RESERVED FOR PROJECT LOGO/IIEADING i _.._.._.._.._l ORIGINAL : English For [o: m For Tot L ANNUAL PROJECT TECHNICAL RBPORT SUBMITTED TO TBCHNICAL CONSULTATIVB COMMITTEE (TCC) DEADLINE FO SUBMISSION: To APOC Management by 31 Januarv for March TCC meeting To APOC Management by 31 Julv for September TCC meeting AFRICAN PROGRAMME FOR ONCHOCERCIASIS CONTROL (APOC) csV EPI Bt rrt tr$ r*o IU co LFOFo r0t t U).*rl Prqieet-Naue: NOTF/APOC- WHO/AK\ilA IBOM STATE COUNTRYAIOTF: NIGERIA Launching year: SEPT. 2003 From JAN, 2007 To: DEC 2007Renortine (Month/Year): (circleone) I 2 3 (4) 5 6 7 8 9 10Proiect Year this renort: NGDO partner: HELEN KELLER INTERNATIONAL Date submitted: June,2009 2 { A0ul 20c9 APO c RECU LE I DIR WHO/APOC, Approval vear: APRIL 2003 IANNUAL 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: NIGERIA/LIBERIA National Coordinator Name: Dr. Yemi Fayomi Signature: ... Date Zonal Oncho Coordinator Name: Mr. J. O. Eluwa Signature Date: .... NGDO Representative Name: Dr. Musa A. Z. Obadiah Signature Date This report has been prepared by Name : Veronica I. Itina (Mrs) Designation : State Oncho Coordinator Signature: ...... Date WHO/APOC,ll Table of contents Acronyms v Definitions vi FOLLOW UP ON TCC RECOMMENDATIONS 1 Executive Summary 3 SECTION 1 : Background information. 1.1. GeNeRalINFoRMATIoN............. 1.1.1 Description of the proiect (brieJly).----. 1.1.2. Partnership 1.2. Popu1nuoN............... SECTION 2: Implementation of CDTI. 2.1. TIuer-ne oF ACTIVITIES ............ 2.2. Aovocacv 2.3. MOEILIZATION, SENSITIZATION AND HEALTH EDUCATION OF AT RISK COMMUNITIES 2.4. CotuvrxtrY INVoLVEMENT...... 2.5. CepRclrvBUILDING.. 2.6. TnsnrveNTs.............. 2.6.1. Treotmentfigures............. 2.6.2 What are the causes of absenteeism?.......... 2.6.3 What ore the reasons for refusals?-............... 2.6.4 Briefly describe all lvtown andverified serious adverse events (SAEs) that -.. 2.6.5. Trend of treatment achievement from CDTI project inception to the current year t9 2.7. ORoeRmc, sroRAGE AND DELIVERY oF IVERMECTIN ........."20 2.8. COvvcnruY SELF-MoNITORING AND STAKEHOLDERS MBernlC ............20 2.9. SupeRvlsloN............... ...'.......'..........21 2.9.1. Provide aflow chart of supervision hierarchy . ...... . """' 21 2.9.2. Wat were the main issues identified during supervision?.--..'..............""""""""" 21 2.9.3. Was a supervision checklist used? ..... ..........""' 21 2.9.4. What were the outcomes ot each level of CDTI implementotion supervision?........ 21 2.g.5. Wos feedback given to the person or groups supervised?...-..--....-... """ 22 2.9.6. How was the feedback used to improve the overall performance of the project?..... 22 SECTION 3: Support to CDTI 22 3.1. EqumurNr .....................22 3.2. FrNaNctnl CONTRIBUTIoNS OF THE PARTNERS AND COMMLINITIES............. ..............23 3.3. OrHeR FoRMS oF coMMUNITY suPPoRT.....'......'.. ....'-.-........24 3.4. ExpeNotruRE PER ACTIvITY ..'............... .....-.......24 SECTION 4: Sustainability of CDTI25 4.1. INrenNe.r.; INDEPENDENT PARTICIPATORY MONITORINC; Evar.UeTlON....................25 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable). .. ... . ..........- 254.1.2. What were the recommendations? -....'.....'. 25 4.1.3. How have they been implemented? ...-.------.- -.......-..-.....25 4.2. SusrerNnsrlrry oF IRoJECTS: ILAN AND sET TARGETS (MANDAToRY AT................25 Yn 3) 25 4.2. t. Planning at oll relevant levels... ..........--..... 25 4.2.2. Funds....... ...........-... 25 4.2.3 Transport (replacement and maintenance) ... - --- -.-- 25 4.2.4. Other resources ...... 26 4.2.5. To whot extent has the plan been implemented................ .............- 26 4.3. INTecRATIoN ................-.26 ...4 4 4 5 6 7 7 9 9 lll WHO/APOC, 12 4.3.1. Ivermectin delivery mechanism,s................ .................. 26 4.3.2. Training.... ..............26 4.3.3. Joint supervision and monitoring with other programs........... ....-. 26 4.3.4. Release offunds for project activities ...-..-. 26 4.3.5. Is CDTI included in the PHC budget? .............. ........... 26 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements?............. .....-......-....-.. 26 4.3.7. Describe others issues considered tn the integration of CDTI. ..... 26 4.4. OpenerroNAL RESEARCH .-....-............26 4.4.1. Summarize in not more than one half of a page the operational research undertaken in the project area within the reporttng period. -.... 4.4.2. How were the results applied in the project?......... . SECTION 5: Strengths, weaknesses, challenges, and opportunities SECTION 6: Unique features of the project/other matters 28 lv WHO/APOC, Acronyms APOC ATO ATrO CBO CDD CDTI CNFR CSM DHS F FLHFS HKI IEC ITN LF LG LGA LOCT MOH NGDO NGO NID NOCP NOTF NPC PHC PHCC REMO SAE SHM SOCT TCC TOT TV UNICEF UTG VHCs wHo wo African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Community Based Organization Community Directed Distributor Community Directed Treatment with Ivermectin Currently Non Functional but Repairable Community Self Monitoring District Health Supervisors Functional Front Line Health Facility Staff Helen Keller International Information Education Communication Insecticide Treated Nets Lymphatic Filariasis Local Govemment Local Government Area Local Onchocerciasis Control Team Ministry of Health Non-Governmental Development Organization Non-Govemmental Organization National Immunization Days National Onchocerciasis Control Programme National Onchocerciasis Task Force National Population Commission Primary Health Care Primary Health Care Coordinator Rapid Epidemiological Mapping of Onchocerciasis Severe Adverse Event Stakeholders Meeting State Onchocerciasis Control Team Technical Consultative Committee (APOC's scientific advisory group) Trainer of Trainers Television United Nations Children's Fund Ultimate Treatment Goal Village Health Committee World Health Organization Written Off v WHO/APOC, Definitions (i) Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). (ii) Etigible population: calculated as 84o/o of the total population in meso/hyper- endemic communities in the project area. (iii) Annual Treatment Objective: (ATO): the estimated number of persons living in meso/hyper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. (iv) Ultimate Treatment Goal (UTO calculated as the maximum number of people to\- / be treated annually in meso/hyper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage (normatly the project should be explctld to reach the UTG at the end of the 3'd year ofthe project). (v) Therapeutic coverage: number of people treated in a given year over the total (vi) population (this should be expressed as a percentage). Geographical coverage: number of communities treated in a given year over the totut *.Uer of meso/hyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). Integration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) through CDTI (using the same systems, training, supervision and personnel) in order to maximise cost- e-ffectiveness und empower communities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTI. Sustainability: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future, with high treatment coverage, integrated into the available healthcare service, with strong community ownership, using resources mobilized by the community and the government. Community self-monitoring (CSM): The process by which the community is ".npo**A to oversee and monitor the performance of CDTI (or any community- based health intervention programme), with a view to ensuring that the programme is being executed in the way intended. It encourages the community to take full ..rponr=ibility of ivermectin distribution and make appropriate modifications when necessary. (vii) (viii) (ix) vl WHO/APOC, FOLLOW UP ON TGG REGOMMENDATIONS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC Recommendation 25 I Number of Recommend ation in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROTECT FOR TCC/APOC MGT ASE ONLY 291 (t) The project area is well described but the summary is scanty and does not include details. The summary has been made comprehensive. 2er (1i) The project is encouraged to respond to those TCC 23 recommendations which have not been answered in the appropriate section, i.e.: the disaggregation of information on community involvement along community/district lines to show clearly the areas that need help. All sections have been addressed and all tables appropriately completed 2el (iii) Explain the meaning of 'Oncho Office' (this is probably clinic based treatment whose data should not be included in the calculations of population and coverage). This refers to passive treatment, and data has been excluded in calculations of coverage rates. 29r (iv) Verify the figures in every table to be sure that errors in coverage calculations are detected (tab. 7) Figures contained in the report have been verified and coverage rates properlY calculated. 291 (v) Include more details into the Executive Summary to include information on Sustainability, integration. This has been done 2e2 (i) Commence SHM and CSM since training for CSM was conducted in the month of July/August 2006 at the state and LGA level. This will be tackled in the 2008 treatment cycle. 292 (11) Train more CDDs (the present ratio of 1:627 is too high) to reduce the work load There is a slight improvement as current pop/CDD ratio is now 1: 572.The problem is the perception of CDDs that no incentives are attached to it. Communities are therefore not encouraged to select additional CDDs to be trained. 292 (t11) Select and train women CDDs because the project has no women CDDs supporting CDTI activities. More than a third of existing CDDs are females More efforts will be made to increase this number. WHO/APOC, 292 (iv) Increase advocacy to the communities so as to increase their cash contributions. See below 292 (v) Intensify sensitization at the level of communities to reduce absenteeism and refusals Mobilization and sensitization of communities are being done, and will be intensified but a major hindrance has been the presence of intra- community strife due to chieftaincy tussles. 292 (vi) Treat during the dry season and out the farming season (April - MaY is of Efforts are being made to address this. 292 (vii) Conduct sustainability evaluation. This has been done in 2008, and reflected in the technical report (Please add more rows if necessary) 2 WHO/APOC, Executive Summary Prepare an Executive summary of the report in not more than W,9.page. Akwa lbom State is located in the south eastern part of Nigeria and is now a part of the south - south geo - political zone. The State has a total population of 3.9 million people (2006 Nationallopulation census figure projection). Languages spoken are Ibibio, Annang, Efik, Ika Ibom and Oro. English is generaliy understood. Majority of the people are Christians, a few are traditional worshippers=and an insignificant number are Moslems. Akwa Ibom State is in its 4ft year of projeci implementation. It is unique in the fact that only 2 of its LGAs are endemic - Ini and Ibiono Ibom with a total of 13 communities.. These 2 LGAs however are difficult to reach areas. The peopl e are not nomadic but permanent residents as such absenteeism was largely due to farm activities. A total number of 13 communities were treated giving a 100%o geographic coverage. 13,368 persons were treated out of a total population of 23,463 persons. This resulted in a 57oh therapeutic coverage rate, and achievimints of 68%o and 83o/o of the project's UTG and ATO of tg,l1g and 16,i65 respectively. 41 CDDs were trained/ retrained out of an ATrO of 49 while 22healthworkers wtre trained/ retrained including LGA staff of an ATrO of 22. To ensure sustainability, regular planning meetings will be held by the state and LGAs at the begiming of the y"*. ih" meeting will be an avenue to develop yearly work plans at the state and LGA levels with specific funJs assigned to the government. The State has been releasing regularly its counterpurt fundr and it is expected this will continue. Efforts are being made to .n-rur. the LGAs follow suit. The puC stiff are involved and take responsibility of Mectizan and Vit A by collecting them and allocating them to Community-directed distributors for distribution. They also jointly supervise the two activities. Some of the challenges faced include transfer of some health staff (LOCTs and DHS) out of CDTI areas, CDD attrition and refusal to work for lack of compensation, lack of/inadequate compensation of CDDs, and inadequate drugs at the lower levels. Other challenges were: - Some communities (Ebo and Ikpe lkot Nkon) are experiencing chieftaincy tussles. - The death of some mobilized viilage heads (lkpe Ikot Nkon, Obotme) affected distribution - Laxity on the part of LOCT leaders - Communal clash at Nkana community led to dispersion of settlers (ljaws) - Inadequate support by LGA Executive to the programme - Non-identificition and involvement of CBOs and VHCs in CDTI activities. - Inadequate logistics The challenges were addressed through the following ways: - New heatttr staff were recruited on the spot and Local Govemment Services Commission was contacted and appealed to not transfer staff involved in CDTI activities out of the CDTI LGAS - New CDDs were recruited and old ones were encouraged to continue - Community leaders/members were sensitized on the need to compensate their CDDs even in kind. - Calls were sent to the supporting NGDO for more drugs - Some heatth staff had to travel long distances and difficult terrain to supervise the distribution. - Communities that had more than one village head were treated as separate communities - A LOCT leader was replaced to help the programme function effectively. - Helen Keller Intemational assisted with an additional vehicle during CDTI activities aJ WHO/APOC, SEGTION'l : Background information 1.1. General information 1.1.1 Description of the project (briefly) G eo g rap hical lo catio n, topograp hy, c limate Akwa Ibom State is located at the South East corner of Nigeria lying between latitude7025l and 8025rand longitude 4032t and 5033r East. It comprises 31 LGAs but conhol activities take place in only two (Ini and Ibiono lbom) LGAs. These two LGAs occupy the North Eastern part of the State. The project area is undulating and has poor and difhcult terrain. Areas that have plains are usually flooded (Ikpe Ikot Nkon, Itie Ikpe and Ananamong in Ini LGA and Afua in Ibiono Ibom LGA). The hills are found in places like Ikpanya, Ebo and Obotme, and the valleys in Abaitiat, Ikweme and Edem urua. The entire State is situated in the rainforest bio-climatic zone. The northern part where the project is located is moist woodland savanna. There are two marked seasons: the wet season iturtr i., March and ends in October while the dry season starts in November and ends in February. Pop ulation: activities, cultures, language thi State has a total population of 3.9 million people (2006 NPC). As part of the culture, some days are set aside for masquerade festivals such as, Akata, Ekong, Ekpo nyoho, Abon and Ekpe are being displayed. Majoriiy of the people are Christians, a few are traditional worshippers and an insignificant number are Moslems. Many of the indigenes speak Ibibio, while others speak Annang, Efik, Ika Ibo and Oro. English language is generally understood by the educated ones. Communicatton systems (roads,..) The roads are tarred but unmaintained (i.e. the one linking major cities) others are ungraded roads and foot paths. The roads are used with much difficulty during the rains. Telephones especially the mobile ones are mostly used these days for communication. Others include radio and television for wider coverage and in the local setting town announcers (criers) are employed. Main occupations of the people are fishing and farming. A distinct characteristic of the people is cleanliness. Administratio n str uct ure There is a two tier administrative structure at this level. A democratically elected Governor heads the State executive council. The local Government chairmen who are also democratically elected head the local councils while the communities have leaders (chiefs). Health system & health care delivery (provide the number of health posts/centers in the project area if the information is available), ff.uttt care is delivered at 3 levels in the State. There is the tertiary level (University of Uyo teaching hospital). The secondary level which is represented in all the LGAs but far apart and the primary tevel (PHCs) which are expected to be found in majority of the communities, but this is not the case. 4 WHO/APOC, ricULGA Number of health staff involved in CDTI activities. Total Number of health staff in the entire project area Br Number of health staff involved in CDTI B2 Percentage *100 Ibiono Ibom 159 7 4 Ini r20 15 l3 Total 279 22 8 1.1.2 Partnership Indicate the partners involved in project implementation at all levels IMoH, NGDOs (n atio n al/inte r n atio nal), co mm un it ie s, lo c al o rg a n izatio ns, e tc. J Partners involved in project implementation at all levels are: - African Programme for Onchocerciasis Control (APOC) - Federal Ministry of Health - NOCP - State Ministry of Health - The 2 LGAs - The Communities: CDDs, Local organizations have been identified but will be used next year. - NGDO: Helen Keller International Describe overall working relationship among partners, clearly indicating speciJic areas of project activities (planning, supervision, advocacy, planning, mobilization, etc) where all partners are involved. Co4ql1glttlgE Assistance is given in the areas of yearly Mectizan usage, selection of CDDs, a.,rg *ff."ti*, storage, distribution, carrying out CSM and supervision of drug distribution. LGA: The LOCTs, DHS, FLHFS and Nutrition focal persons plan activities in their LGAs tik*o--unity mobilization, training of CDDs, collection of drug from State, storage and delivery, monitoring and supervision, writing and submission of treatment reports. State: State plan all CDTI activities, conduct TOT trainings at LGA, make advocacy visits to LGA "*..utives, collect Mectizan for LGAs, monitor and supervises the drug distribution and write reports for submission. NGDO: Helen Keller Intemational provides technical assistance by training SOCTs, lead in high level advocacy to the State and LGA policymakers, apply for Mectizan consignment, approach rulers and influential members of the community for support. Working relationship between partners is cordial with regular meetings to maintain the relationship and make CDTI a success. State plans, tf any, to mobilize the state/region/district/LGA decision-makers, NGDOs, NGOs, CBOs, to assist in CDTI implementation' The State, LGA, District and LGA decision makers have been mobilized. Those who will soon be mobitized are the local NGOs and CBOs. This will be included as part of activities of 2008 in the workplan. Proposals would be written and sent to partners for sponsorship. 5 WHO/APOC, Number of health staff in project area and number of health staff involved in CDTI activities. Table I : Number of health staff involved in CDTI (Please add more rows if necessary) O^ i o E o H U) bo H >. (d bo Lr(n cr) E (d L9dVL(c0)o_c a .!FG) U J P-5(),U tv .tL.I ova AJN= Sri !!U9odL 9cdo (!()o'a L*6ebt VH od 0) tit(t LrJ €* Hq r<9C.)5 PLF€{Yd 9oa; Rk- '50-u .ao c) -iC)=o.lQ.= cLO t=bO eor) cQr ij H-€ oq, dgK F 9b q!ho() l-i ed} 'I ra6 I .H A J-iP4a O 'E; h?.e, EEE !lXE E5F # <d ,2 I I I I Bo C) * do ^.H9X 'o v) 6 l-r =G)0)P s\J Cg oQ €ngu ;(€ va o5EU)eE <+r(.)oo(J=oxLHt.9.o U) (d= o,4c\ Eg= !vi^0) *d6> d zH* o z I It',o € o k C)g bI) '5tr oa 0.)k o -c bo tr L) otroE (-)(,) 'a lrp. o l-< .P (r) (r) oo (d .n c! ci oq) o'\\ q) q) >\$ \)\ a) .o o \) B !3 $-OL:\ "qr 6.b \Gup -sA -S s) B*PiBa) c\ S) 'is TS .tB sr\$x $U \q)\\O*t%U$tlSs) \q) }!uq)$ qJ q) ^a\ o U) ti a'o\ s) 5 L o S q) bos\q) o() u L bo oq) bo q) U q)\ >. \q) a)L q) .o o q) a_ q) .\ o' Lq) "ot s trH q) \q) Blsl() Itllu I Pb v1 =o\ q) L o t -!o ko o. bo Lr o0.oLr() o0 l-< '13 o Lr o ! 0) (g oL{ o l-< cld >.() t<q) o) B cl() L 6l (J q) oL q) L trq) C) }1 rn *< (g o (! aoa E d a(.) cttr c)Eo-qOU 0< C.ll orl qFl Fr Fl \o $$rn\i $\o ca 6 r- o\ (J F !?E = o- = ge (\ t--\o n (a\o =m ot + lls .c)LE -oo .= .N -\ Ei r€ o\\r- . "-g Et't-9r&E.Er: >,! 6) o -E E E'fN^ o\\r- c.lr-\o ?a\o$- ca c.l o E o GI o Fr o N: E 9orUgsi $ o\ ra I () ciN3.v c!() oF .eE E.Fq)= Eofl4)E E i- cqotr >r c)FTE -O N + o\ ?a -l(l)l bd ctl el uzlq)t trt E Eo() o Lq)E E z a 'EgE ^9r= k ?a.,U gsx. ?o\ot(a c.l o\\ Ir* cilt-r\o(n .i Gl aC)EoL .r L bY --i-c!:E = E 6.9-i *cr 9' v9-iH AE A Eo ,..o oq o I Fl Fr otr E,t .F€.9 9-V- 5I iHH()5 E'S SEGTION 2: Implementation of GDTI 2.1. Timeline of activities Fill in table 3, timeline of activities for areas treated in current year, tndicating when the key activities were implemented by the month they began and the month they ended. 7 WHO/APOC, O Or Elr o rn tIq a o5EE o U c- C\ o.()a tr- N a.oa Lr. ?E d: a- r-OO c.l c.))h t-rooN (l) tr h L rr) bT L c)e o.5EE oU r- c\ a.(.)a r- c\ O.o(n bo-c+ 1iE d: f-- ON Cd t--o N x cd q) 6l16 cD tt) ah Eq) U o.5EE oI r- O o.l >. Cd t-- ON >.(d z aD-E+ 1itr d= aiE tr-OON *(d z tr- O c.l >.(o Z b0 E Gfrtr or a.6EE o U r-.O N >td a r-OON *(d z o0-tr+1 fE d= A;E r* o(\ k c- a N k a. -€)o.ts5E s= .atroo = (.)a c)9 EOEE o U c=o(\ l<a F-OO c'l La o0- ftr(!= u)- tr- c.l L o. c- N H o. q) ,-4 ah rs AFI E o -o o op d € rt) q) tl E () Lq) l. l*I CN H . 0.) x(63>Qr rbE Hq cle9EQ> +. L.,;o(d (g d9 trxstrdQ7al zad6l^ tr -lJ9c d.o c)i;Eotr< -lq).i 9U ,tr ":Eq)'(, € r/) 'i .9 etrdJ dtr +<X o, .o CrtoO: Eo .E€ c).N .r, -acl 'lstq> 9Vj U')\)U a) 4 + r. t\ o ! S q) Va q) 5 Li(s C) >. tro E o o Eo (d otrI U)(d(.)tr Cd o lr € an(.) o(s (H 0) (.) tr F ..it ol -ol'(d FI 2.2. Advocacy State the number of poticy/decision makers mobilized at each relevant level during the current year; the reason(s) for undertaking the advocacy and the outcome. Describe difficulties/constraints being faced and suggestions on how to improve advocacy. Policy/decision makers mobilized at each relevant level during the current year are as follows: State level:(i) Hon. Commissioner for Health - 1(ii) Permanent Secretary of MOH - I(iii) Director of Public Health Services - I 3 people at the State level were visited for sustaining good working relationship and support to the project through provision of materials, logistics and financial support. Outcome: The State released her counterpart financial contribution for the year LGA level: 8 policy makers were mobilized which include the chairmen, Councilors for Health, PHC coordinators, and the Head of personnel to encourage them to set-up their financial support to the prograrnme At the community level, Community leaders, Opinion leaders, Religious groups were mobilized to encourage them to embrace the programme, support their CDDs, provide storage and safety of Mectizan and monitor/supervise the distributors Diffi culties/Constraints : It has been difficulty meeting the relevant LGA policy makers. They are not always available when visited. When available, a lot of time is wasted before seeing them. At times after appointments have been made, they do not honour it. How to improve on Advocacy: - Step up advocacy visits to the State and LGAs for increased and continuous financial support to the programme - Develop advocacy tool kits for target policy makers - High-level advocacy by State Commissioner to the LGAs together with NOCP & the assisting NGDO. 2.9. Mobllization, sensttization and health education of at risk communlties P rov ide info r matto n o n : The use of media and/or other local systems to disseminate information - Announcements are done in the churches, mosques and during community associations or cooperative society meetings. - Town announcers disseminate information to community members Types of IEC materials used Flip chart, Brochures, posters, fliers 9 WHO/APOC, Mobtlization and health education of communities includingwomen and mtnorities Women and minority groups are mobilized during their fellowships, associations, and other meetings. Re sponse of target communities/villages Communities accept the continuous use of Mectizan Accomplishments - l3 endemic communities sensitized - Communities are making efforts to take charge of CDTI Constraints - IEC materials inadequate - Community heads not inviting the entire community members to meetings to discuss CDTI - Certain communities not accessible at certain times of the year - Inadequate logistics for effective follow up by the health staff - presence of factions in communities struggling over chieftaincy positions Suggest ways to improve mobilization and sensitization of the target communities- - PHC staff at the community level should be encouraged to sustain the mobilization of the communities where they live and work. - Provision of good motorcycles to health facility staff - Frequent advocacy visits to LGA Executives by the State team to solicit for support to enable health workers do proper follow up on communities' 10 WHO/APOC,
DistricULGA Number of communities/villages with community members as suPervisors Number of CDDs Number of communities /villages with female CDDs Total no. communities in the entire project area Br Number with community members as supervisors Bs Percentage Bo= BJ B. *100 Male CDDs Bu Female CDDs Bs Total Number of communities with female CDDs Btn Percentage Brr= Bro/8.*100 Ibiono Ibom 4 1 25 7 2 9 2 50 Ini 9 6 67 19 13 )Z 8 89 Total 13 7 54 26 15 4t 10 77 2,4. Communityinvolvement Table 4: Communiiies participation in the CDTI (Please add more rows if necessary) Comment on: Attendance offemale members of the community at health education meetings Attendance of female members oithe community at health education meetings has not been impressive. They are always not invited to such meetings because of cultural reasons. In general, how do you rate the participatton offemale members of the communi$ mitings when CDTI issues are being discussed (attendance, participation in the discussion etc) 'Mh.r. they are allowed to participate, their opinion is always to sought in making decisions regarding CDTI activities Incentives provided by communities for the CDDs Few of the communities do not provide incentives to their CDDs either in cash or kind. Attrition of CDDs. Is attrition a problemfor the proiect? If yes, how is it addressed? Attrition ii a problem to the proj;ct where CDDs refuse to distribute because they do not receive inceniive from their communities. This is being addressed by continuous mobilization and enlightenment of the community members to see the importance of the progralnme and the need to supPort their CDDs. Other issues t2 WHO/APOC, 24 November 2003 Bq= Bz*Br 2.5. Gapacity building Describe the adequacy of available knowledgeable monpower at all levels. The project has availabli and knowledgeable manpower at all levels, however, not all Health workers have been trained for CDTI implementation. ll/herefrequent transfers of trained staff occur, state what the project is doing, or intends to do, to remedy the situation. (The most important issue to describe is what measures were taken to ensure adequate CDTI implementation where not enough knowledgeable manpower was available or rf staff are frequently transferued during the course of the campaign). The proJect continues to experience the problem of frequent transfer of trained health staff at the LGA level. The Local Service Commission has been contacted to either allow them to remain or post them to the other CDTI LGA. No response has been received yet. t3 WHO/APOC, 24 November 2003 :: sd o .= + '(J ]>to o\ o\ c.l : N : q) C) q) s o\6 c- c-l \ot q) 6lL ah a (.) a q) z ?:F(J ol I i9 e Su= tst$ (\l c) 0) q) (J \o (-) o ov)?a E9 EF. .0 6)FtvOF o arz Eg Es! z GT : o ml : c..l r-- ra (\I U .L (J. = I + U ?rt6,7 q) q) q) q) \o N \n r-. I IEIol dhl 1=E E3E> zE o c) (JoL ?.) ra : $+.q z I .I ts.; +lF-dl $ $ o\ o\ ra (J $ o\ !H c( o O () F] 9o9() a!Y q)E z Eo ,o otr o -o tr Fl tr o Fr o 0) q) (D I \oc\ I rl (,) 0 a c.tO c.l L C) -o 0.) o z$ c.l O Or o > + Fi t-( U oq) L L q) c! q)L c{ q) o =t cl a xo q) 4) c) Q7. aLtEOo) u)tr's c(65s)4) u) be ,(! crh%9q)o^tr cq(.)L-C "rEhaEY 6=li rlr+.A li ..6)!aEE o>.s9(H ,-l-l t- bo o i o B o bo o B tt I t o A. oi € * B U \ .L l< e + o B \ .\ - 4q q) v v q =o q)\o t ! q) U1 q) 5 o Cd tro F q) a E F oO(H o rh o o q o l-< _6)E ! o P(€ bo tr cdtiF .iir ,l -ol(dt FI Trainees Type of training CDDs Other Community members e.g Community supervisors Health Workers (frontline health facilities) MOH staff or Other Political Leaders Others(speciff) Progtam management How to conduct Health education Management of SAEs CSM SHM Data collection Data analysis Report writing Others (speci&) Table 6: Type of training undertaken (Tick the boxes where specific training was carried out during the reporting period) Any other comments 2.6. Treatments The project was able to treat 13368 people out of an ATO of 16165 including 400 people (passive) with 37333 tablets of mectizan 2,6.1. Treatment figures If the project is not achieving 100% geographical coverage and a minimum of 65% therapeutic coverage or the coverage rate ts fluctuating, state the reasons and the plans being made to remedy this. The project achieved 100% geographic coverage and 57Yo therapeutic coverage. The reasons for low therapeutic coverage are:(1) Distribution took place during elections leading to increased absenteeism(2) Also certain communities present two heads leading to break down of law and order (power tussle). E.g Ebo & Ikpe Ikot Nkon 15 WHO/APOC, 24 November 2003 O o. o J< \o $s v E{t $. Oo \oT H{ or'l!v\) -\0)3H-i6H .g 'se's\ o,iS *ss -.an '=ooi +llrE:i a.iBHEUeEt .dE'o -=>EF'_a €EE oEl-trb TE.+ss =a€bH SE(.) .s '$a.HE\.Ui $ +RH \ sqJ .Y \ '='{d tr t- ot I S 'iE' ol ! \J q!II-8 : E\ *l o .i Blgl! E i!gt F s tB orl E- .S YrBr S \S tsl E $ t':HI= b 813 sl E $ ss EIE E E+Zlt- I ItLE 6.$!) sf .Q\ .: ss st " t EtE Ss\. :'; \ ON3 ts s :sE i S; .o E .sP € E Ei(! cr q)tO E ESFrrttS? i Hs o\ \ ag (.) ooF - C) 6oLF d o CdL 0) oo!(^0)X oo F (o C)L(n P C) C)g 6i.oL6)(! -c9PoU 'a^ ! C) rrl td. =-o! I )tt IaoF .= (.)tr!) 6tr(! Fb6.9oe .ei H OI tr() ol =-o -l E6 xl 3 -r 'ol _-b sll.9o- cdl tr>. gl6Eq €l 'O sf $E sl -l tr -:l Ai:l; El $ rl 9l ro 6l: gEl:i El E t o.ll - Al ' c)BE EIE EBIH 8IE E(gl 5 ql -= (Hol ia- ol tr o -l o pl f r<olo- oltr o Ele Ele EZl? zll- z al 0)l bodlLI C)l >l ol :t cdlol -clal cdll-lhll ol C)lbllrltrl cdl ol 9l BI oldtLIol 9l hd cl €l ,t ol trI ol :l €l cl )t EI ol fr.l q v.)q) Uq) U'2 =5\ q)\o t q) riq) s J1(n k ts (/) cdoH(n (d o Fl o H (n t >. -o a rl] a\, Cd tr() tr d G)frF r*t a-ll -ol(dt FI o(!L c) bo(0 lro oo oa (dlr bo o C)o o d o oo(! Lo oo(),^ 9o\ o a.dL C) F ! rDt .15Zsll 4,o_c'd I ;;*iESz 8t & O O O rrl *?Ea AO b!? Eoi z€ t@ ca+\o r-Nr- h 9-+e €E;EE2O E E @ n o\\o * r a I a o il a o!o =boO d^ &-9o\ ooEOF b E'o -o6!l E [EZq € =o? 6.2 itri)!E()t eFFU .Yr.d E " &HF€ .?.gE.!dE E 9! .E EEF o\+ \o tr-ia rn c.l oo^ cn ca+\r) €\o ?a(n F-Nq co oo cO c.l N rn\o \o o\\r- N tr-\o (n\ot(n6l * a )P-,3q o= x o EEete- il E .9o -Mi6^ :e O6\Ebl- uo0 qEO.- 6 . .= o€ .B E -B'€E E= giHaeza- tso6 o.= itro E E.g<86 H E oO O OO $ o\ ?a $ o\ ca $ o\ ra .9<;v o\- cc -o -o j t-r ott 2.6.2 What are the causes of absenteeism? Community members involvement in elections during distribution period Some community members leave their houses in the early hours of the morning because of political crisis e.g Abaitiat Some community members were either in their farms, market or prayer houses during distribution CDDs not revisiting cases of absenteeism because of lack of compensation. 2.6.3 What are the reasons for refusals? - Feeling of wellness by some community members - Religious belief of some members on non use of drugs - Some feel the drug is for family planning and so would prevent them from having more children or make them barren. - Some community members take alcohol very early in the morning 2.6.4 Briefly describe all known and verified serious adverse events (SAEs) that occurred during the reporting period and provide (in table 8) the required information when available. . In case the project did not have any cases of serious adverse events (SAE) during this reporting period, please tick in the box. No SAE case to report t7 WHO/APOC, 24 November 2004 $ oN k c) -o 0.) o z$N o.{(J i. B oo q) \ q) k- o' Lq) "a s Lq)q tf -:\ r-' sq 4U() q) q- t4 i vI\ q)\ t B a)q Bq) U .d o LioA bo ti op. C) r< C) bo lr ttoLlr oo o (d anH a r.r7 €tr C) q) (.) ah Lr C) (c a o L(.)(h(t o u)(.) tn(d O #r ol _ol(dl FI 0.) 99E EE a <.9 E \-;e8 €EE(!ota tr o!gtrd _x 6.:ll.,l o o o o> ,2 EAOE!.t bD 6E (t)H P: HO qb ^ 7E Eo-E tr&9d (*;o-O.9EC6) tr tr= _F.9 I 9t-tEE+: eq-Cu' o'===9 tr d'- O H.Eq8 (d €-gqpE EEEEg q o o. E a trEt=o) oJ !i c)EE qd h- 3 E-s xg r q) ooc G.i =o0>6 X o)a o bI) * a C) ooI $s /O O s@\o s ca ra) s otr- s €\o o (o)aop< rr i .-i EJ rI1 o -bo9 E.;ti oo\ <, >v o o\ tr- N\o \or- caoo e ll + !I)rI,1 ri \o oiEo =bood e-9 oo -.c oF r-(r) .+$ \o r-lr) f.i € ,o o(! .o o5E-Etr2?,AE o. ca Ot oo tr-r- oo tr-(r) ca @\o cn cn t{ =o? b.z t EtrF\J C.l|r) tr- ca ta)+N co oor- c- rt\o \o aq:rd -; B.HEE"E€:A ' d. 39o Ex o. o\ caN\o N+\o t-- C\r- caC\C\ ca\o$ coC\ o o) oo cO q() o c) ll + EllI] Ti o ^bO!, E.;F oo\ <, >v -o o OO O OO o-bo=d- !qaI i P u 9 Crnrq (,oEl (n @ N o\ O OO I{ a()o:E 8_ E 5 SE tr tr=;i;Et! >oa c.l ca c-t e ,o(! 0.= d d.= < gPFU N ca c.) ooG =q -r6(:>:1oO> 9 E-H + 6)E >.:: o=cnq10F E - E9 Eq oo co cA ca cn & rrl F- o\ o\ 00 o\ o\ o\ o\ o\ ooo c\ oo c.l c.loo c.l c.)oo a.l $oo c.l r)oo ci \oo c-l r-ooN € C\l o\oo c-l o o o.l (.) o > o\ -.r) I 5s =B' c)\Bc!\c)\to .\ s(t-:-9 --avLX .VeI su -b :.iP \q):\;i l. q. 6l =qr'd7,q.);S: .gFiS'ir a{r cl oEgE8E ot-e5c(FA+.J c)9vooc)A'E l .r :, +.Ea2 c)rY'a.E sLrJ- -LLXbO vL= Ll(Dx,E.2l-l€a!rxedq)EL{2o co .).LC)v+ih- 9.ILYEHI 9oEl =trcl iY6st E q)ol .- IAtHEcJ -ol O, :B,et(t=9brr H8-EEE 'rldDva v,o'trE r:C)+.!)tr0)LHy , 'ii 6t '. 0 .gra-EX'r:ol .r)El * 'rllul -Fl 0r 2.7. Ordering, storage and delivery of ivermectin Mectizan@ for by - wHo Qtlease tick the appropriate answer) I.INICEF NGDOMOH Other (please specify): Mectizan@ delivered by - (please tick the appropriate answer MOH wHotr UNICEF NGDO Other (please specify): Please describe how Mectizan@ is ordered and how it gets to the communities The ordering of mectizan begins from the community where after community registration (census), has been conducted and number of people obtained. These are sent through the LGAs and the State to the NGDO (HKI). HKI will then use the information to apply for Mectizan. Where distribution has been on-going, information is obtained from the treatments reports from the community summary forms. When mectizan reaches the port of entry, HKI will collect it to her store. The State collects from HKI store and later distributes to the endemic LGAs who deliver it to the designated Primary Health Centres which are collection points for the CDDs to collect for distribution. Inventories are properly kept at all levels. Table 10: Mectizan@ Inventory (Please add more rows if necessary) How are the remaining ivermectin tablets collected and where are they kept? The remaining tablets of Mectizan are collected by the Front Line Health Facilities and LOCTs during collection and collation of treatment reports. These are in-turn sent to the State Onchocerciasis Control Unit at the State headquarters for safe keeping and used during the next treatment cycle List and briefly describe the activities under ivermectin delivery that are being carried out by health care personnel in the proiect area. Health Care Personnel are involved in the following activities: o Collection of the required Mectizan from the State o Delivery of Mectizan to the designated PHC centres which serves as collection points o Provision of storage for safe keeping of Ivermectin o Maintain proper inventory for them o Collection of treatment reports and left over tablets and return to the State Any other comments 2.8. Community self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? State/DistricU LGA N"-b.. "f Mectizano tabletsNumber in stock Requested Received Used Used/Person treated Los t Waste d Expire d Remaining Ibiono Ibom 1 1000 I 1000 r0862 3825 18 t20 Ini 2s000 2s000 2497r 9543 29 0 Passive I 500 1 500 1500 400 TOTAL 37500 37500 37333 13768 47 120 20 WHO/APOC, 24 November 2004 n DistricV LGA Total # of communities/villages in the entire project area No of Communities that carried out self monitoring (CSNI) No of Communities that conducted stakeholders meeting (SHIvt) Ibiono Ibom 4 Ini 9 8 TOTAL 13 8 If so, When? Yes, 2007 Table 11: Community self-monitoring and Stakeholders Meeting (Add rows if needed) 2.9. Supervision 2.9.1. Provide a flow chart of supervision hierarchy. 2.9.2 What were the main issues identified during supervision? Non provision of allowances for the LOCTs and other health workers involved in CDTI activities by the LGA Executives Some CDDs refused to distribute because communities are not supporting them. Due to wrong timing for the distribution (farming season) some people were not available Many communities members were absent because of the elections. 2.9.3. Was a supervision checklist used? Yes What were the outcomes at each level of CDTI implementation supervision? The LGA Executives were requested to provide allowances to the LOCTs to enable them carry out effective supervision The communities were encouraged to select more Community-directed distributors and support them during distribution NDGOA,IOCP STATE (SOCTS) LGA IOCTs) DISTRICT SUPERVISOR CLINICS i/c COLLECTION POINTS COMMLINITIES/CDDS 2.9.4. 2t WHO/APOC, Front Line Health Facility Staff were requested to increase their supervisory visits to the communities to ensure compliance 2.9.5. Was feedback given to the person or groups supervised? - There was feedback to the supervised and action taken to address what was deficient. 2.9.6. How was the feedback used to improve the overall performance of the project? Yet to see any improvement based on the recomlnendations made. SEGTION 3: Support to GDTI 3.1. Equipment Status of t 'lease add more rows neces, OthersNGDOMOH DISTRICT/ LGA APOC No CondttionNo ConditionCondition No. ConditionNo Condition No.Type of equipment Source 1 Fl. Vehicle 4 F2. Motor cycle(s) I F3. Computer(s) F14. Printer(s) FI5. Photocopier (s) I F6. Fax Machine(s) F17. Generator I wo8. Overhead Projector 1 F9. Projector Screen wo 1 FI10. UPS I F11. Air Conditioner 6 F12. Tables F713. Chairs I F14. Fridge J F15. Steel cabinet 2 F16. Stabilizer (2) 2 F17. GPS *Condition of the equipment (F:Functional, CNFR=Currently non-functional but repairable, WO=Written off). How does the project intend to maintain and replace existing equipment and other materials? The Project will utilize State Counterpart funds to maintain and replace existing equipment and materials 22 WHO/APOC, $O cl (.) -o C) o zs c\.l d o { a) co(tN C') tr() Lr H oo d o ! € c-. €o a)a 0.) Fr € .o d >. C) 0)L{q) Bo ,/i c ,tr Ld P C)Uv)\4 5q o9(1)t3r(l)= g 'lr €8 3E rn9 HL 0.),r _60'Oo L^ ,o. ,ttEg 0);>!t o.l .Eb HF (n l-r Cd 0)E>' .- C) .E9 a=EAgd O6)e-c sxct(tr(n v)r. l-.BH{iLLrdc! o. q)(d trr -oOu) o= LX Eo8E 6lC '6E cl tlE tr c.l -lall .i El(a Fl N'S e\\ st- t c!t) IE -ts o^ *?5qEU&<' $N O \o O d+ Eq.3$g Otr)\$ co No\r- co ca Nt(r) oo\o G' 6t\ B .q)a t., ({q) -l*5^sa ?2p3#e oo\o^ ta) -+ oo\o (r)t sa=gg - ? -m oo\o tr1s oo\o (al $ a a.l\ $t- GI c!o '-l-E^ E3$3 rat$\ ol(\ tr) tr) co c.) ra) o\C\ \o rat EEAsaH?ea= I soN\ t- (! o rE -l+r o^ *?sqHa&? O € ca O O ra)N @ oo ca EEasa H ? ea = N o\q o\ oo lr ! L o U +c) -cdRlI?aE-: -q:e sr'5t,.E6B ZO. o k V) a o;; 2.I (/) o a z> =EO(Ho.i U) ko Lr d& o ao z roLq) d p tn LrF C) ^Eo.H<fi Fl t-r otr 3.3 Other forms of community suPPort Describe (indicate forms of in-kind contributions of communities if any)(1) In Ini (Abaitia| CDDs were allowed to dig gravels free(2) Some (Ikpe Ikot Nkon) were given a piece of land to farm(3) Prayers 3.4. Expenditure per activity - Indicati in table 14, the amount expended during the reporting period for each activity listed. Write the amount expended in US dollars using the current United Nations exchange rate to local culrency. Indicate exchange rate used here l$ : FII28.20 (for MoH) Table l4: Indicate how much the project spent for each activity listed below during the reporting period. Activ Drug delivery from NOTF HQ area to central collection int of communi Mobilization and health education of IEC materials Sources of funding APOC MOH 4700 9055 3500 1908 1500 r6t6 Training of CDDs Training of health staff at all levels Supervising CDDs, monitoring and Evaluation Advocacy visits to health and politi authorities cal 8028 4605 399 Vehicles/ Motorcycles/ bicYcles r 300 4409 Salaries 6900 2008 TOTAL 25,928 24000 Total number of persons treated 13368 If other partners contributed on Table 13, re flect how the funds were used under this table also - Any comments or exPlanations? 24 WHO/APOC, 24 November 2004 SEGTION 4: Sustainability of GDTI 4.1. Internal, independent participatory monitoring, Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable) NO Year I Participatory Independent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation Internal Monitoring by NOTF Other Evaluation by other partners 4.1.2, What were the recommendations? N/A 4.1.3. How have they been implemented? N/A 4.2. Sustainabitity of projects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period? No Was a sustainability plan written? No When was the sustainability plan submitted? N/A What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.2.1. Planning at all relevant levels Regular planning meetings will be held by the state and LGAs to plan at the beginning of the year and at different periods during the year. The meeting will be an avenue to develop yearly workplans at the state and LGA levels with specific funds assigned to the government. Proposals will be written to the government for approval of funds approved for the programme at both levels. This would be cascaded down to the lower levels. Plan of activities will be drawn during the review meeting with the LGA officials at the State level and integrated into PHC 4.2.2. Funds The State Government Counterpart Funds will be used. With the problem of release of counterpart contributions to LGAs, a step-up advocacy would be planned to address this. 4.2.3 Transport (replacement and maintenance) Maintenance and replacement will be done using Government Counterpart Fturding. 25 WHO/APOC, 24 November 2004 4.2.4. Other resources The State has been providing other resources through its counterpart funds. It is hoped that this will continue and the LGAs will also follow the pattern. 4.2.5. To what extent has the plan been implemented 4.3. Integration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4,3.1. Ivermectin delivery mechanisms The PHC staff are involved and take responsibility of Mectizan and Vitamin A by collecting them and allocating them to Community-directed distributors for distribution. LOCTs and HWs supervises the distribution and collect reports 4.3.2. Training The LOCTs attend training workshops on other health prografirmes and supervise NID activities 4.3.3. Joint supervision and monitoring with other programs PHC staffjointly supervise both Mectizan distribution and Vitamin A supplementation 4.3.4. Release of funds for proiect activities Funds released for CDTi supervision, and funds released for other PHC prograffImes are jointly used to supervise both CDTI and other programmes. 4.3.5. Is CDTI included in the PHC budgett No 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? The CDTI structure is used to deliver Vitamin A to the community members. This is done replicating this structure in non-CDTI LGAs/Communities and many children have been reached through this strategy with the use of CDDs. 4.3.7. Describe others issues considered in the integration of GDTI. Malaria programme (ITN) is using CDTI structure in 5 LGAs of Eket zone (oil producing area). 4.4. Operational research 4,4.1. Summarize in not more than one hatf of a page the operational research undertaken in the project area within the reporting period. None 4.4.2. How were the results applied in the project? N/A 26 WHO/APOC, SECTION 5: Strengths, weaknesses, challenges, and opportunities List the strengths and weaknesses of CDTI implementation process. Strengths - Availability of trained and committed health workers at all levels - Availability of literate CDDs - Strong support, the facilitating NGDO Wealcnesses - Lack of support at the LGA level - Inadequate community support - Inadequate logistics at all levels List the challenges and indicate how they were addressed. - Transfer of some health staff (LOCTs and DHS) out of CDTI areas - CDD attrition and refusal to work for lack of compensation - Community leaders/members not compensating their CDDs - Inadequate drugs at the lower levels - Distribution took place during the rains - Some communities (Ebo and Ikpe Ikot Nkon) are experiencing chieftaincy tussles. - The death of some mobilized village heads (Ikpe Ikot Nkon, Obotme) affected distribution - Laxity on the part of LOCT leaders - Communal clash at Nkana community led to dispersion of settlers (Ijaws) - Inadequate support by LGA Executive to the progralnme - Health workers asking for increased allowance - Non-identification and involvement of CBOs and VHCs in CDTI activities. - lnadequate logistics How challenges were addressed - New health staff were recruited on the spot and Local Government Services Commission was contacted and appealed to not transfer staff involved in CDTI activities out of the CDTI LGAs - New CDDs were recruited and old ones were encouraged to continue - Community leaders/members were sensitized on the need to compensate their CDDs even in kind. - Calls were sent to the supporting NGDO for more drugs - Some health staff had to travel long distances and difficult terrain to supervise the distribution. - Communities that had more than one village head were treated as separate communities - A LOCT leader was replaced to help the programme function effectively. - Helen Keller International assisted with an additional vehicle during CDTI activities - Efforts are being made to identiff and contact CBOs and VHCs in order to involve them in CDTI activities. 27 WHO/APOC, a SEGTION 6: Unique features of the proiect/other matters 28 WHO/APOC, I