas budgeted the total sum of $60937.5 while the communities contributed $2807.375 to support the CDTI activities in the state during the reporting period. Mobilization was carried out in 589 villages within the reporting period. Most of the villages showed high commitment to the program by giving incentives to2582 CDDs. Challenges: Lack of release of counterpart funds and CDDs incentive by the State and Local Government. Poor incentive for CDDs. The project is requesting the NOCP for advocacy visits to the state govemment to help facilitate the release of the 3.8 million counterpart funds approved for the project by the State. The project conducted advocacy visits within the period. The Country Representative Carter Center Dr.E.S. Miri , Director Oncho, LF, and Schisto Nasarawa/Plateau State Dr., Abel Eigege carried out advocacy visit in company of the Project Administrator. John Umaru and the state Oncho Coordinator AIh.AA Umar to the Commissioner for Health and Commissioner for Local Government and Chieftaincy Affairs and some targeted Communities on the need for prompt payment of counterpart funds by both the State and the local government for effective control of onchocerciasis. In conclusion, the projects performance was adjudged as satisfactory but heavily dependent on The Carter Center, the supporting NGDO. 4 Section 1: Background Information LI General information 1.1.1 Description of the project (briefly) Geographical locations, topography, climate: Nasarawa State is located in central Nigeria in the middle belt zone of the country. Nasarawa state lies between Latitude 70 and 90 degrees North and longitudes 70 and 100 degrees East. The State shares common boundaries with five (5) of the 36 States of the Federation and the Federal Capital. To the south and west are Benue and Kogi States, and Abuja the Federal Capital is to the Northwest. To the North are Kaduna and Plateau States and to the Southeast is Taraba State. Climate: Situated in the tropicalzone, the climate of Nasarawa State is both hot and cold. The state lies wholly in the tropics with pleasant climate and a mean temperature of 600f and 800f (maximum). Annual rainfall varies from l3l.75cm in some place to l45cm in others. Three months in a year (December, January and February) are cold and known as the Harmatan season. Population: Nasarawa State has a total projected population of about 3.1 million (based on l99l census projections). Nasarawa State has l3 Local Government Area of which 7 are endemic (Akwanga, Kokona, Karu, Lafia, Nasarawa Eggon, Toto and Wamba), the other 6 LGAs are hypo endemic for onchocerciasis. People: The state is inhabited with over 24 ethnic groups with common historical and cultural affiliation with no single group large enough to either dominate or claim majority position. The people are both hospitable and accommodating and have almost similar cultural and traditional ways of life. People from other parts of Nigeria co-exist peacefully with the indigenes of the state. The major religions in the state are Christianity, Islam and Traditional religions. The 24 major tribes found in the state include: - Alago, Agatu, Ake, Arum, Afor, Eloyi, Bassa, Chessu, Egbura, Egorma, Eggon, Fulani, Gade, Gbagyi, Gwandara, Hausa/Fulani, Kamberi/Kanuri, Kantana, Kwarra, Mada, Mama, Migilli, Rindre, Eggon, Tiv, and Yeskwa. The name of the ethnic groups goes with their language,T0o/o of the people live in rural communities with agriculture as their main occupation. About 30%o are in urban areas practicing small and large businesses. Culture: The importance of culture cannot be over emphasized considering the rich culture of the state. These play an important role in the lives of the people of Nasarawa state in showcasing its rich culture annually through cultural festivals. Amongst them are the famous and annual Oganni culturaland fishing festivals at Umaisha of Panda Chiefdom in Toto LGA, salt festival in Keana, the Omadege in Nasarawa, Odu in Doma etc. Communication System (Roads): Nasarawa state has very good road network throughout the state and other neighbouring states of Benue, Plateau and the Federal Capital Tenitory. Local Government headquarters are also linked with good roads to facilitate transportation of human and material resources. The state has an estimated population of 3.1 million people withT0yo of them in ruralareas practicing agriculture. a a a o a a Rural settlement are either clustered or scattered, with a minimum population of 250 people per settlement. Thirty percent of the population lives in urban areas. 5 a Health System Structure: There are three tiers of health system in Nigeria the primary health care which is closest to the people and is constitutionally the responsibility of Local government, the secondary health care which is for those problem that cannot be resolved at the PHC level and are delivered in general or district hospitals under the supervision of the State governments, and the tertiary health services, which is the most sophisticated and costly for government and patients. The tertiary health service deals with the most difficult cases referred from secondary health care systems to teaching and specialist hospitals and are supervised by the Federal Ministry of health. The challenges at the primary health care level are to establish a health service system that will touch the lives of every citizen and tackle the conditions that cause the highest mortality and morbidity. The system must organize from the grassroots and woven into the fabric of the community through the process of community participation. It must integrate preventive, promotive and curative services, where Onchocerciasis falls in using the type of technology the community will accept, at the level it can afford, and with an efficient and effective system of supervision and referral. The most important principle of PHC, as defined at Alma-Ata in 1978, is community participation. It coincides with the CDTI planning, implementation and management. Nasarawa State Health System is well structured such that Oncho Control unit is under the directory of PHC/DC, which is headed by the SPO who is answerable to the Director PHC/DC of the Ministry of Health. All communication are passed through the Director PHC/DC up to the Honourable Commissioner. At the LGA level, each has five Primary Health Care district referred to as referral centers headed by District Health Supervisor. In each health district there are health posts or first line health facilities (FLHF) headed by health facilities staff (HFS) who oversee the activities of CDDs within their catchments areas. (.See table 2 on population of CDTI LGAs) A Primary Health Care Director who supervises all health activities in the LGA is the head of each LGA health deparfment. The State Ministry of Health developed policies and sends them to the LGA for implementation. Each LGA has 33 staff that are involved in CDTI activities. At the state level, there are 7 personnel who carry out Onchocerciasis Control activities. They include: the SPO, 4 SOCTs, I Data Clerk, and I Driver. The programme is integrated into the PHC system at both the state and local government levels. T 1: Number of health staff involved in CDTI The project trained all the 1869 health facility staff of the 7 LGAs out of this number 253 were assigned specific CDTI activities within the project area. More health staff are expected to be involved when CDTI is futly integrated into PHC. 6 a a District/LGA Total Number of health staffin entire project ore8 Br Number of health staff involve in CDTI 82 Percentage of health staff involved in CDTI B3:B2/B1*100 AKWANGA 301 33 tT.0% KARU 329 43 13.0% KOKONA 2t8 JJ t5.r% LAFIA 342 45 t3.t% NAS/EGGON 256 JJ t2.9% TOTO 2t6 JJ t5.3% WAMBA 207 JJ 15.9% Total 1,869 253 13.50 1.2.2 Partnership (role of each partner) state, LGA"/Communities The state Ministry of Health is the implementing agency and her major roles included planning, staffing, manpower development, advocacy, counterpart funding, mobilization/Flealth education and supervision/distribution. The Carter Center our supporting NGDO provide funds and logistics for CDTI implementation, provides technical assistance to the project, advocacy to high government functionaries, procurement of Ivermectin tablets from MSD and development of Health education materials, while MSD provides mectizan tablets, through WHO, Nigeria. The roles of Local Governments include Planning, Staffing, Training, Distribution, Supervision, Mobilization and Health Education. The roles of the communities include collection of mectizan, selection of CDDs, provision of registration books and incentive to CDDs. CBOs - These are philanthropic and religious organizations based in urban communities. They provide support for CDTI implementation such as providing transportation to CDDs during training, mobilization and supervision. 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Commissioner for Local Government and Chieftaincy Affairs on the responsibility for effective control of Onchocerciasis by contributing their quota of counterpart funds in both state and Local Government Areas. The main issues discussed were on sustaining the programme through counterpart contribution. Promises were made by State and Local Government for the contribution of their counterpart fund The project wishes to appreciate the effort of the NOCP and Global 2000. The Carter Centre on their Advocacy visit to the state and local Government executive to facilitate the release of funds for project activities though their meeting was not possible due to tight schedules. The project is still solicit the report of the high advocacy visits by the NOCP and Global 2000 to Nasarawa State project on the counterpart funds 2.3 Mobilization, Sensitization and health education of at risk communities. The objective of the project was to reach and mobilize 589 communities on CDTI activities through: - The use of Town announcers or town criers, posters, videos, radio jungles etc Health education of Women and Minority groups is done through Women Leaders, Religions leaders, Market Women Union, Youth Leaders etc. The response of target communities/villages: they accepted CDTI as their programme and promised to give incentive to CDDs in kind or in cash, as the programme belong to them. The outcome of the mobilization/health education was impressive at the community levels, all 589 communities were mobilized on their roles and responsibilities in CDTI. This is indicated by a therapeutic coverage of not less than 73.1% and 100% geographical coverage at December 2006. t0 2.4 Community involvement Table 4: Communities rtici in the CDTI *ln all the endemic communities female CDDs were selected based on socio-cultural and religious beliefs, this is the basis of their acceptance to their communities. Comments on females' performance on CDTI activities:- o Attendance of female members of the Community at health educotion meetings: The attendance of the female members at community health education meetings was encouraging as women were coming out for the meetings, about 15 - 20 per village women attend the meetings regularly. o In general, how do you rate the participation of female members at the community meetings when CDTI are being discussed (attendance, participation in the discussion In general the females were participating actively in the community meeting when CDTI is being discussed. Women asked relevant questions, gave answers and actively participated in discussions. o Incentives provided by communities for the CDDs. Yes, the communities in the project area provided incentives for the CDDs. 84%o of the CDDs were given some forms of incentives of cash, assisted with farming or household chores or farm produce. Although the communities could be more generous. o Is attrition o problemfor the project? There were only 59 CDDs who dropped but the affected communities replaced them with new CDDs immediately. 2.5 Capacity Building in the State Project. The number of SOCTs trained - 4 The number of LOCTs trained - 48 The number of DHS trained - 30 The number of HFS trained - 175 The number of CDDs trained - 2851 All the health staff in the 7 CDTI LGAs have been trained on CDTI activities, from this pool replacement are made. Communities readily provide replacement for CDDs or increase the number as in the kindred approach. The project has adequate staff and currently the LGA s have a policy where no inter-LGA transfers are made. However when internal transfers are done replacement is made immediately from our reserved pool. Number of CDDs and the communities involved Number of com munities/villages with female CDDs District/LGA Number of communities/villages with community members as supervisors Percentage B; By'B1* 100 B? Male CDDs Bg Female CDDs Be=B7*B6 Total Bro Number of communities with female CDDs Percentage Brr= Bro/81*100 Total no. Communitie s in the entire project area B4 Number with community members as supervisors Bs 100% 32r 65 386 t9 t8.6%AKWANGA 102 102 326 134 460 34 34.3%KARU 99 99 100% 265 t7 36.2%KOKONA 47 47 100% 196 69 36 s0.0%LAFIA 72 72 l00o/o 447 144 591 565 34 40%NAS/EGGON 85 85 t00% 442 123 99 100% 216 66 282 28 28.2%TOTO 99 WAMBA 85 85 r00% 289 t3 302 9 10j% Total 589 100% 2237 60s 28s1 177 30.30589 11 N!o CN ! !(J C) E Z (df :+r) FQ(H co \o\t \oa.l o\ \o e.l @ c.l N m ra co cl .\ lJG'0)ri&Y st 00 c-.1 aN co o\ co c.) r- o\ e.l s00 o\€ € 6 ,eOF C.l @ @ (\ c.l co N 00 o\ ca c) = c.t ooLL \o 00 \o$ \oc.l o\ c{a c.! c.t ia co6l -69> .=a € /\ qG Fbo o.E - it)LO oc ET alP LO9-c!otr -:z5s (d^i O+eFH+ F- Fr F- l'- F- co F- larf b-o- \o \o r- l'- N co?a O- cl o a.l F- L -Lt "3<o F- F- r- F- F- F- rA = o. o () o -a!E Uli !o b'F tr !*- =q)6 r- d+ FIL N c.l o.t N c.l c.l a.l l.a r- oF- o\ N tc.l \o NN =t NN t 6) \c) \o N o\ ra?o ! ,i-( o3{O c{ (\ c.l N c.t c.l N rar- 0) F 9- d riOYlv) JV:.^o= i5A X€H e >\ o- tr^ f€ r' Err ONFI! @ 6tr s tc^)ra oo @ \o !+ $ l.a ON e.l $ N s \o \o r-N e ^Qji-F <g< oo 6F- -.] .9 o cd o0 Cd -v, dV (g o ,Y v d (! 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C)L o 0)a o rr.la z a cl x .E5 li (.)o_c Arj oo .tr fc) a.oqr9rrU :E a0E L() EoO 1f .FoijLr! -O-6eO Eoo u)= u) tr.) sdtrvq)(h ob ?oo() ro6 OU =(gOv) aro.Yoz Hrlc 6 rrcllO 0()Gd; Eo:E€.CE'E FEc)BO>o't cs .:1tr: 3€; gSeo) O) L'-qr'= 9tE,.oFE 9q)o* 'is q ^Ae= €v o.c ii r:E taEE 3E i BE P !-l =4 =u,Zo io;E aa >A \o F- c.l r- N N $N c\ o\ o\rI ca (\l t'- o l,a : 9-+E .E E.ei EEb}3E2" EE o\ t'-e.l + r- cotr .9 =sq 6^i d oo\X' eo }: 6\ <t\o { 00 o\ 006 ^\q o\00 -\q N o\ \o .i \o s c! c)t- H EEE = O- z + o\ N €q co+ F- \f F-\o oo oo\t c.t 00 F- o\ fr) alF- " 0.izFEiEt * o\ € $ o\ c.l F-+ c.) +\o oo \o €NN \o oo \t o\c\ oo $ \o F- F- rr € o 6 q er a -E 2..3- .gEE€EE -E EE' \o a. ro- st N(\ a o\ c\l\o r- o\F- c.i\oN F- € $+ F- € @ F- \o 6 € o\ t e lt '= BD EEoBA'3- \o 5\ 6\ O o\ .oo\ o\ o U.E g"T €566 =E>eZ N o\ o\ Fr.+ c{F- @ o\o\ @ o\cora EsB N o\ o\ F-$ a.lF- € o\o\ a o\ € ra alo OD CE 0 0) oU =.= I 9.9i E Sg IE z i:tr>tr;a: F U.g E i c.l o\ o\ F.-v o.lF- oo o\o\ 00 o\6lr') .9< .p F] bo 63 Bv L(c V oJZ o M J o oo bI) a z o oF -o (d U) F a Table 8: period Cases of Serious Adverse Events (SAEs) that occurred during the reporting 2.6 .5 Trend of treatment achievement from CDTI project inception to the current year Since treatment started in 1998 - December 2006 there has been a progressive increase in the number of persons treated each year. a) In 2001 to 2003 there were influx of people into the state due to communal clashes in Sanga LGA in Kaduna State and Shendam LGA in Plateau State accounting for high total population and persons treated. b) By 200412006, peace had retumed and most people had returned to their various homes/states resulting in reduction in number of people treated and total populations. STN Agc Scx Villagc of ongrn Drac mcctizrn wes trkcn Detc l'r symptoms eppercd Symptom! Holth !tatus bcforc tsking mcctizen Drtc of edmissi on in helah fecilitiq Dctc of dismiss el from herlth frcilitv Rcsulas of tcsts (.hick blood smclr Outcom cof prognos is Extcnurtin gor complicrti ng circum- satncg Alcohol involvemc nt or not No serious adverse events were experienced/reported t6 t-r -i \) s a- S' rB ,\Jx\o I :.f \) S' \ I ts \) q \) '{i \,)q ! \)s l)t\ ilSl\\ a E o : G)a(itr 0) \o o\ c.;t'- o C)L (t) U)L() ol o ".i aNXNV ..N c)LL(! clg) E; 6)a sX o.= rr Q. .o 0) Glotr >r5 L ,r< qdq) '= EE. >:!- t-.1 roU C)!o9A(E IE\o o)eEtr() cE>l-() o(s o0)botr rr itc)c)Its 9: cEu o.9 C)otrbo Gt:.i9; FO ah U) o \o r- F-r- € q) c! Ie c) t- o\ q) r!F *r It tqo ri s 9uL]G <Lot s\ o\$ -o o\r- +\o s - o\ s\ o\ .o o\ ar; o\ \o o\ ca t'r o\ s od oo s V,l $t'- * E] frl o il EI .9 -? =vooaaD c! c! ooE>LO -o ^\ oq ol$ o\\o f-(a) -oo\ r") oo s o.l co oo 9\or- o\r- oo scl € r-. o\ caf- o G E]i= EE7 ae oo c..l c.l o.l@ N oo @ l-- t-- r- o\ oo^ c.) .f, o\ @t- ra)\i$t-. N F- N f- o\ cot'-t-. o\ co C{ l'r rri ce> =EEtr 9!.4<.Ef ooc\$ ca o\ la) cosf $ oo co t*- $ oo oo F- tr) oo ta) @ c- t'r\o o.l cAf- \o r- f- c- oo oo o\l-. I F] :oa sE€ft g $\o F-\i o\$ o cO o\ oo$ co tf, o\ co t-- c-$ .f, ce co \o -f c- o\ € f-- o.lr- oo \o @ oo o\ \o oo oo o\ o u0 CE o oQ Ii>e rI]=ll x ri q) o t- F 4)o\ \oo\ c\oo q $ o\ o\ (-l N oo r-i>EH=ili tll =". t €!- €EaL Gt L-cO0o {)o\O'- >voo 9c) -o6\\o o\ -o ^\cJ C-t@ -o o\ o\ + o\ \o o\ ol o\ \o o\dl c! oo \oo\ sa -oo\ ri o'E o h'E toE : = cE!? E= I =Et!z - \o\olr) s oo$ o\la) ra) F. co(n (n oo .+ o\ oo r.) o\ oo rn o\ @(n ri -EoGIO> = EEE9!t.E CE .:I <.8 1' o\ oo ra) o\ oo r.) o\ oo|r) o\ oolr) o\ ooln o\ oo rat o\ oola) o\ oolr) ri --9-,8E€: E grr'E.= ;: cE = Ei <'= .E E Pfi E va6) o\a|r) o\ oo ta) o\ oo(n o\ oola) o\ oolr) o\ oo ra) o\ oo ra) o\@(n c!{) o\ o\ o\ o cn N crl c..l cO c.l .f, o c.i rr) N \oO c.l 2.7 Ordering, Storage and delivery of Ivermectin MOH MectizanI ordered/applied for by -wHo tr TINICEF tr NGDO Other (Please specifr): MOH Mectizan delivered by - (Please tick the appropriate answer) MOH wHo T]NICEF tr NGDO Other (Please speciff) Before the procurement of mectizan is done by NGDO, each CDD calculates his or her mectizan requirements based on the eligible population registered and multiply by average of three tablets. Together with FLHFS, they arrived at their requirement for each village, which is sent to focal persons at the LGA (LOCT), until it reaches the SOCTs. The SOCTs/SPO compiles all requirements for the seven LGAs and sends to the NGDO for procurement. When mectizan arrives in the country, WHO clears from the Customs and stores it in their warehouse. The NGDOs then collects the drugs to her store. The state project officer puts up requisition for each LGA. When mectizan is supplied to the SPO by NGDO, SOCTs collect for their respective LGAs and deliver to the LOCT team leaders at the LGA levels. The team leader then hand over the drugs to the five DHS for allocation to the five FLHF or collection centers where CDDs come to collect for their respective communities. Mectizan Status *Drugs in the field (502,276 tablets of Mectizan was returned to the state store at the end of the year) Number of Mectizan tabletsState/District LGA Requested Received Used Lost Wasted Expired balance Oncho LF State Office 2,940,000 2,940,000 272,387 AKWANGA 360,930 360,930 l32,l13 ll4,77l 114,046 KARU 541,792 541,792 397,905 I I 1,953 31,934 KOKONA 198,175 198,125 155,122 16,744 26,259 LAFIA 719,000 719,000 416,828 302,172 0 N/EGGON 440,645 440,645 360,416 80,229 TOTO 265,387 369,387 137,766 231,621 WAMBA 210,071 210,141 191,954 I 8,1 87 Total 2,736,000 2,g4o,o2o 1,792,104 7,369,124 502,276 I8 aHow ure the remaining lvermectin tablets collected and where are they kept Each CDD returns any drug balance to his /her Health facility staff supervising him/her, who in turn returns all balances to the LOCT/DHS in charge of the area. who also retums all balances to the LOCT Leader for the LGA. The LOCT Leader then hands over all drugs returned/retrieved to the SOCT member in charge of the LGA who returns same to the SPO for safe keep to next treatment round. CDDs from the field hand over drugs to the health facility in the clinic, health facility staff hand over the drugs to LOCT and the LOCT hand over the drugs to the SOCT. The SOCT collect the drugs and hand over to the SPO and the SPO keeps the drugs in the store. List and briefly describe the activities under lvermectin delivery thqt are being carried out by the health care personnel in the project area. Mobilization/Health Education: The health personnel mobilized and health educate the members of the communities on CDTI activities and the importance of CSM, sustainability and incentives to the CDDs. Training: The health personnel trained CDDs on how to keep good records, distribution of Ivermectin, recognition of reactions, census update and data collection. Treatment: The health personnel collect Mectizan and distribute to the CDDs to distribute to the effected communities. Supervision: Health workers supervise the activities of the CDDs in the field during and after distribution of Mectizan and supervise drug issues to the communities CDDs on proper record keeping. Any other comments? The supervision has to be in the CDTI hierarchy: SOCT -supervised LOCT at the LGA levels LOCT -supervised HFS at the health facility levels HFS -supervised the CDDs at the community levels. 2.8 Community self-monitoring and stakeholders meeting. Yes, training (of trainers) for CSM and SHM were carried out in the project area in May 2005. 19 District/LGA Total # of communities/villages in the entire project area No of communities that carried out self monitoring (CSM) No of communities that conducted stakeholders meeting (SHM) AKWANGA t02 15 1 KARU 99 9 J LAFIA 72 t4 2 KOKONA 47 3 I N/EGGON 85 6 4 TOTO 99 7 3 WAMBA 85 6 2 TOTAL 589 60 t6 Table 11: Community self-monitoring and stakeholders meeting Training (of trainers) on CSM and SHM was carried out in the current year therefore 76 village were able to conduct both CSM and SHM. 2,9 Supervision NB u NOCP/FMOHNGDO cater ZONE'D'PLAIA PROGRAM STATE MOH LGA PHC FLHF 2.9.1 Flow chart of supervision hierarchy 2o (Zonal Coordinator) (Dir PHC/SOCTS) (Dir PHC/LOCTs) ffiFS) (Comm/Kindred Leaders & CDDs) 2.9.2 What were the main issues identified during supervision 1. Most CDDs are now complying by using durable registers. 2. Some communities give incentive to their CDDs while others do not 3. Inadequate logistic for supervision at LGA levels 4. Most Community leaders are now carrying out CSM during distribution. 2.9.3 LI/as a supervision checklist used? Supervision checklist is used during supervision by at each level of health staff involved in CDTI activities. 2.9.4 2.9.5 2.9.6 What were the outcomes at each level of CDTI Implementation/supervision? -More incentives to the CDDs, more CDDs were selected by the communities and improve report collection by the health facility staffs were as a result of LOCT supervision at the health facility level. - During the SOCTs supervision there is improvement in realizing the counterpart fund from the LGAs. lYasfeedback givento persons or groups supervised? Yes feedback was given to the persons or group of persons supervised. How was thefeedback used to improve the overall performance of the Project: The feedback was used to plan and carry out targeted advocacies/awareness campaigns, training and mobilizations at various levels for persons or groups during monitoring or prior to next treatment round. This impacted positively on the overall performance of the project, in addressing: inadequate number of CDDs, absenteeism etc. 2t c.l oi L 0')U I/ ogH a= L \-,/ v> c/))9 -o5*o-ot/)>t- cdliEO aQ. =a ^LV- aL!vE +;tr oQ c Eib E"i,A Edhor6 9^q aE J -A\ (o-ll 9(g;i9()i:)Aa <.: o.r !2 92 ui=E.Si e AA - E 3 cB <ii !l tj o.ru:E>.9! o-o-:Ca., QEE H 9 E2 ETE 5 s€ J\--H.o > >v-- O.= t) t) -<cotrtr €!HL -eoor.J!PL-r-!r U-<- .LE(Bd €9 FU^^L^99 '=- d (d .:Jcooc o!! 'EoFFci FqvveEUFF.T ULHo o Q-o.-.: -L-rL LJJd -999-3'=::,estsssE 9 S t'H'AE.: O O';a !i o.r o.r a -rb: t acaC)--EtrOtrtr8dE99d9!VLL- .FFLL -;io6)-r(€r:O()=!tsdduqaB o-o-;=3 E I s.N o o.r o.r q.r E -iF-(uFFFF Y *lt.rFt+o oi -o(! (o o z lt z o o C) () I L od (.) 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(h (n bo L o o(! 0)L c) .o a cl 3 z U) N co <f rn \o t'r oo o\ o c..l aa SECTION 4: Sustainability of CDTI 4.1. Internal; independent participatory monitoring; Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? No -No- Year I Participatory Independent monitoring No Mid Term Sustainability Evaluation No 5 year Sustainability Evaluation No Internal monitoring by NOTF 4.1.2. What were the recommendations? Nil 4.1.3. How have they been implemented? 4.2. Sustainability of projects: Plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period? _no Was a sustainability plan written? When was the sustainability plan submitted? _ Oct.2006 4.2.1. 4.2.2. 4.2.3. Planning at all relevant levels A: Planning at the state level was as follows: - l. To train 50 LGA health workers on CDTI strategy, SHM and CSM 2. To conduct update of registration in 589 communities 3. To attend APOClZoft review meeting 4. To maintain project vehicle, computer and photocopier 5. To procure drugs and supplier 6, Maintenance of telephone landline Funds To source money for the sustainability of the programme from state, LGAs and the communities through counterpart contributions Transport (replacement and maintenance) Request for APOC to replace the old vehicle with a new one. tf 4.2.4 4.2.5 4.3 4.3.1 4.3.2 4. Other resources of programme The programme plans to source for funds that will take care of other resources such as computer, IEC materials etc. from Local NGOs such as National Union of road transport workers, Association of Market women, and NGDOs such as The carter Center etc. To what extent has the plan been implemented? 1. All 589 communities were mobilized and Health Educated 2. 4 SOCTs were trained. 48 LOCTs were trained 30 DHS were trained 175 HFS were trained 2851 CDDa were trained 3. 723019 persons were treated 2851 CDDs were supervised by HFS, 175 HFs were supervised by SOCTs and 48 LOCts were supervised by SOCTs. CDDs conducted an update of registration in 589 communities APOClZoft quarterly review meeting was attended by SPO. Maintenance of project vehicle, computer and photocopier were carried out in the state office, through counterpart contribution from state. Procurement of mectizan and supplies was done by the Carter Center State has been maintaining the telephone landline through state counterpart funds. Integration Outline the extent of Integration of CDTI into PHC structure and the plans for complete integration: Ivermectin delivery mechanisms The plan has been on ground with the following programs for delivery of Mectizan with lymphatic filariasis, schistosomiasis, and roll back malaria programs. The four programs use the same LOCTs, DHS, HFS, and CDDs for their distribution and, mobilization, treatment, training and supervision when they are going out for other programs activities they integrate the delivery of Ivermectin. Training: The training on CDTI, RBM, LFEP & SHC are planed and executed at the same time by an integrated team. 5. 6. 7. 8 9 ) 4.3.3 4.3.4 4.3.5 4.3.6 4.3.7 4.4 4.4.1 Joint supervision and monitoring with other programs- LF, Malaria, and Schisto- pool their logistics and staff to monitor and supervise iield work. Release of funds for project activities - The four programs oncho, LF, schisto and malaria plan their work together so that they use their funds collectively to carry out their activities. Is CDTI included in the PHC budget? Yes CDTI is included in the PHC budget. Describe other Health programmes that are using the CDTI structure. Lymphatic filariasis, Schistosomiasis and Roll back Malaria. These programs are using CDTI structure they collectively plan activities together for their outing during training, treatment and supervision. The achievements: a. Cost of the programme is reduced as a result of using the same staff at state, LGA, and community levels. b. Manpower is reduced because of more staff being involved. The same staffs working in Oncho are the same in schisto, LF and RBM. c. With increased knowledge and skill of staff involved, time wasting is reduced. d. The programme has achieved the following a. Reached 589 communities and treated 753,227 for oncho b. Covered 97 communities and treated 249,615 - schisto c. RBM-ITNs Distribution covered 99 communities and treated 55,107 Nets. d. Lymphatic Filariasis covered 4 communities and treated 252,254 persons. Describe other issues considered in the integration of CDTI. Manpower: Generally manpower are scarce it is better to maximize using the few hands we have on ground, therefore, it is important to increase the knowledge and skills of the few available to enable them take up and share more responsibilities. Funds:Most of the programmes do not have enough funds to plan their programs efficiently. It will be wise if they integrate with other programs. Logistics: Most of the programs do not have enough vehicles for their daily activities, but when they integrate with other programs they can use their resources to meet their various individual needs. Operational research To summarize in not more than one half of a page the operational research undertaken within the reporting period? Yet to commence operational research. 27 4.4.2 How were the results applied in the project? The result will be used during distribution and treatment period if carried out, SECTION 5: Strength, Weakness, Challenges and opportunities Strength: * High geographical/therapeutic coverage. * Time of treatment has been reduced because of more hands on the job. * More awareness by community on self-ownership. * Training of Oncho Team on CDTI activities is now a targeted training. * Collection centers are now nearer to the community making it easier for the CDDs. Weakness: * Drugs passing through many hands before reaching the community cause delay in treatment * No adequate incentive to the CDDs by the communities. * No adequate counterpart funds by the State and Local Government. * Some CDDs left their job without handing over the registration books to their village heads Challenges: l. Poor counterpart fund from state and local governments 2. Poor incentive to CDDs by some communities Recommendations/Opportunities: * Overall budget for State and Local Government should include CDTI activities * Community should intensifu giving incentive to the CDDs. * All hands should be on deck by all tiers of government and communify for the sustainability of the CDTI activities. * Blindness due to Onchocerciasis is drastically reduced. * Skin diseases reduce to some extend * Some women were pregnant as result of taking the drugs. 28 SECTION 6: Unique feature of the project/other matters The project operations were integrated where the same staff at the state, local and community levels was involved in CDTI, LF elimination programme, Schistosomiasis control and Roll Back malaria activities. The project made the following achievements during the period under reporting period in addition to CDTI. ADD-ON ACTIVITIES TO CDTI IN NASARAWA STATE o The ATO was based on estimation of urban populations thus under estimated. o Entomological studies of Black flies and Mosquitoes were also ongoing to monitor impact on Lymphatic Filariasis and Onchocerciasis. S/N PROGRAMME VILLAGES POPULATION ATO COVERED ATO % ATO PERSONS TREATED ATO o//o Schistosomiasis l6s 32 19.4% 9,641 6,599 68.4% RBM-lTNs Distribution 100 100 100% 1000 Nets 1000 Nets retreated 100% Lymphatic Filariasis 4 4 100% 259,505 211,846 81.6% 29 ROLL BA MALARIA ITTs RETREATMENT Akwanga 27,000 Keana 14,691 Nasarawa 6,451 The State Ministry of Health RBM distributed 6,203ITNs in Nasarawa LGA in 2006 LGAs NO. OF ITNs NO. OF PREGNANT WOMEN NO. OF CHILDREN ANDER FIW yR,s N/EGGON 168,257 33,651 134,601 AWE 34,665 6,934 27,734 KOKONA 51,765 10,353 41,412 WAMBA 28,618 22,894 5 ) 723 NASARAWA 78,255 62,604 15,651 3"