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

TARABA CDTI PROJECT ORIGINAL. Enghsh Proiect Name: TARABA STATE CDTI PROJECT coUNTRYAIOTE' NI Approval Year: 1997 Launching vear 1997 Reportine Perio4: January/2006 Decemberl2006 From: To (MONTH/rEAR) (MONTH/YEAR) Proiectyearofthisrepgrt: (circleone)l 2 3 4 5 6 78 (9) 10 Date submitted January 2007 NGDO partner: I}TITOSATH I i- 0 g ftv zrir; ^'-f i -. --ir,i] Io: CCq tor j;:ic;;,.;iion Ir,AiR lo noh-1tr -E r 5ir{ CS\ AoP Al€ BFp rc ., ,lI WHO/APOC, 24 Novembcr 2004 r{ a I ANNLIAL PROJECT TECHNICAL REPORT ST]BMITTE,D TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) DEADLINE FOR SUBMISSION: To APoc Management by 31 Januarv for March rcc meeting To APoc Management by 31 JuIv for september TCC meeting AFRICANPROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) t a WHO/APOC, 24 November 2004 I .; il ANNUAL PROJE(;T TECHNICAL REPORT TO '|I:CI{i.lIC.Al . ( (lI-tSl_I_,TATI\/E CON4N4I.fT.t:I:. (.t.( C) EI\DORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to s ign the r, report: Country: Naticinat coordinaror Name: .Pne+ro h..Cwl.Pr*q-r- Signature: . c-q- Date: .5.il1>."*l:. ....... ZonalOncho Coordinator Name, fr:qru, L-t.*,. C.gAu- Signature: .q%*.q*... . . . . . Date: sali/**= NGDO Representative Name: !:,|.+.t...f.F.trgsg*...eL*-rnrjq Signature: Date: .X.:...)g.s.=*,.*ct. t oo L This reporthas beenprepared byName, DA.. ./t ..:....L. OkN Designation, .S. JA-f. .-€. .. . .CO3 D r n/A-Til(. Dare ..?..6't^... D<-q*u.* b i I II \Vt{C/n POC. 24 November 2004 @^'" ! ! I i ! i 2=gO ;lt Table of contents ACRON}'I\TS...... DEFINITIONS ............. FOLLOW UP ON TCC RECOI\IMENDATIONS....... EXECUTIVE SUMMARY ............... SECTION l: BACKGROUND INFORT{ATION l.l. GpNenaltNFoRMATroN............... l.l.l Description of the project ftnefly) .......1.1.2. Partnership 1.2. PopuurroN.. SECTION 2: IMPLEMENTATION OF CDTI.. TtueLrNp oF ACTrvrlES ..... Aovocncy MostLIzntIoN, sENSITIZATIoN AND HEALTH EDUCATIoN oF AT RrsK coMMr.rNrrrES 222 Coutrlurury INVoLvEMENT.............. Cepecrry BUTLDING Tnernrapvrs................6.1. Treatmentfigures............. 6.2 What are the causes of absenteeism?.............6.3 llhat are thereasonsfor refusals? ................6-4 BrieJly describe all lorcwn and vertfted serious adverse events (SAEs) that.... 6.5- Trend of treatment achiarcmentfrom CDTI project inception to the curient year ORDERING, SToRAGE AND DELIvERYoF IvERMECTTN 2.t. 2.2. 2.3. 2.4. 2.5. 2.6. 2 2 2 2 2. 2.1. 20 22 23 24 26 26 29 29 29 31 322.8. couruwtry sELF-MoNrI'oRlNc nNp sta,rEHoLDERS MEETTNG ...........342.9. SupeRvrsroN ............... .................. 352.9.1. Provide a/low chart of superviston hierarchy. .......... 352.9.2. What were the main Lsszes identified durtng supervision? ............................. 352.9.3. Was a supervision checklist used?.............-............. ................... J52.9.4. lVhat were the outcomes at each level of CDTI implementation supervision 352.9.5. Was feedback given to the person or groups supervised?.................. ............. 35 2-9.6-How was the feedback used to improve the overall performance of the project?... 3 j SECTION 3: SUPPORT TO CDTI ...........36 3.1. Equrrurvr .................363.2. FrxnNcrnr coNTzuBUTIoNs oF THE pARTNERs AND coMMUMTrES.......................... 373.3. OIUER FoRMS oF coMMUNrry suppoRT ...........373.4. ExprNorruRE pER AcTrvrry ..........3g SECTION 4: SUSTAINABILITY OF CDTI ............39 I 4.1. INteRNnr-; INDEPENDENT PARTICIPAToRY MoNIToRING; Evnl-ueuoN....................39 4- 1.1 Was Monitoring/evaluation carried out during the reponing period? (tick any of the following which are applicable) ............ ........ 394.1.2. Wot were lhe recommendations? ...........404.1.3. How have they been implemented?................ ............404.2. Sust-atlnntLlTy oF pRoiEcr:s: rLAN AND sET lARcETs (nanNoeroRy AT ...............40Yn3)......... .........40 IV U/HO/APOC. 24 November 2004 .....-............. \'l l5 t5 17 l8 I4 2.1. Planning atall relevant levcls . .... .......40 4.2.2. Funds........ .........40 4 2.3 Transport keplacement andtanetance).. ..............40 4.2.4. Other resources... . .... ...40 1 ) 5 To wha extent has lip plun 'lter. i.nplcritanted ...... ... .. .. ....4 t AI4I INtr.r,RnltoN.. .........r, 4 3 1 lvermectin delivery nechanis*t: ....... .. 4l 1 3 :. Training ..... . 4 t 4.3.3. Joint supervision and monitoring nithother programs... . ..... ....41 4 3.4. Release offundsfor project retivtties .........41 4.3.5. Is CDTI included in the PHC budget? .........4 t4.3.6. Describe olher health prografiiles tlut are using the CDTI structure and how this was achieved. What have been lhe achievements? ............. ................442 4.3.7. Descibe others issues considered in the tntegration of CDTI. ...432 4.4. OpenanoNAL REsEARCH..... 433 4.4. I . Summarize in not more than aru lalf of a page the operational research undertaken in the project areawithin lhereporting period........ ...... ... .. ..433 4.4.2. How were the results applied intlu project? ............... ........ ....433 SECTION 5: STRENGTIIS, WEAI(NESSES, CHALLENGES, AND oppoRTUNITrES..... ............434 SECTION 6: UNIQUE FEATURES oF TIIE PROJECT/OTHER IVTATTERS .........444 WHO/APOC, 24 November 2004 Definitrons (i) (ri1 (iii) (iv) (u) (vi) (vii) (viii) (ix) Total oopulation: the total population living in meso/hypcr-endemic communittes *itt i. tt " project area (based on REMO and census taking)' Eligible populalrsn, calculated as 84o/o of the total population rn lrlcsu/hlPcr- endemic communities in the project area. Annual Treatrnent objcctive: (ATO): thc estimated number of persons living rn r""*n yp.t*"d"mr" areas ttrat a CDTI project inrcnds to treat with ivermectin in a given year. Ultimate Treatnrcnt Gcal (LITG): catculated as the maximum number of people to b. tr*t"d annually in meso,hl2er endemic areas within the pro;ect area, ultimately to be reached when the project has reached full geographic coverage (normally the project should be expected to reach the UTG at the end of the 3'" year ofthe project). Therapeutic coverage: number of people fieated in a given year over the total population (this should be expressed as a percentage)' Geoeraphical coverage: number of communities treated in a given year over the trt"l "r-b"t of meso/hyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage)' Inteeration: delivering additional health interventions (i.e. vitamin A supplements' ufU"narrof" for LF, icreening for cataract, etc.) through CDTI (using the same systems, training, supervision and personnel) in order to maximise cost- e-ffectiveness 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. I Sustainabilitv: CDTI activities in an area are sustainable when they continue to fi.rnction effectively for the foreseeable future, with hig[ treatrnent coverage, integfated into the ivaiiable healtlicare sen'ice, with strong communiff ownership, using resources mobilised by the community and the government' Community self-monitoring (CSM): The process by whilh the community is ".po*o"O to ou"o"" *d monitor the pcrformance of CDTI (or any community- based health intervention programme), with a view to ensuring that the progftllnme is being executed in the way intended. 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F F@ Fls ::; alo -.cl - C!r€ ;:g j g E$F Io-.:aoary>.u t =E 3 o2 +1 q tsg oGlL.c 3.e7):U o17 a9) =5c,x a.oEr,> dz H* .- <: : : i) I i, ! \ o -o a qt t :8i'sU\:\ _qr 'a- b\b$9 -< ^, .: er Sq) ho'(l-PE ^tto ;Uq)A'-{ =<S= t (\qJ<\\ *s 9\bo$u-^lsP 6 .:or' Sl .t.5i -(,:9 0ss E\",S.6 o0(li ESJ\I tre-i I$h* sE gq, .9 c) 6'\ $\i stti 'trr5 =u: a, -o:ss H F9 o -s- ! :Ya crNcr c)6i ssp o. c, I o,)s: -c r,S hx\rYg\{ 6S!^ a:{v) :.: 6 'i :' c)tt i cl, rrS 6X! Jo)t t 3 s C)!) a.U' C)ol-. o0 o o A oU (l) o3(\l o -ocl tl) cll(, 'o SECTION 2: Irnplemenration of CDTI 2.1. Tlmcllne of ecttvlflg [:rll rn table 3, ltmeline o{activitiesfor area: treated in current year,indicating when the key,acti.'itres r'"ere imple rrienred by tae n::nth .,b.c1t;egilr. arrd the rrorrth they endeci. l I I )n WHO/APOC, 24 November 2004 1u - -! 7, - t o..t an o) E oO C' B Cabq)() q) S b s a\ qJLo \\s q) C)(3q) o v (\, 0.) q) F =o o) tr 4) C! 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Advocrcy State the number of polrcy'rdgcision makers rnobilized at each relevant level dunng the currenrye?r; rhe reason(s) for uadenaking thc advocaoy a,tl the outco,e Describedifficuttics/collstraint-\ beiug fa;e,l arrd suggertions orr hou' to rmprove advocacy. 'An advocacy visit *3.*T"d.out by MITOSATH and Nocp on rhe 176 of March 2006 tothe policy makers of the Taraba State Ministry of Health to solicit among other things therelease of countcrpart fund to support ttre ongting cDn i.o;""t in the state. presentarionswere made on CDTI achiwements as well .r rrlu" rrciH perronnance in the retease ofcounterpart fund' The Pennanent secretary of the Ministry of H*ttt "*pr".rJ "oncern onthe non-perfonnance by the statc in the rilease of counrcriart fund since the year 2000 andsaid efforts will bc made to irnprove the situation. The major challenge faced in implernenting the recommendations reached at the end of theadvocacay was the frequent chaoge of poricy makers in the State. The project will revisit the recomrnendations in Year 2007 when the political environmentis more stable and ensure thcy are irnplemented. At the LGA level advoaacy visit were made lo the chairmen of the endernic LGAs. 60%o ofthe LGAs released counterpar-t funds totalling about $2,000(Two thousand dollars). Theproject hopes to institute a rervard system liki an award to tLe best p;"-;;; chairmanwhich might futher improve their support and commitnent. 2-3, tloblllzefion, rcnrtttra{on and hcalth cduceflon of at rbk communlflcr Provide information on: - The use of media and/or other local systems to disseminate information - Mobilization and health education of cornmunities including women and minorities - Response of target communitieVvillages - Accomplishments - suggest ways to improve mobilization and sensitization of the target corrununities. loslgr! were produced in year 2006 for community sensitization and mobilisation in bothEnglish and Hausa tanguages-These carried ro-r ortn" ["y rr*"irability messages likeo Katabata ka sha Mectizan kowane shekaraiEnsure that yiu take riectizan every year in your community) o ldon ka shi ne karfin ka (your sight is your strength)o Be pan of the community efort tn the contror of'Riverbrindnesso Mectizan magani don kowa sedai mata ^*r"iki,yoran dabasu kai shekarubiyant ba,marasa tafiya sosai,matan da sun haifu satr daya .(Mectizan is adrugfor a, escept pregnant mothers,underfivi ch,dren,'s*)rry sickpeople,women who delivered a week ago.o Karke'e-Idanun ka daga ciwon makanti,sha Mectizan,ko wane shekara(protectyour sight frorn Riverblindness,take mectizan every year) 22 'r&'HO/APOC, 24 Novembcr 200J ! I The posters wcre distnburcd in thc LGAI, HF ard in thc communities. Efforts werc made to sensitize cornrrnroities on thc necd to sclect women as CDDs and ityrelded good resulr as rhe project now ha'c 3 I I trzined female cDDs. Inrolventent of women was also inrcnsifie<l by involvrng women organlsatlons as CBOs andcurrentll'thesc w,omen support the projecr in mobilisation and moniionng. The project hopes to select CDDs even from each househol to reduce workload for the CDD More posters will be produced in year 200? and bc uscd for more indepth sensit:,etion withthe community leaders.The project will atso try to document support given to CDDs by thecommunity leaders.This will help to monitor and assess community ,uppo.t. The.APoC support special country initiative which the project is benefitting from will beused to mobilse mone communiry rrernbcts to be involovd in supervision and encourage more community involovement in monitoring and supervision. 2.4. Gommunlel lnvolvcmcnt Table 4: communities participation in the GDTI (ptease add more rows dnecessary) Table 4: Communities participation in the CDTI (Please add more rows if necessary) I I J l l l l l l .l I Nuohr of communltlcrfolll4cr witf conDudty mcd|hffs rr tulErilor! Nurbcr of CDDI ud thc communities involvcd Numbcr of communities /vtlhges with fcmde CDDs Numbcr of communities with femrlc CDDs Percen(ege Brr= ," 100 Totel no. communitacs in thc entire projcct rrct B. I XunUer yvlrtr I communlty mcttbcrs g supcMsorr Br ?crceatrgc Br: i BJ B, .too I MrhCDIh 81 Fcmelc CDDs Br Totrl Bi= Br+8.Ardo Kola 66 8l 2E 109 5 7.5 Bali 189 281 6 289 7 3.7 Donga r50 20t IO 2u 8 5.3 Gashaka 66 145 3l t76 4 6.1 rbi l,+0 357 37 394 l8 12.8 Karim [amido t57 328 t6 344 l5 9.5 Kurmi t70 23t 27 258 22 t2.9 Sardauna t72 356 39 395 3l r 8.0 Takum 89 215 t5 230 t3 14.6 Ussa I r0 l3l 37 t4E l4 12.7 Yorro oo 236 44 280 2t 23.3 Zng t52 232 t9 25t l7 lll Totrl l55r 2n1 3tt 30t5 175 I t.3 Comment on 23 WHO/APOC. 24 November 20G{ I t / il I l I I I l l J l I I Attendance of female manbers of the community at hearth education meetingsIn general, how do you rate the partcipation of iemare ..rt", of the communirynreetings when CDTI issucs are'teing di*rrr", (anendance, participation in rhedrscussion etc). Incentives provided by communrtres for the CDDs a[:::ffJ:DDs rs aurhon a probrem for the project? rf ves, how is rr addressed? women are participating more in GDTI either as a cDD or cBo members.communityacceptance of their involovement is improving gaau"llly.- - Some communities provided monetary incentives to cDDs while some gave in_kindincentives' There is however pur.irv Jraata on d; 16;; which is the reason the project ismaking effort to improve data on community rrp;;;',h" iear zoo7. cDD attrition reduced in year 2006. some old cDDs that didn't participate in the retraining ;nffj'[$"JffiH%"Jl"ctme.ctizan,o dir,ribr,","ili;;;"use r-shirs were provided ror 2.5. Capacity building - Describe the adequacy of available knowledgeable manpower at all levels. - where frequent hansferc of trarned staffoccuq state what the project is doing, or intends todo' ro remedy the situati";!T: ioli ip"rront bsue to describe is what mec*ures weretaken to ensure adequailcprr inpli,"jrrorion where not enough lorcwledgeable manpowerwas avatlable or if stalf is frequenity transfened i"r"ii, "Z'urse oythe campaign). The project has a good number of trained personnel.l0 trained socTs (6 currently active inCDTI whire others are invorved i, "th;; p_HCactivitiesiiii6crr, l60rlFs, 3085 cDDs andI103 cBos(some ofthem y.ard Headsj. u"arr,r*ork";;;;;" and LGAs are invorved bothin GDTI and other addons rik. Npi, REM as we, as Nutrition programmes. Frequent transfer of trained staff was not a problem for the project in the year under review.Healthworkers in non endemic LGA;;;;irso rained ";6;h during the vitamin Atraining so that when transfeo do o"cur there wiil be no gap. 24 WHO/APOC, 24 November 20Gt N o -o o z s al Uo o al s o a. E ! q 6 E:E I 50 E \i E \ i \ \ B s\ ! E o oi;t-- oF. a o' !C E s ! L= .!, !i)t Eio 6: o\ oE I s E \ o q. ls 3< : t o\ q) L \ q) v,$q) FoO o ch (D C) q G'H .c)!H ! o (g l 't ) l l l l l J l l l l l l l J l l l l s o q o c q\S \o <t = cl a @ o 7J(J r <t o\ € €; I a -- -l g r\o \oo N \o\t : & r ct = oN € Cg r : 6 = t o, { I € a & 9 r c ,:,. = oo9 EL AA(J o of .o z =o (.\ ?F =.Uc--+ - v ': i- *o t <t o o <t €\o od r+ \o .+ N oo Io\ oN € N =d \o 6N r <tr o\ Fi € =(, E(, a) s @ \o o F r- \o € \o r,. € It ra € o O o) .=G6tr r- tro: .oE t- Gl oL z (.r- i e L\J g '(J S ,,= io o t e <) C) o @ o\ o rt tr1' t ru C'I s s o9 t\o o o cq cq Il6 [: I c.l N r.- l= lcnt- .: lo\[: \o c.t (.I ----l (r)\e o\ rA ! o oq o C' t,o(u -a ca ti !jj (u ! z I 6 u' o F =rdF.r"t ab' q t o sf .t c.) GI \o \o s a.l o\o o 11) a) -oc\ \c Gie t fi $ r+ t $ t $ $ s rf 6l 0 0 IJ9sq, q) Ec! a- o c)& z 6 (.) (JF E.r?F-d .LEq i t (J J c, 0 o l. lo 5l € G trt octcoo I o =c dJ c (lI Ea! 6F G = o Eo e 19 al E e, -co\] I ra ra$ $ ra ra soo ooc is -] t- o F. rt" ': -^T s I t -t Table 6: Type of training undertaken (Tick the boxes where spectfic training was carried out during the reporting period) Any other comments t l 2.6. Truatmcntr 2.6.1. Treatment figures If the project is not achiwing 100% geographical coverage and a minimum of 65%therapeutic coverage or.the coverag;t" iifluctuating, tLr. it" reasons and the plansbeing made to remedy this. In the year 2006 the project achieved g5% therapeutic coverag e and99.g/ogeographic coverage- Tnis happened because one community in Ardokola did not trearbecause the cDD did not collect dnrgs. This has been addresseJ and treannent isgoing on there but thier rcport is not contained in this yru, zooareport. Trainees Typ. of trai CDDs Other Community mernbcrs e.g Community 'rsors Health Workers (fronthne health facilities MOH staffor Other Political Leaders Program management * * How to conduct Health education * * * * CBos Management of SAEs CSM SHM Data collection * * * Data analysis :t * * Report writing * Others (qpecify) 26 \YHO/APOC, 24 Novembe r 2O03 L] ==6J ! -a = 7_ T C .L r- ...l br o\ ql\o tB -vo lr Gt an CO o) r<d (B o *l () k o E (n E] a EE R! tr() E(, o) F l! o o3 E z a o o-s I E8!Eg_E6rzj.9.) " -o4 = €:i z cr) LOoo Eo@o =q o\t r $N N6t \oor N o\ r o\ o o IN No 6l sN Nt \i o\ = 6 dc o N € o o6 Eaz c5eI-E[EE*E- \or- o\ !\o N I$ Nrt r o\ € oo €\o \oa oN oF \o\or\o \{6 r:@@ @ c!N6 q\o@ dl@ oq € n F-@ \ co N \d oo \t F € n\o@ F Yt € \o o aF €@o t-E o6 t+ + 6GI N\o aO \o\o 6 r 6o rt+ o\<tt\o\r 6 r \o o\ N cl I F aFq €o o\o\t N o\6l o.t F-\o € \o\o €\t 6@ $\o €t-\o r- o t--\o F- o\ o\6o a{ 6 a6 r\ \o\o r,- oNFtf \or-N -E-.&sa e = ^E 6F€:*g Er o.o 6 t 68. Ee a o o =od o-Z =E3E .O "86' '=o ru0o6 E'9 so o-E9Fo ec llr oo a ?:5c;;68a o-g o\N No\ o atrd T o\o 6 c N r- Er r{' ct@{o\ Not-o o\tl @I NIF o\ \o\o 00 <t c6 N 6l 6 Io\o F N rt o\6 6t aa n6 o\ oo oI oo oo o0 oo oo q o\ o\ -8c J.o'.2'; &.gM:.5 5 E; E= - 9E ELh>OO o\ E A o b06 .9 .= ca E E oa t)() E troO o oD z Eo Go o 6ao '=u =66 o\oEb:e)gu cc ll .dd a co E:-8;c a -F O \o o\6 o \o\o o = t- or Nr 6@ o o a\ N YlYI \o\o 6 € o ot? r or NF o\6 o o a\ 6t bh \o\o o\@ o: \oE o: r\ or Nr o\6 oo\ n nh .E<!3o\ g ou o = ao GJ (, D otr= L= 6iVJ tr) :l aE t t- 4 -l3 i- I! z 5 .J oc(-.l $6o E- $\ s & =osit- \rL$J{irt 6Us! ()b .(.)so'tgis\ ;!s tJlol >*Utr€EHTt: s!t=$!JEseIigXsti -c @aiEi'Ss € *stH S .s.! 8r s s EE;l-r : At El : s iifla r i,! ;l g s tsEr t iE 6€ t si .He $ sPEIE X .S. zt1 i IS .s EE .I'i! ll s !rr E$$$$I I: r, ! iS9 I SEE i ts st_E i ig) o gt\o L LO .\ = ::S olOIit l0)xl.z EIEgls 9rOItr BIE EIE €lEtrt calc zt< q) c, C) co Gl^ 95 oq) oF ()E(! (.) q) 'a .Luo.!() * o([)E o'LU,o- =.z9Ei JP (.) L o DO(€ Lo c I o^ o alL <)sF -C -O '-v ,a) oEo .=6tr:o Ehts(gtr0oc)o'E Oe, '=-ts or E € =l EF il EH Ul <.rN HI'E> El b ^.o qldtsl3 &? -lE sl6 il 3 H5(6lc .YIO ol .r el 6rt.= 'Et 9ol- =l trEI E EItsEIE HI uHA HELlO Lla El; €l; zIP aIP C) rtl (') o0 c, o oo Eo.: E_- co o o 2.6.2 lVhet are the causes of ebsenteeism? The causes of absenteersm in the project have been traced to culture and practice of some tribes. Some TIV community members move house shortly before farming season and do not return until after the farming season. This therefore makes them unavailiable for treaunent. Efforts are currently on to ensure that treatment commences early in January to further reduce absenteeism amongst these groups. The Nomadic Fulani's are another group that are quite mobile and unstable and are found around different communities of Taraba State. Efforts have been made by the project to monitor coverage amongst the Fulani Nomadic group. The project forwarded an operational research proposal to ApOC which has been given a tentative approval by TCC. 2.6.3 What are the reasons for refusals? Some religious sects in the state do not take any form of drug including Mectizan. They contribute to the refusal figure. A -fg* community members also refuse because of an earlier side effect especiallyitching when Mectizan distribution started some years back. The CBO members are playing an important role in sensitizing these groups and rhere is improvement from what it was last year. 2.6.4 Briefly describe all known and verified serious adverse events (sAEs) that oc_curred during the reporting period end provide (in table g) the requiredInformation when available. In case the project did not have any cases ofserious adverse events (SAE) during this reporting period, please tick in the box. No SAE case to report * 29 WHO/APOC. 24 November 2004 al ! ) z Y .J 'r O q) \) o' q) -o q * :.t U4 g Uq) S \p o t B q)q \Jq) o-\i- 'o o L C) o. o0 .E o o. C)L o) @ L '(, G) H ooo (g t/) rLl U) lr) tro o) c) U)L a) T' c, q o 0.)0 o ooq(! a ddr ..1 -ol -lLI J J l l l I I I I I oc oo>c oo dlo oq =EEO o.=OO o{tr G co I! Irlo.2 cqb9gEo aooa 'oI !iE o o o i I I I =-ItEEa O E E= 6000o€,Ee I.s tro o3-cb E€EE E €-9oo.N #gEEE Eo o. x(A Eoo9 s3tro.xo.6qqt C)(t o E* EgE o oao-ct.= =c0 -o I xoa q) oo _ ]*_ I a slo 50 PSs -><- -oL) a.a € o\ l-lo. to o 6o q o\ q o\ \Cic\ o6 t n: td l LJ o ^aoUc^r- bS o o 3u)96^O-F-od oo\ ooEOF Eo 6o co o o. -Eed o.= =EEc (,.:<86 E;-5EI-= - O Ef gto o o d o\ I r-o o r-o o @o q o\ o\ ri o\ \oo\ \o\o @r\ @F- ai@ \rco .'6 O € € r\ r; @ t7) F-rc aso\ o\\o @ rr)to @ rol6-l 6lol6l l-- l ool ;t@l o\+o o\ .f t-- 6 o\ .+ 6r-\o o\ r- o\rr o\\oo oeo^ loolrl o 8 o \Oi o 8 o F- o 8r olot ool o8 otctl6l o 8 or)6l oI o €i oFrr- ao!f o\ O r.- =r\ol r-lO\l (.l\or\ol c.l c{ No ol c{ alo \o$\o t\o c-tr- \ooo o\ \o r-o (-l otNo t'r GI @o o\ €to\c{ !f ot @ oio\ o^ t o\@ odI c.t q() o0s =a o c EF o() e6 ll . rd I{ lll o oF^F bS<>v -o o 6 € o\ .+ o\ \o oi o\ @ d, o\ r- + o\ Ot dt@ oo o\ oi o\ €t"tE=EaliSU 9-tili (,oi € @ o\ +o\ \o oi o\ @ dt o\ r-t o\ oo\ d@ oo o\ oi o\ l{ oio!ESE; E= I; E? ts >O,i @ @ 6fa (\6t \or- $ .f c-\o o Ll --odo.a E 5."u "86 t\o $\o @ o\ 6(\l F.o\ r-o\ l'-o\ v g =6:* g t E *.9E *' E E.E <.: E E gE5tr Ec5oI .c\o t\o € o\ €6t r-o\ r\o\ t--o\ .C ) d T:] r- o\9 @ o\I o\ o\9 Iocl ooe.r oloo6l ooa.l !coo a.l ooN \ooo ^l l'-oo oa @oO6r o\oo a.t o at $ at ! ! z $N o J. an 0 cl c.) Gt(.| q) oo(lt o o(J J I I I I I I I I I I t () t-r -Dil-b-t: \.i9l s9&E rr^,E$s E :.:E sqe ABH o)uc)5N: ^vEo = gE 3u sCJO)- ;E I .9p IP.E Io.E I F BP U X\E:{ CdlLol r.lGlE=l c, EEI E e*l EO) ol .E E3lIJ 8og E E!tr>o E!U T CF =C€)iE.gEc)ij9trq.r f-E6 -C)q)qi€\O'._ tr ,.i 6l ';()l 6 EI E .J ! ) Z N Fr ol aa Ec .9 .= E E o O o o -otr tr (l o o @ q d C) atr -o(.)ro o oo(d Ok C!o e.l oJ ..o (.) '1, G) 0q ro (g '= E o() oE oa .Eo !o (,)0(.) () G' -E \d .95 .= ..t cr)hh() -o(!ecr)OO = c.l -5c * a.l t- I I l I I I I I I I I I I I I I I I 2.7. Ordcrlng, storegc and dcllvcty of lvcrmrcdln Mecti answer)tick the appropriate UNICEIJ Mectizan@ deliyered by - Qtlease tick the appropriate answer) MoH D wHf,I UNIcEd Other (please specify): Please describe how Mectizan@ is ordered and how it gets to the communities Usually the NGDO partners orders for and collect the drup on behalf of the project, which then collects the drugs (from the NGDO head office) for delivery to the various LGAs. In most cases the drugs are collected by the I-GAs and delivered to the collection centers. The communities collect the drugs from the ccllecdcn centre. However as a result of lack of funds most LGAs could not deliver the drugs to the collection centers, a situation that made the NGDO partner to intervene in that regard. Table l0: Mectizan@ lnventory (Please add more rows if necessary) How are the remaining ivermectin tablets collected and where are they kept? StatelDistricU LGA Number of Mectizano taUtets Rcquqstcd Reccived Uscd l,o5t Wlstcd Erpired Remeining Ardo kola I 34000 134000 131476 0 0 0 2508 Bali 268000 258000 268m0 0 0 () 0 Donga 20t420 20t420 r97l8s 0 0 0 25574 Gashaka 124940 t24940 123737 0 0 0 t203 Ibi r65000 I 65000 164405 0 0 0 595 Karim Lamido 427295 427295 426176 0 0 0 r88r6 Kurmi 185000 r 85000 l8314 r 0 0 0 I 859 Sardauna 380000 380000 379%2 0 0 0 0 Takum 203288 203288 20t6t9 0 0 0 9t4 Ussa t76937 176937 t7455 0 0 0 408 Yorro r85000 185000 182!)61 0 0 0 2039 Zing 295000 295m0 2945t9 0 0 0 481 TOTAL 2,783505 2,7t35oti 1729,5t0 0 0 0 75405 33 'M] O/APOC. 24 Nor embcr 200-4 MOH Other speci!): I I The remaining Ivermectin tablets were returned by the LOCTs to rhe SOCTs in charge of a particular LGA.The remaining tablets are kept in the State onchocerciasis Control office store and later camed over for Year 2O07 treatrnent. - List and briefly describe the activities under Ivermectin delivery that are being carried out by health care personnel in the project area. Health workers are involved in planning, community mobilization, training, supervision and data collection. PLANNING As the year 2006 ends, plans are in place for the implementation of special country initiative sponsored by APOC as well as other haining and mobilisation programs.Healthworkers are involved in the planning of the programmes at the state,LcA and disrics. COMMMUNITY MOBILISATION The healthcare personnel will use availiable IEC materials and face to face contact ro mobilize the communities under their supervision.The CDD guides them on issues of concern which becomes the main focus during the mobilization with the aim of solving problems where they arise or comnending the community for their support. TRAINING Training is usually carried out in a cascaded manner. SOCTs trains LOCTs, LOCTs trains HFs who in turn trains the CDDs.In year 2007 a lot of training will be carried out at all levels. Inorder to have an effective cascaded training, capacity of the healthworker will be improved and further enhanced especially on data collection, verification and management. SUPERVISION Documentation of findings during supervision is usually carried out by healthcare personel.Supervisory checklist were not used during some of the supervisory visits in 2006. ln 2007 efforts will be made to improve documentation of frndings like support by the communities,identified data management problems, and other important information for programme improvement. DATA COLLECTION The CDD collates the community treatnent data and submits to the HFs in charge of his collection centre, The HFs submits to the DHs who then collates for his area and submits to the LOCT. The LOCTs collates for the LGd summarizes it in an LGA summary form and submits to the State.With the training/retraining on data management ,data retrival and management is hoped to improve in the years ahead. Any other comments 2.8. Gommunlgl rctGmonltodng and Etakchotdcn tcctlng Has any training (of trainers) for community self-monitoring been done in the project area? None was done during the period under review.However the project is planning a follow up on implementation of CSM/HSM in some LGAS that started implementation 2 years ago and will also initiate it in some communities in year 20O7. 34 \W{O/APOC, 24 Novernber 20Otr I I I t I If so. When? Table I I : Community self-monitoring and Stakeholders Meeting (Add rows if needed) Describe how the results of the community self- monitoring and stakcholders meetings have affected project implementation or how they would be utilized during the next treaunent cycle. 2.9. Supervlslon 2.9.1. Provide a flow chart of supervision hierarchy. SOCTs--- LOCTs-*DHS-HFS---CDDs-,COII{MLII.IITY MEMBER.S 2.9.2. What were the main issues identified during supervision? The project carried very minimal supervision at the LGA and FLHF in the year 20O6. Supervision for the year 2006 focused more on finding the level of uiilization of newly trained CDDs and CBOs and their effectiveness and their input's effect on reduction of work load by the CDDs. l.The main issues identified was that most of the new CDDs and CBOs trained supported CDTI but were more involved in mobilisation and monitoring. The old CDDs still laid claim to distribution and recording. 2.Another issue identified was that there will be need to produce more community registers and clearly deline roles and areas to be covered by each individual in view of the new hands availiable for CDTI activities in the community. 2.9.3. Was a supervision checklist used? Supervisory checklist was designed and used to enable health workers address the utilization of newly trained CDDs and CBOs. 2-9.4- What were the outcomes at each level of CDTI implementetion supervision? When these issues were identified at the community the attention of the health worker in charge of the area was drawn to it as well as the community leader,who promised to discuss and find solutions to them. 2.9.5. Was feedback given to the person or groups supervised? Feedback given was on the spot instruction of the CDDs io collaborate more with the new hands stressing that they were trained to hetp them in the work and reduce the workload. 2.9.6. How was the feedback used to improve the overell performance of the project? There is going to be more follow up on the issue of roles and responsibilities of the newly trained CDDs and CBOs as the issue will be discussed at the review meeting coming up in January 2007.The recommendations that the review will come up with will ielp in iinproving the programme. 35 WHO/APOC, 24 Novcmbcr 200-l SECTION 3: Support to CDTI 3.1. Equlpmcnt Table l2: Starus of equipment (Please add more rows if necessary,) *Condition of the equipment WO=Written off). (F:Functional, CNFR:Currently non-fu nctional but repairable, **APOC has approved to provide one new additional Hilux for the state which is yet to be received by the project. How does the project intend to maintain and replace existing equipment and other materials? Regular servicing and use of l,og book will be employed to make sure the available equipments last long. The State has plans to replace ttre venlcb but this can only happen iffunding is regular from the Government. As is the case in the past two years now,anyother programme that wants to use CDTI vehicl es is mandated by the Director PHC to service it or effect minor repairs before use.This is a short term measure until the State government start releasing counterpart frmd. Source Type of equipment APOC MOH DISTRICT/ LGA NGDO Others No. Condition No. Conditim No. Condition No. Condition No Condrtron l. Vehicle** 3 F I CNFR I F 2. Motor cycle(s) 20 l5-F 5- CNFR CNFR 14 F 3. Computer(s) 3 2-F l- CNFP, I F 4. Printer(s) 2 l-F l- CNFR I F 5. Photocopier (s) 2 l-F l- CNFR I F 6. Fax Machine(s) I l-F 7. Others a)FILLING CABINET I F b)BTCYCLE 20 F c) 36 *'HO/APOC, 24 Novemhe r 2004 b) 3.2. Flnenclal contdbu0onr ol tho prrtrrm rnd cornmunlflrc Table l3: Financial conributions by alr par&ers for the lasr ilree years *The state government paid the salary of it's staffinvolved il the project,and also supported the maintenance of some of the project vehicles **CBOs were involved in the mobilisation and sensitizatior of community as well as monitoring of compliance. Efforts are currently on to quanifo their support. ***MITOSATH's contribution is for Ivermectin disributionr, Sorre Vitamin A add-on activities like production of IEC materials and data veri fication, Nutrition Education, Rehabilitation and Schistosomiasis survey. All these activities used the CDTI structure forimplementation. - If there are problems with release of counterpart funds, how were they addressed? There had been several advocacy visis to the MOH by the parher NGDO on the subject. we arc soliciting for High level Advocacy maybe tne ePbC aduoc""y team to see the Governor of the State on behalf of the project. l,ast year's emphasis shifted a bit to the LGA and it isyielding good results while efforts are still on for the ieleasc of funds by the state. - Additional comments 3.3. Othcr iormr of communlty rupport - Describe (indicate forms of in-kind contributions of communities if any) In-kind contributions by the communities arc m:rny and rraried- They could be foodsruffs, assisting the CDD on his farm, donation of some gifl items, nominations to represent I I Contributor Yeer 7 (2OU) Yerr 8(200J)I rornrI cr.t Budgeted {us$) TOTAL Cash Released (us$) TOTAL Cash Budgeted (us$) 1OTAL Cash R.eleased (rrs3) TOTAL Cash Budgeted TOT,{L Cash Released MOH (Central + Provincial/State) 0.00 0.00 0.00. 0.@ 0.00. MOH (DistricI/LGA) l I 13,765 t,923 12,s00 2,000 Local NGDO(s) ( if any) CBO** Yct to bctr quantiticd NGDO partne(s) MITOSATH 70,6t9..54 CBM 35,125.15 TH 70,6E9.51 CBM t25.16 MITOSAT}I 3 l,l 96+'. I 1.196" MTTOSATH 3Or5 I 9... MITOS^TH 25,794..r Others I T I Communities Yet to be.r quantificd APOC Trust Fund 6,700 0.00 0.00 6.700 E22E 8,228 TOTAL I13,5t4.9 106,8t4 I:g,ars 51247 36,022 37 \\'HO/APOC, 24 No,r.cmber 200.1 conlmunlty in duties rvhere momentary compensations are gi'e. e.g.Immun ization exercise . lhs National The CBos are also provided support for mobilisarion ,supervrsion and monitoring which isvet to be quantified. 3.4. Expcndlturu pcr actvlel - Indicate in table 14, the amount expended 9y"g the reporting period foreach acri'iryIisted' write the amount expended in US dollarJurirg irr" .,r*r united Nations exchange rate to rocar currency. Indicate exchange raie used herc niir'to $l 38 Wh(l/'APO(^ J4 Nqr crtrbcr 2r./(r.l Table l4: ':.Hi"":;ffi:n the project spent for each activity risted berow during the Drug deli communi rvery from NOTF ty HQ area to central collection point of lMobilization and health education of communities Training of CDDVCBOs Training of health staff at all levels Supervising CDDs and distribution Internal monitoring of CDTI activities Advocacy visits to hearth and poriticar authorities IEC materials iummary (reporting) forms for reannent I Vehi c leV Motorcycl ey bi._yq!"_l mgrrlglrgg_ 9T". Equipment (e.g. computers, printers etc)Others{.**** *Summary forms were produced along with other IEC materials.**Internal monitorir ..1rT;il;.;-"iil1,tr"ilxff $3.,T+il',I'trIfi ffi:ll1*ro.ArHprojectvehicrern the fierd'MoH effected.ro-" i"puil on tn" Apoc .s project vehicre. - J*#,1 ;:?ffi:L'#il1,fr. * tmff;o ffi6ie rH starr to attend re,evan rAny comments or explanations? d|r?:otoved the p"th*t oi i-p-J""t vehicre for Taraba CDTI project which is yet to be SECTION 4: Sustainabiliry of CDTI 4'1' lntcrner; rndcpcndrnt perrcrpetory monrtorrng; Evarua*on 4'l'r was Monitoring/evaru",ioo^:".ri{. o1t during the reporting period? (Tickany of the fottowing which are eppliceble) E Year I Participatory Independent monitoring Mid Term Sustainabiliry Evaluation 5 year Sustainabilirv Evaluarion 3c) \\riloiApoc. 2.1 Novernber 2(x)t Acti Expenditure US Source(s) of fu 393 {.:l rl s00 12,500 50 400 8,900 400 75t 12,229 MITOSATH MITOSATH MITOSATH MITOSATII LGA,APOC, MITOSATH MITOSATH MITOSATH MITOSATH STATE,LGA MITOSATH MITOSATH APOC TOTAL 36,022 treatedTotal number of 1069797 Nigeria 4.1.2. Whet The results of this with Ivermectin achieved with I 4.1.3. How The project is ensuring that detailed listing of all Training ofmore CDDs and therapeutic coverage. 4.2. $ustalnablltty yr 3) Was the project evaluated during tk> Was a sustainability plan writtco? When was the sust4inabili0/ platr What arrangements have been maalc tb 4.2.2. f,'unds APOC funding ceases in terms of: state, because a + 4.2.1. ptanning at ellrel0rdnGiErAs , Partners at alr revers --st"rc, racEffi-dnmr"ity and MrrosATH _ are involved inplanning of GDTI activities. rvery paraii h^",itr;;;rI-rrni.t is usually hannonized andadopted at the annual review.""do;-=' Release of counterp*-ryd by the state has been very difticult. Efforts were made in 2006 toseek support from the LGA and CBOs. - 4.2.3 Transport(replacementandmaintenance) The state and NGo jointly'*ppo? epoc in tht;;;;inence of vehicres in the state.Motorcycles are mantained- by id" iG;- Bicycres "* .*out a to be maint"in"a by the ffitt community. There is uo upptrur fo, trr" p,rotle one new hirux vehicre by 4.2.4. Other resources The project plans to mobilise resources at the LGA by instituting a reward system for LGAChairmen supporting CDTI..Modalil;f; this wiil b. d;;;; at the Review meetrngscheduled to hord in January zwT.rn"oairion a totar "a ,t;;"rs of cBos from the r 2endemic LGAs have been invited,",rr.J^r*.y review meeting to discuss areas of support 40 WHO/APOC, 24 November 2004 t*'. hish NO a{l - -f ,Y t III ' 4.. t_i s . E: -' Ii[ Itlt4/l I ] .s y sr! -- : ;{ r, It a 1{ 'f rt i}.'1 . ; -i ,]pvfiru 't' ,-* tt**t:/..; I+r C +'i especially at the district and community level.At ttris meeting video clips of the disease andefforts by other donor partners will be shown.This the pro1.J, believes wrll consiencerrzethenr and gamer support. 4.2.5. To what ertent has the plan been implemented Plan has been implemented but source of fund is different from the source proposed in theplan due to non release of counterpart fund. Indicators of succsess.seen in the implementation of plan includes fund released by the LGAsfollowing advocacy vists,Procuremits of mec izan,icizan delverea to LGA stores,retnevalof tratment data,production and dissemination of tEC materials,Maintenance of vehicle.Fieldvistts to the field,etc. .3. Integration outline the extent of integration of GDTI into the PHC stnrcnrre and the plans for completeintegration: 4.3.1. Ivermectin delivery mechanisms CDTI has been integrated into prrc stmcture in respect to Ivermectin delivery mechanisms for example ,calculation of mectizan need is from bottom op.riom ne toLGA,LGA to state and then to NocP tlrough r.icoo.me siorage 6f ivermectin aswell as the release to the LGA is carried o,rtiy ure strte.m are also collection centre/Inventory centres for ivermectin delivery at the distict *a "o-n1rrril levels.. 4.3.2. Training Training involves both the onchocerciasis and Nutition unit of the pHC. A list of all thethe LGAs Healthworkers (both those presently involved and those not -roir.al nu, u.",compiled this is to enhance their involvement'in ttr" coiipiograrnme. ln zooT specificallyarrangment has been made to involve Guineaworm Survellence ofhcer in CDTIimplementation. 4'3-3. Joint supervision end monitoring with other programsSupervisory visit for other PHC activities like RBfu, rupi-Jiitamin A distribution isrsually used to supervise CDTI activities as well. 4.3.4. Release of funds for project activities Release of counterpart fund by the state las been very difficult because the little they get issaid to be for all PHC activitiis and priority is giving to disease like Hrv,polio,RBM . Effortwas made in 2006 to seek additionaf support specifically ac from chairmen at the LGAthrough the PHC coordinator. This yielded very good r"*ii", tn" project was able to trackhow much the LGAs actually budgetea and released. 4.3.5. Is CDTI inctuded in the pHC budget? Yes. 4t wHO/APOC, l4 No.,.errrbcr 100_l 4'3'6' Describe other heelth progremmcs that are using the CDTI structure andhow this was achieved. whet heve been the achievements?Vitamin A supprementetion Assessment in Terebe state The prolect used the GDTI strucrure to support vitamin A supplements to chrldren under fir,eolage and postparrum mothers. This lasiiound rd;1";;iration activiry was carried ourbetween october and November 2006 using LID and IpD lampaign as directed by NpI andul"iICEF' Some of project's-earlier planned activities rike training, communiry mobilizationand supplementation by the cDDs courd not take prace us ttey were taken over by L'NICEF.Nonetheless the gaps identified like the need to carry out post LID monitoring, productionand distribution of IEC materials, supervision ldata veification *ere filled in order to achievegood coverage. The cDDs were who have earlier been trained on the dosage and benefits of vitamin A wereused as community mobilisers during the v]tamin A rr;;1";.ntation excercise. They werealso involved in some communitiesL local guides for the.ouir" teams. Data collection hasbeen complered and.the-overail-coverage.for.iil q "rg"ig", ps is g2%o.coverage for 6_r rmonths is rr2**%o,l l-5g months is aE'% while ppM is liy.. -' t:'#;T,"'Ji:""J#l?'iilHili;sc ,.tc which resultcd mainlv fiom thc verv high covcragc nrc for rhrs tarscr Foup submitrcd Commu nity Based Rehabilitetion With mobility and orientation already carried out for more that 100 blind beneficiaries inGashaka LGA' The s}qe Yas-set foiimplementation orcg[rne present two key areas offocus are Medical and Agricultural Rehabilitation. rte rorio*irrg has been achieved;l.Sening up of State and LGA nionitoring Committee ^Z !91etonm-e-nt of a joint implementation-ptan. 3. Kicking off of Medicat Re-nabilitation. 4'Arrangement in place for the provision of Micro credit for 3g of blind farmers in 2 pilotcommunities by February 2007. In Rehabilitation, the cDDs were used as mobilizers of the blind people to take up the cBRservices availabre rike free treatment, joining the blind peopre cooperative in theircooperatives in their area in order to Gnefit from sociainiuuititution . This has realty helpedthe blind communities in the improvement of their sociar rives. VISION 2O2OT rroject is carry out free eye care services in MITosATH's field office Jalingo.The StateGuverurent have constituted in" st t" virionzozo c"--itt""flans are in prace tocofirmence meetings. Efforts are being made to ensure that the state eye care plan is developed between December2006 and Jan20O7. Sc histosomiasis/LF If rachoma A survey on Schistosomiasis prevalence in Mayo salbe community was carried out and-shared with the Federar Mrnisry orn""r,n (LFTSchistor";;i unit). The FM.Happreciated the effort 1d said they will be willing to provide Lchnical support when needed.Discussion has reached.- S"g"" statcfor control using treatrnent and Health Education.cDDs and Health Facility Staffs are iniolved in identiling children with schistosomiasis andalso in screening eyes foi trachoma and ottre, eye interventions. 42 WHO/APOC, 24 Novernber 200_l Also some LF research work has been on in Taraba, the most recent one was prevatence rnapping in one LGA handled by University of Jos in collaboration wirh MrTbSATH.The result is currently ben analyzed. Prelimnary result showed prevalence. In ustng CDTI structure to carry out other health interventions, there has been appreciable success like increase in community aw,ueness and mobilization, increase in coveiages and early retrieval of reports. Survey Baseline study on the nutritional status of Mayoselbe, one of the Onchocerciasis endemic communities was carried by project. A total of 84 community members were interviewed. The CDDs were used as local guides and monitors. The baseline data is available and will be used in monitoring impact as interventions in Nutrition continue. Nutrition Education In Mayoselbe community of Gashaka LGA Nutrition Education was also carried out rn collaboration with UMCEF.A total of l8 TOTs were trained on rhe 3 KHHP packages, which are care during Pregnancy/ Infant Nurifion and complimentary feeding. The TOT's trained the communities while the implementation team played supervisory roles. The Number of community members that participated ranged from 96-- 106 and sometimes about a I 12 attended training. Some of the immediate outcome includes; o Increased care for pregnant women at home, adequate nutrition and enough rest for them especially on the part of family members. o Improved aw:rreness on seeking for antenatal and postnatal services. Also, A total of 18 TOTs were trained on utilization of Key Household Practice on Disease Prevention and Management.These included CDDs,TBAT, CgO Members and tIFs. 90 community members participated in the training the first day and 93 the second day. Participation of men increased in the course of the training. The village chief took part in ilt the trainings. The involvement of CDDs and CBOs in the community Health programmes such as this is really helping bridge the gap between community activities carried ort Uy CDDs and services availiable at the [IF. 4-3.7. Describe others issues considered in the integration of GDTI. 4.4. Opratlonel rercelch 4.4.1. Summarize in not more than one half of a page the operational research underteken in the project erea within the reporting period. An operational Research on Sustainability of Ivermectin Distribution System at Comrnunity Level Based on the Hamlet Kinship System: A Study of Selected Communities in Taraba State was undertaken during the period under review, after the subrnission of the baseline data. Post intervention monitoring was carried out. Data obtained is currently been analyzed 4.4.2. How were the results epplied in the project.l SECTION 5: Strengths, weaknesses, challenges, and oppormnities - List the strengths and weaknesses of GDTI implementation process. - Lrst the challenges and indicate how they were addressed. +t \\1IO/APOC. 24 Nrr,crnLr:r l(rGl STRENGTHS I' Abiliry to use GDTI structure for other Add-on interventions.2' Ability to select and train r"-"r" cDDs rra cgd't" i,,p.ou. the invorvemenr offemale CDDs and promot. g.na"r lulance.3' The take-off of ti:e to-ti*il- Based Rehabiritation was an opcn door for donorinvestrnent in arelof educatiori, provision "f ;i;;-e water and sociar amenities. Itwas also a means of encouraging oth", int"*"n,tJnr. ----, : At"'i'f,J:rfi*:"" 'na os"riu'ui" r-rr,i* ,, lii cDDs and cBos, which greatry 5' Ability to showcase impact of Ivermectin disribution using CDTI structure which isimproving donor confidince ana nopea to encourage more support. WEAKNESSES counterpart *orrt.-^l^ Despite the high_ rever advocacy to the state as regardscounterpart fun4 the state govemment is'yet to release fimds.Frequent change of key poricy makers at itre state and LGA revers. "?,j*,:,y"Bthe use of tir" ,";_li";;.L__*iry rr_."o.;s by some non_ 2 RECOMMENDATIONS The project is recommending that Apoc sup.por a high rever advoc acy toherp securecounterpart funding for the CDTI project at the State leve!. SECTION 6: Unique features of the project/other matters The project last yearrnore than doubled the number of cDDs availiable for cDTr activites. Atotal of 1600 new cDps *"t t uir"a ,nni"n io"r"r".Jtrr. ioat nr-u"r of trained cDDs inTaraba CDTr proje* from 1,48i;;; ;;* 2005 to 3"08;-i,;" year 2,,6. ln addition a totar of r 359 new cBos .,"TTl were targeted for frainin g in year 2006 outof which I103 were hained gri";;:iZ" *ioing achievemenlTaraba .DTI project il.".vileG, "ao-", interventions to GDTI rikeI\ c'Rehabilitation,Eye ;*"*;s.;Jtosomiasis control :rnis i, really helping rhe projectto r"rld more capacity aittr,e communif,i"r.r,impr";i;;"; geographic and therapeutic;ffif;e"t#ve also improved communitv utlilr"iion oiffi"ur" serviies at the I I l I I I 44 l\'llo/APO(- 14 November 2(r(}4