Edo CDTI project technical report submitted to Technical Consultative Committee (TCC): January 2008 to December 2008

it ,-t frt G_ TR c 3 frr EDO STATE CDTI PROJECT OzuGINAL: English t &.. ', COUNTRY/NOTF: NIGERIA Proiect Name: EDO CDTI PROJECT Approval vear: 1999 Launchins yearz 1999 Reporting Period: From: JANUARY To: DECEMBER 2008(Month/YeaD ( Month/Year) Proiectyearofthisreport: (circleone) I 2 3 4 5 6 7 8 109 Date re-submitted: JULY 2009. NGDO nartner: GLOBAL 2OOO/THE CARTER CENTER NIGERIA ANNUAL PROJECT TECHNICAL RBPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) DEADLINE FOR SUBMISSION: To APOC Management by 31 Januarv for March TCC meeting To APOC Management by 31 Julv for September TCC meeting AFRICANPROGRAMME FOR ONCHOCERCIASIS CONTROL (APOC) fl lo c f ': e WHO/APOC, 24 November 2004 ANNUAL PROJECT TT]CHNICAL REPORT TO TECHNICAL CON SIJI,TATIVE COMMITTEE (TCC) ENDORSEMENT Please conlirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: Country: NIGERIA National Coordinator Name: DR. Y. FAYOMT Signature: Date Zonal Oncho Coordinator Name: OTUNBA A.O. JAIYEOBA Signature Date: .. .. W NGDO Representative Name: MR. J. O. EGUAGIE I L Date This report has been prepared by Name: SALIU A. KADIRI. Designation Signature: . STATE COORDINATOR ffi,' Date ....1 S L ,.}.n2 ll WHO/APOC, 24 November 2004 , Table of contents DEFrNrTrONS......... .....................vI FOLLOW UP ON TCC RECOMMENDATIONS .... VII EXECUTTYE SUMMARY........ ..................... x SECTION 1: BACKGROUND INFORMATION....... ......................1 1.1. GeNpnal rNFoRMATIoN............. 1 . I . 1 Description of the proj ect (briefly) L 1.2. Partnership 1.2. PopularroN.............. SECTION 2: IMPLEMENTATION OF CDTI....... .......5 2.1 I I 2 4 Trueurue oF AclvrrEs ....... CouurxrrY TNVoLVEMENT.. .............5 .............9 ........... l0 2.6.4 Briefly destibe all lotown and verified serious adverse events (SAEs) that ... l4 2.6.5. Trend of treatment achievement in the CDTI project from inception to the curuentyear.......... ............. 16 2.8. Couvr-rNrry sELF-MoNIToRING aNo SrereHoLDERS Meernqc ............ 18 2.9. SupBRvrsroN ................... 19 2.5 Cepecrrv BUILDING.. 2.9.1. 2.9.2. 2.9.3. 2.9.4. 2.9.5. 2.9.6. 2.4. 3.1. 3.2. J.J. 3.4. Provide aflow chart of supervision hierarchy , ................. I9 Wat were the main issues identified during supervision? .............................. 19 Was a supervision checklist used? Yes............ ............20 What were the outcomes at each level of CDTI implementation supertised? . 20 Was feedback given to the person or groups supervised?................................ 20 How was the feedback used to improve the overall performance of the project? 20 SECTION 3: SUPPORT TO CDTI 2t EqurrueNr FrNeNcIel coNTRIBUTIoNS oF THE pARTNERS AND coMMLrNITIES..... OrHen FoRMS oF coMMLINITy suppoRT ............... ExpeNprruRE PER ACTIVITY 2t 22 24 24 SECTION 4: SUSTAINABILITY OF CDTI. ................25 4.1. INrenNeL; INDEIENDENT pARTICIpAToRy MoNIToRINc; EvnluarloN......... ...........25 4.1.1 Wos Monitoring/evaluation carried out during the reporting period? (tick any of thefollowingwhich are applicable)........... ............25 4.1.2. What were the recommendations? ............. 25 4.1.3. How hove they been implemented? ............. ................. 26 4.2. SusreNRsrI,rry oF IRoJECTS: ILAN AND sET TARGETS (MANDAToRv AT Yn 3) .....26 4.2.1. Planning at all relevant levels.. .................. 26 4.2.4 Other resources:. .... 27 4.2.5 To what extent has the plan been implemented?............. ............... 27 ....2t4.3. INrpcReuoN 111 WHO/APOC, 24 November 2004 4.3.1. Ivermectin delivery mechanism.r............... ...................27 4.3.2. Training.... ..............27 4.3.3. Joint supervision and monitoring with other programs........... ...... 27 4.3.4. Release of funds for project activities ........ 274.3.5. Is CDTI included in the PHC budget? Yes...... ............. 27 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. Wat have been the achievements?............. .................... 28 4.3.7. Describe other issues considered in the integration of CDTI. ....... 28 Joint Review of all programme fficers at the state and LGA levels .............. 28 4.4. OpenaTToNALRESEARCH .....28 4.4.I. Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period. ........ 28 4.4.2. How were the results applied in the project?............. .................... 28 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AND OPPORTUNTTIES.... ...................29 SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS...........30 iv WHO/APOC, 24 November 2004 ACRONYMS WHO APOC UNICEF MOH FMOH LGA NGDO NGO NOTF NOCP RBF G2OOO/TCC LCIF LCI CDTI CDD HFS DHS CDHS ATO ATrO UTG CBO CSM SHM PHC REMO SAE TCC TOT NPI DSN SPIC PMRC World Health Organization African Programme for Onchocerciasis Control United Nations Children's Emergency Fund Ministry of Health Federal Ministry of Health Local Government Area Non-Governmental Development Organization N on-Governmental Organization National Onchocerciasis Task Force National Onchocerciasis Control Programme River Blindness Foundation Global 2000 lThe Carter Center Lions C1ubs International Foundation Lions Clubs International, District 404 Nigeria Community-Directed Treatment with Ivermectin Community-Directed Distributor Health facility staff District Health Supervisor Community Directed Health Supervisor Annual Treatment Objective Annual Training Objective Ultimate Treatment Goal Community-Based Organization Community Self-Monitoring Stakeholders meeting Primary health care Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Technical Consultative Committee (APOC scientific advisory group) Trainer of trainers National Programme on Immuni zation Disease Surveillance Notification State Programme Implementation Committee Project Management & Review Committee WHO/APOC, 24 November 2004 Definitions (i) Total population: the total population living in meso/tryper-endemic communities within the project area (based on REMO and census taking). (ii) Eligible population: calculated as 84%o of the total population in meso/hyper- endemic communities in the project area. (iii) Annual Treatment Objective: (ATO): the estimated number of persons living in meso/hyper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. (iv) Ultimate Treatment Goal (UTG): calculated as the maximum number of people to be treated annually in meso/hyper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage (normally the project should be expeited to reach the UTG at the end of the 3'd year of the project). (v) Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) Geographical coverage: number of communities/villages treated in a given year over the total number of mesolhyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). (vii) Integration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) through CDTI (using the same systems, training, supervision and personnel) in order to maximise cost- effectiveness and empower communities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTL (viii) Sustainability: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future, with high treatment coverage, integrated into the available healthcare service, with strong community ownership, using resources mobilised by the community and the government. (ix) Community self-monitoring (CSM): The process by which the community is empowered to oversee and monitor the performance of CDTI (or any community- based health intervention programme), with a view to ensuring that the programme is being executed in the way intended. It encourages the community to take full responsibility of ivermectin distribution and make appropriate modifications when necessary. v1 WHO/APOC, 24 November 2004 FOLLOW UP ON TCC RECOMMENDATIONS TCC Review session 27 Number of Recommend ation in the Report TCC RECOMMENDATIONS FOR 2OO7 ANNUAL REPORT FOR EDO STATE PROJECT ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY 12 (Al Recommendations for improving the report: i) Correct UTG 2007 UTG was increased by 1% to get that for 2008. ii) Clarify disparity in the number of CDDs trained in sections 2.4 and 2.5 Section 2.4 shows total number of CDDs available in the Communities, while Section 2.5 shows the number of CDDs that were trained during the reporting vear. (B) Recommendations to improve Proiect: i. lmprove on training of health staff and CDDs There is standard number of DHS in use, i.e. 5 per LGA, but other supporting staff differs by LGA, hence the figures were as presented in the table for 2008. ll. Ensure timely release of funding by State and LGAs for maintenance of motorbikes to support CDTI activities. There was timely release of funds by LGAs & NGDO during the year for activities, and it is a remarkable improvement over last vear's fundinq. lll. Ensure adequate health education and mobilization of communities. Extensive health education and sensitization was conducted at LGA and Community levels alongside distribution of printed posters by programme officers at various levels. iv Update census Census update was not carried out in 2008. v I m prov e CD D/pop u I ation ratio. There is improvement in the CDD / population ratio as compared to 2007. vi. Check sufficiency of drugs requested and drug inventory. The inventory of drugs requested, supplied and distributed is accurate. No wastage was reported from the field. More Mectizan will be ordered in 2009 based on the UTG. vii. lmprove therapeutic coverage in Akoko Edo, Etsako West, lgueben, Ovia Northeast and Owan West LGAs. Akoko Edo has been undergoing communal crisis in Akuku and Ewan communities; Etsako West and Owan West LGAs. This affected distribution coverage even though no record of Mectizan were not returned unused. WHO/APOC, 24 November 2004 Number of Recomme ndation in the Report TCC RECOMMENDAIIONS FOR 2OO7 ANNUAL REPORT ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY vilt. ldentify NGOs and CBOs active in the State within and outside the health sector to suppori CDTI. Efforts are being made to identify willing NGOs and CBOs within or outside the State to support CDTI. Boys Brigade, Religious bodies and market women association were identified. Discussions are ongoing with these bodies to support CDTI activities in the State. tx. Ensure implementation of CSM and SHM in allcommunities. The State is aware of this problem Training on CSM and SHM had been conducted and stakeholders sensitized at the LGA level to implement it. However, a formal report of the exercise is yet to be made available to the State. lt will be effectively addressed in 2009. x. Continue implementation of the recommendations of the sustainability evaluation and internal monitoring. The specific areas of weakness highlighted in the Sustainability Evaluation Reports have been noted by the State. Majority of the LGA key officials in LGAs are becoming more conscious of their roles in the programme. xi. Cond uct operational research Schistosomiasis survey was conducted throughout the State between My and June 2008 with Carter Center support. Preliminary survey has also been carried out on LF, though yet to be scientifically proven. xll. lmprove on generalCDT| implementation. The State is highly committed and concerned towards a greatly improved CDTI project, following the approval of N4.9 million counterpart support which was yet to be released before a new government came to power in the State in November 2008. xlll. APOC, NOCP and NGDO should support advocacy visit to state policy makers. Our appeal remains that APOC, NGDO and NOCP should jointly pay advocacy visit to the new State Governor in order to secure sustained political and financial support for the proqramme. vlll WHO/APOC, 24 November 2004 TCC Review session 28 Number of Recomme ndation in the Report TCC RECOMMENDATIONS FOR 2OO8 ANNAAL REPORT FOR EDO STATE PROJECT ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY 12 (A) Recommendations for improving the report: i) A new style of advocacy to State and LGAs should be developed in 2009. Arrangement has been made for B- Zonal Coordinator and the Carter Center representative to pay advocacy visit to the State and LGAs. iD Continuous mobilization, advocacy and sensitization at the Community/village, LGA and State levels, to be undertaken. Mobilization and sensitization of LGA and Communities is being undertaken by State and LGA prograrnme officers. This will be continued throughout the year in order to secure the community and LGAs' support in a sustainable manner. ut. Ensure that regular meetings are held in rotation with participating LGAs. Quarterly review meetings of LOCTsIDHS are already put in place for cross-fertilization of ideas in pro gramme implementation. tv, Continued NGDO. support from the The NGDO (Carter Center) has always provided technical and financial support to the State. v Initiate the conduct of CSM and SHM and encourage training of more community supervisors. Training on CSIWSHM had been conducted at the LGA level for implementation. Reports of this exercise are being compiled for a follow up. Training of community supervisors was conducted alongside CSIWSHM training. Yl. Facilitate kindred level training of CDDs and ensure increased number of female CDDs. Listing of villages as a step ahead of kindred level training is ongoing in most LGAs in the State. The need for increased number of female CDDs is also being addressed in these LGAs. The State is praying for the approval of the SCI from APOC, in order to fully implement the kindred level training exercise. Yll. APOC, NOCP and Carter Center are requested to carry out high powered advocacy and sensitization visit to Edo State, in order to secure the right political and financial support for the programme with the newly sworn in government in the State. Our appeal remains that APOC, NGDO and NOCP should jointly pay advocacy visit to the State's new Governor, in order to secure sustained political and financial support for the prograrnme. lx WHO/APOC, 24 November 2004 Executive Summary (l) A total of 603,612 persons were treated in 530 endemic villages of 12 LGAs, with 1,774,500 tablets of Mectizan. An estimated total population of the 12 endemic APOC assisted LGAs is 918,668. The ATOruTG for 2008 591,466 persons (see detail in section 2.6.1). Therapeutic and UTG coverage was 66%o and 102% respectively. Refusals and absentees accounted for 1.3%o and 12.7% of the total estimated population. Four hundred and eighty four (484) persons experienced mild relations during the treatment period. (2) There were communal crisis at Akoko Edo, Etsako West and Owan West LGAs hence the low treatment coverage in these LGAs. Normalcy is expected to return to the areas with the interest of the new Governor to ensure peace throughout the State. The State is determined to achieve improved treatment coverage generally in the entire LGAs, especially with focus on areas where low coverage was recorded, i.e. Ovia Northeast, Uhunmwode, Akoko Edo, Owan West and Etsako West. t3l Treatments were also carried out in hypo endemic LGAs under The Carter Center sponsorship. 158,354 persons were treated in 134 villages using the 480,000 tablets of Mectizan. t4l Section 2.4.-2.8. shows level of community involvement in CDTI activities. 87Yo of the Communities had community supervisors, and 30.5% of the endemic villages had female CDDs. No CSM or SHM activities were conducted during the period. In Section l, 316 out of the 363 health staff in the entire project area, or 87Yo of the health staff in the LGAs were involved in CDTI activities t5] Training was conducted for different categories of staff that were involved with CDTI activities. Under capacity building, 36 LOCTs, 132 Health centre/post staff, and 2,475 CDDs made up of 516 new and 1959 refreshers, were trained / re-trained during the year. In addition, 936 female CDDs were trained / retrained during the period. This is an improvement over previous years' training of female CDDs. ln 2009, efforts would be intensified to train more CDDs using the kinship system, and continue increasing the number of female CDDs. To this end, the Project is using this opportunity to draw attention to the proposal earlier submitted to APOC for approval for the training of more CDDs using the kinship system. ] Challenges and how they were overcome:1. Advocacy/mobilization of key officers at the State, LGA and Community levels. 2. Getting the LGAs to execute prograrnme activities in a timely manner; 3. Monitoring and supervision visits; 4. Timely provision of the right quantity of Mectizan tablets in the respective Communities/ villages for treatment. 5. Intensification of CDD training at kinship level; 6. Population census update The NGDO supported the State by providing needed fund and logistics to carry out advocacy, sensitization and mobilization visits to the LGAs/Communities, in the face of difficulty in commencing CDTI activities. Adequate quantity of Mectizan tablets were also delivered to the State by the NGDO. 6Ir x WHO/APOC, 24 November 2004 As a result of high level advocacy carried out, the twelve LGAs in the State provided encouraging financial support for CDTI activities in their LGAs to the tune of N3,786,000. This represents 75.7Yo of the LGAs' budget of N5,000,000 for the prograrnme in 2008. No CSM or SHM activities were carried out in 2008. We believe that the 2009 programme year will present the appropriate opportunity to commence the activities. They will be closely monitored to ensure compliance by the CDDs and other prograrnme officers. New Appointment: Mr. Saliu A. Kadiri (formerly Assistant Coordinator) was appointed as Acting State Coordinator, to fill the vacuum created by the demise of the former Project Offrcer, Mr. Abudulahi O. Abu, who had been in the programme since 1996. May his soul rest in peace. xl WHO/APOC, 24 November 2004 SECTION 1: Background information l.l. General information 1.1.1 Description of the project (briefly) Geo graphical location. topoeraphy. climate. population. etc. Edo state was carved out of Bendel state in August 1991. The state has 18 local government councils with a total population of 2,350,040 (1991 census). The latest population census indicates a provisional population of 3,100,000 (2007) for the State; however the details are not yet available. Edo state is among the youngest states in the country and she still retains the original boundaries of Bendel state except for minor adjustments. The State is bounded to the north by Kogi, to the west by Ondo and Kwara states, to the east by Delta and Anambra, to the south and southeast by the Bight of Benin on the Atlantic coast. APOC's sponsorship of 12 hyper/meso endemic LGAs out of 18 LGAs in Edo state started in June 1999. Treatments have consistently been carried out in the 12 endemic LGAs since 1999, while passive treatment is under the sponsorship of Global 2000/The Carter Center Nigeria in the six hypo endemic LGAs. Edo state lie approximately between longitude 50 east and 600 45 east and latitude 50 north and 7030 north. The area is generally low lying except towards the north where there are some highlands that form the old Afemai/kukuruku hills. The existence of many rivers particularly rivers like Osse, Siluko, Okomu, Ossiomo, Ojirami and their tributaries to mention but a few, provide fast flowing rivers and streams that are ideal for the breeding of black flies. The vegetation varies from the impenetrable mangrove swamps along the coast, relieved northwards by a wide belt of deciduous and evergreen belt and terminated by savannah. In the north, the tree vegetation belts are prominently noticeable as one travels from the south to the north. The state enjoys a tropical climate of dry and rainy seasons. The dry season is from November to April, while the rainy season is from April to October. However, there exists a brief dry spell in August commonly referred to as "August break". From December to February, the harmattan wind blows over the state. During the rainy season some of the rural roads leading to at-risk villages are not accessible thus making Onchocerciasis activities difficult to execute during such period. The project area spans the north, central and southern areas of Edo state. In Edo state the common languages spoken are Bini in the south, Esan in the central and Afemai in the north; the culture is homogeneous. Farming, fishing, trading and office work are the major occupations of the state indigenes. They live in permanent settlements and practice a communal system of living. During farming periods, some live nomadic lives as seasonal migrants. Leadership authority is vested on any person chosen by the entire people of the environment to lead, and the person so chosen becomes the leader and exercises authority ultimately over others. The administrative structure of the project flows naturally from the state to the LGA and then to the villages/ communities. The health system facility is evenly distributed throughout the State and there is reasonable means of communication between the State headquarters and the constituent Local Government Areas. 1 WHO/APOC, 24 November 2004 Table 1: Number of health staff involved in CDTI (Please add more rows if necessary) District/LGA Number of health staff involved in CDTI activities. Total Number of health staffin the entire project area Br Number of health staff involved in CDTI Bz Percentage B3=B2l Br *100 Akoko Edo 28 18 64% Esan Northeast 25 t7 68% Esan Southeast 36 36 r00% Esan West 25 20 80% Etsako East 39 39 r00% Etsako West 35 35 r00% Igueben 26 23 88% Ovia Northeast 28 20 7t% Ovia Southwest 30 T9 63% Owan East 26 24 92% Owan West 36 36 t00% Uhunmwode 29 29 t00% GRAND TOTAL 363 316 870h NOTE: These are the numbers of health staff in each LGA that were involved in CDTI prograrnme during the year. 1.1.2. Partnership Indicate the partners involved in project implementation at all levels [MoH, NG D Os (n ationaUinternational), communities, loc al org anizations, etc. J Describe overall working relationship among partners, clearly indicating speciJic arcas of project activities (planning, supervision, advocacy, planning, mobilization, etc) where all partners are involved State plans, d any, to mobilize the state/region/district/LGA decision-makers, NGDOs, NGOs, CBOs, to assist in CDTI implementation. Between 1992 and 7994, the River Blindness Fourdation (RBF) frrnded the programme in collaboration with the State Ministry of Health and the benefiting LGAs. Between January 1995 and May 1999 funding was provided by the Lions Clubs International, District 404 with the Technical support of Global 2000 /The Carter Center, in collaboration with the State Ministry of Health. From June 1999 to-date, WHO/APOCAIOTF commenced the provision of 2 WHO/APOC, 24 November 2004 support to the programme. This is in collaboration with LCIF, Global 2000lThe Carter Center, the Ministry of Health and the benefiting LGAs. All the aforementioned partners are involved in planning, supervision, advocacy, mobilization and health education at various degrees. Mobilization strategy used includes radio, television broadcast, jingles and production of fliers. The partners involved in the project implementation at all levels are the NGDO, APOC, MOH, LGAs, Villages. The working relationship among partners has been very cordial as it relates to programme implementation. However, lack of fund from the state government and some LGAs affected effective supervision. We wish to reiterate our call for a high-powered advocacy visit to Edo state by APOC, NGDO, NOCP particularly as a new govemment had just been inaugurated in November 2008. At the project level we shall continue to visit the LGA policy makers and the community leaders so as to solicit their much-needed support to the programme. APOC Trust provided support to the tune of $4,895.00 in 2008 out of the approved budget $6,293.00. A balance of $1,398 is yet to be received. I 2. a) b) c) d) e) Global 2000lCarter Center provided funds for: drug distribution and retrieval of data carrying out advocacy visits, monitoring and supervision Surveys for add-on programmes e.g. LF & Schisto. Schistosomiasis survey was conducted by the LGA Program Officer but yet to be scientifically confirmed, while LF was scientifically conducted but yet to be confirmed by FMOH. Overall logistic and administrative support to the programme. Maintenance of vehicles and equipment. State Ministry of Health and LGAs provided funds for: integrated monitoring and supervision of field activities mobilization/health education through T.V., radio jingles, Oncho day celebration; office accommodation; Training of CDDs and HFS. Drug distribution/supervision at the village level. 3. a) b) c) d) e) J WHO/APOC, 24 November 2004 IAoE tt E Prrr Etr.= oF oE'!ED=h gf Y EL9Y @ rO O)- l{) oo rO- s l()(f) otr) @N$- (f) rO oo o- !O(o oN @-(os N o)\lr) (f) oolr) o(f) (o l() s_ @s co(f) lO^ [o o s- os (o \Ns (o @\t^ rF 6) 1.) tr o .E EL oG 'I t.e "EEiE g F"aEE# 3= ol- rysN N ro @ 1() tO (f) rO O)- O) o(o s- s (o s- l() o) ooo r() o) O)(f) o_ s rO o) @ Or_ N O) No O)- N(o o @- s(o o,s r() e.i(o (oo(f) (o r() 00(0(o- 00 rF ct) . ...E E sE$EEo.i x o N. sN N r() @ rO t() o o(o s_ s o o o o)o o)- N o) No or- N(o f-o @_ s(o o)s r()- N(o o o)N @- I\ e') lO .o.E EI E I "SE E 85.8.6= g o o cf) rO Or_ o) o (ot- ro o) oo o- rO O) o)(f) o- s rJ) o o o o ( I o) sP Aoli f.(o N o) rF rt o)(r) oo EDg o olt E z r- .9 o E E *Eg v F- F.-F- 6> s f-(o (o(f) lJ)rO rOrO (o(f) o$ l()!t o)rO @(f) os Ns o(r) lcl ..E E sE$eso., x s N(o o rOr.() o o o lJ)$ o,rO @(f) o$ o Nco .o.E EOtro (EllthOOr EEE€.A6E g o o (o(o o lJ)lJ) (o(f) o$ o o o o N$ CDoN EL 3eE q E;'gHo'- cLF o 6L$N Nlr) @- r() l() (f) r() O)- O) o(o a.s (o a. r() o) oo o- ro O) o)(f) o- s r() o)@ Or- N O) No O)_ N @ o o- s(o o)s r()- N(o (o @(f) (o l() @(oq. @ -o) OoEJEy EE.*oE oEtIl o -voJ o(U o) E oz C(E o tU o(u o) ) o U) c(U o tu oq) =c(5 u, l'U o(U I.JJ o .Y(E o LU oo =o .!z(5 o l.U c o -oo = -9 o(E o !E oz (U '= o o o) = oa .(U o o(5 tu c(s =o oo =c(U =o q) Eo =E f t oN L C) -o o o zs c..l Pr r,o L G) CL cTlc Eo o- o) OJ -c1,) trtlc L =E oE t-o E' o)Lt(oq) L q) L(o o .c L G) .E 4F)o 3 (I, o)l-(g +,(J(u 'a Lo E L'cq) o = .c .)z v, L (o o Co L'(tr f CLoo !C(g ti o) L' .E J E E oU c.i o)E(o $ ii oF -.i lr c) h0 E} o.=c)0)Hl) 0)a -c<'{.j > oo9 .Etla eoOo\otr \o^ xoo gor()(rr c)c)Lr! 940 cS 9r bE P(d ea6P - -B= ^o(Etr(Da cBO 9 bI)q)tr LCga-9 G)a ox 9oo Jo.u?o eG) cd -q Foo .l ! dLi =EOag #() Ec s[ieO.E YE'E HE =-7:tlrI Eg $,: BNl ca ,.t =$i;l E r c6l q)F FIU !+ a.l L(.) -o o o z +N o o *r B tr .9 ..2I o EL @ C o #!O=trbEtro-o ) - oC J o -oo o o o -oo o o oz o o .>) o.c) U) o)) #oo o.oct) f oz trD- H9 a- ocf - := o- o -oo o o o -oovo o o o o. oa oc J -) o, ) CLo U) o)) oCJ =Lo. tr o .Ct ,|2 o E, =o C o o=trbttro-O oC) oc) o.oU) o oa o o o o oCf o. o) U) o.q) a o o o o o)) (,o o)- H9 a- := o- := o- ) = o)) Po-oa __ o- o)) )? o.oa o)) o)c) =CL o (E!, CL :) o otr oo c o O=q6ttro-o o G' =E9o(E=I.o c8 d*o o-o C,)- #I-E9 a- E" .E tr '6 LF g o #l-OEtrbEtro-O L o. := o. oC J oC) )a o.oct) (5 OJ J oC) - v o. o c/) )? (u = +,o oo cD- #t-H9 a' -co (E oL o (E (u oc) o.oa := o-(E ) o o,= o)c J := o. () L G = oo -0,o= (E=NE =S -Otr *E c o o=qbttro-o so o l-(J (tr := o. := o. (U (,)) .CoL(U oC) .? (5 o)) (E :=o. E" o)- H9 u) t- -ootL -ootL -co (U .CoL(E = := o- J? -oo LL (5 =CL ) -) : o- oL o .o o!r oJ o .9, o oE I.JJ otz olz o o o t- oz C(o o l.U o G o .C) o U) C([ a I.JJ oo =C(E o I.JJ o(E IU o .Y(u U' I.IJ U, o =of<(E o I.JJ E o -oo J _9 o(5 o .CE oz .g o o o =.C) o U) .E o o(5 tu C(E =o 6o =co =o oE o =Ecf -cl E oF lr) tro o o trOo 'Eog= o'E =o .ETo.otro =NOZEgi= F oUJI(/)(\r t c.l ()p C)I z <lN { o \o th O (t o tr o) (h q) ()(d 7n o) q/ .= obo(!trqr o.lP eo A() PLi u)q =tO-t .H8 O EEtclLT C) (.)a)x .aCgE6EE =t)rv43o oI) I 6d =() o9' ?.oEu) ot.E 9: R9 -cd € (.) =9OH -qq(h it U) o tr oO I N 2.2. Advocacy State the number of policy/decision mokers mobilized at each relevant level during the current year; the reason(s) for undertaking the advocacy and the outcome. Describe dfficulties/constraints beingfaced and suggestions on how to improve advocacy. At the state level, the Hon. Commissioner, Permanent Secretary, Director, and Deputy Director and some other key officials were mobilized by officials of the Carter Center during advocacy visits for logistic supports and for government counterpart cash contribution (GCCC) to the prograrnme. During the advocacy visits, the State Coordinator highlighted some of the achievements recorded so far in the progralnme and the number of Mectizan tablets donated since inception of the programme implementation. This was also replicated at the LGA level with visits to the Hon. Chairman, Head of Service, notable politician and some very influential persons. The major objective was to win their hearts to give support to the programme as APOC support was frzzling out. However due to the uncertain political terrain and the itinerant nature of the political office holders, the advocacy cannot be said to have achieved much. On the whole, about four State officials and25 LGA functionaries were visited during advocacy in the year. D i ffr c ultie s/C o nstraints : * Inability of Council officers to release funds as promised during advocacy * Most of the motorcycles donated by APOC have been grounded. To improve advocacy: a) It is necessary for NOCP/APOC and NGDO officials to pay advocacy visit to the State, and later send a letter reminding the State of her role in the programme. 2.3 Mobilization, sensitization and health education of at risk communities. Provide information on: / The use of media and or other local system to disseminate information / Mobilization and health education of communities including women and ministries / Response of target communities/villages / Accomplkhment / Suggrtt ways to improve mobilization and sensitization of target communities. [a] Broadcast media or other local systems were used to disseminate information in urban and rural communities. It is still the best way of reaching out to the people. lb] Funds released as counterpart cash contribution would be monitored to ensure it transcends to distribution of Mectizan in the LGAs. [c] The State team & the NGDO also wish to repeat this kind of visit in 2009 for strengthening of our cordial relationships. td] The response of the people during the mobilization exercise in many endemic communities was encouraging. There were expression of better eyesight, knowledge 7 WHO/APOC, 24 November 2004 on onchocerciasis control as well as the proposed add-on progrumlme like Schisto and LF. The communities also expressed gratitude to the donor agency for the Mectizan drug provided. [e] During health education session, emphasis was stressed on women and children especially pregnant women, nursing mothers and children below 5 years of age who are ineligible to take the drug. Communities were also directed to recruit more female CDDs in their area to balance gender inequality.(f) At the rural communities town announcers is the best method used by the various CDDs top disseminate information on Onchocerciasis. Accomplishment: The 530 endemic villages were fully mobilized during the ninth- year operation. Weakness/Constraints :{a} Refusal by some CDDs to distribute Mectizan in their communities due to social or political reasons.{b} Some villages refused to select CDDs as a result of inabilty to provide support.(c) High cost of fueling of vehicles and motorcycles. td) Lack of commitment on the part of some CDDs and LOCTs. Ways to improve mobilization of the target villages: o Intensification of Monitoring and supervision o CSM and SHM activities would be initiated and carried out with a follow up action. o Continued health education/mobilization would be intensified to villages so as to change their mind and orientation on the disease pattem. o Training of more CDDs on kindred level would be conducted in 2009 for effective coverage to reduce the demand for incentives. 8 WHO/APOC, 24 November 2004 2.4. Communityr involvement Table 4: Communities participation in the CDTI (Please add more rows if necessary) Total Note: 936 female CDDs are available in 1.64 Villages. Comment on: - Attendance offemale members of the community at health educotion meetings - In general, how do you rate the participation offemale members of the community meetings when CDTI issues are being discusses (attendonce, participation in the discussion etc). - Incentives provided by communities for the CDDs - Attrition of CDDs. Is attrition a problemfor the project? If yes, how is it addressed? - Other issues 1. In Edo State, attendance of female members at health education meetings, is observed to be improving. 2. Attrition is no longer a problem in the project area. 9 DistricULGA Number of communities with community members as supervisors Number of CDDs and the Communities involved Number of communities with female CDDs No. of comm in the project area Ba No. with comm member AS supervis or Bs Percen- tage Bo= By'Be*1 00 Male CDDs Bz Female CDDs Be Total B9=$7+ Ba Number of comms. with female CDDs Bro Percen- tage Br= Blo/84*100 Akoko Edo 47 42 89 137 114 251 l5 40% Esan Northeast 37 3t 100 76 39 115 t6 43% Esan Southeast 36 30 83 137 113 250 t9 s3% Esan West 55 45 82 129 47 176 l4 2s% Etsako East 55 47 85 224 39 263 10 r8% Etsako West 36 36 100 159 61 220 13 36% lgueben 40 40 100 98 49 147 l0 25% Ovia Northeast 45 43 96 134 92 226 9 20% Ovia Southwest 59 52 88 119 109 228 2t 36% Owan East 38 34 89 110 91 201 11 30% Owan West 40 38 95 102 111 213 t2 30% Uhunmwode 42 40 9s% 114 71 185 t4 33% s30 484 91.3"/o 1539 936 2475 164 400 WHO/APOC, 24 November 2004 so N ko .o () o z$ ol t, o B ri) o I B su * o B bo o + s U t I\ s -a s o Bt\ 4l L a)Lo N F Oq-i o arl 0) o q) L{ .()q.i (,) e5q)B' \SFh .ES \Lso b vR.o sr rtr/: sOaS$+q)- \iFrP .!+ - .A I AoFS SR SNs^-tEu h\ .;* :$\.du> SE\ -o'\a\rS *bov -\)o v\\q) EESs) .sb LF v.> oo!FU\.n *€EYaIsI x = BSB's Q- -vsIls$ xr:}tQF $rE $EEIJ - R E!_v\q) L ^,_\s$ s\. *BFB =ls-$ \!bl^FU!AASSY .t<-Q *\ssNe-\h\Si'=\oobssP.F .s.Gt ls EEesEe s s 3.N.b-ss S S 'B ERtN g.-s $E +6*TS Sb x* v urxs ut6{lTt \ sIo a) (a(o c{ oNN F-s r (o NN @NN oN (f) N lf) @ roNtN PEIO E.i *= o ro c{ rr) o rON (o ls r g)log)N @N @N @ N (O$ @t- r l- @@ (o Ntso&d ooN (f)o, rON CD|r) (0 14,lo NN o,(a oro ro$ o,(f) CON oo oro o(f)i{*d @ o)!o (o o) l^() @ o, ro @ o)!o (o o)lr) (o o) ro @ o) r() (o o) ro @!t I\ tr o E o .9 (, s !, 6)tr (6 ooo o o oll E z aoId @o,l() (f)o)ro (f)CDrr) (oo,ro N N N N tlN soo :EttO E.i io N N N N N N N N N N t(\to toq N N N N N N N N N N o o o o o o oio8d o o o o o o (, Eo .9 o sN N N N N N N N N N N $$t o o .= alFFEO O l.-Eo6E o.= r!UoE!l rrEo3z oo o F N o o) c! o NG) sc,t\ \rfGllv r:oci O) r() (a r @ o o s $ NtFotoq (o (f) s (o ro N (f) N N l- @ CD l- @ (o oo@o:o = o, @ ro o) @ (o lr) lr) ro rtr) ro ro lO lr) ro lO r.() ro ooo c o, Eo .9 o s o tr C' !,a! 6' E(EEtsGls r(E oo 6qA(J =cLE z oo o l-\ (f) (f, (f) (0 c:) soo Errd E "".3 (f) (f) (f) (f) (f) (f, (o (f) (a ro(\to+oq (f) (f) N (a (o c! N (f) r N o o N ooio = o o c\t o N o E o .9 o s(, ot (f) (Y) (f) (f) (a (Y) (f) (f) (f) (f) (f) (f) (0(Y) o oJ *o .=o .0'EOE EE O0,ll E z C o -oo) -9 o(s o .CE oz (g 't o a o) = a oa (E o o(E tu C(E =o 6o =c(5 =o E oF o D(, .9,o oE uJ ovo .Y o(5 o -cE oz c(E o tU a(U o f oa C(U o tU o o =C(E a TU o([ uJ o .Y(E U' tu oo =o -v(U o UJ oEo =Ec) l $ N 0) -o c) o z$ c.l o o. lJi -.:(,) (clr Otr 0) B hi(t v) A r+ rltu o.l ca (n C')FO o F] X U) >) L F \ci Cd (r') t-.1 O olro (ri o bo (tlr (.) Lro o o (! >.Lts^ od(J LI ,CEO o:(.)iq=9a* o* €a() r-.1 EU:xc6 S?aqAI}qH JD<g o0):bn a6o> Po (!oE -0)OH i: .o) C6o(to9)(h c) oaE -t l.rg'€ "6 Ets '=) .5 c.)lrr Lr o:l a Fr zri =ar-a U os o =) o U)oOqjri OI)vcd -trN9 r\o$< ..o {en Adu9 o.E €Hc.- .ro 6E *6) oo-tr> ,=- iI o.t +ieOO eOotrb0()li-CEooC)tr '6 .t< ooP '=9 'E ca lrP c)v>>.(.)F 9()9oE€tro -Y PoL .ar- ^ Ol)(Eo t _\G) i.j E.5o-ii +rQO o _y,!sorsOo H9 OE rn G) =Ntr(o 'Ee o-h L,- F; 0) -o tr E Cd (,) bI) (,) Bo lz 0) o(ti C) Lr(.) (,) olr(.) B (! +id U) o C)lr C) B U)d(.) k C6 lr .o q) Lr! CBo (.)fr(.) B v) oo (t H (t O ts C) c.; <io(h v)(.)ti (d q) 5<o B cn() bo(B ti o U) lr(.) B oa d (rr v) oH € (! c.) (s(t o cd >' 0) olr V)(t B tr 0) B q (g (,) (s (d c.i E c.) (6 H (.)lr E c.) (B H olr C) U)c- U I \o cO (.) o O r- on() o C') L U tr .o () o0 V) U)(B oos o d -l ()(d o (n c- Oc r.1 o(.)lr o o Ol- cd6EECB rn (l)Ij !9 dL< 0A4g (n$ Table 6: Type of training undertaken Qick the boxes where specific training was carried out during the reporting period) 2.6. Treatments 2.6.1. Treatment figures If 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. A total of 603,612 persons were treated in 530 villages with a population of 918,668 of Ultimate Treatment goal (UTG) of 591,466 giving a therapeutic coverage of 66Yo and geographical coverage of 100% as shown in Table 7. The Project attained 100% geographic coverage and66%o therapeutic in 2008, based on the population of 918,668 persons in the State. Trainees Type of training CDDs Other Community members e.g Community supervisors Health Workers (frontline health facilities) MOH staff or Other Political Leaders Others {speci&) Program management ,/ How to conduct Health education ,/ ,/ ,/ ,/ Management of SAEs ,/ ,/ ,/ ,/ CSM ,/ ,/ ,/ ,/ SHM Data collection ,/ ,/ ,/ ,/ Data analysis ,/ ./ Report writing ,/ ,/ Others (speci&) 12 WHO/APOC, 24 November 2004 + o c.l L 0,) -o q) z$N o. B ca o bo(c HO oo B o o0 U)otr o Lroa ao tr oq() t< 0) oo tr U) th lro (B c) () o () t<oaXo (h J v)(.) d B E C6 q) C) o -54 .h r! dEr! oJ o J4 r"i Er z E oF -:\ 4?g Iq) q > l. q) t S q)q !q) U H(g(,) >\ oo c..l L an Lr (d U) () t-<(! J o L a >.p cr) rrl a d () ofrt- r-1 ot -ol(dl FI !=; + 'ieE o o o o o o o o o o o o o oislll2"6 o o o o o o o o o o o o o :EH c< l() o(o cf) f- o, o, c) (f) Nl- @ o)o rO^ l- rJ) \ l- rO @- (f) O)f-at cf) lr) (o $ (o @ co r()o\ !O COl--(a rr)o @ No oq.(0 - - ! t+g-5 O)l- o) o)(o rOq^ r N rO r() o) r() N oo @ o (f)- N (oI- @ o cf) NN @ rr)|r) o,N cf)- ttor rF rF tr .9g =CL o o- oo I;. dd No$[' sNtr) sol- sol- sNN s cf)N slos ssf- s CA rJ) sN @ sN @ sN(o ss(o s(0(o tso b 9p s. BE o Or- s(o l()$ os @$(o- tr) r() N$@ co ro o)so of- $ O) o_ (f)$ l- O)- o) CO (o(o @ @s @ rO lr)- rr) $(o @- NlJ) o \ @(o o^$s N -@_(9o(o @o Eot 6.> =troi E.s < E* @ rr) O) rOl- oo !O- $ rr) cf) olr) @N a.(o rO oo o- r()(o ON6(os N o)l- rO(o oolr) o,(f) (o l() a. @s @ cf)lo- rf) f-o s.o$ (o \Ns (o(o\t- -g)lo o .ttaisu E o == 5 " ol- ry$N N ro @ rO rO (o rO Or- O)l- o(o a.sl- @s- lr) o) ooo|r) O) o)(ao$ r.() o,6 or- N o) No o)_ N(o f-o @$(o o)$ rr)- N(o (o @ co(o lr) CE'(0 @- € o) oo CDg 5 o .9 .=tr E E oo ooII cio o o E''d (!^8Ir o(, soo soo soo F soo soo soO soo soo F soo soo soo soo soo rF o sset l-s l-co (o(f) l()lr) lr)lr) (ocf, os |r)s o)r() @cf) o$ Ns ocl, IC, No EoE 6.2 =troE E.e. < E* Ns f-CO (o(f) rOrr) rOrO @CO ot r.()$ O)rO @cf) os Ns ocr) rO =-t t ,. iEgfiE H- l-s Ncf) (o(f) r.r)rf) rJ)rr) (o(o os rr)s O)rO @(f) ot N$ o(v)ro o Do .9o oE ul olz olz PU'(g o)EE oz c oo tu o(tr o .CP =oa C o U' I.JJ ao =C(5 o LrJ o(o tU olz(E a l.U o o =orz(u oP tu c o .cl o :, -9 o(5 oEE oz (5 '5 o o o =-c) oa(! o o(5 tU c o =o o o =Lo =o oE o =Ec = -cl 2.6,2 What are the causes of absenteeism? a) Some people are getting tired of annual Mectizan dosage and they claim that they are no longer sick of Oncho. So they absent themselves from treatment. b) Many youths move out of their communities in search for greener pasture outside. c) Migration of inhabitants in times of communal clashes/conflicts 2.6.3 What are the reasons for refusal? a) Religious belief. b) Some others believe that they no longer harbor Oncho as a disease hence refusing treatment. 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. In 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 V t4 WHO/APOC, 24 November 2004 $ oN L()p o o z$ ct B (n q) a. \) .a q IT ! Ua4\)uq) ? L \ t Ua uq) s o Lroq b0 ! oaOH o o0 Lr ()lrH o C) o C6 t, r! a v) o o o chtr() (s th o lrO rn +i o an C,) v) O #r ol -olCBIFI (.) -Ei=o99 EE A -r t2 L 6Pg CEOLD 6 == ,85= o o;.9 EA ^=gq0 =s/oa a a(Di(*: o9 ^ 6.= L)o-q tril9d -G(H;()ro.2s c() q q=(!oo() O € 8,.9 ,. .9,;6>eaEu' o)'=== A Y Y,Id CE €-99p1? =.o.= c)f;EE!g () bo C) -o CBo o-oi1 (.) cc o' O9.:ro(,)'oGl r'r >H A.at!t.. ah o o o U) ;=(.) -; L0.)=c) e! x>. o2aa6 =c) .N*EE; Ag E o 0)boc =bn?o X()a o oo L 1a (,;) ooI $s ro O s oor- sN6 s$ o\ sa Or 6|f- o\ slal o\ s -oo\\ sO sN o (d)oo o< oo ll r li 0) 9 Sala oo\ o s €r- s oo s o\ ^\N o\ s o\ sr\ s so'! o\ o\ s CJ sN ll r !i lI1 f.l \co\ o5() =oood =o oo .EoF s$\o s+\o s f- s o\\o s r- 5\ o\\o s oo s v?(n t- -o o\ f\ s\o\o hl ,o od l:9 4a E6zg q $(.- C\ co$ \o co \$ ca o\ o^ C.l rr) \o \o $(r) r-tq co ca(n ca\n tN\.} \o+c\ ( la! la) $$^ olla) rr1 €r\ cat\o N \o ca \o td :o 6 (l).= } UF (n( \o\n NN N c-\n ra} oltri \o €lr.l o\ co c! o\\ c.) ca oo oo$ r-\o \n(n o\\a \o^ \o\.) la) \o cn s oo(r) \o\oq Or\a) Lq ^.16 - olu -: o.EA.E o bo o .6s€='Elr ' a 89 a "6 o\ \or\\o o\N oo\doF o cn \a) $Ir \o\ co@t- oo c.lq f-\at- s ca \o^ o\(n r\ o\N o^ rr €\o o\ ca c- oo\o \o^ oo o\ 6\o \o^ oo o\ q c) o0 rB oo tr oQ e ll { ld l.l ri C) o Bo,= F Oo:d>v o s n\o oo scl ( o\ -oo\r- o\ sr\ o\ s co o\ s € o\ r.o 6\ \oo\ \oo\ \oo\ $= g8,tOot.l s n\o oo s oJ la) o\ sf- o\ str- o\ s cn o\ s € o\ \oo\ :.oo\ -oo\o \oo\ ri LOOE E-9; HI] 5 E-i !z8' €(r) + lat ra) $ (a r- ( c.l o\+ NN\r) cnt.) co\.} cala) co( ld :o6 o.= ;/ !) -o't- (J O ca(n c.t\a cr)(n calal calrl carn cnr.) c.)(a c.trn co\n )9-,3!.q)E ts I ".= tr aE E E$EE" . 8= E E co\.} ca(n ca(a colr) c.lla) o co(.) cora) co\a c.t\n co\.t o\ Or o\ c{ ol c\i c! ca c\I $ oN r.) N \o N r- N oo N $ N () .o o o z$N o \o an a)Lq)q \o\o = o\ia cl C)L GI I() La q) tr E E-( Er q) c) 6lI o 02 CEq) 8 €\q) .tr st>.: :=g.r l-= 6\(.)yEEi ET .5U 9E .= q) E.? f,g e)=ox Q o.r ArE -Ht-( qYQ:\J 0) oh =dtEPI .- 6l Esl E5l>()q)oo 9C)ct> Ec)q)n EFGraC) {i 3() *tr E9o- ti-F oit ui -91 "4 €lNFI 2.7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - (please tick the appropriate answer) MoH n wHo tr uNICEF tr NGDO V Other (please specify) : Mectizan@ delivered by - (please ttck the appropriate answer) MoH tr wHo tr LINICEF tr NGDO EI Other (please specify): Please describe how Mectizan@ is ordered and how it gets to the communities The Oncho Coordinators in the Local Govemment areas make their requests for Mectizan after getting CDD requirement through the HFS, based on census updates in village registers This application is forwarded to the State Coordinator through the SOCT in charge of such area. The sum total of the estimated number of people to be treated from all LGAs are collated and multiplied by 3 to arrive at the approximate number of Mectizan tablets needed. This final figure is forwarded to the NGDO project office for further processing of the request. On arrival of the tablets to the State from Mectizan Donors, they are allocated to each LGA based on the original application. The tablets are delivered to the LGA and it follows the same process from the LGA down the line to the Frontline health facility, and finally to the CDD with the consent of the Village leader, for treatment activities. 10: Mectizan@ lease add more rows ne Number of Mectizan tablets Received Used Lost Wasted Expired Remain- mgS/N LGA Requested 200,000 200,000 0 0 0 01 Akoko Edo 200,000 0120,000 120,000 120,000 0 0 02 Esan Northeast 0170,000 170,000 0 0 0J Esan Southeast 170,000 160,000 160,000 0 0 0 04 Esan West 160,000 0200,000 200,000 0 0 05 Etsako East 200,000 0130,000 130,000 0 0 06 Etsako West 130,000 0 1 10,000 1 10,000 0 0 07 Igueben 1 10,000 0140,000 140,000 0 0 08 Ovia Northeast 140,000 150,000 150,000 0 0 0 09 Ovia Southwest '150,000 150,000 0 0 0 010 Owan East 150,000 150,000 120,000 0 0 0 011 Owan West 120,000 120,000 124,500 0 0 0 0t2 Uhunmwode 124,500 124,500 0 0 0 0 Treatment in 6 Hypo endemic LGAs 480,000 480,000 480,000 2,254,500 0 0 0 0Total 2,254,500 2,254,500 t7 WHO/APOC, 24 November 2004 aa How are the remaining ivermectin tablets collected and where are they kept? There were no reports from the LGAs regarding tablets remaining at the end of treatment exercises, neither was any retumed as unused. List and brieJly describe the activities under ivermectin delivery that are being caruied out by health care personnel in the project area. Drug delivery moves from SOCTs to LOCTs, then to HFS/DHS, and finally to the CDDs Monitoring/supervision of drug distribution. Mobilization visits. 2.8. Community self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? If so, When? Yes it was done in 2003 and 2007. Since year 2004, which was the fifth year of APOC implementation CSlWStakeholders' meeting were not being carried out in the State due to inadequate logistic supports from the government. The activities were not conducted in 2008. : Communi and Stakeholders dd rows NOTE: No CSM or SHM activity was undertaken during the reporting period, but this will be firmly addressed in 2009. DistricV LGA Total # of villages in the entire project area No of Villages that carried out CSM No of Communities that conducted SHM AKOKO EDO 47 0 0 55 0 0ESAN WEST 0ESAN N/EAST 37 0 ETSAKO EAST 55 0 0 36 0 0ETSAKO WEST 0IGUEBEN 40 0 ESAN SIEAST 36 0 0 OVIA N/EAST 45 0 0 0 0OVIA S/WEST 59 OWAN EAST 38 0 0 OWAN WEST 40 0 0 UHLINMWODE 42 0 0 0 0Edo total 530 18 WHO/APOC, 24 Novemb er 2004 APOC FMOH; NOTF/ZOTF NGDO - The Carter Center SMOH ; DIRECTOR OF PHC/DC 2.9. Supervision 2.9.1. Provide a flow chart of supervision hierarchy. The Project Administrator of The Carter Center Edo/Delta project, State Coordinator and State PHC Director carried out supervision and advocacy visits to LGAs to solicit for support. The SOCTs also did the same with the assistance given by the Carter Center. Even at some LGAs where support was given, we found out that only minimal supervision were undertaken by some HFS/DHS, and LOCTs concerned. 2.9.2. What were the main issues identified during supervision? Incorrect dosage entry in the notebooks. Diff,rculty in recording census update I 1. 2. STATE COORDINATOR SOCTs LGA ; PHC COORD; LOCT ; LOCTs DHS HFS CDDs / COMMUNITIES r9 WHO/APOC, 24 November 2004 In some communities, old notebooks were not replaced. DHS/HFS complained of lack of means of movement to supervision site. 2.9.3. Was a supervision checklist used? Yes. 2.9.4. What were the outcomes at each level of CDTI implementation supervised? The outcomes of supervision carried out were normally discussed at the State & LGA review meetings. Some of the outcomes are as follows: (1) LGA Level: During the reporting period all the twelve (12) LGAs in the State released substantial financial support for CDTI to the tune of N3,786,000. (2) FLHF Level: Generally, there is inadequacy of staff at this level. The few staff available say they could not ride bicycle provided by APOC for monitoring of CDTI activities. From the discussions we have had with some local government functionaries, there are plans to recruit more hands for the FLHF. It is hoped that this would be realized in no distant date. (3) Villaee Level: In some communities, despite the apparent difficulties being experienced by some CDDs, they still participate in the prograrnme. Such CDDs believe that they are helping their Villages. The awareness created by mobilization at the community level has helped the programme tremendously. 2.9.5. Was feedback given to the person or groups supervised? Feedbacks were always given to the people supervised as debriefing at the end of supervision. Sustainability of the programme is the all-time message. The peoples' responses are good and there is hope for improvement with time. The feedbacks were also further discussed at State and Local government review meetings. 2.9.6. How was the feedback used to improve the overall performance of the project? Ia] There is hope at the end of the tunnel as problems identified were also passed down the line to CDDs to enable them know the areas that require improvement in subsequent treatment years. tb] Although, there was improved community participation, some communities/villages are still not showing enough interest in the prograrnme, saying that they cannot continue to fi.rnd government prograrnme. Despite the orientation given during mobilizatior/sensitization. J. 4. 20 WHO/APOC, 24 November 2004 SECTION 3: Support to CDTI 3.1. Equipment Table 12: Status of equipment (Please add more rows if necessory) NOTE: (a) The State is grateful for the new Toyota hilux vehicle that was delivered early in 2008 to facilitate prograrnme activities in the State. (b) Information is not available to the project about LGA equipment set aside for CDTI activities. *Condition of ihe equipment (F:Functional, CNFR:Currently non-functional but repairable, WO:Written ffi. The damaged APOC motorcycles are not repairable due to lack of spare parts. The motorcycles are currently at Esan West, Uhunmwode, Etsako West, Ovia Northeast, Esan Southeast and Etsako East of Edo State. How does the project intend to maintain and replace existing equipment and other materials? The MOH will depend on the NGDO for maintenance of existing equipment and other materials. However, the issue of local replacement of APOC equipment will be far fetched. It is our recommendation that NOCP/APOC undertakes a high powered advocacy visit to the State to clearly define the responsibility of the State in the maintenance and./or replacement of bad equipment. Describe the adequacy of available lcnowledgeable mqnpower at all levels. Available manpower can be said to be adequate, but areas of manpower shortages would be addressed as promised by the new Government in no distant time. Source Type of equipment APOC MOH DISTRICT/ LGA NGDO LGA Functional Non functional Functional Non functional Functional Non functional Func- tional Non functional Func- tional Non functional Motorcycle t2 6wo 0 0 0 0 4 0 0 0 Vehicle 2 0 0 0 0 0 1 0 0 0 Computer 2 0 0 0 0 0 1 0 0 0 Printer 2 0 0 0 0 0 1 0 0 0 Photocopier 2 0 0 0 0 0 1 0 0 0 Fax machine 0 1 CNFR 0 0 0 0 I 0 0 0 Bicycle 180 0 0 0 0 0 0 0 0 0 Generator 2 0 0 0 0 0 0 0 0 0 Overhead projector I 0 0 0 0 0 0 0 0 0 Radio/ Tape recorder 1 0 0 0 0 0 0 0 0 0 Television 1 0 0 0 0 0 0 0 0 0 2l WHO/APOC, 24 November 2004 +N L 0)s o o zsN d o > c\I C.l o\ o Lr a6 C) o ,L U)lrq) L CBa d >.p U) o ! k oo () (s cal -lo)l -l cdlFI o o!-tal -iI -E -E o o ! -t oI o -tt\ Ea oGtI h o o -|l o .ltIa .-\t -rt o o\ o .- o -rt o - -E Gi Fi ooN I G o Eo SE *A 5 3tqF(JEg o oo s_ (f) o r o) s- N o (f) N. @s NN s(o Eoi=Ba 5 REEF()dl= f-@(f) $ (osN os o @s cD- o (f) o{ @s N r @- s o) t(tooN I @ (E q) Eo Er$8FO(rg o (f) o) a.l- o N(o (f) o,s o o rolr) @ @ ro Eoi-Ba 6 3EEF()co= T\o(a c.f @so{ o$ o N(o(o os o (f)N o) rr) ro @(ao F*s tlooN I la, a! o Eo 3c F6 5 36qF()E= ro oof- (r) o (f) r(o- (f) (f) o $ ct) o) @(f) NN a.st\ Eoi=Ba 5 3EEFocog $o(f) rr) (ot\o c)N o (f) (o- (f) (f) o s o) o) @(f) l-(oo o,o (r)ooN I t (! o Eo F;EfO o o<F()(r= o ool-(o o @ rol- os o)o @ C! o @ ro t\l- @ ni ooi=EaSEBEF()trl= o o o @ ro I\_ o)$ o (f)N@ @lr) o)l-lo @o NooN I c) (E(, Eo Er$4F()E= o r-o(a_ N o lr)(f) o_ s(f) (oo @ (f) @t\ olr) (f) o)(o o) Eoi=Ea 5 EEEF()co< o o o ro(f)o s(f, o o CD o- N(o ro N @ o) ooN I N Go Eo 6r$8FOE= o (f)lOl() s o (a @(o s o, s (f)lot- (f)(o o @o(a @ Eoi=Ea63EqF()6= o o o (f)(o(o s o (f)l() s- t- (o @@ oooN I G o Eo 6r$QF(JE= o (f, r c\l t- o olr) N- N N(os ct) o,l- @o sNf-(oo DoF- 3,a 5 3EqFodl< o o o olo N. Nr o o) CDl-(oo o,so o, o, o Q 'r'() t! -sEEJ'E\r'5tr. .E (JO ZL o L rn x< zl .A Za(dtrocq o(l -v .t) xeHtr z 'd- an 0.) =aEC)!io!I-(6 (, F OAE r*= < fr. F] E-r o3 +N (.) -o q) o z$ ct Q o L' F coN o o o Lo o bo o o olr Hop 0) U) O (.) lr o -o o ox .o oo N +6 9= oN!L AE6 c')aq BA COos tr9< Z ,,8 Ebo4.5IJr tto-=)(trrt) Ia Sep d i-l A (, .9X.-i-. oo5:io\9E-t I5u)6.9D -A*OaO cB'- oAUP o.rFs -qOctie op 10.n q)q 4q) t $' a) L.q): ei "|s ! S. q) () \._ a)4 S q) L 4 \) .a L-\ q) L \)\ S- @gE c!.. rtO O,S -Z$o E rs g= o @ @ ryo cf) o O)s\ o,s lr) o) @ s N e) o) +G' EJ _ o^{ i-69-6385 rY-v 'co oo o-(o ooo os o o)sl- o,$ CO O)ot(o NT\\ t-gE N.' rlOo$ -Z .Ee; E(DJA ET$Qlot-- oo o^ CO oN(o- rr) (f) o N n!t o Ntr)o$ cf) c) st rF 1{G' EJ _ O^ Effgq r Y -v'co oo o- o,N o)f- o- slr) o N$- s o N ro o- s(f) Nl(,q N o t tt tr oo o G a .(EoC't o o_ + E c oO I o (, o L .9. o I o c G l= o oo(, z (E o o a o)c l-(o o- oo(, z o o o)s Ec) LL o J o oL l-oF a N 3.3. Other lorms oJ community supporl o Describe (indicate forms of in-kind contributions of communities f any) a) Exemption from commtrnal taxes b) Exemption of CDDs from communal labour; c) Giving out communal land without charge to CDDs for farming purposes. 3.4. b<penditure per activityt Indicate in table 14, the amount expended during the reporting period for each activity listed. Write the amount expended in US dollars using the current United Nations exchange rate to local currency. Indicate exchange rate used here: Nl25 to us$1.00 Table 14: Indicate how much the project spent for each activity listed below during the reporting period Any comments or explanations? Cost per person treated was $0.14 per treatment for 2008. The State and LGAs prograrnme offrcers were paid salaries during the year I 2 Activity Expenditure ($ US) Source(s) of funding Drug delivery from NOTF HQ area to central collection point of community 200 NGDO Mobilization and health education of communities 6,920 APOC/LGAs Training of CDDs 3,200 APOC/LGAs Training of health staff at all levels 10,200 APOC/ LGAs/ NGDO Supervisine CDDs and distribution 9,562 LGAs / NGDO Internal monitoring of CDTI activities 4,840 LGAs / NGDO Advocacy visits to health and political authorities 4,170 APOC/LGAs/ NGDO IEC materials 0 Summary (reporting) forms for treatment 1,600 NGDO/State Vehicles/ Motorcycles/ bicycles maintenance 6,128 LGAs / NGDO Offrce Equipment (e.g computers, printers etc) 0 Salary for State and LGA staff 38,712 StAtE / LGAS Others (Capital equipment) 0 TOTAL $84,932 APOC lStatel LGAs / NGDO Total number of persons treated in 2008 (active) 603,612 persons 24 WHO/APOC, 24 November 2004 SECTION 4: Sustainability of CDTI 4.1. Internali independent participatory monitoringi 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 Internal Monitoring by NOTF Other Evaluation by other partners 4.1.2. What were the recommendations?(a) Proper documentation of CDTI activities.(b) Conduct training need assessment and focus future plans for training on these needs.(c') Identify communities that need sensitization and sensitize them.(d) Project should integrate and target activities on essentials for reduction of cost.(e) LOCTs should produce year plans that take into account community requirements.(0 Monitoring and supervision should target on weak areas.(g) DHS should be encouraged to supervise at their own level.(h) Sensitize communities to perform their roles(i) Encourage communities to support CDDs and select more CDDs to reduce the workload of existing CDDs. O LGAs should collect their Mectizan from the State,.(k) Train the staff at the next level only on areas where they are weak or lack skills.(l) Increase HSAM in communities with low compliance in Mectizan treatment.(m) Increase therapeutic coverage to a minimum of 65%.(n) Target supervision ofproblem areas.(o) Use checklist for supervision.(p) Keep copies of monitoring report in the FLHF.(q') Conduct CDD training need assessment. G) Target training on areas of needs only.(s) The SOCTs should be trained on computer skills.(t) Government should fund the maintenance of vehicles and equipment.(u) Introduce the use of log books for the control of motorcycles.(v) Government should assume a major role in funding CDTI activities by increasing its budget allocations and eventual release for CDTI implementation.(w) An MoU should be signed between APOC and the State government detailing funding expected from the State. 25 WHO/APOC, 24 November 2004 (x) (v) (z) (aa) (ab) (ac) Govemment should budget and release frurds for the running and maintenance of transport and other capital equipment. Government should meet the cost of supply of Mectizanto the LGAs. Written health plans should integrate all health prograrnmes at the FLHF level. Minutes of the planning meetings should be documented. Training of staff on record keeping at this level Government should provide transport and training materials for CDTI. 4.1.3. lal (b) How have they been implemented? Most of the Items listed in 4.1.2 (particularly (a) to (s) are already being implemented as recommended. Other items not yet implemented (t) to (ac) are being hindered by lack of counterpart support from the State government and other factors outside the immediate reach of the project team. The training of front line health facility staff was 74oh achievement. Effort would be made to surpass this achievement in the year 2009. The lesson of proper Mectizan lnventory has been imbibed at the LGA level down through to the CDD/Community. Use of check sheet and proper recording/tracking are put in place. Ic] 4.2. Sustainability of projectst plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period? _ No Was a sustainability planwritten? Yes When was the sustainability plan submitted? December 2005. Wat arrangements hqve been made to sustain CDTI after APOC funding ceases in terms of: 4.2.1. Planning at all relevant levels The State is currently embracing integrated planning for all PHC components which include CDTI, even though this is gradual. 4.2.2. Funds Since regular APOC fund stopped in December 2004 it has not been easy carrying on with the State project as flrnd were not released by the State, since inception of prograrnme implementation. The Project is grateful to the continued support from APOC AIGDO in order to achieve sustainability. Happily, during the year substantial financial support to CDTI was received from the twelve LGAs in the State to the tune of N3,786,000.00, though lately released.. 4.2.3 Transport (replacement and maintenance): The NGDO has been assisting in the maintenance of vehicle and other equipment. It is hoped that the State would take up the responsibility as from 2009, since some money that was approved in 2008 was yet to be released before a new govemment came to power. 26 WHO/APOC, 24 Novemb er 2004 4.2.4 Other resources: Effort will be made to attract support and provision of other resources from willing local CBOs, NGO and others as required from time to time. 4.2.5 To what extent has the plan been implemented? The plans have not been fully implemented as desired due to unavailability of counterpart funds and the desired political will from the State. Despite series of advocacy visits paid to the Honourable Commissioner of Health, the political will is yet to be shown from the Govemment. 4.3. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3.1. Ivermectin delivery mechanisms CDTI is being fully integrated into Primary Health Care in the state. Apart from LGA Coordinators coming to collect drugs from the State store, other programme officers are given this responsibility provided their requisition for movement is duly approved by relevant authority. For other ad-hoc duties and drug delivery, such drugs intended for LGA is safely delivered and proper inventory taken on arrival at the LGA office. The LGA in turn package the drug based on requisition from the FLHF and subsequently to designated communities. This process has been very helpful in the state. 4.3.2. Training Trainings were carried out in an integrated manner to cater for staff without previous knowledge of CDTI and also to take care of targeted training needs for the old CDTI staff . The training is usually conducted by officers of higher hierarchy to the one below. Integrated training of all prograrnme officers was carried out; and this will be consolidated in 2009. 4.3.3. Joint superuision and monitoring with other programs Supervision and monitoring of CDTI are usually ca:ried out side by side with other prograrnme officers handling disease such as Malaria, Schisto, NID etc. These officers are involved in more than one programme. All the personnel involved in health prograrnmes utilize a unified checklist during supervision activities. 4.3.4. Release of funds for project activities Release of fund from the State government is still a bottleneck to effective implementation of CDTI in Edo state. With all advocacy strategies that have been applied so far at State and LGA levels, in addition to the advocacy support anticipated from NOCP/APOC, it is hoped that before long the State govemment will start supporting the programme. At the LGA level, substantial support was received from the twelve endemic LGAs to the tune of N3,786,000 and we are looking forward to a sustenance of this development. 4.3.5. Is CDTI included in the PHC budget? Yes 27 WHO/APOC, 24 November 2004 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? Other progriunmes that are planning to use CDTI structure are NID, Malaria control and HIV. The officers in other programme in the State collaborate on intersectoral basis. n:.r. Describe other issues considered in the integration of CDTI. Joint Review of all progralnme officers at the state and LGA levels. Departmental work plan especially at the LGA level.! 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. Not applicable during the reporting period. 4.4.2. How were the results applied in the project? Not applicable. 28 WHO/APOC, 24 November 2004 SECTION 5: Strengths, weaknesses, challenges, and opportunities - List the strengths and weaknesses of CDTI implementation process. - List the challenges and indicate how they were addressed. Strensths APOC's continued support to achieve sustainability Availability of Mectizan drug. State team is willing to work. Some LGA policy makers demonstrate desired interest towards the programme Few available APOC motorcycles enhances monitoring and supervision of CDTI by LGA staff. There is assurance of the NGDO's determination and commitment to ensure effective prograrnme implementation. High level advocacy has been achieved at State and LGA levels resulting in LGAs' financial support to the programme. Non release of fund by the State government. Lack of commitment by prograrnme officers in some LGAs. Some CDDs refusing to distribute drugs for reason of non-incentives Constraints Unfavourable political terrain at State and Local government levels. LOCTs at the LGA level are not sufficiently committed to the programme due to lack of funds and unfavourable political terrain. Lack of effective supervision of the prograrnme by some key officers in the State and LGAs. Some CDDs are completely un-interested in the progralnme irrespective of whatever motivation is put in place. Challenges 1. Getting the LGAs to execute programme activities in a timely manner; 2. Timely provision of the right quantity of Mectizan tablets in the respective Communities/ villages for treatment. 3. Intensification of CDD training at kindred level; 4. Population census update How to address the challenges : Continuous mobilization, advocacy and sensitization at the Community/Village, LGA and State levels. Ensuring that regular programme meetings are held in rotation with participating LGAs. Continued support from the NGDO, The Carter Center. Initiate the conduct of CSM and SHM and encourage training of more Community health supervisors. Facilitate kindred level training of CDDs and ensure increased number of female CDDs. APOC, NOCP and The Carter Center are being requested to carry out high powered advocacy and sensitization visit to Edo State, in order to secure the 1. 2. 4. 5. 6. 7. Weaknesses: 1 2 J 1 2 3 4 1 2. 4. 5. 6. 29 WHO/APOC, 24 November 2004 right political and financial support for the prograrnme with the newly sworn in govemment in the State. SECTION 6: Unique features of the proiecUother matters None. t a 30 WHO/APOC, 24 November 2004 aa D