Ekiti State CDTI/APOC annual project technical report submitted to Technical Consultative Committee(TCC): January to December 2009

EKITI STATE CDTI PROJECT (coluj u@yahoo.com) ORIGINAL: Enelish It COUNTRYAIOTF: NIGERIA Proiect Name:EKITI STATE CDTI/APOC PROJECT Approval year:1999 Launching year: 2000 Reporting Period: From: JAN 2009 TO: DEC (MONTH/YEAR) ( MONTH/YEAR) 2009 APOCfundinsyear: (circleone) I 2 3 4 5 [6] 7 8 9 10 1l 12 13 APoCProiectimple t: (circleone) I 2 3 4 5 6 7 [819 10 ll 12 13 Date submitted: Ministry of Health African Programme for Onchocerciasis Control (APOC) Mectizan Donation Program (MDP) UNICEF NGDO 422 communities , *- ' Partners: 4,1 ,i-;- .i it I It : I I ! ai t.J{ ,l l I .l($P II 1 i I,.$ II l:rfornrof\ct To, \tR LE 2 s Jutll 2010 r { i i ! { i APUC / DIR WHO/APOC, 14 September 2009 ) I - ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) DEADLINE FOR SUBMISSION: To APOC Management by 31 January for March TCC meeting To APOC Management by 31 Julv for September TCC meeting AFRICAN PROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) T 2 t ? WHO/APOC, 14 September 2009ll +1 ANNUAL PROJECT TECHNICAL REPORT TO TECHNIC+ CONSTILTATIVE COMMITTEE (TCC) E,NDORSE,MENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: I I Country: National Coordinator Name: ...DR FAYOMI Signature Date Zonal Oncho Coordinator Name: OT{.INBA A O JAYEOBA Signature: .... Date NGDO Representative Name Signature Date This report has been prepared by Name : MRS C O OGUNBIYI Designation : STATE COORDINATOR Signature Date I I I I I ! ! I I I I I lll WHO/APOC, 14 September 2009 Table of contents 1.1. GENpRelrNFoRMATroN............. 1 . 1 . I Description of the project (brieJly) 1.1.2. Partnership 1.2. Popu1RrroN............... ACRONYMS VI DEFINITIONS VII FOLLOW UP ON TCC RECOMMENDATIONS I EXECUTIVE SUMMARY 2 SECTION 1: BACKGROUND INFORMATION 3 ERnrun ! SrcNnr NoN DEFrNr. ...... Erreur ! Signet non ddjini. ............... J ................6 .38 .39 .39 .39 .39 f 2.t. 2.2. 2.3. 2.4. 2.5. 2.6. 2 ) 2 2 2 2.7. 2.8. 2.9. 2 2 2 2 2 2 3.1. 3.2. J.J. 3.4.r SECTION 2: IMPLEMENTATION OF CDTI 8 TItv,tpt-tNe oF ACTIVITIES ............ ......... 8 Aovocecv ..................... 12 MogtLtznttoN. SENSITIZATIoN AND HEALTH EDUCATIoN oF AT RISK coMMuNIrlgs l3 Cor,tvunrry INVoLVEMENT......... ..... 13 CRpncrtv BUILDTNG... .....16 TReerlreNTS.............. ..... 19 6.1. Treatmentfigures.......... ........... 19 6.2 What are the causes of absenteeism? .......... ................. 24 6.3 LVhat are the reasonsfor refusals?................ .... .... ..... 24 6.4 BrieJly describe all lcnown and verified serious adverse events (SAEs) that ... 24 6.5. Trend of treatment achievement from CDTI project inception to the current year 26 ORornmc, sroRAGE AND DELTvERv oF IvERMECTIN ...........28 Couvwtry sELF-MoNrroRING RNo SrareHoLDERS MpprrNc ............ 30 SuppRvrsroN ............... ...................... 3l 9.1 . Provide a Jlow chart of supervision hierarchy. ............ 319.2. What were the main issues identified during supervision? .............................. 31 9.3. Was a supervision checklist used? ........:......... ............. 31 9.4. What were the outcomes at each level of CDTI implementation supervision? 3l 9.5. Was feedback given to the person or groups supervised?................................ 329.6. How was the feedback used to improve the overall performance of the project? 32 EqureveNr FTNIaNcIRI- CoNTRIBUTIoNS OF THE PARTNERS AND COMMUNITIES OrHpR FoRMS oF coMMUNITy suppoRT ............. ExpeNprruRE PER ACTIVITY SECTION 4: SUSTAINABILTTY OF CDTI , J 4.1. INrenNa.l; INDEnENDENT pARTICIpAToRy MoNIToRINc; Eve1uartoN................. 4.1 . 1 Has the project ever been evaluated/monitored? (fick any of the following which are applicable) ........... 4.1.2. What were the recommendations? 4.1.3. How have they been implemented? ............. 4.2. SusrerNesrt-rry oF eRoJECTS: ILAN AND sET TARGETS (MANDAToRv AT............. Yn 3) lv WHO/APOC, 14 September 2009 SECTION 3: SUPPORT TO CDTI 32 32 ...34 ... 38 ...38 I4.2.1. Planning at all relevant levels.. .................. 394.2.2. Funds....... ............... 404.2.3 Tronsport (replacement and maintenance) .... 404.2.4. Other resources ...... 404.2.5. To what extent has the plan been implemented............... ................... 404.3. INrecRarroN ............... .....................40 4.3. 1 . Ivermectin delivery mechanisms ............... ................... 404.3.2. Training.... ..............404.3.3. Joint supervision and monitoring with other programs........... .... 404.3.4. Release offunds for project activities . ..... 404.3.5. Is CDTI included in the PHC budget? .............. . . .... 404.3.6. Describe other health programmes that are using the CDTI structure and hou, this was achieved. What have been the achievements?............. . . .. ... 404.3.7. Describe others issues considered in the integrotion of CDTI ..... 4l 4.4. OppnerroNAL RESEARCH .....45 4.4. 1. Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting periotl. . . .. 151.4.2. Hoy,ttere the results applied in the project?.... ...........45 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AND OPPORTLINITIES 45 SECTION 6: TINIQUE FEATURES OF THE PROJECT/OTHER MATTERS 45 ! I v WHO/APOC, 14 September 2009 Acronyms APOC ATO ATrO CBO CDD CDTI CSM African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Community- Based Organization Community-Directed Distributor Community-Directed Treatment with Ivermectin Community Self-Monitoring Local Government Area Ministry of Health Non-Governmental Development Organization Non-Governmental Organization National Onchocerciasis Task Force Primary health care Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Stakeholders meeting Technical Consultative Committee (APOC scientific advisory group) Trainer of trainers United Nations Children's Fund Uitimate Treatment Goal World Health Organization Lymphatic Filariasis t , LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT UNICEF UTG wHo LF ? J vl WHO/APOC, 14 September 2009 !{ Definitions (i) Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). (ii) Eligible population: calculated as 84%o of the total population in meso/hyper- -- endemic communities in the project area. (iii) Annual Treatment Objective: (ATO): the estimated number of persons living in meso/hyper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. (iv) Ultimate nt Goal (UTG): calculated as the maximum number of people to (v) be treated annually in meso/hyper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage (normally the project should be expected to reach the UTG at the end of the 3'd year ofthe project). Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). (ui) Geographical coverage: number of communities treated in a given year over the total number of meso/hyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). (vii) Integration: delivering additional health interventions (i.e. vitamin A supplements, albendanzole 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 function effectively for the foreseeable future, with high treatment coverage, integrated into the available healthcare service, with strong community ownership, using resources mobilised by the community and the government. (ix) self-mo The process by which the community is empowered to oversee and monitor the performance of CDTI (or any community- based health intervention programme), with a view to ensuring that the programme is being executed in the way intended. It encourages the community to take full responsibility of Ivermectin distribution and make appropriate modifications when necessary. .t I vll WHO/APOC, 14 September 2009 FOLLOW UP ON TCC REGOMMENDATIONS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session ADDRESS CURRENT TCC RECOMMENDATIONS v a V 1 Numher of Recommendatiott in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY I Train and involve more health workers The project had plans to train 1600 health workers as a step towards the ultimate plan of training all the health workers in the project but unfortunately was able to train only 928 Efforts are being put in place to achieve a higher figure of trained personnel by next reporting year. 1 I CDD per 290 persons is still high, efforts should be made to recruit more CDDs 4lll weretrained this year as against the 3800 trained last year. This has improved the ratio to I CDD per 284 persons. This will still be further worked upon. 3 The figure for absenteeism at3.54oh (38,896/1,100,247) is very high. The absenteeism for Irepodunflfelodun took 37,432 persons. There is need to do a lot of work in this LGA to reduce the number of absentees The project ensured mop up treatment was conducted in order to tackle the issue of absenteeism, especially in LGAs like Ire/Ife where the number has now been drastically reduced to 86. 4 CDTI should have a ,. budget line in PHC at the LGA level' CDTI budget line is available within the PHC budget at the LGA level. (Please add more rows if necessary) WHO/APOC, 14 September 2009 aExecutive Summary Ekiti State is located in B-Health Zone in the Western part of the country. The state is divided into sixteen LGAs with a population of 2.3 million according to the 2006 population census. All the 17 LGAs are endemic and implementing CDTI. Yoruba covers alarge percentage in the population of the state though other tribes such as Fulanis, Igbiras, Hausas, Egedes and Agatus dwell in the state. Population movements in the State occur during religious activities such as Christmas/ Satah celebrations, and during the farming season. In addition, students do move during holidays and commencement of school periods. Most dwellers in the state are Christians but there are still other religions such as Muslim within the State. Treatment started in 1994 with the support of UNICEF. The prevalence survey of 1988 - 1990 and the subsequent REMO of 1994 and 199812000 revealed that all the sixteen LGAs of the State are endemic for Onchocerciasis, By the year 2000 APOC/CDTI came into been covering 322 communities. 486 policy makers and community leaders were mobilized in various advocacy meeting to support CDTI activities. There was emphasis on the need for continued counterpart support in other to achieve sustainability. The state support for the prograrnme in the year 2009 was low compare with 2008, and some LGAs are still lacking behind. Capacity building was improved through appraisal meeting with SOCTs and LOCTs, training and retraining of health workers and CDDs. With the support of APOC and UNICEF, 8 SOCTs and32 LOCTs, 928 health workers and 4111 CDDs were trained by the project. . - CDDs population ratio obtained for this reporting year was l:284. 'The community population from the register is use for Mectizan ordering to achieve adeqriacy in supply. Enough Mectizan and Albendanzole tablets were supplied to the state in the reporting year. All the 422 communities were covered resulting to 100% geographical coverage ,896 782 community members were treated with both Mectizan and Albendanzole tablets out of the total target population I l7l 143 given a therapeutic coverage of 77o/o. UTG for the project this year is 983 760. The high level of health workers and CDDs trained, adequacy of drugs supplied is a great asset to this prbject resulting to high level coverage. High level of commitment to CDTI was shown especially by the state level staff and the LOCTs. The challenges faced this current reporting year is non release of counterpart fund by the state goverrlment, late distribution (e.g September) due to inability to carry out sentinel survey on Lymphatic Filariasis in the remaining two senatorial district (Ekiti south and Ekiti north), There has been the usual problem of late submission of report and lack of incentives from the community to there CDDs, there is also lack of commitment from the health workers and record keeping is also an issues at all level. 2 WHO/APOC, 14 September 2009 { To address these challenges, high level of advocacy visit was made by the zonal, coordinator to both the State and some LGAs policy makers and continuous community mobilization and dialogue with health workers were conducted. Orientation was given to health workers during appraisal and management/planning meeting supported by IINICEF. The LOCTs and Health workers were also trained on proper report keeping and reporting format. SEGTION {: Background information 1.1. General information 1.1.1 Description of the project (briefly) Geographical location, topography, climate Ekiti State, located in the southwestern part of Nigeria, was carved out by presidential fiat from Ondo State on October 1996.It covers an area of approximately 5,500 square kilometers while it has a bio-climate of rain forest in the southem area and Guinea Savannah in the northern parts. A greater percentage of the landmass is made of rocks and mountainous regions. The rains commence in April and end in October" while the dry season starts from October ending by March. Population activities, cultures, language The Yorubas constitute overwhelmingly the major ethnic group in the State and it is mainly the indigenous population. However, individuals from other ethnic groups such as the Fulanis, Igbiras, Agatus, Igbos, Hausas and Egedes have migrated into the State and are cohabiting with the indigenes. With a current population of about 2,384,212 accdrding to the 2006 census, the State is divided into 16 LGAs. Settlement pattern is compact with population densities of between 280 - 350 persons/ square kilometer. Farmsteads exist but are seasonal. Communication system (road...) Roads between major cites are in good condition, but access roads to most of the endemic communities are very poor. Some are not accessible during the rainy season. Despite this. transport by road remains a major means of communication among the communities. The electronic and print media are also veritable channels of communication only in the State capital. Within the communities the town announcers and announcements in churches / mosques communities meetings are preferred means of communication. Administration str ucture The State is made up of 16 administrative units known as local Government areas. Each LGA is headed by a Chairman, usually elected, whom career officers assist. There is a legislative arm made up of elected councilors from the various wards that make up each LGA. Beneath the ward levels are the communities. At the State level, the Governor is the chief executive, assisted by an executive council made up of commissioners in charge of various ministries. There is also a legislative arn comprising elected persons from the LGAs. ) a t J WHO/APOC, 14 September 2009 ti t I Health system & health care delivery (provide the number of health posts / centers in the project area dthe information is available). There is an official PHC policy and structure in the project area. It is a system of health care services where community participation forms the mainstay with support from the State, Local Govemment and NGOs. Levels offunctionality however vary across the State. Scattered throughout the State are various health facilities ranging from health posts to hospitals. There are 552 health facilities in the project area. Number of health staff in project orea and number of health staff invotved in CDTI uctivities. Table l: Number of health staff involved in CDTI (Please add more rows if necessary) DistricULGA Number of health staff involved in CDTI activities. Total Number of health staff in the entire project area Br Number of health staffinvolved in CDTI B2 Percentage Br=Bzl Br *100 ADO 268 t54 57% EFON 232 t54 66% EKITI EAST 407 2ts 53% EKITI SOUTH WEST 308 t72 s6% EKITI.WEST 284 8'7 3t% EMURE 248 124 50% GBONYIN 251 84 33% IDO/OSI z5) 87 37% IJERO 527 260 47% IKERE 376 206 55% IKOLE 254 106 42% ISE/ORLTN 252 139 55% ILEJEMEJE 313 t92 6t% IREPODLIN/ IFELODUN 239 88 39% MOBA 459 190 4t% OYE 232 95 4t% TOTAL 4 883 2 353 48% 4 WHO/APOC, 14 September 2009 1.1.2. Partnership - Indicate the partners involved in project implementation at all levels [MoH, NGDOs (national/international), communities, local organizations, etc.] The partners involved in project implementation within the project area are:- NOCP, MOH, WHO, APOC, UNICEF/1.{IGERIA, LGAs, NGOs, Communities - Describe overall working relationship among partners, clearly indicating specificJ' areas of project activities (planning, supervision, advocacy, planning, mobilization, etc) where all partners are involved. The State and LGAs through their various teams are involved in training of field personnel, advocacy, community mobilization & health education, planning and management of project implementation, supervision and monitoring, Mectizan procurement and delivery, and report writing. APOC support the training, mobilization and Advocacy, while LINICEF assists in the training of Health workers and CDDs, LINICEF also assists in the clearance of Mectizan from the sea port. The Zonal and National Offices assist in supervision, monitoring, training, advocacy, distribution of capital equipment, Mectizan procurement and evaluation of the programme. LGAs help in provision of health personnel and some counterpart funds for the programme activities. The communities play such roles as selection and remuneration of CDDs, collection of Mectizan, determination of mode and period of drug distribution, census update, Mectizan distribution, recording and reporting of treatments. - State plans, if any, to mobilize the state/region/district/LGA decision-makers, NGDOs, NGOs, CBOs, to assist in CDTI implementation. Advocacy visits to both the state and LGA policy makers, sensitization meetings with both the state and LGA policy makers, involvement of NGOs on the supervision and monitoring of CDTI activities. a , 5 WHO/APOC, 14 September 2009 N ! 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C) a/ €(\ \o \o t-- ca oo o\ C..l\o$ r- (a!+ r- r+ (ain (\\o <- r- o\?t € \o ol6l .<r ra \o o\ t ol\o$ r- (at r- E] o Fl Ir oF tt SEGTION 2: Implementation of GDTI 2.1. Timeline of activities Fill in table 3, timeline of activities for areas treated in current year, indicating when the key activities were implemented by the month they began and the month they ended. I 8 WHO/APOC, 14 September 2009 {O N q) -o () o.q) a$ U o o- - B t o trq) a EE U (-) r! ! (-) q ri q.l o U tI.l (J rr.l o Qt! o Uq.] tJ Q IJ.] IJ (.) q.l o (-) q.l o U s.l o O El o (J tr.l o O El ! (Jql ! O trl ! u0trt?tr 6= u)- F q.l a F * q a Frql(A F o.p a F r!a F o. Ela F s.la F tLl(r) F a F o.Ha F ot Ela F o. r!a F r r! C) F o. r!a F rI]a F o. s.la L ah 0( tr o6EE (J Q E] IJ U El () El o QI! (.) r! 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E]d o rr.l o\ -:\ L. q 4q)(J q) q > \ \ t s q) Fi q) 5 l-((t q) >' C)L{!)o() E c) (B(l) Lr .t)(€ q)trd C) lr € Ch C) (.) Cd +r o (,) o E F .'ir o)l -.ol'cd FI o\ oN 0) -o C) o.q) a v Q -) E o > O I J I()-dvE() -k .JE =oo>' *9U' LJ , (/)d_oq) dL C)!otr -ooa v9 dd V) (hd.r FL 0J .L -r (-)0i->Et<- -g6<tF6> d? P A()u ch'E €\v dHto eH (.)tr -oj5() O)H EH 69. 'r qjl AA .EU Fe . (.) bo -o k o-r 9,()gB 9r oao-l Cd \J9J 0)+F(d o,: ").E bod t-o tsE :ctrbo'- -o .-P-E()tr -dEE:- ca O. o eA ecoE o'E'- -d oEeeoCEtr ':6S a\U)a .9oc0)>6tad 7 =!vP*E ra ^^Po (€ =Ed\Hrtr >'= () ' /E 9.= E -Y(l)c'(dq./s H o ,FH! I av 2.2. Advocacy Advocacy was paid to the State and Local Government Policy Makers, top government functionaries, religious Leaders, Medical Officers of Health, traditional Rulers and some notable opinion leaders on the need to provide more counterpart fund especially now that the State is in her sustainability stage. From this activity, twenty-six [26] State Policy Makers, forty-eight [48] LGA Policy Makers, four hundred [a00] community leaders, sixty-two [62] opinion and religious leaders were mobilized. During this activity, the role of each group were well spelt out to them which resulted to better understanding of CDTI concept and the need to control both Onchocerciasis and Lymphatic Filariasis in all our communities. The entire group mobilized promised to play their role At the state level5+10,000,000 was budgeted and approved in the 2009 estimated budget but only NI00,000 was released for receiving drugs both at Lagos and Jos. M,000,000 was budgeted in the 16 LGAs but only F+823,000 was released. At the communi level these of were mobilized CONSTRAINTS:. . High cost of transport both the SOCTs and LOCTs to the different communities and to the Policy Makers were bore on individual. This is due to the fact the new project vehicle had an accident during the reporting year. o Non- release of adequate counterpart fund from both the State and LGAs \ SUGESTION FOR IMPROVEMENT Both the SOCTs and LOCTs should make sure that Onchocerciasis control prograrnme is budgeted for during budgeting with considerable amount of money and such should be followed up for onward release after approval The Policy Makers at all level should always be reminded of their roles to play in controlling both onchocerciasis and Lymphatic Filariasis diseases a a 3ruu LGA Traditional Rulers Opinion Leaders Religious Leaders Market women group Other CBOs Ado-Ekiti 22 l8 9 10 3 Efon t4 2 5 8 0 Ekiti East )Z l3 l0 2t 2 Ekiti S.W 18 18 2t l0 0 Ekiti West JJ 20 l5 t2 0 Emure l1 7 9 ll 0 Gbonyin l8 r2 l0 l5 I Ido-Osi 20 ')') 7 t9 I Ijero 44 34 l8 32 I Ikere 37 t4 8 15 0 Ikole 20 l7 8 t7 0 Ise/Orun 23 t6 7 9 1 Ilejemeje 52 l5 9 24 I Irepodun/Ifelodun 26 t2 6 t7 0 Moba 45 24 l5 8 I oye l8 10 t6 7 I TOTAL 433 254 173 235 t2 t2 WHOiAPOC, l4 September 2009 2.3. Mobilization, sensitization and health education of at risk communities Provide information on: The use of media and/or other local systems to disseminate information Mobilization and sensitization was done through media (FM radio and Ekiti radio) which is an effective medium in reaching a large number of people. Jingles were also aired through this medium. There were also face to face meetings with community leaders Mobilization and health education of communities including women and minorities In the reporting year, majority of women participated in CDTI programme with an adage that "HEALTH IS WEALTH". Some of the women volunteered to be community directed distributors. Response of target communities/villages Communities responded by selecting additional CDDs. collection and use of Mectizan and albendazole tablets. Some of the communities willingly gave incentives to their CDDs. Accomplishments - Awareness of the communities in CDTI project has increased in this reporting year. - More CDDs were selected both male and female. - Community leaders were more interested in the program due to the increase in awareness of the roles of partners and communities in CDTI. - There are more demand of the use of drugs at the community level - Improved support in form of incentives to CDDs Suggest ways to improve mobilization and sensitization of the target communities. - Production and distribution of posters on Onchocerciasis and lymphatic filariasis in Ekiti State.Drama groups to be formed at LGA/community level to drop the message of CDTI and co-implementation nearer to the community members at the grassroot. - Arrangement of mobilization workshop for the State and LGA policy makers and all groups of organizations at the community level. - The FLHF staffs should pay advocacy visits to the community leaders plus a regular community leaders meeting. - Feedback should be given to each community leaders on CDTI and co-implementation in their community. 2.4. Gommunityinvolvement Table 4: Communities participation in the CDTI (Please add more rows if necessary) r l3 WHO/APOC, 14 September 2009 ''l Disfrict/LGA Number of com munities/villages with community members as supervisors Number of CDDs and the communities involved Number of communities /villages with female CDDs Total no. communities in the entire district/LGA area Number with community members as su pervisors Bs B. Percentage Bo= By' 84 rl00 Male CDDs B7 Female CDDs Br Total Br= Br+Bt Number of communities with female CDDs Bto Percentage Brr= Bro/84* 100 ADO 22 l3 s9% 126 187 313 22 r00% EFON 11 u i to\% 108 251 359 1t r00% EKITI EAST '\1 'Lt i l5 56% 206 319 525 27 100% EKITI SOUTH WEST .\1LI l3 48% lll 199 310 27 100% EKITI WEST I 6 16 100% 99 238 337 t6 100% EMURE 10i 8 80% 130 220 350 l0 t00% GBONYIN 17 9 53% 113 241 354 t7 t00% IDO/OSI I 3 lt 85% t27 192 319 r3 100% IJERO 57 27 47% 238 311 549 57 100% IKERE 37 28 76% r52 180 332 lt r00% IKOLE 20 l3 6s% 164 162 326 20 100% ISE/ORUN 23 13 57% 77 218 295 23 r00% ILEJEMEJE 52 22 42% 73 221 294 52 100% IREPODUN/ IFELODLIN 15 l0 67% 9t 196 287 15 100% MOBA 59 39 66% 130 475 605 59 t00% OYE t6 t2 75% r64 144 308 t6 100% TOTAL 422 260 620/0 2109 3754 s863 422 100"h t Comment on: - Attendance of female members of the community at health education meetings Attendance of female members of the community at health education meeting is very high and highly encouraging. At this type of meeting, all ages are in attendance, both old and younger ones. 'In general, how do you rate the participation of female members of the community meetings when CDTI issues are being discusses (attendance, participation in the discussion etc). In general, the participation of female members of the community meetings when CDTI issues are being discussed are highly encouraging and this is yielding to good coverage in treatment/ control of both Onchocerciasis and Lymphatic Filariasis diseases. The involvement t4 WHO/APOC, 14 September 2009 of female as CDDs in CDTI are higher than that of men and this is enhancing the perfornance at the grassroot. - Incentives provided by communities for the CDDs The issue on incentives is being provided by the communities though it still few communities that are committed to this but the project intends to further sensitize community leaders to address this. -- - Attrition of CDDs. Is attrition a problem for the project? If yes, how is it addressed? With the current number of CDDs that the project is having in the reporting year, CDDs' attrition is not well pronounced like before. Other issues a I l5 WHO/APOC, 14 September 2009 ') 2.5. Gapacity building - Describe the adequacy of available knowledgeable manpower at all levels. During this reporting year, the project trained 2063 new CDDs and 423 new health workers Also, 520 health workers were retrained and all the-<ild CDDs were retrained as well on data collection collation and proper record keeping. - Where frequent transfers of trained staff occur. state what the project is doing, or intends to do, to remedy the situation. (The most important issue to describe is what measltres v)ere taken to ensure adequate CDTI implementation where not enough knowledgeable manpower u'as available or if staff are frequently trans.ferred during the course of the campaign). More health workers are been trained on CDTI. And the project is still planning to bring as many as possible to CDTI so that transfer of technical staff would not affect the implementation of CDTI. Also, one of the objectives of bringing more health workers into CDTI is that anywhere they are been transfered to they would continue the implementation of CDTI there. l6 WHO/APOC, 14 September 2009 q) cqtr o I q) z 2 o.: +L\J l .Q {: c.lN ca \o \o <- r-- c- @ r-. oo t-'t NN r- c.l c.l \o oo o\ c.) o\ c- C.l co co co \o \o ('- v a.l\o a.l cO oosN $ c\ c.l c..l c\$ c.l N o.l v t-t al r= ca t-t co $ C\ c.l a'l \o al &O co c..l(-- \o @ @ o\ c.l o.$ \o C..l $ NN ?:U rl @ o\ c- o, oo co t.- $ - tr- c.l\o a.t$ c.) r- Oc.) oo $$ ca t.- \o $t-- N\o 6ll v F v.i >v Q F---- +. q L (n O .a o'dr< ar: o6) ,q) LCE ol- z 0) e1 !#- !t: 2? E:- ZE q) I E.T+F-u' (-)+. z o\ @$ C.l <- N oo $$ @ c- oo c.t C.l c.) N@ $$ oo cn o.l N N o,N c.l a.l crl N \o c- s N oo <f,$ co \o \o N a.l o] o\ c.l co(..l \o cn t--N c- co 6l c'l r- oo c\l ca \o c.l ULF O O O O 6l ah o F] 9e9C) ;.F 0) z Ori +F-d U \) q z a.l N c! al a'l O c.l ol N N O N c.l N c\ (..l a.l N N c\l c.l c.l al O c.t ...l C.l c.l N N c.l o c.l UL r) (J{ a 0 a o o z oT! trl Fa sl F vI! Fa E1 > a F vlrl F u) r! > =v rrl trl& rr.l Z z oo(, a o o o d rI] q& r!g trl -]og z & o s.la rr.l rI] r! trlJ 7Z QOooO.J IJ.] t.lJilh o rl] I c.l !(.) -o 0) a(.) a $ O o o- :E > I r- -:-. qq\)Uq) 4: \ q)\ E q)q q) s o 0) C) a. FoQ(+r o t')() C) 0.)H .()qi q) Cd o0 tr 63LrF .i-i I ol .ol(dl FI \o6 o\$$N o\OON (.) -o () o.(.) a =O(J 0. o > I @ b0 o a € o p M\ o * L o p t a a. !t € B B o t +. s e; t 6t .I (.)\o al m ra € 0a (l) o o (] \ot 0) 4) q) € al o\ cll,o (.) arrc \o q) o q) (,) s6 r,o alt) F- al ia € F] F oF (l) q) (,) (,) \o !f, Trainees Type of training CDDs Other Community members e.g Community supervisors Health Workers (frontline health facilities) MOH staff or Other Political Leaders Others(specifu) Program management { { How to conduct Health education Management of SAEs CSM SHM Data collection Data analysis Report writing ^/ ^/ Others (specifl,) Table 6: Type of training undertaken Qick the boxes where specific training was carried out during the reporting period) Any other comments 2.6. Treatments 2.6.1. Treatmentfigures lf the project is not achieving 100% geographical coverage and a minimum of 65oh therapeutic coverage or the coverage rate is fluctuating, state the reasons and the plans being made to remedy this. a 19 WHO/APOC, 14 September 2009 o\ N Ho -o q) o. C)a$ Q - B c.l : fi€ q "aa4^'=L-6\WEP o=La-'a -o-Y o-E= OCs)ao;;-CEsEEF=}Z 9d od9 0- O O O O o O O DLatr olJ.] = -<Zaa O O O rEx:, s =Y t$ E Es H 3z d', a " C.l a.l r- o. tr- c{ c.) \o \oc.l <1' a- N @ lio co zd I O o\ I \o c\c.l \oo. o, r- Oaa € o\ \oco t-- I $ao a.I(-l s sf c.l co o\ \o I a@ " hi; E6 -/6a x.9-o o =ooao- l3: Fo o =Devv Z,* u tso doa </ 9) -oFU o\ oo o\ \oo\ F- o\ (-- \oo\ al oo o\$ 00 o\t-- c'- o\ oo o\ oo o\ r- o\ 00 o\ oo \o c.t oo \o N co .o o\t-.(-- O .{- t-- c- c-F-6t o\ c-l € a-l\o oo co $s c- oo \o co ca o\$ \o ca\o aa aa \o aa $ r-\t(-- C.{ o,$ co \o € € o\ ca \o $ o\ an \o o\ \o\o co € c.l c.t t-- r-N t-* ca oo ca\o\o o$ $ o\ o\ o\ o\ oo .d- F- co co$ a..l oo o\\o t-- \o $$ o\s oo F- (.l$ C.l ca N(-- c-| o\ oor- oo C..l c.l aa oo a.l o\\o $c- c- o\t-- t--\o o\ o\ oo $ oo$ .t o\ $ t-t \o c!\o .f,$ o\ c\l \o\o o\ co oo s cn cl$$ ca o\ c- o\ oo aa r o\ co c-- oo o\ o\\o a- oo c.) c{r-r- C-l oo o\\o o\ s o\ lt \OAqd-td !.o= d S) -.= tr oE+t e - >r -. 6; O> -r1i tr o0!? tr3 ES 39 o>*6 .Eoo- oocd- cd- tro )''i o o\ o - >voo r'l o o'i q b E gPU tr E=;i5 E-i tsz8^ tsod o.a < 9*F\J r/) o) oQ \oo\ 5\ s \o \oo\ o\ s \o 5\ \oo\ o\ 5\ o\ \oo\ .oo\ c.l c.l tr- r-(-.l \o t--(\ c.) oo r-aa C.l co(\ ol oora) N c).1 r< t--N \o (--c..l co oo r-c.) Oat cac\ c-.1 oor c.l c.l t-- t--ol \o t--c-l c.) ootrl F-c.t c..l aac.t N(r) oo .9<L.i;v o o z t\ r! r-Fiav<stH a F Mr! B F vr! tr.]d D rrl z zoa o U) o o &r! l- tll& EI!, rrlJoV 7D& o rrla sl H z rI] rrlJ .l rrl frr trl& cqo -:\ a. q 4q) Qq) \- q > \ q) S. v N ! q) a sq) 5 Jc, l-r d cr') 0)Ld oJ o L U) '(, >a .o an r! a '(, (t q) E (d 0.)lrF C.-f 6rl -ol cdlFI e *_l al ol o\ N ro -o Eo o-()a t (-) - o tt > ol o O N olN $ o\ oo c.l c.) a.) (-- \o oo t-- o\ t-- r-. t-- € oo \o$ c{ar- \o o\ € € c.l \o \o t-- co oo ol\o$ r- ca$ c- .o6\ -oo\ \o c.lC.l$ \o (\c.l$ \o olo]$ tJ.I o F] t'( oF I o\o N Lo .o (J o.{)a =(J o o > 9( o= a ,a-ra9-'oii o> o g; oi5EEF.C;9{ od9 0- = o o -o E z o o -oa,aE ot! = u{Zoa O O o ;;$ae 5 Ee H 5z i'rE' \o N r-- ca €a.l -ubs EO zc3 O \ooo € \o c- ::.'l'oE :q o 2 6 D cF^-r<-E =-L>C==e Y'v U O O t--C' oo.i- o\ $C' a-l$ (s ol O. I ll + oo0 c eJ^ cl9l:€ o )- Fo \o \o o\ tr- o\N oo o\ oo o\ c..l oo o\ c-) oo o\ 00\o o\ r- o:!ei9ts6N5 0$r t--(-- c..l o\ c.l oo $$ r- oo \o c.| <i- r- $F- \o o\ \o\o $ c-t c.t ca \o co (..l\o o\ ca -Eed o.a -l 9D FV c.)\o\o .d- o\ o\ oo .{- c- ca o\$ oo F- oo cl o\\o C! N ca c- \o $$ Ir- €$ oo ca q@ " h;; - A e6 -=@a -* 9! o oo $ €$ s r-- \o t N\o $$ c..t$s ca o\ c.lr- t-- ol oo r-. € a-l $ a.) F-r- \o c.t .{- I r, ll rx; Eoo. bod- cd- o0)\ oo\ o - >voOrt O -o o\ -o^\ \oo\ o\ s o \o ^\ o\ \oo\ aOOE ? o = laPo 70a r-- c..l \o oo(r) ral c.l co c.l o\ H (€ o.= E E.O , o-o' FL/ tr-N \o oo o] ca (..1o\ \o64a-rd =.oE 6I + c - >r-. ! E to} E -: ES r9 o>*D r-a.l \o oora) c'lra) co (..l o\ <)j ;q z olrr E] > a F v rI] F vH o&ql J tLl ql & r! r! z rr1 rI]J a o o Fl l'{ oF NN qq s)U q + \ q) s. "ts q) - q) 5 J< U) L< (€ V) d C)L(t (€ oil o t< q) >' -o ar) r! a cd o) oNd o -o q) (u 0)trF cbr o.ll -ol cllFI I o.O c'l r() -o E 0) o-oa $ (-) -) o- o Oo ! a-$ bo n) 0O s\ F ! :\ i.S!s 'i*M} e1 .si s! !\irls E: ls odi s-EtsEYE' 'Si. E stq sq)r ss .a\|! io' =\- t qr:aq'Ia.s sGs rts ss' .3 Yt:s bss F.: S .E'.tY E:b g_E * s)v s' st 3 tsrl is .s sE 0a aJ qJS' S\ :: SS : U\ * El:t sP$ ,**s' .- qr\ S.a3 tss ss = sd \ t*S :El! S'\s 'r\ 'r d\3 SE cr \lis *rt\ t\ ='r rFP FE\ ag ca C'l r ,.,) F oL o c.) .F L a-() =.: a () d o () o IL C) a. oa C) o Cd ^, 0) ol ! -l o.rxl o -l osl ; cnl =6)l t]r-t o -l ()ol a 51 ool uOl c)ol I(.rl E Pl tr trl d.o =t b:Zl F o. o\ o\ olol '-l o.r xl .zEI :EI U EI HPl -ol : ol 0)ol tr 81 Ecrl !'rUI L rl ' 3l E al)g-\ trl tru-tts = zl< C)L o() 'a ! o- o .E c & -o ! C) .E C) .; ch() "l EEt _- o.ll - e dt E9l 6 €l E alC ol 6)b0 lsl b .-t g>l >,\I F -t -0.rl ^el 6 '=l q) =l HEl (*trl oXl uYl c) -"1 -o ot tr LI J0)l c -ol _trl (B 5l ozt? oL o() ! o-() .: t, C) .= = Eoo o () C) IL C) a. >. otIol () IExl ; El uoClI C o)l .-!l >et .i d)t ()l q (l.l 5ol o-pl o(.)t o- trl co ."El !o\ZIi B a C) 0) od oF D .o o\ ()Z L 0) oo !wA 9E o oF 0) =L C)bodL C) oo (! o- .q 9\. (! h oo oo () (EL obo(! L o) oo O,^ .r \oEo\ ood C) F u)l c)l b0dtLI 0)l BI 'l(Bl ol -clOI(dl Lrl$ C)lbllrltrl cll ,-: I )t ol ol cdll-rl o)l -ql €l bd trl €l3t al EI ol ol -l €l dl 5l EI ol fr. I ll il ll il ll ll 2.6.2 What are the causes of absenteeism? The major cause of absenteeism within the project is as a result of migration of the settlement and student going back to their school as at the time of distribution. a a a 2.6.3 What are the reasons for refusals? Religious belief Mild reaction with Mectizan from the previous treatment Mis-information from the co-community members who have used Mectizan in the time past. 2.6.4 Briefly describe all known and verified serious adverse events (SAEs) that occurred during the reporting period and provide (in table 8) the required information when available. o Parasitologisttrained? o Existence of microscope? 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 case to report 24 WHO/APOC, 14 September 2009 a.l L C) -otr o o.oa$ O oq oI B (a) c..l \: \) N a. a) \-a' t\ ! a)q * q 4 a)U a) q > S. a)\ t ! q)q q) 5 o Lr() o. bo ts a(.) l-r() o0 Lr olr .k oo (B U) r! Ch th tro o o)(nfr C) .o Cd U) o l< C,)(n(rr o U) C)(h CdQ #r o-rl -ol(Bt FI () E93 EE A <.E E - bood)- O aj(!.ij ooo tr o-=ai4 x=L rr.r 5'5 I i l I i I o ol ,2 C^ ^=!-l oo 6L q O-ex(*? a-O ^ 7= 3()-q tr&=a q;o- oaEC(J E CJ d409O E ,i=,8 v4L- N H.H.E (n € - 9 ep.! = = o.= (JtitEX-Y a:E;5S> q oq a tr-o ;.y r- o!+()EE A. ^AUa6d =() .N* 99-(dJg do> B o ooocd.l =bo?o xoa o bI) * 4U) I I I l Il T ] I () -- 9p\J i:.:F oX '- ><-rO Q \o N o\ ca a.l \o \o ca \o o\$ \o o\O o\ € o\\o @ -o o\ o\ oo .o o\\o tr \Q .{- @ s o\ \a r-- 00 .o o\ o\ o C€ =la.lot ,-l rIJ ti o ^oov!v-F 6o\ o o\ o' o\@ ca .o o\ co .o o\ *C\ o\\o\o \o \oo\ \o \ao\\o oo o\O o. \0o\ o, \o t,,- 00 .o o\ o\ ll * l! kl f:l o .=otooU 6^O- ..L ro6 yo' ooEoF o\ o o\$ o\o\ o\\o a- .o o\ o\r- o\ t-- o\ € t-- o\ c=t,- o\ t-- tr- o\ t-tr- Ii ,o od -9Ur:s.. Lt,u o. \o O s co ...t ca r- c.l co o\ w a- o\\o $ N\o € t1- F- \o o\ si' t-- $ oo oo 00 st--$\o oo oo t-- r.a) oo $ \o oo oo a-.1 cor- o, @ =o6 0.= 7 -J-o F\J o\ w oo (r- a- s O t-.\o oot-' O F- Or- t-t @ .{-\o o\ oo\o(-. o\ r- C' o\ oo co c..|s at o\ \o r-. oo o\ q6 ^.rd - oy/ - *6S.i o h- - '=qo = 92E o OO \o o\o oo\oO co \o aa c.t\o\o r-. 00$ @ o\ o\ c.) oo o\ o\ r- $ o oo\o F- t-t$N o $ t* () bo(U a(I) U ll r E1 l{ lI] o ^bov !w- ti Oo\ o .o o\ c- t-- \o cn @ o\ cn o\ o\\o oo o\ o' o\\o6 o\OO o\ .\ o\ \oo\ o\OO o\OO '=a,o s'= E"a r ; XoU 9tr.r-d Oe!Q o\ c-f-. o\ c.)@ o\ 6 o\ o\\o co o\ o\ o\\o @ o\OO o\O o\OO o\oO \oo\oO o\ o \o ti qi 0) o.=o o =:Yo -: E= 6E !;- 9: >o6 \o a.t \ot'- a.l ON ca o\N \f c.l $ o\(\ N(\!i- c..l(\$ (\ Ns N(\$ (\ N+ a.lN * c\l ol$ EI _;r,6 0.4 c (€.: < 9PFU $s c-t $$ $$ ca NN$ ct c.ls a.l c\$ (\(\$ c.lN.{- c.lc.l (\N$ C\Ns c.lc.l$ c..lc.l.{- bo Cd =6E<, E i] rr-9E >,;: -!Ft.Y .: E'- o Ft E 3 q€ EO o l-1 $$ c.) w t{-$ c.lN NN <- ot c..l$ NNs N ol * c{Ns c.] o.l$ c.l c.l$ (\(\$ c'lN$ & tr.l t-- o\ o\ € o\ o\ o\ o\ o\ N oO a.t c!oo o.t c.) o c.l $oo c.l rr)o c-l \oo c.l r- c.l 6 o o.l o\ N o oN o,OON ro -o E C) o.() a 1 Q -p. - = q) bo lr o o F D cq o q) (r) G c) ho a) o an \o tr- ?a € o\ I Gq) cl I 0) Lr q) fr - q) \o N 8\i - hip\ S s,U\ ,r -99= !.=E= -\\ iql6g q)\) \ ! !*rS I cl =99L 9lY Aeq)9 9() I It-Ea .g 9)LvLt EI q) Lr 0) +t-l €UX -HILOCB .rr (.) TItrEt9!lEUI6al c)ol I .gileslGo ... OOtrcd9b g6 (: 63 r3Etrc)9tL L.its(! .ara ,l \o e.i o\l C)l _t -oldlFI q) cd-c) u) 16: tr.= oi: H3 e.U o\OO c1 r 0) -o E 0) o.() U) $ U o. o :E > r- a.l 2.7. Ordering, storage and delivery of lvermectin Mectizan@ ordered/applied for by - (please tick the appropriate answer) MOHM WHO T UNICEF N NGDO tr Other (please specify) Mectizdh@ delivered by - (please tick the appropriate answer) MOH tr WHO tr UNICEF d NGDO tr Other (please specify) Please describe how Mectizan@ is ordered and how it gets to the communities Mectizan ordering and delivery in Ekiti State CDTI project originated from the community through their Community Directed Distributors [CDDs]. Since it is the community that determines when Mectizan would be distributed to them, they are the one that do ask for their yearly drugs and the CDDs would inform the FLHF staff [health workers]. The health workers would make such request known to the SOCTs through the LOCTs and the State Coordinator would collate all requests for the State and send it to Zonal Office, who will collate for the Zone and forward the same to NOCP. NOCP collates for the country and makes it known to MSD. On approval, MSD ships the drugs to the country and IINICEF cleared it from the Port Authority and stored in their storage facility on behalf of NOTF. The drug delivery follows the ordering process but this time around in a reverse order The Mectizan flow chart 28 WHO/APOC, 14 September 2009 State /District ILGA Number of Mectizano tabl"ts In stock from previous year Requested Received Used Lost Waste d Expired Remaini ng ADO 0 282 s00 281 000 210 953 364 9 683 EFON 0 82 000 80 000 77 871 468 I 655 EKITI EAST 0 24 I 000 240 000 237 761 s42 t 691 EKITI S WEST 0 91 000 90 000 88 0r6 1 984 EKITI WEST 0 l 13 000 llt 500 108 255 512 2 733 EMURE 0 172 000 170 000 t66 479 106 3 415 GBONYIN 0 202 000 200 000 r90 800 126 8 474 IDO/OSI 0 102 000 100 000 97 559 981 I 460 IJERO 0 24t 000 240 000 224 262 542 15 196 IKERE 0 82 000 80 000 76 230 670 3 100 IKOLE 0 202 000 200 000 t98 210 364 I 064 ISE/ORUN 0 205 000 204 000 169 194 34 806 ILEJEMEJE 0 l 12 000 I 10 000 9s 835 t4 t65 IREPODUN/ IFELODUN 0 232 000 230 000 200 738 228 29 024 MOBA 0 235 000 233 500 219 349 I 827 t2 324 OYE 0 143 000 142 000 140 658 t99 I t43 TOTAL 0 2737 500 2 712 000 2 562 176 7 529 t4t 923 Table 10: Mectizan@ Inventory (Please add more rows if necessary) - How are the remaining ivermectin tablets collected and where are they kept? Usually, the remaining tablets are kept in the health facility drug store ant those that are close to the LGA headquarter keeps their own at the LGA drug store while those ones with the State are kept in the State office. - List and briefly describe the activities under ivermectin delivery that are being carried out by health care personnel in the project area. The activities carried out by the health care personnel in the project area include:- . Training of the CDDs . Mobilization of the community members . Advocacy visits to the community Leaders and opinion Leaders . Collection of Mectizan from the LGA a/ 29 WHO/APOC, 14 September 2009 . Distribution of Mectizanto the CDDs r Keep records of Mectizan issued to the CDDs under their health facilities . Monitor and supervise Mectizan distribution Any other comments 2.8. Gommunity self-monitoring and stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? If so, When? Table I community self-monitoring and Stakeholders Meeting (Add rou,s if needed) Describe how the results of the community self- monitoring and stakeholders meetings have affected project implementation or how they would be utilized during the next treatment cycle. The distribution of the Mectizan was made easier than the previous years and acceptance ofCDTI by the communities are getting clearer. Refusal by the community members is no more issue within the project area. District/ LGA Total # of communities/villages in the entire district/LGA area No of Communities that carried out self monitoring (CSND No of Communities that conducted stakeholders meeting (SHIvf) Ado Ekiti 22 22 22 Efon ll 1l II Ekiti East t7 17 17 Ekiti South W 27 27 27 Ekiti West 16 t6 t6 Emure r0 l0 - 10 Gbonyin 27 27 27 Ido /Osi l3 l3 l3 Ijero 58 58 58 Ikere 37 5l 37 Ikole 20 20 20 Ise / Orun 23 23 23 Ilejemeje 52 52 52 Irepodun Ifelodun l5 l5 l5 Moba 58 58 58 oye l6 t6 t6 TOTAL 422 422 422 30 WHO/APOC, 14 September 2009 2.9. Superuision 2.9.1. Provide a flow chart of supervision hierarchy. NOCP I I + ZONAL N.O.CP AKURE I STATE ONCH ERCIASIS CONTROL (socr) LOCAL GOVE,RNME,NT ONCHOCERCIASIS CONTROL (LOCr) FLHF STAFF CSi - CDDS 2.9.2. What were the main issues identified during supervision? * The FLHF staff are not carrying out the ideal/proper supervision during the Mectizan distribution t Lack of commitment of the FLHF staff * Provision of funds by the State and LGAs for SOCTs and LOCTs respectively to carry out supervision is almost zero. .E Lack of adequate mobility for 8 LGAs for monitoring and supervision at the LGA level * Poor record keeping by CDDs and the problem of improper data collection and reporting by the health workers. \ 2.9.3. Was a supervision checklist used? Checklist was used during supervision by SOCTs and LOCTs 2.9.4. What were the outcomes at each level of CDTI implementation supervision? * Emphasis were laid on supervision by LGA personnel following findings of lack of adequate supervision at the LGA level * FLHF staffs were encouraged to be more committed to the CDTI implementation. CO 3r WHO/APOC, l4 September 2009 2.9.5. was feedback given to the person or groups supervised? The feedback was given to personnels responsible at every level leading to result oriented outcome in the programme implementation 2.9.6. How was the feedback used to improve the overall performance of the project? Strategic plans for improvement at all levels were drawn. CDDs also have started improving in their record keeping, moreover, the coverage is highly improving. SEGTION 3: Support to CDTI 3.1. Equipment Table 12: Status of equipment (Please add more rou,s if necessary) *Condition of the WO:Written off) equipment (F=Functional, cNFR:currently non-functional but repairable, How does the project intend to maintain and replace existing equipment and other materials? Continuous advocacy and mobilizationwill be paid to both state and LGA policy makers to release counterpart funds for maintenance of project equipment and purchase of various materials. The project requested APOC to provide more motorcycleJ for monitoring and supervision. Source Type of equipment APOC MOH DISTRIC T/LGA NGDO Others No Condrtron No Condrtro N o Conditron No Condrtron No Conditron l. Vehicle 2 lF&l CNFR I NF 2. Motor cycle(s) l5 8F& TCNFR 3. Computer(s) 2 1F& ICNFR 4. Printer(s) 2 F 5. Photocopier (s) 2 1F& lCNFR 6. Fax Machine(s) 7. Others a)Bicycles 70 CNF b)TV set I F c)VCR I CNF d)Generator 2 lF& lCNFR 32 WHO/APOC, 14 September 2009 As regarding the project vehicle that was involved in an accident, the insurance has been sent as the sum of N400 000 through WHO for repair and the State has been requested to complement this. JJ WHO/APOC, 14 September 2009 3.2. Financial contributions of the partners and communities - Fill tables l3a, l3b and l3c If there are problems with release of counterpart funds, how were they addressed? Additional comments 34 WHO/APOC, 14 September 2009 N o ,o oq() a $ O -) o. o > aooN E oE o CLg ct '6 -ct G u, r!tc -et!o tr o Eo e flt .!!!, ^o L oct o CL tr lrJ r o ttcCl= ,-r Lr- IE LF o rO(t i- o) co olr) @ @$$ oolr) @sv ol ol- o! lol(f)l ,ol @t oJ@(f) o otr) a)(o @(o ooo orfN ooo o$N I I I I ooo NNN .,, 2 o o .E fco =oE9 oo oEOq8 ooo oz ooo o@@OF N$(ONON$o\f o @ @Nt c o 3a tr o o Fz ul =ztr uJ o o !, o g,) .o .2E's o6 sg EtoEl- '= o =oa5 P6 =i5o!OGo-c =.ett cDooEt o =.E:o 2 I oool ooi o oi c,,$; N rOl ooo(.) @ ooo oo st Ooo of.- ooo o CEN ooo o F- I I ooo oN ooo o(t ooo o(O I ooC' a)N @ I Ooooo ooooo t, o o c,lE =@ ol ool ool o oi ooi -(o@ -' (g OIOIOo!oioo'oio o'o ooo'Fo r-i |o o, olo' olo,o ooro, ol@o(f) (o, ooo ooN N ooo oto N ooo otf) N ooo o ro N ooo o rO N ooo oo rO N ooo oolr) ooO ooo N oo(o (\lt(o (o rO ooo oo N oo @ N$N $ tO oo@ Not ct uJz J UJ(9 of .D G o IaI a0 c o oo5E o) .c. =G o -i o oo o o "i c .o o .N =oc oa ..i c o o .N E o =: o tr .9 GN to so Ut s(, ao o E-(!b iE 8ENf ':ots =8 o Gf s tlJ dtr\ o s o Ei o tnt oaI aa U', o) -Y, Or}I I -c, Gr(.), -r+i o; o,CI '-r Ei otLI EDIcl - Ei SFl e .l rNl {t .l d I I\ i lr 'ol'oilolO. ,O: ,OJ .E; ,Cl ; '6r '(l)l 'c')r lEi '=i .\i '6, ci .gt GI Itl -l .l Nl =l I G o IaS aa tr .o (U f o IU "i(f) oc o =c o = ..i (f, c .9 .9 z o o-la -d ol ci o,)r(l)I o.r i f.i o, EI(E' El o o:al o, OI Ei$>(El \ Et s>l 6 Nt a .l d c .9 = -o .9.o c o o E o -+ so Eo E, Gs G E Ec G EeESfoa> 'tro ES :b EIOG9oEbo>>o Ib G o Iaf ar, c o E .9fo LU ..i lr) 1A. o,l4r sioi$otti a .91 6 .E! (E!i (/)EI <l rJl ' F o oz E, o r) co rdl3l el ol Crl rI]l el ol z1 f-l I cail ri rI] FrU ri a f-l U f-lil ofr 3 n Fl Fr U Hrttr B ariI ne F rc iIF f-lFri Fl larraZ U ,i & H riH Fr ,\ U ritr U) aLr Cd(.) >a c) 0)L I t)(c (.) l-{ € (/) L{ C) ti C6 d >'p t) o -o LrItr oo (d o d t G ?a c) 6lH I I I I o\o a! L() .o () o. C)a sf, O o > \o ca 'o(.) tr oo c) C)l< t) cd C) ! € d U) lr oo d o (d 1 &(a q) E clF T'c(Jt orro-?<3 LF lo$$ ooN N o)N(o$ l(,\t c) $ ait I I i I @o @ N o) @t(o l(tolf, oi @ NI Noi (o .tl - '<tr 'tNr (, lo o,o s @N lo o,o $(o N ooot o) g. o -c o I I I I I 'E =CO:ot'E o C) ofoqE '2. c o E o ?, =lt .9,t oL ocE G ELt UJ -Fo o oo oz !, o E, =Il ost ooo 1l)o o) ooo o O)N ooo rolo ol ool ool o ol o@l co(r)! r I I I I ooo oNF- ooo cl(t)N I ooo o F.-lr) to ro F i I I I I I ooo lr) N ol ool ool .o ol u:F-l O)$l I i ooo ro(olo ooo ooN to ooo oo ooo oo(v) t(, ooo ao (r't ooo o l()(o ooo ooN ooo oo oi oo: c!oi o ol oroi ctNr O) ooo oo ooo oo oo(o Nso o ooo ooN oo(o NtfN G) oo!o NtN tt !) o oE cDoCF '= -9E69E! .!2Eo !,flE ,ofrE!,tr o -.E =o 2 I I I G.oa el .E oIl t uJ oEc -g(E o o otr o tr o : .Ct L c o(, Fz lrJ =ztr lU o(, T' o o E,l!,3o ooo o o(o ooo oo @ ooo o lo ooo oof-- ooo ooo ooo ooN N ooo oo @ CO ooo ooo aO ooo oloN ooo o ro N ooo o rl) F- ooo o rO N ooo ooo N ooo oo rr) ooo oo ro N I oo @ NsN slr) ooo oo N oo @ NtF,(o rO I I oo ao otot N lrJ2 UI(9 o =o o o GN .ts lo o t4 S(, ao o t-GE iEo!E .SP s€ =or€E8 I I I o o .N =oc o ct) ..i o(tr o o E "i I c .9 o .N E o r E o oo =E o ! =(E o J- a G o IaI a4 o GI (E l! $ 'tr o s o Ei o tt,to a.Sq i I ,1.oioi OI *: o: o,ci 'El '6r LI o! Eicl 'Et (El L!Fl FI oil o tr G E tt o) .Y o = -c =o oI G o aaT U, o C, o .=c o = .'i(r) tr .o ah E o o.f U) - c.i tr .9 of o TU .i cr) G o aaI(t, o c o (D o) u, o E o o o oa o c o E o oi(U c o = .'i I c .9 = -o .9E c oo E o -+ tr o E o o)(! s G E ! s G 5eEC5(l,{l> 'to E8 :U EEOG9oEbo>>o Ib (E o aa5ta I .a o lrt coaxo G o E! > G o IaIta o o L o oo -d c o E .9lo LU .'! ro o oz tr o ;i I I I I ao, ol ! o -o o p. oa =(J l-) o. o > F- ca o =lp(Jr olL o. I I I I I I I I I I I I o os o .E =co!o Efl oo E8q8 -z c o E o g. ftt .9,!t e oct6et UJ -Fo o oo oz E o E, :, .cl oSE I I I I o6 egt,oCF '= o Oi:,e'tr?fr =i5Gl,OGoc5.9trEllooEt o =(!E5 z c o =.ct c o(, Fz ul =zt ul o o t, o o o|t =o ooo o @(o o:oloo,o,oo'o:o oioioO; r'Or--1r)(o ooo ooo ooo oo @(o ooo ooo @ ooo ooN N ooo olr) N ooo o(, F- o: ooi ool o o'olr), ro NI N ooo oot(, N ol oo'ool o ol ool oolo NI oo(o N rrl. N$ rf) ooo oo N oo(o Nt Gt,(o lr) oo aO Norf N Foo e! It ot o o. E C'I .g olt E, UJ GIttr o .Eo o o 0 o CL e Go s! o 3 uJz J UJ oo =to o s .9 GN t4 tro tn s(.t Go o t-Gb iEAG5g s€so ES =E o(U o o E .i l c o oN ,6 c o) U) .'i c o (u o fE o E =o o t_ a G o aa5tr, C o og .cI o : tr o GI slrl ds o tr o E o ot o a.5 U, ,9, o; ,{,:o, ,}, ol Et 8i E,oi r, o! oi o,l dJEl c, cl ci(51 (El (Dl ol \l \lor oIcl cl- :EI :EI = (616lG119Fr Nl {l ",ii .il a otr G t: i o .E o =c o ..i(r) o a E o o.f @ -(f) E o o =E t! "i(f, lE o aS U, U' c o o) o)o o E G o) o) oa o C o E oo oc o =oi .t c .9 -o .9.E c () o E o .: -+ s o o E, Gc G E s G 5eESSOQ> 'tro Eg:I 'll 15(,G9oEbo>>o Ib l! o aaI U, I G o Ia5t4 c o E .sfg ul ^itr, I a o EE s al, o) (s (E U) -d o oz d(9 () o o) C)Lr .h C) tr d c/) -o lr oo (B o d ; ?a q) ! 6lF I I I 3.3. Other forms of community support - Describe (indicate forms of in-kind contributions of communities if any) A lot of support is given in kind even though there has been an increase in communities that gave incentives this year. 3.4. Expenditure per activity Indicate in table 13, the amount expended during the reporting period for each activity listed Write the amount expended in US dollars using the current United Nations exchange rate to local currency. Indictate exchange rate used here 150 naira to I US dollar Any comments or explanations? SEGTION 4: Sustainability of GDTI 4.1. lnternal; independent participatory monitoring; Evaluation 4.1-l Has the project ever been evaluated/monitored? (Tick any of the following which are applicable) Year I Participatory Independent monitoring Mid Term Sustainability Evaluation t 5 year Sustainability Evaluation 38 WHO/APOC, 14 September2}}9 4qiyity Expenditure (Naira) Source(s) of funding Drug delivery from NOTF HQ area to central collection point of 230,000 MOH Mobilization and health education of communities 1,568,850 MOH APOC T of CDDs 1.338,350 APOC, MOH UNICEF of health staff at all levels 2,572,480 APOC, MOH UNICEF CDDs and distribution 310,000 MOH, APOC Ad visits to health and litical authorities 449,500 APOC TOTAL N6,469,190 Total number of 896782 { community l. Intemal Monitoring by NOTF Other Evaluation by other partners 4.I.2. What were the recommendations? LOCT members to be increased to minimum of four in order to enhance effective implementation of CDTI activities. Zonal coordinator to write to the ministry of Local Government to provide office space for LOCT. Selection, training and retraining of more CDDs. Provision of printed community treatment registers by the LGAs. SOCT to embark on constant advocacy to Local Government Policy makers for financial support. LOCT to follow up on the activities carried out at Health facilities and communities Quarterly report of activities to be written at all levels. List of CBOs to be identified. compiled and mobilized. Intensive and constant supervision and monitoring to be intensified at all levels. Advocacy by NOCP. Zonal Office, Partners to both State and LGAs Training of more health workers Intensifi ed integrated supervision ll a lll iv vl. vii. viii. ix. x. xi. xii. 4.1.3. How have they been implemented? All the afore mentioned issues were addressed in the work plan during the reporting ye?r. And quite a number of the recommendations are being implemented already such as; There has been increase in the number of CDTI personnel trained 4.2. Sustainability of proiects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period? No Was a sustainability plan written? Yes When was the sustainability plan submitted? -2004- What iurangements have been made to sustain CDTI after APOC funding ceases in terms of 4.2.1. Planning at all relevant levels The project planned with relevant stakeholders in the state and LGA where proper implementation of CDTI activities were considered as regards sustainability of the project 39 WHO/APOC, 14 September 2009 4.2.2. Funds With the evaluation of the project, the State Government has renewed its commitment to fund the CDTI project. Regular advocacy visits will continue to both the State and LGA Policy Makers so as to ensure adequate and timely release of counterpart fund for CDTI implementation. For this year, some LGAsprovided support totaling the sum of N823,000 while the state only released N100,000 4.2.3 Transport (replacement and maintenance) Replacement and maintenance of transport vehicles will be handled through adequate release of funds from the State and supporting NGDO. The project vehicle was involved in an accident and UNICEF has provided funds for its repair. The project is putting measures in place to ensure these funds are complemented by the state. 4,2.4. Other resources 4.2.5. To what extent has the plan been implemented The plan has been implemented up to 70o/o 4.3. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3.1. Ivermectindelivery mechanisms Ivermectin is been delivered under PHC structure. Communities pick their Mectizan/Albendazole requirement from the health facilities through the CDDs 4.3.2. Training Intergrated training of both health workers and CDDs on CDTI and LF were been done in five LGAs( Efon, Ekiti South West, Ekiti West, Irepodun/lfelodun and-Ijero) of the state. 4.3.3. Joint superuision and monitoring with other programs There was joint supervision with other PHC programs e.g Lymphatic filariasis, Malaria, Immunization programs, Nutrition program, HIV/AIDS.. 4.3.4. Release of funds for project activities Fund was only release for the collection of drugs by the state and two LGAs released fund for capacity building and other CDTI activies. This year there was no integrated form of release of funds but it's in the plan for next year. 4.3.5. Is CDTI included in the PHC budgetz Yes, CDTI was included in the PHC budget. 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? o Fill tables 14 and 15 and provide describe other programmes that are using the CDTI structure and how this was achieved. What have been the achievements? o For each intervention listed in table 15, explain what were the roles played by the CDDs (census, mobilization, distribution, data collection, storage, collection of drugs, referral of SAEs, etc ...)? 40 WHO/APOC, 14 September 2009 a Explain what are the combinations of interventions co-implemented? How were the interventions implemented? (at the same time?)a 4.3.7. Describe others issues considered in the integration of CDTI. None a 4t WHO/APOC, 14 September 2009 O(\ o o o.oa !i- O o o. f N$ E 0,) a cq 0) 0 0) o z F c\l € tr-\o o\ @ N o\ ca a() cg oh q) cg a 0) (,) 60L € o q) L C) z oF I-- ca -.f, O t--|.- \o 6l$ q q) c! C) r-tr) rn oo\o rn oo ca ca\o C.l () c! z o.l tr-(a) (r) @+ (r) @ co cal\o a Ua .oE> r-9 EE z F ca r'- ootr) (r) $ o.l c! ,98 $rn tr- co @ \o o(! 2 o\O N c- .+ € :.9 -O=EE za () o a!()il c.lC\$ N o\ (l) c) u0 C!F NNv N o\ oo 4.9 e,0 =Ez q) cqoil \o tr- o O) u0 cg3 \o r- =.s\J\ >:R -os!sq)€ E.5 os Es* .v) ,E.9t d = a.-; = (VEF9A - Uvv-t!p.rs F.Y d) dtr! =3i EE 8255!ooo SSgTEE aaaa .u) ,E.3 I d = a.i- = rvH-9EO=!'--q'.= = .9 i! =(Btr!=E#E# 8 =-ooSoo(cSSstEA clii xtEr O) _c .=oEE9ELL (lJvl a oC(u .9oPN =(! €E eG) OE a o_ co =(o €6!'tr6(! Oo- a oo cE oN;ls -QEo ij -ovt O) ot a + o .9Pf -o 'c(, --zi5i a OJC(gL.-OJ: - oojqt!r! FCC a6- -Eo a .F (! c <o cE '= 0,) roX >6o a o a a a oo E.: --. OF() U') U)(d o t-<q)o- -EeO= lJo o E.sEv)o. cd HL -l q= rh(t oo o a) oAcn Fa oL oo (d k Cd d oL{ tr o(J d lid(t o ! (B z CB o o(l, F v) o(B cU cl(-) .a'h Eg!o. a -I o u G +J Lq) tsI() dIL I (J =trl() -E Gtr a aN (.) -o o o.oa <1- U(-) o. > ca+ I 4 a)\ s Hq) l q q) LR q) "a \) \q) q U) q) Lq) q) co ts a a a a o\ N k(.) -o Eo o-()a <f, O or aa B $$ q a, !k a) i .q) q q) L q) .a \) ...s q o q) \q) a) ao = ao I +r o q) L o o q)I oq) o q () fr b0 Q) u0 ozPQ Ev z q) q) o ()o Lo -!6J^ aD= oF =.9 o.) ic ! o -r " E.e88 =6) 'EEq CJ q) q= bo 'EZ sr, C) o o rro 0 C) o c! q) 0) ql o. t- .=3UE9E LL Aq a O 6.1 bR PL f(l, €EPA ot a o_ co =(! _-o a r=N6(! Oo- a OoJ cE oN '- (O i o.t .= -o6 (L) OE a z J -t o c .o =! L .9o a c OJ E o oo(o c(!.9 - LC6 9EtrEos -o o c .o (\, c <(uCE '= o) >d a a a a a a a a a o I o o F (r) rt)(! C) t< o)o-O^ .c i:o= IJ C) a (h Cg L(€ rE o (d a. rl cr) o(! oo o (h oa Fv) EL oo cd G, C€ oL o(! (d (€ z o L (g 2 o o EF q1 o 60 (B 6 O a oo a.(t) IALo o a \) \) \) h v *t U C) $-< (.) a cO b0 a a c) Cd o0 o q 0) rii t-l o -E G t'( a 4.4. Operational research 4.4.1. Summarize in not more than one half of a page the operational research -' undertaken in the project area within the reporting period. None was undertaking during the reporting period 4.4.2. How were the results applied in the project? Not applicable SEGTION 5: Strengths, weaknesses, challenges, and opportunities List the strengths and weaknesses of CDTI implementation process. STRE,NGTH Support from both APOC and IINICEF. Regular meetings of the LOCTS. Avalaibility of adequate Mectizan and albendanzole for distribution. Cooperation from the LOCTs. Sensitization through the media. Community members demanding for drugs after rcahzing the effect on the body Improved support to CDDs Improved female participation Increased number of CDDs including female ones WEAKNESSES None availability of project vehicle for monitoring. Inadequate release of counterpart fund from State and most LGAs. Comparing CDTI project with immunizatronprogramme or other PHC programrnes by the CDDs on renumeration. Inadequate maintenance of project bicycles by some LGAs. List the challenges and indicate how they were addressed. Political instability in both the state and the LGAs Inadequate counterpart fund from the state that lead to high level advocacy was paid to the state and LGA policy makers by the stakeholders ('B' Zonal) SEGTION 6: Unique features of the proiect/other matters I I a 45 WHO/APOC, 14 September 2009