Nasarawa 8th year technical report submitted to Technical Consultative Committee (TCC): from 1st January 2007-31st December 2007

Prqiect Name: NASARAWA Approval vear;1997 Launching year: 1998 Renortins Period From: l't January 2007 - 31" December 2007(Month/Year) (Month/Year) Proiect vear this renort: (circleone)1 2 3 4 567 (8) 9 l0 Date submitted: 3'o Dec, 2007 NGDO nartner: Global 2000/ THE CARTER CENTER IVA TI OIYAL OIY C H O C ERCIA,S/,S TASK F O RC E ]YIGERIA. 8'H YEAR TECHNICAL REPoRT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) AFRICAN PROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) t--f ..r'l To:fr TL WHO/APOC, 24 NOVEMBER 2OO4 For l;;fcrsiclion TO, .L'IR 40, AI,: I I i Ij d { ! I 1 ,i ir.-,:'. Br4 C,SN coQ ftHtr BPO ?o tru ( n- CO U NTRY/NOT E :N1GER1,4 ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: Country National Coordinator .--) Name::i1&t AICl .A Qd-t tt * Signature Date: rt lrS /.-g Zonal Oncho Coordinator Nu.n.S. \-Pr ( =Jilotuvt 1 Signature Dl loP- """'L'Date: 3.i NGDO Representative Name Ur-a4 Si Date:. . ..- etle/ 0( This report has been prepared by Name: A.A. UMAR Designation.' TOR Signature:, Date: 3t -e/ - oB I t. ProAce Table of Contents ACRONYMS DEFINITIONS:..... FOLLOW UP ON TCC RECOMMENDATIONS.......... EXECUTIVE SUMMARY.......... 2 SECTION l: BACKGROUND INFORMATION....... ............. 3 G EA' ERA L I N F-O R A,IATION... ... ... Des cri pt i on of t lrc pr oj ect ( br ieJly) P Ltrl nership POP('L..ITION .. ) I V VI 7 7-8 9 tt2 t2 3-1 t-5 6 9-t0 1l ll t2-13 14 l4 15 15 t5-16 17 t8- l9 20 2t 2t 2t 22 22 22 22 ,1 23 24 25 25 26 2.6l 265 27 lt SE,('TION 2: IMPLEMENTATION OF CDTI.....].I I'IMI:LINF OI: N ('IIVITIES..... 2.2 AI)VOCACY 2.3 ivtoBlt-tz-A'noN. SENSIT'tzATIoN AND HEALTH EDUCATIoN oF A'f RISK coMMUNITtES].] CoMMUNII'Y INVOLVEMENI".. 2 5 CAPACITY BUII,DINC... l.o Tr'rttttrng ... TREnI'MEN'f.......... 2.6 I T'reatment figures . ...2.6.2 ll'ltul are the cases of absenteeism?......... 2 6 3 ltr'hat ure tlrc reosonsfor refusal?... Briefly describe all known and verified serious adyerse events (SAEs) that... ... ... T'rend o/ lreatmenl achrcvementfrom CDTI project inception to lhe current year. ORDEi{ING, S'I'ORAGE AND DELIVERY OF IVERMECTIN COMMIINIl'Y SELF--MONITORING AND STAKEHOLDERS MEETING.... s LTPERV tS ION... . . . ......... l)r'ttvtLle u llov chttt of supervision hierarchy... Il'ltot t,ere lhe main issues identiJied durmg superyrsron'? ... ll'us tt srrpervisiotr c'ltecklist used? Il'hat vere the oulcotnes al euch level of CD'f I implementation supervision? ... ll'us feedbuc'k given lo lhe person or groups supervtsed2 llcnv v,'us the feedbac'k used lo improve lhe overall performance of the project? SEC'l-lON 3: SUPPORT TO CDTI -r. I t,Qt rtPi\lENT].2 ITINACIAT, CONTRIBUIIONS OF TT-IE PARTNERS AND COMMUNITIES] J OI I II]tI. IORMS OIT COMMUNITY SUPPORT............ 3 1 EXPIltr*DITL.tl(E PER ACTIVITY. SDC'tlON 4: SUSTAINABILITY OF CDTI 2.1) 2.9.1)92 293 :91 :95 :96 .ll 4.1. 1 1.1.2 l. I.3 26 26 26 26 IN.I.tiRNAL; INDEPENDENT PARTICIPATORY MONITORING; EVALUATION ll/us ,llonitoring'evalualion caruied out during the reporting period? (lick ary of the trollou,ing which are applicoble) ll'hal y)ere tlte recomntendations? . Hotr lruve tlrc.y been inplcnrcnted?. WI IO/APOC, 24 November 2004 lll 1.2 Yr 3) /)) /1\- 1J 4.3. t 1J: +)J t31 t35 1JO SLIS.fAINABII,ITY OF PROJECTS: PLAN AND SET TARGETS (MANDATORY AT l'lttnning at all relevant levels... l'uruls Trunsporl ( repluce me nl and maintenance)............ ()tlter resout'c'dJ .. ... To v'ltat exlent hos plan been tmplemenled.. INTF.CILATlON....... I ve r tttc'c t i tt rle I ive r.t' tnec honis m... 'l'rrtt nt tt54 Joutl supervision and moniloring with other programs... ... ... lleleose qffirnds for project activities ls CD l1 tnclucled itt the PHC budget? ... Descrtbe other health progrdmmes that are using the CDTI struclure and how this Il'as achieved ll'hal hqve been the achievements? Descrtbe olher tsstes considered in lhe tntegralton of CDTL.. oPERNTIONAL RESEARCII... ... .. Sutnnrurr:e in not tnore than one half of a page lhe operalional research undertoken in I lt prolect ureu v tlhtn the reporting period... I lotr vere the results upplred tn the project: 26 26 26 27 27 27 27 27 27 27 27 27 +)/ 11 1l.l 28 28 28 28 28 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AND OPPORTUNITIES.. 29 Section 6: Unique feature of the project/other matter WHO/APOC, 24 November 2004 IV 29 Acronyms APOC ATO AtrO CBO CDD CDTI CSM LGA MOH NGDO NCO NOTF PHC REMO SAE SHNl ,ICC TO'I' UNICEF WHO L F'I] P FLHS HFS N4DP N,IEC/AC LF'EP I'I'N RBNl SCH African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objectives Commun ity-Based Organ ization Commun ity-Directed Distributor Community-Directed Treatment with Ivermectin Commun ity Self-Mon itoring Local Government Area Ministry of Health Non-Governmental Development Organization Non-Governmental Organization National Onchocerciasis Task Force Primary Health Care Rapid Epidemiological mapping of Onchocerciasis Severe Adverse Event Stakeholders meeting Technical Consultative Committee (APOC scientific advisory group) Trainer of Trainers United Nations Children's Fund World Health Organization Lyrnphatic Filariasis Elimination Programme First Line Health Facility Ilealth Facility Staff Mectizan Donation Program. Mectizan Expert Comrnittee/Albendazole Co-ordination. l-ymphatic Fi lariasis El im ination Programme Insecticide Treatment Nets Roll Back Malaria Sch istosom iasis WIIOiAPOC, 24 November 2004 De{initions (l) Total population: the total population living in REMO/hyper-endemic communities within the project area (based on REMO and census taken). (ii) Elieiblqpopulation: 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 a given year. (iv) Ultimate Treatmqrl Goal (UTG): calculated as the maximum number of people to be treated annually in meso/hyper-endemic areas within the project area, This is the goal expectation at the end of the 3'd year of the project.). (v) Therapeutic coverage: This re presents the percentage population treated in a given 1,ear.). (vi) Geographical coverage:_This represents the percentage communities treated in a y'ear.). (vii) Integration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, e.t.c) through CDTI (using the same systems, training, supervision and personnel) in order to maximize cost-effectiveness and empower communities to solve more of their health problerns. This does not include activities or interventions carried out by community distributors outside of CDTI. (viii) Sustai abiliW: CDTI activities in an area are sustainable when thev continue to (ix ) firnction effectively for the foreseeable future, with high treatment coverage, integrated into the available healthcare service, with strong community ownership, using resources mobilized by the community and the government. Comrnunity self-monitorine (CSM): The process by which the community is empowered to oversee and monitor the perforrnance of CDTI (or any cornmunity-based health intervention programme), with a vieu,to ensuring that the programme is executed the way intended. It encourages the community to take firll responsibility of Ivermectin distribution and make appropriate rnodit'ications when necessary il,'Ho'.,1poc, 2l .\'ovember 2004 VI FOLLOW UP ON TCC RECOMMENDATIONS 'flrc lecclmnrcndations olthe last TCC on the project and how they have been addressed TCC session 25 r20 ( Nurnber oJ Rec ont ntettdatiotr itt the Report 120: TCC RECOMMENDATION ACTIONS TAKEN BY THE PROJECT FOR TCC/ APOC MGT USE ONLY Continue advocacy for the release of counterpart funds Advocacy visits have been intensified. The new government is favorably looking into the counterpart funding issues for the year 2008 EXECUTIVE SUMMARY Nasarawa State rvas carved out of the old Plateau State 1't Oct.l996 during the Abacha regime. The State comprised l3 local government areas. It has a population of about 3.1 nrillion people with about 30 ethnic groups with diverse cultures. Eighty percent of the people are farmers. The CDTI programme in Nasarawa State started in April 1998. The project is in its 8'hyear (3'd year of post APOC period I't Jan. 2007 to 3l't Dec..2007. The project stilI maintains the old 7 LGAs as approved initially by APOC. The LGAs include Akrvarrga, Karu, Kokona, Lafra, Nasarawa Eggon, Toto and Wamba with total of 589 meso endenric villages. Activities untlertaken in the 8th year include the following: o Advocacy visits to State/LGA officials and community leaders o Training at State, LGA and Community levels. o Mobilization and Health education of LGA and communiry levels o Mectizan distribution at community level o Monitoring and supervision, submission of treatment reports and drug balances.(i) Drrring this period, we aimed to train/retrain 4541 CDDs, 58 LOCTs, 42 DH9,2,222 I{FS and 45 TOTs. In the end we succeeded in training 3,496 CDDs,58 LOCTs,42 DHS.2,222 HFS and 45 TOTs, These figures represent 100% achievement tbr HFS, LOCT. DHS, TOTs trainings and77%o CDDs.(ii) Mobilization was carried out in 589 communities and most of them showed high cornrnitn:ent by giving incentives to the CDDs.(iii) A total of 835,123 persons out of 1,025,623 total population were treated representing 81.4% therapeutic ooverage in 589 communities. The five-hundred and eighty-nine (589) conrmunities treated represent 100% of our geographical coverage, The ratio of CDDs to the population is 1:347 for Oncho. Nasarawa State received2,995,748 tablets of mectizan plus the brought forward balance of 104,495 totaling 3,100,243 from the Carter Certtre (Jos) and used 3,052,874 tablets. The balance of 47,369 tablets not used \\,ils retunted to the state office. i. The Stote Ministry of Health budgeted a total of $4,651.8 this year 2007 but did not release the said amount. ii. Locul Governntent Areas budgeted total sum of $31746 but never released any amourlt. iii. The local NGDOs did not budget and therefore did not release any fund, 'l'he Carler Center (NGDO partners) budgeted $104394 and released $101394 fbr integrated programme (LFiSch/lTN distribution and oncho using CDTI structure. iv. The communities budgeted $4,162.90 but released $3,742.8 to support the CDTI activities in the state during the period. Chullengcs: r Need [o increase involvement of CBOs and women organizations . Poor expattsion of community self-monitoring and implementation of stakeholders' lreeting al the cornmunity level o Need to decrease CDD/population ratio to 2:250 r Evolving ways to mobilize resources at various levels for integrated programme inr p lernentation o Need to ittcrease involvement, number of Health staff participating in CDTI activities. lYen k nesses: * Inadequate logistics fbr LOCT parlicularly at the LGA level for constant supervision * Relativell, high CDD/population ratio (l: 345) .:. Lacl< of counterpart funds by the State and Local Governments. 2 Ilolrcvcr. to address these during the reporting period the following actions were taken lrrtegration with other programme reduced the problem of logistics at the LGA levels. High CDDipopulation ratio l:345 has been taken care of by training of more kindred CDDs, the ratio is now l:150 population. Advocacy visit rvas carried out by SPO/SOCT to the Hon. Commissioner State Ministry of Health, Hon. Commissioner Local Government and chieftaincy Affairs and a rnemo has been submitted by the State Project office in this regard with a promise for the release of counterpart funds when state budget is approved ln conclusion, the projects performance was adjudged satisfactory but was heavily dependent on the Carter Center, the supporting NGDO. Section 1: Background Information L l General information l.l.l Brief description of the project. Geogruplticol localiorts, lopography, climute : Nasarawa State is in the central part of Nigeria. It lies between Latitude 70 and 90 degrees North and longitudes 70 and 100 degrees East. The State shares common boundaries with I'ive States and FC-f. To the south and west are Benue and Kogi States, and Abuja the Irederal Capital is to the Northwest. To the North are Kaduna and Plateau States and to the Southeast is Taraba State, The climate of Nasarawa State is both hot and cold. Three lnonths in a 1'ear (December, January and February) are cold and known as the Harmatan season. The State lies wholly in the tropics with pleasant climate and a mean temperature of 600F arrd 800F (rnaximum). Annual rainfall varies from l3l.75cm in some places to l45cnr in others. a a a a a Populutiort: uclivities, cultures, language Nasarawa State has a total population of about 3.1 million (based on l99l census projections). The State is inhabited with over 24 ethnic groups with common historical and cultural affiliation rvith no single group large enough to either dominate or claim rnajority' position. Such groups include Alago, Agatu, Ake, Arum, Afor, Eloyi, Bassa, Chessu, Egbura, Egorma, Eggon, Fulani, Gade, Gbagyi, Gwandara, Hausa/Fulani, I(arnberi/Kanuri. Kantana, Kwarra, Mada, Marra, Migilli, Rindre, Tiv, and Yeskwa. The rlAllcs of the etlinic groups goes with their languages. Other ethnic groups such as the Igbos and Yorubas also co-habit with the indigenes of the State. The people are both hospitable and accomrnodating and have ahnost similar cultural and traditional ways of lit-e. 'l-lre ntajor religions in the state are Christianity, Islarn and Traditional religions. About 80% of the people live in rural communities with agriculture as their rnain crcctrpatiott rvhile the remaining 20% is in urban areas practicing small and large soale brrs inesses. Culture play's an important role in the lives of the people. This is showcased through their periodic cultural festivals. Amongst them are the famous and annual Oganni cultural and f ishing f'estivals at Umaisha of Panda Chiefdom in Toto LGA, salt festival in Keana, the Onradege in Nasararva, Odu in Doma etc. J a C o nt nt u n ic ut ion Sl,stetn (Ro ads) : There is good road network between the State and other neighbouring States of Benue, Plateau and the Federal Capital Territory. Local Government headquarters are also linked rvith good roads to facilitate transporlation of human and material resources. The roads linking the communities are seasonal, and in poor shape during the rainy season. A dm i nistrat io n slr uct ure 'l'here are two types of administration in the State - the modern and the traditional. The nrodern conrprises of the State and Local governments with theirexecutive, legislative and .judicial arnrs. The head of administration at the State level is an elected Executive Governor supported by a cabinet of commissioners, while at the LGA level there is an elected Executive Chairman. The State has l3 Local Government Areas of which 7 are onchocerciasis endemic (Akwanga, Kokona, Karu, Lafia, Nasarawa Eggon, Toto and \\/amba)l the other 6 LGAs are hypo endemic for the disease. The traditional structure consists of traditiorral rulers who relate more closely with the people and provide advice to the policy nrakers at the various levels. Heultlt s))stem & heilth care delivery (provide the number of health posts/centers in the projec't ureo if the informatiott is avuilable). 'fhree tiers of health system exist in the State, as in other parts of the country. The primary health care rvhich is closest to the communities and is manned by the Local government uhile tlie secondary health care which takes care of problems above the PHC level is ntanttcd by State government. The ter-tiary health services, which is the most advanced, deal u ith the most difficult cases referred from secondary health care level and are supervised b),the Federal Ministry of Health. There are about 1,400 government health f acilitics in the 7 LCAs where CDTI is being implemented. Numbcr oJ'heulth stuff in project urea und number of health staff ittvolved in CDTI ut'l iv it ies. 'I-ablc l: Number of health staff involved in CDTI District/LGA ,{t(\\;,\NG,^ KAI{U l-lte prolecl hus trained over the years(table 5 - page I I - and in Exec Sumnury tndicate that tttrtnbcr us berng truined m 2007) all the 2222 healthJacility stalf of the 7 LGAs out of v,hich 301 ure ossignecl /ully tith C'DTI ac'tit,itres v'tthin the prolect area. The limited involvement rs clue to llte slotv ltuc'e o/'rntegratton of CDTI into PHC at the LGA level. The project rs planrting to tnyolye tttrtrc of tltese heulllr stulJ trainecl, as rt pushesfor greater tntegration of CDTI into PHC. a a a a 4 Total Number of health staff in entire project area B1 Number of health staff involved in CDTI 82 Percentage of health staff involved in CDTI Bl=BzlBr*100 36t 47 t3% 431 54 12.5% KOKONz\ 225 33 14.6% LAITIA 453 56 12.3% NAS/EGGON 297 42 14.3% TOTO 236 36 15.2% WAMBA 219 36 16.4% Total 2,222 304 13.7',h I I t 1.1.2 Partnership Itttlicule the purtners involved in project implententation st ull levels IMoH, NGDOs ( rr ut i o n u I /i u I e r n ut i o u tt l), c o m m un it ies, I oc a I o rgonirytio ns, etc, l 'l'he partners involved in CDTI implementation in the State are: o Mectizan Donation Program (MDP) o l'he African Programme for Onchocerciasis Control o World Health Organization o The Federal Ministry of Health (through the NOCP D-Zonal Office) r l-he Carter Center r The State Ministry of Health o l'he endemic Local Governments I The endemic cornmunities o l'he National Union of Road Transporl Workers (NURTW) I Women in Health t Janraaatul Nasirul Islarn, t Wornen Fellowship Groups (Zummttar Mato) Desc'ribe overull working relotionship among partners, clearly indicoting specific areas of 1tt'oject uc'lit,ilies @lunning, ,supervision, advoc'ocy, planning, mobilization, etc) where ull put'ttte r.\ urc inyolye cl. Ovcrall rvorking relationship among partners is cordial. The specific areas partners are involved are as follorvs: -l'he State Ministry of Health - planning. staffing, manpower development, advocacy, counterpart firrrding, nrobilization/health education, supervision, ordering and delivery of \lcctizan. Thc' Cartcr Center - provision of funds and logistics for CDTI implementation, technical assistance to the project, advocacy to high government functionaries, procurement of It'erntectitt tablets frorn MSD and development of Health education materials. MDP - provision of mectizan tablets FMOH - monitoring, technical support, and advocacy WHO - clearance of drugs and procurernent of capital items APOC - provisiorr of funds, capital equipment and technical support I-GAs - planning. staffing, training, distribution, supervision/monitoring, delivery of N4ectizan. mobilization and health education. Comntunitics - collection of mectizan, selection of CDDs and provision of registration rnaterials aud incentives to the CDDs,. NLTRTW - transportation of CDDs during training, mobilization and supervision Womett in Health - nrobilization and sensitization of communities with particular attention to u'omen-folk .larnaa:rtul Nasirul Islam - mobilization of u'omen in purdah Wonren Fellorvship Groups (Zumunlar Mata) - mobilization, sensitization and health crlucation of worren and y'ouths Stulc pluns, rf ort1,, to tttobilize the state/regiott/tlistrict/LGA decision-makers, NGDOs, NGOs, CBOs, to rtssist in CDTI implementutiort. Thc netv policy nrakers at both state and LGA levels have been mobilized and counterpart funcls budgeted for the 2008 CDTI activities in the state. 5 !! s \J s\ !4 s\)s \i 0o \ 'E' b \i. 4tAs!\o :bo \C :oo -E SE q.)' q \j ^aoootio \bDOE .s' .= =o sqas(.) 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(.)?> .o a). u. -\ \v '=q(,) v tJ -q J ,-) o!OP co =aa? ua- ]u 'c- ,!u =- E.o ='a^ iJ d O /r:v_ =(!c)'-oa) 'J ^r fu;a g i) an n,=y / L 6t .J-qp rc-c0 [- 'cr P ^EqiJA(Jt ),-\Jl.= F- a.l q, I q (,) q,) e F :.: I ral erl -t,!r IFI ,( a2.2. Advocacy State the number of policy/decision ntskers mobilized at eoclt relevant level during the currettt year; the reuson(s) for undertaking the advocacy and tlrc oulcome. Describe di/ficrtlties/cortstraints beingfaced and suggestions on how to improve odvocacy. The general election conducted in April 2007 ushered in new government, resulting in having ncrv policl'mal<ers rvho needed to be visited to formally mobilize them towards the activities of the progranrme.'fhe state conlmissioner were not appointed until September2007, this delay in appointrnent of commissioners seriously affected the processing and release of funds budgeted. Iror tlre period, Januarl'to December2007, the DPHCiDC and Oncho Coordinator paid several advocacl r,isits to the Hon. Commissioner for Health and Hon. Commissioner for Local Covet'ntnent and Chieftaincy Affairs on their responsibilities for the effective control of Onchoceroiasis and, particularly, in ensuring the payment and release of counterpart funding at both State and local government levels. Policy makers'busy schedules made repeated visits irnperative wlrich rvas constrained by inadequate funds. To irrprove advocacy. the 1'ollou'ing needs to be done: Aclvocacl' r'isits by the Directors of the Carter Center and NOCP zonal coordinator to the I'lon. Conrmissioner fbr Health, Hon. Comrnissioner for Local Government and Chieftaincy Allairs. Hon. Commissioner for Finance and LGA Chairmen/Traditional Rulers in the [.ocal Gov'entnrent be maintained at budget preparation, after approval and during inr plerlentatiorr. Scnsitization and involvement of adviser to the Governor and those of the Chairmen of Local Covernrnents for prompt approval and release of counterpart funds. Adrocac!,visit to the State Governor and the State Legislators by the Country Representative of the Carter Center and NOCP Chair. 2.3. Mobilization, sensitization and health education of at riskcommunities Provide inlbrrnation on: - Tlte usc of ntediu ortd/or other locul systents lo disseminate infornrution Jingles tvere developed and aired on Nassarawa Broadcasting Service (NBS), Precious FM radio station and Nigeria Television Authourity (NTA) Channel 7. This covered the entire State including the 7 errdemic LGAs. The Precious FM also covered the flagging off of treatment activities in Al<wanga LGA. At the conrmunitl, level, town announcers provided inforrnation to community members on tirtte and method of distribution. This is cornplernented by public address systems mounted on rnoving r,'ans. - T.1,pes of IEC materiuls used [-'lipcharts. brochurcs and posters rvere used in community mobilization, sensitization and health education. a a I t - Xlobilizatiott urtd heulth education of communities including wonrcn and minorities Health workers first mobilize community heads who in turn call for community meetings w'here merrbers are sensitized and health educated. Further health education for women is done b1'uornen conrmunity'leaders, religious leaders, women market unions and youth leaders. Wonrcn atterrding ante-natal clinics are also health educated. In LGAs like Lafia, before CDDs uere selected the various kindreds and minority ethnic groups (lgbos, Yorubas & Tivs) rvere nrobilizecl. Tlre involvenrent of rvomen groups resulted to increased awareness and cornpliance at various stages of irnplementation. - Rcspottse rf lurget communities/villoges o 'fhe nrinoritl'ethnic groups expressed appreciation in having to be asked to select their CDDs as they claimed that the CDDs selected by the majority group often miss them out during drug distribution. . Man)' CDDs rvere selected by the various communities, and in areas where the CDDs rvere selected along kindred lines demand for incentives drastically reduced. For January - December 2007, a total of 589 communities provided incentives to their CDDs t'epresenting 100% of the total villages. A total sum of ($3,742.8) was providu.d to -1196 CDDs as incentives in these cornmunities. o C't'rt.nrt.runities selected their monitors who assisted in supervision of drug distribution at the cornnrunity level. Accoutplislt nrcnts o All 589 cornrnunities were mobilized on their roles and responsibilities in CDTL FoT the period, Jan - Dec. 2007) the project mobilized 589 villages. o Increased nurnber of persons treated recorded as at December 2007. o 1688 new'CDDs selected and trained. Suggesl ways lo inrprove nnbilizution and sensitizotion of the torget communities. o More hands involvement of front line health facility staff in CDTI irnplementation r Identillcation and involvement of more CBOs and lvomen groups . Capacitl' building for CBOs and health personnel in community mobilization o [)roduction and airing of nrore jingles on radio and Television . Redesign of IEC materials rvith focus on sustainability o lnvoll'etnent o1'National Orientation Agency (NOA) for community mobilization o Identification arid usage of cultural troupes in spreading the message of CDTI o Collaborating ri'ith prinrary and secondary schools' authorities. ,.la I 2.4. Communityinvolvement 'fable 4: Comnrunities tcl on in the CDTI (Please add more rows neces, l)irtrict/1.(i,\ t .4lle ndonc'e ctf Jentole nrcmbers oJ the Comntunity al health education meelings: Attcndance of fernale menrbers at community health education meetings was encouraging as \\onrcn trere coming out fbr the meetings. About 35 - 45% wornen per village attended the nteetirrgs regularll,. l'his rvas as a result of the involvement of women organizations. ln generul, how tlo you rale lhe purticipation of femule members ut lhe communil, meelittgs when CDTI ure being discussed (uttendunce, participation in the discussion?) In gertr,'ral, t'enrales parlicipate actively in the community meetings, including those where CDTI rnatters are cliscusscd. Wouren asked relevant questions, give answers and actively participate in decision nr a l< irrg. c lncenlives provided b!, commuttiliesfor the CDDs. Yes, the cotrrtnunities in the project area provided incentives for the CDDs. A total of 4496 (99oto) CDDs rrere -{iven sorle fbrrn of incentives in cash or assisted with farrning or household chores or with lrlrrn products. Horvever, sonte communities could have been tnore generous. o ls ottrilirttr u problent for the project? Thcre rvere only 59 CDDs who dropped but the affected communities replaced them with new CDDs irnnrediately. 2.5. Capacity building - Desc'rihe lhe udequucl, of uvailable knowledgeoble munpower ul all levels. Adc'cluate rni.lnpo\\'er exists at all levels. However, at the front line health facilities not all trained health sttrtf alc curlerrtlv being involved in CDTL - ll'here.fretluenl lrattsJers of trained sluff occur, slute whul the project is doing, or intends lo tlo, to retnerl.lt lhe silrtalion, (Tlte mosl important tssltc to describe rs whal meqslres tt,ere laken to ensure utlaqttuta L'DT'[ rmplernenlLtlton w'here not enough knov'ledgeable manpov,er was available or if staff trrc fi'eqrtt'trtlt' !rcrusJert'ed clttrrng lhe course oJ lhe cttmpargn). '['r'atts1'els at thc- rnorrrent haldly occur. In any case, in each local governnrent all health workers/Health lrlctlitr Stal'fha\cbeentrainedonCDTlactivitiessuchthateachlocal governmentalwayshasa rcsctroir'. So. rn the event oltransfer of health staff imrnediate replacement was usually done from the pool ol'r'esell'ed trained health staff. 7t Num ber of comm unities/villages n'ith corn m urritl' mom bcrs as supervisors Nurnber of CDDs and the conr m unities involved Numbcr of com nr unitics/r'illages l'ilh fcmale CDDs Total no. Com nr unitie s in thc cntirc project alca lJ{ Num be r rvith com m unity nr em be rs as su pe lv iso rs l]s Perccntage Bo= Ils/84* 100 B1 I\I r le CDDs B8 Female CDDs Total Be=87+Bs Number of com nr un i ties *'ith female CDDs Pcrccntage Brr= B ro/B{* 100 AK\A'ANCA 102 102 100% 32t r55 476 21 20.s% 99 99 100% 339 326 66s 4l 41.4%KARU KOKONA 47 47 100% 196 163 359 l9 40.4% 72 72 100% 447 3ZJ 770 36 50.0% 85 85 l00o/o 5l I 442 953 34 40% I OTO LAFIA NAS/EGGON 99 99 100% 460 216 676 29 29.2% 85 85 100% 340 302 642 19 22.3% 589 s89 100% 2614 1927 4541 199 33.7'h Bro 6TEt,n Nr\ oo <t r-c.l co oo\o oo t'-. al \o o\v sr-r- 5rr2- -+ oo(\ ooc.l oo o.@ r\al $@ o\00 6 6 ,+o-Z= ao co a1 =f o.F- @ oo s o\ $ € co\o LL F 'o o. F-r- o. \o t-- c.l{\o n[n$ .- L -;' t-- r.. r- r- F- F\ lat s O- \o r- t'-. 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F O F F E;i;e;EeE :e EE aaz2 F..-SSc\ \) s\)U i. rrl sv) N ! -.-. ?\5 OlJ Cl SUL'J -=v.-Sr: nF.o y ra) ij rO^, -\9\ ^. lJ 06Xs- \O io,v! \1) : ct) aLU+L\-i7s- \c '9 ta=PH\= !L - 0./ E- !P dv -%d '\Er^i\;, r <,9 -i'i^s =f,s-- -Pr, ^\\d5ae o!\n'\s,Y!si= ^!- : cc ?u, .:.: I :33 Saau\=UOa - .,:-<.= on ^.- OroS li a\ ! a.,S- X' -!-o!c>.o .s iB(, > !^ .r^.5v;.Y S- =SleohaU\- l- ! ! '- ca-\*i!91L9 v9E, a-'--'J ==.ileJ!*\2- T I i $LLl- S.l!1= E . iJ,\I .i q i.s E ai 6t \'\\..-, i o- I EF ,f, rr lG I6! q,) U .:< a E; 7,a |r) o.oo co c\ ca aotr) o\ o\(\l(\l = v,, .E--E .3 3;E EEi.-38 =e !:, z lc \o $ p& 9E ^\o\ o.t- \o +It V') aaro 9\cl t-- o\o\ N]\ ,h' \o cl oo 1O ^\ ,r; F- 'aa c1 oo s R 6 L tr!1?o; trei Z F- c- $ O o\n$ = t- oo c.)(r) sl o\\o + N oo t-- $ aa an oo h cn r- (A(.l ln ?.) € r 9.r =E9: E.1i g{' t-- ca co$ co ca .d$ t-- co C. r/) (-.l N$ oo =faa ca) co ca r- a.Jfas r- (f) a o lfl - = t-!d':",a:-E!=< = ' = ?e \o$ co NN\o oo\o o,N r- r-tr) .a ca \o \o t-- co F- co oo .a(\t l,n(\ .! 9, F 9.oi,a Iue (o ll o\ O \o o\ o\ O \oo\ \oo\ o\ O ^\ ! '= -tr! z ?e s N o. o\ t-$ c..la- tta)oo o\o\ @ o\€tn E q.= =-a:E.g N o\o\ t--$ c\c- n@ o\o\ tr)oo o\@ra = .= , y,.?, .f ! 9oe f =. F U.q E i c-l o. o\ t--$ a.ta- t/)oo o\ V-loo o\€i.n oo (! -v d o oV c! J 00 oor! Z o oF -o E B Cg F a2.6.2 What are the causes of absenteeism? a. Cornmunity members who were out in their farms, which they felt were more important to them than the drugs. So most of them were absent. b. Some cornmunity members were even superstitious of the cause of the disease and therefore did not think that the Mectizan would cure it. They therefore absented themselves during distribution. c. Absenteeism in Karu is high because of its urban setting. People go out as early as possible for their business and return very late. However CDDs have been mobilized to treat in a convenient day especially Fridays, Saturday's and Sundays. d. No absenteeisnr in the 2 LGAs as a result of high mobilization and awareness of community mernbers. 2.6.3 What arc the reasons for refusals? Sorne people refused to be treated because of the under line reasons: o Sonre people were unrvilling to give incentive to the CDDs c Sonre felt they didn't have any infection as to take the drug o -fhere are few cases ofrefusals. The Project plarts to reduce oraddress cases of absenteeism in Karu and Lafla LGAs by aclecluate rnobilization of communities and the selection/use of CDDs along kindred Iines. El'lbrts u ill also be rnade to ensure that drugs are delivered at the community level during the d11 season befbre community members leave for their farrns. To address the refusals, the projcct rvill carrl'oLrt rnore intensive awareness and health education campaigns 2:6:1 Bricfly describe all known and verified serious adverse events (SAEs) that occurred during the reporting period and provide (in table 8) the required information lvhen available. Itt case the pro.fect did not have any case of serious adverse ev€nts (SAE) during this reporting period, please tick in the box 45 No SEA case to report l,/ 'IaDle 8: periorl Cases of Serious Adverse Events (SAEs) that occurred during the reporting No serious adverse events were experienced/reporled 16 I si\ I I I I I gc Yrllrgc ol 0rrgril Dil tc nr cctizn n Nas lill.cil Date l " sym Ptoms appearetl Sym ptonrs Hcalth status befo rc tfl Ling nrectizan Date of adm issi on in health litcilitres Date of dlsmiss a I fronr health fa cil ity Rcsu lts of tests (thrcL b lood smear Ou(com eof p ro gnos t5 l:\tciluatitr g or conr plica ti ng circum- sta n ccs Alco h ol in volvcrn c nl or Dol l I it\.' E!(!trE'(gLA()(i -qott) = UD' 6c9 ES? \./ -o ?E .,i 9.) J? Cg -CP o.r =oC,U tro. c)Eoo) =()v(J )io JL =ooo-o= ,' -:: ex(.)x 7)J: o-9 €-c ^oo o..c Qro.o(.) sq7(F6 t= G9eC) g.?(..)5 - ,F6 C,OJX o 6-iag co=EOd(J ..J:o 6! EsA.- 6) o? o-a'l .i o aV () ra LY o o-ci a uoo- o\\ V)N o\ $ .A ^\@ \o co o\$ \e ca o\ c.l \o oo o\ v? ca o. .o o\q $ o\ o\\ o' o\ * E] Glo c u0 .o o\ c- O.$ o\\o t o\ o\ .o o\\ o\ o\ tr)q\ o\ an r.- o\ o\ oo oo o\ $ o. .o o\t- O. o\ ti Elo I t! o. oo c! c! o\ oe c.ls -oo\ f- r/) .o o\ ..) oo o\ c..! aa oo o\ \o(-- -o o\\ oo -o o\cl @r- o\ r,- o\ c- \oo\ n oo CE t:Etu = oiZ o.! oo a! c'l a c.l co c.l 00 oo t- l-- t-- o. oo aO$ ool-rtr)6 <f F- c.l t-- c\l c- a.)r- c- tr) r- $ oo(-- C.N rn ca oo -E()*qr> iTEO < i-e a co ...l$ o\ lr) $ \r co oo t-- $ oo cor- V') oo rr) ool-- c-\a N ao t-- r- t--r- oo F- c.] oo cO c.lq t-- aa oo E 1.e "E Y;E:Ft=*€ fl"YF o.o; tr c OqJql tr s\o I-r o,$ O aa oi oo$ aa $ o\ co t- t-- sf, $ CO oo strr o\ @ r-(\ t-* oo oo oo o. ca $ oo o. co c.l\o tta)(\O o0 uda-o tulO !s ->QF UXr!= <>vll * \oo\ o\ c.l 0,o 6\q !f, o. .o o\ - o\ o\ c1 o.t oo o\O o\ o\ G-o= .Yo-- i 9q-; :3oEq a, tt- o\ .o o\ c..l o.l co o\q sf, o. \o cl o. \o .1 c\l oo o\O o\ \o a\O c/ tr bo: -D = c er-r' =t>-z6 \o\o \roo$ o\tr) tr) F- .a rn @s o, co o\ co o\@ rr) o\@ 6q/> =EE^ = : U tr <:-o @ o.oon o\@ ra) oo oo o\ ootr) o, co ra) o. co o\ ootr) >9.,8 F:g: tH+ tr'- >, .. e=?€':tl: E 5oo tr : E C! U* vaO o. co o\ cotr) o. con o, co o\ cotr) @ o. ootr) o\ ootr) o\ oo o. ...l c.l c.l (-.l ao c..l $ N tr) c-l \o N t-- c.] q) EO (,) (, D q) q,) a o b0 a I Al I I I I I I I I I I ffi a.l\? r- .a 00 m' I I 0, '= E D o q,) a)a =.= a)=Fcr L Ii .J t\ ! it Qa! aL '=u)- _c .o r.J all :. 9l =t :t ol u -Ll>ut at) a,) eAE .-) 'Jv cq6 C,J P '*tr e(J(,F L ,r', ul (^.t |--t 2.7 Ordering, Storage and delivery of Ivermectin Mectizan ordered/applied for by -MoH X wHo I Other (Please specify): MOH NroH I Other (Please specify) Mectizan delivered by - (Please tick the appropriate anstuer) UNICEF tr NGDO UNICEF tr XCOOwHo ? The State deterrnines the number of Mectizan tablets needed based on populations o1'endemic communities collected at the comnrunity level and collated by the HIrS and LOCTs. Requisition to MDP is made by the Carter Center. On arrival of rnectizan to the national office (Jos), the state project officer puts the requisition for the cndernic local government areas based on their populations. From the SPO, the clnrg reaches the SOCTs in charge of the various LGAs. These then deliver the drurgs to LOCTs, who in turn send the drugs to the HFS. The HFS give the drugs to CDDs rvho distribute to community members. T Mectizan Status I State Oftlce ,,\K\\,\N(i,,\ t- l(,\ll,[' t-,,\ r.t,\ I..OKO\,\ 3,100,243 xDrLrgs in the lleld (47369 tablets of Mectizan was returned to the state store at the end of the y'ear) 4L Number of Mectizan tabletsStatc/District LC,\ Requcsted Received Used Lost Wasted Expired balance Oncho LF 3100243 3100243 0 489,096 341.629 147,467189.096 -168.-5 36 468.536 375.678 92.812 16 t70.259 170,259 l5 1,839 r2"500 5920 | , r2s"000 I , 125,000 776,500 348,500 N,/l_(icoN 1t7,584 417,584 37 6,181 41403 t ot0 231,621 231,621 231,621 198,147 198,147 198,147\\'r\ !lll,\ 'l-otal 3,100,243 2,451,595 601,279 17,369 aa a The CDDs return any drug balance to the SPO via his supervisor, via the LOCT/DHS in charge of the area, the LOCT Leader and the SOCT member in charge of the LGA. It is the SPO that keeps the drugs for the next round of treatment. List utrd briefly describe the sctivities under lverntectin delivery that sre being carried ttttl h1, lltc henlllr core persottnel in tlte project areo. 'fhe health personnel collate population figures of the communities in order to delermine number of Mectizan drugs needed. They l<eep records on Ivernrectin given to them arrd distributed at the comrnunity levc'1. l'he health personnel collect Mectizan and deliver to the CDDs to distribute to tlre afl-ected conr rn un ities. I-he1 provide security and storage of the Mectizan before delivery to the next level .1n1' o t lrc r con t nte nts'? No other comments Hotv ore lhe renruining lvermectin tqblets collected and wltere are they kept 4e 2.8. Conrmunity self-monitoring and Stakeholders Meeting Hts urt.t' lruining (of trainers) for comnrunity self-monitoring been done in the project ureu? ll so, ll'hert? ltty 2007 Table l1: Community self-monitoring and stakeholders meeting NB: Inadequate funds prevented the expansion of CSM and SHM to more comrx un rtres Describe how the results of the community self- ntonitoring and stakeholders nteetings Ituve r(fccted project intplementotion or how they would be utilized during the ne-rt lraultttcttl c)tclc. Thc excrcises identifled the need to have more CDDs, and additional CDDs were selected alorrg kindred Iines and trained. The issue of incentives was addressed in a few cases. and this led to remuneration of CDDs after they finished drug distribution. The meetings afforded comrnunity members opportunity to gain more knowledge of their roles and rcsporrsibilities. District/LCA AKU/ANGA Total # of com munities/villages in the entire project area No of communities that carried out self monitoring (CSM) No of communities that conducted stakeholders meeting (sHI\{) 102 4:3.9% 2t -- 20.s% K,ARU 99 6:6% ll:11.2% LAF'IA 72 17:23.6% t5 :20.8% KOKONA 47 4 = 8.5%o 6: 10.6% N/EGGON 85 9:10.s% 8:4% 'l'oTo 99 |: ll.l% 9 :9% \\ ANlBA TOT,A,L 85 7 :8.2% 8:9.4% 589 58:9.87o 78:13.2'h ls NOCP/FMOH c trc NGDO catcr NOCP ZONE 'D'I'I-'\,\ I'RoCR,,\M STATE MOH LGA PHC FLHF COM ES 2.9. Supervision 2.9.1. Provide a flolv chart of supervision hierarchy. I Coordinator) (Dir PHC/SOCTs) (Dir PHC/LOCTs) ffiFS) (Comm/Kindred Leaders & CDDs) 2.9.2 l'Vlrul were the msin issues identified during supervisiott Some conimunities supported their CDDs rvliile others have difficulties in supporting theirs No release of counterpart funds by state and local government. Frequent transfer of health staff. High number of absenteeism in urban communities They feel they don't have any' infection. il 2 1 J .t 5 2.9.3 lYus u supervision checklist used? The project within the reporting period used a check list for supervision at various levels SOCTs, LOCTs, and CDDs. 2.9.1 llhut were the outcontes at etclt level of CDTI Implementation/ supervisiorr? o LGA policy makers provided political will. a a a HFS were rnore committed on CDTI activities Therapeutic coverage 81/% geographical coverage l00o% o Conrnrunity support $3,742.8 2.9.5 lltus feedback given to persons or groups supervised? Yes feedback rvas given to persons or group ofpersons supervised. 2.9.5 How wus thefeedback used to intprove the overull perfornmnce of the Projec't: o Cotntnunities collected their drugs from collection center of their choice. . More communities supported their CDDs with a lot more incentives. o More kindred CDDs were selected for training and the old CDDs were encouraged to continue to render services. o This forrned the basis for targeted meetings and prompt actions where necessary. EL (JoA= YUA6otr !U,\ q,, - 1-- ? o-5 dtva v,= L (J'- C)eG _.ctrN _v_ --LLFd -Obld9k ./i v\^L \J (J !JtLS -E()VC,0)E -F-te9- o()69^FdUF ::!L Tlrr-IVr^OJA;i pHri >.<'=t.oa is, *E9Z 'i= u= : 3 *.8 s o-L =-.^F\!-(d(!qJu-c- <+ - :b - .\ sJA/VL v.^ (J (J\;'=ES:YcsU;s = qq !2Ff't xG n,El .3N'\t-i=!P 6F e "i6-u: r,; = (J .=i. 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D ')t a a.) a O E r\\i- q a_ t\ v U p c ^a v + i-\ a! fJ a i v\! a: !\ 6La- 1, ==tha .l .-: -: -) \-,-. { i! ,): -rJv= ? -^/ ca*r I() , a si-- :-rj +i ') - -fa .-; i * o; oZ € .J r € € ..tO x N cl €6rr r € .o \oo\a a vl a.l 9 a\\o =n { s ,c 4 1 { -< .r, Z Z Z Z z Z z Z Z z Z z a t v7 7 r3 € € 3 € * o, r .o c a N o\ c1 o o.a -j' o. \o @ O 6 \o € O t o\ ra o (.) a IJ- o bo '= F o U o co .= ,= LF c0 C 0 L o- a (h o c) F O(ts o co .E o E L() o o (! o a th -6a'(J ()Loo <d 6 (.) E Qt! (.) E (,) L _o a E ,o oo F o. o i. E a C) C) o o g a o o L oorr<o Z.e ocE9 (.)(! >E a 0.) o- U)L o E oo qo o C) E a- o oo (FO \-J o) (h o C) o 6 U) oo L o q) C)E a oF c..l7-i L CJ ,z ! aa L =o N -oo z. a-) $ \o t-- oo c.1 CO SECTION 4: Sustainability of CDTI ;1.1. Intcrnal; independent participatory monitoring; Evaluation -l.l.l Was Monitoring/evaluation carried out during the reporting period? (tick any of the follorving rvhich are applicable) Year I Participatory Independent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation Internal Monitoring by NOTF Other Evaluation by other partners None u'as carried out during the reportirrg period 4.1.2. What lvere the recommendations? NiA 1.1.3. N/A Horv h:rvc they been implemented? 1.2. Sustainabilitl' of projects: plan and set targets (mandatory at Yr 3) \\/as the project evaluated during the repofting period? No \\/as a sustainability plan rvritten? Yes W'hen u'as the sustainabilitl, plan submitted?_2 004 \\'hat atrransements har,'e been made to sustain CDTI after APOC funding ceases in tenns of: 4.2.1. Plurrrrirtg ut sll releyunt levels Alier the evaluation a sustainability plan was drawn up by stakeholders at State and LGA levels. l-lrcre'alter, these plans rvere integrated into the PHC annual estimates. The LOCTs, having been scnsitizecl arrcl trained on programme planning, have since then been developing annual plans l hich arc shared u ith all paftners. This is expected to continue. 4.2.2. Futrcls: Advocacy to relevant authorities at the State and LGA levels will continue to solicit for counterpart firnding. In doing this, as have been stated in earlier parts of the report, paramount nrlers and etrinent persons having close contact with the chief executives will be identified and utilized. The projcct expects tlre Carter Center to continue supporting programme implementation until the discasc ceases to be of public health significance. 26 4.2,3. Trunsporl (replacement ond mointenunce) I'he project intends to maintain capital iterns/equiprnent with counterpart funds when provided by the State and LGAs. Irr the meantime, the NGDO partner has been providing support for traintenance of existing iterns. The project has requested APOC to effect replacement of capital iterns earlier supplied betbre devolution. 4.2.4 Olher resources. 1'he project plans to source funds for the procurement of materials like computer, IEC etc frorn local NCOs and NGDOS lilie the Carter centre. Efforts will continue to get government at all levels to provide needed ntaterials. 4,2.5 a a a To tultut exlent hus the plon been implemented? AII 589 conrmunities have been mobilized and health educated annually 1688 or 61.7% ATrO of kindred CDDs rvas trained. 100% geogl'aphic coverage has been maintained, and an average of 81.4% therapeutic coverage sustained. Maintetrance of project vehicle, computer and photocopier has been carried out, rvith funds fl'onr APOC and the NGDO partner Procurement of ntectizan and supplies was timely and adequate. 1.3 Integrttiort: Outline the extent of iilegratiort of CDTI into the PHC structure und p I u rt s .ftt r c' o trt p I ete i nle grut i o rt. 4.3. t I vc nrt ec'l i rt del i ve ry m ec h{, n isms 'lhc Nassarau'a project is carrying out an integrated programme for Onchocerciasis, lrnrphatic fllariasis, schistosomiasis, and malaria control. Most of the commodities and drugs fbr these programrres are usually delivered together. At the LGA and FLHF levels, thest"'are Lrsually stored in the same place with other drugs. 4.3.2 Trtining The training on CDTI, RBM, LFEP & SHC are planned and executed, where applicable, at the sanre time by' an integrated team in an integrated manner. 4.3.3 Joint supervisiort ond monitoring with other progroms LF, Malaria, Onchocerciasis and Schistosomiasis control programmes pool their logistics altd stafTto monitorand supervise field rvork. However, no integrated checklist is r,rsed. 4.-1.4 Relcusa of futuls 'l'he fbur prograrrmes are planned for together and funds when released used to carry out activities in an integrated manner. 4.3.5 Is CDTI ittc'ludad in the PHC budget? Ycs CDTI is inclr.rded in the PHC budget. o a s 4.3.6 Dcscriba other Hetrllh progromntes tltot are usittg the CDTI structure. ll/ltut ltove been lhe uchievements? The other healtli programrnes using CDTI structure are Lymphatic filariasis (LF), Schistosomiasis, and Roll back Malaria. Trachoma also uses aspects of CDTI structure fbr irnplernentation of some of its activities. Tlre achievernents in2007 have been: a. Cost is reduced because ofjoint use of staff at state, LGA, and community levels. b. Manporver is redr-rced because less number of staff are involved. c. Capacity of staff involved is enhanced. d. 589 commurrities were covered and 835,123 persons treated for onchocerciasis/LF e. 208 communities were covered and 57,444 persons treated for schistosomiasis L RBM-ITNs distribution covered 187 communities. A total of 45,000 Nets rvere d istri buted.g. L1'mphatic Filariasis treatment in 4 urban areas where 259,443 persons rvere treated. 1.3.7 Describe otlter issues cottsidered in the integrutiott of CDTL :llturprnver: The project hopes to maximize Llsage of existing manpower, increase their know ledge and sl<ills to enable them implement the integrated programmes effectivell,. l"tutcl.;; Most of the prograllmes do not have enough funds to execute their programntes el-ficientl1,. It is expected that the problem of inadequate funding can be minirnized if allthe prograrrnres worl< jo intly, Logistic's: Most of the progranrs do not have enough vehicles for their daily activities, but rvlren they integrate with other programs, they can use common resollrces to rneet various needs. 4.-1. Operational research 1.1.1. Suntmarize in not more than one half of a page the operational research undertaken in the project area within the reporting period. No operational research rvas carried out during the reporting period. 1.1.2. Hou'n,cre the results applied in the project? N"\ S E C T IO rY 5 : Sl re n gt I t s, tuco k nes ses, c h ul le ngcs, {r rttl opport unit ie s Strengths: .l Corrlnitnrcnt of health u,orkers at State and LGA levels * High geographical/therapeutic coverage. n Availabilitl' and involvement of more trained CDDs. * Irrcreascd a\\'areness of the programme at the community level. * Collcction centers are now nearer to the comrnunities as this eases the collection of Mectizan b1 CDDs. * All the 589 endernic communities (100%) provided incentives to the CDDs. .:o Conslarnt support by the assisting NGDO (Global 2000 Carter Center) \\'eaknesscs: * Irtadecluate logistics fbr LOCT particularly at the LGA level for constant supervision. .1. Inadequate incentive to the CDDs by some communities, * I-acl< ol'counterpafi funds by the State and Local Governments. 'l Sorrte CDDs lelt their job for the greener pasture without proper handing over. 28 o List the challen$es and indicate how they were addressed Challcnges: r CSM/StlM rneetings is not firlly corrducted. r l-acl< of counterparl funds to the project by the state ministry of Health and endemic LCAs o Poor tunding- project deperrd on integration and funds to execute her activities or occasionally on the good rvill of community members. Intlicate hon' they rvere addressed? . lntensive rrobilization to the communities for CSM/SHM meeting. . Irrtensive rnobilization to the community leaders, religions leader, youth leaders market women r"rnion on CSM/SHM rneeting. ' Advocacy visits to the high executive members of the state and LGA forthe release of coLlnterpaft funds. During the y'ear, mop-up activities by existing staff were carried outto provide short term solutions. Ilorvever in the y'ear 2008 specific and long term solutions will be put in place. Opportunitics: * Intesralion of distribution of ITNs, schistosorniasis control and LF elimination into the CDTI stil.tctLlre, 'l Llsirrg integrated firnds in other programmes '1. ,,\ccluircd krrolvledge fiorn othel integrated programme SECTION 6; Unique feature of the project/other matters The projecI operations were integrated where the same staffs at state, Local Government and Conrr-nr.rnitv levels were involved in CDTI, LF Elimination Prograrnrne, Schistosorrriasis Control Programme and Roll Back Malaria activities. The training of CDDs by kindred in 589 communities to improve the ratio of CDDs 2:250 popLrlatiorr. a a o 19