CDTI annual technical report

-/i, ORIGINAL COUNTR Y: Benin Tchaourou SIZ Area: OuakeDjougou, Copargo atiN B T,oucoumbetingou, oucountouna, BasKouande s ila, N DalParakou, l, r JanI u 2004 I Jrary 2005anuary Date of submission 21 February 2005 @ CDTI ANNUAL TECHNICAL REPORT I r t'" t-' I I I CDTI ANNUAL TECHNICAL REPORT ENDORSEMENT Please confirm reading this report by signing in thp place provided. SIGNATORY of Report: Country Name of National coordinator: Dr FAGLA-MEDEGAN VALENTINE Signature : ...... ,r........ Date : ...... "" 't.l .. ... 2 Definitions (ii) (iii) (D Total population: The total population living in the meso/hyper endemic communities of the area (based on census). Eligible population: Calculated as 85% of the total population in the meso/tryper endemic communities of the area. Annual Treatment Objective (ATO\: The estimated number of persons living in the mesoftryper endemic areathat is earmarked for treatment with ivermectin in-a given year.. Therapeutic Coverage: number of persons to be treated in a given year out of the total population (to be expressed as a percentage). Geographic Coverage: The number of communities treated in a given year out of the total number of meso/tryper endemic communities in the area (io be expressed as a percentage) (iv) (v) 4 Fill the table below with the recommendations of the last SCC, and describe how they were addressed.. SCC Session Table 1: Implementation of SCC recommendations (Please add lines if necessary) No RECOMMENDATIONS OF SCC ACTIONS UNDERTAKEN RESERWD FOR SCC 1 Extend treatment period by one month (April) and one month (November) The treatment period is earmarked for April and November. 2 Use the guide made available to countries in 2003 to address the issue of blacklly nuisance - A consultative meeting took place between the Ministries of Health, of the Environment and that of Agriculture and Fisheries. - Sensitisation of community radio officers 3 Use available national resources and identify other funding sources - Consultation ongoing with SSI to find funding for CDTI activities. 4 Continue epidemiological and entomological surveillance - Impact study conducted on nine points of the Alibori, Sota, Mid- Oueme Okpara, Zouand Couffo basins. - An epidemiological evaluation was conducted in twenty SIZ villages, and in nineteen non-SIZ VI 5 Enhance collaboration and integration of programmes in countries - Sensitisation of coordinators of other programmes (Blindness, Malaria, Schistosomiasis) on the integration of community-based treatment activities - CDTI and LF treatment are undertaken in an integrated manner. 5 SECTION I : Previous Information 1.1 Background Information Executive Summary Administrative Structure Health system (specify number of health centres in the zone) The Benin Special InterventionZone spans 11 communes organised into six health zones that are distributed over two departments. Each commune is beneficiary of a communal health centre managed by a doctor. One or several communes may form a health zone with a zone hospital. The health zone is managed by a doctor/coordinator. The eleven communes of SIZ- BENIN have in all seventy-eight Arrondissement health centres that are involved in CDTI. Indicate partners involved The partners involved in Oncho control in Benin are the populations, through the availability of community relays, and the consideration in some areas of their incentives charged to community funding of health centres, the World Health Organisation, through the WHO/SIZ Project, the Beninese government, through the Public Investment Programme, the Mectrzan Donation Program, through the supply of ivermectin. Discussions are underway with Sight Savers International, but nothing has started yet. 6 r-. 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N z tr Q Ha oo (.)tr EEolu.9 € €i0 -U - -q) -: H .l ah a.- OL ! -9EEn^.-Yli .I -.,bo=v .ii 6)tr,.trtrl r. *E -d F-AC) L\ro - E9 Eu)j'-;sC)ri .-'F €- .i- Gll- Id- 9- -c!E()o >.tr !vaq) { a9 .-- E&;a u)V.-G+. +ttr Its tli I aGtUS,):.: -9ocl6A .! otr o U.r .- rrH\J hJ+. .-.- a.alE€A23ii'g f .ni.€ 9ahL Gt.r6t o.€zgy ! cq'P .!rl-irooG ErEu)/E.2i * s9a -d.-'!EE -tt +i .: ir 3 E 3i!rtr2?ESbe F7\7.--il LJ\JAY.-t4d I o oF E o a tq)g a tra L{& trq liq kO. ka" l-{a La La r<a k +.q H9 a* tra tia l.ra La Ha Ha ka ka l-iq Lra L{a o & L U) n a0 L a l9(')tr EtsotrL)o lra *<a t{a Lrp. kg Lq Lip. l-{O. lrq ka Ha *-c?€ a/ t<a. L{A. ka lrq l<a kA. Lra La pq *rq pa ah uh q) U ax tr GIEcp I00)d o-trE E.= O ka l-iq ka fr tiO. t<a kq t<a lrq l-{q Ha 3-c =9 L^i PFIa* !a ka hg kq trq Ha L<O. kq HP. Lra. r<q bD L Fr I o-trEE.9 5 *<A. tiq Ha lrq l-<q t<a. tro. kq Lp. t<a l<q *-c li .i(Bx €Ha- Hq ka l-rq ka !o. ka trq Lrq lro" lra l<g 50 l=l {..ri Gl =u) tsEooU> I +FEH.= O tia l-ra L{a kq Lr Ha lrO. kP. r<a k L<E a- H9PHa/ (-)tr(d z C)k(d =a C)Lrd 4 okd <z o t-r(s z (_) H Cd A oli a OHd z ok CU a ot<(t okd a I L .o C)p oO ca o0 P d z CB c o C)) F ot (s M b0lrdq O U bo t-.1 o E \J U) U) ca o Elq Bi d IJ 2 oH o 03 oF ?\n Bq L)\) \) 4q) t B q) 14 vq) U k(B 0)X okL o o0 L .d Eq)P(d olr o o Nk € U) O ! o(B +i o o)p dP o F oi1()l -ol(Bl FI District Number of VtictEano[ablets Requested Received Used Lost Expired Boucoumbe 162 707 162 707 140 326 Toucountouna 70 212 70 212 s4 694 Natitingou t2t 276 t2t 276 t02 367 Kouande tt9 645 tt9 645 94 630 Tchaourou 224 078 224 078 t90 487 N'Dali 107 000 r07 000 87 384 Parakou 38 623 38 623 32 608 Bassila 140 144 t40 144 122 424 Djougou 296 800 296 800 247 822 Copargo I t6 807 l 16 807 96 210 Ouake 133 349 133 349 108 673 TOTAL I 530 641 I 530 641 1277 625 2.2, Order, storage and delivery of ivermectin Table 3 : lnventory of Mectizan@ (Please add more lines if necessary) Indicate activities that are conducted by health staff in the project zone under ivermectin delivery. The health staff is in charge of assessing ivermectin needs on the basis of the population counted per village, and placing orders at the coordination level. Upon taking delivery of the drugs, the staff is in charge of warehousing and distribution to cDDs according to their needs. It is also in charge of stopk marage*ent. At the end of the campaign, the staff is in charge of retrirlving the remaining tablets and taking stock of the quantity used. 2,3. Advocacy and Sensitization Indicate the number of policy makers at each relevant level in the course of the year, the reason for sensitisation, and the outcomes. Describe the difficulties/constraints encountered, and suggestions on how advocacy could be improved. Advocacy and mobilisation were conducted in structured and non-structured frameworks. The structured framework is made up of the departmental planning and mobilisation workshop; two administrative officers, and six officials of the related fields and of health were invited as follows: a a a 9 2.4. - Departmental public health directors of Atacora./Donga and Borgog/Alibori - The prefects of the departments of Atacora./Donga and Borgou/Alibori - The departmental officers of the ministry of education of Atacora,/Donga and Borgou/Alibori - The departmental officers of the Ministries of the Family and Social Protection of Atacora./Donga and Borgor_r/Alibori Stock was taken of the last CDTI campaign at this meeting, as well as the problems encountered and solutions envisioned. It would have been desirable for the meetings with mayors and chiefs of districts (arrondissements), held at the beginning of the 2003 campaign, to be repeated because they enable the local representatives, who are quite close to the social actors. But this could not be done, due to budget constraints. In a non-structured framework, this has to do with sensitisation particularly of mayors and chiefs of districts (arrondissements) during CDTI supervision sessions. Mobilisation and health education of at-risk communities Provide information on the following: - Use of media and/or other local systems for information dissemination - Mobilisation and health education of women and minority groups - method and response - Reaction of target communities/villages - Achievements - Weaknesses/Constraints - suggest means of improving the mobilisation of target communities. Two information and community mobilisation strategies were implemented.: - Proximity information in villages and hamlets, main actors of which were community relays. - Mobilisation per rural radios. The first strategy was implemented by relays in the villages. Picture boxes were used, as well as notices, which were developed during the 2003 campaign. The second strategy was made up of radio announcements on rural radio stations. Four radio stations were involved: - Regional radio of Parakou - Rural radio of Bassila - Rural radio of Djougou - Rural radio of Ouake On the whole, 65 radio announcements were broadcast in 9 different languages: French, Peulh, Bariba, Nagot, Dendi, Yom, Kotokoli, Ani and Betamaribe l0 $,:s=l+i=-o rv +egtr.= o z iz 5BI tl {- ^n (.) o0 oS ooko Or =a0; HEEE q)E> H9 oA AE v.:(:E o= ZE () n d F 6Hci oEl >U t\ aEA r= z5 1,q) o U) O)L0) €) .|.!tn .Err> tHE- o)I-ltL) Lq) z Il 'x- a.i 0) bo(\, I 0)ok(.) . al-E€ U 9X :EEE: ; qi e.=o A -A oa.9 ,,X,= h o'H; E* TE1i* o 0) -e >-cF'P I fr U) ()p oo ir.,i (d o (.) oF b0 (d z o (g M tr o(d oF 63 o 2 ) o -V(d L{(dA (€ (h a FA o bo o .F t-.1 b0 L 6dq O o) JZ GI) o F,] t- U'F 5r Urbq) uq) \ 4q) q)\ t g \) uq) A.\- F oQ b0 .=o .ji '.5cl 'a E= oH 09 EEEE .=? v) q)o-V EB sl:- (-]a irX ojJiCdtra.9 ';.'a.= OL . ^\vtr lfr _rl orlqFt 6l Fl N(d F Q rJ C) o U)() bo Otrl tsc; o.o9(g o$(dcd(l)(I)lrHc)tu 4b EO(d ri Ei- r- o)AEU9bo,trqr '5OC r-.C.)oi^o otr .=o s€ u)aoxFGSco l\() OH .i5trbo6(i dz octr6iOcaqr (Hoo AN ClD U)L) o)\-/.Q aPoqLr .i AA60 t-J -qiiEttsr. - (.) -i_o(E ',d trtr(1)., caH 'raxor 9I G) r-.1 L,/ (B H o dq () L Cda (.) o a oo rd(.) rn rr) o(/) '(, 0)L(g (n O) U)t) F oO o (/) bo oo H >. ) AHb0= o.,)|O 0) arH€ C<rioo U9 =tr(l)> tr t= 3< _QO .=(c -a .Eoa'.= E i5.tr o.l ,o o-r odk O? rl (Jtrx >.o^H*.; J U dTbs;3H55 d .gG 'a .9;i Lr (,) . .i U f ir IHVFT 0) (aEAOEO U)jllrd 0)& 2.6. Capacity buitding 2.6.1. Training 13 \f, bh Q a) "a € v ,"i q)\ q)\ U., .t \ j o v bn \ a{r q) Lr. U q) b0 qt "aB s R \)L v \i q)\\ st I \0F > qJ * R %q q) S %q) t I q) * 5 o tr C)t C) A E F n Q +r o a o o th o lr (d bo kF fir rl -ol(dl FI q) E clL u) aQ l- dz U cll+tr f<v\r'- U q) t\ Iq)q > .q) R oo :_ \o o\ .f,$ c.l t--ca (a)cn \o: cnN oo ra ah tq) E C) q) q) c[ sQ oFo ah oa ovL9irE E.Fe)- Eut =kii ,:( E} -t z N Er*. s v l- Iq)q + R tr} |..) (.) (r} $ $ co ca co o ca C. an -* + <f, s + U $ in ?a ra ro U) o e o q) cl sl)[-,( o q) t<q) L etZ ij c!0, z E ,L t,.- €t t'u q) vL t n< t * ttl [a ah q) q) o c) cl ^\ ? "t I li q) d o C) F op J< a o o0 .F t-l 0)j4 d o boL p. O () T, Cd M o bo I € z U) rh m o -v tr(t Oi E Z ol-{ (B F .t F F oo$ Table 6: Type of training given (Iick boxes where specific training hos been conducted during reporting period) This is standard training whose content was just readapted to the context. 2,6.2. Equipment and human resources Table 7: situation of equipme nt (Please add more lines if necessary) *State of equipment (Good Trainees Type of training CDDs Other members of community eg: community supervisors Health workers (FLHF) Ministry of Health agent or other Political leaders Other (speci- ry) Programme x x Comment conduire l'6ducation sanitaire x x Management SAEs of x x CSM ? SHM ? Data collection x x Data analysis x Report writing x x Other (specifu) Source _Dp. of equipment SV Ministry of Health District NGDO State of equipment State of equipment * Please indicate L Vehicle 5 J 0 0 Good state 2. Motorcycle 0 2 0 0 Good state 3. Computers I 7 0 0 Good state 4. Printers I 8 0 0 Good state 5. Fax machines 0 I 0 0 Good state 6. Others _eD D c) state, Not working now but repairable, depreciated). l5 How. does the project envision ensuring maintenance and replacing equipment and other existing materials? The replacement of equipment is done from the budget that is annually put at the disposal of the programme by the Benin goverrlment. Of course, the budget is inadequate and so we are looking for assistance. - Describe the adequacy of skilled at all levels. Human resources are generally inadequate. At the national level, persormel of the programme, reduced to two doctors, two nurses, one driver and two secretaries has, since -2000, been charged with the control of lymphatic filariasis. At the intermediate level, "disease and disaster" nurses and SPPS senior medical officers, are in charge of the programme. They are also in charge of most of the public health programmes, and so their availability is seriously affected. At the peripheral level, it is the movement of health workers that is a problem, for apart from the numerous personnel transfers, management recruits "contract" st;ff, whose instability is well known. L'instabilitd est connue. - Where there is frequent transfer of trained staff, say what the project is doing or plans doing to address the situation. (The most important issue is to know the measures taken to ensuri adequate implementation of CDTI, where there isn't enough skitled personnel, or where personnel is often transferred during the campaign.) The programme is practically helpless when it comes to the numerous transfers and hiring of contract personnel. With respect to transfers, we can still carry out advocacy during 'transfer meetings'. For the time being we have make do with the situation, and conduct regular training sessions. t6 2.7. Treatment 2.7.1. Treatment figures t7 oo arts'riE.Er 2AEEE-A9o. g,-B E EE5 E E:E Ezt^g E +rOotr . (.) (a ^(rC);sA(B ,.ohO -Xccre ;EEEEzPbirtr o cB o Fr l,+ r :,.l8ogAss o\o\ra) oo ca\o la) € \o s oo r-a + oo $ N oo $ F-r- c.l c..lr- \o N \o t-- tr) ca sr- \oq oo tr- $t-. \oa a t- tr 9toEg .{o(6;6e $\o o.l <1- o\ o\(\ o\O c-t co ca\o$ \or- c..lrf, aa oo t--rr F- rr. c.l co o\\o ca c.lt-- cr\o a.t 6 c.l\o\o c.) a.l\o (a) N tn (..l o\ r-N la F c.r co o\$ F- cft\or-(\ $ lrl rat \o oo co $ 00 <f,$ co o\ cn oo\os st- t-- C\ € sf o\tr)N o\$ $ o\ t--sl\o \o o\ o\t--N a\o 6l\o O> o EE P [E HF trq:.A E X ^eoc) oq) a! o o) o U ll 1' r0)t!- bOF-(Ec!aOI)(J L.oO'= o o\()+ >vrfr '+ O O o\ o\ o\ n o\ NvI co o\ € oo tr- o ca\o F.f o\ c.) co co ca o\ t-- tr- r- o\ \o a o\ : Eggfr'A 8 E'; b c.t\o ra)co ao t-- .f ca cnN c-'l cn co oo $ o.l rnoo \ooN $$ ralaia oF c.l\o coco cO c.l ol \oca \ocaN c.t co c.)@ t--N \oco ooO(..l $ in F-in t- * E.q u} gs l-PV!-L!FAUVEO o tr= tr_a'E NI<(r'-() (J L o 0)J6i obo o Ll (! a6($ a o bolr(ta U o! (! C)F ,j( cl c( CI z AD G z 0) 6 11 (.)s ri o m (g o C) oF Fl F( i'r o q) q) r.\ i\ U't U.)p u \- L1q) q)I\ t B q) JIq) 5 V) 0) o N ,yt) l-r IP d o lr u) rc k 0)A (h I C) lJl C)otr o E a) o Lroa (d q) (d okF <idr orl 3ldt FI o\ e$gb 3q\ E ilElvt\ 5:\ .o.ssgs'x : N !S 'g ! :SS5 ; E$E 'S sSs E qsE : EShtELE 3 ES6 S .\=\ sstil H i ss: 3 ssx s tsE S 18jr s sDI ! Sq,; s E* 8l ; r !r -l E * N.gxl I s' $* .ql E i SE Eli S tFEl{ s Er Eli $ st rl u :: ss -l F \ a X €l s sNEI $t; \NJ\ ,, t E: = sqJn :!\ s.s * =sF .SS.E f S$t nr qloo .; s s\E r\ *qO ll ll3i P P.lX \ bE 0) p Oo (.) d(.) t<t- (d c () (d l< o bodLr^0).o')o\ o F X 0.) d()lr th o cnkOoqr lro .o z (rl q)k(! oo 'a t<o (h 0) I ol ool ., -l ')ixl tr .t 0J EIE isl o)0)l p!--l o);t * o0< csl o =l u)5l HAl .* .etE trl ()3l -oEI Eil 5 5l tr 3lEol o r-l F ot -ol trl 2t doLrd Poo 'a Lq a 0.) H Q() q) 0) t<() a.x o(h o Cd q o< (B F O X () edoLr a oaHo o(ri lio .o Z a.) cdLr 0.) oo(c l-{ C) oo ed(-) ^ -\vp. <-,(s l< oo o 0) o 0,) cd Lr o b0(d l.<(.) o o^ 'jl .o' JO-0)v a.(s l-<o F al a)l9l(gllrl o.rl brl cdl bl 6t :l cslol -clol EI s(I)l bd 'ol EI ol '51lt ol ol EI ol -cl €l 14 it olH ol ol rl .ol+'il cdl )t EI L<l ol r!l (.) X 0) Cd P O oo oO rh tr o t-< o c) C)a lt - Ifthe project does not achieve the geographical coverage rate of 100% and at least 85% of therapeutic rate, or if the coverage rates fluctuate, give reasons for this situation, and say how you plan to address it. For most of the communes that did not achieve 100% geographical coverage, the reason is that the villages selected for epidemiological evaluation are temporarily excluded from the programme. These villages were treated later on after the evaluation, but treatment figures were not included. In regard to therapeutic coverage rates, the reason most frequent reason is the population movement. 2.7.2. What are the causes of absenteeism? 2.7.3. Briefly describe all known and verified SAE cases, and provide in table 9 required information if available. No SAE cases 2.7.4. In the event the project does not have any SAE reported case during the period under review, please indicate in space below. No SAE cases Aucun cas 20 c! q) N A U\ a) *a S\q t( t\p uq) L 4q) V) c) t{ :(q e -\ v;q) uq) S t4 \)\ t B q) 4sq) U 'uo l-r C)q b0 Eoq o)t< bo L<) E() LrL o(-) o n € U) 0)t4 o (.) i! q)t)lr C) cn o ! 0.)a O\l 0Jl ^l(El FI €sc <.E" . E|I)CO r.latrtr!!tr 00)'5't7.2 agE.$3EE(J o'E r Otroo !o9,d rhA -rC aq0qY&e^ qr o EEEdg;q3& E*$EEg l!A&-6.Y= 6AA.'J c) (/);\-'! A Ef .3!ilUH EP d €ssgoSTEE!EFNEiJCU(l)r+r-'^€H z a o a tr >' rl) th- -?-FU j3 0.odco.o 5.s .,.! vt a ss E* O-trol) .;Cd(H tr ="OI)?o tr 0) oU C) bo (Dx NN (,^ Froho\ o) ^boI EaIa Oo\ <: >v -o o r,* -r iJi E G Il .:: HE1 ll o ij o)t b{)(D rdaO-!roiB 9) orE >voo ,qoF \o € € b EE ,i(,6J zEe kI o\ rrN in I k) Eo(d o.= i .d) -o' F \-' €\o N\o b 9..r ! >- h €:<.8 Ea- 9E hI E6 C) _boI Eat1 Oo\ <, >v -o o .ir.,37 Ir.l 4 kl kl rO) <d- bO FoB EaO'! O o\ o.:= > v r''l q ovO ,l + L;,) \o 6 o\ rri 0) -.ts f,i *bSsE o H= iiZ Ei TOth (a ra r,a (d C).= E E.o) <.s*' int-i,a bI)di. . aOaH.: A d eJ- }'Pd R< Ez.i 9,.g, ,: -'= o EPs=Eb r: E.E EF-o 3a) L c! C) (r- o\ o\ oo o\ o\ o\ N O a.l N N co N $ N N \o N tr- N oo ON o\ N N ,s S L €q) oL li, -cE6s) Ocl EE 5o'AL(l)a 2c) .=L F: xo) Q€ OL9dtrq) LEq t lJr o0)Eb0bg roH-o e= ov)EE o5li t3!6) OF q) Lt-( ol -td; qlt- *l NFI 2.8. Supervision 2.8.1. Provide an organisational chart of the supervision hierarchy. Three supervision levels could be noted: - Supervision by the intermediary and national levels. This supervision is carried out by the national team and the chief medical officers of the SPPS. All the health centres of the corlmune have been visited. After discussions with the head doctor, the health centres under the commune are visited, with priority given to the districts (arrondissements) that have dysfunction problems, if the said discussions reveal them. With respect to the district health centres, after discussions with the senior nurse of the health post, one or two villages are visited at random to ascertain the progress made in terms of treatment. The community relays are met and discussions take place with them too, as well as some members of the community. Supervision carried out by zonal doctor coordinators and senior medical officers. This supervision is carried out in almost the same way as the first. The doctor coordinators cover the communes under their control, and the communal doctors cover the district health centres. - La supervision conduite par les infirmiers Nurses of the district health centres are charged with the follow-up of all CDDs of their health zones. 2,8.2. Quelle 6taient les principaux probldmes identifi6s pendant la supervision ? The lack of ivermectin stock files in some areas. The inadequacy ofsupervision ofrelays by nurses; Wrong filling of treatment and census books in some areas. Bad management of ivermectin stock. Treatment in 2003 coincided with the annual ceremonies of the Betamaribes, i.e. in the commune of Copargo. This brought about a lot of population movements toward neighbouring Togo. 2.8.3. Was a supervision check list used? YES 2.8.4. What was the outcome at each level of CDTI implementation supervised? - Knowledqe qf nurses The level of knowledge of nurses on the onchocerciasis disease and its treatment is high on the whole. Knowl, of CDDs This level is equally good, though there is already the need for re-training. It is to be noted that the CDDs working in the areas where Oncho and lymphatic filariasis treatment is going on are somehow confused. They mix up the disease symptoms of the two pathologies. 23 - La Management of lvermectin Some nurses still have problems with ivermectin management. They do not know theformula for estimating needs, and do not keep ivermectin stock cards either. This situation affects the availability of ivermectin on the field, and hence coverage rates. - Activi\t implementation level Apart from some exceptions, ivermectin has reached all endemic villages, andtreatment of communities has been done. It is to be noted that after the treatment incentive to be paid by community was announced, it was noted that the level of motivation of CDDs, whosi centres were not able topay, due to various reasons, dropped. The lack of supervision of nurses and CDDs by senior medical officers of communal health centres. 2.8.5. Was feedback given to persons supervised; and how did was this feedback used to improve the overall performance of the project? There was immediate feedback enabled the situation to be addressed there and then on thefield' During the reviews, after this, and during the CDTI planning workshop, feedback isgiven to field workers. 24 SECTION 3 : Support for CDTI 3.1. Financial contributions of partners and communities Table I I : Financial contributions of all partners for the past three years. The amounts indicated in this table for the national budget is the total budget niade available for the entire country. If there are problems in the disbursement of counterpart funds, how were these problems addressed? The availability of funds on the national budget a big issue, sihce the budget is generally not ready before May'June, and closes in November. There is ge(rerally no tilme to avail of this budget as expected. Having other partners would solve the problem. o Remarks Contributor Year I (Provide period) Year 2 (Provide period) Year 3 (Period) TOTAL Budgeted ($us) TOTAL Disbursed ($us; TOTAL Budgeted ($us) TOTAL Disbursed ($us; TOTAL Budgeted ($us; TOTAL Disbursed ($us) Ministry of Health 40.000 28.000 66.000 s3.000 166.000 9s.000 Local NGDO (if applicable) NGDO partner(s) Others a) b) c) Communities TOTAL 25 3.2. Other forms of community support o Describe (indicate forms of in-kind contributions by communities, if any) Following a ministerial order, community financing of health centres is called upon to give an allowance of CFA2,000 to each community relay. But not all the health facilities *. able to pay this allowance, and it is difficult to account for this. 3.3. Expenditure per activity Indicate the expenses incurred for the activities below in $US on the basis of the current IIN exchange rate in local currency. Table 12: Indicate how much the project spent on each activity mentioned below during the reporting period. The amounts mentioned correspond to the activities conducted with funding from WHO/SZ in Benin. Activity Expenditure Source(s) of funding Drug delivery from the coordination to the central point of -c gU g gti qt- o-L!b9_99 rys g.nilv Communi mobilisation and health education of CDDs Health staff at all levels lgpSryi"rigrl 4"1P9 et distribution Internal DTI activitieS A_{ygcqcy visits to health, political and other authorities IEC materials Treatment forms Yq.ttiglg/*-ojg{c_ygl_e4lqyglgmainienance 9_[tg!.eg]jp$glt_(e_gj_c_o__mputers,printersetc.) Miscellaneous PM 1,000,000 12,0_00,000 2,200,000 TJoo,ooo 0 PM PM PM PM 0 0 TOTAL Total number of persons treated 502,719 ( first round) 26 SECTION 4 : Sustainability of CDTI 4.1, Internal monitoringl external participatory monito4ing; Evaluation 4.1,1. Was monitoring/evaluation carried out during the reporting period? (Tick where applicable) None Year 1: participatory monitoring independent None Mid-term evaluation of sustainability None Evaluation of sustainability after 5 years _ None Internal Monitoring by national coordination None Other evaluation by arlother partner 4.1.2. What were the recommendations? There was no monitoring. 4.1.3. How were recommendations implemented? None 4.2, Sustainability of projects: Set objectives and plans (Qompulsory at year 3) What are the measures taken to make CDTI sustainable at the end of the financing of the SIZ? 4.2.1. Planning at all relevant levels There is annual planning at national level. In regard to the other levels, it is difficult, for most of the actors still have the vertical nature of the programme in mind. Some communes and districts (arrondissements) take CDTI into account in their annual schedule, but that is far from the rule. 4.2.2. Funds Funds for onchocerciasis control come from the national budget, WHO/SZ and the community (with respect to incentives for community relays. Discussions are far advanced now with Sight Savers International. 4.2.3. Transport (replacement and maintenance) The vehicular means of the coordination office are maintained pnd renewed, within the limits of the resources made available to the programme by the national budget. The vehicles of the communal doctors, and the motorbikes of district nurses are replaced, under an integrated framework, by the Ministry of Public Health. 27 4.2.4. Other resources Human resources are made available by the national budget. 4.2.5. Please provide a written plan with set objectives and achievements to date. None 4.2,6. What is the level of plan implementation? Without subject 4.3, Integration Define the extent of integration of CDTI in the structure of primary health care, and the plans drawn up for achieving integration. 4.3.1. Ivermectin delivery mechanisms Ivermectin is delivered to the senior medical officers of the SPPS, who in turn supply the communal doctors of their health zones. The doctors in turn supply the district(arrondissement) nurses, who then supply the CDDs with the drugs for mass treatment. But at times the coordination office is forced to go to the field to address situation where ivermectin is not accessed. 4.3.2. Training Training of CDDs is currently carried out entirely by the field nurses, under the supervision of their doctor. In 2003, 213 of this training was financed by community budgets in the SV. 4.3,3. Joint supervision and monitoring with other programmes 4.3.4, Supervision in the areas that are co-endemic for Oncho/lymphatic filariasis is integrated. 4,3,4. Disbursement of funds 4.3.5. Is CDTI included in the PHC budget? Only in some communes 4.3.6. Describe other progriunmes that use the CDTI structure. How was it achieved, and what were the achievements? The coordination office of Benin is also in charge of LF, and so all the resources we have are also used for the LF programme. Everywhere the two diseases are co-endemic, it is the same relays and workers that carry out distribution; collection tools are integrated. Collaboration is also planned with the National Malaria control Programme (PNLp) for CDDs to sell insecticide-soaked mosquito nets. 4,3.7 . Describe other issues that were taken into account in the integration of CDTI. None 28 4.4 Operational Research 4-4.1 Sum up in half apagq at the maximum, operational research that has been undertaken in the project zone during the reporting period. None 4.4.2. How were results applied to the project implementation? Without subject SECTION 5: Strengths, weaknesses and challenges - Mention the strengths and weaknesses of the CDTI implementation process. Weaknesses: . Inadequate financial resources . Inadequate integration at peripheral level . Inadequate human resources . Problem of motivation of community relays . Late treatment reporting :> acquisition of drugs Strengths - Political will - A well-structured national programme with a regular budget line, albeit insufficient. - A well-structured national health system that makes available to health workers the necessary logistics (mopeds for nurses, and vehicles for doctors.) 29