Zamfara CDTI Project sixth year annual project technical report to Technical Consultative Committee (TCC): January-to December 2004

ZAMFARA STATE CDTI PROJECT ORIGINAL: English Proieet veer of this reoorfi (circle one) I 2 34 78910 (RESUBMISSTON) SAVERS INTERNATIONAL i\tit. t,r'b For lnforrnction to, Ji e Au Aalt'r' Proiect Name: Zamfara CDTI Pnojcct COT NTRYNOTB': ITIIGERIA Leunchins Year: 1998Anorovalyear: 1998 JAI\ruARY TO DECEMBER 2OO4 ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE coMMrrrEE (TCC) AF'RICAN PROGRAMME F'OR ONCHOCERCTASIS CONTROL (APOC) SIXTH F Fcr Ac'.i:n Io: rrc $U csS(cp 0 8 sEP, ?006 ct r/ t itl ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TBCHNICAL CONSULTATTVE COMMITTEE(rcc) DEADLINE F'OR SUBMISSION: To APOC Management by 3L January for March TCC meeting To APOC Management by 31 July for September TCC meeting AFRICAN PROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) /\- ANI[UAL PROJECT TECHhI"ICAL REPORT ST]BMITTED TO TECHI\IICAL CONSTILTATIVE COMMITTEE (TCC) DEADLINE F'OR SUBMISSION: To APOC Manageme,nt by 3l Januaw for March TCC meeting To APOC Manageme,nt by 31 JuIv for Seotember TCC meeting ( AFRICAN PROGRAMMB FOR oNCHOCERCTASTS CONTROL (APOC) L/ \- I IAI\IIUAL PROJECT TECIIIICAL REPORT TO TECHNICAL CONSULTATTVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign fte reporh Country National Coordinator Name:pfl ?*lLl.*..C4-U Signatue: ... e4_ Zonal Oncho Coordinator Neme: . Signature: Date NGDO Representative Name. ,s, Date... . Signature Dater:/qg f>op^ t"?A I cL Date. ...7.Y This reporr has been prepared by Name, if/,r/h/n.4 lal46 Designation: (m C.o.*tul4* 7tl LVL Date k 0 Table of contents Acronynns vli Definitlonsvlll FOLLOW UP 01{ TGG REGOf,TENDATIONE I Execrrtlve Eummary li SEGTION't: Background lnformatlon lv 1.1. GrumarxronrraeloN 1.1.1 Description of the proiect (briefly) 1.1.2. PartnershiP ....Iv iv ....vi I.2. POPUI-ATION SEGTION 2: lmplementatlon of GDTI i 2.1. TIMELIM oF AcrrvITIEs ...................I 2.2. AOVOCECY ERROR! BOOK}IARKNOTDEEINED. 2.3. MOSNZANON, SENSITIZATIONANDHEAI;TIIEDUCATION OFATRISIKCOMMI.]NIIIHS...I 2.4. CouuusrrYINVoLVEMENT 2.5. Capecrrv BUILDING........... 2.6. TP'EATlvffi.rTs .......'-........I 2.6.1. Tleatmentfigures............. .-......i 2.6.2 What are the muses of absenteeism?..........'..... .........'..i 2.6.3 What are the reasons for refusals? ......-......i2.6.4 Briefly describe all lmown andverified serious adverse events (SAEI tlwt.......i 2.6.5. Tiend of teatmmt achtewmentfrom CDTI project inception to the anrrentyear...i 2.7. Onornntg SToRAGEAI.IDDELTVERYoFT\|ERMECTIN............ -.................I 2.8. Comarxrry sEtx-MoNIToRINGaTVO sreXrHOrOnnS MEETINGERROR! BOOnVilnX NOT DEFINED. 2.9. SuprnvtsloN 2.9. 1 . Provide a fiow chart of supervision hierarchy. .... 2.9.2 Whatwere the nain issues tdmtifiedduring supervision? 2.9. j. Was a supervision checHist used? 2.9.4. Whatwere the outcomes at mch level of CDTI implenentation supervision? 2.9.5. Was feedback given to the Wrson or groups supervised?2.9.6. How was the feedback used to improve the overall performance of the project? i SEGTIOII 3: Support to GDTI Error! Bookmark not defined. 3.1. EQUPtvfrI.rr ................ I .....,......'...23.2. FtrIaNcTeT CONTRIBUTIONS OF TIIE PARTNERS AND COMMI.,MTIES 3.3. OTM.FORIVI^SOFCOMMUMTY SI.JPPORT 3.4. HGMDIIIIREPERACTIVffY SEGTIOII 4: Eustalnablllty of CDTI Errorl Bookmark not defined. 4.1. h[TERI.{AL; INDEPENDENTPARTICIPATORYMOMTORING; EVarUaUON.....................4 4. l.l Was Monitoring/ewluation canied out during the reporting period? (tick any of the following which are applicable) 4. 1.2. Whatwere the recommendations? ........ 4.1.3. Howhovetheybeenimplemented?................ ..............J 4.2. SusrAnIABLrryoFPRoJECTS: PL-AIiIANDSETTARGETS(uauo1ronv4r.................6 Yn3) I i i i i i 3 3 ....,............,.., 4 4 ...................6 ,..............,...6 .'........,.......,6 .............,,..,,6 .,......,......,,..6 4.2.1. Planning at all relevvnt lwels 4.2.2. Funds 4.2.3 Tlansprt (rephcement mtd naintenance) .... ........ .... 4.2.4. Other resources... Lil I 4. 2. 5. To what extent lws the plan been implemented ............. 4.? INTEGRANON. 4.3.1 Ivermectin delivery tnechanisms .... 4.3.2. Tiaining............. ..,,.,6 .....,7 ..,,..7 ...,,.7 4.3.j. Joint supervisionotdnnnitoringwithother progtams..... .............7 4.3.4. Release offi*tdsfor proiect activities......... ...'.............8 4.3.5. Is CDTI irrcfuded in the PHC budget? ...........8 4.3.6. Describe other health progratrunes that are usingtlu CDTI structure and hout thiswasachieved. Wlnthwebeentheachievvments?............. ....................8 4.3.7. DesuibeothersissuesconsideredintheintegrationofCDTI. ....'..8 4.4. OPMATIONAT RESEARCH.. 4.4.1. Sumnarize in not more than one half of a page the operational research undertal<en in the project areawrthin the reportingperiod. ........8 4.4-2. Hawwere the results applied in the proiect? ............. ....................8 SEGTION 5: $trengrthr, weaknesses, challengear and oPportunltler I SEGTION 6: Unique featutes of the prolectlother mattenr I 8 ..l Acronyms APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT I.JMCEF LrrG wHo African Programme for Onchocerciasis Confrol Amual Treatnent Obj ective funual Training Objective Community-Based Orgarization Community-Directed Distributor Community-Directed Treatrnenrt with Ivermectin Community Self-Monitoring Local Govemrne,lrt Area Ministry of Health Non-Crovernmental Dwelopme,lrt Organization Non4overnmental Organization Naional Onchocerciasis Task Force Primaryhealth care Rryid Epidemiological Mapping of Onchocerciasis Severe adverse event Stakeholders meeting Tectnical Consultative Committee (APOC scientific advisory goup) Trainer of trainers United Ndions Childre,lr's Fund LJltimate Treafrnent Goal World Healtr Organization Ut Deflnttlons (D (ii) (iii) (rv) (v) (vi) (vii) Total population: the total population living in mesoftrper-cnde,mic cqnmunities within the project area (based on REMO and oe,lrsus taking). Eligible population calorlated as 84o/o of the total population in meso/lryper- end€mio cmmrmities in the project area Amual Treatment Objective: (ATO): the estimded mrmber of persons living in meso/lryper-e,nde,mic reas that a CDTI prqiect intends to treat with Ivermectin in a givenyer. tlltimate Treatnent Goal (JTG): calculated as the maximum nrmber of people to be treated anmally in mesoftrper endemic ueas within the project areq ultimatety to be reachd rryhen the project has reached full gmgrryhic coveragp (ncmatty the projat shorld be oryected to reach the UTG at the end of the 3d year ofthe prqiect). Therryersic cov€rage: rumb€r of people treated in a give,n year ov€r the total population (this shculd be opressed as a perce,tage). Geoeraphical coveraee: number of cmmrmities treated in a given year over the total number of meso/lr5rper-endemic cmmurities as identified by REMO in the project area (this shorld be opressed as a perce'dage). lntegration: delivering additional health interventions (i.e. vitamin A supple,ments, albendazole for LF, screening for cataract, etc.) through CDTI (using the same Exst€,ms, training supervision and persmnel) in ader to madmise cct- effectiveness md empower commnities to solve moe of their health problms. This does not inclu& activities or irtervertiqrs curied orf by cmmmity disributors orilsi& of CDTI. (viii) Sustainabilitfr CDTI activities in an area are sustainable wheir t}€y cotrinrc to firnctim effectively for the fseseeable firture, with high trreatrnelrt cioverage, integrat€d imo the available healtbcre service, with strong c,ommity orrnership, using resorces mobilised by the community and the governrnelrt. (ix) Comunity self-mmitoring (CSM): The process by which the community is empowered to overse md mmitm the performance of CDTI (or ry curmmity- basd bealth inteiveirtion programme), with a view to ensuring that the programme is being cr(ecut€d in the way intendod" It mornages thc comnunity to takc full responsibility of Iverretin disribrrim and make apprqriarc modifications when necessary. v I \ \ FOLLOW UP Oil TGG REGOTTE]IDATIOIIS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC scssion 20th Ntrtcrof Rmsadfun hthe RcDorr TCC RECOMMENDANONS ACTIONS TAtrEN BY THE PROJECT FORrcUAFOC MGT ASE ONLY I Use mst rece'nt reporting format lviost reced reporting fqmat has b€m used for reporting ll Prroject should gfue reasons for the orte,oded period of treatmerf Distribrnion was acuully plamed md done nfor 2 - 3 months. The additioral months othcr nonthr wcrc corcred for follow up treahe,nt. lll Explainuthy no training was dore ed what is the future plaos fm Eaining. Trainingwas not cmducted due to inadequate finding Ttrre was a plan for tb tsaining of all cadres of CDTI imple,menter, The future plm was to train all hcalth worters in eodemic reas to ensure that health st8ff transfer does not affect project imple,me,ntaticn lv Giw reasons for the loss or wastag,e of irrcnnectin, number remaining and urhere they were *ored for next campaigg NfectizaoO allocation and usage for the year has b€m rwiewed. Fron o:r reca4 there was a loss of 100 tablets aod the CDDs could not orplain the loss. Three thousand sswnhm&ed aod forty for (3,7,M) tablets were I rE|nafured at the qrd of the I cmpaip and were ke$ in the medical store at the State MnisW of llealth. v honid€ mqe infonnation m zupervision conducted Duing sry€rvisioa it was obosrrcd tbat cormterpart firnds wtre Dot release. There was no $ryport to CDDs, inadequate comunity self-mmitcring and conmrnity stakeholders ne€tiDg was not hcld. Recording of treahent in sone cmmmities was poqly dore. vll Elaborate in futurc reports thc lerDl of imqration into PHC fimds Atemp,ts bad b€eir made to integrate CDTI itro PHC from inceptim md thc realisatim of this would be re,ported in future rcDOrtS. vlll Integrate hainingof cmrmity sryervisors into their strategy to increase cormmity onnership Ptans hnd beeir concluded to introduce commmity self- mcnitoring as prt of commmity sup€rvisioo md for pronoting omership. (Please add more rovts if necessary) \ r\\ - WHO/APOC- 24 Norcmber 2004 Executlve Summary/ heparc an F.xutttiw surnmor! otthe repofi in not ,rrore than one page 1. Background ontredn€,lrt ard populAion data - Total commgnities, communities teded, total population, UTG, ATO utd persons treded. 2. Background on popultion movqnexils. 3 Training data - CDDS, health workers, Total population (community) per CDD trained. 4. Challengm and how they were overcome. EXECUTryE SUMMARY Tlre African Programrne of Onchocerciasis Control (APOC) Community Directed Treatme,lrt with lvermectin (CD'[D projec-t nZanfuaStde is in its sixth year of implementation From the inception of the progftunme in 1998 to 2O02, tredne,$ coverage and geographic coverage rates in-creased annually, as indicated in the table below. In 2004, 151,363 people were treated out of a populdion of 193,156 n l2l endemic communities within the five LGAS. There are 5 Onctro endemic LGAS comprising of l2l e,ndemic communities with a population of 193,156 Oased on the oensus tak€n by the CDDs). A total of 153,363 people were treded n 2OO4 attaining 92.2yo of the annual treafin€nt objective of 165,000 for the fifrt year of CDTI implementation. Ninay-ei$t (98) traditional birh att€ndarts and the 102 islamic scholars from the endernic communities were trained on CDTI, while 358 CDDs were tain/reilrained based on identified needs. The objective of these rainings was for fte trainers to reach out to women in purdah. This is to health educate them wtren they go to Islamic sdrools at night. The State md endemic Local Governmelrt Areas took responsibility for 2004 treatment, witr support from Siglt Savers krtemaional. Like in 2003 migration of the nomads from endemic communities to better $aingland urd the youth to the cities for menial jobs during the dry season accounted for the recorded absenteeism Year Population No Treated Geographic coverage Therapzutic coveraqe 1998 t35,572 96,513 lOOo/o 7l.lB%o 1999 140,424 108,092 lOOo/o 76.97yo 2000 754,970 t19,526 lOOo/o 77.lz%o 2001 161,972 132,797 l00o/o 81.98% 2002 169,449 140,267 l00o/o 82.77o/o 2003 184,666 152,712 l00o/o 82.7% 2004 193,156 153,363 lOOo/o 79.3yo \x - WHO/APOC- 24 Norcmber 2004 There is poor goverilnent financial support coupled witr trmsfers of Local Govemment rained personnel s/hich advosely atrected the 2004 tredmeNrt round. To remedy the above issues advocacy visits were conducted to the LGAS to seek for finding for the implementation of CDTI in the year under roview. x - WHO/APOC- 24 Novcmber 2004 SEGTIOII | : Background lnformatlon {.'1. General lnfiormation 1.1.1 Description of the proiect (briefiy) - Geoglaphical locatioru topograptry, climate - Population activities, cultures, lmguage - Communication systems (roads...) - Administationstructure - Health Exstem & heallh care delivory @rovide the number of health posts/cenfes in the project area if the information is available). - Number of health staffin projec't area and nunber of health staffinvolved in CDTI activities. The State is located in theNorthwestem region of Nigeria and shares boundaries wittr Sokoto State and Niger Re,public in the norlb, Kasina State in the east, Kebbi State in the west md Kaduna and Nigo States in tre south. The State is made up of 14 Local Government Areas. The vegetdion of the state is mainly Sudan and savannah grasslmd. There is a vast land of agriculture and two main rivers (Nver Bunsuru and River Ka). About 80% of the population lives in rural communities. The State has trvo seasons namely the rafury and the dry seasons, the raining season commences from May to November, while the dry season starts from Decemberto April. The State has a population of over two (2) million people with tlausa and Fulani being as the main ethnic groups, md Islam is the predominant religion in practice. The main activities of the people are crop production and animal husbandry. With the advent of the Global Satellite Mobile telecommunication Eistem in the state has improved communication ternemdously. The state populace also has access to the electronic media through the radio and television stations - Nigerian Television Authority owned by fte Federal Govemment of Nigeri4 the state owned radio station ltnown u Zarfara Radio md the Kaduna State Radio Station The state has ur established Ministry of Informaion with other local means of disseminating ffiormdion to its people in iural communities. Eighty percent (807o) of communities are difficult to be access during the rainy season The road networks to some of the local govemments re feeder roads with difficult terrains, which means patients, have to travel long distanccs for health services. Public means of tansportation to most of these communities are available only on market days, the cost of whidr is hi& (about $8) for an average community me,mber. During the dry season there is a high migrtion of male youth to urban areas to e4gage in petty trading and other unskilled professions to earn a living. They however retum to tlrcir communities in the rainy season for agricultural activities. There are two main tiers of govemmurt operAing in the state - the state and local govemments. An elected Executive Govemor and elected Chairmen and Courcillors at tre state and local govemmenB, govern respoctively. There are also the traditional and religious /l - WHO/APOC- 24 Nowmber 2004 institutions of leadership, which have an influence on the administrdion d the local govemme,nt. A General Hospital is based in each of the 14 LGA headquarters and in the surrounding districts; there are sporadic primary Health Care delivery hfrasructures, ranging from comprehensive health c€ntes to healttr clinics. The Primry Health Care facilities serve as training centres for CDDs and other trainings as well as Mectizat@ collection points. The project area has a total number of 96 health stafr and 62 are currently involved in CDTI activities. Table l: Number of health staffinvolved in CDTI (Please add more rows if necessary) Dtrtricfl,GA Nunbcr of lrcelttrteflhvolv.d ln CDTI rtiviths. Totel Nunbcr of h.dfrst IIh6c cntirc proJoct rrce B1 Nunb.r of hc.ltt strfrhvoh/cd in CI}TI B Pcrccntrgc B!=Br/ B' '100 Anka l3 8 61.5 Suogrdu 2t l3 61.9 Sukkuyun 28 17 60.7 N{am l6 ll 68.7 7:rni t7 l0 58.8 StateMOH 6 5 83.3 Totd 5 96 a 54.3 + The involvemerf of other health workers in other health programmes of the local govemment is uihat accounts for the varidion of the health workers involved n2003 I 2004. 2 - WHO/APOC. 24 November 2004 'a 1.12. Paflnership Indicate the parrrers involved in project implementation at all levels [MoH, NGDOs (nationaUintemational), communities, local organizations, etc.] Describe overall working relationship among parErcrs, clearly indicoing specific areas of project activities (plarning; supenvisio4 advocacy, planning mobilizatiorl etc) wlrere all partrren are involved. State plans, if ary, to mobilize the state/regior/disfict/LGA decision-mak€rs, NGDOs, NGOS, CBOs, to assist in CDTI implementation Parrrers inthe Zanrfara CDTI project comprise of ftre following:- ZarnfaraState Ministry of Health The Ministy for Local Govemment ard Chieftaincy Affairs (representing the five e,lrdemic LGAs) African Programme for Onchocerciasis Contol, (APOC). Federal Ministry of Health Communities in endemic LGAs Sight Savers Intemational All the partrers play roles and perform their responsibilities in the implementation of flre project activities. Zulnfara, State Minisfiy of llealth The Zamfara Stde Ministry of Health is structured in line with the Nigerian Health Structure tha is based on the concept of the Alma Ata declaration of 1978. Based on the above the National Health Care Delivery System is stuctured into primary, secondary and tertiary levels of care assigned to the local, state and federal governments respectively. The Zamfara State Minislry of Health is therdore resporsible for the provision of secondary health cae, supervising LGAs to provide primary health cre serrrices to its popularion There are 8 departrn€nB in the ministry; each of whidr has a role to play in the provision of eye care senvices. The 8 deparrnerts are Adminisfrarioru Public Healft Services, Primary Healtr Care, Pharmaceutical Services, Nursrng Services, Planning Research and Statistics, Finance and Supplies and Inspectorate Services. The ministry supervises three parastatals - Hospital Service Management Boar( School of Health Tectrnolory and Health System Development Project. The activities of the Ministry md health services provided are frmded from budgetary allocdion from the state govemment. The Ministry is involved in plarfng, advocary to the LGAs, monitoring and provision of logistic support for implementation of CDTI in the state. Provision of counterpart fimding by the state and LGA5 has been poor. Sight Savers Intcmational Sight Savers International has been supporting Onchocerciasis contol in six Local Govemment Areas (Bukkuyurq Bungudtl Tsafe Ank4 Maru ard Zurmi) since 1996. The organisation has provided technicd support in terms of training of project staff and plamring and reporting; including logistics support (vdticles, IEC md€rials, spares, monitoring advocacy etc). The organisation also supporB trachorna control and provision of cataract se,rrrices in the state. l. 2. 3. 4. 5. 6. 3 - WHO/APOC- 24 Nove,mber 20O4 Minishy for Local Govemment and ChieftaincyAffairs The Ministry is the supervisory organ of the local govemment areas in the state ard the endemic local govemments fall under them The Ministry has assisted the project throu$ communication and advocacy towards ensuring thd the local govemme,lrts provide the necessary support for implementation of CDTI. The local govemments under the minisry involved in CDTI ftrough plarring; advocacy to fiaditionaUcommunity leaders, monitoring and supervisiorq health educdion and mobilization of communities, reporting ad management of adverse reactions as a result of treafnent wittr Mectizan@. The State Ministry of Health ard the LGAs provide office acconnnoddiorL pay salries and emoluments of SOCT$LOCTs. During the trefrnemt year under review they responded to m advocacy meeting held to solicit for political ard financial support towards ilre project sustainability, as a result of tris tre state allocated a counterpart fund of five hmdred thotsand (N500, 000) to Ondrocerciasis Control Programme, while the two LGAs (Bungudu and Bukkuyum) released sixty-two thousand naira (N62, 000). African Programme for Onchocerciasis Control (APOC) The African Programme for Onchocerciasis Control (APOC), lvttidt is a WHO organ, was established in 1995 with ttre sole objective of supporting flre contol of Onchocerciasis in zub Satraran Africa using tre Community Directed Treafinerf with Ivermectin (CD[D srategy. APOC has supported the Zamfara CDTI project witr funds for implementation of project activities since 1999 md also provided capital equipment and logistic support for the project. Federal Ministry of Health This is the organ of the federal govemmat that is responsible for forrrulding national heallh policies. The National Ondrocefciasis Contol Progamme (NOCP) is a unit of tre deparhne,nt of public health and is headd by a National Coordindor. There are four zonal offices - ZoneA (Enugu), B (Ibadan), C (Kadma) and D (Bauctri), $/ttidt are headed by zonal coordindors and have the resporsibility of monitoring CDTI activities in th€ir catdmem states. The NOCP on behalf of federal govemment endorses all letters of agreemeats wift APOC and monitors implementation of CDTI in the state including advocacy for support to the stdes. Endcmic Communities A community or village in Zamfara Stde refers to people in either small or large groups, who live in the sane place, strare tre same culture, customs and traditions with a oommon leaderstrip. In the project area ttrere ue l2l endemic communities ttat fit these descriptions. These communities bave been receiving Mectizan@ for 9 yers. The commtmities are responsible for the selection of volunteers as distributors, provision of incentives for the volunteerg collection of Mectizan0 from cental poirfts, distibution of Mectizan@, monitoring and supervision and reporting among other responsibilities. t \{ - WHO/APOC- 24 Novembcr 2004 EDe E, ootrt P FF E E El ,fp I r9trAFl Eq 5E -dF* Ft lo lE Nt E F E \o L,I(, \o {5 oO@ 6{ @6 o\ 5 o5@ I' EIE HrEA-_ flAEEEEBdl't9 -. li\o(r) FUI a\ { trt{(,l \0 @ h)6 \o taqJ t, Elr i Fg He ;.7D a7 sg* fE z r-aF z z z z z \o l.ri(, t, ts E(D!EE H ? (D Eo6 E a No E'6b 7I E Eorl orl \o @ }J o\ ll\oL) l- ?rt6 { L,T{(, \o L,I(, \o \tFo@a o\{ @@ o\ 5 o5@ r Eir i Fg z z z z 3 z -EErsB *E tlI r., ' z Z. z z z z EBoo ESa(< sttooE' :I Fr o\tt ooo 5 ooo @ ooo L,I{ -o oo o\ "|ooo t) ooo e Fl o stF INI ! o! 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E €x!B?Bd:E aE E'E EE3 F .r i, Iotr9rDu.x8U E --- ts' g o 6) >' € E G)trg o. E Eoi.BeEH 'rt qi .F() .z a)HS c)a&6 G)L €p co3sBN9BEH .9tsTEtrt\ .t>hH Abeso$Ft3:()<)O .s€ \EEBPH5c)3tsXHvL. LGITB E :E.g I E EE ;i,dE Erbb .E L ---C ()o.x: flotE o .=.s g g -9iE EE or !E ._ts F EE :, *#E. fl Fat, lF o Ep I6fl E o Eg B E ltN - oIl-t, uto v, 0) u,o -e. GI o €o A o) H q) A o o)a o F I ciLr C) .ts oE C)tr d tA(+{ Bp H:E O(Hoo 'do ao o* €=l .EE EE clr> a99; 9.9 ;!sH> 8.b s€ g .!r otri trc, tr. J2oa;troOaEE EE .O 6)E€bB €s3€ H6 oo o arl €s JEE _t I I -t I , Eo c,t a)e a eoE! TE EE(J Ea .E r Lt LEt Lr -Sst.E #E Lq Lq r EEL EL Io T € .F I v, t BT E e E. EC(J EA La tc r LA -Hr .t.E ;E .E a El. Le LEt tl. slctEl sl)> tlEt)(J EoE'!o9EE EE o .di,L a E .d I E I a,L3 = II I E t(J I E Hei.E i= aa .doLI E !IJ I E €L6 E !I t E !g LI E an EI E E Er coElE EE EE(J .d L cl E .dULI E tILI E €La E .dI a E -HstsE #E tl,) 6 E I TJ I E IIJLa E IIJ 6 = ,do ql E rarOra ril €.E SE EE co5 -r! B:I rioIr{ <;G'tu -doh -dC)trr dC)Ei Sr +.E .l= aE do tr{ j ofr tio trr tt0) tr{ .r, 0) tri (, Fl t) .E 3J' e 6JIt E = =!!Io JE =otr3tr E6 = E :N Fl tr otr I ; , I t- 2.2. Advocacy State tre number of policy/decision makers mobilized at each relevant lwel during the current year; the reason(s) for rmdertaking the advocacy and the outcome. Describe difEcultieVconstraints being faced and suggestions on how to improve advocacy. Letters were written and advocacy visits made to policy makers in all the e,lrdemic LGAs to solicit for support particularly release of counterpart funds. All togetrer 5 Directors of Primary Health Care (PHC) in tlre ende,rnic LGAS, the Director of P H C in fte Ministry for Local Government and Chieftainry Affairs, Commissioner of Health and the Permanent Secretary Ministry of Healttr were reached for advocacy. All the policy makers promised doing alt tha is within *reir authority to see that fimds are released to the project. The state Ministry of Health allocded N500, 000.00 to the Ondrocerciasis programme in the Ministy of Health budget, of whichN20l, 000 was released. The Oncho Coordinator also attended an advocacy workshop organised by the Sight Savers Intemational to develop advocasy skills for the implementation of CDTI. The lessons leamt from the taining have been very usefrrl in soliciting for support for the project 2.!. tobillzatlon, sensltlzation and health educatlon of at rlsk eommunities The use of media and/or other local systems to disseminate information Types of IEC materials used Mobilization and healft education of communities including wome,n and minorities Resporse of target communities/villages Accomplishments Suggest ways to improve mobilization and sensitization of the target communities. The project has not used the media to its full potential in the mobilization and healttr education of the population on CDTI. ln the earty years of the project the film on CDTI produced by APOC was aired on the Nigenan Television Auttnrity and radio discussion prograrnmes on the disease. Local town criers were also used to disseminate information on CDTI in communities. NOTF developed posters; flip charts ard brochures were used as IEC materials for health educdion urd mobilizaion. Zamfara State is predominatly Islamic ard t wom€n are usually in purdah- Ttre project in its efforts to reactr thern holds special trcaltl education sessions for them at the community leaders' house; most of tre women are however not reached. In the yar 20O4 Islamic sctrolars were rehained on CDTI to provide mobilizoion for women in purdah during school hours. The response ofthe commmities was encouraging as most of tre endemic areas s€ril sctrolars to be trained on CDTI. The communities have continued to respond positively to the programme through annual compliance to treatment. The project parmers should intensify efforts to hold stakdrolders meeting annually berfore md after each campaigl These meaiqg should be held as close to the communities as posible to erurure higher participation and ownerstrip in the communities. Provide information on: + WHO/APOC- O 24 Norember 2003 2A. Gommunity involvement Table 4: Commurities participation in the CDTI @lease add more rovts if necessary) Comment on: - Attendance of female members of the community at health education meetings - h general, how do you rate the paticipation of female members of the community meetings when CDTI issues are being discusses (attendance, participation inthe discrssion etQ. - lncentives provided by communities for tre CDDs - Attrition of CDDs. Is atnition a problern for the project? If yes, how is it addressed? - Other issues 8 DtutdcULGA Ntmbcr of comrndtlc#villrgcs wtth conmdty mcmbcn er opcwkorr Ntmbcrof CDIh Nmbcrof cormrddcr Mllegarvittfcrndc CDDI Totd no oorlrrrnddcs h ttc cntirc prolect ree Br Nunbcr rltt corrurnldty mcrnbcn rs mpcrvkon B. Pcrrcdrgc BF BJ B. .IM MdrCDIh b ['Gm.lc CDI)t B Totd BF BrFBr Nunbcr of ccnmmittcs riftfcrrelc CDIh Brn Porcentrgc &r: &/Br'lll0 Arks l3 8 6L5'/o 39 0 39 0 0 Bukkupn 53 t7 30.3o/o l0l 0 l0l 0 0 Bungudu l9 13 68.4o/o 8l 0 8l 0 0 Maru 26 ll 42.3o/o 86 0 86 0 0 Zrtrot 8 l0 l25o/o 5l 0 5l 0 0 Totd r19 59 49.1t/o 35t 0 35t 0 0 WHO/AFOC- D 24 Notcmber 2003 r- 2.5. GapaclQr bullding - Describe the adequacy of available knowledgeable manpower at all levels. - Where frequent transfers of trained staffoccur, state what the project is doing or intends to do, to remedy the situation. (Ihe most impofiant issue to describe is what measures were talcen to ensure adequate CDTI implementationwhere not enoughlmowledgeable manpover was available or if staffare frequently transferred during the course of the campaign). During the teafinent yer there was a re-training of the 102 Islamic scholars and 358 CDDs conducted usingtheN20l, 000 released by the state, this was done to ensure ownership of tre project at the community level. However, there is aneed to really add to the number of healtt workers for effective monitoring and supervision of the project due to frequent transfer of stafrand to also address the issue of reluctant Atitude by some of thenU s/hidl is as a result of non release of cowterpilt fimd by LGAs. The project has decided to ensure that more new health workers are tained for nsrt tredment year. t- L-. 3 WHO/APOC- tr 24 Norc,nbcr 2003 r-I I ^t -l l -t i I -.rL _! ov ! I 8N .Eg t) o z +(\l E dot oH F fl€ es 'at a. E8E9oo) EEsi H.E EE rroof t- tl8$ E*. Fi ut95 ;EE ebE geF EEt- '6 .9 -=ll So+, ().E3 itE EsL ttjtD ?*E:EB A9 E E0fi B'€gc B g EfE E€SE ESF' 'E €e5g E €ggE E E.$E EE T H: H: $E etE 'E H eE E EEEEOoo t-its oi)t sSo os tld G ,t ti $ E B s o{{ s\ oE t .b R , i. eB4 a4q)() q) sb sb\ q)L o R NB q) U, Bq)g tr3 trl c(D A o) a ts F oU(r. o U) o) (!) 6 f; € o IJ GI o0 tr cl F ,iit ol -ol cTFI .:.. I----. €Y)(.tEd .t zrdl E.r3 Id o\(rl o: - \o :-. .lotEll 'et LIrl U2laa L) E fit)E E z 0Ed a ooal oN rr- v)t At) E a) > a) E s6\o Yi\o Ed ir *$ J zrcil €d!()I o DL a) .Ee E3 oet.E LGll9 l-ge E z ()?I{ A €) E a) a) € s $$q d E5" T et) Et) t) € s .l EEI EEI ECEE E UeF< E,t -t(JI d9t dE $T -----t t----. t----. QcI ts6l aa 0 (J 11j3r 9C) .EE;'a Ets o Lo € E z rJ Er oH E a) E a) a) EC' s (,j E a, E t A alxtr E 3. LJ o ! u E trl g IElN I ) I I ! I t ! t_ Table 6: Type of training undertaken Qick the boxes where specific trainingwas canied out during the reporting period) Any other comments i- L I: Trainees Type oftaining CDDs Other Commrmity members e.g Commmity $Dervisors Health Wo*en (fromline health frcilities) MOH stafror Otber Political Leaders Otha (specify) Islamic Teachers Program mfinage-InErt Howto cmduct Health edrcation t/ \/ lvlanagement ofSAEs J CSM \./ SHM \^/ Data collection Data analysis Report writinc \/ Others (specifr) L/l WHO/APOC- O 24 Norember 2003 r 2.6. Troatmenb 2.6.1. Treatuentligures If the project is not achieving L00%geographical coverage md aminimum of 650/o therapeutic coverage or the coverage rate is fluctuating state the reasons and the plans being made to remedy ttris. /LL WHO/APOC- tr 24 Notember 2003 t1/ I I : I I I ot- eI GI o() o' o. o) .q E B oI GI o E o)tEg (l)g €o CA 6.) E E R d3tdl c) xl s nJglJogE qoBtgu HE rl ilfl;aaZll- E Ioo 'aE}cl -E9P8.EE9spE3. .EB - rJl .g 'EEEE3Eg()E € =l EH -1 I EflE3ff gF ;I E fl8. H$ EflEIE .H B H€ H! bI 1 HE s€ s€Alt- Zlt- t I (.) 8al .E Eg) o z$ e.t E C)I o B sIJ5, 6 C0 E E It E!r s s .C .! E ! s s{ 6 t tl) .P \h I B Itt 3lrtg s III s B B E E !o .5 ;ll s s,ttt6 Ett\rtr Ts B trt!Fr lt s \ ts B aq) aq) b hi oL q)Lo s Ns q) V1 Bq) E J4 .A P GII 6) H e u .l u anE >\s ut EI rA !tr GI E E Gto t- r.t ol €lFI olol -l arxl> dfrg8 HE Elt flEzl< Eo o) E(ll oFD s o.t GI & cla EEI oti 0) GI C)bo GI a, oo Q^9-O eD6bI(, o) GI o) oo GII c) I .eGtsct GI !)FH t I lt ,n et3 g E{?EEg o o a o o o E51.uAO o o o o o a E€ ,lr >d oF- \ot- o\ \o+ Bca \l Or$ Nlll) o\ N EE*EE oo o\alrl o Nsl o\\o cl €tF fldEtrt ,r8F Eer E E.a < s€'F9 3* $€ .E E6F ol o\ \Nt\ \6 9t\r.- (a ci € ('t o\rr €t o\ GI ro$ Or$ t-(\l \o an@ rrr Eat it\o(rr F! ra 3 eo( 8od\o 8o ,d 8o ,ri € €- ra\o €so$ \o @ €- r-\o €6o.$r\ o\ r o\ V) F.-\ r- \o rtl (') o\ ltd EEgE€ $r' EE$E E3g sI \oa\8 sg s8 s8 st-Oi ro \o rn @ oal o\ \o (?) \o € ool o\ \o (a fa r o\ \oGI € o\ .9<gq 6< dLCI E x LJaa € u E tq 6 E N FI * o Ei t il Y/ -f I I s 8N B -o H oz vat g o. so B I !i) st E E .t$ bqt eo sr e, \iqlt!tt B{ EU P GL tr{ Itlr{s a\tB$i S t' EtIt !tUt Es .r$ f;{ 'Eb l!.!tl oQt E*!s!G *rr('t NE 'lr u E*rEtr !Da\ ss str *B. ti 3r BTt{FS nT BS :1 i t lt d I L I I t I qa o r 2.62 What are the causer of absenteelsm? The causes of absenteeism were as a result of moveme,nts of nomads who move to tre southem part of the country and may sometimes stay for very long periods, likewise some youth go out for menial jobs. The project has taken decision to continue ensuring that mop-up exercises were carried out, by soliciting for CDDs to do tha despite non-compensation by most communities. 2.63 What are the neasons for rcfusals? Most refusals were as a result of beliefs by some people, some thought that the drug is not their innnediate need, while some feel that the disease is not in existe,nce despite the health education on what the disease is, others refirse because of some religious belief. But with the Islamic scholars trained about the project ard if fully taking on their responsibilities, it is hoped tha the issue will be finally addressed. 2.64 Briefiy describe all lmown and verified serious adverse eyents (SAEs) that occurred during the rrcporting period and provide (in table t) the requircd infomation when availabla ln case the project did not have any cases of serious adverse events (SAE) during ttris reporting period, please tick in the box No SAE case to report ! a /15 WHO/APOC- tr 24 November 2003 )1/ 'l .) t 8ol .t Eo oz *(\t 8 Pr d B I I V) =oL Po s NB o tJ E, 6) oo o Gt q) E. q) o' Lq) .s sS B\ E * an U o c) an o t cl u, o o) .A o u, o) B() ! ocl- EE88E b ?.E a leB EBE ts o.9EAg$ oE 6 o9r ts_g 99 n?,t H &gH t f -Ea 6, H d= E€E.E d trots'gob EEEE Efr$95 q Eo og (A .E B tE"$ H EE{ z o G' s.s =oo>5 o z x E €) a0 i a -l j I I I t \v I J Ij I 1) !fooN E trIIoz rf c.IDI0. d F a - -c I6 - - ^96 CJ o a0 GIebSE NPTDS=tr\cl8.8.EE.s sEE.EAs'ErsEg\)g EciEOPu,5=q,B; E : FSEa.2'ee€iE s HEEitr/kOlE € ,r,,1E bsrr ,-t qlEEI Ht€l EE .BI E. E $tflo'LE E€E;PrHbifitlEsFtda .(l)c)UirIE\etrc'i ?l 'il EI E Ij i ! 1t I ! sHu o sFo sg scto sro -o6\t-o s o \o6\ o\ ci o\ o 'E(t q oA t ;I B rt tsl q$' st-o sa!6o\ s9rno\ s(ad,Oi sdo s09o scloto t t FI rI I r{Eft38t< t. o\6r- r-t\ q @ ':ot@ \q cl co c7) oi r-. et tE sa (a i \o o\ GIq @o \o ol r o\ c-. o\ r., t\ t.\o6l o$ al r-- cl \o (a r ldE5$ 8od o\ ooo o ooo ra(\l ooo i rt ooo o$ ooo oin ooo \o E €- t€'' Olr- r rn(.i rt6l$ os or- o\ .(r ra) clr. o\ \o o\$r+ o\\o \o\o\o- $d \o rn Or oo 00 al o E E Eoo t I r{ H rL tdq$t s 8 s 8 s 8 \o q\I \oo\8 \oo\8 srao\ B'$'*l 6\ 8 \og\ 8 -o6\ 8 \oo\ 8 s E sI srf)o\ r-TEE$Iz8d I @o o o\ (\l ot \o ldE3s e 6o o o\ cl cl GI rf,* [E EEtEE" 6 o\ €o o o\ (\I c.l N d trI F- o\ o\ 6 o\ o\ o\q\6 Et\ 86l GIoo(\l c.t 8ot tooGI iooGI \o 8ol r-oo ol @IN o\oocl o oN I l 2.7. Ordering, storage and dellvely d lvermectln Mectizan@ ordoed/applied for by - (please tick the appropriate anwe) Morr Y wHfl rmcnn NGDGI/ Other (please specify): Mectizar@ delivqred by - (pbase tick the appropriate answer) MOII S/ wHfl TINICE# NGDC] Otrer (please specifr): Please describe how Mectizan@ is ordered and how it gets to the communities The NGDO (SSI) procures Mectizan@ for the project, fte project collects from the NGDO and gives to e,ndemic LGAS who in tum inform communities to come and collect treir slrares from collection points. The number of tablet ordered is based on tbe estimded popultion of people multiplied by a factor of 3, but in the futurg the stAe will completety take over flrc task of orderhg Mectizan@ Table l0: Mectizar@ Inventory (Please add more rmts if necessary) Number of tablets - How are the rernaining ivermectin tablets collected and where are they kept? The balance of the Mectiza@ tablets were returned to the front line health facility by the distributors then to the project coordinator at the LGA level who finalty retumed the drug to the State Oncho Office for safe keeping at the state medical store. List and briefly describe ttrc activities under ivermectin delivery that are being carried out by healft care personnel in the project area The obligation of Mectizan@ order at the State and LGAs i.e. from FLItr to LGA then to State. o Collection of Mectizan@ for fronfline healttl facility by LGA coordinators. o Collection of Mectizan@ for enderric communities by FLIIF health workers. o Notify commrmities to come for the collection of Mectizan@ at FLIIF. Any otho cornm€nts StatdDistrict/LGA NumbcrIn ctock Rcquotcd Recelved Ured Urcd/Perron trcetcd I.ott Wertcd Eryired Rcnelning Anka 50,000 40,000 394o7 328 265 Bukkuyum 150,000 132,771 131896 422 453 Bungudu 138,(n0 136,455 133251 89 26 Maru ,16,000 44,369 43651 410 308 Zurmi 43,000 41,2W 39818 840 542 TOTAL 4n,00o 393,595 388,02:1 2,089 1,591 ,4-\ WHO/APOC- tr24 November 2004 2.A. GommunlQl self.monltorlng and Stakeholdenr teeting tlas ary training (of trainers) for commmity self-monitoring been done in the project area? If so, When? Table I l: Community self-monitoring and Stakeholders Meeting (Add rovts if needed) Describe how the results of tre community self- monitoring atd stakeholders meetings have affected project implementation or how they would be utilized during the nsril treafrn€nt cycle. District/ LGA Total # of conrmrmities/villages in the entire project area No of Communities that canidort self monitoring (Csnfl No of Corrmrmities 6at con&rcted stakeholders meeting(SEM) None None None None TOTAL /L3 - WHO/APOC- 24 Nowmber 20Ot i- 2.9. 2.9.1. Eupervlsion Provide a flow chaft of supenision hieranchy. NOCP/ZOTT NGDO STATts ONCHO TEAM LOCAL ONCHO TEAMS TR,ONTLINE HEAL'TII FACILITY COMMIIMTY LEADER^S DISTRIBUTORS (CDDs) COMMIII\ITIES Lo WHO/APOC- tr24 November 2004 Lb. 2.92. Whatwene the main issues identified during supervision? None release of counte,rpart funds at State (which was allocded) and LGAs levels Non Insufficient support to CDDs by some communities leading to attrition of CDDs 2.93. Was a supenision checklist used? The supervision checHist developed by the APOC was used during supervision and monitoring. 2,9.4. Whatwere the outcomes at each level of CDTI implementation supervision? The state level was zupervised by the NGDONOCP md the main issue of getting the state and LGAS to support the project was not actrieved. Supervision at the LGAs ard community levels was adequate. 2.9.5. Was fecdback given to thc penon or groups supenised? Feedback was given to the supervised levels and the recommendtion followed thoroughly during subsequent activities. These activities were however inadequate due to lack of adequate funds and thrs the overall performance cannot be fully reported. The project however attained its teatment objective. 2.9.6. Howwas the feedback used to imprnve the overall per{ormance of the pnoject? t_ 2t, - WHO/APOC- 24 Normber 20Ol Source Typed equipmm APOC MOH DISTRICT/ LGA NGDO Others l.Io. Condition l.Io. Coaditim l.b. Cooditioo M. Gnditioo l.lo. Cmdition l. Vchiclo I Feirly firnctior I 2. Mdoroyclc 5 Fairly firrctiqa I I Fairly firnctior I 3 Nm functiGrn I 3. Comprtors I Fairly finrctirm I 4. hintcrs I Fairly fimctioe I 5. Fax Machinos Fairly fimctioa l 6. Othors Fairly firctioa l a) Bicycle t4 Fairly functimr I l3 Non fimctiom I b)T.V/ Vidco I Fairly fimctisrt I c) Ovcr head Projcctor/Scrcor I Fairly firooticne I d) Gcocrator I Feirly fup1iom I EEGTIOII 3: $upport to GDTI 3.'1. Equlpment Table 12: Status of equipmelrt (Please add more rows if necessary) *Cmditionofthe WGwritt€n otr). eguipment (F=ftm6i-u1, CNFR{urrentty non-functional brf repairable, How does the project int€nd to maintain and replace existing equipm€nt and other mderials? Maintenance and replac€mcrt of existing equipment will be done by using these equiprnent for CDTI activities only md throughthe use of counterpart funds if made available. 2t WHO/APOC- tr24 November 2@t a!.2. Flnanclal contrlbutlons of the partnerc and communitlec Table 13: Financial contributions by all parhers for the last three years If there are problems with release of counterpart fimds, how were they addressed? The ever constant chmging of policy makers in 2 tiers of govemment operating in the stde is u/hat is accounting for the non-release of counterpart funds. The project in coqiunction with SSI paid advocacy visit to the officials of the ministry ard have liased with Director of PHC in Minislry of Local Governments so that counterprts can be directty dedusted from the LGA allocations. Additional comments I Contributor Yar 4 (2002') YctS 2N3') Ycnr6 0004) TOTAL AMOIJNT (cAsIr) Budg€t€d (us$) TOTAL CASH Released (JSS) TOTAL AIUOIJNT (cAsrT) Budgeted (USD TOTTAL CASH Released (USD TOTAL AMOI'N T (cAsIr) Budgeted 1US$) TOTAL CASH Releas€d (USD MOH (Central + ProvinciaUState) 3,937 0 3,703,70 0 3,623.18 1,5t1.73 MOH (District/LGA) Only salariedallorance to eacfi contrd personnel LocalNGDO(s) ( if any) None Nme Nane None None None NGDO partrcr$) 3,229.16 3,279.16 2,445.63 2,639.39 5,371.31 5,581.25 O&ers a) b) APOC Trust Frmd 9,645 20,265 14,702 10,000 0 0 TOTAL 16,811.10 2?,W.IC 20,851.33 1effi9.39 8,994.40 7,102.9E ?-3 - WHO/APOC- 24 Notqnbcr200t 3.3. Other forms of communltyl support - Describe (indicate forms of in-kind contibutiors of communities if arry) Contibutions of the communities are mostly in kind. The most common motivation to the CDDs is'Thankyou' and'God bless you' 3J. Expenditure per activity - Indicate in table 14, the amount orpended during flre reporting period for each activity listed. Write the amount orpended in US dollars using the curr€nt United Nations exchange rate to local currancy. Indicate orchange rde used here_ Table l4: Indicde how much trc project spent for each activity listed below during the reporting period. Any comments or explanations? 2\ L a Activitv Erpenditurc ($ us) Souroe(s) of fundinq Drug delivery fromNOTF HQ areato central collectionpoint of community Mobiliztion and healft education of communities Td4qrgqt of health staffat all levels CDDs ard distribution Intemal of CDTI activities {drqseryuplq!o-!e-49-t-q44 IEC materials authorities forms for treatment v gtc) Commrmication Travel to CDTI activities Others - travel, insurance, communication and training of scholars 308.42 652.17 155.34 2,030.78 326.08 sst.{4- 327.28 2,351.62 ssr ssr ssr SSIA{OH s$r SSI ssr ssr TOTAL 7.102.94 Total number of persons treated 153i363 - WHO/APOC. 24,November 2m4 D maintemance Office ,t t :' SEGTIOII 4: Sustalnabllltyr of GDTI 4.1. lnternal; lndependent partlcipatory monitoring; Evaluation 4.1.1 TYas Monitoring/evaluation camicd out during tte rrcporting period? (tick any of the following which arc applicable) Year I PaticipAory Independont monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation Internal Monitoring by NOTF Other Evaludion by other parurers ,./ 4.1.2. Whatwerc the recommendations? Recommendation fior Urc LGA Level: -a LGA Recommendations Plan plans that take into account community requirement Monlbrlng t' SupeMslon target on weak areas supervise at their own level Mecdzan@ Supply and Dls0:lbuUon of the supply of Mectizan@ to the LGAs Mectizan@from the State level Trainlng i HSAII assessment of FIHF staff areas, where they are wek or lack shlls 2s - WHO/APOC. 24 November 2004 I Financlal Rsures essenUals for CDTI implenentaUon should be increased Transport & Other llabrlal Resoures maintenance and running of vehicles and equipment the control of motorcrrles a , 4.13. How havethey been imptemmted? 2_6 ., LGA Recomnrcndatlons Implementation Plan plans that take into account community requirement Eadr of the LOCT in the endemic has a comprehensive CDTI work plan. t{onitoring & Supervlslon target on weak areas supervise at their orn level Emphasis on monitoring and superuision was canied out in areas suspect€d to be having problems. DHS made supervision of the project activites at fieir own level. Hectlzan@ Supply and DlstribuUon of the supply of Mec{izan@ to the LGAs. Mectizan@from the State level The gorenment facilitoated the suppty of Mectizan@. Ivlectizan@ tablets were ollected bythe endemic LGAs at the stafte lenel. Tralnlng & HSAlrl assessment of Ft.l-lF staff areas, where they are weak or lack shlls Trainings of Islamk scholars and CDDs were canied out - WHO/APOC- 24 Normber2004 I f- .a t' :' Flnanclal Rsulcs essentials for CDTI implennntaUon should be increased \fital aspects d CDTI activiUes were captured inb the yea/s uork plan. Mvocacyvisits have been made b key stakeholders. It is hoped goemmant will prwide ounterpart fund. Transport & Odrer MaErlal Roures mainEnance and running of vehicles and equipment the onUolof mdorqde When counterpart funds are released, maintenance, running d vehicles and equipment would be done. 42. sustalnabllltt/ of profects: plan and set tatgets (mandatory at Yr 3) Was the project evaluated duringthe reporting period ? Was a sustainability plan written? Yes When was the sustainability plar submitted? It was submiued Wha arrangeme,nts have been made to sustain CDTI after APOC funding ceases interms of: 4.2.1. Planning at all rrlerant levels Planning meetings at both the state and Local Govemme,nt levels will be carried out before lhe commencernent of subsequent tredm€nt rourds. 4.2.2. Funds Advocasy visits will be used to significant parrrers the need to release courterpart funds toward supporting ttre project. 4.23 Transport (replaccmcnt and maintenance) The Minislry of Health and the endemic Local Govemment Areas will continue to maintain the odsting trarsport system of the project while request will be forwarded to APOC for the replaceme,lrt of the Toyota Hilux and the 5 motorcycles as ttre sustainability plan budget forecasted. 4.2.4. Othcr nDsources Otrer resources would be maintained and replaced as courterpart funds are being released by the state and the LGfu, also taining of health workers on progrrmlme { 2+ - WHO/APOC- 24 Normber 2004 management will be used to mainain €xistfutg equipment and those to be replaced subsequertly. 4.2.5. To ufuat ertent has the plan bcen implcmented o Each of the LOCT has a comprehensive CDTI work plan o Emphasis on monitoring md supervision was canied out in areas suspected to be having problems. o DHS made supervision of the project activities at their own levels. o The govemme,!il facilitated the zupply of Mectizm@. o Mectizan@ tablets were collected by the endemic LGAS at the stde lwel. o Training of Islamic scholars and CDDs were carried out. o Vital aspects of CDTI aCIivities were captured into the year's work plan. o The issue of corurterpart funding is hoping to come to reality as advocacy visits have been paid to key staketrolders. . Plans on vehicles and equipment usage are now on ground and will be impleme,lrted to fte full once counterpart fimds are released i.e. tlp use of logbooks etc. 4.3, lntegratlon Outline the erdsrt of integrdion of CDTI into tre PHC structure and the plans for complete integration: 43.1. Ivemctin ddirrcry mechanisms Programmes vehicles such as disease surveillance and NPI are sometimes used by the project in the delivery of ivermectin to the endemic LGAs and for collection of reports and drug balances. 43.2. Training PEC - Primary eye care was integrated into the past raining of trainers for ivermectin delivery. 433. Joint supenision and monitoring witr other pnogranrc NPl/Disease surveillarrce and CDTI staff help one another in supervision md monitoring through inter programme collaboration 2-t o It E r I - WHO/APOC- 24 Nsr/Emb€r 2004 ! + I 43A. Rdeasc of frmds for pnoject activities There is a combined budget for all programmes under the DeparEne,nt of Disease Contol this year. It is hoped that money will be released to the programme as the needs arises. 4.3.5. Is CDII included in the PHC budgefl yes 43.6. Describe other health programme that are using the CDTI structurc and how this was achieved. What have becn the acliovements? The National Polio Immunization programme has adopted the CDTI line of attack to eradicate the poliovirus. 43.7. Describe others issu$ considered in the integration of CDII. 4.4. Operational research 4.4.1. Summarize in not more than one half of a page the operational research undertaken in the project anea within the rrcporting period. No operational research was carried out within the project area. 4.4.2. How werrc the nesults applied in the proiect? SEGTIOII 5: Strengths, weaknerses, challenges, and opportunlties List the strengllrs and weahresses of CDTI implementation process. List fte challenges and indicae how they were addressed. Strength: Involveme,nt of TBfu md Islamic scholars in enlightening women in purdah There has been a continuous decline in the reaction rate. Integration of PEC into CDTI Trained and committed SOCT/LOCTs. Committed NGDO Selection of distibutors by a good number of communities Collection of Mectizm@ by communities. { ,1(--) - WHO/APOC. 24 Norcmber 2004 Wealmess: - Untimety ad partial release of counterpart funds. - The need to continue training Islamic scholars - Nonavailabilityoffemale CDDs - Frequent movement of the nomadic populaion. - Non compenstion to CDDs in most communities - Reluctance by head of households to allow selected CDDs to dispense Metizan@ to their wives inside the houses. From the above listed drallenges only the involveme,nt of TBAs/Islamic scholars to reaching women in purdah was noted to have improved. Advocacy visits to key stakeholders to solicit for the release of counterpart firnds; creaing awareness for female CDDs to be selected ard sensitisation for CDDs to be compensated are still on Likewisg emphasis is still on to see thA mop-up teafiient is carried out for a good therapeutic coverage. SECTIOII 6: Unlque features of the profecUother mattelrs a t I { a- fi= L { l t I i i rg-L f--t 30 - WHO/AFOC- 24 Norunber 2004 I