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

ERESERVED FOR PROJECT LOGO/HEADING ORIGINAL: English Reporting period From: January to December, 2006 (Month/Year) (Month/Year) COUNTRY/NOTE: Nigeria Project Name: Jigawa state CDTI project Approval year: 1999 Launchinclyear; 1999 Proiect vear this report: (circleone)_1 2 3 4 5 6 (7) B 9 10 Date submitted: March 2006 NGDO Partner: CBM ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATTVE COMMTTT',EE (TCC) t I , ub AIUT tnn, I DEADLINE FO SUBMISSION: To APOC Management by 31s January for March TCC meeting To APOC Management by 31s luly for September TCC meeting r$[ gsF AU9 oNcHocERcrAsrs coNTRoL (APoc) AFRICAN PROGRAMME FOR Bffi F?l I i r"l t -)! 0uv I jEc Itl for lnionaqtion ro'.\ir{ /\0. - nd U{sd H,ts"fo.d 0 7 luul znol WHO/APOC, 23 December 2006 Ii I i i I It I {j I I I 1 D ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by sg ning in the appropriate space. OFFICERS to sign the repoft: Country: NIGERIA N ati o n a I coo rd i n ato r : N a m., . .p.*; A t .*r A. . . . .0 ffi# =i "'-nt..fr r K t @. L\. { L Date:...,/ .-:',.Q..!:. i Zonal Oncho Coordinator Name: S hif .ff.Li , i.r t .fri,ry: ". Signature: ". Date Ir'o / Signature: Date /. This report has been prepared by Name: A.U. Abdurrahman Designation : State Coordinator Signature sfu /- )t- 2,,,- I ach*, L d-( ) WHo/APOC. 23 December 2t,06 2 WHO/APOC, 23 December 2006 r}.i Tables of contents ACRONYMS DEFINITIONS FOLLOW UP ON TCC RECOMMENDATIONS EXECLJ-IVE SUMMARY SECnON 1: BACKGROUND INFORMATION I. 1 GENERAL INFORMATION 1.1.1 Description of the project (briefly) 1.1.2 Partnership 1.2 POPULATION AND HEALTH SYSTEM SECION 2: IMPLEMENTATION OF CDTI 2. lPERIOD OF ACTIVITIES 2.2 ORDERING, STORAGE AND DELIVERY OF IVERMECTIN 2.3 ADVOCACY AND SENSITIZATION 2.4 MOBILIZATION AND HEALTH EDUCATION OF AT RISK COMMUNITIES 2.5 COMMUNITIES INVOLVEMENT IN DECISION _ MAKING 2.6 CAPACTTY BUILDING 2.6.1 Training 2.6.2 equipment and human resources CONDITION OF THE REQUIREMENT* PLEASE STATE 2.7 TREATMENTS 2. 7. 1 Treatments figures 2.7.3 Trend of treatment achievement from CDTI project inceptlon to the c'urrent year Supervision Section 3. J WHO/APOC, 23 December 2006 Acronyms APOC ATO ATRO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHCA PHC REMO SAE SHM TCC TOT UNICEF UTG WHO African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Community - Based Organization Community - Directed Distributor Community - Directed Treatment with Ivermectin Community Self - Monitoring Local Government Area Ministry of Health Non - Governmental Development Organization Non - Government Organization National Onchocerciasis Task Force Primary health Care Agency Primary Health Care Rapid Epidemiological Mapping of Onchocerciasis Severe Adverse Event Stakeholders Meeting Technical Consultative Committee (APOC scientific advisory group) Trainer of Trainers United Nations Children's Fund Ultimate Treatment Goal World Health Organization i lr;.1 ,i'rJ14\.\;+ t. 4 o WHO/APOC, 23 December 2006 ,Definitions (i) Total population: The total population living in meso/hyper - endemic communities within the project area (based on REMO and census taking). (ii) Eliqible population: Calculated as 84% of the total population in meso/hyper endemic communities in the project area. (iii) Annual Treatment Objective (ATO): The estimated number of persons living in meso/hyper endemic areas that a CDTI project intends to treat with Ivermectin in a given year. (iv) Ultimate Treatment Goal (UTG): Calculated as the maximum number of people to be treated annually in meso/hyper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage (normally the project should be expected to reach the UTG at the end of the 3'd year of the project). (v) Therapeutic coveraoe: Number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) Geoqraphical coveraqe: Number of communities treated in a given year over the total number of meso/hyper endemic communities as identified by REMO in the project area (this should be expressed as a percentage). (vii) Inteqration: Delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc) through CDTI (using the same systems, training, supervision and personnel) in order to maximize cost - effectiveness and empower communities to solve more of their health problems. This does not include activlties or interventions carried out by community distributors outside of CDTI. (viii) SustainabiliW: CDTI activities in an area is sustainable when they continue to function effectively for the foreseeable future, with high treatment coverage, integrated into the available healthcare service, in with strong community ownership, using resources mobilized by the community and the government. 5 WHO/APOC, 23 December 200G FOLLOW UP ON TCC RECOMMENDATIONS Using the table, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC Sessio 1, Number of Recommendation in the Report TCC RECOMMENDATIONS ACTION TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY the project mobilized the community to select more CDD's that can distribute mectizan in which 1327 CDD's were selected and 550 are trained There is in adequacy of CDD's per community therefore more CDD's should be selected No proper documentation of mectizan inventory at LGA and health facilities level No female CDDs in the community Training was conducted at both LGA and health facility level to ensure mectizan inventory documentation the project mobilized TBAs in all the project area to be part of the CDD and accepted 2 3 6 WHO/APOC, 23 December 2006 I aI don't know where thsse recsmmsndations are frtm, but the latest available to !"ts are th<ise *f TCC fS. se{: belsw t}te comments on the last report sui:mitted * Sth y*ar report, Jigawa State CDTI Proiect (5th ye@ 21. TCC acknowledged that the report was well-written, comprehensive and informative although it requested that future reports should include a more comprehensive summary of programme activities in the executive summary. 22. The Commttee commended the project for maintaining high coverage for several years (100% geographic and over 83% therapeutic). 23. The project raised a number of issues and the necessary actions taken to resolve them. Other issues identifred incltrded: 1) inadequate support of CDDs by communities, minimal supervision by LOC'ts. 2) Payment of incentives to village workers by other health programs has caused problems with CDTI implementation. 3) Low participation of women in CDTI 24. TCC recluested that the project a) explaintheUTGof 150,000 (L)4%oof total popr:lation). Thisfigureseemedhighsinceit was unlikely that 94o/o of the totalpopulation would be eligible for treatment. b) explain what expenditures were covered by funds released by the NGDO and communities Funds were released by these partners but were not indicated in the expenditures in Table 12. c) explain expenditures made by the State sir-rce no release of funds by MOH was indicated in Table I 1. d) use the tl'fG o1' 150,000 in all calculations recluiring a percentage UTG coverage (Last column, Table l0), rather than using a diff'erent denominator for each calculation. e) coutinue tcl encourage the selectior-r of adc'litional CDDs. Dr-rring reporting period CDD/population ratio rvas approximately 1 :.166. fl train MOH stafT at all levels on nlanagement of SAEs. g) continue eftbrts to involve \\'olren in all programme activrties. 25. TCC accepted the report with the undcrstanding that llte projec't v'ould adclt'ess all the ubove issues in lhe its report. Executive Summary Jigawa state is situated in the Northern part of Nigeria. The state was created out in September 1991 from Kano state. It is one of the smallest states in Nigeria and has a population of about 4,4 million peoples residing in twenty seven Local Government areas. 7 WHO/APOC, 23 December 2006 The people of the state are predominantly farmers and practice Islam as their religion. Hausa language is the main language of communication with few people speaking (Fulfulde) Fulani. The CDTI areas in Jigawa state are predominantly farmers and nomadic herdsmen who sometimes move away from their settlements to other areas especially during rainy season. The people are also involved in dry season farming activities out side their communities. CDTI is however being implemented in B LGA's is the state with a target population persons living in 112 endemic communities. irui:'.+i. ..:* i"rr,\{l} :c I'i,r. nunrl}er uf target {l.rr}lrrrilrritie*" lh*ie.rrc difii:rillg iiEui'e$:r} ilr* r'ept-lrt'"^ i"11, 112, I"05. please rec*ncile. The training objective for year 2006 was a set at training and re - training of additional CDD's selected from endemic communities. The ATrO for CDDs in the year 2006 was 1100 out of which 550 were trained. More could not be trained due to lack of funds to support the training activity. Treatment was conducted in all the 112 endemic communities of the B CDTI LGA's. This gives a 100% geographic coverage. A total of 174,783 persons were treated out of the total population of 241,999 persons {r;'*r;'ltilt fitTtr; * i:iurn ;;i;'sj iuitii th;,t pr*vi.dert u: Tabie "{ *ad':r.i;*;'s*cri*:r:.r *i:iris i"rg:*l"t}. This gives an overall therapeutic coverage of B1% in the state. A total of 444,571 mectizan tablets were used out of 456, 500 mectizan tablets received. The major challenges faced by the project, and which it is facing include: . InadeQuate support to CDDs by the communities . Low level of supervision by the LOCTs due to poor funding for supervisory visits. This was as a result of inadequate support from the local government's counterpart. . Payment of incentives to village workers by some programmes suclr as NPI has affected the CDTI implementation negatively. . Paticipation of women group in the CDTI process is still not adequate. The challenges encountered were addressed in the following ways (but they still remained current challenges). . Intensified mobilization/education of community members, influential persons and interest groups to support CDTI activities. " Continue training of selected CDDs ii,';ir;l+:-ii;il*;""i; .iicl i,,".i ii; -:.,.it5r;:l;:;' 1 8 WHO/APOC, 23 December 2006 SECTION 1: Background information 1.1 General information 7.7.7 Description of the project (briefly) Geographical location, topography, climate Jigawa state is situated in the nofthern paft of Nigeria. The state was created out in September 1991 from the then Kano state. It falls in the Sudan Savannah and Sahel zones. The terrain is generally flat or slightly undulating with few rocks and hills in sorne places particularly the southern part of the state bordering Bauchi state. The state is drained by some major rivers such as River Hadeja, River Chiyako and their tributaries which are largely seasonal. While the main rivers have swampy areas the presence of some dams in the state provides breeding sites for black flies. Population : activities, culture, language Jigawa state being one of the smallest states in Nigeria has a population of not more than 4.4 million people living in twenty seven local government areas. The people of the state are predominantly farmers and practice Islam as their region. Hausa language is the main language of communication with few people speaking (Fulfulde) Fulani. The people of Jigawa state particularly those of the CDTI areas are predominantly farmers and nomadic herdsmen who sometimes move away from their settlements to other areas especially during the raining season. Some of those people are also involved in dry season farming activities outside their communities. Com m u n ica tion system ( road..,................ ) The roads connecting the towns and major cities are relatively in good condition, but the roads to the communities are In varying shapes. While a few are in good condition, some others are full of pot holes. Other still are latrite roads and can be impassable durlng the rainy season. Communication channels are many and varied. Some follow the traditional authority structure (from the Emir to the district heads to vlllage heads, then towards 'ilrheads and lastly to household heads). At the communlty level town criers, local musicians and drama groups are veritable means of communication. Radio is a medium that is widely listened to as Hausa is the major language of communication and used for most programmes. Newspaper especially those in Hausa are also read and television is a medium that some listen to. 9 WHO/APOC, 23 December 2006 Adm in istration structu re The administration system in Jigawa state is in two folds - the modern system and the traditional system. The traditional leadership structure is hierarchical in nature, lai'ge areas are under the authority of a District Head, who is responsible to the Emir. Under the district head are village heads, and under them, the ward heads, who relate directly to the heads of households in the communities. Under the modern administration structure the state consist of 27 LGAs. The LGAs are further subdivided into wards, which in turn are made up communities. The state has an elected Governor as the head of the executive arm while there is a house assembly made up of elected representatives of the different LGAs. This forms the legislative arm. The same pattern applies at the LGA level where the legislative is made up of councilors from the different political wads. The traditional system relates to the modern in an advisory capacity but welds a big influence on government decision. l0 WHO/APOC, 23 December 2006 Health system & health care delivery (provide the number of health posts centers in the project area if the information is available) . The health care delivery and the health system of Jigawa state are relatively good. In prevention aspect there is the state primary health care agency (PHCA) that oversees health care delivery to the local governments. These health care seruices include immunization, health education, maternal and child health, HIV/AIDS, water sanitation, Oncho control, malaria control, guinea worm eradication, and growth monitoring and nutrition. In the curative aspect there are general hospitals in all the 5 emirate councils, and comprehensive health centers in all the remaining LGAs. These provide curative services to the people, while health posts are provided in villages. Table 1: Number of Health staff involved in CDTI (please add more rows if necessary) District/LGA Number of health staff involved in CDTI activities 40 30o/o 35o/o 360/o 20 22 B 24 23 B 5 33o/o 22o/o Fr il',;i11,' +,:','"..-:i "" 7,7.2 Partnership Indicate the paftners involved in project implementation at all levels (MOH, NGDOs nationa l, international) Percentage Bz - Bzl Br x100 B/kudu Birniwa Dutse Total Number of heath staff in the entire project area Br 42 23 27 Number of health staff involved in CDTI Bz 15 B 7 35o/o 360/o 260/o Gwaram Kafin Hausa t2 7 Ringim -: I aura Kaugama ll WHO/APOC, 23 December 2006 I The partners involved are Federal Ministry of Health, CBM, SMOH, PHCA, WHO/APOC endemic LGAs, First line health facilities, CBOs (pl*ase fiame the CB*s involved) and the endemic communities. Describe overall working partnership among partners, clearly indicatinE specific areas of project activities (planning, superuision, advocacy, planning mobilization, etc.) where all partners are involved. There is a good working relationship between the paftners. The state performs such functions as training and re - training of LGA health workers, mectizan distrlbution, and formulation of operation guidelines in order to ensure good implementation of the programme, community mobilization and education. The LGAs are responsible for training and re - training of health facility staff and CDDs, mectizan procurement and supply to communities, community mobilization and education, monitoring and superuision of mectizan distribution. The assisting NGDO, CBM, supports in the production of IEC materials, provision of technical support to the project, advocacy for financial support and supervision of CDTI activities in the state. The endemic communities collect their yearly mectizan supply from the health facilities, ensures distribution of mectizan to eligible person, selects distributors and determines times and methods of distribution. They also minimally monitor and supervise the distribution exercise. The CBOs helps in supervision and monitoring, community mobilization and education, and training of personnel at community level. The NOCP through the zonal office provide technical and moral support to the programme, supervises the activities of the state of Oncho control programme, and pays advocacy visits to policy makers to solicit for support to programme implementation. State plans if any to mobilize the state/region/district/LcA decision - makers, NGDOS, NGOs, CBOs, to assist in CDTI implementation. The project rntends to mobilize other local NGOs and stake holders especially those from the problem areas to support CDTI implementation in the state. The appointed LGA policy makers were mobilized on the CDTI process with the aim of knowing their roles and responsibilities, ll"i- .;.:i"r;-o''.'i1".1r,.i..r;,.. , :.:1 .'1"1.'.ir."t',1 $;itii i:;;'iu I;i iir-l-ril .,t1. t 12 WHO/APOC, 23 December 2006 1.2 Population and Health System Table 1: Communities and population at risk in the entire project area whether they are treated or not during the repofting period (please add more rows if necessary) cDn Districts/ LGAs in the entire project area. Total population in the entire project area Number of communities/Villages in Population of Meso endemic zone in the project area Hyper - endemic zone in the project area Total in meso/hyper endemic zone Meso endemic zone in the project area Hyper - endemic zone in the project area Total in meso/hyper - endemic zone Ultimate treatment Goal (urc) Birnin kudu eirni*a 85340 622t 39 5 39 5 85340 6227 85340 622t 85000 6000 Dutse 16600 8 22 8 16600 16600 13000 Gwaram 37009 22 37009 37009 t972t 279t6 19190 3s00 K/hausa t9721 9 T4 11 3 105 9 t9721 219t6 18s00 Kaugama Ringim Taura Total 279t6 14 18500 19190 9002 11 3 105 19190 20,000 9002 9002 10,000 165858 C6rtlt)f:'tr. i:itil; t..qirir:. *lt.."..r..' .:.rl'.;t.:i h{:i'r;l r:$trl i*irr"i:ai ...r,.li,.,i :, : ri:: rili'l'"r {il .: i}T.{ t'". - t._I lfrll:: i: : ;-))' 3 d.>"r', Source: National census CDD Other, Speci Year: UTG = calculated as the maximum number of people to be treated annually in meso/hyper endemic areas with the project area, ultimately to be reached when the project has reached full geographic coverage. - If you are using the term community or village define what constitutes the community or village. This will help understand the profile of the project area. - Any other information of interest to programme. l3 WHO/APOC, 23 December 2005 Community means a group of 250 - 500 people leaving under the same traditional ward leadership. I 14 WHO/APOC, 23 December 2005 aSECTION 2: Implementation of CDTI 2.1. Period of activities Insert Plan of action indicating activities by month, which were implemented 2006 PLAN OF ACTION Table 2: March - September 2006 November 2006 S/No. ACTIVITIES MONTH IMPLEMENTED 1 Programme review and appraisal meeting for state and L.G.A January 2006 2 Advocacy January 2006 3 Ivermectin collection by LGA February 2006 4 5 Re - training of LOCT and health facilities staff on superuision/record keeptng Selection of additional CDDs march 2006 June - July 2006 6 Targeted mobilization of some communities March 2006 7 B Traininq of CDDs selected (phase 1) Census update of community members to determi ne the qqality of drugs required Au 2006 January - February 2006 9 10 15 WHO/APOC, 23 December 2006 tloo olt E o oo (Yl N $E. o I = G)c +-J LJfEC oL) o +J aEc =(ts ta(o Eo 'f q) o c o .E :f _o '= +) .!tE ro fg c(o C,)E '= =E E 0l +J(J fac oU(,(o 3 aooU E(u -pU 0) o)(n ->Bn;0ii,cru b- q) .c<uCE(U fi] r=U arU;ot- o_ ttr+to v;trc FCOro().: .9 .9 l-(l) EL =tn g o ua_ o_tf,ECbeUE L G) _o Eo4J o- G)a :f L 0) _oo+)(J L qJ ! E G) {F) o-(ua :l L G) _ooJJ(J o r- GJ -o E CJ+)o(u a Lo -o E o ,+) o_ o.)a (rl EE(go(rtr -c(JL(o = -cUL(o = E(J L(E E -EUL roE -c(.) L rI) = :Lo :=L o- -EUL((, = c. o ,P = .ct t- +t Ul E' E'T l- o c op0i_ o_!FC o:lUE L(u -ooPL)o L(u -ooP(J o L G) _o E(J P o-(u a f L CJ -oo uo L(u -o E(u +) o-(ua L(u _o E(u Po(u a C,lE_cEE(oo Lr.) tr -cLJL(o E \oO _o(u LL :l L o- \oo _o I o.rIu- _cUL(g u -E(J L(] = (OO _o OJ LL -c(JL(o = .EUL ro E rJ) O -o OJ LL .C L)L(o = \oO _o OJLL -lel(ol =l \o c) _o() LL I oP oE CLf o th tr o(J Eo .F Q_ o- tlCCbgUI \oO _o olJ- @O -o o) LL (,l c -c.EErgo urt \oO C(o \oO _oq) tL \oO -o a)IL \oO _o G) LL \oO -o(u LL \oO -o(u u- rJ)o ! G)LL \oO -oqJ LL E'I |El-F co .E q) o-5CCbeUt (:tr c-C '-!rCroO P-(nE c opq) -o- 5trc59(Jtr . ro fL -o(u LL s(.) L ro = L:L o_ sUL ro = :L o- Ou) -oo.t tE=Ntr -6tro9E ,., -CUL rgE -cUL roE q)c-c '-pECroO tnt -(o :fc(o -C(J L(o = E(J L(o = suL(o = -C(J L ro = EUL roz E(JL ro z -CL)L ro = (, J P .9l-P ,9 o fcf, rz C '- L i5 G' = c L iD (u U1 .p fo E(f,, L rU E(9 (o tn =G'E V (t, E(g o :f Gl\Z E Olc E (o !*J ruF E ,P oF EN 14(J\ qJ(J q) \(n =a QoG Ea q)(4$ a a. !r ro a) 1)c(u L Lf(J qJ -c)-) .E -(f q) -u(g oL +) a rg G)L ro OJ -c.JFJ L o(+-(, o 'j5 'r= U(o rl- o q) C q) E tr col ol ol -lol rolFI 2.2 Advocacy Several visits were made to all the B endemic LGAs, aimed at sensitizing/mobilizing the policy makers during the period under review. The Chairmen and Councilors as well as the Director Personnel management and the LGA treasurers were sensitized on the need for continued support to CDTI during the visit. The aim of the visit was to sensitize the LGA's to release their counter part funds to facilitate the implementation of the planned activities. Advocacy and sensitization activities has yielded fruitful results in about 600/o of the t-GAs visited, as fueling and maintenance allowance of the Coordinator were provided as and when due. At the state level, the Government is taking care of the maintenance of the project vehicle from the PHCA central pool. Already the state Government is assisting the state team during supervision, f3!tir:,:. '.,'i''-'j"1"- ;,;,":iilL::::': i:f tl'.r:::-* ,:'l:"hili:l:::: .:i.'l::l,i: i..'."'' Some of the difficulties faced are: . Frequent change of council members especlally at the LGA level. . Too much commitment of the policy makers to other activities makes it difficult to pin them down for advocacy. Some suggestion to improve advocacy . A high level advocacy comprlsing the NOCP, our supporting NGDO, Ministry for Local Government and that of Health should be carried out to all endemic LGAs . The project should organize a media forum to further mobilize the community and policy makers. . Involvement of community based organizations. 2.3 Mobilization, sensitization and health education of at risk communities The use of media in mobilization The services of Mass Media (Radio and Television) were utilized during distribution activities in the community and LGAs by the state team, Other local strategies used in community mobilization include: - Use of traditional and religious leaders - Face to face discussion with community members - Town criers mobilizing community members l7 WHO/APOC, 23 December 2006 Mobilizing and health Education of Women and Minorities Communities were fully mobilized using traditional and religious leaders, meeting face to face with the community members and the use of town criers. Their combined effort brought about wider acceptance of the CDTI. Women were also mobilized at clinics for those who attend pre natal clinics. Some got CDTI messages through listening to the public address systems or reading the posters made available at community level. Response of target communities The various communities have demonstrated their commitment to the implementation of CDTI, and are actively pafticipating in the CDTI process. Accom plish m ent of Ta rget Com m u n ities The project succeeded in mobilizing all the endemic communities and this has resulted in overall high treatment coverage and getting female CDDs in some communities Weakness/Constraints The women in purdah sometimes are deprived 0f getting the correct information on CDTI during mobilization as the messages get to them only through their husbands and grown up children. This does not however affect the coverage, as permissions granted by their husbands enables them to be treated. Pafticipation of women as CDDs remains a challenge even though we have started getting thenr. Treatment coverage remains high because compliance is adhered to annually by both male and female eligible. Suggestion to improve mobilization The quali$ of Information that gets down to women in purdah is of serious concern in predominantly Muslim communities. The project will co - opt temale PHC workers to be in the teams both at the state and local government levels to open up better and easier ways of Interacting with this important group of people, This will be necessary especially as we are adding other intervention programmes to the CDTI structures. The project will also identify female community based organizations to assist in educating this group of people to continue taking their drugs yearly. The project also intends to target the men to educate them on the need to have the women to be involved in the programme either as distributors or as mobilizers. l8 WHO/APOC, 23 December 2006 Effort is being intensified to use community based groups such as Padicipatory Learning and Community Ownership (P[-ACO) and Catchment's Area Planning and Action (CAPA) available to many endemic LGAs for increased community members' participation. t9 WHO/APOC, 23 December 2006 2.4 Community involvement Table 4: Communities participation in the CDTI (please add more rows if necessary) il'it.i$-*::1)l{'ri,:!(.1rj i..:t.,)i:;,..,-"i''.. ) i:'.:rfi..i;1.^lf.*., '.1.. -..tii..,i"-. Comment on: - Attendance of female members of the community at health education meetings - In general, how do you rate the pafticipation of female members at the community meetings when CDTI issues are being discussed (attendance, participation in the discussion etc). Females are generally not allowed to attend health education session with the men, and communities have refused to have their women assemble at a comrnon point to be educated by female health workers. The men have insisted on being part of whatever information that needs to be passed on to their women folk. In very few places as could be seen in the above table female CDDs were selected. Given the background of the communities this is a good starting point. - Incentives provided by communities for the CDDs District/LGA Number of communities/villages with community members as supervisors Number of CDD's and the communities involved Number of communities/villages with female CDD's Total No. communities in the entire project area Ba Number with community members AS supervisors Bs Percentage 86= Bs/84x 100 Male CDD'S B7 Female CDD'S B6 Total 89= 87+88 Number of communities with female CDD'S Bro Percentage Brr = Blo/84x 100 Birnin kudu 39 6 22o/o 366 32 140 1B 460/o Birniwa 5 1 600/o 45 5 10 5 3 lo/o, :'i Dutse 7 3 16 9 100o/o 100o/o 54 11 1 31 27 43o/o Gwaram 22 9 t92 Kafin Hausa 4Bo/o 63 1B 99 16"::, 72o/o ?"? Kaugama Ringim t4 l2 B 5 3 620/o 57o/o 69o/o B5 72 29 6 11 4 o. 6 3 44o/o??? 100%??? 50o/o??- 100o/o B 15 74 73Taura 'fotal 3 20 WHO/APOC, 23 December 2006 - There are reports of token remuneration to CDDs by community members in groups or as individuals. Some CDDs are assisted on their farms but such contributions are suppressed by the CDDs in anticipation of better gesture from LGAs or MOH when questioned. Others contribute with prayers and political campaign for CDDs when they indicate their intention to contest for elections. All CDDs are satisfied with prevailing conditions and are happy to serve their communities. Attrition of CDDs, Is attrition a problem for the project? If yes, how is it addressed? - Majority of the CDDs are either primary or secondary school leavers, and there is the tendency of leaving the job to further their education and this will warrant selecting new CDDs by the community members. Attrition by CDDs is a cause fbr concern but is quite minimal, and there are always people to continue when a CDD withdraws or is absent. - Other issues The state project is happy with the existing cordial relationship that exist between CDDs, FHLF and community members in their respective areas. 2l WHO/APOC, 23 December 2006 2.5 Capacity building - Describe the adequacy of available knowledgeable manpower at all levels. There is adequate manpower at state and LGA levels; these are adequately trained to perform their roles as SOCTs, LOCTs or FLHFS. Training for various categories of CDTI personnel envisaged for the reporting period couldn't hold due to the delay in the release of funds. However, LOCTs/Health facilities staffs were re - trained on calculation of mectizan requirement and entering of registers. Selection of CDDs was conducted by community members and 550 new CDDs were trained in the year under review. The second phase of the training will be conducted next year in 2007 when the money is released. 777 CDDs are yet to receive their training on CDn activities the training is being planned for the second phase. NAME OF LGA TOTAL SELECTED CDDs BIRNIWA 53 BIRNIN KUDU 450 DUTSE 96 GWARAM 3s9 K/HAUSA 61 KAUGAMA t57 RINGIM 9B TAURA TOTAL 53 itit TOTAL No. OF CDD TRAINED TOTAL REMAINING TO BE TRAINED 25 182 42 t32 28 268 54 227 29 32 9265 50 25 550 48 28 777 tl'.,: ;:1ss u^":r!"tf*i,; 'dXtll. i 1. i i1q.1 il^1li lt-liil'j Ins*rt i:lr* lrxil:irq t;:i 'i .- . .:a*t;iir*.,1 iii ih, r-rtrrtnlr:ir: lrri< 22 WHO/APOC, 23 December 2006 Trainees Types training of CDD'S Other community members e.g. community supervisors Health Workers (frontline health facilities) MOH staff or other Political Leaders Others (specify) Program management How to conduct Health education Management of SAEs CSM SHM Data collection Data analysis Repoft writing Others (specify) CDD Training Selection of CDD Table 6: Type of training undertaken (Tick the boxes where specific training was carried out during the repofting period) 23 WHO/APOC, 23 December 2006 E E E .e t;E E e cOOcLUh!!- : Hi H6IE g '13 (o oo t I! E o)(J oo(n r{ R oI B fr eil rS s : 4) il U X .3 U LN l: *} -cl aI) ,,w fl"., '',- ,l: t-- J:-.; 1) ': -.. ) 4," rli ':- l.L !* ,il lt ,rtri .* l:.ir) .:s r- LJ tti : -r-t \: r-.1 Li, (g a(n oUoc E Ul =ol- ol- o E -o E ro a)a(o q) rz(, 'C lF)(I] LD ro 0)!- rU ro .E (9 l_ -p ,9E a LU tJ) EE(I, C 0) E .L,,(o ot-F lo E at E(o Lo (I, .= (, th =d fE =lz .C uJ U 'tr I I I I #{E(nJqzo t, obs -ocCG,L6 f,q-OZo$ Ol{'o H o oo c\,1 o c!tn NNNr{ rloN t LN Ot (rl r+ t-'{ t--l rO rn v-.{ H CE'o tn tN C'T r{tf Eh19Eq € 8"q.E2rB.€EEE tnlrl tnr-.{ \o\t- ,o@ Ol Nor-l Nr\ s@ Ir. st@ s F{ @ U u q5'3sq;G * Oo\F Uv s ao @ so@ s c'lN s\oN soOl s rl @ cn @ LOor\ \r LN Ot\r @() rl oo r-{ N '.o @ N af)\o T\N H o Ot\o N F{ tn c! Olt H cr1 Ottnr\ rnoN rft\ r'{ b Po -o xq)LA; f,- 6 9Jz o nE P69 EEts:(oo = p6.iFo E E-.o .:l >. s .: e Et re6Bi9q.,EF oO tr I (I] o$ ra l..) @ t-{ c! r\.l\o oo(O(O d OrooN cf) !-{ a!N Ot H \o r-l Ot H N o Ot r--{ OlH NooOl C'I oro tf HN I Eo +)(I, olol o- soo H soo H soo t-{ soo: soo H soo rl soo soo H soo (,l ca tn @ I c{N Ot s- Hr--{ ca N .o .9{ o-rh'gLIU o) :'io Y1\ 6 8C (, 0)(f)(p th *.oo:Lc GJ f,! -oEc.) ->9ct-(glxq)ZYb Or oo LN @ (\l N Ol $H ilH oo N cG) - 9.2(tlFP J!YE(o.9-c 9J _6' <.: O co N F{ r{ -lc)l o1(o1 \\ th(u Ec =E EoU *U bo: c o- ,, c - >ull - 6 C'=EO >E,.: EEgPEtEFU>EE(u(o o\oo tn @ Nr\l clr $H !--{F{ G(,LE I I I Before now the total communities in the project area of the state were 105, but as a result of the creation of new wards head in Marke district at Kaugama Local Government area, additional communities were created with their ward heads in view of this Kaugama LGA is repofting 14 communities for the year under review which make up additional of 6. Formula for computinq therapeutie anLqeoqraphica| coveraqe Therapeutic coverage rate = Number of people treated x 100(%o) Total population living in meso/hyper - endemic communities within the project area Geographical coverage = Number of communities/villages treated x 100(o/o) Total number of meso/hyper - endemic communities as identified by REMO in the project area 25 WHO/APOC, 23 December 2006 2.6.2 What are the causes of absenteeism? . No much support for the CDDs by both parties i.e, (communities, LGA) please explain tkis * haw it affects absenteeisrn . In adequate mobilization . Communities are preoccupied with other activities during distribution i.e. (farming) etc. 2.6.3 What are the reasons for refusals? . ln adequate mobilization 2.6.4 Briefly describe all known and verified serious adverse events (SAEs) that occurred during the reporting period and provide (in table 8) the required information when available. . In case the project did not have any cases of serious adverse events (SAE) during this reporting period, please tick in the box. No SAE case to report 26 WHO/APOC, 23 December 2006 27 WHO/APOC, 23 December 2006 ro(,( I o .ct E 0,Iq, o (Yl(\g N o - = c(u u G' o_ (t) -C )F)(E o L o.) -o E f,c 6 L(u a - G' u't U)oUq) E lb LN 3ot_ c)L o E EE((, q)(n c,q) o_ Eo L o) o_ olC E o o-q) L (u -EJJ (,) C L :lE .IJ (u\- L f(J() o +)((,s 4J a LU tn (n ,1F) C OJ G) (l) {.oL OJ E(u U) :l o L(IJ Lr1 ra- o (n o(n ruU 6l orl -ol GIFI cq) E oEu ooc t, c,oly'u LE Efi CnL .EEa ,Ib8; -- thP'6EOOE!2 u) (JOO- fr;sEH o3 o,)CCP=LL3€EEE Cfo .N (-) o E f- uoP - = -SE EE €cgq)$EEE tJl E oP o- E tn i/'t,;cro OY or"s3UFOe;(ruo(5 C ro N LYV(nglm(U(trxoE=.9 OJOl .C .o.,l LL xq) tn ogl z a OJ E 0 F6S =UY- st)|.\ s\o @ s CN Or s Ot@ s\o Ot sn Or Co o l o- o o- OJ r! e9,;E8- evOl sLNOr soc'l s\r-ol sN@ o\ o(uBE E3C sl'.. sm6 stco srn@ s(oOl s@@ -PE(u^o !rIg oN@N c!Nc!\o N\o N N \o No F\ Or Noo m N r')\r co ol ca CqJ(U> oF- tHd LPO oooo{- oO 6\o on tr- oO n O' Oo o m oo tn i !u9L= -0,EY>.- !!:i6c ==0J00Fo!Elo o c})G99akug ES =vE F'3 oh8X(,U t\o N N m c! N @\r N t N rn @ \o 6o N N \or) @ u) Ol C'r n AJ o e > OJ Ef, E E oU s OO s o soO soo s so o\o soo soo so oo s o o OJ o')E AJE qJfD -oEoc=LFro z.U.: NN Nn- aN n(f 6O O co)qJ> co!/ cQ_b' N N N\,- ON no r)o LNo o, 3,P G= rr ibHq6af 9UEcro ol--- E=to)qtrE .eo-cF9.=O NN Ns- oN r)o ho LNo (oq) N O,Ol @ ol ol Clr ol Ot o o N oo N NooN \o(, c,N o .ct E o oo (rI rr{ IJ h oE = ni r- 9)3E 2o ooLr-l- CLBE O '.: -trEPOgo r5 .sb Otl-l-LELrl F.. O (]ule€ltrtr|6olisltrxo, ltlEoOEDEfrO uo-E,GeEP_!ro Ll-I E'=tr+rEfTHEgEE rtstu+'oPc s6 xl iEr;l o,;orlH NEI E IL oII E oI oo lYlN ri s oE 3 so crr s N @ s$@ s @ so cll s6 F\ ;<\o @ s N @ s ol @ s(o\o s oo s @ <)f.\rt rn\r m <. olv o u) N N ra @ F\rrF. d oo 6 n- oo ooN oo O N h ot ot\o(o N oO o ON @n @ u)\o OrN Or\oNN Ol OtOlf N soo oo sOo H ooi soo soo o r= soo O rl 6o no u)o r)o LAo tno N mo c{ $ooN hoo N \oooN ry! t, :l i{ \V F. :;t !- I CN L. qI{n OO N 2.7 Ordering, storage and delivery of Ivermectin Mectizan @ ordered/applied for by - (please tick the appropriate answer) MOH WHO UNICEF NGDO Other (please specify) : Please tick as apprupri*te Mectizan @ delivered by - (please tick the appropriate MOH WHO UNICEF GDO y' Please describe how Mectizan @ is ordered and how lt gets to the communities The state compiles population figures and determines total number of tablets that will be required for the next treatment cycle. It provides this information to CBM who fills the application forms and submits through the NOTF to MDP. On receipt of the drugs, the state collects the mectizan from CBM headquarters in los. The LGA Coordinators pick the consignments from the state while the health facility staff fetches their mectizan from the Local Government Headquarters. They in turn inform the CDDs of the availability of mectizan. The CDDs pick their consignments and distribute to the community members. Table 10: Mectizan @ Inventory (please add more rows if necessary) State/District/LGA Number of mectizan @ tablets Requested Received Used Lost Waste Expired Birnin kudu 170.500 170500 770,200 15,000 15000 t4486Birniwa Dutse 34,000 34000 31959 Gwaram 75,000 75000 74270 k/Hausa 44,000 44000 43916 Kaugama 53,000 53,000 51,938 Ringim 45,000 45,000 39333 Taura 20,000 20,000 18490 3l WHO/APOC, 23 December 2006 Total 456,500 456,500 444,591 List briefly describe the activities under lvermectin delivery that are being carried out by health care personnel in the project area. i. FLHF staff put up requisition to the local government coordinator ii. FLHF collects the supplies and informs community members/CDDs of mectizan availability at their nearest facilifi. iii. CDDs put request to FLHF staff and collect supplies signing mectizan inventory at the health facility. iv. CDDs distribute to all eligible members of the community under supervision of FLHF staff, LOCT, and community members. v. After completing the distribution CDDs return all remaining drugs to FLHF staff. 2.8 Community self - monitoring and Stakeholders meeting Has any training (of trainers) for community self - monitoring been done in the project area? Yes, community self - monitoring and stakeholders meeting since 2003 for the year under review there is non communities that conducted they need to be retrain. Table 11: Community self - monitoring and stakeholders meeting (add rows if needed) District/LGA Birnin kudu Birniwa Total N of communities/villages in the entire project area 40 5 No. of communities that carried out self - monitoring (CSM) No. of communities that conducted stakeholders meeting (sr-rM) B ?_2 k/llausa 9 Kaugama t4 Ringim 11 Taura 3 Total Dutse Gwaram , 32 WHO/APOC, 23 December 2006 Coordinator SOCTs LOCTs Health Facility Staff CDDs/Communities 2.9 Supervision 2.9.L Provide a flow chaft of supervision hierarchy. 2.9.2 What were the main issues identified during supervision? The maln issues identified during supervisory visits include: . Inadeguate contribution by LGA's . Poor participation of CBOs . Most community leaders appear committed to the implementation process. . No drug shoftages recorded or repofted. . Incorrect registration and poor entries of dosage by new CDDs with low literacy levels. . Determination of dosage by the use of calibrated corn sticks by some old CDD's where wooden sticks aren't adequate. . Inadeguate support to CDDs. . Low level of participation of women in the CDTI process. 2.9.3 Was a supervision checklist used? SOCTs used supervisory checklist but such is rarely the case with LOCTs. JJ WHO/APOC, 23 December 2006 2,9.4 What were the outcomes at each level of CDTI implementation supervision? . Health facility staffs are being encouraged to superuise more thoroughiy, although there are complaints of inadequate logistics. . Policy makers at LGA level are routinely visited to solicit for CDTI support . The LOCTs were requested to organize retraining for old and newly selected health facility staff and CDDs on keeping and entries into the community log books. . During superuision some efforts were made to correct CDD's on poor entries. 2.9.5 Was feedback given to the person or groups supervised? Effofts were made to give feedback to both health workers at the LGA and health facility levels as well as the communities. The major issues for emphasis was for the health workers at the community levels, to intensify on following them up. 2.9.6 llow was the feedback used to improve the overall performance of the project? Targeted training was organized at state level for local government Oncho teams, While at the LGA level a similar training was organized for FLHF staff which apparently transcend down to community levels. a 34 WHO/APOC, 23 December 2006 Source Type equipment of APOC MOH DISTRICT/LG A NGDO Others Condition of the equipment * Please state 1. Vehicle 1. (functional) 2. Motorcycle 5(functional) 3. Computers 1(non- functional) 1(non- functional) 5.Fax Machines 6. Others a. Photocopier 1(non- functional) 1(non- functional) 1(non- functional) 1(functional) Functional b. Generator c. TV & VCR d. 50 bicycles Section 3: Suppoft to CDTI 3.1 Equipment Table 12: Status of equipment (please add more rows if necessary) 4. Printers x Condition of the equipment (F = functional, CNFR = cUrr€fltly non - functional but repairable WO = Written off). How does the project intend to maintairr and replace existing equipment and other materials? iiii:., ... .r''i..ii',-:'.:,', lri:,sii,.i,j.i,*... 35 WHO/APOC, 23 December 2006 Year 7 Jan Dec 2006 Year 5 Jan 2006??? Dec Year 6 Jan 2006??? DecContributor Budget ReleaseTotal cash Budgeted (us$) Total cash Budgeted (us$) 7570 Total cash Released (us$) 1,680 31400 1 14501 150 Total cash Released (us$) 938MOH(Central + Provincial/PHCA) 46,738 22,L8515,65035,500 800 1200 1200 10,200 1700 1200 MOH (District/LGA) Local NGDO(s) (if any) NGDO partner(s) 33,860 1700 Others a 85308750Communities b 64850 6000 t27205800 L742 3200 t742 648s0TrustAPOC Fund 3.2 financial contributions and the partners and the communities Total 59930 334s8 tt2970 B89BO 92058 43365 ? 36 WHO/APOC, 23 December 2006 - If there are problems with release of counterpart funds, how were they addressed? - Additional comments 3.3 Other forms of community support - Describe (indicate forms of in - kind contributions if any) The communities support the CDDs in kind by giving them some measures (mudu) of maize/millet/guinea corn/beans, or give them other farm products in appreciation of their work. During farming season some communities assist their CDDs by mobilizing some members to work on their farms. t'l'le issue i* it*t ftr.;f *sil"iaf r,rqr$ntlnrti*s s!6 $t"rr CD$s, but grneral contrihution t* CIITI- 3.4. Expenditure per activity - Indicate in table 14, the amount expended during the reporting for each activity listed. Write the amount expended in US dollars using the current United Nations exchange rate to local currency. Indicate exchange rate used here N 100/$US Table 14: Indicate how much the project spent for each activity listed below during the reporting period. Activity Expenditure ($ us) $700 Source(s) of funding sMoH/PHCA sMoH/PHCA$7s0 $6,750 $B1s $300 APOC/SMOH SMOH/LGAs SMOH/LGAs $8,350 SMOH/LGAs Internal monitoring of CDTI activities Advocacy visits to health and political authorities $s00 SMOH/LGAs IEC materials $Bs0 SMOH/LGAs Summary (reporting) forms for treatment $220 SMOH Vehicles/Motorcycles/Cycles ma intenance $800 sMoH/LGA Training of CDDs Training of health staff at all levels Provision of log book registers to CDDs Supervising CDDs and distribution Drug delivery from NOTF HQ area to central collection point of community. Mobilization and health education of communities 3t WHO/APOC, 23 December 2006 Office Equipment (e.9. computers, printers etc.) $3s0 SMOH Others (commu nication) 1000.00 SMOH Total 89,987.00 Total number oi persons treated 529r535rtt rs rhis rhe n*rr:t'er trr.at*d i* ?SS$? The total In the aboue tablc is ah*ut $21,385. corrert. Rernncile rryith table X.3 where the amount c*ntributed hy all the partners is *b*ve $4$r$CIS - Any comments or explanations? - Comments t 38 WHO/APOC, 23 December 2006 SECTION 4: Sustainability of CDTI 4.1. Internal; independent pafticipatory monitoring; Evaluation 4,t.L Was Monitoring/evaluation carried out during the reporting period? (Tick any of the following which are applicable) 4.1.2 What were the recommendations? NiA 4.1.3 How have they been implemented? N/A 4.2 Sustainability of projects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period? No Was a sustainability plan written? Yes When was the sustainability plan submitted? December, 2005 What arrangements have been made to sustain CDTI after APOC funding ceases in terms of2 4.2.1Planning at all relevant levels Representatives from the state & LGA have developed a realistic 3 year sustainability plan based on basic CDTI activities and recommendations made by the evaluators. These plans are being fine tuned, but draft plans have been submitted to the policy makers and used in preparing the 2006 estimates. 4.2.2 Funds The state and LGAs were made to realize that external sponsorship (APOC) ceases after expiration of 5 years period which terminated in December, 2004 they have been requested to contribute increasingly to the implementation of the series of activities. The state and majority of the LGAs have responded by releasing funds for this year's CDTI NO 39 WHO/APOC, 23 December 2005 implementation. Efforts will be made to continue sensitization of the policy makers at these levels to increase support and eventually fully fund the programme. In the meantime the project has been assured of continued support by the assisting NGDO, CBM, although the level of support and its terminal end have been given. 4.2.3 Transport (replacement and maintenance) There are written applications to replace existing transport. The project is requesting APOC to replace the vehicle and motorcycles supplied. Meanwhile the state has started givlng some input into the maintenance of existing transport and this is expected to continue. Most LGAs have started giving maintenance and fueling allowance with the salaries of LOCT leaders. 4.2.4 Other resources Some LGAs have been providing training and mobilization support, the project will continue sensitization and mobilization of the endemic LGAs and the state to ensure that materials needed are procured when required. The project also expects short - term assistance from the supporting NGDO. This is the tradltional area of support. 4.2,5 Please provide a written with set targets and achievements for so far, The sustainability plan ls attached. 'iris i'. ,:{.ri .}i il',t."r*ri, 4.2.6 To what extent has the plan been implemented? Implementation of plans has commenced according to 2006 work plan, specifically the following were conducted: . With advocacy vlsits, approvals of State/LGA's counterparl funds for 7th year sustainability budget were approved but yet to be release. . Strengthening advocacy among leaders and Local NGOiCBO groups. . Procurement of addrtronal capital equipment (printer), computer, photocopy machine. 4.3 Integration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3. 7 fvermectin collection F 40 WHO/APOC, 23 December 2006 aThe LGA focal persons who are part of PHC department normally come to collect the Ivermectin whenever they come to collect NPI vaccines or other PHC logistics for their LGAs. Also at LGA level Mectizan collection is with PHC structure because LOCTS, first line health facilities and staff are all with PHC department. 4.3.2 Training There has been an instance where training on CDTI was infused into the programme of training for the immunization campaigns. There were also occasions when Onchocerciasis Coordinators were invited to give lectures/presentations on CDTI during training workshops for other programmes Currently CDDs are co-opted into measles and dracuncunliasis surueillance in CDTI projects area. 4.3.3 Joint superuision An integrated checklist for supervision of PHC activities will be developed by the ministry and is to be used for supervision of all PHC activities including Oncho control to begin in 2007. 4.3.4 Release of funds. All the PHC programmes have a common account where PHC funds are lodged and release follows routine procedure. However, there is a state Oncho account where state counterpart funds are lodged when released. 4.3.5 Is CDTI included in the PHC budget? At the state level CDTI is included in the PHC budget. At the LGA level it is subsumed in most cases in general line items. 4.4.6 Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? National Programme on Immunization (NPi) has started using CDTI structures through involvement of community members as local guides and commr-rnity supervision in their respective polio campaign using CDTI structure through CDDs for early report of any suspected case of measles. 4.4.7 Describe others issues considered in the integration of CDTI With the assistance of CBM the first line health facilities are being used to serve as primary eye care centers following an intensive training on blindness prevention in pilot 4l WHO/APOC, 23 December 2006 LGA (B/Kudu). However, there are plans to integrate vitamin 'A' supplementation into existing CDTI structure. 4.5 Operational research 4.4.7 Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting. None was carried out during the reporting period. 4.4.2 How were the results applied in the project? N/A J s 42 WHO/APOC, 23 December 2006 aSection 5: Strengths, weaknesses, challenges, and opportunities Strengths i. High commitment by community leaders and CDDs ii. Training of CDDs at a location close to them is a good strategy as other community members watch training event and this boost the knowledge of community members. iii. Committed staff at both state, and LGA level. iv. High treatment coverage. v. CDTI strategy will be an inroad to other PHC programmes. vi. Additional CDDs selected with female representation Weaknesses i. Non release of adequate counterpart funds by state and Local Governments as requested. ii. Payment of monetary rewards by other programme i.e. polio eradication campaign lowers the morale of CDD. Challenges . In adequate support to CDDs by the communities . Payment of incentives to village workers by some programmes such as NpI has affected the CDTI tmplementation negatively. . Low participation of women and community based groups in the CDTI process is still not encouraging, List how the challenges were addressed. The challenges encountered were addressed in the following ways (but they still remained current challenges). . Intensified targeted mobilization of community members, influential persons and interest group to support CDDs. . Advocacy visits to state and LGAs functionaries. Recommendations 1. Advocacy visit by NOCP to policy makers in the state in collaboration with CBM for early release of counterpart funds. a 43 WHO/APOC, 23 December 2006 a 2. Release of funds from APOC for the remaining training of selected CDDs at various LGAs 3. Release of capital equipment e.g. motorcycle and vehicle 4. LGA to release counterpaft as budgeted for CDTI activities on time These are still being pursued. The CDTI programme has given opportunities to the communities in the project area to solve their problems among themselves as a result of the integration of the health related issues. .s fairly gu+ri repcrt. .:l*nss revise tafrinE into csnsiderxtltrn the comments. $,tibn"lit r*vi*,:* {.{.}iiy iu.l' l'lrrth*r' t'Svlttr"r hr'f$r," lrrnritrr:tlrtn ,:f i.t*r.d t+pr*S. l.{creover', pl*r.s* i}i'ep*}',l *rx! rtui:lrr;t n }t$s t*i:itnic*l rrp*i.i t , t 44 WHO/APOC, 23 December 20OE