Nasarawa (6) year technical report submitted to Technical Consultative Committee (TCC): from 1st June to 31st May 2005

C O UN TRYAI OTE :N1GER1,4 Proiect Name: NlSARAWA Approval vear:1997 Launching vear: 1998 Reportins Period: From: I't JUNE 2oo4 To: 31't MAY 2oo5 (Month/Year) (Month/Year) Proiectyearofthisreport: (circleone)l 2 3 4 5(6)7 8 9 10 Date submitted: 5 /1/2007 NGDO partnerz Global 200U T CARTER CENTER NATIONAL ONCHOCERCIA,S/,S TASK FORCE NIGERIA (6) YEAR TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) AFRICAN PROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) Ytz- Tr3+ vgirt C5"b CoP A tlL Bfo YO .\ia AtD a: ,i 1i r;.0, rJAlwyA WHO/APOC, 24 NOVEMBER 2OO4 , 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: Countrv:J National coordinator Name: [f f +{.,.|..\.. {.i.i A t, -lr,r\,.L€' Signature:... .'ffi-, . Y. .IL, Date: . 2J. .2,, I ..':?:e. ::eI7. . Zonaloncho CoordinatorName: P*C*tat.A.. f.l,P, v\* {)t;'rt 'Lc-L'- Signature: ftitr.l-k.. Dare:.ri.+r-,... . .>.i. 1 .. 3r:.: 7 NGDo Representative xu-"'h . .o!r!l<...1..,€|ff:J< Signature: ,kffr{.- Dare: . .{*n. . .?.or. .A*. 7 . . This report has been prepared by Name: A.A. UMAR Designation: OYHO CORDINATOR Signature: @q)Date .... I DEFINITIONS:....... #- Table of Contents ACRONYMS:........ GENERA L INFORMATION... ... .., Description of the project (briefly) Partnership... POPULATION... ... ... INTERNAL; INDEPENDENT PARTICIPATORY MONITORING; EVALUATION Was Monitoring/evaluation caruied out during the reporting period? (lick any of the Fol I owing w hic h are appl icable) ... What were lhe recommendations? ... How haye they been implemented? 25 V VI I 2 3 3 5 8 FOLLOW tIP ON TCC RECOMMENDATIONS..... EXECUTIVE SUMMARY...... SECTION 1: BACKGROUND INFORMATION....... t.t I l.t l. 1.2 t2 -4 SECTION 2: IMPLEMENTATION OF CDTI..... 2.1 TIMELINE OF ACTIVITIES............. 2.2 ADVOCACY 2.3 MOBILIZATIoN, SENSITIZATION AND HEALTH EDUCATIoN oF AT RISK COMMUNITIES 2.4 COMMLTNITYINVOLVEMENT........... 2.5 CAPACITY BUILDING... 2.6 Training... TREATMENT....,........,. 2.6.1 Treatment figures... ...2.6 llhat are the cases of absenteeism?......... 2.6.3 What are the reasonsfor refusal?... 2.6.4 BrieJly describe all known and verified serious adyerse events (SAEs) that ... ... ..... 2.6 5 Trend oflreatment achievementfrom CDTI projecl inception to the current year.. 2.7 ORDERING, STORAGE AND DELIVERY OF IVERMECTIN 2 8 COMMLTNITY SELF-MONITORING AND STAKEHOLDERS MEETING........ 2.9 SUPERVISrON.............., 2.9.1 Provide aflow chart of supervision hierarchy... 2.9.2 What were the main issues idenlified during supervision? ... 2 9.3 Ll/as a supentision checklist used?... 2.9.1. Ll/hat were the outcomes at each level of CDTI implementation supervision? ..... 2.9.5 Llas feedback giyen to the person or groups supervised? 2 I2.9.6 How was lhe feedback used to improve the overall performance of the project? SECTION 3: SUPPORT TO CDTI.... 3.1 EQUTPMENT 3.2 FINACIAL CONTRIBUTIONS OF THE PARTNERS AND COMMUNITIES 3.3 OTHER FORMS OF COMMUNITY SUPPORT............... 3.4 EXPENDITURE PER ACTIVITY... SECTION 4: SUSTAINABILITY OF CDTI 9 9 10 l0 ll lt l2-t3 t4 t4 t4 l4 I5 l6 l8 l9 20 20 2t 2t 2t 2t 4 4 )', 22 23 Z5 24 25 25 25 254.t.2 4.1.3 rii WHO/APOC, 24 November 2004 ) 4.2 4.2. I 4.2.2 4.2.3 4.2.4 4.2.5 4.3 4.3.1 4.3.2 4.3.3 4.3.4 4.3.5 4.3.6 27 27 27 27 27 27 27 28 SUSTAINABILITY OF PROJECTS: PLAN AND SET TARGETS (MANDATORY AT 25 Yr 3)... ... 25 Planning at all relevant levels... 25 Funds... 26 Transport (replacement and maintenance)......... Other resource.r... ... ... To what extent has plan been implemented.. INTEGRATION....... lvermectin delivery mechanism... Training... Joint supervision and monitoring with other programs... Release of funds for project activitie,s ... . . . ... Is CDTI included in the PHC budget? Describe other health programn es that are using the CDTI structure and how this Was achieved. What have been the achievements?...... Describe other issues considered in the integration of CDTI ... OPERATIONAL RESEARCH... ... ... Summarize in not more than one halfofa page the operational research undertaken in The project area within the reporting period... How were the results applied in the project? 28 27 4.3.7 4.4 4.4.1 28 28 28 28 4.4.2 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AND OPPORTUNITIES.. 29 Section 6: Unique feature of the project/other matter 30 WHO/APOC,24 November 2004 IV Acronyms APOC ATO AtrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT UNICEF WHO LFEP FLHS HFS MDP MEC/AC African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objectives Community-Based Organization Community-Directed Dishibutor Community-Directed Treatment with Ivermectin Community Self-Monitoring Local Government Area Ministry of Health Non-Governmental Development Organization Non-Govemmental Organ ization National Onchocerciasis Task Force Primary Health Care Rapid Epidemiological mapping of Onchocerciasis Severe Adverse Event Stakeholders meeting Technical Consultative Committee (APOC scientific advisory group) Trainer of Trainers United Nations Children's Fund World Health Organization Lymphatic Filariasis Elimination Programme First Line Health Facility Health Facility Staff Mectizan Donation Program. Mectizan Expert Committee/Albendazole Co-ordination. WHO/APOC, 24 November 2004 Definitions (D (iv) Ultimate Treatment Goal (UTG): calculated as the maximum number of people to be treated annually in meso/tryper-endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage (normally the project should be expected to reach the UTG at the end of the 3'd year of the project). Total population: the total population living in REMOftryper-endemic communities within the project area (based on REMO and census taking). (ii) Eligible population: calculated as 84%o of the total population in meso/hyper- endemic communities in the project area. (iii) Annual Treatment Objective: (ATO): the estimated number of persons living in meso/hyper-endemic areas that a CDTI project intends to treat with Ivermectin a given year. (v) Therapeutic coverage: number of people treated in a given year over the 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 meso/ltyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). (vii) Integration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, e.t.c) through CDTI (using the same systems, training, supervision and personnel) in order to maximize cost-effectiveness and empower communities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTI. (viii) Sustainability: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future, with high treatment coverage, integrated into the available healthcare service, with strong community ownership, using resources mobilized by the community and the government. (ix) Community self-monitoring (CSM): The process by which the community is empowered to oversee and monitor the performance of CDTI (or any 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 distribution and make appropriate modifications when necessary I,VHO/APOC, 24 November 2004 vl FOLLOW UP ON TCC RECOMMENDATIONS The recommendations ofthe last TCC on the project and how they have been addressed TCC session l8 Number of Recommendation in the Report 120: TCC RECOMMENDATION ACTIONS TAKEN BY THE PROIECT FOR TCC/APOC MGT ASE ONLY 120: r Identified advocacy for release of funds by State/LGA Advocacy has been intensified but State could not releasefundsonlyLGAtoreleaseN I 96,000 for CDTI activities.. 120:ii Used new format in subsequent report The new format has been used during current report writing. 120:iii Increase the number of CDD. The number of CDD has been increased from I 808 to 285 1. 120:rv Provide missi ng information Management of SEA UTG Special advocacy workshop. Revised ATO of 6 LGAs Monitory/supervision Ordering ,storage and delivery of rvermectin Plan for integration Serious advert events were not recorded. The project is matured and has attained 100% geographical coverage. Workshop was carried out by Dr Korve 2001 & the reporting was sent to APOC Hqtrs through NOCP Nigeria, we do not have a copy now. The 6 LGAs from Nasarawa state are being handled by LF. Monitory/supervision has been carried out by SPO, SOCTs, LOCTs, HFS and community leaders. Ordering storage and delivery of rvermatin is carried out systematically from community to LGA-state and the NGDO. Integration is being carried out in the project by Oncho, LF, Schisto, RBM and NPI. i. Health is been inducted on CDTL ii Integration involving Oncho, LF and RBM. iii. Structures and staff for CDTI are involved Simultaneously in LF, Schisto and RBM whenever scheduled, similarly, non CDTI staff and facility are involved CDTI activities vii FOLLOW UP ON TCC RECOMMENDATIONS Recommendations of the last TCC session on the project, and how they have been addressed. TCC session 22 Project rerated: Number of Recommendat- ion in the Report 120: TCC RECOMMENDATION AND QUERIES RE S PO NSE S/A C TIO NS TAKE N BY THE PROJECT FOR TCC/APOC MGT ASE ONLY I The Executive summary should be written in more narrative format, and data therein should match those in the body of the report. The executive summary with the report contained statements that contradict the data in the report (e.g. Training accomplishments, financial contribution by communities, etc.); The executive summary is now written in a narrative format. The data therein match that in the body of the report. (See page 4) 2 The outcomes and feedback given after supervision were not clearly described. Moreover, it is not clear why LGA staff fain, mobilize and supervise at the community level; this should be the responsibility of the FLHFs; The outcomes and feedback given after supervision is addressed in the report. LGA staff only supervise training and mobilization activities that are carried out by HFS at the village level. (See page2l) 3 The financial information needs to be more clearly presented in one currency with column totals calculated correctly; The financial information are stated and presented with the totals calculated correctly in US dollars equivalent. 4 The timeline was difficult to interpret as most activities were indicated as having occurred for spans of 7 - l0 months and often during the entire reporting period(12 months). This should be clarified. The timeline has been rearranged for more clarity and easy to interpret. (See page 9) -T 4 Project related 5 The eligible population provided on page 6 (732,067 people) is less than the UTG provided on page 5 (877,716). ln a project like this which has had more than 8 cycles of mass featrnent, the UTG and eligible population should be nearly equal; The Eligible population and the UTG have been properly addressed and calculated correctly. (Seepage 4,14,&15) 6 It is recommended that project partners continue their efforts in advocacy to improve on the release of counterpart funds from the State and LGA; The Carter Center is committed to advocacy visits for the purpose of release of counterpart funds by the State. 7 The project is commended for training over 1,000 new CDDs and is encouraged to train even more new CDDs in order to reduce the population/CDD ration. Inclusion of women in opportunities for health education is essential; The commendation on training is noted and we shall strive to increase on the number trained to improve the CDD/population ratio. 8 It should be explained why female CDDs are chosen based on socio- cultural and religious beliefs. It is the basis of their acceptance by their communities. (See page 11) 9 No refusals are indicated in the treatment tables, yet reasons for refusals are given in the text. The project should clarifu; It was an oversight for not including refusals. However this has been corrected. (See page 15) 10 The project should explain the significant fluctuations in numbers of people and total population in recent years (e.g. close to one million were treated in 2001 and 2002, while 753,227 were treated in 2005; Fluctuation in number of people treated and total population in recent years have been explained in the body of the report. (See Page16) 1l It is unclear as to why the 5.4 million naira released by the State for CDTI was not accounted for in the financial information on pages 18 and 19 and why it was not mentioned in the response to TCC 18's recommendations on page l; The five million four hundred thousand naira (N5.4m) 540,447.44 was not released during the reporting period. It was released in August 2005, the amount will appear in the next report. t2 While CDTI is being integrated into LF, schistosomiasis, and RBM, are all of these programs regular activities of the MOH at the State level? Yes, all these programmes are regular activities in the state MOH. Planning was done SPOs of Oncho, LF, RBM and Schisto, Commissioners of Health and Local Government & Chieftaincy Affairs planned on the counterpart fund budgeted and released. 2 FOLLOW UP ON TCC RECOMMENDATIONS We first and foremost wish to apologize to TCC/APOC management for the mixed-up that we had in sending an unvetted report which was for NOTF to cross-check/correct before we send to APOC. The corrected and endorsed version is hereunder and has addressed the issues. Recommendations of the last TCC session on the project, and how they have been addressed TCC session 23 Nasarawa Project: Number of Recommendat- ion in the Report 120: TCC RECOMMENDATION AND SUERIES RESPONSES/ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY The UTG is 89% of the total population. Typically the eligible population is 80 - 84%o of the total population; thus the figure of 89% seems high. The above observation is true and is noted. The increase is generally due to seasonal movement to Toto, N/Eggon and Karu LGAs of casual workers to Abuja and farmers who move without their families. This shall continue to monitored.) Did the NGDO partners really released nearly $600,000 to the project? During the years 2003,2004 and 2005 the NGDO partners actually released the sum of $244,750.20 to Nasarawa state, 40oh for Oncho and, 600/o for LF/Schisto and Malaria - Add-on activities. The newly 5600,000 contributed was imputed for both Plateau and Nasarawa states which rncluded other budgetary items. 3 The data in table l3 are unclear and the total seems to be more than s309,r 14.40 We apologize, this has been cross checked and corrected. The total now stands at $93,509.09 4 Some percentages in table 5 are miscalculated. Percentages are calculated correctly 5 The outcomes and feedback given after supervision have not been provided. Outcomes and feedback are dealt with in 2.9.4 6 In table 13, district (LGA) contribuuon does not match values rn the executive summary and community contribution does not match values given in the document entitled "Answer to comments/queries". LGAs and community contributions have values that are consistent 7 Table 14 is reported in one currency now, but expenditures only add up to $55,000 while several hundred thousand were reportedly released Final figure for expenditure on table 14 is s93,509.09 v 1 EXECUTIVE SUMMARY Nasarawa State came into being on l" October 1996, when it was carved out of the old Plateau State by administration of General Sani Abacha. The State took off with 13 Local Government Areas. Nasarawa State has a population of about 3.1 million with about 30 ethnic groups and diverse cultures, with 80% of them in rural areas and practicing subsistent farming. The implementation of CDTI in Nasarawa State started when APOC's letter of agreement was signed in April 1 998. The proj ect is in its 6th year ( I st year of post APOC period 1 " June 2OO4 to May.2005. The project still maintains the old 7 LGAs initially approved by APOC for CDTI (Akwanga, Karu, Kokona, Lafra, Nasarawa Eggon, Toto and Wamba) with 589 meso endemic villages. Activities undertaken in the 6th year include the following: o Advocacy visits to State/LGA officials and community leaders o Mobilization and Health education of LGA and community levels o Mectizan distribution at community level o Monitoring and supervision, submission of treatment reports and drug balances. During the period under review, we targeted to train 2851 CDDs, 48 LOCTs, 30 DHS, 175 HFS and 45 TOTs. At the end of the year the people actually hained came up to 1808 old CDDs, 1043 kindred CDDs, 175 HFS, 48 LOCTs 30 DHS and 45 TOTs, This represented 100% achievement for CDDs HFS,LOCT, DHS and TOTs. A total of 773119 persons out of 988,161 were treated representing 78.2% therapeutic coverage in 589 villages were treated representing 100% geographical coverage. The ratio of CDDs to the population is l:347 for oncho. Also the project received 3,257,842 tablets of Mectizan from the Carter Center, Jos and used 2985455 a total of 272387 tablets were returned. In 2001 to 2003 there were influx of people into the State due to communal clashes in Sanga LGA in Kaduna State and Shendam in Plateau State accounting for high total population and persons treated. By 200412005, peace had returned and most people had returned to their various homes/States resulting in reduction in number of people treated and total populations Local Govemment Areas contributed the total sum of $1,468.16 while the communities contributed $4213.07 to support the CDTI activities in the state during the reporting period. Mobilization was carried out in 589 villages within the reporting period. Most of the villages showed high commitment to the program by giving incentives to 2413 CDDs. Challenges: Lack of release of counterpart funds and CDDs incentive by the State and Local Government. Poor incentive for CDDs. The project is requesting the NOCP for advocacy visits to the state government to help facilitate the release of the 3.8 million counterpart funds approved for the project by the State. The project conducted advocacy visits within the period. The Country Representative Carter Center Dr.E.S. Miri , Director Oncho, LF, and Schisto Nasarawa/Plateau State Dr., Abel Eigege carried out advocacy visit in company of the Project Administrator. John Umaru and the state Oncho Coordinator Alh.AA Umar to the Commissioner for Health and Commissioner for Local Government and Chieftaincy Affairs and some targeted Communities on the need for prompt payment of counterpart funds by both the State and the local government for effective control of onchocerciasis. In conclusion, the projects performance was adjudged as satisfactory but heavily dependent on The Carter Center, the supporting NGDO. 4 { Section 1: Background Information LI General information 1.1.1 Description of the project (briefly) Geographical locations, topography, climate: Nasarawa State is located in central Nigeria in the middle belt zone of the country. Nasarawa state lies between Latitude 70 and 90 degrees North and longitudes 70 and 100 degrees East. The State shares common boundaries with five (5) of the 36 States of the Federation and the FEderal Capital. To the south and west are Benue and Kogi States, and Abuja the Federal Capital is to the Northwest. To the North are Kaduna and Plateau States and to the Southeast is Taraba State. Climate: Situated in the tropicalzone, the climate of Nasarawa State is both hot and cold. The state lies wholly in the tropics with pleasant climate and a mean temperature of 600f and 800f (maximum). Annual rainfall varies from l3l.75cm in some place to l45cm in others. Three months in a year (December, January and February) are cold and known as the Harmatan season. Population: Nasarawa State has a total projected population of about 3.1 million (based on 1991 census projections). Nasarawa State has 13 Local Government Area of which 7 are endemic (Akwanga, Kokona, Karu, Lafta, Nasarawa Eggon, Toto and Wamba), the other 6 LGAs are hypo endemic for onchocerciasis. People: The state is inhabited with over 24 ethnic groups with common historical and cultural affiliation with no single group large enough to either dominate or claim majority position. The people are both hospitable and accommodating and have almost similar cultural and traditional ways of life. People from other parts of Nigeria co-exist peacefully with the indigenes of the state. The major religions in the state are Christianity, Islam and Traditional religions. The 24 major tribes found in the state include: - Alago, Agatu, Ake, Arum, Afor, Eloyi, Bassa, Chessu, Egbura, Egorma, Eggon, Fulani, Gade, Gbagyi, Gwandara, Hausa/Fulani, Kamberi/Kanuri, Kantana, Kwarra, Mada, Mama, Migilli, Rindre, Eggon, Tiv, and Yeskwa. The name of the ethnic groups goes with their language,T0%o of the people live in rural communities with agriculture as their main occupation. About 30%o are in urban areas practicing small and large businesses. Culture: The importance of culture cannot be over emphasized considering the rich culture of the state. These play an important role in the lives of the people of Nasarawa state in showcasing its rich culture annually through cultural festivals. Amongst them are the famous and annual Oganni cultural and fishing festivals at Umaisha of Panda Chiefdom in Toto LGA, salt festival in Keana, the Omadege in Nasarawa, Odu in Doma etc. Communication System (Roads): Nasarawa state has very good road network throughout the state and other neighbouring states of Benue, Plateau and the Federal Capital Territory. Local Govemment headquarters are also linked with good roads to facilitate transportation of human and material resources. The state has an estimated population of 3.1 million people with70%o of them in ruralareas practicing agriculture. a a a a a o Rural settlement are either clustered or scattered, with a minimum population of 250 people per settlement. Thirty percent of the population lives in urban areas. L-J a Health System Structure: € There are three tiers of health system in Nigeria the primary health care which is closest to the people and is constitutionally the responsibility of Local government, the secondary health care which is for those problem that cannot be resolved at the PHC level and are delivered in general or district hospitals under the supervision of the State governments, and the tertiary health services, which is the most sophisticated and costly for government and patients. The tertiary health service deals with the most difficult cases referred from secondary health care systems to teaching and specialist hospitals and are supervised by the Federal Ministry of health. The challenges at the primary health care level are to establish a health service system that will touch the lives of every citizen and tackle the conditions that cause the highest mortality and morbidity. The system must organized from the grassroots and woven into the fabric of the community through the process of community participation. It must integrate preventive, promotive and curative services ,where onchocerciasis falls in using the type of technology the community will accept, at the level it can afford, and with an efficient and effective system of supervission and referral.The most important principle of PHC, as defined at Alma-Ata in 1978, is communify participation. It coincides with the CDTI planning, implementation and management. Nasarawa State Health System is well structured such that Oncho Control unit is under the directory of PHC/DC, which is headed by the SPO who is answerable to the Director PHC/DC of the Ministry of Health. All communication are passed through the Director PHC/DC up to the Honourable Comm issioner. At the LGA level, each has five Primary Health Care district referred to as referral centers headed by District Health Supervisor. In each health district there are health posts or first line health facilities (FLHF) headed by health facilities staff (HFS) who oversee the activities of CDDs within their catchments areas. (See table 2 on population of CDTI LGAs) A Primary Health Care Director who supervises all health activities in the LGA is the head of each LGA health department. The State Ministry of Health developed policies and sends them to the LGA for implementation. Each LGA has 33 staff that are involved in CDTI activities except Karu and Lafia with 43 and 45 staff respectively. At the state level, there are 7 personnel who carry out Onchocerciasis Control activities. They include: the SPO, 4 SOCTs, I Data Clerk, and I Driver. The programme is integrated into the PHC system at both the state and local government levels. : Number of health staff involved in CDTI The project trained all the 1869 health facility staff of the 7 LGAs out of this number 253 were assigned specific CDTI activities within the project area. More health staff are expected to be involved when CDTI is fully integrated into PHC. 6 a a District/LGA Total Number of health staff in entire project area 81 Number of health staff involve in CDTI 82 Percentage of health staff involved in CDTI Bs=BzlBr*100 AKWANGA 301 33 tt.0% KARU 329 43 t3.0% KOKONA 2t8 JJ t5.t% LAFIA 342 45 13.t% NASiEGGON 256 33 12.9% TOTO 216 JJ 15.3% WAMBA 207 33 t5.9% Total 1,869 253 13.50 1.2.2 Partnership (role of each partner) state, LGA/Communities The state Ministry of Health is the implementing agency and her major roles included planning, staffing, manpower development, advocacy, counterpart funding, mobilization/Flealth education and supervision/distribution. The Carter Center our supporting NGDO provide funds and logistics to CDTI implementation, provides technical assistance to the project, advocacy to high government functionaries, procurement of Ivermectin tablets from MSD and development of Health education materials, while MSD provides mectizan tablets, through WHO, Nigeria. The roles of Local Governments include Planning, Staffing, Training, Distribution, Supervision, Mobilization and Health Education. The roles of the communities include collection of mectizan, selection of CDDs, provision of registration books and incentive to CDDs. CBOs - These are philanthropic and religious organizations based in urban communities. They provide support for CDTI implementation such as providing transportation to CDDs during training, mobilization and supervision. The State political leadership provides the political will, security and conducive environment for operation. 7 @rrlolol c.rl L(s o I J '5 0.) a. an C)ok o U) Lo o z o U7 t-] O (n U) oo (o o (d z U)o o rro st E3Xcd 9 o.> e€ oo9 !sg orH fi(J E,*(): x3 o= -c0PA!c) u)6 U),tr(!o)Eo> aro(scF= aa I I tl-t\ 100tol$lbot{ t\lr'lq) IU IUt\ t$ t* lsl'$ILt\lA) t-ls t: !' l! F lx \ $\- :E >!, &sSi. *9- \\ dqr$q)ts qrG .P. r", P'F $a.ss .SsSE ':$s\ %Os\s\ .U s\ *qj :: s*so-ta (Jq)q)E'$ >q, ='ss*'Bs sv9u .db a5 Luq) -o d p d lp cl q g()^ CE e flt = Er/ c)L t'- ca oo +o\ @ co \o$ c- oo ra) ra) os v1 \o c.l o\$ oo c.i cO o\ c\ ca oo r cO r-. 6 o\ Fr + il I q) *g oN o.= cEq) oF \or-\o r$ c.lN\o^ oo\o o\ c..l ,o^ F- o\f- N\o c..l t-- oo ta) +s r- oo oo \otn r-o \o € € o\ ,g .q,Ep'{)= tro!'lr9E i<iec! oE >: 6) 'ir E N \o r-\o- ra)$ I r-- oo oo ra €\o rO(.) N O() EOi 3x-g.c I{ a:,!q.=c)-, 2E N c.lct\o^ oo\o o\N\o- t'- o\ r.. N\o N F- oorr sf$ \o rn r- €r-d tin r-. 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' * - al L ^O iaoo -olOL :E3 go o.9 ,UA o oo o H oo .cjo l;o o xd 2. >'d z d z DO!E 'F= do U)E .+ s .i a.o Ch 9 o U) $ €o t rio $ aio o I 6t != 5.r o0 o o E--c -9Y $ oo + oo H o -doE. j oIL 2 o d z z E h0 d U) t o.o(/) $ oo v) +o Jo <l o t z i z * i z I o\o G)< :-> oI o OEEPOE + o s o a i oz ot oz $ oo ! $ oo ! oo H bI)tt EtrGO ae, .jg oU) + .i a.o(/) <f o o ioz $ ioz $ i az \o FI \OL= .:: .l2.; o00 c! 3 o=oo U6 sf o C') so ao(t) + t o z + i oz s ooo a oo o s do o bo .EE (!o thtr * bb hb o $ o $ ; z ioz + ioz o0 G=NE '=E =u o o _o9 + .j o U) t 9ooU) $ o t : o sf : o 6I)(r (6o U)E o $ o + ub + ob : o.oU) $ € o.o U) a.o ch -] z v D& v z v u gr J z o z F F EA in .I clr-a I .c GI o l- U)a I cl o o i'r ..t ?ol ol -al6lFI L(B,(.) = og EO bO ra )6 a(!4t E] cdq-oAO oo (d(, -Oq .= a) I o.r *O .ot Cd C)o> o9 a=Bf f+ La ^!oE d\ -qJC\J c! cr:NV .E 8E O.utro (.)Eoo c)v =6Eo) .Y o-lo> 'E€ $o =o.0o r0)Eo_o- = 6.)t= v= Pe ct .-JlCdr!!-6U(Uo .j>tr >r'v- -.rU(!r.l3 .- U i\8=50 L6A6a-LY ,r =6 - L?l .9 uiE Fec).= .-.-F- >-=;l i5 >= x9..= > ic! o<Pr-<d-ci ? = -0€;he 3 -tlo- o'=E e E€ .-&ri\ F Q c) q) N z F(, ria Advocacy High advocacy visit was carried out by APOC officials to the Executive Govemor Alh. Dr. Abdullahi Adamu Sarkin Yaki Keffi, Hon. Commissioner for health, Hon. Commissioner for Local Govemment and Chieftaincy Affairs on the responsibility for effective control of Onchocerciasis by contributing their quota of counterpart funds in both state and Local Government Areas. The main issues discussed were on sustaining the programme through counterpart contribution. Promises were made by State and Local Government for the contribution of their counterpart fund The project wishes to appreciate the effort of the NOCP and Global 2000. The Carter Centre on their Advocacy visit to the state and local Government executive to facilitate the release of funds for project activities though their meeting was not possible due to tight schedules. The project still solicit the report of the high advocacy visits by the NOCP and Global 2000 to Nasarawa State project on the counterpart funds 2.3 Mobilization, Sensitization and health education of at risk communities. The objective of the project was to reach and mobilize 589 communities on CDTI activities through: - The use of Town announcer or town criers, posters, videos, radio jungles etc Health education of Women and Minority groups is done through Women Leaders, Religions leaders, Market Women Union, Youth Leaders etc. The response of target communities/villages: they accepted CDTI as their programme and promised to give incentive to CDDs in kind or in cash, as the programme belong to them. The outcome of the mobilization/health education was impressive at the community levels, all 589 communities were mobilized on their roles and responsibilities in CDTI. This is indicated by a therapeutic coverage of not less than 78.2% and 100%o geographical coverage at June 2004_May 2005. l0 Jaar frurl District/LGA Number of communities/villages with community members as supervisors Number of CDDs and the communities involved Number of communities/villages with female CDDs Total no. Communitie s in the entire project area B4 Number with community members as supervisors Bs Percentage Be= By'B.* 100 Male CDDs B7 Female CDDs Bt Total Be=B7fBg Number of communities with female CDDs Bro Percentage Brr= Bro/81*100 AKWANGA r02 102 100% 321 6s 386 t9 18.6% KARU 99 99 100% 326 134 460 34 34.3% KOKONA 47 47 100% 196 69 26s t7 36.2% LAFIA 72 72 100% 447 144 591 36 50.0% NAS/EGGON 85 85 100% 442 123 565 34 40% TOTO 99 99 100% 216 66 282 28 28.2% WAMBA 85 85 100% 289 13 302 9 10.5% Total 589 589 100% 2,237 614 2,851 177 30.30h 2.4 Community involvement Table 4: Communities n in the CDTI *ln all the endemic communities female CDDs were selected based on socio-cultural and religious beliefs, this is the basis of their acceptance to their communities. Comments on females' performance on CDTI activities:- o Attendance of female members of the Community at health education meetingsi The attendance of the female members at community health education meetings was encouraging as women were coming out for the meetings, about 15 - 20 per village women attend the meetings regularly. o fn general, how do you rate the participation of female members ot the community meetings when CDTI are being discussed (attendance, participation in the discussion In general the females were participating actively in the community meeting when CDTI is being discussed. Women asked relevant questions, gave answers and actively participated in discussions. o Incentives provided by communitiesfor the CDDs. Yes, the communities in the project area provided incentives for the CDDs. 84%o of the CDDs were given some fonns of incentives of cash, assisted with farming or househoid chores or farm produce. Although the communities could be more generous. o Is attrition a problemfor the project? There were only 59 CDDs who dropped but the affected communities replaced them with new CDDs immediately. 2.5 Capacity Building in the State Project. The number of SOCTs trained - 4 The number of LOCTs trained - 48 The number of DHS trained - 30 The number of HFS trained - 175 The number of CDDs trained - 285I All the health staff in the 7 CDTI LGAs have been trained on CDTI activities from this pool replacement are made. Communities readily provide replacement for CDDs or increase the number as in the kindred approach. The project has adequate staff and currently the LGA s have a policy where no inter-LGA transfers are made. However when intemaltransfers are done replacement is made immediately from our reserved pool. 11 No O L C) -o Z df:.+ r, \o @ \o .+ a] o\ \o (\ oo a.l c.l co l,a €6l .\ !6-Or t oo ot ooc..l @ oo F- o\ c.l <l' co 00 €o € >eOF c-t @ @ c.l N € e.t 00 o\ ?r)t ca OUEL \o oo + c.l o\ \o c.t @ e.l aal ra66l os ,=a €.\ @GFb0 F6 LO()tr ,a Lo)hr5 rO9<!o =(u E^- O-(HFq+ cr F- F- c- Fr c- tat .\ .b-o- \o \o F- F- 6l 6c) >- Oi e.l c.t F- L -L( o9(O F- r- l-- t-- Fr m F.. rat o- () () oda €E U*r E() o!v tr!E JO F- O\o ltl N c.l c.l c.l N N c.l iar- \o i:ao l'\ o\ mN +c'l \o c.lN + olc.l t o\o \o N co ra?al .b AF( o3(O (\ c.l (\ c.l (\ N a.l rar- C) LF (! (^ .aOY ?,'lJv)ca .Y'rrx '5€ ;(,oa\ tr^ =€zt f') dll o e.l @ €F- o\ 5^ora 00 \o 00 t $ la (JN C.l $ N + \o \o F-GI e ^9j:-F < 5< @ cor- J .9 ! o0 d -lz o -vov d d -.] oo oo r! z o F (t -o E(! c! oF q) o) I 6l s 6l q,) o 3 I O o q,) c) .q) q) u0 - fi1 ol -oldlFI CA $ OO Si \) * CJ \) \\J s U) 0o S' a- ,s $ a \,) *tt\ * (.) ! c)tdo (! LF o q) D 00 rl tr o F \o c) F q) () .:o ^-9 r= 6xz ae *+€*-gi t €: E eo9L !tr6 EA E=--B!=>SEEdEE oE o5a)90 U u0 7i ,= i:o F 6.) E o bo(s (g 0) E (o l<bo oL (.) o >o i< o) U)I! (, qi o o (.) oo (c a(-) z a o oo oo (o o a 0 >. (c oo (g oo ti =L o o& e()(,)o U) (h L C) $o -o L U) E(H o() o o)! *a =bo E!otroo oiE -c c)e(g -6) C): Po ;(n o> t€ o.9> PL bo.9lu)o2zdL.= b0= ano Ug .^ 6)ii 00 x(d !) co i.iB0)(sH E:trG: tt() 5o0 oo3cflL6(o F(h =n o)- -c \-/ rl !C)c) 6.)()po ll =o)t:(, CE0 O)il U) to \o N :A .Eo €O6E6o. r<dE6L 9: €E .9P o)63E 9,3?-C,Js ;,e()Er lvJE Eoo .9Rf E;q =4St-or.. ? EX;S;Ns f En €r'-F-€e 6 o 6o\6F-F*Fr E *; = =l c0 g€T T g FE r r r r | (d I '9 arEE a € ii' ah':-E(hat6)=E E € E EQ* €€ ,gE$FiBggEgiiiigg s E E T H € E € p€ E U *q g: CEE:€EgfFFc.i ;.4 6EEE*EE:EEtig zooge' aA9.,a f E -o 1n ^^ oJ aaal< 5 =Qr9cz =qr9d r c.ia qr4t?r? e.i & c.i ..i o) lL t' Itroq C)L $ooN\ ao oN g tr oaoL o) L(.) B (n o)L ootii L C) q< u l') (o o. .f, ct.l Lo rat C\ t C\E o C)ts Ero o)er< a.I 35EC\()a E0)o>ooqn < c:) r* SetroE}76 =boc6etEtr)q8 o+ ZX ciS e.l eh cl (t) o 6l t] I L v) U) rd o CE o clq) F F- q) FI \ t- oL (.) v) o g.l U) z q) E5o_o Loo-cA€ OD .E Q- C) o9trU -3E a0E LO) !bO G)€lik qO-6e €-C aleEbo ta= aEl 9ritrvOu)qrb ? o.) oc) !6 =cgO<n oo.Ytt=h 9CEV) ,9=q-rai60 ocEA 60tE F=o) o'5 E JEE cE,.: g c)E5 L!iC)oIUo)ir r'-o'= 9 hO ar ooP FA:H oo' o -es GI E;*ea;iaE O 9rd -eA za \o c- o\ <tN $F-@ o\o\ oo €o\o \o LE 9U =t =ozE = 9- -E ts;zE2" E E o\ F-c.! + t- 6F- =M 6 90\L >v90E9 6\ oo \o o\ 6\q @ \o ^\q \o ^\ oi oo \o cl o\ @ o\ n \o scl 6r- H LCY9 0i3 Et9 = o-z sf o\ 00 c.l c\l 00 o\ € € F- o\ c.l e.l+ od F- s \o o\ c)r-r- c 9.= = EE iE*s + o\ oo + o\ c.l F-$ co + 00o\o 00N c.l \o 00 $ c.t o\ C.l 00 $ o\ \o r- F-r-6 cg o -E L.=-gEE<E E -=. rE" F-\o + N c.l\o €\o o\N \O^ F- o\F- c.l N F-@ +$ F- € € F- \o aO o\ a lt '=ME9r^F AS ioAr- ^\ ^\ ^\ \oo\ \oo\ sco Ln bE gE €56k =E>!za N o\ o\ F-v NF- co o\o\ € o\ €l,a E5B N o\ F- =f NF- 00 o\o\ oo o\ € ra 0q) 0,0 c! 0q) U H -e A O u; EE.:.$E e?EEIc-9fl F.YU E,r N o\ o\ c-$ c-.1rr oo o\o\ € o\6m .9< 0r (c bo cd JZ L M CB Ji ov CB li=(gJ o oo boq z o F (! (t qh F a Table 8: period Cases of Serious Adverse Events (SAEs) that occurred during the reporting 2.6 .5 Trend of treatment achievement from CDTI project inception to the current year Since treatment started in 1998 - May 2005 there has been a progressive increase in the number ofpersons treated each year. a) In 2001 to 2003 there were influx of people into the state due to communal clashes in Sanga LGA in Kaduna State and Shendam LGA in Plateau State accounting for high total population and persons treated. b) By 200412005, peace had returned and most people had returned to their various homes/states resulting in reduction in number of people treated and total populations. S/N Agc Scx Vilhgc of ongln Drtc mcctizrn wrs aakcn Detc 1'r symptoms rppcrrcd Symptoms Hcrlth strtus bcfore trking mcctizen Drtc of cdmissi on in hcelth frcilitio Dr tc of dismiss el from hcrlah fecilitv Rcsults of adts (thick blood smclr Outcom cof prognos is Extcnuctin gor compliceti ng circum- sttnccs Alcohol involvcmc nt or not No serious adverse events were experienced/reported t6 r- .j \) \.) s t a .q) \o I Iq) \\ \,) F \ q)s q) 4 B \) ,a Ut\!\) il Sl\\ a C) o o. cgLo s ol @I-t (! C) (n C) v) v') o ol co Itt lal cqoI ..I 9-()o)^ aH o5Lo Oa rrO Lo)ciootr Gl^8,tr c) l'i CE C)e'a >rk t-ra '^C) IJ 7,. (Jcii z,ot4r reeo) obtr 0.) =>l-() o(g oc)g0E fi cdoc) >L 9: Gb u) .' ooEbo q!6$r> FC) o) th rr o \o rr Frr- € clo G I o) q) F D o\ q) tr *r f-] fr1 o ri 8 3$ <E o s\ o\+ s\q$\o \o o\ o\ -oo\\ o\ slr)o\ -o o\ .tl F- o\ s od oo * H Elo lt ri .eG =vooau0 €!c! () Q,)F> 'o .o o\ oq C\$ -o ^\9f- rn s c"l € s c.l co € 9\o r-. s\ € scl oor- o 6t o ri O-9 ErEf;5 oE Z Pr! oo N N N oo c\ oo oo r-. r- r- o\ oo- cO .+ o\ @F- ra)\itf r-- N t- N F- o\ cOr-l'- Fri :e? 6q)> =EEEiJ!aE fi.1 < .E: @ c-.1 =f, cO o\ ra) C.$ t oo oo r-. $ @ oof- lr) € ta) oor- t--\o o^ N car- \o t'- r-t-- @ Iri =oo sErfi g +\o F-\i o\$ ca o\ €$ aA sf o\@ f- r-.$ sf c-l oo \o $r- o\ oo\o tr- c.ir- oo \o € oo o\ o a0 c! o U ri>a ?F rI] o o t- F oo\ < >v'o \o o\ Noo q =fo\ o\ c.l N oo o ti >3 ll * ti t". t!6t-Gta FoE bSO'- >voo(,e \o o\ cl N oo q <r o\ cl o\ (tl N oo O ri o'E o;'E toE :=6'!; E= IiEa!zE- \o\olr) $ oo .f, o\ln 1 r= aOtal la) €$ o\ €tr) o\ €lr) ri -trq,6q)>:, EEEEg.i Ei o\ oo o\ oon o\ oola) o\ oo rn o\@la) o\ co(n o\ oo rr) ri )9.,H!.9t i IiE.s *F cE = Ei <'=! E hDo tr3 Es 8.9 vaO o\ oo rr) o\ oon o\ ootr) o\ oo\.| o\ € ra) o\ oo(n o\ oo|..) cq €) o\ o\ o\ N N c.l N co c.l $ ot tr) c..l 2.7 Ordering, Storage and delivery of Ivermectin MOH MectizanI ordered/applied for by -wHo tr TJNICEF f] NGDO Other (Please speciff): MOH Mectizan delivered by - (Please tick the appropriate answer) MOH wHo I]IIICEF tr NGDO Other (Please speciry): Before the procurement of mectizan is done by NGDO, each CDD calculates his or her mectizan requirements based on the eligible population registered and multiply by average of three tablets. Together with FLHFS, they arrived at their requirement for each village, which is sent to focal persons at the LGA (LOCT), until it reaches the SOCTs. The SOCTs/SPO compiles all requirements for the seven LGAs and sends to the NGDO for procurement. When mectizan arrives in the country, WHO clears from the Customs and stores it in their warehouse. The NGDOs then collects the drugs to her store. The state project officer puts up requisition for each LGA. When mectizan is supplied to the SPO by NGDO, SOCTs collect for their respective LGAs and deliver to the LOCT team leaders at the LGA levels. The team leader then hand over the drugs to the five DHS for allocation to the five FLHF or collection centers where CDDs come to collect for their respective communities. Mectizan Status *Drugs in the field (272,387 tablets of Mectizan was returned to the state store at the end of the year) 18 Number of Mectizan tabletsState/District LGA Requested Received Used Lost Wasted Expired balance Oncho LF State Offrce 3,257,842 3,257,84? ?72,387 AKWANGA 451,344 451,344 281,980 166,020 3 344, KARU 773,008 773,008 613,882 103,625 55,501 KOKONA 328,034 328,034 184,389 2,300 141,345 LAFIA 675,958 675,958 253,258 397,604 25,096 N/EGGON 597,705 597,705 597,705 TOTO 249,442 249,442 203,157 46,285 WAMBA 182,351 182,351 181,535 816 Total 3,257,842 3,257,842 2,315,906 669,549 272,387 aHow are the remaining Ivermectin tablets collected and where are they kept? Each CDD retums any drug balance to his /her Health facility staff supervising himftrer, who in tum retums all balances to the LOCT/DHS in charge of the area. who also retums all balances to the LOCT Leader for the LGA. The LOCT Leader then hands over all drugs returned/retrieved to the SOCT member in charge of the LGA who returns same to the SPO for safe keep to next treatment round. CDDs from the field hand over drugs to the health facility in the clinic, health facility staff hand over the drugs to LOCT and the LOCT hand over the drugs to the SOCT. The SOCT collect the drugs and hand over to the SPO and the SPO keeps the drugs in the store. List and briefly describe the activities under lvermectin delivery that are being carried out by the health care personnel in the project area. Mobilization/Health Education: The health personnel mobilized and health educate the members of the communities on CDTI activities and the importance of CSM, sustainability and incentives to the CDDs. Training: The health personnel trained CDDs on how to keep good records, distribution of Ivermectin, recognition of reactions, census update and data collection. Treatment: The health personnel collect Mectizan and distribute to the CDDs to distribute to the effected communities. Supervision: Health workers supervise the activities of the CDDs in the field during and after distribution of Mectizan and supervise drug issues to the communities CDDs on proper record keeping. Any other comments? The supervision has to be in the CDTI hierarchy: SOCT -supervised LOCT at the LGA levels LOCT -supervised HFS at the health facility levels HFS -supervised the CDDs at the community levels 2.8 Community self-monitoring and stakeholders meeting. Yes, training (of trainers) for CSM and SHM were carried out in the project area in June 2004/l\4 ay 2005. t9 DistricttuGA 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) AKWANGA 102 15 1 KARU 99 9 J LAFIA 72 t4 2 KOKONA 47 J I N/EGGON 85 6 4 TOTO 99 7 J WAMBA 85 6 2 TOTAL 589 60 t6 Table l1: Community self-monitoring and stakeholders meeting Training (of trainers) on CSM and SHM was carried out in the current year therefore 76 village were able to conduct both CSM and SHM. 2.9 Supervision NB: 20 2.9.1 Flow chart of supervision hierarchy (Zonal Coordinator) (Dir PHC/SOCTs) (Dir PHC/LOCTS) ffiFS) (Comm/I(indred Leaders & CDDs) NOCP/FMOHNGDO cater tre ZONE'D'PLAIA PROGRAM STATE MOH LGA PHC FLHF 24 2.9.2 What were the main issues identified during supervision L Some CDDs do not use durable registers like hard cover note books . 2. Some communities give incentive to their CDDs while others do not 3. Inadequate logistic for supervision at LGA levels 4. Inadequate IEC materials. 2.9.3 Vf/as a supervision checklist used? Supervision checklist is used during supervision at each level of health staff involved in CDTI activities. 2.9.4 2.9.5 2.9.6 What were the outcomes at each level of CDTI Implementation/supervision? -More incentives to the CDDs, more CDDs were selected by the communities and improve report collection by the health facility staffs were as a result of LOCT supervision at the health facility level. - During the SOCTs supervision there is improvement in realizing the counterpart fund from the LGAs. Was feedback given to persons or groups supervised? Yes feedback was given to the persons or group of persons supervised. How was the feedback used to improve the overall performance of the Project: The feedback was used to plan and carry out targeted advocacies/awareness campaigns, training and mobilizations at various levels for persons or groups during monitoring or prior to next treatment round. This impacted positively on the overall performance of the project, in addressing: inadequate number of CDDs, absenteeism etc. 21-' 22 tro \N L C)U cdg t o(r* L-o= -Yir- \JU>(, .L!oLVOEa.ot)>/- CdHi50rP(0= V) aL!v!- b oPaC,C)CO = Egb E.i,A =door6E Eo(.) r) (a o boYJ -A\ rd_g !lcddv9J]Aa <.: ar !) 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No _No_ Year 1 Participatory Independent monitoring No Mid Term Sustainability Evaluation No- 5 year Sustainability Evaluation No Intemal monitoring by NOTF What were the recommendations? Nil How have they been implemented? Sustainability of projects: Plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period? _no Was a sustainability plan written? yes__ When was the sustainability plan submitted? _April . 2003 Planning at all relevant levels A: Planning at the state level was as follows: - l. To train 50 LGA health workers on CDTI strategy, SHM and CSM 2. To conduct update of registration in 589 communities 3. To attend APOCIZOFT review meeting 4. To maintain project vehicle, computer and photocopier 5. To procure drugs and supplies 6. Maintenance of telephone landline Funds To source money for the sustainability of the programme from state, LGAs and the communities through counterpart contributions Transport (replacement and maintenance) Request APOC to replace the old vehicle with a new one. Other resources of programme The programme plans to source for funds that will take care of other resources such as computer, IEC materials etc. from Local NGOs such as National Union of road transport workers, Association of Market women, and NGDOs such as The carter Center etc. 26 4.2.1. 4.2.2. 4.2.3. 4.2.4 4.2.5 4.3 4 To what extent has the plan been implemented? 1. All 589 communities were mobilized and Health Educated 2. 4 SOCTs were trained. 48 LOCTs were trained 30 DHS were trained 175 HFS were trained 2851 CDDa were trained 3. 773119 persons were treated 10 2851 CDDs were supervised by HFS, 175 HFs were supervised by SOCTs and 48 LOCts were supervised by SOCTs. 4 SOCTs trained 48 LOCTs, 30 DHS, 175 HFS trained 2851. CDDs conducted an update of registration in 589 communities. APOCIZoft quarterly review meeting was attended by SPO. Maintenance of project vehicle, computer and photocopier were carried out in the state office, through counterpart contribution from state. Procurement of mectizan and supplies was done by the Carter Center. State has been maintaining the telephone landline through state counterpart funds. 5. 6. 7. 8. 9 4.3.1 4.3.2 4.3.3 Integration Outline the extent of Integration of CDTI into PHC structure and the plans for complete integration: Ivermectin delivery mechanisms The plan has been on ground with the following programs for delivery of Mectizan with lymphatic filariasis, schistosomiasis, and roll back malaria programs. The four programs use the same LOCTs, DHS, HFS, and CDDs for their distribution and, mobilization, treatment, haining and supervision when they are going out for other programs activities they integrate the delivery of Ivermectin. Training: The training on CDTI, RBM, LFEP & SHC are planed and executed at the same time by an integrated team. Joint supervision and monitoring with other programs- LF, Malaria, and Schisto- pool their logistics and staff to monitor and supervise lield work. 27 4.3.4 4.3.s 4.3.6 4.3.7 Release of funds for project activities - The four programs oncho, LF, schisto and malaria plan their work together so that they use their funds collectively to carry out their activities. Is CDTI included in the PHC budget? Yes CDTI is included in the PHC budget. Describe other Health programmes that are using the CDTI structure. Lymphatic filariasis, Schistosomiasis and Roll back Malaria. These programs are using CDTI structure they collectively plan activities together for their outing during training, treatment and supervision. The achievements: a. Cost of the programme is reduced as a result of using the same staff at state, LGA, and community levels. b. Manpower is reduced because of more staff being involved. The same staffs working in Oncho are the same in schisto, LF and RBM. c. With increased knowledge and skillof staff involved, time wasting is reduced. d. The programme has achieved the following a. Reached 589 communities and treated 773119 for oncho b. Covered 97 communities and treated 249,615 - schisto c. RBM-ITNs Distribution covered 99 communities and treated 55,107 Nets. d. Lymphatic Filariasis covered 4 communities and treated 252,254 persons. Describe other issues considered in the integration of CDTI. Manpower: Generally manpower is scarce it is better to maximize using the few hands we have on ground, therefore, it is important to increase the knowledge and skills of the few available to enable them take up and share more responsibilities. Funds:Most of the programmes do not have enough funds to plan their programs efficiently. It will be wise if they integrate with other programs. Logistics: Most of the programs do not have enough vehicles for their daily activities, but when they integrate with other programs they can use their resources to meet their various individual needs. Operational research To summarize in not more than one half of a page the operational research undertaken within the reporting period? Yet to commence operational research. 4.4 4.4.1 28 4.4.2 How were the results applied in the project? The result will be used during distribution and treatment period if caruied out. SECTION 5: Strength, Weakness, Challenges and opportunities Strength: * High geographical/therapeutic coverage. * Time of treatment has been reduced because of more hands on the job. * More awareness by community on self-ownership. * Training of Oncho Team on CDTI activities is now a targeted training. * Collection centers are now nearer to the community making it easier for the CDDs. Weakness: * Drugs passing through many hands before reaching the community cause delay in treatment. * No adequate incentive to the CDDs by the communities. * No adequate counterpart funds by the State and Local Government. * Some CDDs left their job without handing over the registration books to their village heads Challenges: l. Poor counterpart fund from state and local govemments 2. Poor incentive to CDDs by some communities Recom mendations/Opportunities : .E' Overall budget for State and Local Government should include CDTI activities * Community should intensiff giving incentive to the CDDs. * All hands should be on deck by all tiers of govemment and community for the sustainability of the CDTI activities. * Blindness due to Onchocerciasis is drastically reduced. * Skin diseases reduce to some extend * Some women were pregnant as result of taking the drugs. Recommendations/Opportunities : * Overall budget for State and Local Government should include CDTI activities * Community should intensifli giving incentive to the CDDs. * All hands should be on deck by all tiers of government and community for the sustainability of the CDTI activities. * Blindness due to Onchocerciasis is drastically reduced. * Skin diseases reduce to some extend * Some women were pregnant as result of taking the drugs. 2e SECTION 6: Unique feature of the project/other matters The project operations were integrated where the same staff at the state, local and community levels was involved in CDTI, LF elimination programme, Schistosomiasis control and Roll Back malaria activities. The project made the following achievements during the period under reporting period in addition to CDTI. ADD-ON ACTIVITIES TO CDTI IN NASARAWA STATE o The ATO was based on estimation of urban populations thus under estimated. o Entomological studies of Black flies and Mosquitoes were also ongoing to monitor impact on Lymphatic Filariasis and Onchocerciasis. S/N PROGRAMME VILLAGES POPULATION ATO COVERED ATO o//o ATO PER^SONS TREATED ATO % Schistosomiasis t65 32 84% 9641 6,599 68.4% RBM-ITNs Distribution 100 l 000 100% 1000 Nets 1000 Nets retreated 100% Lymphatic Filariasis 4 I 100% 259,505 211,846 76.6% 30