Edo CDTI annual project Technical report submitted to Technical Consultative Committe (TCC): January to December 2006

rr EDO STATE CDTI PROJECTORIGINAL : English AI\NUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATTVE COMMITTEE DEADLINE SUBMISSION: To APOC Management by 31 Januarv for March TCC meeting To APOC Management by 31 July for Sentember TCC meetrng fol To } A AFRICANPROGRAMME FO ONCHOCERCIASTS CONTROL ( E*ce ! I'e c! 13 JUIN rnn, For To: 'f(d5 / !. tll la't ,*t f t', '{ tl! t *tf An rt, \ f o loc 0 I JUIN ?007 t Proiect Name: EDO CDTI PROJECT COUNTRY/NOTF: NIGERIA Launchins Year: 1999Approvalvear: 1999 From: JANUARY 2006 To: DECEMBER 2006(lllonthiYenr) ( Month/Year)Renortine Period: 7Proiect vear (circleone) | 2 3 4 5 6 8910this reoort: NGDQlartner: GLOBAL 2OOO/THE CARTER CENTER NIGERIA Date submitted: JANUARY 2OO7 ? t C()of(t-r I {'. WHO/APOC, 24 November 2004 ANNUAL PROJECT TECHNICAL REPORT TO TECHMCAL CONSULTATTVE COMMITTEE (TCC) E,NDORSEMENT ! Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the rePort: { Country NIGERTA National Coordinator Name: Mrs. P. Ogbu-Pearce Zonal Oncho Coordinator Name: OTUNBA A.O. JAIYEOBA ,' signature: . Signature W*"*'QS-. Date, l{gl: Date: oslpl-l?? NGDO Representative Name: MR. J. O. EGUAGIE L- "-- Date )2 This report has been prepared by Name : MR. A.O. ABU Designation: STATE COORDINATOR Signature Date 6I ll k WHO/APOC, 24 November 2004 Table of contents FOLLOW T]P ON TCC RECOMMENDATIONS...... EXECUTIVE SUMMARY............... SECTION I: BACKGROT ND INFORMATION........ l.l. GeNpRAr- rNFoRMATroN................ l.l.l Descriptionof the project (briefly).. 1.1.2. Partnership l-2. PopuLRrroN............... SECTION 2: IMPLEMENTATION OF CDTI.. 2.1. TrvtsLrNe oF ACTIvTTTES ..............2.4. Couuuqrry rNVoLVEMcNT..................... 2.5. CRpacrry BUTLDTNG .... VII IX I 5 9 2.6. TRrerusxrs................ ................. 132.6.1. Treatmentfigures........... ....... t32.6.4 Brie/ly describe oll known and verified serious adverse events (SAE| that.... t 5 2-6.5. Trend of treatment achievement in the CDTI project from inception to the currentyeor.......... ........ 172.8. coNaNatrl.rny sELF-MoNrroRrNGaNo SrareHoLDERS MgerrNc ...........192.9. SuppRvrsroN ............... ..................202.9.1. Provide aflow chart of supervision hierarchy. ..........202.9.2. What were the main issues identified during supervision? ...........212.9.3. Was a supervision checklist used? Yes. .....................212.9.4. What were the outcomes at eoch level of CDTI implementation supervised?..212.9.5. Was feedback given to the person or groups supervised? .............212.9.6. How was the feedback used to improve the overall performance of the project? 2t SECTION 3: SUPPORT TO CDTI. 3.1. EqureunNr 3.2. FtNeNcw- coNTRTBUTToNS oF THE pARTNERS AND coMMUNtrtES........3.3. OrneR FoRMS oF cor\tMUNrry suppoRT3.4. ExpeNorruREpERACTrvtTy SECTION 4: SUSTAINABILITY OF CDTI. ......26 4.1. INTeRNIL; NDEpENDENT pARTrcrpAToRy MoNrroRrNG; EveluarroN ...................26 4.1.I Was Monitoring/evaluation carried out during the reporting period? (tick ony of thefollowingwhich are applicable) ............ ........26 4.1.2. llhat were the recommendations? ... .......264.1.3. How have they been implemented? .............. ..............22 4.2. SusrelNastLITY oF PR0IECTS: PLAN AND sET TARGETS (MANDAToRY AT yn 3).....27 4.2.1. Planning at all relevant levels ................27 4.2.3 Tronsport (replacement and maintenance): . .. ..... ....28 23 23 24 25 25 284.2.4 Other resources lll WHO/APOC, 24 November 2004 .,...4 ..5 4.2.5 To what extent has the plan been implemented? 4.3. INrpcReuoN........... 4.3.1. Ivermectin delivery mechnnisms 4.3.2. Training.... 4.3.3. Joint supervision and monitoring with other programs... 28 ...28 ...28 ...28 ...28 4.3.4. Release offunds for project octivities 4.3.5. Is CDTI included in the PHC budget? Yes............ .....294.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievemenfs?............. ....... ..........29 4.3.7. Describe other issues considered in the integration of CDTI. 4.4. OppnauoNAl RESEARCH.. 4.4.1. Summarize innot more thanone half of apoge the operational research undertaken in the project area within the reporting period. ... .... 4.4.2. How were the results opplied in the project? ............. SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AI\D 29 29 OPPORTT'MTIES......... 30 SECTION 6: UNIQUE FEATURES oF THE PROJECT/OTHER MATTERS...........31 28 29 29 lv WHO/APOC, 24 November 2004 ACRONYMS wHo APOC UNTCEF MOH FMOH LGA NGDO NGO NOTF NOCP RBF G2000 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 Fund Ministry of Health Federal Ministry of Health Local Government Area Non-Governmental Development Organization Non-Governmental Organization National Onchocerciasis Task Force National Onchocerciasis Control Programme River Blindness Foundation Global 2000 lThe Carter Center Lions Clubs lnternational Foundation Lions Clubs International, District 404 Nigeria Community-D irected Treatment w ith Ivermectin Community-Directed Distributor Health facility staff District Health Supervisor Community Directed Health Supervisor Annual Treatment Obj ective 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 lmmunization Disease Surveillance Notifi cation State Programme Implementation Committee Project Management & Review Committee WHO/APOC, 24 November 2004 Definitions (i) Total gopulation: the total population living in mesoftryper-endemic communities within the project area (based on REMO and census taking). (ii) Elisible 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 expected to reach the UTG at the end of the 3'd year ofthe project). (v) Therapeutic coverase: 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 treated in a given year over the total number of meso/hyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). (vii) Intesration: 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 CDTI. (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 govemment. (ix) Community self-monitorine (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. vt WHO/APOC, 24 November 2004 FOLLOW UP ON TGG REGOMMENDATIONS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session 22 (Please add more rows if necessary) Number of Recommend ation in the Reporl TCC RECOMMENDATIONS FOR 2OO5 ANNUAL REPORT FOR EDO STATE PROJECT ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT ASE ONLY Nit Nit Nit Nit vll WHO/APOC, 24 November 2004 Yvlll WHO/APOC, 24 November 2004 tExecutive Summary (l) In 2006, a total of 552,441 persons were actively treated with 1,621,692 tablets of Mectizan in 530 villages of 12 LGAs. The total estimated population of the 12 LGAs stood at 731,900 persons and the year's ATO was 556,659 persons (see detoil in section 2.6.1). This treatment gave geographic coverage of 100%, UTG coverage of 99.2yo and therapeutic coverage of 75.5% for the 12 months ended 3l't December 2006. Refusals and absentees accounted for 4.29o/o and 16.30/o respectively of the year's treatment. No serious population movement was experienced. t3l Section 2.4.-2.8. shows level of community involvement in CDTI activities. 54.7o/o of the LGA health staff were involved in CDTI activities, 87o/o of the Communities had community supervisors, and 29.8%o of the endemic villages had female CDDs. All the staff involved in CDTI were duly trained as appropriate. No CSM and SHM activities were conducted during the period. t4] Training was conducted for different categories of staff that were involved with IDP activities. In section 2.5 -capacity building,60 LGA staff were trained, 120 Health centre post staff trained, 12 TOTs and 945 CDDs. Effoft will be intensified in the coming year to train more CDDs using the kinship system, as well as to raise the number of female CDDs. t5] Passive treatments were carried out under Carter Center sponsorship. A total of I18,573 persons were treated in 156 hypo endemic villages in Edo State using 340,804 tablets of Mectizan. t6l The total Mectizan tablets of 1,962,500 that was issued to Edo state project were fully utilized for treatment during the period. However, four (4) tablets of Mectizan were reported wasted during treatment activities, and this is duly recorded at Section 2.7. I7l Challenges and how they were overcome: The NGDO came to the aid of the State by providing needed logistics in the face of difficulty in commencing Mectizan distribution activity during the year. Successful effort was also made to penetrate the Local Government political process through the Directorate of LocalGovt. Administration which led to securing LGA support and release of NI.742,000 or 33% of the l2 LGAs' budget for the programme in 2006. Although no CSM and SHM activities were carried out in 2006, there is hope that these will be conductedin200T based on the new plans on ground. tx WHO/APOC, 24 November 2004 JSEGTION 1: Background information 1.1. General information 1.1.1 Description of the project (briefly) Geosraphical location. topographv. 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 populatio-n census indicates a provisional population of 3,100,000 (2006) for the State. Edo state is among the youngest state in the country and she still retain 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 tlie Bight of Benin on the Atlantic coast. APOC sponsorship of 12 hyperlmeso endemic LGAs out of l8 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 7"30 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. [n 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 executive 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 occupation of the state indigenes and they live in permanentiettlement and practice a communal system of living. During farming periods, some live nomadic lives as seasonal migrants. 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. I WHO/APOC, 24 November 2004 ,H:fi:f,1J:#r,i:#*lJ::lffjJ"tii:..T,"$:.:C has released the two installments of Tablel:NumberofhealthstaffinvolvedinCDTI(Pleaseaddmorerowsifnecessary) NOTE: These are the number of LGA staff involved in CDTI programme' l-l-2. PartnershiP ,#ttr;:,i;i:rff;:#ffi4.,::'#:#ri;:tri:xr#:iliii!{i-r,',,r, '{'":i,;2,;",,:;,x;;t:'';i;,':"Wr1:;1T,1;;";;,,od,o,o,v,ptinning' r::l'r;:u:lwriiritrriii:m:t::GAdecisi'n-makers' idobt,NGos' CBos' to asstst ttt Lttrt 't"Y'v"v---'- Between 1992 andr994, the River Blindness Foundation (RBF) funded the programme tn collaboration with,n"?"i."*,*luo "f *r"i'kh;il tk;:,".fittnn LGAs' Betrveen January r ee 5 and Mav 1 ee e ;;ffi ;;; n'91'gia"[vln;;'";';'Al*mi1'"#I il il;.lfJ': : :. [*:5***[fl"{i*o}:l:'rg,m;:*ts,"s"sJK8ffiI;;il;;'ionso'sr'ipot'lt'" 2 activities.CDTIlninvolvedstaffhealthofumberN Bf&zlBr *100 PercentageNumber of health staff involved in CDTI ofNumberTotal staff in entire Proiect area District/LcA 53%t528 Akoko Edo 60Yo1525 Esan 60Yo1525 Esan 60%1525 Esan West 500h1530 Etsako East 50o/o1530 Etsako West 57o/ot526 53o/o1528 Ovia 50o/ot530 Ovia 510ht526 Owan East 55%l527 Owan West 5r%1529 54.1"h180329ALTOT WHO/APOC, 24 November 2004 programme in collaboration with LCIF, Gtobal 2OOO/The 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 includ", .udio, television broadcast, jingles and production of fliers. The partners involved in the project mplementation at all levels are the NGDO, APOC, MOH, LGAs, VillageVCommunities. The working relationship among partners has been very cordial as it relater to p.ogru111n1" implementation. Lack of fund from the state government and some LGAs hindered effective supervision. A high-powered advocacy visits to Edo state is being requested from ApOC NGDO, NOCP. At our own end we shall continue to visit the LGA policy makers and the community leaders so as to elicit their continued support to the programme. J WHO/APOC, 24 November 2004 oc E 3roE.t 6FE au El=)5E o rO o,(") I- @lolr) @(f, lo(f) sro @N$ o,s ro o) lolo oN@(o$ N o,t- ro(f) @o@ @(o (olr,$ CO\t s $ @(o No$ o!t (o rf- olif o) ro(0_ (0 1O ro tr o -g =CL o o. 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Advocacy State the number of policy/decision makers mobilized at each relevant level during the current year; the reason(s) for undertaking the advocacy and the outcome. Describe dfficulties/constraints beingfoced and suggestions on how lo improve odvocacy. At the state level, the Hon. Commissioner, Permanent Secretary, Director, and Deputy Director and some key officials were mobilized during the advocacy visits in respect of logistic supports to the programme for government counterpart cash contribution(GCCC). During the advocacy visits, the State Coordinator highlighted some of the achievement recorded so far in the programme on transparency and the Mectizan donated so far since inception of the programme implementation. This was also replicated at the LGA level with the Hon. Chairman, Head of Service, Chairmen and their wards, notable politician and very influentiat persons were visited. The major objective was to win their hearts to give support to the programme as APOC fund had come to an end. On the whole, about six State officials and 30 LGA functionaries were visited during advocacy in the year. Diffi culties/Constraints: * Inability of Council officers to release funds as promised * Higtr cost of fuelling vehicles and motorcycles * Most of the motorcycles donated by APOC have been grounded. To improve advocacy: a) special fund will be required from APOC to enable advocacy visits to be carried out effectively to State and Local government functionaries. b) it is necessary for NOCP/APOC officials and NGDO functionaries to pay advocacy visit to the State and LGA functionaries. This will go a long way to boost the programme. c) any money released by LGAs based on the collaborative arrangement with the Directorate of Local Government and chieftaincy Affairs, would be strictly monitored by working closely with all the HoS in various LGAs to see how money transcend to the distribution of Mectizan in such LGA. 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/ Accomplishment/ Suggest ways to improve mobilization and sensitization of target communities. 7 WHO/APOC, 24 November 2004 [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. tb] [n year 2006, the second year of implementation of sustainability plan, health education, sensitization, advocacy visits and mobilization were carried out through T.V., Radio broadcast and jingle. Public address systems were used on market d-ays and on those living in densely populated areas.[c] The State team also wish to repeat this kind of visit in2007 for strengthening of our cordial relationship. ldl The State project has run out of posters, and the few handbills that were available suggesting signs and symptoms of onchocerciasis were distributed in market places, villages/communities, mosque/churches. Local town criers were engaged to announce CDTI activities to the people. tdl The response of the people in many endemic communities was encouraging. There were expression of feeling better in their eyesight, knowledge on onchoierciasis controlas well as coming add-on programme like Schisto and LF. They also thanked the donor agency for the mectizan drug provided. [e] During health education session, emphasis was stressed on women and minor children especially as it relate to pregnancy, nursing mothers and under age children below 5 years of age who are not to take the drug. Communities were also directed to recruit more female CDDs in their area to balance gender inequality. tfl The outcome of these activities resulted in good "or".ug" oi Mectizan distribution.There were pledges to support the programme at the community especially as it relates to CDDs. tgl At the rural communities town criers is the best method used by the various CDDs to disseminate information on Onchocerciasis. Handbills *ere aiso given every Friday in the mosque and in churches every Sunday. This also enlight"n"d th"* on river blindness disease. th] The response of the people in many endemic communities was encouraging. There were expression of feeling better in their sight. They no longer used medicit"d glasses as they became knowledgeable on Onchocerciasis control as well as ad-on programme like Schisto, LF, Vit. A supplement. They ever remain grateful to the donois of Mectizan tablets. tg] Mobilization and sensitization of target communities can still be improved upon by:I. Placing radio jingles II. Training of more CDDs at kindred level to reduce problem of incentiveIII. Improving logistic supports (in terms of provision of fuel for motor vehicle /motorcycle as well as provision of additional motorcycles and bicyclesIV. Continue mobilization of villages for CSM implementation Accomplishment: The 530 endemic villages were fully mobilized during the sixth year operation. Weakness/Constraints :{a} Refusal by some CDDs to distribute Mectizan in their communities due to lack of incentive.{b} Some villages refused to select CDDs as a result of inabilty to provide incentive.{c} Claim of shortage of drugs in some LGAs.(d) High cost of fueling of vehicles and motorcycles.{e} Lack of commitment of CDDs, LOCTs, SOCTs. Ways to improve mobilization of the target villages: 8 WHO/APOC, 24 November 2004 o Monitoring and supervision would be intensified; o CSM would be initiated and carried out in at least 20%o of the villages in each LGA. 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 intensified. 2.4. Gommunity involvement Table 4: Communities participation in the CDTI (Please add more rows if necessary) Total Comment on. Attendance offemale members of the community at heolth education meetings In general, how do you rate the participation offemale members of the community meetings when CDTI issues are being discusses (attendance, participation in the discussion etc). Incentives provided by communities for the CDDs Attrition of CDDs. Is attrition a problem for the project? If yes, how is it addressed? Other issues ln Edo State, attendance of female members at health education meetings, is encouraging and improving. As far as the programme is concerned now, the recent split of Primary Health care into two i.e. Ministry of Environment and pHC has created a greater opportunity for female members to come onboard the programme both at State and LGA levels, which hitherto was not the case. I 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'Br.1 00 Male CDDs Bz Female CDDs Be Total Be=$7+ Be Number of comms. with female CDDs Bro Percen- tage Brr= BrdBr.100 Akoko Edo 47 45 96% 100 l0 ll0 l0 2t% Etsako East 55 45 82% 85 t7 102 l0 t8% Etsako West 36 36 r00% 82 l8 100 t2 33% Owan East 38 28 74% 69 9 78 {j t5% Owan West - 40 40 100% 58 l4 72 t4 3s% lgueben 40 20 50% 57 1l 68 lt 27% Esan Southeast 36 36 l00Yo 102 l8 120 l8 50% Esan West 55 45 82% 85 l3 98 l3 23% Esan Northeast 37 37 100% 74 l6 90 l6 43% Uhunmwode 42 42 100% 80 l3 93 l3 30% Ovia Northeast 45 45 100% 72 20 92 20 44% Ovia Southwest 59 45 760/o 87 l5 102 l5 25o/o 530 484 87o/o 951 174 tt25 158 29.8'A WHO/APOC, 24 November 2004 2. J 4 Incentives are not currently provided by Communities. However this is is expected to improve with unrelenting intensive mobilization of communities for full ownership of the CDTI programme. Attrition is a problem in the project area. This has resulted in some community not distributing Mectizan tablets but when such Community is identified it is remobilized to replace those that left the programme. In recognition of this problem it has been decided that many CDDs would be trained on kindred basis in order to take care of any vacuum that may be created by a withdrawing CDD. There was no new training of CDDs at Etsako East and owan East LGAs,. The old CDDs carried out CDTI activities in those LGAs during the year. l0 WHO/APOC, 24 November 2004 3 c.t o 0.) oz + e.l oA *L' lr(g -o) G) bo t< 0 -l th CB Ir] oi/(! v)Fr! (6 v1 CB rr.l CU o -o C) LL(B o U)(g bo () o z o z 6b o a € o $ o o t o\ o \ ;. .. e toc (E oooo o olt E =z sErro E.i io or o oor o C\tr- @(o oc\l @ct) oC" (f)o) NCD No (,!t(r, roo;(Y) +o&d oCD o .t@ o r.-l.r, (oro o@ (f,I- ot- r.-r- !t(o r-(o q, coE o .9 o s o=o = o C\t o (or o lor N ov roC.l oC{ @r @c\t ro(f) (\I(\t Peto oo(f) oo(f) oo) ooc\l ooc! o(r) ooN ooN o(o @lo oro ooN c,@(r)(\t 2o FPEO O'Y *avo o.= u!EoE3rrEo =z :EtrO E,i i o F r r ot oo o +oq o o o o o o o o o o o o o tro E o .9 o s =o*d o o o o o o o o o o o o o oo o A F r (\t o trOEoE E(E(EEOs .r.E oo TE?CLE z ,!tEllv E.t; o o o o or o o o o o o o oot oo Fo *a\oq c\t .t cf, ro rf (o e{ ro $ (o f.- CDt o o .g o s o io = @ o, (o N rf, (o $ @ ro (o $ (9 1.- o ot o o or o o or o o oF oF o o oot o o Er .9'aots TEOOlt E Jz ,lGltv r:od 1r) lo lr) ro ro rr) ro ro lo lr) ro ro o(o oo o toq (f) C9 $ N (f) F N C\l (f) (oot go E o .g o s flo !o = c\l !t 6l (o 6t $ $ (9 (o $ N tt(v) o o A lr) 1r) lr) ro ro lf) ro ro lo rr) ro |r) o@ oJD(, .9,o oE lJJ o .Yo .Y ootu oJoo trJ U' o =o .Y(U o ]U oo lIJ c o =o oo3 (I, 3o E o) -oo f oi (t, oot J oa (5 o tU oo =E(I, o trJ ooq) c L oz C Go TU c)Eo3 E L) l o(g oc L oz .q o o o) =E J o U) o 't o E oF -\ U2q q) uq) .b 4 t\ p +3v q)q ! a-v d o 0) F oU +i a) o G) EtHEX1'E -loa€ .= bo(, .EIEtrc'Fr!I:(, rftl .ollo 5l NFI $ c.l C) .o q)I z$ c.l O o c.l 03e cc)titr ao .L>>trtr rrl LII t*(HO o; >..:ts!a .?'E €zAo 0)Pthn d9 . -.: c) ^,o<>\./ oJtr 96 -o(!, o<B(, €J .9 qrH-q 9E63aUE :E 0) Poo a.oE'otr o.r L(DAB ei-(J(6 +5 E*r(,E 3BPC) e-EE+, OqHdio P'hooEZthE)-:*o 0)e o)O -od o.r \J(BJ(),69;{ ;igbb;.q.E o -q'= 'oE gb0 :Y o) .E rJ- O.l tcBo o-rEP +r<6")FQr-E C) oo o. V)() L (,) (t o 'o c) c.) (,) o) 0) o 0.) 0) 'o o)L JI Cd t', o t-tU (,) li o (! L ! C) o) 'a t<o. 0) 0) (B C) o o0 E l- €() oi o rc C) ,o lr) (n d;u;'c) Q.= !-d!,8 o.E <8 O (, bo o (rr o o(B o o lE c) os o E o C) o0Ld o F o o oU 0) (d bo (c Lebo o.=>trg'E Eb !D +r 'ov .=o -v> _o _o- EO 29at9 o.r = c-)(,c)(!-c Boo ;tr r\ (d bo9 EcP>\0)F rrttJFC) aFzHra a,r-ta U cOo{ !- Trainees Type of training CDDs Other Community members e.g Community supervisors Health Workers (frontline health facilities) MOH staff or Other Political Leaders Others {specify) Btqg.am management How to conduct Health education { ,/ Management of SAEs ,/ ,/ ,/ CSM ./ ,/ SHM Data collection / Data analysis Report writing ,/ ,/ Others (specifu) Table 6: Type of training undertaken (fick the boxes where specrfic trainingwas caruied 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 650% therapeutic coverage or the coverage rate is fluctuating, state the reasons and the plans being made to remedy this. The project attained 100% geographic coverage and 75.5o/o therapeutic coverage this year. l3 WHO/APOC, 24 November 2004 E'x $'iau* o o o o o o o o o o o o o o u.t o jt o o o o o o o o o o o o o :[$3< 6tN or-(o r @(o @ (o t_ C\t $o @_ F- o$(f)- ro r o) o) (o r ro N c\t^\t lo(a o @ @r-@ $ (f,$ @- C\l r.()o F- t (fr- .(l @tol o)C' bpeE"E :tEE"E CDto 6 @(o o(o N (oo c\t- @N$ o, lOo o_ (o N@ NF- @_ O)oC! o@ - CDo$ tq ot o G 3o o o. ooII- oo o $Hu F E- I- NI- $$(o o o, o, N 1'* @ (o c"j ct, c{ lt-(o q ro c!(o(o r 'dF- F a'-@ COd(o o oi(o slO rC, 1'. tso b Pu!,* 69 S"BE Nr @ .t I- o,$ CD ro(f) o(oo o,to (olo r @$ (o rt- @ ro r r(fJ ro lif CO o, F.- o(o o @(o CO CO @N o) o,(f) o@s @$ (o @ rO @(f) 1r) r o, @ CO t ---ol rolo o -Ee( og =tr4,EEST < E! @lO C')(") N @lo ro @(f, lo(o s rr) @Ntt_ o)s ro o, rolo o N@ @\r N O)i- lr) co @o@ @ co (o ro -l: (f)s $ s @(f, t-o$ o .ir (o f.- o$ o)to(0- (0 ro l(, o $*PsE e o(a (f) (o o) Nlr) @ lolo CO @(o o,lf) sNN ro rO o ro r- N(o \t f.-rt- N(o N(o C9 o, ro Nr o) o ro o(f) N colo olo(o tolr) Ntiro o,lr) (o @ cf)(o ro oo(t)- (e N oo C,l s E oo .E =E E] ol oo nI .io o o E')A (E^ d Iroo soo r soo soo soo soo soo soo soo soo soo - soo soo soo o!sct F-$ I-(9 (o(e rr,lo lolo (oCO o$ l{)rt o,rr) @Cf, o$ c\trt o(9lo No r E.g =EEE . . =86 t-$ F-(a (oCE rr)rO 1r)lf, (o(9 o!t ro$ o)ro @C9 o$ c\I\t o(r)lo *Eg-$e e.tsvE o o E r-$ F-(9 (ocr) rr)lo rr)lo (oC9 os rr)$ o,ro @Cf, ort C\l.t o(') ro o o .t2o oE UJ o! ov @(U o E oz c oo LU oo 0) =oa c Go ut oo =coo]U oo UJ o! oo TU o 0) =o .Y o @ tu co -oo) _9 oo c) E oz .o o oo = J o U) .g o oo TJJ L(U =o 6o =c(, =o o1'o 3 Ec =cf x o.l 0) .o 0l o z t C.l U oA $ L' q) Uq) %: \ q)\ *s q) U) q) U L cto \o O c\ -\4(/) L t) c)L (d () -] c) L an E >. .o (n rq U) c) c) l-iF F-l o.,l -olctlFI E o 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. 2.6.3 2.6.4 b) Search for greener pasture outside the communities. What are the reasons for refusal? a) Misinformation of people in the affected community i.e. in terms of reaction or passing on incorrect stories about reaction. b) Some others believe that they are no longer sick of oncho hence refusing treatment. c) Some people say their continued intake of Mectizan for upto 25 years is unjustified. 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 ofserious adverse events (SAE) during this reporting period, please tick in the box. No SAE case to repoft V l5 WHO/APOC, 24 November 2004 <t a.l a .o 0) z $ C.l a) oA o > a \o ! q) \- Lq) .a \ -\)q) l( B4 % q) S 4l p p o .x N \) Fi E ! o l<o o. bo t- oaoL c) bo L E 0)Lt- oo o o trl a tt) o 0) (.) oL c) Ed v) o L C) U)(t o (n ott) 60U cicir orl -ol(dl FI o EOQ E2kO7 rl1 yo <.s E 3,:.U ESii E 3EXHEr! u'5 o o.9c,q o=9&59l, o- o-eY ;-io o9 -57i c,6.= C)o-c tr&9d *SE-o.9'c s o c E= doooOE,he vo-c9' d-l= !Y o lJ d-c(E d5-9oo.N $HEIE .t-, o(D 'a q o 'oI! C) ,o(B C) q O. cd o aI! a o. >ra -E9H:l h O!* oEF + H406 =o .N -X o:i- Es g ()b0e =b0ao x(., a o oo * a a (\ C) -otr q) oz$ e.l() A{ r\ j o CdLr C) (l) 0.) t- oo 0) bo o s(B t) IJ oU o () (€ oo o(,(g o'{=FO(o:()!g()(g .io8idso'E o 0,)d65= rrCxo() 'r= sDd()r =6 .9p H orq OE -o()(o() o() FF Fr C.l f-lu z e !l\ \J s.Lq)G\9\) { o.st\ie. L) ov1 Et! o(B '5o\oBH I9EGI .=.o: 49rE oAa ,!srE U :'E0q)iil- o;50) 'e;o L-q€\ aPiA ih\Ot-,r ,il \iALfat- Rt ralJ c) oh: €hl p;Et eol !9-lg)trt (sl q)q) (.rl '= E'IL !t ob0: -Ei:!ooL :3€EorE6)n\/trEH XLU-)89q)rtrs:oeEEEd€ 'I 6) g)E-'E Foy'; uigl 2e€l -uci Fl Oi () bn v uaF oX '1 >:/ O -o o\ oor- rO 6\ c.l oo rO ^\sf o\ o\ co o\ \o o\ I-r o\ o\ ra) o\ .o o\ 5\ t-- o (d oo I rI] r-l il:ri o ^ ot)I Ecr oa\ < >e -o a -o o\ oor- \o o\ 00 .o 6\ o\ -o o\ C\ o\ \o^\ o\ .o o\ F- o\ rO6\c] o\ o\ o ll t HEI EI \oo\ o5o ,u)OGP.h ooEqoH \oo\tf,\o 1O <f\o s t-- \o o\ o\\o -o o\ r- \oo\ o\\o \oo\ oo o\la) ro It- Ii E .o o6 .o6l]EaEE z?,o o. =tc\c\ ca$ \oo ct} ta)$ co o\ c\ta) \o \o $ rat t-+q ca c.) ra) ca lal <t c.l \o$c\ rr) .d.q c\ ra) ra) r.1 =oE 6.1tEtiE E.9. < 94't-e rat la) o \o r.) c.lol c.l t-* ra) tr} c.tial \o oolr) o\ cO c..l o\la) co cO od oo!f, r-\o rat o\ ra)\o \o ra G6A.rd : 6!) - A *6S'.E o h- . o (d€<.=trl ' a 3s o o\ \o c-\o o\ a.l oo\i F- ao r -f r- \or- ca ooF- oo a.t o\ r\ ratr- $ ca\o oiinr- o\ c.l r- oo\o o\ a.)r- 0) bI) Gt 0) (-) ll r ri El H o ^boP gGt- oo\ <' >v -o o \o n\o oo \o5\cl o\ \o ^\r- o\ rO 6\r- o\ \oo\ c.) o\ .o o\ oo o\ \o =oQo.bo=S= EaiI i' Ao u 9 alir.l(Jord s n\o oo o\ c.l rn o\ o\ c- o\ \o^\tr- o\ o\ ca o\ .o o\ oo o\ .o o\ \oo\o qoo= E* u E sg = c= cE E.; g >Oti co ta)$ tr) s r- c.l o\$ c..l(\ !t ro a.trr) =o-E.b .u iob' F \-i co ra) cotr) cala) cota) car calr) corn aolal !E€ I $ ;.E.E * IE = E<'XH E E-&"HE o>*6 o cOla) cara, ca ca cora) ca ca ce & sl o\ o\ o\ c.l cl N a.t ca c.l .+ c.l (a) c{ \o e.l 2.7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - QtleaseMoH tr wrotr tick the appropriate answer)TTNICEFtr NGDOE Other (please speci$r) Mectizan@ delivered by - Qtlease tick the appropriate answer) MOH ! wHo! T]MCEFtr NGDOE Other (please speci$r): Please describe how Mectizan@ is ordered ond how it gets to the communities The Oncho Coordinators in the Local Government 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 charg-e of iuch 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 oflice for further action. On arrival of the tablets 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 p.o""s down the line to the Frontline health facility, and finally to the CDD with the "ons"nt of the Village leader. Table l0: Mectizan@ Inventory (Pleose add more rows if necessary) Note: Four tablets of Mectizan were wasted in the course of treatment during the year ' How are the remaining ivermectin tablets collected and where ore they kept? Not applicable in the project during the reporting period. SAI LGA Number of Mectizan tablets Requested Received Used Lost Wasted Expired Remaining I Akoko Edo 211,496 211,496 211,496 0 0 0 o 2 Esan Northeast 110,000 110,000 110,000 0 0 0 o J Esan Southeast 170,000 170,000 170,000 0 0 0 o 4 Esan West 145,000 145,000 145,000 0 0 0 o 5 Etsako East 170,000 170,000 170,000 0 0 0 o 6 Etsako West 130,000 130,000 130,000 0 0 0 o 7 Igueben 90,000 90,000 89,999 0 2 0 o 8 Ovia Northeast 99,000 99,000 99,000 0 0 0 o 9 Ovia Southwest 120,200 120,200 120,200 0 0 0 o t0 Owan East 150,000 150,000 149,999 0 1 0 oll Owan West 110,000 110,000 110,000 0 0 0 o t2 Uhunmwode 116,000 116,000 115,999 0 1 0 o Treatment in 6 Hypo endemic LGAs 340,904 340,804 340,904 0 0 0 o Total 1,962,500 1,962,500 1,962,496 0 4 0 o l8 WHO/APOC, 24 November 2004 ' litt and briefly describe the activities under ivermectin delivery that are being caryied out by health care personnel in the project orea. - Drug delivery moves from SOCTs to LOCTs, then to DHS, HFS and to the CDDs. - Monitoring/supervisionofdrugdistribution. - Mobilization visits. 2.8. Gommunity self-monitoring and stakehotders Meet-ng Has ony training (of trainers) for community self-monitoring been done in the priject area? If so, Wen? Yes it was done in 2003 and2006. Since year 2004, which was the fifth year of APOC implementation CSM/Stakeholders, meeting have not been carried out by the State, LGA/community due to inadequate logistic supports from the government. The project is hopeful to intensi$, cSM/Stakeirolders, meeting provided logistic supports is given to meit this very important component of CDTI implementation. Table I l: Community self-monitoring and Stakeholders Meeting (Add rows if needed) Describe how the results of the community sel"f- monitoring and stakeholders meetings have affected proiect implementotion or how they would be utilied during the next treotment cycle. l. No CSIr{ activity rvas undeftaken during the pcriod of report. Reasons being that they were just trained in October/Nlovember 2006. Assignments were given to them to carry out a CSM test of their respective villages. District/ LGA Total # of communities/villages in the entire proiect area No of Communities that carried out self monitoring (CSM) No of Communities that conducted stakeholders meeting (SHIvf) AKOKO EDO 47 0 0 ETSAKO EAST 55 0 0 ETSAKO WEST 36 0 0 OWAN EAST 38 0 0 OWAN WEST 40 0 0 IGUEBEN 40 0 0 ESAN S/EAST 36 0 0 ESAN WEST 55 0 0 ESAN N/EAST 37 0 0 UHIINMWODE 42 0 0 OVIA N/EAST 45 0 0 OVIA S/WEST 59 0 0 Edo total 530 0 0 l9 WHO/APOC. 24 November 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. In this seventh year report of APOC implementation, there was extreme difficulty to conduct supervision due to inadequate logistics from the government. At different times, the Project Administrator of The Carter Center Nigeria, Edo/Delta project, State Coordinator and State PHC Director carried out supervision visits to LGAs to solicit for support. The SOCTs also did the same with the assistance given by the Carter Center. It was extremely difficult for the State team to move down the ladder to carry out effective supervision. Even at the LGA level where fund have been released, we found out that supervision was never undertaken by some HFSiDHS, and LOCTs concerned. + STATE COORDINATOR SOCTs LOCTs LGA; PHC COORD; LOCT DHS HF'S CDDs / COMMUNITIES 20 WHO/APOC, 24 November 2004 1. 2. 3. 4. 5. 2.9.2. What were the main issues identified during supervision? Incorrect dosage entry in the notebooks. In some communities, notebooks were not replaced. DHS/HFS complained of lack of means of movement to supervision site. Break-down of APoc donated motorcycle which were not repaired by the LGA was another problem identified. Some cDDs refused to distribute Mectizan due to rack of incentive. 2.9.3. Was a supervision checklist used? yes 2.9.4. what were the outcomes at each lever of cDTr 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) (3) LGA Level: Late release of fund by some LGAs posed serious threat to the programme. [n some cases when fund were released such fund did not add value to the frog.umme in terms of monitoring and supervision. (21 FLHF Level: There is generally inadequacy of staff at this level. The few ones available say they could not ride bicycle to monitor activities. From discussion with local government functionaries, there is plan to recruit more hands. It is hoped that the new administration coming will address the issues critically. Villase Level: This is an area we need to praise the CDDs. In some communities, despite the lack of of incentive they still participate in the programme. They believe that they are helping their villages/communities. The awareness created by mobilization at the tommunity- level has helped the programme tremendously. As a result some eager communities even come to LGA secretariat for their drugs. 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' response is 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? The feedback used has not improved the overall performances of the project.[a] There is hope at the end of the tunnel as problems identified ui" ilro passed down the line to CDDs in the area of shortcomings. tb] The project is hopeful that if there is a clear policy from the Honourable Commissioner for the Directorate of Local Government and Chieftaincy Affairs to the 12 APoc assisted LGAs, the approvar already granted by the 21 WHO/APOC, 24 November 2004 lcl state Deputy Governor for each Local Government to contribute a participatory fee of N436,000 will continue to be provided for the programme. Although, there was improved community participation, some communities/villages are still not showing enough interest in the programme saying that they cannot continue to fund government programme. 22 WHO/APOC, 24 November 2004 SEGTION 3: Support to GDTI 3.'1. Equipment Table 12: Status of equipment (please add more rows if necessary) NOTE: Information is not availab activities. le to the project about LGA equipment set aside for Oncho *Condition of the equipment (F=Functional, CNFR=Curuently non-functional but repairable, WO=Written offl. The APOC motorcycles are not repairable due to lack of spare parts. The motorcycles are currently at Esan West, Uhunmwode, Etsako West, Ovia Northeast and Etsako East of Edo State. Upon approval of the three-years sustainability plan, certainly those broken down capital equipment would be replaced through AiOC support to enhance CDTI implementation. How does the project intend to maintain and replace existing equipment and other materials? The MOH will depend on the NGDO for maintenance oieiisting equipment and other materials. However, the issue of local replacement of APOC equipment will be far fbtched. It is our recommendation that NOCP/APOC undertakes a high powered advocacy visit to the State to clearly define the responsibility of the State and/or LCAs, in maintenance and/or replacement of bad equipment. Above all, APOC is expected to fulfill her earlier promise to replace capital equipment before pulling out of the programme. Describe the adequacy of available l*towledgeable manpower at all levels. This can be said to be relatively adequate, but areas of shortages will be addressed. Source Type of equipment APOC MOH DISTRICT/ LGA NGDO LGA Func- tiuonal Non functional Func- tiuonal Non functional Func- tiuonal Non functional Func- tiuonal Non functional Func- tiuonal Non functional Motorcycle 8 5wo 0 0 0 0 4 0 0 0 Vehicle I 0 0 0 0 0 I 0 0 0Computer I 0 0 0 0 0 I 0 0 0 Printer I 0 0 0 0 0 I 0 0 0 Photocopier 0 I 0 0 0 0 1 0 0 0 Fax machine 0 CNFR 0 0 0 0 0 0 0 Bicycle 60 0 0 0 0 0 0 0 0 0 Generator I 0 0 0 0 0 0 0 0 0 Overhead proiector I 0 0 0 0 0 0 0 0 0 Radio/ I 0 0 0 0 0 0 0 0 0 23 WHO/APOC, 24 November 2004 a I I .fo N () Eo z!+ c.t o o > + c-l bo oL 0)E o3o) L .Y 0.) o)s -A EH3E -'iV.* <t) a!-h.9$i -cbB l< 0)0iF -t(.)tr >= ALii boAO L ,;o69 "Ft()- {} o.pq2 aS-l A xYo >cdaP'!2 5\E9 P(, I ibB ^E(,6-Es -- y c)N o=\ ooc\s .YtsoE *(1),PI c- E6Htcc) ooE *n E Br.?G ii \./ "Y o. a)u o-s\=€ iQcU^tal-e s 0i'E strii .a lEIo9q! bqlvu)\ E=9'a (o u>als9H\-o-o -'e 9 rF(B o o a- *a at E3 E E o(, u)LESL>r .! .x OthLeOH EeL+(!;c.o o2to)UtrbLoii o=E:'o* tF u) f= fl .-=LiJT) LEOE(r3 t! .E I.lE -(B -lE :Frl{ a-lr. gl .rlN5lGt sl .Uo .c)JA Ea$ AF()(rE= o oo$_(.) o o, .t_ N o (f) C\t @tt o{N +(o sr$gFO(n1, I-@(rr_\t (o\t ot o\t o @$(D_ o (r)6l @t (\t @d C') CO (! o Es#,s o (o o,!t- N o c\t(o Cf) ot$ o o !o rO @-(l' ro r*9s I.-o(O c.i (o$o{ o$ o c\l @(o o,t o c.)N Ct- r.r) rf) @(r, @_ t ro oo .oJ6 EE$ AF()(rEJ r() ooN c."t o c.) @_ CO(O o \t o)(r, @(v) N ott .ft\ D _d) t (l,^ EEgAF()(D-- s@(O rO (o N o_(o c\t o (f) @_(o (f) o .t o,(D (o(O (lo o- (Do t a!o o .(I) -lo EE$AF()(r3 o oo l.-_ (O o (o rO t .-_ o,!!t ct)o(o N @ @ ro NT\ G'. N d'$8(J C, =t-l-O@E o o o @lo N. o)$ o (r)(\l @_ @ rO (D|.- to_ cr'o GI' (E o .c,J6 6eg aF(J(rE-- o No(O N o lo(r) o- $ C9 (oo@ (o @N. O) rr) (9(r, (o o) )6 EEg,-AF().D d3 o o o rr)(t)o $ Cf) o o o,o N(O roN (O <D N .Eo -(l, -lo E€$ AFO(tsoJ o (r) rr)|r) .t o CO @ @_$ O) lt (f) ro s_ (O(o @G' -o-(,) 6 o^x@X(lri'l GIE J 5EFO o o o (o(o(o- $ o (O ro $_ N (l' (O G' (E(, ro -c) -la 6E$AF()(r3 o (f) ol N o olr) o! c.l N(O .t O) O)N- @@ $N\(l' o sa$gF()dro o o o olo oL c{ o o, CDN-(o @ o)$o- (D(r) t- o E L (,) Rt(g LPEAo=\r'6 6 el z p-l C) at1 o zJl t) Z<, (tL O(g oq< rr) L o) t- o. o o z V) c) trl = (,l -Y o)te bol E ar) F L)oA Fl F F 3.3. Other forms of community support - Describe (indicate forms of in-kind contributions of communities if any) a) Exemption from communal taxes b) Exemption of CDDs from communal labour; c) Giving out communal land to cDDs for farming purposes, without charge. 3.4. Expenditure per activity - Indicate in table 14, the amount expended during the reporting period for each activity listed. Write the amount expended in US dollari using the current United Nations exchange rate to local currency. tndicate exchange rate used here: N I 30 to US$ I .00 Table 14: Indicate how much the project spent for each activity listed below during the reporting period Any comments or explanations? Activity Expenditure ($ US) Source(s) of funding Drug delivery from NOTF HQ area to central collection of commun 308 NGDO Mobilization and health education of communities 4,262 LGAAIGDO Train of CDDs 3,192 APOC/ LGA of health staffat all levels 2,939 APOC/ LGA I CDDs and distribution 2,445 LGA NGDO lntemal of CDTI activities I 769, LGA /T{GDO Advocac visits to health and authorities 2,300 APOC/N]GDO IEC materials 0 forms for treatment 242 NGDO Vehicles/ maintenance 1,859 LGA A.IGDO Oflice u e. etc 0 Others 44,809 APOC TOTAL 64,122 APOC/ LGN NGDO Total number of treated 552,441 persons 25 WHO/APOC, 24 November 2004 SEGTION 4: Sustainability of GDTI 4.1. lnternall independent participatory monitoring; Evaluation4.1.1 Was Monitoring/evaluation carried out during the reporting period?(tick any of the followipg which are applicable) I Year I Participatory Independent monitoring Mid Term Sustainability Evaluation / 5 year Sustainability Evaluation Internal Monitoring by NOTF 4.1.2. (a) (b) -* ""- ,- .*.*::::"'uation bv other partners Proper documentation of CDTI activities. conduct training need assessment and focus future plans for training on these needs. Identiff communities that need sensitization and sensitize them. Project should integrate and target activities on essentials for reduction of cost. Locrs should produce year plans that take into account community requirements. Monitoring and supervision should target on weak areas. DHS should be encouraged to supervise at their own level. Sensitize communities to perform their roles Encourage communities to support cDDs and select more cDDs to reduce the workload of existing CDDs. LGAs should collect their Mectizan from the State,. Train the staff at the next level only on areas where they are weak or lack skills. Increase HSAM in communities with low compriance in Mectizan treatment. Increase therapuetic coverage to a minimu m of 65%o. Target supervision of problem areas. Use checklist for supervision. Keep copies of monitoring report in the FLHF. Conduct CDD training need assessment. Target training on areas of needs only. The SOCTs should be trained on computer skills. Government should fund the maintenance of vehicles and equipment. Introduce the use of log books for the control of motorcyclei. Government should assume a major rore in funding CDTI activities by increasing its budget allocations and eventual releise for cDTI implementation. An MoU should be signed between Apoc and the State government detailing funding expected from the State. (c') (d) (e) (0 (e) (h) (i) 0) (k) (l) (m) (n) (o) (p) (q') G) (s) (t) (u) (v) (w) 26 WHO/APOC, 24 November 2004 t(x) Government should budget and release funds for the running and maintenance of transport and other capital equipment Government should meet the cost of suppry of Mectizan to the LGAs. writen health plans should integrate all hearth programmes at the FLHF level. Minutes of the planning meetings should be documented. Training of staffon record keeping at this level Government should provide transport and training materials for GDTI. How have they been implemented? Most of the Items listed in 4.1.2 (particurarly (a) to (s) are already being implemented as recommended. other items not yet implem"nt.d 1t; tolac) are being hindered by lack of counterpart support from the State govemment and other factors outside the immediate reach of the project team. The training of first line health facility staffwas fully done. Effort would be made to repeat this achievement in the year 2007 in the hope that the sustainability fund for 2007 would be released early by APOC. There is proper documentation to support Mectizan inventory at the LGA down the line to the CDD/Community. (v) (z) (aa) (ab) (ac) 4.1.3. laI (b) lcl 4.2. sustainability of proiects: 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 2004. What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.2.1. Planning at all relevant levels The State is embracing integrated planning for all PHC components which include CDTI. 4.2.2. Funds Since regular APoC fund stopped in December 2004 it has not been easy carrying on with the State project as fund were not released by the State, since inception oi programme implementation. Our saving grace is the release by ApoC and thore from some Local govemment councils. we plan to sensitize the appropriate functionaries this year to issue a new statement about the funding io tnut every year, the LGAs will release something. 27 WHO/APOC, 24 November 2004 !?.3 Transport(replacementand maintenance):The Ministry of Health is solely depending on the NGDO for maintenance of existing equipment due to its scarce limited resources. The NGDO is assisting in the maintenance of vehicle and other equipment. We hope that this trend will chinge. 4.2.4 0ther resources: Effort will be made to attract support and provision of other resources from theNGDO, local 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 d-esired due to unavailability of counterpart funds and the desired political will from the State. Despite series of advocacy visits paid to the Honourable Commissioner the politicai will is still notthere. Further advocacy visits have been reserved for the incoming administration asfrom May 2007. 4.3. lntegration outline the extent of integration of GDTI into the pHC structure and the plans forcomplete integration: a 4.3.1. Ivermectin delivery mechanisms 9PTI is being fully integrated into Primary Health Care in the state. Apart fromLGA Coordinator coming to collect drugs from the state store other programme officer are given this responsibirity provided their requisition is duly sig-ned by relevant authority. For other ad-hoc duties and drug delivery, such druls intended !r LGA is safely delivered and proper inventory tuk"n on #ivat at th;LGA office. The LGA in turn package the drug based on requisition from the FLHF and subsequently to designated communities. The process is very helpful in the state. 4.3.2. Training Trainings are 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 onebelow. with the system now in place more officers in other programmes are expected to be fully involved in training activities. 1.3.3. Joint supervision and monitoring with other programsSupervision and monitoring of CDTI are usually carried but-slae by side with otherprogramme officer handling disease such as malaria, schisto, NID etc. These officers are involved in more than one programme. All the personnel involved in health programmes utilize a unified checkrist 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 put in place, and those expected from NOCPiAPOC, it is hoped that befoie long itre Stut" gou".nment willoffer her support to the programme. At the LGA level, *i u." relying on the continual release of LGA fund as already approved by the State Deputy G-overnor and consented to by the Directorate of LocalGovernment and Chiehaincy Affairs. 28 WHO/APOC, 24 November 2004 a 4.3.5. Is CDTI included in the pHC budgetr yes 4.3.6. Describe other hearth programmes that are using the cDTI structure and how this was achieved. what have been the-achievements? Other programmes that are planning to use CDTI structure are NlD, malaria control and HIV. The officersin other programme in the State are working based onintersectoral collaboration. They hive shown a good level of commitment. 4.3.7. Describe other issues considered in the integration of GDTI.Joint Review of all programme officers at the state and"Lce levels. 4.4. Operationat research 4'4'l' Summarize in not more than one half of a page the operational research undertaken in the project area within the ieporting period. Not applicable. 4.4.2. How were the results applied in the project? Not yet applicable. a 29 WHO/APOC, 24 November 2004 sEGTloN 5: strengths, weaknesses, challenges, and oppoilunities - Lirt the strengths and weaknesses of cDTI implementation process. - List the challenges and indicate how they were addressed. Strenpths Availability of Mectizan drug. Willingness of State team to work, despite lack of perdiem. Some LGAs provide support which enfiances cDTi activities in such LGAs. some LGA policy makers demonstrate desired interest towards the programme Few available APoc motorcycles enhances monitoring and supervision ofCDTI by LGA staff. The NGDo's determination to ensure effective programme implementation. Weaknesses: l. Non release of fund by the State government.2. Lack of commitment by programme officers at the LGA lever.3. Lack of supervision by DHS, HFS and LOCTs.4. Fuel scarcity and its high cost following government's deregulation of the oil sector. 5. some cDDs refusing to distribute drugs due to non-incentives. Constraints I State govemment not demonstrating the desire to support the programme.2. High cost of fuel and maintenance of APOC vehicle.3. LOCTs at the LGA level are not commited to the programme due to lack of funds. 4. Lack of supervision of the programme by various key officers. Challenses l. Intensification of advocacy/mobilizationof key officers at the State, LGA and Community levels.2. Strengthen the empowerment of LGAs to initiate and execute programme activities without the involvement or prompting of the State Oncho team members. 3. Monitoring and supervision at least three to four visits to be undertaken by LGA staff/ DHS to be intensified.4. Regular meeting with LGA staff5. ldentification of problematic LGAs, Communities with a view to remobilize such LGAs and communities.6. Ensuring that Mectizan tablets get to the Communities/villages earmarked for treatment. 7. lntensive distribution of Mectizan tablets in all the endemic LGAs / villages8. Intensificaticn of CDD training on kinship level a l. 2. J. 4. 5. 6. 30 WHO/APOC, 24 November 2004 )How to address the challenees : l. New strategy will be devised in2007 for advocacy to LGAs by State. Emphasis will be to sensitize the Directorate of Local Government and Chieftaincy affairs to direct the LGAs to release the participatory fund of N436,000 annually for CDTI.2. Ensuring that regular meetings are held by empowering each LGA to host such meeting in rotation.3. NGDO- continuing support to the programme will also enhance cDTI implementation. 4. Encourage training of Viltage health supervisors / and conduct of CSM and SHM activities 5. Facilitate the training of CDDs on kindred level and increase the number of female CDDs. 6. APoc, NocP and the supporting NGDO are being requested to carry out high powered advocacy and sensitization visit to Edo State to change theii mind and orientation about the programme. This request is expected to be carried out not later than June 2007 after the nerv political administration would have come into power. sEGTloN 6: Unique features of the proiecuother matters None. a 3l WHO/APOC, 24 November 2004