Kebbi State CDTI annual project technical report submitted to Technical Consultative Committee (TCC): January to December 2006

II I I I I : KEBBI STATE COMMUNITY DIRECTED TREATMENT WITH IWRMECTIN PROTECT ORIGINAL: Enelish COUNTRYAIOTF.: NIGERIA Proiect Name: KEBBI STATE CDTI Approval vear: SEPTEMBER 1999 Launchins vear: DECEMBER 1999 Reportins Period: f,'rom: JANUARY 2006 To DECEMBER 2006 (Month/Year) (Montl/Year) Proiectyearofthisrenorf (circleone)l 2 3 4 5 6l 8 9 10 Date submitted: MARCH 2007 NGDO Partner: SIGHTSAVERS INTERNATIONAL t lr o FIFTH YEAR ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE coMMrrrBE (TCC) AFRICAN PROGRAMME FOR ONCHOCERCTASIS CONTROL (APOC) .t tL * ,a tft t I E'il TFKE trlru E o r"{ Po f =\L)\' A,[,.\ s Beq'g=qB \_ Ft o l! 2 0 JUlt, 200A7 6 Itl!Er otrn II ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) DEADLINE FOR SUBMISSION: To APOC Management by 31 Januarry for March TCC rneeting To APOC Management by 31 Julv for Sentember TCC meeting AFRTCAN PROGRAMME F'OR ONCHOCERCIASIS CONTROL (APOC) # * a > For Acticn TorIt tu &- dil * il 1 rt t & For lnformeilo, r"'-biR ffttw 1 2 0 JUlt, 2007 t{t it r & !: i"f. ANI\UAL PROJECT TECIINICAL 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 Coordinator N*,.' ffiil-A l.cJ. a . .C.aAu - Signature: ce- Date: i: 1*r.lg ZPs.T Zonal Oncho Coordinator Name Signanue Date: *.i*ur". + NGDO RePresentative Name: S a-lC*--"' Signature ^\;.- Date: ...7?. O+ This report has been prepared by Narne: Aliyu Salisu Bunza I ..) Coordinator Signature: Y}N.:L, 9i --e -'LoDDate II Table of contents 3. l. 3.2. 33. 3.4. EQTIPMENI FINANCIAL CONTRBUTIONS OF THE PARTNERS A]'{D COMMUNITIES Ornnn FoRMS oF coMMtrNTry SIIPPoRT . . E)GENDILIR-E PER ACTTVITY FOLLOW UP ON TCC RECOMMENDATIONS I EXECUTM SIIMMARY........... ...............3 SECTION l: BACKGROUND INFORMATION ..........................4 1.1. Gm,TFRALINFoRMATIoN .................4 L1.1 Desuiptionoftheproject(briefly) ............4 1.1.2. Partnership ...........7 1.2. PoPULATToN .....10 SECTION 2: IMPLEMENTATION OF CDTI........ ....................11 2.1. Tn\rGLtrIE OF ACTMIIES ................ ......12 2.2. ADVocACY .. ... .........13 2.3. MoBtr-IZAnoN, SENSITIZATIoNANDHEAL.THEDUCATIoN OFATRISKCOI.,ffUUNIIES 14 2.4. Cotrnr,ruuryINVoLVEMENT.............. ............16 2.5. Cap.a,crrv BUILDING... ...,.. ..... 17 2.6. Tnsanmrrs................ ... ..,..........19 2. 6. 1 . Treatment figures .. . .... .... .. . . .. . 202.6.2 W'hat are the causes of absenteeism?...... ......22 2.6.3 l(hat are the reasons for refusals? ................ ............22 2. 6.4 Briefly describe all lmown and verified serious adverse events (SAEs) thnt. . . . 2 3 2.6.5. Trend of treatment achievement.from C.DTI project inception to the antent year24 2.7. Onopnnqc, SToRAGEAND DELTVERY oF IVERMECTIN ............ ...............25 2. 8. Cor,nvruvrt-v sELF-MoMToRING AND SrarBnoropRs Mnprntc . . .. . . .... .21 2.9. SilppRvrsroN ..............28 2.9.1. Provide allow chart ofsupervisionhierarchy. ............29 2.9.2. Whatwere the main issues identified during supervision2 . .. ........ .-..'....'..' 29 2.9.3. Was a supervision checkhst used? ......... '.-.... .29 2.9.4. lil'hatwere the outcomes at each level of CDTI implementation supervision? 29 2.9.5. Was feedback given to the person or groups supervised? . ... 292.9.6. How was the feedback used to improve the overall per.formance of the project? SECTION 3: SUPPORT TO CDTI ...........3o 30 3i 3l 32 SECTION 4: SUSTAINABILITY OF CDTI ..............32 4.1. hTTERNAL; INDEPENDENT PARTICTAToRY MoMToRINc; EvaruauoN............. ....,.32 4.1.1 Was Monitoring/evaluation caruied out during the reporting period? (tick aryt of the followingwhich are applicable) ............ ........32 1.1.2. Whatwere the recommendations? ...........33 1.1.3. Hovt have they been implemented? .............. ...........'..35 4.2. SustaNae[rry oF eRoJECTS: pr-AN AND sET TARGETS (MANDAToRY AT YR 3). ... . . 35 4.2.1. Planning at all relewnt levels . ..........' 35 4.2.2. Funds....... .........jj 4.2.3 Transport (rephcement andmointenance)......... ......35 4.2.4. Other resources... ..................35 a { "i & t !- E 4.2.5. Towhatextenthastheplanbeenimplemented...""" """""""""'j6 4.3. INTEGRATION """""""36 4.3.1. Ivermectindeliverymechanisms """""""36 4.3.2. Training... """""36 4.3.3. Jointsipervisionandmonitoringwithotherprografirs..... """""'36 4.3.4. Release offunds for project activifies ""'' 364.3.5. IsCDTlincludedinthePHCbudget? .....37 4.3.6. Desuibe other health programmes that are using the CDTI structure and how thiswasachieved. Whathavebeentheachievemenfs?...........'. """""""""37 4.3.7. Describe others issues considered in the integration of CDTI........................37 4.4. OpERAIoNALRESEARCH.. ........'....""'37 4.4. I . Summarize in not more than one half of a page the operational research undertaken in the proiect area within the reporting period. . -....37 4.4.2. Howwere theresults applied in theproiect?...........-. . - -..........'37 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AND OPPORTUNrrrES....... -...........38 SECTTON 6: UNIQUE FEATURES OF TIIE PROJECT/OTHER MATTERS...........39 s Jl { I E t Acronyrms APOC ATO ATrO CBO CDD CDTI CSM FLIf IEC LF LGA LOCTs MOH NGDO \Ir:/1r\\l\, NOTF PHC REMO SAE SHM SOCT TCC TOT TINICEF UTG wHo ffiican Programme for Onchocerciasis Control Annual Treatment Obj ective Annual Training Objecti ve Community-Based Organization Community-Directed Distributor Community-Directed Treatment with Ivermectin Community S elf-Monitoring First Line Health Facility lnformation Education and Communication Lymphatic Filariasis Local Govemment Area Local Onchocerciasis Control Teams Ministry of Health Non-Governmental Development Organization N on-Govemmental Organi zatron National Onchocerciasis Task Force Primary health care Rapi d Epi demi olo gr cal M ap ping of Onchocerci asis Severe adverse event Stakeholders meeturg State Onchocerciasis Control Team Technical Consultative Committee (APOC scientific advisory group) Trainer of trainers Uruted Nations Children's Fund lIltimate Treatment Goa] Worl d Health Organization { ,l ,l ita t tI ;llt 5Definitions (r) Total population: the total population living in meso/hyper-endemic cqnmunities within the project area (based on REMO and census taking). (ii) Eligible population: calculated as 84Yo of the total population in meso,t5,per- endemic communities in the project area. (iii) Annual Treaunext Objective: (ATO): the estimated rmmber of persons living in meso/hyper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. (iv) Ultimate Treatnent Goal (UTG): calculated as the maximum number of people to be treated annually in mesoy'hyper endemic areas within the prqect are.a, ultimately to be reached when the project has reached fi.rll geographic coverage (nonnally the project should be expected to reach the UTG at the end of the 3" year ofthe proJect). (v) Therapeutic coveraqe: number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) Geographical coverage: nunber of communities treated in a given year over the totaf number of meso/lryper-endemic communities as identified by REMO in the project area (this should be o<pressed as a percentage). (vii) Integration: 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) Sustainability: CDTI activities in an area are sustainable when they continue to frmction effectively for the foreseeable future, \.ith high treafinent coverage, integrated into the available healthcare service, with strong community ownership, using resources mobilised by the commuritl- and the govemment. (ix) Commturitv self-monitoring (CSM): The process by which the conrmunitf is empowered to oversee and monitor the performance of CDTI (or an1' communitl- basefrhealth intenryntion progranrme), with a vieru to emuring that the programme is berng executed in the way intended. It encourages the commumtl to talie fuIl ."sponslbility of ivermectin distribution and make appropnate modifications when nocEssary. 4 i$ :t 1 I E & FOLLOW UP Oil TGG REGOTTE]TDATIOilS Using the table below, fill in the recommendations of the last TCC on the project qnd describe how they have been addressed. Recommendations from 23'd TCC session has been addressed in the 6th year project report, which is yet to be reviewed by TCC. TCC session 23d (Please add more rou,s if necessary) 8 ii- + t & T r il& Number of Reconvendation in the Rqtort TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FORTCC/APOC MGT ASE ONLY Executive $ummary Prepare an Executtve sammary of the repofi in not more than Wpage / Background on treatment and population data - Total communities, communities treated, total population, WG, ATO arul persons treated. / Background on population movements. / Training data - CDDS, healthworkers, Total population (community) per CDD tained / Challenges and how theywere overcome. Executive Summary Kebbi State is located in the North-westem Nigeria with an estimated population of 3 08 million people (based on l99l census). Onchocerciasis control programme commenced in the state in 1995 with Community Based Ivermectin Treatment (CBIT) with support from Sightsavers International while the Implementation of Community Directed Treatment with Ivermectin (CDTI) with support from the African Programme for Onchocerciasis Control (APOC) commenced in 1999. Out of the 21 administrative LGAs, Onchocerciasis is meso-endemic in 6 and hypo-endemic in 3 local govemments. APOC supports the project in the 6 meso endemic local govemments of Bagudo, Ngaski, Sakaba, Danko Wasagu, Zuru and Fakia, while Sig[tsavers Intemational supports control activities in the 3 hypo-urdemic local govemments of Bunza, Suru and Shanga in addition to the 6 meso endemic local governments. The project completed its seventh year of CDTI implementation in December 2006. A total population of 167n3O8 were treated with 457,726 tablets of Mectizan@ n 2OZ endemic communities out of a population of 192,428 thus attaining 87o/o therapeutic cover4ge and geographic coverage of l0Do/o. Principally most people are Moslems and stable with nomads who move southwards during the dry season for greener pasture for their livestock and retum al the corrmencement of the rains to either same or different locations rvith a resultant effect on both therapeutic and geographic coverage. Trainings .were conducted for one hundred and eighty eight (18t) Front Line Health FacilityStaff outof atargetof 196, and777 CDDsoutof atargetof 1,110fromthe six endemic local governments. All of them actively participated in the implementation of the CDTI activities. The LGA and Sightsavers lntemational provided funds, which were used for the implementation of CDTI activities during the treatment year. APOC funds arrived after the completion of activities. The project has many difficult-to-reach areas, and the monitoring by the state was by spot-checked during implementation The inadequate monitoring and supervision by the health workers at the first line health facilities continuous to be a ma$or challenge. Other challenges were atrition of community distributors due to poor incentive from communities and confusion of CDTI with other community based health programmes where incentives are paid. Efforts to reach women in purdatr have been slow due to cultural and religious hindrances. Though several efforts were made for FLFIF staff to 9 ta. i & 1 l =t rll ensure adequate monitoring and supervision towards proper implementation of the progftrrnme, community members to kindly compensate their distributors after distributiorU and community/religious leaders to let awareness reach their women who are on purdah for their participation towards sustaining the programme. t *. I t I l0 SEGTTON {: Background information 1.1. General information i. Description of the proiect Qfleny) (t (ii) (iii) (iv) (v) Geographical location, topography, climate Population : activities, culture s, language Communication systems (roads ... ) Admini stra tion s tructure Health system & health care delivery (provide the number of health posts/centres in the project area if the information is avwilable)' -Number of health staffin proiect area and number oJ'health- sto.ff involved in CDTI activities. r* 4 (vi) Kebbi State is located in the Sudan and savannatr grassland of north-western Nigcria covering a landmass of 36,229 square hlometres (almost same size as Guinea Bissau - 36,li} sq. lan, or half the size of Sierra Leone - 71,740). The state is made up of twenty-one (Zf ; aAministrative local government areas with an estimated popuiation of 3.08 million people based on the l99l population census. It borders Niger and Benin republic both francophone West African countries to the northwest and Niger State to the south. It shares its northeastem borders with Sokoto State and its eastem borders with Zamfara State. The state was created out of the then Sokoto State in 1991 from the 4ft century Kebbi Empire, a remnant of the historical Songhai Empire (which covered northem parts of present day Nigeria and Ghana), whtch was founded by Muhammed Kotal Kanta a famous warrior of the Kabawa decent (an ethnic group now livrng in the northem parts of the state). Relative to its geographical location, the climate in the state is characterised by two seasons. Rainfall begins in April and ends in October and heaviest in July and A'r.igiist. The dry season is from November to March wittr dry Harmattan winds between November and February. The mean annual temperature is 100'F/40oC, while annual rainrail is 500mm. Most of the roads leading to the local govemment headquarters are motorable, but the roads to the communities are mainly laterite roads, which become rnaccessible in the rarny season. Access to these communities is usually by bicycles, motorrycles, four wheel drive or foot paths. The existence of many rivers in the state particularly "Gulbin Ka " (River Ifu/ and River Niger along w.ith their tributaries provide fast flowing rivers for breeding of black flies, u'hich trarsmit Onchocerciasis. The predominant tnb€s in the stde are Hausa, Fulani, Kabawa and Dakarkari with Islam being the dominant religron The tenets and larvs of Islam as practiced in Sharia Law guide the people of the state. The main occupations of the rural people are farming (subsistence farming), fislung, tradrng and animal husbandry and nomadic herdsmen. The state and local governments provide formal employment 80% of the people live below $l a day which makes services such as health and other social services unaffordable, and thus puts the people at the rural level at a disadvantage. The significance of this is that services have to be free or highly subsidised for ttrem to afford. About 70o/o of the population live in rural communities with poor accessibility particularly in most of the rainy seasoq while 30% lives in urban and semi urban centes (Birnin Kebbi, Argungu, Yauri, Jega and Zuru). During the dry season there is a high migration of male youth to urban areas to engage in petty trading and other runskilled professions to {aii I I T F &, il qeam a living. They however return to their communities in the rainy season for agricultural activities. There are two main tiers of govemment operating in the state - the state and local govemments. An elected Executive Govemor, state house of assembly members, and elected Executive Chairmen and Councillors at the local govemments governs respectively. There are also the traditional and religious institutions of leadership, which have an influence in the adminisfration at the state and local govemment. The Kebbi Starc Ministry of Health is structured in line with the Nigerian health structure which is based on the concept of the Alma Ata declaration of 1978 which states: "Primary health care as essential health care based on practical, scientifically sound and socially acceptable methods and technologt made universally accessible to mdividuals and families in the community through their full participation and at a cost that the conununity and country can afford to maintain at every stage of their development in the spiril of self reliance and self determination". Based on the above the national health care delivery system is sffuctured into primary, secondary and tertiary levels of care assigned to the local, state and federal govemments respectively. There is a Federal Medical Centre in the state at Bimin kebbi, which is iupported by the federal govemment and provides services to all the citizens of the state. The state govemment through the MiniSry of Health is responsible for secondary health care and supervision of primary health care delive.tv. The local governments provide primary health care in their respective areas. The Ministry has the following 8 departments: Administration, Public Health Services, Primary Health Care, Pharmaceutical Services, Nursing Services, Planning, Rssearch and Statistics, Finance and Supplies and Inspectorate Services. Other parastatals under the ministry are School of Nursing and Midwifery, Bimin Kebbi, School of Health Technolory Jega and Hospital Health System Management Board. The state has twelve secondary health facilities in Bimin Kebbi. Argungu, Yauri. Zuru. Koko,Zuru. Dandi, Ribah, Maiyama and Jega. There are 240 first line health facilities in the six endemic local govemments, 79 of which serve the endemic communities with only 35 involved in CDTI implementation. The programme plans to increase this number to at least 120. The activities of the State's Mrnistry and health services provided are funded from budgeary dlocation ftem the state governm€nt. The eye care md the ondrocerciasis control programme have budget lines at the state level. while Onchocerciasis control is under the PHC budget in the local govemments. The state and local governments have consistently contributed a range of $4,500 - 510,500 arurually since 2000 as counterpart contribution for CDTI implementation. In the year under review the govemmant paid counterpart funds of $13,953. One car,not discuss Kebbi State without considering the traditional structures, which play a very important role in the development and lives of the people. The extended i*n fy ryrie. is the basic unit of the community stmcture in ttre state. A household neaAinat is usually the eldest male family member i.e. the father or grandfather hearis each exended family. The population in these households ranges from 5 to 40 persons per household. The head of the household takes all decisions, including finance and health issues in households while the mother ensures implementation of domestic issues. The poor and women are disadvantaged and marginalized. Most women in the - * & T & I Its G 12 .l state are in purdatr and are not involved in decision-making. A group of households form a community in Kebbi State as in most part of northem Nigeri4 which is headed by a communiS leader known locally as Maiunguwa (Head of community, nalnes vary depending on tribes). Tlte "Maiungtnvas" (village or community head) govem their communities in consultation with and assistance from heads of households, religious leaders (Imams) and opinion leaders hke"Magajiya" (head of females) aad "Sarkin Samari" (head of male youth) in the communities. Kebbi State has four emirates - Gwandu, Yauri, Argungu andZwu, headed by emirs. The community atd religious leaders report to thenr, while general communal activities are carried out under the coordination of the village development committees. & 5 : & 1 l F i+ll 13 Aret^lcU GTAANDI.l t(E t(AlGo .EA DAT{I) MANMA loto, ETSTE Bt.R MAPOFXE SB]E SIOWNG CDII I.GAS I AFG srppored I NoN-AFoc s.rpported r+ 5 l4 {* Table l: Number of health staffinvolved in CDTI (Please add more rows if necessary) District/LGA Number of heelth staffinvolved in CDTI ectivities. Totel Numbcr of lrcalth steff in the entire project area Br Number of hedth stelfinvolved in CDTI B, Percentage Br:Bil & ^100 Bagudo 54 37 690/o Danko Wasagu 96 48 50o/o Fakai 3l 27 87Yo Ngaski 36 32 89o/o Sakaba 47 36 77o/o Zuru 2l l8 86% Total 285 19E 690 These stall supervises distribution of Mectizan@. The project plans to continue to train more additionat health workers in the endemic local govemments on CDTI as part of the projects sustainability plan. These training will however be based on need. t a * {f{ & t I" f l5 1. Partnership (vir) Indicate the partners involved in project implementation at all levels MoH, NGDO s (notional/internati onal), communi tie s, local organizations, etc.J(viii) Describe overall worhng relationship among partners, clearly indicating specific areas of project activities (planning, supervision, advocacy, planning, mobilization, etc) where all partners are involved. State plans, if any, to mobilize the state/regionldistria/LGA declsion- mol<ers, NGDOs, NGOs, CBOs, to assist in CDTI implementation. The partners involved in the project implementation at all levels were: 1. Kebbi State Ministry of Health 2. Kebbi State Ministry for Local Govemment and Chieftaincy Affairs (representing the endemic LGAs) 3. African Programme for Onchocerciasis Control (APOC) 4. Federal Ministry of Health (National Onchocerciasis Control Programme) 5. Endemic Communities 6. Sightsavers Intemational Kebbi State Ministry of Health, Birnin Kebbi, Nigeria Thc Kebbi State Ministry of Health and its structure including function and responsibilities had earlier been described under background. In addition it provides the project staff and infrastructure for the programme. The staff are involved in all aspects of the project implementation from planning, advocacy, Mectizan@ procurement, training, monitoring/supervisioq community health education and mobilization (as observers) and reporting. The Ministry pays staff salaries and allowances and has consistently contributed counterpart funds since the inception of the programme, but unfortunately in 2006, the stale could not release counterpart lunds budgeted by the project. Kebbi State Ministry of Local Government and Chieftaincy Affairs All local govemments' activities in the state are under the supen'ision of the Mtnistry of Local Govemment and Chieftaincy Affairs. The Ministry is headed by a Commissioner who liases with the Local Govemment Service Commission in the employment, posting, promotion and discipline of staff of the local governmcnts and monitonng of utilization of stalutory allocations from the federal govemment. It also sets up general gurd'dines for sffi rnatters. including human resource development and sen'es as an appellate body for local government issues. The Ministry-is invoiveci in planning and ensures that local govemment for implernentation of project activities releases counterpart funds. The Ministry was able to get the LGAs to release $13,953 out of S38,759 budgeted for the implementation of CDTI activities within the project arcain2006. ln each of the 6 endemic local govemment areathere is a local Onchocerciasis control team headed by an Onchocerciasis Coordinator, which is mainly responsible for training of Community Directed Distributors, ensuring that the communities collect and distribute the Mectizan@ and community health education and mobilization. The 6 Onchocerciasis control teams also monitor the overall distribution in the communities, ensuring that records are kept at the first line health facilittes and communities. They treat cases of severe or mild adverse reactions and reporting. ls tr f iL f TE 16 African Programme for Onchocerciasis Control (APOC) The African Programme for Onchocerciasis Control (APOC), which is aWHO organ, was established in 1995 with the sole objective of supporting the control of Onchocerciasis in sub Saharan Africa using the Community Directed Treatment with Ivermectin (CDTD stratery. APOC has supported flre project with funds and capital equipment since 2000. A team of independent monitors appointed by APOC carried out an independent monitoring of the project n 2004. A management plan was developed from the recommendations of the report, which was used for the implementation of the project in 2005 and 2006. A team of evaluators was appointed to evaluate the project for sustainability in 2006; unfortunately two of the participants lost their lives as a result of a plane crash thus resulted to suspension of the evaluation. Federal Ministry of Health (National Onchocerciasis Contrcl Programme - NOCP) The National Onchocerciasis Control Programme (NOCP) is an organ of the Federal Ministry of Health, which is responsible for overall implementation of the programme in Nigeria. NOCP is a unit of the department of public health and is headed by a National Coordinator. There are four zonal offrces - Zone A (Enugu), B Qbadan), C (Kaduna) and D (Bauchi), which are headed by Zonal Coordinators and have the responsibility of monitoring CDTI activities in their catchment states. The NOCP on behalf of federal government endorses all MoUs with APOC and states and receives support from APOC, The zonal office in Kaduna is responsible for monitoring the implementation of the programme in Zone C, where Kebbi State falls under. The office also provides technical support to the project. Endemic Communities A communitv or village in Kebbi State refers to people in either small or large groups, who live in the same place, share the same culture, customs and traditions with a common leadership. In the project area there are 2O2 endemrc communities, which fit these descriptions. These communities have been receiving Mectizan for between 8 - 12 years. The traditional structure and decision making process as explained earlier is what is found in these commuruties. These communities play a m4jor role in the implementation of CDTI in their vanous communities, and these include selection of volunteers to distribute the drug, actual collection of drugs from central collection point, distribution of the drug provision of incentives and reporting among others. Si ghtsavers International Sightsavers Intemational has supported onchocerciasis conffol rn nine local governments (Sakaba, Zuru, Ngaski, Danko Wasagu, Fakar, Bagudo, Suru, Bunza and Shanga) since 1995. Since the commenceme,lrt of CDTI, this was introduced in aii 9 local governments with APOC supporting 6 and Sightsavers Intemational continued support to the progranrme in the other tlree LGAs (Suru, Shanga and Bunza). They have provided logistic support (vehicles, spares, transportation of Mectizan@ etc), technical support - planning, advocacy', monitoring, provision of IEC materials and reporting forms, support training of health workers and CDDs on primary eye care etc. tn general the relationstrip existing between the parbrers mentioned above has been cordial and where necessary, roles/functions are cascaded for effectiveness of prqect implementation. Support is still being solicited for commifinent to CDTI activities at 5 i l G IT 17 the grass-root. Communities were re-mobilized on their responsibilities as parbrers based on CDTI principles, so that at the end of APOC support the project can be sustainable. i -;a {t I G & l8 E' A'F P. 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H e) ? 0,HI ? t- E a) F) C) ?rt o,r.r c) 7 !lH c) o IrBgE F Ei. l, 2 ali4505E 3 Fi'tris =o(!Juo rl r-t E f6iJ. J. rd Ft fd F' E E a ,D a E oq ? A) ? A) E 3 E rt E r> E ooIrE9! Et, ot H E ,t) g t o) a o, d O) a? B F)q o) 0)iu ot p) .z A' O) a: 3?:tD E*FE' Frl (D 6 E .E Frj (D dI A'q Ffl (D d E A) Ff, (Dq E O) .? Ff, og E A)q Frl (D d e o,rt oo EIB9! Er s. a oo ED .A eEB t9 (D a(DE (D C'(D o od(DFt 7 o: E o() o <t(DEt r- A, -a E'* Er It'oo o o(t (D H o od(D tst A!t U(D o(D -(D >t Uo C) @ doFt o lrB91, lt !t ot, .l ,Q EL a s a o ?It s) o ? lt)El o ? o)Ho ? toHo 7rt otho 7 D'Ho E3 =D 0q zo (D (t (D >t zo (D)6(Dit zo (D d(D ,-t zo g P d(D r-t zo (D)C(Dht zo (D)o(D ooEIE E= 'E- a Eo{ a o R.=.\ P OB=+mr:-oS$l.lN{\rI *.;" il g - Ixs='-TN.O NsS'O rr +(! a tFr is *. ='Et]\rtN-i-irIi\R g. o <8l:oRIR'ruo\a(\rr!o\tioHrrto .*E F={ \I =F.x =. oa{ s (\ h.. .s ^o =(\q a\ G \ s s(\ S. G ll .a ..1 (D o o F+, ot a) (D an aEt @ A) (D Ea +H(D D) (D A 5 (D o r-t(D (! t (\ a(\ !a 6'E E q * > ng g $H; H.E. P. EEftB: i *HX:= s oE?e',B 6 q B.9? I; BHEUF: * ;AFd_13 r, g;*1x 3. *.dp- 69 t Bi8()H9Fe a ts*5'ls E +HHEe 9 8+5 == E Btsr69. + 6stsE3 q rr6(D6s S 1a=5g r +s*3.(D 3 E f U93 P qEXPiita5.-iu $ rJ = R 6'o-6'e:. E HEECr - { - O-E' *i F E:A3tl D e: FiiDqa :. EEa Yrt(<, ",PHLQ-U, = ==5dEg -F 6Yc0ae - r.hF,BH E, R6?i1 x B (lr i;l 3 #Pg+iU .D PiD5;' x +-1c 9 ti I?-! =. <Fsg ? H8;5 GF@<Lv-a's "_.EY l; (r)'P; ga, 'aS:- o tro : E{e Es!riru 8- !16n. HE = trBF' rh?P h=i P*: t,,axa)irc 6(D3 E8)lt E (D 'J.e. 5(Da: 60-s 8-g o.+ Lo) oN L*r I l TT E .+ 2.2. Advocaey State the number of policy/decision makers mobilized at each relevant level during the current year; the reason(s) for undertadng the advocacy and the outcome. Describe dfficulties/constraints beingfoced and suggestions on how to improve advocacy, The project has continued to advocate for sustainability of CDTI activities post APOC support. Advocacy was carried to govemment at the state and local govemment levels and other stakeholders. Advocacy was carried out early in the year before actual comlnencement of CDTI activities and subsequently during implementation of CDTI activities. This was done to ensure that the project gets ttre needed support toward sustainability. As a result of this govemment support to the programme in terms of provision of counterpart funding has been cheering. The project's advocacy objectives for 2006 were to solicit for early approval and release of funds, political and moral support. As a result of this the local governments release counterpart funds ($13,953) for CDTI implementation. This is very important because the funding at this level was discovered to be a major factor in the monitoring and supervision of CDTI by the Local Onchocerciasis Control Teams (LOCTs) in all the LGAs. Based on the traditionaUreligion structure, both traditional and religion leaders had a big role to play in ensuring that women in purdah are reached, get their communities to provide incentives for the CDDs and the selection of female CDDs. Advocacy was made to policy/decision makers in the Ministry for Local Govemment and Chieftaincy Affairs, the Ministry of Health and six endemic local govemment areas. A total of 37 persons were mobilised to support CDTI implementation and they include Hon. Commissioners of Health and Local Govemment and Chieftaincy Affairs, Permanent Secretaries in both Ministries, relevant Directors, Information Officer at the state level: Chairmen of the six LGAs, Directors of Primary Health Care Services at the LGAS. Councillors for Health and Information Officers at the LGA level were also visited. At the community level 35 community leaders/representatives, ieligious leaders and women leaders were also mobilised. The outcomes of the advocacy were; all the policy/decision maliers at the state/LGA levels urd most of the conmrunity/traditional rulers promised to ensure that counterpart funds and incentives are provided to SOCT/LOCTs and CDDs respectively- endemic communities also consider the inclusion of female CDDs, and during monitoring and supervision some among the communities visited kept to their promise. The issue of women in purdah is religious and cultural and thus not much can be done, commitment to CDDs compensation is also an issue to the project. These are challenges to the project that we would continue to advocate for. iti Iit I t $ 22 2.3. tlobilization, sensitisation and health education of at risk communities Pr ovi d e informa ti on o n : The use of media and/or other local systems to disseminate information Types of IEC materials used Mobilimrion and health education of communities includingwomen and .uinorities Resp ons e of tar get c ommuniti e s /villa ge s Accomplishments Suggestways to improve mobilization and sensitisation of the target cani;'i\Uiiities Information on CDTI was disseminated to the endemic communities through the use oi distributors (CDDs) in collaboration with community leaders during community meetings and town criers. Religious leaders and Islamic scholars were used to mobilise the people in mosque and Islamic schools. IEC materials (posters and flip charts) were also used extensively to disseminate information, health educate and mobilise communities. Endemic communities were mobilized and health educated annually based on need in some occasions since the inception of the project. During the year under review, targeted community mobilization was carried out to address problems identified during monitoring/supervision to 35 commrmities in five of the endemic LGAs (Zuru, Danko Wasagu, Sakaba, Fakar and Ngaski). The communities have continued to demonstrate good knowledge and awareness of CDTI and response during mobilisation, which has been urcouraging. This is demonstrated by the performance of their roles and responsibilitres and the request for their drug for annual treatment. The response in the provision of incentrve for CDDs has continued to be poor despite the repeated mobilisation and sensitisation. The use of electroruc media i.e radio station and identify other forms of communication within the communities to sensitise, health educate and mobilise communities was gtven a consideration, but due to non budget allocation to such specifically tlus was not used, though the project hopes to implement such in the future. Loudhailers provided by the supporting NGDO (SS[) were used during e.ommurury sensrtisation and health education; this was to ensure that n'omen in purdah got adequate information and to fully comply !\,rth CDTI. , 23 i& E L * {. 2.4. Gommunity involvement Table 4: Communities participation in the CDTI (Please add more rows if necessary) Comment on: - Attendance offemale members of the communit.y at health education meetings - In general, how do you rate the partrctpatrun offemale members of the community meetings when CDTI issues are being discusses (attendance, participation in the discussion etc). - Incentives provided by communities.for the CDDs - Attrition of CDDs. Is attrition a problem.for the project? If yes, how is it addressed? - Other issares I a a o Female attendance to communit).'heatth education has not improved. This is due to the Islamic norrns and culture that prevents women from freely nii.tiilg with males, though few old women and young girls attended meetings. Loudhailers were used to ensure that the females rn purdatr are informed about the programrne during mobilisation and sensitisation sessions. Attendance and participahon of women m the discussion and implementation of CDTI continue to be poor due to the Islamic way of life that does not allow at free mixing of males and females. Compensation to distributors has continued to be a problem in most communities. These incentives are not provided in a good number of communities and where they are provided, they are not regular. Though the project is trying to make communities see the need for the provision of inccntives, through encouraging them to provide incentive in kind instead oi cash. CDD attrition wi$ an issue of concemed too; this was as a result of non- incentives to the selected distributors. However there are CDDs who have been in the programme for quite a number of years and have continued to l+- & & t r & Number of commruitics/villages with commmit5l members as supervisors Number of CDDs Nurnber of commurlties /villages with femalo CDDs Totel no. communitics in the entirc project erce B1 Nwnber with community members es supcrvisors B" Pcrcentege B5- B./ Br *100 Mrlc CDDS B? Femele CDDs & Total Be= By'Br Number of cornmunities with female CDIh Bro Pcrcentegc Brt= B',/Brrl(X) Bagudo 32 l5 47% 2t0 6 2t6 6 l8o/o Danko Wasagu 83 26 3t% 330 t2 342 t2 l4o/o Fakai 11 7 64% 99 2 l0l 2 l8o/o Ngaski 36 22 6t% 240 J 243 3 goA Sakaba 30 20 67% 110 8 4 118 80 8 4 27o/o Zwu l0 6 60Yo 76 40o/o Total 202 96 18Yo 1,(b5 35 1,100 35 l7o/o a 24 serve their communities without asking for any form of incentives. The project has continued to request communities to select new CDDs in a situation where there is attrition is found. Local governments are also encouraged to use CDDs for all health and development programmes in the communities. For example they should be use as guides during Nalional Immunization Days so that they get some incentive. The provision of incentives for other community ba.sed health programme like the National Immunization Programme has not helped in resolving the incentive issue. a :a & t I 25 lrt 2.5. Gapacity building - Describe the adequacy of available lmowledgeable manpower at all levels. - Where frequent transfers of trained staffoccur, state what ttre project is doing or intends to do, to remedy the situation. (The most important issue to describe is whet measures were taken to ensure adequate CDTI implementation where not enough lonwledgeable manpowerwos available or if staff arefrequently transferred during the course of the campaign) Since the inception of APOC support for CDTI activities in Kebbi State, human resources had been developed and contributed to the success of the control programme Onchocerciasis. A total of One hundred and eighty-eighty (188) members of the Local Onchocerciasis Team and health workers, seven hundred and seventy- seven (777) commtlrity distributors were only retrained out of the target of 196 and 1,110 respectively during the year under review to manage the project based on CDTI principle. Trarsfer of trained staff was experienced by the project particularly in all the endemic LGAs. Some were within the endemic area and few staff outside, which the project found very fair unlike the previous years were most of the stalf were transferred from the endemic areas. Decision is still on to address such issue by training all the health staff at each of the endemic LGAs on CDTI implementation to address such experiences in future. s tL l t g 26 Fl oH F N E v) A: * Oldgt z oa O)6r Ff, A: * F' 'U!r- Elfft' Edpr 0c)d o.o U a Et F o O O o o -i 6 s (D oE (D E' I s o O O O O o O O O o O o .rl !$ z = +l,E org z E6a- EO!!lrl P.35f.t!aaa Fo 6 \o o\ t-J l..J { t-J -I tJ o, o Ha s l! o E' o I o\5 s OO 66 NJ oo -I { t-) FJ O O s5 AA tl ? o.N F^-l A"i1 tJ N) z oit Ea =A EE -t! '.t F .!a:4,(D .D x ta O O O O O s (! 6 E' G O o O O O O O O C) * z IE e9, ox ^= -rg ta Z.vE tt U' o Ha a nZ s{ o = A- alla t @ @ N.)+t]) tf)+N) [^Jo\ OEEAs lrJ E. -o4 o\(! 6 I tJs : t, N) : -t{ -I tJ o\{ -IA l.J t'J t'J \o Ol A { (,l o\ \o u) t.JO -lo\ 1..)Ur sOi s \o f.J s) o F : Q. o.a.a t r+ * z H= E. r!5rlg.q .) a l-'l lo)l(, lo l.-r, rl Ft E. c. 0a D) ti a i-+t(D' r_t .D (D (D o F+) o U .J = ,d a (D g) E N(\ Rr :r \(\\ o % Go(\ !4 \_ *t € x -\ s : o \ oI oa o o S n + q 6' I: qo .\*\* c'9STQ: *G sS .o%\s ^. rt :. -(!s\(\s' E-.5 s: csR\Fd- =.r::}IFEsRG(\= N: N-8 SRo.p *.G .*F -?. RN \^ =. r-JNX\\i FS SS iiGl\ S. * G rt d E a .4 -& iL I t * & N){ t-..)@ o oHo t) r3(} c) 5 Ug, DI tl ,g F ra 13 o :1 oa UD FT A, o: o o Ug, p oo o c) o o rJr3 oa Q?>F trB oa(D .D o+, Eg -gE EAFE II FU ECJ6q9dqd EB(D Fi cl E6oq oi 16(D ,e oo * (ao (Dq o U U EY tl=lri aOr.\ -E -? tDtrET' a(< oPEit9OE,A6GEi a,d H9 Eq9 - oo Eq oa I tD0 @a (Db (Do I (D O @@ *g E f=F _,D € Et ''u;q3 a9 60 FEtbo .! ;' a19 EYg; aa l-l IDJtd lo lcn E; ?+oqO (\+ c"B H514 0ala Go.]o \jF(\(D a5 6', h sd q R{(\ 6 A :i oa (\\ o\ oo (\ -t o e s s (s \ A e(\ +E G a o i a G : N s o ei G 4 t i)\ s 6' s N\ a!!+ .d\a\ *- G k $S f! F. s 5\< o (DEt C) o =t (D (f) !+ ir l t r E N v a2.6. Treatments 2.6.1. Treatment figurrcs If the project is not achieving 100% geographical coverage and a minimum of 6595 therapeutic coverage or the coverage rate is fluctuating, state the reasons and the plans being made to remedy this. in the period under review the project attained 100% geographic coverage with a therapeutic coverage of 87o/r. The project in the past reported having 2I0 communities, during monitoring and supervision some places were found to be one community but have sections, which were classified as communities. This was fourd to be as a result of tryrng to have more recognition to such places, but clarity was made which they accepted, as such this brought about the present 202 u total number of endemic communities within the project area But it has to be noted that such places have same community household treatment register, though with list of households accordingly and based on which section of the community a household falls. It should be noted that there is a drop in total population and population treated compared to the last year's (2005) treatment, this accourted to migration by nomads and some few indigenes from Ngaski LGA, this happened before treatment commenced. il 3l E s Fil oFi F Nt e o6)H E2d!t z 0ap IA 6: Ff, t0ts ot go A) }I BX-dao Ed o, 0qg o.o >ghB >d' t\)ot\) ()) (, o\ @u) t,N roc -o =B+$*.Fe{ - { r a'q o o 3 c @ A) 00ot/) b.)oN t, (]) o\ @tj) (, N a*lte > az= EEE.o* }.Joh) (, tJ) o\ oot]) UJN) o ts3, +5Eo ='3 =G9Qc1!i*S.o (P o oo s O o\ 6\ 6\ O o\ yO 6\ L) ^d ^p8d$€oa5o6' UU ,il \o t\) 5h)6 5 @ @ (,l Po{{5 5 t.J @\) I @(r) \o 5 fo @s@ t, N(, 6o X E e6 sE i $ gia*51o5 g U FU o r5 o) o -Ib.) \o (,r o\s (Jr 5 N -ItJ) (]){ t, A{ JJl @\o\o 55 o\ tJo "t^) t)N ^-l.(' 6i .> oi= =.e E d= o\{ Irjo6 s o\N (,rs tJ (,l (, o\ Lrr(J) o\ (.rt "o\(, lJ) 5 J')tJ(^ t.) t.J5 t.) - 9",gE 5&g g 6 -I s @ u) ^\ l,) o\ @(,l ^\ @tJ q\ @ o\ 6 ..l o:iOo .i torEE@OQtro+ o U ,v -- t\) -t N{ l.)Ntr) |J)5 5 I'JvtJ 5+i{S"Ee'6 5 g -+3gq\ (.) \o UIo o\5 o\ (,l6 @ t\)(, t\) L,I(Jr { L,I O z r o B a oo o aZPOr @6 O B =; z.Q.d Fae &E 5g[[Fg$Eil Y.i=.*v" o @ ^E-o Y,, l-l la)l(t lcl-l -lr-t @$ =Jp(D sliJo. O lnin o o. U) tr' o -p A) e:H(D O)a, O) (t) ,r E a (\ s- s \os l- (t1() <\ <4 N I'r1lo IT lo)l*l'-t lolo l3 tcl Itr l5 0al*l!t l(D ]E l(Dlcld la) le lo- oa l(Dlo trc tFt lotleI IElt) leL lo t? l(DIr la) oa l(Dltt) 6)'t6i'oaEfi ,a=,aC\o-\oa .D h' €.- 5' cJe3OEf;B(Dr -9lBiD(D *.1 o oo rg aio\Hvs, OQo o:a(D 8 EE H 5E rr rr =ld Nrs A,< Iatr E HrI'A G 3 anS:e s'^ASEF. HH. ssi *[a:I 6 ETT EIq: 1 $$F a$tB H ,, ri sE 3Xf.i =R i:' H ,.,$iE gE' N s'S E lE$IE q L I$[ $ECT E. E Ee.S: olR $$E EltFe S S.lxt$ I H15\is +'- t lr' ! i$t E$t$ HS.q * -AS s^ H -FF 9 s'E[= 'il,' l. sd s.f SN s$IF *.R: Sr :F\{ Gt\\e q S e GE$\ E'tr O0 s ff €t sI il >12 -1 lZ.4l2.5lc olr' olEEIH SIE EIHEls;18;ls =]E EE €I:stt BH fH[B $tE EB EIB AE HH5.la €lz- ='lo;E EIF 5I:18 iE gr=gIE E5E q8F E El= fE. ?)H8 .i5 PB3 e o-lJo=' ;. =(D a '!i o- =. FEFdBEE(J.Q E(Deo +G!ts .DH 'cS .8. g !9H(D !+ r* i- * f & I !r i,*u oa a o 2.6.2 What are the causes of absenteeism? There is always a high migration of male youth and some heads of households to urban settlements during the dry season to engage in petty trading and other unshlled professions to earn a living. They however return to their communities in the rainy season for agricultural activities. The nomads around endemic communities do move southwards annually for pasfufe for their animals during the dry season and return in the rainy season, which of course they may settle in the initial point or make a change. There are also people who have to go to schools in other townVcommunities and only come back to their communities during vocation. 2.63 What are the neasons for refusals? Religious belief and norrns 2.6.4 Briefly describe all known and verified serious adverse evcnts (SAEs) that occurred during the repofting period and provide (in table 8) the requircd information when available. In case the project did not have any cases of serious adverse events (SAE) during this reporting period, please tick in the box. No SAE was reported t + n 1B € &, I + IT 33 lFll$ lE laDl* olr aa et, o a2(D o v, Da (D do (D (D t, O Itl(r, I oaa rt{orr 0e o .l ID oll t. OQ Eo ,J.6 "lgGt V2 G tr. s. = N 4 \ G GI v,S .fs- * ($- .t a sG\ (\ G 5* 5'>e5[i 3r u)(Jrr5 T t g ra 2 * ooo aox o1 EO G.€!, {U60t/r d0)? ,( s.(Do !Jo N l0 N@HE:5 !r 65 rDNX o-5q (A I @ l Ii I H A *Y iSa ^ o 6 B,E'# V =ts, o.a t6 o -6@+6D F$u Ho!r 3 Se EH e-fr E Is - d'A xtx+ I rJA Egaa Z;,@ o >+) ooH rll:<93* HCE 91 a E BdT I f.J !.) -l b.) o o\ FJ o(^ !,Joo5 N.Jo(, N)OO N.) N)ao !,Jooo \o\o\o \o\o @ \o\o -J 6 ts iJ o IJ t-J Ur@ o\tJ) (,()) ta(J) 89r E .'ggg H.E' HE *[]OLl-'<r$r' H f; b,J f.J N.) @ € o\ t, (,l oi- .ddi P6.!I EOHH e6EoF+ [.J N.J N O F.J o l-.J N) m@ tj @ b.) f.J N)(, i..J \o\o N) @a (,a o\(, (, u) Itl OH _ "-9, 3H EB 1 E.fi E. I ia +) ^\ @ -J o\ \o o\ 10a\ \o(,t \oo\ \o 1O o\ o\ 10o\ 1Oo\ t!aOR-o(Dg,r,Q 6 s € * ll :.ai Lqi =da'dx(Dtt )- \o6\ \o -ts \o o\\o^\ \o 9\ -oo\ -oo\ 6\ \o 6 s \o6 rO ^\ \o @ s FI itl Fl l ll oo- ^<->\o (} i.l9ts -i o oo 'e, 3 o0 s olda() o \o "r95 l.J m hJ \o -tJ-) oo -)Pt-)Ui 5 ,o\5 tJ))o NJ hJ 5 "9{ 5 \o -l{t\) o\ @(, t-J o\ -l "po\ u) 9* 'dx5 06'9 E FHSfFF HE i -B" + -INJ o\@ -J tJ(Jr -l o\ (, \o{{ N) o\ oo tJ o\ {f.J (,) ll, ^Fl.dai P6.E EoHzi6Eda o\ ;J(i) € o\)o\o t) s JJJ a (.T .i@5 jo @5\o ,5 o\ l..J(I lr,+\o \J \o o\ (J) ooi \o -t -t --J 9,tOE arj* REta'oro tt'o @ -I g\ @ Ut s 6(, 1O o\ 6\o s @ N) s @ N) o\ 00t.) o\ \o @ 6\ \o\o s \o :J 6\ F't_ rr, lt, ,llt l-to rrroiD sri€vgz (! oQdo tr'.o \o{ s s \o(,r s l.J5 s t\) s \o\o s \o6\ \o @ s \o\o s \o -ts tr,r- .! il - .) ^: >Sg.<,oi - o ru o €tr F' o \o{ s o s \o(JI s \o @ s {9r .o 6\ \o6 s 6 -l\o6\ \o\o\o6\ \o\o -o6\ \o -t -o o\ oO= E$ x B liJ hJl$h la lrr l.p r.l _iH(D Ex *o5+O*i, 'f8g E}BEaB o5O(+(cc o= aii'oo ='o:i ldot<= lo.Dlel ='liD t15+lir -lE; ctD3daqU tc Fl +ElEf 'roo EE. drtEB s.tsoo !r ttg+ (D GE IE ihg =dr.E =-rs G ils il a. Fd (D s0() a aD (D (D Fl o en (D (D .! DEl (D D o\ ra,o at, D9O (D a(D o D o - D9 H o {.* aD a p FI o 0 lJ){ * t iit f,I t $ N) \o 2.7. Ordering, storage and delivery of ivermectin Mecfizan@ ordered/applied for by - Qtlease tick the appropriate answer) MOH E WHil T]NIICEF E NGDO f] / {r* Other (please specify) Mectizan@ delivered by - Qtlease tick the appropriate answer) MOH E wHil UNICEFE NGDo E r' Other (please specify): Please describe how Mectizan@ is ordered and how it gets to the communities The LGA Coordinators compiled the Onchocerciasis treatment report and Mectizan@ used in their various endemic communities and submit it to the State Onchocerciasis Office. The quantity of Mectizan@ tablet required by each community for the next year treatrnent rotmd is based on total population of that community after the previous treatment rotrnd (distributors do update census while distributing) and multiplied by three (x 3). This is then collated at the local government level and sent to ttre state level -thm to the supporting NGDO (SSI) which in-tum places orders Mectizan@ for the project through NOCP to the Mectizan@ Donation Programme. After approval and shipping by Mectizan@ Donation Programme, LINICEF thereafter takes charges of the Mectizan@ clearance after arrival from the airport and its storage before collection by the supporting NGDO (SSI). The state then receives its own allocation based on the total number of people to be treated likewise the local governrnents and all the endemic communities at agreed points of collection. At the community level the first line health facilities receive and store the required drug for communities within their area of supervision. Communities are then informed to send their distributors/representatives to collect their Mectizan@ allocation after pre- distribution activities have been concluded. i ; -, & l t G 38 Table l0: Mectizan@ Inventory (Please add more rows if necessary) How are the remaining ivermectin tablets collected andwhere are they kept? The distributors (CDDs) retum balance of the Mectizan@ tablets along with their community treatment reports to the front line health stalf (supervisors) at the first line health facility These are then passed on to the LGA Coordinator from all FLHF staff along with treatment dat4 he/she collates all the reports and drug for all first line hea!fli facilities and submit same to the State Onchocerciasis Coordinator who retums them to the medical store where they were first collected for storage against the next treatment I t LtllLl. List and briefly describe the activities under ivermectm delivery that are being carried out by health care Wrsonnel in the project area. Front Line Health Staff at the first line health facilities calculate the amount of Mectizan@ required from the updated census done by the CDDs, this is done b-v each of the endemic communities under their supervisions, and submits their request to the Onchocerciasis coordinator at the LGA. Based on their request Mectizan@ is issued to them from the Medical store. They keep the drugs in the first line health facilrtl' from where the communities come to c.ollect their allocatiorq after notification of the avarlability of the drugs. a - Any other comments None l: i., ,.{, Iit L t G C LGA Number of Mectizan' tablets Number in stock Requested Total Received Used UsedlPerson treated Lost Wasted Expired Remainlng Baeudo 3,O20 I10,000 105.980 73,921 24.620 2 0 0 35,077 Danko Wasagu ll,2g9 140,000 130.000 150,746 42,252 I 6 I 0 0 -9,608 Fakai 5 ,1 66 15,000 12,000 16,496 5,633 664 0 0 6 Ngaski I 680 100,000 95,000 80,867 36,536 58 0 0 15,755 Sakaba 60 130,000 125.000 124,996 54 205 4 0 0 60 Zwu 1,774 17.000 15.000 10.700 4.462 0 0 0 6,074 TOTAL 22gee 512,000 482"980 457J26 167,308 819 0 0 47,364 39 i{ 2.8. Gomrnunity self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? This was not done in the year under review. This u,as scheduled but could not be held due to late released of funds. Nevertheless as a result of community mobilisation and sensitisation conducted, some of these endemic communities were able to carry out CDTI activities for the year under review, though there are plans to conduct this training and before the next round of treatment. If so, when? Table I l: Community self-monitoring and Stakeholders Meeting (Add rows if needed) Describe how the results of the community self- monitonng and stakeholders meefings have affected proyct implementafion or how they would be utilized during the next treatment cycle. & & I t T Disnict/ LGA Total # of mmmunities/villages in tle entire project area No of Communities that carried out self monitoring (CSM) No of Communities that conducted stakeholders meeting (SHIvt) TOTAL 40 2.9. SuperYision 2.9.1. Provide a flow chart of supervision hierarchy. NOCP (ZONAL OFFTCE) ILGDO (STGHTSAVERS rNT'L) STATE ONCHO TEAM LOCAL ONCHO TEAMS FRONT LINE HEALTH FACILTY SUPERVISORS COMMUNITY LEADERS CCMMUNITY MEMBERS COMMUI\-ITY DIRECTED DISTRIBUTORS 41 i& t il 2.9.2. Whatwerc the main issues identified during supervision? o Lack of female distributors in most communities o Non-community self-monitoring. a Poor health education and mobilization of women in purdah as a religious belief and culture. CDTI records were fairly kept at FLFIF. Monitoring and Supervision by local Onchocerciasis team was inadequate Transfer of trained health staffto non-endemic communities. Attrition of selected community distributors as a result of not getting any form of incentive. Treatment record at community level by CDDs is poor in some instances a o a a 2.9.4. What were the outcomes at each level of CDTI implementation superuision? LGA/FLHF: At the LGA level it was noted that some health staff still have the impression that CDTI is not part of their primary assignment, as such they should be paid. This attitude has affected the implementation of CDTI activities. Follow up w:ls done several times by their coordinators and NGDO before treatment reports done by endemic commwrities were submitted. 2.9.3. Was a supervision checklist used? The supervision checklist was used in some few cases as noted during monitoring and supervision exercise, even though this was provided. Community: Compliance to treatment b1, community members \4rils encouraging drug shortqge was not an issue, and CDDs were poorly' motivated as such thev distributed the drugs at their convenience community mobilization and health education was camed out in affected communities with emphasis wir on provision of incentives in kind to motivate CDDs. a a a o iF 2.9.5. Was feedback given to the percon or groups supervised? a Feedback was grven to both LGAs/FLHF and communities concemed 2.9.6. How was the feedback used to improve the overall performance of the project? o The response to parmers concemed stressed issues and recommendations. They were motivated to fi.rlly continue participating as parhers through .- *. I t C 42 carryrng out their roles and responsibilities; this of course resulted to a success. .+ SEGTION 3= Support to GDTI 3.1. Equipment Table l2: Status of equipment (Please add more rows if necessary) *Condition of the equipment (F:Frmctional, CNFR= Currently non-firnctional but repairable. WGWritten off). How does the project intend to mnintain and replace exisfing eqaipmcnt and other malerials? The project intends to maintain existing equipment tluough repuurs using the state and LGAs counterpart fund on existing equipments; there do still exist plans for the replacement of the existing equipment and materials through an approach partners and the use of counterpart fund too. > a l t ft Source Type of equipment APOC MOH DISTRICTi LGA NGDO CIhers No. Coodition No Ccndition No. Condition No. Condition No, Condition 1. Vehicle I F 2. Motor cycl{s) 6 CNFR 7 4- WO 3. Computer(s) I F 4. Printer(s) I CNFR 5. Photocopier (s) I CNFR 6. Fax Machin{s) 0 7. Others a) Television I F b) Video Recorder t F c) Air Conditioner I F d) Calculaors 0 25 wo e) Bicycles 30 CNFR 2t wo f) Overhead proiector 1 F g) Generator I wo 43 3.2. Financial contributions of the partners and communities Table 13: Financial contributions by all partners for the last three years Exchange rate: Year 5 - $1 : Nl38, Year 6 - 8l - NL27, Year 7 - $1 : Nl29 If there are problems with release of counterpart Junds, how were they addressed? Effort was really made by advocating to the stakeholders concemed at the Ministry of health and Ministry of Finance, but despite the advocacy visit on the need for the govemment as a parher to take up it's responsibilities towards sustaining the programme nothing rvas done. 3.3. Other forms of community support Describe (indtcate Jorms oJ m-hnd contrfiutions of'commuruties q/-cut1) a a .# a The forms of support to commumty drstributors were m cash and in-krnd (food items), though this was from few members within the communities. 3.4. Expenditure per activityr 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 tlruted Nations exchange rate to local currency. Indicate exchange rate used here - $l = Nl27 .: { l t Tt Contributor Year 5 Q004) Year 6 (2005) Year 1 (2006) TOTAL AMOUNT (cASH) Budgeted 6us$) TOTAL CASH Released (us$) TOTAL AMOUNT (cASH) Budgeted rus$) TOTAL CASH Rcleased (us$) TOTAL AMOUNT (cASH) Budgeted (us$) TOTAL CASH Rclcascd (us$) MOH (Central + ProvinciaUState) 28,985.5 7,246.3 78,740 7,874 38,759 0 MOH (DstrictilGA) 18,260.86 13,913 23,763.7 ll ,8 ll 38,759 13,953 Local NGDO(s) ( if any) 0 0 0 0 0 0 NGDO parher(s) 10.265.83 9.470.43 9,251.9 1 I I 86 6,157.49 6,156.14 Others 0 0 0 0 0 0 APOC Trust Fund 8,750.00 8,750.00 142,O30 0 7,920 0 TOTAL 66,262 39,380 1l1,898.6 30,871 91,595.48 20,109.14 44 'ra Table 14: Indicate how much the project spent for each activity listed below during the reporting period. Any comments or explanattons ? t I T l Activitv Expenditure ($ US) Source(s) of funding Drug delivery from NOTF HQ area to central collection point of Mobilization and health education of communities Training of CDDs Training of health staffat all levels Supervising CDDs and distribution Intemal of CDTI activities Advocary visits to health and political authorities IEC materials Summary (reporting) forms for treatment , Vehicles/ Motorcycles/ birycles maintenance Office Equipment (e.g. computers, printers etc) lotn"., 562 3,7'13 3,291 tjie 562 2,213 | 0t+ 412 l+rz I 6,003 220 0 SSI LGAS/SSI LGAySSI LGAs/SSI SSI LGAs LGAs SSI SSI LGAYSSI SSI TOTAL 20,108 Total number of persons treated 289,151 45 4a SEGTIOil 4: Sustainability of GDTI 4.{. lnternal; independent participatoqr monitoring; Evaluation 4.1.1 Was Monitoring/evaluation carried out during the rrcporting period? (tick any of the following which are applicable) Year I Participatory lndependent monitoring: NONE Mid Term Sustainability Evaluation: NONE 5 year Sustainability Evaluation: NONE tntemal Monitoring by APOC: NONE Other Evaluation by other parhers: NONE 4.1.2. What werc the recommendations? 4.1.3. How have they been implemented? 4-2- sustainabitity of proiects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period? No Was a sustainability plan written'l No When was the sustainabiliq'plan submitted? NA_ What arangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.2.1. Planning at all relevant levels There wrll be a meeting to develop a sustainability plan meeting with relevant stakeholders Advocacy would be made to the relevant stakeholders both at the govemment and community levels to support the sustainability plan. Each LGA will meet with staketrolders including religious and community leaders to discuss and implement decisions taken on sustaining the project Communities will be heatth educated and sensitised on their roles as parhrer toward sustaining the project. a o a o a *B & I l G 46 4.2.2. Funds o Advocary as continuous process since the inception of the project will be intensified to relevant parmers to release counterpart frnds to support the CDTI project. 1l o I 4.2.3 Transport(replacementand maintenance) It is hoped that counterpart fi.urds would be released and used for the maintenance of project vehicles at the state and local govemments. No specific plans have been made to replace the transport and capital equipment. The project would however approach partners for a one off donation to support the programme. 4.2.4. Other resources Other resources for the successful implemertation of a sustainability progr.rmme will be discussed and explored during the planning meeting. 4.2.5. To what extent has the plan been implemented . The plan is not ready, but the project has commenced sensitisation on the sustainability plan and it is expected that stakeholders would accept the idea. 4.3. Integration Outline the extent oJ-integration o.f CDTI into the PHC structure and the plans.for complete integration: 4.3.1. Iverrnectin deliverymechanisms Ivermectin delivery has been integrated into the PHC system from the state to the front line health facility. When ivermectin is received it is stored in the state Medical store from where LGAs collect their allocations. The allocation to the LGAs goes through the PHC drug delivery system and stored in the medical stores from where the supervisors from the lront line health facilities collect for the communities they supervise. 4.3.2. Training Training of personnel for CDTI activities is yet to be integrated into the PHC system as all programmes hold their trainings separately. Attempts have been made to train some Traditional Birth Attendants on CDTI stratery when they are being trained on matemal and child health in a few communities. 4.3.3. Joint supervision and monitoring with other programs There is yet to be a formal ilrangem€nt for this, neverlheless, state and local control teams are encouraged to supervise CDTI when they 47 a t t o)\ )i f r a o ri r( n; t ta 'T o t r supervise National Immunization Programmes in their areas. It is expected that this would be discwsed and agreed as a strates/ for the sustainability of the programme. 4.3.4. Release of funds for project activities The commitment by the state and LGAs in the release of counterpart fund has been quite encouraging to an extent; these are however released separately at the state and LGA level. I 4.3.5. Is CDTI included in the PHC budgeP o Yes at state and LGA levels 4.3.6. Describe other health prograrnmes that arc using the CDTI structure and how this was achieved. What have been the achievements? Sightsavers supported the training of supervisors and CDDs on primary eye cilre services with the hope that would help in the screening, identification and referral of eye patients in their communities. It is expected that ttre CDTI structure would be used to aclueve this; the performance of the supervisors and CDDs on this has not been evaluated. a a 4.3.1 . Describe other issues considered in the integration of CDTI. The state and local governments stands the chance to reach people at the grassroots with the necessary awareness related to public health services and to incorporate members of the community to take ownership of most primar)' issues regarding their health. It is cost effective for all partners that may be involved in implementing CDTI pnnciple. 4.4. Operational research 4.4.1. Summarize in not more than one half of a page the operational research undertaken in the prcject area within the rrcporting period. o No operational research was undertaken during the reporting period. 4.4.2. Ifow were the results applied in the project? o NA. a C r* 1rl n i i *, I t T l 48 SEGTION 5: $trengths, weaknesses, challengGsr and opportunities List the strengths andwealmesses of CDTI implementation process. List the challenges and indicate how theywere addressed. Strengths: Continuous compliance to treatment by communitiesa o Weakness: o a a Commitment by some heatth staffto monitor and supervise implementation. Good community awareness about the programme. Distribution of Mectizan@ by most CDDs despite non-provision of incentives by their communities. Financial and logistic supports from Sightsavers lntemational. Poor involvement and participation of wome,lr in CDTI activities due to religious and traditional believes. o a Lack of female distributors in most communities. Poor motivation and incentive for CDDs by some communities leading to CDD attrition every year. In adequate monitoring and supervision by some supervisors. Lack of counterpart funding for the year from the state govemment t a a a t b * + Ii i& jI I T T Ghallenges: I Non-release of fund by the State Ministry of Health during the year. Most health workers see CDTI not part of their primary' assignmurt. The project has continued to advocate for sustainability of CDTI activities post APOC support. fu such advocary was carried out to the state and local govemments. Health workers at the health facility level were at all times made to know it is their responsibility to handle CDTI issues even as they do for other health prograrnmes. 49 SEGTIOI{ 6: Unique features of the projecUother matters a t {* : , L *. :i L I t G flh5 50