Report of independent monitors of CDTI activities in Bauchi State, Nigeria: 21 July to 13 August 2001

TEATN STATE HI}IO STATE PLI'IEAU R1-:l) tll.t l}r - MESO WHITE - FTYPO BLACK -LGA BOUNDARY STATE YOE ST,IIE 601'lBE SITIE TARIET STATC REPORT OF TNDEPENDENT MONITORS OF CDTI ACTIVITIES IN BATJCHI STATE, NTGERTA 2i Jtjt.Y - l3 ALjcLts'r- 2{)$t i AFzuCAN PROGRAMME ON ONCHOCERCIASIS CONTROL (APOC) ! tAltt utt BAUCHI REcu 0 I 0cT. 2001 APOC/DIR AUGUST 2OOI ^tA*l ilx6t xtnFl iLr(ttcBr REPORT OF INDEPENDENT MONITORING OF COMMUNITY DIRECTED TREATMENT WITH TVERMECTIN IN BAUCHI STATE, NIGERIA 23 JULY. 13 AUGUST 2OO1 DR EDITH N NNORUKA Department of Dermatology College of Medicine University of Nigeria, Enugu state Nigeria DR.EMMAI\UEL EMUKA Project Administrator GLOBAL 2000 Zonal office Imo state. Nigeria MR. FEMI AJAYI State Epidemiology Unit, M.O.H P.M.B. 1477,llorin Kwara State,Nigena. Submitted to: TIIE DIRECTOR a.i. APOC African Programme for Ochocerciasis Control Ouagadougou, Burkina Faso By TABLE OF CONTENT List of Acronyms 4 Acknowledgement 5 Executive Summary 6 Introduction 9 Methodology ll Results 16 Discussion and Conclusion 35 Recommendation 36 Appendix 4l i) Study Instruments ii) Samples of poor CDD Treatment Registers 4LIST OF ACRONYNIS a.r. ad interim Acting Afrrcan Programme for Onchocerciasis Control Community Based Ivermectin Treatment Community Directed Distributor C omm unity D i re cted Treatrnen t with Ivermectin Ivermectin Distribution Programme Information, Education and Community Lions Club Intemational Foundation Local Government Area Local Onchocerciasis Control Team Management Information System National Immunization Day Non Governmental Development Organization National Onchocerciasis Control Programme National Onchocerciasis task Force Onchocerciasis Control Programme Primary Health Care River Blindness Foundation Rapid Epidemiological Mapping for Onchocercias is State Onchocerciasis Control Team State Project Officer Tuberculosis Training of Trainers Village Health Worker World Health Organization Ag APOC CBIT CDI) CDTI IDP IEC LCIF LGA LOCT MIS NID NGDO NOCP NOTF OCP PHC RBF REMO SOCT SPO TB TOT vHw wHo 5ACKNOWLEDGEMENT The team would like to express its sincere gratitude to all those that assisted it during this mission. Of special mention are the following. o The Honourable Commissioner for Health, Bauchi State, o The Permanent Secretary, Ministry of Health, Bauchi State o The Director of Public Health and Disease control, Bauchi State o The Deputy Director Disease Control, Bauchi State o Chairmen of all the Local Government Areas visited o The Primary Health Care Coordinators of all the LGAS visited o HonorableCouncillors o Members ofBauchi State Onchocerciasis Control Team o Coordinators and Members of Onchocerciasis Programme in the LGAs visited o The Leaders and members of communities visited o The Community Directed Distributors of the communities visited The Zonal Coordinator Princess Patricia Ogbu-Pearce, the State Onchocerciasis Coordinator Yusuf Abudu Barazu and the entire Staffin the project offrce are also immensely appreciated for all the warm hospitality that was accorded the team during the mission. 6EXECUTIVE SUMMARY The Independent Monitoring Team that was constituted by APOC Management to visit Bauchi State Community Directed Treatrnent with Ivermectin (CDTD project, Nigeria, from 23'd July to 13ft August 2001,had Dr Edith Nnoruka of the Deparfinent of Dermatology, College of Medicine University of Nigeria, Enugu as the Principal Monitor. Dr Emmanuel Emuka (Project Administrator) Global 2000 zonal offtce, Imo State and MrYemi Ajayi(State Project Officer)Kwara state, Nigeria were the other monitors in the team. The team had the Bauchi State SOCT and LOCT members as local guides. The assignment commenced with a briefing of the State Onchocerciasis coordinator and stafl Zonal Coordinator, State Onchocerciasis Control Programme and Health Policy Makers, on the terms of reference of the Independent Monitors and the areas where their cooperation would be required. The methodology and instruments adopted were the same as those developed in Ouagadougou and finalized in Kabale, Uganda. The objectives were equally left as stated in Kabale, Uganda. Six Category A" and 24 Category B, villages were selected through an elaborate, multi- stage, sampling procedure. The findings show varying degrees of the establishment of the CDTI process in the APOC LGAs of Bauchi State. Some serious elements of the CDTI process were noticed in a few of the communities/villages visited. Great emphasis still needs to be placed on the sensitization of all the communities toward their responsibilities and the full involvement of the health service personnel and the utilization of PHC facilities in the planning and implementation of CDTI activities to engender ownership and sustainability of CDTI. The key findings in Bauchi State CDTI project include the following CDTI has taken off only in two LGAS of the six visited, which were expected to be implementing the programme in Bauchi state. Jam'are, Gamawa and Darazo, which is hyper endemic, has not implemented the CDTI process due to some political problems (in one ofthe LGA) and lack oftraining from the SOCTs. Distribution of Ivermectin (mectizan @) was based on CBIT strategy in majority ofthe communities visited. There was no indication of community participation in the decision-making on various aspects of the CDTI process. Health workers are still responsible for selection of CDDs and in some cases distribute the drugs. o a a a a Community perception of CDTI as an NGDO or Govemment project. Limited community sensitization and health education Majority of CDDs were not fully conversant with the CDTI concept. They were not able to record correctly in the registers nor understand the concept of household. This could be an element of quality of training and supervision. 7o The standard of training, in terms of quality and quantity, was very poor at all levels but still has rooms for improvement. Training was not at community level, as recommended by APOC. Training materials were inadequate and trainee-trainer ratio was too large for effective teaching considering the low literacy level. Supervision is weak. Most supervisions were done before distribution and without any standard checklist Poor record keeping at all levels It was also observed that these findings are attributable to management and logistic constraints at these levels of the CDTI operation. For instance lack of team leadership has lead to SOCTs inability to work effectively as a team due to poor coordination. In addition community mobilization and health education has not been carried out by either LOCTs or the SOCTs. The reason for this laspe is attributable to the fact that no provisions have been made in the state budget for community mobilization. Non-utilization of equipmens for effective Data Storage and Analysis as capital equipments are yet to be released to the SOCT for installation a year after collection.. Some reasonable integration of onchocerciasis control into the other primary health care programme/activities was observed in a majority of the LGAS visited. There was a very high level of political commitment by policy makers at all levels of government (LGA to the State). The State Govemment had already released N3 million in year 2000 as its counterpart fund for the project. a High level of information dissemination in the State, using the radio and traditional town criers. Generally, it is pertinent to mention that some level of awareness on the disease and benefits of the annual treatment with ivermectin had been created by the Bauchi state project in some communities. Furthermore, the communities are well organized and easy to mobilize. For instance to mobilize the entire community takes just some minutes using the town announcer (use of the wooden gong "kanga", metal gong or the local flute).They also have some noticeable self-help effors/activities as well as features for successful ownership and management of programmes. The CDDs who were matured exhibited some literacy levels and skills necessary for distribution activities, including accurate dosing, record keeping and reporting, which are very crucial for implementation of the CDTI strategy. If the positive features identified in Bauchi State are hamessed along with determined efforts, the CDTI project will no doubt yield the desired results. Based on these findings the following recommendations are being proposed to enhance proper CDTI implementation in this project area: o a a o a a 8o o o O a a o a Continued reorientation, training and involvement ofthe health service personnel at policy and implementation levels on the APOC philosophy and their roles in the CDTI as well as is integration into the PHC system should be intensified. Adequate time should be devoted by the project for proper dialogue with community leaders on the benefit of the Ivermectin treatment, their roles and commitment in the long- term sustenance of the treatment process. They should be made to be aware of their ownership of the programme and right to make the necessary decisions. Retraining of SOCTs on all aspects of CDTI implementation should be undertaken together with an exchange programme to older CDTI projects for practical experience; whereby the State sends out two or more SOCT leaders in turns. More personnel from other components of the PHC, media and educational institutions with skills in health education, mobilization, and gender issues should be co-opted in CDTI implementation activities at all levels. Steps should be taken to increase publicity of the CDTI programme as in other disease control programmes. Steps should be taken to improve on the training of CDDs. CDDs should be trained within the community to avail the programme of the following benefits: sensitization of community on the CDTI programme during training; reduction in cost of participating in training session by CDDs and promotion of a sense of community ownership. A deliberate attempt must be made to improve the quality of record keeping at all levels of the CDTI implementation in the State. There is the urgent need to give orientation to the CDDs and other health workers on the NOTF Management Information System for recording and reporting CDTI activities. The State and LGAs should continue to take definite steps of commitrnent to the CDTI process. NOTF and APOC should ensure greater monitoring of the various CDTI equipment and projects to ensure that they conform to agreed plans and processes. 9INTRODUCTION 1.1 General Background Nigeria, which is Africa's largest and most populated country, with well over 100 million people, still remains the worst affected with onchocerciasis. An estimated 30 million persons are at risk. The most severe consequence of onchocerciasis is blindness, which may affect one third of the adult population of the most affected communities. Other important problems are disfiguring skin disease and severe unrelenting pruritus which cause great suffering to millions of people. It is also a major contributor to the low socioeconomic status of the agrarian population living around the numerous fast-flowing streams and rivers in the country. Mass treatment with mectizan@ (ivermectin) has been on-going since 1991 in Nigeria, with the assrstance of IINICEF and various NGDOs, such as Riverblindness foundation (RBF), AFRICARE, Sight Savers, Rotary International and Lion Club. These agencies are now partners with the Afncan Programme for Onchocerciasis Control (APOC). APOC was established in December 1995 with the main objective of setting up an effective and self-sustainable community directed treatment with ivermectin (CDTI) programme in 19 endemic countries. APOC's strategy is based on the mectizan@ (ivermectin) donation programme of the Merck Company Inc. Studies have shown that mectizan@, is well tolerated and effective in reducing microfilarial load, improving ocular lesion, skin lesions and reduction of transmission. The studies further reveal it has anti-helminthic, anti scabetic and anti pediculosis effects, which will increase its acceptability in the endemic communities. The CDTI project proposals are based on an effective partnership between APOC, the National Programmes and several NGDOs. The first grants were awarded in 1997. Each project is funded for a maximum of five years. During this period, it is expected that APOC support will decrease proportionately to that of the other partners and that the cost of treatrnent per individual will reduce by 90 per cent. In addition, it is expected that the National Onchocerciasis Control Programme (NOCP) will continue to manage their CDTI activities for up to 15 years after APOC, in order to guarantee effective control of onchocerciasis. APOC's philosophy for CDTI is to ensure that the recipient communities own the programme in order to sustain it. The communities themselves determine the activities. They determine where to obtain their mectizan@, when and howto distribute it. They select their community directed distributors (CDDs), collect information about coverage that help the determination of programme success. Unlike the community based ivermectin ffeatment (CBIT), the CDTI is a process building up based solely on the experience of the community members, and consequently, enhancing the decision making and problem solving capacity of the communities. This has by itself engendered ownership by the communities of activities designed to improve their own health. l0 1.2 Bauchi Background Bauchi State is located in the North-East of Nigeria. The State lies between longitude 8050'and 110'East and latitude 903' and 1203'North. Kano and Jigawa, Taraba and Plateau bound it on the North, to the south Gombe and Yobe to the East and Kaduna to the west. It has a population of 2,826,444 and is made up 20 local government areas.The administrative seat is located in Bauchi town which is also the state Capital. The state lies in the Savannah area of Nigeria, with variations in ecological conditions, with the southem and western parts being sudan or guinea Savannah having a relatively higher rainfall while the northem part of the state is sahel Savannah with flat lands and fewer hills. Some major rivers transverse the State, these include river Hadeja, Jama'are, Gongola and Dindima. Most of the endemic local government areas lie along these rivers. The settlement pattem varies in different parts of the state, from nuclear settlements with surrounding farmlands to dispersed settlement. Agriculture is the mainstay ofthe economy of Bauchi State and the farming season is from May to December. There are l3 CDTI LGAs with an endemic population of 964,138 out of which 765,180 are eligible persons. IMass distribution with ivermectin started in the State in 1991 soon after the REMO was completed. Treatment then was CBIT based through the assistance of UNICEF Proposal for the implementation of CDTI in the State was approved in December 1999, funds were received in March 2000 and the financial cycle was revised to start from March 2000 to Febuary 2001. The project has just completed its first year of implementation of CDTI in Bauchi State. Currently, the 13 hyper/meso LGAs are expected to be implementing CDTI. The present report outlines the findings of an independent monitoring mission of APOC supported CDTI project in Bauchi State, Nigeria. It must be noted, however, that Jama'are one of the meso endemic LGAs that has not commenced the implementation of CDTI fell into the random sample of LGAs studied. 1.3 Team Composition The independent monitoring team that was constituted by NOTF, Nigeria, on behalf of APOC to visit Bauchi State CDTI project, from 23'd July to 136 August2OOl, had Dr. Edlth Nnoruka, of the Department of Dermatology, College of Medicine, University of Nigeria, Enugu Campus as its Principal Monitor. The other monitors included Dr Emmanuel Emuka of Global 2000 Zonal office Imo state and Mr. Femi Ajayi of the Kwara State Epidemiology Unit, Ministry of Health,Ilorin. The team also had Ms Juliana IJmar, one of the Bauchi state SOCTs and some LOCTs as local guides. I2. 11 1.4 Terms of Reference The team was charged with the following terms of reference Succinctly document how ivermectin treatments were undertaken in a sample of Communities with approved CDTI project in Bauchi State, Nigeria. Assess community involvement in drug collection, decision making on the period and modes of distribution, the selection of distributors, and the willingness of the community to accept and bear these responsibilities designed in the CDTI process. Document community perceptions of CDTI processes especially the issue of ownership, and expectations for onchocerciasis control, based on these perceptions and expectations determine the degree of satisfaction of the community wrth the different programme activities and outcomes. Assess the quality of training received by CDDs and health personnel involved in the project. Examine the record books of the CDDs and assess the quality of record keeping and their ability to keep accurate records. The same applies to the health services staffon the project. Determine the number of communities and eligible treated and compare findings with records of the CDDs and the records at the other levels (LGA the State -level records. ) Determine whether the health personnel participated in ivermectin distribution and assess the degree and quality of supervision by health staff (and the quality and orientation of the health staffto the CDTI) Identify constraints in the distribution and recommend appropriate measures to APOC management to be taken before the next round of treatments. 9 Discuss the prospects of sustainability based on the findings above. 2. 1VIETHODOLOGY The methodology used for the selection of the villages was as a follow-up of the methodology that was developed during the meeting ofthe nine monitoring team members in Ouagadougou in 1998. In a reviewof the tool workshop in Kabale, this was further refined to include a few of the things that were not previously taken into account. It was therefore decided during that meeting that selection of villages would be based on both the endemicity and distance from the health services. 2.1 Study Design -J 4 5 6 7 8 t2 For the monitoring conducted in Bauchi State of Nigeria in July-August 2001, a cross- sectional research design was adopted. This design was considered the most appropriate to generate the needed data and meet the study (monitoring) objectives. The data collection exercise consisted of a triangulation of qualitative and quantitative instruments designed to collect information from different segments of the target population 2.2 Population The target population for the monitoring exercise consisted of four broad groups. These include: I ) Health Personnel involved in the CDTI process at various levels; 2) Village leaders; 3) Community Directed Distributors (CDDs); 4) Household members in the hyper and meso endemic Local Government Areas (LGAs)/communities contained in the REMO result for Bauchi State. On the whole, there were four meso and nine hyper and seven hypo endemic LGAs. However thirteen with a population of 964,138 persons were expected to implement CDTI in Bauchi State. These are Ningi, Warji, Darazo, Alkaleri, Kirfi, Dass, Tarfrwa Balewa, Toro, Shira , Jama'are ltas Zaki and Gamawa. 2.3 The Sample and Sampling Procedure A study sample of thirty villages was chosen using an elaborate, multi-stage, random sampling procedure. The sampling process began with stratifying the LGfu by levels of endemicity. Since treatment focus is prioritized based on hyper and meso, the hypo endemic LGAs were excluded from the sampling. Consequently, three hyper and three meso endemic LGAs were chosen through a simple random sampling process (balloting), which was applied to each sampling stratum. The hyper endemic LGAs sampled include Itas Gadua, Darazo and Toro. The sampled meso endemic LGAS were Gamawa, Jama'are and Dass. The communities in each selected LGA were listed on pieces of paperand one community was randomly selected by balloting. The communities sampled through this process were Bilkicheri, Wahu, Jamaa, Polchi, Hanafari and Udobo from Itas-Gadau, Darazo, Toro, Dass, Jama'are and Gamawa LGAs respectively. ('ategory A and B Village.s, Having selected the six communities, one from each of the earlier sampled LGAs to be visited, the villages in the chosen communities were listed and classified according to their proximity to health facility that serve the respective communities. This was to ensure the selection of Categories A and B villages on the basis of near and far. Villages were -) considered near to health facilities if they are located within eight kilometers from health facilities. Conversely, villages were considered far if they are more than eight kilometers from any health facilities. In two of the communities, namely Bilkicheri and Polchi, villages far from the health center were selected as category "A" villages. In other communities villages close to the health center were taken as category "A" villages. The reason for this variation is found in the simple logic of all the villages in the community being disadvantaged in terms of the non-existence of a community health facility. It was also reasoned that the farttrest village might be much more disadvantaged in this circumstance and thus called for an in-depth understanding of its situation. Moreover, such communities may suffer poor coverage in health related programmes and also lack adequate health education. Next was the selection of the Category "B" villages. To do this, other villages in the community were plotted on sketch maps of the community and categorized into near and far from the chosen Category "A" village. Two villages in each community were sampled by simple random sampling process from the villages near to, and far from the Category "A" village. This gave a total of four Category B villages for every Category "A" village chosen for the study. (See Table 1A below for a listing of the sampled villages) Table A1: Local Government Areas (LGAs/Communities and Villages Covered: Local Goverrrment Arcas (LGAs)/Communities t'AotVillages *B'Villages Itas Gadau (Bilikicheri) Hyper Billiicheri Gululu Kurna gari yau Kuran yan uku Saban Sara Darazo(Wahu) Hyper Wahu Fulatman Lagon Wahu Jiro Magume Toro (Jamaa) Hyper Garin Jamaa Wom Nabrado Kanwaya Tashanduromi Gamawa (Udobo) Meso Udobo Lariye Garin Alhaji Wabu Marana Jama'are (Hanafari) Meso Hanafari Aliye Guda Lariye Kuliiri Dass (Polchi) Meso Polchi Durr Zumbul Lukshi Barraza l4 Households In each Category "A" village sampled, fifteen households were chosen. To do this, the village is carved into three clusters guided by the village head and local guides. The systematic sampling approach was then applied to select five dwelling units from each cluster. The sampling intervals were determined through a quick estimation ofthe number of dwelling units in each village-cluster. This diftered from one village-cluster to another. In each sampled dwelling unit one household was randomly chosen for the treatment coverage study. Furthermore, to check on the correctness oftreatnent, one household was randomly chosen, and the dosage for one household member, randomly selected and crosschecked. CDDs and Village Leader,c ln each Category "A" village sampled, the village leader was purposively selected and interviewed. The village CDD was also purposively sampled and interviewed. In cases where there were two CDDs both of them were interviewed, but where there were more than two CDDs, only two were selected by balloting. Similarly, the village leaders of the Category "B" vrllages were purposively chosen and interviewed. The village CDDs were also purposively chosen and interviewed where the CDDs were one or two. ln some villages with more than two CDDs, two were randomly selected for the Category "B" village CDD interview. In some villages, however, CDD interview could not hold because of the absence of any CDD figure during the study. Health Personnel. Various cadres of health personnel involved in CDTI process were purposively selected and interviewed. These included Supervisors, Local Onchocerciasis Control Team (LOCT) members and Coordinators. The Coordinators of Primary Health Care and Health Officials at the State level, involved in the CDTI process were also purposively selected and interviewed. The purpose ofthese interviews was to examine the onentation to CDTI process and provide information on the records and quality of training they receive and/or give on the CDTI process. Other lssues Advocacy visits to policy makers at all levels as follows Commisioner for Health Permanent Secretary for Health Director Primary Health carelDisease control Zonal Coordinator NOCP zone D i. State l5 ii LGA Executive Chairmen Secretary PHC Coordinator iii. Community health education and sensitization on CDTI strategy inmost villages visited. iv. On the spot training of CDDs on record keeping and reporting of CDTI activities LINIITATIONS: In the course of visiting villages it was found that in one of the initially selected category A villages and two category B villages, interviews could not be conducted because the villages were not treated. The next neighbouring villages were monitored instead. 16 Instruments Eight instruments were used to gather information from both Categories "4" 4nd "8" ,llg"r. Copies of these instruments are included as appendices to this report' Table A2: Summary of Instruments and Sampling Issues Instrument Category of Villase/Unit Sample Sampling Procedure In-depth interview & Record review rvith CDD A&B I - 2 pervillage Purposive (Simple random. where there are more than 2 coverage survev A l5 households Per Molti-tt"ge (i.e. cluster. s-ystematic and srmPle random Key infonnant interview of village leaders A&B I village leader Per village Purposive Group discussion A Convenience Health personnel interview A I PHC coordinator I Oncho coordinator I LOCT member I health cente staff Purposive Programme rnaua gerlPolicv malier interview Project. State & National levels Project administrator I Director. Disease Control Per State Zonal Coordinator NOCPzoue 'D' UNICEF Project Offrcer Bauchi. Purposive fro"p.po"itloge(i.e.l male and I fernale adult and 1 fe,male or male Youth grouPs). 6-8 persons in eaohglgYP-- (,J F ttla Fri a 19 o a, 'lD (D (D a(, o I DT 0a rE .! oOto o o F(D o El o ot, t, t! tr,tll\JB ro 'o 'uttFtooo ooo :1 :1= ooo A)OrS) o- o- o- 5ddoo(D rtt ooot tst ts+)oo()ooo 3. E|. 3.o@(Dou)v) tD;-'-Iq)D)(D0a0q +(D(Dt@ v)(l!tr{ +C):t=.O ='o r^o-E b.P5 C] ;.:. c +6- -YP O. @^o(DY5Q*+ 36(Da=? +a 5(D +o Eo-o o-o!oTi H)-r - +(D l-,i o i+u9tsU3E rr @i ,, 3 -J; llG il:u) o u.) L! 6 ',-,\e \o \0o\ 6\ 6l. ...o J a>i=g t E'EI *d E+\'6 e YbBi, ^'o- tr^*_.oY+,6' 9 2, ABJ.9rfe.-r -+V)v-LUBE'{ :JJ ..oo I\Ja?-llJ o b'o =f^O!93 1rtsg#E -a ^*i1.Pll=o,HiEn -='o I iw s ...s r F i =f;6-X 5 H.Do 6- +: Fx'o;.h'nx 'to'() =Hr.*ALi^o-rDAsias, a(-,1 H. !+ ^!+EV Yc dJ P\J=.tr* Yg td jw) o (D aD o (t) OOO O\HO goI N)(J.) {o- t9 r,!^'} 'u) z1tl -: BF =(D0e OOO OO- I UJ ONO I _t Fl< oDr;E 999{-J{ O\Nu) -tJsgo 90 \,NO\\O LAO\H Hli-\Y9 o< ODt0q o N I..J N) (JJ u) u)(/JuJu) 'UJ ',.) '(*.) rNe Y N..r -rr@5 .o o\ L,J UJ-).tr' .GG O IJJ o\(+)\) 4- ^-o 6= 't I{ (})Oo !c ooo tD Ai+/. ''oo= jri. --- = 30e ,r(! o\{ soo N N N I..J 999 -I -I -J o A1 =l0e =.o OOO OON) N) 9|o o\ OOO ort O\ O\ O\ Q{-I(J),^,^ U) UJ U)OOO OOO tro-3sEr ;- Gn 18 The decision-making processes on issues of timing and mode of distribution as well as CDD selection were employed to gauge the level of community involvement and ownership of the programme that exist among the communities. Here, decisions that were reported to have been taken in village meetings were taken as indicative of the ownership of the programme. Looking at Table l, village leaders, CDDs in categories A and B villages were interviewed. Focus group discussions (FGDs) were also held with people in category "A" villages. The Table reflects the varied responses on who decided on the mode and timing of distribution as well as selection of CDDs. For instance, only (3.3o/o) ofthe village leaders reported that decision on timing of distribution and selection of CDDs (%.1%) were taken at the village meetings. The mode of distribution (0%) was not decided at the village meeting. A look at other segments of the village leaders interview however shows that in some villages, the village chief (20%) and health worker (23.3o/o) took the decisions particularly in regards to mode of distribution. On the other hand, only 14.3 per cent of the CDDs interviewed indicated that decision on mode of distribution were made in the village meeting and that their selection as CDDs were decided mainly by Health workers (30.3%). From the FGDs, it is observed that a majority (33.3%) of the communities had the decision on mode of the distribution, time of distribution and selection of CDDs made by the Health worker. According to one of the participants in an FGD, " Government owns the drugs. Why should anyone worry about when it is brought to us and who should distribute it for us or what we should give to those that sharelhe drugs? We are getting the drugs free, and are willing to take it whenever we are called up-on to come for it. Those who spent their hard earned monies to produce the drug for us should enjoy theprivilege of determining when it is convenient forthem". This is typical of all the groups. A sample ofthe very common responses to this question is as follows: ... Whenever the drug is available, the health people will bring the drugs and give the CDDs who shares the drug for our village. ... When the drug arrives, we are unaware but the town crier is made to inform us. ... Anytime the drug is available we take it, we cannot determine when the drugs should be brought because we do not know when the health people get it. In effect the communities were agreed on the fact that such decisions are always, and better taken by the health workers, who are providing the drugs. Some village leaders oppose this. Most of them indicated that such decisions ur" oft"n taken in tf,e village meeting andTor the village health committee meetings. Also in the six communities, in which FGDs were conducted, the selection of CDDs was not done in the village meetings. This is in conformity with the responses of the CDDs and some ofthe village leaders on this issue. l9 In measuring the indicators (E-1 andB-Z),the responses of the village leaders were used' This is because the village leader information appeared more representative by virtue of its geographical coveragl of categories A and B villages, and the three subjects, namely' decision on mode and ti-ming of distribution, as well as the selection of CDDs. The FGDs were limited to category e vittages, while the category B village CDD interview did not ensure the collection of information on the timing and mode of distribution. Following from this therefore, it is observed that 23.3 per cent of the communities indicated that the selection of CDDs was done in the village meeting, while 3.3 and 0 per cent indicated that the decision on timing and mode of distribution respectively were taken in the village meeting. t,:, :: t'i.': L i.,, cn o\tv o]!f, aa tlt .E o(l) d\oEo\Loc) oaSf l[ o\ rf) O_l rQ*-5 x*'6 'r-Vr\ '=ll T9) ^- IlEEx€i,cOi:> =od2'e.!.oo EaX'"(IrPa^ (uLv-d 3 e oc -LLF =c)6.)=5;3; C€.-Li:EEEyE= >, a 6 6t^;8 8; g ,J--LA 3 6 6 HE5_8_8bEtr (B d o€) <rcrqrcr Foooo= v oooo= r#!J.- s;sFHFFts- HHHH9 =35=Octrtrc> EEEE 6,cccce,(B(c(Bd9 aseaa6 6 6 66'tr'F'F'F c\6 6 6 6qq a. a o.r-ooooYLLLL\E) Fl 0i Pi 0i r., lrN 6ttt \J \J I,/ o) .h 0)lr a. olr .d 0) (3 oti o H a ot/) o qi o a() b0 (.) oL C) o. o r-l rio c) tc)ots do E .15 €b0 uC96 -- -o Lto€o,^ =Faol4a "U ()t<sc) qiPo>, a! ao oad -tr g) SE a* .9 or()x O)PLGq)H ab dx 9L *O CO(€ (c G3o oil o H Io^EH o\N .o o\ o z la, Ssr O r.)$ oti Nse aq Ar- OGzg a.l\O C\l -r-- a'=AE4=d^u C)o c4 \o $ \o z O c.l tf) ir' c.l ar) jFg a9J r+ c.l oroza |r) \o9 aaKs t'.-CQ x'O\ \- N <ld=}E oQ .r,Er oGZC - I'-vO\ H"-H00 $ OroF7 o\ \o coY l/) C'l +' c..l i OJc..l :- O)\+ c.r :- 1 !iXa: 8A04F c.n Oroz9 OJ ta)o-'t.J O $F-o\ ^'U^C{U avtHrc 'ri 5 OGZ. se c) 00\+ -'EiJ G) .rxE<=*E06 O u U a< OGz9 Ia H ..r ta) o€za cl \OJ ^ c.'i\oi &o\;$e rd4 4 -ccEE 1d r- ;{ c) a1 Mtn oG'z9 NOO* O *$E9 ;sUv AaEro ao a'l -o o\ o z \oorJ Cal v tr-. Ns6 * CB F U) a o 0(l) o o an ehtrq) €) o;r z o Gotr3 an rr)o 6)tr !- a {) q) tr3 al q) 3 c'l I a T a

2l The Table (2) above presents no definite pattern in the comparison between the results from the sample survey of household treafinent and the treatment summary from the CDDs' records. In some cases the records show higher proportions than the sample survey results and vice versa. Treatrnent records were generally poor at all levels. At the village level some of the CDDs had the NOCP registers that were fairly well maintained given the limited understanding of the CDDs. Fortunately in almost all parts of the State the CDDs chosen were literate and therefore had legible records. However, the format of the registers varied and inmost cases there were discrepancies between what was recorded and what a community member actually took. Many villages had incomplete records. It is either the sex or age columns that were not completed, while some did not differentiate absentees, refusals, underage, pregnancies and those the drugs did not reach.Also in several places updates were not made for the population of the community. In one community namely, Bilkicheri treatment summaries were totally absent. The excuse given, however, was that the records were handed in for collection of more mectizan from the LGA headquarters. At the LGA levels there were some Treatment summary reports and Ivermectin inventory showing number of tablets given out What is not shown in the latter is the number of tablets that are remaining or that are collected back from the community and redistributed. Fig2: Treatment sumnrary by LGA 4Yo Ta/o 30a Zala 2% 1o/o 1Ya aoh HHEI ECDD

22 Comparing the results of the household survey and the treatment records of the CDDs showed great disparities. For instance, in Toro, the proportion reported to have refused treatment is 2.5 per cent in the CDD record. This is higher than what was obtained in the survey (0%). The same is the case with the other LGAs with respect to the recording of refusals. The proportion of absentees from treatrnent records and household surveys who were not later treated was 2.'7o/o and 4.5%o respectively and from household surveys, 0.7olo of absentees were later treated. This result shows that: o There was defective community mobilization and health education on the importance of extended treatment with ivermectin. o The CDDs were not efficient in follow up of absentees o The communities probably had not agreed on a definite period for distribtion. o There was probably shortage of drug as reported in some villages. Table 3 Proportion of Villages treated and in which CDDs were changed after the first treatment O-3 Proportion and number of at-risk villages treated : l5 (50.0%) O-5 Proportion and number of communities where CDDs were changed by the community after the first treatment: I (3.3%) Table 3 above shows thattreatment has taken place in l5 villages out of the 30 at-risk villages visited. It also shows that CDDs have been changed in I (20.0%) of the communities, after the first treatment. From the FGD, the discussants would often retort that, "there is no need to change the CDDs, they are our children and they are doing their jobs very well." LGA Villages (Both A and B) Treated CDD changed Jama'are 5 0 (0%) 0 (0%) Itas Gadau 5 2 (40.0o/o\ 0(0%\ Gamawa 5 3 (60.0%) t (2o.0%\ Darazo 5 t (20%) 0 (0.0o/o) Dass 5 4 (80%) 0 (0.0%) Toro 5 s (r00%) 0 (0.0%) 23 Table 4 Proportion of villages which received health education, and number of villages in which CDDs were supervised by health care personnel LGA Villages (Both A and B) Received health education (YesA{o) CDD Supervised by health system Jama'are 5 r(20 0%) 4 (80.0o/ol Itas Gadau 5 2(40 0o/o) 0 (0.0%) Gamawa 5 2 (40.0%) 2 (40.0%) Darazo 5 0 (0 0%) I (20.0o/o\ Dass 5 2 (40.0%\ 4 (80 0%) Toro 5 3 (60o%) 2 (40%\ 0-6 Proportion and number of communities in which the CDD is supervised by the health care (communities scoring 50% and above) : 13 (43.3%\ O-7 Proportion and number of target communities which received health education (i.e. 50% or more of the different segments in Category A village received health education) :10 (41 7%) Table 4 above shows that in most villages assessed it was clear that health education had not been properly carried out. The proportion (41 7%) of community segments, which received health education about the importance of ivermectin treatment, shows this. However, what remained unclear was when this was done. It was observed that health education is a cumulative process and therefore whatever might have been told to community members before the CDTI implementation might still be retained. This is reflected in the responses provided by leaders, CDDs and some community members during FGD. Most of these responses had to be prompted. Similarly,only 43.3 percent of the CDDs were supervised by health personnel (see table 4) The supervision was carried out mostly during the drug distribution and the level of supervision also varied from LGA to LGA. On the other hand, eighty percent of CDDs in Jama'are, one of the LGAs where CDTI has not commenced indicated that health staff personnel supervised them during the last distribution. IFl or.t o F)a(n c) A'N o 00 lD{ E) FD U) o o) o- F0 eo s) g) o f- o (rt (Jl Lar (n R"S ll 6i 0q(D(t) (,.t \oo\ ( -oo\ N \oo\ 5 oo -oo\ N) s 'o -o o\ 5 @ .^ \o O-t \J O) \,5U)o o- O N) .^ NJ -oo\ N) \oo\ N) \o o\ (r-trD) tsotr (]) o\ .^ \oo\ t) s .O -oo\ o NJ 'o yO o\ NJ ;, \o 20 og :10e ID oq(D 5 @ .^ -oo\ 5 ooIO\o N)I -o o\ E!1>-ooo *-oF0C) o 5 @ '^ 1Oo\ 5 @I -oo\ t) .^ \o N) .O -o o\ N 'o \oo\ N .^ \o 6\ 9<?s6'2(DE 3 0q o\ NJ FPo -o o\ (/) o\ .^ \oo\ N 5 .^ yO o\ NIO -oo\ ()) o\ ;- -o o\ Ed @t 96 I \o O a/\o I rO o\ 9 -o o\ O i/ -o o\ I -oo\ >e 6 ?EgHB c) o-og= o Ul qrr O (, O LA (/l O L,r o a\(n FH 3 5 tDt'J5 tsd a i.i o UI .) o .j o o o o tlbJ -. -*HH'u v v v v Y vaaaaaaard€!dEE'OrOooooooo :1:1=3:1== ooooooo J'P))JJ oro)o)!rA)Fol09pJ)r// a-o-Q-O-OO-O- - H H H9JJ)))/cccEtdt JJJ)94<JJJ)JJ'ddd('6d- ooo(Do(D(D ttlEllt- ooooooo +) +) +) l+) t..l) Ft) Fn +aosaaQ s g ud8 E x x L J H- ) P /ids\/:{=:1i ^JUlJtr*e. - o C g: tro5<o555 3 *:$i a:a:a: = ii5=oou) c < ta 5 =9,r =.P =-d d -.a: =E6al=r?sIi5ii?q -'ri, <;.i b) = BT *E E F d!-Ai.-.(9 :t:? (D ):(D (D O-(9-Plt = ) ='o C) o r) =-xo(D@t-tJt\Y-AAvtEIS+qYlsxiEE yE rr e;15P-3 -Qa o.*XE 95 A 3; 5+'ui q : + S5 P H'5 ?':-6-r! a 3 Qi-.ro H,(D iq.o) o () 5u-<-A o^rx + (J rr i.oll 5 B 6-: il8 8'BEll I 't.r rr-ro\ rd SL! av\e =. o\vU)Od '^o I .o o\)v(D'er + oo J+(DFt il \o GO -o o\ v -titi-lttl\fO\Ul5 NJ5 25 Table 5 above shows that most villages (70%) indicated that their CDDs were trained except in areas where there was no CDTI. It also shows that thirry percent of communities collected drugs from a designated point and presented some form of treatment registers. Four communities (13.3%) indicated that they experienced late supply of the drug. The perceived promptness in drug supply was attributed to the fact that they did not decide on when the drugs should be brought. "... Whenever the drug is brought by the health personel, through the CDDs is the accepted time". There was shortage of drugs in seven villages (23.3o/o). From records it was obvious that population census was either not carried out properly or it was not undertaken at all. However, the proportions of CDDs with measuring device differed from one community to another. For instance, in Itas Gadau only 1(20%) of the CDDs had measuring device. Similarly, over half (50 0%) of the CDDs, in three of the communities visited were without treatment registers. Furthermore, most of the CDDs interviewed could not produce their measuring device on demand. None of the communities showed reported cases of severe side reaction. Understandably, therefore, no records of side reaction were seen. Furthermore all the communities visited had a completed summary form, for at least one month between January and June in the State office. B Constraints Management Support at the State level has been remarkable. The State Government had released N3 million for the year 2000 as counterpart funding. This shows the readiness and commitment of the state to the implementation of the programme. However, more has to be done by the State for continued support in the implementation of the programme particularly with the bureaucracy of funds release from the State MOH for the programme. The State is in its second year of CDTI, yet balance of its Capital equipment for year one has not yet been received from APOCAMHO Lagos. Equipments collected are yet to be installed as an offrce accommodation had just been allocated. According to the Director of Public Health who had just returned from a special posting ' the main problem in the area of accommodation lies with providing enough security at the state office, however, the state is taking action by providing another office where some of the SOCTs will be used in a more secure place.' When asked of their achievements so far with regards to onchocerciasis control, the Director of Public Health and the Deputy Director Disease Control all argued that, " Not much had been done because of no funds from APOC. This is largely due to delays from 26 the state in rendering their accounts. There were mistakes in our accounts, which were returned back to us from WHO. However, training of CDDs in the 13 LGAS, census registration for mectizan and mobilization of all communities to such a level that CDTI is accepted has been undertaken'. The State Onchocerciasis Coordinator on his own part complained of the delay in receiving fund, which he attnbuted to both delays in making returns to NOCP and delays in disbursement of fund from MOH. He argued that "the delay in making financial retums was because the APOC Accountant had an excessive workload". Though the SOCT members are willing to work for the success of the prograflrme within their respective domains, lack of Team leadership at the state level has led to poor coordination, reorientation and training ofthe SOCTs. Most Local Governments demonstrated support for the programme by releasing fund for training, supervision and monitoring activities. However, others were reported to have given mere verbal promises and approval of request, without actual release of the funds. According to one of the HODs in charge of health in one of the LGAs visited, "the health department in the LGAS should be funded separately, because the Chairmen do not like investing in health. This is because they all want to erect tangible structure that will leave alegacy of their tenure in office". On the other hand, the Onchocerciasis coordinators in the LGA level argue that while the Chairmen may release funds, this may not get down to the Onchocerciasis units, as "the intermediaries tamper with such released funds". The health staff in the field also has faced logistic constraints due to inadequate transportation-- motor cycles. This applies to the LOCTs and the District Health Supervisors. The State with 13 hyper/meso endemic LGAS have just a few motorcycles. The shortage of motorcycles may have informed the pooling and rotation of the motorcycles among the LGAs depending on the urgency of the need. It needs to be remarked however the proper supervision should be a continuous process. It may be necessary to reconsider the practice of rationing motorcycles. The SOCT members also highlighted the logistic problems. They arguedthat, "with the withdrawal of the APOC project vehicle due to a major mechanical fault, they are constrained to rationalize movement in a way that impinges on the smooth execution of the CDTI activities, particularly monitoring and supervision". The NGDO offtces, UNICEF \|{OCP zonal office have not been adequately involved in the supervision of CDTI programme in the state. Their presence in the state should be an advantage to the implementation of CDTI. In an interview, the Zonal Coordinator said that ' UMCEF has no manpower on ground therefore theZonal offrce took to support them technically. The support from the Zonal office is not enough because ofthe system. However, proposals are written to UNICEF and if it is their plan ofaction they will assist. They assist rnZonal meetings, trainings and have also given theZonal office a free hand. 27 With regards to implementation of CDTI in the state, the Zonal coordinator went on to say that "the slow pace of CDTI in the State in regards to ownership and accepting their roles in communities, was because their minds are geared towards Govemment doing everything for them and so most areas are not yet ready". Futhermore, in an interview with the IINICEF Project Offrcer, Bauchi on the perception of APOC strategy for ivermectin distribution he said that due to their large activities\work load their main difficulty was in the capacity to supervise. They therefore rely on government structures on ground and plan of action on ground. "This has led to our using the NOCP Zonal offrce\Zonal coordinator to buffer the responsibility and areas where APOC is not funding UNICEF relies on proposals for assistance". He went on to say that "---the State has not been able to enjoy funds from UNICEF because of poor proposal writing. So far only a few proposals have been written by the State one of which was a proposal written for supervision/advocacy worth N36,000(thirty six thousand naira only). UMCEF is ready to pay for the allowance of SOCTs for monitoring, mobilization and visitation of all endemic communities in Bauchi." Technical Most of the LGA health staff and majority of the CDDs interviewed showed poor knowledge of the APOC philosophy and the right process for the CDTI implementation. This may have adverse effect on the quality of CDTI implementation in these LGAs. C Community Perception Community involvement and participation was generally low in all communities visited. Thus community perception of CDTI programme varied greatly among and within the LGAs, communities and villages. While most segments, particularly women and youths exhibited total ignorance and lack of knowledge on role of the community in the CDTI process. There was a poor knowledge of the disease and the drug in most of the communities. Also, in all the communities and within the different groups the exact role of the community with regards to ownership of the CDTI programme was still poorly understood. Village leaders and elders reiterated that they were in "no position to know if the drugs arrived on time or not, our own is only to take the drugs whenever we are told that they available". The programme is being perceived as govemment program, where they can make little or no inputs especially in decision making about the timing of treatment. Worse still, the women who argued that they are in no position to take decisions at all (based on their religious and cultural background) believe it is soley the duty of the men to take any necessary decision, particularly with regards to time, mode and on the selection and compensation of CDDs. 28 Nonetheless, some groups within the communities visited exhibited positive disposition towards CDTI. They even demonstrated their preparedness to educate and mobilize reluctant members of their respective communities by testifying to the usefulness of the drug. According to some of the participants in adult male FGD at Bilkicheri, in Itas Gadau, "there was no such discussion on the community control but now that we are part of it, we would now sit down and discuss it." Futhermore according to one female traditional birth attendant during the adult female FGD at Polchi in Dass,'---- I had to intervene in one occasion between the CDD and a group of women who had refused to take the drugs because they felt it was a birth control drug. After convincing the women they now agreed to take the mectzan.' Also, almost all the people interviewed within the community could not show the difference between CDTI and CBIT. This lack of understanding of the fundamental difference between the two programme may be responsible for the poor attitude exhibited by some of those interviewed as they retort, ' what is this idea of asking us the difference when we have taken the drug years back. These people were paid for theirjob in the past, government should continue while we decide on the time and place for distribution.' The preparedness of the community to take on whatever responsibilities is hinged on the knowledge of the importance of taking ivermectin tablets annually for several years. In this area there is doubt that project personnel have not yet done a good job since the distribution started whether under CBIT or under CDTI. This also has not addressed other aspects of health education. It must be pointed out that the foregoing implies the continuation of the old "servant master relationship wherein the government plays the role of the health provider and the programme and in some places was called on to fulfill other roles such as providing incentives for the CDDs. This needs to change in line with the concept and principles of CDTI and thus calls for intensive mobilization and education ofthe target communities. D QUALITY OF CDTI IMPLEMENTATION It must be noted that the State had been implementing CBIT and thus CDTI was seen as a continuation ofthe CBft process with slight modifications. This is evident in the overall approach to community mobilization. From the State level, letters were dispatched to the LGAs on CDTI and from the LGAs letters were sent to the communities, the contents of which are not specifically known. In most instances LOCTs and SOCT3 were not involved in prior meetings with the community leaders and the vanous communities as laid out in the protocol for CDTI. The reason given for this lapse being that there was no provision made in the state budget for community mobilization. j t9d o O\a E) v= - o5 =o 5(Di3 =-|oEl o= $o o !l tD .)c o (D U) \l H L ar) t.J t\a vtD cal (n O.l -r! =P. =' OQ o fs$?,ro oo v:HI -Eo o at) o ?<Eo'(DLJ u)o oI rt (l e.u Qlo o tD O-1 =trla^-5 UXeJ-]P F( -.J a+(D -(D J5=+86=*o'P d oVi.E +Eg X E.Qt{.O *r!r D D. ?z (D -.t v)(DpD a- o- 'o ee o a-ErloPqFga E fi ag 3 I a6 8 5* < E * E a o-S = H a -5 ;+Di+ €isBs3 t= $q g=rF-E 5 E rrE "A g [;a+'+E B g;= gE - = -Ei $g -r!P o c Xi = = DTO B? B' oc( 'o(Dqa v)o o o az t,: ?<o !i (D EBY -of-o ao3 -ra )(Di O+tDXd6 D9 p{ ?fs5LK -rl .'b-:l-< ^ tr r r #Ear)_- a' H.#H.g 8 3i5 !3rB.Q5 = (D 5 -'rs 6aH s €! 3Fr fi-.s +ig) <\6 o- *eg: rEE ;$ - 7=o A=Ig:H8='i.-iD >i - i;.: =d.='o a*=,='.= ck -O a2A I5 =il =e aErF= rt N l:l)910E;HEP. ?'d rt -=A)-3 E-d sE(o IJA'i'tr Q6gE3 =Fu)#" E'+ f+), t 2.i 4oiN<!tiD.DO-. r e,g F0q +8.(D3=5 d.= Qrr)* i(Dbo+ =(DtDO'*v) a/D I +3 o o 3ilxFE+H *#g5[&a€. ei ail9=-q + 3- -? 0c ?s-XB'ea q &F U aa d^E(D ;i Do' ='v ='0e ;/ ID o ? V) o (,n oE - =X aiI5:16':1 =tD(Dyi a- o- fi fr3 +E ss I -*6-)Jl.C a) qlhB=. q:"_ z ..jr f.-+c $ - gg'3 I B o=" I.* q -.-J-J..^ ==o=oatr+ I3 5 H >= I { O = ++s Hf =*iEU&=p-9[o-3.=' F) -- fo Y -.cn == ov))30:f fr 8@oo 5 =EE- "i er8-qB EE 9f,8 3 -l oi OEa9b' i+=o3 ,e= ltD( loo o c (D5,^ a 9.5 B.FE E< !t CL i r>Ead 9Hq =< = D' 40 a oo EqB -.E =r a tas 6a ?- 'aL) o-aF?oa ='7\d8 oq Fl Elgs Uo o o P {E96'g= 9 +> i: F€EE q+3;FgHEEfS6=:Qa =: ab P/1 +P=U, g Eo- -; =i-zi s; A (D :.', otsE3 o<d- NOaDHP5 =.d\JXHE o) !.(I0o.-.7 u,(a 'o 5'Pq a; (u =nJs= @= r5{ Fc65o' F"oo €'E gEgt* iaia - A-tD \JO L.,i ^l 9, F€ FU o o Egr <H:1'dz 50 o't ("r al rt ra i-o (DPo a0d '9) (DN -=(D a,- !1 =rP -:t! +t(D*b:t0Qz(Dit<orsEf. ta l-O-r!5oi' '<Pdq6- aco +r rF &i iq9^rPaU^q E A FE g Y=B!+ r ^ E ='NSl^.&8EP= xE g s r3. !t ,<oe OiJgurDEo99e a=5=a- B5U5-P = E .?ts .D TD c;, =.istbr(D 5- ?vOED G,Q D' a- o-H 0at) o v<(D(D8a a? oFt z o BY -o (D B rzr(D^ o-= (D {ot(D gr{ do o EO :-r tx0at+ o) =oP.P 1E ?Pi.d ='!rtlo it ati agB B'X'o -,a 0l) a_OrD e.H A : =rr€;Xo)<oa " F(D 5?-J(io-(D -U iSol{o: VEF Nr;Si'i < =f. ro ro -6 F q * EAUax E 8..FtsI 5'23 E FA 2V ari (D ',7 D' o- o-) oa(t) o :g o o 2 o r-tI ot o-q 3 ZFBOEt<+t (D 00 3a,(Dte i.{ *9o'* s< =(Do)-0Qa(Dx oa(D5$ ;-.o-Ne& P o- PtEE.E-5^q+> -='.i rr(E = '@ +z'=@=a')^ a- -J-gJ-.*EqE#8q^6S'EHU9E-)=A-t-'L ^ A :^i OH B i.oEaz!tsJ.Vi. -- (') 5 t Q-:e_ri^.0= A 6- -e =19= 5 i at.) =d o() - j n5= o-o = Na-.{LA O)H $$Fl .D orJ E ar'.X a, (t -'(o(D{ @t(D rt(D O)s)Q- o..< ?7OFD(,li(D a- a- ra(t o o ot ttaooI o-t(D(D 0a o o 't(D D o o (D o ,f v) ea1 ot :,q N(D H{EE.6-5'g+> -='.i BrG f Jia - ='l'@=6'7 6--J-Ulr.---S"EEBgBX'' =) -E 6 r-E ., Fg^ O'=. E ='2 >H J.V J-E7i -p_;^.0a o 5-I=.YEi - P <od =5-qE I e ? e.,595 3itsB A R -Etlxf? =8.8 EY g g -=,qBEHE' -(D65i(,s=.;,(9+khJr^--lJ,< it = o-< o) o) t-t fDN.J E iitso, o- tD(D{ ot tD (D o, TD Q. o..<i -4_ A 45'O E P caoQB ,6 (eB"-E aiJYO+9=a-o.< E H oF \-/ ^:qF€ oxaX :-* 5 a F(D o 0a ait', i+l3< @ + o)oo >t o s{E(DD'i(Dx 0a -B)(D5f) i. *Etg ol a- H{E9tAo=>?+€ 3H 3 ',8: -J-v)-----frqEEBq^6S' ' =l -u.i tr tlo <l =q Ot iD g.Q -.--<D;r ^ H'= x'!-ri^.6 E-a- -a =1a= 5 6- 8 ? s$a 36A BEHns &E EE 8 o*.5' _.3 tro3' 6' F0 =59o, Iv ! r^ J (9 ;1 .< f6 o-= ar$l- (Ds-J tr FoY;$o oCD{ cDt(D t(D D)Q. -+@ F PE E & Bi.,B a Y'JOE < \JO- O-CD LJio- E9t ir6 U:c; 9.,, B CD :, E1 qa ts'tI >-.1 o- ci e) a ,-53<(D () o t o, o { tD U) U)oF 9L ()- J, U'trtsl]=()co OH .,.=(J + xE /trd EO= aC)- -!LU L,-gq ;a U'tr9YLP ii!) (g/a LAo -(J?l),,.= u {\-Lr'/Qd ()a EE 'r. U'trHbtrCjl(B*o 5o iJ.,i o Y -trd c)c)t<€hoo o E(B'5.= 9 -iHU.-HAUi=x(cEEC) L eU9"H _L +oF1=5r()F _!J(6.,oEEg H E 8 oo a() a. a o 32 Table 7: Quality of CDD Training in Category "A" villages LGA No. of CDDs No. Trained Length of Training No. Trained ina session Jama'are 1 I (100%) 1 day 37 Itas Gadau 1 I (ro0%) 2 days 38 Gamawa 1 1 (100%) 3 days 40 Darazo I 2 (r00%) 3 days 38 Dass t I (100%) 3 days l0 Toro 1 1 (lo0%) 2 days 45 Table 7 above presents the results of investigation into the quality of training received by CDDs . This also serves as a pointer for the success and sustainability of the CDTI process. The table shows thai the quality of training varied among the communities' both in terms of length of training and the number of CDDs trained in each training session' All six communities reported of CDDs having been trained. However, in Jama'are, Gamawa andDarazo, ii *as observed that the implementation of the CDTI process has not commenced. The SOCTs, LOCTs and community members in separate in-depth interviews and focus group discussions attested to this' With respect to the length oftraining in the communities, where CDTI has commenced' it lasted for between one-to three days. Three communities indicated that the training lasted for three days. Two indicated that it lasted for two days and one for one day respectively' With regards to the number of CDDs trained in each training session, it was observed that it was tJo large and ranged from 37 to 45 persons per session, with the exception of Dass where ten persons *".. t*in"d. This was too large for effective teaching learning and practicals. Consequently, poor comprehension and limited competence in the pe.formance of COOs activities, including poor recording and reporting with low treatment coverage. The location of training is very far from the villages and does not offer opportunity for the training of other members of the communities. o-)-) E UNIQUE FEATT]RES OF THE PROJECT AREA Strengths There is high political support and commifinent at all levels (State to LGAs) as shown by the counter part contribution of N3 million which has already been released by the state and also the willingness of some LGAs to release funds. Has organized administrative set up of all communities/Disrticts with effective community leadership, respected by community members and functional. Effective communication within the communities is in existence There is also an observed evidence of commitment on the part of some of the SOCTs and LOCTs. Most project staff are involved in other PHC activities such as Guinea worn eradication, National Immunization Programme (NPI), malaria, health education and environmental sanitation. This is good for integration and therefore sustainability. Most of the selected CDDs are willing to carry out their duties without the issue of incentives. Availability of motorcycles at most off the LGAs makes accessibility to very remote areas by the LOCTs. The presence of monitors/monitoring teams has helped to create further awareness. This awakened the SOCTs to various salient areas where they had been weak. According to one of the SOCT member, "...the presence of monitors has helped to open our eyes very well on what we should do and what we should not do. we can make our correction and then fudge ahead". It also created an opportunities for educating the communities further on their roles and generating the sense of community ownership. 34 o Weaknesses One major weakness of the CDTI planning and implementation in Bauchi State is the fact that communities have not yet been given a good mobilization and reorientation on the change from CBIT to CDTI as a result they are yet to take up their responsibilities under CDTI. Decision-making is still at Health personnel level. Health personnel at the health facilities in most parts of the State have a poor grasp of APOC philosophy and the CDTI concept and principles. Programme ownership and responsibilities by the State, LGA and communities not yet fully taken up. Managerial capacity at State programme offrces unsatisfactory, with SoCTs not working effectively as a team due to poor coordination. Non-utilization of offrce equipments for effective Data storage and analysis has led to misplacement and inability to retrieve documents. Communication and support amongst all partners has been inadequate particularly from StateY LGA Y District Health Facilitiesy Community. There is also inadequate support by NGDO/Zonal NOCP office. There is also uncertainty in roles and financial regulations. This affects the number of days dedicated for training, monitoring and supervision among Socr members. The frequency and duration of training can be improved upon if the SOCT members are well motivated. In relation to poor training there is also poor supervision. No effort is made to use any standard checklist in the supervision exercise. These, poor levels of training and supervision have led to poor record keeping, census taking and reporting at all levels. There is also the problem of logistic encountered in the field by at all levels. The SOCTs are constrained to operate with only one vehicle, following the withdrawal of the APOC vehicle due to a major mechanical problem. Lack of IEC materials at various levels in particular at community level. Communities are unaware of neither the importance of the disease nor the efftcacy of treatment with ivermectin, this reflect the poor level ofmobilization of the different segments of the populations of the different communities on the CDTI The people thus lack knowledge of their ownership of the programme. 35 This inhibits sustainability of the programme and the ability of the communities to make major decisions. Non-involvement of women as CDDs was noted in all the visited communities. Lack of monitoring of Mectizan tablets at community level in particular failure of retrivial of expired ones and those not used. There was limited use of health facilities in the affected communities. Population census not carried out properly or is lacking in most communities, with concomitant under estimation of drug requirement and therefore very low treatment coverage. DISCUSSION AND CONCLUSION Some components of CDTI appear to be in place in a few treated communities in Bauchi state. However, majority of the community members lack a clear perceptron of the CDTI concept as they still perceive th programme as that of "govemment or the white mans own (supporting NGDO). They are yet to fully understand their roles in the planning and implementation of the CDTI project. This lack of comprehension of the CDTI concept and the need for the community to take ownership of the prqect is probably due to poor community entry, defective community mobilization and education. A large segment of the communities (adult females and youths) were not involved in the decision making process in communities that had commenced CDTI. In orderto ensure compliance and sustainability ofthe project, all segments ofthe population should be allowed to contribute in decisions for distributing the drug. An intensive community sensitizatron and education should be undertaken in Bauchi State all media available particularly their very effective Bauchi Radio, to reach most communities. The community and villagers also have very vital roles to play in this respect. In most communities visited it was easy for the village leader to summon the entire population to a central location in a matter of minutes, through the town cner (announcer) using the wooden gong or the flute. Furthermore, there is some remarkable level of enthusiasm among the SOCT members for the success of the programme in their domain but they still need to be retrained and re-oriented on CDTI. An exchange programme to older and mature projects for practical experience should be undertaken. 36 In some communities, CDDs were supposedly selected by community members (occasionally at village meetings) yet they did not fully understand their responsibility to them. They still expected the govemment and the supporting NGDO to provide incentives for the CDDs. The reason for this being that in the past distributors used to be payed according to the number of persons treated in each community. Generally, there was marked deficiency in recording and reporting of CDTI activities. There were no community summaries seen at the LGA or community level. This was observed in all places visited except at Toro LGA. Consequently, LOCTs should also be retrained on CDTI and in particular on record keeping just like the CDDs. Some levels of integration of CDTI with other health activities, at the different levels of partnership seem noticeable. The health workers who are designated to oversee onchocerciasis, the LOCTs, are also involved in other public health activities. The same goes for other health workers' participation in onchocerciasis programmes. However, getting primary health care facilities for the implementation of CDTI, particularly for supervision remains to be fully realized in Bauchi State. With respect to some other key components of the CDTI implementation, namely monitoring and supervision, this was also poor but there is much room for improvement. A greater involvement of health facility personnel in supervision of CDDs as well as the involvement of a greater number of health facilities and their personnel in the CDTI process would help. This is because it is often left to the LOCTs who often complain of lack of feuling and logitic supports from the policy makers at the LGA level. The SOCTs, on the other hand, complain of their not being allowed to do field visits to LGAs, communities and CDDs. As a result of the poor supervision some CDDs who have not understood the CDTI philosophy still operate on very wrong premise. Some do not ensure that those they ffeat take the drugs in their presence. This creates room for the very "caring" mothers sharing their doses with their under aged children who were not given drugs by the CDDs. In most of the communities visited the male CDDs had to give most of the men drugs for their wives based on estimation. This had to do with their religion as well as their custom .In one female FGD some of the wives response was that, 'we were all given two tablets, our height was never measured before drug administration.' For such communities female traditional birth attendants could be encouraged to serve also as CDDs for their females. In view of these findings, the following recommendations are made both to sustain the commendable steps taken so far and make amends where necessary for full and efiflective implementation of CDTI in Delta State. 37 RECOMMEI{DATION Approaching the llealth Services and the Commanity To ensure a proper transition from CBIT to the CDTI approach by the project, precise and concrete steps must be taken to conduct proper reorientation of the health personnel and community. It is recommended that the project intensify the following: Re-training and re-orientation of health personnel on the policy and implementation of the APOC philosophy and their roles in CDTI should be undertaken. More health personnel, at all cadre, should be involved and made to understand that more commitment is expected of them with respect to mobilization, health education, training, supervision, monitoring and reporting of CDTI activities. o a a a a o Continued dialogue should be held with community leaders on the benefits of ivermectin treatrnent, their roles and commitment in the long-term sustenance of the treatment process should be emphasized. Mobilization should continue to target everybody, including women, youths and religious groups, as they have been found to lack good knowledge of the CDTI philosophy and process. More personnel from the components of the PHC, media and educational institutions with skills in health education, mobilization and gender issues should be co-opted into the mobilization of communities and introduction of CDTI activities to this level of partners. Supervision of the community by village leaders and health personnel should be directed more to periods during and after distribution. These supervisors need training for at least 2 days as TOT and supervision in CDTL Health education materials should be made available to the communities in their local language (Hausa) and in communities implementing CDTI more posters needs to be printed and distributed. a The use of TBAs (Traditional Birth Attendants) as CDDs to reach out to women in Purdah. To the Project: Training of Health Staff a38 The initial training should be for a minimum of 3 days, whilst retraining should be for 2 days. During the training, a day should be set aside for practical work and assessment. a A schedule with the content for training of health personnel, as well as for training of CDDs should be made available. The content of the training should include sessions on the APOC philosophy, techniques on advocacy, mobilization and health education, with special emphasis on community responsibilities as well as the specific roles of other partners in the CDTI process, supervision, recording and reporting to effectively address the requirements for CDTI implementation. o More health staff should be trained on CDTI programme to further enhance integration in PHC. 'fraining and Supervision of CDDs This should be done within the communities particularly when the communities will select more CDDs. Initial training should be for at least three days, while retraining activities can be for two days. During the first three-day training, a day should be set aside for demonstration on record keeping, census taking and reporting. The current trainee-trainer ratio should be seriously reduced and LOCT training should be zoned into 4 areas to bring the training center closer to the LOCTs. The involvement of literate members of the communities, such as teachers and retired civil servants for CDTI implementation atthe community level should be encouraged, to help re-enforce training and record keeping at community level. More attention should be paid to the aspects of record keeping and reporting during training, particularly with regards to household composition and documentation of colour for easy assessment of treatment accuracy. Training and supervision checklists should be made available and used to assist in these activities. Supervision should be emphasized at all levels, especially during and immediately after distribution for the CDDs. Record Keeping and Reporting The quality of record keeping at all levels of CDTI implementation in the State needs to be revisited seriously. o a a a o a a ao 39 Review of the process of census taking in the villages to determine accurate population to enhance adequate planning for ivermectin procurement and distribution as well as effective determination of treatment coverage. Adequate training on household recording and recording of treated persons immediately after administration of the drug should be emphasized Integration of CDTI into the PHC System The current level of integration of CDTI into PHC in Bauchi State is fair for this early stage. o CDTI activities should be included in the PHC budget plans at State and LGA levels To State: The State must be very active to ensure that the facilitative role of APOC is felt in the first and second years of implementation of CDTI. This will afford a great opportunity of re-orientating the CBIT programme into CDTI. o a a o a a o Supervision should be enhanced and budgeted for in the APOC budget, if not done already. State should make proposals to purchase more durable motor cycles and bicycles to enhance supervision and monitoring by health personnel and district health supervisors respectively Demands from State Project officers (SPOs) to LGAs must be done cautiously and more resolutely. Lack of support from LGAs could also be an element of excessive or unrealistic demands by health personnel. In this early stage of funding from APOC, the State must ensure that APOC funds are rapidly utilized to train CDDs. If this is not done, there will be great variation of entry of CDTI and exit of CBIT in the different LGAs. Some LGAs have had no training using APOC funds. Training of CDDs should be budgeted for in the APOC budget, if not already done. State should continue to support the programme through the payment of counterpart fund while the State APOC accountant should endeavour to retire funds promptly in order to avoid unnecessarily delay in programme implementation through lack of funds. a Experienced Resource persons from older CDTI projects should be invited for Training. 40 State MOH should endeavour to immediately repair the State vehicle to support the APOC project vehicle in view ofthe vastness ofthe State. a a o TO T]NICEF /NOCP ZONAL OFFICE The State budget needs to be revisited and revised to cater for community mobilization and health education. They should make out time to carry out regular monitoring and supervision of field actrvrtres. More training manuals should be made available to the SOCTs and LOCTs to help them with training of the communities. They should also assist the State Coordinator and SOCTs by also training them on data management. All the LGA5 are actively involved in the implementation of the programme. However for sustainability there is the need for an advocacy workshop for Policy makers in the MOH, the LGA and Traditional rulers. I-INICEF/NOCP zonal office should assist the state in putting up this advocacy workshop. It is also necessary for UNICEFA{OCP zonal offtce to continue wrth its regular advocacy visits to the Policy makers in the MOH as a way of assisting the State Onchocerciasis Coordinator in the CDTI implementation. To National Onchocerciasis Taskforce NOTF should ensure greater monitoring of the various CDTI projects to conform to agreed guidelines and processes. NOTF should send out high-powered advocacy teams to the State to proper sensltlze the Government on the APOC philosophy and CDTI strategy. This will go a long way to elicit corporate support and promote sustainability Greater efforts should be put into plans for mobilization ofthe communities. Relevant radio jingles and public address systems should be put in place. Bauchi state is currently on its second year of CDTI and has not yet received the balance of their capital equipment for year one. These comprising of photocopying machine, generator and airconditioner.NOTF should kindly ensure that they receive o o a a o o o a I4l these items soonest, particularly the generator as a result of the non-reliability of NEPA nationwide. To APOC Management APOC should consider procurement of more motor-cycles and bicycles for LOCTs and DHS respectively to facilitate their supervisory roles in the CDTI process. The independent monitoring should be encouraged. It creates more awareness for the programme as well as confers credibility on the SOCTs and LOCTs. APOC should once more send out financing/fi nancing of CDTI proj ects. clearly stipulated guidelines on pre- o a o i h L IL- h Kcy ltt[ortttutrt ltrtcrvlctv: Vlllugc "A"l cutlcr rttis irc)rawttt ls ro bc dnitistcred otr rlrc village heod or a re.resentative of tlrc village head' Ttn hcd catt ask onoih* proott to assisl with ite intemiew.attd.to cven lnve a say cturing tlrc itttcnlcw. Do rrot rrpsi-. rtost of tlrc questions are structured' Circtc appropiatc codes' Do nol pron,pt tl, respo,tses; rather oitoru ti, respondent to d'$wer while you circle tlrc oppropilate optiol lo tlrc respotrdenl's a,$wer, Listen to ltre chieJ and choose antott1 the itens provicled' I he says so,ttethitrg dilferent select 'other' aild writi ilrc octual resPot$e resPo"se iu tle space provided. L Vltlagc Nsrtte Vlllage Code:- District/Shle:-Sulxouuty/LGA CountrY: Morrth.rud year of lqst distribution l. plcasc tell us about arry ptog,rallulrc conceriliug qucttocetciasis lrcatlttctt(in this villagc? (PI(OBE TllE FOLLOWING lssuEs ARE ADDRESSED) rvlrc brougltt tlrc idca oJ flrc onclrucerciasiqprogranu"e lo lltis village? . tvltctt did tttc pcrsot(s) contc to tai4- with you about orcloccrciasis? Did tlu pttut$) nearul:O Xr uil ul+ct ui&5v la&n lirst? ' Did ttuy o;tlq turt to anotttc a ruutingl what did tltcy lctt you about conumuity responsibility 2. How waq tlc liluc (nrouth/seaso[) for distribution rlecitled? l. rt r villagc tneclittg 2. villrgc cldcrs llrcclillg 3. vlllrgc chlcf/lcadcr 4. hcaltlr rvorker 5. vitlagc ltcaltlt cottttttittee 6. vitlage cottttttiltee lucetilrg 7. othcr (specifY) 3. Whal tnodc o[ distributiorr was tlccirletl? L ltouse-to-ltouse 2. cctttral placc (sPecifY) 3. lrcth ttousc'to-llousc atttl cetttral ;llace 4. otlrer (specifY)- 7Murltoring lnsUunrntr Klnprlr , Mry 1999 I lri' Eri ;;s ..4 l-q 14. &ri ffi &[, lDl'ffi ffii m ffi # ffi m ffi ffi h" #d in #t,,4 trs ffi,$l ill:il ifi !l$ 'f, 16,'l TJt 'r.itt$l:d il -;li ['!i ftd $ f: r *,{ i i, ;l!:,. ti i. i"'r rl' J\'i,,,il firI E^, :iiffrT F,ril {i 4, i:lJlt r :i- tt.E 11 ::1 I .t a L3 4. ilow was tlte tttotlc of distribution dccidetl? l ' at a village tlrcclinB ' 2. village cldcrs nEetitlg 3. viltage clric[/le;rdcr 4. hctltlt workcr 5. villnge trealth cottttttiltce 6. village cotllllliltee lueelinB . 7' olhcr(s;rccifY) 5. ilurv nrany persolls (cDDs) ill tlris villagc givc oul ltrc drug frrr ottcltoccrciitsis? a / a 6.HowtllattyllraleCDDs?-tlowttmrty[ettulcCDDs? 7 Itow rvcre tlte lrcrsotts (CDDs) sctcclcd ttl rlrr tlte work'l t . at a villagc lllectillg 2. village eltlcrs tllcctitlS 3. village chief/leatler 4. I lcalth rvtlrkcr 5. Villagc lrcaltlr colttlttiltce 6. Villlgc cttttttttitlcc lllcclillS 7. Otlrer (slrcci[:yl I Wlry rlirl you cltoose rltese pcrsou(s)? (Probc for criteria) t. 2. 3. 4. a t 9 llave the CDDs receivetl atry lraining? l' Ycs 2' No 3' t)ott't kttow 10. lf yes to Q9, rvherr ditl tttey rcccive trairring? Ucforc tltc [irst tlistribution Duritrg rlistritrutiort Soott t[lcr tlrc lirst tlistribution Dort'l kttorv/Calt'l rclllclllbcr il llorv well ltavc lltc CDDs tlottc tlte work'l l. rvell 2. fair 3' Poor (Explair llavc you ctrtrtgctt atty of yuur CDDo? t' yes 2' No 3' Dott'l ktttrw I 2, 3 4 8 12. Morilortn3 tnrlrunrnll Krnprlr , Mry 1909 I i I I i I t h\ t4 Itave you (tlre conrurunity) receivcd ctlucaliott on tlte itttportattce of takilrg ivernrectin/rnectizatt/ Onclto tablct anttually ftrr several years? l. Ycs 2. No 3. Dott't kttow/Cart t retttetttber 15. lf ycs to Qt4, ask: Wlrerr ditl you receive the educaliorr? (circle all lhat apply) l. During ilre first ttrceting 2. Belore tlre first rlistrihrtiort 3. During distributiott 4. Soon aftcr distribution 16. lf yes to Q14, wlrat wcrc you ttlld? (l'rcLrc ftlr: arrrrual treatruent for several years- lrcnefits corrrurunily responsibilitY t7, Was there auy conuuunity tlecisiolt on how tlrc drug slrould bc collecled frottt a collecliorr point? l. Yes 2. No 3. Dott'l kttow 18. Did arry nrernbcr of llrc cornmunity collcct the rlrug [roltt a collectiott poilrl? l. Yes 2. No 3. Dutt't kttow I9. lf tro lo Q 18, wlty? 20. Where is tlte collection pqirtt? I 2t I Did you experieirce late sup;tly of tlrug durirrg lhe last distributiori? l. Yes 2. No 3. Dott'l kttow l'lease expla lI 22a Did you experience sltorlage of drugs dttrirtg tlre lasl tlistributiorr? l. Yes 2. No .3. Dort'tkttow 22b. If yes to Q22, lrow wits tlte probletrr solvctl'l a lr c, ( *,gt :l 14 i; t t) 'f ? I Morritorirrg hlslrurlEllls Krltrpala . Muy ltl99 t / a I I a h5 I a I 23a Was tlre cellsus tlI l rur village urtdertakctt'l l. Yes2.No 3' Don'tkttlw 23b Docstltecttttttnuttityltavealreattuelltregister,l l. Yes 2. No 3' Dotr't kttow 24 lf ycs to Q24, where is thc rcgistcr kcpt'l 25. llow were you itrvr:lvetl in rnobilisation? 26. t'low wcre you irrvolvcd irr sulrcrvisiort? 27. wtrat are your suggcstiorts ott lttlw.ltte cotturutrity coultl be tttore ittvolved itt ttcattttg -'- tttentbers with iveirrrcctirr for several years? 28 ls tlrcrc auyttring you will like to tell/ask us? its rr lt,..,ili.ri,ru lrrrlttttttcttls Klrrtpulr, Nley 1999 ll h6 (;ItOUlD DISCUSSION GUIDU AMON(; COIvtAltJNl'l'Y lvlltMllliltS.Vll,l,ACli A ln cach cotego,y rl vilkrye, one Mule url one l;cttuile ulnlt group discussiott ttutst be cotulucted. ltt tlvee of the six cutegory A vilhrycs, grot1, disrtrssiuts ilntst hc condut:tul ttillr nrule youtlu_and in the reuruining lhrce vilhgcs, ilist'ussiot,s u,ust be lrclil witlt faruile youllts. For nrunitoritry CDTI project.r, yotttlts ure dr.fined us itxliviilttttls betx'een l5 utul24 yem's. 'lltc CDD tnusl arrflt,Be fitr t cottttottuble plotc tluu oflirs sottto privucy utul enouglt plnces lo sit . &tch group,t,ust cot,siil o[6-8 paople , l)epuulittg otr t'ultnre, the gruup discttssiotts ttttty need sepilftile t,teeting ploro fitr ruilc utulfetnulc stt llttt people erut spcuk fi'eely. One of the intenml nrunitors sltouhl lrc the jrcilirotor whilc t lonil guide. tukes notes (recorder).'lhe gruup discttssiott tttttst lrc lqte-ret'onleil. At the end oJ tlrc sessiott, pkty buck tlrc tqte fitr u [ew uituiles to be nte tlutt the discttssio,t t\t$ properly recordeil. hltel the cussellelMtlcs (Nume ol the fillugc, the group iilctttily, tlutc). TARGET CltOUl'S: A DU UI' MALLS; A l)U L'l' ltliMA l-ljS; YOUNC MALES Olt I:EMALIlS l'lcasc tcll us lvlrill you krrol abrrul lhc orrclrrrccrciasis lrcnlnrcnt l)rogratnulc (I'LUA.5l-1 l,RollE rott l'il8 t?oLLovtNC tsst",titi.) llrc lrcrsorr(s) wtro brougltl tlre itlca of tl,. ,,,,.t,,*crciasis l)rogrntuntc lo lttis villngc lhc litrrc wlrcn llrc;rcrsorr(s) canrc to talk with yuu:tlxrut orrclroccrciirsis wltctlrer tlrcrc rvas a villagc rrrcctirrg at thal titrrc lssues tlral wcre tliscussed al tlrc rrrccliltg o owtrcrslriP of tlre l)rogriuunlc . crl)cctalion ltorrr llre pftrg,rarrrrrrc . rcsl)onsib.ility of tlrc curnrrrurrity 2. l'leasc tlescribc how tltc cottutttttrily lrxrk rlccisiorr orr tlrc litrre (trrorrth/scasorr) atrd rrrodc of rlistributiun. l'LllASD I'ltOllE l;Olt: Itrrltr iuvolvctl in deisiul-utlling 'l'inrc of tlislributiun Why tlrc lirnc was clrorrr Methuj of tlistributiorr Wlry tlrc nrcthul of distributir)n lvits clroscrr l'lcasc dcscrilx lull lltc cortttrtuuily trxlk dccisiou orr ltrs l)crs(,n$ rcs;lorrsiblc for 1listrilrutirrg lhc rlrugs lo corrrrrrurrity lrrcrrrlurs. l,LliASlj l)llOl-tD t;Olt: o l'crsonr iuvolvcd iu rlcr:ision-trmkiug o Wlto will lrc rcslxrnsible for rlistributiorr 3 Mmibhg tlu&rrtr:tilt Xrrprtr.Mry, l|I}f il t I I I I I t T I I T t I T lr-+ 4a. . lttlw llrc l)clli(,lls wctc sclcclutl . WhI tlrc lrcrsrxts wctc rhctcd o Mctlrrxt o[ tlrrrg ctllleuliur llas rtrere becrr arry clrangc ht lltc ;rcrurtt teqxxsibl! I9l t-lIF distributiuu (CDD) sittcc tlte bcgirrrrirrg uf ttic l,rt,glattrtrrc? 1l'l-CnSn'l'lit-L US WllYi llas ttrcrc bectt arry cltattge itt tltc progrntttttrc? . Wtto brouglrt tltc chatrgc o Wltlt wls lltc cltalrge What were you tultl alruut tlre lrcert for cottttttuttity lrcatlllcltl-.lith iverttrcclirr? (l'ltOuE rOII ^ N N U^ L'I'R IJ^'I'M EN't' T;OR SI,V ERA L YEA RS,'t'I I E D Ery g1.T' :9Y I.9.E oF lNt;oltMA'l'loN, coMMUNl',l'Y Rl$l'oNslulLrrY AND llEAufll EDUCAl'lON) lluw is ttrc tlrug lgrrrrllty llruuglrt irrto ttre corrrrrrurrity nrrd rtistributed lo ctlttttttuttily trtetttlxrs? l'ltOll ti l;Olt: a 4b. 5 (r o poittt o[ ctlllccliort . t)qIsull rcslrurrsibtc [tlr brilrgiug it ttr t!rc cottttttuttily, . ;,.rro,, resjrorrsiLrle fgr dislribuliolt wilhill lltc cgttttttuttily . tnodc o[ tlistribtrtiott o wlrctt was llle dtug srvallowctl 7 critcriil)'l 8 ttorv was rlosagc (tctcrilti[cd try ttrc clJDs tluring ltre tasl rjislributio|t? PltoBE l:OR MEASUItINC DLrVlCE 9 Wlrat ,roSlcrrrs tr:rvc you tratl rvith rcs;rccl ltl ttrc tlislrillutitllt of llrc rlnrg? I'ROUE l;Olt o litttctittess oI su1ryly lu lltc cottttttuttily o atlctlpacy o[ supPlY . st(,rilgc 10. Wltat grroblcttts ttavc you tr:xl altcr lnking llrc rtrugs? I l. I low ,reparctl is thc corrrlruuity, to takc coulrot of ivcrrrreclirj rliiiritxrriolt ;lrogratttttrc?(lt,w'tlocs llrc cuuuuunlty lrrtcirU lu suslattt ttre cxcrclcc for rrcrrl ycrrr?) 12. wtrat suPport ttas tlrc cotrttttuttity givett. ttr tlrc cl)D? PROUE t;OR : , trrccttlivcs itt caslt ur irr kiud . ttrrvlslutt of ttrutps uf tmtlslxtrl Mobilizaliort oI cutttlttuttity Wnultl ytxt Srlcasc tcll us tlrusc wlur strouttl nol lrc ltcalcd wiltt ivcrttpctitt (crclusiurt ,I a o a Mrnltrio3 trilhxllEttlt Xrtr;rlr ,Mry l9lD l2 / l-'E Ensurirrg cornpl iarrcc l3' coukl.y::,plt:t" tell us llowyou woultl urea.sure rrre success ol'tlre cl).l.l ,rograrr,rre.l 14' How wclt tus ,rc cDD pcrfirrnEd? (pRort IoR A.rIl.uDE). 15. Wlrat suggestio,s do you trave lo irrr,rove ltrc ,rrgrar,llre? a ,l ',t Mlxritrfurj lrrtrul1arl. Xrltyrb, Mry.lttog t3 t., L1 aa To be ,Ntttittistcrcd onlY in grouP 'A' villages, lntcniaY 2 CDDs Per vilktgc it ilrcre urc uwtc tltut one CDDs. lt end of tlrc iilerviev usk tlrc distributor rc la You scc his tools: ncal*,ring dcvisc, tcg, Wltctt tt queslion rcqui islcrs, rctutitting ilnry d it is tlrc cuse ' 'rcs tnultiPle rcsPot$es, tlo ttol fitrget to Pttl u circle uxtutul crclt applicuble ,'esP0t se code l'xtlte lr'hcre uPltn'ryriute N:rtue o[ Villagc V illagc crxlc : -Sutrcrlrrrrty/l'(iA District/State Nanr of CDD Scx; t. l;elttale 2' Malc Mairt Occupatiott: Morrrlr arrd year of first CDl'l tlistributiotl irr tlrc village -l- Morrrlr arrd year o[ last cD'l'l ttistributiott in thc vill:rge -l- l.Iltlwwasthetittrc(rrltltrtlr/scasrrrr)lorrlistribuliorrdcciderl? l. at a village llrcetirlg 2. villagc cldcrs' lllcctillg 3. vitlage clticf/leatlcr 4, hcalth worker 5. village lrcnlth cottttttitlee 6. village cotttlttitlee tltcctirtg 7. otlrer (specifY) 2. Wlrat nrrxle of disrributir-rn was decidctl? l. ltotlsc-to-ltttusc 2. cctltral lllace (speci[Y) 3. llutlr lrouse-to-ltousc atxl cattmlPlace 4. othcr (sPeci 3. llow was tlte trpdc of rlistributiun decitlcd'l l. at a village ttrcctittg 2. village elders' llrcetillg 3. villagc chie[/learler 4, lrealtlr wtlrker 5. village lrealtlt cotntttillee 6, vitlagc cuttttttillcc llEclillg 7. ollrcr (s1rccifY) .. Molitorirrg tlltlrullEnlt Krrquh ' Mry 1090 t4 F t, I tt {o 4. ltow were you scleclctl lo tlo thc work? at a villagc tnecting villagc clders' ttteetiltg village clrief/leatJcr lrcalth wot kcr village ltcaltlt cottttttiltcc village cottttttittcc lllcetillS olhcr (s1rccify) 5. llas any CDD bee[ clralrgctt after thc lirst distrilrtrliott'l l. Yes 2. No 3. Dott't kttow 6. lf YES to Q5, Why was thc CDD charrgcd'l I 2 3 4 5 6 7 7. tlave you evcr bqett strpcrvisctl 'l l. Yes' 2. Nrt 3. Dott'l kttotv 8a.'lf yes lo Q7, wlro supervisctl you ? (tt; NAMIj WAS MljN't'lONl-:D, l'LDASli ASK l;Ol{ I DENTITY/POS lTlO N/STAl'US O F'l'l I lj PljR'SON) L llealth sta[[ 2. Vitlage lteitlllt cottttltillec tttctttllcr 3. NGO partrtct 4. Cotntttuttily tttctttltcr/clticl' 5. Otlrer (specilY)- 8tr. Wlrat ditl the su;lervisor rJo'l Clreckcd llte ivcrtttcclitt ittvettltlry Checkcd tlri recortls/trcatlllcllt registcr Cullatctl tltc reltorls Atlvisetl otl tllc lteallllclll trI itbscttlecs otlrcr (spce ify) 1), At rvhat occasions were ),ou suPcrvisctl'l (Cll(CLt.: Al-L'lllA'l'n l'l'l-Y) I 2 3 4 5 I 2 3 llclirr e distrillutitlrr Dulirrg distributiott Soott a [tcr tlistrillutiott l. Ycs l. Ycs2 l. Ycs2 2. No Nrt Ntl l0a. llave ygu receivctl cdllcittron olr tlrc irrt;lorlttttce oI tirkirrg tvcrtltcclitt litblcts atutuallY lor sevcral Ycars'l 2. Ntr 3. Carr'l tctttetttbcrL Yes Murrtluttttg ltttltuttrcttll Krrrrpala , May l9()r) t5 t t T I I T T I I T I a1 I 5t / l0b. lf Yes, wltat were You toltl? ll.Dklyuprovirletttecotrununitywi0rcrlucatiolroltiverltrcclinlrclurlcnt? l. Ycs 2. Ntt / I 12. lf ycs to Qll, wltett tlitl you prtlvide rlte crlucatiolt ttl tlte coltrtnunity? (ClltcLE ALL TIrAT APPLY) . During tlre l'irst llleetlllg . tlcforc ttle first tlistritrutiott . Durirrg distributiott . Soon after distribution . Otlrer (sPecitY) 13. If yes to Q l l, wlrat tlid ytlu rett tlre cottttttuttily? (CtRCLE ALL TIIAT APPLY) l. Takirrg ivertttectitt attttually ltrr several years 2. Betrefits of treattttettl 3. CotntnuttitY resPorrsibilitY 4. Sitte elfects 6. Otlrer (sPecitY) l4.Didyourcccivcanyrraitrirrgottttowlotreatcotttntuttitytttetttlrers? l. Ycs 2. No l5.lfYesloQl4,wlrerrtlitlyoureceivctraitrirrg? 16. Who traincd You? t. tlcalth pcrsontrel/Ottclto coorlitnlor 2. NGDO statf (sPcitYl- 3. Another CDD 4. Otlrer (sPecilyl- 17. How lorrg did the trainirrg last? lx trairtirtg-.-- 2'r traittittg- l-ast lrainittg 18. llorv Drarry CDDs rvere lraittert togctltcr (size of thc gloup)'l l" traittittg- Last trairrirrg / I 2 3 4 5 Yes Yes Yes Yes 2. 2. 2. 2. Ntl Ntl No No Yes Yes Yes Yes No Ntl Ntt No 2. 2. 2. 2. Morrtlortng lttsltuttrttls Kotrrirala ' Moy 1999 t6 I I I I / I I I I I I I I I I I I 5L ,l ) 19. Whete was tlte vettuc tll tlre last trairrirrg? l. Witlrin tttc comtnuttitY 2. Outside llte cottttttuttitY 3. tlealtttcare tacility/lrospital 4. Otlrcr (sPccitY) - 20. Was tlte vettue of rrainirrg llear lo yur unmurtity? t. Ycs 2. No , l. Cause 2. Sytnlttottts 3. Strcio-ecotrortric itttportattce 4. Cottttttuttity ntobllisatiott and etlucaliott' 5. tverttteclitt as ltealllrcllt for a lottg littte 6. Otlrcr (sPecifY) 22. W[ar werc you tauglrt ahrut llrc rJrug? (clltcL[ ALL l'tlA'l'Al'l'LY) I I L zi. wt,ur wcre you tauglt tlurirrg lrairrirtg about otrcltrxerciasis (Clltcl-E ALL'l'tlAT Al'l'LY) i l. Ycs L Ycs l. Ycs L Ycs l, Ycs Yc.s Ycs Ycs Yes Yes Ycs Ycs Ycs Yes 2. No 2. Ntt 2. No 2. Ntl 2. No (, (, o t, (, o t) (l l. I Duration of trcaltttettt 2. Covcrage of distrillutiorr '3. Dosagc detertttittalion by ltteasuring lreight 4. Expiratiou of r.trug altcr retttovittg colttaitter seal 5. Trcattttcltl of absetttees artd rc[usals 6. SirJc cftccts (counsclirrg alrd rcfcrrll) 7, Exclusiott critcrin E. llecortl keePitrg 9. Ccttsus Nrl N N N N N N N N il 10. Otlrer (sgrccifY ) 23. Wlrat wcrc you taugttt ahrul rc;xtttilrg? (ClllCt,lj At-L'l'llA'l'Al'l'LY) Nurttbcr of pcrsotts trcatcd Nutttlrcr oI rcfusals Nurttlrr ttI allscttlccs Nutulrcr of excludcd tlcrsr)lls NuntLrcr rvitlt scvcrc sittc efl'ccls Otlrer (s;rccilr 24. Did tuy rucurlrcr p[ llrc corrtrrrurrity cutlcct ltrc dnrg frrrttt u colleclitxt Puilrt durirrg tlrc last distributitllt'l l. .Ycs 2. No 3. Dott't ktlow 2. 2. 2. 2. 2. L 2. 3. 4. 5. 6. l. Yes l. Yes l. Ycs l. Ycs l. Ycs Nr.r Nrl No No No U. lf 'txr' lo Q24. whY'l Mrnitrxin3 hrrlrulrEnlt Krnplr . l'hy l9$) l7 2. 2. 2. 2. 2. 2. 2. 2. 2. il h.J' ffi I i{ l, I !,-l ,:I 2(r. Whcrc is ilre collcctiou poirrt'l 27. Did you experietrce latc suppl y of drugs durirrg tlre last tlistribution? Census/reg istratiorr record Previous treatuleut recortls coutltitlg tlte ttutltbe r oI lrouselxrltls s3 nity'l I'LEASE CIRCLE ALL'I'IIA'I' 2. Nol. Yes Plcase exPlairt, uonrtally ttetertttittc thc tluarttily tlf tlrugs requiled by the collllllu 28. llow do Yttu 29a tlv Otlte r (speci[Y) l. Ycs 2' No l. 2. 3. 4. Did you experiettce shortage of tlrugs duriug the last r'listributiolr'l 29b. 30. lf yes, Ptease exPlain tlow tlo You deterrnine the THAT APPLY) l. Take hciglrt lucasutelllclll 2. Usc wcight i 3. Visual observation nuttlber of tablets ttr givc to arr irrdivirlual? (CIRCLE ALL l. Ycs l. Yes L Ycs l. Ycs rrg ttortttal distribution period'l 2. No 2. No 2. No 2. Ntl 4. ABe 5. Othcr (sPecilY) 31. What do you do about irrdividuals wlto are abscltt tluri 32 Wlrat do you tlo atrout irrtlividuals who lcfttse ttcitttttcttt'l '13. Wlrich categories of lleople would you llot givc thc talllets ( Al'l'LY) I . ludivitluals below 5 years of age/ bcluw 9Ocltt 2. Pregttattt "9"t:']. :ck bc[orc tlistributiorr;. Writ,r,t who dclivered less lltittt ttttc wc 4. Sick intlividuals 5. Visitors 6. Other (speci[Y) 34. lklw tto You ettsurc tltat llrcsc categtlt ics tll' llctllllc cvettttlally tccclve I I Yes es 2. Ntt 2. No 2. No 2. No 2. Nu Yes Yes Y ': ii trcattttettl? Morrilolirrg lll5lrunEllts Konrprle ' l'lly 1999 Yes t8 i) S/, ll i I 35a. llow lorrg do you rrorrrrally kccp tlrc lablcts irr thc currrrnuuity'/ 35b. tlow rnany tlays rJid you take to corrrpletc llre lasl rlistributiou? 36. Wlrere do you rronnally kcep the tablets? 37. Do you lravc drugs lo takc care of rrriuor side sffects? l. Yes 2. No 3E. What kind of support tlo you reccive frorn llre colruuuuily? I. Transportation for drug collectiorr 2.' lncentives (specil'y) 3. Otlrcr (spccify) 39. Do you have problerns witlr record kccping? l, Yes 2. No 40. lf'yes to Q39, pleaso exl)lain 41. Plcasc tell us how you fecl alxrut tlrc prograrrrnrc with respecl lo: a) sustainiug the prograrurrrc lr) conrrrrunity responsc i *r.ii c) constraints 4L;llntdo you thirrk should be tlone to iut;lrove tlrc progranture? 43. Arc you willing lo continue as a CDD? t. Ycs 2. No Pleasc PLEAcE ASK FOR REGIS'I'IIR AND MEASURING DEVISE'IO PROVIDE TOLLOWING INFORMA'I]ON 44n. ls neasuritrg devicc fr.rr hciglrt present? .{ tu *J Mmlmrh3 lnrlrun:nlr Krnplr, Mry l9)g l9 .i. .&r / I I, 4. l', i' 9i ,1 Ia 5s I a L Yes, seett 2. Yes, bul not scert (BxPlaitl) 44b. llow rJo you use it? 45. ls trealruent register prerrrl? l. Yes, scert 2. Yes, but not seetr (Explaitt) 3. N,r, exploi,,- 4(r. lf Q45 is "Yes, seett" IIXAMINE l'ltliA'l'MEN'l' ltUCts'l'Ett AND Oll'l'AlN 1'llE I;OLLOWINC INFOITMA'I'ION ON : 'l'otal populaliott_ Agc cotrtpositiutt of people: 0clttw 5 years- 5 years attd alxrvc- Sexcotttpositiorroftlreprrpulatitrtt:Male-l;etttale- Nutuber of persotts treatetl-Male- Fertnle Nunrlrcr of llersotts undcr-S ycars wlto rcceivetl treallllelll- Nurnlrcr of re[usals Nuruber abscrrt duriilg lasl trealtttcilt_ Nurntrer rvitlt severe sirle effccts- Nurrrber of tablets received 10. Nurube r o[ tablets userl I l. Nurrrbcr o[ tirblcts leli irr thc drug kit- l 2 3. 4. 5. 6. 7. 8. 9. i/ i I ) F T.ii ,. r.,'* i,. !* r .i' i1, ..i .,$: l, I Mrurtlorirtg lrilrultlctllt Katrrprlo , May 1999 20 ,l I a II I l ia a I I I -f .j ,t I a :'1', 1l a L Ir il ,;., ; .i , I I I L ; I I i t i 'i I t -l I I I i 56 Key lufonuaut luleryicrv: Villoget' U', I_,eurlcrs Tlris tool is to be odniuistered to ilrc viltage lrcad or a ,'epreset,tfltive of the village lrcatl in ull cileSoty 'D' villages. ltt tltc cose tlutt tltc villogc lrcrul wuttts sonteotre else to assist witlt tlrc intemiew, do lutt refitse. Pul a circle aroutrl the q4tropriore reqtonse codes. Do ttot protttl,t rcsPo,lJes and allow respondent tiurc tor onnvering the questiott. llse tlrc optiot, "ollrcr" where tlrc respottse is not listed but reueutber to spcci[y tlrc response in the space provided. I a village head is not available, inteniew his ussisttutt or rqtresenrutive. Villoge Nriurc: Stele/Dislrict Villugc Corlc:_.subcounty/LGA :_ Country: Motrth eud yeur of last dislributiou I l. l{ave people in this cottttnurtily been lreated wittr iverrrrcctirr in the past orrc year? l. Ycs2. Np 3.Dou'lknorv rF NO TO Ql END rNTERV|EW rF YES TO Ql qpNTIN,UE TrrE INTERV|EW 2. llow was tlre riurc (nronth/scason) filr rlistribution tlccitlctl?l. at a village rneetirrg 2. villagc cldcrs' rneeting3. village chief/leatler 4. hcalth worker 5. Village health corlrnrittee6. villagc conrnri[ee nrccling7. orlrer (specify)_ 3. Wlrat rrrqle of disrribution was decidedl Irouse-to-luruse ceutral place (specify) botlr housc-to-house ar rul cerrlral placc other (s;lecify 4. llow rvas lhe nrode of dislributiorr rjecirledl l. at a village nreeliug 2. village elders' nrrcling 3. village chief/learler 4 health workcr 5 Village lrealllr corrrutittee6 villagc conruiucc trrccting7. other (s;rccify) _ t. 2. 3. 4. I Murilorrrrg llrslnrlEnls Krrlpolo, Ml'l lggt) 2t t .J -i 5 llowtrrattyl)ersollsilrtlrisvillagc(CDD)givetrtttllrcdrug[rirtlttclrtrcerciasis? b tlow urcrc rlrc pcrsoru (CDD) selccled to rlo ltre work? at a villagc rtrcting viltage ettlers' ttrcclitlE village clrie[/lca&r health wotker v iitage hcaltlr coltt-tttillee vitlage cotntttittcc llEclillS otlter . 7. Havc the CDDs receivcd any lraillillg? l.Ycs2.Nrl3.DoIt'tkrrtlw/CattIrctttclttlrcr 8a. t'lave ynu clranged auy of your CD$? l' ycs 2' No 3' Dott'l kttorv 8b, lf yes, rvhY? 9. Dirl any rrletttbe r of tlte conttnullity collect tlre tlrug frottt a cotlection poiill? l. Yes 2. No 3' Dott'lkttuw t0.Didyoucxperiettcclatesupptyofrlrugdurirrgltrctasttlistrillutiorl? l. Ycs 2' No 3' Dolt't kttorv ll.Didyrrucxlleriettccsll0rlaEeofdrugsrlurirrgtlretasttlistrilrutirrrt? t. Yes 2. No 3' Dott'l kttow 12. Does tltc cotntuutrity lrave a treatllrcllt register? l. Ycs2. No 3' Don'tktttlw 3+ l. 2. 3. 4. 5. 6. 7. i i r i Mrnitrlnl ltrrlruttrttlr Krrrr;uh ' Mry 19(I'l 22 56 I I t t I h I P t: ,i t h ts ,l I, itl ltI c t It h I r I I: i t i I Irlo lc:lq lrq lsIt" Itr leth Ifilx lu IRh lEIN ,olol) t: Its' ko lG E p 6 eo oIla o FlJ(D 7 o!, o aj (D TI o =o( 5 I'Q aco 1 o B 9q E r B I ar< ln oq = n dria o ,o E otr, art IDig F l1 >t tn ]n 7( ,() 4.o o,o. o Jo J. oc oJIo oI *Ffro86' E 8,f,it lF .Q d€gIf, E3H!,"re.[;6 sda slFgEi 14.-ll lt 4.PFg *rrU ErlAl. t- Ife }[[ rEI E *ENTQ A 8.8 i 1f,r :8il tp Eir6'4t f) E:'U{oo AE !lo otr .da'_o tr tftbB rj xr 'vE OarCJ8e. , 7A9-o. I ntd.>5aat o. >{ o ,.t V ol^o. F o an o ,!6 ,!r .!!, or d L,l!tts ntItg o o E' o a o o.o D' UQ(! z A) tso E' UQo o & o I 7 o 3' :, o !,I ai o!, 5o,5 l- .t oE]n(l g o. U zI U U; !, g (l r g s-'rg-ggE 5 f, lEEgsi["r p.$O g OxrP el718 < 5 Hr l- r o rrt llr lral o HA c mtlA -t 6 z 'rl rrtln{o aC m a^{ o z br rrnErHIr 's.€Elr< o oD oI a E'€ (t< (, oE o9s{Ri fl #.3 ts s tllttNx [[FrErx .-r t x ='E9nrO :-., h ( * 8'o ^d qE fgs Arr o- ts t A= I \ i*fr[EE o E' z o .l o aq rrt Utd - Z<g 9. E B E E snp"H rfi il3 oF r r $ f F rE8. flB;g " FF oc trt a-l' coz a.J rri *q 4 iIit ? * .* + j tt I I i i I : I o 2. o a. a GI a ? ,!6 xL5Ii f 3o t.) tJJ I 53 FIEEf T F 8' g A fIfiE$fi3 .*"$e Iao rgE 8 E ? F$E "IE] ilB T$ UJ I FnEP'Efd ? AH?E i,T{ fl."s Fll t"ar.rr llr t T TotOa flr o. tr' Bq rr fl ro .A o ll o il# It I ai o a of art 1 2 a d b xL I x T 7 It a U ,"|,, t ?.. ..,, i' ,1,. il,: , 1T? ,,1 .1 ,r-' IJ t I F h [,I li F.k' [d t. I t, t[' E F lr 'r tl h W I i I [: I I' {l li I H I{ E t !1 ,.i. :i (o To bc ndnitistered ouly in group "8" villuges. lttrervicw 2 cDDs pcr village i! ilrere are ,nore thatt ottecDDs' lt rlrc end oJ tlrc iuitvii, usk tlte iistributor ii tr, y* ,ee his touti: tieosuing devise, registers,ramhing drug iJ available' wlten a qiestiott.reqii,:is-ii,,iii1,t, respot,ses, do not fitrget to prr a circreororurl each opplicable respotuc ,ortr. ij,lit, rvlrcre apltropriute. Narrp of Village Distric/Sratc ----_Village crxle: _ sulrcounty/LGA: Narrre of CDD &r: l. Fcrpalc Meilr Occupation: Morrtlr aml year of last rlistribution I l. How wcrc you sclcclcrl lo rJo tlrc work? l. at a vittage nrcetingZ, villagc cltlers, rrrc"tino3, villagc chief/learJcr 4. lrcalrh worker 5, villagc healrh corrrrrrillcc 6, villagc conrrrriuee tnecting6. orher (specify) 2' llrs a.y cDD rrcc'ctra,ged afrer trre first di$ributio,./ l. Yes 2. No 3. Don,lkuow/can,treruerrrber l. llave you evcr lrcerr supcrvisetl ? l. yes 2. No 3. Dorr,lkuow 4' lf ycc ro Q3, wrro s1ryy1lg vou ? (rF NAME wAS MEN,pSNED, t,LEASrj ASK FORIDENTtry/postTtoN/srnriis or rua pERt6d . ., l{caltlr statf Village lrealth corrurriltce rturrber NGO partner Corruuunity uren rlrcr/clricf Othcr (spcify 5. lhvc you reccivcd erJucaliolr scvcral ycrru? l. ycs 2. Nu 3. Can,l rerrurrrbcr (r' Did yru receivc a,y trairri,g o, rrow ro rrear corrr,rurriry rrrcrrrbcrs? 2. Male l. 2 3. 4. 5. or thc intponatrcc of taking iycnrrrctirr lablets anlrually for , ,j iit,4t 2. No I I I l. Yes Mnrituln3 tnrlrunEou Xrlpeh. Mry l9#) 25 6t i r-r, 7. ls ttrcasuring device ftrr lreiglrt llresettt? . Yes, scctt ,. Yes, but tlot socn No, (Explairt) 8. Is treattttettt register presetlt? Yes, seetl Yes, but llot s€en (ExPla No, (explai lf Q8 is "Yes, scen' EXAMINU'IRDA'luliNr Ruolsl'Elt AND Oll'l'AlN 'l'lll'j I:OLLOWINC INFORMATTON ON: l.'lblal population- 2.Age cotttllositiott of peollle: Delow 5 ycars- 5 Years atxl abovc- 3. Scx contpositiou of ttre poputarion: Matc- Fcttralc 4 Nuurbe r o[ persols lreatetl-Malc- Fcnnlc- 5NurrrbcroIpersottsaged5yearsattdalxrvcwltorcccivcdtrcatttrcnt 6 Nutnbe r of refusals 7 Nuurber abscttt tlurirrg last trealtttcttt 8 Nutulrcr rvitlt scvetc side cl'l'ccts 9 Nulnber of tablets receivetl t0 Nurubcr of tablcts usctl t I Nurrrbcr of tabtcts left in the rlrug kit=- ,! I 2 3 t. 2. t 9 .f' Lt ia r.f, il; .i u.: i I Ij 1"",'j Mo[ilorin3 lnrlrunrnls Knnrprh ' Moy lrl99 26 ,J. .;i' /Qb(- 0 U DST I 0 N NA I RD FO lt I I Lul L't'I I P UIISO N N Ii L lhis qucstiorunire is aduittistercd ou any hculth workcr in llrc urcu who is directly iuvolyed iu CD'II Progmnune i.e lhe lrcaltlt slqff neoresl to llrc vilhge. Tltc tuuber of lrcalfu persomrcl to lx iutcniewed depads ott tlte situatiott o,, tlte growul. A rttittittuutt of 3 hculth perso.turcl who'ore ntpenison of CDDs sltould bc iluemieved witltitt tlte project urea. Alter the intervier ask the heultlt persourcltor tlrc docuuents used for CDTI activilies. LCA/Subcourrly State/District_ Counlry Natttc of lrcalth personflel_ Scx: l. Malc 2. Ferrrate No, of Oncho. Villages_ No. o[CDDs irr villages coverctt ' tttl .irl, i'),, Pusition; Qualification: llcspotuibililies in ouclro conlrol Progranrrrre; I orrctro ctxrrdirmtor 2 CDD sugrcrvisor 3 other (speci 1. Dirl you receive any general orierrtalion on CD'fl? l. Yes 2. No I . ',tt 2a. Dirl yul rcceive trailrirrg ou lrol to lraiu CDDs? l. Ycs 2. No ,:1,' li'i,., :lili tr rri iI '.; ,tl 9, -t, ,,t # 1 rt r, 2b. lf ycs, lrow lorrg ? ,(, 2c. Li$ tltc nuirr topics coverctl 2d. Wcre you taught how scverc sidc cffects slnruld bc lrurragcd? l. Ycs 2. No 3.|'lcesc lell us wlnt you krrow abour drc cD1't progr$rurp wirtr reqrcct lo: I t 1, Cmuuuuity rcsp<lnsibit 2, lrvulvcluell of tlrc lrcalth sygcnt il CD'l'l 4' Wu drts rn lnitirl rrrccrlrry wltlr dr conunutrily wtrcrc CD't't was iltroducctl? l. Ycc 2. No Mrrritcvln; lndrurrrnls Xrnprh . Mry l9g,l) 21 63 5. lf ycs lo e4, wlat rstc dirl tlre trealrh stal'l' ptay irr nrrattgirrg ftrr tltc lirst ttrceti[g? (CIRLCE ALL ,TItAT APPLY) 1. Faciliuted tlre nrcling 2. Mct witlr villagc lcadcr lo arrang,c lor llre ttrcctirtg 3. Other (specify) 6. Who led tlre facilitating leatll to tlte cotruttuttity'l lrealtlr staff goverritnettt adntittistrative staff (rrou-lrcalth) NCDO staff othcr (spcify) Notxxly I 2 3 4 5 T. Were llte cottuttunities (wlrere you worked) ed talllets? L Yes 2. No 3: Don'l kttttw 8. tf yes to Q7, wtral were tlrey tokJ? (CIRCLE Al-L TtlA'f A I'PLY) ucalej,on tlte itttporlattce oI treattttettt with iverttleclirt l. Yes 2. l. Yes 2, l. Ycs 2. 1. 2. 3. 4. Anrrual treatruent for sever4l ycars lleuefits of treatrttettl Cornnrunity. responsibil ity others Gpccity)- No No No 9. Were CDDs irr tlre conrnruuities (wlrere you worked) trairrcd for llre CD'l'l ltrogratntne? 1. Yes 2. No 3. Dott't kttow l0a. tl'ycs to Q9, did you parlicipate irt lhe lrairrirrg of CDDs'l l. Yes 2. No l0b. lt ycs, lrow long did this trainilrg sessiott last? lrritial lraitring_lletraitring_ l la. Who sulrcrvised the CDDs L 2. 3. 4. 5. Not'superviscd Village head Village health cormtitlee ttrctttber hcalth grersonnel Othcr{ I tlb. lf suprvised, trow.rrnny CDDs rlid you sugrcrvise rlurirrg llre last tlistributiotl? l2 lf url eulrcrvisetl, w 13. .Ar whictr occasiotts tlid you visit tfte CDD'I (ClltCLE ALL'l'llA1'APPLY) I tlefore distribution l. Yes 2. Nn Monilorirrg ftlslrllnElrls Korrrpala . Mry !999 28 6h 2 3 4 Durirrg rlistritiutiolr l. Ycs $rco aftcr tlistributiorr I' Ycs Otlur (specity) l. No g)nstraiuts 2. irudequate/lack of ttteatts of transport/fucl 3. Too rnuclr work 4. hmdequate/lack of supcrvisiott allowatrcc 5. lrraccessibility 6. Otlrcr (spcify) 2. No 2. No 14. Wlat fulctiorrs do you perftrlrr r.lurirrg your visit to ttrc CDD? (CllfCLE ALL 1'llA1'APPLY) l. Coltcction of ultused rlrugs afler rJistliLrution l. 2. Review o[ records l. 3. Mattagcttrcnl of sitlc. cft'ccts I . 4. Supcrvisiort o[ drug distributiorl I . 5. Otlrcr (specify)_ 15. Wtrar couslraints rlo you lrave irr sul)crvising tlrc CDD'l (Clltcl-L: ALl,'i'llA'l'Al'l'LY) Yes l'es l'cs )'cs 2. No 2. No 2. Ntt 2. No l. Ycs 2. No l. Yes 2. Nu l. Yes 2. No l. Yes 2. No l. Yes 2. No [; ,t t l6a. llave therc been any delays in receivilrg iventrcctitt? ll Yes 2. No )'r't .r '1' l6b. lf yes, explain l6c. lluvc tlrcre bccn rrry rlelal,s irr collecting ivcnrrcctirt by tlre conllnunity? l. )'es 2. No 17. lf ycs to Ql6c, plcase cxpla ln 18. Whal conslraiuts have you ex;xrienced in getting the drug? (ClltCLE ALL 'l'l ln 'f Al'l'1-Y) J"I ,i; D. .t" .!. 1. I 2. 3. 4. 5. Nottc Trausport problenr Itrarlequate supply l. Ycs L Yes l. Ycs l. Ycs 2. 2. 2. 2. No Nrl Nrr No ,t ,t ,l ;ili I i iJj i Delay in supply Otlrcr (spccify) 19. llow do you csliuule tlrc quarrtity of rlrug rerluircd? l. Not responsible 2. Nutulxr used durirrg last trcalnrcrrt 3. Basctl on requests frour lhe CDDs 4. lbtalpopulatiorr (wittr lhe forrrrula) 5. Otlrcr (spccifil_ 20. Did you gct thc drugs when rcrluired'l l. Yes 2. No t I Morriftrrirtg hrrlrunrcnlr Kurrlrirh , Mlty 1999 29 r: '.;h. .t,i . t:: ';;F' J"i *{ '|,i -l U1 I . -arLl-ls" ---r-* 6{ 21. fi rrrl trl Q2O, why? l. Slrortagc al gtlc, rcgiunl lcvel 2, Mearu of translnrt 3. Otlrcr (speciff) 22. h you have facility for sloragc of ivenncctin? l. Yes 2. No 3. Dott'tkrxrw 21. tlavc you cxperienced loss of tablets due to pi!ferage? t. Yes 2., No 3. Dort't know 24. Werc cascs o[ scyerc side cffecs rcportal to you? l. Yes 2. No 25. RBCOITDS OI.'SEVERE SlqE ETFECTS (CilECK AVArLArlrLl'r'Y) : l. Avaitablc 2. Nor avaihbh 26. What odrer healft activitics rlo you courbinc witft Oncho Control Progratune activities (PltOllE FOR HEALTH ACTIVITY lN Tllli CDTI COMl,lUt{mES)? 27. How do you feel about the CDTI progranurrc? 4rit ffi I ')li.r rt1 ia.; I Mrrritrhp lnrllrnnrlr Xrrrquh .Mry l+n 30 I I I l. il I I T T I I T I --*^' rN.rirRvrriw GUrDrr FoR por,lcy-MAKriRs/ wil, trupluisDN'r'ATrvri/prr0GrrA,vlMu ,o tYIANAG lilts/ COORDINA'I'O lts Tltis iilerviev iS odutittistcretl ott co-ortlitntors, Progiltttttt'e t"dtnile''s' represenlatives ittCDTI,Mittisttyo[ltealtltpolicyttu,/ret.sam!tnewttorePreseillutiveinilrcCounl,y. interuiew oJ heattlt persoturcl. Docrrnrcttls sicn as regislers sltoukl be requ?rtcd bcfore so tltat infirtuatiort can be es'tracted for llrc repctrl SECTION A: PROCRAMME MANAGERS/ ONCI{O COOIIDINATORS l. ptease rlcscritre low llre cDTl progranuuc is bcing itttlllettrctttctl itt your area o! NGDOs ittvolved fi is sinihr to ilrc ilrc fornuil inlen'iew a. b. ft +t, 9! t{n :i) .n Sn PlrotlE Folr SPECIFIC ROLES) c. cerrcral re-orielttatiurt of health Jrersottttet t0wards cD'l'l prograllltlrc d. Mobilisatiorr of ttre cotttlnultities e. Trainilrg of trealtlt staff as traitters Please explairr process of receiving ivertttectitt' PITOBE FOR: a Delays irr suPPlY {t1't:'; .'r' ' t . at what level arrr.l rvhY? Adequacy of the quatttity rcceived/sltortage Stnrage \' it" ' I " ,,,, Distributioll lo: collllllunities '[trg appnractt used for irrtroducing CD'l'l to llle culllllurrities Eternents of collaboratiott [crwccn Conltttultity' lleattfi sysletll ald NCDOs (lDENl'lFY E r 2 c. d. e. i. [. Cortsrrailtrs (storate, transporl' etc) ,.,,?.)i,:,fL]t Lrr r i t,il, l'.'l' . 1,.,.1 1, 1, ,;rr. g. Pil[erage 3. r ,'r,.tjUNDtNG: Please probe ftrr I -'.' ' "'' I ' n. Delays itt crtttorsetttettt o[ lctters o[ ag'reellrcllt , ,l'riri'r'Wlty? b. DelaYs irt receivirrg [ultrls . itt rvhat level arrtl whY? c. l)elays itt tlisburselttettt oI futlds o Al what tevel arrd wlrY? i,' ,lL. tt Mortikrring ltrstnrr ' ''rryah ' May 1999 ll !ir n t ri i {? d. lrrarlequacy o[ prcvit'rus butlgct r:Futrdatttrritristratiolt:dclaysittsubtttissittttol.littattcialreptttts, disbursl ttteltt and retircttrcttt procedures' rlelays i*i...fir"f frour Al,dC 'eadquartcrs ott filtatpial reporls 4. l)tcasc describc ttte prograttlttte's plalts for irtrprovirrg sustairrability 5. wlrictr otlrer trealth activities do tlre onctro sullervisors courbine with tlreir oltcho cortlrol Progratttttte activities? (r. would you please cxplain tlte ltrogratttttrc s rccurtl kccpilrg procedurcs I]XAM tN E'I'I I E FOLLOWING ITECOITDS . Sutttttlary sltects: l ' Available 2' Not available 7 ExrttAc,t rN[ortMATIoN oN ,r'Ilr, troLlowrNG (rerare ro rtre tqvel of operation c'g' state arul LGA) a. Total PoPulatiorr b. Nurutxr of villages itt tltc arca c. Nuttrber of villages rvitlt sutttttury forttts- rl. Nutttber of villages treatctl u. Nunrbcr rvitlt severe sitle e[[ecls t. Evidencc of report u;xlatc (ctreck attltuat tclullls alter tlistribuliort) 1.. Updaterl 2. Not uPlaled SECTION B: MOII l'ollcy ITIAKBRS ( Pcrura[e[t sccrctary/Direclu Di*asc c0[lrol) t ga. Do y,u luvc a rnlionat l,lnu lor ttrc cnntrot o[ onchuucrciarir ( Protrc lor tlrc inrportatre attacltetl lu orrclpcerciasis cotttrol gb. wlrar ki,rl o[ suplxlrr do you prnvide lor onctro. cotttrol activitics (PRol]E FoR FINANCIAL rNPUT) 9 How tlo yur prccivc rlrc cDTl srralegy of Aloc ( Proh for pcrurmt opiniort arxt official Jrulicy olt cDTl) l0 ts tlp oncho progranurr intcgrrtctl irrto tlrc lrcalrlr systcru ( Pnrbc lor activitics wlriclr ilxlicatc illtc8ratiollatxlowncrslrip/Plarrsforsustairrability. L l Muiltah3 hulrutnb KrrYrle. MrY l9)9 32 I I I i(_ SDC'tlON C: WIIO COUN'tttY ttDl'ltESliN't'A'l'lVl' ll.wlrar is your pcrccpriolt abour tltc APOC slrfllcgy for ivcrttrcctirr rli.slribution ( prop ior teasiUiiity'oI rtre CD't'l approactr itt sotvittg otlrcr lrealth pnrblettts) 12. wtut is ttre relationship bctwecn the Wllo ottice arxl ttre Natiorral orrcttocerciasis'[ask Force (NorF) wirlr.rcqrcct to CDTI i[rptirrrerrtatio[. (lrrobc [or issues rclatirrg to lransler of furtds' supporl t0 NO'I'F and rrronitoring) .t t ,t t s *tt' il'f ,,I t: MonrlortrS lnslrtrtttcrlls K.ttrl;lala ' Nlay lr)r)r) :ll J) ,L . ,tt ;L r{ dtt i I I I I I I I (, ) I i I l, ;,, l. t? '' .'q !n"r-- t, ._t ig 'rl .t i\, .', '' I ,, l'l . rl ., t. ,"t, l,i ' ri .t ,,1 )i'J tl\.$# riltir\... flrr ffi IffiH ffi ffiff ffi 'N ffi ffi . ;i* t: '.,'; . ,t - ';t -,1 i $";$ . ','' ril t :frrr:. :! F-n.l; frn"l{ tf,:i,i: n.IfiFrtll l4'Itr "' trlr\!tr , f,",yh ,tft\.r! 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