Second meeting of the national onchocerciasis task forces (NOTFs) representatives: Abuja, 17-22June 2002 assessment of the self-sustainability of the Hoima CDTI project

aAfrican Programme for Onchocerciasis Confrol (APOC) Programme Africain de lutte conffe l'Onchocercose Onchocerciasis Task Force (NOTFs) of Nigeria Second meeting of the National Onchocerciasis Task Forces (NOTFs) Representatives, Abuja' 17-22 June 2002 ASSESSMENT OF THE SELF.SUSTAINABILITY OF THE HOIMA CDTI PROJECT DIR/APOC r6t06102 Hoima Executive Summary APOC support for the Hoima District CDTI project is in its last year of the five-year agreed funding. An evaluation of the self-sustainability of the project was carried out in May/June 2002, by a team ofthree evaluators. The three-fold task ofthe include to: . Evaluate the self-sustainability ofthe project. . Working with local stakeholders to plan for self-sustainability, based on the findings of the evaluation. . Advocacy with local political and civil service leaders, regarding their future role in the self-sustainability of the project. The entire exercise was carried out over a period of thirteen days. Inforrnation was collected by document study, interview and observatioru at sampled sites at three levels of the health service, namely, District, Subcounty/trealth centre and village/community. The overall judgement of the team is that the Hoima CDTI project is not far from being sustainable. Regarding the six elements of sustainability, the situation is broadly as follows: . Effectiveness: The project is effective at all levels. Geographic coverage is quite high as 125 of the 127 endemic villages are under treatment. The two v'rllages not yet under treatment were discovered last year through REA exercise. . Effictency/financing: Many activities are not properly targeted, resulting in inefficient use of scarce resources. Supervision and training, for instance, are being carried out as routine activities or as motivation of CDDs and the supervisors. The lower level subcountyftrealth centre personnel are not yet fully empowered to carry out tasks at their level and the DOC often carries such tasks alone or with the lower personnel. . Simplicir); Routines are generally srmple and easy to carry out. . Integration: Tlte prograrnme is by now well integrated into the official health system at the District level. The same cannot be said of the Sub-county health centre level activities. Some activities are still prosecuted vertically at the health centre level. . Attitude; The stakeholders have accepted the project as part of their responsibilities. However, some key players have not accepted the fact that they will have to cope without outside resources in the near future. Some health centre staff do not see Mectizan as essential drug since it is not included in the essential drug kit supplied to them . Resources; The project still relies too heavily on APOC. At the village/community level CDTI activities appqr sustainable. The sustainability potentials appears weak at the Sub-county/health centre level both because of lack of committed trained health centre staff and the heavy dependence on APOC resources for the vertical implementation of CDTI activities. The Subcounty/health centre and the District levels have to sort out the key issues of planning, .funding, transport, ffid delegation ofresponsibility, if they are to be self-sustaining. II Detailed recommendations were drawn up, based on the findings of the evaluation at the three levels. The recommendations were prioritised, and indicators and deadlines were suggested for each. These included: Facilitation of tlre lower level to organise for the treatment of the two communities discovered to be endemic. Identification of firnds ttnt will be available for the 2003 distribution and their respective sources. AIso there should be clear identification of dependable arrangements for meeting deficits. High level advocacy involving the NOTF and MOH ofEcials to the District level political and administrative machinery The evaluation team carried out advocacy activities at the level of the administrative leadership of the District. The newly elected LCV Chairman was also met and coming from a background where onchocerciasis constituted a major public hedth concerr! he promised to pay attention to CDTI in the district. Particular attention was also given to the DDHS, DHE and DOC as key players inn future action to ensure sustainability of the prograrnme. One feedback/planning workshop was held for both the District and subcounty level stakeholders. The team gave feedback on its findings, which were discussed in depth. The evaluators and other frcilitators then guided the participants to draw up realistic 'plan for self-sustainability' for their respective areas of operation. The workshop process worked well and considerable enthusiasm was generated. There is considerable agreement between the plans produced in this way and thee recommendations that the evaluators have made in this report. This may be attributed to the fact that the evaluators' recommendations were based on the findings, which were given as feedback to the workshop participants upon which they drew their plans. All the same the plan still needs to be thought+tnough refined and adapted to a participatory plaq involving all stakeholders, in the light of the recommendations made by the evaluators. Finally, there has to be a-mechanism of ensuring that plan is meticulously implemented and not treated as 'business as usual' if the self-sustainability of the Hoima project is to be assured. -'t