Imo CDTI annual project technical report submitted to Technical Consultative Committee (TCC): from June 2004 to May 2005

W RESERVED FOR PROJECT LOGO/HEADING COUNTRYAIOTF: NIGERIA Proiect Name:IMO CDTI Approval year: 1998 Launching vear: 1999 Reportins Period: From: JUNE 2004 P To: May 2005 (Month/Year(6)78e4 5 l0 Date submitted: JUNE 2005 NGDO Partner: Global 2000 ORIGINAL : English 2 fi itjt!- i ?0rI$ ,n/ /a,t .(SJ? @4) :t, r t'L fif{t wltr For lnformoilon ro, NrrL 'ifirn'oU WHO/AP()C. 2J Norember 2004 I Fclr I'o 3 ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATI\TE COMMITTEE (TCC) DEADLINE FOR SUBMISSION: To APOC Management by 31 Januarv for March TCC meeting To APOC Management by 31 Julv for September TCC meeting AFRICANPROGRAMME FOR ONCHOCERCIASIS CONTROL (APOC) WHO/APOC. 2-l Norember 200-t Ai\J]\UAL TECHNICAL PROJECT TECHI{ICAL REPORT TO CON STJLTATIVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: I'-\rc,ffi-r fr Coordinator Name: .)*...]Y,.j-.D, Signature: .=et'G*3 Dare: ..... fi.-.1.7'1.-r. Dqtg ,.. 1o!=".lLlNE 2o_05..... Countrl': National ZonalOrrcho NGDO Representative This repoft has been prepared by coordinatol Name' .I=L'. q!sd=n flr,rr"rure: d)-l-l ru,., ...|?.:.....7..:.......S)- lll WfIOiAPOC. 2J \orember 2f)0.1 ru,.,-? a.y, €if"t Signature :.....8G : Table of contents ACRONYMS............... ............ vI DEFIMTTONS ......... .............. vII FOLLOW UP ON TCC RECOMMENDATIONS .......I EXECUTIyE SUMMARY......... .................2 SECTION l: BACKGROUND INFORMATION ........3 L I . GENERaI TNFoRMATIoN ............... .......3 1.1.1 De,rcriptionof the project (briefly1 ........................3 1 .1 .2. Partner.ship .......................1 1.2. PopuLarroN ......................6 SECTION 2z IMPLEMENTATION OF CDTI........ ......................8 2.1. TlpmlnE oF AcrrvrrlEs .............. ........8 2.2. Aovocacv .....................10 2.3. MoeLIzaTIoN, SENSITIZATIoN AND HEALTH EDUCATION OF AT RISK CoMMUNITIES.... I O 2.4. CovpruNrry rNvoLVEMENT............ .....................12 2.5. Cepaclry BUTLDTNG ........13 2.6. TnsarvENrs................ .....................15 2.6.1 . Treatment figures........... ................... 15 2.6.2 What are the caul;e,s of ab.senteei.sm?............ .. ..19 2.6.3 What are the rea,vonvfor refu,sal.s?................ ......19 2.6.1 Briefly de,scribe all known and verified serious adver.se event.s (SAE,;1 that ............... I9 2.6.5. Trend of treatment achievementfrom CDTI project inception to the current year.......21 2.7. OnoERINc, STORAGE AND DELIVERY OF IVERMECTIN......... .....22 2.8. CoupruNlty sELF-MoNIToRTNG aNo STITEHoLDERS MErnNc ...............23 2.9. SupERvlsloN............... ......................24 2.9.1. Provide a flow chart of .supervi,sion hierarclry. ......................21 2.9.2. What were the main i.s.sue.v identified dttring .supertti,sion? ......... ..............25 2.9.3. Vla,s a .supervi,sion checkli.st u,sed?......... . .. .25 2.9.4. WhaI were the outcome,s at each level of CDTI implementation .supervi.sion? ............25 2.9.5. Was feedback given to the person or groups .supervi.sed? ......25 2.9.6. How wa.s the feedback u.sed to improve the overall performance of the project? ........25 SECTION 3: SUPPORT TO CDTI ...........26 3.1 . EeurptuENr .....................26 3.2. FrunNclaL CoNTRIBUTIoNS OF THE PARTNERS AND COMMLrNITIES.............. ................27 3.3. Orgrn FoRMS oF coMMUNrry suppoRT ...............27 3.4. ExpENorruRE pER Acrrvrry ..............28 SECTION 4: SUSTAINABILITY OF CDTI ..............29 4.1. INTERNaI; INDEpENDEN-I pARTrcrpAToRy MoNTToRING; EveLunttoN.......................29 l.l .l Wa,y Monitoring/evaluation carried out during the reporting period? ftick ary of the following which are applicctblel ............ ..............29 1.1.2. What vvere the recommendation.;?. ......................30 4.1.3. How hrne theybeenimplemenled?.............. ........30 4.2. SusraNasllrry oF pRo.rECTS: eLAN AND sET TARGETS (MANDAToRv AT ...................30 Yn 3) 30 1.2.1. Plonning at all relev(tnt level.s..... ...... 30 tv WHO/APOC. 2.1 Norember 200-l 4.2.2. 4.2.3 4.2.4. 4.2.5. 4.3. 4.3.1. 4.3.2. 4.3.3. 4.3.4. 4.3.5. 1.3.6. Fund.s 30 Transport Oepl ace menl and maintenance) .........30 Other re.\ource.t; .. . .. 30 To whctt extent has the plan been implentented................ ......31 Jo int .supervi,s ion and monitoring w ith o lher pro grams.. ... . ... .....31 Relea.se offundrfor project activities.... ..............31 Ls CDTI included in the PHC budget? .................31 De,scribe other health progromme.s that are u.sing the CDTlstntchre and hov' thi.s wa:; achieved. Wat have been the achievement.s? ............. .....................31 4.3.7. De,ycribe other:; is,yues con,sidered in the integration of CDTI. .. ...........32 4.4. OprnarroNAl RESEARCH .....32 4.4.1 . Summarize in not more lhan one half of a page the operational re.search undertaken in the project area within the reporting period. .......32 1.4.2. Hotv were the re.yult.y applied in the project?............. ............32 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AND OPPORTUNITIES .......32 SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS...........33 WHO/APOC. 2.1 Norember 2004 Acronyms APOC African Programme for Onchocerciasis Control ATO Annual Treatment Objective ATrO Annual Training Objective CBO Community-Based Organization CDD Community-Directed Distributor CDTI Community-DirectedTreatmentwithlvermectin CSM Community Self-Monitoring LGA Local Government Area MOH Ministry of Health NGDO Non-Govemmental Development Organization NGO Non-Governmental Organization NOTF National Onchocerciasis Task Force PHC Primary health care REMO Rapid Epidemiological Mapping of Onchocerciasis SAE Severe adverse event SHM Stakeholders meeting TCC Technical Consultative Committee (APOC scientific advisory group) TOT Trainer of trainers UNICEF United Nations Children's Fund UTG Ultimate Treatment Goal WHO World Health Organization GRBP Global 2000 River Blindness Programme HKI Helen Keller Intemational SSI Sight Savers Intemational NOCP NationalOnchocerciasisControlProgramme NOTF National Onchocerciasis Task Force SMOH State Ministry of Health LCI Lions Clubs Intemational LGAHD Local Government Area Health Department VHW Village Health Workers DHS District Health Supervisor HFS Health Facility Staff VI WHO/APOC. 2l No!ember 2004 (v) Definitions (i) Total population: the total population living in meso/Lryper-endemic communities within the project area (based on REMO and census taking). (ii) Eligible population: calculated as 84%o of the total population in meso/lryper-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 (UTG): calculated as the maximum number of people to be Ireated annually in meso/lryper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage (normally the project should be expected to reach the UTG at the end ofthe 3'd year ofthe project). Therapeutic 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 number of meso/hyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). (vii) Integration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cararact. etc.) through CDTI (using the same systems, training, supervision and personnel) in order to maximise cost-effectiveness and empower communities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTI. (viii) 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 mobilised by the community and the government. (ix) Community self-monitoring (CSM): The process by which the communitv is empowered to oversee and monitor the perforrnance 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 responsibility' of Ivermectin distribution and make appropriate modifications when necessary. vii WHO/APOC. 2-l Norember 200{ FOLLOW UP ON TGG RECOMMENDATIONS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed' TCC session l8 Number ol Recommendafion ln the (Plea,se add more rotu:; if neces'sary) FOR TCC/APOC MGT USE ONLY ACTIONS TAKEN BY THE PROJECT Advocacy visits done See Pg. l0 Intensi',e adlocacl Number of CDDs recalculated More CDDs to be trained APOC to release outstandi ng pro.iect funds APOC management has notified the project through the NOTF of an impending monitoring of the implementation of its sustainability plan in the month of July/August 2005. Implementation of sustainabilitl plan to be monitored WHO/APOC. 2.1 Norember 2004 Executive Summary Prepure an Executive summary of the report in not more than one puge. lmo State was approved along with Abia State as a project in September 1998 for CDTI im plementation ( I 9981 1 999) The project has completed its I st year of sustainability activities (June 2004 -May 2005) after its fifth year evaluation in 2003. The project area has a total of 1,647 villages with only 1.229 vrllages treated for this fiscal year, June 2OO4 -May 2005. The total population of the area was 727,946 persons with an ATO and UTG of 618,751 persons. However. the project was able to treat 395,226 persons (54.4% therapeutic coverage). Population movement within the project area is dynamic with rural urban migration arising form employment, occupation and educational pursuit' In terms of training, atotal of 55 District Health Supervisors and Health Center Staff and 90 Health Facility Staff were trained, and 784 CDDs were trained, the shortfall in CDD training was due to targeted training. However. a mass transfer of health workers from CDTI to non CDTI local govemment areas affected th'e programme. the project is making efforts to conduct training to the affected staff. One of the major constraints that faced the project was inability of both the State and local government areas to release budgeted fund for CDTI implementation in their respective areas. (Xher challenges include (a) -l-o improve community involvement in community self monitoring. (b) To increase the number of CDDs in the projectarca. WHO/APOC. 2,1 Norember 200-l SEGTION {: Background information 1.1. General information 1.1 .1 Description of the project (briefly) Imo State is located in the southeast region of Nigeria. The state lies between latitude 4o45' and 6nl5'North and longitude 6o30'and 8o09' East. Abia and Anambra Stares border it on the North, on the South are Rivers and Bayelsa States. East is Abia State while Anambra State is on the west. Imo state has an estimated population of about 3.4 million people with over 727.946 at risk of Onchocerciasis. The state has27 local government areas and l6 are supported by APOC in the implementation of CDTI strategy. The state has a lot of fast flowing streams and rivers such as Otamiri. Nbaa, Ogochie, Oramiriukwa Rivers, etc. the climate is partly dry (Nov. - March) and wet (April - October). The people are mainly farmers, there are also fishermen and traders. Community leaders in consultation with the elders and community members mainly take decision. In 1998, a proposal made to APOC for Onchocerciasis control in Imo and Abia States was approved, with Global 2000 Nigeria as technical partner. The project has completed its phase I of CDTI implementation, which ended in September 2003; and culrently, is in its second phase or the sustainability'phase. The project has enjoyed a good working relationship with Global 2000 and other stakeholders in Onchocerciasis control. \!'HOIAPOC. 24 '\or ember 200.1 Table f : Number of health staff involved in CDTI (Plea.se add more rotvs if necessory) Dirtrlct/l-GA \umbcr of health staff involved in CDTI ectivities. Totrl l{qmhcr of liumber of Pcrccntage hcrlth rrrff ln the health strff cntlrc projcct invoh'ed in &rcs CDTI Br=Brl Br *|fi) Bt Bz Ahoh Mbaise 62 24 38.71 Ehime Mbano 8 t 30 37.03 l.t-inihitre 62 26 41.19 lhitte [Jboma 6u 23 33.82 lsiala Mbano 94 21 25.53 Ikeduru 80 29 36.25 ldeato North 44 19 43.1 8 ldeato South 62 2t 33.87 Mbairoli 66 23 34.45 Nrt angcle 43 20 46.51 Ngor Okpala 18 32 41.02 Orsu .r3 19 44.19 Obo,rlo 5t 22 -13.1-t Qluif 66 27 10.91 ()nuimo 37 I 5 40.54 ()uerri North 84 26 30.95 Total 1021 380 37,2"h 1.1,7, Partnership - Indicate the partners involved in project implementation at all levels [MOH. NGDOs (national/international), comm un ities, local organ izations, etc.] - Describe overall working relationship among partners. clearly indicating specific areas of project activities (planning, supervision, advocacy, planning, mobilization, etc) where all partners are involved. - State plans, if any, to mobilize the statelregionldistrict/LGA decision-makers, NGDOs, NGOs, CBOs. to assist in CDTI implementation. The partners involved in project implementation: l. African Programme for C)nchocerciasis Control (APOC) 2. National Onchocerciasis Control Programme (NOCP) 3. t.ions Clubs International District 404 (LCI) 4. Global 2000 River Blindness Programme (GRBP) 5. State Ministries of Health (SMOH) 4 Wll0l APOC. 2-l Nor ember 200'l 6. Local Govemment Area Health Department (LGAHD) 7. Endemic Communities. The partners have a harmonious working relationship and are working towards the successful implementatlon of CDTI in the project area' Speciflc Areas: Advocacy: Advocacy is a continuoul process, weak communities and Local Government Areas are tatgeted and during advocacy visits, issues pertaining to their roles and responsibilities are stressed for the purpose of sustaining the programme, issues like fund release to the programme are stressed. Organizations involved in the advocacy include NOCP, GRBP, LCI and SMOH. Funding and Technical Support: The major partners which have provided funding and technical support to the programme are APOC, GRBP and LCI. Mobilization and Supervision: Partners involved in mobilization and supervision include GRBP, SMOH and LGA health department. Training: Targeted training for weak and new personnels were carried out by GRBP, SMOH, LCA hpalth department while the endemic communities assisted by selecting the CDDs and health committee members for training. In view of the frequent changes involving political office holders and executive arms of the Ministry'. the state is planning to organize a stakeholder forum to enable them to be sensitized and mobilized toward CDTI concept. WlfO/APOC. 24 Norember 200.1 1.2. Population Table 2: Conrnrunities ancl population at risk in the entire project area rvhether they are treated or not during the reporting period. (Pleu.sa utld nutre rovs if'nac'e.ssrrrrl CDTI Districts/ LGAs in the entire projcct are:r Totfll population in the entire project area Numbcr of communities/villages in Population of N{eso-cndemic zone in the project nrea Ai llt'per-endcmic zone irr the project flrerl A, Totnl in meso/ht'per- enrlenric zone A.; = A1+ A-. Nleso-endemic zone in the project nren Ar Hyper- eudemic zone in the project nrea A.; Totnl in nreso/hyper- endenric zone 46 = A1+ A,; []ltimnte treatnrent Goal (uTc) Aboh Mbaise 74,589 82 0 82 74.58e Q i 74,589 63.40 t Ehime Mbano 55.940 0 t27 t27 0 55.940 , 55,940 47.54e Ezinihitte 52.866 0 137 137 0 s2,866 s2,866 44.936 lhitte Uboma 33.308 0 93 93 0 33.308 33,308 28.3 l2 lsiala Mbano 52.472 167 0 t67 52.472 0 I s2,472 44,601 l keduru 48.833 129 0 l2e .18.8-t j 0 18.83i + 1.,508 ldeato Nt-rrth 4 r.32 I 0 9j sj 0 1t,ilI {I,i2t i5. r 22 ldeato South 42.727 96 0 96 42.727 0 42.727 36.3 l7 Mbaitoli 74.566 104 0 104 74.566 0 74.566 63.38 r Nrvangele 24.549 96 0 96 24,54e 0 24.549 20.866 Ngor Okpala 4e.368 137 0 137 4e.368 0 4e.368 41.q63 Orsu 35.499 67 0 67 35,,199 0 35.499 30. r 74 Oborvo 34.5 le 77 0 77 34,5 le 0 34,5 le 2e.i4l Okigrve 48.564 0 l15 il5 0 48,564 48.564 41.27e Onuirno t6.072 0 1l l2 0 16.072 16.072 r3.661 Ou,erri North 42.7s3 85 0 85 42.75,j 0 12.753 36.340 TOTAL 727,946 r 0{0 607 16.t7 479,875 248,071 727,946 618,751 WllO/Al)(X'. 24 Norcnrhcr 2(X)-l6 \\/as a census tbr the pro.iect done during the reporting period? Yes ll'No, rvhat is the source of the data in the table above'/ No * Source:National census CDD Year : Other source. specity: atea. A village is made up crfkindreds while a community is made up ofditlercnl villages rvith a traditional ruler. At the village level. thee is no traditional ruler. ls there any other information ofintercst about the populalion in the proiect area? Itso. include it here. WIIO/Al)(X'. 24 Ntrr cnrbcr 2()()4 SEGTION 2: lmplementation of GDTI 2.1. Timeline of activities Fill in table 3. timeline of activitie,s for area.s teated in current year, indicating when the key activities were implemented by the month they began and the month they ended. WHO/APOC. 24 Norember 2004 Districl/LcA FIobfui*r d communities Trainiug CensuVUpdate Drus distribution Supewision Slarting qlo.lth Completion cmth Starting month Complttion coilfh Stafting God Completion aonth Startiag moaS Complction co+th S*rrtiag E6ilS Comf,ctiol month Ab'oh Mbaise .lunc 2(X)-l Nlal 2005 .lunc 20(H Srpt.2(X)J .lunc 2fi)-l Aug. 2(X).1 Junc 2(X)-l Ma1 2fi)5 June 2il)-l Ma1 2005 Ehirne Mbano Ezinihitte lhitte Uboma lsiala Mbano Ikeduru ldeats North ldeato South Mbaitoli Nwangele Ngor Olipala Orsu Obowo Okigrve Onuimo OrveriNorth TOTAL Table 3: Tirneline of activities for the areas treated in the current lear /P/e'crsc udtl,Hlre rou'.r if'necessun') - C()mments: Mobilizatitln is a continur)us exercise. evcn atter the initial nrobilization has bc'en carried L)ut. pft)blem areas are continued to be attetlded to. Wl I(YAKX'. 2-l Norcmht'r 2()0{ 2.2, Advocacy State the number of policy/decision makers mobilized at each relevant level during the current year; the reason(s) for undertaking the advocacy and the outcome. Describe difflculties/constraints belng faced and suggestions on how to lmprove advocacy. Constraints: I . Lack of political will by policy makers. 2. State LGAs appear not to see Onchocerciasis as a "serious" health problem. Suggertions of Advocacy [mprovements: Integrated advocacy by all partners - APOC, NOCP, Global 2000 2.!. Moblllzatlon, iGnsltlzetlon and health educatlon of at risk communitier Mobillzation A total of 72 policy and decision makers were mobillzed during the current year at both State and LCA levels. The reasons for sensitization was to enable them fully understand the programme with a view of rendering adequate support. The Imo project carried out an intensive mobilization for effective CDTI i m plern entation us i n g the fol lowi n g strateg)': (a) No. of policy makers To mobilize State Officials for the release of counterpart funds. Outcome Promises were made for the release of counterpart funds. Imo State released fund to collect APOC donated equipment from No. of vlrlts To mobilize LGA officials for release of funds to LGA Oncho teams. A few LGAs actualized their promises and released little funds despite promised to keep their !9!Inl!!!19,[t!-- l0 WHO/APOC. 24 Norember 2004 (i) Macro level - where State and LGA officials were mobilized. (ii) Micro level - where community leaders and village members were mobilized. The mobilization was conducted using: l. The mass media: . Radio/television discussions o Jingles o Press releases o News talks 2. Face to face discussions (Community forum in each village) 3" Correspondence with States, LGAs and communities In addition. we identified some important traditional mobilization channels in all the villages such as: (l) Use of village heads and chiefs including the opinion leaders.(2) Groups and associations such as age-grades, women organizalions, schools, clubs, and above all women in health andfamily support programme.(3) Town criers - who are the news disseminators or local radios of each village, have proved to be the most effective means of communication and mobilization. CDD training activities are announced by the town criers as well as commencement and end of distributions.(4) Girls Guide, Girls Brigade, Boys Brigade and Boys Scott were used as well as(5) Religious organizations.(6) Church announcements - we have utilized most churches to send messages especially during the Onchocerciasis day celebrations. Church services were held to mark the day and offered opportunity for people to be made aware of the CDTI and Oncho control efforts in the State and the l6 LGAs A total of 1647 villages in the projeclarea were fully mobilized. Field experiences reveals that some difficult villages require more efforts at mobilizing them. Hence more time should be devoted to these problematic villages. lt WHO/APOC. 24 Norember 200.1 2.+ Gommunity involvarent Table'l: Communities participation in the CDTI lPleuse rufu| nnre rot's iJ'nece.ssan'i DisrrkdlGA l{urnbcr of eetnmuailieslvillrges r,r ith csuaaritv mcmbrrs as saptrlisors Nurubcr of ('DDs rnd the coamsnitiai imolrcd i\Iulc ('Dl)s I l'enrnlc 'l'otal , (.DDS Numlx.r of r Aillrycnitt Nrrnrbcr of I conrmunities N ith l'cmrlc('tllx l lBto l :qrmunities ftrntle ('DIls I Perccntlge I II q,=I BrJBr*l(ts 'lirlal \o. \unrhcr uiih Perccntngt conrmuniticsin comnrunill thc cnlire memhtrs rs pruitr.{ r*e supenisors &=B{ 85 BJ Br *100 Aboh Mbaise 82 3l 37 80 103 83 69 M. t5 Eh me Mbano 127 25 l9 86 t03 89 74 58.27 EZ nihitte 137 27 l9 7t I 12 83 83 60.58 hitte Uboma 93 23 24 67 102 69 70 75.27 siala Mbano t67 53 3l r04 t34 238 14 44.3 r keduru 129 l9 t4 78 105 t83 66 5t.t6 deato North 93 l4 t5 67 79 146 35 37.63 deato South q6 25 26 6q 82 r5l 62 64.58 Mbaitoli t04 3l 29 89 il0 199 7l 68.27 Nwangele 96 20 20 7t 84 155 4q 51.04 Ngor Okpala 137 24 l7 t03 97 200 82 59.85 Orsu 67 32 47 63 5l u4 35 52.24 Oborvo 77 26 JJ 55 83 t38 6l 79.22 Okigrve u5 28 24 73 I l0 t82 74 64.35 Onuirno 42 l5 35 5l 35 86 32 76.|q Orverri North 85 2q 34 6t 85 146 6l 71.76 I'oiul 16{7 122 25.6"/" I188 l{75 2662 998 60.6"A Comrnent on: In INo pru.icct. lhere \\as on active participalion ol'Nomen in CDTI activilie\ eren during heallh educalion and nobilization snd this also reflected in the selection ofCDDS rvherc ntore communities nominate l'emale CDDS 0s their distributors. During the year. 8 total of78J CDDS werc ttained with 510 new CDDS while 274 sre old ones. Thcse new 510 CDDs \lerc added to lhe already ej\isting CDDS in lhe commuities. l2 Wt I(yAP(X'. 2.1 Novcnrtrr.r 2(X)-i 2,5. Gapacity bulldlng - Describe the adequacy of available knowledgeable manpower at all levels. There is an adequate manpower available in the project areas, however, the problem is frequent transfers affecting the trained health personnels especially at the local government level from the CDTI areas to non CDTI areas. Though manpower available at the health facility level is weak due mainly to the caliber of staff at the level; (l) 'fhe solution to frequent transfers is to train health.(2) Strategy of training CDDs at kindred level has been adopted in the state. - Where frequent transfers of trained staff occur, state what the project is doing, or intends to do, to remedy the situation.(The mo.tl important i.ssue to de.gcribe i,v what mea.vure,l were taken lo en:;ure adequate CDTI implementation where not enoup;h knowledgeable manpo'wer wa.\ available or if ,staff are frequently tran.rferred during the cour:;e of the campaign). t Training has been targeted at new personnel and weak ones. r The stratery of training CDDs according to kindred level has been adopted, but lack of follow up by LGA personnel is hampering the progress. It is envisaged that with an increased number of CDDs, agitation for compensation will reduce. o Training of health staff has mostly been that of on the job training. r3 WIIO/APOC. 24 Norember 2003 l-able 5: Training at the ditterent levels of CDTI implementation (P/ease, tuld ntore rotr,s if'nccessrrn/ l4 District/LGA Number of Dist trai A I rO .\'er' ('r i ('.' 'icts/LGAs staff ed i xet I lirtrrli : ('r= i t'. i ('r+ (\ cent l'l'ro ('. lumber of Health )r/post strff trlined \i,rl i,tc/,i lirt{tI i : ('*=(; I 1'. : ('.+(i Num l'l'ro (\, ber ofother trainers of trainees ( TOTs) \ eu ", Relt i t'otut : i (r:= I C,n I (',, I (',,,+ (',, Number of CDDs trained{l'ro',\'"',, l*,rit'or,rt(',r ct1 i ,',, i .'1-.."i',.Aboh Mbaise 9 I -l l-5 -l 7 () 2 2 161 i6 Itl ,i.l Ehime Mbano 9 2 2 + 2l l .l 7 { ) () ) 2-54 2tt l{ +2 Ezinihitte 9 I I 2 l7 2 5 7 J 0 I I 27.1 29 26 55 Ihitte Uboma 9 I I 2 l1 2 4 6 ) 0 I I tt6 -1t Itt l9 lsiala Mbano 9 0 2 2 Li I -) l J () I l.j{ -l -'i l6 59 lkeduru 9 l -i 2() 2 .l 6 2 0 I 25{ ll 20 52 Ideato North ) I 2 -) li I 2 J 0 I I I ti6 35 l9 51 ldeato South 9 I I 2 t2 2 -t _i 4 2 I 2 l9l -10 27 57 Mbairoli 9 l l -l llt .l 7 ) 0 I I I ()ll -ll Li -;7 Nrvangele 9 2 5 ll l ) () 2 2 t92 29 l6 -l-5 Ngor Okpala 9 I 2 -l l9 4 7 ) 0 2 2 278 2ti LS ti Orsu () I 2 -) t0 .) 2 -i J 0 2 2 l -'i{ Iti I -.i -jt Oborvo I ) 2 l l4 -t (r J 0 ", 2 I -i.l i6 l9 55 Okigrve 9 ', '; Iti 5 2 7 J ) I J 2:i() 2l ,58 Orruirtro I I 2 -t (r I I l 4 0 -) J 8{ 2() 6 26 Ulverri Nortlr I 1 2-.i .l l 6 2 0 l 2 l7() l6 lr l7 TOTAL r{{ 2J J2 S:T 256 {3 17 90 {5 6 2J 28 J29{ I StO 271 78{ '%r .\chicYcntcttt I J[1,2, tX, .\cltievcnrent I J7.8'%r (%, Achievenrent 59.{%, (%, Achievenrcnt 22,7tYt Wl l(YAl)(X', 2.1 Novcnrbor 2(X)j ! Iabb6: Type of training undenaken(Tick the hoxe:t where .specific lraining was carried out during the reporting periocl) Any other comments 2.8. Treatments 2.6.1 . Treatment figures - If the project is not achieving I 00o/o geographical coverage and a minim um of 65%o therapeutic coverage or the coverage rate is fluctuating, state the reasons and the plans being made to remedy this. During the period under review, a total of 395,226 persons were treated from a total population of 727,946 persons in the l6local government within the project area. This gives a gerrgraphical coverage of 74.60/o and therapeutic coverage of 54.4%o. -fhe reasons for low coverqge were due to :(a) The inability of the local govemment authorities to release budgeted funds to LOCJs to enable them carry out effective supervision of the CDTI activities. because the progr4mme was not eflectively supervisied. it becomes difficult to monitor the activiteis of the CDDs, even when the CDDs complete their distribution, returning the treatment summaries to the project becomes a problem due to funding at that level. t5 1'rainees 'T'y pe of tralning CDDs Other Community members e.g. Community supervisors Health Workers (frontline health faci I ities ) MOH staff or Other Political Leaders Others(specify) Progrum manaHsment ^/ ./ How to conduct Health edu$qtlon ./ ^/ ^/ ./ ^/ Managcment of SAEs ./ CSM ^iSTIM ^/ ^/Data collcction { Data analysis ./ ./ Reporl writirrg ./ Others ( speci l) ) WHO/APOC. 2.1 Norember 2003 T(b) Some CDDs after collecting Mectizan from the health facility delay treatment due to non appreciation of their (CDD's) services by their villagers for the previous year. (c) Some health workers dely comrnencement of CDTI activities while waiting for funds release from the local government. (d) Some CDDs after treatment, refuse to submit their returns with the hope of prompting the communities for compensation or motivation. Plans to remedy the situation: (l) Efforts is being made to ensure that both state and local government authorlties release funds budgeted for the programme.(2) Selection of CDDs at kindred level is hoped to solve the problem of compensation. However, the training of the selected CDDs by health workers is envisaged to be a problem because health workers still require funds to carry out the training activities. 16 WI{O/APOC. 2.1 Norember 20().1 Table 7:Treatment and SAEs b1 district/LcA in allareas at risk (Pleuse udd nmre nnts if'rece.s.srm'/ Ilistrict iI,(iA CommunitieVVillages Population Numbc'r ol' pL'rs()ns shtr retused thc trurtnrmt Nrmrtrcr ol' ahscnter;s Nunrber ot'SA[:s Nurdtr ol' scritxr-s ixJlerse o'ants (SAlis) rctlrrerl ttr tlr h.calth ptxt/kxpitnl I otal # ot' ctrnmtrnitics/ r illagcs iu thc nrcstVhvpt'r- cndcmic areas D, Annual l'realment ()bict'tn r' IL Nunrtrcr ol' ctrmnruniiicsi rrllapi trsrated Dl (icographical c()\'efa8c (" n) Dr- D/ l),* loo I otal poptrlatitrn ol' tl*- nrcstr,/h1pcr- rrxlcmic arcts l)s Anrural l.rcatment ()*ritctirc t\ Nunrtrcr ol' f&"rvurs tfrru*d DI lhera{etrlic c()\ eragc ("") t\: D?/ l\*100 Aboh Mtraise 82 8l 82 IW,,E 74.58q 63..tOl 52.7m 7t 2t4 135 0 0 Ehime Mbano 127 127 85 67o/a 55.910 47.5.1e 24.431 44 92t ,165 0 0 Ezinihitte 137 137 ilt 8l% 52.866 44.q36 30.026 58 515 429 0 0 Ihitte Ubonra 93 q3 80 86ozu 33.308 :8.3 r 2 le.i64 60 JIJ I08 0 0 lsiala Mbano 167 167 80 48% 52.172 44.601 23.61 I 45 189 52i 0 0 lkedum 129 129 IJ 57o/o 48.833 4l.508 1e.02 I 39 274 804 0 0 ldeato North 93 9-l 63 67% 41.32 l i5. I 22 15. I l5 37 1.854 l.l l3 0 0 ldeato South q6 q6 75 78o/o 42.727 36.317 20.0e3 47 1.28e 1.759 0 0 Mbaitoli 101 l0^t t0t 97o/s 7.1.566 63.38 t 42.4e6 57 82t 947 0 0 Nrr'angeh 96 96 52 -i.l% 24.51c) 20.866 9._571 3q .t+7 388 0 0 Ngor Okpala 137 t_17 lt7 85.4% 49.368 41.q63 40.482 82 t.142 t.634 0 0 Orsu 67 67 3l 46% 35.4q9 30. t7-{ 13.4q0 37.7 845 1.f,+1 0 0 Oborvo 77 77 77 r00% 34.5 le lq.34 t 21.q60 63 J'J 64t 0 0 Okigrve il5 il5 t05 sl% +8.56.t + 1.27q 28..161 59 1.338 rJqS 0 0 Onuinro 12 1: 12 100"h t6.072 t3.661 il il7 70.4 25r 183 0 0 O*'erri Nortlt 85 85 5_5 61% .12.75,'i ,36.-3-10 23.087 53.5 l. l0-\ I.578 0 0 TOTAL l6{7 l6{7 I 229 11.60/o 727,9t6 618.75t J95J26 5{.{06 l2.l { r lI7{e 0 0 l7 U'tK),AP(X'. 2-l Novcmbt'r ?tXH Formula tbr conlpuiine thempeulic and seosraphical coverases Therape[tic covemge mle = Numberofoeople lreated \ l0O(t") Tolal populalion livirs in n'leso/hJ'p€r-endenric connnunities wilhiD lhe project area Cmgmphical co! emBe rale = Nutnber ofcomNunities villalles trealEd :( IOO("") Tolal number ofmeso/h)per-endemic comrnunities as identitied bl. REMO in lhe project area ATO coveraSe rale = Numher ofpeople treatei \ 100("") Annual Treatment Objeclive % UTC achieved = Nurnber ofpeople rrealed )\ 100 Iolalnunlber ofpeople to he hMled in Neso/h]'per-endemic sreas Nithi the project area (UTG) lfo= m.$tiDutetl uatb.r olp<opl.lititrg h np\dhlperuadenia oM thd t CDTI qmie.,t i tcttls b nut vith lprrld}..i4 in u Ehu yor. hbnu l.t tc tt.ict ttotl bc cl{,etat k, rair tha LTC tt th. ttt ot th..rd wr tttl;c wiett). t8 U/l lo/n I'}(X'. 2{ Nor cnrhcr 2(X).1 !'*.:- 2.6.7 Whst nro the causog of absenteeisrn? The major causes of absenteeism have been the rural urban migration of the productive sector ln search of jobs. Also, some youths attend boarding schools, outside_their communities and hence may not be there during the rreatment plriod. 2.6.J Whnt ore the reasons for rofusats ? ,Sonrc .felt thut the1, were cured and hence had no need of rhe drug. 2.6.4 Brlefly descrlhe all known and verifietl serious adverse events (SAEs) that occurred durlng the roportlng porlod ontl provide (in table 8) the required information when avallahlo, The state has monitorecl Mectizan treatment for a long time and has not recorded any severe adverse event (SAE) r In case the project did not have any cases of serious adverse events (SAE) during this repurting period, please tick in the box. No SAE case to report l9 WHO/APOC. 2.1 Nor ember 2004 E Table 8: Cases of serious adverse events (SAEs) that occurred during the reporting period (Pleuse ruld nnre rov'.s if nec'e.s.srrrl'/ I)atc l)atc l'' lVlc'e tiza s\ mptonl n \\as s talcn ufpr'arr'd Sr nrptonrs I lealth status trc'ltxc talir*u Nlcctizan [)atc of' admissirxr in hcalth lar'ilitr l)utc of Results ot'tcsts dismissal (thick bkxrl lionr snrcur) health tlcili ()utcrrnre tirtcnuatinq or Alcrrhol ol' conrplicating irn olr cnr pnlgnosis circumslancr's cnt or not lr I' 'i,ri ,l,ti tl t,,lrl,il l ,ii N A9 Sr'r Villlgc trl' trriqin - i i I llr 'iri ;,t i * ,Scrirr/ numhar ol'llrc putiant U/llO/n l)(X'. 2-l Norembcr'2(X)l20 2.6.5. Trend of treatmetrt rcticreBent {rom CDTI pmjeci iEceptiotr te lL cErrt l -ycrr I!b!q2: Trealrncnts and covemge b\ calendar \€ar for the enlirr proir.t rr... (Plase f l h rfu ftqu .d ttutd) Plersc iudicrle tbe tlTG for lhe proj.ct rrc.:_______-.16!&251____________lusc this 6grre rs the detroDtitrlaor ir dl flTG clv.frge c.lculrtions.) YI]AR ConrmuniticVVillagcs Population 'lixal # ot' crxnmunitres;r illag t-r itr tfu n*vh11u- crtdenrit'areu F. Annual l'r!'iHr}!'iil(\arirc F, Numtrc'r trl' ctxunumitic s'r illages [Edcd Er (itrrgraphi cal cr)\ I'rdsc ("") llr- f,J E,rtu| AT() r'(}\ cTirsc ( or) f,.- EJ UlrtS lirtal Jxpulltion of ttE mc.rVtnptr- tndtn.tic areas u^ Aunuul '['reattrent (tsten:trrc E. Nuurtrr ol' pt'rvxrs trraterl & I'hcraJxrHic c'irr rrage (" o) E"= E/ f."lm A'l() c.t)r'ff48e("') f rr= E/ f7*tu) t 1'l'(i (\ncrugr. (o.) l(x)7 t+)tt 1999 l6{7 l6-17 l-168 tt-1 8i ti{7.q{{ 72().7i2 166..192 5-i 65 75.{ ](XX) l6{7 l6-17 l6-17 l(x) l(x) til7.9{{ 7t0.7-i2 -t6:.1_i7 _i-1.5 (}l.l 71.7 l(x) I l617 lf}l7 1647 t(x) Irx) 79-t.78,1 675.565 5:t'.97{ 66.-1 7t 85.: 2(X)2 I t'-17 I 617 l6-17 I (X) l(x) 7-i6._i94 6ll.e-i.l t7i.87l 75.8 tt9 e2.7 l(x),3 l6{7 I 6{7 l617 I (X) lu) 72-i.183 616.-190 Yll.lU.r 69. I Itt.l 1i0.9 ](X)J I617 l617 r 2:q 7.1.6 7-1.6 727.e{6 618.751 -1e5.116 5{.1 6-1.8 6-1.8 2(X)5 l(x)6 l(x)7 l(x)lt l(x)e 2() I () la 2l \\'tl()/AP{X'. r{ Novtmbt'r l(X[ 2.7. Ordering, storage and delivery ol lvermectin Mectizanos orderedlapplied for by - Qtlea,se tick the appropriate an.nt'er) MOH wHo ! uNrcEF tl NGDO Other (please specify): lvlectizanfl*+\ered by - Qtleu.se tick theMoHllwHon Oth?r lpTease spec i fy;: appropriale annter) UNICEF N NGDO Please describe how Mectizan.D is ordered and how it gets to the communities The order of Mectizan commences with the census update and determination of ATOs by local government areas and the State project. The total requisition is therefore routed to the Mectizan donation programme (MSD) through the Global 2000 (supporting NGDO). The bulk drugs are procured by Global 2000 to their zonal office from where the project is issued with their requisition after proper documentation. Consequently, various local government areas, come to the State to collect their shares. at the local government level, each district and health facility levels collect their, while the communities collect from their nearest health facilities, based on their target population to be treated. During the Mectizan transaction, health care personnel ensures that accurate Mectizan tablets are released and delivered to each level based on requisition. They also ensure that Mectizan tablets are kept in a sa[e storage facilities. Table l0: Mectizanoy Inventory (Plea.ye add nrure rov'.s if nece.s.sary) - Flow are the remaining lvermectin tablets collected and rvhere are they kept? Wfl()l APOC. 2.1 Nor ember 20().1 State/District/ LGA Numher of Mectizanr trbl"t" _n.gg.j_!gq Received [Jsed Lost Waste Expired Remainlng Aboh Mbaise l7 5.(XX) 175.0()0 t65.593 () () 2.J()7 7.000 Ehime Mbano q).(NN) 90-00() 7 5.930 0 o 70 14.0()() Ezinihitte t05.0(x) t05.000 98.178 o o 522 6.000 Ihitte Uboma 70.00() 70.000 6().412 () 0 2.088 7.50() Isiala Mbano 120.000 t20.000 .18.83 t 0 0 t.169 70.00() lkeduru I12.()0() t t2.000 59.566 0 0 1.931 50.5()O Ideato North 80.0(N) lto.ooo 19.060 o 0 110 30.500 ldeato South u().()0() 80.()o() 6().993 0 0 3.507 15.500 Mbait()li t85.00() 185.000 t35.217 o 0 763 49.000 Nwangele _ 15.000 .15.000 r9.333 0 0 1.667 21.000 Ngor Okpala 106.000 106.()00 t()5.761 0 0 236 0 Orsu 70.()()() 70.()()o 31.7()t () o t.299 37.OOO Obowo qlLerl 85.0()0 ioi.orro tt5.(x)0 72.1()7 () -tl 0 93 12.500l()5.(xx) 89.917 0 t.()53 1.t.0(x) Onuimo 15 -(NX) 15.0()() 36.773 () o 1.227 7.000 Owerri North ll0.()(N) lt().00() 66.579 o 0 921 12.500 TOTAL r,5s3,000 1,553,000 7,176,601 0 0 19,396 357,000 22 E l'he remainingMectizan tablets have been received as opening balances and re-issued back to the LOAs for the next treatment cycle since they are yet to be expired. - List and briefly describe the activities under lvermectin delivery that are being carried out by health care personnel in the project area. Health personnel ensure that accurate Mectizan tablets are given to the local government and also ensure that Mectizan returns are collected. - Any other comments 2.4. Gommunity self-monitoring and $takeholders Meeting Has any training (of trainers) for community self-monitoring been done in the projectarea? If so. When? ]'able I I : Community self-monitoring and Stakeholders Meeting (Adcl row.t if needecll Describe how the results of the community self- monitoring and stakeholders meetings have aff'ected project implementation or how they rvould be utilized during the next treatment cycle. Sadll'. there were no reports on Community Self Monitoring (CSM) and stakeholdrs meeting(St'lMl conducted dumg the period under reporting. The l-GAs attributed the lack of funds as being the reason lor the non organizaion of these activities. 23 WIIO/APOC.2^l No,,ember 20()-l Dlstrict/ LGA Tolal ll r:f communities/villages in the enlire proiect area No of Communities thal carriecl out self monitoring (CSM) No of ('ommunlties that conducted stakeholders meetlns (SHM) Aboh Mbaise 82 lrhime Mbano 127 [,zin ih itte 137 lhitte Ljboma Iriala Mbano lkeduru 93 t67 t29 ldeato North 93 kleato South 96 Mbaitoli 104 Nyqngg&-_--- Neer -rlhrsb- 96 t37 0rsu 67 Obowo 77 Okiswe il5 Onuimo 42 Oweni North 85 'f'qtel 1641 2.9. Supe rwision 2.9.1. Provitle a flow chart of supervision hierarchy. SUPERVISION FLOWCHART PRO,IECT ADMINI STRATOR STATE CO-ORDINATORS/ STATE PRO.IECT OFFICERS STATE ONCHOCERCIASIS CONTROL TEAM MEMBERS (SOCTS) LOCAL GOVERNMENT ONCHOCERCIASIS CONTROL TEAM MEMBERS (LOCTS) DISTRICT HEALTH SUPERVISORS (DHS) HEALTH FACILITY STAFF (HFS) coMM uN,* r,*,:;f:D DrsrRrBUroRs 24 Wl IOIAPOC. 2.1 Nor ember 200.1 ?.9.tr. What were the meln ilsues ldentified during supervlsion? The following issues were identified during supervision and are being addressed as follows: (l) Frequent intra LCA transfers: The quality of supervision of some LGA health workers were low especially those transferred from nor CDTI areas to CDTI areas, hence more training and retraining is being organized for thern. (2) Inadequate number of CDDs: During supervision, we came to the c<lnclusion thar there is need to increase the number of CDDs as the CDDs cover a long distance hence low treatment coverage, effort is being made to select CDDs at kindred levels as against the village level. (3) Low motivation to CDDs: 'fhe selection of CDDs at kindred level will address the issue of CDD nrotivation, qs supervision revealed that most communities do not moti vate the distributors. .9.3. Was a rupervlsion checklist used? Supervisory checklist has been developed by the project and used in the course ofsupervision. 2.9.4. What were the outcomes at each level nf CDTI implcmentation supervision? The issue of supervision wfls used to ldentify areas of weakness that needed to be converted to strength. Was feed-back given to the supervised, and how was the feedback used in improving the overall performance of the project Ars-late lcrEl; The supervision at the State level by the Project Administrator empowered the State Coordinator and SOCTs to do targeted supervision. However, this was grossly inadequate because of limited funds for tranportation. tGA" Level: ldentification of difficult communities and CDDs with poor records. Once again this was inadequate because the I.OCTs could not move to problem areas. eommunity Level: In the few communities supervised the CDDs returned their summaries on time and treatment was concluded. 2.q,5. Was feedback glven to the perron or groups supervired? Supervisory reports were given to the groups supervisecl. 2.q,6. How was the feedhack used to improve the overall Due to the low level of supervision across board, the overall terms of project performance. perforrnance of the project? impact was not really, felt in WtlO/APOC. 2-l Norember 200-l25 SECTION 3: Support to CDTI 3.,,1. Equipment Tablc l2: Status of equipment (Pleu.se acld ntrtre rrtv':; if neces.\ary') rCondition of the equipment (F=Functional, CNFR:Cunently non-functional but repairable. WO Written ofO. How does the project intend to maintain and replace existing equipment and other materials? 'fhe state w ill maintain the existing equipments through release of fund from the Onchocerciasis control budget. All our efforts will be to ensure that such budgeted funds are released firr activities. loUfce I ype of urlriptnent APOC MOH DISTRICT/LGA NGDO Others No Condttron No Condrtr No Condrtron No Cond rtron No Condrtron I Vchicle 2 l-F I-CNFR J Motor cycle 2l 5F.8CNF R 1 ('omputcrs 2 F "1. ['rinters S f'ax lrfichine.s 2 t-F I-CNIJR 6 ()thers a) Ilicycle 85 CNFR bt IJPS I F c I Fhotocopiers 2 t-t. t-wo 26 \\'l I()/n POC'. 24 Nrx cmbe r 2(X)-l ( Contrihutor lelr{ (OLt 2()01 .lept )0()2't lerrj lOct. 2002 Sept 20()3t lear6 l.lune 20()1 ,llay 2005'l TOTAL TOTAL Cash Cash Budgeted Released(US$) (US$) TOTAL TOTAL Cash Cash Budgeted Released(US$) (US$) TOTAL Cash tsudgeted (US$) TOTAL Cash Released (US$) MOFI (('entral + Provincial/State) 6.000 656 I 1.608 0 9.210 I 1.520 MOI{ (District/l.GA) t6.173 2.881 8 35.7 12 6 1.255 .6 r0.lJ3 '769.2 l,ocal NCDO(s) ( if any) 0 0 0 0 0 0 N(it)O partner(s) 98.260 I lt1.12t 58.s'70 35 12.222 37.367 I 200 Others 0 () 0 () 0 0 a) 0 0 0 0 0 0 hl () 0 0 0 0 0 ('r)nrmunities ,\I'()C -lr;stF;;,1 5t.qt7 t.589 I 73.2t2 t.517 L 5'7.00() 270 11.'t t4 +2.t15 2 3ti. I 29 -l t8.0(x) 7.5t)0 -1,(x)0 TOTAI, 217,3(A t65,627 210,262.35 65,021.8 t2t,250.t 7,759.2 3.2. Flnancial contrlbutlons of the partners and communities -Iab"l_pl3-: [rinancial contributions by all partners for the last three years - [f there are problems with release of counterpart funds. how were they'addressed? In lmo State, the issue of counterpart fund release by the State and local government has been a problem. The project ensures that funds are budgeted at both state and local government levels but to release has been the problem. F{orvever. during the period under review. the Dircctor Southeast Programmes o[Global 2000 visited the State and had discussions on the issue of counterpart fund release. also. the Project Administrator Global 2000 had made efforts on this regards. 3.3. Other formc of community support - [)escribc (indicate forms of in-kind contributions of communities it'an1') Other forms of communit)'support Some of'our communities are comfortable in motivating their CDDs in kind. Such method include i) [:xemption from some community levies and dues. ii) Arranging labour to assist CDD in his 4rer farms. iii) Special recognition in community gatherings. iv) f)onating food to the CDDs 27 WI IOlAP()C. 2J Nor cmbe r 200.1 3.4. Expenditure pGr actlvlty - lndicate in table 14. the amount expended during the reporting period for each activit)' listed. Write the amount expended in US dollars using the current United Nations exchange rate to local currency. lndicate exchange rate used here---$Il30- 28 Wtl()/n POC. 2J Norembcr 2(X).1 4sU-"-lry Expenditure ($ US) Source(s) of fundins Drug delivery fiom NOTF HQ area to central collection point of community lVlobilization and health eclucation of communities Iraining of C'DDs Iraining of health staff at all levels Supervising CDDs and distrihutlon lrrtemal monitoring of CDTI Bctivities Advocacl' visits to health and politlcal authorities ll:f'nraterials Sumnrnry (reporting) fornrs fbr treatment Vehicles/ Motorcycles/ bicycles maintenance Office [:quipment (e.g. computers, printers etc; Others: Collection of capital equipment .I'OTAL 200 1039.2 I 000 4.000 t.520 {l,ls,g.z Clobal 2000 MOH Community/ LCiAs Global 2000 APOC MOH 'l'otal number of persons treated 395,226 Iablf l4: Indicate how much the project spent ftrreach activitl listed below'duringthe reporting period - Any comlnents or explanalions? J'he cost of capital equipment purchased by'APOC for the State totaled 551.500 which sum was retained by APOC management. SECTIOH 4: Sustalnabllity of CDTI 4.1. lnternall indopond@nt participatory monitoring; Evaluation 4.1.1 Was Monitoringlevuluatlon carried out durlng the reporting period? (tick any of the following whlch are applicable) Year I f'articipatorl lndependent monitoring Mid -ferm Sustainability' [:.valuation 5 year Sustainability Evaluation Internal Monitoring by NO1-F ()thcr [:valuation b1 othcr partners 29 WI l()in P()C. 2-l \or cmber 2()0.1 { No monitoring was carried out during the repofiing period, apart from Global 2000 coverage survey. 4.1.2. What were the re*otnmendatlons? The result is still being awalted. 4.1.J. How hnve they hcp4 implernonted? Yet to be implemented as the result is still awaited. 4.2, $ustalnabillty of proloote; plan and s6t targets (mandatory at Yr fll Was the project evaluated during the reporting period?_ No Was a sustainability plan written?_ Preyiouslv When was the sustainabillty plan submitted? Ausust 2003 What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: Sustained advocacy to convince State and Local Governments to redeem their commitments. 4.X.1. Plannlng at all relpvant levels '['he prcrcess of plannlng is very relevant to the success of CDTI sustainability. Joint planning of activitips wlll continuo between the project offlce, the State Ministries of Health and the I-CAs. Planning aI the community level will equally crrntinue between CDDs and their community members. 4.2.2. Funds Continued efforts to ensure that various tiers of Government release budgeted funds will continue. Increased and sustained advocacy meetings at various levels will continue. Also involvoment of key officers - Finance Officers, Planning Officers and Mobilization Officers will be ensured. {.2.i Tranrport (replacement and maintenance) Imo State received a Toyota Hilux to replace the aging landcruiser, 5 motorcy,cles, a computer, printer and photocopier by APOC management. The state and LGAs have been informed that it is their responsibility to maintain these equipments. We are expecting the remaining I I motorcycles from APOCI for other [,GAs as indicated in the 7"' year plan. 4.7.4, Other rosources Government has been adequately informed that it is their responsibility to maintain these equipment. 30 WIIO/APOC. 24 Norember 200.1 4.2.3. To what extent has the plan heen implemented Covernment has not fully implemented the plan but APOCI has released part of the capital equipment t0 the State. 4.9. lntegratlon Outline the extent of integration of CD'II into the PHC structure and the plans florcomplete integration: 4.3.1. Ivermectin delivory mechanisms lverrnectin delivery has been firlly integrated into the I'>liC structure with states collecting their drugs from the zones and st<lring them in the statc drug str:res. [-ikew'ise. l-CjAs collect the Mectizan fiom the States and distribute them through the PHC structures to the health fac ilities. 4.3.2. Training Training - T'raining on CD'l'l is carried out by'rvorkers who are anintegral part of the PHC structure. 4.J.J. Joint supervislon and monltoring with other programs fhere has becn an improved joint supervision rvith CDTI catalyzingthe integration. This is exhibited in cases where other health programme such as nutrition, mental health etc. piggy back in the CI)'l'l vehicle. {.3.-1. Rclease nf funds for project activities Funds forthe control o[Onchocerciasis areparl of the entire PHC budgets. But in most cases, budgeted funds b1'government are not released. 4.3.5. Is CD'tl included in the PtlC buclget? CD I'l is fully' integrated in the I'}FIC budget. 4.J.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? ()ther health pr()grammes using existing CD'f I structures include leprosy'control w'here some LO("ts arc utilized in carrying out leprosy control activities. Some CDDs are used to cover DO'ls trcatmcnts, community mental health etc 3l Wlloin POC. 2.1 Norcmber 2()().1 :' 1.3.7. Dcgcrlbe others issues considered in the lntegration rtf CDTI. An is.iue towards which efftlrts are being made to improve are.ioint planning sessions rvith othcr program me leaders/coord Inators for better coordinated action. 4.4. Operatlonel rottarch 4.4.1. Summarlze ln not mnre than one half nf a page the operatlonal research undertaken ln the proJect area wlthin the reporting period. None was conducted but Global 2000 carried out a coverage survey but the report has not been completed. 4.4.2. How wcre the results applled in the project? lhe results arc ]'et to bc applied. IIECTION 5: Strengths, weaknesses' challeng€or and opportunitles - [,lst the strengths and weaknesses of CDTI implementation process. STRIiNGTHS: ( I ) (iood working relatir:nships betrveen Ministrl' of Flealth. Glc-rbal 2000. Local ( iovernment Areas and communities.(2) ('ommitted health staff.(l) (iommunitl' awareness of the magnitude of Onchocerciasis problem in their areas. WEAKNESSES ( I ) Poor llrrding oI the programme by govcrnment at all levels.(21 ('ommunitics not motivating their C DDs. - Lirt the challenges and lndicate how they were addressed. ( I ) -fo improve community involvement in community self monitoring by communities -* more communities rvere mobilized to organize communitl self monitoring.(2) 'l o increase the number of CDDs in the project arca -- '[he strategl of selecting('DDs at kindred level has been embarked upon b1'the project. hoping that when completed. this will reduce the quest for motivation by CDDs.(3) '['o increase funding lorthe programmc-- consultation is on to see if it will be possible to dcduct at source Fund from local government areas for Onchoccrciasis control before releasing the money to the LGAs. 32 WtIOiAPOC. 2-l Noremher 2f)().1 ! SHGTIOH 6r Unlque featureg of the prolect/other mmttera Imo project is locatcd inanurea where its citizenry are highly'mobile.'fhe people are commercial orientecl. this mobility aflect consistency' of treatment. Again, the project has lasted upto l0 years. some people are now drug fatigue, therefore. there is every need tcr add a new programme to Onchocerciasis control to raise their inte rest again. Ihe issue of National Programme on Immunization spending a lot of money'on the eradication strategy should be addressed. as all inlerests are focussed on NPI as against anl olher programme by health workers at the local government level. JJ W'l I()in t'()('. l-l \orcmhcr f ()()J 7,N YEAR SUSTAINABTLITY PLAN FoR IMo STATE (YEAR 2) JUNE 2OO5 - MAY 2006 S/N ACTIVITY PERSONNEL RESPONSIBLE DURATION INDICATOR OF SUCCESS REQUIREMENT TOTAL COST SOURCE STATE NGDO APOC OTHERS Planntng meeting with PHC coordinator & LOCTs for review of previous years distribution & updating of infomation for 2003/2004 distribution year. PAL SPO; SOCTs, DPH/PHC & other Programme Officers 2 days 2005/2006 Plan of Action Stationeries - Paper - Biro - File Jackets - Hiring of Hall - Lunch - Perdiem for LGA staff Sub-Iotal N2,500 N17,000 N51,600 N512,000 11583, r00 N2,s00 N17,000 N30,000 N19,500 N21,600 N21,600 LGA N512,000 N512.000 Uollectton ot census update supply of drugs to 16 APOC LGAs & estirnation of drug requirement for 2004/2005 distribution SPO, SOCTs LOCTs 2 wks - Census figure obtained - Drug available at the LGAs Fuel Sub-tdotal Ni,500 N7,500 N7,500 Procurement ot drugs torm Abuja/Lagos SPO Driver 3 days - Drug collected/ availabe in the state Perdiem SPO Driver Fuel Sub-total N15,000 N7,500 N16,800 1v39,300 N1s,000 N7,500 N22,500 N16,800 Nl6.800 4 Supervision/monitoring of drug movements, distribution (twice a year per LGA) and rerieval of treatment. SPO, SOCTS 8 weeks Drugs avaialbe At LGA, Districts, H/Facility & communities - Distribution in progress Fuel Perdiem: 5 SOCTs SPO Driver Perdiem for NGDO staff Sub-total N64,000 N32,000 N24,000 N19,000 N185,000 N324,200 N64,000 N32,000 N24,000 N19,000 Nl39.200 N18s,000 N185,000 5 Report Writing SPO SOCTs Monthly & Quarterly Monthly, Quarterly, 6 monthly Technical Report and Paper (10 reams) Biro (2 pks) Printer ink Toner (2 pks) N 12,000 N1,200 N20,000 N10,000 N200 N12,000 N1,200 N20,000 N10,000 N200 t.lt I J I Annual RePort' Cveloper I ttto,ooo File jackets I tloooBindins I N5'000Sub-total I 11159,000 N10,000 N600 N5,000 1rr59,000 Vehrc6 & I -Servicing equipment in | -RePlacement of oood condition I tYres - I -Change of sPare I parts (NGDO) | -CoPier servicing i -Generator repalrs lC,rh-tatrl r,ran nnn I N4R 000 N115,000 Nl15,000 6 ffi lseomaintenance I I I I I Revtew meel,ngryranet,Y,1 "r.* ZOTF 6 monthlY technical I SOCTs report, Global 2000 assisted I Drivep, ^ review meetings, SPIC I DPH/PHCmeeting I I I --l - , === 2 months Monthly. N120,000 lt'tlzo,ooo I N142,000 lnzz,ooo N30,000 | N30,000 N18,000 iN18,000 N3s8.000 \ uzts,ooo I rmproveo i pedormance i by all staff i concemed. I lmproved i therapeutic & I geographical I coveraoe | -Awareness I created | -Approval& I release of fund | -lmproved I perlormance I by state I nffiners Fuel Perdiem: Review meeting SPIC meeting TechnicalReview Meeting -r,itT lN43,2oo N66,000 I r.roo,ooo I Nlg,ooo It'ttg,ooo I N105,000 I t'tgs,ooo I N70,000 N232.200 | maz,zoo I Nto,ooo 7 l-.lirinn nf hall N17,600 N21,000 tI38;600 N17,600I Stakeholders meeting at state level (twice a Yeafl to create awareness & solicit suPPort for CDTI imPlementation I P.A, SPU, SUU ls, IloPwPHc, lTmonths I Perm. Sec. I .tutzoos - I oir.otAccounts I Jan2006 I Oir. of Planning I I Otner program I I officers I EntertainmenU Lunch Sub-total N21,000 N38,600 N79q noo N325,000 I Renewal of insurance SPO - Motorcycles (11) -Generator -Video Camera -Camera -Flip chart board -Overtread Proj. -Fax machine Sub-total APOC to decide N30,000 N30,000 1130,000 10 Replacement ol equiPment and procurement of new equipment due to long usage, and none functional status of most equiPment and so cannot serve for the next 3 years. 1.997,700 721,500 763,400 512,000I,KANU Il-' t 1i) .{ I I : i\IinistrY of Health Name: 0 ' Lr- ANVAA.T e-,-.t zr Position:? 6 AhAtn6'Vr fE?/?E7t^/ GIobal 2000 River Blindness Programme ( U. Znl/'a)z't7^,,/ ;l- t(- 7 - L"n>3 ,-f_ Sign.: Date: 7- o? r :.i?,- - '- - 1 - : --' ' 4.- -----+- e .' F \