Zamfara CDTI annual project technical report submitted to Technical Consultative Committe (TCC): January to December 2006

ZAMFARA STATE CDTI PROTECT ORIGINAL. English t t Date submittedz 2007 NGDO nartner: SIGHTSAVERS INTERNATIONAL .**.,#g*. j I I r I Fq:r Ac5uf,u io:rl" '{nR ir,} BlF4 doP AHTbfo a ji s qL rl ,il tf * sL r5 For lnformdron To' t\rR AO. t+Alil',a: n.B"h;l '' i) 2 t utt znot j C OUNTRY/NOTF' : NIGERIA Proiect Name'. Zamfara CDTI Project Approval Year: 1998 Launchins vear: 1998 Reportine Period (Nlonth 'ear): JANUARY TO DECEMBER 2006 7Proiectvearofthisrenorh(circleone) l2 3 4 56 8910 . LL. It ANNUAL -P,ROJECT TECHNICAL REPORT SUBMITTBD TO TECHNICAL CONSULTATIVE COMMITTEE(rcc) DEADLINE FOR SUBMISSION: To APOC Management by 31 January for March TCC meeting To APOC Management by 31 JuIy for September TCC meeting AFRICAN PROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) 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: € a J a a Country Ntthc Ar1 National Coordinator Narne: haiArc'lA"CGr+ft Signature: W-*{""' Dater 73.327-'9|,7 Zonal Oncho Coordinator Name \ \e Signature NGDO RePresentative Name..llro.tt .e .h.q dar{.v).9 -1 1 Vttt"t Date: Datg, Date ..[" [ 7{:a:7 This report has been prepared by Name: Abdullahi Labbo Designation: Proiect Coordinator Signature: e:r:qt Ct Date *7Y[oT *. { E I I I I i I I i I : I I I I I Table of contents Acronyms viii Definitionsix FOLLOW UP ON TGG REGOilITE]IIDATION$ I Executive Summary ii SEGTION 1: Background information iv 1.1. Gu.rmarINFoRMATIoN .................IV 1 . 1.1 Description of the project (briefly) .'.. .. '.... iv 1.1.2. Partnership ...'..'... vi T.2. Popur-A,TroN ...................I SEGTIOII 2: lmplementation of CDTI i 2.1. TnGLtrIE oF ACTlvrl-IES ........... .... .....................I 2.2. AOVOCACY ERROR! BOOKMARKNOTDEFINED. 2,3 . MOBILTZATION, SENSITIZATION AND HEALT}I EDUCATION OF AT RISK COMMT]NITIES . . . I 2.4. Cot'ryrrnury bTVoLVEMENT ..............I 2.5. Capacrrv BUTLDTNG .........I 2.6. Tpoarumrs......... ........I 2 o.i Treatmentfigures,...... -..-....t 2.6.2 What are the uuses of absenteeism?............ ................i 2.6.3 V[/hat are the reasons for refusals?................ .-...-........ i2.6.4 Briefly describe all known and verified serious adverse events (SAEI that. . .i 2.6.5. TrmdoftreatmmtachievementfromCDTIproject inceptionto the anrrentyear...i 2.7. Ononnnqc, SToRAGEANDDELIVERYoFIVERMECTIN ............I 2.8. COTT,IIVINUTY SELF.MONTTORING ENO STAXPHOLDERS MEETDTGERNON! BOOTCU,MX NOT DEtr'INED. 2.9. SupBRvrsroN .................1 2.9.l. Provide aflow chart of supervtsion hierarchy. . Enor! Bookmark not defined 2.9.2. Whatwere the main issues identtfieddurrng supervision? ................................i 2 9.3. Was a supervision checklist used?..... ... .t 2.9.4. Vf/hat were the outcomes at each level o.f CDTI implementation supervsion'/ . .i 2.9.5. Was.feedback given to the person or groups supervised)) . ..............i 2 9.6 How was the.feedback used to improve the overall performance of the prqcc!') i SEGTION 3: Support to GDTI Error! Bookmartr not defined. J i EqunlcNr I 3,2 Fn.taNcnICoNTRIBI]TIoNSoF-TI{L]PARTNERSANDCOMML]NTTIES......- ..- . ...2 3 3 OrggN FORMS OF COMMLNruY SLrPPORT .] 3.4. ExpEtIDrruRE pERAcTIVITy ..........,......3 SEGTION 4: Sustainability of GDTI Error! Bookmark not defined. 4.1. INTeRNAL; INDErENDENTpARTTcIpAToRyMoNTToRTNc: EvatuRrtoN............... .. ..4 4. 1.1 Was Monitoring/evaluation carried out during the reporting period? (tick an)' of the followingwhich are applicable) ............ .....,...14.1.2. What were the recommendations? . Error! Bookmnrk not defined. 1.1.3. How have thervbeenimplemented?................... Error! Bookmark not defined 4.2. SusrantABn-ITyoFPROJECTS:PI-ANANDSETTARGETS(uaularonvAT.................4 YR3) ... ...........,.4 4.2.1. Planningatallrelevant levels .................J 1.2.2. Funds........ ..........i 4.2.i Transport (replacement and maintenance) ......... .........5 1.2.4. Other resources... .....,............ .5 T 1-2.5. Towhat extent has the plan been implemented......... .....................5 4.3. INTEGRAIoN ................5 4.3.1. Ivermectindeliverymechanisms ................5 4.3.2. Training.... ............6 4.3.3. Jointsupervisionandmonitoringwithotherprograms..... .............6 4. j.4. Release offindsfor project activities.......... ......,.........5 4.3.5. Is CDTI included in the PHC budget? .......6 4.3.6. Describe other health programmes that are using the CDTI structure and how thiswasachieved. Whathavebeentheachievements?............. .......6 4.3.7. Describe others issues considered in the integration of CDTI. .......6 4.4. OpERATToNALRESEARCH.. ..... .. . .........7 4.4. 1 . Sumnarize in not more than one half of a pqge the operational research undertaken in the project area within the reporting period. . . . .. ... 7 1.4.2. How were the results applied in the project? ............. ....................7 SECTION 5: Strengths, weaknesses, challengGsr and opportunitles 7 aEGTION 6: Unique features of the proiecUother matters 7 a i ta : J .. J4 II E Acronyms APOC ATO ATrO CBO CDD CDTI CSM DH GCR LGA MOH NGDO NC,O NOTF PHC RAM REMO SAE SHM TCC TCR TOT UNICEF UTG 'J'/HO African Programme for Onchocerciasis Control Annual Treatment Obj ective Annual Training Objecti ve Community-Based Organization Community-Directed Distributor Community-Directed Treatment with Ivermectin Community Self-Monitoring District Head Geographical Coverage Rate Local Govemment Area Minisry of Health Non-Govemmental Development Organization Non-Govemmental Organi zatron National Onchocerciasis Task Force Primary health care Rapid Assessment and MaPPing Rapid Epi demi olo grcal M apping of Onchocerci asis Severe adverse event Stakeholders meeting Technical Consultative Committee (APOC scientific advisory group) Therapeutic Coverage Rate Trainer of trainers United Nations Chrldren's Fund Ultimate Treatment Goal World Health Organization 1 .1 * i{ {t E Definitions (i) Total population: the total population living in mesoy'tryper-endemic commrxritiec within the project area ftased on REMO and census taking). Eligible population: calculated as 84Yo of the total population in meso,typer- endemic communities in the project area. (iii) Annual Treatment Objective: (ATO): the estimated rmmber of persons living in meso/tryper-endemic areas that a CDTI project ntends to treat with Ivermectin in a given year. (iv) Ultimate Treatment Goal (UTG): calculated as the maxrmum number of pmple to be treated annually in meso/hyper endemic areas within the project area, ultimately to be reached when the project has reached frrll gmgraphic coverage (normally the project should be expected to reach the UTG at the end of the 3'd year ofthe pro1oct). (v) Theraoeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) Geographical coverage: number of communities treated in a given year over the total rmmber of meso/hyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). (vii) trntegration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screuring for cataract, etc.) through CDTI (using the same systems, training, supervision and personnel) in sder to maximise cost- effectiveness and empower communities to solve more of their health problems. This does not include activities or interventions carried out by cornmunity distributors outside of CDTI. (r,rri) Sustainabilitv: CDTI activities rn an area are sustarnable when they continue to frrnction effectively for the foreseeable future, with high treatment coverage, urtegrated into the available healthcare sen'ice, with strong community orvnership, using resources mobilised by the communiry'and the government. (ix) Commumr.v self-monitonng (CSM): The process by w'h,rch the communitl' rs empowered to oversee and monitor the performance of CDTI (or any commumty- based health intervention programme). with a vie\il to ensrning that the programme is berng executed rn the way intended. It encourages the communih' to take full responsibility of Ivermectin distribution and make appropnate modificatiors rvhen necesSan'. (ii) l i rI t It[umber or Recontrendation inthe Rcwrl TCC RECOMMENDATIONS ACTIONS TAKEN BY TTIE PROJECT I The project inGgrates training of community supervisors into the shategy to increase commtrnitY ownership, if frmds are available. Otherwise APOC strould prwide fimds. Fund was provided by APOC ard SSI for training. Two LGAs also contributed fimd for training. There is only one CDD per 540 persons rn the project; howwer the range across LGAs is from I CDD/250 to I CDD/over 950 people. Project should train at least double this hgure, but preferably three-five times the number of CDDs depending on the LGA (along kinship lines) to reduce the workload of CDDs and better ensure sustainability Local Govemment should W t<l find fiurds to enable more training and supervrsion activities. Communities were informed to select more CDDs based on kingship line for better coverage. .New CDDs rvere selected in communities of two LGAs. There were 84 old aod new CDDs trained. Advocacy visits were carried out to community leaders, they were requested to select more CDDs. This is to enable meet the requirement of ICDD/250 population. These would be traind to distribute Advocacy visits wer€ turdertaken t<r the state and local governrnents soliciting tbr support and release of cormterpat finds to the project. Two LGAs cotributed li'rnrls for flre training of CDDs and activities, lv Project should ensure improvc<l integration into public health service to better stxtaro rxrc.hxerciasis pro3ects after the end ol APOC Project is making effort to ensure improved integration into prblic health service to better $Istain srctrocerciasis projects after the erd of APOC Project should tr_v to shorten the periat of distributirxt uith a more rntense social mobilization just as before Within the year treatlnent started late. Wrth the alrporntment of a new Coordinato it is hoped that treatn€nt in zubseqrrnt years will be done ealy. Project should start ensuring that Mectizm ordering tasks are undertaken by govermnent and not NGDOs as soon as possible This is being followed through n'ith the State Ministry of Health I FOLLOW UP (,1{ TGG REGOHHEI{DATIOilS Using the table below, fill in the recornmendatiom of the lmt TCC on the project and describe how they have bee,n addressed. TCC session 21't FOR TCC/AfrC MGT ASE ONLY - WHO/APOC. 24 November 2004 l1I drugs. I .i * ' {t 1{ tl (?lense add more rows ifnecessary) Executive Summal hepare an kuutive sarrunary of the rqor, in not more than onepage 1. Background on teatment and population data - Total communities, communities ffeated, total population, WG, ATO and persons treated. 2. Background on population movements- 3 Training dato - CDD{. healthworkers, Total populafion (commuruty) per CDD trained. 4. Challenges and how they'we-re overcome. EXECUTTVE SUMMARY Support from African Programme of Onchocerciasis Control (APOC) Communit-v Directed Treatment u.ith Iverm..t , (COf! project n Zamfua State is in its seventh year of CDTI implementation The state is made up of fourteen administrative Local Govemment Areas GeAs) witr five identified iN meso-endemic for Onchocerciasis. These LGAS (Anka Bukkuyunr, Bungudu, Maru and Zurmi) and have 116 endemic communities. Their updated population rn the year under review according to census obtained by CDDs is 204-O92' Out of inii teS,+Zt p"ojl" were treated in 2006 from an annual treatment objective of 175,500 using 441-576 Mectrzan@ tablets. The geographic and therapeutic coverage is 100% atd 81% veh'. THERAPEUTIC COVARAGE Withrn the year two hundred and eigtrt (208) Front Line Health Facilrty Workers (FLHFWs) in charge oi tr"utttt clinics, 5 Pnmary Health Care Directors and Councillors of Health from the endemic LGAs were trained on CDTI. Ei$ty four (84) old and new CDDs were also trained /retrained in Bukkuy-rrrm and Maru LGAS. They rvere trained on the CDTI stralery t YEAR POPULATION NO. TREATED @ocntnruc I COVERAGE 1998 t35,572 96.513 100% 7 | .18 o/o 1999 140.424 108.092 IOOYy 7697 % 77 .12 o/o2000 200I 154 970 t6t.972 rte;25_ lOOo/o 132,797 ,100yo 81.98 Yo 8277 %2002 169,449 140,267 l00o/o 2003 2004 194,666 152,712 100% 82.7 o/o 79.3 %193,1 56 153,363 100% 2005 201.210 163,780 100% 8t% 2006 204,092 165,421 lOOo/o 8l o/o - WHO/APOC. 24 Novcmb€r 2004 ,i i * *_ 1{ I L IIL't and were encouraged to support implementation of activities. The state md endemic LGfu took responsibilit-v for thi 2006 treaffirent witr support from APOC ard Sightsavers intemational. Abselrteeism for treatment during the dry season was due to migration of nomads to bettsr grazng lands. Migration of youth to it" cities for menial jobs also accounted for the ibsenteeisrn These were mopped-up when they retumed' Advocac-v visits were conduited to the state and local govemments, community and religious leaders seeking for counterpart funding and support to the implementation of CDTI activities tn the year under review. Some of the challenges faced by the project which hindered timely implementation of activities included tfre aeUy of appointing a new State Oncho Coordinator. The former coordinator was transferred to the Sihool of ffeaft Technolory Tsafe. Replacement of the Bukkuyvum LGA Oncho Coordinator due to poor performance was also delayed. Non- inclusiLn of female CDDs due to religious belief and non-compensation of most selected CDDs were also experienced. Reaching women in purdatr was therefore slow. To find a way around the issues, discussions *ere held with community and religious leaders. It is anticipated that ttre communities would be encouraged by their leaders to give incentives to CDd. Women distributors are also expected to be selected. An improvement in coverage and reporting was experienced as a result of replacement of the BuHarllum LGA Coordinator. There *as poor govemment financial support by the state and endemic LGAs. Letters were written to Chairmen throug[r the Ministrv for Local Govemment Affairs as reminders for release of counterpart flmding. As a result of these, N95. 000 and Nl11. 000 were released by rhe state and 5 LGAs ,"rp"itir"ly. The funds w'ere used for drug distribution, rep4lrs and fuelling of motorrycles foi morutoring and supervision Eighty four (84) CDDs were trained/ retrained rn Bukkuyyum and Maru LGAs to increase coverage. - WHO/APOC- 24November 2004 'i '-i I& a + T{ E SEGTIOII {: Background information t.'1. General information 1.1.1 Description of the project (briefly) - Geographical location, topography, climate - Population: activities, cultures, language - Communication systems (roads ..) - Administrationstucture - Heatth system & health care delivery (provide the number of health posts/centes m the project area d the information is available). - Number of heatth staffin project area and number of health staffinvolved in CDTI activities. The State is located in the North-westem region of Nigeria and shares boundaries with Sokoto State and Niger Republic in the nort[ Ifutsina State in the east, Kebbi State in the west and Kaduna and Niger St to in the south. The State is made up of 14 Local Government Areas. The vegetatio., of the State is mainly Sudan and Savannah grassland. There is a vast land of agriculture and two main rivers (River Bunsuru and River Ka). About 80% of the popr-rlation lives in n-ual communities. The State has two seasons namely the rainy and dry seasons: the rainy season commences from May to November, while the dry season starts from December to April. The State has a population of over 2 million people, with Hausa and Fulani being the main ethnic groups. Isiam is the predominant religion in practice. The main activities of the people are crop production and animal husbandry- With the advent of the Global Satellite Mobile telecommurication system in the State: comrnunication has improved tremendously. The State populace also has access to the electronic media through the radio and telelision stations - Nigerian Television Authority owned by the Federal Govemment of Nigeri4 the State owned radio station (Zamfara Radio) and also the Kadtrna State Radio Stafion. The State has an established Ministry of Information with other local means of disseminating informatron to its people in rural communities eighrv percent (SO%) of communities are difficult to access during the rarny season. The roaci networks to some of the local govemments are feeder roads ruth diffrcult terrams. Pattents travel long distances for health services. Public means of transportation to most of these communities are available only on market days, the cost of which is high (about $8) for an average community member. During the dry season there is a high migration of male youth to urban areas to engage in petty trading and other unskilled professions to eam a living. They however retum to their communities in the rainy- season for agricuttural activities. There are two main tiers of govemment operating in the State - the State and local governments. An elected Executive Govemor and elected Chairmen and Councillors at the State and local govemments govern respectively. There are also the traditional and religious I 4 1 * - WHO/APOC. 24 November 2004 4" il{ T [l institutions of leadership, which have an influence on the administration d the local govemm€nt. ^t Crenerat Hospital is based in each of the 14 LGA headquarters and in the surrounding districts; there are sporadic primary Health Care delivery infrastrustures, ranging from "o*pr.hooive health c€ntres to health clinics. The Primary Healfi Care facilities serve iN training centres for CDDs and other fiainings as well as Mectizan@ collection points- I}e project area has a total number of 108 health staff and 76 are currently involved in CDTI activrties. Table l: Number of health staffinvolved in CDTI (Please add more rows if necessary) Distric-l/LGA Number of health staffinvolved in CDTI activities Totel Nrnnber of heelEr stelf in the entire project eree B1 Nurnber of hcalth stelt furvolved in CDTI B, Pcrccntegc *100 Anka 16 12 75o/o Bungudu 25 l6 64o/o Bukkuyum 28 20 TlYo IvIaru Zrfin: StateMOH l6 13 81Yo t'7 12 7lo./a 6 J 5ff/o Totel 6 108 76 7O.3'/o - WHO/APOC- 24 Novenrber 2004 L.l2.Partnership - Indicate the partners involved in project implementation at alllevels [MoH, NGDOg (nati onal/international), communities, local or gani mtions, et c. J - Describe overall *orking relationship among partners, clearly indicating specific areas of project activitiei (planning, supervision, adwcacy, planning, mobilimtioli, etc) where all partners are involved. - State plans, -tf any, to mobilize the state/region/district/LGA decision-makers, NGDOs, NGOs, CBOs, to a.ssist in CDTI implementation' Partners in the ZanfiaraCDTI pruject comprise of the following: - l. Zmfarastate Ministry of Health Z. The Ministry for Local Govemment ard Chieftaincy Affairs (representing the five endemic LGAs) 3. African Programme for Onchocerciasis Control, (APOC)'4. Federal Ministry of Health 5. Communities in endemic LGAs 6. Sightsavers Intemational All the partrers play roles and perform therr responsibilitres in the implementation of the projcct activities based on CDTI stratery. Zatnfrra State Ministry of Health Tne Zarnfwa StAe Ministry of Health is structured in line rvith the Nigerian Health Structure that is based on the concept of the Alma Ata declaration of 1978. Based on the above the National Health Care Delivery System is structured into primary, secondary and tertiaqv levels of care assigned to the local, state and federal goYemments respectively. The Zamfara State Ministry of Health is therefore responsible for ftre provision of secondary heatth care, supervising LGAs to provide primary health care services to its population. There are 8 departments in the ministry: each of whrch has a role to play in the p.orision of eye care services. The 8 departments are Admirustration, Public Health Serlices, irrl-u._u Health Care. Pharmaceutical Services, Nursing Services, Planning, Research and Statistics, Finance and Supplies and lnspectorate Services. The ministry supervises three paias-ratals - Hospital Service Management Board. School of Health Technolory and Hsalth 'S,r-stem Development Project. The aitirities of the Minist4. and health sen'ices proYided are frrnded from budgetary allocation from the state govemment. The Ministry is involved tn planning, advocacy tL the LGAs, monitoring and provision of logistic support for implementation of CDTI rr the state- despite that provision of counterpart funding by the State and LGAs has been poor. Si ghtsavert Internation al Silrtsavers tntemational has been supporting Onchocerciasis control in six Local Govemment Areas (Bukkuyum, Bungudu, Tsafe, Anka, Maru and Zurmi) with Tsafe LGA as non APOC LGA. This has been since 1996. The organisation has provided technical support in terms of training of project staff, planning and reporting; including logistics support J l iT - WHO/APOC. 24 Novomber 2004 (vehicles, IEC materials, spares, monitoring, advocary e1c). The organisation also supports t a"t o*a control using flre SAfp stratery and provision of cataract services in the State- Ministry for Local Government and chieftaincy Affairs/LGAs fne Uinistry is the supervisory organ of the loial govenxxrent areas in the State and the endernic loial gorernments fali *d". them. The Ministry has assisted the project through communication and advocacy towards ensuring that the local govemments provide the necessary support for implementation of CDTI. The local governments under the ministry involved rn CDTI ttsough plarming, advocacy to traditional/community leaders, monitoring and supervisiorl health iducation and mobilization of communities, reporting and management of adverse reactions as a result of treatment with Mectizan@. The State Ministry of Health md the LGAs provide office accommodatiorl pay salaries and emoluments of SOCTs/ LOCTs. Within the year N95, 000 and Nl11, 000 was released by ttre State and LGA respectively. This wa.s :ls a iesult of advocacy visits seeking for their political and financial s-ripport towards proj ect sustainability. African Programme for Onchocerciasis Control (APOC) The African Programme for Onchocerciasis Control (APOC), which is a WHO organ, was established rn 1995 with the sole objective of supporting the control of Onchocerciasis in sub Saharan Africa using the Community Directed Treatment with lvermectin (CDTI) stratery. ApOC has supported the Zarnfua CDTI project with funds for implementation of project activities since 1999 and also provided capital equipment and logistic support for the project, Within the year APOC contributed fund based on the sustainability plan and also provided capital equipment to the project, Federa! Ministry of llealth This is the organof the federal govemment that is responsible for formulating national health policies. Tt. Nutiorrut Onchocerciasis Control Progamme (NOCP) is a unit of the department of public health and is headed by a National Coordinator. There are four zonal offices - Zone A (Enugu), B (Ibadan), C (Kaduna) and D (Bauchr), rvluch are headed bY'zonal coordinators and have the responsibililv of monitoring CDTI activities in their catchment States. Zarrfara State is inZone C. The NOCP on behalf of federal govemment endorses all letters of agreements with APOC and monitors implementation of CDTI in the State including adlocac,v for support to the States. Endemic Communities A community or village in Zamfara State refers to people in either small or large groups, who live in the same place, share the same culture, customs and traditrons with a common leadership. ln the project area there are I l6 endemic communities that fit these descriptlons These communities have been receiving Mectizan@ for 11 years. The communities are responsible for the selection of volunteers as distributors, provision of incentivc for the volunteers, collection of Mectizan@ from central points, distribution of Mectizan@, monitoring and supervision and reporting among other responsibilities. - WHO/APOC- 24 Norember 2004 7 r- F'rt E!t &da Edclx-Fd 3 >tp g r,8 s.o =Eg AEJaiQPJJ* v?'F ;'AaD.+FrE Fl oFt F NgI N "(, tJt o\ Nlr) "oo -J o\ @5 o\o\ "N' t.)\) { "s N|..) 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A. rr)(t) F o. a ts ula a: Ha E! -e ?EI d: an FA(, F.p. a F a -G. a L. .., fE Qa r(D o-E 'sict= EE -atrSEz E s5 EH(J .o()Fr -oo oq)t! -c,6) Ir{ n0) t& B= 9E €= atr -d()f! n6)t! .o() -o()frr nC) rh rl I lr u, e (ll J1tr tr) v -v rq E , botr la H 2 ls Fl ti o Fr ia, C.l H 0) -o Eo z <l6l D -: .J o a- F B ii O09.E cl irtr6 €tsxoo-og(J.E Qo> ()rj LJtr ,'E i3E AV, EOJI6edF -E5 'F lA 6E *0 *.HCBH oE 9./ -I .:! cdi bB .= =t g) * tEr gst r=ts cle,t3 nE *t doE E;h#5 0)e E cOE Ir _- E -$ HE9o >=t; ePs?ALL9 Aia 'Ehlo) U-!Cqead5 EE4€9 Gl -!rg1- o = 'or = tnE HB o)9oB -O .h SO06) <). 1 .Fla() .= 6EH E= -96lO:= EqpE EE5 EEE H6tr -g '- oo&t .E.g(l strg .E.E Hq Ffi E i+qIEr{trE6oE19o9E os(gE olE cLHoPotro.g 0,}a. 16 srgtbrh ^i ^, '- '.)t:--H+H'iasbsP3o i, e ,?,= -E .\ ..E 8 Rqo s sf - ts Sbb' ep E5f E e){g It =IE € +$s E sQ'-.r -t.= r \ di: F i v.16 a =' Es: o i gt= |r = o--, o : eoL:-i'-5 E \ .ESE 9 E B -Crrs'r r i -aFE G ; gti Z s g$z o i FEfi E E} ii<E O 'ES x\). I .!.=.E G=F-3 c .=i€ A Eg E HBB EE€ ,r ERi .e}A N gEE I:is - Esr E!; o E;-e ? 5'E - .= t-E; F FEE (-RE i, -:: TI Eg H i=E Ei t 7- Li. 1- tr !E t rl ,E)tJEI(DL o.* B6 elaca tr,E A(D AU rlovt t) o9 a tDA Li o aF(D o (D D]H(D ED E o o o+) .) oHo !D oEt o 3p tJ5 z (a do - t.) s I { 1 + T t l 2.2. AdvocaeY state the number of policy/decision nakers mobilized at each relevant level during the current year; the ,"irorig for undertaking the advocacy and the outcome' Describe diffiailti'es/constraints beingficed and suggestions on how to improve advocacy' Advocac,y was carried out to policy makers in all the endemic LGAs to solicit for support to CDTI ;tivities implementation and release of counterpart fi.mds. Five Directors of Primary Health Care (pHCf in the endemic LGAs, the Director of Primary Health C*9 T the Ministry for Local Government and chieftaincy Affairs, commissioner of Health and the Permanent Secretary Ministry of Health were viiited for advocacy All the poliry makers promised to persuade relevant govemmort levels to release counterpart funds based on the sustainabilitv Ludget. The Ministry of health budgeted N500, 000 and released N95, 000 for mobilizatiorl healttr education, data collecdott *rd repairs of project vehicle. More advocacies would be carried out to LGA' ard St*e govemmenti (the State Govemor and Honourablc commissioners of Health and Local Govemment and chieftainry affairs), religrous Td traditional leaders to solicit for increased financial support. A staff of the State Ministry for Local Government and Chieftainc-v affairs will be part ;f the advocacy team. Advocacy to the Ministry for Local Government and Chieftaincy Affairs is antrcipated to influence the LGAs Chairmen to release funds for project activities' Other requests made to the State and local govemments were to integrate CDTI into other community based programmes. This is to crit cost of monitoring and supervision of CDTI activities in the communiq'. 2.3. tobilization, sensitisation and heatth education of at risk eommunities Provide information on: - The use of metlia and/or other local systems to disseminate informafion - Types of IEC materials used - Mobiliianon and heolth educotion of communities mcludingwomen and minontrcs - Response of target commuruties vtllages - Accomplishments - Suggest woys to improve mobtlization and sensfiisalion of the targel L'otnt?ttttlilies. The project did not use the media for mobilization and health education on CDTI, front hne hAalih s-taff in collaboration with CDDs and local torm criers rn'ere used to dissemrnate information on CDTI in their respective communities. zartfwa state people arc predomrnantly Moslems and women are usually in purdah. The project made efforts to hold ipecial healttr education sessions for the people at the community leaders' houses; most of the women are however not reached due to cultural and religious hindrances thus making information dissemination on CDTI slow. This is despite the training Islamic scholars received on CDTI in the yew 2O04 to mobilize women in purdah during school hours. Notwithstandlng response from communities was however encouraging, as most of the communities have iontinued to respond positively to the programme through annual compliance to treatment using Mectizm@ tablets- The communities in all the endemic LGAs were re-sensitized on the disease (the causative agent, signs and symptom and the use of Mectizan as the drug of choice for the control ol oi"fro."iri*ig. They were encouraged to take ownership of the programme' Posters' flip WHO/APOC- E 24 Novernber 2003 i * : ct TI Ita T charts and brochures developed by NOTF were used as IEC materials for mobilization health educatioq and sensitisation of endemic communities. The project intends to henceforth continue the use of audio and audio-visual means to dissemirite CDTI information to all endemic communities prior to release of frrnd to the project bo*-*ities will be visited when other health related programmes eg. Tuberculosis and Leprosy programme (TBLP) are working there. This wrll afford an opportunity to share *"*. Lttraiportation eg. motorcycles and vehicles used by the programmes to mobilize and sensitize communities' - WHO/APOC- 24 Novemb€r 2004 .i'i *. A t T iI 2.4. Gommunity involvement Table 4. Communities participation in the CDTI (Please add more rows if necessary) Comment on: - Attendance o_f-female members o-f the commurutv at health education meetings - In general, how do vou rate the partiapalion offerrutle members of the commuruty meetings when CDTI issues are being discassed (attendance, participalion in the discussion etc). - Incentives provided by communities.for the CDDs - Attrition qf CDDs Is attrilrcn a problem.fitr the prqect'l l_f .ve.r. hov'ts t arldressecl? - Other issues lnvolvement of female members in all endemic communities is still an issue. This is due to the people's cultural and religlous beliefs (who are predominantly Moslems). This means partial or non involvement of women in decision taking generally. Attendance and participation of rvomen during CDTI discussions were poor. because J/ounger and active women are in purdah, Mectizan@ only reached these r,vomen rvhen approval rvas given by their husbands or head of the cluster. The project experienced problems rvith givrng rncentives to CDDs b1. their commurrla members. Community members feel that other communitv health based programmes such as the Polio Immunisation Programme are payrng community members involved in their activitics. The community is therefore not expected to pay" the CDDs as the CDTI project is (perceived to be) paylng them There is also attrition of CDDs. They go out of their communities seeking for menial jobs, business and to attemd school. This situation is experienced by the project arnually. To address this, community members were encouraged to select at least three CDDs for distribution. i t -t* DistricULGA Nurnber of communities/rilleges with conrnrurity members zs supervisors Number of CDDs Nunber of commrurlties /villeges with femdc CDDs Total no. communities in tb entirc project aree Ba Nrrnber with community rrrernbcrs es supervisors B5 Percentagp B; 85/ B. *100 MehCDDs B7 Femdc CDDs & Totel Bc: B7+Br Nrmbcr of conrnunities with femelc CDDs Bro Pcrccntage Bl: Bro/Br*10O Ant" 13 8 61.5o/o 39 0 39 0 ff/o Bukloryum 53 t7 32.3o/o l0l 0 l0l 0 U/o D.--.t--DUTBUUU 19 13 68 4o/o 8l 0 8I 0 V/o Maru 23 ll 47.30/o 86 0 86 0 0o/o Zlrmi 9 l0 I I loto 5t 0 5l 0 lf/o Total 116 59 5O.9.'/o 35t 0 35E 0 Oo/o WHO/APOC- ! 24 Novernber 2003 t- i !t{ I 2.5. GapaciQr building - Describe the adequacy of available knowledgeable manpower at all levels' - Where frequent trarsfers 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 measures were taken to ensure adequate CDTI implementationwhere not enough knowledgeable manpower was available or f staff are frequently transfered during the course of the campaign). There is a State Project Team with long term experience in coordination of activities. Local govemments' onchocerciasis control teams work with train health workers to ensure communities treatrnent. During the treatment year a planning meetrng was held with the relevant staff of healtlo, environment ard local govemment affairs ministries, State and LGA Oncho Control teams. This was to s(pose them to CDTI activities and atfact their support. Training-and re-training of health facility staff and community volunteers was planned. Frontline healttr facilities staff were trained asplanned including those from non endemic LGAs. This is to educate them on CDTI activities in event that they are transferred to Oncho endemic LGAs. Active CDDs were used to see to the success of this year's treatment round. WHO/APOC. ! 24 November 2003 J I I - : I *. q { u { oFt F N E E ,1 TD 5 m otr t}f ,,ft 5x0l U aq, F o FJ 5 t\) o H aN - s a (! t! EoE i.J c N N tJ O s s o N N) $ :, ^ Fl :iia F: h z -ort P.3E=.GAsr F o 6 - E =B o\O O o rlIt)6 \c t! (D E G t, -l(.) bJ € tJ t.r 5 t) FJ s tJ { t-) N) a'{ .F !^-r+r,9 oila a(D =oz <=E*Zd $;i!T EE -t Dt (! \? p \c (D .D (! !' f.J O C C O c) O C O C O z it!l9i J=.8o' 'aD Hrl FIl, o=' r!Et a I I a sq '.t a - ^-i+ -'o : o\O N b.J -)O o H:.\o 0\ a r! (! 5(! OA 65 65 z o @ s a o. s szgs O O O qgz o\a 2*bZIe O sq o=\{ oi ^H+ :' o oll a z rtEt oU a rt 19 (? l.Jlo)IU Io Ir-rr ;r-t ca c -' 0a !) (! a(d', laE o o *) o UJ - 3 a Jo 0, A (\ G F. !r G 14 o q r:i\:-- t q- E ..-q : o E $s -G\ o ^\\ I I 0a 6' h o t :r o\ o $ o qq l.l o o! n FoEt a o c (D6a {(D Cd - 19 o : o lo ao ox li { o o D) .6 !9 a (D rt rt o o0 o Fl { o dI ti t-)J\ 2.o d o f-' iII * + 1 & TI T I Trainees Type of training CDDs Other Community members e.g Community superuisors Health Workers (frontline health facilities) MOH stafi or Other Political Leaders (hher (specify) Islamic Teacherr Propram management ^/ How to conduct Health education ./ Management ofSAEs { CSM SHM Data collection { Data analysis Report writing Others (specr&) Table 6: Type of training undertaken (fick the boxes where specific trainingwas carried out during the reporting period) Any other comments o l. 4 WHO/APOC. n 24 Novernber 2003 t+ 2.6. Treatments 2.6.1. Treatment figurrcs If the project is not achieving l00o/o geographical coverage and a minimum of 650/o tfrerapeutic coverage or the coverage rate is fluctuating state the reasons and the plans being made to remedy this. The project area has a total of 116 communities. The fieatment report sent by the endemic LGA5 indicated 100% geographical coverage. This was as a result of merging of some communities in Bukkuyu* -*d Maru LGAs by CDDs during treatment. This was due to CDDs attrition, where CDDs from neiglrbouring communities had to assist in distribution in their neighbouring communities. In gving treatment reports CDDs could not separate report of their lifferent communities where such cases occurred. The project looked into this issue and planned to continue advocating and training more CDDs to address such issues. The therapeutrc coverage attained was 8106' WHO/APOC. ! 24 November 2003 t I'l lo,td t6- l-r ;r-t D+ (D oi o. U) E Lr.l v) d a o F =' o) H(D A)t O) r-t u)F E R- G G n+,\ S o\(\ o a 6 CJ(\ q :aE Ft FiI F Nc H F a d (xr o. dEx)E * 00 Ets >6' o\ \o N(, \o (,t.) t, ilep3+ EE +=qq AaYA > gae o 9, Z. -<3E ESETx o =.r*'Iq aQ ^zE .sqgv l0 !a-qB E. E t I o\ \o Ntj) \o (Jrt) t, o\ \o N(, \o Lart9 (f) c s LOo\ 6\ 6\ 6\ \o^\ b.)o5lol\o lh) N (, o\ NU) ",*){0\ as o\o\ "tJ N{ -J 5 t\) N) !, o FIO^' A: Boil^-3a1T6"' +t!D+i o =-aq 3. A-l .ve > a P-g eHao* z agE *8rX5i *@ o t ^JOo ='q€vlo o{trco l'. o -t o LOlo O t.J o\Ur O o\ OO o\ O o\tt 5c t\) (Jl -I }.J @ N(}) o\{ t.J o\ -J o\ 5\t\o a s 00 '@ ^\ @{^ \ @ o\ {{ 6\ \oI Lar ^\ o\o (j) o\ Lrr @t-) E*'EEE &FE fI +- 7lhii Fe b.l(, 5t\) { @ o\{ o\ t\)o\(]) (, ^2FEoc8+r9o- o1 b-=H*b'{ B qg z gsiaf H?Efu + I (D A' 13 .D -oae5' 8 o Eg oa(D Els (D o(0 o oEt EIa= o_- c) oo(! ts A'@(D n O) (D Ho oo a{ro Gio\Hvo,to(D o) (T s - -l a o) a" (D (DE \ il s G u d! h G s.. $ G ! t sh ! u YS tG T s F- It A l.s S b .o q G s GE l- .i { T Of .: s : !+ op ! t-) z 6 q @ 19 O fl >lZ. -112. 112,elE glE 9Eil lil t! 13 o) llj E.IF. ;F ;IF ,1,-r eF olE =:lo =llo E lo;ri lrt P- l+, E lF,BIH E18 il8eE dE 6'{seF' trl= aF-ols 6lE. ?lFs t[i x tF. 5'lbi sts FB Tts.<lx dl-J :lxol- glF 3l-18 .{ts E18 =tq I6-l+ = 3 lo' fE5IE' E8F s Bt= $ E.c) -6gE o)5apdFo=' r^tai. TA* !.\1 * F=hI 6 o.aE8 5tD( e OBIH&.(Dg q (D c, 1tz.olc stH -laEH I- le" El8 ^toE+,16 EloglH =ts(Dkt AlA elx(Dl- {l^ta r-g: (Do 5)(Doo d(aFl 6 o.(D 9 c) !r (D !,0 3 (D fd E(D C) B'H c0F' a EI * * q I * 1& I t v il $a 6t b .otr o o z $ aj. 0- H B 0OtrL -Q) o s G sL$ 5o ri !tB P B .{ g .\ E\ tJ € Et) ,* \ *! \ 6 St !tT s TB F!i S'+hU;.F €\ I\JssEb eS :..i nr x5,\r! 'Es ssItY\ *\t si. rl!'.S s* K?BY r:t), \r)tr ai .t\U\i s\ sss\tt8I *$bc €\ SEl.t Ss!'h EE. s{Fr is' ilE PS DS , tr L It =2.6.2 What are the causes of absenteeism? The main causes of absenteeism were due to movements of nomads to the southem part of the country and who may sometimes stay there for very long periods, farming activities for communities that were treated during the rainy season; likewise some youth go to urban areas to seek for menial jobs. The project decided that the communities should be visited immediately after distribution by CDDs, to treat untreated persons. The CDDs were requested and encouraged to mop-up the communities as part of the year's work plan d-espite the stress and non-compensation by most communities. 2.63 What are the reasons for rcfusals? Cases of refusals were due to either personal or religious beliefs by some people; some thought that the drug is not their immediate need, while others feel that the disease is not in existence despite the health education on the disease, The Islamic scholars ffained on CDTI put in their best to see to it that refusal is at a minimum level. It is hoped that with better understanding people lvill not refuse treatment- 2.6.4 Briefly describe all known and verified serious adverce events (SAEs) that occurrrcd during the reporting period and provide (in table 8) thc rrcquired infomation when available. In case the project did not have am, cases of serious adverse events (SAE) durmg this reporting period, please tick in the box. No SAE case to report WHO/APOC. ! 24 Novembcr 2003 l o t9t, ,i6 o t, o o lt2 193 o d o o r6 lu2 o P o a a Jdg g a| o F N G S c ts lt)(s-\ h ssG\ .o G (\ V) z * 00(D w/. o1 da=E. F]POQ(! o z o # FF FN.@li z s@@l-l .:lINld Ea' t -oll9 r3 t! U) I 'd o o I I I $F$Hg .iicAo . ;:. + H FVr'tr trl F ,? sd'o -(Dx?- f 3 e.C aH9H iig - da 65q q AC EE' aa d;' er o I It- L II I I i ooH{l?Xq3*HgEd6kt3s F5 H.5867 P*3 P s5Fi f s (D ,ti U FU L,,, 'oNA z o do t'.) 8 5 I * * If T T t h) o -t tJOo o\ t)o (/l 1..) O hJoos l.J i.) hJ tJooo \o\o\o \o\o6 \o\o *J lrl F o\ o\ hJ t.) h) \o @ \o\o o g* I6H " s I s,H g;3't::.<Eo+ HE a 5e.tri=a; Edo o o3 H. oq to00(Dq o\ t)O tJ l.J hJ \o O o& \o\o a-lY; > i3eda tr o\ o, o\ tJ tJ O o@ @\o - e-9. 3 A rr3 t Efi5q - d e.oor+ ts Oo\o 810 \o s E s E s 8\o Es Es Itroor-oQ trr!'t{}5 o# -'-rt 9E sts =oo-o -05 Oo o\ OO o\ \o o\o O -\ O o\ o\ o\o OO s o ^< Doo i '#u o E tt, Dll tJ \o F-) FJo t) \o o\ @5 Or o\ o\\o "s s\o o. \o -JtJ \o -J A s FJE y, .J\o E- -dFa € tr=5fEFE.i 3-g+ s i,o o) o I -J -.1 OO oO c A O N) O O OOO ^-lYe > 9iE :'o gd= E J> TJ { 00o o\lo Ur }J\ l.J 5 N) o\{ '! IJi -J t.J o\ @ !c t-J a 3z rli a @ o- @ s @ s { LD @tJ b\\o co J...,{ 6\ 00 \, s -lJ \o \t0 \o -t s J o!ioo .i lets:oQeo =r.o o\ EE:'a'rll \o -,1\o \oo\ !')tJ\o bos ; \o \o 90 o\ \o b\ s \o 9. t.J s O -ls oo- ^{.P -oO -re#o (D rrl o \oA irr\o 6\ O s \o\,\o\oo\ O ^\ {\o os OTJ ss O{o\ -l o o tttlq oo(D s E l-le' lel!e lY-u2 ltD(D l-- Hi;hE e;tLJ=(DBdf g EAPgEa96)8 $36SEt A afii5 -uYl6(Di+rsl?B "E. ls FstEx6l=rEIE.E(! l, rl!:$3 ItFtdLdTst(i A tu)rIAaDL,/X;'i E- 23.E(v= .+a6d =. .E ?'3 .E. 3.E gEoDEHag. *?Ef c IA-Y-ESre.8e =.:$iE $g; tEtetn =s1I. HN.as;s E GIo g rt F o Z I -> i..tl x.I ;tJA 7 d s \J oA I ; d* * I{ t T l 2.7. Ordering, storage and delively of lvermectin Mectizar@ ordered/applied for by - lplease tick the appropriate answer) MOH N WHOtr I]NICEil n NGDGI/ Other (please specify) Mectizan@ delivered by - Qtlease tick the appropriate answer) MOH tr WHOtr t]NICEil NGD@ Other (please specifr): Please describe how Mectizan@ is ordered and how it gets to the communities The supporting NGDO places the State's order of Mectizan@ to the donors through NOCP. This is based on an updated census of all endemic communities within the project area When this is approved and procured NGDO collects Mectizan@ meant for the State from IINICEF. The Stati is given itsallocation. Each endemic LGA Coordinator takes Mectizan@ from the State's medical store and in turn gives each front line health facility its allocation. Selected distributors from endemic communities receive their allocations based on census update conducted from agreed point of collection for distribution. The number of tablet ordered was based on the estimated populaion of people multiplied by a factor of 3. In future, the State '*ill be expected to completely take over the task of ordering Mectizan@ tablets mertt for their communities Table 10: Mectizan@ tnventory (Please add more rows rf necessary) How are the remaining lvermeclin tablets collected and where are they keptT The balance of Mectizan@ tablets was retumed to the front line health facilily by the CDDs after distribution. The project coordinators at the LGA level received the drugs and finally retumed them to the State Onchocerciasis Office for safe keeping at the State medical store. The remaining drugs will be used for next treatment round. Ltst and brieJfu describe the activities under lvermectrn delivery thal are being caruied out by health care personnel in the project area. The State Ministry of Health receives urd keeps custody of Mectizan@ allocdion for distribution to endemic LGAS. a State/District/LGA Number of tablets Number in stock Requested Received Used Person treated Lost Wasted Erpired Remaining Anka -50,000 55 000 53,588 16,479 0 0 0 t.4tz Bukkuyum 150,000 133,000 128,477 50,917 0 0 0 1,523 B'ungudu I39,000 148,011 148,01I 67.026 0 0 0 o Maru 46 )000 60,000 59,632 20,823 0 0 0 368 Zurmi 43,000 40,000 34,263 1 0,1 57 o 0 0 5,737 TOTAL 427,00O 435,0tr 423911 165,421 0 o o l2ro4o WHO/APOC. ! 24 Novernber 2004 T aa Collection of Mectizan@ for frontline heatth facility by LGA coordinators at the State's medical store. Collection of Mectizan@ for endemic communities by FLTIF health workers at the LGAs'medical store. Notiling communities to collect their allocations of Mectizan@ at FLFIF by thelr selected CDDs. a Any other comments 2.8. Gommunity self-monitoring and Stakeholders teeting Has any training (of trainers) for community self-monitoring been done in the proiect area? If so, When? Table 1 l: Community self-monitoring and Stakeholders Meeting (Add rows if needed) Describe how the results qf the communiht self- rnonitormg and stakeholders meetings have affected prolect implementation or how thel'would be utilized during the next treatment cyclc District/ LGA Total # of communities/villages in the entire project area No of Communities that canied out self monitoring (CSM) 'No of Communities that conducted stakeholders meeting (SEIVO _ None None None None TOTAL - WHO/APOC. 24 Novernber 2004 2.9. Supervision 2.9.1. Provide a flow chart of supervision hierarchy. COMMUNITIES NOCP/ZOTF NGDO STATE ONCIIO TEAM LOCAL ONCHO TEAMS FRONTLINE HEALTH FACILITY COMMUNITY LEADERS DISTRIBUTORS (CDDs) WHO/APOC. [24 November 2004 2.9.2. What were the main issues identified during supervision? o There was a poor release of counterpart funds at State and LGAs levels. o Poor support to CDDs by some communities leading to attrition of distributors. o Non-selection of female as distributors. o Cases of refusals in some few communities. o Partial commitment to CDTI activities by some few endemic communities. 2.9.3. Was a supervision checklist used? The developed checklist for supervision by APOC was used during supervision and monitoring of programme implementation. 2.9.4. What were the outcomes at each level of CDTI implementation supervision? The State level was supervised by the NGDO/NOCP and poor funding to the project was noted despite inclusion of CDTI budget into the Primary Health Care main allocation. Effort made through advocacy to State and LGAs to solicit support to the project yielded little results. The fund released was not enough for implementation of actrvities, Supen'ision aI the LGAs and community levels was not sufficientll' done due to lack of fi.rnds. Some LGAs kept good records of CDTI actir.ities w,hile other need to improve on it. Community involvement as a whole to CDTI was partial in some few communities. 2.9.5. Was feedback given to the person or groups supervised? Obsen'ations tvere made know.n to the supenised levels and the recommendations followed during subsequent CDTI activitres. [mplernentation of these activities recommendations were however inadequate, thus the overall performance \l/irs not as planned. The project however attained its trealment objectrve. a a a + { ir { I I I 2.9.6. How was the feedback used to improve the overall performance of the project? o Feedback was given to partners stressing areas of weakness in some aspects of the project and the consequences. Ways forward were discussed in an effort of finding lasturg solutions. Training on CDTI stratery was given to directors and councillors of health, they were also briefed on the need for communities to sustain and own the project. This was also to encourage thern influence release of counterpart funds for project activities. The front line health facility workers were asked to take CDTI as a responsibility which forms a part of their primary - WHO/APOC. 24 November 2004 assignment. This gave staffinvolved in CDTI a better understanding of what is expected of thern This improved the results of the yeat's treatment. - WHO/APOC. 24 Novembs 2004 -t i { 3{ SEGTION 3: Suppoil to GDTI 3.{. Equipment Table l2: Status of equipment (Please add more rows if necessary) *Condition of the equipmenl (F-Functional, CNFR:currently non-func'tional bul repairable, Wo:Written olfl. How does the propct mtend to maintam and replace enstmg equryment and other matermls ? c These equrpment lrill be maintuned through counterpart funds if made avarlable. Source Type of Equipment APOC MOH DISTRICT/LGA NGDO Others No. Condition No. Condition No. Csrdition No. Condition No. Condition l. Vehicle 2 I new and I farrly fimctronal 2. Motor cycle l0 5 New 5 old 2Fairly functional 3 Non fimctimal 3. Computers 2 I New lFairly fi.rnctional 4. Printers z I New lFairly fimctional 5. FaxMachines Fairly fimctional 6. Others Fairly fi.urctional a) Bicycle 14 Fairly frmctional l3 Non functional b) T.V/ Video 1 Fairly firnctional c) Over head Proiector/Screen 1 Fairly firnctional d)LCD Projector I Nerv e) Generator 1 Fairly fimctional WHO/APOC. !24 November 2004 + 4 Id II t 3.2. Financial contributions of the partners and communities Table 13: Financial contributions by all partnerc for the last thrce yeans - If there are prohlems with relea^se of counterpartfunds, how were thqt addressed? Major issues accounting to non-release of counterpart funding have been the regular changing of policv makers at the State and LGAs govemment levels, bureaucracy and lukewarm attitudes by some of the stakeholders. More mobilization and advocacy visits need to be undertaken. The prqect however in collaboration with the supporting NGDO paid an advocacy visit to the officials of Ministry of Health and liaised with Director of PHC in Ministry of Local Governments so that counterparts can be released to the project. - Additional comments Contributor Yezr 5 (2004') Ye* 6(2005') Ye*i (2ffi6') TOTAL AMOUNT (cASrr) Budgeted rus$) TOTAL CASH Released luss) TOTAL AMOUNT (CASII) Budgeted rus$) TOTAL CASH Released (t]ss) TOTAL AMOUNT (cAS}D Budgeted rus$) TOTAL CASH Released (us$) MOH (Central + ProvinciaVState) 3,623.18 1,521.73 1o,669 0 3,876 736 MOH (District/LGA) 0 0 5,023.62 0 3,846 730.7 LocalNGDO(s) ( if anv) 0 0 0 0 846 NGDO parrrer(s) 5,37r.31 5,581.25 6,362 4,989.77 3.656 5 3,72 1 Others 0 0 0 0 0 0 APOC Trust Fund t4,702 r 0.000 108,834 0 48,064 13,730 TOTAL 23,696.49 t7,LO2.9E r30,888.62 4989.77 s9442.5 19,763.1 - WHO/APOC- 24 November 2004 + * l I t3.3. Other forms of communityT support - Describe (indicate forms of in-kind contributions of communities if any) The communities have been supporting the progrrmtme as much as they can through re- selection of most distributors that do refuse to continue with the distribution or got e ll'ork 0r have to relocate. Some few members do assist their CDDs with little funds while others do appreciate or motivate CDDs verbally. Distributors during the year under review gave maximum support to the programme by distributing the drug with little or no compensation from members of their respective communities. 3.4. Expenditure per activity Indicate in table 14. the omount expended during the reporting periodfor each octtity listed. Write the amount expended in US dollars using the current United Nafions exchange rate to local curuency. Indicate exchange rate used here Tablc_]4: Indicate how much the project spent for each activitv listed below during the reporting period. lr JS t Activi Expenditure ($ us) Source(s) of funding Drug delivery from NOTF HQ area to central collection point o commumty Mobilization and health education of communities Training of CDDs Training of Islamic scholars (Re-Training) I ITraining olhealth stalf at all ler,els and plarulng meeting Supervisrng CDDs and distribution Internal monitoring of CDTI activities Advocac-v visits to health and political authoritres IEC materials Summary (reportrng) lorms for trealment Vehicles/ Motorcycles/ birycles maintenance (Major parts replacement, Repairs, Fuel) Office Pquipment (e.g. computers, printers etc) I Communication (Telephoneffax, PosVCourier) f to project areas for various CDTI activrties - insurance, planning meeting and data man lTravel lo*"r. 10,669 620 1.253.8 3l0 233 956.9 1,008 388 605 3237 6 233 SSI State / LGAs APOC/SSI StAtEiLGA APOC SSI SSI SSI SSI SSI APOC/SSI SSI TOTAL r9514.3 - WHO/APOC. 24 Novernber 2004 ( F! rl 165,421Total number of treated-, t.} Any comments or explanations? SEGTION 4: Sustainability of GDTI 4.1. lnternal; independent participatory monitoring; Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which arrc applicable) Yes Year I Participatory Independent monitoring No Mid Term Sustainabitit-v Evaluatron -5 r ear Sustarnabilitl' Evaluation Intemal Morutoring by NOTF Other Evaluation by other parbners No No No 4J,. Sustainability of projects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting penod? No Was a sustainability plan written? Yes When rvas the sustainability plan submitted? Yes What arrangements have been made to sustain CDTI after APOC funding ceases in terms of. 4.2.1. Planning at all relevant levels Planning meetings at both the State and Local Govemment levels will be carried out before the commencement of subsequent treatment rounds. Advocacy to stakeholders will be done continuously to ensure total commitment at all levels to the sustainability of the work plan developed on CDTI activities. Mobilisation, health education and sensitisation of endemic communities shall be of priority for communities to take ownership of CDTI programme. a a a - WHO/APOC. 24 November 2004 4.2.2. Funds Advocacy visits were used to relevant partrrers on the need to release counterpart funds toward sustaining the project. The state govemment budgeted N500, 000 out of which N95, 000 was released. The LGAs released N11 1, 000. 4.2,3 Transport(replacementand maintenance) a The Ministry of Health and the endemic Local Govemment Areas will continue to maintarn some existing vehicles and motorcycles provided by zupporting organisations. 4.2.4. Other resources Other resources would be maintained and replaced as counterpart funds are released by the State and the LGAs. Health u,orkers from non ender-nrc LGAs rvill be trained This is to expose them to CDTI activities in event that they are posted to endemic areas. 4.2.5. To what extent has the plan been implemented SOCTiLOCTs developed a comprehensive CDTI work plan. This rs berng folloued through. Morutonng and supervision rvas carned out in areas where problems were antrcipated using the checklist developed b1'NOTF Fronthne health facilrty lvorkers supervised project activities at their own levels. Mectizan@ tablets rvere collected by the endemic commumties at agreed points- likewise LGAs. Endemic communities \ rere mobilised. health educated and sensitised on how to take up CDTI responsibilities at community level. The release of counterpart funding is hoped to improve as advocacy visits are on golng both at the state and LGA levels. . There was flrll usage of vehicles and equipment for CDTI actilitres. 4.3. lntegration Outline the extent of integration oJ'CDTI into the PHC structure and the plans for complete iniegration: 4.3.1. Ivermectin deliverymechanisms a a a a a a a - WHOiAPOC- 24 November 2004 o aI tt -I 7! Vehicles for other health prograrnmes such as disease surveillance, NPI and staff were used by the project in the delivery of lvermectin to the endemic LGAS and for collection of reports and balance of drugs. Likewise Front Line Health staff carried out CDTtr activities when implementing other community based health programmes. 4.3-2. Training Primary eye care was integrated into the past traimng of trainers for lvermectin delivery in the previous years. Re-training and training of community distributors for identification of individuals with eye problems in their respective communities was scheduled to continue in 2006. Not much funding was received from the state and LGAs which timited activities and the identificuion of individuals that have eye problems by CDDs. The project plans to carry out these activities next year with availability of funds. 4.3.3. Joint supervision and monitoring with other programs NPl/Disease surl'eillance and CDTI stalT help one another in superr,ision and monitoring. through inter programme collaboration. 4.3.4. Release of funds for project activities A combrned budget for all programmes under the Department of Disease Control had been established. The fund released b), the state and local govemments dunng the 1'ear under review was insufficient to carry out activities iN budgeted and planned. Nevertheless it is hoped that funds wrll be released to the programme as budgeted for subsequent treatment year rounds. 4.3.5. Is CDTI included in the PHC budgetr Yes .t.3.6. Describe other health pnogrammes that arr using the CDTI structure and how this was achieved. What have been the achievements? Health workers in other community based health prograrnmes and CDDs were trained in the CDTI stratery and on Primary Eye Care. This is anticipated to help them use the strategy in other related programmes and in screening, identification and referral of eye padents in their communities using the CDTI structure. 4.3.7. Describe others issues considerrcd in the integration of CDTI. The strategy is cost effective; people at the grassroots can easily be reached by primary health care services. This will help them take certain responsibilities towards sustaining and developing health programmes. t - WHO/APOC. 24 November 2004 -! 4.4. Operational researeh 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' There was no operational research canied out within the project area during the 1'ear under review. 4.4.2. How wert the results applied in the proiect? SEGTIOI{ 5: Strengths, weaknesses' challenges, and opportunities - Lrst the sn'engtlts ancl Y'eLlkncsse .; of'(-L)'l'l nntrtlcmerltafion proces,\ - List the challenges and mdicale how they were addressed. Strength: Severe adverse events continued to decrease. Integration of Primary E1'e Care into CDTI. Trained and committed SOCT/LOCTs. Committed NGDo Selection of distributors by a good number of communities. Collection of Mectizan@ by communities. Distribution of Mectizants) by most CDDs despite little or no compensation by their community members. Weekness: - Release of little counterpart funds for the year under review both at state and LGAs level - The need to continue training Islamic scholars - Non availability of female CDDs - Frequent movement of the nomadic population. - Non compensation to CDDs in most communities Stakeholders support is being solicited for the release of counterpart funds; creating awareness for female CDDs to be selected. The communities are sensitised on compensation of CDDs. CDDs are informed to conduct mop-up treatment to ensure good therapeutic coverage. t r - WHO/APOC. 24 November 2004 '1 !! SEGTION 5= Unique features of the proieeUother matters a .a' t a t WHO/APOC. D24 November 2004