Kano State CDTI project year 5 annual project technical report to Technical Consultative Committee (TCC): from January - December 2003

t a Ei.*h \, ,' .il,1 t, ^*, I COUNTRY/NOTF: Nigeria Proiect Name: Kano State CDTI Proiect Approval year: 1999 Launchins vearz 1999 Reportins Period (Month/Year): January - December 2003 Date submitted: March 2004 NGDO partnerz CBM ORIGINAL : English YEAR 5 ANNUAL PROJECT TECHNICAL REPORT\O\*N5 TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) .oD.sU rcq$ crj)(p? AUE CEV tsI11 bf0 f0 I 0 A0tJl 2004 *'z- ,rc{/\ AFRICAN PROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) WHO/APOC, 26 September 2003 |'1 o1 51.'lr["* t 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. J. Y. Jiya. Signature Date Zonal Oncho Coordinator Name: Princess P. Ogbu- Pearce, Signature: Date This report has been prepared by Name : Shehu M. Ishaq Designati on : State Coordinator. Signature Date ll WHO/APOC, 26 September 2003 Table of contents ACRONYMS IV DEFINITIONS v FOLLOW UP ON TCC RECOMMENDATIONS 1 EXECUTIVE SUMMARY ) SECTION 1: BACKGROUND INFORMATION....... ......................3 1 . 1 . GpNBRer- TNFoRMATToN .. .... .. ... .. ...... l .l .l . Description of the project (briefly) l. l. 2. Partnership..... 1.2. PopulerroN AND Hpar-ru sysrEM.. SECTION 2: IMPLEMENTATION OF CDTI....... .......8 J 3 4 6 2.r 2.2 2.3 2.4 2.5 Peruoo oF ACTIVTTIES ............ ORonruNG, sroRAGE AND DELIVERy oF rvERMECTIN............... Aovocncy eNo SeNsrrrzATroN MoetI-tzauoN AND HEALTH EDUCATToN oF AT RrsK coMMUNTTIES ............. CouuuNrrIES INVoLVEMENT IN DECISIoN-MAKING ..8 11 T2 13 t4 t6 t6 ................... 19 ................... 19 2.6. CepecrryBUrLDrNG.. 2.6.I . Training.... 2.6.2. Equipment and human resources ........ CoNprrroN oF THE EeurpMENT * PLpesp srATE ..... 2.7. TnnRrupNTS.............. .....212.7.1. Treatmentfigures............ .........21 2.7.3. Trend of treatment achievementfrom CDTI project inception to the current year262.8. SuppRvrsroN............... ....27 SECTION 3: SUPPORT TO CDTI ...............28 FTNaNcnT- CoNTRIBUTIoNS oF THE PARTNERS AND CoMMLINITIES Orgen FoRMS oF coMMUNITy suppoRT............... ExpeNornrRr pER ACTIVITy ............. SECTION 4: SUSTAINABILITY OF CDTI 4.1. INreRNel; INDEPENDENT PARTICIPATORY MONTTORTNC; EVar_UeUON 4.2. CouuuNrry sELF-MoNrroRrNG aNo STaTBHoLDERS MpenNc 4.3. SustelNeaILITY oF PRoJECTS: ILAN AND sET TARGETS (MANDAronv er yn 3) 4.4. INrBcRarroN............ 4.5 OpenauoNAl RESEARCH. SECTION 5: STRENGTHS, WEAKNESSES AND CHALLENGES ............33 3.1. 3.2. J.J. 28 29 29 30 30 31 31 32 JJ lll WHO/APOC, 26 September 2003 Acronyms APOC ATO ATrO CBO CBM CDD CDTI CSM FLHF FMOH HFS IDP LGA LOCT MDP MOH NGDO NGO NID NOCP NOTF NPI PHC REMO SAE SHM SMOH SOCT TCC TOT UNICEF UTG wHo ZOTF African Programme for Onchocerciasis Control Annual Treatment Obj ective Annual Training Obj ective Community-Based Organization Chri stofell Blindenmission Community-Directed Distributor Community-Directed Treatment with Ivermectin Community Self-Monitoring First Line Health Facility Federal Ministry of Health Health Facility Staff Ivermectin Distribution Pro gramme Local Government Area Local Onchocerciasis Control Team Mectizan Donation Program Ministry of Health Non-Governmental Development Organization Non-Gov ernmental Organization National Immunization Day National Onchocerciasis Control Programme National Onchocerciasis Task Force National Programme on Immuni zation Primary health care Rapid Epidemiolo gical Mapping of Onchocerciasis Severe adverse event Stakeholders meeting State Ministry of Health State Onchocerciasis Control Team Technical Consultative Committee (APOC scientific advisory group) Trainer of trainers United Nations Children's Fund Ultimate Treatment Goal World Health Organization Zonal Onchocerciasis Task Force lv WHO/APOC, 26 September 2003 Definitions (i) Total population: the total population living in meso/tryper-endemic communities within the project area (based on REMO and census taking). (ii) Eligible population: calculated as 84o/o of the total population in meso/h1per- 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 treated annually in meso/tryper 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 of the 3'd year ofthe project). (v) 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/tryper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). V WHO/APOC, 26 September 2003 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 session 17 (Please add more rows if necessary) 1 Number of Recommendation in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY 234 The sustainability plan was provided although financial costs were not included in the plan Cost has been included in the State Plan. WHO/APOC, 26 September 2003 Executive Summary Kano State is situated in the northem part of Nigeria and falls in the Sudan, and sahel zones. However, the endemic areas are generally located in the Sudan Savannah. The terrain in these areas is generally flat or slightly undulating with sandy soil. The State has 44local government areas with a population of about 7.5 million people based on the 1991 population census. The people of the area are mainly Hausa/Fulani with few other tribes usually found in urban areas who serve as the minorities in the State. The vast majority of the population of the communities are settled agriculturists, keeping herds of cattle, sheep and goats. There are numbers of pastoral Fulani some of who move according to the seasons. CDTI is however being implemented in 18 LGAs in the State with a target population of 494,085 persons living in 881 endemic communities. The training objectives for year 2003 were 533 for health workers and 1,855 for CDDs. By the close of the year it was able to train 406 health workers and 1818 CDDs thus achieving 760/o and 98o% respectively for the different categories. The ratio of CDD to community population stands at l:272. Treatment was conducted in all the 881 endemic communities of the 18 CDTI LGAs. This gives a 100 % Geographic coverage. A total number of 425,503 persons were treated out of the total population of 494,085. This gives an overall therapeutic coverage of 86%o and an ATO coverage rate of 87%o for the State. The major challenges that faced the project include inadequate support to CDDs by the communities and the payment of incentives to village workers by some prograrnmes such as NPI, which has affected the CDTI implementation negatively. Participation of women groups in the CDTI process within the project is still not encouraging. The challenges encountered were addressed in the following ways (but they still remained current challenges): groups to support CDDs. This is still being pursued. and generally increase female participation. To address low female participation the project intends to do the following in the coming years: o Mobilize Islamic scholars and use them as mobilizers and health educators of women. o Make use of women vaccinators/guides used during NIDs (generally accepted) in reaching women in purdah. o Mobilize and use of traditional birth attendants in the community treatments 2 WHO/APOC, 26 September 2003 SEGTION'l : Background information 1.1. General information 1.1.1. Description of the project (briefly) Geographical location, topography, climate Kano State is situated in the northern part of Nigeria and falls in the Sudan, and sahel zones. However, the endemic areas are generally located in the Sudan Savannah. The terrain in these areas is generally flat or slightly undulating with sandy soil. There are occasional rocky out crops and granite inselbergs. The rainy season begins in May and ends in mid October while the dry season lasts from early October to late April. Population: activities, cultures, language The State has 44local government areas with a population of about 7.5 million people based on the 1991 population census. The people of the area are mainly Hausa./Fulani with few other tribes usually found in urban areas who serve as the minorities in the State. At the community these ethnic groups (both from within the country and from neighboring countries such as Niger Republic) are more or less assimilated into the local populations. Hausa is the major language of communication. Islam is the religion that dominate the State with a little percentage of Christians, who are mainly found in the cities. The vast majority of the population of the communities are settled agriculturists, keeping herds of cattle, sheep and goats. There are numbers of pastoral Fulani some of who move according to the seasons. There are fishermen along the river valleys. Craftsmen of various descriptions exist and traders abound. Some of the traders are itinerant seeking markets for their goods and services. Communication system (road...) The roads connecting the towns and major cities are in relatively good condition, but the roads to the communities are in varying shapes. While a few are in good condition, some others are full of pot holes. Others still are laterite roads and can be impassable during the rainy season. Communication channels are many and varied. Some follow the traditional authority structure (from the Emir to the district heads, to village heads, then to ward heads and lastly to household heads). At the community level town criers, local musicians and drama groups are veritable means of communication. Radio is a medium that is widely listened to as Hausa is the major language of communication and used for most programmes. Newspapers especially those in Hausa are also read and television is a medium that some listen to. Administrutio n structure The Administrative system in Kano state is of two folds - the modern and the traditional administrative systems, each of which exert some level of influence on the people at community level. The traditional structure is closer to the people and therefore well utilized for community based activities. The traditional leadership structure is hierarchical in nature, large areas are under the authority of a District Head, who is responsible to the Emir. Under the district head are village heads, and under them, the ward heads, who relate directly to the heads of households in the communities. Under the modern administrative structure the State consists of 44 LGAs. The LGAs are further subdivided into wards, which in turn are made up of communities. The State has an elected Governor as the head of the executive arm while there is a house of assembly made up of elected representatives of the different LGAs. This forms the legislative arm. The same pattem applies at the LGA level where the legislative is made up of councilors from the different political wards. J WHO/APOC, 26 September 2003 Health system & health care delivery @rovide the number of health posts/centers in the project area if the information is available). The State operates two forms of health care system. The first is the primary health care services which takes care of the health of the people at the grass root through health education, environmental sanitation, provision of essential drugs and control of communicable diseases. The services are provided to the community through health posts, health clinics and comprehensive health centers. This level of care is operated by local governments and communities throughout the State. Professional health staff as community health extension workers mainly staffs these facilities. Further still, out side the health institution there are other health professionals who are found in the communities as environmental health workers. These groups arc engaged in health education/mobilization, water and basic sanitation in the communities. The other system of health services is the secondary health care, which is more specialized that serves as a referral to the lower level of health care. Secondary health service is only available in cottage hospitals and general hospitals that are mostly located in towns and cities. This level is largely the responsibility of the State. There are about 300 health facilities spread across the endemic communities of the 18 affected LGAs in the State. 1.1.2. Partnership Indicate the partners involved in project implementation at all levels (MoH, NGDOs - national, international) The partners involved in the implementation of CDTI project in the state include: 1. Communities (endemic) 2. The endemic local government (LGAs) 3. The State Ministry of Health (SMOH) 4. The Federal Ministry of Health (FMOH) 5. The Christofell Blinden Mission (CBM) 6. WHO/APOC Describe overull working relationship among partners, clearly indicating speciftc areas of project activities (planning, supervision, advocaqt, planning, mobilization, etc) where all partners are involved. The Federal Ministry of Health (NOCP) provide policies, operational guidelines, and trains the State level workers. The State performs such functions as training and re-training of LGA health workers, Mectizan procurement and supply to LGAs, monitoring and supervision of mectizan distribution, formulation of operational guidelines in order to ensure good implementation of the programme, and community mobilization and education. The LGAs are responsible for training and re-training of health facility staff and CDDs, Mectizan procurement and supply to communities, community mobilization and education, monitoring and supervision of mectizan distribution. The assisting NGDO, CBM, supports in the production of IEC materials, provision of technical support to the project, advocacy for financial support and supervision of CDTI activities in the State. The endemic communities collect their yearly mectizan supply from the health facilities, ensures distribution of mectizan to eligible persons, selects distributors and determines times and methods of distribution. They also minimally monitor and supervise the distribution exercise. The partners enjoy cordial working relationships. 4 WHO/APOC, 26 September 2003 State plans if any to mobilize the state/region/district/LGA decision-makers, NGDOs, NGOs, CBOs, to assist in CDTI implementation. With the elections into local govemment positions scheduled in March 2004, the project intends to mobilize those newly elected. 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Period of activities lnsert Plan of action indicating activities by month, which were implemented 2OO3 PLAN OF ACTION S/N Activities Month implemented. 1 Training of state team on CSM & SHM January 2 Training of LGA teams February -l Procurement o f mecti zan tablet February 4 ZOTF review meeting March, June, Sept. & Dec. 5 Training of CDDs and Health workres March - May 6 Mobilization Jan. - March 7 Distribution of mectizan to comm. Members April-July 8 Wrap up of treatment activities August - November 9 Supervision May-October 10. Bi-annual APOC review meeting May & November 11 Advocacy to new LGA council members November 8 WHO/APOC, 26 September 2003 co O c\ 0) ,a c)g()a \o e..l O {o B o\ at) L e)c a =9,trH U a bo Lo oOq) t-.1 l- a bo a bo a bo li()p E !.) z lio -o G) z HO ,.o O o liop 0) g 0)a lro -o E C) o z ID) bo a0dE >.(d z d z (o =a h(n z c, z cd z 2 z O! z z d z (\, z oLd z oH 63 a E L an ol L LI o 3EtrH o Q a bo tiq)p E(.) o 0) t-.t o bo a b0 lr) bo H 0) s.) o z H 0) -o s) z F, lrop o(J lr C) o aoa H 0) o o z ch b0 9P- () l- c) l- }r a. (!z d >,d z C) C) h >. CO z G, c, z c, d >td (l) cl cD ah (, A c) Q o PO EE U a oo z >t) cn bo c/) bo cn bo *i()p E C) o z ti o)p Eo o z >' h t-rop o o o tio -o 0) p. C)a H C) .o C) z a bo) h En= ct= c) L >. CN d hd z C) l- C) h >t(t x(d >.cd >.CB cl >.CB z UI GI Lr3 o PE EH L) tr EoLr(d z x cd ct z lro >'G, (c !o. La lr L d *rg P= d= otrd a lr (-) H a li lia o!(! z lr l<a t<p. () l'< 63 A ol< cl z oti cl lr Ha rO .= .irrl= s= -otroo =cJa 1- 5H(J ti GI li ,oo frr oHd z r Lp c.) frr o lid z (.) lr a ti ct ti .o C) tJr C)Lrd a o lid z o li G! z L< Cd l<p q) tli () H <n >.L co li -o(.) lr< C)trd oHd z ao 6= t CO >'Ld CN d t< .oo l+r h(! li -oo tu t- cd J ti -o(.) tu L CO L(! lrs 0) Ei r L .ooA () li z lid <d t, cd E!o tri Ld d c)lr(n z oH(! Z F] (,) (a (d bo N .o(! B tr ! F a -oo E] (n a H o CO}r v s o! a lr M C) (! ti(o v o bo & oNH o € v ,(! F L.t d (n .o d a .o }z(n z -:.A S v1 V) a)Q a) .S o\ q) r. o { B u V1 Bq) E H(! 0) >' C) E)o 0) o C6 o) t< (h 63 C)Lr(d C) *i H an C) o(g qi o 0) C) E F oir o)l -ol(€l FI ao N !(.) -o ()q oa N O UH lio -oo oo li C) -o () o Ho o o ti(.) -o () ()a G, z >'(d z oH(n z oti(d Z lrq) -oo o l-) lro € c) o l<q) € o o tiOp (.) p.(,) a h <n a >'(! z d z a t- C) € oo liq) ,o o O o lro -o C) o tiop E C) p. C)a >.d (n a hd (d (ll lrp. (n z Ha Eo. lia t<g C)t-(n z c)lr z o t<(o o li(n z >\|-d (n h -oq) tJi olr(n z () trd z JzdF C! co E a (d (! bo .7 2.2. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - Qtlease tick the appropriate answer) MoH tr wHo N UNICEF N {Ncoo tr Other (please specify) Mectizan@ delivered by - Qtlease tick the appropriate answer)MOHIE ETTO UNICEF tr NGDO E Other (please specify) Please describe how Mectizan@ is ordered and how it gets to the communities The State compiles population figures and determines total number of tablets that will be required for the next treatment cycle. It provides these information to CBM who fills the re - application forms and submits through the NOTF to MDP. On receipt of the drugs, the State collects the mectizan from CBM head quarters in Jos. The LGAs Coordinators pick their consignments from the State while the health facility staff fetch their mectizan from the local government headquarters. These then inform the CDDs of the availability of mectizan. The CDDs picks their consignments and distributes to the community members. Table 3: Mectizan@ lnventory (Please add more rows if necessary) Districtll,GA Number of Mectizant tablets Requested Received Used Lost Waste Expired Doguwa 250,000 165,000 164847 153 Nil Nil TAVada 157,000 150,000 r494r8 Ni1 Nil Nil Bebeji 98,500 90,000 8942s 32s Ni1 Nil G/IVIalam 146,000 93,000 85479 21 Ni1 Nil Kura 100,000 100,000 99960 40 Ni1 Nll Madobi 72,700 60,000 59718 82 Nil Nil Kiru 48,000 46,500 46021 79 Nil Nil Karaye 51,000 38,000 36885 115 Nil Nil Rogo 13,200 12,500 12500 Nil Nrl Nil Gwarzo 55,000 50,000 47842 i58 Nil Nrl Kabo 39,500 36,000 34456 44 Ni1 Nil Dltofa 41,200 39,500 39451 39 Nil Nil Dambatta 35,000 34,000 29576 24 Nil Nil Makoda 20,000 18,000 17987 13 Nrl Nil Takai 67,000 65,000 64807 193 Nil Nil Sumaila 45,000 38,500 38000 Nil Ni1 Nil Alingi 42,000 42,000 42000 Nrl Nil Nil Gaya 36,500 35,000 34576 24 Nil Ni1 Total 1,311,600 1,112,500 1,092,958 1,310 Nil Nil 11 WHO/APOC, 26 September 2003 State activities under ivermectin delivery that are being carried out by health care personnel in the project area. Activities under Mectizan delivery that are being carried out by health care personnel in the project include: . Application for mectizan to the immediate upper level. o Collection of Mectizantablets by each level from the immediate higher level o Determination of the quantity of mectizan required for each level. . Keeping of mectizan inventory o Storage of Mectizan collected at each health level. o Delivery of Mectizan to some communities especially where there are shortages or communities are far The project did not experience any problem of mishandling or theft of Mectizan tablets. Any other comments 2.3. Advocacy and Sensitization State the number of policy/decision makers mobilized at each relevant level during the current year; the reasons for the sensitization and outcome. Describe dfficulties/constraints being faced and suggestions on how to improve advocacy. Advocacy and sensitization of policy makers was conducted at State level. Five commissioners and one permanent secretary from ministry of Health, Agriculture, Women Affairs, Rural and Community Development and Information attended the meeting. The then Hon. Commissioner for health advocate and sensitized His Excellency the Governor and His Deputy. At the local govemment level the 18 endemic local government chairmen, councilors for health, Directors of personnel management and treasurers were sensitized on the need for continued support to CDTI. The main reason for advocacy and sensitization was to solicit support for CDTI project in areas of vehicle maintenance, fueling per diem for local workshops and seminars on CDTI and other logistics support. The outcome for the advocacy was good as all LGAs are providing motorcycle fueling and maintenance allowance with the monthly salaries of the LGA oncho Coordinators. At the State level, the Government has started to take care of maintenance of the project vehicle from the MOH central. Some of the difficulties faced are: o Frequent change of council members, especially at LGA level o Too much commitment of the policy makers makes it difficult to pin them down for advocacy Some suggestions to improve advocacy: o Hon. Commissioner for local government should be fully involved in sensitization of policy makers at LGA level. o Plan should be made to sensitize the state executive council and the legislators I2 WHO/APOC, 26 September 2003 2.4. Mobilization and health education of at risk communities Provide information on : The use of media in mohilization Community Health Education and Mobilization was conducted through the State Radio and Television especially during advocacy meeting and visit with policy makers at both State and LGA levels. The media also covered the State Mectizan launchins Other local strategies used in Community mobilization -Use of Traditional and Religious leaders -Face to face discussion with community members -Town announcers mobilizing community members -Posters -Public address systems Mobilization and Health Education of llomen and Minorities Mobilization and health education of women was conducted through their husbands and other relatives. They were also mobilized at clinics for those who attended health talks during pre - natal visits. Some got CDTI messages through listening to the public address systems or reading the posters made available at community level. Response of Target Communities. The various communities have demonstrated their commitment to the implementation of CDTI, and are actively participating in the CDTI process. Accomplishments The project succeeded in mobilizing all the endemic communities and these has resulted in overall high treatment coverage. Weakn e s s es/C o ns traints The women in purdah sometimes are deprived from getting the correct information on CDTI during mobilization as the messages get to them only through their husbands. Suggestion to improve Mobilization The quality of information that gets down to women in purdah is of serious concern in predominantly Muslim communities. The project will co-opt female PHC workers to be part of the teams both at state and local government levels to open up better and easier ways of interacting with this important group of people. The project will also identify female community based organizations to assist in educating this group of people to take their drugs yearly. The project also intends to target the men to educate them intensively on the need to have the women involved in the programme either as distributors or as mobilizers. 13 WHO/APOC, 26 September 2003 '=v 9o trrr zl E! o o O O tr) O O aa E.g * E =EiE E+c.,rZ?, O O N O CE F 9-E. A r\ U O o 9> cg9 oZ O z O$N \oO cO t-, oo|r) F-- N $$ ttr) F-- o\ tr)F- ca@ $lr) oooo \oIr- \c N c\ \oO aa tr- ootr) t-- c-l $$ t{r) oo\o Oo\ nt-- caoo ttr) oo@ \ot-- O\o >o sa >oEr 'Ea Eq) to otr e= ze o DO cE o o Z tr)$ z N Z \o ca z \o$ z cO ca z cA N z tr- aa { z tr) ca E >-g tn 7'].- r 2 E E+ i 2?Ez .r.9 -E ilE'E;; -=eiSEgUiE:P U.r * z \o @ z oo N z $ z OF- Z z w z $ ca F (J I.9 OE o o o z o oo q) o L!i16- -O-r >^!=!=- = f, >->YC o\OO N 1Oo\ ca t--- c.lN \oo\ oo @ l./') \o O oo \oo\ N t-- \oo\Ntr) o\ tr- o\\olr) .i- r) N o\ $ N \oo\ t-- ca \oo\ $ c..l ca \oo\lr)lr) ON o\ @ cO oo N o\tr) cA tr- C.l .o o\ N ca @ lr) o.l -o o\ t-- ca CE tr) aO @ :E E 3 EYE K ZZ o ?, - !''l -c.afr:-O N aA t-- oo lr) N o\N j (t bo o t-l d F (!L V F CS cB ?)(t 'd o ca h bo e F (! (g E a Nti rl o -o(d M (.) ti v E E -oo z (! o ON CJ -c a .) .J ''f)\cN tr. o sJ- -:. \^r 2qi(.) qJ l*- qtriET a-JYGSESl!trIo: o3r-!(r*os!; c- r- l-1 #OCoo€EEOc OH Ec) .- 'trOEop. (nt, c) a-tr; Jd ?=trtsEEo.o:. $t .olnElt (BlNFI OO6l !o -o D a a)a \o N(, o. otsl tr) q q a a o9(* ooOEE!cJ= rd) 60J-yu E-3 Iq9e:Sk-Yy ;6i5T E€9oo + E= .s 5.5 Ev9H! .a a.c.-?P E -Us 99cq ooL.l\)(J=^!LL9H .? EEY! 3:.s\ qi'Ea 9E9 f : ! ,\\J S-rE Us 6 E6s -q5u,i E qp8q 'E.HEbo '=qtr .s =;e!LOo-r\J F- r.S sEg@ v a.r il '\Ya-ZS E C-Ora :| te': (soos ioe E S HE EYVa)F# t ^. - at !Y :S E F CiSF-& €b EE; vS',ES$d6aNr .e b I!- S i g 9s -\"-a:i^.d-=:{ 5-c =\B.iPOES ES:bS ='q cc'\ \.-a I o) UlE S'l)'q)= c)I s G€ H H ! S SE€EU^6*-t-g .::. ?i * -o .o sJ.Y:'i c 9.1 - trI.E{HqIiI il e E s E' ttiE:=Ei:€=EsE r 3$E 1E 3s\r>,E-u: FS x.E E:g -\^aZa--P+JUUo>.;:Sioos:.ts:SiiHr:5 E s $t!#E EE\'\gF F X U! - v * -a UBarP(J r r II. c0-OE cO cO s O $ t-- ca t-- \o rnrna t t-- co \o in ao z z \o z Z € t--N $ o\|.n ca s cA ca r.oo\ ca ca s rn t-- $ $ (\rlN N N N s (o -o (s a b0 o& (E J16 a cl t-r 2.6. Gapaci$r building 2.6.1. Training The various training conducted was supported with materials like CDTI manual, CDD guide and brochures translated in local language (Hausa), the oncho flipchart, and posters and training forms. Others include handouts on stakeholders meeting and community self-monitoring. The performance of both CDDs and health staff involved in the implementation of the programme was quite impressive. Each of the partners is now aware of their roles and responsibilities in the project with communities taking a leading role. However, more training is required in the subsequent year to improve the programme. Re- training on planning and management for LOCTs and health facility staff as well as training on the calculation of mectizan requirement for project areas is required. t6 WHO/APOC, 26 September 2003 co o] () -o Eoq (,) V) N o Pr o H B r- -:. n v1 qj u a) o\ q) L o \ S Uq E o d 0) q) g E F o(-) qr o an C) c) olr q-l C) Cd oo trF ,At o-,l -oldtFI q) 6l a, U 0) z dv o-F' : E : z $N tN \o aA \o ca F- F- @(n : oo(r) tr- o.l tr- N $$ $s o\ : o\ : tr- tr- o\ o\ (.) : (.) : co oo co @ t ta) $ r r-@ r--@ la)t ta)$ \o t-- ra) cO O$N \o cA tr-- @ ra) tr- N $$ o\t1 F- ta)o\ (.}r- ca@ ttr} @@ \otr- \o 4) q) .a'o' cl F.rL>\ ptr ai: .oE Llllc)H z dv F -.: U ':zv ,L\' \o \o \o ra) \o \o I ta) ra) I r.) ra) I aO co ca co $ $ F- r- $ s cA ca co cO C. ca ca cO \o F \o \o 1.} ra) co ca $ $ ca co ca co \o q) =6dL o)- Q) .A €E_tr:- zE q) 9 l,v F-.J .L z oo \o N oo N tr*N co c\l aoN F- c.l r-N I \t sf, N N F-N tr-N \o ot \o N c.lN N @ @ N N c..l N ca oi NN o{ c.l L N cA r- @ |.f1 N F- ra)N $N o\N OcA N N N U1ol tf)ca cl at) o ()I 3s9C) 0) z 6v = \o .f, c.l tn $ $ $ $ + I $ co N N N N ol N I $ co ca co ca N c! cA C. N $ t F \o $ $ $ .t N N c.i s cA ca N ca N $ Fl q boo o (o )F Lr v d Lr .D 0) ca d rF) bo e '= JZdF c!3 E a oN! O o -o M () L M tr M -oo (n a d: o )4 Cd CB t-.1 I I co (..l !(.) ,o Eo p. c)a N O o olTr B oo bO o p 5 a o U0 o\ o o a_ s' a ts i r- : F- : \o : \o \o \o a € : ra € : ra € o\ q) o C) v r- co \o \o rn ra € ca ca N N N N s € \o rr € o\ 0) 0) q) () v ca c..l N rrrr $N $N coN ca C.l N N I \o\o (f) (f)\ot) l,n o\ q) c) q) C' N o.l N ot N N N N N ra ra$ a o q) o c) 9 N N 6l rnra CO (g -o (B a bo o& (n o JZd z c! 3 Table 6: Tlpe of training undertaken (Tick the boxes where specific training was carried out during the reporting period) - Any other comments 2.6.2. Equipment and human resources Table 7: Status of equipment (Please add more rows if necessary) *Condition of the equipment (Functional, Currently non-functional but repairable, Written off) NB: All the equipment currently non -functional are repairable. Trainees Type of training CDDs Other Community members e.g Community supervisors Health Workers (frontline health facilities) MOH staff or Other Politrcal Leaders Others(speciff) Program management ^/ How to conduct Health education { ^/ ^/ ^/ Management of SAEs ^/ ^/ CSM ^/ ^/SHM ^/ Data collection ./ ^/ ./ Data analysis ^/ ^/ Report writine { ^/ Others (specifu) Source Type of Equipment APOC MOH DISTzuCT/ LGA NGDO Others Condition of the equipment * Please state 1. Vehicle 1 (functional) 1(F) 2. Motor cycle 18 (functional) 3. Computers I (functional) 4. Printers 1 (functional) 5. Fax Machines 1 (functional) 6. Others a) Photocopier 1 (functional) b) Generator 1 (functional) c) TV &VCR 1 (functional) t9 WHO/APOC, 26 September 2003 How does the project intend to maintain and replace existing equipment and other materials? The State government has made provision for general maintenance of transport and equipment. The Local Governments are also releasing some funds for maintenance of the motorcycles as well. The project intends to request APOC management in the short term to replace the capital items supplied while efforts continue to mobilize the State to replace them on the long run when they prove un - repairable. Describe the adequacy of available knowledgeable manpower at all levels. There is adequate and available manpower to facilitate the CDTI process trained enough manpower in case of frequent transfer of staff. The project has Where frequent transfers of trained staff occur, state what project is doing or intends to do to remedy the situation (The most important issue is what measures were taken to ensure adequate CDTI implementation where not enough lorcwledgeable manpower was available or staff often transferued during the course of the campaign). ln case of transfer of CDTI personnel and the assumption of one not conversant with CDTI, the project usually conducts an orientation for the new one pending the time he will be formally trained. 20 WHOiAPOC, 26 September 2003 2.7. Treatments 2.7.1. Treatmentfigures 2t WHO/APOC, 26 September 2003 co N k() _o 0) p. 0)a \o a.l O o o AEEpls** o-r= O *:rsf -o# odg o' o o o -o E z t I #?Ea zz I I I bE -otrco =-ozd \o o\ o\ co co vNtr} (\ o\@ o\r- cO N a.)\o ooIr- tr- \o oo\otr) <f, r- co c.l C{ LO b:i o'I E -o;-c d trE!>@=j6. SP €ot r N\o @ Nrc t-- ca\o $ \o r-.c-- t-6\o lr) coN n.f, o\t-. ao o\ co o\ lr)$ ra)\o \o o (! o Pr o\ o!o =bood =ooo -coF oooo @ o\ o\ t--@ o\ €r- oo ra)oo ra)oo \or- o\oo @ 6 r-o\ o --o^o CI::roIf o.!z o\F-("1 @\o o\ o\ r-t1 $ rl^) co + co o\F- c.i co oot'-6d$ ooO ,rI N r- co r- $ c.l$ cON n" r.1 \o\ t\ o\ aola) N @ o\ ra) $ co co c.l co\o- oo \or-c* $c\ :o d o.= =E6::ot strF9 c.) o\ o\\o N\o o\ \o o\ co cO @\o r-N ca $ oo co + *+ $$\ oo c-l6 o\ + o\ o\ n" ta) aO\o ra) oo o\ N o\ oo $ t--la) N\o c\N \o o\ oo N o\ n^$ c.l .9 .'H *, Eh6-E i <.ro,-< = E - q€: Etr -9OF s$ cor-r- co co o\ r- o\ co oo ca s ooO ta) aa \o$ r-$ € o\ ca c.l F-N@ N (al F- tr-r- N\o co\o 16$$N @ t.,r ca\o o\ o\\o C.l o\\o @$O rn N t) c) b0 (n o oO E .9o aMEF9s650>83 o o\ o\ \o o\O \oo\ '.o \o O \o \oo\ \oo\ \oO \o o\ o\ :.o .- -8 = PXtr tr= Aiftr>! AO I \o @ @ N OF- O$ (a)t tr-aO caN cnca \o \oco \o$ (nco r-c.l $ s =odoa j 9-o' -t:o \o @ @ N c- t ra)$ r-ca cao.l cAcA \o \oca \os ra)co r-N .+ $ .oEEB &g * c oo >-E @ : =-s€.E b *^-6 E= - A'O i-: c >.= 6 c d ,: br E e @ @ c..l tr- $ ra) * t-. ca caN cacA \o \oaa \o$ rca r-c.l $ $ E .'') o-, H oo o t-.1 d c0 F 'd -o 0.) na (tr z(, cn Lr V d L M ()x cO Lrd M o oo od o Ntrd (J o d V ,E o l-.1 -o l-] o .V z (c JZ CgF c.l c.l q V)q) v a) \- U) I q)\ o \ a) v) a)g ,51(n li d (h 0.)L{ (n \J r.l o L a >. r.n rI] a (! () (d() LrF ci<it ,l _ol(Bt FI I II ao e..l o -o E 0) a.(.) a \o(\ (J - Or -) B ca on 0o\l vI\ I E a.!t\ Eo qJ 50 \ \J!l-> -t !l\(!qsscG ;. o.:.6-) S' ..L 9ll*a \!(..) s : AU abo:i:i '- .S ,.S:taES cBqJr0Jllc)H S:o'a:EES'oitiEE.SUY\ E-s s5t r:EEn 's '$^ =t\!.'H S \UT s tRH\.:arJl t\ {sE 8 EB; : SH -o ! s*E : .IL al S Sc)a s tt3 .i sbfrst.E r- $ \{o .r cs$6tqrE 5 so) \ cF\* t '-5 = ci !u .,i s rsF .S E*bo :{ .s .3r € ssi *\I SE\sv! a-\t buI rt s S:\-q \ \rcrl9\-sS .S'ESli\E d\8 E: u qJts Srlr F!=' il r!P PS \!! x o doH () oo0 +i o L C) ,o E z Eo 0) o oF o\ olol -t''t ()xl >rl I sl udt =gt6 o.rl =ol(.)ol trol E0ldq.l I9t L *-l '3tE El d =l trzt< ()lr () C) 'a !p. C) o z r!d € 0) o a(! ano ^l H xl 3 El eEI H sl b €l Eol trol 0)bll rdl b =l o.tt x 0)l ^ El e2l trH! Et vot :'i .ol5 ol tr -l Iatl C -ol _trl (t =l ozt? CB()lr(c o(.) 'a !g o B U) 0.) o C) o G)ro o Ilro o-x cno o0 o (B p. oo (t F x o (n otr o oo0 +r o lr C) .o E z C) d}{ (.) b0 !u,^6S o oF o d li o bo lr -o o dO- li oo oo o 0) cd $< 0) bo H 0) c)(),^ ()a(d tio t- tt O b{(tlrq) oo o Hb{ 0) b{ (! o q) Cdl< 0) b{ 6 C) L € d t: l-iot\ c.) r-(r- tr)$ co N s \o$ r-N .t € o\6t r- ral @ o\ o\ \o € $ $ ao\o@ N rr1 c-l $ rae rf) l,o GI$ o\r- .t co t-r co o\ o\v}$ (t)ia\o aat Nr-$\o O $ @$\o rn ia € o^ s o\t :.o \oo\oo \o \o s ca N o\ € $ co N o\ a t ca N o\ € a O bo e rl F olr I I I If the project is not achieving 100% geographical coverage and minimum of 65% therapeutical coverage rate or coverage rate is Jluctuating, state reasons and plans being made to remedy this. The project is recordingal00oh geographical coverage and more than650/o treatment coverage. 2.7.2 What are the causes of absenteeism? 1. The people of Kano State are predominantly farmers and, some are nomadic herdsmen and itinerant traders who may not be around during distribution. 2. Movement from rural to urban areas in search of better opportunities when treatment with mectizan or CDTI is being implemented. 2.7.3. Briefly describe all known and verified serious adverse events (SAEI and provide in table 9 the requtred information when available. 2.7.4, In case the project has no case of serious adverse event (SAE) during this reporting period, please tick in the hox No case to report ^/ 24 WHO/APOC, l0 April2003 co o c{ kg O Q oA B (r) N q) S a) o' rr er) *a \q)q S v.1 Va AJU\J o\ q)\ o t q) v) q) s o li C)a bo l< oA.(Dli C) bo ! Eo H oo (ll v) E] a t) C) () C) U)lrO (o v)) o Lr(.) aqi o v) C)adU O,l ol -ol CBIFI 6) AU9 o-= r12;o112 ! - an(Jood q '- = (B cEOLa a7);EC 9.1 UU (H o Q.2 E9 9sp \J O. a OH l3P^ 6.= a()-d trd3d I h a =d(H;(l)-o.9 -q tr6r e c=9HE.TG!60()O 8.ts,8 I ( I t -. o o2^b()'=== dE-8& l sr I ) ;s€€E - C I I }A a uaa. a t ( I -- L 0)!+oJHF **l-loocl -t lr (! I) =ON= o'i'i *A: i fi .a ) L. lH ot{c O.F =oo?o It X()a C) bo i( a !) rD (D coo N H(.) -o E(,) a 0)a \o N O o< o lJr B \oN a) .s 6l C)3eiE:Yor!csiEEo' OA tro)OL BF Eo.:) EE6) l-r?€a: FC)Ei(.) (dl -Ettrcto iDt !H dl :olb>lEsl9o)69p eq)cE>!OEo Gt(!?- oc)EE ocgr. c) - .rr .F rq r- Ol ^i -lo)l -oldtFI () o0 f>') cd ^,v !:^F o>< 'r ><./ -o O o\ cO @ \o o\ yO o\ \oo\ o\ o\ \oo\ oo o\ yO o\ o\ o\o\ o o $o.=F 6X4)- o l- \o tr) o\ta) 6\C\ o\ o\t \o o\ @ \oo\ c-@ \o co@ o\\o oo o\ ir- o '.= o5boo6 e-9 oo ,CoF o\ '.o @ -o o\$@ s@ o\ @ :i ,o Ocd .o6E9-FC =oz2,o o ra) ca o\ N oo \n $ c.t F- o\ rn N tr- o\ co $ co c.l o\(\l @\o ca $ (a) N .<r ca rf1 ta) N$ O lat co ca(a) \o^ @ €$;iJ tsoE6Z :tr'o E E.gTi 99' -FO OON O caN O o.lr- o.l O @ o\N OOO co $ o\$$ cn tr*$$ o\$ (a) oo s o\$ o (d o o< qq -locxt - A *6Q i q) )o . ' a 89 o. *6 cnNr- o\ o\ c{ co\o o ca @$ rr}\o o\N o\ o\ (.) $ o -bo(J!B- r Oa\ <, >v -o o ;L Ii sUU o\ sOO o\ yOo\ -o^\ =o?obo:d- 6^E_i Lro -"-bo ;; q o\ ',i ..'I - e"-: rt O ...v \oo\ 1O^\ \o o\ o\O o\OO o\ O I: qOo:= 3_ e = Hg? E= 3 =Eibz3- o\ c.lo\ ooo\ ra)(-rF- ra, r-r- (.) o\I-r @oo L =od o.= itro < 9PFU o\ c.lo\ @o\ (.) tr-r- rn r- t-- ta) o\r- @€ () oo e (.) 3 o bo =@G> hiio> I E_k+ o= >l: o=t2aaF tr U 9.O = EEEO oo o\ No\ @o\ ra)|..rr- (.) F-F- r.) o\r- @@ & IJ.] tr- o\ o\ @ o\ o\ o\ o\ o\ c.l ON N ON caO c\ $OON OOc\ \oOO c.] r-OO a.l oo c..l o\ N O e..l 2.8. Supervision 2.8.1. Provide atlow chart of supervision hierarchy. 2.8.2. What were the main issues identiJied during supervision. The main issues identified during supervisory visits include: o Low level of participation by health facility staff o lnadequate contribution by LGAs o Poor participation of CBOs o Most community leaders appear committed to the implementation process o No drug shortages recorded or reported o fncorrect registration and poor entries of dosages given by new CDDs with low literacy levels. o Determination of dosage by observation rather than by use of calibrated sticks by some old CDDs. o Inadequate support to CDDs o Low level of participation of women in the CDTI process 2.8.3. Was supervision checklist used ? SOCTs made use of supervisory checklists but other levels did not. Coordinator SOCTs LOCTs Health Facilities CDDs/Communities 27 WHO/APOC, 10 April2003 2.8.4. ll/hat were the outcomes at each level of CDTI implementation supervised o Health facility staff are being encouraged to more active, although there are complaints of lack of logistics o Policy makers at LGA level are routinely visited to solicit support for CDTI o The LOCTs were requested to organize retraining for CDDs on record keeping and entries into the community log books. o During supervision some efforts were made to correct CDDs on poor entries made and usage of the measuring devise for dosage determination. 2.8.5. Was feed-back given to the supervised, and how was the feedback used in improving the overall performance of the project Efforts were made to give feedback to both health workers at the LGA and Health Facility levels as well as the communities. The major emphasis was on the health workers for those issues seen at the community level, as they are expected to follow up on them. SEGTION 3: Support to GDTI 3.{. Financial contributions of the partners and communities Table l1: Financial contributions by all partners for the last three years If there are problems with release of counterpart funds, how were they addressed? Some advocacy visits have been paid by NOCP and the CBM officers to policy makers in the State. These are yet to yeld desired results Contributor Year 3 (2001) Year 4 (2002) Year 5 (200j) TOTAL Budgeted (us$) TOTAI Released (us$) TOTAL Budgeted (us$) TOTAL Released (us$) TOTAL Budgeted (us$) TOTAL Released (us$) Ministry of Health (MOH) 54,450 0 54,450 0 49,236 0 Local NGDO(s) ( if any) NGDO partner(s) 80,000 6,105 92,000 7,400 95,000 14,000 District/LGA 66,000 0 66,000 0 66,000 0 Others a) b) c) Communities APOC Trust Fund 46,074 17,1 10 44,258 44,258 38,585 20,000 TOTAL 266,524 23,,215 256,708 51,658 248,821 34,000 28 WHO/APOC, 26 September 2003 3.2. Other forms of communiQr support Describe (indicate forms of in-kind contributions of communities if any) The communities support the CDDs in kind by giving them some measures (mudu) of maize/ millet/guinea corn/beans, or give them other farm products in appreciation of their work. During farming some communities assist their CDDs by mobilizing some members to work on their farms. 3.3. Expenditure per activiQl - Indicate the expenditure on activities below in US dollars using the current United Nations exchange rate to local currency Table 12: lndicate how much the project spent for each activity listed below during the reporting period Comments Activity Expenditure ($ us) Source(s) of funding Drug delivery from NOTF HQ area to central collection point of community Mobilization and health education of communities 5,580 4,936 APOC/CBM Eetqir_,g of CDDs Training of health staff at all levels APOC/CBM !qp_"*irilg-9!Plald distribution lnlgrnal monitoring of CDTI activities 3,386 1,3Ji 4,650 APOC CBM 4drqq uqy_ _uqllqlgelt! * g IEC materials authorities S umm ary (t.ep_o4l+g_) fo 4n q _pggq!rynt Vehicles/ Motorcycles/ bicycles maintenance O[.gEguip_rp9q!_(9.gco4rpq!9_r9,p_ri{qqglcl Others APOC/CBM 3,590 6,152 APOC APOC/CBM 3,735 APOC/CBM TOTAL 32,029 Total number of persons treated 425,503 29 WHO/APOC, 26 September 2003 SEGTION 4: Sustainability of GDTI 4.1. lnternal; independent participatory monitoring; Evaluation 4.1.1 ll/as Monitoring/evaluation carried out during the reporting period? (tick where applicable) Year 1 Participatory lndependent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation lnternal Monitoring by NOTF -- Other Evaluation by other partners 4.1.2 What were the recommendations? The major recommendations were: - Conclude work on the APOC sustainability plans for all levels - Sensitize all stakeholders at State, LGA and community levels on the need for increased and continuous support ofthe project - Ensure that CDTI continues to be budgeted for within PHC, VBDU, and donor projects budgets - Facilitate integration through joint training, monitoring and supervision - Retrain members of LOCTs, staff of FLHFs and CDDs on calculation of coverage and determination of required tablets - Improve on CDD/community population ratio - Sustain the present impressive leadership, good Mectizan requisition/ collection/ distribution, and good maintenance culture. 4.1.3 How have they heen implemented? The evaluation was done in late November to early December, and it was not long the project received the report of the exercise. Issues raised will be addressed in2004. However, draft sustainability budgets for 2004 has been submitted and included in the 2004 MoH budget estimates. The same is also true of LGAs. { 30 WHO/APOC, 26 September 2003 District/ LGA Total # of communities/villages in the entire project area No of Communities that carried out self monrtonng (CSM) No of Communities that conducted stakeholders meetins (SHM) TOTAL 4.2. GommuniQl self-monitoring and Stakeholders Meeting Table 13: Community self-monitoring and Stakeholders Meeting (Please add more rows if necessary) Describe how the results of the communilt self- monitoring and stakeholders meetings have affected project implementation or how they would be utilized during the next treatment cycle. Community self monitoring and Stakeholders meetings are yet to be conducted although LGA staff have been trained on it. 4.3. Sustainability of projects: plan and set targets (mandatory at Yr 3) What alrangements have been made to sustain CDTI after APOC funding ceases in terms of 4.3.1 Planning at all relevant levels. Representatives from the State & LGA have developed realistic 3 Years Sustainability Plans based on basic CDTI activities and recommendations made by the evaluators. These plans are being fine tuned, but draft plans have been submitted to the policy makers and used in preparing the 2004 estimates. 4.3.2 Funds The project is encouraging the State and Local goverrrments to realize that external input will be discontinued by the 6th year of the project, and are being requested to contribute increasingly to the implementation of activities. Some of the LGAs are responding, although the level of support is still not satisfactory. At the State level there has been little or no support in the past but the present set of policy makers at the MOH level appear very willing to release funds for CDTI implementation. Efforts will be made to continue sensitization of the policy makers at these levels to increase support and eventually fully fund the programme In the meantime the project has been assured of continued support by the assisting NGDO, CBM, although the level of support and its terminal end have not been given. 3l WHO/APOC, 26 September 2003 4.3.3 Transport (replacement and maintenance) There are no written plans to replace existing transport. The project is requesting APOC to replace the vehicle and motorcycles supplied. Meanwhile the State has started giving some input into the maintenance of existing transport and this is expected to continue. At the LGA level, most LGAs have started giving maintenance and fueling allowance with the salaries of LOCT leaders. 4.3.4 Other resources Some LGAs have been providing training and mobilization materials. The project will continue sensitization and mobilization of the endemic LGAs and the State to ensure that materials needed are procured when required. The project also expects in the short term assistance from the supporting NGDO. This area is the traditional area of support. 4.3.5 Please provide a written plan with set targets and achievements for so far. The sustainability plan is attached. 4.3.6 To what extent has the plan been implemented The year has just begun. Implementation will commence soon. Results will be reported in the next technical report. 4.4. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration 4.4.1. Ivermectindeliverymechanisms The LGA focal persons who are part of PHC department normally come to collect the ivermectin when ever they come to collect NPI vaccine or other PHC logistics for their LGAs. Also at LGA level Mectizan collection is with PHC structure because LOCTs, first line health facilities and staff are all with PHC department. 4.4.2. Training There has been instances where training on CDTI was infused into the programme of training for the immunization campaigns. There were also occasions where Onchocerciasis Coordinators have been invited to give lectures/presentations on CDTI during training workshops for other programmes. 4.4.3. Joint supervision and monitoring with other programs The State Ministry of health has formed a committee to harmonize and develop overall supervision checklist to be used by PHC programme including oncho. This will extend to LGAs. Meanwhile supervision of other PHC activities is simultaneous with oncho supervision. 4.4.4. Release offunds All the PHC programme have a common account where PHC funds are lodged and process of release follows routine procedure. 4.4.5. Is CDTI included in the PHC budget? At the State level CDTI is included in the PHC budget. At the LGA level it is subsumed in most cases in general line items. 32 WHO/APOC, 26 September 2003 4.4.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? No programme has started using CDTI structures. 4.4.7. Describe others issues considered in the integration of CDTI. 4,5 Operational research 4.5.1 Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period. None was carried out during the reporting period 4.5.2. N/A How were the results applied in the project? l. ii SEGTION 5: Strengths, weaknesses and challenges List the strengths and weaknesses of CDTI implementation process Strensths i. High commitment by community leaders and CDDs ii. Training of CDDs at a location close to them is a good strategy as other community members watch training event and this boost the knowledge of community members regard to CDTI. iii, Committed staff at both state, and LGA level. iv. High treatment coverage. v. CDTI strategy will be an inroad to other PHC prograrnmes. Weaknesses Inadequate cash flow of counter part funds at both state and local government hampers the smooth impJementation ofCDTI. Payment of monetary rewards by other programme i.e. polio eradication campaign lower the morale ofCDD. Challenses o Inadequate support to CDDs by the communities o Payment of incentives to village workers by some prograrnmes such as NPI has affected the CDTI implementation negatively. o Participation of women groups in the CDTI process is still not encouraging. List how the challenges were addressed. The challenges encountered were addressed in the following ways (but they still remained current challenges): o lntensified targeted mobilization of community members, influential persons and interest groups to support CDDs. This is still being pursued. JJ WHO/APOC, 26 September 2003 a Efforts made to identify and mobilize women groups to sensitize/ health educate women and generally increase female participation. To address low female participation the project intends to do the following in the coming years: women. in reaching women in purdah. 34 WHO/APOC, 26 September 2003 la) c.l o tn$ \o $ O \o rn o oO *O th.53E E:E;srE-EE J c.i €odl - c!3 e 0.)q^d;ibD!?Er trE:F3 -€ 6 h F'tr<'S E 6.50Ern o P gozi E"E e E q booLCC).iO E FEb E EU €X'5- qrEUEEfzz d.aE 8 ^'E o.;E-IJ3ErsEii()E Xii )l EE BE E=er=-8EU:B8E;E=;E -EiEEaasI r'i b P.E Q. o- =Y tr X C = r-nrJ O.o d i, O EEo =E € 0)UiF9FLA*6-9Ecl6o.r.dr:H xEE'EeEe\J o >.9? 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