Adamawa State 6 months report on Community-directed treatment with ivermectin (CDTI): June 1999 to November 1999

IAFRICAI\PROGRAM FOR ONCHOCERCIASIS CONTROL (APoC) 6 MONTHS REPORT ON COMMUNITY DIRECTED TREATMENT WITH IVERMECTIN (CDTD ADAMAWA STATE, NIGERIAI,i I JUNE, 1999 TO NOVEMBtrR,tggg. t ADAMAWA STATE SECTION I: BACKGROUND INTRODUCTIQN: Adamawa State, .r.iGi-L.ilh" d"funct Gongola State in August, 1991 is located o. the northeastern Part of Nigeria' The State..lies between latitude 7" zlr and l0o 55 I and longitude llYz' and 143ho East:' There are 2l Local Government Council areas (LGAs). The State lies within two notable vegetational zones, the sub-Sudan Savannah with short grasses and spar:e trees in the northern part and the Guinea Savannah marked with tall g*tttt in the southern zone' The presence of few dotted mountains along the Camero*iu1 border where three major rivers and have tt ei. sourcl, has given the laid undulating landscape' These *-ut"] courses with their tributaries have traversed and turned almost thJ entire land area arable for agricultural activities and nice breeding sites for the Similium Damnosum. The State has two main seasons, the dry and the rainy seasons' The rainy season begins in April and ends in mid October with ui"rug" rainfall of 759 mm in the northern parts and l0llmm in the rouit"* part, particularly-around Ganye and Toungo LGAs' The wettest months, which ,ignify tfre peiioa of highest rainfalls, are August and September' The dry season starts from the end of October"to Ap.il, with the driist months being January and February when humidity is as low as l3o/o' The State is multi-ethnics with varied cultures, languages and dialect groups. Their rural settlements are in large and small satellite groups,-wtricfr are often than not along socio- cultural, and language lineage. Despite this apparent diversity the people are still lo^und together by their natural hospitality' political/administrative struciure oitt. State and few common languages like Hausa and Fulfude which u." *id"ly spoken. This is in addition to English, which has been adopted as the official medium of communication' Onchocerciasis is prevalent in 17 out of the 2l LGAs in the State There are nine hyper- endemic LGAs and eight Meso endemic LGAs. In some of the Meso-endemic LGAs only few heavy foci have been noticed. Only nine (9) LGAs out of the 17 LGAs are presently enjoying the support of African Program for Onchocerciasis Control. However, the program is in the State of expansion with the Mectizan Distribution Program, which has almost reached every endemic area rvith Mectizan drug in this treatment season. Approximately 1,364 communities were receiving Mectizan treatment before APOC assistance started coming in. The number of communities under Mectizan Treatment has now increased to t,zlt "following the APOC support, which became effective from July, 1999. I I 4 The Project is in the ls year of CDTI implementation which came to being with effect from June, 1999 following the presence and supports of HKI and APOC. Before now it had been Community Based Ivermictin Treatment approach where the Governments (State and LGA) in collaboration with their supporting NGDO bring the drug to the doorstep of every recipient without meaningful contributions from the communities (in cash or kind). Now with the CDTI approach, the frontier of partnership has been expanded to four thereby including the benefiting ccmmunities and th; APOC. A community refers to a group of people who recognizJd and fall under the leadership of a government recognized traditional leader. The popu-lation of communities vary and most often along language and cultural group(s). NUMBER OF ENDEMIC COMMUNITIES AND TITEATN'IENT ROUNDS. SECTION 2: YEAR 1. CDTI IMPLEMENTATION (IST 6 NIONTHS) Note: Sonte commutti lies have expressed lheir willingre,ss to sttpport lheir CDDs, however, we ore yet lo determine how many xrpported them ei'ther in cash or kind. fhis will be determined al the end of otr-going Mectizan lrealment, come end of Decenrber,l999. I 2 4 L s/ll LGA IIyper Endemic Communities Meso Endemic Communities Communities under Treatment before APOC Communities included in APOC Treatment Round I GOMBI 140 107 107 7 2 MADAGALI 213 213 213 7 3 SONG 280 105 280 4 4 GIREI 6l 6l 61 5 JADA 289 164 289 6 SHELLENG 52 l8 52 4 TOTAL 1,03 5 668 1,002 2-7 sa{ DistricULIGA #of Commtie s/Villages #of Comms/Y illages which selected their CDDs #of Comms/V illages which Collected Drug #of Comms/Yilla ges that decided on the method of Distribution #of comms/Yillage s which decided on the months of Treatment #of Comms/vil lrges with trained CDDs #of Comms/Yilla ges paying CDDs in Cash or kind. I JADA 289 289 289 289 289 289 ') SONG 280 280 280 280 280 280 3 GIREI 61 6l 61 6l 6l 61 4 GOMBI 80 80 80 80 80 80 5 MADAGALI 161 l6l 161 161 l6l 161 6 SHELLENG 52 52 52 52 52 52 TOTAL 923 923 923 923 923 923 I) I ,l it S/N 3 4. IN IMPLEMENTATION Z.l The annual training objective was to trained 1,364 programme staffand PHC workers. Out of this, 1,170 were trained for ivermectin distribution. Z.Z The materials used were CDD Training Manual, CDD Guide, and Flipchart, provided by Helen Keller Worldwide and APOC Respectively. 2.3 There is need to increase training of trainers, more training materials and better scheduling of time and venues close to treatment communities. Training materials produced by HKI to supplement those already produced by the State: DISTRICT/LGA No of Training Undertaken No. of TOT Trained No. of District or LGA Staff Trained in CDTI No of Eealth Centrer/Post Stalf Trained in CDTI No of CDDs Trained JADA 1 4 9 Not yet trained 384 2. SONG I 4 8 (a 2r7 GIREI I 2 8 <a 65 GOMBI I 4 l0 <a 155 5 MADAGALI I 4 8 aa 283 6. SFIELLENG I 2 6 a< 47 TOTAL 1 36 49 1,150 SAI ITEM QUANTITY PRODUCED QUA}ITTTY ISSUED BAIAI\CE I Household Cards 20,000 a Community Register 1,000 100 900 3 Community Summary Treatment Form Big Small 2,000 3,000 500 1000 1500 2000 4 Community Treatment Form 2,OOO 1000 1000 5 Adverse Reaction Form 2,000 500 I 500 6 LGA Mectizan Treatment Form 1,000 500 500 7 State Mectizan Treatment Form 1,000 500 500 8 Mectizan Inventory Form 2,000 500 1500 9 Posters 2,000 1000 1000 10 Information Brochure 2,000 900 I 100 lt HKI Training Manual 186 70 ll6 , 3 3t II TI TION O MM Z.Z.l During community mobilization and education of target communities, personal face- to-face contact as well as town criers were used to mobilize the people. 2.2.2 Mobilization exercise was satisfactory, however, more intensive efforts need to be done to increase awareness and involvement in the CDTI implementation. 2.2.3 Most communities have responded favorably. This was evidenced by the level of community involvement and support to the programme. 2.2.4 More time for mobilization and education needs to be included in our timeline of activities. Emphasis during training of health workers need to be increased in this area to improve the awareness and further increase the community support' LGA staffneed to step up efforts in mobilizing leaders and their subjects on regular basis. SECTION 3: ACHIEVEMENTS: @juststartedCDTIimplementation(aboutsixmonthsago),the following achievements have been recorded. 3.1 fiave been able to train 36 trainers (LOCT), 49 district health supervisors and 1,150 CDDs in CDTI Mobilized and health educated 923 communities. Drugs have been collected by the communities and cannot determine treatment now until treatment s have been retrieved. l i I -1 I I , ! 'l t: 3.2 33 treatment is on gotng, so we No of NGDO staff involved in Mobilization No. of MOH Staff involved in mobilization No. of Advocacy Visit to State or Regional Dircctors of Eealth No. of Comm./ Villages Mobilized No. of Comties/Villages which received HE about Importance of Ertended Treat S/N DISTRICT/LGA 222289JADA 289I 22252SHEI-LENG 52) 2)261 6l3 GIREI 242280 2804 SONG 24a/-80 805 GOMBI )42l6l1616 MADAGALI t218)923923TOTAL No. of Treated Communiti es/villages with summsry forms. No. of Comm./Vill ages which CDDs is a health worker No. of Distributio ns supervised by health workers Cost per Person treated No of Target Communiti esAy'illages Treated No. of eligible persons Treated DistricULGAs/N None289JADAI (( 280SONG2 aa80GOMBIJ l6l4 MADAGALI aa 525 SFIELLENG ((6l6 GIREI a923TOTAL I ln a SECTION 4: 4.1 STRENGTHS/WEAKNESSES/SUGGESTIONS EEALTE EDUCATION/IYIOBI LTZATION COMMUNITY PARTICIPATION SUSTAINABILITY a STRENGTHS \ryEAKNESSES SUGGESTIONS TRAINING: Training was organized and conducted by the NGDO for SOCT and LOCT members who in turn trained the CDDs at designated centres in the LGAs. Some LGAs and communities were not adequately informed on time about the dates for training Inadequate Training Materials Too many trainees at a session. a a a Need for more tramrng materials. More trainers should be trained Adequate and earlY notices should always be sent to LGfu and communities during any activitY. a Community particiPation was quite encouraging rvith State, LGA and NGDO offi cials involved. a Inability to reach and fullY interact with all the communities on the concept ofCDTL Some communities were in accessible due to rains and flooding rivers. lnadequate IEC Materials a a a a More time is required for a community mobilization and health education. Need for adjustment ofperid of communitY mobilization. Production of IEC and Training materials for the State strould be centralized. a STAFFING: Dedicated and committed programme staff. PHC District Supervisors have been incorporated and trained for CDTI Implementation. a Staff are yet to fullY understand the concePt of CDTI as it has jus been introduced in the State. a More SupervisorY visits to be made. More PHC Workers to be trained on CDTI a LGA PARTICIPATION Have recognized the problems of Oncho in their areas Willingrress to support the LOCTs a a Financial Support to the programme is inadequate. a Need to intensi$ advocacY visits to lhe LGA executives. a Most have accepted the programme. Supported the programme financially. Selected their CDDs. a a a No communitY involvement during the planning stage. a There should be more community involvement during planning stage. Frequent visits and mobilization of some of the communities who are Yet to the LOGISTICS Availability of vehicles from M.O.H., APOC and NGDO. No motorcycles, which could be used in areas where vehicle could not, reached. Inadequate logistics support by LCCs. a a State and LGCs should be encouraged to supPort the programme with vehicles and motorcycles. Involvement CommunitY Based Bamako Initiative Committees would ensure sustainability. Emphasis on shifting the orvnership of theprogramme to communities. a Limited time and aflenlion to communities during mobilization. a a Adequate time and attention should b€ given for interaction with the communities when visited. 5 a a a a a n o a a rI 4.7. 4.3 4.4 4.5 4.6 4.7 4.8 CDDS PERFOR]VIANCE OF TASK: lementation, CDDs were motivated by the comm-unity members to carry out distribution activities. I ) rn It TO Most of the communities participated in CDTI during the first six months of activities. This was demonstrated by their level of support to the CDDs during training and for collection of drugs. The communitY members, through the Community Based Bamako Initiative Committees (CBBI) found their involvement and roles quite interesting since theY could also plan, and ParticiPate actively in the imPlementation of the programme. Some communities, through the CBBI committees even went to the extent of Producing ng sticks, community registers and some trainingmeasurl i 0 a materials INVOLVEMENT OF THE NOCP: The National Onchocerciasis Control Programme (NOCP) has been very supportive in the CDTI Implementation and activeiy involved in the training of trainers' It facilitated in the release of APOC funds and advocacy visits to policy makers to enhance political will and supports to the programme' THE STATE IVIINISTRY OF EEALTH: TheStatevtini,t@fu.beencommittedtoherrolesand responsibilities. They have a dedicated team who has been working relentlessly at ensuring the success of the programme. The SOCT members have demostrated their commitment to the programmely agreeing to receive half of their travel allowances, thus, doubling their field visits to ensure proper programme implementation from the onset. CONTRIBUTION OF STATE GOYERNMENT: . ft " St.ut" Covernme-nt has made the following contributions. 1. 1 Toyota Hilux 2. 1 Peugeot 504 Station Wagon 3. 2 Motor CYcles 4. Approval of N3 million counterpart funding during launching of 3mg Mectizan distribution to the programme which is yet to be released' LOCAL GOYERNMENT AREAS: e programme provided funds and logistics for community activities. They were alio involved in the mobilization of some communities. With more advocacy visits in future, we are sure of their better commitment to the Programme. THE DISTRICTS: The various communities are directly under the districts. This makes their roles in COff implementation very crucial. The paramount. chiefs meet frequently with uarious ,iilage and ward heads to discuss how they could assist in the implementation of CDTI activities in their areas. The community leaders met with their subjects, selected cDDs and mobilized members to support the programme. 6 t I t a a 4.9 5.2 d) EXTERNAL INVOLVEMENTi Religious "nd ,or.6.*u-rrfty development organizations have contributed greatly in the implementation efforts. They were involved in community mobilization' and supported CDDs training. It is envisaged that more community organizations would be involved in the n"i futur". Release of APOC funds and logistics supports enhanced the programme implementation' The roles of the facilitating NGDO, Helen Keller International in providing, technical' materials, logistics, ;a;Igerial and injection of funds into the CDTI activities il;;;;"i thJ establishmeit of the p.ogro**". Tlr is courtesy of the Nippon Foundation for sponsoring HKI',s presence and operations in the State. ,t i-x i't SECTION 5 5.1 ua"ron ACHTEVEMENT Or THE.BRO:IEC:T:. t Tt"trttg of CDDs in Centres within the districts b) Involvement of senior MOH and LGA Offrcials in CDTI mobilization and suPervision. c) Community mobilization within the context of CDTI' Community suPPorts to their CDDs. e) The presence of some community leaders and LGA ofticials during CDDs training. CONSTRAINTS AND CHALLENGES OF TIIE FUTURE a) Inadequate number of trainers b) Lack of adequate support to LOCT members by the council officials during CDTI activities. There is the need to meet with the LGA authorities regularly to encourage them to be more committed to the programme' c) Some communities are yet to embrace and accept the programme as their own and supPort their CDDs' d) Frequent strikes bY LGA staff. e) lnadequate availability of Logistics support such as motorcycles and bicycles for adequate Programme coverage.I n 5.3 ASSISTANCE REOUIRED FROM a) GOYERNMENT: o Increase level of involvement of senior government officials in advocacy visits to LGAs. oReleaseofcounterpartfundsfortheprogrammetoaugmentHKland APOC fi nancial assistance' o Increase the number of State workers involved in the programmes' o Increase the number of motorcycles required for adequate supervision at the communitY level. b) APOC MANAGEMENT: o More training and education materials o Supply of more motorcycles for field activities' o Need for bicycles for easy access to areas where motorcycles cannot reach' and for easY maintenance' ^ir1 I \ ! a a E a i I II ,.1 z u, aFl:e3[IvE, d t)o fD FT >GH' \O5'\)Pir ;€(2 -I -a -Eon(+. 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