Jigawa State CDTI project year 3 annual project technical report to Technical Consultative Committee (TCC): September 2001- August 2002

JEJ,Hvil $l,tt+ Br)iI ;Pro;i*,lf ORIGINAL : English COUNTRYINOTFz Nigeria Proiect Namez Jigowa State CDTI Project Approval yearz 1999 Launchins Year: 1999* Repo.rtins Period (Month/Year): September 2001 -August 2002 Date submittedz February 2001 NGDO partner: CBM YEAR 3 ANI{UAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATTVE COMMITTEE (TCC) ixDp-1, cal) ce4 [tr,e .Bli 'n*r3rr ^F:e .ra:l Inr : I I/i ,I b Di,bSbt' 1 Li ^I w tu.il: a Lgft(1,,t1 AFRICAN PROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) o 2 aout 2oot A ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: country : NIGERIAILIBERIA National Coordinator Name: S \-: Zonal Oncho Coordinator Name: Prtncess P. Ogbu- Peorce. Signature: [-t Date: j This report has. been prepared by Name : Hadi Hassan Ringim. Designation: Coordinotor. S Date Table of contents ...............rv DEFINrrIONS......... """"""""' v FOLLOW T]P ON TCC RECOMMEIYDATIONS .......1 EXECUTTVE SUMMARY.............. """"""2 SECTION 1: BACKGROIJND INFORMATION......... """"""""'3 1.I. GEUENAI INFORMATION l.t.L Description of the prciect (briefly) I . I . 2. P artnership ........ 1.2. PopwanoN aNo Hpet-rH sYSTEM..... SECTION 2: IMPLEMENTATION OF CDTI........ 2.1. Penroo oF ACTIVITIES................ 2.2. ORopnntc, SToRAGE AND DELIVERY oF IVERMECTIN 2.3. AovocecYnNoSeNsrrlzATIoN. 2.4. MOsLVATION AND HEALTH EDUCATION oF AT RISK COMMUNnIES ... 2.5. CouuuuunlEs INvoLVEMENT INDECISIoN-MAKING.... 2.6. Capncrrv BUILDING 3 3 4 5 6 6 8 9 9 2.6.1. 2.6.2. Training Equipment and humon resources... .....12 ..... l3 ..... I 3 ..... I 5 ....... I 5 ,.......17 ....... l7 yeat22 2.8. SuppRvstoN............ ..23 SECTION 3: SIIPPORT TO CDTI """""'24 24 )5 3.3. E>CPNOTUNTPERACTIVITY SECTION 4: SUSTAINABILITY OF CDTI """""""26 4.1. INreRNet-; INDEPENDENTPARTICIPATORY MONnOnnvC; Ev4IUATION 4.2. ColrytuNtrv sELF-MoNIToRINGAND SrnxgHoLopRs MEETING 4.3. SUSraNnetLrY OF PROJECTS: PLAN AND SET TARGETS (MANDAToRY Ar YR 3) 4.4. INTecRAtroN ................ 4.5 OpenenoNAl- RESEARCrL.... SECTION 5: STRENGTIIS, WEAKI\-ESSES AI\[D CHALLENGES """""'29 CouontoN oF THE EQUIPMENT * PI-Eesp srATE..'.... 2.7. Tnrarumirs 2.7.1. Treatmentfigures.........-... 2.7.3. Trend of treatment achievementfrom CDTI prcject inception to the current 3.1. FwaNCLu CONTRtsUTIONS OF TIIE PARTMRS AND COMMINITIES... 3.2. OTUrR NONMS OF COMMTJNITY SUPPORT.... .25 26 26 27 28 28 Acronyms APOC ATO ATrO CBO CBM CDD CDTI CSM FIFS IDP LGA LOCT MOH NGDO NGO NID NOA NOTF NPI PHC REMO SAE SHM SOCT SPHDA TCC TOT UNICEF UTG wHo African Programme for Onchocerciasis Conbol Annual Treatment Objective Annual Training Objective Com m un ity-Based Organizatio n Christofell Blindenmission Com munity-Directed Distributor Corn m un ity-Directed Treatment with Iverm ectin Community Self-Monitoring Health Facility Staff Ivermectin Distribution Programme Local Government Area Local Onchocerciasis Control Team Ministry of Health Non-Governmental Development Organization Non-Governmental Organization National lmmunization Day National Orientation AgencY National Onchocerciasis Task Force National Programme on [mmunization Primary health care Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Stakeholders meeting State Onchocerciasis Control Team State Primary Health Care Development Agency Technical Consultative Committee (APOC scientific advisory group) Trainer of trainers United Nations Children's Fund Ultimate Treatment Goal World Health Organization t Definitions (i) Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking)' (ii) Elisible population: calculated as 84% 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 rnoo/hyp".-endemic areas that a CDTI project intends to treat with ivermectin in a given year. (iv) Ultimate Treatment Goal (UTG): calculated as the maximum number of people to be treated annually in meso/hyper endemic areas within the project are4 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 3d year ofthe project). (v) Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a perc€ntage). (vi) Geoeraphical coveraee: 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). FOLLOW UP O]II TGG REGOTIMENDATIONS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session l7 Number of Reconunendafion in the Rewrt TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY 243 r Provide the consistent total population and eligible / UTG figures for the prqiect Figures provided in the rePort mder the appropriate tables 243 ii lncrease the number of CDDs The No of CDDs were increased from252 in 2001 to 343 in 2002.the projwt intends to errcotrage communities to flrther increase the number in subsequant years 243 lll Increase the involvement of women in CDTI The recommendation is noted for implemantation in subsequurt years. In the report the project has rePorted mapped out strategies to increase fernale involvement. Currently, Women groups are being identified and mobilized to participate in CDTI activities. 243 iv Include cost in sustainability work plan for LGA and State Costs are included in sustainability work plan" the sum of 282,000 U.S dollar for the state while I l6E0 U.S dollar for LGA. 243 v TCC 15 recommendations o Increase in number of CDDs. o Greater involverneat of women in CDTI. These have been dealt above. Meanwhile the number of refusals and absentees has reduced fiom 10,852 in 2001 to 6,495 as a result of intensi fi ed mobilizaion and befter supervision. (Please add more rows if necessary) WHOiAPOC, 26 Septernber 2003I Executive $ummary Jigawa State is situated in the northern part ofNigeria. The state was created out in SJptember 1991 from the then Kano State. It is one ofthe smallest States in Nigeria and has a population of about 2.5millions people residing in twenty seven local government areas. The people of the state are predominantly farmers and practice Islam as their region. Hausa tanguage is the main language of communication with few people speaking (fulfulde) fulani. Thi people of Jigawa stite ard particularly those of the CDTI areas are predominantly farmers and nomadic herdsmen who sometimes move away from their settlements to other areas especially during rainy season. Some of those people are also involved in dry season farming activities out side their communities. CDTI is however being implemented in 8 LGAs in the State with a target population of 159,958 persons living in 105 endemic communities. The training objective for year 2002 was set at haining and re-fiaining of 178 health workers at different levels of CDTI implementation and 343 CDDs. A 100% achievement was recorded for each ofthe categories by the end ofthe year. Treatment was conducted in all the 105 endemic communities of the 8 CDTI LGAs. This gives a IOO %oGeographic coverage. A total number of 139,843 person were treated out ofthe total population ofl59, 958 people. This gives an overall therapeutic coverage of 88% in the State. A total of 355 , 494, mictizan tablets were used for the above treatment out of 391,500 mectizan tablets received. The major challenges faced by the project, and which it is facing include: o Inadequate support to CDDs by the communities . Low level of supervision by the LOCTs due to poor funding for supervisory visits. This was a result of zero allocation from the federation account. o Payment of incentives to village workers by some programmes such as NPI has affected the CDTI implementation negatively. o Participation of women groups in the CDTI process is stillnot encouraging. The challenges encountered were addressed in the following ways (but they still remained current challenges): o Intensified targeted mobilization of community members, influential persons and interest $oups to support CDDs. This is still being pursued. o Efforts made to identify and mobilize women groups to sensitize/ health educate women and generally increase female pg{tlclp+tipn. fo address low female participation-the project intends to Oo'tEffi#$fi the coming years, o Project is aware ofefforts being made at the highest level of government to stop payment of all community based workers. 2 WHO/APOC, 26 SePernber 2003 SEGTION {: Background information 7.1. General inforrnation 1.1.1. Dcscription ofthe p"oiect (brielly) Geographical locatio n, topography, climtte Jigawa State is situated in the northern part ofNigeria. The state was created out in September l99l from the then Kano State. It falls in the Sudan Savannah and Sahel zones. The terrain is generally flat or slightly undulating with few rocks and hills in some places particularly the southern part of the State bordering Bauchi State. The State is drained by some major rivers such as River Hadejiq River Chiyako and their tributaries which are largely seasonal, while the main rivers have swampy areas, and the presence of some man made dams in the State provides breeding sites for black flies. Po p ulotio n : a c'tivities, c ult ures, la ng uag e Jigawa state being one of the smallest state in Nigeria has a population of not more than 2.5million people living in twenty seven local government areas. The people of the State are predominantly farmers and practice Islam as their region. Hausa language is the main language ofcommunication with few people speaking (fulfulde) fulani. The people of Jigawa state and particularly those of the CDTI areas are predominantly farmers and nomadic herdsmen who sometimes move away from their settlements to other areas especially during the rainy season. Some of those people are also involved in dry season farming activities out side their communities. Co mmunication system (road.. ) The roads connecting the towns and major cities are in relatively good condition, but the roads to the communities are in varying shapes. While a few are in good condition, some others are full of pot holes. Others still are laterite roads and can be impassable during the rainy season. Communication channels are many and varied. Some follow the traditional authourity structure (from the Emir to the district heads, to village heads, then to ward heads and lastly to household heads). At the community level town criers, local musicians and drama groups are veritable means of communication. Radio is a medium that is widely listened to as Hausa is the major language ofcommunication and used for most programmes. Newspapers especially those in Hausa are also read and television is a medium that someJisten to. Ad mi n istratio n str u d ure The administration system in Jigawa state is oftwo folds - the modern system and the traditional system. The traditional leadership structure is hierarchical in nature, large areas are under the authority of a District Head, who is responsible to the Emir. Under the district head are village heads, and under them, the ward heads, who relate directly to the heads of households in the communities. Under the modern administrative structure the State consists of 27 LGAs. The LGAs are further subdivided into wards, which in turn are made up of communities. The State has an elected Govemor as the head ofthe executive arm while there is a house of assembly made up of elected representatives of the different LGAs. This forms the legislative arrn. The same pattern applies at the LGA level where the legislative is made up of councilors from the different political wands. The traditional system relates to the modern in an advisory capacity but welds a big influence on government decisions. J WHOiAPOC, 26 September 2003 Heahh system & health care delivery (provide the number of health postdcenters in the projecl orea dthe information is available). The health care delivery and the health system of Jigawa state is relatively good. In prevention aspect there is the State Primary Health Care Agency @HCA) that oversees health care delivery to the local governments. These health care seruices include immunization, health education, maternaland child health, HIV/AIDS, water sanitation, oncho control, malaria conffol, guinea worrn eradication, and growth monitoring and nutrition. In the curative aspect there are general hospitals in allthe 5 emirate councils, and comprehensive health centers in all the remaining LGAs. These provide curative services to the people, while health posts are provided in the villages. 1.1.2. Pertnership Indicate the partners involved tn project implementation at all levels (MoH, NGDOs - natio nal, intern atio nal) The partners involved are CBM, MOH, endernic LGAs, some CBOs and the endemic communities. Describe overall working relationship among partnerc, clearly indicating specilic areas of projec.t activities (planning, supervision, advocaql, planning, mobilization, etc) where all pafiners are involved. There is a good working relationship between the partners. The State performs such functions as training and re-training of LGA health workers, Mectizan procurement and supply to LGAs, monitoring and supervision of mectizan distribution, formulation of operational guidetines in order to ensure good implementation of the programme, and community mobilization and education. The LGAs are responsible for training and re- training of health facility staffand CDDs, Mectizan procurement and supply to communities, community mobilization and education, monitoring and supervision of mectizan distribution. The assisting NGDO, CBM, supports in the production of IEC materialq provision of technical support to the project advocacy for financial support and supervision ofCDTI activities in the State. The endemic communities collect their yearly mectizan supply from the health facilities, ensures distribution of mectizan to eligible persons, selects distributors and determines times and methods of distribution. They also minimally monitor and supervise the distribution exercise. The CBOs helps in supervision and monitoring, community mobilization and education, and training of personnel at community level. The NOCP through the Zonal office provides technical and moral support to the programme, supervises the activities of the state of Oncho Control Programme, and pays advocacy visits to policy makers to solicit for support to programme inrplementation. State plans tf any to mobilize the state/regiorddistrict/LGA decision-makerc, NGDOs, NGOs, CBOs, to assist in CDTI implementation. With the elections into local government positions scheduled in March 2004, the project intends to mobilize those newly elected. There are also plans to identiff and mobilize more CBOs to support the CDTI implementation process. Specifically the project intends to mobilize the National Orientation Agency (NOA) at local government level as well as the community vigilante groups to assist in mobilization of communities and supervision of CDTI activities at the community level. 4 WHO/APOC, 26 Sepember 2003 co o a^t c) .o C) o.(,)a \o GT U s o Es€ * >(r(J .Uoti#-Eq)os{LbSE sSe\rE s -s6x$E s *E'E::*$'E !s-s €cE EsF= Ss\F .S -Y.-9t () =TE$ Ne9. s il.$ $ h cl= .a II E $$ie s PX E S -\ 9\".d =.+G= E Er E Ss:; sstE \SHg 'i s$E $ ES$ 5 d3S'r t Ei$g: E, *tE s .a tEE * e -.\ L hS-(D ll (! s$E t EEFPO : H rs; ss E EPIE S ; tlnE SsBtt ' ssi\Q) ra) B0EI 3o 5 .lal EIolel Er' €=qtt zl I ; 'CO-c u) )1 I .x a) %Bq) s Ei .9 o) o. oo L oo G) o) o0 E o o 6,) CB 0.) (.) li cg () o) o) B 6l c)L cl (Jq) oha oL E €) E9L+o:9.=Or 9r- (GEtr -9E5o€ -2*o.rleEE6E Eqlo.H -.=fltr6= -cE=od .rlNEI .(\l1FFI L ta IFDst= ooo(.l\o oo rn$ oir| a ooo rat C\ ooo(rl oooo ooo\o ooo\o 6ln o\ o\ ra = [H iEEtrE t€o\r-\o \o rat ial .+ ol o\o o\\o6t € C\l €r\ rOlat c?) oo t cflrt\o cqO c.)\o . .-t Ei=€cEtE.E; >EoO =sFt tE o E o cl o o0i €cF €=; ?.: Eo cl"= #sx. $ € o\r-\o \olat( + C{ o\ o\\o a.l € c.l a c-- c.li c.l oo + ca i\o c.lo c?l\o 6ra o\ o\la v) I I *g ER8.eEE -l:ct a) oF o\eo tr) € otC\ o\ oo eO .gEEFr)=! E-EoH9E E rle €t,E >i Q)+.E N I I I I I I t I c-) !n ttq) BD €E qh(,) oI o Lq) ! z CJ EgE FtEo E'Xr *sr o\ea r € c.l(.l o\ € c.lo\O Or\o(\ € or oor- co rat trt oo sf colat\o cOo co\o € rn o\ o\ia GttrP .9E; --9 -= ;- cJ? !l 6.gtE 3g P'F trtE EL $ € o\ c-\o \o rn rn+ d c,F F1 t'( o Fr +.(l)CJ .F€.9 Entsa ={ iHF 9'5E'A .E M L o C! .= li ca 0)(t) o E(g H B(, GI .t) (o V C, E GI ao cl M t o0 & a SEGTION 2r lmplementation of GDTI 2.1. Pcriod of activitier Insert Plan of action indicating activities by month, which were implemented. 2OO2 PLAN OF ACTION S/N ACTTVITIES MONTH IMPLEMENTED I Programme review and appraisal meeting for state and LGA. January 2 Training on CSM and SHM April 3 Advocacy visit to LGAs February 4 Training of LOCT and facilities staffon supervision and sustainability April 5 Stakeholders' meeting April - May 6 Targeted mobilization of some communities. March 7 Targeted training of CDDs March 8 Census up data of community mernbers to determin the quantity of drugs required. May 9 Mectizan distribution and spot check supervision August - September l0 Community self monitoring Novernber ll Wrap-up oftreatment and collation of results November 6 WHO/APOC, 26 Sepember 2003 Fl od F -rlF:l ts v 0a X o)C oaF' D) e F]d0 c) o{ D:I A' UIE1 ln(D ID T A' E! I 5 X U TA rl ti F z q f) ? o:rr .) ? qq z q o qq z Bo ? Bq D) E9EH5d -=t 85 =rE =Ftrt9 =9. (De IAA ? Ho Et E a) 'oFt otHI o:HI rT, o6 o EE9's !r= oE EI z D ! z B) !I 'lfI '1, !I a9EE =* =T-0e rtEt D' 0eE o: ? E z A' A) E 1Jt EI o AE9E -6 = g'. o ? 0, ? D) ? A: z q: o)k 0,k o) 7 A) -0Ei rE o(D tr, U) ID l' (D z o)k 2 o) 7 A) z a ? O) z A) 7 A' z o:k oo =l ErgE -9 (D c (.0 (D o art () c o E o _a 3T =+ -5 -ce El UE a o -t Ezo zo o() zo oc) r+ oo oC) r+ V)t] o -9 =,9'o o :, @ o (1 c (! E (1 E (1 E () D' -aD;PEl.+sF a o! O o z o zo ol) zo ooi+ oo oo :-+ ao! r+ o Eg3E Er3 g l-l lottd IrD It, ; (D =l(D oFl) o) a) (Dt, o' (D H(D o,tt H(D o, (D o- (D o r-t (D (D !,t B (! (a $ o(\ o s (! o(! la Ca c s_. I oo o v, { o _o t\) o\ U)G .(, tD 3r No 2.2. Ordering, storage and deliverY of ivermectin Mectizan@ ordered/applied for by - Qtlease tick the appropriate answer) eroH n wHon uMCEFtr {xcoC] Other (please specify) Mectizan@ delivered by - Qtlease ttck the approprtote answer)MOH.I] IYHO tTnrrCEFtr NGDO! Other (please specifr): Ptease describe how Mectizan@ is ordered and how it gets to the communities The State compiles population figures and determines total number of tablets that will be required for the next treatment cycle. It provides these information to CBM who fills the re - application forms and submits through the NOTF to MDP. On receipt of the d*g:, the State cbile.t. the mectizan from CBM head quarters in Jos. The LGAs Coordinators pick their consignments fiom the State while the health ftcility stafffetch their mectizan from the local gonernment headquarters. These then inform the CDDs ofthe availability of mectizan. The CDDs picks their consignments and distributes to the community members. Table 3: Mectizan@ Inventory (Please add more rows if necessary) Snte oaivities under tverneclin delivery that are being canied out by health core penonnel in the project area The health staffperformed a number of activities under ivermectin delivery-that includes the following: o Based on the population figures generated by CDDs through census up date, the health staff apply for ivermectin. . The health workers ensures collection and delivery to the next level of Mectizan requested and applied for. o The health staffalso stores mectizan for safety at all levels. o Mectizan inventory are also kept by health staffat all levels. 8 District/LGA Number of Mectizant tablets Rcqucsted Receivcd Used Lost Wastc Expired Birnin Kudu 155000 I 55000 154470 Birniwa I 8000 18000 12000 Dutse 30000 30000 19956 Gwaram 63000 63000 62900 K/Hausa 40000 40000 38000 Kaugama 35000 35000 23551 Ringim 35000 3s000 30000 Taura r 5000 I 5000 14617 TOTAL 39rs00 391500 355494 Any other comments WHO/APOC, 26 Segember 2003 2.3. Advocacy and Eensitization State the number of policy/duision moken mobtltzed at each reletant lael daring the current year; the reasonsfor the sensifiZptbn and outcomc. Dacribe dfficulties/constraints being faced and suggestions on how to improve advocacy. Advocacy visits were carried out during the period under review to Local government areas (LGA) chief executives before and during the take off of the treatment cycle, in order to solicittheir cooperation and support for programme implementation. A total of twenty four (24) local govemment chief executives, twenty eight (28) district and villages heads were mobilized.- The advocacy visits made the policy makerVtraditional leaders to mobilize their wards which resulted in high therapeutic coverage rates for the LGAs. Constraints The onty constraint encountered was the inability to meet some of the policy makers, and a repeat visit had to be made.. Suggestions Advocacy meeting with LGA chief executive should be held at the Ministry for Local Government Affairs. This is necessary because of the importance that LGAS attach to that offrce that supervise them. 2.4. tobilization and health education of at risk communities Provide information on : - The use of media and/or other local systems to disseminate information Radio Jigawa has been of great help to the project most especially the "Laftya Jan\" programme, a Hausa programme that usually interview progralnme coordinators ( Oncho inclusive) on the disease pattern and the control strategies. Communities lvere mobilized using the following channels of communication: - TraditionaU Religious leaders - Face-to-facediscussions - Town criers - Posters - Mobiliution and health education of wonun ond minorittes - method and raponse During the reporting period the project relied on mobilization of the men to mobilize the women in purdah. Efforts were made to get the men agree to the involvement of women (wiveVsisters/wards) in the CDTI process, but these did not yield the desired results. The project could not pscertain during this period the quality of information on CDTI that finally gets to the women folk from their husbandJfathers. In order to increase the level of involvement of females in the CDTI implementation process, the project intends to do the following: l. Constitute a research team that will use focus group discussions to ascertain the quality and quantity of information on CDTI that gets down to the women folk. 2. Using the same team try to ascertain ways and means of involving females in the implementation process within the limits of the traditionaVsocio - cultural structure. 3. Mobilize Islamic scholars and use them as mobilizers and health educators of women. 4. Encourage usage ofpublic address systerns in health education and mobilization of communities by health staff(particularly, health facility $aff) so that women in enclosures could overhear what is being said. I WHO/APOC, 26 Sepember 2003 5. Make use of women vaccinators/guides used during NIDs (generally accepted) in reaching women in purdah. 6. Mobilize and use of traditional birth affendants in the community treatrnents - Response of target communitiahlllages The vaiious communities have demonstrated their commitrnent to the implementation of CDTI, and are actively participating in the CDTI process. - Accomplishmena The project succeeded in mobilizing all the endemic communities and these has resulted in an overall treatment coverage of 88%. - Weaknessq/Constraints The women in purdah sometimes are deprived from getting the correct information on CDTI during mobilization as the messages get to them only through their husbands. - Suggat ways to improve mobilization of the target communitis- The quality of information that gets down to women in purdatr is of serious concern in predominantly Muslim communities. Strategies mapped out to reach this Soup ofpeople have already been reflected above. l0 WHO/APOC, 26 Sepernber 2003 { C cn { ?7 e -t(, g Fz 1 EE v2 2 xco.E t q,r o D -t C ts F2 z x o 1..) o\ tJ -J t.J N) E =.9:l Er3? i +e+ \oo tJ i.)5 t)N) l9o 5 s -t a'71oi*Ew< Itor!&:9 !r ei 6 (r) 5 5 -I 5\oo\ -l\oo\ hla s G a lr lteo zE C6 o 6 !0 EF$.o i.E Erl!. E' o or t, o F.t h,) \o o\ u)\o6\ c s 6\o6\ hJ 1Oo\ t.J o\ -o o\ 6 \o i..)tJ @ \o 513:r i63Si46E- e * 1.= .i i' =' :'looii o \o N) FJ \o oz^Zfsgi ? r3 E ,i'n = 'o 6 =.,;a€+ 6 o s o s e s \co\ \oo\ oo\€ o\ o o E BEo aZOE =o!.o rZE lo +E E6@q a< EFJ.8Et li? oo s o s \co\ 5 o -: hJ 5 6 t)€ SJ t) € ? tD - I t trE .d. 5 \t t.J5 o o\o\ 19@ tJ N@ -to E z r! o Zqolc ;trA.* (t o c o l I siE+ * E,-s I a t to 6 a ts 0ea r:z EiO;{r =taQ r3a3oEl ,.r E. 9cq N a t,| a o o :ld 3 E - - -at) -o o -T o -( o 3 oIt -t c o o x o -ao3I 3 Dr -a5 € oo 3 = (D tt) (D() Url S(! q(\ $ s o\(\ os $tg*$rsI Es3*ES$surE[::t$ g gSsiS 3E i*: s -;IE t$IaIR'u il fiSEFEF E'S?;'g FTiavtH+\t)2-- *s. e.S. -E <cl s- g S'R 7e- tN.3fi E s 'fra $$ =3. .3 Rit = \l ='3; ssgd ls ra s $(Du S.t ='E S i;a'3 .$'CDo\ *:J :toE it == !S- E:A' dEE =ss $ii- oE.A Uif E{'& E'$EE6E S ='U) S.+? s.5+ooBd': *6'' k =€ Ns3 F -(D955 iEa Ro-Gu)S5s =5s { ot op l.J o\ a(D .o (a5 er a! N) U) 6 I I 2.6. Gapacity building 2.6.1. Treining Training being an integral part of the CDTI process was given due consideration during the period under review. Materials were developed in line with the NOTF instructions. Little modifications were made in some materials produced such as posters and T-shirts to have some Arabic wfiting which is in line with customs and beliefs of the ofthe people. Currently, the CDD brochure has been translated into Hausa language. This is to make comprehension better. lA WHO/APOC, 26 Septonber 2003 l-l lo)ld lCDl* ; ts oa D) (D o- tD'Ft o3 (D (D t/) o o U -l \, (D (D 8e o a(\ V1 $ o cS s\ (\ o Vl Ca U 0o @ { F) EE J xc o.E E' o t: F o Fl o -t F -l O)c ts 3. ge x D)c oap D] l D)c TD F) o{ P s, 3 F ,l a s 5 5 5 5 5 5(, hJ + + t t D z E(D -l o ci9 ==.(!asd F o la (u E ,.at s a ET r! (D ll oo t, TJ t, N) I 5 5 I 5 5 I 5 F 5 5 5 5 A 5 5 5 5 \r -l a (, a (J) A 5 Ur *J 5 s o oE .! I (, € (,6 I (j) u) I 5 I 5 5 t (n lJt I { -J A 5 t A 5 l \t { t $ -lo t a(D *z <= 5eroal i5 rrr -i!l =i .D o € l.J N) 5 @ t'J tJ 6 ,J a I o t) NJ I tJ N) s I 5 € I 6 I tJ N t.) N) a I @ @ d :l' -to z -t(DErl E'9. aDO '](D ri 't its(, ='(D 0 \o a (! tl o o c6 c ea I (,5(, o frJ{ t.)5 U)o o\o\ t.J€ N)o [..J6 6 -\ a o !! o o \oq\ 5{ t,5(, o I <) 1..) t,(,r r! -t tJ5 (r) N) (,J I (, o o\o\ o\ tio UJ (.T tJ@ NJo Ul (n N)@ @ F.J -io t 6- s, z ET(D o o E'Uo !9 (Do o o o s 0a { \ oo N) o, U) t.0ro (! cr a! t9o(, ;( I 5 Trainees Type of training CDDs Other Community mernbers e,g Community supervisors Health Workers (frontline health facilities) MOH staffor Other Political Leaders Others(speciff) Program management ./ How to conduct Health education ./ ./ { { Managernent ofSAEs ./ CSM ^/ { SHM ^/ Data collection { ./ { Data analysis ./ ./ Report writing { ./ Others (speci&) Table 6: Type of training undertaken (fick the boxes where specific training was catied out during the reporting period) - Any other comments 2.6.2. Equipment and human resourccs Table 7: Status of equipment (Please add more rows if necessary) *Condition of the equipnrent (Functionaf Currently non-fimctional but repairable, Written off). NB: All the equipment cunent$t non -functional ore repairable Source Type of Equipment APOC MOH DISTRICT/ LGA NGDO Others Condition of the equipment * Please state l. Vehicle I (functional) 2. Motor cycle 5 (functional) 3. Computers I (non -functional) 4. hinters I (non -functional) 5. Fax Machines 1 (functional) 6. Others a) Photocopier I (non- functional) b) Generator I (non -functional) c) TV &VCR I (tunctional) WHO/APOC, 26 Sepanber 2003 How does fhe project intend to nuintain and replace existing equipment and other motertols? The State government does provide funds for purchase of spare parts and general maintenance of transport and equipment. Most of the items already that were indicated to be currently non - functional have been repaired, but had broken down again. The Local Governments are also releasing some fi.rnds for maintenance of the motorcycles as well. The project intends to requestlPOC management in the short term to replace the capital items supplied while "ffortr continue to mobilize the State to replace them on the long run when they prove un - repairable. Descrihe the adequacy of available knowledgeable manpower at all levels There are adequaie and available man power to facilitate the CDTI process. The project have hained enough man power in case of frequent transfer of staff. For example at LGA level all the staff *oiking within the PHC departrnent have been trained on CDTI and a lot of the health facility staffwithin and out side the project areas have been trained. Wherefrequent transfen of trained stalf occur, state what proiect is doing or intends to do to remedy the situation (The most important issue is what mectsures were taken to ensure adequate CDTI imptementationwhere not enough browledgeable manpowerwas available or staff often ffansferred during the course of the campaign). In case of transfer of CDTI personnel and the assumption of one not conversant with CDTI, the project usually conducts an orientation for the new one pending the time he will be formally trained. l6 WHO/APOC, 26 September 2003 2.7. Treatments 2.7.1. Trcatmentfigures The State project conducted treatment in all the 105 communities of the 8 CDTI LGAs. This year's total population ofthe endemic areas is 159,958 people are recorded during census up date. A total of 139,843 eligible persons were treated. This represent a therapeutic coverage of 88%. The project has made plans to confirm results from LGAs with high treatment coverage of 90Yo and above to ascertain validity of the population figures. t7 WHO/APOC, 26 Sepernber 2003 .l tl F i e F 2 o2 x e o ? 4 e U) o F 7 t(- -Ja(rJ ID zI AEE =roYZ\-2 xa' rJ. lJ) @ \o tJt\) aa (,)\o 6 H eE xq e8 5's.g Fg s i$rE:tr 3< odo 5 *6E E A,q oo (D u) S) oa(D ta UJ 0p \o l.JtJ @ u)\o Y e'>8.ts Ho37 E.d Eo!a (r) @ \o t\) hJ @ (,\o o9ZqS.dE Bfi E.q' *@ =.^ta o 1Q O o\ \oo\ \o6\ o \oo\ o -o6\ oo s o\oo\ o -o6\ ^6xo ^>(Fro<i tro\-gvts 9 rb5 g \o\o(, 0a o\ UJ lJJ o\ lJ)s t-l UJ{ 00 N) ooN) o\\o \oN 5(i(, o, o\ *J\o oo5 F]9a 9.a= E 5 Y 6Y6'g stlo,i o =-tx ii !, i =' oE O) o 5 s5tJ6 s o\ o\ @ s5 t,(a \o tJ o\s \o N) t.) o,6{ o\ o\ ^-l.Ye > GECOr= ?.H Ed=, *5 u) s -.t6 -.t 5 5tJ {\o \o 5 u) NJ5 tJa s t-J oo o' UJ6 tJ o, UJ o\ zqT EoxJ LA; 6 @ o\ { 6 \t\o \o 6UJ {5 @s \ot\) 8r \66 E o\lEvE 60aao=- o s @ (^ a -ro\ o\ N)(, o\ 5\o ef +a *9*-ai o\ N) hJ N) 5l.J (, i.J S.Jt) @ \ooO oZ6trE3BIG- I az 95_ ri, li I t 'cl A9O =rd ZSaHBFEE E i39ff E q - -HE =};' BG:i l-l lF)t6 l(D loo ; (D E) o F) o- U) E]U' 6 o t, Ft o -o D) F)Ft(D Do u) 8) Fl o7r e(\ V1(! :L ci ci V2 G a$ V1 \)\- l?tlo ITIE lo) la t;lo l3 TEls l5tat-l=loIE lo) tc, l(DIEl- la) lol5lir-[a t(DlotaI4 la)tol=l() l!:- ls l5l- IA' 0a I(D lu) -t (DI A' EGEe6'I () ts oao d (D o(D oq o: og oo o ts 0a(D >t A) o -llZQlcst3;trolrro lotr l+) PIE E'E -lo .:. t(D o? lH' ='lo:tx dlootOo 'o(D II(D p. (D o oo J (D u1{ 5 (D 'o e.o c) A)I(D F' 4tzo lc' !]ll -ld5t6 'F l-5loJ I'nqE e" li5|trB l=.I lf.\t@ =r t\Vl< rJ l= str elg o- l* Ets ='I(D(' IO-Rlx HIo5lo ='(D v, o, 14 a(a s. (Da v rr,? o (D ,o €.(D C) !9 E 6 o o t-J o, a(D "o (D o'6 tJo tr) I -l o c)o s0 .-A, oa(D AJ (a >lz 5t5 E.IH. -: lr;, lo stil:Jtoo lct =l(!Yta(Y. IAJ slH <lx(nl t5la BE 5 5Ell ll Fl5r $ ori t a Eg $. ERE il d;: 3 ol.s =sE !Er SNS v vQ 'i ss $ds stBH ',6S rr$ S.rio s *i i tl{Ss g Elq EE E Tlg,f$ S cl9ti $ E'15i$ E El[ 3E t rl:qt o filo .s! O ts F$ E i!- E *s r esdsS 6=v:s€H *8 -F=(D *[ FTE.Jt*A' '$sE =5'Ais 3 GG;+F={:ftli rs/Fh.;:ixx! t=. +G(}G:f)\iS+ ,I:TBt'a 6F l. t4S-U, 1!AG .h,1s$ Ni.btr Oa GI €S.i l:S G s Oa G \o o o tJ o\ ao .o (n o.r! tJo If the project is not achieving 100% geographical coverage ond minimum of 65% ih"rrp"uii"ol coveroge rate or coverage rate isJluc'tuating, state reasons and plans being made to remedy this. The project is recording a 100%o geographical coverage and more than 65%o treafrnent coverage. 2.7.2 What are the causes of absenteekm? l. The people of Jigawa state are predominantly farmers and nomadic herdsmen who may relocate at distribution times. 2. Movement from rural to urban areas in search of better opportunities when treatment with mectizan or CDTI is being implemented. 2.7.3. Brielty desuibe all known and veifred serious odverse events (SAE{ ond pmvide in table 9 the required informttion when available 2.7.4. In case the project has no case of serious advene event (SAE) durtng this reporting period, pleose tick in the box No case to report J 20 WHO/APOC, l0 April2003 l-l lorl6 lo I'o o D)tntt an oFt o)t! o o D) o- (D -tt,() (D o t) a rn U) s) ooo Ft o o- o- oa @ o ot Oa 'oo o o. a G r.,(! =. rd c5 \ G oG V2 a4 a .'t * V)(t: (!\ (! G N) t ,U "o o ro N)OO UJ U) + 0qo a(D x o1 J. r.oa= ='tDJOQo o DIt I a C EIF rE -hI !7 a-ll $o@HjJ-ltpI{ €6x5( a 3 .5UI G C ) ) I $F$HstI )hd t Sfr'BV i=q ^ E'I -ICt , )I q)':t'=v69aD =5 J (Do=6'o -6@t ni D) Ft 2^fr3:rcE dee3;' =oX+a6I @ T EOOaBAoxq= a'(D o 9.a l!1r:/Xq3ripH 3qE adE '*3 Pq aE- X.io (D - o a.l o3 E 0) o.oo o.l U o T c.l c.l q) s o;3p 66LL!tAE oEE.sEtsooE, ErEdi rH !i tll Orl?€lEEIo rDlEEI -()lEl -lE5lc)0)B9p Ao!l> eOEc) rl,!rE qt(ltPur e=tsE EE F \olGtl orl -oldlFI sra o\ 5\rl F- \oo\\o € -oo\ o\ \oo\ O1 oo \o o\ 6) 6a)9Sal e5 U sF. € s o\ o PBaF Oa\<B- o \oo\s o\ \oo\ o, s o\ 6\\f o\ \oo\ c7} oo s\o o\ 1Qo\ € € o 'Eo ,mO d^gTE ooEOF -o6\ F- .o6\ ca oo s -t@ at\o c..lF- \ot'. * o\ c\lo a.l tt+ € o\ €q.9 od ,oE.: =@tsE 2E p. O c-l €r\ CA (\t r.- c.) a.l\o \o o F la) o\ Oc.)=oEEE E E.C < g*'FIJ oost c.l \o .+ € o, o, I tro 6 ao o< -: re EEgSEt Et t\o r'. o^l (\t rr €s r.- rf +F- @ \o o e{ \o \oo\o 1O \o6\ -o6\oO so9fa5 9C o \oo\ s -6o\ 8 6\o 19 o \oo\o =oo. ooE= EGooX oo\g - e- n+{Oo'E ql b'5 s3 E E= E - tr. 5>o6 6l c\l N o r-. o N -t oF- ho o roEo E Ei E E.S < g4'FIJ N6l !og ,yts* g E H+.9= >; =.= tr <.= E E , EEE *6 oo ol6l c.l.+ t- ra 6O o0 c, () a E U o\ 8 c.l c.t too c{ tf 86t r) 86l \o ol t\ oN oo O ot € o\ o\ o\ o\o\ Oot oc.l 6t oolr! F- o\ o\ 2.E. $uperwision 2.8.1. Provide aflow chart of supervision hierarchy. 2.8.2. What were the main rsszes identilied duing supemisiott The main issues identified during supervisory visits include: o Incorrect registration and poor entries of dosages given by new CDDs with low literacy levels. o Determination of dosage by observation rather than by use of calibrated Sicks by some old CDDs. o [mproved community participation in some areas. o Inadequate support to CDDs o Low level of supervision by LOCTVHealth Facility staff o Low level ofparticipation of women in the CDTI process 2.E.3. Was supervision checklN used ? Both LOCTs and the SOCTs made use of supervisory checklists 2.8.4. W'hat were the outcomes al each lewl of CDTI irnplementafion supentised o A one day meeting was held at the Ministry of Local Government for all the LGA PHC Coordinators and Oncho Coordinators on the low level of supervision. PHC supervisors were encouraged to provide fueling for supervision. Coordinator SOCTs LOCTs Health Facilities CDDs/Communities 23 WHO/APOC, l0 April2003 . Some women groups have been identified and are being mobilized to participate in the CDTI process. o The LOCTs were requested to organue retraining for CDDs on record keeping and enhies into the community log books. o During supervision some efforts were made to correct CDDs on Poor entries made and ,sug" of t[r. measuring devise for dosage determination' 2.g.5. lyasfeed-back given to the supentised, and how was thefeedbach used in improving the overall pedormance of the proiect Efforts were made to [ive feedback to botli health workers at the LGA and Health Facility levels as well as the co=mmunities. The major emphasis was on the health workers for those issues seen at the community level, as they are expected to follow up on them' SEGTION 3: SuPPort to GDTI 3.{. Financial contributions of the PaltnGrs and Gommunities Table I l: Financial contributions by all partners for the last three years If there are pmblems with release of counterportfunds, how were they addresed? When the project encountered some difficulties in the release of counterpart funds it liaised with the NOCP and the NGDO partner to pay advocacy visits to the State Governor. They appealed to him to give his support to CDTI by giving counterpart funding to the programme. Contributor Yezr I ('provide the priod') Yce.r 2 ('provide the period') Ycar 3 ('provide the period') TOTAL Budgeted (us$) TOTAL Released (US$) TOTAL Budgeted (us$) TOTAL Released (us$) TOTAL Budgeted (US$) TOTAL Released (us$) Ministry of Health (MO[D 45,120 r,780 3,850 2,8s0 2,700 Local NGDO(s) ( if any) NGDO partner(s) 67,145 28,145 28,921 2,r00 I 8,200 District/LGA 3 r,9E0 1,500 2,s72 1,200 12,620 r0,220 Others a) b) c) Communities 3,000 3,000 5,000 APOC Trust Fund 60,500 60,500 25,250 25,250 lt,220 t8,220 TOTAL 222,745 (r,780 63,593 33,469 6E.2M 51,640 24 WHO/APOC, 26 September 2003 8.000 !.2. Other forms of community support Describe (indicateforms of in-kind contributions of communities if any) The communities support the CDDs in kind by giving them some measures (mudu) of maae/ millet/guinea corn/beang or give them other farm products in appreciation of their work. During farming some communities assist their CDDs by mobilizing some members to work on their farms. 3.3. Expenditure Per activity - Indicate the expenditure on activities below in US dollars using the current United Nations exchange rate to local currency Table 12: Indicate how much the project spent for each activity listed below during the reporting period Comments Erpenditure ($ us) Sourcc(s) of funding Drug delivery from NOTF HQ area to central collection point of community Mobilization and health education of communities Training of CDDs Training of health staffat all levels Supenising CDDs ard distribution lnternal monitoring of CDTI activities Advocacy visits to health and political authorities IEC materials Summary (reporting) forms for treatment Vehicles/ Motorrycles/ bicycles maintenance Office Equipment (e.g computers, printers etc) Others 10,642 5,225 3,920 2,737 5,320 3,840 3,790 1,850 2,600 12,284 APOC/State/ LGA APOCiState/ LGA APOC/State APOC/State APOCiState/ LGA APOC/State APOC APOC/State APOC/Stale APOC APOC TOTAL 51,640 Total number of persons treale{ 139,843 25 WHO/APOC, 26 S@ember 2003 SEGTTON 4: Sustainability of GDTI 4.1. lnternal; indr-.pendent participatory monitoring; Evaluation 4.1.1 Was Monitoring/evaluation canied out during the reporting period? (tick where applicable) -Year I Participatory Independent monitoring Mid Term Sustainability Evaluation 5 year SustainabilitY Evaluation tnternal Monitoring bY NOTF Other Evaluation by other partners None was carried out during the reporting period 4.1.2 What were the recommendations? N/A 1.1.3 How hove they been implenunted? N/A 4.2. Gommunity self-monitoring and Stakeholders Meeting Table 13: Community self-monitoring and Stakeholders Meeting (Please add more rows if necessary) Describe how the results of the community self- monitoring and stoheholden meelings have affected project implementation or how they would he utilized during the nut treatment cycle. The project intends to utilize the results of the CSM and SHM exercises in the following ways: 26 WHO/APOC, 26 SePember 2003 District/ LGA Total # of communities/villages in the entire project area No of Communities that carried otr self monitoring (CSM) No ofCommunities that conducted stakeholders meeting(SHM) Birnin Kudu Birniwa Dutse Gwaram WHausa Kaugama Ringim Taura 39 5 8 'r) 9 8 l1 3 25 5 5 l8 4 3 8 3 27 5 8 t4 7 6 9 J TOTAL 105 68 79 o Utilization of the suggestions made in planning activities for the next treatment cycle o Decreased supervision of those communities conducting CSM well by the health staff. o Utilization of results to encourage other communities to implement CSM and SHM 4.3. Sustainability of proiects: plan and set targets (mendetoryat Yr3) What arrangements have been made to sustain CDTI after APOC funding ceases in terms of 4.3.1 Planning at all relevant larcls. The State and LGAs have been doing routine planning of activities for each year. Communities do same but in a more informal manner and definitely not for a calendar year. There has not been efforts at developing sustainability plans, although project implementers realhethat external support cannot continue forever and there is an implicit understanding that government will be expected to continue from wherever the support stopped. 4.3.2 Funds The project is encouragulg the State and Local governments to realize that external input will be discontinued by the 6ft year of the projec! and are being requested to contribute increasingly to the implementation of activities. Most ofthe LGAs are responding, although the level oisupport isstill not satisfactory. The same applies to the State. Efforts will be made to continue sensitization of the policy makers at these levels to increase support and eventually fully fund the programme. In the meantime the project has been assured of continued support by the assisting NGDO, CBM, although the level of support and its terminal end have not been given. 4.3.3 TransporT (replacement and maintenance) There are no wriffen plans to replace existing transport. The project intends to request APOC by the 5n year to replace the vehicle and motorcycles supplied. Maintenance of existing ffansport is expected to be devolved fully to the State and LGAs on cessation of APOC support. Currently the State and LGAs are providing some funds for the maintenance of existing transport. 4.3.1 (Xher tesourcw Some LGAs have been providing training and mobilization materials. Within the reporting period a total of :N:160,000.00 worth ofmaterials was provided by some LGAs. The project will continue sensitization and mobilization of the endemic LGAs and the State to ensure that materials needed are procured when required. 1.3.5 Please provide a written plan with sd tatgds ond achievenuntsfor sofan The 4fr year plan is attached. 4.3.6 To what extent has the plan been implemented The extent of implonentation will be reflected in the Year 4 technical report as they fallout of the period currently being reported. 27 WHO/APOC, 26 Sepanber 2003 4.4. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration 4.1J. Ivermectindeltverymechankms The revitalization of routine immunization and distribution of Vitamin A supplementation has opened an opportunity where delivery of Mectizan-to some LGAs and communities is done alongside with vaccines and the Vitamin A capsuleVdrops. 4.4.2. Training There has been inst-ances where training on CDTI was infused into the programme of training for the immunization campaigns. There were also occasions where Onchoierciasis Coordinators have been invited to give lectureJpresentations on CDTI during training workshops for other programmes. 1.4.3. Joint supervbion and monitortng with other programs There is some effort to encourage joint supervision within the project as during NIDs the SOCTs participating in the campaign are posted to Onchocerciasis endemic areas so that they use the opportunity to supervise CDDs as well. 4.1.4. Release offunds Funds are released foi all the programmes in the PHC department, and units/programmes can take loans from others when the need arises. 4.4.5. Is CDTI included in the PHC budget? At the State level CDTI is included in the PHC budget. At the LGA level it is subsumed in most cases in general line items. 4.4.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achiqements? Malaria control and Guinea worrn eradication programmes will start using CDTI structures from next Year. 4.4.7. Describe others issues considered in the integration of cDTI. ^ 4.5 Operational research 4.SJ Sumnortze in not more than one half of a page the opemtional raeorch undertaken in the proiect area within the reporting period' None was carried out during the reporting period 4.s.2. N/A How were the rusults applied in the pruiect? 28 WHO/APOC, 26 S@ember 2003 SECTION 5: Strengths, weaknesses and challenges LN the strenglhs and weaknessa of GDTI implemenlation process Strengths o Good community commitment and participation due to good mobilization o Prompt delivery of Mectizan to the communities o Integration of Mectizan delivery in the delivery of other PHC products during NIDs in some LGAs o Training of CDDs at communities very close to them thus reducing the burden of having io travel long distances. This has also enabted more community members to participate in the training process and gain more understanding of the CDTI process and the roles exPected ofthem. o The project enjoyed the services of dedicated SOCT and some PHC staff. Weakn esses/Challenses o Inadequate support to CDDs by the communities o Low level of supervision by the LOCTs due to poor funding for supervisory visits. This was a result of zero allocation from the federation account. o Payment of incentives to village workers by some programmes such as NPI has affected the CDTI implementation negatively. o Participation of women groups in the CDTI process is still not encouraging. List how the challenges were addrased The challenges "ncourtered were addressed in the following ways (but they still remained current challenges): o Intensified targeted mobilization of community memberq influential persons and interest groups to support CDDs. This is still being pursued' o Efforts made to identify and mobilize women groups to sensitize/ health educate women and generally increase female participation. To address low female participation the project intends to do the following in the coming years: the quality and quantity of information on CDTI that gets downJo the women folk. the implementation process within the limits of the traditionaUsocio - cultural structure. women. mobilization of communities by health staff(particularly, health facility statr) so that women in enclosures could overhear what is being said. in reaching women in Purdah. Project is aware of efforts being made at the highest level of government to stop payment of allcommunity based workers. a 29 WHO/APOC, 26 Sepember 2003 do t! 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