Ekiti State CDTI project annual project technical report submitted to technical consultative committee (TCC): from December 2003 to November 2004

ORIGINAL : English COUNTRY/NOTFz Nigeria Proiect Namez Ekiti State CDTI Proiect Apnroval vearz 1999 Launchins yearz 2000 Reporting Period: From: December 2003 Toz November 2004 (lllonth/Year) ear) Proiectyearofthisreporfi (circleone) I 2 3 (4) 5 6 7 8 9 10 Date submittedz Sqt. 2005 NGDO partner: UNICEF ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSTILTATIVE COMMITTEE (TCC) DEADLINE FOR SUBMISSION: : TccB To APOC Management by 31 January for March TCC meeting I To APOC Management by 31 Julv for September TCC meeting t\ lc T. AFRICAN PROGRAMME FOR ONCHOCERCIASIS CONTROL (APOC) c€r, Bitt cra b? ft{E 6&to ,.) 3 I'tk 3 0 LU|N 2006 AI{}[UAL PROJECT TECHIUCAL REPORT TO TECHNICAL CONSULTATTVE COMMTTEE CTCC) . ENDORSEMENT Pleese confim you heve read lhis rcport by signing in the appropriate 3pace. OFFICERS to sign the report Country: NIGERLA / LIBERLA National Coordinaor ]rfarns : Dr J. Y fiva sign*nre, . i6J. Date : ... l. :./. L..'jtffi { UMCEF B Zonal OffEcer Name: Mr Bade Olokan Signature: Date: T,alnarlOncho Coordinator Name : Oaubo. A.A Jaiyeoba gisnarrrre , .0&&@.1: Date : {rr{.u.5.......... This report has prepred by Name : Mn C.O Ogunbtyi Designation : Stote Coodhaor Sisndure,@*$y- Dde: ..}J.*,.1..1..1.*S.. u Table of contents v FOLLOW T]P ON TCC RECOMMENDATIONS .......I EXECUTIVE SUMMARY 2 SECTION 1: BACKGROUND INFORMATION ........3 1.1. GuNsrarNroRMA'IroN............... . ..................3 1.1.1 Description o-f rhe project (briefl! ............3 1.1.2. Partnership ...........1 1.2. Popur-ATroN .................6 2.1. TnuruNr o1.ACTrvnHS................ ....................8 2.2. Aovtxucv .................10 2.3. MOBILZANON. SENSITZATION AND IIEALTH EDUCATION OF AT RISK COIVfl\'IUNIES I I 2.4. Comvrururv INVoLVEMENT.............. ...............l2 2.5. Capncnv BUTLDING... .......14 2.6. TREATI',[8NTS................ .................17 2.6.1. Treatmentfigures........... .......17 2.6.2 What are the uuses of absenteeism?........... ........20 2.6.3 Y[/hat are the reasons -for refusals? ................ ...............202.6.1 Briefly describe all l*town and verified serious adverse events (SAE{ thnt....2a 2.6.5. Trend of treatment achievement from CDTI project inception to the anrrent year 22 2.7. OnDERn.Ic.SToRAGEANDDELIVERYoFIVERMECTIN ..........23 2.8. CorauuNrrysELl-MONnoRrNGANDSraxruororRsMllrNG ...........25 2.9. SnpBRvrsroN ...............25 2.9.I . Provide a /low chart o-f superwsrcn hterarchy. .............. 252.9.2. lYhat v'ere the mam rssile.s denttfied durmg supervision? .......... 26 2.9.3. Was a supervision checklist usedz ......... ....................26 2.9.1. lllhat were the outcomes at each level oJ CD'lI implemenlation supervision2 26 2.9.5. Wa,s -feedback given to the person or groups ,supervtsed? . ......... . 262.9.6. How was the.feedback used to improve the overall performance o.f lhe projectz 26 SECTION 3: SUPPORT TO CDTI 27 3.l. Equnrrauur 3.2. FAMNCnL CoNTRIBUTIoNS oF THE PARTNERS ANDCoMMI]NTTIES 3.3. Ormn FoRMS oF cotvMuNlTy suppoRT................ 3.4. E>opxom-nE pER ACTTvrry ............. 27 28 28 28 SECTION 4: SUSTAINABILITY OF CDTI 29 4.1. IvreRNar; TNDEPENDENT PARTTCTPATORY MOMTORING; EVALUATION...... ..............29 1.1.1 Was Monitonng,"etnluation carried out during the reporting penod? (nck an7, of the.followingwhich are applicable) ............ .............. 29 1.1.2. W'hat were the recommendanons? .. ...... 29 1.1.3. How have theTt been implementeclz................ ............ 3.1 4.2. SUsTaNaBTLITYoFPRoJECTS:PI-ANANDSETTARGETS(MANDAToRYAT...............3l Yn 3) .........31 1.2.1. Planningatallrelevantlevels ......31 1.2.2. Funds........ .........- 3l 1.2.3 Transport (replacement and mointenance) ......... .......32 4.2.1. Other resources... ......... .. ....32 1.2.5. To what extent has the plan been implemented ......... ...................32 4.3. INTEGRAIoN ......32 4.3.1. Ivermectin delivery mechanisms ............-.32 1.3.2. Training..... .........32 1.3.3. Joint supervision and monitoring with other programs..... ...........32 1.3.1. Release o"ffnds for project activities .......... .............. 3J 1.3.5. Is CDTI mcluded in the PHC hudget? .....33 4-3.6. Describe other health programmes that are usmg the CDTI strucrure and hov' this was achieved. What have been the achievements? ............. ..................33 1.3.7. Describe others issues considered in the integration of CDTI. .....33 4.4. OpERAnoNAL RESEARCrI................ ......................33 1.1.1. Summsrize m not more than one half o.f a page the operational research undertaken m the proJect area wfihtn the repornng penod. ...... 33 1.1.2. How were the results applied in the prolect? ............. .................. 33 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AND oPPORTUNrrrES..... ..............33 SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS...........34 Acronvms APOC ATO ATrO CBO CDD CDTI CSM IEC LGA LOCT MDP MOH NGDO NGO NID NOCP NOTF NPHCDA NPI PHC REMO SAE SHM SOCT TCC TOT UNICEF UTG VHC wHo African Programme for Onchocerciasis Control Arurual Treatment Objecti ve Annual Training Obj ectiv e Communitr-Based Organ ization Communitl -Directed Distributor Communiry*-DirectedTreatmentwithlvermectin C ommunit-v S el f- Monito ring Information. Education &Communication Local Govemment Area Local Government Onchocerciasis Control Team Mectizan Donation Program Ministry of Health Non-Go vemmental Development Organization Non-Govemmental 0rganization National Immunization Da1, National Onchocerciasis Control Programme National Onchocerciasis Task Force National Primary Health Care Development Agencv National Programme on Immunization Primary health care Rapid Epidemiologrcal Mapping of Onchocerciasis Severe adverse event Stalieholders meeting State Onchocerciasis Control Team Technical Comultative Committee (APOC scientific advisory- Soup) Trainer oftrainers United Natrons Children's Fund Ultimate Treatment Goal Village Health Committee World Health Organization Definitions (D Total population: the total population living in mesoihlper-endemic communities within the project area (based on REMO and census talitng). (ii) Eliplble population: calculated as 84% of the total population in meso/hyper- endemic communities in the project area. (iii) Annual Treatment Obiective: (ATO): the estimated number of persons living in meso/hyper-endemic areas that a CDTI project intends to treat with ivermectin in a givcn,vcar. (ir') Ultimate lreatuent Goel ruic): 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 (normallj the project should be expected to reach the UTG at the end of the 3'd year ofthe project). (\') Therapeutic coverage: number of people treated in a given vear over the total population (this should be expressed as a percentage). (vi) Geographical coverase: 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). (r'ii) Integration: delivering additional health interv'entions (i.e. r,itamin A supplements. albendazole for LF, screening for cataract, etc.) through CDTI (using the same systems, training, supen'ision and personnel) in order to maximise cost- effectiveness and empower communities to solve more of their health problems. This does not include activities or interv'entions carried out by community disl.ributors outside of CDTI. (r'iii) Sustainabilitl,: CDTI activities in an area are sustainable when the-v" continue to function effcctivcly for thc foresecablc future, u'ith high trcatmcnt coverage, integrated into the available healthcare service, with strong communitl' orvnership. using resources mobilised by the community and the government. (ix) Community self-monitoring (CSM): The process by rvhich the communiry, is emporvered to oversee and monitor the performance of CDTI (or an}, communitv- based health intervention programme), with a view to ensuring that the programme is being executed in the wav intended. It encourages the community, to mke full responsibilit_v of ivermectin distribution and make appropriate modifications when necessary. FOLLOW LIP ON TCC RECOMMENDATIONS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session 18 Number of Rectnnmendulio n in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FORTCC/APOC MGT USE ONLY 13s (i) Increase the number of CDDs per community 373 new CDDS werc trained in the period reported. It is em'isaged that more will be trained when approved funds are released by partners. 13s (ii) Intensify / improve advocacy at the State and LGAs level in order to obtain their financial contributions to CDTI activities Advocacy visits were made to policy maliers at both State & LGfu. with the funds made arailable by the State as well as some funds from APOC . and they promised to provide counterpart fund; but only a few firlfilled their promises. More could not be done due to suspension ofthe project. 13s (iii) Provide accurate population figures Census update u'as carried out lvith the support from IINICEF. NOCP, State and Local Government. and the results are provided in the report. However, validation is still being carried out. 135 (iv) Should rnclude Management of minor side effects. record keeping. and data collection in all training The management of mrnor side effects, record kceping and data collection are included in all Eaining sessions. 135 (v) Clarify actions taken on the recommendations from the last sustainabilifi evaluation The actions taken so far on the recommendations are reflected in the report. 135 (vi) Shorv specific activities and their output under the supervision process Training of LOCT and Health staff were well supervised by SOCT while the CDDs were supervised by LOCT (Please add more rows rf necessary) WHO/APOC. 24 November 2004 Erecutive Summary Prepare an Exesttive summt ry of the report in not more than one page. 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 projected populatio n of 2.5 Million. There are I 6 LGAs in the State. all of which were selected for implementation of CDTI. The Yorubas constitute overwhelmingly the major ethnic group in the State and it is mainly the indigenous population. How ever, individuals from other ethnic groups such as the Fulanis, Igbiras, Agatus, Igbos and Hausas have migrated into the State and cohabiting with the indigenes. Population movements in the State occur during religious activities such as Christmas/ Sdlah celebrations, and during the farming season. During these periods. there is a seasonal migration of people from one place to another. Moreover, there is movem€nt of sfudents during holidays and commencement of school periods. 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 u,ith the recent census update, is I .09 I .000 in 344 Commuruties. The UTG is 91 6-440 u'hile the ATO for the reporting period is 770,0O0. Treatrnents commenced in the project area when it was stitl part of the old Ondo State with assistance from UNICEF and NOCP using the CBIT approach. [n 1999, the CDTI strategy was initiated. The prqect trained and retrained 8 SOCTs. M LOCTs, 14 PHC Coordinators. 350 Health Workers and 2,866 CDDs. thereby achieving 90% overall for its training objectives. 344 communities were mobilized to select their CDDs and collect mectizan from designated points. Current CDD to population ratio stands at ICDD to 381 persons. A total of 342 communities were covered and 8l4,l4l persons were treated with 2,451,707 mectizan tablets during the reporting period, thus giving a geographic coverage of 99%o and a therapeutic coverage of 7 5o/o. The number treated also represented an achievement of 1067o of the ATO and 89% of the current UTG. Major policy makers at LGA level and community leaders were mobilized in various advocacy meetings to support CDTI process in the State. The mqior challenges that faced the project included the suspension of funding b1,'APOC management mid-way into the 4ft year. inadequate funding by other partners (both factors leading to non-implementation or inadequate implementation of planned activities), demand for incentives by CDDs, inadequate information on target population, inadequate logistics particularly at the front line health facilit_y level leading to poor oversight, These challenges were addressed by continuous advocacy for release of funds bv partners. reconstitution of the present SOCT coupled with leadership change. conduct of census update with support from UNICEF. 2 WHO/APOC. 24 November 2004 SECTION l: Background information 1 1 General information 1.1.1 llescription of the prcject (brieIly) Geographical location, topogrqhy, climale Ekiti State, located in the southw-estem part of Nigeria. rvas carved out by presidential fiat from Ondo State in October 1996. It covers an area of approximately 5.500 square kilometers while it has a bioclimate of rain forest in the southem area and Guinea Savannah in the northem 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 seasons starts from October ending by March. Populalion: activities, cuhures, language The Yorubas constitute overwhelmingly the major ethnic group in the State and it is mainl.v the indigenous population. How ever, individuals from other ethnic groups such as the Fulanis- lgbiras, Agatus. tgbos and Hausas have migrated into the Stale and cohabiting with the indigenes. With a current projected population of about 2.9mlliion, the State is divided inlo l6LGAs. Settlement paltem is compact w.ith population densities of between 2tl0 - 350 persons/ square kilometer. Farmsteads exisl bul are seasonal. Comnunication systems (roads...) Roads between major cites are in good condition. but access roads to most of the endemic communities are in poor shape. Some are not passable during the rainy season. Despite this, transport by road remains a major means of communication among the communities. The electronic and pnnt media are also veritable channels of communication. Within the communities the town criers and announcements in churches / mosques are preferred means of communication. Administratbn sbadare The State is made up of 16 administrative units known as local government areas. Each LGA is headed b1' a Chairman usuallv elected. who is assisted by career offtcers. There is a legislative 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 Governor is the chief executive- and he is assisted by an executive council made up of commissioners in charge of various ministries. There is a legislative arm comprising elected persons from the LGAS. Heallh system & hedrh care dclivery @rovide the number of heallh pos&/centen in the project area if the infomnation k availahle). There is an official PHC policy and structure in the project area. It is a system of health care sen'ices where community participation forms the mainstay with support from the State, Local Govemment and NGOs. Levels of functionalit_v however van/ across the State. Scattered throughout the State are various health facilities ranging from health posts to hospitals. There are 552 health facilities in the project area. Number of heahh staff in project aru and number of health staff inwtved in CDT.I acfivifia. WHO/APOC. 24 November 2004 Table l: Number of health staff involved rn CDTI (Please add more rows i.f necessarl) District/LGA Number of heelth steff involved in C'DTI activities. Total Number of heelth stalf in the entire project eree Br Number of health stelf irrvolved in CDTI & Pcrccntege tr3:82/ 81 ^l0l) Ado Ekiti 50 25 50o/o Efon 40 25 62.syo Ekiti East 45 25 50Yo Ekiti South W 55 25 45% Ekiti West 50 25 5OYo Emurc Gbonvin 40 izs I ?{ I 62.5% 60 42o/o Ido /osi )) 25 45Yo Ijero 60 25 42Yo Ikere 50 25 5OYo Ikole 60 25 12% Ise Orun 50 25 50% Ilejemeje 40 25 63'/0 Irepodun Ifelodun 60 25 ^ao/+z /o Moba 55 25 45Y" O"ve 56 25 45Y" 'l'otel 838 i I 400 $Vo 1.1.2. Partnership Indiate the partnar involved in projed implemantalion at all levels IMoH, NGDOs ( nationalfi,nternationd), aomtnilnilies, local organizalions, dc. I The partners involved in project rmplementation within the project area are UNICEF / Nigeria. NOCP (National & the B-Zonal Offices) the State Government. the Various Local Govemments and the endemic communities Dacrtbe owrall working relatbnship amrrng Wrtnen, clearlJl indicating specifrc ureas of projed adivities @lanning, supeivkion, adwcaty, planning, mobilization, etc) where all partnen a?e inwlvd- The Stare and LGAs through their vanous teirms are involved in training of field personnel. community mobilization & health educatioq management of side effects. planning and management of project implementation, supervision and monitoring, and Mectizan procurement and delivery. TINICEF is involved in supervision, advocacy and training and assists in logistics provision. The Zonal and National Offices of NOCP assist in supervisiorL monitoring training, advocacy, Mectizan procurement and evaluation of the programme. The communities play such roles as selection and remuneration of CDDs. collection of Mectizan. A WHO/APOC. 24 Norcmber 2OO4 determination of mode and period of drug distribution census update. Mectizan distribution and recording and reporting of treatments. There is a harmonious w'orking relationship among the partrrers. State pbns, rf any, to mobitize the state/region/district/LGA decision-makers, NGDOs, NGOI, CBOs, to assist in CDTI implementation The LGA policy makers rvere enlightened and mobilized to support CDTI activitres. The Hon. Commissioner for Healtl_r- the Permanent Secretary and the Director of Disease Control mobilized the State policy makers so that each LGA can contribute Ii 50,000 for CDTI census update as a first step towards counterpart funding. The Hon Commissioner and the State Onchocerciasis Coordinator moved round all the 16 LGA to enlighten and mobilize the people to support CDTI activities. The Driver's union, CBOs and market !\'omen association rvere also mobiliz.ed. These will be follou'ed in the coming,""ear. 5 WHO/APOC. 24 November 2004 I IN I ! oE E -ot I' ot B l-l{ lel.GIU d, Io(\ lt'J 8-;N9 x5v!\F :(DS(, .*. H -\ iJ3'EFE -tr s-o F) at (D (D d d oa rt tD D) + (D (Dt (D -(D ,.t(D F' @a o o p- 0a (D I(D o>t 0a (Dt g Bo op. (D' o o- e.(D .(D o o(D o Fo o (D (D (D o g o q o o q trl o tr/F {oq tll (r) o tr/ ,(. E:o rn o' o lrlt AI xi.i -LV+Arl -. t) ) DD d I- E= I.#Fjj+ ?'+1.aaD;+E- { ,6t.)j\ @ (f)i @ {(.)() @ .Ir m{ @i o\ @ .,6 + @N) \J) NJ I +. .90t, + N)(i 't) + o\(Jr +- o\ { .i\o\o\o 5 t])I \o(r) 9-9- 3 H€ E .i6'9 tr E338 EA5' .i5E I +@ NJ (/) o\ @ \o { N.J .o-E :oU ic.iI.*f= 6t== N 5 i,ri(!.< !J6te *71-6:rilDrg6-i"gtr;' P z 5oi o ae IDt2 E 0a(D a I t I t,) o\ I I \o I I I I I + oo b.J UI @ \o \o --t b.J rl t!El :l:' =oNC (! 7 il + -l "N.l + @ (, "}(, @ \tI @ @ +- @+ o\ + -9o{ +P --l o\ @ -o 5 @ -t,tJ b.J 00 1..) u)[.J Ut -$+ 5 P()) 5 .6 u) +r NJ ..U. l..J+ NJ "NJ + o\ o\ J'f' +- o\ 'J. o\ {i { +- "\o \o + l_ ; t, -o L} t, :sFg.to 1.!A E r3 .E. ii s r! * tD O g< .i' = ='9 8D * 3.it = ta'ii(l EoE o o { o\ 'i.J 56 u) .i @ -Itr) ',j @ @ + t) .,6 \otr) *3 'li Q.g -.=E nd=' E? lt { + o\i 5& ItJP\o\o o\{@\o +o\ 5 I @ {tJ tr) o\)o +\o +r ;-l u) @+ + o\ NJ N){ Ur+ \o5 o\ "N \o\9 (^)F @ o\5 qJ -I(, 6 {d=QEg. loi'. =d rl u o IJ +. z, d 3 (}E tJO +, I a oH F o (} 7 od \o - @ F.)+ o\ +-lJ) f.') (r) 5 \o 6 qJ I I (.J 55 \o 6 € -r5 \o hJ b.) o\ P € @ -q tJ+ + u) NJ \o - - @ NJ .I: o, "J= tr)N o\ 55 { NJ N) o\C 'o\ u) il a l\ € G o \ s s\ s o G\G .r \ A s Gi EI G c: \ +. a G\ .o a {No:x?h s- o)R c)\s= ?k o-o!rTULE\ +s. (D ! .viE€ o-sots JI(DS a-1t'? -.:. a ua\ (Di- ail odat oas (D .)rt\ qc '!\ (D^\ lr) :-ilQlr.tn la'I \]ISt\l3 (\ (s G \: ,o a) *E zp ,r'(h<s8[l- td u) 3rl.)s.x 5E) o a)^E Y', @= i;olr t-.l=-II'l(Dldro) -(DYo, .\J irrlolrlo.l.!{ I I I I I I o E ao 6 JD a 13(D6 .? I I I I l I l I l I I I I I I I I I I I x 1>\qs u8s.Es 3Ec,:i EEtit 8ssi$ 3* fr'\ 16 sS' )J- Gi' =b ss EI sE 50 RS' 9s Str.{- : sF sil i.R tDE t>B EB iri {c =S tr:5 S Y Eq FF ET & E Ei E's ()- e = (D(D SB- e5 R,S'A\ds 3+ Es s1 s4-R\ 6d I '€- E5 F3 gr IE T; Tr ;9 sq EH .B7,E+s gF es' <= =R r:H * S EE €,\l EVS EE sG OY: F.rr +-.1 qs g.E I 9a\ ,!iS. -H GaE tEA sso(D = -"_ E: aE $(D(D :EC \(D'O ko^ :FFU rt 6- ....i \ =\il,9gN o.s =\r/]s \v E0 s. J se { C p N)5 z d o l.JO +- { zo SECTION 2: Implementation of CDTI 2.1. Timeline of activities Fill in table 3, timeline of activities for areas treated in current year. indicating when the kev activities were implemented by the month they began and the month they ended. ,t WHOiAPOC. 24 Norpmber 2004 o(D o (D (! (D (D o g o @ d o q lll Ho rn ,f {(! o lrl (A o rr, rn E)a lfl o' ol lrltr (u .t. .) F o Fl oFl F o (} od D] (D oE Gi, o e. o -o(i Ot ter-t !, EI t Ot B: !, r< s: _ (r) =B =r*6=' -0e A: !,t A: !Dt Dl !,t S) s Ft s !,I E: !o r-t A' E S) loFt O) !,il ? D' E) ? O) ? E: 7 o, ? B' O) ? S) O) o, B) O) E) o BEo; E 7aHco =g EN =.8'(D-o, gl D) O) o 9rto z EI C) z D) o z 9lt c) ? Ol o 7 g) o z D: o z B) C) ? Ol o o: o z s) o ? 0: c) -ao=E+ i-E ? or o z ort C) z 9lto rd I o 33 !, Flit D ,eE rdI 'or-t B J. I fo I rc E r-t 'r3B ,d n ? o ? o o ? o ? I(: z H() z 4() 7 F) o ? o ? D) o z o z o z c) z o ? o ? to -a E; FE .d E E'H E o l:f Or o tD a art cr, p t! E id E ! !5 E -(h 5.l -oa 4 B E I. tJts rdt 'dB rt 4 B n B H E B z, o @ d(D4 z, o tD do zo (D d(n zo (D 6(Dt zo o C(n E z, o (D 6(} i z, o (} d(D H z, o o Co z, o () cr(}E z, o (T 6o z, o o C(D zo (D d(}t 2, o (D ot zo (D d(at 2, o (a d(D 2, o (a (t(Dt o =Boi =t=;G xtg a Et q o c) D'() D'Eo tD o O) C) S) c) t) o D) c) D)() tDIc- SDI c) A) o 7 loI c) 7 g) o otts() OJC) - (r, 5* F= '0e z, o (D 6o zo .d ct(D zo .D 6 .D z, o (D 6 .DI 2, o @ (D 2. o (D C' .D z o (} 6 .D z o (} q .D z, o (D d(Dn z o (D d(D z, o (D q (D z, o .} (D z, o (D d(D 2, o .D q (Dt z, o d d(D zo (} d(D o 3E an U) lj(D - U) o I (\ 5 -l (D (D o+) c) (Dt, a' @ F) (D s)a Ft(D o,H(D (D o -H(D x u R. (\ € P o b.J +- z d !J e NJ +' 2.2. Advocacy State the numher of plicy/dccision mtkers mnhilized at each relevant level duringthe current year; the reason(s)for undertaking the adwcacy and the outcome. Dqcribe dfficutfies/constrainfr beingfaced and suggeSions on how to impmve advocaqt At the State level, the Commissioner and the Permanent SecretarS,. Ministrv of Health. Chairman and kev staff of Local Government Service Council were mobilized. At the LGA level key officers / policy makers were mobilized during advocacy visits to the various LGAs to support CDTI particularly wrth respect to the census update. This led to the release of N50.000 by most of the LGAs for this exercise. Other groups and numbers mobilized at the LGA/Communilv level during field visits are listed in the table below. Much could not be done with respect to advocacy workshops as only one installment of approved funds was released to the before it was The major constraints in achieving required objectives include the rapidity of changes of poticy makers at the LGA level and inadequate funds from partners to carry out needed advocacy visits. There is need for high-level advocacy visits. One has been planned but this is being delayed due to inabilit_v to secure an appointrnent with the Executive Govemor of ttre State. Moreover. the burden of Onchocerciasis need to be kept on the front bumer for the political groups through: . Airing ofjingles and radio / TV discussions on the disease and control strategy o More interactive sessions with prominent traditional rulers and policy makers at the LGA level o Holding of stakeholders' meetings at all levels Opinion I-eadeIs Religious Leaden Market Women ASSOCs. Other CBOs LGA Traditional Rulers 23-5 3 t4Ado Ekiti 20 10Efon 10 7 I l3 4Ekiti East 40 t4 5 4 llEkiti S.W 27 30 8Ekiti West 20 l-5 4 5 6 15 IEmure 8 )l0 7 9Gbonyin 7 27 4 t7 4Ido / Osi 22 Iiero 35 40 5 25 Iliere ll l5 1 l0 t6Ikole t2 l8 2 I J 5 - 3 I Ise/ Orun Ilejemeje 10 8 t7 10 2 18Irepodun / Ifelodun t7 25 I J 13 t2 2 1 Moba ove t6 5 2l t2 268 301 55 2U9 20Total ro WHO/APOC. 24 Norembcr 2004 2.3. tobilization, sensitization and health education of at risk communities Prolide information on : The use of mdia and/or other local systems to disseminate information The project made use of the following media for the mobilization of the endemic communities: electronic media - Ekiti radio and television. endemic communities or CDDs. 'F Vans with mounted public address systems Mobilizotian and health educotfutn of commanities including utomlen and minorities Efforts were made by the health personnel to mobilize most of the communities during the reporting period to select CDDs where necessary, provide incentives to such CDDs, collect their drup and comply with mectizan treatment. There was an active participation of female members and minorities/settlers of the communit-v al mobilization meetings and during health education sessions. It had been reported earlier that some of the women have volunteered as CDDs when those serving expressed unwilling ness 1o continue due to lack of incentives. This is being encouraged not just where CDDs are unwilling to conttnue but n*rere there is need to select more CDDs. Resp onse of target communitiedvillages Commtmities have responded by coming forth to collect their Mectizan tablets. Members have expressed willingness to comply with Mectiz.an trru;trrrent. The communities have fulfilled most of their responsibilities under CDTI such as selection of their CDDs and determination of the mode of distribution. Though some commuruties provide some form of incentive to their CDDs, this rernains a problem in the project area. To address it the project intends to encourage the selection olmore CDDs along kindred lines. Accomplishments o There is an increase in awareness of the communities of the benefit of Mectizarq and its continual intake over a long period of time. o Involvement of CBOs in the implementation process. o There is an increase in awareness of the roles of partrrers / communities in CDTI o The communities are still very much willing to keep on taliing Mx,tizan provided it is available. Suggerfrmys to bprove mobilizdion and. sensifizstbn of the taryd qrmmunitiq- o Mobilization of more CBOs and local NGOs to participate in the CDTI process. . Equrpprng of local NGOs, market women. religious leaders, road fransport w-orkers and other community based organi:ralions wilh necessar-v skills to mobilize the communities. o There should be regular meetings with the community leaders. r The project will continue to collaborate with relevant sections of the ministry of information and culture in order to malie use of appropriate staff with skills in community mobilization. l1 WHO/APOC. 24 Norrmber 2004 2.4. CornmuniQl involvernent Table 4: Commgnities participation in the CDTI (Please add mare rows i.f necessarl) Commstton: Afrendance offenale mcmbers of the communiE at hmhh edtcation mcaings Female members of the communities in the prqect area ire uninhibited with regards to attendance at health education meetings. Though they respect their men folk - particularly the elderly ones, they are still free to participale during the meetings. In genoal, how do you rale theparticipotion offemale memben of the ummanily medings when CDTI issues are being discussa (atlendance, participatian in the discussion etc). Most at times women are not involved in community members where key decisions are taken. This is the preserve of the elders. When a general community meeting is however required women are free to attend and make inputs. Diskict/LGA Nunber of csnmunities/villagcs with cormmunity mernbcrs es supervisors Numberof CI)Ds and tlre communities involved N umber of cornrnrnitics /villeges with fcmele CDDs Totd no. corrmunities in the entire project area Br Number with communify members as supervisors & Percentege Br B</ Be *100 Mele CDDs B1 Female CDDs h Totd BrB+& Nurnber o[ crxnrnunities widr female ClDlls Br Percentege Brr: &,/ts *100 Ado Ekiti l0 5 5tr/o 108 20 128 3tr/" Efon T2 10 83o/. t20 10 130 7 58% Ekiti East t7 9 530 100 40 140 t7 100% Ekiti South W t0 7 TOYo 199 9 208 2 Zff/o Ekiti West 15 l5 LOOYI 183 7 190 7 4T/o Emure 9 9 tooyo 129 16 145 9 10004 Gbonlin 9 9 40Y" 270 20 290 2 22o/o Ido /Osi II 5 450h 175 l0 185 4 36%0 Ijero 58 39 6T/o 200 20 220 l5 26Yo Ikere 36 24 6T/o 122 8 130 8 22% Ikole Ise / Orul t2 l0 J 6 25Y" 6U/o 248 t72 t2 t8 260 190 4 l0 33Yo 100r" Ilejemeje 48 48 l00yo 82 8 90 8 44Y. Irepodrm Ifelodun 10 7 7tY/" t75 20 195 5 5tE/o Moba 58 53 9lY" t62 l3 175 l3 55V" Ov"e l9 13 68olt 175 15 190 9 4T/" Totel 344 262 160/o 2,620 46 2,866 123 36o/o t2 WIIO/AI'OC. 24 November 20O3 Incentiva provided by commanitiesfor the CDDs Generally, incentives to CDDs are in kind, though in some areas there are cash gifts. Due to the effects of modemization most CDDs prefer and advocate for cash incentives, moreso when immunization campaigns monetize those that participate in the periodic campaigns. Afrrition of CDDv Is afrrifion aprohlemfor the proiect? If yes, how h it addressed? Though the issue of incentive is causing some disaffection among CDDs. the attrition rate is low. From reports available to the project management team the attntion that occurs is usualll' w-hen the CDD leaves for school or s@ures a job. Overall, this is not a problem within the prqect area. However, lvhere CDDs leave for anv reason community concemed is mobilized to replace him/trer. Other issres .t? WHO/APOC. 24 Nowmber 2004 2.5. GapaciQr building - Describe the adeqncy of availablc knowledgeable mnnpnwer al all level* There is enough available manpower for CDTI implementation. The project however needs to train more health facility staff and ensure CDTI is part of their routine responsibilities. The project also intends to train more CDDs in order to reduce the workload on existing ones and possbly address the issue ofincentives once for all. - Where frequent transfers of trained staff occur, state what the pnoject is doing' or intends to do, to remedy the situation. (The most important issue to describe is whnt measures were taken to ensure adequate CDTI implementationwhere not enoug,h knowledgeable manpower was awilable or qf sta.ffare -frequently tans.ferred dunng the course o.f the umpaign). Staff are usually stable, although in the last year there was a massive transfer of health staff, and movement of environmental health officers to the newly created Ministry of Environment. There are plans to train more LGA stalf as well as health facility staff, not only to replace those transferred but also reduced the area of coverage and supervision for each staff. This has been hrndered due to insuffrcent funds from parhrers and suspension of funding by APOC management mid-way into the 4th year. t4 WllO/AI']OC. 24 November 2003 o (} od!) (D' (D xo =o- e.(D ,(D(l 0(D o J o (D tf(D tD (D o A q d o rn (D tal ,f {o0 lll (r) o Lr/ ,( ln tr)6 rn o' gi lrl F o (f) (r) u) t, I u) UJ tJ) u) (.) llJ t]) 1 (}) I u) t, I tfJ I u) i i -? tr z r! t9!a t!E F L>G a I U) u) u) tr) u) u.) u) (f) t! tJ) u) (, u) u) (r)i l I t]) q (,) t, ()) (.) (,) (.) t (,) (,) (, (,) u) UJ tr) UJ tr) 0,r i+ r' a -ll d !-J 00 t.J * [.J @ b.J6 N] oo NJ 00 N) @ t.)@ N)* NJoo NJoc t..)@ NJoo N)* N.)6 N)0c 'l.E t! =7,<= z6 !F9 r! rJ) ()) t+) t, tr) (, (, u) u) u) (, (, t, u) tJ) UJ F * a\ NJ N) l...) N) N) l.J t.J l..J NJ l..J l..J t.) tJ N) NJ N) x$-a i.) @ tJ @ l..J& l'.JQ NJ@ N,)@ b.)@ NJ@ NJ@ F.J@ b.J@ b.J@ N)@ I.J@ N'@ NJ@ +l,q ail g I.! z Fr (! Drti'c i{o 6Fi -r Ft rte=' ID O I I I I I I a a I O I $F6S sq 'o = Ai+ -' o f.J l.JO tJ N) (,) OO N) N) t) N) u) N) O N)O u)O OEta z t! o 0 (? tJr 5 t.) tJ) s t.J (rr .J 5 { (rr 00tr) ^<{g J: (.) _..t @ o\ N.J N) l.J trJ b.J t, u) € \o l.') $E f'J \o \o \o t9 u) N.)NJ @ l.J\oC +\ O t.J @ J: t,J NJ @ 3^- oll!L ?, li la)l,r l(D l,r, iEt s) 0e O) (D p- :t ci't(D (D (D a ot o U -l (D (D A) o t(\ % s. (\\ €4 (\ o 44A Ut I o .! .r) t.J5 za @ o N) I I I I I a |., -l F € ^\ o o (D E 5 € € € 6 \o o\ (D (! (} !, 5 x 56 o\ -o t? al o\ o\ (r) b) o\ (.) -l(.) \e (D (D @i' b.J bJ\o(, -l .n b.) € o\ o\ * E +* t" a o \ a a- > o \ o s m C o ,.} i k j a Bt- o qa , P o IJA z d 5 o t.JO Table 6: T5pe of training undertalien (fick the boxes where speci.fic tramingwas carried out during the repornng penod) Any other comments 2.6. Treattrents 2.6.1. Treatrnent figures If the pnfect is not achieving l00oi gmgraphical coverage and a rtnimam ol65% therupeutic aovenage or lhe coverage mte isfluctaating, state the reasons and theplans being made to remedy this, Though the available records indicate an average geographic coverage rate of about 86Yo for the past three years and a consistent therapeutic coverage rate ofover 65%(and this has been steadily increasing) in the last four years, efforts are being made by the new project leadership to authentic these information, and ensure that they really reflect u,hat has been done. This conc€m is bome from some of the data received for the 2004 treatment cycle. where some LGAS reported treatments more than the total target population. The project is aware of figures orr clinic based teatments sometimes merged with mass treatments data- So far the SOCT has not been able to venlv at the community level some of these data due to the suspension of funds by APOC and inadequate support from other parmers. The validation of the results of the census update is on-going but is again being constrained by lack offunds. Trainees Type of training CDDs Other Community members e.g Commumt_v supervisors Health Workers (frontline health facilities) MOH staffor Other Political Iraders Othen(specifl) Program management How to conduct Health education x X X Managemem ofSAEs x x x CSM SHM Data collection x x x Data analrvsis x x Report uriting X X Others (spccify) 17 WI{O/AI-UC. 24 November 2003 7 o5 (D' (D rJE e.(D e.(D 0o o o t) F .D (D E:(D o r o @ odo j. rn H(D rnI {(D o <F oo rr, ,f1 ln E)o lrJ+o' or lrln \U >6' @ 5@ O tJ UJo\ & \o \o O { N) O I = i8 =s,g$ Eev -., sH! = *='oo v =G *,H i6!._ o o J (D @ o) 0a(D a @ +@ i.J tJ o\ (I @ \c \o { tJ ^ F-l _€@ r gi c =Er'o= co oo 5@ l.J (J) o\ @ \o \o { f.J 2, o o o o o e= 6@a- il \o @ A\ 10 \o o\ \o \eo\ rOo\ \oo\ \o \co\ \oo\ o\ ^o 700 .i :l aiE oo5o6 g ,t- rll H o\ +tJ) N) {I t'J5& u) .5 @ { J,) @ 5P{ o\ @s o\ @ + @ .l.J(]) f..) I{> @t,+ N,)j.rr tJ+ o\ + { _!\o\o\o + (Jr L,l UJ ()) >-1O^' !i- o :- =o;ir6'.7 =!D; o =-a! r oE o) o Itr) t-) (, tr) @ NJ+(, O (, + N) o\ m lJr @ u) @ + L)O { @ 5 NJ tJ L'I l.J\o 1' t.) @ A,J si a OBE ,'d Ed= i-9r 5(, O (,) "@ UJ+ 59{\t{ o\+ h..J * o\t, "tJ + + o\ o\ o\{ +{ UJ9 f.J ++ * i..J O1 s + O 5 * * z.+EdloE 8-; q \o o\ \c \o N) o\5 (.) +. {(Jr o\ { o\ @ +-\o o\ I.J @ y3 { l..J o\ \o o\ -loods -Eso cf. U ,vv E I I I I I I I I I I I I 1, VC-ai 5 E +E * av=i I \o { tr) 9tO O ,Jt \oO O 9t O + NJ DZ @= 5'qc^ I I a, ?=fir I rOEA' setalq=g *+aq 6 8'E.5c >6;:!DH.g- l.i lo) lol{ -lt(D A) (D !) o- (r) ln(t) a- a ,.1 t) - trlH(D sl(h D) f-t (t) ,f e(\ <a F* \ \ o -\ (\ aG? \- e I U :d o b.JJ. z o' o f.J + IItII I I q (D Fl Fl F (, 5{: \o Ll)s5 \o t)5t) \o \o\o s -o ^\ \o t b ,o\ l.JJ: -t -t - \o € .r. +. -t(I s o\ + o\ t ltt) I I -l (D t(D o\ *.va) CJo (Dt A) oao i EO o (D o 0a E ^E :-o o, o o (D D oa(D E B: (D -l o o -1xo oe(} n D' (D A\V 6F il=so DH =ihE:s(D s.G ,s €E'il h : izE E, IES rlH- rs = l_'t\ 5r()? ir*)S E]HFaO s -19 =. rO ltaI PlaI ElaB 6'iEs 6l&B olxFtDF{\dcS 6O Ni)SE .E= GPa,=: =(D BEsd r@ R65 =aS.' 6t' il .6 c,ieG(D3.H t= oo =' st\eO !E . 6i.(? o sH(D S) e -lo9 ,sa! SH : -','slr .S* =sa SS!s s.s RS :-:S!E=ris +S rq Q. €r'XGdsG:.\a act$SGi+SiG$Ra\\ -l!rl llsUqs l..S tq\A .ss:}ss-\G:({Oi.s XG HB \t sF s.a:\* >.+ S€. x E s G € a. Gt g G +G + G\ { *.S t(\ t::- Oa Il €> s o a G 9a G Ii o E "a NJ +- z (i =do l'.J E o o o !D a o >tz 112 1lz.blc OIc olcIIL+IL+I' tr l1 E-l* E.l)916 =16 E16,lr e lr o lrI, lo 5lo E lo ai lH, = lFi tr lFt B lH E 18 E'IH E{a e"E slg =lo r-ll --lo^t- 5 tE l.t-EIE flIi EIEq la =lg oe 16E. la di l> E'lo<lx rCl* jlx 'l= ElEi ll:t3 6ffi Ul= =t6 IA-H E HIF Et9 I3lx g!l I- if-Jl^; JIU) tsE.o66 Ui;3 s)5a) a-5(D ='H!.>(D a i F*!J(rl aD o,E E'@eoF3(Di (a I -&.(D o d O)t(D o) ll II 2.6.2 What are the causes of absenteeism? The major problem is the inadequate mobilization of community members. As such when treatments are supposed to be on - going some of the members might have gone for their farm work or trading places. Unfortunately. these absentees are not followed later. More interactive meetings with communities are envisaged to address this issue. 2.6.3 What are the reasonsJbr reJusals? The project management has not received information of refusals. If they occur, obviously the-v are followed up by the community leadership and LGA health staff. In any case the benefits of Mectizan intahe are w'ell known and community members are usually eager to talie it. 2.6.1 BrieJly describe all hnorwt and verifid serious adverse events (SAEs) that occurred during the rqrorting period and provide (in tahle 8) the reqaired i nfo rmatio n w h e n av ai la h I e. N/A ln case the project did not have any cases of serious adverse er,-ents (SAE) dunng this reporting period. please tick in the box. No SAE case to report ./ )(l WHO/APOC. 24 Norcmber 2004 l-l IA)l5t- t(D loo .) o)a(D a F+) a(D -t ota o) a- (Dt@(D (D d u) V) IrJth O) oo C) H(D t oo (D >t(D oFt 0a (D E o o- \i(\ 4G F* Gi\ s ?1 (\ o C4 4 s_ r\* (i. (\\ P N t c o "o NJ +. z d d c0 !J s a z * 0a(D a(! x o1 tio =P4Q G ai;* f!; 9qqf1 ,d ,< :J @5(D =+-d 923 zsfs:E H E'e'g g Foa d r B !D @ P o O.:? J-)r, :alq ^ B++UACaB ;c i a -b?- 3'+ A)!J i'oo x'9?E i+Lt ce HO q9e AYts3 i;'<D ()-Q El d 7'q @oa!rs+ 6 iJ,i6ooa ^ s5F -^6O (! rE l-l t!l*Dl=0lO .D l,^ Nr =' ': hEL=ut ,,! tD!eerts *UEo3.d +(DE ''IEtl7-0l-i)+ -ixsa=d!) *u- rrEd 6ts: 'Eid; =t<JE. lo 6' stFgElaBcBlgsPt;=loi-'It00tt IJl*Jtq'al+Ul(DE !otl -Us\=.d ,si E'l9i+ld='ILrJ aa Fa(D i av(! :e $.f.i= v2*Etc:u:J5 L(\tDdEc E.G= -| El .ts HJ(DS+q $Ee;.'BS Ie s.8N ='steS e .l o ao orl oa .D aI l,) 19 c ahi/ N) t.J o t.JE z d ot i.J E N O N) \o t')Oo 00 t) -.t tJ t-) f.J 5 tJ (]) t.J t*J t.J N \o\o \o\o @ \o\o{ Jtrl U)55 .d + +. u)+ +. tr)+ +. u)+5 ,J + +. UJ+ +. UJI +. o o5 t=6'e e E f, -= Q = I.E -< =o +d o " j;iH'' =D oo o o A) fJo o u)+A u)+5 r!+5 (/) 55 tJ)+s tr)+s t])+s (, ++ -€Fe > aYio!i 7dEo= (, +t) (,) +{> N) + NJ + tJ\o (.)tJ N){ N)o\ @o1 l<==I == ad# g I*9 a: o G+r FI \o\o :\ & o\ \o @o\ \otrJ o\ t*t) ^\ -.I{ c\ l-l - e)<_oq ratr12! o;lF. ^\Y 6v: ' li,si -d;-04€xav \o\c o\ o\ @ o\ \o o\ @ o\ o\ \o tJ) -oo\ @ u) {{ 10 oo. ^<.>'?o ! .: Bi -)0a-o E s-, 'I'rii \o UJ \o \o @ .t: @{ o\ o\ UJ .(}) o\ u) "o. @ A ttJ J- J:@ o\ O o\ O E- 'tr E'q E.tr,;;f53', HE : -E!' h FU o A)+ o) {{ O {9r { O { s O AJ Y e'> crE20:roA tr, G i +. {@)o @{+ {+ "@ o\ N) 5 L't o\ \t 5 @ l.J{ UJ u) & * I..J +. \o o\(,r 3z a'6 3(}drDO tr, { o\ ._l\o ^\ { o\ o\ \o\oo\ \o5 ^\ ._t oo o\ (, o\ (,) l.'J\oo\ ,_to:t' E€D@oatr o HE:'.'I' ll A\ A\ a o\ $.Js\o oo- -:5 5 o trl @ \o oo 00 \e lj+ o\ UJ N)t/) .\o o\ N) S@-;v:ts^' oo (.D 2.7. Ordering, storage and delivery of ivermectin MectizanG) ordered/applied for by - (please tick the appropriate answer) MOIUNOCPfl tr WUO UNICEFtr Other (please specifu) NGDOtr Mectizan@ delivered by MOII/N(rcP.8 - Qtlease tick the appropnate answer) tr WUO UNICEFtr NGDOtr Other (please specifu) Please dacribe how Mectizan@) is ordered aad how it gds to the commanitiq The State provides population dara and number of Mecfizan tablets it believes it $,tll require to NOCP who processes the data after receiving similar information from other UNICEF - assisted States. The population data mmes from the census update conducted, which flows from the communities to the LGAS (LOCTs). These are compiled and forwarded to the State. NOCP submits a re-application for the LINICEF-assisted States to the MDP. On approval, the drugs are shipped to the cormtry and UNICEF facilitates clearance and storage. The State collects from NOCP wtrile it releases to the LGAs. LOCTs release drugs to the district health supervisors or the health facility staffwho in tum malce them available to the communities. FLOW CHART OF MECTIZAN DELIYERY Reporting flow T.onal Office Delivery process LGA District Health facilities Communities It I I I STATE UNTICET / Nigeria MDP NOCP 1a WHO/APOC. 24 Norember 2004 Table 10: Mectizane) Inventory (Please add more rows i.f necessary) - How are the remaining ivermectin tablets collected and where are they kept? The remaining tablets are sometimes kept wrth the LOCT leaders who utilize them for the next realment cycle. The quantity retained is subnacted from that which will be required for thal treatment cycle. At other times the drugs are retumed to ttre State, where they are kept for the nexl treatment cycle. - List and brieJly desoibe the acttvities undq ivermectin delivery thd are being canted out by health care personnel in the projec't area The health personal at the various levels have been responsible for the following: / Storage of ivermectin '/ Supplv of ivermectin StatdDistricU LGA Number of Mectizane' tablets Requested Received Used Lost Wasted Expired Remaining Ado Ekiti 160.000 156.750 155.937 35 758 Efon 140"000 136.751J 135.000 1.750 Ekiti East 170.000 163-750 I62.000 45 I I 705 Ekiti South W r60.000 I 58.750 158.000 750 Ekiti West 140.000 133.750 132.000 22 r.728 Emure 120.000 I 13.750 105.000 60 8.690 Gbon3rn 150.000 143.750 140.500 15 1.235 Ido /Osi 200,000 193.750 185.000 8,750 Ijero 200.000 193.750 192.500 l0 r-240 Ikere 200,000 196.750 190.000 I 6.750 Ikole 200.000 193.750 192.500 1.250 Ise / Orun 150.000 143.750 140.000 20 3.730 Ilejemeje 100,000 96.750 95.500 22 r.228 lrepodun Ifclodun 140.000 136.750 135.000 1.750 Moba 175.000 168,750 165,750 3,000 oye t70.000 16E,750 165,000 3.750 TOTAL 2575,000 2*500.m0 2A5t,7O 7 229 48,061 Any other commen$ )t WHO/APOC. 24 No';cmber 2004 2.8- Gornmunity self+nonitoring and Stakeholdens teeting Has any trarning (of trainers) for community self-morutoring been done in the prqect arcal If so, When? Table I l: Community self-monitoring and Stakeholders Meeting (Add rows i.f needed) Not l)one, due to insuflicient funding and suspension of funding by APOC Management during the repor.ting period. Describe how the results of the community self- monitoring and stakeholders meetings have affected proJect implementation or how-they would be utilized during the next treatment clcle. 2.9. Supenrision 2.9.1. hovide aflaw chart of supemision hierarchy. ZONAL N.O.CP ,I STATE ONCHOCERCIASIS coNrRoL TEAM (SOCT) LOCAL ONCHOCERCIASIS CONTR TEAM (LOCT) I COMMTINITY - CDDs ADAN DisfricU 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 (SHIVO TOTAL )\ WHO/APOC. 24 Nowmber 2004 2.9.2. WhaI were the main issues identified during supovision? (1) In some communities the registration was not alright.(2) The CDDs were demanding for incentive(3) The distribution was not properly done.(4) Inadequate involvement of health facility staff 2.9.3. Was a sapervision checklist used? Yes, but not at the lower levels or all the time. 2.9.4. What werc the outcomes N each lcvelof CDTI implementntion supemision? l. Efforts were made to teach the CDDs how to updafe their census. Dunng the census update several errors relating to this was detected and corrected. and this resulted in more realistic population figures obtained. 2. CDDs were encouraged to continue working despite the absence of cash incentives, and they did. Where problems were detected in the course of the distribution they were rectified. These resulted in improved coverage. 3. Though some health facility staff have been trarned they feel reluctant to participate fi,rlly in CDTI implementation since there are no funds and logistics are not there. Efforts were made to encourage them. While some heeded others did not. Where more health staff were involved supervision appeared better. 2.9.5. Wasfedback given to the puson or gnoaps supervised? Feedback is normally given on the spot. 2.9.6. How was thefeedback ased to inprow the overall performance of the pmjed? Those concemed usually made efforts to make amends, and as has been stated under outcome of supervision these efforts resulted in improved coverage and in some areas better supervision of the CDTI process. )6 WHO/APOC. 24 Nolcmber 2004 SECTION 3: Support to CDTI 3.{. Equipment Table 12. Status of equipment (Please add more rows if necessary) *Condition of the equipment (F:Functional. CNFR{urrenfly non-functional but repairable. WGWritten off;. How does the project intend to mnintain and replace *isfing equtpment ond other materials? ln the interim the project will repair and maintain all capital equipment's with the frrnds provided b1'APOC, supplemented by the little made available by the State and Local Governments. Effiorts will be intensified to convince government to release c,ounterpart funds for maintenance of prqect equipment and purchase of various materials. The project has requested APOC to provide a replacement of most of the equipment supplied. Source Type of cquipmcnt APOC MOH DISTRICT/ LGA NGDO Others No. Condition No. Condition No. Conditim No Condition No Condition l. Vehicle I F I wo 2. Motor cycl{s) 7 9 F (wo) 7 F 3. Computer(s) I F 4. Printer(s) I F 5. Photocopier (s) 6. Fa,x Machine{s) 7. Others a) Bicycles 50 CNFR b) TV Set I F c) VCR I CNFR d) Generator 17 WHO/APOC. 24 Norcmber 200-1 Contributor Year 2 ('Mqv 2001- April 2002) Yar 3 (May 2002 - . pril 2003) Ye* 4 ('Dec2003 -Nov 2004) TOTAL Cash Budgeted (us$) TOTAL Cash Released rus$) TOTAL Cash Budgeted rus$) TOTAL Cash Released rus$) TOTAL Cash Budgeted rus$) TOTAL Cash Released (us$) MOH (Central + ProvinciaVStale) 70.000 150 i0.000 3.676 2,m0 MOH (Distnct/LGA) 2t,440 10,200 2t,440 4,850 5,882 5,882 Local NGDO(s) ( if any) NGDO partne(s) 19,520 500 414 Others a) b) Communities APOC Trust Fund 157-500 9 r.330 107.680 57.280 42_910 25.000 TOTAL 268.460 1101.680 I 1.r9.120 62. l -10 52.968 -1-1,296 3.2. Financial contributions of the partnerls and communities Table 13: Furancial contributions by all partners for the last three years - If there are problems witk release of uanterpartfunds, how w*e thqt addressed? Through advocacy and links with the Department for Local Govemment & Chieftaincy matters. Additional umments 3.3. Other fiorms of communitt/ support - Descrihe (indicueforms of in-kind contributions of ummanities if any) Words of appreciation, occasional food items are the most cornmon. 3.4. Expenditure per actiYitt/ Indicate in table 14, the amount expended during the reporting period for each activiry* listed. Write the amount expended in US dollars using the current United Nations exchange rate to local currency. Indicate erchange rate used here ?8 WHO/APOC. 24 Nowmbcr 2004 Activity Expenditure ($ US) Source(s) of funding Drug delivery from NOTF HQ area to central collection point of communitr, LGA APOC APOC LGA MOTVAPOC APOC Mobilizarion and health education of communities Ds Training of health staffat all levels Supenising CDDs and distribution Intemal mgnifo_nng of CDTI, ?c.qvttigg Adyogagy yi!i!! -t-o- he4!_th and political authorities IEC materials S ummary' (reportrng) forms for treatment Vehicles/ Motorcycles/ bicycles marntenance 2941 2363.6 'h6,;.6 294t 3181.8 ii86.i 1430 7681.8 APOC APOC AP__OC APOC Offrc9_ Equipment (e,g cglppulgl!. prinlglq 9!-c) Others TOTAL 2363.6 tiir.i 32.882 Total number of persons trrcated 814,141 Table 14: Indicate how much the pro.lect spent for each activity' listed below during the reporting period Any comments or explanations? SECTION 4: Sustainabilitv of CDTI 4.1. lntetrral; independent participatory monitoring; Evaluation 1.1.1 Was Monitortng/evalaation carried out during the reporting period? (tick any of thefollowing a,hich are qtplicablQ Year I Participatory Independent monitoring Mid Term Sustainabilitv Evaluation 5 year Sustainability' Evaluation ./ Intemal Monitoring by NOTF Other Evaluation by other parfirers 1.1.2. What were the recommmdations? The major recommendations of the evaluation were: ?q WHO/APOC. 24 Norcmbcr 2004 1. Parhrers should participate in the planning process, and needs should be talien into consideration. Planning should not be routlne. 2. Supertisorv checklist should be utilized, and supervision done based on need. 3. Training should be focused on needs with each level training only the immediate level below. 4. Functions and actirities should be integrated. 5. Govemment should make financial contributions for the implementation of the CDTI programme. 6. LOCT membership should be defined and properly formed. 7. CDTI should be integrated into training for other health proglammes as much as possible. tt. All communities should be under treatment. 9. Communities should be empowered to select their CDDs and remunerate them. 10. Training of CDDs should include the compilation of the quantity of tablets required for their communities. 11. Communities should select CDDs to attain the ratio of 2CDDs to 250 population. 12. The peculiar situation in Emure LGA should be thoroughly addressed and followed up. The main recommendations of the independent participatory monitoring were: 1. The State needs to release counterpart fimds in support of CDTI activities. 2. Members of the SOCT need to be more active in supervising and monitoring the LOCTs. The LOCTs members also need to do likewise for the FLFIF health staff and the FLHF health stafffor the communities in all aspects of CDTI activities but most especially in the area of mobilisation to increase awareness level and in dissemination of right messages in promotion of the programme. 3. Communities should be encouraged to carry out self-monitoring of CDTI in their localities. This will help to increase partrcipation. 4. CDTI activities should be integrared as much as possible into other health programmes especially in the areas of supervision and monitoring using integrated checklist. 5. Local partners need to be identified at all levels in support of the programme. 6. Health workers should allow the communities to malie decisions and collect their share of mectrzan from the health facilities. 7. Communities need to be encouraged to provide incentives to the CDDs. 8. NOCP needs to provide technical support and ensue that the SOCT is empowered in data handling, record keeping and retrieval. The SOCT in tum has to ensure that the LOCTs are so empowered rvhile the LOCTs ensure that the health facilit-v staff involved in CDTI are also so emporvered. 9. The State Oncho Coordinator should make available adequate supplies of mectizan and in good time to the LGAs to overcome the problems of shortages and delay. The LGAs will also need to do likewise for the FLFIFs. 10. SOC should ensure adequate provision of LE.C. matenals up to the communitv level. 11. Treatment needs to be extended to all 'at risk' villages such as those identified in Ikere LGA. 12. Therapeutic coverage needs to be greatly improved upon in Ikere and other similar LGAs with poor therapeutic coverage rates. 13. SOC should ensure the provision of adequate health education to those that needed ir. ?o WHO/APOC- 24 Noreinber 2004 1.1.3. How have they been implemcnted? The following have been achieved as a response to the issues raised in the evaluation: l. There has becn a mqior overhaul of the prqect team at State level, and a new Coordinator appointed. 2. Where necessary LOCTs have been reconstituted 3. A sustainability plan has been developed with inpul from major slalieholders 4. A checklist for supervision has been made available and used occasionall-v 5. The State Government released $2.000 for activities for CDTI activities. Though the amount appears small, it demonstrated Government's willingness to sustain the project. 6. Communities are being mobilized to select more CDDs md to provide incentives 7. A census updale has been conducted, although validation of the results is on-going 8. The situation in Emure has been addressed, and distribution is going on very smoothll' nolY. 9. There are plans to identify local NCOs at ttre LGA level and to mobilize them. This is expected to ta.ke place by 2005 with help from UNICEF and NOCP HQs. 10. There are also plans to train LOCTs and the present crop of SOCTs on communit_v self monitoring. This is also expected to talie place in 2005 with assistance from UNICEF and NOCP HQs. I l. The NOCP HQs has conducted informal. hands-on training for the new leadership, and sxll some SOCTs will be formally trained by 2005 particularly in report writing and data management. Most of other recornmendations can not be followed due to lack of funds 4.2. Sustainability of proiects: plan and set targets (mandatoryl at Yr 3) Was the project evaluated during the reporting penod?_No Was a sustainability plan written? Yes When was the sustainabiliry plan submitted? Yes What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 1.2.1. Planning al all relevant levels AIier the evaluation of the state project, a planning/debriefing meeting was conducted dururg which a draft 3 - Year Sustainability Plan was developed. Present at the meeting were representatives of the LGAs (policy makers and health workers) and the Stale representatives. The Plan has been finetuned and subnutted to the MOH for inclusion into the Yearly health plan. It has been plarured that at the close ofeach year. a review ofthe succeeding vear's plan rvill be undertaken and where necessary amended. Subsequently (after the third year), plars will be developed on a vearly basis. 1.2.2. Funds At the State level, there has been some counterpart contribution, but these have been inadequate and irregular. Afler the evaluation of the project, and later the suspension of the project funding by APOC Management. the State Govemment has renewed its commitment to provide counterpart funding to the CDTI project The LGAs have been encouraged to do ?1 WHO/APOC. 24 Norembcr 2004 likervise, starting rvith a contribution of about:N:50.000 per LGA for the census update. Advocacl,'visits will contrnue to ensure that LGA keep on releasing at least mrnimal amounts for CDTI implementation In order to get LGAs to be more responsive, the project has come up with the modus of passing information to the LGAs ttrough the Ministry of Local Government and Chieftarncy Affairs. 1.2.3 Tranryort (rqlacement and maintenance) As staled in the earlier section of the report, the project has requested APOC Management to replace transpo( before it finally withdraws funding. This applies also to other capital items. u,hich 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 nrotorrycles for NIDs which are distributed to ttre LGAs. These are also being used for CDTI actirities. At periodic intervals some of the motorcycles are replaced by NPHCDA. With respect to maintenance, some LGAs release minimal amounts for the periodic maintenance of the motorcycles. With continuous advocacy, it is expected that funds provided by govemment will be the main stay for the maintenance of project logistics at both State and LGA levels. 1.2.1. Other tesources This has been partly addressed in the prer.ious section. With regards to IEC materials, the prqect is sensitizing the Govemment on the need to produce some with the w'ithdrawal of APOC fundrng. 1.2.5. To what Nent has ke plan been implemcnted The plan was fine-tuned dunng the reporting penod, and nothing much has been accomplished due to inadequate funding. Mid-way into the 4th year funding from the Trust Fund to the prqect was suspended. 4.3. lntegnation Outline the eritent of integration of CDTI into the PHC structure and the plans for complete integration: 1.3.1. Ivermedin delivery mcchanisms The Mectizan delivery process occurs within the existing PHC stmcture. Communities pick their Mectizan requirements from the health facilities. except in few cases w-here the drug is talien to them during NIDs. [n some instances, the LGA /PHC staff who come to pick up their vaccines for NIDs at the State level also use the opportunity to collect Mectizan. 1.3.2. Training Currenfly. CDTI training is not integrated into any other health programme training activit)' 1.3.3. Joint supewision and noniloring 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 programmes like guineaworrn eradication and immunization. On some occasions they talie opportunit-v of their visits to the field for these activities to bnefly look into CDTI issues. At the LGA level. some of the LOCTs are also involvd in other prografilmes and sometimes use the opportunit_v of visits to the community / health facilities for one programme to look into other programmes which the-v- are handling. 7') WHO/APOC. 24 Norember 2004 1.3.1. Release of fundsfor proiect adivities Where there are release of fund, imprest is released for PHC activities and is controlled by the PHC director. From there minimal amounts are made available to the Onchocerciasis Coordinator for some routine visits, collection of Mectizan or motorcylce maintenance. At bottr State and LGA levels, proposals for the release of funds however must pass through the PHC director and other normal channels. 1.3.5. Is CDTI included in the PHC budgd? 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 1.3.6. I)escrihe other hulth programmes that aru using the CDTI structure and how this was achieved What huve bem the achievements? None at the moment 1.3.7. Describe others issues considered in the intqralion of CDTI- 4.4- Operational nesearch 1.4.1. Summarize in not nore than one half of apage the operalional research andertnken in the project area within the rqorting period N1A 1.1.2. How were the resulh applied in the proied? N/A SECTION 5: Stengths. weaLnesses. challenges, and opportunities List the strengths and weaknesses of CDTI implementalion process. Strrcngths . Some communities are fulfilling their roles under CDTI. o In some communities where village Health committees have not been in- exstent- these have been constituted and made functional in the course of implementation CDTI. o Most LGAs made counterpart contributions of 50,000 Naira with respect to census update. We hope to sustain the utilization of the channel used to secure this, and hope it will produce better results. o A fresh committed SOCT has been put in place o LOCTs where needed has been reconstituted and made more functional o High rate of CDD retention despite inadequate motivation Weaknesses . Lacls of adequate commitment of LGA Coordinators particularh' in retum rendition supply of vital and urgent information as demanded by the NOTF secretariat. o Feu,communities are giving incentives to their CDDs. o Low involvement of health facility staffin the implementation process. List the challenges and indicate how thqt were addressed WHO/APOC- 24 Norember 200-1 Suspension of funding to project by APOC Management coupled with inadequate funding b,v- other parmers. This led to non-implementation or inadequate implementation of planned activities for the year. Inadequate information on target population Inadequate number of bicycles for supervision Demand for incentives bv CDDs in manv communities These challenges were addressed by continuous advocac."- for release of funds bv partners, re- constitution of the present SOCT coupled with leadership change to meet the conditiors set b-1,' APOC to restore lunding. conduct of census update with support from UNICEF SECTION 6: Unique features of the project/other matters 74 WHO/APOC. 24 Novcmber 2004