Ondo State CDTI annual project technical report submitted to Technical Consultative Committee (TCC): December 2003 to November 2004

tONDO STATE MINISTRY OF HEALTH CDTI PROJECT COTINIRYNOTF: NIGERIA Proiect Name: ONDO STATE CDTI PROJECT Launching vear: 2000Aoproval vcar: 1999 Reportine Period: From: December 2003 To: November zo04 Proiect vear this reoort: (circleone) I 2 3 (4 )5 6 7 8 9 10 Date submitted: December 2004 NGDO partner: UnicefI ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) AFRICAN PROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) For oil L J to: i i li.- l' I I I I i i I I ! -i -f tj .; ffiffi#il"E 'fi ? r'rv 20u5 *.F${lntR For h\formotton i.Tor 'i 'i , *-rl\ \- =-.-l ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMEI\T Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: Country: NIGERIA National Coordinator Name: DR J.y. JIYA Date Ifr:. 1 : Q.f Zonal Oncho Coordinator Name: MR. A.O. JAIYEOBA. Signature Date: NGDO Representative Narne: UNICEF Signature Date This report has been prepared by Name : MR E O ADEJAI Designation : ST RDINATOR 4 Signature Date .../. ,-.k-(." - / .'I \,t -J*L \-''Li- o r* atrl \ Table of contents ACRONYMS DEFINITIONS FOLLOW UP ON TCC RECOMMENDATIONS EXECI..TTIVE STIMMARY SECTION I: BACKGROUND INFORMATION I. I. GE}'{FRAT INFORMATION l. 1 .I Description oJ'the project (briefly) 1.1.2. Partnership 12. PoPUI-ATIoN SECTION 2: IMPLEMENTATION OF CDTI 62. I.TIMELINE OF ACTTVITIES 2.2. ADvocACy ..................9. _Z3. Mosu.zauoN, SENSITTzATToN AND HEALTH EDUCATToN oF AT RISK Cotr4MuMTIES ................ ......9-10 2.4 Colwruxrrr INvoLvEMENT. . . 2.5 Capacrry BUILDING 2.6. TREATNm.IIS 2.6.1. Treatmentfigures........... 2.6.2 Vf/hat are the muses of absenteeism? .... 2.6.3 What are the reasons for refusals? ................ ............172.6.4 Briefly describe all lotown andverified serious adyerse events (SAEI tlat...lLg 2.6.5. Trend of treatmmt achievvment from CDTI project inception to the arrent year 192.7. Onornwq STORAGEANDDELTVERY oF rvERMEcrIN......,...... ..,.......20-212.8. CoMauxrry SELF.MoMToRINGAND STAKEHoLDERs MmTI.IG ..,........22 2.9. SUPERVTSION ...............25 2.9.1. Provide aflow chart of supervisionhierarchy. .....,....25 2.9.2. Whqt were the main issues identifed during supervision? .............................25 2.9.3, Was a supervision checHist used?..,...... ,......,...,........2s 2.9.4. Whatwere the outcomes at each level of CDTI implementation supervision? 25 2.9.5. Was feedback gtven to the person or groups supertised? .............25 2 V VI 8 8 a ................ 12_15 SEC',f iili{.; 5t_rPPclil--t-(-'f'L\-i't 2t-, -l I E(-)1 jll,lvllll'll 2t- 3 2 FU.lrrNCIAt Ct)N'fliillU fioi{S OI" ll lE I']Ali'll.iLIiS r\l.li-) ('oivilvitrNfl'l}]S -l i O't-I]m fo]{Nis ()tr c(ltvtN4t INl i'\' sUt)RllU' i { L:i},l,NDIt'trtiL t,trtt A('ltvl i1' SE('I-ION 1 SUSTAIN,{BILITY OF CDTI 29 4 J Jr.r.I'ERNAI: INI)EPEND]]N]'PARIICIPATORY iVION]TOI{II"IG. EVTTiIIAL'ION 29 -l t I ll/as lulonitrtring/evcrlt.ialton carrte Ll oui tluriitg lhe reporlntg pertocli' (tick an.t, a.l ihe.lbllow'ingwhtchare applicable.).. . . .. .. .. 29 1 I 2 Llhal v,ere the recontntendation.s2 29 -l 1.3 Hou' hai,e ihe-v been tmplemenled2 .29 4.2 Sustan tagt].t'ty oF I)ROJIic'rs. pl,rrN ANI) sliT,tAR(itrl's (MAliDA.rol{Y A1' . , . 2() YR 3) 2t) -l 2 I Plannmg at all relevant levels . 29 1.2 2. Funls. ...........29 -l 2 3 fransport (replac'emetil and nlnfiltenancE . . 29 J.2.1. Otherresources... -...............29 1.2.5 l'owhm extent has the plan been unplementecl . .29 4.3. INTEGRATTON ..........30 1.3.1. Ivermectin delivery mechanism,s........ ..... ....30 4.3.2. 'Iiaining ...............30 1.3.3. Jointsupervisionandmonitoringwfihotherprograms.... . ..... ....30 1.3.1. Release offunds for project activities ...............30 4.3.5. Is CDT'I included in the PHC budget? ......30 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES. AND OPPORTT,NITIES. :;; f L-l Acronyms {POC AT'O ATrO CBO CDD CDI'I CSN,l LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT TJNICEF UTG wHo r\ Iircan Pro gramme for Otrcho ce rct asl s C ont r'-'l .,\nnual I reatnrent Oblectrr e Annual Trarnrng Oblectir e Communr tr'-Based Organrzal I on C rrnrnrunrtr'-Di rected Distrr buto r Comtrtutrtr'-Direcled Treatntenl *'lth lr erlneclln Communitv Self-Monitoring Local Govemment Area i\4rnrslr-v of Health Non-Govemmenlal Dev elopmenl Organizatton N on-Go vemmental Organizati on National Onchocerciasis Task Force Pnmary health care Rapid Epidemiologrcal Mapping of Onchocerctasis Severe adverse event Stakeholders meeting Technical Consultative Committee (APOC scientil-rc adlisory group) Trainer of trainers United Nations Children's Ftu:d Ultimate Treatment Goal World Health Organization Definitions 1l) trr ) J'otal popuiiriion. thc totai poprriairon lrrrng rn ntescl,4rvper-endcntic cormrturtilrss u'rlhrn thc projcct arcir (bascd on REMO imd ccnsus ta]iing) Elrgrble population: calculated as tl4% of the total populatron in meso/hyper- endcmrc conrmunities in the pro.lect arca rrrr ) ,{ry1ual Treatmeut Q_bgectrvc (ATO) the cstimatcd number of pcrsons living rn meso,4rrper-endernrc areas that a CDTI project intends to treat ri{th ivermectin in a gr\ cn vcar ( rr') Ultrmate Treatment Goal (UTG) calculatcd as thc maximum number of pcople to be treated amually' rn meso/h-r,per endemic areas rvitlun the project area, ultimately to be reached r.r,hen thc projcct has reached full geographic coverage (normally the project should be expected to reach the UTG at the end of the 3'o 1'car of the prqect) ( r') Therapeutic coverage: number of people Eeated in a given year over the total population (this should be expressed as a percentage). (t'i) Geographical coverage. number of communities treated in a given year over the total number of meso/h1per-endemic commuruties as identified by REMO in the project area (this should be expressed as a percentage). (vit) Integration: delivenng addrtional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) through CDTI (using the same systerns, 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 bv commumtv distributors outside of CDTI. (viii) Sustainability: CDTI activities in an area are sustainable when they continue to function cffectively for thc foreseeablc future, with high treatment coverago, integrated into the available healthcae service, with strong commtmity ownership, using resources mobilised by the community and the government. (i*) Community self-monitoring (.CSM\: The process by which the community is empowered to oversee and monitor the performance of CDTI (or any community- bascd health intervcntion programmc), with a vicw to ensuring that thc programme is being orecuted in the way intended. It Encomages the community to take full responsibility of ivermectin disribution and makc appropriate modifications when necessary. FOLLOW UP OH TGG REGOTIHEHDATIOilS Usrng the table beloii'. fill rn the recommendations o1-the last 'l'CC on the project and descrrbe irou thev hat'e been addressed TCC session l8 Number o! Reconnnendation in the 2 All thc LGA coordinators have been sensitized to CDTI activities and advocacy rvith policy maker be intensified. Allthe LGA coordinator havc been sensitized to rvards CDTI activities and Advocacy visit to the LGApolicy makers have been carried out All the LGA coordinators were invited to a two day training rvorkshop i,v'here they rvere rvell informed about CDTI activities and the roles of each par[rer. The workshop was sponsored by the State Government. A.lso the monthly review meeting of the SOCT and LOCTs were used to sensitize the LGA coordinators. Advocacy visit to the LGA policy makers rvere also carried out to assist the LGA Coordinators. TCC RECOMMENDAT'IONS AC'I'IONS TAKEN BY THE PROJECI' FOR'ICC/APOC MGT LTSE ONLY 1 Detailed in fonnation on supervision. Detarled rntbrnmtiorl or1 supen'isron have been provided WHO/APOC. 24 Norrcmber 20041 Executive $ummary OIrdo State ls orre of the Sta1es rn the South Western parl of the ('oLrnln'and rs located rn B- Health Zone 11 has a prolected populatron o1- about -J -i n-irllron ard covers an area of appro\rmalelr l5 -600 square kilorneters Mectrz.an drstnbulron rn the State started rn 199-l under the ausplces of UNICEF rn fir'e Local Gorentmenl Areas of the State Follourng REMO updates. the programme erpanded to cover ten LGAs Between the penods ol 1994 to 1999. CBIT strareg\ \\;as adopted in proJecl areas APOC CDTI slra1eg1,' became operatronal rn the stale rn June 2000 follo*,ing APOC approval of fifleen LGAs. Following lhe rerrer.r, of REMO e\ercrse carrred oul in the State. the number of endemic communities u'as reduced to 579 tn fourteen LGAs Okitipupa and Odigbo LGAs have been exempted from endemic LGAs- therelore the neu,-targeted population rs I .2rnillion Population movement in the State is attached to various events and seasons of the year. Such evenls include religious activities such as Christmas celebralion pilgrimage to holy land etc, educahon. farming season, etc. During these periods. there are migration of people from one place 1o another. Majority of the people engaged in farming migrates from other part of the Counuy* to the rural areas whrle students move in and out of the rural Communities durlng holidays and school periods respectively. Empou,erment and capacity building of communities through training of CDDs, Community mobili:ration and networking were aggressively pursued in the fourteen designated LGAs in the third year. The project trained and retrained 336 LGA stafil00 TOTs, 350 Health Workers and 5973 CDDs, thereby achieving 90o/o overall for its training objectives 579 communities were mobilized to select their CDDs and collect mectizan from designated points. Additionally, 576 policy makers and community leaders were mobilized in various advocacy meetings io support CDTI process in the State. Health Committees have been constituted and made functional in the course of implementing CDTI in some communities. As regards treatment of endemic communities, the project was able to treat 935,406 people in the communities with \807,781-mecizwt tablets. The therapeutic coverage rate is 78Yo while &e geographical coverage rate is lW%. The projects in the coming months intend to carry out some targeted training aimed at correcting some lapses identified during monitoring exercise. More advocacy, mobilization and Health education will be carried out in some targeted communities and Locat Government areas. The frequent transfer of the trained Health workers from one health facility to another is a mqior challenge facing the project. The project during the reporting year have beem able to train and retrain more health workers wtrile ttre Local Government Service Commission personnel have been involved in various form of mobilizaion and sensitization. This has enable the personnel responsible for the traufer of Health workers to acquire knowledge about CDTI activities in tre State. , I I WHO/AFOC, 24 Novembq 2004 ?SEGTIOH l: Background information 1.1. General information I.l.l Description of the project (briefly) GEOGRAPH|GAL LOGATION, TOPOGRAPHY, GLIMATE Ondo State rs rn the South Wesl of the Countn'and covers al alea of approxrmatelv 15.(,()0 squa-re kilometers It rs borurded on theNorth b),Ekiti State. EastbvEdo State. West by'Osun States South West bv Ogun State and South by Atlantrc Ocean The Bro-climatlc zones of the s1a1e range from ra:n foresl to forest savannah mosarc. to gurnea savannah and mountarnous areas. The rainy season is from April to October rvhile dry season starts from November to end ol March Farming is throughout the -v"ear ivhile plantlng period co\/ers April to October and harvesting period is Oclober 1o March. POPULATION ACTIVITIES. CULTURES LANGUAGE Ondo State located in the B-Health Zone has a projected population of about 3.5 nullion. The major ethnic groups are the Akoko, Akure, Owo, Ondo, Iliale, Ilaje, Ijaw Arogbo/Apoi The malor language spoken is Yoruba but there are various dialects. The occupation of the State is farming which include growing of Coco4 Yams, Oil palm, Cassav4 Cultivation of Maize, Beans and Pepper etc. Fishing along the riverine areas is very common, Crafts such as weaving of clotls, using raffra to make baskets, ma1s, chairs etc. Some people in the State also practice keeping of domestic animals. COMMUNICATION SYSTEM (ROAD):- Traruport by road is the major means of communication among the communities some of the roads berween major towns or cities are in good condition while accss roads to most of the endemic Communities are very bad some are not passable during the rainy se:Non for the communities at the riverine areas, transportation by river or water ways is used. The uses of electronic and print media are also means of communication in the State. Schools, Churches, Mosques are other means of communication in the communities. Town criers are used in some rural areas to aillounce or communicate within the communities. ADMINISTRATION STRUCTURE:- Ondo State administration is headed by the Executive Govemor. There are the legislative and judicial arms. The local Govemment with the Chief adminisfiative officer being the Chairman supported by the legislaive arm made up of elected councilors from different wards. The State consists of 18 LGAs with the State capital located in Akure. I{EALTH SYSTEM AND HEALTH CARE DELryERY The health service ofthe State is structured to provide health care for the people at all levels. Primary Health Care (PHC) system provides health services with the community participation and support from the State. Local Government md NGOs. Different levels of health care delivery and services are provided across the State and fte project areas. ? WHO/APOC. 24 Norrember 2004 State Specia.list Hospitals General Hospitals Comprehensi ve Health Centre Hea.lth post- and cenlers .i l4 18 r68 Table I : Number of health slaff involved in CDTI (Please add rnore rows tJ'necessarlt) DistricULGA Numb+r of health strff involved in CD'I'I octirities. I'otal Number of health staff in thc entlrc projcct area Number of heelth staff lnvolved ln C]}TI Perccntage AkokoN.E. 54 AkokoN.W 74 53 72 Akoko S.E 83 57 69 Akoko S.W 75 53 7t Akure North 85 53 62 Akure South 98 50 5t Idanre 84 54 64 Ifcdorc 75 50 67 IleolujilOkeigbo 65 41 68 Irele 82 63 77 Ondo E. 69 49 7t Ondo W 75 62 83 Owo 98 62 63 Ose 80 58 ?? Tofrl 1,127 762 680/o 1.12. Partnenhip Parrrers involved in CDTI project implomentation at all level in Ondo Stare is as listed below. World Heal& Organization (WHO) African Programme on Onchocerciasis Coffiol (APOC) United Nuion Intemuional Children's fimd (LIMCEF) National Onchocerciasis Cotrrol Programnre (NOCP) Fed€ral, Stue ail Local Ciovernments LocalNGDOs (Progressive Club; Elite Club; Cordat Club; Union of Friends) Communities in the e,lrdemic Areas. Unicef has been able to collaborate with the State Midstry of Health by releroing funds for tmining and retraining of Hoatth rvorken, mnitoring and sryEvision of CDTI activities at the LGAs and comrrnrnity levels. A WIIryAFOC. 24 Nowmbcr 20O{ 78 lhe state and thc ]1 APOC assrsted LGAs haire bcen able to apprcYed ard release thetr counterpart fundrng md prorlde loglstrc lor CDTI actrvrties Advocacv and mobrlizatron of the nen'pohcv makers communth' leader-. GDOs. arid NGOs and CIBOs have been carned out throughout the Stale The State hope to carn oul more advocac\' \,'tstt to the pohct'makers rvhen considered necessan'. f WHO/APOC. 24 Noriember 20O4 -1 O6l a)p o oz -i- a?. a m € '4 E NO4. c.lr- 6l6l € F- -$ € oa. r Or n c{r t-.@all-T r clq N\c CI ir Crr r 6!f,\ N r $ 6 3 \c o FEO *(! L d!l) qt ts 'a A 0)s (F g ol< 0) cg 6Li C) a o) '5 V) F oi oo <o l<o fl E Eoo o) .c v, o) t,coo Gt B o qI q)E (D bo GI o >\ l! oo E 0) 0) o0tr 'd)(!) cl oh H a .s U L\ t! s \q) P i a) E IIGrs E- :!$L :A. "ou:t sh' :s -I! ). EL *s 12 O'S*TIBq) F* *s 'tq st) r.RSU$o bs3HEN Ea 'Bd Ssst) s$. \c,S"a PE ,qt'o !P .SNalrSE R r.$ EP\ bo *rEr+ rtE sEP qp llv 'E =cr C!! M .tt EE B:tt =ttltsr *'BE * XF ETS ; i$ ! sE # \o 8" LIF €, .tso c o F- o, & a-@ o) o 01 \a ca& t-- o\& \o, 0cr q\ln 6 $ od\o N\o1 I -11'o-d lcar16 I l 1 I Ir-& q a..l rn l' al al c.lI a .9-E8E8"0 agf -E a >tr co\oq r.-\o €No\ \D Eq O a- o+ --i sNd ctr N" a.t t-- .],. 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F. laloIt lJa l< rd IEi l{ E7 I!t IE It Ei t8 lor IE Ir E g o -o.EO G) l6 l'B IE lE i,E ;lr v,6 rII oE6 B l>o Ir lo l6 Ir Fl tr otr \. E 13 l=l 2.2 ADVOCACY Advocacl'mobilization n,orkshop fbr the slate policl'makers. LGA policv makers. Top Govemment functionaries. Traditional Rulers. Religious Leaders. PHC Coordrnators- and some notable opimon leaders rvas carried out in the stale. The Adrocacv mobilizalron risit- rvhrch was carried out b,v the Top management from State tr.linistr.v of Health rvas facilitated by offrcials lrom WHO, I-INICEF. NOCP Headquarters, B-ZonaI official and members of SOCT \\'as ven' successful. A total of forn'-five state Polio'maliers. one hundred and sixty-eight LGA policl makers, eighty-five Traditional rulers. Seventv religious leaders- One hundred and sixtv-five schooll'eachers and thirtl,-five opinion leaders in the communities rvere mobilized Advocacy and sensitization of these groups rvere carried out to enable them undersland the concept of CDTI and the roles of partners in the implementation of CDTI project in the State. As a result of the advocacy and sensitization of the policy makers. State and LGA counterpart frrnding were proposed and released for implementation of CDTI activities. The State Govemment released a total sum of #2.6m while the sum of #l.lm was released by the 14 LGAS where CDTI is in operation 2.1 tobitizatlon, sensitization and health education of at rlck communlties The mobilizdion and health education of the endemic communities were supported by the use of posters and radio/television jingles developed in the Local languages. Additional trained health staff ard town criers were used as mobilizers . Churches and Mosques were also used as places of mobilization. The State Ministry of Health continued to sponsored a T.V. progamme known as "ste'wardship" and also a radio programme known as "Our Guest" where CDTI programme is sell to the populace. There was no separde rrpbilization and Health education of women urd minorities in Ondo State project sirrce there were no segregation in all the CDTI project areas. They all live together in peace and harmony under one community leadership. As a result of the mobilization carried out on CDTI implementatiorl the positive response of the communities were recognized on these areas. Communities selected their CDDs withoutdelay Non-funstional village health committees were reactivded. More Commrmities decided on mode/period of distribution Communities collegted their mectizan ftom the collection points. Communities give incentives to tlreir CDDs. Communities moniter CDTI in their domains. Despite poor terain 6d innrlequde firnd for fueling of projeut vehicles, most of &e endemic communities were visited for mobilizuion, seilsitizuion and health educdion The leadqs and members ofthe comrnmiti€s promised to asure the q WHO/APOC. 24 November 2004 a e I a a a success 01 CDTI actl\:ltres in therr domains Thrs has also resulteci into increase lrealrnent coverages and reduc-.tron in refusal rate, \4ore linte should be dei'oted to communrtr mobiltz-atton- sensttiz-atton and Ilealth educatlon. Thls should be supported rvith adequale logrstics I e good proJect vehlcle. adequate fund for fueling to talie care olunstable fuel prices and vehrcle parts lo WHO/APOC. 24 November 20O4 ! f . a..l 0)& o oz cl t) o. O ts = (.)t th 3 cEhll 'r' s) o ,d oo *= 0) 0) E .E d9opo E:F d:o"HHHlr bo ra .=oh-6S ,o6= -C q, E€ ooi sg ll r, 5sENlo.E Eg>E .9 .!1 SE .E> 90 HA 6a .E -JdegB UtsE>, =a)al .E6)vfa TB .gb tsq) cl 6l HEOo9Eua tsE tsE36'Eo ogE;(,E! EE ,,9 9q. .!lOg *B EggB <t qA .Eu lgEEEE FE .> 9o Ebnlszl h! G oI t t t t t t :t !t - t ".E A 91t\J +l'tl o! EE - Ee o @ € oN N s a .t r.- lr) <t \oc.l @ao tN Fr!f, 00ca o\r- ra) o .9 I E ri E l,l O €.o E+ 6.4 aQ o Ic z l I o F. &t'. F.. .tot 00s vt o $ @ 00 ooa mo\tn r+ ia) co r-. cn\o o\r-in co o\$ cnF o\ \n 9o ER3nELV €t €o@ F. $ o \o c.l aoo ct N F o\ 6 € $6 cain \o aaaI o a 2 6 00 at al o\ ct F-l--(.) o\ F. \ot-N \o6cl \o F- c.l ta\oN o\ + (n o\(a t(a ta\ofn r+ ta!9 EEEax .I >a Ee5rEIEI' EE3tOErE .rEaa5B2., 1l < o bDi E 6 b a\ CIt.- ts-\o \o r\t t o\t (r) OIr- o\co o\ \n$ \ool yO o\ $ f rr r !EIE F.l $ o.t at c.l 6 i \ocl r.) tcil N o r-(f)rl d E Ttr oa €E ;E ECL 00 00 ool N \o \o(a !t F u1tt \otat €CA $N t-st €(n o\F-rn 3 I i z o .I .q E z oJ3 EI {1 o! F ?A oJ s ! E z o .q ll Eot) o -!l o Ed $ 3 EO 'd 5 '=n E EI oEk Ei o *, 6 F oE, 5 o Bo c) 6 Ili Eo L) (l) € rEZ'a5e -QdE > .LtE3ZHEobg .ir.E EE .,4 EE H-ao(.U+r{flcl trl t t Majority of CDTI communities provided incentives to their CDDs. It may be in form of cash. materials or in kind The rate of attrition of CDDs is not a problem to the project because large number of CDDs have been trained within the community and this give room for easy replacement 2.5. Gapacity building TRAINING This is a continuous exercise. All officers involved in the distribution of Mectizan in the State have received one form of training or the other since the inception of Onchocerciasis Control in the State. However for the purpose of CDTI Implementation in the fourth year, members of the SOCT and LOCT were retrained. The B-Zonal Coordinator Mr. A. O. Jayeoba and other facilitators from NOCP facilitated these. The training of the Local Government Oncho. Control Team for CDTI implementation was canied otrt in fourteen Local Government areas simultaneously in the State. Training of CDDs at various LGAs was done by the trained LOCTs and supervised by the SOCTs. They were trained on disease identificatiorq registration of Community members, measurement for dosage and mectizan disfibution. Also management of mild reactions and the referral of severe reactions were discussed. Stake Holders meeting as well as community self monitoring (SHIWCSM) were thoroughly explained. During the training course, attention was given to some targeted areas where lapses were deteoted during monitoring exercise at different levels of CDTI implementation. The training materials used include the following:- Flipoharts, Posters, CDD field guide, SOCT/LOCT field guide, training manuals, tape measures, community register book and a prqiector. As a rezult of the training carried out the number of trained CDDs increased. This resrlted in increased coveragB. In the proc€ss of zupervision the CDDs demonstrated greater understanding of their responsibilities, this explained the increase in coverage. t2 cCN 0) ,c trI z -t c.t () p- t o > a U o z 2, LF cc$ CO co$ O r- O \o a$ -t c] -t\o c.l O\o v\o N O @ <t O clt U Ca :t o -t C o\o <l -t n CO aa ct \c C $ d) cc $ C $ : I + : NC al O $ r- C ca tr- F. :: \o t1- & $ \t 6 F- |r) r7) al tn t'- \o \oo\ tr o o o \c as OCt-- a q) .= v2 crl Fq Lts G.) oc) =EL6gUl tr z (\, l+- = i= 2J LF co \o o \o s cl o @ 11- s o F- .f F- N o @ 00 c.l F^ F- al @ O r^ v O \o v a.l F- $ o a.l € s s r- E o! a) 6) s o -Elttcd! 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A z z 9\ c.l o\ a.l\o ^\ r*-r. o\r- r-' .\ 5o t-- \o\o r- $ $l v(\ sc.l F- a.l 00s' t--alr- .f r-- c.l o\ t-- o\ odN 01 E \ 7 z z 8 o \o 8 o r- O $\o o\ @ @ s o\ r-ON v o\ z z z 8 o\o 8 ^Sco 8 oo| tr- Tr!o e.l t--$ c..l ON 6o!oq, t 8 E s Eoo !i F.l p$. la O.\<e- o z z 7 -oJ'oo a'oo so soo ;.Oo =o?aa $t E8,rOotri z z z o\ r d. F- tr- s\o @ q\oo .6 ts H lfi s-{ ESf; EE*O z z z @ O s oo o\F! o\F tsiEEs z z z aa (fr II 8ra o\1..ra o\F 00(! Ee tE E't€ z z fi, Orr\ ra.l o\t\\ o\t- v'r OlF- v.t Oir-\n 4, EI T\o\6 oo\ o\ I6 EN I6t elIN a.rI6l H v.tI c{ t\IN o\IN o0NE6l a 2.7. Ordering, storage and delivery st ivermectin Mectiznn@ ordered/applied for by- MOH wHo tr UxrCEF tr NGDO tr Mectizan@ delivered by - MOH/NOCf] v IHO ur[crr NGDotr Please describe how Mectizan@ is ordered and how it gets to the communities Mectizan ordering and delivery in Ondo State CDTI project originated from the Community through the CDDs. The Community Directed Distributors requested for their yearly needed Mectizan tablets using their Mectizan treatment census register. Their request is forwarded to the LGA Oncho Control team (LOCT) through the Health facilrty staff(FIFS). The LOCT compiles the requests from the various Commmities in the LGA and forwarded it to the State Oncho Control Team (SOCT) who submit to Zonal office for onward transmission to the NOCP Headquarter. The National Onchocerciasis Control Programme Headquarter collates all requests for Mectizan. and makes application to MSD . On approval MSD ships the drugs which are cleared by UNICEF and stored in their storage facilities on behalf of NOTT . Drug delivery follows the ordering process but in revised order. MSD t+ NOCP UNICEF t 'l' ZONAL OFFICEtJ STATEt+ LGATI HFL AIl* (CDD) COMMI-INITY .fr WHO/APOC. 24 November 2003 o Table 10: Mectizan@ Inventory STATBDTSTRICT /LGA NUMBER OF MECTIZAN TABLETS REQUESTED RECEIVED USED LOST WASTE ONFIELD EXPIRED Akoko N.E. 212,000 211,250 208,454 2,796 Akoko N.W 214.000 2t3,460 211,364 2.096 Akoko S.E. 182,000 181,510 179,213 2,297 Akoko S.W 205.000 2M.420 201,920 2,500 Akure North 214.000 213,720 211,819 1,901 Akure South 210,500 210,060 208,2L4 1,856 Idanre 200,000 189,900 t87,206 2,694 Ifedore 204,000 203.670 200,923 2,747 Ileoluii/Okeiebo 152.000 1s 1,820 149,668 2.152 Irele 210,000 207,020 204,524 2,496 Ondo E. 190,000 170,500 1,68,42'l 2,073 Ondo W 235.000 232,820 231,120 1.700 Owo 213.000 21r,270 zto,4l9 851 Ose 250,000 235,490 234,510 980 TOTAL 2.891.500 2.836.910 2,807,781 29,129 In some communities, the remaining tablets are kept with the Health workers at the health facilities nearest to them while some communitios kopt their remaining mectizan tablets with their supervisors which may be a CDDs, commturity leaders or any appointed members of the community. 20 WHO/APOC. 24 November 2004 *ON "B 0) oz vN Oop< o = 'ci sdo ts o) bD 0) a otrE' clo J] o Ft Uo a EH o h ct a c) t El G' .bao t cl0, El)E RI f;k ng €g EItr cl E6 E B arl a 0) EI E 3 c.l H L c) E (o Ei{ c)rD .g?o' .=!IH$€ -.8 OELA €; p -oH'f;!!q6o:5IT:|EBr6 sn E EE;8nEEEeBr^E EE'ots.cEE'E --4EE r- (J LaO(JclgkEai IE ffi.EEEEi€5EX-l $EH 6!a F-:(pEg E6EEEroEEootsE trO O'E E.E Ho5zo cn \o el c.I me.t (n $ el c.lN t'-m octf, oi ]-.N GI t EEEE;gE6E E ts'E -Q'tr .lJ9 H.Et!oo otr z co o\ t co (\ r- cn o r\ ralr)cn \o a c) .r G6 o !t)b sE ^.5 O# E.SrF.ra o'EBEo'El o - E'Ets6 Eo oo 6 (\ rN \o(n \ocrl r+ t\ca \nt \o(n @(') $c.l r-.+ 6m o\r|{) o *I B 'tr 6 a Ei z so -V B z sot rdri .eoJ. E a so -r. €o zg =J' € o rn !u sJ 0) trla 'o (l) o R o -o u0 0) '\4o I q)E Ei oE, o U,!) oE rlo o Bo o(A o L1 Ei o Ei I 2"9, Supervision 2.9.1. Provide a flox' chart of superuision hierarchy. SOCT J LOCT J DHS J HFL J CSM J CDD 1.92. What werc the main issues identified during supervision? Issues identified during Supervision depends on activities at hand and varies from one Community to another some of the issues include:-(1) lnadequate knowledge on reporting(2) Recording problems by CDDs(3) Lack of incentives from the Community. 7,93. Was a supervision checklist used? Yes 2.9.4. What were the outcomes at each level of cDTI implementation supetr'lslon? Througfr the supervision of CDTI activities d each level, the health facili$ staffwere able to provide reports and daa with conect figure. The CDDs were able to carry out proper recording and update their treatment register. Treatment coverage at the community level improved 2.95. Was fccdback given to the peruon or groups supcrvlsed? Feed back was given immediately and this has assist the project to have increase in therapeutic coveragp 7,9.6. How was the fccdback used te lmpruve the ovcrall performancc of thc pnoiect? Every mernber of Ondro. Contol team including the CDDs and the Community members were-able to id€iltii, their roles and where perfonnurce ane bdow average. As sudr, all personrol involved in CDTI activities improved their pe,rfonnmces thereby increase total traffid coverage and reporting. ,r, WHO/ArcC. 24Norcmber20o4 SEGTIOII 3: $upport to CDTI 3.{. Equipment Status of *Condition of the equipment (F=Functional, CNFR{urrently non-functional but repairable, WO=Written off;. How does the project intend to maintain and replace existing equipment and other materials? The State Ministry of Health has put in place a plan to ensure that project equipments and materials were adequately maintained. The plan include adequate budgeting and release of fi,urd, integration into other PHC activities and periodical servicing and replacement of materials. The project has requested for some capital equipments such as Motor vehicle photocopier, Computer set and Iaptop from APOC in the fifth year budget while other materials will be replaced by the State Project office. APOC MOH DISTRICT/ LGA NGDO OthersSource Type of equipmcnt No. Condition No. Condition No. Condition No. Condition No. Condition 1. Vehicle 1 F 1 wo 2. Motor cvcl{s) 15 F 5 wo 3. Computer(s) I CNFR 4Jruter(s) I CNFR 5Jhotocopier (s) I CNFR 6. Fax Machine(s) I F 7. Others a) NC I F!Lrv I F c) Bicycles 150 wo 2g WIjO/APOC. 24 November 2004 3EGTIOII 3&rppoilhGDTI !.2.Flnanclal contributlons of thc partners and communltler Table 13: Financial conributions by all par[rers for the last three years Release of counterpart funds are always processed md disbursed for the project activities without problem 3.3. Ollrer fornrr d cornmunlty tupptrt Some of the srdemic communities provide incentive to their CDD, such incentive include transportation, allowance, food items recognition of CDDs during celebrdions in the comnnrnity Contributor Ycrr I Junc 2000-Mrv.200l Ycrr 2 Jurc. 2001-Mev,2002 Yeer 3 June. 2002-Mrv. 2003 Ycrr 4 Nov 2003 - Dec 2004 TOTAL Budgctcd russ) TOTAL Rclarcd rus$) TOTAL Budgctcd rus$) TOTAT Rclc.!€d (us$) TOTAL Budgetd rus$) TOTAL Rclmcd rus$) TOTAL Budgctcd russ) TOTAL Releaed rus$) Minidry of ficrlth (Mori) 18750 r2500 10,000 8,000 1a800 8,000 16,000 I6,000 Locel NGDO(I) ( if rny) NGDO p.rhcr(6) Fivc Motorcyclcr Fivc Motorcyclcs 6,'m0 6,400 Dis$ictI-GA t,750 3,750 8,000 5,000 8,000 5,600 t,Eoo Communitice APOC Trurt Fund 171,680 104,1&) 135,860 10qffo 73p32 61,534 11622 14622 TOTAL l99,lr0 120,430 153,8@ tzL8fi 93,832 75,t34 73,822 73,822 4+ WHO/APOC. 24 November 2004 , I I I a3.4. Expenditure per activity Erchange rate used: $t : N136 Table 14: Indicate hou'much the project spenl for each aclivrtv lisled belou,during the reportrng period Activity Expenditure ($ us) Source(s) of funding Drug delivery from NOTF HQ area to central collection point of communlt) N4obilization and health education of communrties T.rI1l,lg of CDDq Ealilg of health staffat all levels Sqp..rvl! CDDs and distribution Intemal moni of CDTI activities visits to health and es IEC materials lut,.nqry ( forms for treatment Vehicles/ Motorcycles/ malntenarlce Offrce e. nters etc;) Others 1.800 10.100 s,600 8,895 14,900 G-Jso u,gq0 6,650 VQH LINICEF/MOH APOC/MOH 4POC/MOH MOH/LGA LINICEFA4OH APOC/LINICEF APOC A4OH APOCiMOH APOCA4OH APOCA4OH APOC/MOH 600 600 2,000 s97 TOTAL 73,822 Total number of persons trcated 935,406 :, {5 WHO/AFOC, 24 Novenb€r 2004 SEGTIOII 4: $ustainability of GDTI 4.1. lnternal; independent participatory monitoring; Evaluation "t. 1 .I Was Monitoring/evaluation cartied out during the reporting period? (tick any of the following which are applicable) Year I Partrcrpatory Independent monrtoring Mrd Term Sustamabilitv Evaluailon 5 year S uslainability' Evaluation Intemal Monitorrng bi' NOTF Other Evaluation by other partners 1.1.2. What werrc the recommendations? Recommendations have not been sent to the project although feedback meetings rvere heid after the exercise 4.1.3. How have they been implemented? Some of the issue discussed during the feedback meetings such as inadequate reporting, supervision and Health education have been implemented. 4.2. $ustalnability oI proiects! PIan and set targets (nrandatory at Yr 3) Was the project evaluated during the reporting period?-$ A Was a sustainability plan written? NA f When was the sustainability plan submitted NA? D What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.2.1. Planning at all relevant levels 4.2.2. Funds 4.23 Transpoft (replacement and maintenance) 4.2A. Other nesounces 4.25. To what extent has the plan been implemented Q6 WHO/APOC. 24 November 20O4 aa 1 t a a 4.3. lntegration Oufline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3.1. Ivermectin deliverymechanisms Health rvorkers at the health facility level who are also engaged rn other PHC activities are involved in the process of mectizan procurement and delivery, 4,3.2. Training Health workers at various health facilities who are also engaged m PHC activities are used for CDTI training. 4,33. Joint superuision and monitoring with other programs Supervision and monitoring of CDTI activities are carried out aI different levels b1, Health rvorkers during PHC actit,ities such as home visiting. immunizations and Health education. 4,3.4. Release of funds for project activities Release of fi.rnds for CDTI activities always accomparued PHC progrzmlmes especially during routine immunization prograrnme and other activities. 4.35. Is CDTI included in the PHC budgetr The State and Local Government Areas have been able to include CDTI budget plan as part of the overall budget of PHC. SEGTION 5: Strengths, weaknesses, challengGsr and opportunities STRENGTHS 1 Most of the communities so far trealed and where distribution is cunently going on have taken on the responsibility of collecting the drug from the nearest Health facility. Generally, the CDDs exhibited a high sense of responsibility and understanding of the CDTI concept. 2 The numbers of CDDs selected by the communities and trained for CDTI has increased thereby improving the ffeatment coverage. 3 AII the LGAs have also followed it up by either lending moral support rvith the physical presence of Policy Makers at relevant occasions or/and by git ing financial assistance to the implementation process. The 14 APOC assisted LGfu provided N80.000 each as couterpart funding dunng the period under review. WEAKNESSES l. During the spot checks by the SOCTs, it was discovered that some CDDs had problems in reeord keeping. Inadequate supervision of CDDs by LOCTs,/FIFS Inability of some communities to give incentive to CDDs. 2 J {t WHO/APOC. 24 Novernber 2004 .l CHALLENGES:- Late approval of proposals and fund by Unicef. Increased operalional costs particularly the cost of fueling the project vehicle and maintenance. LateA{on submission of reporls from some of the Onchocerciasis Control Team LESSONS LEARNT Need for timely arid adequate fundurg by partriers Appropriate budgeting for CDTI activities Early submission of reports I a t t a z8 WHO/APOC. 24 November 2004