NGKG CDTI annual project Technical report submitted to Technical Consultative Committe (TCC): January to December 2006

-t- I I KOGI STATE NINTH YEAR ANNUAL TECHNICAL REPORT OF COMMUNITY DIRECTED TREATMENT WITH IVERMECTIN ORIGINAL: English I { COUNTRYAIOTF: NIGERIA Proiect Name: NGKG Approval vearz 1997 Launching year: 1998 Reporting Period: From: January 2006To: December 2006 Proiectvearofthisreport: (circleone)12 3 4 5 6 78(9 10 Date submitted: 13th January 2007 NGDO partner: Sight Savers International I I t +- L a ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) DEADLINE FOR SUBMISSION: To APOC Management by 31 January for March TCC meeting To q-^ nt by 31 July for September TCC meeting WHO/APOC, 24 November 2004 f}r s IL ff u E for Lrbnotlon T",JiA CBD$ For Action Tol qE Received It, JU|L, ?007 AHE/SDD/APOc &&-"r I 2 ilAns 200i Il_ t- f t* E" a- t I f - lll - ANNUAL 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 Y.**-. Zonal Oncho Coordinator Date: . .4fl Ip.z.l.*?.!7 National Coordinator .--) i\Name: .. .. .lAr.!:A&'.4r.1 =l:gtur<s@*rgnatureS ameN, ignatureS Date Signature Darc:3, This report has been Name:...D.J. Amdife Designation : State Coordinator. kr,t r 1K-[rlbt. t 2@? by I I I I il WHO/APOC, 24 November 2004 -lv- Table of Contents ACRONYMS...... DEFINITTONS.... FOLLOW UP ON TCC RECOMMENDATIONS.. EXECUTIVE SUMMARY SECTION l: BACKGROUND INFORMATION. ' I.I. GENERAL INFORMATION. 1.1.1. Desuiption of the proiect (brieJly).. 1.1.2. Partnership 1.2. POPLTLATION.,. SECTION 2: IMPLEMENTATION OF CDTI. 2,1. TIMELINE OF ACTIVITIES. 2.2. ADVOCACY,.... 2,3. MOBILIZATION, SENSITIZATION AND HEALTH EDUCATION AT RISK COMMUNITIES........ 2.4, COMMTINITYINVOLVEMENT 2.5. CAPACITY BUILDING 2.6. TREATMENTS.. . . v vi I .2 .3 ,.3 ,.4 .5 .,6 /. ..8 .8 .10 2.6.1. Treatment figures.... 2.6.2. What are the causes of absenteeism? ....... 2.6.3. lThat are the reasons for refusals? .-- -..... .- SECTION 4: SUSTAINABILITY OF. CDTI. 4.1. INTERNAL; INDEPENDENT PARTICIPATORY MONITORING, EVALUATION. 4. 1 . 1 . Was monitoring/evaluation carried out during the reporting period? . . . (tick any of the fotlowing which are applicable) 4.1.2. What were the recommendations?. 4.1.3. How have they been implemented?.....' .18 ..22 ..23 2.G.4. Briefly describe all lonwn and verified serious adverse events (SAEs) that 23 2.6.5. Trend of treatment dchieyement from CDTI projecl inception to the current year 23 2.7 . ORDERING, -STORECE AND DELTVERY OF IVERMECTIN. ....,24 2.8. COMMUNITY SELF-MONTTORING AND STAKEHOLDERS MEETING. .,....27 2.g. SUPERVISION.. ..,,..29 2.g.1. Provide aJlow chart of supervision hierarchy"' """ ""29 2.g.2. Ylthat were the main r,ssues identified during supervision?......... ...."29 2.g.3. Was a supervision checklist used? -.. "' ""30 2.g.4. What were the outcomes at each level of CDTI implementation supervision j0 2.g.5. Was feedback gtven to the person or groups supervised? "' ""'30 2.g.6. How was thefeedbackused to improve the overall performance of the project?....30 SECTION 3: SUPPORT TO CDTI' """30 3.1. EQUIPMENT...... ""'30 3,2. FINANCIAL CONTRIBUTIONS OF THE PARTNERS AND COMMUNITIES.. 31 3.3. OTHERFORMSOFCOMMUNITYSUPPORT".. "......,...32 EXPENDITURE PER ACTIVITY 3.4. l: tu- q. to .33 33 .33 ,,3 3 ..33 IE '1, WHO/APOC, 24 November 2004 4.2, SUSTAINABILITY OF PROJECTS: PLAN AND SET TARGETS (MANDATORY AT YR 3). 4.2.1. Planning and all relevant levels '.. 4.2.2. Funds... 4.2.3. Transport (replacement and maintenance) "' 4.2.4. Other resources... 4.2.5. To what extent has the plan been implemented"' 4.3. INTEGRATION.. 4.3.1. Ivermectin delivery mechanisms 4.3.2. Training... 4.3.3. Joint supervision and monitoing with other programs "' "' "" 4.3.4. Release offunds for project activities..' 4.3.5. Is CDTI included in the PHC budget?... 4.4 4.1.6. Describe other health programmes that are using the CDTI structure and how this was achieved. what have been the achievements?...........36 4.3.7. Describe others issue considered in the integration of CDTI ......36 OPERATTONAL RESEARCH. ... " .. .36 4.4.1. Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period... .......36 4.4.2. How were the results applied in the project? ...... ""'36 ..37 SECTION 5: STRENGTHS, WEAKNESS, CIIALLENGES' AI\D OPPORTUNITIES SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS... Problems. Recommendation ..37 .37 ..38 .L= t t"- F L I I f WHO/APOC, 24 November 2004 .. ......35 ....34 ....34 , ,..34 ,.,..54 .....3 5 ....35 35 35 ...36 ..36 .36 -vl- Acronyms APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT TJNICEF UTG wHo MIS LOCT African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Community-Based Organization Community-Directed Distributor Community-Directed Treatment with Ivermectin Community Self-Monitoring Local Government Area Ministry of Health Non-Governmental Development Organization Non-Governmental Organization National Onchocerciasis Task Force Primary health care Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Stakeholders meeting Technical Consultative Committee (APOC scientific advisory group) Trainer of trainers United Nations Children's Fund Ultimate Treatment Goal World Health Organization Management of information systems Local Onchocerciasis Control Team this pleascupdate accordinglv WHO/APOC, 24 November 20M -vll ' Definitions (i) l'otal population: the total population living in meso/iryper-endemis communities within the project area (based on RLIMO and ccnsus taking). (ii) [-'.lieible ponulation: calculatcd as 84ozir oI'the total populatiorr in mcso4*pc.r- endcnric communities in thc projecl arca. liiil i\ttnual 'l'rcatmenl Obiective : (A-l'O): thc cstimittcd nurnhrer ot' trrcrsons living in meso/hyper-endernic areas that a CI)'l I project intends to treat vvitlr iverrncctin in a given _vear. (iv) Ultirnatc 'lreatment Goal (U'I'C): calculatctl as the rnaxirnuur nurnbcr crl'peoplc tcr be treatcd annuallv in mcso,/hyper entlcnric arcas rvithin the pnricct arda. ultimatcl.v to he reachcc{ u,hcrr thc project lras ri:aclrctl lirll gcogragllric covcraqe (rtortttalll, thc projtct rIrrrtrl<l hc c\p('clc(l trr i'cach thr- t.-l (i rrt the cncl of'llro -]''l y'car ol- thc pro.j crct). (l) 'lhr't'aDeutic covelauc: ntrrnbr'r' rrl' llctrple treated rtt a g.ivrrr -\,r'lr' (',\'L't' lhc t(\t.ri population (this should bc explessed as a percentagc). (vi) (ieogranhical covcraec: numbcr ol comnrunities trcatcd iu ti ni,u'on y.'ear ovcr tlro total nurnbcr oI nrcsoihy'pcr-endcrrric c()rnulunitics as idcrrtilied b"," Itl:\,1O in thc projcct arca (tlris shoulcl bc cxprcsscd us a pcrccnta.u,e ). (vir) lnlcqralion: dclivcring adclition;rl lrcrltlr intcrvL-ntions (i.e . vrlamirr .\ supplemcnts. albcrtdazolc lol I.l'. scrcening lirl cataract. ctc.) through (lt)l'l (Lrsing thc samc s]-sL*lIls, training. sttpclisiott ilud personncl) irr ordel to rna-rinrisr-'cost- ellcctivcness and ernpower comnlunities ro solve ururc ot'their lrcalth probleurs. I'his <loes nol ittr:ludc trctivitics or intcrl'cntiorrs ctu'ri*rl orrl hv corrrmtrrrilr. clistributors outsicie ol' ('D l'1. ( viii) Sustaiuatrilitr,: (ll)'l I aclivitics in an area arc sustainalllg u,ht)ll tlrc,r crlrrtinrrc 1o Iitrtctirrn efl-cctivell filr thc ftrrcsccable luture" rvitlr high lrcatrncr.ll covcrilqr^ irttcgratcd inlo the availahlc hcallhcare scrvicc. rvillr stronu corrrrrrulrilv orvrrcrship. ttsing rest'rut'ccs nrobilisetl hy llrr.' conrurunill, ancl thc g()vcrnntcllt. (ix) Clomrluuitv sclf-rrrorritorine (('Si\4): I'he process h;- which thc conrrnunitl, is cmpowerer.l to oversec aud moniltlr tlre perfbrmarrcc ol'CD'l-l (or an-r, cornmrlnit,r,- based health intervention programnle), rvith a vierv to ensuring that the programlllc is being exccuted in the way intendecl, lt encourages the community' to takc, tull rcsponsibilitv of ivcrmcctin distribution and uraLe approprirtc urodifications rvlrcn ncccssar,v. rf, WI{O/AP()C. 2.1 Novcmbel 200.1 E cl- it& f & -8- 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 23 Number of Recommendation ia the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROIECT FOR TCAAPOC MGT ASE ONLY I the project need to facilitate communities to seleqt and train many new CDDS Some communities were mobilized on the need to select new CDDS for haining especially in dekina, kabba/bunu, ijumu, ogori, ofu, y/east and ankpa LGAs. About 252 new CDDS were trained on CDTI this year.With the APOC Special country initiatives we hope to train 3,300 new CDDs in year 2007. 2 To release budgeted funds at LGAs and state levels needs improvement Advocacy visits were made to some LGAs especially in olamaboro LGA by the hon. Commissioner and perm Sec. which yielded positive results as each oncho team supervisor enjoys monthly imprest of 1,000 naira each since September 2006 Also at the state level the Government released the sum of 500,000 naira as counterpart funds for CDTI activities. 3 Focus on improving data in the project Some new CDDS were trained on recording and reporting of CDTI activities at their level while some old ,l L T : tE I ffi -9- were also re- orientated. Moreso, a computer literate staff is deployed to state ministry of health and now presently on database training to subsequently manage our data generated from the field. We 've been able to create a fairly realistic database for each LGA along the line of no. of CDDS and health staff and their facilities. (Please add more rows if necessary) +I. & f, Y 8. T 1, I t -10- EXECUTIVE SUMMARY Kogi State is made up of twenty- one (21) LGAs with 2544 communities all of which are endemic with Onchocerciasis. The projected population for the State is 3.2 million based on the 1991 census. The project was one of the first four (4) projects approved in Nigeria in 1997. During the period of report 1,096,224 persons were treated out of population of 1,546,715 in 2544 communities. This represents 70.8o/o therapeutic coverage. The Annual Treatment objective for the year was 1.2 million. 100% geographic coverage was attained. The ultimate treatment goal (UTG) is 1,221,531 representing 79.6% of the population. Population migrations occur mainly during Christmas festival and more especially in 5 LGAs of the State where they celebrate their festivats thrice in a year. There are also little rnigration of the nomadic fulanis in some LGAs viz; lbaji, Bassa, Kogi and Lokoja during the peak of dry seasons normally January to April. This accounts for fluctuation in the census update of the areas. However, poor census update was observed in most LGAs of the State. 4 SOCTS, 1 Nutrition Officer were re-oriented as TOTs on Vitamirl "A" supplementation at the state level while 457 LOCTS and 88 other trainers of trainees were trained to supervise CDDs on vitamin "A" supplementation in 21 LGAs. 297 new CDDS were trained on recording data while 672 old CDDS were also re-orientated from 10 LGs viz Ofu, Olamaboro, Ankpa, Kogi, Lokoja, Kabba- bunu, ljumu, Yagba- east, Ogori rnagongo and Dekina LGAs There was late release of state counterpart fund, which was rather inadequate and as such, activities like spots checks of lvermectin distribution in few LGAs was implemented lately. The project was faced with poor commitment of some communities and some LGAs to CDTI activities as they failed to compensate their CDDs and the non-release of counterpart funds by some LGAs, especially ofu LGA where they were a protracted strike action that lasted for over 7 months. However, the Hon. Commissioner, the Permanent Secretary visited Olamaboro and Ofu to advocate for release of funds for CDTI activities. This yielded positive results in Olamaboro as they redeemed the promise to release monthly imprest to their CDTI health supervisor while Ofu had not been able to do something concrete to improve on their CDTI activities. ltE f ;lh 1' L I & f IL f?t - 11- SECTION 1: Background lnformation 1.1. General lnformation Kogi State is located in the Middle Belt of Nigeria and shares boundaries with Niger, Nassarawa State and the Federal Territory to the north. To the east, the State has boundary with Benue State and to the South with Edo, Enugu, Anambra and Ondo States while to the West it has a boundary with Kwara State. The two largest rivers in Nigeria, rivers Niger and Benue form a Confluence at Lokoja, the State Capital. There are also several other fast flowing rivers namely Ofu, Anambra, Ubele, lnachalo, Okura and Oyi, which transverse the several endemic communities in the State. The main occupation of the people is farming, lumbering, fishing and trading. The vegetation is made up of rain forest in the Western part of the State, wooded savanna and grassland in the east, forest savanna mosaic to the south and guinea savanna in the north. Onchocerciasis was first reported in Nigeria in Kogi State in 1907 at Lokoja. Kogi State is a multilingual State of about eight (8) ethnic tribes but three major languages viz lgala, Yoruba and Ebira are predominant. The topography of the state is highly undulating, while some parts are mountainous, some riverine and as such, 50% of the communities are hard-to-reach areas especially in rainy season, while the remaining 50% have manageable network of roads. However, all the 21 LGA headquarters are well connected with all season roads except one (tbaji). Also the 21 LGAs have mass transit buses that ply their headquarters and the State Headquarters. About 95% of the LGA are directly or indirectly connected with GSM communication. This has made network communication easier and affordable to partners. The administrative structure is a politically elected Executive Governor at the State level and politically elected chairmen in the 21 LGAs of the State. Several hierarchies of traditional institutions are in place to oversee the districts and communities. .i. c t & G- : tE f, & I F + I-t2- About 1,027 primary health centers and health post are fairly distributed in CDTI areas of the State. With this arrangement the collection points of mectizan tablets by CDDs is easily accessible and affordable to members of the communities. Table 1: Number of health staff involved in CDTI. Despite the attempts made through advocacy to heads of health Department at the LGAs to involve rnore health staff in CDTI activities, only few health workers were involved in the ,* f * 4 Districts/LGAs Number oi health stafr involved in CDTI activities Total number of health staff in the entire project area B1 Number of health staff involved in CDTI B2 Percentage B1=82/Bl *100 Adavi 110 14 12.7 Ajaokuta 81 19 23.4 Ankpa 358 25 6.9 Bassa 137 26 18.9 Dekina 168 41 24 lbaji 334 16 4.7 ldah 381 23 6.0 lgalamela/Odolu 149 38 25.5 ljumu 86 27 31.3 Kabba/Bunu 110 26 23.6 Kogi 329 12 3.6 Lokoja 149 14 9.3 00Moparnuro 79 14 17.7 Ofu 1 7 1 50 29.2 Okene 122 25 20.4 Okehi 100 26 26 Ogorimagongo 57 14 24.5 Omala 91 20 21.9 Olamaboro 266 49 18.4 Yagba East 103 18 17.4 Yagba West 108 14 12.9 Total 3,489 s11 18% t fi it t t-* LI -13- activities this year .We hope to intensify our advocacy on the need to involve more health workers for effective CDT! activities in subsequent years. We are not sure of the authenticity of the number of health staff in the entire project, as there was retrenchment and recruitment of new health staff. However our collation was based on what was received from each LGA. 1.1.2. PARTNERSHIP The partners involved in the project implementation in the State are MOH, SSl, APOC,21 LGAs and 2,544 communities and the Federal Ministry of Health while the NOCP (Zonal level) supports the ordering of Mectizan from Mectizan Donation Program (MDP). The partnership between the State, the NGDO, and the benefiting communities has been very rewarding as a result of useful advices and contributions from NGDO partners. The MOH provides office accommodation, pay salaries and emoluments of SOCTS. The State Government in the 9th year of project implementation in response to various memos to His Excellency released Five hundred thousand naira (N500, 000.00) as counterpart funds in the month of october. This was rather inadequate and as such only few field trips could be made to some selected LGAs to oversee the level of implementation of CDTI activities for the year. This contributed to late collation of treatment figures and submission of the project's technical report. The State project NGDO (SSl) Partner made some visits to the State and to sorne communities to carry out spot checks on the activities of the supervisors and the CDDs. The supply of mectizan and other materials like posters, MIS forms and some other - logistics like the donation of 4 suzuki (100) motorcycles to 4 needy LGAs namely ofu, kogi, kabba bunu and ankpa LGAs by the NGDO helped to encourage further commitment of ' the SOCTs and LOCTs to CDTI activities. Furthermore, the integration of vitamin A into CDTI and the intended surveillance of measles and guinea worm using CDTI structures ,.t will build a strong hope of CDTI sustainability. To solicit for further commitment to CDTI - activities at the grassroots, a high power advocacy visit by our partners to some LGAs .+& (ofu, olamaboro, kogi, bassa, lokoja and ankpa) would be highly appreciated. We are also , grateful for APOC special initiative funds as this will help to plan and remobilize sorne& communities on the need to select and train CDDS, giving of CDDS incentives and also F' t acceptance of mectizan therapy in some selected communities in Olamaboro, Kogi, and Lokoja LGAS.f f, 1. I I aso sGob6g\(E= .=Gslo 15(9 @\t tr)-\t\t r{) rO rf,\t @o ry(\lo N(o ol c') (os tO_ @f-|o_ oi,- N(o N. olr) @ s-$f- (ao co_ f- l.() CO(o(o @lo s(o r()_(\I$ lr)s .t:(o(\l o)l{) o_$N (f) @- o N CO c\l l'-f- sfN\t_ N\t ooo sNP R< ,i -'E i lE t€, leFsr No (o lr) N(o f.-- F*to r() @ @- oo O) o,\N tF $l\-lo co$ ro@ N o, @ o)o\t- t-(o l() CO F-_ c{ o, rO (f)I- c., F* N c\ ro N sI-o(olo oo o-(o!t No{ -CA CA(o (f)_ N$r CO cf) co- @ O) f-to f,--$ro 9Eb.sNP' .g a. $g: i lf)o o- N II o @ o- lr) (f) o)$s-$N (f)(o s- f- lr) @ o- o(o of- o{ (o @tr) @_ NN oI.- O)r @ (o$o-(o rr) c! roN o) cf) l.C) CA @_ @ cf) cf) cf)to-(o N f-(f) N. F- ro o, -t: l- lo(o o-(o €s<Eo ts$9E cFR N o)o -f ro N(o t-- N ro roo(o- ro @ o ro (f)_ @@ r r (o N I-o @ lr, ro (f, (o CO t-I,- @ o,(o 1r)(o l-- t- r @o o, NN @- @ to(o tt- @ @ @- t (oNr lo @ C{$(o ; @ C! O)(o- @s 9Eb.sNP' .g a.Eots sb.s h< os o N (! '=< a<!nb< sg .sE Hf o lrt o ES oa S = @ ro o(o COs. c{ r.c) @ NsN N(o r @ F- o @ $ o, F-o o) o, o) @(oN o(o NI- N s@ C\t(o o@ lr,s O)cf) sf(o COI- f-o) O)@ I- lr) (o I.- o o) (olr, o@ O)N (o N N(o f- O) CO (o r N or oCA s@ $ N O) otr) CA(o trE .9Et DSH *Eo E Bi $ +- a.S O. No (o lr) N(o f.-- f.- rr) lo @ @- oo O) o, I.-- N \tl.- ro- cf)!t r N O) o_ ro6 o,osf-(o to (f)\N O) r,(f)\ cf) r- f- c{r ro F- $I- o_(olf) oo o-(o$ sNN. r (f) (f)(o (f)- N$ (o (f) co co o) I.-to F--$to .= (, ot'0oa d.s 'tE. ooo6S h 't (UE (U) .Y o G (uo -vc (E ao G c0 (E C .Y o)o 'e -o E oE o (U o E G (U o) ) E a -- fc =d) o -o -o(EY '6, oY o .6. .v, o o =E oo o = 5 o o)c o) .Y o =o .Y o tio L o CL o)E E o o- oL o -c o)tr Lft, oc o o o (s o c)L o o .C o E. c) L =(U oL(E o o) o-'L o- oL c o Q)c .g .Yo L (s tro I lar I .F (E f o- o o- Etr o o .9 .E5iE a,qo \''o ail orl .i €lFI f : t f, li, ilI T t r It oo, +_\!'E EA Eqos\cTES8 bq; -.= -EB =6 .QE-:s *E .FSo= O)(B = BE\Qtroa.rit b8Sa.\ -)=Edc\.E BEooGE s 3EE ER * Esqs.e.soO*S . E .E€F s 'ds'6 = \e9od'.s'3e!s E E € €H H, E ior\ = C G *o 'S o *tS * 5 q *iO O d\ Ae, I S tsl '= .sl S .s EEl S b:or tr S €:,^l 8d E ss3 F$ E EEE E"h 8 € =tP f'O rbP Ei$ E$ EEB sHs ;H E s$ E€ scp8.EX _o '= o)Eair SEos\(n(E o9 ER 3E Orqs -E o\OPo-\ )s\o .s B,tt :rdococE ESEb8g -7r o-. u) .o ts .0) *E ! oo .9EEE E Ea Stn$ E iBt I Fsq g ECt BtrH E : ES R tafi +S Pf, AsSe g ll -JL (4 P$E E s(o F-N @ @- (o O) O) cq- $@ t- o) o- CO CO @$_ @N co rO FNN (o 1.-(f)- $(f) O) Or- @$ @o n cf) cI) @ l-- .t o, o- F- CO rO -\ @\t rr)^ o,(o o) rr) co l- CA (o (t)- (o$ (o @ $N @N$- f-N \to .t (v)o(0 F-o$- @N @ @- C! O) o- l-$ rO O) rO- F- r cf) @(o_ O) (v)_ (r)\t o) o(o o(o - ro$N Ntr) o, t st ro-(\ cf) r @ @ o, co @ CDoo F-s COF- $ N F 1() rOt_ (o F- Cf)-$ CO o, Or- @$ @oq CO O) -@\ r$ O) o_ F- cf) 1.) r\dst tO o o)c o o, G E L o C,) o o G E o o o -oG E G o a o LrJ (E -o(,) (U @ o =(E -o C,) G E+, oF J t I 9 fl5 t, rt I t T f l. a o .e Tq) CLSq o o a.b FE6E o o U) od o) = o- o CJ) o o U) o. o U) Ia tI oo o- o U) oz o) = o o U) trt EEg9(/)E o oa Cf -) o)f 0)c :,? ocf I I I I o) J ocf 'a oz ct = o))(E o Sa\ .9E Ul tra tr o 'sr o a.tFtr SE oo o- o U) oo o- 0) U) o- o) ct) f - o o o o () o C) o oz oz c,) = oz o- oa o. o)o b €Ea9G')E (U = o)E) (5 (E = G (E := o- (! = (U = o- o U) = := o oz q) cf = - o GE a. aq T 3t, stolo tr .9 o a!Ftr st o-oa o-o)a )-) oo oo oo oo oz oz :=L o- o- oa o oa trl ETg9(,tts o (It = o (s := o- f - :L o- : oc =.? = -) tr .9 G Eo trrE .=sc:i E<]- .S EG s o c o o Ftrxo6E oz oz oz oz EI EEs9(aE oz oz I oo -Oo.E GI ES tr .s o a.t FE 16E = o. :=l- o- := o =o- := o o (U = :=L o- := o (o -c,oL(E EI ETs9(llE := o- := o- := o- =o L G (U = (U Lo E o = .Co (5 o $o b .e o oE (5 =.V o G oo .Yc ooa(U c0 (U C =o)o 'e -o E oI o (u o E(U (0I ) E) '- =c) d) (E -o -o(u}z '6, oY (E .6- -vo o J E(E o- o = =o oc o .Y o =o .Y o oo *, 't *ao(! rF o(, .E o E F tro C) ra- o c o +,(E +,tr o E o CL .E 6l z o -Fo IIJ Cr, I r- I L lI & & I t t I II I o r,o-c'lioE(E(I)00\rx 5 EH =;EE P b-a dEeE E frH :;EE f; f'; rcfi8E E €g +EEN o ; B Ea=E E EE ;E€E E Eg .9 F o: -E-Ec.E?6'EE,t ,EB: EE.EoAE;i_E'Efi t EE5 gEt E E ;EE EEe6 F o E o 5b i qEr +:rP € E=€ EEE3_ E E EE EBE E t EEI Egp9 H q.Eg a E oo-OcE ; iEg 6iE7 E :qE JgqE E seE BsBE = .o 6$ gec E E gHE ;AEeI H g*E .P u,oB;IEa*igIa o oo.gO o OJ tEqB€I8N?EgEiEPdo,"? E .= ; e: 3- R e E S E ErEg:=EEIt:I E E E E ,& E S F ; P E E aaaoa urlFI ol zl o Et- o t- oE C o ot-q) =oL o EL G o o E c o)E =C oo o oo E9>.=(l)E E(o 9ortc g'€ OE -G)o=i-o oE .o -9 EE3ao<oo .o) POgO OC CAOGoo>EE P8EO,a ;o8EiEo =Eo-t\aaE(o 'EoooaN C!o Gf to€o+=o.QNEI rE 9.E ,+Ooo 9ofc o)(t, a*, : -)l06 b.N(JE co ;E .F> =?_o_= .o=o! oh =Ei. '-ooobE _c o)F-o I @ L .;4 r r! t. ?t- it t t t 'a o,a (,) J ooa lo,l= l< 'a o)a (,) = o- 0)a cT) = ooa o. 0)a vo o o- o) U) o) = o c, -, .>) -) oCf, -) oc = - G E ooa o- oa () o o)Cf - O)f, oc = =Lo :=L o_ oCf, -) G o z. oz oz oz oz oz oz L o o L(I, Lo E L o E L o (E L(U (E Lo E o cT)E o c') o E L o(,) o o o E o ol- o -oo E o o o(U I.JJ G -oo)$ vt o =N -oo) o l l 3E€E€Eg::E€ E I i E E E E E fi E ;I E E E i p ; $ [ e aE d = hge.Ej:38f,,EEg EgtErEg:*:EE E1f,EiEggEEIEEx;EEEiE:;!e E;*tsEt!5gH,EE * fl E :: f B E n ! q e a;EetEEsiIg; s#;sEEEgEEEl *tt;!E-E*EiiiD 6=E'F E.ee<gi EeEHEEfr 3E,8E EIg*EEE!iEEi ,I i A E E Z - € P E E F'P:EEt aP."Fg 8 s E EE E6Ei;.* EEEEfiE ;.5 E i Eeo X 5EE E E x E E E # a E € e 6 "iCN gEEEE:fi brET.s€ii E;Eq*H; =2 B,E E: E;IgE[€;;e;s;tE; r;;#E Eq €Ex-e;Et E IF* sEeE,nEggE EEE;er6 eRE*=;i6 EfiEI.ESEEE"t€E.BEIE ecEiFS€,9fE;*!EEfib!:_;:EEEEtE E3e a'E Bi€E#3Efi3Pq,;EE*:E 3 = E F o_E €a:sa8fiEE .ENgE;:.ag6prHIE;€;Tf gIEEEEIaE .l N I o c{ E L t- L r L I r E t l aob lE E^e EUi*EE Ee o oa IEIS l= lloo I t6 -} aa ob G o e6 a. s(f) ci(o s cf,d s oq c{ s oq !t s\t c\ s c! l() s(f) l'- q c') s @s s alr, sI sN saI- C{ -. t o sI oo '= S E 8,p bH rQo- SE l()CA rO @ o, o)(o O) o) cf)(o \tN N C\,t lr) !o I E oo 5 E Eo o o E!tr o ti ooo o oaItr ISl= $(\rQO + a\ o IG ot- r @(o (osN l() @ o)f-N f-r CON f-I- cf) rr)!r) F-(o c') O) rO NN CO F)a ta ,Pg ro(f) rO (o O) O)(o o) O) (o cf)(o sC\l c{ C\l $r rO (\a a v,ooo o GE (oI- (o(o osN (o l- oN N(o r $ (O rr @(o r(a rO(o N O) I-(f) F-r (f) b8 ^Q.EPB s o'rtr{t c =tro EE$u o co o S c oo '5 ESe Et. oo I GIr8 Ntioa i b sI r B- o 14 G eoa o E t I II II I 1 o r() o(o (f, FN r() @ N$ GI N(o @ r.- o @ $ O) f-o O) r O) o) @(o N '= GE o f .Y o(u (u o-!tr (u U'a(E d) (U c .Y oo 'e -o .r-(UE o -oo Es(E -9 ) E) '.- )c =d] (5 -o -oGY '6, oY o 'd .E o otr =E(u o. o =o Eoq cn oo oc an =e eo !! G q) u, G eg troo o)s.t .E c o (Eo o E(s o- o .9 ,=Cf E E oo +l olItI(ElFI{.,tr o E o -zo E +, .E -J E E oo t-oo-(D (6 .9 (rooro €eD a:- -sE9o EE(l)'= a(uoJcED '=o) jv =oAJ ao(Eq) =-c .tn x l-Fo :>, I- .EH EX '=o =o)E-o <Dl,U'fooo.s =o -i Vt oE .C o o= -a (.)r- ctgn) Eb€EdYLcfgo oTi G.9 6"9 'E +-i! q)zo o-o -c, o .A .e, .98 -oE =co-o I N I t; u ,{- t- {-tl" f & fl'F i =ootr'G )o '= I Itr tolo loIr-lola IEIS l= I I I It II cc kU) otro o g (U o'- CZ ='C EE *E EE fE *E I'e cE EEEEfiEt=o ..o- oo =E y(5 beEs n: EigC 9' .CEE*E E 9t*E Ee 683. rTE E: EEH ;;F E: E E: E5E ea $*E iiB EE gEI fiEF EE EflE IxP 9#6ar*I EH; E q;-:iE d HE =EIEE S f;:c rsE #r$ :eee gt:+Ei =E= B*=Eg? :;e Bfi asE$ H! * ** iE sI *Ee iEae Ee =-- H - E q s ro.!,P O =.E o q o ';t-eEfrEfi €8 E 0r€t I(U o c) =o .9, tro o c o 3 o)c c) o E .E c., =EEBpE U .;() EEE E l-# cH oe; ;8.E^ P E EE EsEb i Er s ; -F(J ()6 6.o .gl- AEEA Hh -io ole.E.soE EE.STEO'iI 'E g rqEBeE = 8g EE 3P EE L ^g* -J (E3ep. Ec E IE EE E 9. E a!EeErt ,E =xEBE 9 6 00v L a X rr u)o - f, *- o8E 8 EE; * P=;5'3e o orc.5 t 5# 3E pif; *r\-l-a-Y\Vtr o E trrrltr oo (..l st- F-N sq !t sq C\ sq(o s@$ sq (f) lt- sq CD ,F o c\t rr)N s (o l()c\l s o)N\t l- $@ f- I-o co @$r (of- Foot a) oN roc{ $ (o c!rr) (f) ci, s)$ lr) o)lr) F-(o o)N (oO) lf)$ ot 00N I I tI II I I I I c!f- o(o o(o rJ)sN Nr() o,r t+lo- N E o .Yo o o)c o o) G E L o o) o o (U Eo o o -oG E o o a(U trJ (5 -oo)(5 U' o =(E -oo)o E{J oF c\!(v f- c')(r) l- r c\c\ II o(o oc oIo I C.l c..l /i"- s- E: f .3jc I L I E E II I04, a-l I,i d# rt t T t t -24- 2.5. Gapacity Building 4 SOCTs have been trained and retrained as facilitators on vitamin A supplementation. 1 nutritionist was also trained to facilitate vitamin A supplementation under CDTI strategy. 457 LOCTs from the 21 LGAs were trained while 297 new and 672 old CDDS were trained in 10 LGAs on proper recording of data On transfers of trained staff, the project rarely witnesses such, since the advocacy visit to the Local Government Service Commission was carried out earlier. Staff commitment to CDTI activities were observed to be very poor, as witnessed in Ofu, Lokoja, Okehi and LGAs. The replacement of such staff was effected. :." i- d, ,l ;! ilG 4' !r & g E t d o)t- $roC!lo NF-(o(o I-c')N(o ].- o) C\ + ll(otr, ooo (o NC\rr)$lo Nto O)(f) cf)(o \r(f)Nro(f)I)o @ C\lo) f-C!N ro$ cf)r(o(o!tOF =o f-C\ o rr) oloo(o oo o ro o co f-o CA o(o!,o s \t s $ro .t cf)lr) \t s roro (f) s !t(o $ s + I c{OF ooo (f)c{ cf) Cf, cf)CO CO (f)CO CO cf, cf)(o (a CO COo co CO N (\INN roo r \f!t .(f sr sf$ lo to $$ ro s|r) $ ss s s or lor os(f)N rocf) |r)co(oN o,N NcaO)!r ro@c! O)N o6(Ooo No ll+ i-ro,c{ rr)N oc!r cf) $roF o)r (oroF (oo) lr)N (oc{No o (f,N lr) o) (oN cf) o(\(f) lf)N cf) cf)(oo (f, oN @ o$oN rocf, roCf)o(f) oC! toN(or ocf) lr)C!oCO o(o roCO oNloo<( roC! oN to .E(E o$toCf) roco or rf)r@ cf)Nro (oN o)N C\lCOo O)@N o)Nt(\roo 6aoI+ N s o r F-$r o,N loN(o N(o lr) O)(o(\ o (oo) lr)NG)o cf)N(o o roN ro o,n- COrcf) lr)N cf) (f)c{o cf) oN o o\toN ro(o rocf)o(o oN rr)N(o o(f) roNo(f) o(f) lo(f) oNo{ r()(\ oC\I (E (u E o oC o) -vo =o) .Y o o o)c o o)o E L o(r, o (U '6" J o oL =E o o- o J o f E J:- fc =d) o -o -o(UY '6, o:l ,-d -o E(EI o (I, o E o (U IED (Eo .Yc (u U'a$ m (E C lz oo 't oE (E :, .Y o(U Co {J .!{JCo E -9e .E Foo o .9, o -9 +,tr oL o ra- E oE +a{-.o cD .= tr (ELF t'l ol -ol(ElFI I tr)N I I 1'a li { L f' L f ffi E C) .E(!L ooo o o oo E =z I I I I I I I I I 1 I I ,lolol ,EIGI o e 11) ,9G!!FEO o(- o o o)o IElllz I I o l\ o)<o I I bEJ Aeococ=fc E e * s9l o* oEN-o r6hV E -\LrvEEU d8€t E9 a E 'Ei E6, .u ^\E(5O .v-(Eb a.s- =8 b 3 =I E'o g =Eg bOO^-coo=oo-o9LVE EE I =E.i c(rqx.9 \r= r_ lJ uO'=-ON o)i: E ECtrO .EE(U E 'cu gO o EA E 3 .A aO oEclv g E9 E EXNo,qE v.CJ-t--= LLVv'-E Y ?P o)6 (D.=rr.E'E=Ee.= 8f 8 hg .P=S 5: E Ez-'E6.1 =a)<f.YlcH€g " 6 5!J *o *s 9, 'E \F --=-sob9r5EEiEpi.='EE I \o c.t F: I I 1' 1. (.|, Oa o\t o)(o o) No) loN I NN(o atr) rO N o)6l O Lc) ost N$o rf) s rr) €@ m (f) (o (')(0 C-{ r N lf, N rJ) t rO o6) cf) - c\,1 cf) t\|(,\t co - @ C') GO(v) cf) N @ o)t oN F- @l(, rf, (o N 1\lf, st (Y) @ r CD a)(Y) (f) N @ o$ oN r.- I o o -o(E E -go oo UJ o -o o)(E o o =oo o, o E+, oF -27 - Table 6: Type of training undertaken TTi"k fhe boxes where speciftc training was carried out during the reporting period) Any other comments t c t= lL) ! L {- + L ft 1tt fl Tralnees TYPe of tralnlng CDDs Other community members e.g. community supervisors Health wo*ers (frontline health facllltles) MOH Sfrff or other Political leaders Other(speclfy) P rogram rnanagement ./ ./ How to conduct health education { { .l Management of SAES CSM SHM Data collection { { ./ ^/ Data analysis ./ { Report writing .i ./ LGA coordinator Recording ON MIS Other (specify) -28- 2.6. Treatments 2.6.1 . Treatment figures lf the project is not achieving 100% geographical coverage and a minimum of 65% therapeutic coverage or the coverage rate is fluctuating, state the reasons and the plans being made to remedy this. T; a- L L rtr alltl' t" r 1 ol!o :, o o =uo ro O) o)_ o, N o) o-$ - o)N tr)- lf) N oo @-(o(o N @(o ca- lolo(a No(o- (o O) ro N .t- v o @ o- @ N (o N n o) F- lflo o{ N ro r (o rr)- l- ro F-- c{o o, @ O)-(o cf)(f) cf)-(o tf (oo F-- lJ) O) @- o, COr rr)q $rN @o or_ o stN ol urlF] uJ d,F tt,z o @trlrl o. N @ CD. $sf @sl--$tf @N(o- o@ ro(o o- o o, sf c\l o rf $- (o N(o ryo ro rolr) @_ NF- so ot 1'* r() N F- co_ @ rO O) rr)- N$ o ry(o N o(o o-(o N sF- tO_ $ (o rr)- N F-(o o- Ns OJt l-F- CAo r o@ =lol F J =o. o o. d J UJ o!t rO^\f!+ rr) r()- rO$ @o c\l N@ N cf) a,{ r o) (o$lr)- @l-lrl oi\ N(o ryo rO (o -i: Cf) (f)o(a- f.- rO (o(o(o- @ ro $(o lr)- N$ ro$t^(o N o, r() o_$N CO @- F-o r .t(o\f-N sN nNs N(o c\l f-F- O) O) c"l s@ zl ol F 5f o- o o- J F oIF No (o rO N(o l- r.O LO @(o- oo o, O)\N $ t()-(o!+ N o, @- rO @ o)o$_ (o rr) cf)\N o, lr) CO N^ cf) F-N rO $f.- o-(o tr) Oo o-(o\t -N c\l (o (f)(o(o- Nt (O F-(f)- $ CO f-!o F--$ ro (f) cf) @^ @ o) @o s. (f) O) '= oE o =.Y o(U a (oo .Yc ooo oo oC .Y oo 'a -o -co! :,6E o G6 E(U (EI =E :, - fc :, d) ([, -o -ooY '6, oY N 'a -voJ o f E c, o- o f o o o)c o o)(E E L o o) o E o .Y o oc ov o o o -o(5 E o6 I o\ e.l I oot- .9lr o E (E ot-F ,cl N o 'l..I-o E+,(E ol-F (o Gi I k f i' li 1-t lL I IFIt ltt ,tF{t o @ co-$ r (o(o c\l(o CO(o ro o o) (o @sl o t- e, rI- o_ F-(o $ cf)(o- rr) cf) @$- @N $N o,1(o o) o_ @ o^ t-(o o)No F- cf) (f, @tf- @ C{ co u)_ Nc{ O)o, @$ @ l'-_ $ c',o l'-(f) ro !F\(0 r+ to rF (E (5 Eo o G UJ (5 -o o)(E .n o =(E -oo)o t +a ol- E ato to o o o o : o o o EE G oq Go e ! o (E o IE o G G oJ o +, .12 o lt o Ltl o t tr G +,tr o E *a(E oLF I o c.t -.L, f: t i 5 F *r I E E 3 cxci$r UJ< ar1 o 8 EIz II II II II II II II II II II E=t 'rt (f) O)t- lr)(, sf (o\f o(t)(\l @ O)oN o @(o o,N oC\I o)@ t(o \frr) (ooN o)N (f) @ : Erc E B€E $ rO (o ro (o N\t co F- o N F cf) o l()C! rO!o rr) (f) NN o o @ o tr .rS e E $*s s r oi F,- s u? i- so@ sq o @ s oq(o s n @ 1\.* s nsf.- sq @ s u? F- F- sq? F- s oq rOt- sq @f- s\ @ s a(a (f) so@ s oq(o s@ N a t lo o eoo o oo ESz N @(f)- $$ s @\$t @N(o- oo ro(oq o o, $i-ol o sf n F-(o N(o o{ otr) rO rO @- N to ryi-t() C!f.- co- @ r() o) r ro^ N$ o c.l(o (f) o(o O)- cf)C! $ r.O- $ (o rO^ F-N (o o- N$ o)$r 1- F. SI AJotq.l ao Eo 6 Et s t9 E IB<so o\ CO\t F-o(o_ $$ o(f)(o- oo (0 \(f) @ t F- o_ lr) o) $o cq_ r.-(o @ o{ o rO Ni- Or- t\ $ o) CD.(o lr) o,r- @- @!o F-(o(o- o\t O)(o(o- CON cf)s o_(o N oo o-(o O) rO c\l @N $N s- N\t @(o lo_ @t- o IE;! .E EG rE =o o e o5a& G 6ts No (o rO N(o F-- l- rr) rO @(o- Oo O) o) F-- N r $ rO- cos N o) o_ lr) @ o)o$- (o rO (f) F-- N O) r() (f) F-_ cf)F- t-N l() F- rf o-(o ro oo o^(o$ -NN. (f) c9(o co- N$ (o l- cf)_ $(o t() F-- $lr) (f, (f) @- @ o) oo n o ci o l o E8 Eg EH oo oo oo oor oo - oo iF Oo oo Oo oo oo oo oor oo oo oo - oo oE.Er$E olr) orr) $ N (o lr) NtN NF- @t- ol- r (o rr) O) r O) O) N o(o o(o o(o NaEE$ @rr) orO s N @ rO N$N N € oF- (o rO O) O) O) N o(o o(o o(o E6.xlct8E I. EgEEo= - so >s o o d G @ rO olr) sr N (o rO N\tN Nr\ @N O F- (o rO O)r o) o, N o(o o(0 o(o 't oE G =.Y oNa Goj c ooo o co (E t- =oo 'e -o E G = o o o E(U (E _9 5 Ef - )cf d) o -o -o(EY '6, oY o '6' ll o -) o =E o o. o f o o o)c o O)o E L o o) o '= o .Yo 0)Eo .Y,o I co I L J tt I ,l u. Ft f?fi It t tI tI tI II II Ia I t a Goo a' a. Go\ E cr) q) o ! c o q) gE ose >.J oo$t .sr =.8 EsG!t=$ .u8 o- o->x\r- Ol oosa .sE =b_SH a'5GA 'P q, b=EI EE{tr sgSoOU)3EE9 -o.\ EE(US oa-SQ eH' OO) *e IEb3 0) aradEs =ij-o)E'o .\ox.c(t,+.E5 oss= 'E ilo otL(trba { oo c 0) o) G c ooE\ o) E =G a o U)B q) c o o) o' a. l- oo o G q o o) G() L o)! o( q)g \oq o E c O) o o-o o o. Lo a)a = !o (U E q o o l- It ol-q oor x $l- cll cf) cll ro- <ol -o)lNolN -l- s\ o, @ il sq tf o, soo s oq ot- il OOPP xx IO NIB -Nl rE .+r$ o1;+ +l t o)l toro- LoJ,o- oJ- rNl N-l - il ! o) .9 -co G oFf s o#([ L o cT)(E L 0) oo oF lt o o o) o,(U o oo 6 .9 -c. o-(u L o) oo(, I o G o) o)(o L o oo o aq)o E o)EF G oO x $Nol @ o)q I c..l cn t,tr it4 L I E IF tI o) N(o N (f) N c! (o @ o o O)(o F o u) o)(0 s c? l- s\ rO @ s o{ rO @ s\(o r- s a @t\ f- @- F-(a (f)o o@ $(f)(o- rO co @t- @N tN(\t(o C')o @ @- @ co c\t@$- No F- O) o- l- CO (o$ s"I\N o6 o) r(, O) o)- @$ oo n cf) o, o\ $ cr, o- r- cf) rO t\ G)tlf, oo oo oo oo soo o(o F o € Nto st ro$l o(o @@ N rO tsftf,(\ o(o @@ N rO \tt rf,(\l o o E o o o! o Es o o o I,IJ (u -oo,o oo =o -o(,) (U E +a ol- lr il It II II II II I co co I {' tE &" t I I mt E a oI -34- 2-6.2. What are the causes of absenteeism? From our observation, the following are the likely causes of absenteeism. o All persons whether resident or not in some communities were registered. And during distribution these people are counted as being absent. . Distribution is often done at peak of farming season when most people stay on their farms. The CDDs distribute at their own leisure especially as most of them are not compensated. Most CDDs do not take extra pains to revisit households for mop-up as a result of poor or no incentives to them. 2.6.3. What are the reasons for refusal? Coincidental illness at the time of treatment round' Fear of unknown repercussion which might result from taking the drug. 2.6.4. Briefly describe all known and verified serious adverse events (SAEs) that occurred during the reporting period and provide (in table 8) the required information when available ln case the project did not have any cases of serious adverse events (SAE) during this reporting period, please tick in the box. No SAE case to report a o a a .fl' f- -C T- L { L I E B ./ c ag oE c ooI o. =E(o o -o c o .0)@trEs Erfi trq6 8de ,9.9b EE{ '49 (, reEi o Xc,rq se o =AEEE>+r(\ OO) r <o, G rri O) ojr >' ro c! b(! o #?c,6CDEESL= -t c) -o oS(l) So>G eo) = BSE -g sx E HT *, S-tcL :-o .\EO Fc(r \.- .3 otrt H€O E.E .-\r-arEt EB - (g'(JF cro)cl 65o 'OpE fsA.=Jy =o)L. I- r-rts +. a.9 FF!L =#O g-lE €8Ie Edo >c{E EI:IH EI EE EIXo .el.EE sE-a! Eqo 9#l-Zs *, Hota- v r+-o Ego P5s-L- l- dro 9iL t*F 6.9s8 l-g ..4 L . cDt --co ol H ,ri €lEN FI(L I ta) co I I q I t= L L r5 r la IF E s r O) c\l ro o) a$ O) \(o F* \ o)@ s -q 6 sq lr) q (f) @ s ct) @@ o CD E aq c) Ee8 d O) (f, G, u? !t o, nor s I or roor C, F c! @ o, [[ o O)Er E Es;He F- r oq oF-F-@ q o)@ (o o,@ \ F- o) +@ q @ ol $@ (o@ eS AE HEt6FO ,l @ I uj o rrJ n SE ro(o o)- F-Nr t c{N(o o)o r-@ ro @o F-- rr) r (o rr)f--(o rOa olo ro CO(f, N F- @- N c{(o @(f)- o roN - Io o- o o! EJz !o oI co oo \t u.l ooo. ooN r oo o- ooN. @@ O)lr) r oo o- oo o_ oo o- ooo- oo o- oo o- r sf ro rr)- NF- - ooo ooN oo o- $(o LONUJ co -o>6 a=EftAEOO' <!o lr, F*-(o$ 1()J ooot(o(o c{J lr)f- eo- tt6NIJ (o ry$ O) c\l co @r o.i ro- oo- o(ot- ooo- ooot r or o- rN o{ r C .o o fo oo 6 o LF o ID E oE o .o Eooctog E o6 eo @ UJ NN o-(o @N oooo oo oooo oo r oo oo E oc5E z.E -ilds pH Hne oo oor oooo r c? o, O) oo r oo r E 6)c oE oz oo Oo :eil ;Poo EUJox 6; $\tlf) N (f,o$N (oo stN (9o$N $$ roN (0N O) @ t.*rN (f,o$N E .-o EE EEF6 6 ttu Eoc Lr (l) z.E $$!ON COosN (f,osN .t$ roN @ C\I o, (o r- N (f)o$ ot COo$N oC 1J o)6CgE o oo6o Nul (f,o!t N $$t()N *sfloN (o F* N (f,ort C! (oo$N (oo\t c{ @N o) (ON o) $u, <- 6 l.g fi El*icE hE.PE IE EE EE ooN oooN o)ooN o oN sooN lf)oo c{ (oooN oooN ooN c!ooN cf)ooN o o, O)r O) o, o)r \(! o -36- a 2.7 . Ordering, Storage and Delivery of lvermectin Mectizan@ ordered applied for by (p/ease tick the appropriate answer) MOH[ ] wHo I I UNTCEF [ ] NGDO [/] Other (please specify) Mectizan@ delivered by (p/ease tick the appropiate answer) MOH I I WHO [ ] UNICEF [ ] NGDO U lOther(pleasespecify) Please describe how Mectizan@ is ordered and how it gets to the communities. Reports of Mectizan treatment are complied by LGA coordinators and submitted to the State Coordinator. The quantity of Mectizan required by each community for the succeeding year is based on total population multiplied by 3. Sight Savers lnternational (SSl), who places order through NOCP to Mectizan Donation Programme. The clearance of the drugs from the Lagos ports and its storage before collection is the responsibility of UNICEF. The state receives her consignments from the NGDO and informs the LGAs for collection of their allocation. The first line health facilities receive and store the requirements for cornmunities in their jurisdiction. Communities are informed to send their CDDs for the collection of their drugs. e 5; {* !- L I E t!! W NOCP SOCT LOCT FLHF COMMUNITY aEo o o_ o,E t-oo- o) G) o) l- '= =E o o) l-oo- o) L(D o (D a (D E(t' a = .9 o)a o GOa.c q) bre *= tr EpEErF- o *t; ss$8(5l,tt:= tr E FB ,tr 8'b A) E oo So o U, a4 o b o a. eE E;ss H o8 aD -\ rsseE EE" TE=E \ Efi$$$ tt, o a. tt, EriE$ E $* cGN 9E o E 8s sE obG s o b o xo U, ob ct B d)(€ a oS9E -= !L ae > .eQ €eoaEE{ =EEG EH =o)ES E' ?iodo-: o.E oo -c o_o .eo -E86o-=Or LT, EE .= '68 €o :tf G 9, a# _-.o uJc=d € =s-eU,C! EE =oo' >c/, -. o :3Eg =8bE.s EEo coooC)(,)= = E'3(l)corts.= u) = lt[* s(!;A o) o-- b E ,i,l *E € -gl gIE EI I r- c'1 I G ir 1- l- rLL PI-I E 3B a q L n- L E E C -39- Table 10: Mectizan@ lnventory (p/ease add more rows if necessary) State/Distrlct LGA Number of mectizan tabletRequested by LGAs Recelved Used Lost Wa s0e d E x p ir e d balance Adavi 120,000 120,000 1 19,995 5 0 0 Ajaokuta 120,000 120,000 114,992 I 0 0 0 Ankpa 250,000 260,000 257,529 137 0 0 2334 Bassa 280,000 270,000 266,800 472 0 0 2783 Dekina 380,000 360,000 355,368 2 0 0 4630 lbaji 200,000 200,000 196,602 123 0 0 3275 ldah 120,000 1 15,000 114,425 0 0 0 575 lgalamela/O 220,O00 220,000 218,080 0 0 0 1920 ljumu 200,000 180,000 '179,426 29 0 0 545 Kabba/Bunu 160,000 160,000 152,254 208 0 0 7538 Kogi 120,000 1 15,000 111,537 13 0 0 3450 Lokoja 120,000 120,000 82,715 24 0 0 3736 Mopamuro 80,000 80,000 76,989 0 0 0 301 1 Ofu 270,000 250,000 146,333 253 0 0 103414 Okene 220,000 215,000 214,051 0 0 0 949 Okehi 160,000 140,000 139,817 0 0 0 183 Ogori 100,000 98,000 95,786 0 0 0 2215 Omala 120,000 116,500 114,880 57 0 0 1 563 Olamaboro 250 ,000 245,000 240,908 50 0 0 4042 Yagba East 120,000 1 15,000 1 13,263 144 33 0 1 560 Yagba West 100,000 100,000 98,536 12 0 0 1452 Total 3,710,000 3,599,500 3,410,286 1610 0 0 182,800 The rate at which drugs get missing in some LGAs is rather alarming. We shall take sorne precautionary measures to put this under control in subsequent distribution. i t.t I E L r ,1L I E E t a-40- How are the remaining ivermectin tablets collected and where are they kept? T he remaining lvermectin tablets are usually returned to the front health facility staff who rnake the submission to district supervisors and are handed over to the LGA Coordinator who finally returned them to the State for safe keep at the medical store in the h eadquarters. List and briefly describe the activities under lvermectin delivery that are being carried out by health care personnel in the proiect area: Placement of mectizan order at State level and LGA. (FLH-+ LGAs-+ State) Collection of mectizan to frontline facility. lssuance of lvermectin to frontline health facility staff. Notification of community to come for the collection of their drug from FLHF. 2.8. Community Self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the proiect area? Yes It is frustrating to express that all the communities trained on self-monitoring a nd stakeholders meetings are not implementing as expected. lf so, when? The training was conducted in November,2004 and 63 participants were trained, Due to limited funds reorientation and training on community self-monitoring a nd stakeholders meeting could not hold ever since then. Any other comments: .8* J E I L r ? E t C E -41 - Table 11: Community self-monitoring and Stakp/rolders Meeting (Add rows if needed) Describe how the results of the community self-monitoring and stakeholders meetin gs have affected project implementation or how they would be utilized during the next treatment cycle. a DisficALGA Total # of communities/villages in the entirg project area No of communities tl:lalt canied out self rng4itoring (CSM) No of commM conducted sfalreholders meeting (SHM) Adavi 58 Ajaokuta 60 Ankpa 2\3 Bassa 185 Dekina 242 !baji 172 I dah 78 lgalamela/Odolu 170 ljumu 111 Kabba/Bunu 156 Kogi 119 Lokoja 91 Mopamuro 19 Ofu 211 Okene 60 Okehi 79 Ogorimagongo 39 Omala 120 Olamaboro 188 Yagba East 52 Yagba West 18 Total 2,544 4- & fl t G -42- 2. However, we are hopeful that more LGAs and communities would be trained to implement CSM/SHM when the special initiative on community mobilization and health education would have been carried out. z.e. Supervision 2.9.1. Provide a flow chart of supervision hierarchy: 2.9.2. What were the main issues identified during supervision::t Poor record keeping (only eligible persons were registered in some places). * Lack of counterpart fund in some LGAs. * Very poor CDD incentives. * Few Registers not well kept and not kept with the community heads but with CDDs. * Complaint of mild reactions such as swelling of limbs, itching and skin rashes which make some persons unwilling to take the drug. t; SSI NOCP ZONAL SOCTS LOCTS FLHF COMMUNITY LEADERS COMMUNITIES CDDS -43- * lnadequate supervision and monitoring by LOCTs due to lack of logistics (their motorcycles have broken down), non release of funds for maintenance and fuelling of motorcycles, and purchase of bicycles spare parts. " census update was carried out in most communities lately' * Broken down motorcycles in some LGAs. * Delay in collation of treatment figures due to non-compensation of CDDs. * Unwillingness to supervise the CDDS activities as witnessed in ofu LGA r Use of health attendants to distribute drugs in some LGAs like Okehi, lokoja LGAs where CDDS has become adamant to distribute the drug willingly. 2.9.3. Was a supervision checklist used? No 2.g.4. What were the outcomes at each level of CDTI implementation supervision? It was observed that most communities combined census update and lvermectin distribution. Lack of incentives makes the CDDs to distribute at their convenience. Most LOCTs did not carryout supervision during distribution as a result of lack of funds to fuel their motorcYcles. Unwillingness on the part of some health supervisors to supervise the CDDS is posing a problem on the quality of data entry. 2.9.5. Was feedback given to the person or groups supervised? Yes . but not all communities had opportunity for feedback. This is due to 2.9.6 lack of funds to reach all the communities- How was the feedback used to improve the overall performance of the project? The feedback stressed the area that the project was failing and the consequences. This created fear in the policy makers and as such, most supervisors were encouraged to use integration strategy to carry out CDTI activities. These yielded positive results, as they were able to detect and correct their areas of weakness. However, in few LGAs, some supervisors view Onchocerciasis activity as an adhoc work and as such not enthusiastic about treatment collation more especially as there is no remuneration tied as in NlDs. ln such areas, advocacy visits were paid to policy makers and HODs of health to see to how their health staff could be refocused to their primary assignment as public health workers. a t&, *.- {' L r n lL F tr F It G a-44- SECTIN 3: Support to CDTI 3.1. Equipment Tabte 12 Status of equipment (p/ease add more rows if necessary) , Condition of the equipment (F = Functional CNFR = Currently non-functional but repairable, WO = Written of| How does the project intend to maintain and replace existing equipment and other materials? The project hopes to maintain the existing equipment and other materials with the judicious use of counterpart funds from the State Government and LGAs. The hope for the replacement of these equipment is very slim as the government finds it hard to release enough counterpart funds for CDTI activities each year. Source Type oi equipment APOC MOH DISTRICT/ LGA ,VGDO Others 1 . Vehicle 3 F 2. Motorcycle 34 20F 4 F 3. Compute(s) 2 F 1 F 4. Printe(s) 2 F 5. Photocopier(s) 2 One F 6. Fax Machine(s) 1 F 7. Others a) A/C 1 F b) Fridse 1 F c) Generator 1 F j'- 4- fi- tu" fl & fi- It -45- 3.2. Financial contributions of the partners and communities Table 13: Financial contributions by al! partners for the last three years. lf there are problems with release of counterpart funds, how were they addressed? The release of funds for CDTI activities was not easy but through persistent and repeated memos and lobbying, the Government released 500,000 naira for the year. This was inadequate, as most activities planned for the year could not be fully implemented. Additional Comments: 3.3. Other Forms of Community Support - Describe/indicate forms or kind of contributions by the communities (if any) Some opinion leaders in few communities compensated their CDDs in kind such as group farming etc. This was witnessed in lgalamela/Odolu, Omala, Yagba East LGAs. ? Contributor Year 7 (provide the p91iod) 2001 Year 8 (provide the period) 2005 Year 9 (provide the period) 2006 TOTAL cash budgeted (us$) TOTAL casfi budgeted rus$) TOTAL cash budgeted (us$) TOTAL cash released (us$, TOTAL cash budgeted(us$) TOTAL cash released (us$, MOH (Central + Provincial/State 71,429 71,429 20,992 37,037 6,666 MOH (District) lAn A46. vvtv rv 160,645 14 rroA 821 15,385 3,846 Local NGDO(s) (if any) NGDO partner(s) 19,402.96 19,402.96 19,609.61 19,609.61 12,934 Others a) b) Communities APOC Trust Fund 90,151 70,096 2,000 2,000 TOTAL 25'.1,475.96 20,830.96 192,282.61 1 11,519.61 54,422 25,M6 tr r ;u- a; & q Ir I E a-46- 3.4. Expenditure Per activities: Table 14: lndicate how much the project spent for each activity listed below during the reporting period. Any comments or explanations? The counterpart funds released for the project this year was grossly inadequate, as purchase of new tyres for the project vehicles was inevitable. Other funds spent on the project were made possible through mutual integration with other PHC activities. Activity Expenditure($su) Source(s) of funding Drug delivery from NOTF HQ area to centra I collection oint of com Mobilization and health education of communities LGAs Training of CDDs 2,980 LGAs, APOC and communities Trai of health staff at all levels Su IS CDDs and distribution 2,070 LGA/state lnternal monitoring of CDTI activities 923 State Counterpart visits to health and authorities 462 MOH IEC materials Vehicles/motorcycles/bicycles maintenance 2,692 State counterpart Office equipment (e.9. rnaintenance computers, printers, etc) 577 State counterpart Review meeting 808 State counterpart TOTAL 10,512 APOC/State Total number of rsons treated 1,096224 4 F E" G 'irti $ t:I, m -47 - SECTION 4: Sustainability of CDTI 4.1. lnternal; independent participatory moryipring, Evaluation 4.1.1. Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable) Year 1 participatory independent monitoring Mid term sustainability evaluation 5 year sustainability evaluation lnternal monitoring by NOTF Repeat impact assessment & evaluation of sustainability work plan was sponsored by APOC in May 2006. 0ther evaluations by the NGDO partner. 4.1.2. What were the recommendations? a) That the State with the LGAs should jointly develop a comprehensive work plan on community mobilization and health education in some communities in Olamaboro LGA. b) That the LGAs project staff should endeavor to carry out serious follow-up to bring about full community participation. c) That there should be a forum for LGAs and the State to cross fertilize ideas on how best the project could be sustained. d) That advocacy visit targeting LGA new council members and other sources to give financial support to CDTI activities at this level be carried out. e) That the State team should endeavor to become computer literate for effective data management. 0 That a data clerk be employed to manage treatment data generated from the field for effective programme sustainability. 4.1.3. How have they been implemented? a) There had been a follow-up for the implementation of these plans by LGA, but these has not yielded the desired results as there had been weak political will at the LGAs level and other administrative bottlenecks. irl q rt li t fI I f,I rx S'r b) There had be an organized forum for the LGA and the State to cross fertilize ideas in an integrated manner on how best CDTI could be sustained . so me suggested on-the -spot deductions of little funds from the LGAs monthly allocation which should be kept in a separate account at the state and _48_ disbursed for CDTI activities. We hope to organize a forum to address this in year 2007. c) Most LOCTs are actively involved in other PHC activities e.g. NPl, Roll back Malaria ect. This has help to bring the LOCTs closer to some community Members. d) Although unwillingness on the side of the LOCTs to work has been observed as a result of untold stipends received during NID rounds, this has been addressed in the state council on health meeting and all HODs gave promises of getting back to enlighten their health staff. Already, the APOC speciat initiative will help to address this matter further as training of more health staff will take place and will reduce work burden on the older LOCTs on CDTI activities. e) Some members of the state team are now computer literate, moreso, a data entry clerk has been posted to the unit to help in the management of data generated from the field, she is undergoing a refresher course on data management, with this, the project now has a fairly comprehensive database for CDDS, health staff by their LGAs which now makes it easier for collation of CDTI data at all levels. 4.2. Sustainability of projects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period? No Was a sustainability plan written? Yes When was the sustainability plan submitted? Feb.2003 What arrangements have been made to sustain CDTI after APOC funding ceases in terms of:- 4.2.1. Planning at all relevant levels: At the APOC sponsored sustainability planning meeting held in February, 2003, it was resolved that, at the beginning of each year, Onchocerciasis team members should meet to plan and draw plan of activities for the year. This is being implemented at the State level. The LGAs have been encouraged to hold planning a d -b r ! tL I' ir" t3 _49_ meeting at the beginning of each year to give room for efficiency. With this in place, there had been remarkable achievement in the area of programme management +.2.2. Funds The inclusion of yearly budget for CDTI activities has been instituted. At the State level, provision has been made to include Onchocerciasis control in the annual budget.This has paved way for writing of memos for reiease oi funds though, political bottle necks is often experienced. The frequent reminders to the LGAs council members on the need to release funds for CDTI activities and personal contact has in no small measure contributed to the release of funds at the LGAs though meager releases. Transport (replacement and maintenance): APOC promised the donation of another 4 wheel drive Toyota Hilux. 12O motorcycles, 120 Raleigh, bicycle, 1 desktop computer, sharp photocopier, 1 LaserJet printer and 1 overhead projector. These were redeemed and conveyed into the State in December 2004. lt is hoped that other replacement and maintenance of capital equipment would be carried out from the counterpart funds , lf the releases from the state government improves as we pray. The State has been responsible for the maintenance of the capital equipment. lt is gratifying to express that, all this equipment are in good functioning condition. The sight savers international graciously donated 4 suzuki motorcycles to some needy LGAs. 4.2.3 4.2.4. Other Resources: It is our sincere hope that other philanthropists would contribute to CDTI sustainability and when this happens, the funds; materials would be judiciou sly commifted to CDTI activities in the State. 4.2.5. To what extent has the plan been implemented: A five-year sustainability plan was drawn from feb 2003 to 2007. 4.2.6 The plan contained replacement of capital equipment by APOC which was Redeemed in 2004 a t 4- E s r. rt u -50- 4.2.7 Orientation of 60 LOCTs in 2005 to their post APOC responsibility using CSM/SHM approach to ensure continued 100% geographic coverage and 65% coverage. 4.2.8 Training of 297 new CDDS and re-orientatton 672 old CDDS on proper record keeping from 10 LGAs in the state. 4.3. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration. 4.3.1. lvermectin delivery mechanism: Letters to LGAs informing them of availability of mectizan tablet at the State for collection are normally sent through other PHC staff going to the LGAs for programmes and LGAs staff that comes to the headquarters. The vehicle that comes for collection of vaccines helps in the delivery of mectizan to the LGAs. Also the LOCTs/DHS are PHC staff in their various LGAs. 4.3.2. Training: Some M & E officers at the LGAs are also trained at the LGAs to help monitor lvermectin distribution. ln the same vein, some nutrition officers and other health staff were trained on vitamin A supplementation using CDTI strategy both at the State and LGA levels. 4.3.3. Joint superuision and monitofgg with other programme: Formal organization for this is yet to be put in place, however, few incidences of joint supervision exist during NlDs but its implementation is been awaited when this is in place, they would be empowered to monitor all aspects of health care delivery in PHC. I r& g' k f t" sfiL Gt9tl -51 - 4.3.4 Release of funds for project activities: Funds for activities are stringently and lately released at the State level more especially as not all approved funds are often released. 4.3.5. ls GDTI included in the PHG budget? Y a 4.3.6. Describe other health programme that is using the GDTI structure and how this was achieved. what have been the achievements? NPI in Polio Eradication and Vitamin A supplementation in 21 LGAs of State. lmprovement in the coverage is being achieved as more awareness is being achieved through one on one contact. 4.3.7. Describe other issues considered in the integration of cDTl: The government stands to achieve programme cost effectiveness in terms of man power, money, materia! and other logistics, if other programme are integrated into CDTI or vise versa. More coordination of activities would be achieved if proper implementation Plan is put in place and if all partners have a joint plan and implement in an lntegrated manner. 4.4. Operational Research 4.4.1. Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period? No operationa! research was conducted during this reporting period. However, we wish that an operational research on CDDs attrition be conducted in our State as to address issues affecting CDTI sustainability in the state. However, we hope to develop and submit a proposal for an operational research on distribution of mectizan using CDTI Structure visa- vis clinic distribution in the cosmopolitan areas like the State capital, LGA headquaters. N/A a a-52- SECTION 5: Strength, Opportunities Weakness, Ghallenges and STRENGTH - Most CDDs still distribute Mectizan@ despite their demands for incentives - Availability of project vehicles (motor vehicle and motorcycles). - Availability of skilled CDTI manpower (SOCTs & LOCTs)' WEAKNESS (political will) - lnadequate support for project plans at LGA level' - Lack of provision of incentives for CDDs. - lnadequate logistic support for LOCTs which is affecting supervision and rnonitoring. SECTION 6: Unique features of the project/other matters - To ensure community commitment to providing incentives to CDDs and mass acceptance of mectizan, visits to some communities by the state team was made to ofu LGA. The state Hon commissioner took interest through personal visit to the LGA chairman to see that Ofu LGA, despite the protracted labour dispute which contributed to the withdrawal of interest in CDTI activities by some key supervisors still carried out supervision of distribution of ivermectin, though lately. Problems Funding of NlDs by WHO and other agencies has affected CDTI in the State. This has led to refusal of some communities to compensate their CDDs and as such, treatment with lvermectin in such communities was actually very difficult. The LGAs mostly affected are Kogi, Lokoja, Ofu, Okehi some parts of Olamaboro, Okene, and Adavi ln some LGAs like Ofu, Kogi, Okehi and Lokoja the health superuisors who should oversee the activities of CDDs. were very unwilling to accept responsibilities, as a result of non-provision of funds for fuelling of their motorcycles for su pervision. a rt I 2. 3-53- The cosmopolitan towns Iike the state headquarters and all LGAs headquarters is facing low treatment coverage as nobody wants to be responsible for CDDS selection and their incentives, more so, to get willing CDDS is difficult in these areas. Competitions of programmes (HlV, malaria, TB/Leprosy) are sources of threat to CDTI sustainability, as funds are made available to the implementers down to the grassroots. The 100% change in LGA decision makers seat and probably 75o/o or 10O% change in the state decision makers seat would result to ignorance on CDTI activities on the part of the new decision makers and as such the fear of loss of previous gains in advocacy, health education, sensitization may become reality. The following are strongly recommended: - Recommendations High powered advocacy and sensitization on CDTI to include neglected diseases like measles, guinea worm, lymphatic filariasis to the new policy makers both in LGA and state level by the middle of the year 2OO7 when the new policy makers might have assumed duty for political and financial support. To be sponsored by APOC and the assisting NGDO. APOC to sponsor operational research on clinic base distribution in comparison with CDTI approach as to address the problem of distribution in cosmopolitan cities in the state 4. o C 5 a t t