AFruCAN PROGRAMME FOR ONCHOCERCIASIS CONTROL (APOc) co m m u n ity-r,.IHi t lxffi,'*,.h rve rm ectin(cDrr) ). M*t:Y fl,u{'t ' ,? ,r,l r Tt r r I rr I(r, '' .'' l,,p'' ! [,i/ rt 1 5 FEV. 1999 Gwagwalada Municipal Abaji Kuje apital Territory, Nigeria Federal C April 1998 to March I ggg ,.[: : ,l ri' _r) ,Bwari : EXBCUTIVI' SUMMAITY: I-lre Federal capital Territory (Fcr) lies in. the center o[ Nigeria, just north of the hothumid lowla,ds of tlre Niger-Benue Trough, but south of thJdrie, ur"u, to the ,orth. Itlies just nortlr of tlre wiclc alluvial plainr"lb.;;"t v ,rr" confluence of the Jos plateau,exte,ds well irrto the ,riddlc of FCT. ttour mai<lr .i"J., flow through the arca, all of thenrflowing rotrghly lrorn nortlr to south and clrai'inf in," trre river Niger. The rivers oftcn[l,w swillly th*rugh rgckv gorgcs' provicling anl,lear habitat ft,.. tli".rinruliur, fly. .1.6clrcl'l'c,rrsists,l'a tiltcd 1;lair, ris-irrg ii',,,,, ,,,Ilcvation ,l'300 irr thc srutlr- wcst, t, a[;ovc i;3"1fl"1i11 at the rtortltcasl cor.cr. I(ising out of rhis prai, ,." ,,un,".ous r,cky arrtl I-he trcl- is divided i,l'o six aclntinisl.r'ative areas, comprising twe,ty-eight 6istricts. cDllis being implemented in areas outsicle the "rpili;lr. clinic based treatnrent is nraclcavailable to the urban resiclents through "*irting ,i.r",rr", within the city capital.There is a good road network leailing Lo the Aia Councirs Fleadquarters. However, r,ostto the slttaller setLlettretrts are at b.est ruclinrerltary. About 20y, of t6ese roads are notaccessible duri,g rai.ing season. 4wD vehiclcs u.e quitc esscnr.iar fr.-i.orrpurtatio, oI :H'j-"'t' supplies unJp".ro.,n"t. tutori ""i"rircr ""'"0 ,o be concruci.a a*ing rrre <rry Fcr is highly endenric of onchocerciasis, and it is in view of this that NocP askecl cBMt. assist i. the c,tltrol ol"this discase, which has affecr.ecr a lot ortn. a.i.,ing co,rnrunitynrembers, causing them untord hardship -----'vu 4 ru ur rtte Iarnt Mass distribution of Mectiz-an tablets began in rgg5, after conducting the ItapidEpidemiological Mappi,g 'f onclio.cerciasiJ (REMdi in some "",r,rrri,ies r.o p*rvidcthc insight as Io ttrosc c'rnnrurriti"r.. g1y1' .wr;IJ ,.*.n[ trcatnrcnt. -flrrouglr tlrccollabora[ivc cllirrl o['thc gru".,',,',.,",r1 .l'trc'r'rni Curra, a t.terr or-57,54, pcrsor.rs wcrctreated in I78 conrttluttitiei' -l'reatrnent started i, these communities trrrougrr usirrg thccontrnunity Based Distributo* fcnor; *itn irr" Locar Government oncrrocerciasisc<rntr,l w'rkcr supervising. In 1996,' trr" "or"r[. crorl was exr.endcd to 2ll ;H:lTlt;::r:ffi,9,l:4e.perso,rs were trearecr. rn r sts7, atotar or i r t,l'i'gpersons were Fcr wrote and t:Pglt"g a proposal for APoc assistance, which was approved forfunding in April of 1998' a"tiuiti"llrave so lar assumed a different dimension with muclrenrphasis now shifted. to community ownership of th" p.og.-u,n from the beginning ancr tomake decisions on when is their b"rt tin'," to L" t."ui"'Ju,rd how distribution w'uld bestbe undertaken given their peouliu. "i."r,rrtances. Ail enrphasis now is to let cD.l.l takelrold in each conrrrrunity at thcir u*r'oplr,.rpriate pace. S, far thc ilrrplcrttcntati,n lta.s cotnmencccl but success of inrplcnrentation rras to bcgrudual lrccausc wc arc aolually clcalilrg *itn JilrJ.rr-i"u,u,r*ritics witrr vari,us s,ciarattd cultural backgrou,ds. A toral o7. t6z,7lo9-;;,;;,,, lrave bcen trcatcd i, 420conrrnunities during tlre period un<ler review. n fl SBC'I'ION I: BACKGRO UND INT.'OITMA'IION : ]'he FCT Oncho control CDl'l activities is being inrplemented in all the six AreaCouncils. 'l'hcse Arczr Councils include Municipal, nLaji, Kuje, Kwali, Bwari, an6Gwagwalada. There are approximately 530 communitics tlmr-wlll participate in the CDTIprogram' Sttnre of these comntunities are quite small due to the diflerences in the tribes ol'thc pcoplc. 'l'he ty1;ical population ol'a cornrnunity is bctwccn 350 to 600 pcrsorrs. I '2 l)rior [o n l'ocl itssist:tltcc, a total of 276 c<lrnrnunitics wcrc trcatcd in 1997 in1997' CurrenLly,420 colnttrunitics are inrplernenting CDl'1.'l'his is not say that CD'l'l 6asbeett very successlul in I;Cl' now, but a lot of et'lort has been put in to create t6e awareness on the concept and principles of CDTI. We clo hope t6at^better results will beyielded in the 'ear luture as regards to true sustainability. l'3 'l'he followings are the nunrber of names of the Area Courrcils participal.ing inCDTI and the number of rounds of treatment of each. l. Murricipal Rouncl 42. Abaji Rouncl43. Kwali Round 44. Kuje Round 45. Bwari Round 46. Gwagwalada Round 4 It should be noted tltat although all tlrc six Area councils are in their lorth rouncl oftrcatttrcttt, n<lt all the 420 commurrities treated have actually rcceivecl the fourth dose ofMcct izalr. wc h,vc a policy' r gr,truar cxpansiorr t' ncw conrnrunir.ics. Slrcl'lON 2 .TABLI] I. TIIE IMI,LBMNTATION OF CTDT (Aprit _DEC) t998 s/N 2 3 4 l)istricUl,GA Murrici No. of(lomnr / Villages 89 58 85 No. of Conrmunilics /Villnges 'l hnt selecterl CDDs 8tt 58 82 58 No. of Conrmunities /Villnges lhet collected Drugs 88 58 No. of Comm /Villagcs thnt decirJed on Monlh(s) of dislribution. No. of Comnr /Villeges thrt deci<led on lhe nronth(s) of No, of Comm /Villegcs wilh lrrined CDI)s No. of Comnr /Villngcs paf ing Cl)l)s in cnsh or Kind. 8t 56 79 5 6 LrwAprvalada Krvali Brvari 'r o1'A! 66 64 (r6 (t4 4,6 64 4t6 4t6 58 66 64 416 r. 58 64 4t6 53 (t4 60 J9J *+ l)lcasc ltotc tltat wc carclully sclrcdulcd thc distribution pcriod irr accor4a,ce witlr thcwishes^ol'the people who will want to be treatecl belbre thc commencement ,f- theiractive larnring activitics, since r.ajority,f the villagcrare farnrers. 88 'l rerlnrcnt. 88 s8-------l82 I 88 l sBI 82 I YTIIAINING OF DIFFEIIBNT LBVBI-S OF S'tAFF INVOLVED IN CDTI IMPLEMENTATION 2.1 Troiningobjectives/achievenrcnt 'l'he annual training ob.iectives lbr IrCl' is to train 7 SOC'|, 3 I LOCT, 150 I lealth workcrs and 4tl0 CDt)s (totalirrg (167 prcg,rarn workcrs). Out of this ttutttbcr, 6 SOCI', 3l I-OC1', 45tl CI)l)s arrd 97 llcaltlr rvorkcrs (totalirrg 592) havc bccn tretittcd bctwccn April to l)cccrnbcr l99tl, which is 89'2, aclticvctttcltt. 2.2 Developed training nruteriol used The material developed and used for tltese trainings are mainly those that CBM had produced. Such nraterials include LOCT and CDD guides and flip charts. APOC assistance was received late, during which tlre first phase of training and distributiort were over. 2.3 I'erfonnattce of the CDD,s CDDs perlorrned very well. They understood their roles aud respousibilities in the irnplententation of CDTI within rLheir rcspcctive cornrnunities. The basic indicators uscd to nteasure tlreir level of performance includes reaching treatnrent targets, registering the houscholds corrcctly and the ability to rnanage and account lor the Mectizarr'[ablcts in their possession. 2.4 Intprovirtg the quolity of ,lraining. 1'raining is still a scnsitivc issuc in tlrc succcsslul inrplernclttation of CDTI in FC'l'. l-hc Local Govenrnrent Onchocerciasis Control feam members (LOCT) needs more'l'O'l'to become more efficient in trainirrg which is a cardinal role that they will have to play especially now that the Area councils are partners in the implententation of the prograttt. It is hoped that AI'>OC will endcavor to release money on tinre for nraterial productiolt. t
YN DistricULGA No of Conrnrunities nntl Vi llages lll obiliz.ctl No. of 'l'nrgel Conrnr/Villeges thet receivcd Ilerlth llducation nbout the itnporlnncc of extcntk:tl lrcAtnlcnl. No of Advocecy Visits to Strte or llcgional l)irectors of I lcrlth No of lllOll slr[f involved in llf obilizntion. No of NCI)O Staff involved in Mobiliz.etion. I Murricillitl lt9 89 5 It 3 6 2 2 Ahr{i Kujc -s lt l 6 ) l lt5 85 3 6 ) ,l .5 (irvagwal:rrla .58 66 (r4 5tt l 6 2 K rvali I ! rvnri 66 (r4 l l (r a )66 'lotAl, 4ztt 420 t8 6 1 TABLB 3 MOtllLlzATION, AND I'DUCA'I'IOT{ OF TAITGET COMMUNI'TIE,S. * The sarne MOII and NCDO staff involverl irr tlre rnobilization activitics travcled to pr<ljcct LGAs SECTION 3: (See table 4) ACHIBV M[,N1'S o 3.1 'freatment coverage rate 3.2 Total(census)population 3.3 l3ligible populatiorr 87% 212,045 197,036 3.4 Absentees/Refusals l3o/o of the eligible population in the cndernic communities were eithcr absentces or re[usals. 4.5 Sonrc of fhe reosorrs for absentees ond refusals spelt out by sonrc of the corrrrrrutrities include.' .(l) Most of the villagers are farmers thai sometimes travel to some distant areas, whiclr incidentally coincides with the tinte of distribution.(Z) The learof side reaction by some people that had suffered from it during past treatltlcnt.(3) it"ligium believes on the part of some people who believe that Mectizan is lbr population control (fantily panning).(4) TSestatues of these comnrunities being close to tlre center of the country's capital has ilrcrcascd activiLics olsonrc conlrnuttity Ilrclllbers wlto havc ttt travcl lbr dilfcrcllt rcasolls. I 3.6 The plans we have for reducing tlrc number of absentees and refusals during the nert round of distributiort. (l) Discussing with the community members on how to get this group o[people treated durirrg distribution or after. Increase the time for mobilization and education of the communities.Making slight ad.iustnrent in the tinring of distribution and specificallyItavirrg to agrco with. the cottrttunity nrernbers on the bcst trcatnrell. pcriod nrosl convelrielrt to thcln. I I I I (2) (3) .I'AIJLIl 4 'fliltA't'M riNl' RristJL-rs IN l,'C]'AltltA COUNCILS A ril to l)cccnrbcr I998 * SECTION 4: 4.t sl'turNGTrr IiAKNESSI'S/S UGCT'S 't'IoNS. cost per d<lse will be calculated at the err<I of thc financial year. LGA rrarticipation. o Strength: 'fhe Six Area Councils participated in the program with most of t6emvoting sol.llc l1'lollcy, wlrich was released to the workers to carry out supervision. -f6ey recognize the presence of the disease in their various areas. o weakness: They are over relying on the MoH too nruch at this stage of the progra,rinrplementation. o Suggestion: The State government should contact and discuss with the Ministry ofLocal Governrnent artd Aflhirs ancl the Fanrily Support program in the liederalcapital 'l'crritory to solicit lbr Area Councils attention in the area of the co,trol of theclisczrsc. s/N 2 3 4 l)istricUl,(iA Murri Gwa No. of 'l'ergct C'omnr I Villrgcs 89 .s tt 85 58 No. of Eligible pcople trcalcd 43 771 14 3t Cost person trcaled. pcr No. o[ Comm/Villnge s in rvhich CDI)s are heeilh tvorkcrs Nonc No. of l)istribulions srrpervised by heallh workers No. of lreeled Conrm/Vill f,ges with sullt nt try forlns. lt9 5E 85 5 (, Krvali llrvari l()'tAt 66 GI 420 18,694 25, I l5 t7,952 t62,709 Nonc 6 58 66 64 421) v II 'f raining: a Strcngth: 'l'he project places nrore emphasis on the decentralization of the trainiltg centers to as close as possible to the conutrunities to avoid long distalrce travel by the CDDs to attain training. a Weakness: I nadccluatc competent trainers in the LGAs to carry out thc training prograrlr. Suggestion: The LOCT and the other health workers trained need to be encouraged to be able to assume rnore responsibiilities of training the CDDs in the near future. a a Staffinq: Strength: The MOH has dedicate,C and comrnitted staff, who are ever ready to work according to planned schedule. lfhey have worked with the Area Councils to put together a Teanr ol- LOCT in all the Area Councils lor the sake of CDI'I irnlllcrncntntiott. a Weakness: Though more PHC staff have been trained during the period under review to help in the implenrentation o[ CD'ft, they are yet to participate in any of the distribution activities. Suggestion: There is the need for strengthening the PHC facilities staff by allowing them to play great roles during the subsequent treatment exercise. Ilealth liducation and Mobilization Strength: There was an encouragirrg turn out of people to be treated. Their involvenreltt and participation is also oommendable due to the increase in awareltess. Weakness:'l'hc nunrerous nunrbcr olcomnrunities requiring trcatrnenl in thc statc ltas greatly increased the work load of tlre SOCT and LOC'| who do not have tlte opportunities of nraking return visits to cotnmunities for further discussion after thcir llrst visit. Suggestion: The health workers already trained need to be encouraged to play greater roles irr ensuring tlrat treatment communities are adequately mobilized and educated during, belore and after distribution activities. a o a o n oa Mectizan Distribu tion : Strenqth: Dosing with Mectizan has been highly accepted by the communities who turn otrt en-lnelsse to bc treated during distribution activitics. Weakness: Inability to get all comnrunity menrbers treated during distribution due lnainly to absctrl.ccisltr artd sonrc cases of rclusals. Support cffbrts to CDDs ilt sornc ol'thc cornntuuitics arc not elrcouragilrg. Suggcstir-rn: A tttop up progrant lor trcating abscntccs and rclusals nccds to bc workcd otrt irl ttcar luture to dose those that wcrc noL treatcd during the last trcatlncrrt exercise. Conrntunity leaders need to be educated of the needs to support CDDs during distribution. a a a a o \try' NESS: Most CDDs are still aided by their immediate supcrvisors in the final conrpilation of the community treatntent data. Suggestion: l'he LOCT should effectively nronitor and correct the CDDs in thc area of record kecping during distribution activities. Ilccord Keeping: Sl.rength: NOCI'] MIS sirnplified f<rrnrs have been printed for use during thc sutrscquent cxcrcises. Wcakness: SOCT and LOC'| ouLings were affected because of the lack of logistic support lrorn AI'OC, which are yet to be rcceived. $gggestion: AI'OC support slrould be worked out for approved progranr quite on tirne, so that the implenrentation will be smooth. Data analysis: Strength: 'l-he State, LGAs and Conrrnunities were involved in analyzing treatment data alicr cvcry trcatrtrclrl [o nrcusurc succcss or failure. a Monitorins and Sunervision Strength: A planned sohedule of supcrvisory visits is carried out by the SOC I and LOCT members during distribution activities. Appraisal meetings are held to receive reports and review straLegies. o a a a a I aWeakness: LGAs and communities do not adequately conunit their time to the final conrpilatiotr of treatment data without necessarily depending on the SOC'|. Sup.gestion: 'l'he LGAs ancl conrmunities should view this program as theirs and not thai of tfte Ministry o[ llcalth. 'l'hcy nccd to assume the role of pronrpt data conrpilati<ln without over depending ort the SOC'[. L tics: Strcngth: 'l'hc projcct clcpcndetl on vehiolc and tnotorcyoles li'onr the NGDOs, arld futClll tir. Iogisiics sultport during tlrr: succcsslully cortrplctcd clistribution cxcrcisc. w, FCT has distant comnrunities and bad roads that are ltard to reach. The o a t ness: a few vehicles and ntotorcycles used vuere grossly inadequate. Suggestion: APOC should provicle the required and approved logisticai support to progrants otr tittre to etrhance perlornrance. Strengtlr: Since t5e iptroduction o[ CD't'l in the State, enrphasis has been slrilied completely to comnrunity ownership of the program fi'om the onset. All activities are plarured with that in nrind. Weakness: Accepting to own the prrogram completely by the comrnunities is still far f"r'r, t"irg realiie<I. Sonre comnrurrity rnembers are conrplaining that they are poor and so carrnot cotrtirtuc to support thc CDDs {br a long pcriod ol'Linrc' SUggcstion: 'l'lte conrnrunities shoullcl be cducated more olt this issue of ownership as t[C prograll rcaclrcs t[c sccond ycarr of itlplcnterrtation. a a o l'rog m Plannin and Evaluation: Strength: The project sclreduled oI tinre Iine activities lras been developed for inrplettrctttation. Weakncss: tnability to conduct appraisal workshops at tlle LGA level for CDDs, *itv leaders an<t the executive personnel to discuss issues ol'concern in tlre lasl' <Iistribution exercise ancl what strategies to embark on to correct future anomalies. Suggestion: Appraisal workshop at the LCA level should be planned to interact with the CDDs and community leaders y,early. The LGA should be encouraged to organize and host such nreetings. a a I a r] Sustainabilitv: a4.2 CDDs perfonnartce of tosk. During the period under review CDDs were selected by the community n-rembers, based on trust.'l'his inspired tt'tost o[thenr to carry out their roles and responsibilities during the distribution activities. 'fhc various communities showed appreciation to the CDDs either irt oaslr or kind. CDDs took good care of tlte drugs in their possession, registered and treated the people in tltcir ltotncs.'l'hcy citrrictl oul surnnurry activitics ol'tallying distrilrution rcports with thc aid ol'tlrc l,(Xl'l', bcirrg lltcir irrrnrcdiatc supcrvisors. 4.3 lYillirtgness of cotturtrtnities to participute in CDTI. 'l'he comr.nunity members, since the inception of the Mectizan distribution prograrn ilr IiC'l' have delttonstrated the willingness to support and particillate in acfivities. 'l'he introduction of CDl'l is like placing nrore confidcnce and responsibilities on the conrmunity nrembers who now see tlremselves as key partners in the collaboration. 'l'he expectation on tlte conrnrurrity Lhouglr lor now seems very high to inrplement CDTI, care should be taken against such as inrplerncntation lras to be gradual with thc necessary awareness and cncouragcment given to the colnntunity nrembers.- 4.4 lrtvolventent of the NOCI, The NOCI) has supportive of the program in FCT. 'Ihey were instrumental to the successful drafting of the proposal. They have conducted several training as it relaLes to CD'fl and its implcnrentation. 4.5 The Federal Capitul Territory Minislry of Health. The Ministry of Flealth have worked hard towards implementing CDTI in the territory. The SOC'| menrbers have worked through the existing Area councils to get to tlre coltrnrunities. 'l'ltere is indeed every sensc oIconrnritrnent on the part of the IrC]'. ! t oPLANNED ITPOC ACTTVITIES (February - June, 1999) Advocacy visit to Chairmen, Slecretaries, PHC Directors and paramount Chie[s; a a Ite-mobilization of E,ndenric Clolnrnunities of CDDs Inventory of Cornmunity selected Distributors (CDDS) Training and re-training of CDIDs Updating of Commur-rity Regir;ters (Census) Treatment of approximately 200,000 persons in endernic communities SOCT, LOCT, Zonal and NGDO staff supervision Data/report collection, collation and analysis Mop-up treattne nt of absenteers/refusals O o o o o o + ? I t