Ekiti State CDTI annual project technical report submitted to Technical Consultative Committee (TCC): January to December 2006

ln RESERVED F OR PROJECT LOGO/HEADII{Gr: L: L-llE- trl L:t .,} ORIGINAL : English sp 2F For krlomdon t r t F I I l I _l l .l T] I] rrl t L] 8"1 EI il I mr:l \ ;c: fce I I I ) ! to, 5lR ffit 11- 2 n JUIL 2007 I COINTRY/I{OTF: Nigerra Pro-iect !furme: EKITI STATE CDTI/APOC PROJECT Approval vearzl999 Launching year: 2000 Reportine Period (Month/Year):JAN 2006- DEC 2006 Proiect year of this report: (circleone) l2 3 4 5[617 8 910 Date submitted : January 2007 NG rtner: UNICEF OUA frrf, cvn bFo FO WHO/APOC, 24 November 2004 tANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) DEADLINE F'OR SUBMISSION: To APOC Management by 31 January for March TCC rneeting To APOC Management by 31 Julv for September TCC rneeting AFRICAN PROGRAMME }'OR ONCHOCERCTASIS CONTROL (APOC) ( I *r' {' WHO/APOC, 24 Novernber 2004ll ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATWE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: ) E 4 iii M-IO/APOC, 24 November 2004 Country: NIGERTA National Coordinator Name: ...Mrs.. P. Ogbu-Pearce Signature Date ?,,5,)-l""""1' Zonal Oncho Coordinator Narne: ...Otunba A O Jaiyeoba -& lt S '--wDh .{ ; '3".J 2.-ri'})--J... ... ..'. .1.. : -. ... ...Date L\ This report has been prepared by Narne : Mrs C. O. Ogunbiyi Designatio n CItl.r,l,.<, e*'=.:*/ Signature %c-/ " Date I ,,/.,,-r., /, .Q Table of contents Acronyms. .........8rror! Bookmark not defined. Definitions ................vi FOLLOW UP ON TCC RECOMMENDATIONS Executive Summary SECTION I : Background information ......... i.I. GENERALINFORMATION 1 .1.1 Description of the project (brieJly) 1.1.2. Partnership I,2. PoPII-ATION SECTION 2: hnplementation of CDTI 2.1. Tnmrnrre oF ACTIVITIES ........... 2.2. Aovocacv 7 8 9 9 9 11 l3 15 15 l6 t d 2.3. 24. 2.5. 2.6. 2.6.1. 2.6.2 2.6.3 2.6.4 2.6.5. 2.7. 2.8. 2.9. 2.9.1. 2.9.2. 2.9.3. 2.9.4. 2.9.5. 2.9.6. MOBILZATION, SENSITZATION AND HEALTH EDUCATION OF AT RISK COMMUNiTIES 17 covtvtuurv INvoLVE\1ENT................ ..... . ....... ... I 8 CapacITyBUILDING 20 TREATi\,8Nrs................. ................22 Trealmefirtgltres.......... ....................24 W'hat ore the causes of absenteeism?........... ......................24 l(hat are the reasons for refusals?................ .....................24 BrieJly describe all known and verified serious adverse events (SAE| that............24 Trend of treatment achievement from CDTI project inception to the current yecu' .. 26 ORognwc, sroRAGEANDDELIVERyoFIVERMECTIN............ .................27 CoI.,fl\4uMTY SELF-MONITORNG AND STAKEHOT-DERS MEETING . . . , . . . . . . . . . 3 O STPERVISIoN . ............... .... ... ....... .. 3 | Provrde a flow chart oJ' superviston hierarchy. ........ 3 I Whnt were the main issues identrfied during supervision? ........... ... .... .. .... 3 I Was a supervision checklist used?......... .................31 llh.at were the outcomes at each level of CDTI implementation xtperviston? ........ 3l Wos.feedback given to the person or gt'oltps supervised? .. .. ....32 How was the feedback used to tmprove the overall performance o.l'the pro.iect? . . . . 3 2 SECTION 3: Suppofi to CDTI.... 3.1 EQUTPMENT 3.2. FhIANCI,AL CONTRIBUTIONS OF T}IE PARTNERS AND COMMUNITIES.... 3.3. Orrmn FoRMS OF COMMUNITY SUPPORT 32 32 JJ 3 .4, EXPENDITURE PER ACTIVITY ...... . SECTION 4: Sustainability of CDTI...... ................33 ...,. .'.,......33 .............34 f! 4 I INTERNAL: INDEPENDENTPARTICIPATORYMONITORING. EVA]-UATION .. 34 1. I .I lhas Morulormgevaluatton carned ottt cltu'mg the reportmfl, perrctcl) (trck cmy oJ the Jbllowmgwhrchare applicable) ...... ................. ...31 1. 1 .2. W'hat were the recommendanons? .. ...... ... i5 1.1.3. How have theybeen implemented?... . ........ -3J 4.2. SusranIABlLITyoFPRoJECTS:PLANANDSETTARGETS(MANDAToRYAT.............35 YR3). .... .. . .. 3s 4.2.1. Planningatallrelevantlevels ................. ....-15 1.2.2. Ftutds........ .......36 4.2.3 Transport (replacement and mnintennnce) ......................36 1.2.4. Other resources.... .......36 1.2.5. Towhat extent has the plan been implemented.. .............36 4.3. INTEGRATIoN 36 4.3.1. Ivermectindeliverymechsnisms ..36 4.3.2. Training..... .................37 1V WHO/APOC, 24 November 2004 4.3.3. Joint supervision and, monitoringwith other programs... Enor! Bookmark not defined 4. 3.4. Release of funds for project activities .... ...... ..... . .. . . . .. . 374.3.5. Is CDTI included in the PHC budget? ........374.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. ll/hat have been the achievements?.............. .............374.3.7. Describe others issues considered in the integration of CDTI. .....37 4.4. OPERAIoNALRESEARCH............. .................374.4.1. Summarize in not more than one half of a page the operational research undertakenintheprojectareqwithinthereportingperiod. ................374.4.2. Howwere the results appliedintheproject?............. ..................37 SECTION 5: Strengths, weaknesses, challenges, and opportunities.........................,......3g SECTION 6: Unique features of the project/other matters. ........3g Acronyms APOC for Onchocerciasis Control ATO Annual Treatment ective ATrO Annual Training Objective CBO Community-Based Organization CDD Community-Directed Distrib utor CDTI Community-Directed Treatment with Ivermectin CSM Commrurity S elf-Monitoring IEC Information, Education and Communication LGA Local Govemment Area LOCT Local Onchocerciasis Control Team MDP Mectizan Donation Prog'amme MOH of Health NGDO NGO NOCP National Onchocerciasis Control Team NOTF National Onchocerciasis Task Force PHC Primary health care REMO Rapi d Epi demiol ogical Mapp ing of Oncho cerciasis SAE Severe adverse event SHM Stakeholders meeting SOCT State Onchocerciasis Control Team TCC Technical Consultative C ommittee (APOC scientific advisory group) TOT Trainer of trainers UNICEF United Nations Children's Fund UTG Ultimate Treatment God wHo World Health Organization on-Govemmental on-Govemmental Or J lF ir v WHO/APOC, 24 November 2004 I Definitions (i) Total pooulation: the total population living in meso/tryper-endemic commurities within the project area (based on REMO and census taking). Eligible population: calculated as 84Yo of the total population in meso/hyper- endemic communities in the project area. (iii) Annual Treatrnent Objective: (ATO): the estimated number of persons livurg i1 meso/hyper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. (iv) ultimate Treatment Goal (UTG): calculated as the maximum number of people to be treated annually in meso/hyper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage(normally the project should be expected to reach the UTG at the end of the 3'd year ofthe project). (v) Therapeutic coverage: number of people treated in a given \/ear oyer the total population (tlus should be expressed as a percentage). Geogaphical coverage: number of communities treated in a given year over the total number of meso/hyper-endemic communities as identified by REMo in the project area (this should be expressed as a percentage). Integration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) through GDTI (using the same systems, training, supervision and personnel) in order to maximise cost- effectiveness and empower communities to solve more of their liealth problems. This does not include activities or interventions carried out b1' commuritl distributors outside of CDTI. (vi) (vii) (i'iii) Sustainability: CDTI activities in an area are sustainable when they continue to fturction effectively for the foreseeable future, with high treatment coverage. integrated into the available healthcare servlce, with strong commufty oumershrp. using resources mobilised by the community and the government. (ix) Community self-monitoring (CSM): The process by whiclr the commuruty is empowered to oversee and monitor the performance of CDTI (or anv community.- based health intervention programme), with a view to ensuring that the programme is being executed in the way intended. It encourages the community to take full responsibility of ivermectin drstribution and make appropriate modifications u,hen necessary. (ii) 1 a+, t- a vl WHO/APOC, 24 Novernber 2004 a 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 23 (Please add more rows if necessary) 7 at 1 Number of Recommendnlion in the Reporl TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY lls (i) Replace or repair Motorcycle Damaged Motorcycles have been repaired 11s (iD Increase number of CDDs per population No action was taken because there is no fund l1s (iii) Promote involvement of female CDDs More fernale CDDs were involved 115 (iv) tr'ocus more on securing State and LGA funds Advocacy visits were paid to the Policy Makers both in the State and LGAs which yielded to the releaseC of the counterpart flmd by the LGfu 115 (v) Continue training involving and monitoring health rvorkers at LGA and facility levels Training were given to 447 health workers as against 337 ofyear 2005 115 (vi) Conduct a population census as the denominator seem not to be knoryn Censns update was dolle in the reporting year ll5 (vii) Continue consolidating and improving this years achievements There has been improvement in the project [improvement in supervision aud monitoring, more lrcalth workers and CDDs rvere trained, etc] WHO/APOC, 24 Novernber 2004 , I 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 _24- (Please add more rows if necessary) ,I ar Number of Recommendstion in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT ASE ONLY t5 The report seems to correspond with the past annual technical report, when this should not be the case. The project believes the same 5th year report was reviewed twice - first in TCC23, and then in TCC24 16 (i) Before sending another annual technical report, check the report and ensure that there are no inconsistencies in the data provided. Efforts have been made to ensure inconsistencies have been eliminated. 16 (ii) Increase number of CDDs and encourage selection and training of female CDDs per population to less than ICDD to less than 100 persons Due to funding problems this could not be tackled. 16 (iii) Focus more on securing state and LGA funds Advocacy visits have been up-scaled at various levels - details are in this report. 16 (iv) Need to begin trarning, rnentoring and rnvolving health workers at LGA and facility levels. With availability of funds from all partners. thrs r,i,ill be done in 2001 treatment cycle 16 (v) The project should have a good grasp of the denominator This has been noted lJ Executive Summary Ekiti State is one of the States in the southwestem part of the country and is located in the B Health Zone.It has a population of 2 384 212 [as at 2005 census]. There are 16 LGAs in the state, all of which are irnplementing CDTl. The main indigenous population that constitutes overwhelmingly the major ethnic group in the State is Yorubas. Individuals from other ethic groups such as the Fulanis, Igbiras, Agatus, Hausas and Egedes have migrated into the State and are cohabiting with the indigenes. Christians form a high percentage of the population of the State. Population movements always take place during religious activities or celebrations like Christmas and Easter. Moreover, there are population movements during Muslim celebrations and during the farming / harvesting season. Closure and commencement of school periods also brings about some population movements in the State. During these periods, there is a seasonal migration of people from one place to another. The prevalence survey of 1988-1990 and the subsequent REMO of 1994 and 1998/2000 revealed that the State is endemic for Onchocerciasis. The total target population with the recent census update is I 054 517 in 344 communities. The UTG/ATO is 885 J94. Treatment commenced in the project area when it was still part of the old Ondo State with assistance from UNICEF and NOCP using the CBIT approach. CDTI strategy was initiated in 1999. The project trained and retrained 8 SOCTs,48 LOCTs, 16 PHC Coordinators,44T Health workers and 1 519 CDDs thereby achieving 84%o overall for its haining objectives. 344 communities were mobilized to select their CDDs and collect mectizan from designated points. Current CDD to population ratio stands at I CDD to 661 persons. A total of 729 229 persons were treated in 344 communities with | 944 2lO mectizan tablets for the year under review, thus giving a geographic coverage of 100% and therapeutic coverage of 69%. The number treated represented 82%o of the ATO and UTG. Major policy makers and community leaders at both LGA and community Ievel were mobilized in various advocacy meetings to support CDTl project in the State. The major challenges that faced the project included the non-release of counterpart fund from both the State and Local Govemment, and non-funding by other partners. Other challenges were demand for incentives by CDDs, CDD attrition, and transfer of Health 8 te I WHO/APOC, 24 November 2004 workers from one LGA to another. These challenges were addressed by continuous advocacy for release of funds by parfirers, State and the LGAs, training of new CDDs, training of additional health workers. SEGTION {: Background information 1.1. General information 1.1.1 Description of the proiect (bfiefly) Geographical location, topography, climate Ekiti State, located in the southwestem part of Nigeri4 was carved out by presidential fiat from Ondo State on October 1996. It covers an ilea of approximately 5,500 square kilometers while it has a bio-climate of rain forest in the southern area and Guinea Savannah in the northern parts. A greater percentage of the landmass is made of rocks and mountainous regions. The rains commence in April and end in October, while the dry season starts from October ending by March. Pop ulatiott activities, cultures, language The Yorubas constitute overwhelmingly the major ethnic group in the State and it is marnly the indigenous population. Horv ever, individuals from other ethnic groups such as the Fulanis, Igbiras, Agatus, Igbos, Hausas and Egedes have nugrated into the State and are cohabiting with the indigenes. With a current projected population of about 2.9 million, the State is divided into 16 LGAs. Settlement pattem is compacl wrth population densitres of between 280 - 350 persons/ square kilometer. Farmsteads exist but are seasonal. Conurutnicatiort system (ro ad...) Roads between major cites are in good condition, but access roads to most of the endemic communities are very poor. Some are not passable during the rain1, season. Despite this, transport by road remairs a major means of communication among the comtnurutres. The electronic and print media ate aiso veritable channels of commurucation. Withrn the communities the town announcers and announcements in churches / mosques communities meetings are preferred means of commurucation. Ad ministr at io n s tnt ctur e The State is made up of 16 administrative units known as local Govemment areas. Each LGA is headed by a Charrman, usually elected, whom career offrcers assist. There is a legtslative arm made up of elected councilors from the various wards that make up each LGA. Beneath the ward levels are the communities. At the State level, the Govemor is the chief executive, 9aat , t- WHOiAPOC, 24 November 2004 and he is assisted by an executive council made up of commissioners in charge of various mlnlstnes There is a legislative arm comprising elected persons from the LGAs. 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. It is a system of health care services where community participation forms the mainstay with support from the State, Local Govemment and NGOs. Levels of functionality however vary across the State. Scattered throughout the State are various health facilities ranging from health posts to hospitals. There ue 552 health facilities in the project area- Number of health staff in project area and nuntber of lrcalth staff invol1ryrl in CDTI activities. Table 1: Number of health staffinvolved in CDTI (Please add more rows if necessctry) District/LGA Nwnber of health staff involved in CDTI activities. Total Number of health staff in the entire project area Br Number of health staff involved in CDTI B, Percentage Br:B:/ Br *100 ADO 120 34 280/o EFON 71 46 6s% EKITI EAST ll6 25 22% EKITI SOUTH WEST EKITI WEST 135 42 3L% 84 53 63% EMURE 68 l5 22% GBONYTN 77 28 36% IDO/OSI 75 25 33o/o IJERO 207 43 21% IKERE 196 30 1s% IKOLE 105 30 29% ISE/ORUN 85 t4 16% ILEJEMEJE 130 24 r8% IREPODT'N/ TFELODI.IN 75 27 36% MOBA 125 24 19% OYE 106 54 5t% TOTAL 1775 514 290/! I ar i- 10 WHO/APOC, 24 November 2004 t- 1.1.2. Partnership Indicate the partners involved in project implementation at all levels IMoH, NGDOs (n ational/international), conmuuities, local organiTations, etc. J MOH, NOCP, UNICEF, LGAS, COMMI.JNITIES Describe overall working relations'hip anwng partners, clearly irtdicating specrJic areas of project activities Qtlanning, supervision, advocaq), planning, mobilization, etc) where all partners are involved The State and LGAs through their various teams 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. The Zonal and National Offrces assist in supervision, monitoring, training, advocacy, Mectizan procurement and evaluation of the programme. The communities play 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 treatments. State plans rf any to ntobilize the state /regiort / district /LGA decisiort -ntakers, NGDOs, NGOs, CBOs to assists irt CDTI irnplenrcntatiort. The LGA policy makers were enlightened and mobilized to support CDTI activities. The Hon. Commissioner for Health, the Permanent Secretary and the Director of Disease Control mobilized the State policy makers so that each LGA can conffibute N 50,000 for CDTI census update as a first step towards counterpart funding. The Hon Commissioner, Director Disease Control, the State Onchocerciasis Coordinator and the SOCT in-charge of each LGA moved round all the 16 LGA to enlighten and mobilize the people to support CDTI activities The Driver's union, CBO and market women assocration rvere also mobrlized. These wrll be further pursued in the coming year The NOTF/APOC was invited to pay advocary visit to the Ekiti State Governor and mobilize him to support the CDTI programme, twice this reporting year. The Commissioner for Health, Permanent Secretary and Director of Disease control met the LGA policy makers and enlightened them on Onchocerciasis control and sought for their support through the Commissioner, LGA Civil Service Commission. In addition, the Hon. Commissioner for Health, Permanent Secretary are working in conjunction with the State policy maliers on how to deduct money from source into the PHC account of each LGA. li l& ! aj 11 WHO/APOC, 24 November 2004 As usual the communities in 16LGA will continuously be mobilized including the drivers unions, market women associations, religious Leaders and CBOs. These wrll be followed in the coming year. t! t- t2 WHO/APOC, 24 Noveurber 2004 {- 1.2. Population Table 2: Communities and population at risk in the entire project area whether they are treated or not during the reporting period ease add more rows neces, Number of communities/villaqes in Population of CDTI Districts/ LGAs in the entire project area Total popula- tion in the entire project area Meso- endem ic zone in the project area A1 Hyper- endem ic zone in the project area A2 Total in meso / hyper- endem ic zone A.r: A1+ A2 Meso' endemic zone in the project area A4 Hyper- endemic zone in the project area As Total in meso/hype r-endemic zone A6-- A4+ Ar Ultimate treatmen t Goal (urG) Ado 58 500 l0 l0 58 500 58 500 49 140 Efon 44 654 L2 t2 44 654 44 654 37 509 Ekiti-East 73 464 t7 t7 73 464 73 464 6t 709 Ekiti s West 58 798 l0 l0 58 798 58 798 49 390 Ekiti West 25,246 l5 15 25,246 25,246 2t 207 Ernure 6t 748 9 9 61748 6t 748 5l 868 Gbonyin 85, 250 9 9 85 250 85 250 71 610 Ido/Osi 82,320 l1 ll 82,320 82,320 69 t49 ljero 86, l 54 58 58 86,154 86.154 72 369 Ikere 134 739 36 36 r34 739 t34 739 113 181 Ikole 70 3r5 t2 t2 70 315 70 315 59 064 Ise/Orur 64 046 10 10 64 046 64 046 53 799 Ilejemeje 35 788 48 48 35 788 35 788 30 062 Irepodun/ Ifelodun 31 060 2 8 l0 31 060 31 060 26 090 Moba 64 i83 58 58 64 183 64 183 53 914 oye 78 252 19 l9 78 252 78 252 65 733 TotaI 1 054 517 316 28 344 961 709 92 808 1 05.1517 885 794 UTG = calculated as the maximum number of people to be treated annually in meso/hyper endemic areas u,ithin the project area, uhimately to be reached when the project has reachedfull geographrc coverage (norntally the project should be expected to reach the UTG at the end ofthe lo year ofthe project). Was a census for the project done during the reporting period? Yes No lr. I r- Please tick as appropriate l3 WHO/APOC, 24 November 2004 If No, what is the source of the data in the table above?t Source: National census CDD Other source, specify:_ Year: Please tick as appropriate If you are using the term community or village, define what constitutes the community or village. This will help understand ttre profile of the project area. A community/village here refers to smaller units under the ward level within the LGAs. the least homogenous group of people made up of householdS having a common socio-cultural heritage, a central meeting place and a traditional leader. It usually comprise of 500-l 000 or more people. Is there any other information of interest about the population in the project area? If so, include it here. No {L 1 i t4 WHO/APOC, 24 Novernber 2004 SEGTION 2: lmplementation of GDTI 2.1. Timeline of activities Fill in table 3, timeline of activities for areas treated in current year, indicating when the key activities were implemented by the month they began and the month they ended. Table 3: Timeline of activities for the areas treated in the currentyew (Please add more rows if necessary) -Please indicate if all activities were undefiaken as planned, and if not, please explain. -Further comments. a! u t District/ LGA Mobilization of communities Training Census/Update Drug distribution Superdsion Start ing month Comple tion month Start ing month Comple tion month Start ing month Comple tion month Start tng month Comple tion month Start ing month Comple tion month ADO JAN MARCH APRIL MAY JI]NE ruLY AUG DEC. SEPT DEC EFON JAN MARCH APRIL MAY JUNE JTILY AUG DEC SEPT DEC EzuTI EAST JAN MARCH APRIL MAY JUNE ruLY AUG DEC SEPT DEC EKITI S. WEST JAN MARCH APRIL MAY JTINE ruLY AUG DEC. SEPT DEC EK]TI WEST JAN MARCH APRIL MAY JUNE ruLY AUG DEC SEPT DEC EMTIRE JAN MARCH APRIL MAY JLNE ruLY AUG DEC SEPT DEC GBON YIN .IAN MARCH APRIL MAY JUNE .ruLY AUG DEC SEPT DEC IDO/OSI JAN MARCH APRIL MAY JUNE ruLY AUG DEC SEPT DEC IJERO JAN MARCH APRIL MAY JUNE ruLY AUG DEC SEPT DEC IKERE JAN MARCH APRIL MAY JUNE ruLY AUG DEC SEPT DEC IKOLE JAN MARCH APRIL MAY JUNE ruLY AUG DEC SEPT DEC ISE/ ORUN JAN MARCH APRIL MAY JUNE ruLY AUG DEC SEPT DEC ILEJE MEJE JAN MARCH APRIL MAY JTINE ruLY AUG DEC SEPT DEC IREPO/ IFE JAN MARCH APRIL MAY JUNE ruLY AUG DEC SEPT DEC MOBA JAN MARCH APRIL MAY JUNE ruLY AUG DEC SEPT DEC OYE JAN. MARCH APRIL MAY JUNE ruLY AUG DEC SEPT DEC 15 WHO/APOC, 24 November 2004 2.2. Advocacy State the number of policy/dechion makers mabilized at each relevant level during the current year; the reason(s) for undertaking the advocaqt and the outcotrte. Describedfficukies/constraints beingfaced antl suggestions on -how to improve advocacy. The Executive Govemor and other top functionaries at the State level were mobilizedby NOTF/APOC twice during this reporting year. Because of the political situation of theState, it was not possible to meet the LGA chairmen together but ttre Director DiseaseControl, the State Coordinator and the SOCT in-charge of mobilization mobilized some in their respective LGAs including the chairman, Local Gouem-ent Service Commission. This resulted in the release of N50 000 by few LGfu to support training of CDDs, and production of some treatment registers to be used for both registiition anO diitribution. Othei Chairmenpromised to release some funds in2O07. Meanwhile, despite all efforts made in the reporting year, no fund was approved or released at the State level. There is hope to get ro-"tf,ing done by the in-coming Administration by 2007 . No advocacy workshop was done because of lack of counterpart funding by the State and the project was able to get only 50% of Apoc approved funds foi the year. At the community level these groups of people are mobilized: The major constraint in achieving desired results is the rapidity in changes of policy makers at the LGA and State levels To improve advocacy there is need for a high-level advocacy that will target the chief executive of the State. Production and airing ofjingles on radio and television should be a continuous exercise. This will be complemented by other Radio / TV discussions on the l+. LGA Traditional Rulers Opinion Leaders Religious Leaders Market Women Grps Other' CBOsAdo Ekiti 26 34 3 t2 J Efon 8 4 2 7 Ekiti East 35 l9 4 l5 3 Ekiti s.w 2l 22 4 9 Ekiti West 17 16 5 8 Emure ll 8 9 l0 I Gbonyiq l3 8 9 8 2 Ido / Osi 18 27 6 l3 2 Iiero 36 38 11 t7 Ikere T4 ll 7 74 Ikole 9 15 4 t4 Ise/ Orun 8 l5 3 4 2 Ile.lemeje 16 8 5 l4 I Irepodun / Ifelodun 15 l9 2 l5 Moba 17 2t 3 9 3 oye 8 11 4 8 I Total 272 276 81 177 18 l6 WHO/APOC, 24 November 2003 i! disease and control stratery. Additionally, there should be continuous advocary visits to the prominent traditional rulers and policy makers at the Local Government level in 2007. 2.3. Mobilization, sensitization and health education of at risk communities P rovide information on: The use of media and/or other local systems to dissendnate informatiort Media [Radio] and megaphone wim used to disseminate information. Types of IEC nruterials used Posters rvere used. Mobilization sensitization and healtlt educatiott of tuontan and ninorities - nrcthod anil resporrse Within the project, there is an active participation of female members of the community at mobilization meetings and during health education sessions. Some of the women have volunteered as CDDs whenever serving CDDs expressed unwillingness to continue due to iack of incentives. Some women have met with community leaders over incentive of CDDs while some gave out money from their personal purse to support CDDs. Response of target conutturtities / villages Communities have responded by coming forth to collect their Mectizan tablets. Members have expressed willingness to comply with Mectizan treatment. The communities have fulfilled mosl of their responsibilities under CDTI such as selection of their CDDs and willingness to add more each year, giving some incentive to some of them and determination of the mode of distribution. Accotttplislrnrcnts o There is an increase in awareness of the communities of the benefit of Mectizan, and its continual intake over a long period of time. o Involvement of more CBOs in the implementation process over what was obtained in the past e.g Women Leaders were involved in mobilization and sensitization of communitr members on CDTI project. . There is an increase in awareness of the roles of partners / commuruties in CDTI . The communities are still very much willing to keep on taking Mectizan provided it is avarlable. o More females are interested in CDTI programme. llteaknesses / corrstraints o Inadequate funds to have more interactive sessions with communities. r CDDs are demanding for incentives o Perception of some sections of the community that the programme is heavily funded and the commurity is being denied its fair share. . Comparing CDTI programme with NPI on payment of incentives. o Unwillingness of some LGA Chairmen to support CDTI project. ,- tr ;t t7 WHO/APOC, 24 November 2004 Suggest ways to ilnprove mobilization sensitization of the target communities. ' Equipping local NGOs, market women, religious leaders, road transport workers and other community based organizations with necessary mobilization skills will help a great deal in improving mobilization of the communities o There should be regular meeting'with the community leaders by health workers. o The project intends to collaborate with relevant sections of the ministry of information and culture in order to make use of appropriate staffwith skills in community mobilization. ' More feedback should be given to the community/opinion Leaders on CDTI prograrnme going on in their community. 2.4. Gommunity lnvolvement Table 4: Communities participation in the CDTI (Please add more rows tf necessary) l- Nwnber of communitieVvillages rvith communit5r members as supervisors Number of CDDs Male CDDs Female CDDs Total Bs Be= 87+86 B? Number of communities /villages rvith female CDDs Number of communities with female CDDs Percentage Bro Br: Bro/Br *100 Total no. communities in thc entire project area B4 Number with community members as supervisors Br Percentage Bo= 85/ 84 *100 ADO 10 7 70% 45 20 65 8 80o/o EFON t2 10 83o/o 58 45 103 8 67% EKITI EAST t7 9 s3% 79 40 119 17 l00o/o EKITI S WEST l0 7 70o/o 71 94 165 5 50% EKITI WEST l5 l5 t00% 49 62 lll l0 67% EMURE 9 9 100% 30 16 46 9 100% GBONYIN 9 4 44% 52 3l 83 5 ss% IDO/OSI 1l 5 4s% 53 t7 70 8 73% IJERO 58 49 84o/o 198 40 238 l5 260/o IKERE 36 24 67% 78 23 1 0 1 8 a ao/LL /O IKOLE t2 5 42% 82 22 104 l1 92% ISE/ORUN l0 6 60% 34 23 57 10 100% IEJEMEJE 48 48 100% JJ 32 65 8 t7% IREPODTN/ IFELODUN l0 7 7t% 35 63 98 6 60% MOBA 58 53 91% 40 37 77 t2 21% OYE t9 l3 680/o 82 10 92 10 s3% TOTAL 344 271 79o/o I 019 575 I 594 150 44o/o 18 WHO/APOC, 24 November 2004 Comment on: - Attendance offemale members of the comnrunity at health educatiort meetings Female members of the community are allowed by men to attend health Education meetings and are allowed to participate and give suggestions in the meetings. - In general, horv do you rale the participation of fentale members of the communigt meetings when CDTI issues are being discusses (attendance, participatiott irt tlrc discussion etc). Women are always allowed to participate and even contribute to the decisions during general community meeting. But on special or key decisions on community matters, elderly men are usually the decision makers and women do respect them. - Incentives provicled by comnrunities for the CDDs Usually, incentives to CDDs are in kind due to the poverty levels. Some communities give cash since there is comparison with other incenfive grving community-based programmed such as the immunization programme. Some communities are however yet to give any incentive to their CDDs. - Attritiort of CDDs. Is attrttion a problemfor the project? If yes, how is it adtlressetl? Attrition of CDDs occurs within the project, but the rate is not alarming. Some of the younger CDDs secure admission to higher institutions; a few leave the job due to lack of incentives as they compare the CDTI project with immunization; some few elderly CDDs die; while some CDDs secure jobs and therefore abandon the distribution. Sometimes, the community leaders were mobilized to select new CDDs and the State presented an umbrella rvith CDTI printed on it as an incentive to each CDD. Other r'ssaes ll { L 5- fls 19 WHO/APOC, 24 Novernber 2004 2.5. Gapacity building - Describe the adequacy of avaitable knowledgeable manporeer at all levels.The available manpower for CDTI implemJntation is enough. All the health staffneeds to be trained and made to see CDT} progamme as part of their routine dailyresponsibility The project needs to train.more too, to replacl those that went away and reduce the workload of the existing CDDs thereby reducing demand for incentives. ' Were frequent transfers of trained staff occur, state what the project is tloirtg, or httends to -do, to remcdy the situation. (The most important issue to desiribZ is what *Zlrrr", ,r*taken to ensure odequate CDTI implementationwhere not enough lmowledgeatble manpower was available or if staff are frequently tansferred during the coirse of thelampaign) Staffs are usually stable During this reporting yJ*, so*" staff were transferred due to establishment of new health facilities and demand, by ,o-. communities. More Health staff were trained from health facilities to ease the problem of transfers. Replacements were effected and reduction in the area of supervision by each staff ensured. More health workers will still be trained in2OO7. I : L L. l* 20 WHO/APOC, 24 November 2003 JKITI WEST ]MURE Table 5: Training at the different levels of CDTI implementation (Please add more rows if necessary) |New', detatl nol avatlable, provde lhe correspondmg total only. Make sure that there s no double count,ng. If "other trainers of trainees" were trained, please explain who they are and their roles in CDTI. b {- f- 1' Number of Districts/LGAs staff trained Number of Health center/post staff trained Number of other trainers oftrainees ( TOTs) Number of CDDs trained District/ LGA ATr o cr Tota I Cr= Cr+ Cr New Refi Cz Ct ATr o Cs New Re[r Cs Ct Totel C:= C.+ C7 Cr ATrO Tota C l2- New Crt' Refr C,, Cr+ c,, ATrO Crr New Ctt Refr crs Total CrF Cu+ Crs ADO J 3 i3 30 10 24 34 90 ')6 ,45 ,6) ]FON 3 3 i3 30 8 :38 i46 100 15 i88 il03 ]KITl ]AST 3 J 3 30 14 tl i25 120 l5 I 04 I I 9 ]KITI S WEST 3 3 J 30 22l0 i12 100 9 9485 J 3 ) 30 10 23 JJ ll5 I 0710 i97 3 1 i2 i3 30 s i10 ils 50 46 i46 JBON NN 3 3 i3 30 2818 i ro 100 8323 iOO DO/ OSI 3 J 30 253 :22 126 7010 ioo JERO 3 3 3 30 ll 32 43 300 3l 207 2 38 KERE 3 J ,-1 -10 l1 r19 !30 120 23 i78 :lot KOLE 3 J 3 30 7 23 30 I 15 i 104 21 t83 SE/ ]RUN J J 3 30 4 l0 14 84 1l 46 157 LEJE \,1EJE 3 3 3 30 16 8 24 80 25 40 t65 REPO/ IELO 3 3 J 30 9 l8 27 100 ,< t-1 98 \4OBA J J J 30 t8 6 24 100 l8 59 :ll ]YE 3 ., 3 30 t2 15 27 100 20 72 92 TOTAL 48 1 47 48 480 L66 281 447 r 800 276 1245 151 9 1007o Achievement 937o Achievement %o Achievement 847o Achievement 2l WHO/APOC, 24 November 2003 -1 Table 6: Type of training undertaken (Tick the boxes where specific training was carried out during the reporting period) Any other comments 2.6. Treatments a; tE : I- Trainees Type of training CDDs Other Community members e.g Community supervisors Health Workers (frontline health facilities) MOH staf or Other Political Leaders Others (specifi) Program management How to conduct Health education x x Management ofSAEs CSM X SHM Data collection X x Data analysis x x Report writing x x Others (specify) 22 WHO/APOC, 24 Novernber 2003 .+ooN 3 q,) o z tN U o. of B i=*gers:rtez ;xovg-"E" I I t3 =u)zZ I I !Ooo trooo ,-o lr.) Oc.l $ a lr) rnlr) o o\ ro O\o rn lr)c.) r* o\ oYrOlii o treo-o: = OPE ", FzzE cE v o p. A ll* oa o '.= o5b0Otnag!s ooEOF N cor- sC\tr) s @ c- s\o € s o\r- s o\ t-- xoo\ o\r- Ba\olr) N oo r- xA co co FA o\ o\ -o O\o 6aN r* *oo\tr) r- H o a-bEU -o6;iEb9 = ogz o\$ c.ls oo o\ o\ N c.l \o F-lr) r-tr) N@ O ra) \o o\ o\ \oN o\ 00st @ @ * t--\o r- -t ao \o$ n @ \o\o o \nt tn @ o\\o co o\+ @ cO N ra) r* !oN c.) c.l c.l cO c..l H _E96 o.= 49,o' -F:o .t $ o\ (n r-. CO o\ t-- \o o\ ca A .+ t-- N N @\o @ rn O \o F- o\$ o\\o o\\o co cnr- m co t\o o\\n o\ o\(-- ca rn N\o co o\ c.i + ", EH4EFg o:oE oF a co|r) .t \o -+$ v\ot ca F-- @ o\|.- colr) \o$ al N @tt-' \o N @ N ca c.l oo $tr) \o @ o\ ca t'r s a.) n ca r- @ .tO$\o oo @ F- tn c.) \oO co a a) ood o o oU ll * HH H s o oo o o d d 50 oo N O B\ O Ba O N O s NAo\ *oO N <) *ao\ O *Oo\ O s *ob\ o *g O *oo\O o9,- O E OIIU!J€E alj>-z6 o o ol tr- O o\ o\ \ co \oca c..l O @$ ! d o.: ar? c € .:a < 94'.FL) O N r- o tr) o\ o\ t/) @tal \oco at @$ \oo4-.I 6I o=: o) "!troE+ tr - >.. _ -aqF,=^E E gob E -UEdY?O o N t-. tr) o\ @tr) \ocO N O @$ ;\4 o\ ot-1 zol! sl Er. -v)V<oEl B U) F M r! B F vH s.l& EI Z z o ca o U) o o & sl I!& rr.lv rrlJ M z r', l-,,) D U) r! t! r!J rI] J EI IJ. tr - N 4q q) Q\) v) > ar. \)L t \o V) N q) A. .v a ! a q)p F J L a -o q rr.l U) o E (.) !F rrf ol -ol c6lFI - 1l 5 T l- I 1T I I I I I -l Fl l{ rn z (J Ed t,55 \o L,I @ (, 55 LA@ (,55 \o L co \66\ o\ N (,r5 h{ { oo N)(, N) s co(,) @6 ut{\o t.J ol LA{(, (n(, \o A {tJ\op N\o o\ o'\ -]t\) 5 \o o\ o\\o s !\o s 6\ UI(, It !o -o N)A z o do t..) s Formula for computing therapeutic and geographical coverages Therapeutic coverage rate Number ofpeople reated x 100(y.) Total population living in meso/hyper-endemic communities within the project area Geographical coverage rate Number of communities/villages treated x 100(yr) Total number of meso/hyper-endemic communities as identified by REMO in the project area ATO coverage rate vt Number of people reated x 100 Annual Treahnent Objective % UTG achieved = Number of people teated x 100 Total number of people to be treated in meso/hyper-eudeuric areas within the project area (UTG) AT0 = The estimded nuntber of peoplz living in meso/hyper-endenic areas that a CDTI projecl intends to lreat with ivermcclin in a given year. UTG = The nuximant nuntber ofpeoplz to be treated in meso/hyper-endenic areas within the projecl area, uhinutely to be reachedrhen the projed has reachedfull geographical coverage (normally the project should be upected to reach the IIN at the end ofthe 3" year ofthe project). 2.6.1. Trcatment figures If the project is ttot achieving 100% geographical coverage and a ,rtit itn ttn of 65% therapeutic coverage or the coverage rate is Jhtctuating, state tlre reasons and the plans being made to remedy this. 2.6.2 What are the causes of ahsenteeisnt? Some of the members in the commuruties might have gone to their farms or trading places. Unforlunately these absentees are not followed later. Some non-indigenous persons also travel down occasionally to their hometowns, and are missed out during treatment periods. The major issue here has to do with ineffective or lack of mobilization of community members. 2.6,3 What are the reasonsfor refusals? Refusals are not common because the community leaders alu a1's mtervene. Some of the community members are even eager to use mectizan tab trvice because of the effectiveness of the drug, which they have experienced. 2,6.4 Briefly describe all kttown and veriJied serious adverse events (SAEs) tlrut occurred during the reportfutg period and provide (in table 8) the required i nfonnatio n w It en av ai lab I e. No report of any serious adverse event. In case the project did not have any cases of serious adverse events (SAE) during this reporting period, please tick in the box. No SAE case to report aL I (- {: 24 WHO/APOC, 24 November 2004 Table 8: Cases of serious adverse events (SAEs) that occurred during the reporting period (Please add more rows if necessary) None was reported aa* Serial number of the patient arr i- SAI{. Age Sex Village of origin Date Mectiz an was taken Date I't sym ptoms appear ed Sym ptoms Health status before taking Mect izarr Date of admiss ion in health facility Date of dismiss al from health facility Results of tests (thick blood smear) Outcome of prognosis Extenuat ing or complica ting circurnsta nces Alcohol involrze ment or not ti 25 WHO/APOC, 24 November 2004 2.6.5. Trend of treatment achievement from CDTI project inception to the current year Table 9: Treatments and coverage by calendar year for the entire project area. (Please-fill in the required data) Please indicate the UTG for the project area:-885 794 the denominator in all UTG coverage calculations.) (use this figurc as a& 1- a- !- YEAR Communities/villages Population Total no of commu nities/ Village s in the meso/tr yper Endem ic areas EI Annual Treatme nt Objecti \& E2 Number of conrmu nities/ villages treated E3 Geogr aphic al cover age Io/o) E3/E1 r100 ATO Cover age l%l E3IEZ {,100 Total Populat ion of the Meso/hyp er End emic area E6 ATO E7 Number of persons treated E8 Therapeut ic Coverage ['/ol E8IE6 *100 ATO Coverage l%l E8IE7 + 100 UTG Cover age lo/ol r997 344 344 265 77Yo 77Yo 600 000 493 000 190 565 39Yo 2lYo 1998 344 344 276 83Vo 83% 600 000 555 785 210 845 38Yo 23Yo 1999 344 344 320 93o/o 93% 575 000 330 819 33% 58Yo 36Yo 2000 344 344 295 86% 860/o 530 685 400 000 498 127 94o/o 24o/o 54Yo 2001 344 344 204 59% 59% 663 356 670 000 4s6 907 69Yo 66Yo 5OYo 2002 344 344 294 86% 860/o 980 487 780 000 741862 760/o r05% AlYo 2003 344 344 344 ljV/o 100% 1 005 319 750 000 741 596 79o/o lO5o/o 860/o 2004 344 344 344 1jE/o r00% l 091 000 770 000 814 141 75o/o lO5o/o 89o/o 2005 344 344 344 100% 100% l 091 000 916 438 850 980 7\Yo 86Yo 16Yo 2006 344 344 344 100% 100% | 054 517 885 794 729 229 69o/o 92o/o 92o/o 2007 2008 2009 20 l0 26 WHO/APOC, 24 November 2004 2.7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - (please tick the appropriate answer) ./uon wHo uNrcEF Mectizan@ delivered by - Qtlease tick the appropriate answer){wtoH tr wHotr uNrcEF- Other (please specify) NGDO NGDOtr Please describe how Mectizan@ is ordered and hory it gets to the conmutnities Th9 -S-t{e provides population data and numbers of Mectizan tablets it believes it will requireto NOCP who processes the data after receiving similar information from other UNICEF- assisted States. The population data comes from the census update conducted, which flowsfrom the communities to the LGAs (LOCTs). These are compiled and forwarded to the State.NOCP submits a re-application for the LINICEF - assisted Siates to MDp. On approval, thedrugs are shipped to the country and UNICEF facilitates clearance and storage. The State collects from NOCP while it releases to the LGAs. LOCTs release drugs to the-district health supervisors or the health facrlity staff who in tum make them available tJthe communities. F'LOW CHART OF MECTIZAN DELIVERY M n- EF/ NIGERIA. ST NAL OFF'ICE. DISTRICT HEALTH FACILITY A I COMMT'NITY DP Nd/ li 1- {F 27 WHO/APOC, 24 November 2004 Table 10: Mectizan@ lnventory @lease add more rows if necessary) aE lr State/ DistricUL GA Number of Mectizant tablets Number in stock Request ed Received Used Used/ Person treated Lost Wasted Expir ed Remain- lng Ado 150 000 149 000 135 012 42491 223 t3'765 EFON 70 000 70 000 68 994 23:9I* t0 792 EzuTI EAST 242 105 000 105 000 to4 137 5V575 242 863 EKITI S WEST 968 140 000 I 40 000 135 529 Sq euz 159 5 280 EKITI WEST 140 000 I 40 000 1 15 215 19 961 294 24 491 EMURE 1 50 000 I 50 000 t46 778 4t2?6 aaa 3 000 GBONYIN 105 000 105 000 104 29',1 6? 498 494 209 IDO/OSI 1 972 175 000 175 000 180 278 4;,6$:47 412 L0 942 UERO 140 000 140 000 139 569 4*,pgi 431 IKERE 7 255 I 40 000 l 40 000 135 003 45 out 5'7 12 195 IKOLE 500 I 75 000 175 000 169 291 69 865 226 5 983 ISE/ORUN 60 000 70 000 70 000 116 290 l8 493 l3 710 ILEJE-MEJE 70 000 70 000 68 430 25'752 220 l3 710 IREPODUN/ IFELODUN 2 719 75 000 75 000 72 485 2t2I.1 55 5 179 MOBA 140 000 140 000 I l0 553 4L 969 561 28 886 OYE 175 000 175 000 r57 028 61 677 t7 972 STATE OFFICE 153 656 3 000 000 3 000 000 t 944 210 72v229 3 165 I 209 446 28 WHO/APOC, 24 November 2004 4- - How are the remaining ivermectin tablets collected and where are they kept? The remaining tablets are sometimes kept with the LOCT leaders who utilize them for the next treatment cycle. The quantity retained is subtracted from that which will be required for that treatrnent cycle. At other times the drugs are returned to the State, where they are kept for the next treatment cycle. - I,ist and briefly describe the activities under ivermectin delivery that are being carried out by health care personnel in the project area. The health personnel at the various levels have been responsible for the following: o Storage of ivermectin . Supply of ivermectin o Record Keeping of drug distributed o Supervision of CDDs. - Any other comments 2.8. community self-monitoring and stakeholders Meeting \^as any training (of trainers) for community self-ntonitoring hacl been done in the project areu?If so, When? Table 1l: Community self-monitoring and Stakeholders Meeting (Add rors if needed) DistricV LGA Total # of communities/villages in the entire project area No of Communities that carried out self monitoring (CSM) No of Communities that conducted stakeholders meeting (SHM) TOTAL Not done due to insufficient funding by all partners during the reporting period. Describe how the results of the community self- monitoring and stukehoklers nteetings ha.te cfficted project inrylementation or how they rruould be utitizect during the next treatment cycle. N/A [! !- b 29 WHO/APOC, 24 Novembe r Z0O4 2.9, Supervision 2.9.1. Provide aJlow chart of supervision hierarchy. J NOCP ZONAL N.O.CP STATE ONCHOCERCIASIS 1 CONTRO TEAM (SOCT) URE LOCAL GOVERNMENT ONCHOCERCIASIS coNTROr TEAM (LOCT) I It :i.- COMMUNITY - CDDS 2.9.2. Wat were the main issues identified cluring supervision? The CDDs were demanding for incentives or payment as obtains in the NPI programme. Inadequate involvement of health facility staff Transfer of health facility staff. Improper and incomplete registration of households in the register. Exercise books were used instead of printed register. 2.9.3. Was a supenision checklist used? Yes, but not at the lower level. 2.9.4. What were the outconrcs at each level of CDTI inrylententation supervision?l. During registration, a lot of mistakes were made in their register, so informal training was done on the registration. This made the population figures realistic and data management easier. 2. The community leaders were sensitized again on giving incentives to the CDDs. Some agreed while some did not. There is a better coverage where they agreed. 3. The health facility staffthat refuse to participate were encouraged to continue and those transferred were replaced. 4. Community Leaders selected more CDDs for distribution. fr lr r l-t 30 WHO/APOC, 24 Novembe r Z0O4 2.9.5. Was feedback given to the person or groups supertised? Yes on the spot. 2.9.6. How was the feedback used to improve the overall perforntance of the project? The feedback was used to have more mobilization bbth with the poiicy makers in LGAs as well as community leaders and CDDs to give more support to eori activities. Those corrected changed for better and improve the CDTI progrimme by better coverage, better registration and supervision of the programme. More CDDs were selected to reduce the workload of each of them. SEGTION 3: Support to GDTI 3.{. Equipment Table 12: Status of equipment (Please add more rows if necessary) Source Type of equipment APOC MOH DISTRICT/ LGA NGDO Others No. Condition No. Condition No. Condition No. Condition No Condition l. Vehicle I F I NF 2. Motor cycle(s) 7 F 3. Compu-ter(s) 1 Floldl 4. Printer (s) I F 5. Photo-copier (s) I F 6. Fax Machine (s) 7. Others a)Bicycles 50 CNF b)TV set I F c)VCR I CNF d)Generator 1 F xCondition of the equipment (F:Functional , CNFR:Curently non-fi.rnctional but reparrable. WO:Written oft) How rloes the proiect intend to maintain and replace existing equipment and other moterisls? The project reparrs and maintains all capital equipment with the littie funds provided by the State and Local Goverrunents.Efforts will be intensified to convince goverrunent to release counterpart nrnas for rnaintenance of project equip*rent andpurchase of various materials. The project requested APOC to prwide a replacement of most oi ttre otd equiprne,ts supplied. :- tt E= l.- ,i 3l WHO/APOC, 24 November ZOO4 3.2. Financial contributions of the partners and communities Table 13: Financial contributions by all partners for the last three years Local NGDO(9 (if NGDO - If there ore problents with release of counterpart funcls, how were they addressed? There is a problem because no amount of money was released in the reporting year. But the new Commissioner and the Permanent Secretary has already paid advocacy visit to the Administrator and he promised to release fund for the CDTI project in the year 2007. Advocacy visit were also paid to the LGA Chairmen, Dept of LGA and Chieftaincy Affairs. Atlclitional commcnts The policy makers at State level were well enlightened and mobilize to supporl CDTI actlvrtres 3.3. Other forms of community support Describe (indicate forms of in-kind contributions of communities if any) Word of appreciation. 3.4. 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 he.e_ 1l l.r Contributor Year 3 ('provide the period') Year 4 ('provide the ' period') Year 5 ('provide the period') Year 6 ('provide the period') TOTAL AMOUNT (cASlr) Budgeted rus$) TOTAL CASH Released (us$) TOTAL AMOUNT (cASIr) Budgeted rus$) TOTAL AMOIJNT (CASH) Budgeted rus$) TOTAL CASH Released (us$) TOTAL CASH Released (us$) TOTAL AMOUNT (CASH) Budgeted rus$) TOTAL CASH Released (us$) MOH (Centrat + Provincial/ State) l0 000 3 6',t6 2 000 7 905 MOH (District/LGA) 2t 440 4 850 5 882 5 882 6 000 4 530 )anner(s Others a)LGAs 400 38+ 62 b) APOC Tnrst Fund 107 680 57 280 42 9t0 25 000 40 654 16 500 TOTAL 139 120 62 130 52 468 32 882 54 959 21114.62 32 WHO/APOC, 24 Novembet 2004 [. iii. iv. V. 4.1.2. What were the recon ntendations? i. LOCT members to be increased to minimum of four in order to enhance effective implementation of CDTI activities. Zonal coordinator to write to the pinistry of Local Government to provide office space for LOCT Selection, training and retraining of more CDDs. Provision of printed community treatment registers by the LGAs. SOCT to embark on constant advocacy to Local Government Policy makers for financial support. LOCT to follow up on the activities carried out at Health facilities and communities Quarterly report of activities to be written at all levels. List of CBOs to be identified, compiled and mobilized. Intensive and constant supervision and monitoring to be intensified at all levels. a vt. vii. viii. ix. ll 4.1.3. How have they been intplemented? i There is a plan to train one more Locr in each LGA in the year 2007ii. The letter has been sent to Ministry of Local Governmentiii. More CDDs has been trainediv' Only Ilejemeje LGA has done the printing of more Community Treatment Registers v The SOCT has paid Ado LGA Policy Makers advocacy visit for financial support on Onchocerciasis programme ui: Quarterly report of activities at all levels would be done in the year 2007 .vii. Few of CBOs were identified. viii. Intensive and constant supervision and monitoring have started and would still continue in the year 2007. 4.2. Sustainability of proiects: plan and set targets (mandatory at yr 3) Was the project evaluated during the reporting period? No Was a sustainability plan written? Yes When was the sustainability plan submitted? ZOO4 What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.2.1. Planning at all relevant levels After the evaluation of the State project, a planning/debriefing meeting was conducted during which a draft 3 - Year Sustainability Plan was developed. -Present at the ,..tlrg were representatives 34 WHO/APOC, 24 November 2OO4 tr aof the LGAs (policy makers and health workers) and the State representatives. The Plan has been fine-tuned and submitted to the MOH for inclusion into the Yearly health plan. It has been planned that at the close of each year, a review of the succeeding year's plan will be undertaken and where necessary amended. Subsequently (after the third year), plans will be developed on a yearly basis. 4.2.2. Funds At the State level, there has been some counterpart contribution, but these have been neither adequate nor regular. With the evaluation of the project, the State Government has renewed its commitment to funding the CDTI project and encouraging the LGAs to do likewise. Advocacy visits will continue to ensure that LGA keep on releasing at least minimal amounts for CDTI implementation. In the meantime, there appear indications that some financial assistance will be coming from UNICEF in the next couple of years. This is being followed up at the national level. 4.2.3 Transport (replacentent and nnintenance) As Stated in the earlier section of the report, 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 activities. At periodic intervals some of the motorcycles are replaced buy NPHCDA. With respect to maintenance, some LGAs release minimal amounts for the periodic maintenance of the motorcycles. In the meantime, a system of strict control of transport has been put in place. Every trip and every expenditure on (fuel, tyres and repair) a logbook and monthly reconciliation of trip authorization and logbook entries has been institutionalized. 4.2.4. Other resources This has been partly addressed in the previous sections. With regards to IEC materials, the project is sensitizing the Govemment on the need to produce some with the withdrawal of APOC funding, IJNICEF is also being sensitized on the need to assist the State in this respect. 4.2.5. To what extent has the plan been implemented The plan was fine-tuned during the reporting period, and nothing much has been accomplished due to inadequate funding. Mid-way into 4u year, funding from the Trust Fund to the project was suspended. In the 5th year, only 5oYo of the approved funds were released. 4.3. Integration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3.1. Ivermectin delivery mechanisnr 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 vaccineJalso use the opportunity to collect Mectizan. t: E r l, FI 35 WHO/APOC, 24 November 2OO4 4.3.2. Training Currently, CDTI training is not integrated into any other health programme training activities 4.3.3. Joint supervision and nnnitoring with other programs At the State level, there are no plans for joint supervision and monitoring at present. A few members of the SOCT participate in other health progr.Lmmes like guineworm eradication and immunization. On some occasions they take opportunity of their visits to the field for these activities to briefly look into CDTI issues. At the LGA level, some of the LOCTs are also involved in other programmes and sometimes use the opportunity of visits to community/ health facilities for one programme to look into other programmes, which they are handling. 4.3.4. Release of funds for project activities Where there are releases of fund, impress is released for PHC activities and is controlled by the PHC director. Rom their minimal amounts are made available to the Onchocerciasis Coordinator for some routine visits, collection of Mectizan or motorcycle maintenance. At both State and LGA levels, proposals for the release of funds however rnust pass through the PHC director and other normal channels. 4.3.5. Is CDTI includecl in the PHC budget? At the State level, here is a line for CDTI in the PHC budget. At the LGA level, CDTI activities are subsumed under a general PHC budget, 4.3.6. Describe other health programn es that are using the CDTI structure and how this was achieved. lYhat have been the achievements? None at the moment 4.3.7 . Describe others issues considered in the integration of CDTI. 4.4. Operational research 4.4.1 Summarize in not nmre than one half of fl page the operational resenrch untlertaken in the project area within the reporting period None was undertaken during the reporting period 4.4.2. How were the results applied in the project? Not applicable. a & {- : L- 36 WHO/APOC, 24 November 2OO4 {" ra IT t3 I SEGTION 5: Strengths, weaknesses, challeng€sr and opportunities List the strengths and weaknesses of CDTI implementation process. Strengths . Cooperation from the LGA Onchocerciasis Managers. o Regular monitoring and supervision. Some communities are fulfilling their roles under CDTI. . Some LGAs made counterpart contribution of N50,000 for the training on CDTI activities and other CDTI activities. Will hope that these will yield better result. o Additional committed SOCT as being put in place. . High rate of CDD retention despite inadequate motivation Weaknesses o None release of Counterpart fund at State level . Comparing CDTI project with Immunization programme by the CDDs on remuneration o Attrition of some of the CDDs on distribution of Mectizan. o Few communities are giving incentives to their CDDs. o Low involvement of health facilities staff in implementation process. . Inadequate number of bicycles for supervision. . Demand for incentives by CDDs in many communities - List the challenges and indicate how they were addressed. The challenges include the following: . Non-release of counterpart fund from the State . Non-release of counterpart fund from some LGAs . Conduct of census update. Though. The CDDs did this but not all of them were committed to it like before and it took long time before they even compiled since they new that they wont be paid for it. These challenges were addressed by continuous advocacy for release of funds by partners; Change of leadership in the State to meet the conditions set by APOC to restore funding, conduct of census update with support from UNICEF; Advocacy visits to both the State and LGAs' Policy Makers to release funds in support of CDTI project. SEGTTON 6: Unique features of the project/other matters 'F L 37 WHO/APOC, 24 November 2004 Activity Expenditure ($ us) Source(s) of funding Drug delivery from NOTF HQ area to central collection point of communl ty___ _ _ Mobilization and health education of communities !tuqtqg of CDDs Irg$lg_qI.bqaltt, staff at all levels and distribution lnternal monitoring of CDTI activities -----__t Ad visits to health and cal authorities IF,C materials _summary_(reporting) forms f_gt qqq$glt _ Vehicles/ Of{i99 Eqyipme_nt (e.g computers, printers etc) Others 15 85 2300 200 4000 400 200 MOH MOH MOH MOH MOH MOH MOH TOTAL 7 200 MOH Total number of persons treated 850 980 Table 14: Indicate how much the project spent for each activity listed below during the reporting period. Any comments or explanations? SEGTION 4: Sustainability of GDTI 4.1. lnternall independent participatory monitoring; Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable) Year I Partrcrpatory Independent monltonng Mid Term Sustainability Evaluation 5 year Sustainability Evaluation ,Internal Monitoring by NOTF Other Evaluation by other partners E t! b a t I ii E 38 WHO/APOC, 24 November 2004 ! maintenance