Enugu/Anambra/Ebony NOTF/APOC CDTI annual project Technical report submitted to Technical Consultative Committe (TCC): January to December 2006

ll ENUGU STATE CDTI 81'II YEAR ANNU TECHNICAL REI'ORT ORIGINAL: English ANNUAL PROJECT TECHNICAL ITEI'OITT SUBMITTED TO TECHNICAL CONSULTATTVE COMMITTEE (TCC) To cL DEADLINE FOR SUBMISSION: To APOC Management by 31 January for March TCC meeting To APOC Management by 3l July for Serrtember TCC meeting t rl*,it*-, fcr fot JA L6 tgt, Mf Ao AFRICAN I'ITO GRAMMB FOR ONCHOCERCTASTS CONTROL (APOC) -LV 5itt cs[w A}IE r:, I I w) dG" COUNTRY/NOTF:NIGERIA Proiect Name: ENUGU/ANAMBRA/EB OI{Y I NOTI/APOC-WHOPROJECT Approval year:1998 Reportins Period (MONTH/yEAR): JANUARY - DECEMIIER 2006 Proiect year of this rcport: (circle one) I 2 3 4 5 6 910 Date submitted: 26 Janu ary 2007 NGDO partner: Global 2000 WHO/AI,OC, 24 November 2004 I I Launchins year:1998 IANIYUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMIT-TEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the rcport: Country: NIGERIA NationalCoordinator Name:PatriciaOgbu-Pearce S ignature: .. Signaturel Oate: .... I Y| c4_. Date: Z*/azl.e-oo7..... Tonal Oncho Coordirrator Namc: John llluwa -l ) I 'n) \) NGDO Representative Name: C.U. Maduka. Sign eg{:*l :f ,Date: This report has been prepared by Name : Lazarus N. Nweke Designation : State Oncho C Signature: Date 26 l 2007 rdinator il WHO/APOC, 24 November 2004 Table of contents AcRoNYMS..........."" """""""v DEFINITIoNS.......-' """"""""vr FOLLOW UP ON TCC RECOMMENDATIONS .......1 EXECUTIVE SUMMARY .1......""""" ERROR! BOOKMARK NOT DEFINED' SECTION 1: BACKGROUND INFORMAT[ON """"" """"""""6 l.l. Geur.RnulNFoRMATloN """""""""6 l.t.l Desuiptionof the proiect (bricJly) """"""6,................ 8 t.1.2' PartnershiP 1.2. PoPuLa'tloN ...........9 SECTION 2: IMPLEMENTATION OF CDTI""""""' 3I 31 4.2.2 Funds........ lll WHO/APOC, 24 November 2004 2.1. 2.2. 2.3. 2.4. 2.5. 11 1l TIMELINE oF AcrlvlrtEs """"""" Aovocncv MostLtzerloN, sENSlrlzATloN AND lluALl'll EDucATloN CovuuNttY lNvoLvEMENT " " " """ CePect'rY BuILDINC 3.1. EQulPueNr.."' OF AT RISK COMMUNTTI ... l3 es l3 .... l6 .... I 8 ....20 3.2. FtNaNctRt- coNTRlBUl'loNS oF 3.3. Orupn I?oRMS oF coMMUNl'tY STJPPORl' TIII] PARI'NERS AND COMMUNITIES " "" """'' 3333 34 Y :ru; L {-L t {E 4.2.i 4.2.4. 4.2.5. 4.3. I 4.3.1. 4.i.2. 4.3.3. Transport (replacement and nraintenance) Other resources... """""":""""""' f" ilr", extent has the plan been implemented ...,,,....,...37 ..............37 NTEGRATION ..37 ..37 ..37 ..37 ,..37 ...37 Ivernrc cl in del iverY nrc c hun i'Y m s Training Joint suPervis ion ond monitoringwith other progra"ts""" 4.3.4. Release offunds for Proiect aclivities 4.3.5. Is CDTI included in the PHC budget?....... ....37 using the CDTI stnrclure andhow4.3.6. Destibe .....38 this was achieved. 4.3.7. Describe others issues considered in the inlegration of CDTI. .........3838 4.4. OpennrloNAL RESEARCH 4.4.1. Sumnnrize innot more lhan one halfof a page the oPerational research undertalren in the Proiect areawithin the rePorting Period' 4.4.2. How were the result's applted in the Proiect? SECTION 5: STRENGTIIS, WEAKNESSES' CTIALLENGES' AND oPPORTUNrTIES....... """"""38 SECTIoN6:UNIQUEFEATURESo[T}IEPRoJECT/O'IIIERMATTERS...........40 othef health Progra'nmes lhat are What have been the achievements? ......38 ......38 .a la r : tv WFIO/APOC, 24 November 2004 AcronYms APOC ATO ATrO CBO CDD CDTI CSM DHA HFS LDC LGA LOCT MOH NGDO NCO NOTF PATHS PHC REMO SAE SHM SOCT SPIC TCC TOT Africarr Progranrtnc lbr Oltclrtlccrciasis Corttrol Annual Treatment Objective' Annual Training Objective Comm unitY-Based Organization Comm unitY-Directed Distributor Community-Direcfed Treatment with I verrnectin CommunitY Self-Monitorin g District Health AuthoritY Health FacilitY Staff Local DeveloPment Center Local Government Area Local Government Onchocerciasis Control Team Ministry of Health Non-Governmental Developrnent Organization Non-Governmental Organization National Onchocerciasis Task Force Partnership for Transformation of Health Systems PrimarY health care Rapid Epidemiological Mapping of Onchocerciasts Severe Adverse Event Stakeholders Meeting State Covernment Onchocerciasis Control Teatn State Project hnplementation Cornmittee Technical consultative committee (Apoc scientific advisory group) Trainer of trainers United Nations Children's Fund U ltimate Treatment Goal World Health Organization UNICEF UTG wHo EE L J'' ,L rb I t'"t; WHO/APOC, 24 November 2N4 Definitions (v) (vi) (vii) (viii) (ix) (i) (ii) (iii) (iv) Total population: the total population_living in meso/hyper-endemic communities ;,'tthfitf* pt"jA area (based on REMO and census taking)' Eligible oopulation: calcuiated as 84% of the total population in meso/hyper- ""d.rit communities in the project area' AnnualTreatmentobjectiv.e:(nl!}.trreestimatednumberofpersonslivingin meso/hyper-endemic i[ffiut'u CDTI project intends to treat with ivermectin in a given Year. Ultimate Treatment Goal (.UTG): calculated as tlre maximum number of people to be treated "nnuullyii'iffiyper endemic areas within the project area' ultimately to be reach"d *tt"n tlr project has reached full geographic coverage (normally the projecl;;riJ b" expected to reaclr rhe UTG at the end of the 3'o year ofthe Project). Therapeutic coverage: number of people treated in a given year over the total p"d,l.td(tht. th*ld be expressed as a percentage)' Geographicalcoverage:numberof.communitiestreatedinagivenyearoverthe total numbe, or *"r7t.ryper-endemic communities as ide,tified by REMO in the ;;;";i";;" (this shouldbe expressed as a percentage)' lnteqration: delivering additional health interventions (i'e' vitamin A supplements' albendazole for ;-p, icreening for cataract, etc.) through. CDTI (using the satne systems, training, 'tupt*itio'n and. .personnel) in order to maximise cost- effectiveness arrO emi'o*"r-"otn*unities to solve more of their health problems' This does not inciu?e activities or interventions carried out by community distributors outside of CDTI' Sustainability: GDTI activities in an area are sustainable wherr they continue to ffifi." "ff*tively for the foreseeable future, with high treatment coverage' integrated into the available healthcare service, with strong community ownership' using resources mobilised by the community and the government' Community self-monitoring (.CSM):. The process Ul:t:"]' the community is empowered to ou.iil*dilnito, the performance of cDTl (or any community- based health intervention programrne), with a view to ensuring that the programm.e is being executed in in" *uy"intended. It encourages the community to take full responsibility of ivermectin iistribution and nrake appropriate modifications when necessary. aE vl L F- b WHO/APOC, 24 Novcmber 2004 FOLLOW UP ON TGG REGOMNilENDATIONS using the table below, fill in the recommendatio,s oIthe rast'I'CC on the project and describe t o*it "V have been addressed' TCC sessio t ]3- MGTFOR I]SD ONLYACTIONS TAKENBY'I'IIE PIIO,IECTRECOMMENDAT'IONS TCC in lhe Number ol Recomnrenilalion yielded dividend' For instatrce, the state sovernor aPProved ih" rr,, of N578, 000 towards the end of the year as a result I unrelerrting Pressure the project mounted on the Hon' commissioner for health to Push the memo on counterPart funding to His ExcellencY. The same goes to some LGAs where funds were approved but not released. [-lowever, onty six LGAs actuallY t'clcasctl funds. These are Aninri, Awgu, Isi- Uzo, Nkanu West, Oji River and Uzo- Uwani. hasro,jectTlre p irancldoistarted ngsensitization and mobilization of PolicY makcrs to cnsurc rclcasc ol sufticient funds' Continue adVocacY'l19: I reviewed and is now realistic. However, the project experienced late arrival of Mectizan and this affected ReallY, this has been timeline. rnetin" and ensureReview ti it is realistic' t19|2 targeted to those who are new and also it bears relatiotlshiP to financial disPositions project TOTThe usualts lytraln ng of the Gprove'tOT trainingI l9:3 1 L {'L t I { F WllO/APOC, 24 November 2004 I it aThe project is sincerely doing its best in carrying out essential maintenance services within the scopc of its financial resources. Ensure maintenance of equipment to suPPort monitoring and supervision I l9;4 The project has since compiled a list of NGOs and CBOs within the State that might be of help in implementing CDTI activities in the state. ldentili NGOs and Ctlos active in the state within and outside the health sector. I l9:5 This is being done as reflected in this report and the project will continue to on this. Ensure up scalingof CSM and SHM in all communities. I l9;6 All the critical recommendatiotts made have been implemented. l-lowever, sonte implementations are continuum in the life of the ect. the recommendations of the sustai nability eval uation. Complete implementation ofll9:7 All these have also been implemented and reported as were indicated in Entrgu state CDTI 7'r' Year annual technical report excePt the census issue which the project has continued to validate and also a suggested 1 proposal on cost study which the project has not actually finalized. As a matter of fact, tlre recomtnendations the project initiallY responded to have no serial numbers as they now being indicated. I suggest that correct serial numberings of recommendations should be made available to projects in future. Even these current TC23 recommendations on the ect have no lmplement recomtnendations of T CC22: 122. l, I 22.2, I 22.3 and 122.4 I l9:E 2 l* t- t* L, r-ilIt r?I, WI{O/APOC, 24 November 2004 serial numbers.'l'he status of implementation of the recommendations of Tc.Czzare however as lbllows: 'Ihis is true but the project has been making genuine efforts toward getting acceptable figures in all the villages. The project has planned to valirlate all census ligures in all villages as corttained in the expected countetPart fund frotn thc state governtnent and also from APOC in the first quarter or in early second quarter ot20O'7. TCC 22: I 22. I - Ccnstrs is not well done everywlrere which explains the changing denominator. There is a need to establish a correct denominator. The project should allocate resources and priority to cnstrre a rcl iirblc clcrrorttinator Certainly, this does not include time. The cost study guide has been applied as can be seen in TCC 23: I 19 below. The project is still working otrt the proposal cletails. TCC 22:122.2 - Cost per treatment is 2 cents (it seems this does not include costing of time). The project should apply the cost studY guide as an interesting case study of a mature project with high coverage. Perhaps this could bc submitted to 'l'CC as an operational rcsearch -l'he projcct had already applied it in 2005 distribution even before the TCC's suggestion as can be seen in both years' Ttlt and 8tlt 'lCC 22:122.3 - Suggcst continuiug supervision unttl the end of tlrc distribution pcriod This is well noted and the project has followed the suggestion. But a situation where the Radio Nigeria Enugu offers a free air services to the project to mark the Oncho day this may not therefore TCC.22:122.4 - For social mobilization purposes, it nrrght be ntore effective tf "oncho day" activrties are held closer to tlre acttral distnbution time The project is collaborating with GHARF president, Professor O.C. Nwaorgu on research. Identify operation research issues and partners to collaboratc with I t9,9 t"- :" L f-tL I t {} 3 WHO/APOC, 24 November 2004 We have met some toPics have been articulated. We hope to come uP with soon and The previous integrate HIV/AIDS has.not worked out. The project is still thinking on any other feasible add-on effort to interventi ons. ldentify add-on interventions I l9:10 othcrissucs that'tcc23 highliglrtcd ascont:tirrcd in N0' ll8 nrc atldrcssed as follows correctness of datn in Table 14 ncerls to lle verified: The amount or rnon"y trr. p,oj."t spent for activities has been verified to be correct' ,thereportingyearshouldbeclarified(coverpagestatesTthyearwhilesection 2.6 shows 8th Year): This observution is apptauded by the project.The data for the year 1998 should not have been included in the report sin"eipoc was launched in the project in 1998 and the first year-annuoit".tni"al ,"po't *as therefore in 1999' Consequently' the year 1998 data is no* art.t"O. ft. pio.i..;;p"- actually reflects 7th year' Thanks' o cost per treatment should be provided: The cost Per treatment is $0' 104' a L- 4 WHO/APOC, 24 November 2004 fiff T..;,H":,.T,T ffifl" T::,, i mpr e m enteq !I .E n u su State c Dt proj ect in 1 5 out of 17 LGAs in sthllo, from Januao'i"'tt;#ilr zo6o. iilr no* three and half vears th*IpoC*ufuut"O ttte project (June 2003)' TheoartnersfortheCDTIimplementationaretheAPOC,G.lobal2000,healthservices(atthe Federar, State and uix j"r"iri""a "r"nlJir#ir'"rr*La r.iil;r. The activities which the project imptementeJtffi;;i9'n"rr"a i,"i;;;;il u" ai';tu"v' mobilizat'ron/ Health Education,tralnlng,drugdistrib,li"l',,."""i.",ingands.,p",,isionaswellasothermatters which included impact afsessment of ivennectin treattnent' 948,581(29.57o)peoplewereregis.teredforivermectinlreatmentoutof3,2l5,630estimated State,s population. "fiJ;i';r'iizi 1ry9i;":;';;;;"i" "ili;;;' were un'rer treatment' rhe basic unit used forii" r"r".tion of cpis'in e,nueu state.wal"vi,og" and they totaled 1373' All the 1373 villaee' *"" treated Y;; l6'iF;:lq':lt''"p'*'"" 100% geographic coverage. ,n" ,,,?i",i fr."*9", Coal (UTG; so'n-"--iitt nnnuat Treatment Objective (ATo) was 7e6,80;'-;;i or tni, o .tr'If i'sl,8al(e8lv'l poto-n: Y."lt treated' The therapeutic .or.ru[J i.,ui .ona, ^, r\z'nl' n-t,or or z'roo'oo0 Mectizan tablets were received by the ,t'J.-pro;".t from cr"u"i ,OOb-auring ,rr" p.ii"o under.rwiew' of this ouantitY. 2,333,g33tableti were used' There was no "pon of any case of serious adverse lr."it tia'es) irom Mectizan treatment Thepopulationmovementsaccountedforanumberofabsenteesrecordedinthisreportand these were pr"a*inuntly migrant rur*""rJ in" t'un'rt' o'' pltiing an promotion of LcA staff especiatty r_ocr uni Hrs o""o*,J to movemen" "iai.'"* pi,onn"t during the period under review' TargetedtrainingofCDDs,Fle^altlrfacilityStaff(l]|ll,""dLoCTswascarriedoutintlre project u,"o. o'?;^:{o ;}3o"t'b'';fl % 1":ll"**il*, }il'"JlTd}Xt:i ffi:iLI,m5ffi ]"":#f f!il3']""*T:H.*;?iIo .'uin"i rhe totar population t""**'"1ty) per CDD trained was 276' ThemainchallengesfacingtheprojectarecontinueadvocacyvisitstoLGApolicyand decision makers a-s a result of frequ#.ir""g.r, .ontinuouJi'"arlh education'mobilization and sensitization for long term corirpliuntt io trJatment; sustaining enthusiasms'in' the communities to cont-inue taking,n. jr* i"spite impro'"J n"itttt status; training new health workers in the LGAs occasionea uy ,tulrt,ansfer; t*puniin' cst't uno sHM at community level; poor *f"IJ" "?""r",Lip"rtfrnO UV itt" .ot" Co"t'"'""""t and most LGAs; and getting more cDDs in all villages through il;ir;ii"^ of kindred system of distribution' 5 :' { 1- I ;t" {' L f,L r # WHOiAPOC, 24 November 2004 SECTTON {: Background information {.{. General information 1.1.1 DescriPtion of the Proiect Enugu State is geographically located in the Southern Zone of Nigeria between 7o lo,N and 7" 45N of eiuator, and on longitude of 7.4878"8 and latitude of 6'4231"N' Enugu state is bounded on the North by kogiiBenue States, on the South by Abia/lmo states, on the East by Ebonyi state and west by Anambra state. The topography of the state has two marked zones, hilly or mountainous and flat zones' The hilly zone stretches through sii LGAs (Awgu, Udi, Ezeagu, oji=River, Uzo- Uwani and parts of lgbo-Etiti) while ih. flut ,on" .ou"it the remaining part of !h9 state' The tritly nutur. oithe areas mentioned above gives rise-to rapids and waterfalls that exist in ,nort riu.r, especially oji, ogurugu, Ajali, Duu and Kalawa rivers. This favours the breeding of Simulium damnoium,which transmits river blindness. The bioclimatic zone is rainforest in nature witlr annual rainfall between 152 cm and 203cm. T he climate is comparatively equable and the temperature ranges from 72'4"F Q\.z"C)to 87.5"F (30.6"c). lt is the humidity rather than the temperature that causes discomfort to newcomers and is between 78Vo and 95Yo. lt is generally cool during the .uiny ,"".on while the mean temperature in the hottest periods of February and April is about 30.6oC. The state has a land area of 7,617.82 square kilometers and a population of 3'215'630 peopte. The activities of the population of Enugu state are farming, fishing,hunting, petty trading, wine tapping, basket making, poultry ke.eplne and rearing of domestic animals. With regardi io tii. main occupaiion, which is farming, the periods-of major commercial activities run from November to February, which is the period for harvesting and land clearing fbr cultivation' The people of Enugu state are of Igbo ethnicity hence spla-k Igbo language' It is a tribe with homogeneous cultural and linguistic origin. 98% of the population practices Christianit! as their major religion *hil" tt " retnaining belongs to the idol worshipers and other religious sects. The main communication systems in the state are by road and air. others are through post offices, courier services, telephones and internet services. within the state, the only means available is road. tutost of ihe roads are inaccessible especially during the rainy season. 80% of the villages exist in remote areas' which are difficult to reach' The state has l7 administrative local government council areas (LGAs). of which' l5 LGAs are hyper/meso endemic for onihocerciasis and the remaining two are.hypo endemic. Additional functional3g Local Government Development centers (Locl was created out of t7 LGAs by the State Government. Each LGA consists of communities with administrative head called lgwe or Traditional Leader. Further, community consists of several villages with administrative head called village head. The basic adrninistrative structures are the State, LGAs, Communities and villages. 6 L'E Wl l0/n I'OC, 24 Novcntbcr 2fi)4 The state health care systern is built on the basis of the rcsponsibilities for state and local governmentr. rn enuJi",;;;,i" r;i[t.vrl""1as evolved into district health system' This district hearth sy-stem is made up or.z Jirtri"t n"urtr' Authorities (DHA) but still based on primary ,J"r,-rr'L*" t*ai.. r'ne^.z oittrict Flealth Authorities (DHA) are Enugu metro lenugi'ioJ1f,,-ilrg, uout "n;'E;,'g, East I-CAs), udi (Ezeagu and Udi LGAs), Isi-Uzo grr-Ur; i6el,'r"ougu-nl*. tGOil\olh, lg6oeze South and Udenu LCAs), Agbani N;;;; JnJN6nu w.ri ilcno and Arvgri(Aninri' Awgu and oji- +l'.':,:Sfilernment uphords the svstem i:ly.lill":::"::-;";;T,T;;5:ll';;:lt'on for meeting tt. t "uiii "'ui. nr.O, oith, ffi;;iv;iittt ptoptt *ithout under rating the interJinkages with ;;;;;d."ry una t"rtiury'n-*r,(.".rg levels The PHC system operates at state, local gou.rn*tii, Ji'tii9t 4 tg'"'t*ity ttn"tt hence the integration of onchocerciarir rontroii.tirities into the system...PFIC services in Enugu state are detivered through il:;iil;;J;;i."iilr clinic and health centers in l7 LGAs' ln the proje., "r"", ,irr.'*.i, " aa.r "iisjt-rr""r,rr centers/posts/clinics in the state' This number reduced from what it was f urt Vtu' Out io ltotu" oi fout facilities - one each in rgboeze Norrh ""d;;l-;;; uca, ;,r t*li" ieu*ir,i !9A. There were a total of l'609 health staff in the project area and "Il[i; nu,n'b"r, 1,235 werc involved in cDtl project' More health stanweie inuotu"o in cpii i'h;;rl"riyear' The breakdown according to ;;;i;rt LGAs is shown in the Table below' Table l: Number of health staff involved in CDTI T- :-l:,r t* 1*- itl g' & t fT Nurnbcr of hcnlth staff involvctl in CD'fl nctivitics' l'crccntngc *l Nutnbcr of hcnltlr st'.rff involvcrl in CD'I'I Total Nurlrbcr of hcalth stnff in the cntirc Projcct arca LGA 84.24857Aninri 84.990106Awgu 83.36578Enugu East '13.2l0l138 Ezeagu 82.6il9144lgbo-Etiti 8782 Igboeze North 92158lI[boeze South 85,35868lsi - Uzo 't 4.183tt2Nkanu East 83.51l85Nkanu West 73.480109Nsukka 89lt'lOji River .28628Udenu 63.69lt43 udi 65. I9't149Uzo Uwarri 76.812351609 7 WHO/APOC, 24 November 2004 1.1.2. PartnershiP Four partners are involved in implementation of GDTI project in Enugu state' They are APOC (external Oon*1, CtoUut iOOO INCOO), health services (Federal' State and Local Government levels) and oncho aflbcted villagcs (1373 in nurnber) The overall working relationship among all the partners was satisfactory as evidence in the success of the distribution during the period under review. The specifltc areas 9l proiect activities where all the partners were involved are planning, training, mobilization, advocacy, drug procurement and storage, distribution, supervision and record keeping and reporting. There is plan to continue rnobilizing the decision makers at the state and LGA level including Health Sr;i;; Irund, cred-ible NGos such as Global health awareness and Research FoundatiJn (CHann'1, influential and reputable persons in the community through advocacy as contained in 2007 sustainability plan. 8 U- WHO/APOC, 24 November 2004 {oo cl ko ,o trt) oZ + crl oo o F o\ F*o\F- r-- ttr| ooo cfl lrr F- or.| rn\ao @ co GI N Orn osf rat r,-| l\o rr cn\o Olrl ao o\O @ o\ o\rr| r- c.t\o ca\o rrt r o\l+ o o\ ra r- tflo\ o\rn o \o TE:E hc, ;)! @O \o € o\\o oo\o \oOrf O\o + ll .a)itr .E &R st E'= EEEEl Cl coo'\o @\o @o \o .+ a c.) lr) l=f, do c.l|rl <f \or-r- o\r^ .t cilO €r- O oo e.t ol\o r ol \ol\o <.c- <f or- o\ocl r- rr) 0lo rr) od'lrr € rr) 6 rn \o € F- @ rrrr- lnr- oor)r- rrtr- @ cOr- oo c.lr- c.l\n cn tr- co ta) ca r- . .3 Ei.'= e 6o E EgCLar'r I\.El o oE 8 E'gNo. rr) o\!f, \oo{ O\o .{- c.lO oor- \or-\ o\trt rrt c..l 1d Iro O@c\ Ol\o o\oc\ r-in sf rr$dr- \o ooF- SEf6 a) t, He o E (ar- ?a \o\o o v)c.ttr-o\tCA t'-F- \o(.)o\ao,t Oo a.l si'(.{r oo o co () EoN (-) o € o I I a)q €oq o E EI st o 1F -f, =F- \o\o o ooo\tr) O :t OO I $ c.llri oo O eO t) oN (J 1) o 9E ec! o\N\o cOr-r-rr \o cA $ caOtf,o\ .{. o\ooCOI EEe6 Ee EE E A EI oo o tro! EI z @ O \o oo o\\o 6 + cilO odlr- sfO ca tr}$ \clr-\ o\ lrft tr)(\ \o\o o ooc\ olro a\o c.l t-- ra) $r- n^o i r-- oornr- rn r- co rn 6 rr) @ c.)r- \o oor- c.lrr) co r- '= og) =E-Eij o. ",EEE 6to sl oN;) i F.,' o F{ €D li C) il o' tr(l) '15 D ar',(l) )c c,vz d J4JZ u')z U)d Irl a Gt .v z ,( ao(n q) N c)o -obt) oND I rr, troz(l) N(l) o -obr) 3 bI) cloNttl P an((l iq L.d tr oc)tqoqPc '- cL 9){eH F]E to L.oa botr tro&(;) L. (l) -c botr l- 'o od Lo € C) cl C)Lr C)L(o >t G) .C L. 0) .d 0) B tll c) 6l q) 0) o 9r q) L q) () -c ;6 'E (d o d =,Jo.oo € dtr3o'E .- '= -a tiiE25Es5O() 6ll . J9ls! €lFFI Ly I ottooN 3<t) .o E! l) o7 rf,N oo o< o E 13oo €€E.g (l)d t- (\l Eb oLoEas "6h ct ri *.50, i<Ltr(l)E 'GtA(H6oE.: -c J Bqlai .p.E btl t!3 Efil=l - t, 'r:'ac)to'= 9 -IY ='a(J:-. (It tr.a.- xgdo.a >. '-= (H .EoF{EE+. =qrclitE9A!L!L 8E Eoh.9L €se- u, ct O.EE. a(L)-cl9Eg .-UV.E .EE.B .E99 Gl vt Clt78ra odqA)B -a-3e€ cttrE99dP .= oo,; =I E *X ;I r- >X q)I o -T hl.s ;e EtE.hf :I E FA EI O -cH !I o e(H 6lI e .E3 Et b E= eI ; 83 .=I E oo9 tr ..t -e '85 I .= -oE O4-:-GlH EEE! ee EhgE 6r - str.oE I e.E.fi: g >rO E rtsE't I :E.o()av, cto 5ottt lr ru .c o c..\0)l ol -on :E3\rdl9t c.llEI El dlHI €-l(,)i €3(H(l) oo 8EE6o'E(,cl az. I :a 9l Ed EU) dzH* s $ql 'o\\qr .s a) !\ '\Iq)\ 3 o \) S+rs d'6. IsLt!i I$Bt\t Iqr-$ I -tri I:r ^l\G 9Ssi Z hO'Er IG$ I st I lB =l *e E' rabEE Er^O +![IB aoEF .EEi E EE g3t e A$fi()f *'s 10s\ .i\9 Ati: € rQ !)3E FSt E s: +. -s c)Eu'3 .FLH5$ trtEi c,u-E.g EEE EX b" -u' Es B FT :st HSE B LJ oz SEGTTON 2: lmPlementation of GDTI 2.t1. Timeline of activities Fill in table 3, tinteline of activilies for areas trealecl in cttrrent yaar' indicating.when the key activities were impte**t"O by the month they began and the month they ended' 2006 CDTI activities commenced Enugu state in January and ended in December' Timeline of activities vary from LGA to LCA as can be seen in the detailed Table in the next page' ; = H, lr ilI,, I I rI tr; il WHO/APOC, 24 November 2004 sfooN C) -o E 4., o ztNdo Pr o OD 1E GI 'O r<a. .o rr!oo 69 rcto. €((lEE. .d u,o 9ctb'ootr!eEe t) +jBbeU,E .E 'E o 0,) =C'JL .n -ot-\ ttH 'E ct a€dEtsGlEBE& .o GItr cl th a .A F-oo c.l .t) o C) 'a rr o. c) botr oLo.o.(q () ro tJ7troo 'o o -car1 C)o o{ AEtrEl(uq)()Eq:E95;Utri r. ., o,r+.. Eot- 9ri €r -c =clo -c 6 n oU oL o E o0 tr c GIL an C(t ,co .tt E c)trE Cd p. tt) cl tr C) -s4d ts(l) 'oc o o)L. rut tn() Io(! C\ (l) rA cl o)q o EI € 6l €q) EI clr t) GI EI c) .:t 6l (l) €E oLq) tB IAq) (J ct 6t .EEtr .-! Gl5 tr-, *Eq) ul do ]A v) E() Lttr o) (rtt) EE o) ar, 6lo F{ Lj @o dolo (oo dq) o (oo ioz (oo ioz (oo@o ctoo () a dtl,lo EIo5E AE EEI (oo ct ola (oo (l, cl .., ()o() c5l-) (o o ol= Q)c l (o o a - ()o ocala (oo o oc :, .? !oL(u HePE 6=diE .oo o l= (oo doo @o d o)o (ooj oz (O o io z- (o o oz d o)o (ooj olz dq) o (o oj oz @o ci(l, a d o)o @o ct o(t) (oo o (oo o)c :, - (oo Q)CJ - (E (l, c (oo o) - @o oc a -, (oo q) E5 -a @o o- .HefElH9tiE (oo o = (oo q, E:, - (oo ocJa o)c :, o,cJa (oo !oL G = (oo ocl --)a (oo ocl -? (oo oc5 .? (O o L o-l< EIo EEEEoI (oo o (o C) (o o oc :,l-) (oo q, c a .., (oo otra '-2 (oo (o i> (oo q) cf '1 (oo f - @C) o,c :f,t-: (oo ocJf (oo ocJl- (oo o o 6) P]ta o tr c)(J "E'e.Fcc= aE ocf a 0)c a? (o o 0)c :, '1 (o o(,cf,l-) (oo (o o(oo 5 L-) (o o o)c: -., (O o o)c :f,la (O o@o (It rE (oo L o- trlo .,PAE EEU (U o,c:a (oo o,c =-? ocf --):t - @o o,c =-) (oo oc fa (oo o = (oo -co(! l= E"e .FE GI: T;E (oo oc :,a (oo ocf - (oo ([ l= @o o(o @o C'c a (Oo o-t< o,cf o gE BOEEo(J (oo G -ootr @o (oo Eo o = (o o co - (oo .co o = b! E 6t(o \oo l,i!) I& o tr o 6t N ! o13A Fl t-l o Fr E;) .E (Il BD oN;) GIlllz th z L.o .:& o' tro € oN I v, P .a G, EI cdJ4z th(l) ) cl A4z .ctro7 G)Noop bt) -q oa C)NooI o0 I ./)(Il rJ] bt) tr rI1 bo(! C)N rq t-tr E 3 ao B(J FI e c:Dtih =o 6) c 15 o)(rt o)L ar,(R' OJL(lt c) H t< ,o u,o Po GIt+{l o otr o Ei: t, p2.2. AdvocacY six policy makers were mobilized by the project at the state level"I'hese are Hon' Commissioner for t eatth, permaneni Secietary and Directors of prirnary health care, personnel / management and financeisupplies as well as chairman of Local Government service commission. At the LGA level, 22LGA/ LDC chairmen were mobilized by visiting them. Other chairmen could not be reached in their offices but letters were sent to them' The reasons for undertaking the advocacy are as follorvs . Some of the StJ. ;fLGAs policy inakers were new and not all that knowledgeable about the coii prrirosgphy and endemic status of the state and LGAs but were aware of Mectizan distribution. For instance, in the ministry of health Permanent Secretary were changed thrice and commissioner for health twicc and Director of personnel management once within the reporting period' . To brief them on the sustainabiiity plandeveloped by both tlre state and the LGAs at the end of the piogrugo"'s "ralu"tion in 2003 and tlreir roles and responsibilities' . To seek their *pportr towards counterpart fund provision. The outcomes of the advocacy were not comparable to the efforts made' However' the pr":*t succeeded in g"iting financial supporti from a few.LCAs and in creating awareness about the project. tn i'odition, the State Governor appr.ved the sum of N578' 000 towards the end of the reporting period. This money was yet to be collected due to series of protocols and unavailability of accountant general' Ditl'rculties/Constrained being faced . Frequent change of poiicy makers at both state and LGA levels' , Delay in releasing the counterpart fund or outright non release by rnany LGAs' Suggcstion on ltow to ittrprovc :rtlvoc:rcy . Visits to the decision makers whinever there is a change of leadership at LGA and state levels with directors of public health and /or finance. , Appointing top piofile personalities to advocate for support from State governor and other influeniiuigou".nment officials at the state and LCA levels on the issue of counterpart fund release for implementation of cDTl activities. . Direct contact of top officials through mobile phones' 2.3. Moblllzatlon, sensitization and health education of at risk communities The use of media anrl/or other locnl systems to disseminate information Radio was the media employed for information dissemination on onchocerciasis and its intervention during the period under review. Radio Nigeria Enugu allowed the ;;"f; one hour air time without cost on the occasion of 2006 onchocerciasis Day. This afforded the state oncho coordinator an opportunity to talk to a wide audience' Other local systems that were used in disseminating information at 1373 villages were town criers, church announcements, school announcements, vi llage/community heads, village/group meetings and market announcements. These were usually used at the begiiniig oithr distiibution or at any stage of the distribution where necessary. l3 WHO/APOC, 24 November 2004 aaU a) n o , o a, bo !a I I Eo o aloE z olol ll rl .ii tr' ob!qt o o F< r'l lrl r= oq Or- q r- q(\ \c) q c.lr- -q o\\o c.l .+ F- <2 or- oo + -f -q c{ r-. \ ao \ o\F- oq o oo cl F- rat a? \o al ra\o l la E.g t !EEE $(o C\lo) c\Ic{ @F- Ni- sCO (o(o @N r(o r-o, (o :.-s o)rr) loO) o)s rO o)(, .E, o o E (, 'E a Oaa(J o D E az o , E Eo tEt + e il e c o F. 1r) c\l N(o o@ cf) @ CD oo cf) o cnN rf)Nr r-. c{ c{ @ (f) rooN r.- (f) oo c{ I-$r o o,r o cf)s ot- Nt!t(iI cq 9-c6Eii9 al N c\I f-(f, r-o) o)@ @$ o, @$ @ roo o).t srr) o)(o osr @ ro ?alf} FA aaug a a. @\t r @ rf) e.l (o (f)oN oc! i-r- (o (f) r N o) sc{ C\lrc{ r|r) (acn rc{r o o) C\I Nr r o\r-N al oO la) @ ra) @ aI la 6lIL 6t (, o r J oato o. q qql 0 1)ll Eo E o E0 o tr a E o o og ' L ll otr E o t l)lt o a)! E U !r E Eo ot i O a,!aa 5 a) a E E o o oo z Oo oo oo Oo Oo Oo oO Oo oa Oo oo oo OO oo oe O c.l ca $(..l oo o.!f, o.$ o\ oo o -+ O .+ + ca $ cf) \o c-l \o c.) o\ rr) o\r.) r.-I c- t-- c.t r-. \o\o o oo att r..(7t -F (.ttr rA o cft r-l + c.l oa o\@ c.lF- \o\o o € Ltr tr bo B .i ct rq)h0 tr EI bo(o(u N rll PlllIo -obr) B= $E (l) B,cots &B oND t) al,(l rll)c cl JZz U,(l) =cd -vz dJ -)l an z t<(.) .zil o' tr 0)!D t .E cl BD oNlp d oF COooc{ Lq)o E(.) ozs6l L,o o. o \o FoU ('){J .tr Lo.tstrc o.E .= g,0'5 ,.EFLi -d'- ii +ro F.E - LJaEEtrELo(.iCl):. -i fllG{ fll {r t -too c.l o .o E(, oz * c\l QoA o :( > t-.- o aU kor\o oil\o z(H o E aD0.5\oOOU)OEc{bI} .E \aou €os, t)(rg U)sl AE OJrpaohEU.Etr.ooc) l9}U AHoD $) .E;Bdobo tdE.= -. bo ar ctFL -tr/ J ,\AEFD0Ei t u .E; E EB-c o ad)qqsES € E a'- ! -c O'- v 'OEb ? s:\>oo:o -o E -41,6 E 2oJi 0) xEB E U E-oJq,>fllboH oc-6l(lJE.E E EH8 e q - tr (r-:.EgE :f;8EE €EEEfr .VZi;€ E.E: € E 3t.EE-E .gEEf X ! q'6 €€ EEEH.^PX ?H.;tr S Xq9 * € €.8,E5E EEEEE :g€E (u c 6t E-o q) H l-. (rl-d - trl o 9E >EEE gE*Eg,E E3fl o;U; , b o!)969Btso *o)yb0 H.E EEE .E q).Y 'ikPE9R ..8 E E. :fi Horc) 'tr [r{ 'o3;.p rfl s -u P * H*l't'E #t Es9ep9t:t "Ets Hr gErcJ'( odLoE0)boH(r(d I o59t= >loax;;6 Efi()o.H)- o=9!H6.o.^E 'td ,a 5' 6 HEE66) d --{ (,r-ti(t,d6 !J o.r- Efl€ B ok96'iti s .r&qEd- E f,o o o.=)..o o-l !EgFP Eeae 'd.E u qEgBI or o o(-lE'E cOf o (€ iiL otsv € r.; b HiEE EiExtsF6dAa-d-o'XnS E.E FE .HHd .tsE=su!p > 5H dE E €> E b tsE #EPcl oq)e hI)(l)d -e'E =d)g g ttt5E ,ts8(a u,oo) 'F L.Eo.yg tr.9 &EO.'AB tbo(1)(g '6 '5 Bo cl- €-a (,N oi6 o t{-Qd(H oOO(.l EV ,cl -o0)e -d(€Fg "; .ts o5ogos la V) 0)=tboe5 €trgrl] a- 6 e'EQ-9u 80H -Hg dv'a o .Es $ <a (r) aO< U)5.*O 'E oo ::ti()E 5".r E GS? oo\J-o\Ol >c! oQN * Uq oE:; r- ai\oy 0)vl!)ra qt- V(l) (l)IJE$()E=s3 >9Efx 52.5. Gapacity building - Describe the adequacy of available knowledgeable manpower at nll levels. At the state level, the avaitabte knowledgeable SOCT was not adequate. The state team is currently made up of three persons (statecoordinator and two SOCT rnembers). Two SOCTs were transferred lo district irealth board as part health system reform going on in the ministry in the first quarter of 2006. However, the authority of ministry of health had approved the transfer back of one of the SOCTs after the intervention of NOCP officials during the data collection and management meeting in Enugu. The affected SOCT would join the project in- 2007. nt t6c LGA lIvct, thcrc arc irratlcquatc numbcrs of available knowledgeable LoCTs in some newly created LDC in the state.'l'rirnsl'ers and retircnrcnts al'lbcted sotne LOCTs and Health racility Staff. For instance, three LocTs and some nurnber of health facility staff in the project were retired. At the community, the ratio of CDD_to population is still.inadequate' Some 6ld knowledgeable CDDs had continued to disengage from the programme by way of old age, death, migration or tired with the programlne' Where frequent transfers of trained staff occur, state what the proiect is doing, or intends to tlo, to remerly the situation. (The nrosl itnporlunt issue to describe is what measures were taken to-ensure adequate CDTI intplenrcntution where nol enouglt knowledgeable manpower was availabte or if staff are frequently transferred during the course of the campaign). . Appointment of 7 district health oncho coordinators to man the 7 district health system created with a view to bridge the gaps due to shortage of SOCTS as well as sharing the LGAs between the two remaining main SOCTs. For LCAs, there was at least one main LGA Oncho coordinator in each old LcA who oversee the cDTl implementation. New main coortlinators and a numbcr of other nerv LOC"I's members in 56 LGAs ILDC were trained. . Recruitment of a youth corper to strpport the state team' . On the spot training of new untrained HFS was adopted in some cases. Besides, those not formally trainel HFS were given a written guide to acquaint them o1 what they should know and do particularly on how to mobilize villagers, train CDDs and distribute the drug. . The remaining Cbps were pleaded with and encouraged to cope with the workload pending the recruitment of additional CDDs' . in future, the project would involve all the health staff by training them- on CDTI activities if fundls available. The HOD would appoint new LOCTs and more CDDs would be recruited based on their kindred' L r i L r L rt -!. l8 WHO/APOC, 24 November 2003 (oooN () -o E() oZ lf(\I do o- so l|<B o\ tr o (o tr(:) E C) a E F oUq o at o o P otr e E o I(d o0tr c clLF ,iir ol .ol cllFI tr t .l trlcl o\ tcl \Dtf o\int \o rn o\ ta) lrr cO N (.)(\.laa c{+ o € € o\ra o\ ol O CN + 6rrl tl ol € ctt € € o\o €+ t ca c.l o\ € N :- o\ c.t ri\o \ot- o o O oF- N ?a)rc(.l o\ \o al s r-+ oo\ oc.r<t r- (o =tral \o 't oo oo c{ F- c.l c..l @ t.t o e.l Oo\ c.l N 6 t o € co o\ oo ca o t- ! u d cF tq (,) = c.r o ra) O ro o o o o : o o = o o o o o o o o O o \o o \o o : o o o o o O o : Lo o o o o I U a ot{ b'q z o\ i. o o\ = \o ?a) o so\(\ ooo..+ o.+(\c.l(..l r-r*o(..l coOs (\O$oOc.) F-$ r..\o(\oo\c.r ..|o. alr-.co?F rr)6l rhF oF .Ao(l) E 6t Lq) o oL o)E a z o 0 (u 6lL <t r* tr- €\ N rAt e) O :? rr) l=r t € c..l CO(\ \o :. lr- c.l cl \o 00 € a.l + h @ o\ c.l o\ o\ O I U 6 oF Uo( = € t.r Aa) E €,) C) C) s 6 e\o e.l o\ c.l ta o\orl\o oo c.lN(.1e..l C.(\re.lsf ca o\c.l @ c.) o t< o 6t0) o r.o! z o) 6t 0 c.l (\ o O o{ o\ : l. o o co c.l o ] (\ o ? o :_ (\ : lc.l c.l (\ Id d oF q * oo te o \o I e.l \o oo@ oo \o\o o \o \o co \ooo cA o @ oo o F \o 6l o U, (J {o q, an e o (uE z q) GI F] tr oH s kq) E, ro' E(uED E 'a cl BD oND Ptn ad rq ttr Rtjz z atq, B 2 (dJlz dll ,!4 th z a)o -obo -cEo z q) N 0)o -oho -c aoa oN C)o -oI 6ItIH oN th litr trl ho B t) d Irl bI) tr EI )bI) cl C)N rrl (J rl q) A \oCO o Table 6: Type of training undertaken Any othcr commcnts No 2.6. Treatments 2,6.1. Treatment figures The project has continued to sustain a therapeutic coverage of above 65Yo as well as 100% geographic coverage for over six years now. Trainees Type of training CDDs Other Community members e.g Community supervisors Healtlr Workers (frontline health facilities) MOt-l staff or Other Political Leaders I Others(specify) Program management ./ ./ How to conduct Health education .J "J .J Management ofSAEs ./ CSM ./ .,/ SHM ',J ./ Data collection "/ ./ ./ Data analysis ./ Report writing ./ ./ .J Others (specify) 20 WHO/APOC, 24 November 2003 t .s oo c.l L 0)o E 0J ozt(.1 do o{ o J< ci o eO oao oooo Oo i* o BEE a E3€* a'EteHsE orii o>ooOL eo oO Oo oOo Oo o El tl, o o .otr B O 6 o\ + co cn$ $|rl$<r l--o\c.)\o ca(\c.lcf) tnlrl$r- \orrtc.lrat o\c.t <f o oo co -od cn r- O O NO \o c.lO oO Oc..l co o o .o Iz e*EE q c.l@ \o ctaca ca oo oq ct@ -q c.l oo n\or- q ca oo \o co@ + oo oq \o € c] oo 9 co co ,a.l c.-) € q c.l oo \ oo ca oo I a o '5o:, bl)o d^sbs ooEO lF" rnO cA O ta1 (\ O\o o(n F- o\ \o r o\ l o\lr) rr| OO oo co -f o\ c.l latlr) r- r- o rr) \o\o c\l o\{ -+oC\ r- ra) cA c- oo r-+ F- c..l oo(\\o o\\or- Orn F-\o(\l @ tat r * o\o oo ca r*. ( cr1 o a-b6Ego6 E[sz \o o\r- $r- Or.l ooo cO r F- o\F- r-lrl O$v} r\o r rn o @ cn rns ,TI lr)lr) rrt ca\o O v-l (\ c.l o oo o\ o\tr) oo o\o oo$ rr co\o ca\o rr) ral o\$ t-- coq o\lrl o O \o O .+ o\ lr) c.l EEB €o \o €q\\o oo\o + c.lo oor- so co rl.)\t \0o .t- a\o O oo c.l a\{) \o l-*F- o.tr| +r-q o F- o\o c.l t-t rat tr) c..l \o\o @rn r- rnr- oo \ € ra) colr) cA F- oo c.rr- c.lr- \o co\ e.l .f i* EE6 Eg F{ oooO oo aaoo Oo OOoO Oo OoOO oo OoOO <>a I a E .9o aU =dF^bsEb>v8E(, oa \o\c) O € rar-tfl t--c- o\ r cnF- \o co =fc.lo\tf o\co ortco tf, c.l aorat € O c.l 0 o -o Etz o = 8qC DI)IJ ,(l1{ c= o E'5 !'oo \o\o O oo rar-tl o\\r) c.tr- \o c7) .t cO r- t-ro\$ o\oo o$ca .f, cl oOrr) € O cOEEB (a rr(f) o\lr) cAF. \o\o O oo \o cO .+ ca t--t--o\oo o$ + cil OO o\strlco o co ca tr =E Eo(J rEeEE .E Gt > oN) r-I Ho t-,' L. 0) E, o' c ru .o €D cl ,rl ad c,ll z o aEd :1z d -v -v 6z oN ln =90*)6cd rll ]tl bo CI tUN EI oo -obI) titr E bo B oJ 6 L cl t)(d c)t{(,0 cl tr oJ o k tul 'lc t) rrl (r-) -o tr 63 Itroc GIoLF tr (F Ii, o o T 1,II tfoo e.ltrc) -o o.' oz =fc.l (J o o- .itr 'lr boBLs5sU B .g 'so-lr- bo S 1r 60 *,\qr (J t3q)\ IJ -t UU 'b(LBs\t$s ooi It\ .i 'E! EPs^-E.sbs sE''is E€Pi sE €bEr-SUE '=i.E h..ts$ *R\ E!x EsF .I\. \) hL .r gSE :As .rL3 Ers tR .9 Y;E b.Et *; Y \:b srtS :Hi rtI Isi EtEG 06 \l \r{ 'Q\ .a ils\ $E$ r G'ot E! : Ei\-h\ \rS IEE .S'B'Si.\::: d\s Es tr cliE ESr xEP PE\ \)g GIsot\t65(uv 'a clGtXg0)Edh-88E:8.o.=rgerq.tEgEE iJ d.E>,€ =!) 903.9d ()ti .La l,rD=s LE6.9cartr bEKEtr.4(u ool6 'i: .b o'EP '=a) q ol H d 'q -l E 6F Jg Eb El.g .Eo. ill trF UI E B o,E EIE or o,Eot or oft .. ol =l ;;l E #l E il s xr! .ol'= <l i' ol fi -ol g gE fls g{ $i8t.E El e Eg AE flE €l€ flE €l€ ulO ul! pl' Ll5 H€ €I€ €IE +I; al1 al1 zle zl9 (\ C{ il -o c) .9 -trod ot-p \o o\ g E 0) bD cSa US oo oF EE$Hta ss EsB.rEg tt {, ll i- 2.6.2 What are the causes of absentecism? lnvolving in Frnnirrg ilotiv.itics outsidc.thcir villagcs without corning back during G period of Mectizan distribution' Migration of villagers to township probably in search ofjobs or for higher school or other activities' information wlten available' . No known case of any serious adverse events during the reporting period' In case the project rlid not have any cases of serious adverse events (sAE) during thisieporting periotl, please tick in the box' ,/ 2.6.3 What are the reasons for refusals? .Duetoeitheradversereactionsonesufferedorseeninsomeone after taken ivermectin' ' Due to one's religious faith ' Fatigue inluf.ingihe drug since he/she is no longer having the sYmPtoms Briefly describe all knorvn nntt verified serious ndverse events (SAEs) that occurred rluring tfre reforting period anrl provirle (in table 8) the required 2.6.4 No SAE case to report 23 Wtl0/nPOC, 24 Novcmbcr 2ff)4 I t? tfooN 0)eE0) c)z rf, c..l ooA. so Ir .+ GI a) s\ q) \- a'\q) -a E R B\ "i* 'Ic o Loo botr ts o o. C)L o -c bo 'tr a € 'o 0) E ooo sl ,E tn rl] a tnPtr() C) o ar, Lo .o (\l U) o Lo U)tr{ o t7ot/) clU #r 6)l -olGttFI q .9t r_Eetc e3 EC'-C Edca $c{G8.9 6E EE ls o o.9E8gs a9oa q 6)ocd EaoL .9 oEr*9E Eb **E-O.iE.6o'E c= Gloo9O€4r+l It) GI o q co qsu E 'd 'ii E E.E EH€$E HF 3/. Or o .d 5Hz< q Eo o. Exa o(l o c,d N 'jjo() tr 0) :1 cl d C' c o E'Ub9*s8 EBqq@ (t o o S.s = bI) lao >a() tr) q) o0 i t7 a @ o\ € + o\ I- l- o) \q$ o\ n+o\ \ c.l oo -q o\ (\o\ obI)I Bs -o U q oo n€ o\ I-q ro @@ ot o) (f) CJo r o)q c{o oq oo c! .{ or obo st a) oo o6 ilgei a$@ 9 c.l oo COc! @F- N +@ $ol ro(o o\ r.-(o @ oq r f.- q l.-(o o bDd o oo GIL5hr (o 'lfrr) @I-I- ca$6 c.t@r- o) o) .(r$ rf)i- r @ rr) c\l LloIt- $r-(o rO IO r.- s$ CD@Nh- N$ $(f, F- rf) @N o) rO l(o to doL o oo. C) .o Eaz ooo@ o\t-- olort co ro ].-- c{ rr) ro(f, tr)il- CDr-@ F-r- o@N@N r.-- t-@s(osi- oooolr)(o oooI F- =ob.zE66 .c)gP, FIJ 6trl oo .{- o\ os c') r(o o) @ @o r.- C')@ rr) r--\t olN o, tr)(o$ -t @o r.- f.- o)\to r i.-!t @ol.- o) @ r.O .t tr,o r ir r.H e€sEE ' d. 8sE EE oooo oor oor oo c)o oooo r lt l,l o .r H)^ .- !-oF oo\< a-o oooo oo oor oo oo oooo 6o obod t) oo 85 ca F- cO COt-(a r Cot-(f) ceN cr)r r.-f-(o r (f, ]..- cf) r NF- co r r.-t-(f, r o -o E)z o .E 3* E psE= IEi ro6o (f)t- cf) Cf, r-- cr)r catt- cO cf) F-- co (f) h.- CO h-F-(o Ir.-r- cf) I.-t- co r EgB cf)i.-(f, r COr- CO - cnr- c.l NN(f) r CO F- cf) r (f) F(o r- 1..- cf)r f,.-t-(o r o bI)(, ='o ;e It E;EEE E6I o o c{ oo(\ \ooo a.l t\oo o.l oooo c{ a.looN oo c.l <too c.l o\ o\ o\ oo c.l oO ol r-o\o\ oo or o\ d tq .+ooc{ o .o Eq, ozse{ do o{ o FIa B (l) bo c{lrq) o C.) uH GI cl !1 o q) .o q) vt 6l 6) bo UI q) u) r/)GI IJ\\\) Bi\) q){ q.t t4)tr\) U dq) t<(l q, 0) o a 0) o) 0) L € L st C) n(tl -E,l trl 0)l?lol >l .!l C) bn(B L 0) oo Etr Gl vlPtr() E CI 0) t- o,t ol -olctlFI 6l o >, trq) L o q) o o a 0) U (,) q) o ts a U o o o o (J cll a (l oli o 6)l. F{ ra \0 cr it a) 6l Io o a q) €() F q) q) c{- a)0 :E€ o.5t, Itlt i) E8 Lr ! I a 2.7. Ordering, storage and detivery of ivermectin Mectizan@ ordered/applied for by - Qtle use tick the u1ryty91triale uns'tver) MoIl 'J " tlb - UNICJF niJ.it** delivered 5to,'" e tick the *,1;"yrffi;anaver) nUoo r,ilJoo Please rlescribe how Mectizan@ is ordererl antl ltow it gets to the communities rt is ordered by the state project by submitting Mectizan requirement to Globar 2000 (The carter center)' Grobal2000 orders for Mectizan, collects oni ,tor", at its store- lt is rrere that the state collects as and when required. LGAs ,orr".irro* the state b"J;;-;lu.ro whire the health care personnel at health facility level come to the LcAs to collect for the .rn,nuniii.s under its controt. rt is frorn here that the communities collect their requirements through CDDs' ^/ Table l0: Mectizan@ Inventory I{ v { I I I t ljiRiver Uderru L* I lo* g L T'L t; I fF Ilolv are the remaining ivermectin tablets collected and where are they kept? The remaining ivermectin tabrets are coilected in the reversed order of distribution. The cDDs at the end of distribution return the unused or rbmainin-fiJi.ir i",rr. r,.ortt "uie personnel at.the health facility, v76e in turn send them to the supervising Locrs at thI lGR. All the unur.J tablets collected at the LGA level are seot to the state. The state coordinator sends all it," ,"*uining tablets to Global 2000, where they are stored' tabletsber ofmNu RemainingExpIg9-Was(edLostUscdRcccivcdRequcstcd 4,157060175,837t 80,000180,000 , .'.lllfl '1A 1,641000178,359180,000180,000Awgu 327000109,673I t0,000I10,000Enugu East 1,901000178,099180,000180,000Ezeagu 3,93903 r 46,058150,000150,000Igboetiti 1,30800 0 0r 58,692160,000160,000lgboeze North 112000139,288140,000140,000Igboeze South 1,052000158,948160,Q00160,000Isiuzo 567000159,433160,000160,000Nkanu East 2,736020157,262160,000160,000Nkanu West 3,5 l6000t76,484t 80,000180,000Nsukka 247000I t9.753120,000t20,000 r,100000158,900160,000160,000 2,2650I0151,734160,000160,000udi 587000I 59,413160,000160,000Uzo Uwani 26,055 01202,3338332,360,0002,360,000TOTAL 27 WHO/APOC, 24 llsYsr,obcr 2004 11,. I List and briefly describe the activities under ivermectin delivery that are being carried out by healtlt care personnel in the project area. o Collection of the Mectizan tablets fiorn the LOCT. o Storage of Mectizan at the health facility. o Community mobilization and heatth education on the availability of drugs and who are eligible to take the drug. o Training/retraining of selected CDDs from different villages. . Ensuring the conduct or update of census figures by CDDs. . Distribution of Mectizan to CDDs based'on updated population figures of villages under coverage. o Supervision of CDDs. r Management of cases of serious adverse events due to Mectizan where it occurs. o Collection and collation of Mectizan treatrnent summaries from CDDs and reporting it to the higher levels. Any other comments Sometimes the LOCT used their motorcycles to send Mectizan to health facility staff with a view to speed up drug collection and distribution by CDDs. Also occasionally, State oncho team sent the drug to LGA oncho team to facilitate distribution, especially when it was raining. 2.8. Gommunity self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? If so, When? Yes, Training of trainers for community self-monitoring was organized by Dr Amazigo (APOC Director) in April/May ZOOZ atGlobal 2000 prernises in Enugu for all state coordinators and their assistants in all zones in Nigeria. 28 WHO/APOC, 24 llqvcrmber 2004 meetingl(silM) thatNo of Communities conducted stakeholders No of Com munities that carriccl out sclf rnottitoring (CSM) Total # of commun in the cntire Project arca rities/villagesLGA Awgu Aninri 24 2l il 37 33 l43l 85 130 Enugu East 2847124Ezeagt 2435100I gboetiti llt649I gboeze North 223l89lgboeze South 6t240Isiuzo 295l136Nkanu East 2349134Nkanu West 7l077Nsukka t62l59OjiRiver l92873Udenu 2034166udi 6t380Uzo Uwani 2674311313TOTAL praised and commended self-monitori and Stakeholders M J L{itI ;Describc how the resurts of the community serf- mo.it_olinq and starrehorrlers meetings hnve affected Project implementation or how they tnouiO be utilizctl durlng the lext treatment cycle' It has helped the project to focus efforts and taryet issues/activities that were found to be weak such as compensation of cDDs, refusars and deray in repr-acem.ent of cDD in sorne virages. The feedback meeting or stakeholders meeting has made comrnunities to realize it . i*ponunce of re[ular annual treatment and providing certain in".nir", to the airtriuuiorr. Health facility staff recognize.d the need of keeping the drugs for absentees and more intense mobilization to community mernbers' A[so, the results were used to improve and sustain on the overall strengths i-dentiR"o and finally comrnunities that performed very well were 4 .J t ; t& i- tr r It tI I E IB 29 WHO/APOC, 2'{ trlsYsrnter 2004 NGDO 2.9. Supervision 2.9.1.1 Provitlc a flow ch:rrt of su;rcrvision hicrarclry. Below is the flow chart showing supervision hierarchy in the Project NOCP MOH LOCT LGA PI{C DT]PARTMENT F I CDDS COMMUNITY 2.9.1. what were the main issues identified rluring supervision? . Provision of counterpart fund is stilla problem in many LCAs. . Cotnplaints of non-compensation by some CDDs. . Some villages have not collected their drugs. . Many health staffare new and they found it not easy linking up the CDDs 2.9.2. Was a supervision checklist used? Yes, the supervision checklist was used' Z,g,l. What were the outcomes at each level of CDTI implementation supervision? . SOCTs met with some LGA policy makers and solicited for provision of counterpart furrd. . LOCTs found that some healih facilities have been closed down and then diverted their Mectizan ' to the closest health facilities for collection by CDDs. . CDDs in lhuokpara community cotlected their Mectizan after a dispute between the health - facility staff and the community supervisor was settled. After meeting with councilors, traditional leaders, village heads and other community members in Akpugoeze community in Oji River LGA, CDDs who refused collecting drugs for distribution due to non- compensation agreed to continue distribution. . One health facility staff in Awgu LGA that refused collecting Mectizan from LOCT later collected and distribttted same to CDDs. ISOCT 30 WHO/ApOC, 24 Nov ember 2fi)4 i {At the community level, people who refused treatment norv have agreed to be receiving treatment annuallY. community members agreed to select new cDDs and they demonstrated more willingness to support them. 2-g,4. Was feedback given to the person or groups supervised? yes, feedback was given either on the spot through oral communication or in writing on the findings. 2.g.5. l-Iow was thc fccdbnch usctl to itttprovc thc ovcrall llcrfortltancc o[ tltc proicct? A strong follow - up mechanisrn was developed to ensure inrprovement of the overall performance of the project. I t& i- I 3l WFIO/APOC, 24 November 2fi)4 n I t I SEGTION 3: Support to GDTI 3.{. Equipment Table l2: Status of equipmeni Source Type of equiprnent APOC MOI{ DISTRICT/ LGA NGDO Others No. Conrlitirut No. Conditi(ll No. Condition No. Condition No. Condition l. Velricle I F 0 0 0 0 2. Motor cycle(s) 22 16 -F 6- CNFR 2 CNFR 3. Computer(s) 2 l-F t- CNFR 0 0 0 0 4. Printer(s) 2 l-F l- CNFR 0 0 0 5. Photocopier (s) I WO 6. Fax Machine(s) 0 0 0 0 0 7. Others a)Cenerator I F b) TV 0 0 0 I F Fc) Video I d)) Air conditioner I F +Condition of the equiprnent (F:Functional, CNFR:currently tron-functional but repai rabl e, WO:Written oFf). How rloes the project intentl to rnaintain antl replace existing equipment altd other materials? Maintenance and possibly replacement of some of tlre existirrg equipment would come from the counterpart fund from the state government. Also, LGAs chairmen are going to support LOCTs in repairing their motorcycles. Atso, APOC is expected to assist the project in replacing old equipment where necessaD/. To this end therefore, the project has made a budget to APOC with strong justificatiorrs for replacement and provision of essential office equipment for 2007. E. L : le t t F 32 Wf tO/A POC, 24 1.1q\zentbcr 2004 3.2. Financial contributions of the partners and communities Table l3: Financialcontributions by all partners for tlre last three years Contributor Ycnr I -2004 )'car 2 - 2005 Ycar 3 - 2006 TOTAL Cash Budgeted (US$) rorAL ICash l Released (US$) TOTAL Cash Budgeted (us$) TOTAL Cash I BudgetedI tussl rorAL ICash I Budgeted (US$) TOTAL Cash Released (US$) MOH (Centralt Prov incial/State) 37,878.79 N/A Nil 37,878.8 n21.2 39.062,5 li7i8-B - Nil MOH (DistricULCA) 4.494.87 9090.9 227.3 308.6 if any)LocalNGDO(s) ( N/A N/A NiA N/A NA NA NCDO partner(s) N/A 2,388. I 8 N/A 47t8.9 NA 3078. I Others a) N/A N/A N/A N/A NA NA b) NA NA NA NA NA NA Cornmunities Nil 4,6t7.56 Nil 349 l. I Nil 2972.4 APOC Trust Fund t000 Nil Nil Nil Nil Nil TOTAL 38,878.79 I1,500.61 12878.7 9558.5 50,881.3 6359.1 If there are problems with relcase of counterpart funds, ltow rvere they addressed? Actually, it was a big problem. The project was able to route a memo through the director of public health to the Honourable commissioner for healtlr who in turn wrote to I-lis Excellency for approval and release' Additional comments ApOC is being requested to assist the project by approving the 2007 sustainability plan of action ' 3.3. Other forms of community support -Describe (indicate forms of in-kind contributions of cotnlnunities if any) cornmunities have ditferent ways of supporting their GDDS apart from the finarrcial aspect' These forms of in-kind contributiorr inclr-rde' . Electing some CDDs as village chiefs' . Cornmunities offer food iterns and entertainment to CDDs dr'rring distribution. ' Exempting some CDDs from certain community levies' . Some communities assist their cDDs in farm work during the farming.season as colrfpensation for offering free service to them. !a- U" rr tL rr rt E E IF 33 WHO/APOC,l{ trlq vembr 2004 3.4. Expenditure per activity lndicate in table 14, the atnount expended during the reporting period for each activity listed. Write the amount expended in US dollars using thti current Unitctl Nations exchange rate to local currency. Indicate exchange rate used here N 128 : I US dollars 34 WHO/APOC, 24 Nor,rember 2OM Source(s) of funding lixpenditure ($ us) Global2000 Global2000 Global2000 Global2099_ Clobal2000 Global2000 LGA 750.0 308.6 600.0 25.0 1421.9 46,9 234.4 l"p-.lyisllg -C P Pt and d.istri bu t io n lyrry.nqry (reporti n g) form s for treatment litical authorities commun Mobilization and health education of communities Train of CDTI activitieslnternal monitorin (,b Others [Q!{f supp_o(_ les/ bicycles maintenanceVehicleV ion point ofto central collectDrug delivery from NOTF FIQ area ln of health staff at all lcvels IEC materials Ad visits to health and Office lrg,l!ry g!_cDPl 3,386.8 783,843 ns treated TOTAL Total number of Table l4: Indicate how much the proiect spent f<rr each activity listed below during the reporting period Any comments or exPlanations? No actual fund came from the state government but there was an approval of N578,000 which would be released early in 2007. Also no direct fund was available for the health facility staff training' Loc'l-s were directed to train their new health facility siaffand they comptied. During the training of health facility staffon guinea worm surveillance and reporting withihe fund provided by UNICEF' alltopics related to oncho and Mectizan distribution mechanit*r i"r. integrated and taught to them. The cost per treatrnent is $0.004. t ,1, t t I I i I t t. I ( . :- t- L_!- J.t L t E m l, [E 35 Wl-l O/APOC, 24 llsysEarber 2004 SEGTION 4: Sustainability of GDT! 4.1. lnternal; independent participatory monitoringl Evaluation 4.1.1 Was Monitoring/evaluation carrierl out rluring the reporting period? (tick any of the foltowing which are applicable) No Year I Partici patory Independent monitoring No Mid'l enn Sustainability Evaluation 5 year Sustainability Evaluation lnternal Monitoring by NOTF Other Evaluatiorr by other partners No 4.1.2. Wlrat were the recornlnendations? Not appropriate. 4.1.3. flow have thcy been ilnplernented? Not Appropriate. 4.2. Sustainability of projects: plan and set targets (mandatory at Yr 3) Was tlre project evaluated during the reporting period? No Was a sustainability p lan written? Yes When was the sustainability plan submitted? 2003 What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.2.1. Planning at all relevant levels Joint planning meeting of all prograrnrne officers in the rninistry of health is already in pl ace, which included the CDTI project. The rneeting is usually translated to the communities through the LGAs. This usually follows with the briefing to His Excellency by the Hon. Commissioner for health at tho EXCO meeting 4.2.2. Funds A plan to release funds by the State and the LCAs has been put in place. lt is contained inth€ State budget-rolling plan for the next 8 years. Our partner, Global 2000, is expected to continue her support to the project. No No ri, tj 36 WHo/APOC, 24 1 avember 20o :-" f- i_I$, t- L t E E ID 4.2.3.1 Transport (replacement and maintenance) State and LGAs are expected to provide necessary fund to tnaintain and replace motorcycles' 4.2,4 Other resources Manpower and field staff are expected to be stable in the project in future' 4.2,5 To what extent has the plan been implenrented All activities plarr*cd in t5c nlrOC post sustairrability plan lbr 2006 were implclnentcd exccpt expandingCSM in all'the cotnmunities and production o15000 IllC rnaterials' 4.3. lntegration outline the extent of integration of cDTl into the PHC structure and the plans for cornplete integratiolr: 4.3.1. Ivermectin delivery ntecltanisms Delivery of lvennectin has been fully and efficiently integrated into the PHC fi'om the state to LGAs using the staff at those levels. The Socrs J;t.,; levcl deliver ivermectin to Locrs at LGA level who in tum deliver to HFS at health facility level which is nearest to the communities. The ivermectin delivery is now routine pHC activity uno "urri.o out along other comnrodities such as filter distribution for guinea worrn eradication, ITN disiribution for rollback ntlaria and dtrring irnmtrnization campaign' etc' 4.3.2. Training During trainings at each level, other topics related t<l o^ther diseases- are included in the training content' For example, the s-po who is also the proglunuu. ol'l-rccr.for guinea wornl Eradication combines oncho and guinea worm endemic LGAs of the sta;. Health facility ituff in Isiuzo, Aninri and Nkanu East LGAs during gNICEF supported training on guinea wonn surveillance were also taught Mectizan distribution mechanisms and other topics rerated to Jncho. The same goes to Locrs at LGA revel who are involved in other activities such as monitoring and evaluation, wl-lo Disease surveillance and national progr€lmme on immunization etc. 4.3.3. Joint supervision and monitoring rvith other progrants Joint supervision and monitoring with other programmes are regular features of cDTI itnplenrentation in the project. Those officers involvid in oncho programme also supervise and monitor other activities of other frogrammes in which they are involved' 4.3.4. Release of funds for proiect activitics Fund is released based on existing budget line for onchocerciasis. 4.3.s. Is CDTI included in the PfIC budget? Yes, it is included in the PHC budget at the state and in LGAs. 37 WHO/APOC, 24 Nor-remtrer 2004 ;; lb t- la lD rlF t*,ta rt '# 4-r,6. Describe other health progrnnlnres tlrat arc using the CDTI structure and horv this rvas achieved. What have been the achieventents? Guinea worm erddication is the only health programme currently using the CDTI structure in the state. lt made the distribution of Mectizan faster. Virtually all the guinea worm village based health workers are involved in Mectizan 4,3.7. Describe others issucs considered in the integration of GDTI. Other area where arrangement is being made to integrate CDTI is immunization. Some LGAs are using sorne CDDs as guidcs. 4.4. Operational research 4,4.1. Summarize in not more than one half of l pagc the operational research undertaken in the project area rvithin the reporting periotl. None was undertaken in the project area within the reporting period. 4.4.2. flow were the results applied in the project? Not applicable 38 W H O/APOC, 24 1.1ev6:mber 20OC sEGTloN 5: Strengths, weaknesses, challenges, and opportunities List the strengths and weaknesses of CDTI implementation process' STRENGTHS strong commitment of sorne LGAs, Health facility staffand cDDs. Reguiar availability .l'projcct vchiclc atttl molorcyclcs lbr licld opcration Ability to make good and necessary management "hung"t of staff at LGA and health facility levels. Technicat/financial support by Global 2000 Targeted monitoring and supervision of drug distribution WEAKNESSES . CDDs not compensated by most villages' . Poor provision of counterpart ftrnd by the State and lnost LCAs' List thc challenges and inclicate how they were addrcssed' CI-IALLENGES . Repeating advocacy visits to LGA policy and decision makers due to their frequent changes' The state project had ernbarked on advocacyof the newly appointed LcA chairmen to brief them on CDTI programme and also to'solicit for their supports' . Delay in sending in Mectizan treatment summaries by some CDDs probably due to non compensation ui ttr.i, communities. This was adrlressed by health facility staff pleading with CDDs through repeated visits to them' . Continuous health education, mobilization and sensitization for long term compliance to treatment. This was carried out by both the state, LGA and health facility staffto educate community members to continue receiving ivernrectin yearly to prevent the possibility of one becomingareservoirofinfectiontoothersinftrture. . Sustaining enthusiasms in the communities to continue taking the drug despite improvcd health status. Health education was carried out at cotnmunity level by SOCT' LOCT' FLHFS and CDDstoencouragethosewhoarenowhealtlrytocontinuetakingtheMectizandrug. , Ernbarking on totiltraining of all health facility workers in the LGAs to forestallincessant transfer at this level. The pioject has included ihis on 2007 sustainability plan sent to A POC' . Expending cSM and sHM at community level. This is addressed through holding meetings with LOCTS, health facility staff and ,o*".o,r*unity members on community participation and ownershiP of CDTI. . Getting the state and LGAs to release counterpart fund irrespective of the amount. This was discussed at the meeting with the commissioner for health, permanent secretary and directors in the ministry oifir,r, af well as advocacy meetings with LGA policy makers and they are aware ofthe need to do so. . providing acceptable ratio of cDD/population. This is addressed through the planned training of more cDDs uni "o*runity directed health supervisors based on kindred distribution gystem' The proposal sent to ApoC has been uppron.d as we learnt but no fund has come frorn APoC' . coping with the inadequate logistic for effective implementation of various field operltions' The additional 39 Locat Government Development Centers have their own complete staff and the T a l il- !t t!- IL I E E E 39 WHO/APOC, 24 Ns</embcr 2004 available motorcycles cannot cover effectively field works and the LGDC are requested to support transportation in'the meeting held with LOCTs. APOC is solicited to support as contained in the project's 2007 sustainability plan. Putting in place a coordinated and functional kindred system of Mectizan distribution in all the communities. This was discussed at the SPIC meetings and APOC is requested to provide fund for totaltake off of this strategy in all parts of the CDTI project areas. a 40 WflO/ApOC, 24 lavember 2fl) SEGTION 6: Unique features of the proiect/other matters An impact assessment of treatment witlr ivermectin was carried out in the Project. This was conducted by a team of health professionals led by Dr Emmanuel Emuka, Director of South East Programmes in The Carter Center of Jos National office. This activity took place in two villages of Umuokabi in Ohodo Community and Amofu in Ekwegbe Community all in lgboetiti Locat Covernment Area in November 2006. The project hosted the training workshop on data collection and management for the data managers and the assistani oncho coordinators in the Zone in August 2006. The training organized by NOCP Abuja was sponsored by APoc and assisted by Enugu state Ministry of Health. The ApOC Director, Dr. Uche Amazigo came to Enugu State in August 2006. Though the visit was not official, she met with the State Oncho Coordinator and encouraged him to sustain the high coverage the state has attained. She opined that she was aware that the State project has neve_r received any fund from APOC after 2003 but expressed the hope of future support to the state by APOC' . In August 2006,the Country representative of The Carter Center held a meeting with the State Oncho Team members at the Zonal'Carter Center office Enugu. The purpose of the meeting was to ascertain the extent of ivermectin distribtrtion in the state and to proller the way forward. The State Oncho coordinator irarticipated in the meeting on the training of accounting officers held in Zaria, Kaduna State in May,2006. The Director of South East lrrogrammes, Dr. Emmanuel Emukah visited Enugu State in April, 2006. The aim of that visit was to write aid sign a letter of undertaking to APOC for implementation and utilization of approved fund for Mectizan distribution using kindred "Urnunna" system in Enugu and Anambra states and other Carter assisted states in South East Zone. Unfortunately, this fund approved for this kindred .,Umunna', system of distribution in Enugu state was not after all released to the state Projt;ct in 2006. The Project is still hoping. Also, in March, the Director of South East Programmes - Dr. Ernmanuel Ernukah and Dr. Onafwukon of the Lions Clubs lnternational came to Enugti for a meeting with the rninistries of health officials and Local government affairs. Unfortunately, it was not held due to transfer of l-lon. Commissioner for health and others at that time. i--- I rt 'T,I& !T- L flv H b E E 4l WHO/APOC, 24 Nsv€:mbcr 2(X)4