Annual report of CDTI activities in Benue State project: October 2001-September 2002

rBENUE STATE NOTF/WHO-APOC PROJECT. ANNUAL REPORT OF CDTI ACTIVITIES IN BENUE STATE PROJECT OCTOBER 2OO1- SEPTEMBER 2OO2 SUBMITTED TO: THE AFRICAN PROGRAMMD FOR ONCHOCERCTASTS (APOC) BY CHINWEUZOAMAKA TERNA F,Jr ./tc.ll^r io: -L e t'l -8,r. M Wo 'Trl'4'/ t,.FYaw For lnformotion Tor btet kcIN NOVEMBER 2002,AT KADUNA, NIGERIA. llltLlAI ITreatment with ivermectin has been on since 1991 1 . Total No. of LGAs . . . . 23 182.TotalNo.ofLGAswithlvermectinffeatment 3. Total State PoPulation......' 4,035,563 4. Total No. of communities. . ' ' ' ' 3942 5. Total No. of Communities receiving treatment 2049 Total population of communities receiving treatment. l, 266,47 46 7 8 Carry over drug from 2001 . . . . . Drug received for 2002..... No. Of CDDs ffained/retrained in2002..... Projected ffeatmed target for 2003 6500 2,800,000 1,000,000 692644 1,850,060 None 1,000,000 9. ATO for 2002 10. Treatment figure for 2002(so far)..... 1 l. No. of table used for the same period t2. 13. 4 EXECUTIVE SUMMARY Benue State has an estimated population of about 4 m,rion, with about 3942 communities' In the first year of .DTI, in 199912000, we treated in r759 communities whose population was about 1083793 persons. Last year, the program expanded to 4 more LGAs' The statistics for thesenewLGAshavenotbeenfullycollated.Itishopedthatwhenthisisready,itwouldbe made available in subsequent reports. Meanwhile, we have a treating community population of about 1.2 million. Benue CDTI was faced with numerous bottlenecks in the year under review' There was a change in the headship of the department in the ministry, the Unicef project officer in Enugu' lack of political will of the government to sponsor the program was another big problem faced by the project in the year under review. None payment of salaries of LGA and state staff made matters worst. The slow processes of fund release faced by the project at all contact points, in the Ministry and the Unicef office' No funds were officially released to the project in the year under review by APOC' The project had in her accounts the sum of about three million five hundred and sixty thousand naira, which was the balance of the first installment payment of the second year project funds. However, we have been able to train/retrain 11 SOCTs, l80LOCTs.We were not able to do the other trainings, that is, the Health facilities staff, other LGA staff and the CDDs for lack of funds. An advocacy workshop was also organized for about 296 traditional rulers' we replenised our supplies, printed some posters with which the trainings were conducted' Some community registers were also printed to enable us replace registers in those communities in Ukum and Guma LGAs where communal crisis took place. We could not carry out the other CDTI activities for same reason of lack of fund, since APOC funds never came and the counterpart funds were not equally present' The SocTs got a new lese towards the program through the composite training it got in May 2002 from the Imo/Abia GRBp facilitated by Dr E. Emuka. we never got any training as clear and rich as this in the past. The acquired knowledge was equally passed on to the 180 trained LOCTs trained in 5 different locations in the State' The SOCTs went out a few times for supervision before the cash squeeze experienced in the project. The bulk of the supervision done at this time was in the last communal crisis area of Ukum LGA' It was 2 Ifound out that about 79369 tablets and most other GDTI materials were lost to the crisis' Some of our cDDs were no longer in place to do GDTI related assignments' There were series of NocP involved activities in the year under review' which we had thought, would revive the govemment's support for the program' NOCP arranged and organized csM/sH meetings in selected LGAs in February' The Zonal office in Enugu' in collaboration with the State Oncho team organ ized aone-day advocacy workshop' sponsored byUnicef,fortheStatepolicymakersandtheLGAchairmeninFebruaryalso. Unfortunately, the tum up from the LGAs was very poor' only 2 chairmen attended in person, that of oju and ushongo, while most others were being represented by either their oncho coordinators or the councilor for Health in their LGA' The decision reached as to the LGAs' input to the program has not been implemented by any of the LGA so far; it was agreed that all LGAs should support onchocerciasis control' It was also agreed that in order to sustain the control program in all such LGAs, counterpart fund be deducted at source from their revenue allocation. However, we have been able to treat 692644 people with 1850060 tablets treatment is still on-going and by the time we are through we would make our one million target' of the 2'8 million tablets collected for the year under review only about 350,000 are in our store here, which will exPire next Year August, the rest are on the field. we are returning a total of 160,000 tablets due to explre ln Dec. of this year to NOCP J SECTION ONE Benue State is one of the states endemic with onchocerciasis in Nigeria. unicef had been assisting her with ivermenctin Distribution project (IDP) since 1991, using first' the mass distribution method, then the community Based rreatment with Ivermectin (GBTI) in 14 0f the Z3LGAs in the state. Apoc joined Unicef since october lggg, in introducing and successfully taking off the community Directed rreatment with Ivermectin (GDTI). The program has expanded to 4 more LGAs; which means the program is on going in 18 LGAs now. we have not commenced cross-validation of census figures in these 4 new LGAs' Since the incePtion of the Program in 1991, the treatment figures are as follows: From the above report it is clear that since the introduction of the idea of ATO into the project in 1998, it is only in 2000 that we met and even over shot our target' However' it is 4 PEOPLE TREATED N TABLETS USED Y TREATED POPULATION AT 1 99 1 77 00, 1 000 77 00 921 3 0 t07 1 J 110 120,3 2 7,948 t994 1 0 124,982 3 578 1995 r97, 234,000 517,578 1996 61,99 ---84frr 579,5 1 1997 7,354 301,942 5 1 7,428 334,787 1 4,353, 5 ,000 1 ,630 - 7',7=11r3$ I J 6 000 2000 595,047 1,535 I 8,030 500,000 2001 696,460 1,746 800, 2002 692,644 1,850,060 3,347, 34 Treatment is still on going al OF -68,ooo note worthy that Benue CDTI have remained steady in the treatment figures, at least since 1997. For the period under review we have done training' advocacy' supervision and mobilization' There was a follow-up supervisory visit in January by the team that monitored the program last year The National coordinator visited the project for the first time in a very very long while in September (O[z.There was a high level advocacy with the ministry's top management after whichtheaugustvisitorleftwiththeHon'commissionerofHealth'thePermSec''Zonal coordinator and some members of the socT in company of the State coordinator to pay a visit to the State Governor' TheNationalCoordinatorhighlightedthereasonforhisvisitandpromisesweremadebythe Governor to look into the issues of supporting the program' The LGA strike actions affected the program activities in the LGAs in areas of collection and collation of treatment rePorts' Lack of project funds hampered effective supervision and withheld salary payment to the civ, servants at a time made it very impossible for the socrs to follow their usual habit of going for supervision from their pockets and being reimbursed later when there is fund in the project account. 5 l rIMPLEM ENTATION OF GDTI 3 COMMUNIry i/N 2 3 4 5 6 7 la 9 10 11 12 13 NO of PeoPle registered NO OF COMM. Paying GDDS iN cash or kind ttO Of I COMMS. I with Trained CDDS NO OF COMM. Which decided [time ot Rx NO OF COMM. That decided Method of Rx NO. OF COMM.W hich collected drugs NO. OF COMM Which selected lcoo NO. OF COMM NO. OF DISTS. LGAS 5316814214210GUMA 38495646412BURUKU 1 0164910210515GBOKO 37791 717112KONSHISH 1047411671 7 112USHONGO 5440033533514KWANDE 411785712 57I</ALA 258880656513UKUM 54958939515G/WEST 66970106 10612OTUKPO 5811812413 124OJU 11723218418414ADO 3058673 7311OKPOKWU 6562716712 167OGBADIBO14 3672665 65815 TARKA 40564867 86LOGO16 4895272 72917 OHIMINI 56439677 67oBl18 126647420402049208Tota 18 1 TABLE SHOWING PERGENTAGE ACHIEVEMENT OF TRAINING CARRIED OUT SO FAR' WPE OF TRAINING ATO ACTUAL % ACHIEVEMENT SOCT 11 11 100o/o LOCT 180 180 100o/o HEALTH FACTLITY STAFF 540 NONE Oo/o OTHER LGA HEALTH STAFF 540 NONE 0.00% CDDS 3000 NONE OYo COMPUTER TRAINING 1 NONE Oo/o ATO 1,000,000 692644(still treating) 69% 7 TABLE SHOWING TRAINING OF THE DIFFERENT LEVELS OF STAFF INVOLVED IN CDTI IMPLEMENTATION S/NO LGAS NO OF TRAINING UNDERTAKEN NO OF TOT TRAINED NO OF LGA STAFF TR.AINED ON CDTI NO OF HEALTH CENTRE STAFF TRAINED ON CDTI NO OF CDDS TRAINED/R ETRAINED SOCTs 1 11 1 GUMA 1 10 2 BURUKU 1 10 3 GBOKO 1 10 4 KONSHISH 1 10 5 USHONGO 1 10 6 KWANDE 1 10 7 I(ALA 1 10 8 UKUM 1 10 I G^/vEST 1 10 10 OTUKPO ,| 10 11 OJU 1 10 12 ADO 1 10 13 OKPOKW 1 10 14 OGBADIB 1 10 15 TARKA 1 10 16 LOGO 1 10 17 OHIMINI 1 10 18 oBt 1 10 TOTAL 18 5 180 E Section 3 TABLE SHOWI NG TREATM ENT COVERI NG'OCTO BER 2OO1 -SEPTEM BERaOO2 S/N LGA NO OF COMM. TREATED -ouu.e I oPULArl I ON NO OF ELIGIBLE PERSONS TREATED NO OF TABS USED COST/PE RSON Rx NO OF COMM.IN WHICH ICDD IS A lsealrn lwonxen NO OF DlSTs. SUPERVISE DBY HEALTH WORKER t'ro or rnenreol COMM. WITH I SUMMARY FORMS 1 GUMA 142 531 69 27603 64000 142 2 BURUKU 64 38495 45967 118179 64 3 GBOKO 105 1 01 649 1 7693 44298 105 4 KONSHISHA 71 37791 29071 76179 71 5 USHONGO 171 104741 38745 99664 167 6 KWANDE 335 54400 91683 2641 99 335 7 I(ALA 57 41178 59320 156024 57 8 UKUM 65 258880 3523 8962 65 I G^It/EST 95 54958 45870 118823 93 10 OTUKPO 106 66970 51 925 1 29030 106 11 OJU 124 58118 53954 131022 '124 12 ADO 184 117232 14649 35487 79 13 OKPOKWU OGBADIBO 73 30586 70257 214805 73 14 167 65627 42581 117541 167 15 TARKA 65 36726 28164 72799 65 16 LOGO 86 40564 11989 32055 86 17 OHIMINI 72 48952 18734 54954 65 18 oBt 67 56439 1 9083 45352 67 19 FERRAL CENTRE 21 833 66687 20 WASTAGE 531 I Tot 18 2049 1266474 692644 1 850060 1 931 3 TherewasnotmuchmobilizationsessionssincewecouldnotgoouttotheLGAsandcould notpayforairtimefortherelayofourjingles,forthesalnereasonearliergiven. SECTION 4 STRENGHTS AND WEAKNESSES The program is assessed to be a failure but we in the State team know that we have not been supported by all the partners to fully bring out the best in us' We may act dumb sometimes but that dose not make us dummies WEAKNESSES: Our weaknesses seem to be many and include: 1. Lack of commitment of all implementers of CDTI 2. Inadequate grasp of cDTI implementation processes by SocTs 3. Lack of support for CDDs 4. Inadequate support by policy makers 5. Frequent change of policy makers 6. Inadequate community involvement 7. Inadequate counterpart funding by all tiers of government 8. Non involvement of CBOs and lack of collaboration 9. Poor tVEducation and mobilization 10. Poor supervision hence poor reporting and record keeping 1 1. Inability to collect drugs early from Lagos due to delay in release of funds, among other things. It may be necessary to change the Coordinator of the State team just so that we will see if things could move ahead for the benefit of the masses at the end of the line in the communities. I hope this may relax the already very tense state in the project. Though the '/o Coordinator dose not assess herself as being incompetent' She' however dose not See any clear success of the program since the inception of the new Director' Though a few of the SOCTs are enthusiastic about the success of the program they lack the articulation and stamina that the .DTI program requires. There might be need for complete overhaul of the State team. The principar officers in the state Min of Health are mobilized to participate on oncho LGA mobilization exercises. More communities have understood the concept of the .DTI and are morewillingtosupporttheprogram,seeingtheusefulnessoftheirfullparticipationinthe success and sustainability of the program' More communities now collect their drug from an agreed center, help in distribution' supervise all IDp related activities and support the CDDs by giving them various incentives' The state govenrment is still making plans to make funds available for the collection of capital equipment that have been lying in Lagos' Some of the major achievements of the project include: * Creation of more awareness of communities to determine ownership of the program through the initiation of the cslu/sH meetings in the CDTI LGAs' * Empowerment of communities to determine their health needs' they can now come together and through dialoguing for GDTI activities also consider other health needs' * Empowerment and motivation of the SOCT and LOCT to more effectively execute their assignment. The constraints and challenges of the next treatment cycle are: 4t JAREA OF IMPROVEMENT o There is need for increased advocacy to all tiers govemment by the extemal parfrrers and the NGDOs. This it is hoped would increase the political will of the govemment. 0 More supervision of the community activities of Oncho control by the SOCTs. t Increased mobilization and tV Education of the communities. o There should be early and faster means of release of fund to the project. t The Directors of PHC or Medical and Health Services should be made to attend review meetings or other meetings where the program's implementation is deliberated. r The Unicef Project Officer in Enugu, in charge of Oncho, should be made to better understand Apoc's philosophy, mode of operation and the difference between Unicef and APOC technical approach to implementation and accounting system. Coordinator: Director: Perm.Sec. ( u SlGt{EO i/,02 ..t Ilo( tuZt --,-. ,EiMrr*r el Hr' "r r. 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