Monitoring of the implementation of Imo State CDTI project sustainability plan

MONITORING OF THE IMPLEMBNTATION OF IMO STATE CDTI PROJECT SUSTAINABILITY PLAN (@ AFRICAN PROoRAMIAE FOR ONCHOCERCTASI5 CONTROL At fie debriefing by monitors, Dr Chidi Mmme' Hon' Comissioner for Health "ong*tul"to lUm- edien Ajugwe, a CDD from Umchu Nsu commity for @nsistent s.ice i, the past ten yeus while (R-L) the pmmmt secretary, Director public Health ud L@T (Ehirc Mbmo) lmk on in admintion. - October 2005 AKOGUN, Oladele NDEKWII, Olisa NKWELLE, Patrice OLAMIJU, Franca NNORUKA, Edith REPORT n .a_G@ a If\l L x-,1 ru -! \ E, I I g. ,l \ ACRONYMS APOCAfricanProgrammeforonchocerciasiscontrol GRBP Global2000 Riverblindness Programme CDD Community Directed Distributor CDTICommunityDirectedTreatmentwithlvermectin LOCT LG Onchocerciasis Coordinator Team FLHF Frontline Health FacilitY HSAM Health Education, Sensitization, Advocacy and Mobilization MoH Ministry of Health NPI National Programme on Immunization NOCP National Onchocerciasis Control Programme NGO Non-government organization NOTF National Onchocerciasis Task Force WHO World Health Organization WR WHO RePresentative 2 EXECUTIYE SUMMARY Background and Introduction: The Imo State CDTI project commenced operations in 1998 with ApOC funding and technical support. It was monitot.a in 1999 and its sustainability beyond APOC funding period was evaluated in 2003. The project was adjudged to be making progress towards sustainability. The Imo State CDTI project developed and commenced the implementation of sustainability plan in 2004 as a consequent of the evaluation' The sustainability plan covers all ihe- sixteen endemic Local Government Areas' In October 2005, APOC management sent a team of five monitors to assess the progess of implementation of the plan and to provide technical support to the project during the mission. Methodology: The team comprising external and internal monitors briefed officials of the Ministry of Health (MoH) auout-ttre mission before field visits to the LGAs. officials of the three selected LCRs: ilgor Okpala, Ehime Mbano and lhitte Uboma were briefed and discussions held with administrative and health officials about the implementation of the sustainability plans. Two randomly selected Frontline Health Facilities (FLHF) and two of their catchment communities were chosen from each LGA and visited' An interactive session was held with the in-charge of the FLHF regarding implementation of the sustainability plan using the pre-designed tools. The issues raised in the sustainability evaluation reports *.r. -dir"ussed at-each level and opportunities, strengths and weaknesses were recorded. Findings: At State, LGA and FLHF levels there has been very little effort at implementing the sustainability plans that were made for the post-APOC period' The MoH has not made any financial contribution to CDTI activities. Neither have any of the LGAs made any financial contribution. Although budgets reflect allocations, there are no cash releases. The attrition rate among the CDDs has reached about 60%o in some communities and the awareness level islow. officials within the project and community directed distributors were not properly prepared before the withdrawal of the remuneration they hitherto enjoyei. ffr" itfcO partner suspended-support.to observe if the project wouli sustain thJ previously reportid successes. Unfortunately the project will'hardly survive another couple of yiars unless urgcnt-assistance is given to sustain activities which are currently carried out with the goodwill of some officials and CDDs' The current state of affairs is reflected in the d-creasing geographic and therapeutic coverage rates. The project is little understood by the MoH officials who appear more concerned about other Projects. Opportunities. The Imo State CDTI is being implemented in an environment where p"opl" are highly community-minded and take community development issues very seri'ously. The people have a trighfy competitive spirit with vibrant community-minded CBOs and associations. This is a veritabl" ."ror.i" pool, waiting to be tapped for community service delivery and support. The implementers are committed, educated and have about l0 years experience working on the programme. J Challenges: the main challenge is the inability of the state team to increase awareness at the FLHF and community levil and ensure that every partner especially at the FLHF and community understand, ih"i. role and responsibility within the programme' The State MoH has not met its oUtigations of releasing funds for activities and still depend heavily on the NGO for frnanci"ng basic activitieJ such as HSAM, training, monitoring and supervision. The temporurf ,urp"nsion of routine support by the NGo has led to partial ;iltrir of this project. ffie UoU does not seem to appreciate the opportunities provided fy tfrl strategy for the delivery of other health intervention services through integration' conclusion: Reflecting on ih" 1999 monitoring and 2003 evaluation reports, the Imo State CDTI is yet to uJd."r, the concerns raised, or to commence the implementation of their sustainability Plans. Recommendations The following actions are suggested to the State to enhance the project's sustainability 1. Set up a committi-e to review the post-APOC sustainability plan and recommendations from monitoring and evaluation reports of 1999 and 2003 respectivelyandtakeappropriatestepstoimplementthem. 2. Empower Local Government health staff especially those at the frontline health faciiity level so that they can carry out their responsibility of health education, advocacy and general mobilization of communities' 3. Establish an oferational office for the State Onchocerciasis Control Programme with compliments of office secretary and book-keeper as well as defined terms of reference to enable it stabilize and share expertise for add-on intervention services which use community-directed approaches 4. Meet State obligations within the Letter of Agreement by providing counterpart funding to enaile the project carry out basic CDTI activities of monitoring, ,up"*i*rion, training *d in"."ure awareness which are critical to project survival. 5. Institute plans foi motivating community and health personnel and partners (especially at the community level) who perform credibly' 6. Top levei programme planners should recognize the pivotal role of the FLHF in CDTI and empower it to perform its responsibilities' 4 ACKNOWLEDGEMENTS The team is grateful to all those who have made the mission possible and enable the monitors fulfil the mission's objectives especially the Project Administrator, Global 2000 Abia/Imo Projects and Dr Uche Enyinnaya withoui whose logistic assistance the mission would have probably come to a -halt. we appreciate the commitment of the Imo State CDTI project Coordinator Mr. Jude Onyenami and drivers Benson and Innocent who consented to work without daily allowances during the mission. we appreciate the hospitality of all those that we have -had the opportuniry of i,1t91acting with during the course of this mission: Honourable Commissioner for Health Dr Chidi Marume, the Permanent Secretary Dr J.N.C. Onyegbosi, Director of Public and Primary Health care Dr (Mrs) V'N' Onyenekwu' and Dr. Nnoruka of the vector control Department. we are grateful to Professor Bertrand Nwoke , the Deputy Vice Chancellor (Academicsiof the Imo State University, Owerri and his wife who were most generous with making the team members feel homely. we appreciate the opportunity to serve on this mission. 5 TABLE OF CONTENTS EXECUTIVE SUMMARY ACKNOWLEDGEMENTS I. TNTRODUCTION 1.1 Background 1.2 Objectives 1.3 Focus of imPlementation 2.0 MONITORING PROCESS 2.1Team ComPosition 2.2 Meetings 2.3 Team Orientation 2.4 Site Selection and samPling 2.5 Information Collection and Feedback Process 2.6 DataAnalysis and Report writing 4. CONCLUSION 5. RECOMMENDATIONS J 5 7 7 7 7 8 8 9 l0 l0 ll t2 3.0 FINDINGS AND THEIR IMPLICATION FOR SUSTAINABILITY 13 3.1 Situation at each level 1 3 3.2 Performance of Action Contained in the Plans and Suggestions l8 3.3 Strengths, weaknesses and opportunities 20 2l 22 LIST OF TABLES Table l: Team members and their contact Details Table 2: Schedule for Monitoring the Implementation of lmo CDTI Sustainability Plans: 4-14 October 2005 Table 3: List of LGAs, FLHF and Villages visited 9 l0 LIST OF APPENDICES 8 Appendix l. Debriefing Notes Appendix 2. Persons that were met Appendix 3. Documents that were seen Appendix 4. Completed Monitoring tools 23 25 26 27 6 I.O INTRODUCTTON 1.1 Background Imo State is located in the South eastern part of Nigeria. Its CDTI project was approved in September 1998 and commenced distribution oiivermectin to endemic communities later in lgggllggg. The State has an estimated population of about 3.4 million people with over l.lmillion persons at risk of Onchocerciasis' Treatments have risen from a few thousands to over ete,.+go persons by 2003. The facilitating NGO for the implementation of GDTI in thel6 endemic ice. is clobal 2000 River Blindness Programme (GRBP)' In June zll3,as part of its plan to achieve sustainability of programme operations' APOC n,n rug.."nt commissior"d u team of consultants to evaluate the level of sustainability of the Imo state CDTI project which was then in its 5ft year of funding by APOC' Evaluators adjudged-tlie iro;ect as making satisfactorY plogress towards sustainability and suggestions were g"ur"dto*ards strengthening identified weaknesses' On the basis of thisl-eport and discissions during the feidback meetings, implementers developed 3- y"u, port-APOC sustainability plans to address issues that posed challenges to sustainability. As a follow up to that evaluation, APOC management has commissioned this assessment team to determine if the activities ptopo."d in the sustainability plans are being implemented as proposed; particularly by the LGAs, frontline health facilities and communities. The report presented here describes the process, observations and recommendations of the assessors of this mission. 1.2 Objectives The specific objectives of the mission are to: a) Determine the extent to which program partners, particularly at the LGA9, FLHF and community levels are implementing the proposed activities in their sustainability plans. b) provide technical support for achieving the objectives of the sustainability plans and the implementation of the CDTI 1.3 Focus of implementation The IMO CDTI covers 16 LGAs, Aboh Mbaise, Ehime Mbano, Ezinihite, [hitte Uboma, Isiala Mbano, Ikeduru, Ideato North, tdeato South, Mbaitolu, Nwangele, Ngor Okpala, Orsu, Obowo, Okigwe, Onuimo, and Oweri North. The project a.rea covers 1,647 villages with a tot 6f fast flowing streams and rivers such as Otamiri, Nbaa, Ogochie, Oamiriukwa Rivers coursing the area. All levels within the implementation chain were visited, from the State and Local Government areas, the main focus of the assessors' activity was the "level where planning and funds allocation decisions are made for health service delivery at State level 7 and where actual CDTI implementation is done, the Local Government Areas, FHLF and community (as appropriate)". Using pre-designed tools-for collecting information at each level, the team assessed the following ind'lcators of sustainability: Planning, Health education/ sensitization/Advocacy/ Mobilization (HSAM), Training, Finance, Transport, Mectizan Procurement, Delivery and Distribution, Monitoring and supervision' Human Resource and core.age. Reclrd keeping had been identified as an important but inadequately addressed "point in CDTI proptt. and was therefore included among those items to be assessed during the visit. 2.0 MONITORING PROCESS 2.1 Team ComPosition The team consisted o] fir" independent monitors (from outside the project) and the State Onchocerciasis Coordinator (Table l) Table 1. Team members and their contact Details The State CDTI Coordinator served as guide to the team. On arrival in Owerri, the team studied the guidelines and tools for assessing the implementation of sustainability plans and the reports and recommendations of previous ApOC monitoring and evaluation teams to the Imo CDTI project. Tasks were allocated to team members according to previous experiences, skills and interests. The team had a biomedical communicator with expertise in mass health communication which became very useful to the State project. 8 Names Address Phone/Fax Email Prof. AKOGUN Oladele Parasite and TroPical Health, Federal UniversitY of Technolory, Yola, Ni geria Tel +234-8037220460 Cell+234 8052526622 olaakogun@yahoo.com Dr Edith NNORUKA Nkechi Sub-Department of Dermatology, College of Medicine, UNTH, Enugu, ENUGU STATE 042 452549 080367106629 08052330420 N kechi-nnoruka@yahoo. com nkechi nnoruka@yahoo.com Mrs OLAMIJU Francisca MITOSATH 605, Hospital Place, OPPosite Green Valley Suites, GRA, J Plateau State 073 464794 Fax 073 464792 080333 I 8085 olamij ufo@mitosath.ore mitosath@hotmail.com Dr OlisaNDEKWU Biomedical Communication Centre, College of Medicine, University of Ibadan, 08023307614 olisasunnv@yahoo.com Patrice NKWELLE Bertrand Country RePresentative, International Eye Foundation, CDTI Project, Adamaoua Province & South Province, Cameroon Tel/Fax 225 22 46 Fax221 55 67 Tel220 50 07 Cel 237 773 72 17 nkwel lepatrice@yahoo.fr Mr. J.C. ONYENAMA CDTI Project, Ministry of Health, Owerri, Imo Stata 0803s526799 ic onve@vahoo.com 2.2 Meetings 2.2.1 The Meetine with the Ministrv ot.4ealth Qfiici4lp The team members . and -!ad a meeting with the State Onchocerciasis Controitoordinator, the Director of Public Health, Permanent Secretary and the GRBp State Administrator. The team leader explained the team's mission, its duration, and the process and then negotiated feedback appointments' Table 2. Schedule for Monitoring the Implementation of Imo CDTI Sustainability Plans: 4-14 October 2005 2.2.2 Meetine the District. FLHF and Communitv officials At the LGA, the LOCT leader was the first to be contacted and briefed, then the Director of primary Health care (pHC) at the LGA, the Director of Administration and General Services (O41,CS;, the Vice Chairman where available. The chairmen had all gone on missions to various places and none was met. The team's mission was explained and a guide was recruited to lead the team to the selected FLHF sites and communities. 9 ACTIVITYTIMEDATEProicct AM of sitesTeamPM Tuesday October Information toAM LGA I PHCPM 2 Wednesday 5th October LGA I PHC level interviewsAM visitto-tFLHFPM Thursday 6h october 3 Visitto-2FLHF aAM LGA2 PHC level interviewsTravel to LGA2PM Friday 76 october 4 Visitto- I FLHFAM visirto-2FLHF -2ViPM Saturday 8h october 5 Travel to LGA3 LGA2AM PM LGA3 PHC level interviews 6 Sunday th october FLHFVisit to -AM visitto-2FLHF 2 Village Debrief LGA3 PM 7 Monday 1os october AM PM Tuesday I lft October AM PMt2'h October 9 AM PM Thursday l3s October l0 AM PM Friday 14s October ll I -t I I 8 2.3 Team Orientation The monitors met on arrival, to study the tools and guidelines. Monitoring and evaluation reports were also studied and paid attention to recommendations and challenges that were poirt"O out during previous visits by APOC teams. During the team's _orientation emphasis was plaied on the approach and the terms of reference which included pr&irion of tecirnical support toit " project. A schedule was drawn for the exercise and team members were enjoined to make notes of all observations and relevant comments and to include those made during feedback as part of the information received. The team worked as a single group sincelhis has advantage of collating more information from different p"rrp".iir"i *t i.t could be synthesised into one single tool of observation at that level. However it was agreed that only one person would speak to the respondent at any particular period. The permission to make notes was received before the commencement of the interview and when pictures were required, permission was also received before doing so. 2.4 Site Selection and samPling Information was collected -on Jach LGA performance in the past two years (following evaluation) and the endemic LGAs were grouped into (Good, Moderate and poor) on the basis of coverage. A list was made of each category and one LGA was randomly selected from the category. A list of the FLHFs in the selected LGA was made and two FLHFs were randoml-y ielected. A list of the communities in each of the selected FLHF was made and two communities were selected therefrom. Altogether, three LGAs, six FLHFs and six communities were visited during the exercise (Table 3) Table 3: List of LGAs, FLHF and Villages visited LGA FLHF Village 1. Ngor Okpata (Good) 1.1. Logara 1.1.1 Umuezala 1.2. Umuenam l.2.l Umuenam 2. Ehime (Moderate) Mbano 2.l.Umteze 2.1.1Ezioma 2.2. Umuokpara/Umudim Nsu 2.2.2Umuakalaba 3. Ihitte Uboma (Poor) 3.1. Amakohia 3.3.1.Amuozu 3.2. Umuzegwu 3.3.2. Total 6 6 l0 2.5 Information Collection and Feedback Process 2.5.1 Interviews and information collection Every interaction for information collection commenced with small informal chats about the official,s work and other familiar things before reference to the CDTI project in the area and the work plan that was made. The conversation was natural and was allowed to mature through proUing until the desired issues of sustainability are addressed within the requirements of the tools. The LOCT members in each LGA were interviewed, documents checked and other members of the LGA such as the Director of Planning and finance were interviewed' In each case the FLHF health personnel responsible for ivermectin delivery activities was interviewed while another team member interacts with the community leaders and the cDDs. At each level, documents and evidence of claims were requested as required by the tool. In each case and at each level the experiences of other projects were shared with the implementers. Lessons learned from them were recognised and commended' opportunities were identified and the strengths and weaknesses discussed. Considerable efforts were made in each case to "n"ourug. the implementer to identiff how the weaknesses could be addressed and in almost all cases the approach worked well. opportunity was given for informal chat when the monitor shared experiences of other projects wiitr the i-mplementer. Every interview or interaction ended with an opportunity ior-the implementer to make inquiries, share concems or raise issues which may affect sustainabi lity of CDTI. 2.5.2 Feedback Meetinss Feedback was given at every stage. At the FLHF it was done on the spot since the information collection process was made fairly informal to allow a natural flow of conversation. The pattern of feeding back to the respondent was the same at every level' The respondent wai encouraged to identiff what would be done to improve the situation' The decisions made *"r. ,ot-"d. In closing the feedback session, the team leader repeated the entire aim of the mission and the importance of sustainability to the overall outcome. But for slight modification to fit into protocols, the feedback at the state level followed the same p*"*. However, a debriefing note was ma!l9 and distributed to officials that *".. prrr"nt. The State debriefing meeting was chairedty-the Honourable commissioner for Health. The conversations and opinions during the feedback were noted as part of the report. The debriefing meeting *ai used as a forum for advocacy, education and for dernonstrating non-monetary motivation approaches that the team suggested (See cover photograph). ll 2.6 Data Analysis and Report writing The team made daily summaries of the received information and took note of observations and their implication for project sustainability. All the data collected at each level were pooled into a single instrumeni as representing observations at that level' The overall project sustainability-at each level was then discussed with reference to the pooled data and the outcome of the discussions constituted the report which addressed the project opportunities, weaknesses and the strengths. Suggestions and recommendations were made on how the project implementation could be further strengthened' t2 State Planning There was a State health plan reflecting onchocerciasis control as one of the target diseases of the Ministry of health. The State project office has a 3-yr post-APOC plan with CDTI activities and time frame. A 4-person team under the leadership of an experienced coordinator was responsible for the state project activities' There has not been any financial or material input during the past two years by the NGDO partner which is currently ,,testing the abiiity of thii highly successful project to sustain without our support" HSAM This activity is the least impressive in the past two years. The project has not been able to show concrete evidence of the HSAM activities that were aimed at influencing policymakers to release budgeted funds. APOC funds were made available for HSAM activities and disbursed for ihir pu.pore without any indication of success at any level' The extent of understanding tf -tn" top functionaries of the MoH about their responsibilities is not very cllar and this is reflected in the uncertain commitment of policy makers at the MoH level. 3.0 FINDINGS AND THEIR IMPLICATION FOR SUSTAINABILITY 3.1 Situation at each level Mectizan Mectizan supply is adequate, but there has been an overlap in distribution at the community tevet witfr Zob+ distribution extending to May 2005 in some communities while some communities are still on the 2005 cycle. This has been blamed on the inability of the team to monitor the process and to retrieve summary forms from the communities since there was no finaniial support to the project form the State to enable the team carry out this important function. Integration There has been adequate sharing of resources such as transport and stationery with the National programme on Immrinization (NPD but there is clearly no evidence of integration oiactivities especially monitoring and evaluation. Athough there are still on claiirs of involvement of itaff oi the Unit in national programme for immunization, and environmental health, there are no documents to support these claims. During the debriefing meeting, the Honourable commissioner mentioned that there are plans Io integrate activities in order to achieve some synergy and that Heads of units have teen mandatid to contribute ideas to the proposed integration. Finance Commitment of the MoH to contribute support the programme with funds is very little. Allocation made has never been released. Emphasis is currently on malaria and HIV/AIDS and the State promptly releases the counterpart fund for these projects which l3 is put at 2 million and 13.6 million naira respectively while onchocerciasis control with a bulget allocation of 50,000 naira is n"r"i released. Some of the MoH oflicialswho stroritO know did not show appreciable knowledge of the programme to warrant convincing decision-makers to release funds for activities. Besides the funds released for the collection of equipment and materials donated by APOC, MoH has not made any financial input into the programme since it was evaluated in 2003. Record keeping The project- hai very well documented data on coverage by communities,. FLFIF and LGAs in both electronics and hard copies which made retrieval and use of information very easy. However these records are within the GRBP office and the need to train a State team member to handle data still remains' Coverages The geographic coverage has declined from l00o/o to 74.6Yo and the therapeutic coverage for last distribution dJclined to 54.4%o reflecting the high attrition of CDDs and the absence of support for HSAM at the community levels and monitoring and supervision at the LGA levels. During the briefing session, the Commissioner expressed doubts about volunteer work and strongly supported the payment of an allowance to CDDs' LGA Planning None of the LGAs had any written plans that could be verified. The information about plans was based on intervilws with the PHC Directors and LOCT leaders. In two LGAs ihe health plans were made without reference to the post-APOC sustainability plans while the other LGA had not made any activity plans. The other did not have any plans at all' policy makers that were interviewed said that they often waited for the plans that are sent from the State oncho office and abide by them. Training There was no evidence of any training since 2004. In the only LGA that claimed having conducted training (no documentary &idence), cDDs were said to be trained within the communities. The LOCT leader canied out the training and did not involve the FLHF incharges. Neither training reports nor training manuals were seen and there was no release of funds or othertrour..r for training and it is doubtful if training actually occurred at all. HSAM One on one advocacy interactions were made by the project teams to the policy makers at this level, without any change in the perception of the project' Many LGAI allocated funds, some approveA, but nor" "r.t released funds for activities' HSAM suffered more than any othei activities at this level and its effect is seen in the communities. There were neither reports nor other evidence of HSAM activity being done since 2004' l4 Monitoring and suPervision There *u, ,o evidence of monitoring or supervision although there was claim that this was been done. There were neither completed checklists, nor reports nor plans relating to monitoring and supervision. There was no visible reward system in place' Mectizan supply euantity of lrermectin collected from state is usually sufficient and timely and bothjorage ana channel of conveyance and delivery is within sustainable systems. Human resources Every LGA has an LOCT leader who is responsible for onchocerciasis control and in many cases also responsible for other health activities such as monitoring and evaluation, disease surveillance and national programme on immunization. Integration Traiiing, monitoring & supervision as well as advocacy visits are said to be integrated with health activities like disease surveillance, environmental health, monitoring and evaluation, national programme on immunization and maternal and childcare. Transport (motor bike and Uicycteil are shared in an integrated manner. In most cases same staff is involved. Coverage ceographic coverage ranged from 67Yo (Ehime Mbano) to 86%o (Ihitte uboma). None of the LGAs had 100% giographical coverage. Similarly, therapeutic coverage ranged between 44Vo (Ehim" tutu*o) to 92%oNgo Okpala while Ihitte uboma has 60%io. Finance There were no releases of funds at all in any of the LGAs. When funds are approved, they are never released. Record keeping Some data were available at the LGA- such as Mectizan inventory and some treatment summary sheets prior to 2004. However, previous years records of distribution were not available. Transport For each LGA one functional motorcycle and 4 or 5 bicycles were available for CDTI activities. l5 Frontline Health Facilitv often one individruil-6ut"d at the FLHF to be responsible for cDTI does not share the information with other-members of the FLHF and there is hardly any other one in the FLHF with information on CDTI. The findings reported here are often on the basis of the individual responsible and not the FLHF as a unit, except otherwise stated' Planning ri.,i+ioo ohn.rrino dqfe re of the FLHFs. others hadSome key CDTI activities showing dates, were seen ln som time tables and duty rosters of health programmes without re.flecting any CDTI activities' In some FLHF, health staff were u*at" that CDTI activities were taking place but no documentation of the activities were in existence Training Some triining activity was mentioned but there is no evidence of this and in most FLHF it seems there has ,ot b".n any training since 2003. There were no training manuals, or other materials. The situation has been worsened with the mass transfers across the State from endemic to non-endemic and vice versa which made retraining of FLHF important. There was the case of a CDD training a midwife and ilc of ahealth facility about CDTI' HSAM There has not been any HSAM in any of the FLHF and they hardly t3k: nart in this activity. They lost inteiest in the work since 2003 when top-ups ceased' There was no intensive and well planned effort to inform the FLHF and prepare them for the cessation of top-ups. Aggrieved, many of them lost interest in the project. Monitoring And SuPervision There were still no'supervisory checklist in any of the FLHFs nor were there reports' Monitoring and supervision was hardly done. Mectizan Mectaizan was adequate, sufftcient and delivered on time' Mectizan inventory are available but treatment summaries were not available at this level Human Resources There is a trained person in every FLHF and the others within the FLHF have very little knowledge of CD'iI. In some .ui.r, a CDD had to go home if the CDTI focal person at the FLHF level is not available thus creating inefficiency and frustration to the CDDs' Integration There were no indications ofjoint or integrated activities at this level. This is mainly due to the fact that one focal p.r.in was selected in the past and given top-up to the exclusion of others who therefore would not share in the work since they had no monetary benefits. t6 Coverage The ge6graphic coverage is about 75%o while therapeutic coverage could not be aeteniinJa in any of the FI-Uft since there were no records at this level' COMMUNITY HSAM All communities had received HSAM at some point in time especially before 2004.ln one community the last HSAM was in 1999. There are no properly plTnt9 HSAM activities. Recently HSAM was only carried out by CDDs at the time of distribution' The awareness level in some communities was very low' Mectizan Supply Mectizan rrppii.. are adequate. However, there no clearly defined channels for supply of these drugsib ttre communities e.g. some collect from the Eze'spalace, others collect from the FLHF but once within the community, distribution is house to house. Some de- motivated CDDs (previously paid but not paid any longer) ask community members to come and collect at their houses. However in one community, a widow, a CDD was so highly motivated that she provides water for those who come to take the drug. Human Resources At least each community had an average of 3 active CDDs and over 80% of CDDs are educated females. Attriiion rate is hfuh reaching up to 60%o in some communities. Withdrawal of payments that were made to CDDs in the past was the main reason for the high attrition rate of CDDs. The remaining CDDs then had increased work load which. For communities using the kindred system there were no complaints on work load. Record keeping There were treatment registers in majority of the communities while a few new CDDs used loose sheets fro recording those that received the drugs' Registers were properly kept neat and clean. In many cases only the eligibles were reglstered. Mosf of the treatment registers were not analysed because they were not trained to do so. Results of treatment registers were reliable but not integrated into record system at this level. Coverage Most households were said to be treated but this could not be ascertained from the treatment registers since records did not reflect entire household but only eligibles. The CDDs purch-ased the exercise books for themselves and did not want to use up the leaves. t7 (, bJ ort!t Et E) oo orf a f) D oa o a t)p BT FU DT E -Eqr!4z\z az rD lrl (J o E,o =p o o o o' \o\e\o z o : oc O 0e 0e6 a O 7P='! 3 -iH;?[isEgal€ Esz5!Z:i 3 5 /1 q)eYE'3eoIie'€ i9s-^ H 6 EiU E}E:ii 6 8.7 fd E sE +Es gB+ = N ;.; =i€ gi3 o6 AU iq] 4.. E =3' gPtr!l 3'6 idEo 6qS#g qa'i_.E-l ?6'?5 ='= iDA a' @E ?EB6 l9e? i33J =m oe oe Br Hti< a Ys" :J .1 I 6 r! o UO A): o= a?aEa o(u , NpiE d.6 .Eo 2:7.O =N -ch =-tsaEtrt:1UEE 6'?o5 'da ID (! o o o -l -l o FIo ! €.(D o o r X ItttE z aDd zo .B o oa!) 0! 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Bg -6: Bg "' =. rio 6C d tsH .- 5'3 !.J Ft rt'(D o -loo E o{o o a 7oo 0a o o'i 0) F9 H{ o o- - o o() * o o FD o o o =ta11 t.JFe*qkI ^ d f -Bxa e 7t2 E I d: eq6=' h- P = ol2 & @uj*j '(3 !: 6' E.9 6 6cro-= =eE Ia@aa a' =. ='S O I)o P)wa) a a 'v o o- Or 6g s-oora o-o 6 a o L)F o' z oo NE p I O.Oq 'aioO P 5.8 B. H &e^X iD=d9o-e.P 96 ; a9 I b5 @ v- u e'6 +a5 et6e pE )a 60<6 E6 oB60 o .)o ,( E!o oa E =' '6 o oa Bo. o .z =.:" & !'' Ep 5 3t'5:6 6 =.od.o;t!. ? ga;3 o d9#AEF *9 5 if;33?EBE*C:.r o -I a ='d' oaPdrtsg5 pr_oY9 od, 5; a- o' o ,l N b o o oD oA o 'E ! - Fil aD :1 r.l I E g 'EI409.;zoE6- B e5 6oQ o l x93tr =6.9z-5 q n-1 .9.n e t - q 9.ri = ='9E3z o.0(D3 6o e'E o6 ora a -'l o$+iJ eqd'85a) =,d9< or flX ot.tDo Fl a-7.tFes9 Xa:.Y * o.E =o-lE't'daE*8; - =' oa o o lqIElo- F F rt g;5 =34 cv L'l E.'o F3.O P otrEld6 =-Ara8oa ='aDo= 7aiaO i! +lo. c. E'o s5 c) oE G ? z Fl F z o z -l -t -5r@(D o- =-r5 ooo aElo5or 3q :€E9f.<6e. '29 Ro^ (, C rE t!,F a z ol! o o-3i95-lad E -F+a5FB= A'EEH2 ?r' B eIG 5 0 --Q c o --g.-d -.FiEHE IAr+=' *. E' 8.3 ov 5 ^04ag ?ra loo| ** A N)HE >Fz E tr1\3 tD t-<o.-P.; =!tr2!Lddo-trQEE rar€dH =). ea ? =(D t- oi (Dp o-6 g;5 t=Jl a.E ?3.Q - ;6tal AG;5 =aa- -Oi5 9. -. o-5iao= B+ o- o 6', oNH @ ='-Fl6- itr'ETda -8-e a .H3 *9-r oo<5o[6 qg o 6Hgr qr o,o o o fto oifq6 c =Po.o rE' @D) o o oa oao o o D o o il'3 s(a oa o o.o o- o(D o-o o ID ID o- - @ oa o E(D fd oo Fo! rt EIos '(DO=FJOE{ .oB ocL Hi A^oox a'*(Did5 <a oo 30 o o ijo TD tsJ 0) .6 >9 <5a'o or ^.oao :P 5:t aaaEa'9oI'd s. =' s oo o o 6 o rJ !o ts !'''9- o-r<x{:j =- rB. ooQ Np- oO6.q5'B D (! tr ao E) o5 |. o o 3 o '6 D' = Bo o(!6Ito o. o doo oo o o (a o o 'o C,o Uoro s oo oi oo @YE€ .o o N (D a oo E6 \o 3.3 Strengths, Weaknesses' Opportunities and Threats 3.3.1 Strengths The progamme personnel have demonstrated experience working amicably with a network of pu.tni.s and stakeholders including APOC, GRBP, the LGAs and the communities. The project is endowed with highly educated, skilful and committed personnel at the MoH programme levels. fhe pioje-ct sites are easily accessible, relatively near the State capital and have a network of motorable roads. The community population is educated, open to information about the drug, ivermectin and are willing to continue to use it having experienced its benefits 3.3.2 Weaknesses The main weakness of the programme is the inability of the implementers to address issues raised in the 1999 monitoiing report and to implement the sustainability plans that were made in 2003. Specific challenges are inability to promote information, education and communication component, und raise awarenls of stakeholders and partners about their roles and responsibilities. Many communities are unaware of their responsibility to motivate and support their community-directed distributors (CDDs). FLHF staff are also ignorant of their responsibilities for training, monitoring and supervision of community level activities. The State Onchocerciasis Control Team lacks management support staff of a secretary and book-keeper as contained in the project documents' There are no tlearly defined MoH policies for motivating community-level implementers (such as using them as guides during NID as is common in many other States). _In many cases dis-incentive pru.-ti."r by local politicians' intrusion into health care delivery at community level has weakened and poie a considerable threat to the sustainability of the project at this level. 3.3.3 Opportunities There are several opportunities for sustaining the Imo State CDTI project. The drug Mectizan'has broad antihelminth effect (and is donated free for as long as required) which is very much appreciated by the people' The CDTI strategy has advantage of ensuring wider coverage of beneficiaries than any other approach and it is being adopted for the delivery of other public health care services (Vitamin A, schistosomiasis control, lymphatic filariasis control). imo State has a highly competitive population with vibrant community-minded CBOs and associations, a ,"iituUt" ."source pool, waiting to be tapped for community service delivery and support. Unfortunately there have not been exploited for the benefits of this programme. 3.3.4 Threats The survival of the Imo cDTI project is threatened by three major challenges Lack of sustained awareness of tie roles and responsibilities of partners (especially the ""-.,,iti".",atnIr,*uin"n*lthfacilityserviceproviders)andabilitytoempowerthem to perform Inability of the State MoH to establish ownership of th9 project through complimenting thecontributionofo@theirobligations(ofcounterpartfunding, establishing a real onchoierciasis control pror"i office which will be attractive enough for the intelration of other programmes). Tiansfers across non-CDTI areas' a threat Uncertainqi about the op.ratiJnal locuiion of thit prblig health proj.ct that has. been in existenceforteny"uil,u,"""ntthreat-thatweareunfortunatetorunintoatthistime. Should this ambiguity remain unsettled before it becomes public knowledge, the survival of the tmo State C6fi pio;""t itself may not only be in jeopardy, i1 influences the decisions of NGos .uo.ntly ,ontemplating using the CDTI strategy to facilitate add-on health intervention services. We apprlciate that tfiis issue be resolved so that this section of our reports will be exPunged. 3.3.3 Technical Support that was offered to the Project @rt was offered during the monitoring exercise. Advocacy-the team had a'biomedical communicator on the team who assisted the team with relevant advocacj materials and showed the project team how they could be used at the different levels with minimum modification. Advocacy meeting was held with to the Ezes, the Chairmen of LGA and top-level oflicials of the Ministry of Health' stql@holders' meeting was held with the commissioner for Health, the permanent secretary, Director oipuUti" Health and representatives of the LGAs and communities including a CDD in attendance. Motivation-The team solicited the recognition of cDDs and the use of creative upp.ou"t ", to motivation. In order to demonstrate this, a widow who served as CDD for l0 years in her community and continued to serve in spite of payment and-an exemplary LOCT leader were invitid to meet the Commissioner for Health and the Permanent Secretary during the debrief who commended them' Resolution- The team arrived there was an unresolved controversy sulrounding. difficulty when the onchocerciasis control Unit was transferred from the Public Health Department to the Vector Control Department leadin-g to a lull in activities and demotivation of the implementers. At the intervention of the monitoring team the MoH has let CDTI remain within the public health Department' 4.0 CONCLUSION The implementation of Imo State CDTI post-APOC sustainability plans was monitored to check the extent to which the MoH had addressed issues raised in the evaluation reports. Reflecting on the 1999 monitoring and 2003 evaluation reports, the Imo State CDTI is yet to adlress most of the concerns raised or to commence the implementation of their sustainability plans. Besides the use of GDTI vehicles for other programmes and the participation oi ttre team members in other programmes integration of services into and activities are Yet to commence. 2l 5.0 RECOMMENDATIONS The following actions are suggested to the State to assure the projects sustainability a) Set up u .J*-ittee to ."uIJ* the post-APOC sustainability plan and recommendations from monitoring and evaluation ieports of 1999 and 2003 respectively and take appropriate steps to redress the lapses. Ulb"u"fop u piu, for empowermlnt of Local Government health staff especially those at the frontline health facility level to enable them carry out their responsibility of health education, advocacy and general mobilization of communities. c) Establish an operationaioffice for the State Onchocerciasis Control Programme with compliments of office secretary and book-keeper as well as defined terms of reference to enable it stabilize and share expertise for add-on intervention services which use commun ity-directed aPProaches Ai rure"t 'State obligution. within the letter of Agreement by providing counterpart funding to enable the project carry out .basic CPTI activities of monitoring' ,up"*iiion, training and intreas" u*ur"n"rs which are critical to the project survival' e) Institute plans for motivating community and health personnel and partners (especially at the community level) who perform credibly' 0 top level programme planners strouta recognize the pivotal role of the FLHF in GDTI and empower it to perform its responsibilities' 22 APPENDIX 1- Debrieling Notes with the state commissioner for Health MONITORING THE IMPLEMENTATION OF IMO STATE CDTI SUSTAINABILITY PLANS DEBRIEFING OF THE MINISTRY OF HEALTH BY MONITORING TEAM Introduction The Imo State CDTI project which has been operational since 1999 with APoc funding and technical support *as evaiuated in 2003 for sustainability beyond APOC funding period' The Imo State CDTI pioject developed and commenced the implimentation of sustainability plan in2004' The current debrief is based on an APOC mission to monitor the extent to which the Imo State CDTI sustainability plans are being implemented' STRENGTHS The programme personnel have demonstrated experience working amicably with a. network of partnersind stakeholders including APOC, Global2000, the LGAs and the communities' ihe project is endowed with highli educated, skilful and committed personnel at the MoH levels' The project sites are easily aclessible, relatively near the State capital and have a network of motorable roads. The community population is educated, open to information about the drug ivermectin and are willing to continue to use it having experienced its benefits WEAKNESSES The main weakness of the progr:lmme is the inability of the implementers to address issues raised in the 1999 monitoring reportLd to implement the sustainability plans that were.made in 2003' Specific challenges --. i*Uitity to promote information, education and communication and raise awareness of stakeholders andiartners about their roles and responsibilities. Many communities are unawaf,e of their responsibiiity to motivate and support their community-directed distributors (CDDs). FLHF staff are also ignorant of their responsibilities for training, monitoring and supervision of community level activities. The State Onchocerciasii Control Team lacks management support staffof a secretary and book- keeper as contained in the project documents. There are no clearly defined MoH policies for motivating communityJevel implementers (such as using them u, guid", during NID as is common in many other States)' In many cases dis- inceltive practiJes by local p"oliti"i-r' intrusion into health care delivery at community level has weakenedand pose a considirable threat to the sustainability of the project at this level. OPPORTUNITIES There are several opportunities for sustaining the Imo State CDTI project. The drug Mectizan has broad antihelminth effect and is donated free for as long as required fhe CDll stratery has advantage of ensuring wider coverage ofbeneficiaries than any other approach and it is being adoptei for distribuiion of other public health care services (Vitamin A, schistosomiasis control, lymphatic filariasis control) to community population!.__ ^ Imo State has a highly compftitiue population with vibrant community-minded CBOs and associations, u r".itubl" ,"*u."" pool, waiting to be tapped for community service delivery and support. 23 THREATS The survival of the Imo CDTI project is threatened by three major challenges . Lack of sustained awaren;ss of the roles and responsibilities of Dartners (especially the "orr-*iti". -a tt " fr*Uin" t ealth facility service providers) and ability to empower them perform o Inabiliqv of the State MoH to establish ownership of lre project -by complimenting the contribution o@g their obligations of counterpart funding, establishing a real onchocerciasis control pioject office which will be attractive enough for the integration of other programmes. Transfers across non-CDTI areas, a threat . Uncertainty about the operational location of this public health proiect that has been in existencero'@thatweareunfortunatetorunintoatthistime. Should this ambiiuity remain unsettled before it becomes public knowledge, the survival of the tmo State" CpU project itself may not only be in jeopardy, it in-fluences the decisions of NGOs currently contemplating using the CDTI stratery to facilitate add-on health intervention services. We appriciatJthat this issue be resolved so that this section of our rePorts will be exPunged' RECOMME,NDATIONS The following actions are suggested to the State to assure the projects sustainability 7. Set up a committeei6 rerie* the post-APOC sustainability plan and recommendations from monitoring and evaluation reports of 1999 and 2003 respectively and take appropriate steps to redress the lapses'g. fieretop a plan for empowerment of Local Government health staff especially those at the frontline health facitity level to enable them carry out their responsibility of health education, advocacy and general mobilization of communities.g. Establish an operational Jffrce for the State Onchocerciasis Control Programme with compliments oioflice secretary and book-keeper as well as defined terms of reference to enable it stabilize and share expertise for add-on intervention services which use community-directed aPProaches 10. Meet State obligationi within the letter of Agreement by providing counterpart funding to enable the project carry out basic CDTI activities of monitoring, supervision, training and inciease awareness which are critical to the project survival. I l. Institute plans for motivating community and health personnel and partners (especially at the community level) who perform credibly' Conclusion CDTI, a stratery used in more than 36 countries, has unrivaled ability to carry services to the targesi numberlf beneficiaries in the widest area. For this reason many projects use it to deliver othir services such as health education for HIV/AIDS, deworming of children, filariasis control, treatment of malaria in Under-S and delivery of Vitamin A. Donors prefer to support programmes which have evidence of sustainable community participation' Acknowledge We apprecia"te the hospitality of all those that we have had the opportunity of interacting with durini'ttre course of tiris mission: the Permanent Secretary Dr J.N.C. Onyegbosi, Director of Public Health and Primary Health care Dr (Mrs) V.N. Onyenekwu, Imo State CDTI Project Coordinator Mr. Jude Onyenam4 The Project Administrator, Global 2000 Abia/Imo Projects Dr uche Enyinnaya and Dr Nnoruka of the Vector control Department. Prof. O. Akogun, P. Ekwelle, F' Olamiju Dr O. Ndekwu, Dr E. Nnoruk4 WHO/APOC Monitoring Team. 24 Owerri, l0th October, 2005 APPENDIX 2-Listof Persons Met Level Person met Position Office STATE LEVEL DR. CHIDI MARUME CHIEF J.N.C O].TYEGBOSI DR. V.N ONYENEKWU MR. M.S.IKE MR. G. N. ALOZIE MR. ruDE ONYENAMA HON. COMM. FOR HEALTH PERMANENT SECRETARY DIRECTORPUBLIC TIEALTH& PHC Ag. DIRECTOR. DPRS DIRECTOR OF FINANCE & ACCOLTNTS STATE ONCHO. CO. ORDINATOR M.O.H M.O.H. M.O.H M.O.H NGDO/ DR.UCHE ENYINNAYA MRS. GRACEAMAH DTRECTOR ( CDTI ) ACCOL]NTANTEINANCE CARTERCENTER CARTERCENTER LOCALGOVT. ( Ngo- Okpuala ) MR.CHL'KWT]MA NWACHTIKWTI MRS. ROSE ONOSIRIKE MR. SABINUS MEGWA CHIEF GREG.NZE MRS. S. C OKORO MR ANYANWT] GODSON NZE ONYENEKWE A EZEANDREWNJOKU MRS. LYDIA OKERE MRS.NGOZIAMALIRI EZE EMEFORONU MRLINUS IWTINDU DIRECTOROF ADMIN. & PERSONN. ONCHO. MANAGER MALTHCOMMU. TECHNICIAN ASS. LOCT MANAGER DEPUTY DIRECTOR (PHC) CDD COMMT]MTYLEADER TRADITIONAL RULER CDD STAFFNI.IRSE ( FLHF) TRAD. RULER CDD LGAHQ LGA LOGARA HEALTH FAC. LGAHQ. LGAHQ. EZIAMACOMMTIMTY UMTINAM UMTINAM UMUABACHICOMMU UMUNAN UMU EZE UMI-IDIRE ( Ehime Mbano ) LADYruDITHN.DURU MR. F.C. CHUKWUOCHA MR. G.CEKEH MRS. C.A. OGOKE MRS, ADLEEN AJUBE DIRECTOR OF ADMIN& GENERAL SERVICES P.H.C CO-ORDINATOR. ONCHO. CO-ORDINA. SENIOR STAFF NURSE/ MIDWIFE. CDD LGA. HQ LGAHQ. LGA.HQ. UMT]DURU UMUOKPARA FLHF. UMT]DURUNSO EhiteUboma MRIGWE JAMES MRS ANOSIKE PHOEBE MRS BASSEY OGOOKE LOCT LEADER STAFF NURSE ( FLHF ) CDD Ehite Uboma UMUEZEGWU UMUAKPI 25 APPENDIX 3-list of documents submited to the evaluation team I [mo State Endemicity MaP 2 Treatment rePort 2004 3 List of LGA and FLHF 4 Preliminary budget 2006 Ministry of Health 5 Imo State apProved budget 2005 6 Annual Project Technical report 2003,2004 7 Imo State CDTI Sustainability work plan and budget 2004'2006 8 LGA CDTI Sustainability work plan and budget 2004'2006 9 Letter of agreementz004 l0 Letter of ageement and budget for 1 year of IMO - ABIA CDTI sustainability I I Draft.rpott' Assessment of the sustainability of the IMO State June 2003 l2 Check list for supervision 13 Minutes of meetings of the State Oncho control team 26 APPENDIX 4. COMPLETED TOOLS FOR THE MONITORING OF CDTI SUSTAINABILITY PLANS INSTRUMENT 1 (State/Region/P rovince) COUNTRY NIGERIA PROJECT NAME IMO CDTI PROJECT NAME OF THE STATE/REGION/PROVIN CE IMO DATE OF COMMENCEMENT OF CDTI OCTOBER I998 DATE OF EVALUATION JUNE 2OO3 DATE OF COMMENCEMENT OF SUSTAINABILITY PLAN IMPLEMENTATION JIJNE 2OO4 DATE OF ASSESSMENT OF SUSTAINABILITY PLAN IMPLEMENTATION OCTOBER 2OO5 NAME OF MONITOR AKAOGUN O. NDEKWU O. NKWELLE P. OLAMIJU F.. NNORUKA EN. 27 Instruction : Check implementation of sustainability plan and verify whether constraints earlier identified are being rectified. Also check ,f lny CDTI activities (Training, Monitoring and Supervision, HSAM and Mectizan procurement ond distribution) are being implemented as planned. STATE/ REGION/PROVINCE 1.T PLAI\INING Characteristics of the indicator Sources of information Is CDTI integrated into the overall health service plan? YES tr Does a detailed list of CDTI activities exist including the dates when they will be carried out? - YES a a Interviews with policy makers and managers at this level Inspection of CDTI plans. Findings: Describe the situation (*comment on leadership at this level) HEALTH PLANS WERE SEEN. AN INTEGRATED HEALTH PLAN WAS SEEN BUT CDTI ACTIVITIES WERE NOT LISTED OUT. THIS OVERALL HE,ALTH PLAN. REFLECTED CDTI AS ONCHO AND ALLOCATED N5O,OOO FOR THE YEAR WHILE MALARIA .NPI AND HIV HAD 2M.13.6M AND 6M RESPECTIVtlLY. AT THE STATE PROJECT OFFICE A 3 YR POST APOC PLAN WITH CDTI ACTIVITES & ].IME FRAME WAS SEEN. THERE WAS A HIGHI-Y EDUCATED AND COMPETENT TEAM UNDER THE LEADERSHIP OF THE DIRECTOR OF PUBLIC HEALTH AT STATE LEVEL. COMMITMENT OF LEADERSHIP AT'THIS LEVEL IS MINIMAL WHILE EMPHASIS IS SHII.-TING TO PROGRAMMES SUCH AS MALARIA AND HIV/AIDS. SOME POLICY MAKERS WERE ENTIRELY IGNORAN'I OF THE PROGRAMME. CERTAIN PROPOSALS FOR SOME CDTI ACTIVITIES HAS BEE,N PARTLY FUNDED BY STATE. NGDO PARTNER IS CURRENTLY USINC THE PROJECT TO DETERMINE IF WITHOUT THEIR INPUT WETHER THE PROJECT WILL SUSTAIN ITSELF If planning was not done give reasons why NOT APPLICABLE Suggest steps to be taken to improve situation 28 D 1.2 HSAM (Advocacy) 1.3 MECTIZAN Characteristics of the indicator Sources of information What was the ective? Who was targeted for this advocacY? What approach was used? What was the outcome? lnterviews with officials responsible for onchocerciasis at this level (managers etc') Inspection of the technical activity reports a a Findings: Describe situation It\,\\l .\('ItVI]ll \ \l\ll I) To (it I kl \ P()l If'\' Nl,,\Kl t{s RF-t-l \sl I[ \l)\ \.t] \ltt.\ I'ol{ I,l \\\l.l)('DII \(ll\llllS\\l.Rl S(lll l)tl.l'-D \l'()( It\l)S\\t.l{l.Rl tt\Sl.lll()R IIII\ Iil I il[ Iil. \\t.tu \() Iil.t)()ti.]s ol: \('ll\lllls (',\ltRII t) ()t I \l IIll I)llll.ltt\l t.l:\'l.t S. \1.\() l\ Iill- t-ll.t.l) Illl R ll,-\s tlt t--\ \o ( lt \R F.\ lt)l \( I ()l lHti. I.l ll('l ol ll\.{\1. ,'\NI)('()Nl\lllt"ll.Nf ()l'I)()l.l('\'NIAKI RS .\l lllls I-i:\'i L IS SIIl.i- MINlN4,\t ' \(ilx) I'.\l<l\tR S\\\ llll \ tll\t: \t.\\ ll\\\l \l \llRl,\l.S. \\lll('tl tl\\l \()l Yt-I [ll-.t:\('rri( t t \ Il t) t)FSPtll Il\ \i I I) I\ IIIt- ( ()\i\lt \ll\ If advocacy was not done give reasons why. \{) L\l'l}l-I( '\tlI I Suggest steps to be taken to improve situation. ('\RRll.l) ot I \lt t ll \loRl I ltl.(.)t I:\TI \ ItLSPt.( il\ I l.\ \l)\ o('{( \ \li I Il\t,S ()\ ( t)ll \llot l.D Ill: I() l,()t I( \ \1,\h. I I{s \ I sl \ lF-,\\l) l(r \ l.l \ L-LS Characteristics of the indicator Sources of information Is ivermectin supply sufficient (adequacy)? YES Is the delivery of ivermectin timely (for distribution)? YES Is it integrated into drug delivery system? YES. TO AN EXTENT Interviews with officials responsible for onchocerciasis at this level (managers etc.) Inspection of technical reports/records a a Findings: Describe the situation- \ll C'I11 \\ \[ I'}l'l Y IS ,{t)l (.)l \ Il-. t}[ l- \O I Il\il I \ l)f.l.l\ t RI I) llli\ ll)()5 RE(',\t \l ()l I)l l- \\ l\ ()lll'\l\lN(i lRI.,\l\lt:\f \t \l\l'\t(ll S t-J(()\l('()\l\lt \llll.\- TRI \l\ll \l ()1. ll)0-1 \\llll Nll.('l-ll\\ l\ \()\l[: C'o\l\lt \llll\ lS \lll I Bl-l\(, ( \RRlt:D \l(i\(r\ll)l l(X)-s IRt:\l\lt'\l \\tll('ll \l\l{lll) l\ -lt\l IlllS I(}R \l-1. CRIII'\l\ll.\. I)t{L(i\ \RI:(1.1 ,\lil.D \ttRI\l \l\(it)()()l ll('i \l\ ILIES'1,'\11.. llto\1 \\Hl('}l sl',\'ll l\ \\Kt.l) l'O ('ol.l t('l Illt'lR I)Rt (iS lolL l)lSTRUt Il()\ I() l(,-\S. IIll.ltl' II\\ llt-F.\ \() l()R\l ()l l\ I I.(lR,\ Ilttl 1r.,, I()'l tlL DI<t (i I)l.l.l\ I.RY SYS ll.\l ()l Il{lr Sl \ IL If ivermectin is not available (sufficient, timely, integrated) give reasons why. NOT APPLICABLE Suggest steps to be taken to improve situation I'llOJI:('l' lNlPl-l:\l! lt It\ \ I \l i- L.t'\ I I \ \tlOt t-D L}\St ltl lll \.l \ll.( ll./ \\ IS ,\\ \lt. \tll I 29 l.4INTEGRATION Sources of informationCharacteristics of the indicator Inspection ofreports, plans, budgets etc' tr o Interview of staffat this level Resources Mention the resources (e.g. transport staff) that are shared between CDTI and other health programme activities (e.g. EPl, malaria, HIV/AIDS) Activities List the activities (e.g. Mectizan procurement and supply, supervision and monitoring and training of lower level staff) carried out in an integrated manner with CDTI DOCLIMENTED. ACTIVITIES: CONDLJCTED INCLUDE NAI'IONAL PROGRAMME FOR IMMUNIZATION' ENVIRONMENTAL HEALTH AND MONITORINC AND EVALUATION ARE ALSO CONDUCTED BY STAFFWITHINTHEoNCHoUNITINANINTEGRATEDFASHION.THEREISHowEVERNoREPORTS AND PLANS OF SUCH ACTIVITIES CONDUCTED AT THIS LEVEL' HOWEVER. AT THIS YEARS PLANNING MEETING. HEADS OF UNIT HAVE BEEN MANDATEDToCOMEUPWITHTHEPROPOSEDINTEGRATEDPHCCHECKT,ISTFoRALL LA YLCTUAREAYARATIONSTNDANTRA POS TRsituation RESOURCESribeDescFindings: w NOTEREE ES ER THHOWIT EUNTA oNED A ULNANGDN ITORIMONAT NPIHAH wREDS HEALTH PROG RAMMES OF THE STATE NOT APPLICABLEIfthere is no evidence of integration give reasons Suggest stePs to be to improve 30 1.5 FINANCE Sources of informationCharacteristics of the indicator Inspection of the plans, budgets, documents showing disbursement, for year of reference a a Interviews with officials at this level the continuation of CDTI? o Are resources released for CDTI activities? o What proportion of allocated funds was released? tr this level forAre resources al located at FOR ( I)'tl,\('I I\ I lll.s. stl,\t(l\(i otr s\l()lI \1.1.(x \ llo\\ I\ I.lsl ()l'lil,\l Ill:ltl,\l \\ \\ \\ll\ Ill\ \ll)\ (i(tl l'r'(t\l' :()\ll ,,\l I.o( '\ lto\\ ,\l{l \l \t)l \l\l)l \( ( ()ltt)l\Lr I0 l'}ltl()RIl\ \l\t '\Rl \ (r\l \\t) O\( ll l\l \() ( ()t \ ll Rl'\t{ i i'i \l)s \\'l l(l I]\ \(rI)(,lI]|. li\().I R.I-l i.\SI t)t](.()\Gtx)I,\RI\t.Rl\t.It{l].1 \ll-\ [SlN(i l.t Il l,l{().II-(.I1.() t)l I'ER\Il\-t il \\llH()t l l\l)t l li{()\l lllt\1. \\ll'llER Illl l)lt()'l l.('1 ('{)L lt) \t \i\l\ )5\171.()0()\\,\Sl(t.l.t''\Stt)loR(()t.l't.(11()\0llrltll)\11-'\l&\llll(l'l:S ,\\t) \7(r. ()00 I()lt \l()\ll()Rl\('r \\t) SI PLR\ l\t()\ \\ \S \l'SC) Rl.l I:'\St.l) Rl,t_E \SI.t) I tt()\l \1 \l F. l\ l0{)-l rt73t7. t10{) \\'\S llt IXilr'l"l't'l) Findings: Describe the situation i I \I-I,I I I( )\\ t.\ t--R. l\ l(x \I \I I\ L]\ \I}(X IIIIS RI I'l Ir('lS t \l)l l(s I \\l)l\c ol I I I I- t- T; \'I-I ()I I lll I,( )t.l('\ \l'\Kt RSIf ftnan..s are budgeted but not released give reasons why \lEI Il\( r \\ lltl I tll l)l'}ll' t)lRt ('I()l{ Ol' I'I\\\(I \\I)I)IRI (I()R0I I'I \\NIN(i \\IIII S L-\, I t l\ I't ,\ \\ li\(l Pt(( )Pt l{ ltl.l I -\St's ( )l I I \DS I()I{ IIII, I'I<(XIR'\\I\II - ('()\l'l\( t I) ,\l)\ t)(' \\ I ( ) I'( )l.l( \ \l'\KF.R\ \l l( )t t.D Ill \ \ tr\SI ll7\llO\Illt RlSuggest steps to be taken to imProve situation 3l 1.6 RECORD KEEPING I.7 COVERAGE Sources of informationCharacteristics of the indicator Interviews with officials at this level Inspection ofrecords and records system a a o Is data on CDTI available? o Are they properly recorded and stored? o Are they analysed and utilized for planning CDTI activities? o Are they reliable? Are they integrated into the normal health record system at this level? APOC.THEREAREMONTHLYREPORTS.TECHNICALREPORTSAREAVAILABLE'ANDWELL STORED. EASY TO RETRIEVE. RECORDS ARE COMPUTERISED AND IN HARD VERSION' BL]TDATAISNo.IINTEGRATEDINToTHESTANDARDMoHHMIS. LE FOR ALL THE 2 YRS POST-TA EXISTS AND IS AVAILABFindings: Describe situation CDTI DA NOT APPLICABLE.Ifrecord keeping is poor give reasons why Suggest steps to be taken to improve situation Characteristics of the indicator Sources of information o What is the geographic coverage ? r What is the therapeutic coverage for the last treatment cYcle? 8l .2ozo o Interviews with officials responsible for Onchocerciasis at this level Inspection ofrecords for previous year Findings: Describe situation (;t'oGR.\l'}lll( ('o\ I R \(lt. \\ \S 7l (r",,. [][.("\[ \[ iltt.R \1,t.[ Il( ( ()\ t I(\Ct. I ()l( l. \\l t)lsTRIl]t II()\ \\ \\ :J.J"" If geographical coverage rates are below 100% and therapeutic coverage rates less than 65%o, give reasons why \o | \t l- l.(i,\'\ \\ I Rt I\\ ot-\ I I) t\ rHI. I'Rt \ tot s YI \R\ I)l\ J RIBI ll( )\ t] (' \losT ('l)t)s REFI \l'l) l() l)l\.lRllJl. I'1. lllt il( I)RI' CS Suggest steps to be taken to improve situation 32 INSTRUMENT 2--LGA (District/LGA) l'\l(il.RI \COUNTRY l\l()('t)llPROJECT NAME \(r() ()l,N \l-\ L ti( )\l \ t tll\ll \il],\N{). Illll'ilNAME OF THE DISTRICT/LGA l()98 1999OF CDTITE OFDA Jt \1.l00rDATE OF EVALUATION .l t \l: l00l SUSTAINABILITY PLAN IMPLEMENTATION OFOFDATE ( X'lolll;R l(,0.iDATE OF SUSTAINABILITY IMPLEMENTATION ASSESSMENT OF PLAN \K( X,I \ ()1,\\ll.lt o. \K\\lllt l) I \\I) \\0RI K,\ I \t)t.K\\ l. ( ). NAME OF MONITOR JJ TOOL FOR MONITORING OF CDTI SUSTAINABILITY PLANS (District/LGA) InstrUCtiOn.' Check implementation of sustainability plan and verify whether constrainls earlier identiJied are being rec'tiJied- Also check if key CDTI activities (Training, Monitoring and Supervision' HSAM and Mectizan ptocutement and distribution) are being implemented as planned' 2.l PLANNING Sources of informationCharacteristics of the indicator Interviews with PolicY makers this level Inspection of the written Plans a and managers atIs CDTI integrated into the health service plan Is there a detailed list of the key CDTI activities (monitoring, training, etc') including their timing? a a overall t() llll.lR I)()SI \l'(X'st sL\l\\tllt.l1\ Pt..\\.\. \f )\lt.()llIF.RS tl\l) \() Ill-\\s \l \l t. \()\lll I'()t.l(\ \i \[1t\ I\lll(\lF\\t-l),\l IIlls tL\Et..S'\lt) lll\l llt-\l.lllt\ll\ l\('t t I)l\tro\('llo I \t \l l.\ St.\l) \( l{()\S PR()['}()S'\tS Ill\l' .\lil l\ll(rR'\1't- I\l(} IIll ()\'L'R\t'l' lll \l'lll \t R\l(t.SUl (itl)l\l(\ I'l ,'\\Ot llll'l(r\ tl()\\['\l.lt\()\\RI III \l'}t \\S\\].RI-Stt'\ \l \\\ ()t IIIt I(i\\\lslllt) t't.t.\' \\'lttlot I I{l It Rl\(l - t\ so\ll t.(i \. PL.-\\S \\ I R t \1.\DF Si.i'}l It,\Findings: Describe situation If there is no plan give reasons whY -RI.St.\\! l l,/ \ l l()\ ct ltl ()lilt \ L\ I ()\ ('[)ll I'}lllt ()\()l'll\ -t (i.\\ lil \il\l)l l) l() I{ )( t \ ( )\ lllt'lR l'()sl \t,(x'-sl. s l,\l\,\llll.l'l \ I)1. \\\ l( ) \t I{\ I. \S (rt II)tjS IOI{ (\RI(\l\ti otI llll IR (I)ll \t Il\ lf It-\ I ()R I \( II \ t- \lt l()\ ()1'lglSSuggest steps to be taken to improve situation 34 2.2 TRAINING Sources of informationCharacteristics of the indicator Inspection of training Programme a a Interviews with PolicY makers and managers training? o What was the content of the training? o How was the need for training determined? o Who conducted the training? r Where was the training done? . Were training resources efficiently used? a What was the objective of the \()\lt' LC,\\ ll\\ l. \of ("\RI{ll I) ()t I' ,'\\\ \ \lt) Ttlt-\ Ilt,\lNl.l) Tllt'lR ( t)l)\ \\ l'lHI\ I'\t.\( 1,. l'lll ()\( ll() \l \\\(il.l< \\l) lllS I()R\l ()t I'R-\l\l\(i \l\('l l00l- \\llll'l ()N'l l(l\ IIIt (()\I\I[\IIII \ IIII- OIHI.R \I IIII I(i\\FS L(X'I\ ( \RItll-.1) Ot I llll\ I'l{'\l\l\(r\ \\ lllt.l ' l)ttS \\l)l\(tl,\R('l \\\ll(i \r)l l\\{)l \ll) \() IR\l\|\(rl{t-'l'(tlll'S\()lL ll('\l\l\C\l |rt \l \\\lRF \\ I R.l \l-l-t -Fi\,\\( l.t) ,\\ ilil \5{i'(X)() I'l<(X)\"\t. Rl (lt I \ll t) IOR ct \l)l)lt()\ l.t) II\l) \()l \ l.l Findings: Describe situation ill i.\ l{l I l-,\\tr.l) \ I ( )\i. OF lllt \l l.(i,'\SRtrS(t[ R('l \ I otl IR\l\l\(r\l I\ \lO\T l.(r \\ ltl l.l '\\Et) \O It'Nt)\ NAtftraining is not done give reasons why --tJOIII\t:\\ \\t) ()t D O\('ll() \ilot I-D llt Rl ol{ll.\II D ()\ IIll Il{ t \ \('l R()l.l s t()R('DIl. -()\('ll() \l-\\,\(rl I{\ \ND t(X'l\ \ll()[ t't) I'R \l\ l)llSit ll!('ll'\R(;l s()\l \ ,\\l)\()l( t)l)t -lXX'L \ltr\ I \ ll()\ ()t iR \l\l\(r '\( l'lVIIll.S sil()[ l.l) Bt-. Kt I',I \l \\ \(it:RS I (X IS Suggest steps to be taken to improve situation 35 2.2 HSAM (Sensitisation and Advocacy) Sources of informationCharacteristics of the indicator Interviews with officials res onchocerciasis at this level Inspection of activity/technical reports for a ponsible leaders about Onchocerciasis at this level? o How was it done (aPProach)? o What was the result? o How manY PeoPle were sensitized? a Was there sensitization of officials, oPinion \l()sl t(i-\s Ii\l) \o'l ( \Rt{ll't) ot t' \\\ ll\'\\l \t)\()(\(.\\'I\ll\\RF-\l\I)l-l-()I,()l,I('\\1\Kllis()\\l)\II()()\lI\ti-R\(Il()\.()\l-\ \\HIlt-\tt]\lIIllN(il)Rt)l,()s,\l-SI.()R(.t)II,.\('II\llIt-\,1\\1,1.|l()l-IlllS.\l()SIt-(1,,\S.tI\\t. \pl)i{( )\ \1.\ \\ l l l l()1. l' t',-\stl l{l l }- \\l-\ l oR ('t) l l'\( l lVl I ll'S' \()Sl,I(.llI(\L-L\l,l\\\tl)\()I{I,\I<(il-IIft:t)}ls,\\I\(Il\lt\RtI,()RIS.t)lR.l(II]t)I() I'()t l( \ \l \KI Rs \\ \\ l.\'l t{ SI l\ \()\ll tlS\\l \('[lYI lll\ lS DIRI ('ll.D I(] '\ tt\\ r)i\ lRlllt 1'l()\ ( o\1\lt \l l lt \ ll \\ l ('oN llNt t'l) i lll I)ltt e Findings Describe situation ('()\l\l[ \llt.s lll,\ I ll \\ I ( \RI{lt l) ot I l () I \l'ltL\S l l ll lR \\ Il I.l\( r\l:S\ I o I \Kt \(.1'lylT'li.s. I;OR s()\ll' \tr\ I IL,\t LACK OF FUNDSwhy ?If sensitization was not done give reasons I'( )l.l( \' \1 \kl R\ --\l-\\ II ( Nl.'\ I L:l(l \t \ \\ I t'l I \'l \\ (' \l) I l( )\S I ()it Si \ I \l\. \tlll, I\ \ll( '[ I t) t]l l'}i<oDl' ( l I) l]\ \l\ll:t-(i,\ -ll( \lt.S\\(rl \ SII()t tl) UE l\ll(rR \lt I) l() ()ltll tt PR()(rlL \\l\lLS \t ('tl \\ lll\ \l \t-'\Rl'\ -ti t.t.r. I'l \\\L I) I \R(i t l-l tjl) \t)\ (x' \( \ 'losituationSuggest stePs to be taken to imProve 36 a 2.3 MONITORING AND SUPERVISION Sources of informationCharacteristics of the indicator onchocerciasis at this level lnspection ofactivity and technical reports as well as monitoring and supervision reports a a responsible forInterviews with officials When were CDTI suPervisions and monitoring activities canied out? How frequently? (at least once a year) Is there a checklist on oncho. activities? Is it integrated into other health care supervisory forms' checklist? Were strengths and weaknesses identified? Were weaknesses redressed? Were there reward sYstems? Was there feedback to those supervised? a a a a a a a a a Was there suPervision and monitoring? situation \l)\tl'l'}ll{\l\l()\lS(\l{l<ll.DOt'lllYLO('1S11111r\l(i()l)o\\\ ('o\l\tt \llll'\ i() \1. I'}t R\ I\l ( I)t)s I\ \l \'loRll\' ()l 'l ill: t'(i \\ Itlt ttt \l()\l'l oRl\(i \()l{ \t I'l R\ lsl()\ \\ lllt Rl \\ \s \() l)Rl''(i DlslRlBt II()\ ('tll( L'i,ISl \\ t-Rt- \()I t \I l) I()I{ \l()\Il()II(\(; .\Nl) sl PI R\ Islo\. \\ III(.ll \\ \\ 11|t) |r) l}l Iil (!t I \Rt.\ t)()\t- IIII RI \\ I RI \() \ ISIt]t-F RI \\ \RI) S\ S II:\IS I\ I'I \('I Findings: Describe \l()\tI()Rl\(j \ I() IIII\\ \\ \o Iilt I<t I (i\\ tt ts r"t) l)l\lRlllL l'l()\ I\ l00l I\ l\los lIf supervision and give reasons whY not donemonitoring were -- RI'\\ \ltl) \\ s ll \l \l.l t)s I() t.\( ot R \(rt t)l\ I l\('t l\l ll.l) \\ OItt\trRS - I [-lll s I \l t lo tll lR \l\l D \\D t\( ()RP()R \ll l) l\l()( l)ll'\('ll\III S O Ilt; Pt 'I IN Pt ,'\('lI Suggest steps to be taken to improve situation 37 2.4 N.'ECTIZAN SUPPLY Sources of informationCharacteristics of the indicator onchocerciasis and drug supplies at this level o Inspectionofactivity/technicalreports o Inspection of drug delivery inventory records for a Interviews with officials resPonsible distribution cycle? Was ivermectin delivered in a timely manner from the state to the DistricV LGA? Is ivermectin supply integrated into the normal drug management component of the health system? a a a Was ivermectin sufficient for last tSt\t-l-\\tlII(I|.,\l\\t)Il\ltt-\..1,1)()\\RI{l\\t-l()IIlIl(,\.\.I}]tl)ll\l\(ll\RGt-S \l(t\\KII)lO(()\ll,\\t)l'l(Kl'tit-lR.\tl'l'l.llst()Rllllll{('o\l\lL\llll'sl\s()\ll l-(r\S.t)IlllR\Il\\l-lItll(X.I\(\ttR\lII()IlIt(.()\I\l|\llltsl\tjR\ll(.ll\ISIllLl) t(I\i)Rt(l\I()llt s \\i)Rt-t-l ,\\I t)lNt)[,Pl \l)I \l()t. I.I]i:\()R.\l \l-I)RtG R()\l \I Vlt .\RI'il\ ( ()l l.t ('ft-.D t-tr'1 ;1 1 t )l IV t.R\ lF(Findings: Descri be the situation- (Jt ( r slol)\"\i lllt \l \r \Gl-\ll'.i ('()\ll)()\L\l ol ill \t.ltl s\'\lt \l delivery not integrated give reasons why timely and itsIf ivermectin was not sufltcient, II\ I.I Y FOR I}II \Il'lJI: S\ \ ll \l \\ ( )RKS I t I I,(Suggest stePs to be tat en to imProve situation 38 2.5 HUMAN RESOURCE Sources of informationCharacteristics of the indicator onchocerciasis at this level Inspection of activitY records a a responsible forInterviews with officials onchocerciasis \ I \ Is s/he trained/knowledgeable in CDTI? \ [: S Is s/he responsible for other health projects or activities? \'l.s a a Is there an officer responsible for t,)lt I'\( il t.(, \. IIIl.l{t l\ \N OI I'l(-'t:R RESPO\Sltll I I.()lL ()\( ll(X II{( l'\Sl)' il)t r( '\ltll) \\D (.riilt l.\()\\ll(it)1.,\lll L\\l),\1.\() Il\\t)i.l:s {)l'lltR tll \l Ill \t llVllll s \t(ll 1-r \l I-' I)I\I \SI \I R\ I I-,,\\('I \\I) \I'I t -\t tl O\( ll() \l \\ \(rt It I\ t \t \l t.\ \l' Pl'}()ttlEl) B\ 'l r)llll:lt t.(X'l \ll \llll R\ \l-So Ri \t)o\slBl.l: t()l( ()illl t{ lil \l ill l,R()ll( l\ \\t),\('Il\lllts. llKtr \l \llR\\i \\l) (lllt I) Iit \1.Ilt. DISt:'\\t. \t It\ I 1.t.,\\( I & \l'l Findings: Describe the situation If responsible offtcer is not knowledgeable, give reasons whY available or Suggest steps to be taken situationto improve 39 o 2.6 INTEGRATION 2.7 FINAI\CE Sources of informationindicatortheofCharacteristics o Interview ofstaff o Inspection ofreports, log-books etc Which activities (e.g. training, are carried out jointly with programme activities? Which resources (e.g. staff, transport) are shared between CDTI and other health a monitoring) other health malaria etc. \situationtheDescribedFinding t)s It!SS S .t_S RT R &\(R I ttr. R(R\ Il\I)Kt_IF tt Kl( tllL RL )( RN TII\R J))\\H FS S S)\\ IrlLItRL,\t) It FIt,]( SI\[) I( LR TXE tlN RE R RE)\\ If CDTI activities and resources are integrated with other health programmes give reasons not well Suggest stePs to be taken to imProve the situation Sources of informationCharacteristics of the indicator Interviews with officials at this level Inspection of the plans, budgets, documents showing disbursement, for year of reference a a Are resources allocated at this continuation of CDTI? \()\F Are resources released for CDTI activities in time? \()\ t What proportion of allocated resources is leleased. \t)\l a a a level for the Findings: RREP0I{('()(l\rlS, \ It].\.\( ) I [ \T)S Ir. \l)\,.\l' \l.l- l.(i,,\s VI\lTi-.1) x1R.\\l\llj-\ \\IIllot I l'\KI\(; .l{l lll..\RD ()t'l I(; \ I } fll\lt)t{()\ I I) \\lltl()t I l{l I I \sl. ()t Describe sR FLE,R -Rl'situationthe [)RI) F Tt_C\,I-(X Rt R([]C I' I'Il 0( X) S.\R \)\ S )RI) I)(li t,( )l l( \ \l \KFIi.S \\ l l( ) I (r,\. ,\Rl. RL.SP( )\\llll.t t t \t)s \RF t)( )l.l I l( l,\N5 '\'l I()R \O\ Rt,l t.,\\1. ()FIf proportion of resources budgeted, allocated and released is inadequate give reasons why ('(lVI t\()t \lt \ r',\l{ltll t) ( )1. I I( ) I'( )l l('\ \\t) {)Itli-R \l\Kl ll()l Dt-R\ \l IIIIS -t,R()(iR. \\t\lt ()l't It t,R\ \llot I.l) st)t I{( 1. I oR I l\\\('l \l \l \ II RI \L \1. I)l)()ll t I I<()\l l'('( \l I \ \t)\'( X'\( \ Stlot I l) BI illt llt\\ I i lll\\\ I.\t l's -lIl(ilI l'o\\ I l{l:t) \1,\ K L I{S I t-\ t.l \\ \ll.\t3l.t I \\ IR(l\\ll \ I Suggest steps to be taken to improve situation 40 5 I) i II( ,.\ I )(\(.IoI\ )\ \(t ,l,\I(II ) II I( ) l{(SP( III 't)(( st.( ('II) I It Il\t] (\ I) ,(( )X))\( I( ). l(I\ \ I' I]II'Irl )(J)( I\ \()l 2.E RECORD KEEPING Characteristics of the indicator Sources of information o Are data on CDTI available? o Are they properly recorded, stored and easy to retrieve? o Are they analysed and used for planning,? o Are they reliable? o Are they integrated into record system at this level? o Inspection records, records system o Interviews with officials at this level Findings : Describe situation s(\\il.1)\l \ \\l:Itt..1.\ \lt.\lll.t \l-TIlt l.(i,\-\t (ll,'\s\ll ('lll\\ l\\L:\l-oR\.\o\lt BIIS()l tRt,\l\ll \l \t \l\l\R\ Itt(oRI)\ .\\t) Ilt,\l\l\(; REP()RIS IIO\\t.\F.R. Ill{1.\l()t \ \t.'\RS B.I('()l<l)\ ()l t)lslRlBL II()\ \\lRI \.)l RI.\l)ll.\ \('('t ssllll.l \\ \\t) \\lll'\ ltl (-)t lRl D \l I Iil\lt' \ll] \\() t (r,\. IIII: l)l I(' llt Il.t)l\(r \\ \\ lll I<\ i D')\\ \' '\\t) S() l"'\SI \ l"\Rs Itl l'()t<T\ 11 1-B1. \r)l \l l.\( ,\I'l lll l,l l( ott'l('F). Iil ('()ltt)\ \\E.RI \l \ltY KtrPl RI'I I\lll l \\D l\It'.(;R,\lll) II()\\tVI.R. \ (()\ll't t'lF- \\\1.\sl\ ()l' Ttlt l\lll(l ll{1.{l\lt"\l l'()l( l()0-l \\ rlli ('o\ t li \(il s \\ \s \oL\\ \ll \tll-t lf record keeping is poor give reasons why Suggest steps to be taken to improve situation -\\ ORK \l l( )l'}S ( )\ R[]( ( )ltl) Kl't.Pl\(; \\l) I)Rl StrR\''\ i I( )\ \ I \ \RIO[ \ll.\ll.\\tl(ll t.l)tll I\KI:N trPl-ORt(i\ llt'\l.ItlSI\l t - \T lll[. lltll l,\('lt-l]'\^ l.(X'l \ltr\llll-R\ Sllot ll) [r\\l RI. lll\l \t \l\l\R\ l\l()t<\1,\1'lo\ o\ ('l)ll IS RI ( ()RI)l:l) l\ Illl llt tRt-.\1\lt N I l{l (;ts Il.ll. BI.l ( )ltl. ( ( )l.t.t ( ll()\ ()l' IIll RI.( ORDS 4l 2.9 TRANSPORT 2.IOCOVERAGE Characteristics of the indicator Sources of information ls transport available for CDTI activities? Yt\ Is it functional, adequate, and used in an integrated way with other health care activities? a a Interviews with officials responsible for onchocerciasis transport at this level Inspection of records, reports, vehicles log-books a a Findings: Describe situation I()t{t\('ill.(i\ \ll.t.,\sl-^llt\('Tlo\\t \l()T'()R('\(tl \\l)l-5 lll(\('t.l.s \ltl.,'\\"\lt-,\Bl-1. t(j(()\tR \ \\l \til \s.l'ol{t'l)II \('ll\lIlis IIIt \ \t(l l\'\l)l (.)t,\ll ,\\l)lsl.t)l\,-\\ I\ II (,R \ II I) \I,\NNNI-IT I'OR IIt \I TH PRO(IR \\I\II \( IIVIIII S I-(i \I)I.I)ISI- \\E \Ltt\ilt\\(l ll('.. If transport is not available (as stated above) give reasons why P()t-l('\' \1,\Kl-R\ \ l t.(; \ Il \\ l \o l ,\( ('l.l' Ii l) ['il( \\ l-llt]lR Rt SI']()NSll]ll Il\ Suggest steps to be taken to improve situation \l)\ ()(',,\( \' Rtr()t IRI I) I( ) l\ll'}R( )\ I t \t)l,RS I.\\Dl\(i \\l) I.l \ I I. ol' ( o\ll\ll I\lt.\'t Io Pll(' .-\\t) ('t) II l.sl'}i ('1,\t t.\' Characteristics of the indicator Sources of information What is the Geographic coverage for past two years? What is the therapeutic coverage for last two years? a a a Interviews with officials responsible for onchocerciasis at this level Inspection of summary records for ivermectin treatment and reports. Findings: Describe situation (ii (XiR,\l'}tll( C()\ f R.{(iE FOR I:lll\ll \ll}.\N() \\,'\s (r7",, il II I I I r I]( )N I.,\ -860,, \(,o oKI),,\l ,.\ 8-i -1",, 'flitrR.\l)trt 'll( ('O\l-R\(il'\l()li. lllt l(1\\\\t.Rl-- Flll\lt-\lLi,\\()-J-1",,. lllllll t tl()\l \-(rOnu. \(-io oKI) \t. \ \\,{s 81",, If coverage rates are below expected (-100% geographical and 650/o therapeutic-) give reasons why IIIIS \\',\S \I,\I\I,\ DII st I,t R\ lsl()\, & \io\1]'oRI\(; li\ ( )lI() I \('R t.(r\\l \ll Suggest steps to be taken to improve situation I\\ ()t.\ | \lt \ I \\l) F-\lPo\\ l-R\lt-\ f ()l lrt.lll. S I \I I 42 a INSTRUMENT 3--prontline Health Fecilitv - FLHF) \t(;t'Rl \COUNTRY t\losi\fl ('l) I I I)R().lt-('1PROJECT NAME \(r()R ()Kl''\l \. t ill\il. \ll],\NoXIUN OF'DISTRICT/LGA t.rrr;,rn\. t'\lt \ \\l.t \si . \\l{ rh \lll \-[ \lt t ll ('\\ I ir. ()1.,t'\R \ t \ll t)l\l NAME OF THE FLHF I 9()ti lq99OF'CDTIDATE OF CouurxcEMENT .r t \t l(l0rDATE OF'EVALUATION .t r. \l l(10-l SUSTAINABILITY PLAN IMPLEMENTATION OFDATE OF coprunxcE,MENT (x'l()lll Rl0i) SUSTAINABILITY PLAN IMPLEMENTATION DATE OF AssnssurNT or' \K(XiI \ { )t. \\ll.l l. \K\\ I,I t I\",tint h,,\. \t)l:K\\NAME OF MONITOR 43 INSTRUMENT 3 Instruction.. check implementation of sustainabilig ptan and verify whether constraints earlier identiJied are being rectified. Also check if key cDTI activities (Training, Monitoring and supemision' HsAMandMeaizanploculementanddistribution)arebeingimplementedasplanned 3.I PLANNING Sources of informationCharacteristics of the indicator onchocerciasis at this level Inspection of charts on walls, work plan' list of things to do. a a responsible forInterviews with officials (monitoring, training, etc) including dates? Where and when were theY conducted? a a Is there a list of the key CDTI activities EC \t r r.) situationDescribeFindings: t_l)Krtt.\R)\l{ []\.t'Kso IIR.IR.F-I st]trR, S\ i R RIILt( il.tr t{(i \t{R \)IF l)hRIIItI)l{llll\ )\ N(S ,R'I() )tt-lt) )( ()\ ('l)il \('ll\ IIII.S \\l) \\ I l{t \\tRI \()I I'lL\l\ t.l)rtos t tlt llll sE lrl.l ll \l \ll \lDi I lt,\( l'.1 I)whyIf planning was not done give reasons [',\Rt{\ ()t I ,\1.1. ( \l)t I(\ {.t-t.lil \. \\)Sl' \ I'}( x'RS t)\FII I{Rt.Rt, I)R t_)RK)I [)(IT -\ \I ST \I\,\I )ll.l I \ \\ ( )RK l',t \\ to improve situationSuggest steps to be taken 44 \ I'\I),\ I,\l)L \ .t)I)l(l \(I\ll\( S I,\()(l' \ rll( .( )\ 3.2 TRAINING 3.3 HSAM (Sensitiz:tion) Sources of informationCharacteristics of the indicator onchocerciasis at this level lnspection of training manuals, training reports' notes etc. a Int"*i"* with officials in charge, of training? a What was the content of the training B How manY CDDs were trained? tr Were training resources efficiently used? for theectives/thewereWhat objtr I \ ll)t \( l. ol' ll{ \l\i\(i Itl l'}()l{'l Rir('oRt)()\ \\t.l{\(,1 5-16 \l'\\ ('l)l)S \\t.Rtr lR\l\l i) l\ \()\1t Illll \\l) I\ oltll I{S N() IR'\l\l\(i \l \ll. \() II<\l\l\(r\l\\['\l\\\].RE{\{lt-\'Llll l\\lr)\l ()l llll ll.lll' t.llll\\lRl(,1\Ilt,,\ll,\t\,\\\\t].I-()FTIIFIRRI\I)()\\lI]ltllll\l()l<('I)ll.l.r)t(l\,SI\\(.t- \l ()\l- Il-llI Illl \I \\I-\ l,()\llI) sf \I]t.\[R\t \llI)\\III l\ (.1,,\li(rl t)1. ltlt tl-}lI. III()t(,ll \\\,'\R.|.()l (t)ll. ll\\\l \llLtll t:\'lR\t\l.l)(r\(l)ll'\()l{tl\\\lll ll{'\l\tl) \\\ situation I IK\l\l\(;\\'.\\S'\11; !{)ll\\l()((tl(RI I) \l\()\it tl.lll '\\tl-il()l"l \\\ Findings: Describe s()\lt III()Rl \ ( t)t). lt('\l\ ILRL\I.\ \\ I lt R\t{t l\ \l.l-\ \lFL.llt' t \ \\\ \ltF ()l: TI lt-lR R( )t.t.\ rtrts f t,LI If \ I \t t- Il,\\ I \\ il it L'u] l ,\(.'li\ llll s Ill ( \L sl llll \ \\ l.lil-\IRllt I\I\\Ol !l t)\IwhyIf training was not done give reasons PO\\IRI I) l() llt\l\ ('l)l)\ \.rt)\oll.(X'l'S. - 1.t t. ,\( ll\ lll!.s ('\RItlt.l) ()t I \ll( )t I l) tll I)O('t Nll \ lt-l) t (,R I'1. I'L I{l L \l -t t.l ll sl l( )l t.l) t]1. \l \l)t I I II \( l t \t- ()Pt l(\ll()\,\l t \-ll l() Bh \Utl I() (()\ll I I'} \\ l l ll l llt t \, \('l \\l( )l' \ l' 'l'lll \ \\ ol l't) Itl (.)1. Iltl I ( )l{ IR \l\l\(r (-l)D\ '\ i Illl llt -t Iill Stl()[ t.l) ul: [r\l ('l \ ll Rs situationSuggest stePs to be taken to improve Sources of informationCharacteristics of the indicator onchocerciasis at this level Inspection of activity/technical reports fora a Interviews with officials resPonsible opinion leaders about oncho' at this level? r What was the objective of the HSAM? o How was it done (aPProach) o What was the result? o How many peoPle were sensitized? e Who were sensitized? Was there sensitization of community and Findings: Describe IHt If)PtPS St I \1,t. \l\ lllL. Rt: t.l1,t.l Il\\F. R \( ll\ lllt.s \1,t.(l\l l\ sl\(t t \\l I l,/ \ I l()\ I() Hl \l \l t \l Illls(, \RI)\ I () ('l) | I )-tl( II1 -\ Ir)I) I IS R I( I-\situation J) Rt Irl R)( RDt I Iis. \(Ir 'tI{S\( l{ Rl?. l(( S)l tf sensitization was not done give reasons why RI Ol{ll.\ i \ ll( )\ r )i l l I ( )\ ( t)l'l PHIL-( )S()l'tl\H \\I)RI.l-R \l\. l\(,\\ t)II(,\I\I\(ISuggest steps to be taken to improve situation 45 a a \( \( t.)\ \( 3.4 MONITORING AND SUPERVISION 3.5 MECTIZAN Sources of informationCharacteristics of the indicator level tr Inspection of documented reports and supervisory checklist etc. o charge at thisInterviews with persons in carried out for CDTI regularly (how many times in ayear)? o Is there a I\4/S checklist? o Were M&S activities integrated with M&S activities of other health programmes? o What were the strengths and weaknesses identified? o Was there feedback to those supervised? a Was monitoring and supervision (lWS) Describe \ \lt RI)(IS R( 'l KR SO \RI)t-the situationFindings: t( .tIIT R(,{ L,t.,-\ N\(H'I TP Itl C, () l( R\R,\(i Ll.It\Rt_R)trlt S t)n\ t \ \\\ \RI. ()l( I) I I l\Iil1.il{ tilll-\ t{()lsupervision was not done as planned give reasons whY If monitoring or EDUCATION REQUIRED FOR THE FLHF' .RECORDS OF M&S AND HSAM ACTIVITIES AND INTEGRATED HE.ALTH-HSAM SHOULD BE KEPT Suggest steps to be taken to improve the situation Sources of informationC har acte r ist ic s of the i ndic ator control tr Interview with nurse or health staff in charge tr and stockRecords of ivermectin ordering tr Are the suPPlies adequate? tr Is it delivered on time for dates of planned distribution? tr Is it ordered and distributed to the FLHF and the communities within the regular health care sYstem? With regard to the suPPlY of ivermectin Rndings: Describe the situation MECTAIZAN WAS ADEQUATE, SUFFICIENT AND DELIVERED ON TIME' MECTIZAN INVENTORY ARE AVAILABLE (AND THERE WERE NO TREATMENT SUMMARIES SEEN AT TI'IE FLHF) delivery was inadequate or untimely, give reasons whY If ivermectin suPPlY and Suggest steps to be taken to improve the situation 46 IRRt I- l( 3.6 HUMAN RESOURCE 3.T INTEGRATION So,,t"es of informationCharacteristics of the indicator a Interview with the Head of the Health Department Inspection of documents Is there a designated Person onchocerciasis control? Is the designated person trained and knowledgeable in CDTI? Is the person able to effectively combine CDTI with his other community-based health responsibilities? a a for t\ s( )\ll I l l ll l lll \ \l{t- \t}l.L: 'i o('()\llll\l ( t)ll \\ Illl OllltrR IJE \L l-lI l,tt(xilt,\\1\ll \ l\ \()\ll. I t.llF Tlll. t \ IIRI' ,\I\t-,D PFR I't,TII;\1]( )t I ( )\l I'}l R\( )\ I\ I'R il III .\I{t \()I IR,\I\I-L) finaings: Describe the situation rtt s t Be E\lPrl \sl./t'l)ROt t ()l t't.lllIf the use of human resources unsatisfactory, identif the weak points and give reasons is inappropriate or - rilt t.\ I'lRL I I ii \l\i.t) \\t) \( il\ltit.s - RL( ( )RDS ( )l Rl()Rll \llI) ()\ (l)ll I'R \lNlN(i Sll()t l.l) ill ht I) I ttrlt Sl\l I \ll()l I I) lllthe situationSuggest steps to be taken to imProve Sources of informationindicatortheofCharacteristics Interview of Project staff Inspection of reports, log-books etc' a a Which activities (e'g. training, are carried out jointly with other health programme activities? Which resources (e.g. staff, transport, space, time etc.) are shared between CDTI and other health programme activities (e'g' a a monitoring) malaria ,\( II\ I III \ ( \I{RII I) ()i I \\ II II ( ) IIII R lil,'\l.lll I'lL(XrR\\l\ltrS \T llllS t I.\ I l. -lll \l.l'l I I'ltO(,R-\\l\lLS \\ I RI I<t \' l\l)t l't Nl)1.\l l.\' {\l) \l \FI t)l l'}l.\l)l l) o\ IIlt.lR PL.RSO\,\1. ill'\\\t'}( )l{ I I ()li(',\lt,R\l\(r ()t'l '\l.t- lll \l III \\l) (l)ll RDC ()F .I0I\ IIilt.l{l. \\ I Rl \o R F('( ) \(.I I\ I'fIL-S theDescribe l' t{( )l II \ \\\,.\RF, OI' I,\,.\(is not effective reasonsIf -l\ IF.GR \ lEt) ('lll ('kl.l\ PIl,()\ lDi t) i'()R IlllS. \l(1, l() Illt\ - HS,\\i I\ \l \() tLl r II(t l) Suggest stePs to be tat"o to imProve the situation 47 a 3.8 COVERAGE Sources of informationCharacteristics of the indicator onchocerciasis control at this level Inspection of summary records for ivermectin treatment and reports for previous years' a a responsible forInterviews with officialsWhat *as the GeograPhic coverage past two Years? What was the therapeutic coverage for the last treatment cYcle? a a for (il (xiR,\l)lll('( ()\ tR \(;E ls ( ()\ l.l{ \(il ( ()i I I) \()l llt' \t]olr'l 75"n,\l \l l l lll.t \lslll l) l\ \t-t. \S(-trRl\l\tll) llt ('\t \l \() IRI \l\ll \l Hndings: Describe situation I()t\l) t l.lII ItiER \Pl't l'l( \I \I\I,,\R.II.5 \\ IJRI TI SK N D t_ t) SI) )( rllR.ri I-( I) It\()t(I(S,IS ('geographical and 650/o reasons whY expected (-100%If coverage rates are therapeutic-) give tr\ llRI: I t.lll \ i \l'l lS I<l (-)t ll(t l)('ol)lt:S ()i l Rt' '\ l Nlt N l lLt ('( )ltt)\ sl i( )t t l) Ill Itl:Oltlt \ L\ Il()\ o KL i'l \.l' t'l.lll f<E't'R tllt\.C, ,\\l)improve situationSuggest stePs to be taken to 48 INSTRUMENT 4--(CommunitY) NI(it.ltlACOUNTRY lNlo S'l',4 t'l: ('Dl IPROJECT NAME N(ioR t rtx)N1,\ ()1,K,\l \.trt Il\1El \lt]-\N( ). II ll I I INAME OF DISTRICT/LGA . L \'ll'ol){R.,,\, t \{l lZ[:(-i\\'t rt 1\lt rl)l\l \st r. \\l \llollt \ t.( x ;.\l{,\.t INlt r\,\N l.t Nlt t'./1.SUPERVISORY FLIIFNAME OF tr\lt l:1.\l tr,/l()Nl\. .\.t \lt I t.N \l\1.i I\1i I)tl{t \l\lt ()lt . t \ll .\KI'}lNAME OF THE COMMUNITY l9t/8 lt)99COMMENCEMENT OFDATE OF CDTI .ti INt. l00lDATE OF EVALU ATION .lt lNtr l(X)-+ SUSTAINABILITY PLAN IMPLEMENTATION OFDATE OF ( x "l l(x)5-l++ SUSTAINABILITY PLAI\ IMPLEMENTATION DATE OF ASSESSMENT OF ,\K(XitrN. \K\\ l.l-t t NNttl{t 1., \ ot.,\\1l.ll. r. Nl)l1K\\'( INAME OF MONITOR 49 MONITORINGIMPLEMENTATI0NoFSUSTAINABILITYPLANS (CommunitY) INSTRUMENT 4 Instruction: Check implementation of sustainability plan and veriff whether constraints earlier identified are being rectified' Also check if key CDTI activities (Training, Monitoring and Supervision, HSAM and Mectizan procurement and distribution) are being implemented as planned' 4.1 PLANNING NOT CRUCIAL AT THIS LEVEL 4.2 TRAINING NOT CRUCIAL AT TIIIS LEVEL 4.3 HSAM (Health Education and Mobilisation) Sources of informationCharacteristics of the indicator leaders and members. Inspection of village-kept records o a Interviews with CDDs and communitYWas there health education mobilisation of the communitY? o How was it done (aPProach)? o What was the result? o How many People received health education? a and N ('S ]l\\\ \ N f soL)tlItI)N t' tlSN4N1t.\ tt_situationDescribeindiF ngs S\ \\\S,,\INVI N1( NNJ) S I-INI 1t\NPo N l'Ii))S \Ilv1I)NNJ))Jlr.I)999 )I ( N) S I{ ]() I\,AS 1( ) )\])( LI{I(N TII S,)( { )SR :LN\\ ITR tN \l \losl' ..\l L l'lll. ( Irl.lll \AI:l{i- NO!'tNV'()l \/LI) "\NI) I'lll(-'t)l)s \\ l l{t 1.t.l l \t ( )Nt. \\ l ll'l{l I l l}.\ \\ I t{I,,\\/,\II,,\BL I ONINllrNlllls [Ht:If sensitization was not done give reasons why sl \l I .\til I.N'lt'}o\\'t.lil'l) & ll{'\lNl-l)' .\NI) ('oNIN'lt Nll'll'\ I{t l\tlNI)irl} Iltl'll{ I{( )1- l:S lN I{ L( i,'\ t{ I)S 'l ( ) ( 't) l) \ ' L(X'lS Stl()['l-l) I t\\t'ltl. l'llnl lllll situation Suggest stePs to be taken to imProve 50 t( t \It((I t( '(\R\ I)S )( (( 4.4. MONITORING AND SI]PERVISION NOT CRUCIAL AT THIS LEVEL 4.5 MECTIZAI\ STJPPLY Sources of informationCharacteristics of the indicator Inspection of drug delivery inventory a a records lnterviews with CDDs and community members.lfor last distribution cYcle? Was ivermectin made available at the FLHF when needed? Was ivermectin collected in a timely manner from the FLHF? a a a Was ivermectin supply suffrcient ('( )l.l.l:("1 l'l lI: | / | \\'r tlllN IIll ('o\1Nl t)t \10'l l\'.\ I l.D ('l)l \I It{t.[{ [OtiSl:S. ltO\.\'l-Vl.lt lN ONl. (()\lNllNll\'"'\\\ltx)\\'-"\(Dt)'ilASAllt',l"l()l'}l{o\/lDE- \\ ,\ll:t{lOI{ IIIOSI I I 1,,\ I ('( )l\{1. A ROt INI) 1() I \Kl situationFindings: Fr() RS N theDescribe NRI{ 'l( \\t'I)I(SS\ [)N C 1 N\ N,1I) Ir) {([)l YSR( N IL ) M( I(P So( )N)]) S RI oRN4 N'(( M,AS K () (-"1.1.,\R. CLrl' I I tirs lr( i S()i\{t: I: Irt.l lt'. ( )N('l' .\\'lillI \It:\\ \NI) ('Ol.l.t:('l I)l{o IItAt'll l) I)ls I'ltlllt I'loN ()l t)Ril(i\ I.NIOI IVr\ IION )1. I)t.1...\\",\N[)IN SONII: ('()\1\ ()t ('t)t)s \\".\s t It'Nl'l IIIS I) ill (,\llSt: ( and its mode of distribution not determined by community give reasons why If ivermectin was not -ufficient, timelY I (X' l's st l( )l rl.t) CI I: \ltl Y SI'}l.l I t'R\lN lllli' ol 1l ltl.sP( S I",\[ F \\ I III )NSttlil.l l'll.s \NI) ST II'I-RVIS0Nsituation Suggest stePs to be taken to imProve 51 CitlN S S ItI) ((SS) (( ((t1 \ I] 4.6IIUMAII RESOURCES Sources of informationCharacteristics of the indicator CDDs and communitYInterview with members How manY trained CDDs are in the communitY? tr Is there a fair mix of both sexes among the CDDs? tr Is the workload for each CDD compatible? with efficient distribution of ivermectin ? o Are the CDDs well motivated ? tr What is the attrition rate among CDDs ? tr there situationindings \\, \\(i \ \\ thebeDescriF \\DC t)s( I'FoI{N.{t)I \) NM'( M(S I.I S (t.IN) l{T Ro ) (S t{( ( ) )8 0 {}t{ ( \oN1 I'lv'l l\,1 N(N)o o-lt{()( N .I l\l( S)( R) K'l ( I{ItI{OS i\1 N I{NE\\' ,,\(\\ \) RS R tl(N (\ ,A N\ t()Ll H() NRt))N ITDKI'N (\ N Nt) l{ ( ('()N,Il'}l ,\ l\ ls oN \ oltK I OAI) \\ l.Rl- ('oNll)i NS,\ l lN(; I I ll. ('l)l)s I]\' lN('l.t DIN(i I lllrN4 lN 'l I IE l\l'l '\('l l\/l'llt'S' I'lll.\' \\'l.l{1. s I'll.l ('()l\ll)1. \ININC & t rN\^'il.1.IN(i t ( ) ('( )N I INLII. \\'l l'l I I'l ll. -loll .,\s ('l)l)s. -( l)l)s sl l()t Il.t) t \l)l.t(s l'^NI) I\('l t rl)lN(; llltrN4 I'R(XiIIAKINIL-, ('ON4l'l:NS,\ I'lON. llE M,'\t)l fo l'lllr llt.'\S()NI OR tN ,\NO'llll.R. Ill.,'\l-l tl l.lKl. ),1[rl .\S lN ( ()l\,ll\ltrNl t-lllS \'-l:\'l:N Ill:l{f. It.lll. trained, give reasons whY If CDDs are not available or are not t'o\,1\lt'Nllll s lrol{ sl.l l.i"ll()N ()l' ( l)l)s t R()\l ttll sNt.'\t l.l.s I t INI I .('()N,11\ltlNtl'll:S SII()i I I) llt' \l'\l)1. Io AI)( )I''I \ S\'S I I NI ,\( ( t,PI AI}I,I t INDITt{S'l .,\NI)'l'lltrll{ I{( )l.t.S l'( ) situation Suggest steps to be taken to imProve 52 ll -I -lt,( (I)I t [) I'('(( ( 't It. ()I'lt ( )S 1 4.7 INTEGRATION NOT CRUCIAL AT TIIIS LEVEL 4.8 FINAI\CE NOT CRUCIAL AT THIS LEVEL 4.9 RECORD KEEPING Sources of informationCharacteristics of the indicator Interviews with officials at this level a o Inspection records, records systemAre data on CDTI availab Are they ProPerlY recorded, properly stored and easY to access? Are they analYsed and used for planning,? Are they reliable? Are theY integrated into record system at this level? o a a o a le? be situation: l.Itl,,.\i \4t-r'\. f I(1,(iISl-l RS lN M,^'l()lt.l \' ()I l.lII- (,()\I\{LlNl I.II S \l \\ ('l)l)\ trSl I) l.(X)Sl: Stlt:1.l'S' l.P.l. I'}lL()PIRL.\', Klrl''l"Nl.A't .\Nl) ('l'1. \N' lN SO\{l (ii\sES ONI'\' I}Il. l.t I(iIt]t-l,S \^/l,Itl: l{t:(lISlt,l{l 1). \i()SI ()l .l Ilt lI{t],,\.tl\1I,Nl Ittl(iISIl:I{S \\'}.I{1, N()[ ,\N \l \'\l t) Bll(.\tlSl- ItlFl\. \\l.,ItI, N()1. l.I{ \lNl:I) D,\ 1,,\ \1.\N,\(il.\ll.Nl'.111.-strllsolll{1"'\tN4l'NllNItl'(ilSIl'll"S\\'lltl.Rt.l-1"\Ul'1. tl'N()tlNll:ciR,,\'ll.t)lN()lRL1('OI{l)sYSl'11\1"\'lllllsl.l'vl.llt'lllB Findings: Descri 'il ll. tt l . \\'E IL l' \\'llll.l..\ trl-\\' ITI -( iIS I I-t{S \\ If record keeping is poor give reasons why I I{n lN ('DI)S ( )N I) \ L\ lto\\ I'O Sl I\lNl \lil,/l I ltr. RI.,S[',l.IS' I'l Iil sll()trl I) I XIR'A(''i INI OIi\1.\'l l( )N. S l( )l{1. r\NI) l'}'\SS uN \N \I-\'SIS ,\NI) l() I (, \ Suggest stePs to be taken to situation improve 53 4.10 TRAF{SPORT NOT CRUCIAL AT THIS LEVEL 4.II COVERAGE Sources of informationCharacteristics of the indicator members. lnspection of summary records for ivermectin treatment and reports' a a lnterviews with CDD and communitY last distribution cYcle? Were all eligible persons treated in the last distribution cYcle? a a Were all households treated in the situationindings: hi \ tl N 65 \\ DescribeF S \\ I{))S) S)\\ \\RN) (N( R ILl\l.t) ()IINI{s(BN) (S ()() ] IR \) )( N\ otN t{(tN ) R))I{ITS(i,R I'*N )(S) )t)(IIR )I{Rt_\\l S\) (iJ(III ISI{ (ItN BKt)l\tt ( I'I-NI{\\t)l{R N I\\N\\)A(], I{ ((( I'I(\ ) J)lS\\'( I{ ((I{ t_I)tl Nt NI t\,I'\I(ItX) ( N)S t{ t]DI(R. AI) RS( NI) S(I N]) T)n1't\)) (t RR.\\ coverage rates are below expected give reasons whY. If household coverage and theraPeutic t,Rol)l.lt Ils \i\l()L I' l() t'lll: t ,\r'l lvl l \' ( )N4lUt rNI'l l I() Bt. ("\ltltltrl) IS l'(' 111-XllNlD il lt-NI ()l' l l tl'lR l{()l I s be taken to imProve situation Suggest stePs to 54 S t: lrl l_)'(( .I II)'ttI )((NI l)t) 't)'(( 't t )\It .I 'lI-)\t, (II(l'S .S ( tt'[) S I It)l,l ( ('t tSI.