Edo/Delta CDTI project final 4th year technical report: 1st June 2002-31st May 2003

I v FINAL 4TH YEAR TEGHNICAL REPORT COUNTRY/NOTF PROJECT NIGERIA NOTF EDO & DELTA STATES APPROVAL YEAR: LAUNCHING YEAR: 1t' JUNE 1 999 1t' JUNE 1999 YEAR BEING REPORTED PERIOD BEING REPORTED: 4,, YEAR REPORT PREPARED N: .6r' JUNE 2003. Resubmitted to NOCP on 5/9/03 E 2002 - NGDO PARTNER: THE CARTER CENTER NIGERIA / GLOBAL 2OOO. 12 MONTHS 11tr JUN 31sr MAY 2oo3 SUBMITTED TO: NATIONAL ONCHOCERCIASIS TASK FORCE & j-;; " '']l* oNcHocERcrASrs coNTRoL (APOC) , /\ .,/ ? tclll cop} i csb i{i v:CoP i $tt r i E, r., srH SEPT. 2003. t't'i"eu'- $lR- t-.; RECU I 6 SEP, 2003 POc/DlRA I * TABLE OF CONTENTS Page numberS/No Desc ,ion 6 7 Cover page Table of contents iLiit of adii,nvins -i-_.__ -- -:---- __--- Map of Edo and Delta States showinng endemic areas ' rieiutive iummiry - SCction i . a"".fgfq.,r1o. ip.1o1ma1ion l poflujeti.qn- ot terget a1et.. . .. i General information / description of project area, table 1 - Sictron lt' , impiemeniaiion oi CDTi: taote i -:- - - - - - - Mectizan lnventory: table 3 - capJcity nuiioing: ianie 4 : nao6iliiaiion a heattn eoucation, taute 5 Status of equipment, table 6 ' rreitment acn revem6 nls,' Coveia ga;, si oe etreCts. refusals and absentees; table 7 i SeCtionlii iSupport io cDrt, tinte t i...-- -- : Cost per activity, table 2 i.s,gt,,,.lV.......................-..-. i Sustainability / financial support in Edo and Delta States i LGA support in the two States, Tables 1 (a), (b) i Village level support in the two States, Tables 1(c ),(d) 1 2 3 4 5-6 7-9i 8-9 10-ro 1o-Ti 11-12 i-tq 15-io 16 ti-rc 8. I 1o 11 12 13 15 16 17 Annexure 4 (a&b) : Communily setl 0.o1'j!p_fLng_, TAFt.e ? (e),(Q) 18 General discussions: strengths, weaknesses, ; conglrglnts, challenges and help needed19 ',, Annexures: Annexure i i T5nie ofsx-montnVireatments ouring tnetourtn vedr ........i Annexure 2 i Timeline of activities executed in the fourth year in the (a & b) | two States: -, - - - - -z - - - - - - - -i- Annexure 3 Record of total yearly treatments in the two States' 19 ie 20-22 zlo 20 20-21 21 -22 22-24 22 -24 25 2a-zl 28 -29 so-gi ppiegt frqr lnqepltpn gplq P9-99rrb9r 2oo2 , Timetine ot iCtivities ptanneO foi 5th yeir in tne two i States. 2 I t NOTF NOCP ZOTF APOC WHO LCIF GRBP LGA SMOH FMOH NGDO CDTI CDD SOCT LOCT DHS HFS SHM CSM ATO SAEs ACRONYMS National Onchocerciasis Task Force National Onchocerciasis Control Programme, Nigeria Zonal Onchocerciasis Task Force African Programme for Onchocerciasis Control World Health Organization Lions Clubs lnternational Foundation Global 2000 River Blindness Program / The Carter Center Local Government Area State Ministry of Health Federal Ministry of Health Non-Governmental Development Organization Community Directed Treatment with lvermectin Community Directed Distributor State Onchocerciasis Control Team Member Local Government Onchocerciasis Control team member District Health Su pervisor Health Facility Staff Stake-holders' meetin g Community self monitoring Annual treatment objective Serious adverse events 3 IEDO STATE Ih pcr Fndtrnic I il \s t}EtTA STATH EAST EtSlf0 tt'r"ia, NDOKWA EAST tH KEY 4 UHUNMWODE l\Ieso Entlenric [,G't'. Hrpo Enderuir: LG'\s T I I Statr- lloundary , EXECUTIVE SUMMARY Edo/Delta NOTFA/VHO/APOC CDTI project commenced operations under APOC sponsorship on 1=tJune 1999.21 endemic LGAs (12in Edo stateand I in Delta state) are under APOC's sponsorship. During the period, advocacy and mobilization visits were undertaken at different times and at ditferent levels to top functionaries in 21 endemic LGAs as well as their villages in the two States. Separate teams of SMOH officials, Global 2000 officials, NOCP B-Zonal Coordinator, LCIF Sightfirst Chairman and other appropriate officials conducted the visits, which were aimed at securing support for sustainability of the programme. Mobilization and health education of villages were carried out in the entire 1,000 endemic villages in the two States. The following activities were carried out in the project. 1. CDTI implementation was successfully carried out in 523 out of 530 endemic villages in Edo and 464 out of 470 endemic villages in Delta State respectively, totalling 987 villages. This is the number of villages which collected their drugs, decided on the timing of distribution. Nevertheless all the endemic villages selected and had trained CDDs. However in terms of compensation, 72 villages (15.3%) out of 470 villages in Delta and 132 villages (24.9o/o) out of 530 villages in Edo state, respectively compensated CDDs within the reporting period. See section ll table 2 and Section lV tables 1(b) and 2(b). 2. Trainings were conducted for the following field personnel: 9 SOCTs (4 in Edo and 5 in Delta), 105 LOCTs (60 in Edo and 45 in Delta), 105 DHS (60 in Edo and 45 in Delta); 210 HFS (120 in Edo and 90 in Delta), and 2,106 CDDs (1176 in Edo and 930 in Delta). See Table 4(a-d) in section ll. Twenty one Primary Health Care (PHC) Coordinators were also trained in the two states. Trainings were additionally organized for relevant personel in the two States on CSM and SH.M activities. ln Edo Siate, 3 SOCTs, 44 LOCTs and DHS were trained. ln Delta state, 2 SOCTs and77 LGA otficials made up of LOCTs, DHS and HFS participated in the trainings. During the fourth year, Delta State Oncho Unit was reorganized leading to the injection of four new SOCTs to the programme. However, one of the new SOCTs, a medical Officer, was appointed as the State Project Officer with effect from 1't October 2002. Edo/Delta project Secretary participated in an APOC-sponsored training on data management / Health-mapping, held in February 2003 at Lagos, Nigeria. 5 , I 3. Mectizan treatments were carried out in 987 villages of 21 LGAs in both States (523 villages in Edo state and 464 villages in Delta). ln all' 1,006,586 persons were actively treated with 2,900,689 tablets of Mectizan out of a population of 1,329,731 persons. This treatment gave a geographical coverage of 98'7% and therapeutic coverage of 760/o for the twelve months, from June 2OO2lo 31"t May 2003' (see table 7 in section ll. Treatment updates were achieved.in ovia Northeast owan East and Uhunmwode LGAs in Edo State and Aniocha-North LGA of Delta State, over the treatment figures reported during the first six months of the fourth year. The number of peoiie that were absent as well as refused treatment amounted lo 117,876 persons in the two States, while minor reaction stood at 1,695 persons. There were no serious adverse reactions/events (SAEs). See details on table 7 in section ll' 4. Mectizan distribution could not be carried out in 13 villages (7 in Edo and 6 in Delta) due to communal crisis in some areas. CDDs' disinterest in the programme due to lack of incentives also hindered treatment in some areas. Efforts would however be made to ensure that treatment is carried out later in these 13 villages and to attempt to reduce the number of refusals and absentees in future treatments. 5. An update population exercise of the target villages was done during the period as directed by NOTF. The outcome was that previous figures went up by 58,738 persons, from 1;264,993 in 969 villages lo 1,323,731 in 1,000 endemic villages. 6. Comparatively during the third year that ended 31"t May 2002, a total of 959,612 persons were treated in the two States in 969 villages, out of a population figure of 1,274,993 persons. The third year coverage were 75.2% for therapeutic and 100o/o geographic coverage. 7. For information only, Mectizan treatments were also carried out passively in hypo endemic villages in the two States, during the reporting period. A total of 150,268 persons were treated with 427 ,024 Mectizan tablets in 378 hypo endemic villages in the two States. However, details of these treatments are not part of this report. 8. Follow up on TCC commendations: At its fifteenth session, TCC recommended that the project should do a research proposal on "The issue of incentive to CDDs"; and an examination of the rate of refulsals and absentees over time in relation to the statement that "it may be due to. post-honeymoon effect". Our proposal will be forwarded in a separate mail. 6 I (- I SECTION' 1. BACKGROUND INFORMATION Table 1. Figures of recently updated population of endemic villages in Edo and Delta States (a) DELTA STATE: :tiGAs HYPer* endemic v.lllagts ,:::iil:l:il MesG::::: ondemic,' vlltago$:': .::::::,,',,,.',,,, :Total. NumUer qf, Erdqmlc Villages :: , :Updated .',:,: ::c,erisus pop. i. i:of endernlc ': : vlllages Aniocha North 50 0 50 70,003 Aniocha South 62 0 62 66,472 lka North East 46 0 46 62,474 lka South 0 65 65 63,203 5 Ndokwa East 0 54 54 62 I 786 6 N{okwa West 0 41 41 52,321 Oshimili North 57 0 57 70,009 Oshimili South 46 0 46 64,294 Ukwuani 49 0 49 74,057 DELTA TOTAL 310 160 470 585,619 $No b EDO STATE 1 2 3 4 7 8 9 1 3 4 5 6 7 8. 57,093 71,245 75,415 43,589 61,175 I 10 11 12 Akoko-Edo 47 0 47 107,493 2 Esan Northeast 37 0 37 50,706 Esan Southeast 0 36 36 Esan West 55 0 55 Etsako East 0 55 55 82,810 Etsako West 0 36 36 lgueben 0 40 40 49,922 Ovia Northeast 45 0 45 51,211 Ovia Southwest 59 0 59 47,868 Owan East 38 0 38 Owan West 40 0 40 Uhunmwode 0 42 42 39,585 EDO TOTAL 321 209 530 738,112 EDO / DELTA TOTAL 631 369 1,000 1,323,731 7 GENERAL INFORMATION Description of the project: Edo and Delta States (both formerly called Bendel State) are in the Mid-western part of Nigeria. They have 43 Local .Government Areas, and a combined total population of 4,730,029.(1991 census), in an area of about 39,000 square kilometers. Both states were carved out of Bendel State in August 1991. The two states are among the youngest states in the country. Edo and Delta states still retain the original boundaries of Bendel State except for minor adjustments. They are bounded to the North by Kogi and Benue States; to the West, by Kwara and Ondo States; to the East by Anambra and lmo States; to the South and Southwest by the Bight of Benin on the Atlantic coast Edo State has 18 Local government areas of which 12 are meso/hyper endemic, while Delta state has 25 Local government areas of which 9 are meso/hyper endemic. This report covers 12 months' operation in the fourth year implementation under APOC sponsorship. The two states lie approximately between longitudes 5o East and 60o 45' East and between Latitude 5o North and 7o 30' North. The area is generally low lying except towards the North, where there are some highlands, which form the old Afemai/Kukuruku hills. The coastal belt is interfaced with rivulets and channels that form the Niger Delta. The existence of many rivers in both States particularly rivers like Osse, Siluko, Okomu, Ossiomo, Ojirami, Jamieson, Oke and their tributaries and Niger, Koko to mention but a few, provide fast flowing rivers and streams that are ideal for the breeding of blackflies. The vegetation varies from the impenetrable mangrove swamps along the coast, relieved Northwards, by a wide belt of deciduous and evergreen forest and terminated by Savannah in the North The three vegetation belts are prominently noticeable as one travels from the South to the North. The two States enjoy a tropical blimate that is marked by two distinct seasons of dry and rainy seasons. The dry season is from November to April, while the rainy season is from April to October. However, there exists a brief dry spell in August commonly referred to as 'August break'. From December to February, the dry harmattan wind blows over the States. During the rainy season some of the rural roads leading to at-risk. villages are not accessible thus making Onchocerciasis activities difficult to execute. The project area spans the North and East area of Edo State, while in Delta State, it covers the Northeast and South. I Farming, fishing, trading and office work are the major occupations of the inhabitants of the two States, and they live in permanent settlements and practice a communal system of living. However, during farming periods, some live nomadic lives as seasonal migrants. Authority is vested on any person chosen by the entire people of the environment. The person so chosen becomes the leader and administers authority over others. Partnership APOC is the current lead sponsor of the programme in Edo and Delta States, in collaboration with The Carter Center/Global 2000 as technical supervisors, and Lions Clubs lnternationai Foundation (LCIF). From June 2QO2lo November 2002, (first six months of year 4), Mectizan distribution was carried out in 422 villages of 10 LGAs in the two States. A total ol 421,516 persons were treated with 1 ,112,535 tablets of Mectizan. During the second half of the fourth year (Dec. 2OO2lo May 2003), 585,070 persons were treated with 1,788,134 Mectizan tablets in 565 villages of 11 LGAs in the two States. The total population of the 21 focus LGAs was 1,323,731 persons. See annexure 1 for details. Annexure 3(a) and (b) also contains yearly data of treatment and therapeutic coverages from inception of the project in 1993 to 2002. I SECTION II a DELfA STATE b EDO STATE TABLE 2 - IMPLEMENTATION OF CDTI S/No Names of LGA No. of Villages in LGA No. of Villages which selecte d CDDs No. of Villages which collected druqs No. of villages that decided on method of distribution No. of villages which decided on month of tx No. of villages with trained CDDs No. of villages paying CDDs in cash or in kind 1 Aniocha North 50 50 50 50 50 50 15 2 Aniocha South 62 62 59 62 2359 59 3 lka Northeast 46 46 46 46 46 46 13 4 lka South 65 65 65 65 65 65 10 5 Ndokwa East 54 54 51 51 51 54 4 b Ndokwa West 41 41 41 41 41 41 0 7 Oshimili North 57 57 57 57 57 57 0 8 Oshimili South 46 46 46 46 46 46 7 I Ukwuani 49 49 49 49 49 49 0 TOTAL 470 470 464 464 464 470 72 S/No Names of LGA No. of villages in LGA No. of villages which selected CDDs No. of villages . which collecte d drugs No. of villages that decided on method of distribution No. of villages which decided on month of tx No. of villages with trained CDDs No. of villages paying CDDs in cash or in kind 1 Akoko Edo 47 47 47 47 47 47 23 2 Esan Northeast 37 37 37 37 37 37 11 3 Esan Southeast 36 36 36 36 36 36 15 4 Esan West 55 55 51 51 51 55 20 5 Etsako East 55 55 55 55 55 55 0 b Etsako West 36 36 36 36 36 36 15 7 lgueben 40 40 40 40 40 40 0 I Ovia Northeast 45 45 45 45 45 45 13 I Ovia Southwest 59 59 56 56 56 59 16 10 Owan East 38 38 38 38 38 38 6 11 Owan West 40 40 40 40 40 40 0 12 Uhunmwode 42 42 42 42 42 42 13 TOTAL 530 530 523 523 523 530 132 10 Summary of lmplementation STATE iNq. of .:: .,,yilligeE :lirylrictl ,,,,1$o,, ofii vitlages ;i Which colkctad ::i.:illO.f0g$::::: :!: ::iii:1::-,i!1:,1-,,, --Nout : ::ylllsgeE that d_eeiddd.6n methodof distribirtion, :::.Nb. qf. villgge+:i ::with :. .liained .:::ODD$, FJ€l:!f village+ 'peyius cDDs,ln casli:pl in ki*d: ,, DELTA 470 470 464 464 464 470 72 EDO 530 530 523 523 523 530 132 TOTAL 1,000 1,000 987 987 987 1,ooo 204 Table 2 shows that72 villages in Delta State and 132 villages in Edo State were paying CDDs in cash or kind during the fourth year. This represent 15.3o/o and 24.9% respectively for Delta and Edo States. Outside this, 523 and 464 villages in Edo and Delta states (totalling 987), collected drugs, decided on the timing of treatment, selected and have trained CDDs. Ordqr- stalqe and deliverv of Mectizan tablets The NGDO - (The Carter Center/Global 2000) is responsible for ordering and taking delivery of'Mectizan tablets. A total quantity of 3,231,500 tablets of Mectizan were received by the two States for the 2OO2|20O3 operational year. A total of 2,900,689 tablets have been distributed leaving a balance of 325,211 tablets towards the next distribution cycle. Table 3. Mectizan lnventory: (June 2OO2lo May 2003) S/No lndividual LGA Number of Mectizan tablets Received Losf Used wasted ln the field ln the Store Delta State 1 Aniocha North 149,500 139,999 0 9,501 2 Aniocha South 175,000 161,976 0 13,024 3 lka Northeast 130,000 118,734 0 11 ,266 4 lka South 140,000 140,000 0 0 5 Ndokwa East 185,000 164,829 0 20,171 6 Ndokwa West 170,000 149,921 0 20,079 7 Oshimili North 175,000 172,147 0 2,853 I Oshimili South 170,000 165,814 0 4,186 I Ukwuani 177,000 175,000 0 2,000 For hypo LGAs 80,000 0 0 80,000 0 DELTA TOTAL 1,551,500 1,388,420 0 163,080 0 11 . .: iil'-- r:' lt{Q,,ut:.,:i rn-€sd ,,,i,hYPgr .,: ::endemici: ,:,VIltaoes, N0i:of,,,::. :vil[agqs .. \rtrrlch: .,:ii decided,.on ,.montfr of ' ,.:ireatmen* S/No lndividual LGA Number of Mectizan tablets Received Used Lost / wasted ln field the ln the Store Edo State 1 Akoko Edo 165,000 155,000 0 10,000 2 Etsako East 175,000 170,000 0 5,000 3 Etsako West 130,000 1 19,900 0 10,100 4 Owan East 135,000 132,001 0 2,999 5 Owan West 1 10,000 93,291 0 16,709 6 lgueben 100,0.00 92,950 0 7,050 7 Esan Southeast 155,000 150,000 0 5,000 I Esan West 158,000 155,000 0 3,000 I Esan Northeast 120,000 109,465 0 10,535 10 Ovia Northeast 1 10,000 106,604 0 3,396 11 Ovia Southwest 115,000 1 10,000 0 5,000 12 Uhunmwode 120,000 118,058 0 1,942 For hypo LGAs 81,400 0 0 81,400 EDO TOTAL 1,674,400 1,512,269 0 162,131 GRAND TOTAL 3,225,900 2,goo,6gg 0 325,211 S/No Names of LGA No of Trarnrng undeftaken Number of TOTs Trarned (SOCTS) No. of LGA staff trarned on CDTI (LOCTS) No. of Distrrct or Health Centres / Post Staff Trarned (DHS & HFS) No of CDDs Trarned (a) DELTA STATE 1 Aniocha North 2 1 5 15 II I 129 2 Aniocha South 2 1 5 1 5 116 3 lka South 2 1 5 15 109 4 lka Northeast 2 1 5 15 130 5 Ndokwa East 2 1 5 15 146 6. Ndokwa West 2 1 5 15 114 7 Oshimili North 2 1 5 15 82 8 Oshimili South 2 1 5 15 I I 46 o Ukwuani 2 1 5 15 58 Total 2 5 45 135 930 TABLE 4: Capacity building TRAININ9 OF DIFFERENT LEVETS OF STAFF INVOTVED IN CDTr Note: The LGAs under treatment are shared between the available SOCTs 12 (b) EDo STATE Note: LGAs under treatment are shared between the available SOCTs SUMMARY OF TRAINING CARRIED OUT IN THE TWO STATES IN 4TH YEAR $TATE Na- {f Tralnlngl :ullder$lcn N6.ofTOTs trilned {sQcT$} : .o-:{q I staffqei , Q$,cq tupcT GA r!+{ rlii: i1::' No- of :tlralth :: cenEr glaff ':: tralned f,n cpIt(oH$. HFSI ,. r*+ qr cDss tfaihad .: DELTA 2 5 45 135 930 EDO 2 4 60 180 1,1 76 TOTAL 2 9 105 315 2,106 The targets and percentage achievement for training of different levels of personnel during the twelve months were as follows: (c) Edo/DEIta Project S/No Category of health worker Target Achievement otto 1 SPOs 2 2 1 00% 2 SOCTs 10 I 90% 3 LOCTs 105 105 100Y0 4 PHC Coordinator 21 21 100% 5 DHS & HFS 315 315 1 00% S/No Names of LGA No. of Training undertaken No. of TOTs trained (SOCTS) No. of LGA statf trained on CDTI (LoCTs) No. of Distrrct or Health Centres / Post Staff Trarned (DHS & HFS) No of CDDs trained 1 Akoko-Edo 2 1 5 15 102 2 Esan Northeast 2 1 5 15 99 3 Esan Southeast 2 1 5 15 105 4 Esan West 2 I 5 15 129 5 Etsako East 2 1 5 15 120 6 Etsako West 2 1 5 15 69 7 lgueben 2 1 5 15 79 I Ovia Northeast 2 1 5 15 111 I Ovia Southwest 2 1 5 15 I 2 1 10 Owan East 2 1 5 15 68 11 Owan West 2 1 5 15 80 12 Uhunmwode 2 1 I 5 15 93 Total 2 4 60 180 LL76 13 b CDDs 2,300 2,106 91.5% Tota! 2,753 2,558 92.9% NOTE: ln addition to the data reported in the foregoing tables, targeted trainings were organized for persnnel found to be deficient in the 21 LGAs under CDTI. Such trainings are aimed at increasing their understandingoftheAPOCCDT|concept. lnthiswise,3SOCTs,44LOCTsandDHSweretrainedfrom the two States, on the methodology of conducting CSM and SHM activities. lt was hosted in the office of Edo State Ministry of Health. A similar training was exclusively carried out in Delta State during the reporting period for CSM and SHM activities. 2 SOCTs, 77 officials from endemic LGAs (made up of LOCTs, DHS and PHC Coordinators) participated in the workshop. The Director of Delta State Primary Health Care/Disease Control was in attendance at the training. A reorganizion of Delta State Oncho Unit led to the injection of four new SOCTs to the programme, while three old hands were withdrawn. However, one of the new SOCTs a medical Officer, Dr. Paul Yinkore, was made the State Project Officer with effect from 1st October 2002. Apart from informal trainings, a formal training was conducted for the new SPO in December 2002, The under-listed materials which were developed and produced by the project, with APOC funds, were used in he course of all training of CDTI personnel, and for the mobilization of village leaders. 1. lnformation brochure for CDDs 2. Calendars 3. Newsletters of project activities 4, T-shirts inscribed with APOC / WHO logo 5. Flip charts for SOCTs and LOCTs 6. Posters for use by SOCTS, LOCTs, CDDs and for placement in village leaders' houses; 7. CDTI training manual for SOCTs and LOCTS. The Project Secretary participated.in an APOC-sponsored training on data management / Health mapping held in February 2003 at Lagos, Nigeria. 14 TABLE 5: MOBILIZATION & HEALTH EDUCATION (a) DELTA STATE (b) EDO STATE S/No Names of LGA No. of Villages Mobilized No. of Target Villages which received Health Education No of Advocacy visrts to State / LGAs by SMOH No. of MOH Staff involved rn Mobilization No. of NGDO Staff rnvolved rn Mobilization 1 Aniocha North 50 50 1 4 3 2 Aniocha South 62 62 1 4 2 3 lka Northeast 46 46 1 4 2 4 lka South 65 65 1 4 3 5 Ndokwa East 54 54 1 4 2 6 Ndokwa West 41 41 1 4 2 7 Oshimili North 57 57 1 4 3 8 Oshimili South 46 46 1 4 2 I Ukwuani 49 49 1 4 2 TOTAL 470 470 I 4 3 S/No Names of LGA No of villages mobilized No. oftarget villages which received H/E No of Advocacy visits to State / LGAs by SMOH No. of MOH staff involved in mobilization NO ofNGO staff rnvolved in mobrhzation 1 Akoko-Edo 47 47 2 5 2 2 Esan Northeast 37 37 2 3 3 3 Esan Southeast 36 36 2 5 2 4 Esan West 55 55 2 5 2 5 Etsako East 55 55 2 5 2 6 Etsako West 36 36 2 4 2 7 lgueben 40 40 2 4 2 I Ovia Northeast 45 45 2 4 3 I Ovia Southwest 59 59 2 4 3 10 Owan East 38 38 2 5 2 11 Owan West 40 40 2 3 2 12 Uhunmwode 42 42 2 5 2 Total s30 530 24 5 3 15 SUMMARY TABLE OF MOBILIZATION & HEALTH EDUCATION ST.ATE... ':' No;.df '':' : No.. Nouot.trtOH :"staff involv+d:::: ,in mohtlizatign:: .: :i i---ll'::. i -l--- ,,:Ne. of,NGO' i"stafl involvedi " irr i:',, : 'mobilizaitiqn DELTA 470 470 9 4 3 530 530 24 5 3 TOTAL 1,000 1,000 EDO COMMENTS: 1. 1,OOO endemic villages in the two States were mobilized for treatment during this reporting period. The strategies used in the course of the mobilization, included: Radio/television discussions; Jingles; meetings with LGA officials and information department; Stakeholders' meetings; News talks, Face to face discussions with leaders, village town criers. Above all, aggressive efforts are being made for the inauguration of CSM and SHM in several communities/villages in the two States. 2. Advocacy visits were made to LGA policy makers and the PHC Coordinators, Village leaders, Opinion leaders and Community based organlzations, etc. 3. Ministry of Health & NGDO staff were also involved in CDTI mobilization and Health education Table 6: Status of e ui Comments/recommendations :1. lt is hereby confirmed that all the equipment as approved for the project have been received from NOTFAI/HO Nigeria.2. lt is to be noted that one motorcycle was reported stolen from the Stores of lka South Local Government of Delta State, in March 2002. The matter was reported to the Police and, so far all efforts to recover the motorcycle has not yielded fruit.3. All vehicles and equipment in the project are placed under preventive maintenance contract to ensure their optimum performance at all times. The 4WD hilux vehicles are under comprehensive insurance cover. However, arrangement is on hand to repair or refurbish the non-functional equipment, as may be deemed appropriate. 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SECTION III: Table 1: Support to CDTI Financial contributions of the.partners and Villages from 1999 (N100 = US$1.00) Table 2: Gost r activ SECTION lV: SUSTAINABILITY Table 1: Financial support from LGAs The figures quoted below are those contributed in the current operatiohal year Contrrbutor Year 1 (1999-2000) Year 2 (2000- 2001) Year 3 12001-2002 Yea 4 (2002-2003) Total budget (US$) Total released (US$) Total budget (US$) Total released (US$) Total budget (US$) Total released (US$) Total budget (US$) Total released(us$) Ministry of Health 0 0 0 0 0 0 0 0 NGDO partner 21,438 21,438 25,661 25,661 59,562 59,562 87,074 78,479 LGAs 0 5,485 0 '12,630 0 105,400 0 7,620 Villages 0 930 0 '1,080 0 36,832 0 1,437 APOC trust fund 151,900 151,900 125,043 111,183 108,859 104,621 105,441 102,941 Total 173,338 179,753 150,704 150,554 168,421 306,415 192,515 190,477 Activity Estimated cost ($ US) Spurce of funding Drug delivery from NOTF hqr. area to central collection point of community 6,000 Global 2000 Supervising CDDs and distribution 0 0 Advocacy visits to health and political authorities 0 0 Mobilization and health education of Villages 3,911 APOC Training of CDDs 6,723 { IEC materials 5,934 ( lnternal monitoring of CDTI activities 6,021 la Review Meetings 6,346 ta Supplies 3,624 I' Travels 39,878 Communications 18,358 Personnel cost 82,754 APOC & Global 2000 Others I2,160 Total $181,709 aa 19 1.(a) Edo state: LGA level su rt to CDTI I (b ) Delta State: LGA level s ort to CDTI Comments: In Edo State 8 LGAs supported CDTI prograrnme with a total sum of N300,000.00 while in Delta State, 5 LGAs supported with the sum of N462.000.00 I Edo state: Vill level su to CDTI S/No LGA Amount contributed (Naira) 1 Akoko Edo 20,000.00 2 Esan Northeast 0 3 Esan Southeast 100,000.00 4 Esan West 35,000.00 5 Etsako East 0 Etsako West 0 7 lgueben 20,000.00 8 Ovia N.E 30,000.00 9 Ovia S.W. 45,000.00 10 Owan East 0 11 Owan West 30,000.00 12 Uhunmwode 20,000.00 Total F+300,000.00 S/No LGA Amount contributed (Naira) 1 Aniocha North 150,000.00 2 Aniocha South 32,000.00 J Ika Northeast 60.000.00 4 Ika South 100.000.00 5 Ndokwa East 0 6 Ndokwa West 0 7 Oshimili North 0 8 Oshimili South 0 9 Ukwuani I20,000.00 Total !I462,000.00 SA{o LGA No. of villages in LGA No. ofvillages that pay CDDs No. of CDDs compensated Amount released (N) 1 Akoko Edo 47 23 23 10,000 Esan West 55 20 10,00020 3 Esan N/east 37 ll 5 5,500 4 Esan S/east 36 l5 20 5.000 5 Etsako East 55 0 00 6 Etsako West 36 t5 l5 7.500 7 lgueben 40 0 0 0 I -Ovia N/East 45 l3 23 19,820 I Ovia SMest 59 l6 25 8.000 10 Owan East 38 6 () 5.800.00 11 Owan West 40 0 0 0 12 Uhunmwode 42 l3 Itt 7600.00 Total 530 132 158 N79,220.00 20 a SA.{o LGA No. of villages in LGA No. ofvillages that pay CDDs No. of CDDs compensated Amount released 1 Aniocha North 50 l5 20 2 Aniocha South 62 23 l5 3 Ika North East 46 13 l5 I 1.400.00 4 Ika South 65 10 l8 r6,000.00 5 Ndokwa East 54 4 5 9,000.00 8 Oshimili South 46 7 27 6 Ndokwa West 4t 0 0 0 7 Oshimili North 57 0 0 0 I Ukwuani 49 0 0 0 Tota! 470 72 100 N89,850.00 1(d) Delta State: Village ldvel support to CDTI 12,000 00 14.000.00 27.450.00 Comments: In Edo State, 158 villages compensated 135 CDDs with a total of It79.220.00 rvhile in Delta State, 72 vrllages supported 100 CDDs with a total sum of FI89.850.00. Table 2 : Comm Self-monitorin in Edo State SA.,lo Name of LGAs Total # of villages in the meso/hyper endemic areas No. of Communities that carried out self monitoring No. of Communifies that conducted stakeholders meeting 01 Akoko-Edo 47 0 2 Esan Northeast 37 0 0 3 Esan Southeast 36 0 0 4 Esan West 55 0 0 5 Etsako East 55 0 0 6 Etsako West 36 0 0 7 lgueben 40 0 0 8 Ovia Northeast 45 0 0 I Ovia Southwest 59 0 0 10 Owan East 38 0 0 11 Owan West 40 0 0 12 Uhunmwode 42 0 0 Edo Total 530 0 0 21 Table 2: Self-monito in Delta State Comments: Community self-monitoring has started in Delta State and 140 villages carried out self monitoring of the CDTI programme in their areas during the fourth year. However, in Edo State, CSM is yet to commence, but necessary mobilization have been carried out towards its take-off. Section V A. GENERAL DISCUSSIONS: The financial contributions from Local Government Councils in the two States are used to augment logistics support for CDTI activities, according to LOCTS. These include fuelling, support for training and mobilization, monltoring and supervision of Mectizan distribution in their areas. The Local Government Ccuncils' top functionaries determine the timing and utilization of the money provided by their LGAs B. STRENGTHS (EDO & DELTA STATES) 1. Availability of Mectizan tablets to the two States. 2. Demonstration of desired interest and commitment by sonie LGA policy makers. 3. The financial support of some LGAs enhance CDTI activities in such areas; 0 No. of Communihes tha conducted stakeholders meetingSAJo Name of LGAs Total # of villages in the meso/iryper endemic areas No. of Communities that carried or,it self monrtoring 50 20 01 Aniocha North l5 02 Aniocha South 62 46 l0 03 lka North East 04 lka South 65 t2 05 Ndokwa East 54 9 41 3 06 Ndokwa West 7 Oshimili North 57 34 0 08 Oshimili South 46 ll 0I Ukwuani 49 26 0Delta total 470 t40 140EDO / DELTA GRAND TOTAL 1,000 22 45 6 7. c 1. 2. 3 D 1. 2. 2. The motorcycles provided by APOC & NGDO enhance monitoring and supervision of CDTI by the LGA staff; Some villages are appreciative of their involvemenUownership of the programme. Some CDDs are committed to high productivity and they maintain fairly accurate records of treatment. The NGDO is dedicated and commited in support of programme activities. WEAKNESSES: (EDO & DELTA STATES) The non-release of counterpart funds from the State and some LGAs. The Onchocerciasis programme is regularly being compared by CDDs with other health programmes where incentives and government recognition is accorded them. This awareness contributes to discourage CDDs from exercising full commitment and dedication to CDTI programme. Some communities/villages are not willing to fully own the CDTI programme. CONSTRATNTS High cost of fuelling vehicles and motorcycles. Unwillingness by some villages to own the programme. High cost of maintaining capital equipment, vehicles and motorcycles assigned to LGAs. E. CHALLENGES 1. The inauguration of CSM and SHM activities in the endemic villages of Edo State and the intensification of same in Delta State where it has commenced. 2. lntensification of mobilization of village leaders to embrace the concept of ownership and community contribution towards CDTI. D. HELPS NEEDED: 1. FROM GOVERNMENTS OF EDO & DELTA SIAIES; l. Release of counterpart contributions to boost field activities ll. Dedicated involvement of SMOH officials in advocacy and mobilization visits to LGAs and Villages 23 2. FROM THE LGAS U,VDER TREATMENT l. Visible dedication and commitment to the success of CDTI programme in their domains. ll. Release of funds and logistic support to their staff to enhance CDTI activities. lll. Dedication of LOCTs for the achievement of CDTI objectives. 3. FROM APOC: l. There is need for timely release of fund from APOC as and when due. ll. A delegation of APOC and NOTF representatives should be constituted to pay a high level advocacy visits to Edo and Delta State Governments to highlight the importance of the States' counterpart contrlbution to the programme. 4. FROM THE NGDO PARTNER:- t. iirtore involvement in high level advocacy to the State and LGA functionaries ll. Relentless monitoring and evaluation of the programme 24 1 tt ANNEXURE 1 BREAKDOWN OF SIX-MONTHLY TREATMENT IN THE FOURTH YEAR Tablets in Store for next treatment 163,080 State Period No. of villages treated Population of treated villages Persons treated Mectizan tablets dispensed Delta June to November 2002 199 262,271 166,172 489,794 December 2002 to May 2003 265 323,348 295,1 05 898,626(a) sub totat 464 585,619 461,277 1,388,420 Edo June to November 2002 223 304,030 255,344 622,761 December 2002 to May 2003 300 434,082 289,965 889,508(b) Sub total 523 738,112 545,309 7,512,269 162,131 GRAND TOTAL FOR EDO & DELTA 987 villages 1,323,731 1,006,596 2,goo,6gg 325,211 25 (o N JLUOz r.tJ O:la9 LUZ o- Foo U) o o_ U) a o- oFooo o o- a)to =U) Foo U) o o-(t) a o_ Foo U) e(E = =o oo o o- U) a o_ (n -o 6 FooJ?Fooa o o-q) a -obFooJ aFoo U) o o- U) aIobFooJ aFoo(n o o-(n (t) :tro Foo) Foo U) o o- U) @ooo U)Io F() oJ Foo U) o o-(n (t)oo(J a -o FooJ Foo U) o o- U) oooo <ntL :tr U) -o oI = aFoo)bFoo U) o o_ U) U) =onFooJ aFoo U) o o- U) U) =obFooJ aFoo U) o o- U) Foo U) o o- U) a o_ o-oo z. ooo z. ooo(J U) =o FooJ Foo U) oooo a -o FooJ F Oo U) o o- U) aooO a -o FooJ F() o <D oLq) a o_ oooo FooJ Fooa o o-a oooo o - = al-ooJ?Fooa o o_a a o- o -o o) LL c(E -) o o E(0 I(t oo$t o @ o o E rO I(\t oo6t o o oz o o o- o @ o) ; = - o)c f -) ..iru, :i.i..:.u, '''iz 'a::::G ,,::{ ''i:.i:ln '1:lM ...:.:i:lk ..f- v! o 6 c 9J lf EeoI!1(E :Z0) o of6.9fre (1)9u 6 =EA- >.o}E(E IIto,-O- >E'l,-<6 c c) E c o cg c o .o E =o- Ec(5 C o o -oo6 o' .:C)c -_ otc) 9eo956C.ob E c oo oEoC o C o o)cE O)o o)o oII v U)(UF (E C oN oI o- oFo oJ uiFo oa o g) .c c 'd q)ua xLL CI6E E'(U '=a '6r FO o(I' c oo ITJ o) o)(U ; c o (E o =E t.lJ ! =o c)I Ec o C .9 c, .N E o o o) _o o o -Jo C G .N oq) o - o bo o .o o o) LI, o c o og o o oc(g o33 L) o o) =a =o(Uo)()= Y.> o) GE o- =c ,9 o ,9 c,)q) a aoc oo c o .N oo o c o -o .2 o C .o (I, c o E o E- E Fo o cIo E(D o_ o o)c o =c o E I o)o o) o)(U oFo oa oFo oJ r) .9 o - o o_ f a o- o oz oo oz -o c .9o E Q) o_ =a tt,q) oC o o -o o) f E E c o oE o o_ 0) o c .9 oq) o o ooo co oo(! o c o E (\, o o_ =I =o o LL o o -o(U c o .N o o o o)C C =ooo E oo o cq) E (\, o ECE o c o s o O Ec f o o) E (I, o x oC o C o (l, (\' o- o(I + ,..D .:::ltr N (f) $ l.r) @ N @ o) o N cr) s tr) @ F- @ q) (v)ooN G =o Noo C{ oc a I (E o r-tl. 6) TIJ =o.=tllo-< -oFJ R.g uJk KEFoq, trlor-otrUJ; f o !, G) (g o o o, 't o o otr o tr i= N UJtfx ulzz o .Ni8IN NJr.tl ozLu ofAU t.lt z. o- Fooa o o- U) ad oFooo o o- U)to =6 FOoa o o- U) aa Foo U) C(g =foCoo o o- U) ad a -QaF() o) aFoo U) oL6 a -oDFooJbFoo U) o o-6 U) -o FooJ Foo U) ooa oooo U) -o Foo{Foo U) oL6 oooo U) -o FooJ Foo CD o o-6 oooo U) LL - U) =o o - aFoo) aFOo <./) o o-6 a -o .D F() oJ aFooa o o- a a -o aF() oJ aFoo U) o o- a Fooa o o-a a o_ o-ooz oo(, z ooo(J (t) =o FooJ Foo U) ooo(J a -o F C)oJ FOo U) o o_a c,ooo (n -o FooJ F(, .o U) oL U) a o_ oooo F(J oJ Fooa o o-a oooo oI = oFooJ aFoo <J) o o- U) a o_ a -o aFOoJ aF() o(,/) o o-(t) o : o n otl- c o --) o c o E @ I(, ooN TE o EH oz Poo o.q) a o) = > f - o Cff o ! 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