Ogun State CDTI annual project technical report submitted to Technical Consultative Committe (TCC): January to December 2005

OGIJN STATE CDTI PROJE,CT Proiect Name OGUN STATE ORI(ilNAI English CDTI PROJECT -l Launch ng YEAr: NOVEMBER' 2001 Reporting Period From: January, 2005 To: December, 2005.(Month/Year) Month/Year)( o /NOT : NIGERIA Approval Year FEBRUARY,2OOO iec! year of this report: (circle one) 123(4)s678e10 te subm itted: December,2005. N DO ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC ) AD FOR SSIO To APOC Management by 31 January fbr March TCC meeting 1'o APOC Management by 3l July fbr September 1'cC Ineeting artner: IFESH/UNtVA. l Po Action Tol \wlF for Homoron Tor -bi8 \9 AFRICAN PROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) CE:rt/ BIM cop Etr Fo csa rf l00z ltnr 0 z WHO/AI'OC. 24 Novernber 2t)0J l J aI ;t ii .t il iL g AI\NIUAL PROJECT TECIINICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSBMENT Please confirm you have read this report by signing in the appropriate space- OFFICERS to sign the report: Country: NIGERIA National Coordinator Name: Mrs. P. Ogbu Pearce Signature ^Y^ -1 Date: 3.... J. LJ ?=p:.1 J ZonalOncho Coordinator Name: Otunba A. Jaiyeoba Signature 't{^ -*- Date. 7!:.' ...5,t-=-+*..7t?' 7 NGDO Representative Narne: Dr. R' A' Aderinoye 4: Signature' . .r.-.:\t.r.<!:'. ::. l.Y].:'l-a ^_-tt.Date: ..J./. {*^^** >r)-D } This report has been prepared by Name : Mr. V. O. Osikoya Designation : Project Coordinator ,e,K.*r..!.r:1.'9. ' t {4444+..Z.ea.V Signature: . .+L Date 2 ... . Table of contents ACRONYMS..... V DEFINITIONS VI FOLLOW UP ON TCC RECOMMENDATIONS EXECUTIVE SUMMARY SECTION l: BACKGROUND INFORMATION........ 1.1. GpNsRel rNFoRMATroN....................,... 1.1.1 Description oJ the project (brieJly) 1.1.2. Partnership 1.2. PopuurroN SECTION 2: IMPLEMENTATION OF CDTI......... 2.1. Trtr,rgLrNs oF ACTrvrrrES.............. ........... 8 2.2. Aovocecv ..... l0 2.3. MoelLIzeIoN, SENSITtzATtoN AND HEALTH EDUCA'noN oF A I I{lsK ('oMMLlNt trt-.s l2 2.4. Con,tivtuNtty tNVolvh,ML,N'r ............ .... .......... I ] 2.5, CRpRcIry BUILDINC... I 3 2.6. TRsatrragNls ......... ........ . l(r 2.6.1 Treatment.figure,\... . 16 2.6.2 What ure the causes' ctf absenteeism'.) .... 19 2.6.3 l(hat are the rea:;onsfor re/u,sal,s.)...... ... 19 2.6.1 Briefly describe ull known andverified serious adverse evenls'(SAEs) that... l9 2.6.5. Trend of treatment achieventent from CDTI proiect inceplion to lhc ctrrur,nt t;arrr2l 2.7. ORon,RtNc. sroRActr n ND DELtvlrtt\'ot, lvbl{Ml-.( t lN ....... ll 2.8. ConavuNtry SELF-rvror-troRINC nNo S'rAKF.Iror.Dr.r{s N4r,r.lrN(,....... .... 1.1, 2.9. SupERvrsroN................ .. l4 2.9.1 Provide uflov, t'hurl of s'upervt,:iorr hicrurt'ltr 'i 2.9.2. Il/hut were the ntuin rs'stre,\ ilentiJied tltrtrtg yupct't't,\ton' :1 2.9.3. llas a supervision checklist used?.. 21 2.9.1. I4/hat were the outcomes at cach lcvel ol L'DTl ittrylenrenlultott .suparvt.ston' )5 2.9.5. I4/a,s feedback given to the per,son or groltps ,strltct't,r.sed. -'i2.96. Howwctsthefeerlbuc'ku.sedl<tintprovatheovcnrll par/ttt rrttrrrtt'rtltlr<'f)t ()ttLI-t.\ SECTION 3: SUPPORT TO CDTI..... 25 3.1 . EqrireH,teNr' 3.2. FN,,ulctel coNTRlBUt'toNS ot l'Hh pAI( l'NEI{s AND r'orvlMUNt I tr;s 3.3. Oluen F-oRMS oF coMMUNrry suppoRl ................ 3.4. ExpgNoIruRE PER ACTIVITY SECTION 4: SUSTAINABILITY OF CDTI 2tl 4.1. INTSRNAL; INDEPENDENT pAR'ilctpATOIry M()Nrr-oRrN(i: Evnr r'A rr()N l8 l.l.l Was Monitoring/evaluation caruied out during the reporlrng. perrod) (ttc'k un.t.' of the following which are applicable) )8 4.1.2. Whatweretherecommendations'?. ..... . ..29 1.1.3. How have they been implemented?............... . ... . . .. 30 I 3 3 4 1j 6 8 t 26)l 27 28 t ill WHOiAPOC'. 24 Nor'crnbcr' l0()4 a4.2. SusrntNaelLlTyoFrRoJECTS: PLANANDsETTARGETS(uaNonloRY At............... i0 Yn 3)......... .. .. ' 30 1.2.1. Planning at all relevant level.s...,. .. . .10 4.2.2. Funds......... .. .. 30 4.2.3 Transport (replacement and maintenance) 31 4.2.4. Other resources ................... 31 4.2.5. To what extent has the plan been implemented 3l 4.3. INrecrRrroN............... ................ i I 4.3.1. Ivermectindeliverymechanisms ..........31 4.3.2. Training..... 3l 4.3.3. Joint supervision and monitoring with other programs 3 I 1.3.4. Release offund,s for project activities.... 3 I 1.3.5. Is CDTI included in the PHC budget? ...... .. 3 i 1.3.6. Describe other health programmes that are using the CDTI structure und hov, this was achieved. What have been the achievements? ........ .. .. .. 3 I 4.3.7. Describe others issues considered in the integration o/ L'DT'[. 31 4.4. OpenarroNAl RESEARCH . .. . -i2 1.1.1. Summarize in nol more than one halJ ol o pogc tlrc operutionul reratrrtlt untlertuken in the projeL'l dre u trilhirr llta rcporlrttg pcrrorl 1.1.2. How were the results applied in the project.)........... 32 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AND OPPORTUNITIES SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATT8RS........... 32 a lv WFIO/APOC'. 24 Nor cnrbcr l(X).I ......32 Acronyms APOC ATO ATrO CBO CDD CDTI CSM GCCC African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Obj ective Community-B ased Organization C ommunity-D irected D istributor C ommunity- D irected Treatment with Ivermect i n Community Self-Monitoring Government Cash Counterpart Contribution t LGA MOH NGDO NGO NOTF Local Government Area Ministry of Health Non-Governmental Development Organization Non-Governmental Organizati on National Onchocerciasis Task Force NPI National Programme on Immunization OGRUMEDOgun State Rural Medical Scheme PHC REMO Primary Health Care Rap id Epidemiological MapIU€ of Onohocerc ias is Severe Adverse Event Stakeholders meeting Tuberculosis and Leprosy Programme SAE SHM TB/L TCC 'foT UNICEF UTG wHo Technical Consultative Committee ( APOC' scientitic advisory group) Trainer of trainers United Nations Children's Fund Ultirnate Treatrnent Goal World Health Organization & r & I a WHO/APOC. 24 Novernber' 2004 ** Definitions (i) Total population: the total population living in meso/hyper-endemic cornrnunrtres within the project area (based on REMO and census taking). (ii) Elieible pspllatiatr: calculated as 84oh of the total popr-rlation in rreso/hvprer- endemic communities in the project area. (iii) Annual Treatment Obi : (ATO): the estimated number of persons living in meso/hyper-endemic areas that a CDTI project intends to treat with iverrnectirr in a given year. (iv) Ultimate Treatment Goal (UTG): calculated as the rnaximum nurnber of people to be treated annually in meso/hyper endemic areas within the project area, ultimately to be reached when tlie project lias reached tirll geographic coveragc (normally the project should be expected to reaclr the UTG at the eud of the 3''l year ofthe project). (v) Therapeutic coverage: nltmber of people treated itr r givt'n Ycur oYcr th| population (this slrould be expressed as a percentaqe). (vi) Geograohical coverage: nurnber of conrmunities treated in a given year over the total number of meso/hyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). (vii) Integration: delivering additional health interventions (i.e. vitamin A sr-rppler.nents, albendazole for LF, screening for cataract, etc.) throLlgh CDTI (r-rsing the saure systerrs. training. supervision and personuel) in order to mil\nrr\c eos[- ef'fectiveness and empower cor.uurunities to solve rnore of thcrr health problern: This does not include activities or interventions carried out by corlmr-rnity distributors outside of CDTI. (viii) Sustainabilit),: CDTI activities in an area are sustainable rvhen they continLrr: to function effectively for the foreseeable fr-rtr-rre, with high treatmerlt coverage. integrated into the available healthcare service, wrth strong eortrnrLrnit,r ownership, r-rsirrg resources rnobilised by the courrlr"rnity arrd the governnrcnt (ix) Comrnirnit)'self-monitoring (CSM.): The proccss br, uhich rlre 'onrnrrrn'.. empowered to oversee and monitor tlre pelformance of CDTI (or an) conrnrLurrt)- based health intervention prograrnme). vi ith r vievr to crrsuring th.r1 thc programme is beirrg executed in the lval interrded [t encourages the cornntnrrtv to take full responsibility of ivermectin distribution and make approprratc modifi cations when necessary. vl WHO/APOC. 24 Noi ember 2(X)4 FOLLOW UP ON TGG REGOMMENDATIONS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session 2l FOR TCC' ,4POC MGT USE ONI.Y' The project intensified community rnobilization in 88 cornrnunities ancl training of 7l FLHF Staff ro monitor the performance of the CDDs in Imeko - Afon LGA. In Obafemi - Owode, in-house micro training was organized for i 1 FLHF Staff on record keeping and supervision technique. 20 registers were procured and distributed to CDDs. 100 Surnrnaly Forms to be photocopied for LG Coordinator /FLHF Staff. il t\ There is some indication that the CDTI philosophy and strategy is not tully accepted or understood at the LGA level and particularly at the F-LHF level. Only 22% of health workers in endemic LGAs are involved in CDTI. This is too low and specifi c strategies should be rnade 1o increase both the nuntber' and the Project should identify specific reasons tbr the lack ofresponsiveness from the LGAs. identify one or two LGAs that have been responsive and engage the leaders of those LGAs to assist in advocacy with their counterparts. i Successful Orientation rreetinss were held with PHC Coor.dinator.s @ LGA and Distlict Levels on CDTI Philosophy. ri. CDTI Practical GLride for Trainers was given. The percentage of health worker.s involved in CDTI has increased to 55% with lorrnal ancl inforrral training and orientation of I additional staff The goal of the project is 1o tlairr and involvr. itll Itealtlt rior'Icrs rn tltr. Starte :tartrrru with the endernic LGAs Poor style of leadership trait @ l.CA level. btrleatrcracl, irr Governrnent service and adrnrnistratrve style appear to be the reasons behind the lack of responsi veness. The project tlrrough its supportrng NGDO intends to mobilize the Deputy Governor who has oversight for the LGAs to help ensure release of funds by the LGAs. The project plans to ensure the issue is listed as an agenda item in one ofthe of the LGA Chairrnen Number of Recommendation in the Report TCC RECOMMENDATIONS TAKEN BY THE PROJECTACTIONS (i) Develop strategies to increase therapeutic coverage in lmeko Aforr & Obafemi-Owode. meeti WHO/APOC. 24 Novenrber 2()0.1 iir i CDD selection in churches This strategy wilt be Pursued further to improve communitY ownershi and i vl Commence tlaining for CSM and SHM. Training was conducted for the FLHF Stafl but there has been lack of follow the FLHF workers vlt Although women participate enthusiastically in community meetings, this is not reflected in the number of female CDDs or the number of communities that have female CDDs. The project should explain this apparent paradox and give strategies for increasing the number of female CDDs. The selection of females as CDDs have not been apProPriatelY sensitized, and cornmunity members have grown accustomed to seeing males perform the tasks thus assurring that such positions belong to men. The project intends to work through worren religious groups and leaders of the market women who have influence in comrrunity decision- making to encourage selection of females as CDDs vllt Although the sustainabi lity evaluation was conducted soon after the end ofthe current reporting period and thus the project did not rePort on recommendations in the sustainability evaluation, the project should irnrnediately begin irnplernenting the recornmendations of the sustai nabi lity evaluation. These activities should appear in the Year 4 technical This is addressed in the relevant section ofthe repolt. 2 & WHO/APOC, 24 Noverrber 2004 -ts :i- Executive Summary Prepare an Executive summnry of the report in not more than one page. Ogun State, located in the South Western part of Nigeria, is nrade up of 20 local govertlrrent areas with a projected population of 3,262,889. The people in the State are predominantly Yorubas of which there are Ijebus, Yewas, Egbas, Aworis. Eguns, and Rernos. However, CDTI is being implemented in 952 communities in 8 LGAs. The total population of the endemic areas is 306,280. Population movements occur with the migration of young ones from the rural areas to urban centers in search of greener pastures. There are also movements when farmers and particularly fishermen move temporarily to new areas during particular seasons. Festive seasons (religious or traditional) provide opportunity for movement of persons from community to community and from urban areas to the communities, and vice versa. During the period being reported 881 communities were covered and 243,1l7 persons treatcci thus achieving 93o/o geographical coverage and 80% therapeutic coverage. The treatrnents also meant a coverage rate of 95oh of the Ultirnate Treatment Goal of 257.276 and 95% of the Annual Treatment Objective of 255,233. 740 heatth workers and 1734 CDDs were trained during the reporting peliocl thLts aehicrirts 100% and 93Yo of ATrOs for health workers and CDDs respectively. 133 State and LCA Policy makers were rnobilized as well as,t34 Village Heads. l4l Wotlerr Leaders arrd -ll7 Religious Leaders to support CDTI. The strengths of the irnplementation process are voluntary participation ot'CI)D in the activc distribution of Mectizan., interest shown by the communitl' leaders to tal<e ownership o1 CDTI activities. involvement of churches in Mectizan distribution and availability of drtrgs and I.E.C materials for distribution in the community. High spirit of commitment has been shown by few health staff at all levels The weaknesses/constraints of the project inclLrde inadequate logistics, collstant l"tatrslcts ol Health Workers withir-r the systerl resulting in delal, ilt e trllatirlg clata. itrrcl itllttletl ir'ttt' counterpart firnding, particularly at the LGA level. fhe challenges f-aced by the project were the bad terraitt of ct-rttttrtlttritl roacis alld hard-t,r- reach health facilities to issue mectizan. Effortto control these obstacles involve integratiotl of PHC programmes into CDTI activities. J WHO/APOC. 24 November 2004 1.1 SEGTION {: Background information General information f .l.l Description of the project (briefly) - Geographical location, topography, climate Ogun Stite, otherwise known as the Gateway State, was carved out of the defunct Western State on 3'd February , 1976 by the Federal Military Government of Late General Mur.tala Ram at Mohammed. It lies within the tropics. It is bound in the West by the Benin Republic; in the south by Lagos State and the Atlantic Ocean; in t[.re East by Ondo State and in the North by Oyo and Osun States. Oguri State occupies a total areas o1' 16,'+09, 16 square kilometers. The clirnate follows the tropical pattern with the raining season startirrg about March and ending in November, followed by dry season. - Population: activities, cultures, language. The projected population from 2002for the state is 3,262,889. The rnajor ethnic groLrps are the Egba, Yewa, Awori, Egun, tjebus and Remo; they belong in the rnain Yoruba ethnic group. Nigerians from other parts of the country as well as expatriates also live in the state. The languages spoken are mainly Yortrba (Lartguagcs t-rl thc pledorrrrrrLrlr,,\ majority) and English (Official language). There are several dialects inclLrding ljebLr, Remo, Egba, Yewa, Awori, Egun, Ikale and Ilaje. The majoroccupation of the population is farming; fishing. Weaving of cloth (Aso-Oke), tie and dye (Karlpala arrcl ad ire) are practiced. Settlement pattern is largely dispersed. - Communicationsystems(roads...) Roads between major cities are in good conditions. but access roads to nrost ot'the endemiccommunitiesareinpoorshape.Sotnearenotpassableduttttgl.hct.atrtl )u.riu, Despite this, transpoft by road remains a major llealls of comtnunication among the comrnunities. The electronics and print rnedia are also veritable channels of communication. - Administrationstructure. The State consists of 20 Local Government Areas rvith the political appointees berng the Chairrnan. Legistative arm made up elected Councilors frotn various wards supporting the system. At the State level. the Executive Cove rnor rs tltc llcad .rl adrninistration. There are the Legislative and Judicial Anns. The capital of the State ts located in Abeokuta. - Health system & Health Care Delivery (provide the number of health posts/centers in the project area if the information is available). There is an official PHC policy and structure in the Project area. [t is a systenr of health care services where community participation forms the mainstay with sLlpport liottt iir,- state, Local Government and NGOs. Level of functionality however varies across the State. The health facilities in the State spread and located in various LCAs. ranging from Health Posts to Hospital are 426 Health Clinic/Cerrters/ Posts and 8 Hospitals. r+ i& 4 WHO/APOC. r4 N,,1 gnll)cv a(x)J -+ *& Table 1: Nurnber of health staff involved in CDTI (Please add more rows if necessary) District/LGA Number of health staff involved in CDTI activities. Total Number of lNumber of health health staff in the , staff involved in entire project area CDTI Percentage Bl B2 I 83=82/ Br *100 Abeol:uta North 185 90 49"4 Abeokuta South 205 120 59% Ewekoro 185 80 43.2 9'," 127 80 63"hIfo Imeko-Afon l16 80 69y:o 190 90 4'7.3 0AObafemi-Owode Odeda t4l I I I 80 I I L 5'7"4 Yewa-North 132 I 80 61'/. Total l28l 700 55 01, 1.1.2. Partnership The partner involved in project implemerrtation in OgLrn State are IFESI-I/UNIVA; FCN {NOCP-NaIional &Zonal Offices}. State Government, varioLrs Local Governnlents ancl tlre Endemic Cornmunities. Some religioLrs Organizations al'e assisting irt tlte distribLltiorr trl' lverrlectin. These include such bodies as CAN, Bible Society of Nigeria, NASFAI', DAWAH. NAWA-RU-DEEN and Christian Corpers' Fellowship. Sorre Market Associations and commercial motorcycles riders' associations are also irrvolved in the CDTI proccss. TFESH/UNIVA is mainly involved in planrring. occasional advocacr itnd nlso.rs\r\t\ ur providing technical aid in Training, cornmunity mobilrzatlon, co-linaltclng PIOgI'alllrllc activities. monitoring, encouraging in Mectizan treatment. The NOCP zonal Otflce provicles the enabling and favourable environment for project implemerrtation. and gives sLtpptirtivc supervision of CDTI in Ogun State. The State, LGA and endemic colrnlLurity carry out their varigLrs respollsibilities under CDTI. The religious groups assist irt cott.ltuLlrlit\ tttobilizatiorr and creation of awareness. Partners are working together in hanlonl to achieve a sttccessfutl itlrplcrrentatiort ol tht' Programme. There are plans to sensitize and mobilize Commurrity Coalition members i.e. an Associatiorr of Local NGOs for the development of each commllnity, and involve them in the CD1'l process. 5 WHOiAPOC, 24 Novcmber' 2004 3oF o' ln ao z! a oo ,f N U)o = a 7f rt zo :1 AI r.U +ALI -. t) ) H: A;!r153 v(D =='ao;++ (r)\ Fl Fl F o{p z :1 (-.) a.oo N o' @' 3 (-) o (/.) 9o oo{O (,) NJ N.) 919- .c5 rD; =E'8 tr- 3 :.:.+fD =6iod=D9 -. (, Q a\ b..) € 5 UJ 5s (JJ UJ "o !5 (-,l 5 5{ 5 NJ LA N) ()) UJ "N(, oo NJ)o (,| LA \o rrt b.J \otn b.) LA(JJ UJ 5 o5 ! o\ ! o\ \o NJ \o NJ oo @ oo @ I I \o \o I z (D o o o U) 7 G (D (! tD 6 6 Er (!o a;i N 6 :.t 6 rt 6 o o N (! ll + 1 (! ID o\ b.J ao 5 L,J s5 UJ L,J !5 ,5 +{ LrJ i'J oo h.J t-.r 5 J\.) NJ 9o oo -J UJ NJ N) t II UJ o\ b.Ja + J,J ss (JJ tJ.) !5 5 s{ +N) NJ (J) (JJ N) oo t\)\o (,.r u) oo oo{ (}J N) tJ tJ Q'I -I b,J -Io\ (/J o\ NJ5 NJ\){ oot) 5 Lfr "5 oos (JJ -I{ NJj-J \o()){ NJ5 5\o (, t'.J o\ NJI\o{5 7Eri 16lD re-ts 65== t aN I ! oE tr -!ltl I' o = l-l lpDtdt- l(D INJ oo 3 CD CD o- 'o 6- FO - ax rD r! tD (D t) E9 G F9{ .0 (D - (D FD - CD - .D FD o o- o - = I oc o -o o - =' oa oI o o- (\ As o $ o cd\U / s.Fl = 8ild :ol o: ij tt I ' 6 ^lo s.ii I .D(\=-l = .\sltt >s \l t, '.tl :s T\l = oSr o,e%:\ rD\a s-! :E <r$ .t6.x .D-:so es -r$DH O-Oor RiE rDxs. o- :\ : =-\_ '\\(I0 -x:.* ^ 5a -rA -.!vrDi.s -O .jl\ o ls a! =::oa id_ -o \aaD Xs ^!:x \:* ^-Y l6! la\I =ll-h I !Y I .i\=I >riZ \( V !t F I sSI r-\s t\| -aRd "E <: urtia :!<\A \-QSi G.Q }I A: .\t !\ -o G\(\ oo \? (\ \_ G\ .o Ga -+) zp 1a1 rDL,= P=d 'r)-' au) =tJ-76 ?Dc - +o c =aa.D -oaD' -+) ?6 l=; '=' A.D tJ tt)l-1 o- '' o l/ tDldTlavr< o .D - = -a)I E + + = IJ ! z a a =T a L -t ;a ; * tt IL T& I I I I :Nd99+ * () 6 0<fs='98 -r =o 'g.! il + *8 -l ,ioo =.>sNi5 ='o6, 6r eFi flg =:' a+ =' lId c\ a _o =! 7 -i "l ? I J\ ! b .BE)u 6)P -c- .L ! o4 -o q) L Eq dQ.a(ts ,O\ . !j 6)Eh\ POO0)L v{E.: \) o) *u U e YP' ! -u 9\o-+(.) o !t .- Pq) J\o\6 c6! as'o) .;\i:tUP L\ -t! 9.=S{PE(d v ,F\ \L sqiG$.=b.,sh'i !eq \O .NE\ L=\ V! soa- U N p 4 o h € ^a (.) u bc q) bO o Q qj ...,; qJ ! a,\ Q L \ ! a) o : q) \L o U\ o' a\ L bO ci q) 1\qJ, 4 U \r (! oL o 0) 'd L o. 0) (H o 0) o.() ch L o o.() a F o b0 ='; o E E o 0) o a o o o 0) -l, q) oo L E E o L() o bo U) oL(o o (H t-- a .!. SEGTION 2: lmplementation of GDT| 2,1, Timeline of activities Fill in table 3, timeline of activities for areas treated in current year, indicating when the kcy activities were implemented by the month they began and the month they ended. 8 WHO/A l']OC. 2-l Noi enrbcr' 1004 l-l ItDtd l(!l- ; o @ +) 0)o =f. o lh o' - o c0Io EDa Io 0') CDo (D .) I (D (D E9 t(\ q s- o a\o s4 o 4q N : I o o 3 3(D t.l Fl F G z f oo- N p a =2. o o-o r= oxo o' o' ln o x-o a o. a =D(, = doox D z o 4 t2 t.) F o FD NJ ID LO N) 0) NJO FD N FD N FD N FO NJ -v) +5 oa zatt EN =+i, =. t!J0^ (D 19 C o f.J o l.J o N) .D t.) G NJ (D N (D t-J o 3IO+{ FDIo :f- IJ DJ o f. NJ - 7 0) -o N)c FD -o N.)O 7 p o NJ 7 A) Io N) A) o tJ l0 o NJ - (t) 5; ==oa Fl !9 rc -o =. t-.JO -o =. tJ =. NJO ! NJ N) =. NJ l! -o N) o o 9r: o = = = = = = 7 = _a += 0q o(D 0 a o tD 4 1 = = 1 4 1 4 o3EO- o -n oI N) TJ N) a NJ Tl o ,o- NJ Tl o LO -!l q NJ -rJ o st NJO -n oq NJ -u) :,; ==oe XQ (, z o .s N) z s N) z s NJ 2. o3 N) z s NJ z 5 N) z o s N) z l.J o il 5 TI o t.) ooi tJ (D NJ (Do N T] o6 N o N) o l.) O TI o N O -a o=E.++;'0a a ort q)zo s tJ z s tJ z J N z s NJ z o5 t\) z. o N) z os N) z o N)a oo3eoi o ,o , .: -= IJ L Z = a IJ J> 1* l, j .+. & Ir il. T * 2.2. Advocacy State the number of policy/decision makers mobilized at each relevant level during the current year, the reason (s) for undertoking the advocacy und the outcome. Describe dfficulties/constraints being faced and suggestions on ltow to improve advocacy. Tables showing Number of Policy and decision makers mobilized at State and LGA level 3l 67 iri 42 ADVOCACY AT STATE AND LGA LEVELS Chairr-nan Local Covernmenl Service Comm issror-r. Chairmen of LGA Director: General Services and Adm itrrstr_atron ']-reasu rers Supervisory Cor-rnc i lors lbr Health. Oncho Ol'ficers. WES Coordinator # I 8 8 q 8 l.t 8 fl & r IL u SA{ LGA VILLAGE HEADS WOMEN LEADERS RELIGIOUS LEADERS I Abeokuta North 50 l8 86 2 Abeokuta South 74 l3 40 3 Ewekoro 38 l9 4 Ifo 52 17 5 Imeko/Afon 48 l5 46 6 Obafemi/Owode 50 t4 66 7 Odeda 66 t8 8 Yewa North 56 t4 TOTAL 434 r4t 411 N/s STATE # LGA I Honourable Comm issioner for Health I 2 Chairman, House Committee on Health. I 23 Permanent Secretaries: a. Health b Hospital Management Board Director: 74. a PHC & DC. Department. PHC Coordinators 8 b. Training District Coordinators 40 c Hospital Services Dept. Nursing Services Departmerrt Planning, Research & Statistics Depart. d e f. Pharmacy Department. ob Finance and Administration 5. Principal: a. Schools of Nursing 3 b Schools of Midwifery 3 c. School of Health Technology Reproductive Health Centre 1 Id 6. Programme Officers: l1 a. NPI unit b Roll Back Malaria unit c. TB/L unit I I l0 WHO/APO('. 2J Norenthcr 2(X)l d. HIV/AIDS unit. I e Health Education unit. f. School Health Service unit oh. Reproductive Health unit. h Monitoring & Evaluation unit I Women - In - Health unit. I Environmental & Occupational Health TotalTotal 30 103 6L ;i Reasons for the sensitization: o To establish their responsibilities for CDTI execution arrd sustainabilitr o To participate in Community Self Monitoring and attend Stake Holders Meetings. o To share ideas and encourage participation of the decision makers. o To determine appropriate incentive to be given to the CDDs. o To strengthen women involvement in CDTI activities. 0utcome: - CDDs are now enjoying motivation from commr"rnity members in sorne communities. - There is an agreement by all partners to support CSM and SHM initiative. - Number of CDDs increased, and rnost are participating in drug distribution without requesting for incentives. - Women groups rnobilized and getting involved Constraints: * Bad road and poor terrain particularly in Imeko-Afon and Yewa North. Collapsed bridges are rampant in Odeda and Obat-emi - Owode L-(iAs. Climatic and Weather conditions - heavy raintalls causing floods hinder easy movement especially in Odeda.LG. a, To improve advocacy: r Sponsor programme segment in media houses such as Radio, 'l elevisron. Meelra Chat and Press Conference to solicit for support and create awareness.. . Marking of Oncho Day. o Shorving documentaries of people affected rvith terminal complications of the d isease. o Organize Drama and Song groups to give orientatiou to Top lirnctit-rnary O1'lle cr: for moral and financial support. o Production, Printing and Distribution of Souvenirs such as Face-Caps. Strckers Jazzy (VEST) and Pocket Calendars "l il& I I ll WHO/APOC. 2-l Nor cnthe r l(x)J -+ 3L 2.3, Mobilization, sensitization and health education of at risk communities. Provide information on : - The use of media and / or other systems to disseminute information. Use of Media Houses: The State Ministry of Health organizes regular Programme tagged OGRUMED for various health activities to be implemented in the rural community. Airing of this in GTV.GBC, .NTA and FM News was regularly done. The Onchocerciasis Programme was aired in the following Media Houses: ,/ 'Eto Ilera ni Ipinle Ogun' in Paramount FM 94.5. ./ GBC -'Healthy Living Segment'. ,/ Mid-day News on Health and Environment [Oncho Day]. GTV/NTA News in Yoruba, English and Egun. I.E.C materials were distributed in churches and some tertiary institutions Utilization of other PHC Programltles'activities, especially during AfrP. t..\PI. I{llNl. ll..rltli Education, RHP and HIV/AIDS training activities conducted in the Departrnent. Mobilization and Health Education of communities including women und minorities These are ainied at ensuring community involvement and participation, par-ticularly wrth regards to CDD remuneration. Mobilization meetings were also held with Religious Leaclers for support in the aspect of giving incentives and negative attitude of CDDs tor,r'ards Mectizan distribution. Mobilization of Community Development Associations and Larrdlords Associations were carried out with Local Governmerlt Coordinators to achieve better coverage. Regular meetings with the State's Christian Association of Nigeria {CAN} has resLrlted rn some Churches in AbeokLrta North and SoLrth LGAs clioosing CDDs that carried oLrt Mectizan distribution. 28 Churches so far have chosen 223 Comrnunity Directed DistribLrtors rvho have been trained. These CDDs did the registration and carried ouI tlcittnrcnt tlLrirtq tlre Health Week in the various cornmunities. There are also periodic health education cilnrpxrgns in ChLrrches and Mosques. Various religious groups (both Christians & Moslerns) including sornc e\'angclrsts anrl missioners as well as the Christian Corpers Fellowship (a Christian organizatiorr tirl rrcrtiort.rl youth service corp rnembers) are involved in dissernination of infbrmation on Onchocclcrasrs control Response of target communities/village: More communities are now dernanding for their Mectizan. Attendance at all OGRLJMED activities and interactions with community members dLrring sLrch activities indicate their increasing support and interest in the drug distribution. Therapeutic coverage has consequently improved. 12 WHO/APOC. 24 )'lor cnrhcr l(X)4 .t- Accomplishments: o Level of acceptance by community members is high. I State Social Mobilization Committee on CDTI Project is now in-place Ways to improve mobilization and sensitization of the target communities: I Formation of Village Committee on Mectizan Distribution o Increased mobilization of local CBOs and religious grolrps 2,4. Gommunity involvement Table 4: Communities participation in the CDTI (Please add more rows if necessary) Comment on: - Attendance offemale members of'the communigt ut lrculth cdrlcutiott mcctittgs This is lairly satisfactory - In generul, how do you rule the participation oJ Jamalc mantbcrs ol lha t'otrtrrtuttil,t' meetings when CDTI issues ore being discusses: Sorne females are recognized community title holders e.g. Iyaloja/lyalaje, and are opportune to raise issues at community meeetings. Their opinions are nortlalll'sought on sotlc issttcs and can be influential. In some cases f-emale participation at corl-lrrunity meetings depends on decisions of the elderly male members. - Attrition of CDDs. Is attrition a problemfor the project? If yes, ltotv is it uddressed'! This is not a major problem in the project. A Number of communitiesivillages rv ith community members as supervisols Numbct of ('DDs and thc conrnrunities involved Male cobsf l Fenrrle CDDs Total B7 Bs Br= Sr+$t Number of conrmunitics /villages rvrth lcmlle (lDDs Nrn.,Le,'of I I'crccntagt comnrunitrcs with I'em:rle CDDs B,N llr r= B,r,/Br* 100 Total no. communities in the entire project area B1 Number with community membem as supewisors Percen tage B. Bo= 85/ B{ *100 Abeokuta North 119 290 23 313 23 | 19.3,'1, )1 ., ; i,' l{q,, 24 .+ I I t5 t2 I-i I I l l -r .o l .j't; ,, , - ,,,,, -34 ln Abeokuta South 110 l I 266 24 290 Ewekoro 88 166 t75 24 190 Itb 110 I 15 t90 lmeko-Albn 92 l'79 t2 l9l 34 233 ltf 223 Obaf'emi-Owode 176 I I 199 Odeda 104 205 Yen'a North 153 220 15 235 l5 I 0",, I'otrl 952 1.700 165 I 865 t65 t? .10' i3 Other issues Nil. l3 WHO/APOC. 24 Novcnrbcr 200-l I {g t& 2.5. Gapacity building - Describe the adequacy of available knowledgeable manpower at all levels. Adequate trained staff is available but most of these need to be trained. llhere frequent transfers of trained staff occur, stste wltat the project is tloing, or intends to do, to remedy the situation. (The most important issue to clescribe is what measltre.\ vrct'c taken to ensure adequate CDTI implementation where not enough knowledgeable munpotver was available or if slaffs are frequently transferred during the course of the campaign). The project organizes in-house training for all health staff newly posted. -fhe trained ltcalth staff are encouraged to do a brief training for successor while harrding-over, in case of re- deployments. iL i: & s L u l4 WHO/AP()C. 24 Novemtrcr 2(X)4 l-J la)ld ltal- ; ID oa (D o- dto 6- (D G o ,+) o U -l 'o o 3 o = o) 5' J e G % d$ G ;\ G a 4q 6 v{ o\ o (D ID Fl H l- G{ B' z o f o o-oa D LJ D o' E { o-o o - o' {o o CG x p a I 6oo x- p z o ;1 rl t- 5 19Jr 5 NJ NJ l.) NJ l'.J l'.J tJ NJ z (D =' -i tD a) - O o !9 ,t a z i S, ^ 'l+1lo 6ir S o o ^ s a 6 (! a! -.t A(,l [.J UI { 6 c -T - - - - Lla t- @ a c C c .c m o €c oo o 6c @ O O - NJ oo TJ z (D tD !9 !) D IDlr ^ -l+.'= -rr g o o o\ (! tJ \o l l I UI UI UI lr z i(DA'- tDO -lD -!ea. ='tD a oa < 9^- a:r o' ^ll D = o \o a o o \o!, i.J s [.J (, -l A € o\( NJ l.J N) NJ N) c NJ N) N tJ NJ O O o z (! -l o o a !l (! oa a?\= ahi' s, 9^-r+:'o ; N) t.J 6 \o oo o\ oo5 \o O NJ co *\o N) o > \ * s ei i C .6 $ .^ a\ o * a s nj a\: S lQ {- -: IJ]- Z c = IJ :, Il" r L ET & l \ I I f*. Table 6: Type of training undertaken (fick the boxes where specific training was carried out during the reporltng pcrncl) Arry other comments 2.6. Treatments 2.6.1. Treatment figures If the project is notochieving 100% geographical coverage and a minimum of 65u/, therapeutic coveruge or the coverage rute is.fluctuating, slute the reusons untl lhe plans being made to remedy tltis. Geographic coverage was less than 100% due to communalcrises in rrost [.GAs (spread along a certairr corridor), principalll,due to clashes of col.nnttutit\ Iletnber: t'ith eattlc rearers. This is more of the case in Ifo LGA. This is the reason for the 600% therapeLrtic coverage. Trainees Type of training CDDs Other Community mernbers e.g. Cornmunity monitors Health Workers (frontl ine health facilities) MOH staff or Other Political Leaders IFESH field Officer. Corntn Lrnity NGOs and Religious Leaders. Program management How to conduct Health education Management ofSAEs CSM SHM Data collection Data analysis Report writing l6 WHO/APOC. 24 November' 2003 i rJ - z<oo .+<5A) I U o-(D o- F) {ood o- l0(Da 3 o +5O'6 I o' rrJ oF I ?> ka -- z>odFt(D -x ID /1 91 \o(,r T,J U) O5 -lo\ \o N) O oo @ \o E Xfi E S'i.=!r = N .,\< -.= +e-o5=^ rd Q =d =.B rd{- \o UliJ (, UJ Os \)o\ \otJ @oo o \o -a .o' ni P6ts= ='a Do)- €6 5}J \o -l o\ oo oo oo oo N) oO- tfi-= r o :l- \o(, s \o U) \O \o UJ i.) o\ \o -l\o oo\o o\ \o -I o\ \o UJ -oo\ @5 o\ o oQ ^>oa -o .i :lo\r= oc=o- !r o o ='oa : FO oa(D U1 \o o\ o\ (, o\ b.J 0a J: UJ 55 -l5 i 5 -.1 5 "N NJO UJ i'J @ N))o ,o co{O UJ NJ N.) --.to^' ci O -ad P.Nr'= = t9 UI|-Il t-J(, "'o tJ{ -(- 3 5 , )\ IJ "5 N-) -.1 : N)Ft\)\o U)IJ L,\o N) NJ9{ o\ .qG ? ::ODd=- F.J5(, -I -J Lr N) \5 +t) IIJ -la f.J ,: \o NJtJ =5 (r)i co tJ N) 'o\ UJ z aq= @:G *u a { o\ s =bo o\ -] :J oo o\ -JItJ @ L: \o o\ I -t\oo\ { oo L: \a oo P o\ \o -)I@\o *t ofo@ -P o0qcO=. o I co o (.,| tJ NJ = = = = = -ozd- rf cis;t*= i so: o a z. 5 = 1 = = (r) NJ !rz i;@a= oo (,r N.J 7 4 s z = 1 = tJA A 9^z b=>ac.6 z z z = z = = 4 z E 13 z!2-LiIF!oc a$$a$Hip =!:,o:i -J Io O) o q (n =.o - LJ p) loto l, FD - V)F lTjlo l=til- lEi la I;lol= ld lc_t-t= El5l(!ln lo, tC, l.D 13. lo tF) t:,to- trqlo bql- IFDlc, IT lo)t-totol<tolr la) oa l.D -l (D (D ':c vo oo o - arc c -DJ o LJ o o oq - -P o3- ^\ -.:-o A) o o a 'ta o -ID (D -lo o .oq J^l 0a .D -A) o z =o-(D -o '+) 16 .D o lo a- ld l(Dlo- t:loiC 1l-7 J Olc O -l=DIIAJ ti =l(D ]J -llA =lo -(]Jl+-ut^ .Dl! a)FIU; olj o -+, lI =ltc qla Vl(D ,=i t(,J l-- '? ll -E t=ol- =TIE i, a:-J )qJ ela ,? )t>u;la (Dlo- -t ^l'/ -vl a=iJU) =. .) a.()(DO u)= T) =o-= .D=' IU0 itG2 a, -. -) V3(rl aD7>U -r ^-Jt. ='4 -e, (Dq (D :l o) e a0o D -o N >12 =l=:l= -t, -tJ =lo:l- _J tofli l*, FD K] =l(Dllo ot5 ^t-;16 2la:l lo_ =1, t^ = ++ a. L C J a IJ I L- & rlt IL ir tk \o -l LJ FDo o o o- RC \ :\i\qcj 6 ffrr llGN\ -s s:.G N!= s .Ei =-iT E si d.{r i .:s si'+ FnG s q^.s =\\ r'x! 6NSt sS- N c= :'Hr "tR: s'\H sSN' E:: ss: _:igs E =8 q ns a- ^(G S\J } R.ls !$s xilsF sx'\i fSN ; =: .ti ! . -E. \:= \ :-f ti! a.Fr$!4. sS.r *Gd -! 3.L =+'5 xs rA({ +=. \t irc =s \:r .o a 3\ oa Oa t E ltzOl- FD IJ =lX 3loo l'-'r .D tc, -l(D o19 -o 16-ol-Ati ilo = la) 3IE -lx9tol- l^ AIO S] o o- =o o -\ !(D o o- o 6' A) -o q = =' o ! a oo FD (D A) C -l -: IJ! C To IJ J- ++ & 1l & I E :+- 2.6.2 What are the causes of absenteeism? Some community members re-located, and were recorded as absentees. Few went for community assignment in the city and some travelled to represent churches at Conferences, Retreats, and Camps during the treatment period. 2,6.3 What are the reasons for refusals? They are mainly cattle rearers. We hope to track them and health educate them Lrsing their own people. 2.6.4 Briefly describe all known and verified serious adverse events (SAEs) that occurred during the reporting period and provide (in table 8) the required information when available. ln case the project did not have any cases of serious adverse events (SAE)durirrg this reporting period, please tick in the box. l9 WHOrr\POL. 2.i Nor crnber rt)t)-i a 2 * oa(D (n c0x { <u lBH +No=j' - ;; --tr<Y! qxo=o H E'-(D:2 o-3 ; -o o @ ZSTgIE-2,;+Bs =.(E A', +p H A +V 3'io ^vae o5 = o'-'* ubO@tD 'o<?+. = Z-NJ 5o a6p Jo-6' q o1 J0a o o po q9 5' d3a'a o oom -:lx EH A @os6 !i ='.3dToY = ='>o:6- Xaio o l I It I I I I --- 1- - t l z = I l .l I -t l lL- .l i l +- I l- l-l lP)l6 laD lo" o (, o(n o +) a o a FD o- (D t,(! o o q U) tn h o .) o = -o o- o- =. 0a (D (D o :1 0a E(D -5' o-t aG -G $ i o o ; (\ ooqq 'x- vG 6 r! Ct G et IJC -F iir t :i = IJ L 7 C J a. IJ t- Il I f IL il *h i I I t' I '- 1 - -t cl .) -c = Z J a: a- E ta c{ (J cq C) t-( d o 0) q) .h e{ o U) q)(, \ot\ 6r (l o (J 0) 6) o q) dq) t';lo)lcdlq)I0.. \ q) s<\) \)s \)4S\) a\ o Eq) Ld L 6et ..9.EA- E9 !r 36 6.U F-o6- r ' Ll =clEo.)l - cllFol E^l o -'>() .9 bo E c-r oo Ea UA o9LCtr tr 0) ViF \A .. N v'l 6)l -l -ot(n1(- .l o\ oo o\ c.l co o\ o. o ho F oXh>:,JO O \o \o o\ c..l oo o\ a- o\ oo o\ a? ca o\(\ oo o\ o\ ,; ci e o ^bo!, gaeF oo\< B-o o\ 4..\o o\ t-. 5\ r\ \o F- o\ 00 G o bt) d o o o o o. Eo F o ll + '-i d rI1 co F-(\ s C] (r- \ <t c.l l-1 ! ea o6 s9o5f,E 4ts o. oo 00 r-- F- a.l -t r- at (\ ol ca $+ c! ol. (\ CI a..l CI N E] d o-a , a-c' Fl/ -tr6t ol -t r- 6l - -t(-- 6t CJC at-6l OO = € c..l .oO 6 q .INv i d) -Y! .o is € ='E I! ' d. 3s o O \o c\ -c o\ O ll r(I)li lrl o ^o09 E.eF uo\ \o t o.& >? a- o\ Eo? $E U8i; o ,i al "b'3aa- ct r! qo a-q ! = 6E = E->.b;a>, L I I -f I i f\ 5 c- \o r- C.f c\ o\ c$ o\ doa =CU i .D-o' -v ol c.l o, 3+ € c..l c..l o\ () h0 : 5 o .: c E E o(J oo6 =q -.rdq>-6) A\ O Y !;3€ *d ,A=E3ll -ooo \o o OI r- ct € O cl al o'. c at F- o, € o. o\ o\I N N (\ a.l a,l + N a.l d r! aa 2.7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - Qtlease tick the appropriate answer) MOH N WHON UNICEFtr IFESH/UNIVA Other (please specify) Mectizan@ delivered by - Qtlease ticfuhe appropriate answer)MOHtr WHOU UNICEFtr I IFESHruNIVA Other (please specify) Please describe how Mectizan@ is ordered and horv it gets to the communities IFESH /UNIVA ordered through NOTF, later supply MOH according to their request. IFESH / UNIVA fbrwards completed Mectizan Application form to Mectizan Donation Program through the NOTF. On approval, consignment is received through LINICEF and supply is made to the state Ministry of Health on request. How it gets to the communities. State Coordinator collects Mectizan frorn IFESH Field Officer to replenish state store. LG Coordinator applies for total required by the Frontline Health Facility Staff. and tnake thesc available to them. CDDs finally collect the needed number of tablets tbr the communities. Table l0: Mectizan I Number of Mectizan tablets red 0 ,/ How are the remaining ivermectin tablets collected and w'here are ther kept'' LG Coordinator retrieve left overtablets and distribute to other contnrttnities. btrt Strtc distribute to static centers fbr clinic base. ./ List and briefly describe tlie activities under ivermectin delivery that are being calrietl rrttt by health care personnel in the project area. - Requisition, Collection and supply to endemic communities. - Keeping of Mectizan lnventory. - Updatlng Registers and supply of Mectizan. - Notification to the community of availability of drug' - Monitoring and supervision of Mectizan distribution. I If I I 0 0 0 0 0 0 .l 0 0 * Used LostRequested Received State/District/ LGA 74.8s2 lJ100,000 100,000Abeokuta-North 93,767 I100,000 100.000Abeokuta-South 100,000 66,762Ewekoro 100,000 lfo 5 8,61 8 98,644Imeko- Afon 65,000 l 15,500 0 2 0 0 0 0 I Waste 0 0 I 15,500 65.000 I 15,000 ll4.l24Obafemi/Owode I 15,500 I77.846Odeda 100.000 095,7 53Yewa Nofth 100.000 680,366 7796,000 r 00,000 100,000 810,998TOTAL '/ Any other comments . Nil WHO/APOC. 26 September 2003 I 2.8. Gommunity self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the pro.jec't area? Yes If so,Vllten? 2005, but the activity was not implemented due to lack of fbllow Lrp by tlic health workers. Table I l: Community self-monitoring and Stakeholders Meeting (Add rows d neededl Describe how the results of tlie community self'- monitoring and stakeholders rncctings havc affected project implementation or how they would be utilized dLrring the next treatment cycle. District/ LGA Total # of communities/villages in the entire project area No of Communities that carried out self monitorins (CSM) No of ComrnLrnities that conducted stakeholders meeting (SHM) TOTAL I 23 WHO/APOC. 24 Nor ernber' 2(X)4 2,9. Superwision 2.9.1. Provide aflow chart of supervision hierarchy. FRONTLTNE HEALTH FACILITY STAFF COMMUNITY DIRECTED DI STRIBUTOR 2.9.2. V[4tut were tlte muin issues identificd during supervision? ,/ lntermittent posting of statf at health facility level resultecl to lach ol-corrtinuitr, ./ Integration of CDTI activities into PHC and WES Programme at Local Government Level. ./ Lack of release of counterpart funds '/ Lack of adequate census update 2.9.3. Was a supervision checklist used? YES DIRE CTOR STATE COORDINATO R & SOCT LG COORDINATOR & LOCT 24 WHOTAI']OC. 24 Nor cntbcr ltt(t-{ 2.9.4. What were the outcomes at each level of CDTI implementation supervisionl State Level: - - Empowerment to the LOCT Staff fbr proper recording in summary fbrn-rs anci subtntsstott at the right time. - 8 Local Government PHC Coordinators were sensitized and improved on CDTI monitoring. LGA Level:- + CDD now report to FLHF Staff at appropriate time Community Level: - > High commitment towards Mectizan distributior, by opiniou leaders. > CDDs are ready to update their registers. 2.9.5. YES. Was feedback given to the person or groups supervised? 2.9.6. How was the feedback used to improve the overall perJbrmunce of tlte project? * Total nurnber of people treated increased over 3RD Round Treattlent. .:. FLHF Staff developed interest in CDTI activities. .1. Improvement in submission of summary forms by FLHF Staff. .:. State received reports tbr the f-rrst time during the monthly meeting lr itlr LC Coordinators. 25 WHOiAPOC. 24 November' 2(X)4 a SEGTION 3: Support to GDTI 3.{. Equipment Table 12: Status of equipmenl (Please add more rows if necessary) Status of equipment (Please add more rows if necessary) Source Type of Equipment APOC MOH DISTRICT/L GA IFESH/ UN IVA Othe rS Condition of the equipment * Please state l. Vehicle Stolen I otd 2 Nil Functional 2 2. Motor cycle Functional 8 Nil Functional 8 Functional J 3. Computers Functional I Functional I Nil 4. Printers Written 1 Functional I Nil 5. Fax Machines Functional I Nil Nil 6. Air Conditional Functional 2 Functional J Nit a) Lap Top Functional 1 Nil Nil I b) Generator Functional I Functional I Nil c) Bicycles Functional 0 Nil Functional Nil d) Public Address Systern Functional 4 Nil NiI e) Television 20" Functional I Nil f) Money Safe Functional Functronal I Functional 2 g) Refrigerator I Nil h) UPS Functional 2 Nil i) Stabilizer Nit 2 Functional j) Photocopier Functiona I I Nit k) Slide Pro l) Storage Boxes Functional FunctionaI Functiona I I 4 Nit I I LllFunctional rn) VCR I Nil n) Over Head Proiector Functional I Nir Nil o) Writing Board Functional I Nil Nil p) Information Board Nir Functional 2 Functional I Nil Nit Nrl Nil Nil Nit Nil I i Nit Nir l *Condition of the equiprnent (F:Functional, CNFR:currently non-tunctional but repart'able, WO:Written off). 26 WHO/APOC. 24 Nor,ember 1004 -+ IL -* -i How does the project intend to maintain and replace existing equipment und other muteriqls? The project intends to maintain and replace existing equipment with the State Counterpart Contribution and support by IFESH/UNVA. 3.2, Financial contributions of the partners and communities Table 13: Financial contributions by all partners for the last three years ,/ If there are problems with release of counterpart funds, how were they addressed'? GCCC is often approved and released. Additional comments 3.3. Other forms of community support Describe (indicate forms of in-kincl contributiotrs of cortuttuttities rl un:') - Purchase of more register nrrtes tbr rcgistration t'rf the popttlation. - Venue allocated fbr trairtirtg t.c. Palace. I on n Ilall. Contributor Year 3 Yetr 4 TOTAL Cash Budgeted (us$) TOTAL Cash Released (us$) TOTAL Cash Budgeted (us$) TOTAL Cash Released (us$) MOH (Central + Provincial/State) 52,860 52 ?( 0 60.340 rs,680 LGA 25,000 5,600 20,560 r0,200 Local NGDO(s) ( Church Society) Nit t10 Nil 98 13,250IFESH/UNIVA 35,000 15,650 25,415 Communities APOC Trust Fund Not ,!l!Qts 57 ,415 I 45 r zs.ooo I I Not qr"rantified 82,030 Not q Lranti fi ed 0 TOTAL 15,7780 113,949 16'7,',785 39,228 27 WHO/APOC. 24 Novembcr 2004 t3.4. Expenditure Per activitY ,/ Indicate in table 14, the amount expended during the reporting period for each activity listed. Write the amount expended in US dollars using the current United Nations exchange rate to local currency. Indicate exchange rate used here_$_l:N 132- Table l4: Indicate how much the ploject spent lbr each activity listed below duling the reporting pelrod * SEGTTON 4: SustainabilitY of GDTI 4.1. Internal; independent participatory monitoring; Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period'l (tick any of the following which are applicable) Year I Partici pator) Ipdependerrt rtronitorirtg Mid Term Sustainabi lity Eval uation 5 year Sustainability Evaluation lnternal Monitoring by NOTF Other Evah-ration by other paftners Activity Expenditure ($ us) Source(s) of funding Drug delivery from NOTF HQ area to centra I collection point of community Mobitization and health education of communities Training of CDDs Training of health staff at all levels I Supervising CDDs and distribution I I Internal monitoring of CDTI activities Advocacy visits to health and political authorities IEC materials. Summary (reporting) forms tbr treatment Vehiclesi Motorcyclesi bicycles maintenance Maintenance of Office Equipment (e.g. computers, printers. Photocopier etc) TOTAL Total number of persons treated 186 3052 I58r 3 800 2800 3640 2030 1020 450 4766 2680 26,005 243,71',7 If tsil/1. rNI\"\ IFESII/I.]NI\A M()II II.-ESI I/I IN IVA MOil lf usil't \ t\ \ MOI I LGA. II I,SII MOt-t .t[.'l]sll MOI I I (,,\. lFIrStl/t lN IVA MOI I IFESH/I INIVA l.(rA. MOil t (i\ ll l.sirl'"i' r lvlOlI. Il'l.,lil'. 28 WHO/APOC. 24 November 2()04 4.1.2. What were the recommendations? STATE LEVEL I Ogun State should have written year plan with a section on onchocerciasis control r CDTI data at the State Level should be consistent with those at lower levels, that is. with the LGA, FLHF & the community o LOCT and FHLF staff should be empowered to train, monitor and supervise the levels below them . SOCT, LOCT & FLHF staff should carry out targeted supervision and provide adecluatc reward for performance. o The GCR shoLrld approach 100% LGA LEVEL o LOCTs with other LGA staff (PHC coordinator, Supervisory councillor for health. etc.,; should in a participatory way draw up integrated plans and budgets fbr the health programs to be implemented at this level. o The Oncho focal person is reposted to the LGA Headquarter to oversees CD'II ae tir rtrr:: in all Health districts. r LOCTs should develop Order forms for Mectizan request, incorporating sufficient details frorn FLHF and community request. i HSAM should be properly planned to address issues relatingto progranr irttplenrcntatitrn and most importantly fund raising o LOCTs with support frorn SOCT shoLrld intensify advocacv towards L,GA aLrthorities with regards to funding CDTI activities. FLHF LEVEL r The Project should organize managernenttraining fbr F[.HF staff involved in C'D'l'l with ernphasis on integrated planning, targeted supervision, record l<eeping. & Mectizan ordering (especially Mectizan inventory). o A ll trained FLHF staff need to be trained on CDTI and encouraged to see it as part ot' their routirre duties I Higher levels should ernpowerand encourage statf at this level to initrate actrvrtle\ particLrlarly with respect to planning and conducting CDD tratning wrth little ()r n() urput frorn the LOCTs o Training of CDDs should fbcus on identified needs (lack of skills in certain area\ ()r' nervly'selected CDDs) COMMUNITY LEVEL . Community leadership should be involved in the planning of CDTI activities o Community members should be sensitized to take ownership of CDTI at tlris levcl rathcr' than being passive. . Cornmunity to select CDDs and provide support to the CDD during his/her dLrties o Treatment should be appropriately and timely reported to FLHFs r CDDs should be ernpowered to prepare treatment reports and retain copies at the community level. I Communities /Community leadership should be sensitized to see CD'f I as their ou,n programme and that it is their duty to provide support in either cash or l<ind to sLrpport Ihe distribution process I 29 WHO/APOC. 24 November 2004 tr Selection of adequate number of CDDs to avoid one CDD treating in other communities outside their own o CDDs should update their census to accommodate ineligibles. a A more realistic census update needed to be immediately undertaken to address the shortcomings occasioned by the underestimated denominator so as to deternrine the Therapeutic Coverage Rates (TCR). 4.1.3. How have they been implemented? I Sustainability work plans for State and LGAs have been developed o Efforts have been made to ensure 100% geographic coverage. but this was hindered by presence of communal crises. r The State 1s empowering the LGAs to initiate and irnplernent CDI'l activitics. and is encouraging the empowerment of lower levels. This will be pursued in the tbllowing year. o Advocacy for counterpart funding is on, and there are plans to utilize the assisting NGDO to mobilize the Deputy Governor to ensure increased firnding by LGAs. r The project is pursuing greater involvement of FLHF and encouraging paradignr shifi. o Community rnobilization is being pursued by SOCTs and LOCTs but a militating f-actor has been inadequacy of funds. The project continues to encourage FLHF to devote morc time to community mobilizatior-r. o Literate CDDs are being empowered to summarize their treatments, br,rt they see thls a\ an additional responsibility which they are unwillingto underlake in tlre absence of incentives. t Communities are being rnobilized to select more CDDs, but more time needs to be spcnt with community mernbers to ensure they understand their roles and responsibilities so that the issue of incentives can be resolved. 4.2. Sustainability of proiects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting periode _No- ,- Was a sustainability plan r,vritten? Yes When was the sustainabilitl, plan submitted? _July 2004_ What arrangements have been made to sustain CDTI after APOC funding ceases in terms oI? 4.2.1. Planning ut ull relevant levels. After the evaluation stakeholders were invited to a planning and debriefing meeting where tentative 3-year work plans were developed for both State & LCA levels. T'hese will later be refined for each year. 4.2.2. Funds release The State government has a history of releasing counterpart contributiorrs. This is expected to continue. Some LGAs have been releasing funds bLrt others have not. a I 30 WHO/A PO('. 24 Nor crrbcr l()0-l Efforts are being made to use the Local Government Department and forum of LGA Chairmen to lobby those that are not releasing funds. 4.2.3 Transport(replacementand maintenance) Using the counterpart funds released by government transport will be maintained. There are instances where old vehicles in the department are released for CDTI activities. IFESH/UNIVA is supporting with 2 vehicles. For replacement the project expects APOC to come to the rescue. 4.2.4. Other resources The project hopes to mobilize funds from government at all levels for the procurement ofneeded resources. 4.2.5. To what exlent ltas the plan been implentented Over 70%o of planned activities for the year has been irnplemented 4.3. lntegration Outline the extent of integration of CDTI into the PHC strLrcture and the plans fbr conrplete integration: 4.3.1. Ivermectin delivery mechanisms There is a sharing of transport and storage facilities for lvermectin. This is morc pronounced at the LGA and health facility levels. 4.3.2. Training Programme staff benefit from joint training such as RBIVI, NPI. HIV/AIDS. TB/LEPROSY and Health Education Progranrtnes. 4.3.3. Joint supervision and monitoring with other programs Usage of Programme logistics for other health activities and usage of NPI rrotorcyclcs for CDTI supervision are the vogue within the project area. 4.3.4. Release of funds for project activities Funds release follow the normal channels within the Ministrl 4.3.5. Is CDTI included in the PHC budgetr CDTI activities are reflected in the health plans for thc Statc and LCAs 4.3.6. Describe other health prograrnmes that are usirtg the CDTI structure arrtl how this was achieved. What have been the achievements? Some Community Based Organizations are using the CDTI structures to assist in the Roll Back Malaria[RBM], TB/L and NPI. 4.3.7. Describe others issues considered in the integration of CDTI ) a 3l WHOiAPOC. 24 November 2004 t4.4. Operational research, NIL 4.4.1. Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period. 4.4.2. How were the results applied in the project? SEGTION 5: Strengths ,/ High technical and managerial skills by IFESH. ,/ Interest shown by the community leaders to take ownership of CDTI activities ,/ lnvolvement of churches in Mectizan distribution. ./ Availability of drugs and I.E.C materials for distributiorr in the conrnrunity. '/ High spirit of commitment shown by few health stafTat all levels. Weaknesses ,/ Some LGAs are yet to release their counterpart firnding. ,/ [nadequate logistics CHALLENGES - lnstability of our political appointees/caretaker/transitior-r committees at thc Local Governrnent Levels. - Non -release of fund after severalapprovals by the LG policy rnakers. * Opportunities ,/ Regular advocacy and sensitivity to the decision makels ,/ Targeted training of personnel. (New Staff). ./ lntensification of mobilizatiorr in the comrnurrity. * SEGTION 6: Unique features of the proiect/other matters lnvolvement of churches in the distribution of Mectizan at Abeokuta North and SoLrth through the Church Health Committee. t I 32 WtlOrAl'}OC. 24 Nor cnrbcr lo()-l