Ondo State CDTI year 2 progress report : June 2001- February 2002

NATIONALONCHOCERCIASISCONTROL PROGRAMME, NIGERIA oNDoSTATENTTF/WHD_AP0CCDTI PROJECT YEAR 2 PROGRESS *,O$ ry\"I e& (r JUNE 2OO1 _ FEB. 2OO2 tL).o3. cY, For lnformotionTor.2 r a STATE COORDINATOR ..- E' O' ADEJAI For Action To: To te nov[t-v'r 59 lt€oo rr"x C5A c e-v B )Iy'I 8Fo RECU | 3 ilA[S 2002 APOC/DIR ZONAL COORDINATOR ---' A' O' JAIYEOBA IE SUMMARY Ondo State is one of the states in the South Westem part of the Country and is located in B-Health Zone. It has a projected population of about 35 million and covers an area of approximately 15, 600 square kilometres. The prevalence survey of 1987 - 1990 and the subsequent REMO of 1994 and 2000 revealed that the state is highly endemic for Onchocerciasis. Mectizan distribution in the state started in 1994 under the auspices ofUNICEF in five Local Government Areas ofthe State. Following REMO updates, the programme expanded to cover ten LGAs. Between the period of 1994 to 1999, CBTI strategy was adopted in project areas. APOC CDTI strategy became operational in the state in June 2000 following APOC approval of fifteen LGAS 2180 communities are estimated to be endemic for onchocerciasis and targeted population is about l.2million. The major thrust of the project in the first cycle of operation was identification sensitising engendering of long term partnership in the control effort among stakeholders at community, State, Local Government levels and NGOs for a sustainable control effort While the second cycle focus on consolidation and continuity of CDTI programme. Empowerment and capacrty building of communities through training of CDDs, Commuraity mobilization and networking were aggressively pursued in the sixteen designated LGAS. In implementing CDTI so far, the following activities have been carried out, - Procurement of capital equipment and project supplies. 2 Training of SOCTs, LOCTs, CDDs, Health Workers and District health supervisors. Mobilization and health education of 1342 target communities Mectizan treatment in hyper and meso endemic communities Monitoring and supervision of CDTI process Health Committees have been constituted and made functional in the course of implementing CDTI in some communities. The achievement ofthe project for now are the training of 8 SOCTs, 83 LOCTs, 16 PHC Coordinators, 409 Health Workers and7761CDDs, 1342 communities were mobilized to select their CDDs and collect mectizan from designated points. Additionally,612 pohcy makers and community leaders were mobilized in various advocacy meetings to support the CDTI process in the state. As regards treatment of endemic communities the state was able to treat 1,025,427 people with 3,096876 mectizan tablets. However lack of adequate commitment to the process of CDTI by some Health Workers, the frequent transfers of LOCTs, inadequate supervision of CDDs and the inability of several communities to offer incentives to their CDDs are weak points in the implementation process. The project in the coming months intend to train and retrain more CDDs especially in the hard to reach areas, intensify supervision and monitoring of CDDs, to ensure proper record keeping and management of minor reactions, and aggressively mobilized and health education selected target communities. To ensure the success ofthe CDTI activities, there should be quick release of fi.rnds from the project partners and issues relating to implementation activities should be given urgent attention and treated with dispatch. 3 TECHNICAL REPORT ON CDTI IMPLEMENT IN STATE OF NIGERIA SECTION 1 BACKGROUND INFORMATION Ondo State is in the South West of the Country and covers an area of approximately 15,600 square kilometres. There are eighteen (18) Local Government Areas in the state with 16 Local Government Areas selected for implementation of Community Directed Treatment with Ivernectin (CDTI). Ondo State located in the B-Health Zone has a projected population of about 3.5million. The prevalence survey of 1987 - 1990 and the subsequent REMO of 1994 and 2000 revealed that the state is highly endemic for Onchocerciasis. The Bio-climatic zones of the state range from rain forest to forest savannah mosaic, to guinea savannah and mountainous areas. The rainy season is from April to October while dry season starts from November to end of March. Farming is throughout the year while planting period covers April to October and harvesting period is October to Marctr- Mectizan distribution in the state starte d n 1994 with UNICEF's assistance and treatments had been on ever since (see table below). A total number of 2227 Communities with a total population of 1.5 in the hyper and meso endemic areas from 16 Local Government Areas are currently under the State CDTI Programme. Before the commencement of APOC Project in the state, about 758 Communities were receiving mectizanwlt/rc2022 communities are now included since the APOC Project has started. A total number of I193 communitieVvillages were hyper endemic, 554 were meso endemic while 480 were hypo endemic. 4 YEAR TABLET USED NUMBER OF PERSONS TREATED 1994 13,900 77,419 1995 201,300 124,538 r996 381,000 26l,8ll 1997 573,000 417,661 1998 354,000 254,314 t999 2,450,000 524,314 2000 746,476 261,397 200v2002 3,096,876 1,025,427 During the period under review i.e.2nd year project Cycle, A total number of 3,096,876 mectizan tab were used to fteat 1,025,427 people. A Community in Ondo State Project Area is regarded as a group of people living in one dwelling place where they undergo their various daily activities. Within a large or big towns there could be a different communities combined together to make a larger community or town. They also have a common knowledge, ideas and has a leader approved of all. Partners in CDTI prograrnme in Ondo State are:- World Health Organisation (WHO) African Programme on Onchocerciasis Control (APOC) United Nation International Children Emergency fund (t NICEF) National Onchocerciasis Task force (NOTF) Federal, State and Local Government LocalNGDOs Communities in the endemic Areas 5 SECTION 2 TION OF CDTI In implementing CDTI so far, the following activities have been carried out. Procurement of Project Capital Equipment and Supplies Training of SOCTs, LOCTs and CDDs. Advocacy Mobilization of the Policy makers Mectizan Treatment in hyper and meso endemic communities Monitoring and supervision of CDTI process Health committees and village development committees have been constituted and made functional in the course of implementing CDTI in some communities. PROCUREMENT OF PROJECT CAI'ITAL EqUIPMENTS ANID SUPPLIES Consequent upon the approval of Ondo State Project, some IEC materials centrally produced by the NOTF Secretariat were supplied to the project. These included CDDs field guide, Household summary forms, Posters, Community Register, flip charts, LOCT and SOCT field guide, training nraterial and Capital equipment such as six Motorcycles, 100 bicycles and Air Conditioner. Writing Board and Elite fiknprojector proposed to be exchange with video camera has not been supplied. ADVOCACY MOBILIZATION OF TI{E POLICY MAKERS Advocacy mobilization workshop for the state policy makers, LGA policy makers, Traditional Rulers, Religious Leaders, PHC Coordinators, and Some notable opinion leaders was carried out in the state. The Advocacy mobilization visit which was calried out by the Top management from State Ministry of Health, was facilitated by officials from WHO, UMCEF, NOCP Headquarters B-Zonal official and members of SOCT was very successflrl. The table below shows the Advocacy mobilization outcome. 6 TABLE SHOWING STATE ADVOCACY MOBILZATION WORKSHOP FOR POLICY MAKERS TABLE SHOWING ADVOCACY MOB ILIZATION WORKSHOP LGA LEVEL State Policy Makers LGA Policy Maker Traditional Rulers Religious Leaders School Teachers Other Group of the Community ATO MOBI ATO MOBI ATO MOBI ATO MOBI ATO MOBI ATO MOBI 60 49 160 148 720 610 700 4tl 480 379 360 275 SCHOOL TEACHERS RELIGIOUS LEADERS LGA TRADITIONAL RULERS LGA FUNCTIONARIES l1 t4Akoko N.E. 22 8 l3 r8Akoko N.W 19 10 t2t2 8Akoko S.W. r6 t7t2 t2Akoko S.E. 2t 19 l68Akure N. 28 2l t225 13Akure S. r8 t1llIdanre 23 15 10Ifedore 22 l2 16 13Ileoluii/Okeigbo 3l 10 l8 r6Odiebo 27 t2 22 l8Okitipupa 37 l5 t7r3 t7Ondo E. 3l l1l0 t6Ondo W. 20 l0t2 t2Owo r8 t6 20l3Ose 25 l3t2 l8Irele 35 252 228Total 400 183 OTTIER GROUPS OF TI{E COMMUNITY 35 51 43 61 47 38 33 29 25 28 32 18 4l 25 22 25 553 7 MOB TH EDUCATION:- Mobilization at the Community level was aimed at ensuring Community involvement with emphasis on these:- Acceptance of the Project Nomination of CDDs Creation of functional village health committees where necessary Timely collection of mectizan from agreed/designated points Decision on the mode of distribution/Time of distribution Decision on incentives to be given to CDDs The mobilization and health education of the endemic communities were supported by the use of posters and radio/televisionjingles developed in the local languages. Additional trained health staffand town criers were used as mobiliser. Churches and Mosques were also used as places of contact for mobilization. As a resuh of the mobilization carried out on CDTI implementation, the positive response of the communities were recognised on these areas. * communities selected their CDDs without delay * Non-functional villages health committee were reactivated. * Communities now decide on mode of distribution * Collect their mectizan tablet from the collection point and also decide on time/period of distribution. {( * * * * * 8 SUMIVIT{RY OF MOBILIZATIONAMALTH EDUCATION OF TAITGET COMMUMTIES )ISTRICTiLGAs {koko N.E {koko N.W Akoko S.E. {koko S.W Akure N. Akure S danre Ifedore I IleolujilOkeigbo Odigbo Okitipupa Ondo E. Ondo W. Owo Ose Irele Total NO OF MOH STAFF I}WOLVED IN MOBILIZATION NO OF ADVOCACY VISITS TO LGAS & COMMUNITIES NO OF COMMUNITIE S VILLAGE MOBILIZED NO OF TARGET COMMUNITIESA/tLLAG E WHICH RECEIVED }I/E ABOUT IMPORTANT OF EXTENDED TREATMENT 426565 3218l8 2 567 67 3J78 78 545656 3 4104104 54189 189 327474 4 493 93 2263 63 2281 8l 436666 583 483 65165 165 6485 85 3245 33 6048I 342, 1,320 NO OF NGDO STAFF INVOLVED IN MOBILIZATI ON 2 2 2 2 2 ) 2 2 2 2 2 2 2 2 2 2 32 9 TRAINING OF TI{E DIFFERENT STAFF INV IN CDTI ATI This is a continuous exercise. All officers involved in the distribution of Mectizan in the state have received one form of training or the other since the inception of Oncho Control in the state. However for the purpose of CDTI Implementation in the second year members of the SOCT and LOCT have been trained. These were facilitated by the B-ZomlCoordinator and the state Coordintors. The training ofthe Local Government oncho control Team for cDTI Implementation was carried out in five local government areas simultaneously between 3'd to 146 January, 2002. Thus the training for the LGAS took three weeks. Training of CDDs at various LGAs was done by the trained LOCTs and supervised by the SOCTs. They were trained on identification, registration of Community members, measurement for dosage and mectizan distribution. Also management of mild reactions and the referral of severe reactions were discussed. The training materials used include the following:- Flipcharts, Posters, CDD field guide, SOCT/LOCT field guide, training manual tape measures, community register book, projector.etc As a result of the training carried out, the CDDs were increased in numbers and able to improve on their performances thereby appreciate their roles and increase coverage. l0 TABLE SHO G TRAINING OF DIFFERENCE LEVEL OF STAFF INVOLVED IN CDTI IMPLEMENTATION. DHS/tIFSPHC COORDINATOR LOCTSSOCT ATO NO TRAINED/R ETRAINED ATOATO NO TRAINEDATO NO TRAINED ATO NO TRAINED 8,000700 700l8 t6 96 96l0 8 CDDS NO 5 76r LGAs NO. OF TRAINING SECTION TOT TRAINED NO OF CDDs TRAINEDLOCTS TRAINED DISTRICT/LGA STAFF TRAINED I]EALTH FACILITY/POST STAFF TRAINED ATO NO ACTUALLY TRAINED ATO NO ACTUALLY TRAINED ATO NO ACTUALLY TRAINED Akoko N.E. 4 4 4 25 25 20 20 239 Akoko N.W 4 5 5 25 25 20 20 297 Akoko S.E. 4 6 6 25 25 25 25 242 Akoko S.W 4 5 5 28 28 20 20 208 Akure N 4 7 7 35 35 28 28 362 Akure S. 4 4 4 20 20 20 20 424 Idanre 4 6 6 25 25 18 18 414 Ifedore 4 4 4 28 28 20 20 338 Ileoluji/Okeigbo 4 5 5 22 22 25 25 325 Odigbo 4 3 3 28 28 l5 l5 214 Okitipupa 4 4 4 32 32 l8 18 5r3 Ondo E. 4 5 5 27 27 2l 2t 459 Ondo W 4 6 6 29 29 26 26 532 Owo 4 5 5 25 25 28 28 s08 Ose 4 6 6 20 20 27 27 418 Irele 4 8 8 15 l5 29 29 268 Total 64 83 83 409 409 361 361 5,761 ll IMPLEMENTING CDTI Drstrict/LGAs No of Communities No Comm./Villages selected CDDs No Comm.Ay'illages collected drugs No of Comm. Decided on method of distribution No of Comm.Ar'illages decided on months of treaEnent No of Comm.Ay'illages with train€d CDDs No of Comm./Villages paying CDDs in cash or kind Akoko N.E. 93 65 58 6l 6l 65 2l Akoko N.W. 2l l8 l6 15 l5 18 6 Akoko S.E 89 67 64 59 59 67 37 Akoko S.W. t29 78 7l 66 66 78 38 Akure N 76 56 50 53 53 56 2l Akure S 210 104 95 84 84 104 33 Idanre 279 189 r60 170 t70 189 33 Ifedore 104 74 63 69 69 74 25 Ileoluji/Okeigbo 150 93 84 85 85 93 43 Odigbo 180 65 59 63 63 65 2l Okitipupa 109 8l 66 75 75 8l 36 Ondo E 190 66 56 62 62 66 2l Ondo W 176 83 77 75 75 83 49 Owo 252 165 145 l5l I 5 I 165 66 Ose t24 85 69 76 76 85 38 Irele 45 33 2t 20 20 33 13 Total 2,227 1,322 1,154 I t I 84 I , I 84 I )322 501 t2 The State received mectbantablets from B-Zonal office and also distributed the drug to the various LGA Coordinators. The LOCTs then made tablets available to the district health facilities or agreed collection points to be pick up by the Communities. During the period under review, June 2001 toW zX[2,the state was able to treat 1,025,427 pople with 3,096,876 mectizan tablets. The rate of refusalVabsents recorded during mectizan distribution in the communities were very minimal. In some communities, those who initially refused treatment came back later following testimonies from satisfied users. The annual treatment objective for the second year cycle is 1.5mffion out of which 1,025,427 people were treated given a therapeutically coverage of 68.Yo. l3 TABLE SHOWING NO OF TREATED PERSON AND TABLET USED District/LGAs Akoko N.E. Akoko N.W. Akoko S.E Akoko S.W. Akure N Akure S I Idanre Ifedore Ileo Ondo E Ondo W Owo Ose Irele Total MONITORING AND SUPERVISIO+Th At the Community level, there are Community leaders and health committee - members who were selected by the communities themselves to supervise and monitor the activities of the CDDs. The LGA, District Health Supervisors are assisting in the supervision of the CDDs. LOCTs also supervise the CDTI process while the SOCTs make spot checks in selected communities to ensure that the laid down criteria are being followed. No of treated communities villages with summary forms No of distribution supervised by health workers Cost per person treated No of Communities/ Villages in which CDD is a health worker No of Target Communities A/illages treated No of Eligible Persons treated Tablets used 6526214,97665 71,685 18t51,375,56518 45,370 67l0180,03667 59,446 78t42,588,72178 86,318 562t227,77656 74,525 104r3369,316104 121,090 r8927192,676189 63,449 )) 7431,654 95,71474 t9 9346,107 140,70093 t2 6565 74,847 226,976 t6 8181 88,014 260,382 l5 6666 51,8867 155,396 83l8174,35683 57,807 1653l249,683165 83,124 85l8165,61585 54,618 332346,98833 15,506 1,3223003,096,8761,322 1,025,427 t4 SECTION 4 S l. The project has been able to carry out Advocacy Mobilization of the policy makers and the grassroot leaders which has enable the project to reach about 2,227 Communities. 2. The project has also been also been able to train all the $oups involved in CDTI programmes i.e. CDDs, LOCTs, SOCTs Health Workers, PHC Coordinators, etc. 3. Most of the communities so far treated and where distribution is currently going on have taken on the responsibility of collecting the drug from agreed collection points nearest to them. In some instances, cDDs have made returns to the collection points after finishing treatment. Generally, the CDDs exhibited a high sense of responsibility and understanding of the CDTI concept. 4. Th numbers of CDDs selected by the communities and trained for CDTI has ihcreased thereby improving the treatment coverage. In some communities where village'health committees have been non existent or dormant, these have been constituted/resuscitated and made functional in course of implementing CDTI. 5. All the LGAS have not only expressed their willingness to embrace the programme but they have also followed it up by either lending moral support with the physical presence of Policy Makers at relevant occasions or/and by giving functional assistance to the implementation process. Some LGAs provided community register book while communities also provide incentives to their CDDs. 6. The State Government has provided a four-room office accommodation and equipped it for the state Onchocerciasis Task Force. It has also released the sum of l.million Naira as counter part funds. some LGAs provided community register book while communities also provided incentives to their cDDs. l5 WEAKNESS OF TTIE CDTI IMPLEMENTATI ON PROCESS l. During the spot checks by the SOCTs, it was discovered that some CDDs made mistakes particularly in record keeping. Moreover records of milk reactions were not being kept by the CDDs. 2. Poor reporting due to inconsistency in information request format and frequent changes in forms design and data requirements. 3. Inadequate supervision of CDDs by LOCTs, 4. Lack of adequate commitment of LGA Coordinators, particularly in rendition of reports and supply of vital and urgent information as demanded by NOTFAIOCP and SOCT Secretariat. TYPES OF IIELP NEEDED FROM STATE/LGA GOVERNMENT l. Allowances should be given to SOCT for monitoring. 2. The State and Local Government Policy Makers should increase the level of counterpart funding to the project. 3. Increasad airing of Oncho jrngles on Radio and Television stations 4.' The State Team should be left permanently including the Local Government Coordinators. FROM APOC Provision of all approved capital items to the project Early release of instalment of funds approved to avoid delay in project implementation Periodic advocacy visits to the CDTI Project. FROM NOCP/UNICEF:- UNICEF should provide its counterpart funding to the project Provide Technical and Management training for SOCTs. Ensure regular supply of Mectizan Supply enough IEC materials for project use. l6 (, 2 o\ (,l 5 lJ) N) !.., \o 90 {5 u) a ct) X(r) o -l a rrl(,n (A p t} R. -I D) oo (D (D D o. 'U O) (D od N tr) o iJ 0(! a) oB o' - Fl4 co oa s) u o. F(1 Bg. 0a o H) v) !0 (D oo a o Fl (Dp B A)a *l i c) (or-a O o o C)ot-t o s) U) U) a7l O] FDi o ElAoa5Eo5E(Dgit 6eoo -o o r_t s)a o s) FU s) oa orl ,fU' o 'd +lo'I F'r >! 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