Ekiti State CDTI annual project Technical report submitted to Technical Consultative Committe (TCC): May 2002 to April 2003

/ a IIffTI $TAT[ CDII /APOC PHOITCIIII t. _. ORIGINAL : English COUNTRY/I.{OTF: Nigeria Proiect Name: EKITI STATE CDTI /APOC PROIECT Approval year: 1999 Launching year: 2000 Reporting Period (Month/Year): May 2002 - April 2003 Date Re-submitted: January 2004 NGDO perUqq: UIYICEF YEAR 3 ANNUAL PROJECT TECHI{ICAL REPORT Toj TECHNICAL CONSULTATIVE COMMITTEE (TCC) . u lStp2iot ' d.' AFRICAN PROGRAMME, FOR ONCHOCERCIASIS CONTROL (APOC) ,-a'.,1.1* \ 9r: , I .t ( \ /llO/APOC. 26 Septenrber 2003 r ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: country' NIGERIA/LIBERIA National Coordinator Name: Dr./. Y. Jiyo i I( Signature: Date: .... ';,.$:'-;# !i1,A,1 Zonal Oncho Coordinator Narne: Mr. A.O. Joiyeoba Signature Date This report has been prepared by Name : Rufus Obaweya Designation : Stute Coordinstor Signa Date il WIJO/APOC. 26 September 2003 i Table of contents ACRONYMS ................ IV DEFTNITIONS ................. v FOLLOW T]P ON TCC RECOMMENDATIONS... EXECUTIVE SUMMARY............. ..........3 SECTION I: BACKGROUND INFORMATION 4 l.l. GeNERalrNFoRMATIoN........,....... I .I .l. Desuiption of the project (briefly) l. L2. Partnership......... 1.2. PopuLerroN aNo HenlrH sysrEM SECTION 2: IMPLEMENTATION OF CDTI......... 2.1. PpRroo oF ACTrvrrrES............... ..........................g2.2. ORDERING, sroRAGE AND DELIVERy oF rvERMIlclN.......... ............,...... I 02.3. Aovocecy aNo SeNsrrrzATroN...... .................122.4. MoarLrzarroN AND HEALTH EDUCATToN oF AT RrsK coMMUNrrrES..........................132.5. Covr,tuNlrrES TNVoLVEMENTTN DECIsroN-MAKTNC ............162.6. CnpRcrry BUrr.DrNG .........,............19 2.6.1 . Training..... 18 2.6.2. Equipment and huntan resources.... 2() CoNortrotr oF THE EeutptvrENT * PLERSe srA'r-E ........,.202.7. TnpRrnapNrs ................. ................22 2.7.1. Treatmentfigure!;............ ........22 2.7.3. Trend of treatment achievernenlfrorn CDTI project inc'eption to the arrrent lteoy)/2.8. SupeRvrsroN................. ........,........28 SECTION 3: SUPPORT TO CDTI ....29 .4 4 5 .6 ......................8 3.1 . FtNRNctnL coNTRIBUt-toNS oF t'uu pAt{t'NIIRS AND coMl\rlln-r-rn-.s ...... 3.2. OIHSR FoRMS oF coMMUNrry suppoRl 3.3. ExpeNotruRE, pER ACTrvrry ............. SECTION 4: SUSTAINABILITY OF CDTI.. 4.1. INrrRNal; TNDEnENDENT pARTrcrpAToRy MoNrroRrNG; EvnluarroN ....... 4.2. CovvtuNrry sELF-tvtoNIToRING eNo StarpuoLDERS MEertNc 4.3. SustntNagtLITv oF pRoJECIS: PLAN AND sE'r TARCETS (M^NDAroRy Ar yR 3) 4.4. INrsGRn1oN................ 4.5 OpsnerroNAr. RESIIARCT-I... SECTION 5: STRENGTHS, WEAKNESSES AND CHALLENGES 29 30 30 .31 .3t .31 .32 .JJ .34 ...........3{ ill WHO/APOC. 26 Septernber 2003 I Acronyms APOC ATO ATrO CBO CDD CDTI CSM IEC LGA LOCT MDP MOH NGDO NGO NID NOCP NOTF NPHCDA NPI PHC REMO SAE SHM SOCT TCC TOT UNICEF UTG VHC WHO African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Community-Based Organization Community-Directed Distributor Comm un ity-Directed Treatment w ith Iverrnect i n Comm un ity Self-Mon itori ng Information, Education & Cornmun ication Local Government Area Local Onchocerciasis Control Tearn Mectizan Donation Program Ministry of Health Non-Governmental Development Organization Non-Governmental Organ ization National Lnrnunization Day National Onchocerciasis Control Programme National Onchocerciasis Task Force National Primary Health Care Development Agency National Programme on Immunization Primary health care Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Stakeholders meeting State Onchocerciasis Control Tearn Technical Consultative Corlmittee (APOC scientific advisory group) Trainer of trainers United Nations Children's Fund U ltimate Treatrnent Goal Village Health Committee World Health Organization IV WI-lO/APOC. 26 September 2003 Definitions (i) Total population: the total population Iiving in meso/hyper-endentic communities within the project area (based on REMO and census taking). (ii) Eligible population: calculated as 84ok of the total population in nreso/hyper- endemic communities in the project area. (iii) Annual Treatment Objective: (ATO): the estimated number of persons living i meso/hyper-endemic areas that a CDTI project intends to treat rvith ivermectin in given year. n a (iv) mate Treatnr calculated as the maxirnum nuntber of people to yper endenric areas within tlre project area,be treated annually in meso/h ultimately to be reached when the project has reached full geograplric coverage (normally the project should be expected to reach the UTC at the end of the 3'd year ofthe project). (v) Therapeutic coverage: number of people treated in a given year over tlre total population (this should be expressed as a percentage). (vi) Geographical coverage: number of communities treated in a given year over the total number of rneso/hyper-endemic conrrnunities as iderrtified by REMO in the project area (this should be expressed as a percentage). WHO/APOC, 26 September 2003 FOLLOW UP ON TCG 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 17 Number of Recommendulion in lhe Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/ APOC MGT U$E ONLY 258 The role of the village health committees The VHCs, rvhere firnctional, perfornr the following functions: programme implementation at cornmunity Ievel at cornnrunity level '/ Assess, identify problems & proffer solutions ')/ Specifically on CDTI. they send inforrnation where shortages of Mectizan occur. give support to CDDs, effbct CDD changes rvhen needed. and shares reactions (positive & negative) with health personnel Without the VHCs involvement no health programme is successfully carried out. 259 The ternrinology 'ATO' and 'target population' are used interchangeably, and no UTG is given. The total population in the endemic areas is not mentioned. The ATO and total popLrlation are given in tables 8 & 10. The project is yet to deterrnine the UTG because the total population figures need rupdating. A cornprehensive census update is planned tbr last two rveel<s of February 2004, with funds frorr UNICEF. Thereafter a realistic total popLrlation will be ltnorvn and the UTG deterrnined. 259 The number of CDDs is still very low (63 l: I ) and TCC recornnrends an increase of CDDs The training data on the report is erroneous. They are actually an update of Year 2 training data. The Year 3 training rvas carried out after the distribution dLre to Ltnavailability of firnds. 2,518 CDDs u,'ere trained bringing ratio to 400:l . The project will continue to encourage communities to select lnore CDDs. 260 Total population should be stated and the therapeutic coverage calculated for the past 3 years based on the These have been addressed in the report. See tables 8 & 10. TCC is invited to note that a rnajor census yp4gte is being scheduled for WllO/APOC. 26 Septernber 2003 total population instead of ATO. Furlher, allthe indicators stated in TCCI4 should be given in the report. February 2004 TCC session l5 TCC session 13 2 Nqmber of Recommendation in lhe Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/ APOC MGT USE ONLY 80 Clarification on 8oh decrease in treatnrents provided in 2000. At the end of 2000 treatments stood at 498,127 over the 330,8 I 8 persons treated in 1999. 80 Clarification on the UTG ofthe project Already addressed 80 Project should reach firll geographical coverage Efforts are being made to achieve firll geographic coverage by the 4tl' year. Reasons for not reaching full coverage are highlighted in the report. 80 More CDDs to be trained in 2003 2,518 CDDs were trained /retrained in 2003. Communities are being encouraged to select more CDDs, but they are reluctant on account of incentives to be given Nulnber of Relommendation in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/ APOC MGT USE ONLY 38 Clarification on ATOs for the upcoming years as ATOs given in the original APOC proposal for years 3 - 5 exceeded total population given in this report The figures given in the Appendix I of the proposal were estirnated total populations to be covered. We have seen about a9Yoincrease in the total population for Year 3. A better and more realistic figure will be obtained after the censLrs update 38 Clarification on the total population of the 416 endenric communities (is it 625,303 or is this figure the ATO for 2001 ) See treatment over the years, table 10 38 Cost per treatment not estimated Orr firnds released by all partners, cost per treatment stood at $0.25 38 I LGA staff needs more sensitization to ensure good reporting and involvement This is being done, and the project intends to bring more health workers into the programme. This will reduce the burden on LOCT leaders, who are programme officers for NPI. (Plea.se add more rows if necessary) WHO/APOC, 26 Septernber' 2003 Executive Summary Prepare an Executive summory of the report in not more rhan one pqge Elciti State, located in the south western part of Nigeria. u,as can,ed out by presidential fiat frorn Ondo State on October 1996. it covers an areaof approximately S,5b0 square kilometers It has a bioclimate of rain forest in the southern area and Guinea Savannah in ihe northern parts. The Yorubas constitute overwhelmingly the rnajor ethnic group in the State and it is mainly the indigenous population. With a current projected population of about 2.9 million the State is divided into l6 LGAs. Population trovements occur in rnigration fiom rural to urban areas in search of better Iivelihood ortemporary relocation to farm areas during the cultivation and harvesting seasons There are 344 communities that are endemic for onchocerciasis and the target population is 1,006,019 persons. Within the reporting period a total of 741.596 persons were tieated representing a74oh therapeutic coverage ivhile 334 communities were covered. The latter represented a 97o/o geographic coverage. A total of 2518 CDDs were trained dr-rring this third year of project implementation representing 75o/o achievement of the training objective of 3,360 persons. A 100% achievement was recorded with regards to training of health worl<ers rvith the training of 60g persons. All the State Onchocerciasis Control Tearn mernbers were trained specifically on record keeping, report writing and effective use of monitoring ancl supervising chechlist. The constraints/challenges facing the project include: Lacks of adeqttate conrmitment by LGA Coordinators particularly in return rendition, supply of vital and urgent information as demanded by,the NorF secretariat. Few communities are giving incentives to their CDDs. Lack of updated census population figures to measure correctly treatment.or.rugj rates. Scarcity of petroleum product last year. Inadequate number of bicycles fbr supervisiolr J WIIO/APOC, 26 Scptember 2003 I SEGTION 1: Background information 1.1. General information l.l.l. Description ofthe project (briefly) Geographical location, topography, climate Ekiti State, located in the south western part of Nigeria, was carved out by presidential fiat from Ondo State on October 1996. it covers an areaof approximately 5,5-0d square kilometers It has a bioclimate of rain forest in the southern area and Guinea Savannah in ihe northern parts. A greater percentage of the landrnass is made up of rocks and mountainous regions. The rains commence in Apriland ends in October, ',vhile the dry seasons starts from October ending till March. Pop ulatio n: act ivil ies, c u h ures, I tng uage The Yorubas constitute overwhelmingly the major ethnic group in the State and it is mainly the indigenous population. However, individuals from otheiethnic groups such as the Fulanis. Igbiras, Agatus, Igbos and Hausas have rnigrated into the State unO ui. cohabiting with the indigenes. With a current projected population of about 2.9 million the State is di-vioed intol6 LGAs. Settlernent pattern is compact witlr population densities of between 2g0 - 350 persons/square kilometer. Farmsteads exist but thet,are seasonal. Communication system (road...) Roads between major cities are in good condition. but access roads to nrost of the endemic communities are in poor shape. Some are not passable during the rainy season. Despite this transport by road remains a major rreans of communication arnong the communities. The electronic and print media are also veritable channels of communication. Within the communities the town criers and announcements in churches/mosques are preferred means of communication. Ad mi n istrot io n str uct ur e The State is made trp of l6 adrninistrative units l<nown as local governrnent areas. Each LGA is headed by a Chairman, usually elected, who is assisted by career officers. There is a legislative arm made up of elected councilors fi'orn the various rvards that rrake gp each LGA Beneath the ward level are the communities. At the State level, the Governor is the chief executive. and he is assisted by an executive council rnade up of commissioners in charge of various ministries. There is a legislative arrl comprising elected persons from the LCAs. Health system & healtlt core elelivery (provicle the number of health posts/centers in the project area dthe information is available) There is an official PHC policy and structure in the project area. It is a system of health care services where comnrunity parlicipation fornrs the nrainstay rvith support fi.orn the State, Local Government and NGOs. Levels of functionalitl,hou,ever var),across the State. Scattered throughout the State are various health facilities ranging fiorn health posts to hospitals. There are 552 health facilities in the project area. l \,\'FIO/,APOC. 2(r Seprermber 2003 1.1.2. Partnership Indicate the partners involved in project implementation at all levels (MoH, NGDOs - nati o n al, i nter nat io nal) The partners involved in project implementation within the project area are UNICEFNigeria, NOCP (National & the B - Zonal offices). the State Government, the various Local Governments and the endemic comrnunities. Describe overall working relationship omong portners, clearly indicating specific areas of project octivities (plonning, supervision, odvocacy, planning, mobilization, etc) where all partners are involved. The State and LCAs through their various units are involved in training of field personnel, community mobilization & health education, management of side reactions, planning and management of project implementation, supervision and monitoring, and Mectizan procurement and delivery. UNICEF is involved in supervisory, advocacy and training roles and assists in logistics provision. TheZonal and nationaloffices assist in supervision, monitoring, training, advocacy, Mectizan procurement and evaluation of the programme. The communities paly such roles as selection and remuneration of CDDs, collection of Mectizan, determination of mode and period of drug distribution, census update, Mectizan distribution and recording and reporting of treatrnents. Stote plans rf any to mobilize the stute/region/district/LGA decision-mokers, NGDOs, NGOs, CBOs, to ussist in CDTI implementation. A nationwide election into positions in the LGA will take place by early 2004. New policy lmakers will be enlightened and rnobilized to support CDTI activities. iWithin the reporting period Drivers' Union and Market Women Associations were mobilized and efforts will be made to re - rnobilize them. The project also used the rnonthly rneetings of Olori.s (the wives of the traditional rLrlers) to rnobilize tirem for CDTI. This will continue in order to get thern fully involved. A CBO with the Oloriof Eyvi as President will be mobilized as well as an environmental based NGO which approached UNDP for funds to support CDTI. The project additionally intends to approach Island Club and Rotary International (State Chapter) to get their assistance for CDTI. 5 WHO/APOC. 26 September 2003 F = OE =a- = ltv ro -oo .= eN ( UE o:: -.4.:E >,'t u o *i=o N: :-: t= ._r : 3xLt oo co ('..1 ooO o] +(..l t-- -j- OO \c)\o co + O aa\o c.l N O o'. q @ co co d$ c\ $+ 00\o O Ir- t-. OOC\ r-r oo O ca OO O $ co O @ oo tr- I oo C\ aoN $(a o, \o .o- w aa O fa o\ o, aa O \o @\o O t-- sf a.l =$n o.l ca oo !f, O a- cat $ tr- O cn N aa t-- -| Os Ra\o c\ @ OO O t-- \o\o N $ .i- ra O .:o E9 otr 'r. 6N E:O iec tr.=!i?oU o:L e''G L O c}N Gq F q) z aa -i cl @ (-.1 (-l aa c.l al ca t-- .J =t O c.l O C. \o O o\ a\ N oo c\ N +(.1 al O N N $N oo o\ 6trg 9Yt o il o.aX ?o 9'vU-L L ^- ^ co oo No F--J O \o O O. \o oo @ co. O 'f, c.l \o O$ n @\o O t-- OO F- c'l tr- O @\o OO O O O gY" .: e.-!c8,.q'' a Q ',=q-LH< g c bJ E U :E .:Z ul o ,a ul oa ,' U dq :zt! o '.= :zt! o L t! o -oo ,a o o o() () o .v o C) o o () .d. E()g o .() a.l o -o E o o- oa N o o aJL ^:! F AJbfi ae s .9 L()o bo .E o c-() L o bo 'T o L o 0) (J L OL 6J OJ L o (.) .C q) a() 0,) o a) .E -th .E o =o oo :\ '1, -, dv a4Oer .: qJ =\\ c :., L) s- "l (JI 5l GIFI E oJq >tq EIJ d o -.t E q tr o +, c, Jq 0r N F \o al U -o E 6) o-o A) \o al ,J o o- c bo ,C\s'= .\J: i\ .it-a \SVULt..?iqJE\*aqor=s\c = s f "; -{ } cc- -\6e 'h q,i = 4.,d\ * s l?o_rE s x:Pa-v; s tE - E,- \' 1 d=E a o'=E-J.-(* .:xsortr x Hv O-Q ! (.t J 9s- \: o'/')i\ H' &1 aEHs E ! 'iv, *t' t ? ?'=\a t : .,,?ua ^ l oE;i=- ='E Ed.: .. :, S O >1ss H i :; :h o t A dSi E ! d3tI .2 !J oj .ce .2 s € ii a = - .. (Jrt tr s tESp ob s C ' Sc E S P E ss g u -.=!H : E fEt!.=SiL ^-'-PSs .! : )os\ (6 : 7 !EP I 1i i=ii ; s :;sb- u J -uo uis i $ tt :is U = i!' i ss g s ;E i. <9E->.EE ^$Avd- -89''=I=(!\ S\ 6 : ei E *+ 3 i =s S:s o P I d \{! 2 : oci i. =i S 6Joo O' =o!\trcs\ E 6) $ E H Ss! - \ q.= Q =I" : e se E'= i o \ a)- =si E YF rE erI -8 s: ;; s-s$ E Si ei SST = =S 'r \.39- ' c\ .29 : iE = \S -tr? \ ,it' .: EE rrS U t O E<s F 05 -t ) (o o L H Q q 6 z LL r- oO \o ra o, s\o o\ \o C' ca c.l N c\ \o\o o\ +N (-) 6l6l ?a F-\o\Nt+ t--NN oi(a o\ r- ?o6\o (\ c-l a.lN v!+ ra) \o 6 F. \o r)\o(\ O \o CN o, $\o o\ \o (g -o (.) J F F SEGTION 2: lmplementation of GDTI 2.1. Period of activities Inserl PIan of actiorr indicating activities bv rronth. whiclr rvere inrpleprented 8 WIIO/APOC. 26 September 2003 C.l Lo -o E C) o. 6)(n \o c.l O o rn CU oo .E (n L< E EL o .-jF6t-> g o.lC)E _Oe L 0EE.n(ggB 9- 6-o oo _t L! C)(, -oE 12 oo9q _0= JC)otr dn eit €* *- ,r, q, ,ao:-troEx OO.= -!trd -(n !.: .9e c) u) -(gF, .oE Ho a,a o-o o-=LA -=90, oo€ a()EoE '=(U oo= 'Ea .; CJ F(dIt(J (r) o E (-) I o, EE (, J o- J I 3- J a l J ! ..,] a o- d, J a q J J J a, o- q) l- 0) (nl UD 'l' tr (t) - o.l 2 eFHE(, ccr!t! ) tL & q r!L LJJ f, t!II ) tD tL f, a till- l& c0 t]-lir d ) m Ll.') IL d f c0 ttltr ) d. cnI! a d :l m r!t! f, a L!IL d, f, co rll IL )d c0(ll I! )d q r!II0 ox ODEE 'ti tr a- Faf,(,) Fa) Of, Faf, O) Fa)(,) F U))(, f, Fa) O) F U)f,(,) Fa) Of, Faf,(, f Fa)(, f Fa) Of, Fa) O) Faf, of Fa)(, f Fa) O) Fa)(,) *oEE U f q r! d, f, ca tJ. f, a q^ tL &. f, u L I'l TL il. L! tL d.) a TL c f, ! rr.lqL fd I r! tL ) d, at! tL ) d, q r! r f& @ qfr f, c0 lrl d f t!fr 3 c0 q IT ) cn lJ.]f! .x q) v) o c) U b.0trE a- Fa) Of Fa) O :) Faf(, f, Faf, af, Faf(, f, Faf, O) Faf,I Fa)(,) Faf, o) Fq f Fa) of, Faf,(, f, Fa)(,3 Faf, o) Faf,(,) F U)) O3 *o trE U :l J f J J) J) :) Jf ! Jf, J) Jf, J) JJ J3 Jfu( C! F bn a- tll z tr.l ZD t! Zf, lJt zf, t! Zf, i! Zf Ld zf, rr.l zf, IJ.,] Z) lJlzf, rl]z) !.)Zf, tLlZ) LDZf t!z3 tlJzf, U -lf J) Jf J3 J:) Jf Jf, If Jf, J) J) JD J3 -.]:)J) J) ADEE 2 2 .= .-eE ii= Fr9a J O a E V t:l o ! z o lL ol Fa F) oa E V trl F(ia Ld Et[] r!) t! Z z o 6 o o! o L! L]j L! Y LdJ o Y zf,& r!a r! i! r! ql J Z3 o oJ LUq z) o t! 4 c0 o t! o rl F F (J AJ q: \ \ 1- .: S) +a q)LL (,) () *i t(D (6 ol+ ,h s() 0, & .o ,^ o (-) ! (, 0) F Nl dJt -ol FI 2.2. Ordering, storage and detivery of ivermectin Mectizan@ ordererl/applied for by - Qttease rick ttte oppropriote answer) MoH/NocP {I wHotr uNrCBpI NGDOtrOther (please specify) Mectizan@ delivered by - Qttease tick ttrc appropriate unswer)MOH.E wHon UNICEF- Other (please specify) NGDOT Please describe how Mectizan@ is ordered ond how it gets to tlte contmunities The quantity of Mectizan@ required by the project is calculated based on treatrnents and totalpopulation frorn the lastcycle. NOCP processes the data after receiving inforrration from other UNICEF - assisted States and submits re - application to rhe H,{op. on approval thedrugs are shipped to the country and UNICEF facilitates clearance and storage. ih. Strt. o,^the Zonal office picks up its consignment fiorn NocP and releases to the LdAs through theLoCTs' LOCTs release drugs to the district health supervisors or the health facility staff whoin turn make thenr available to the communities. FLOW CHART OF MECTIZAN DELTVERY Reporting flow UNICEF/ Nigeria I Delivery process MDP NOCP Zonal Office STATE LGA District Health Facilities Communnities l0 WHO/APOC, 26 Seprember 2003 Table 3: Mectizan@ Inventory (plea.s'e adcr more row.s if neces,rary) State activities under ivermectin deliver.t' thot are being carried out by health care personnel in the project area. The health personnel at the various levels have been responsible forthe following Any other comments State/District/ 4GA Number of Mectizan tablets uested Received L.rsed Lost Waste Remai Ado Ekiti I 150,030 r50,030 149.999 3t Efon I 105,000 r05,000 10s.000 Ekiti East 180,000 t75.040 174.998 42 Ekiti South W 140,020 140.020 140.000 20 Ekiti West 120.000 117.520 117.498 22 Emure 60.000 s2,500 42.703 9797 Gbonyin 1s0,000 140,01 5 139,996 19 Ido/Osi r60,000 r s0,005 139,996 t2 Ijero I 80,000 157.930 157.905 25 Ikere r60.000 157,530 144.991 32 Ikole 105,0 r0 r05,0 r0 r04.989 ll Ise/Orun r60,000 r60.000 r59,998 2 Ilejerneje 100,000 87.500 87.494 6 Irbpodun Ifelodun r 10,000 r 05000 r05.000 Moba 160,000 r60.0 r0 I59,998 l6 oye 150,000 t40,020 139.978 22 TOTAL 2190060 2112677 2t0g,96 2 260 9297 II WFIO/APOC, 26 Septernber 2003 2.3. Advocacy and Sensitization State the nuntber of poticy/clecisiort makers mobitizecl at each relevont levelduring the current year; the reasonsfor the sensitizntion and outcome. Describe dfficulties/constraints beingfaced and suggestions on how to improve advocacy. At the State level. the then State ExecLrtive Council made up of Governor. his deputy, all 8 comrnissioners; the Permanent Secretary, Ministry of Health; Chairmen of LocalGovernrnent Service Council, State Teaching Service CoLrncil & Electricity Board as well as the Secretary of the State Prirnary Education Board attended the workshop organized by the project to mark the 2003 National Onchocerciasis day at State level. Also present at the occasion was the State Cornmissioner of Police & bomptroller of Prisons. The wife of the Governor sent her protocol officer to apologise foi her inability to attend the workshop. The Deputl,ro the Governor riuy.d till the end of theprogramme. At the LGA level several officers/policy rnakers were mobilized during workshops and visits to the various LGAs. See table belorv. These rvere mobilir"i to supportCDTI particularly in financial terms. After the various advocacy activities the Governor approved the sum of one rnillion naira each for CDTI activities and extraction of cataracts. But before the cheques could be processed the executive was swept au,ay in the general elections and a n.* party formed the present executive governor, and new LGA chairnren were appointed. Static treatments colxmenced in sorre police barracl<s and the prisons in the Siate capital, The major constraint in achieving required objectives was the change in adrninistration shortly after the major political players were rnobilized. LGA TRADITIONAL RULERS OPINION LEADERS RELICIOUS LEADERS MARKET WOMEN ASSOCs. OTHER CBOs Ado Ekiti J l0 1J 8 5 Efon J 1 I r0 I Ekiti East 2 t1 5 8 1 Ekiti s.w 3 6 4 4 I Ekiti West 5 t4 4 8 Emure 3 5 6 4 I Gbonyin I l0 7 5 I Ido/Osi I 8 4 5 Ijero 7 t8 5 8 I Ikere I l5 I t0 2 Ikole 7 r8 2 J I Ise/Orun 4 7 I 5 aJ Ilejemeje 2 l0 3 r3 I Irepod/lfelodun 4 12 2 8 2 Moba 4 t5 I 8 2 oye 2 t2 J ) I Total 52 181 55 109 26 t2 WHOiAPOC. 26 September 2003 There is need for high leveladvocacl,visits. The burden of onchocerciasis need to bekept on the front burner for the politicians through: LCA level 2.4- Mobilization and hearth education of at risk communities Provide information on : fhe use of mectia ond/or other rocar q)stems ro clisseminute information The project rnade use of the following rnedia for the irobilization of the endemic communities:(l) Production and airing ofjingles as well health talks on onchocerciasis through the electronic media - Ekiti radio and television. \zt (3) (!) (5) Production and distribution of thousands of IEC material s, particularly posters to the endemic communities. Comrnunity leaders. Tou'n criers - this is the principal means of information dissemination at the community level. Health education meetings tvith comrnunity members by health personnel from theLGAs or CDDs. Vans with mounted public address systems Cultural displays/local drama on Mectizan treatment (6) (7) Mobilization antl heolllt .education of women and minorities - methocl ancl responseWithin the project, there is an active participation of fbmale members of the community at rnobilization meetings, and during health education sessions. In most cases at least two thirds of those present at a session are women. and they talk. Sorne of the women have volunteered as CDDs when those serving expressed unwillingness to continue due to lacl< of incentives. Some women had also had cause to rneet the community leaders over remuneration of CDDsl{hile some gave out money frorn their personal funds to support CDDs. In one particular irlstance. the. wolnen. rnet with a comnrunity - based club to aisist the CDDs, and'they have resolved to be tneeting with different clubs each year to give incentives to the CDDs. There are no problems rvith minorities. Rgs po nse oJ' turget co mmun it ies/v i t I o ges Comrnurrities have responded by'corning forth to collect their Mectizan tablets. Mernbers liave expressed willingness to comply with Mectizan treatment. The communities have ftilfilled most of tlreir responsibilities under CDTI such as selection of their CDDs, giving some incentive to some of them and determination of the mode of distribution. Accomplisltments its continual intal<e over a long period of tirne. the past. is available. r3 WHO/APOC, 26 Septerrber 2003 ll/ e a k n e s s e s /C o n s t r a i nt s commitment and non - invorvement of hearth tbciritl,staff. the community is being denied its fair share. Suggest ways to improve ntobilizatiott of the target comntrutities. (l) Equipping Local Ncos, Market women, Religious leaders, Road rransporr worl<ersand other commtrnity based organizatiorr with necisary nrobilization sl<ills ivill help a greardeal in irnproving mobilization of the communities.(2) There should be regurar meeting rvith the cornmunity readers.(3) The project intends to collaboraie with relevant sectlons of the Ministry of Inform ation/Culture in order to ntake use of appropriate staff rvith skills in community rnobilization. t4 W'FIO/APOC. 26 Septernber 2003 an Lo -o E 0) o. OJa \o(\ O - > tz1 \o (-- al o\ C' o\ o'. o.l o\ \o O = \o N \o O =f o\ o\ o\ t-t Y Ir-\o o\+ o\ta o\\os s o\$ a?u ei. bl1o =,4= za> o? qd .-! rO 9q qM I; oil) ao o co oo a.l O 00 @ co \a) o.l oF- @ a.lN t-- t-- = oo O r-- c\ O = O F c\c\l t-- oo \o r- o\ @$ 6 ia al O(\ \o O O$ o. a- \o C'.lO ol O ON co N oo € c{ \os6t o =-(!, a? 9E!E 7_ lt- F oP 2l) a- O;: oo \o 00co @@ oo NO N O CO o\ N ooON c.l Nt- \o \o c.l c.) (\lF-6l(\I OU] =0 o t* c!c0 c0 \o O \o F- oo o\O o\a.1 tr- ro OO o\OO o\O -J o\ .+ o\ r--\o \o F-\o \o F- c-'l o\ \o o\ o\ t-- o\ o, o\ oo\o s w a =_ >,2 ? g E5 i =^u=Z"e'a aa O oo ON O ON co N r) oc{ o\6l go6 fi 6 .iLEO tre ve 7.e =0.- o tr.i oo -aou aC- :tru oo O O c.l N (...l r)al ON O aa c.l €(\ Na.l Nc! !f,t(f) o\O o\ (\\o .\ -J v-l N\o o\ a.t .i- \o $ o\ an$ \o r) o\N$ o\ o\ \o .o o\ N * \o $ o\r)$cD ,l I 9U X -v za o OIJ oI o ll + co@ (..l al (.l l.o 6\ N o\ a\ c..t N c\ N N v-)c't N lalN N N tnN s €$ v q F L Z. iG L r d O- 4=--\r €tio F= O O$ -f, O$ \o r) O\o O $ \o r) \o a?o6 -] 'L- Jr! ,a LlJ t! "=)lt! (n .ts .:z r! u 't i! (-) L t! x o(, o L0):= 0) L 0,)I (.) o -v q (-J 0) o 'd d()'l -l e ! o-l6)tLI -l -oo J F F q) Uq) q \ q) o ^d V) U F oO o o 0) .: E o() E, E J(! EI E 0t- o a-(, o?t .1.f o E(!i o ,s o .g *, L J E E o o r, N Commenl on: - Attendance of female members of the community qt healrh education meetings This has already been discussed - In general, how do you rate the participalion offenrute ntemhers of rhe community meetings when CDTI issues are being cliscusses (afientlance, purticipotion in the discussion etc). This has already been discussed - Other issues t6 \['HO/APOC. 26 September 2003 2.6. Gapacity buitding . 2.6.1. Training The project personnel at various levels conducted informal trainings shortly before drug distribution commenced, but the formal training sessions organized by the prolect was carried out after the drug distribution. This was due to unavailability of fundi. The'results of the forrnal training sessions are presented on the accompanying table. 4t WHO/APOC, 26 September 2003 o.l 0.) E C) o-oO at (-) I aT T hn u e € o .i a) p q qJt * $ t\IG o hn \ o a_ > o u t': -\ tu ! st : Uz * V-)N : \o O\o l-l^ i' l-l *l ..J J oo a.l o, oo t-- co ca \o O a.l $ \o oo N t-I (r) rt N o NO a-l c..l\o O r/^) o.l oo ao NN co A ca N s co O I lr-r i-N : co O : ootr) c'.1N O \o F- : \o O oo OON lo' len : o\ : oo w : 1 oo tr) c! oo : \o N $ \o ao aa q) o q) C) s l,at-O c.l N O N Oa.l O N EilU L\,9'(, '.r. q .6 LF q 0, .aqFF qr' o0l .o LC! z ca r-- aa t-- -: '1 -l O aa (-- aa (r- = aa I t-- I a : tr- :: a- (-- : aa "_l ca tr. = : *] aa (-- aa tr- ca t--. aa c- \o co .f, N q) ae oa) I o O \o ",, d :'!- U U \ = z F c) q) z lK (-I : aa Kl c\ a..lN -] N a.lN ca .:l a\ a.t ca .',i c.l a.l co N ..n N : i,. l"r 1,, ."] : c\ : aa N c.l : aa N N c..l aa I N NN ca (a) a\ C..lI ae : (-'l : ca (r) N N : c.) :l 4.1 c..l co l c..lN aa O .f, N aa co .+ q,) as) e() (J ol c',l (\l C..l N N c.l a..l rr.)(-.l N c.l N v')o.l c.l Ov ?r, d : ra U Q. UF J aGl o z C. aa caaaaa ca I ca co I co I co ca : aa aa ca ca I .a -l- ao :l aa : ca I C. q) q) q) o \! oov oo$ co$ F F J lr.1 'o J ,c trl cJ a rl] :E g.l a .:)l tL,l a 0) .:z L./r!J J() E lJ.J I (, J 't tr o -o(, J 0 - o 'o QJ olLl 0Jl '-l -t (,J oL O IJ q I J C 0)a (, J 0) 'd d) o'l -l o.oLE I OJ -oo ()J o c -, q aUU qJ =o\ \ o .: aJ V) aJ o_ .9 C o E E. E t- U(+- I C) 0) oL .a)q- E() 5 oo ,= ,= LF -i1 o.ll5l(!l F] aOaacaaOcaaa aa aa aa cr o\ (--. O\t O aa I aa U dll Fv v q) U Lq) z Trainees Type of training CDDs Other Community rnembers e.g Community superv i sors Health Workers ( frontl i ne health faci I ities) MOH staff or Other Political Leaders Others (specify) Program management How to conduct Health education { Management of SAEs CSM SHM Data collection Data analysis ^/ Report writing Others (speci fy) Table 6: Type of training unde(aken (fick the boxes where ,specific lraining v,as carried out during the reporting period) - Any other comments 2.6.2. Equipment and human resources Table 7: Status of equipment (Plea.se add more row,s if necessary) Condition of the equiprnent (Functional, Currently non-functional but repairable, Written ofl). * 8 motorcycles written off ).9 {. * Source Type of equipment APOC MOH DISTRICT/ LGA NGDO Others Condition of the equipment * Please state l. Vehicle I (functional) I (non functional ) 2. Motor cycle l6(functional) I5*+ 3. Computers I (functional) 4. Printers I (functional) 5. Fax Machines 6. Others a) Bicycles 50(functional) b) TV set I (functional) c) Video set l(functional) WI-lO/APOC. 26 Septernber 2003 How does the proiect intend to maintain ond reploce existittg equipment arrl other materials? In the interirn the project will repair and maintain all capital equipments rvith the funJsprovided by APOC, supplemented by the little got frorn the State and Local Coverrr;;;;.Efforts will be interrsified to convince governrnent to release counterpart funds for maintenance of project equiprnent and purchase of various materials. The project intends to request APoc to provide a replacement of most of the equiprnent supplied. 4escribe the adequacy of avoilabte knowledgeable manpower at all let,els. There is enough available manpower tbr CDTI irnplementition. The project however needs to train more health facility staff and ensLrre CDTI is part of their routine reiponsibilities. - lllterefrequent transfers of lrsined sltrff occur, state what project is cloing or intends to do to remedy the situation (The nrost irnportant i.ssue is whati,rrasure., y,ere taken to enslre adequate CDTI intplementation where not enough knowledgeable manpou,er ryus available or staff often transferred during the course of the campaign). Staff are usually stable. However, there are plans to train rnore health facility,staff so that the area of coverage will be reduced and supervision enhanced. ,9.,O WHO/APOC. 26 September 2003 2.7. Treatments 2.7.1. Treatment figures J- 4 wHo/APoc, 26 September 2oo3 aa .T o -o Eo o(r) \o ol U o q I $l D.? q -IJ! AJ ? v U\ ^: lu a U a_ .V A) .E t') 0) (o () J .9 ! .9 -o V) r! a () tr 1) LF #1 0 _ol FI L!,1 = ::9( o-'5- t6-e6 2 o 9 ci.= " t,s 26v, a o o o -o E z II I I I I .bu a c us =.-4zod I I I =q ! ONco \o cn I aa tr- rro\co t/.)co N r-l,n i9!= €q b 9 3 o E 2 g,E'E I I I I I ^:- €ULOa- r-- Fe 4,. - --o=o =?nE-.-O = &5z _c.udYa,- 199'J -F-o -uY ts-!c ;qa =Una== u o o r s.o o\ o.la \o t-- \oo\ \o o\A .f, \o A t-- \oo\ v \oo\N(-- .o o\ o\ t-r .o o\$ o\ o\ t-- t-- \Q $ .o o\ N oo .o o\(.n o\ co \o^\ tr- \o F- s\f, r.- N6l ca F-- t-- aa \o\o ..l co co aa $(-r a- $ N co oo C. r.- .t c.l\oaa oo caN c.l ca aO ca .f, o\ o\ co (..l t-- ca \o o\cn$l-. aa =r ta) o\ r/) r+ r- \o NN$ OO \o $ O O aa OO O t--O\o \o aa oO aa aO \o OO w Otr) a..l aO(r)ooaa oo C.\o ra rn €rrl \or- F- \ot--.v co o\ co c! r tr) ca\o co oo co t otr) Nin\o o r-o\I-* O w$ co\o O ao co\o ON F-. rn\o o\ w o\ \o F ; s^ :. b ; brr< - a.= ,a _q =:"9F : .- O 2ad u a Ec \!a 9= - X L * E - >,_. d=! .\'=: c 009 tr _e c d Yt o U G o F = Al o tr tr oU .o6\ O o\OO o\OO o\\oo\ o\O \oo\ OO \o o\ OO o\OO \oo\ OO o\OO \o o\ OO \oo\ OO o\ a .a o\ F- \o 6\O \U F-- o\ Nca c...1a-l tr) v-) N C'caN Nv-) a.lN c..l(..l tf, (f) m ...tC' O c\a.l N a.)N a\ c..lc.l atN $ .a .a c.l ONc.l N OcaaaN C.l a.lc.lcoN C.lc\ $r+ ca :E -v,ttl oT' !/ c a U .E -v-r! OJ = ,O tJ.,l OJ 0)L Er! !,J a 0) :E -v, IJJ a a) (./) !ttl cJ 'i E]ol -olol J() :l J 0)() .V (, J o (J (, J c oE OJ a 'c E()g oJ L - () q (,J .o o =-If o .u '1' o o- O J o c '] 3 3 I I I If the project is not achieving 100% geogrophicat coverage and minimum of 65% therapeutical coverage rale or coveroge rate is fluctuating, stole reasons and plans being mode to remedy this. The principal reason why coverage had not been acceptable is unavailabilitl,of Mectizan This is coupled with inappropriate information on target populations provided by health workers from which project tries to determine its ATO. Effective coverage has also been hampered because of sporadic release of funds rnaking implementation of planned activities difficult. The project is additionally faced with the problem of inadequate mobilization of communities by health staff due to problerns of counterpart funding frorn LGAs. The project personnel has not been overtime well able to supervise dLre to funds constraints. 2.7.2 lVhat are the cuuses of absenteeism? The major issue has to do with ineffective or lacl< of rnobilization of comrnunity members. As such when treatments are supposed to be on - going some of the members rnight have gone for their farm work or trading places. Unfortunately these absentees are not followed later. 2.7,3. BrieJly descrihe all known and veri/ied serious adverse events (SAEs) and provicle in toble 9 lhe required infornation when available. The project is unaware of any case of serious adverse event. 2,7.4. In case the projecl has no case of serious udverse event (SAE) during this reporting period, please tick in the bo-v. No case to repoft 1'r ,;( 1 WLIO/APOC. l0 April 2003 ca a.l L 6) -o E 0) o. oa \o o.l U o -) > Jq bo\\, a ! ! :\ 0os ! Ca \ Ji q OJ\ L\ d! dr(! eqOqJU ss: * 'i" >- 'Fsd ,'El@U\ v\ =!s tr.!3 u': Ue.: 9Sr dJ\:: u-9L -> il > is ! .< r.i -Y<Y +-+ri:\.:u(J l'\ < .eE F .:T.aJ \] ^s' .! e 3:UY !sg-, ^ ! r, I -. a .aG() P -is+ : Ei H- ! h\(! * i-i :is'e = s' :Y - A .=l- -;!; ! !rjj e *S l- .: !-q oo r-: ':s\ .= :i% ^,x !. A-!! i_{ .\ \_ i !s i-a -x *'a si :s : i<\-%\ ts! :sc s.: ='r}J'i ca.1i s: u uiSSri\ F\ \' illl : ^.-s!v\I.* I-S o E E O .9t U OFf, o\ :it =lI 0-)tl> 'ol H sl u ol !Ll - ol : olDol tr0)- ^l =Ll 9)ot .- Ll ' 6J1 = JI L zt< OL(n (.) 'a L o- o .C c t! -o '.= tr 0) =q a() '.= =E E o '= =(JTi C 4) ILoo a(.) E o L(-) -o = oFz (J L (..) Lo (.) -c .= .: a q .9 .: E E oO .9 tr() -o C(J IL(.) o- .C, ^,o ol c) -l-xl - 9l oo Ol '- ,t> ol l -o]: ^l v PI E ol o- .l^ oJl o_ -ol _ zl; qJ (! L 0_) b,J !!^ c) ^\ o(.) -F 0) =L o 50 !() o(J 1;o; o-- L .J o () d L() bo oi o oo o^ e^\ 0) o-(6 L 0) F al 0)l bIJ 631LI()t ot ol -t ol ,clol(Ul LIq] 6Jl o4 icl (gl ol JI()l o.tdlLI 0)l a el 01 trl ot oj Li ^l I CBI =lEILI ot rrl N() o o LO 't AJ \ U F q o cg c) o z q) (.) q) S q l v :g o -x s q)6 F.;v qJ 5 .9 L C) o- bo ii o a-oL o o0 EoL oo (t at)q.l a 0 co c) o CrL(.) 'o 60 VI o 0) aJ') o Ct oU'(! U o.1 C)l -ol(Bl FI otr-60e t2L !;o <.s E \a ;soB 60La =: E6:i= x=Lt! 5'6 o.r .9CA ^=ll oo L' O- o-!Y(i9 afi ^ 6 .= o)()r q Li;o-O.2EC o c c=(g00()oE,!e o ^q> Q 6-cq: €-9oo'NE :,6.= Ei;3E> o- E >rO _E! 0) !J. 0) !oaG -c .N'* oE: =a2o> z o o0s o0 L o I c)(n 0) oo * z a Ii'!- lr II I L I I I I I I N 0) -o Eo o.o CN \o c.l O o o (9 a? O oI) -o.\.: >:-(, - d-Y -io t6:.,€vio e !, s-'i v i' v3+=bE O O; d F oo\ O o bI) ! .o .o o= 2qFC)z Zi: o. = o- o F o o\ o\tr) c..l o\ \o\o o\ ra) -o o\ co o\ o.\o a\$t-- 0,o @ co c7') t-- a-l oo 'f, t- A \o $ \o tra) t tr- O O ca O O .t O O O co aa \o t---(-- O \o O \o \o .1 aa\o\o O \o q) bJl =l- .9 -- E E Q \c oI) oF \Qo\ $ o\ co o\(-- @ o\ F- ,8, A o@ bn :i o d o\ o,t o\\o oo o\r-6 o\ t-r . = !A 9=-z tr- ..l oo A (-.l -1- ca aa r 9s $$ $$ {$ $$ aa c0 6 -\ O I L - o - qd + a= >- - e -+,-s E'- - E ^ - A 6 .t .- = u u; a') ao $t ca $$ ca $ .f, an w$ a.) o. o.I 6l caa! 6l c.1 q) L o -.: : c,) oo trL .:! fc) OLqro LL !.) vrl E6t ()l 6^ 5 c.r o(d a -0) E() 9q TU rL F r- Ol Nl 6Jl -lot c6lt-t \) 2.A. Supervision 2.8.1. Provide a flow chart of supervision hierarchy' N ZONAL N.O.CP IBADAN I STATE ONCHOCERCIASIS CONTROL TEAM (SOCT) IY LOCAL GOVERNMENT ONCHOCERCIASIS CONTRO rEAM (LOCT) COMMTINITY. CDDS 2,8.2. ll/hat were the main issues identified during supervision. The following were discovered in the course of supervision: out their duties. They depended mostly on the meagre amounts from the Trust Fund for maintenance and fueling of their motorcl'cles. saw little material or financial benefits. cornmunity level operations had been hijacked by the health workers. 2.8.3. ll/as supervision checklist used ? Only in very few cases were checklists utilized 2.8.4. What were the outcomes at each level of CDTI implementation supervised The following constituted the outcome: support not only the CDDs but also the distribution. In solrle cases project staff used thiir positions as supervisors in NIDs to utilize CDDs as guides. Whatever was earned served as a motivation to continue serving as CDD and to cooperate with project personnel. 2-'1 WHO/APOC' l0 APril2003 discovered. NPI/ M & E officers were invited to training sessions on CDTI so that they can assist in supervision. State officers have requested LGs to appoint non - programme officers as LOCT leaders for they tend to have more tirne for the programme. 2.8.5. Was feed-back given to the supervised, and how was the feedback used in improving tlte overall performance of the project Whenever and wherever possible communities were infbrrned of those areas they are not doing well and are rrobilized to correct the anomalies. Such issues as inadequate CDD compensation have to be brought to the attention of the communities. The LGA health workers were also infornred of the findings. and in most cases together with SOCTs try to find solutions to issues identified. SEGTION 3: Support to GDTI 3.{. Financial contributions of the partners and communities Table l l: Financial contributions by all partners for the last three years If there are problents witlt release of counterpartfunds,ltow were they aeldressed? Advocacy visits have been and are being paid at both State and LGA levels to ensure continuous release of counterpart funds. Moreover, stakeholders meetings are being planned.r Contributor Year I 2000 Year 2 2001 Year 3 2002 TOTAL Budgeted (us$) TOTAL Released (us$) TOTAL Budgeted (us$) TOTAL Released (US$) TOTAL Budgeted (us$) TOTAL Released (us$) Ministry of Health (MOH) 70,000 5,000 l 70,000 I s00 r0.000 Nir LocalNGDO(s) ( if any) Nit N I I Nit I I N I I Nit Nit NGDO partner(s) r9,ss0 i Nir I r9,520 N NiI District/LGA 2t,440 Nit 21,440 10200 21,440 4,950 Others I a) b) c) Communities APOC Trust Fund r8s,200 t29,1t0 157,500 9r330 r07,680 s7280 TOTAL 296160 I l:l,t to 268,460 I t 03,030 139,020 62, I 30 Comments W'FIO/APOC. 26 Septerrber 2003 I I 3.2. Other forms of community support - Describe (indicate fornts of in-kind contributions of communities tf any) Some communities do the following for their CDDs: 3.3. Expenditure per activity - Indicate the expenditure on activities below in US dollars using the current United Nations exchange rate to local currency Table l2: Indicate how much the project spent for each activity listed below during the reporting period Activitv Expenditure ($ US) Source(s) of funding Drug delivery from NOTF HQ area to central collection point of community Mobilization and health education of communities Training of CDDs Training of health staff at all levels Supervising CDDs and distribution Internal monitoring of CDTI activities Advocacy visits to health and political authorities IEC materials Slummary (reporting) forms for treatment Vehicles/ Motorcycles/ bicycles maintenance Office Equipment (e.g cornputers, printers etc) Travel 8250 6,950 5000 I 000 2000 7.750 480 3260 r 500 r 6860 APOC APOC/MOH APOC APOC APOC APOC APOC/MOH APOC APOC APOC APOC Communication I 400 APOC Others 7280 APOC 62,130 741,596 Comments 9rl WHO/APOC, 26 September 2003 Total number of treated SEGTION 4: Sustainability of GDTI 4.1. lnternal; independent participatory monitoring; Evaluation 4.1.1 lYas Monitoring/evaluation carried out during tlrc reporting periotl? (tick where applicable) Year I Pafticipatory Independent rnonitoring Mid Term Sustainabi liry Evaluation 5 year Sustainability Evaluation Internal Monitoring by NOTF Other Evaluation by other partners None was carried out within the period of reporling 4.1.2 ll'hat were the recommendations? Not applicable 4.1.3 How have they been intplemented? Not applicable 4-2- Gommunity self-monitoring and stakehorders Meeting Table l3: Community self-monitoring and Stakeholders Meeting (Please culd more rows if necessary) Describe how the results of the community self- monitoring ond stakeholclers meetings hawe afficted project implementation or how they would be utilizecl during the next treatment cycle. District/ LGA Total # of colnrnunities/villages in the entire project area No of Communities that carried out self rnonitoring (CSM) No of Comrnunities that conducted stakeholders rneeting (SHM) TOTAL 3a WHO/APOC. 26 September 2003 a4.3. Sustainability of projects: plan and set targets (mandatory at yr 3) What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.3.1 Plonning at all relevant levels. The evaluation of the State project has been done but the period fell under the 4th year cycle and therefore shall be addressed in the 4'h year report. However, within the reporting p.iioO the project was considering preparation of a 3 - year sustainability plan which will be incorporated into the State health budget. This could not be done until after the evaluation. Meanwhile the project intends to obtain a reliable total population of the endemic lcommunities by 2004; maintain geographic coverage at 100%o, increase therapeutic coveragetfrom the present 74o/o to 84% within the next three years. A need assessment will be iconducted for health workers in the 5'h year so that training needs will be identified and appropriately planned for 4.3.2 Funds At the State level there has been some counterpart contributions, but these have not been adeqr.rate nor regular. With the evaluation of the project the State government has renewed its commitment to funding the CDTI project and encouraging the LCAs to do likewise. Advocacy visits will continue to ensure that LGAs keep on releasing at least minimal amounts for CDTI implementation. The project has also been guaranteed some level of funding from UNICEF till at least 2007. Funding for 2004 is up to, but not exceeding $15,000, and amounts will go down over the next 4 years. By then government contribution is expected to have reached a level that rvill sustain CDTI operations. 4,3,3 Transport (repIacement ond muintenonce) As stated in the earlier sections of the repoft the project expects APOC to replace transport before it finally withdraws funding. This applies also to other capital items which it supplied to the project earlier. At the LGA level the National Primary Health Care Development Agency which is supported by several international NGDOs occasionally procures motorcycles for NIDs which are distributed to the LGAs. These are being used for CDTI 0ctivities. At periodic intervals some of the motorcycles are replaced by NPHCDA. With iespect to maintenance some LGAs release minimal amounts for the periodic maintenance of the motorcycles. This, the project knows, will continue. At the State Ievel, some of the funds released by the government have been used in the maintenance of the vehicle and other equipment. With more and constant releases this will continue. In the meantime a system of strict control of transport has been put in place. Every trip and every expenditure on (fuel, tvres and repair) a log books and monthly conciliation of trip authorization and Iog booh entries has been institutionalized. 4.3.4 Other resources This has been partly addressed in the previous section. With regards to IEC materials the project is sensitizing the governrnent on the need to produce some with the withdrawal of APOC funding. 4.3.5 Please provide a written plan with set turgets and achievements for sofur. 4:3.6 To whut extent has the plan been implemented 3,4 WHO/APOC, 26 September 2003 4.4. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for completer integration 4.4.1. Ivermectindeliverymeclrunisms The Mectizan delivery process occurs within the existing PHC structure. Communities pick their Mectizan requirements from the health facilities, except in few cases where the drug is taken to them. During NIDs, for instance, the LGA/PHC staff who come to pick up their vaccines also use the opportunity to collect Mectizan. 4.4.2. Training As stated in some parts of the report M & E officers and NPI officers at the LGA level have been trained on CDTI so that they can assist in supervision. 1.4.3. Joint supervision and monitoring with other progrants Atthe State level, there are no plans forjoint supervision and monitoring at present. Atthe LGA level we are aware that sotne of the LOCTs are involved in other programmes and occasionally use the opportunity of visits to the comrnunity/health facility'for one programrne to look into other programmes which they are handling. 4.4.4. Release of funds Where there are releases of fund, irnprest is released for PHC activities and is controlled by the PHC director. From there minirnal amounts are made available to the Onchocerciasis Coordinator for some routine visits or collection of Mectizan. At both State and LGA levels proposals for the release of funds horvever must pass through the PHC director and other normal channels. 4.4.5. Is CDTI included in the PHC budget? At the State level there is a line item for CDTI in the PHC budget. At the LGA level CDTI activities are subsumed under a general PHC budget. 4.4.6. Describe other health programmes tlrul are usittg the CDTI structure and how this was achieved. Llthat have been the achievements? None at the moment. However, during the period being reported the CDTI structure was used to conduct eye camps during which 75 patients were examined for cataract and 23 persons operated on. 150 persons received free eye glasses. The programme initiated by the State Onchocerciasis Unit was supported by LINDP. 4.4.7. Describe otlters issues considered in the integratiort of CDTI. I a 3e, \,\HO/APOC. 26 September 2003 a4.5 Operational research 4.5.1 Summorize in not more than one holf of o poge the operational research undertaken in the project areo within the reporting period. None was undertaken during the reporting period 4.5.2. How were the results applied in the project? sEcrloN 5: strengths, weaknesses and chailenges List the slrengths and weaknesses of CDTI implementotion process Strengths 'i' Most communities are fulfilling their roles under cDTI as seen in table 3. * In some communities where village Health committees have not been non-existent, these ' have been constituted and made functional in the course of implementation CDTI. * Usage of CDTI structures forthe distribution of 150 eye glasses and removal of cataracts in 23 patients. lileaknesses 13 Lacks of adequate commitment of LGA Coordinators particularly in return rendition, supply of vital and urgent information as demanded by the NOTF secretariat. rl. Few communities are giving incentives to their CDDs. * Lack of updated census population figures to measure correctly treatment coverage rates. List the challenges and indicote how they were addressed. lfhe project implementation was constrained by:- I 1:. Scarcity of petroleurn product last year.A Inadequate number of bicycles for supervision a 33 WFIOiAPOC. 26 September 2003 a li,a 5 a CA 2o N)UJ5o\ Lh o)t.t9x -.4<o o!{u) ';.o o H) E 5E K =:C) Bz. € Ets 9 3 ?&H F6,E: , H *H .l Ft c) 5 0a o>t a oo -lt, --l o ii' AP oa o 'F{) C)rd-lugtsUts 5'o e.a' E.(n oapqa nF oa o El N rFuz tsHF E6N 8.H E d or-kr g oo o ()oEn,9,tlo 5 0 x-t o 1+EEts. =o - !J aH'69LiixiBO:+'o E-iD *)E'6 E ra-a 3 -op A ,( d"O F.lUB A.B:H< a x'!l - i r-{'9Ee.pH.oa =5 0(!iDa(D oor!SrE t'6B+ E o o IA: to t' f,gg$BE A E*E*B ono#*6' tX "r6a +=,i E0C)trat EE 0a< ?t BaLHE l,g o l:o l:5 I OFI B3 BH(!trI o= E) U' a o (D U1 U1 c) o o(D oa *H EB.FE'9*EgtsE ErieaE .;.i OEi,E aF$gIEEgl6 (D o)tl F64.?B *aa a 6'F B It FU trd () 'D) 5 t^o-> EE: E 'gE' 5'P d FO o) r.f o E .F) (n a-ooQ>49t/)H[18tCH.Er'6q.OraOHer'na HEtrH I-rf=6oE I' 6>u, o. oU U U'Eie lg B'6 l''** FA HRo- zq L'EJg ?D, .J- TD .,P Frj Fl Bts3oo ?<E IFqiH ,Fror=- ti o. - TE?=H o.< TQa ==wLH o- '< F.? U) E>N.) H'6 r .E?r (,rt o. tr) @ c z o tn >t1 oo "o oo N)oPoo .o N) oo t'')oIaoo l.Joo -o oo \o "o oo ot-o w F I a -l -l rn oboo (-,r O o (n o (-,l POoo tJ(, ooo l (r -f I t ,)---,{ :c1oL, { a- t) -o 1 a aa {@\o o f) o U o)ar gFE a E s 3g6" Eg f g E Htr5 *PTF;I tu: air ZN(D=9Edf ,( EJ onoo C)o o gEgiE}BBe EE gEEIH ?;- E 1" ?'p'i Hrc F: H2cn sE.fEEEi E3 3,8. t€ Ei € aB s s e - 6'.? o )' o-'+)d l*) g8B' rlfre ts +'6'aant t,g lo -lO.EgE'8. ^Eq g? (D 0) It ?r-o ?fr F& 5A)tie H BaEEBE .)oooo!, xFl D) olr F(a oqt o)H oo oat) (A t, a) 0. p o. >P ?E AH,6'so o, (D (.15 Er'o no.@3 'a) o E{ No (D V) ts(D o >>AAOa r>r-r: (D i. E lteg*b o- FU"E.H- -p<6 E.HH - DgE"g't95 n a& trd g Eg g H -x H'3 ta8[+FE HAE ig Fx E'EB F gegH' H\FtIJJcLrfO- $hsH ,-r ts ,-r E'H FS0)i5< *< g. 5' E# { oo a Eo 55I ap-5: at)4() HHo o@ oI oo -o oo oo ooo (.ltoboo (, -I "o oo N)o o o (/. t-r1 a t I