NOTF/WHO APOC Oyo State CDTI annual project technical report submitted to Technical Consultative Committee (TCC): January to December 2006

Oyo Stittc: xTl Proiect ORIGINAL: English Proiect Name: NOlr{7wHu ArUC OYO STATE CDTI PROJECT t:rt't ril 1 t I C'O (J AI\hIUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT DEADLINE FOR SUBMISSION: To APOC Management by 3l January for March TCC meeting To APOC Management by 3l Julv for September TCC meeting ft AA eiv orJ 12 Jt)tN ?nn7 j( ir AP C) OCERCIASIS CONTROL Fcr Acli*e * I I I : I I I ! I I I I I I I I I I i i I I I I ! I I AFRICAN PROGRAMME FOR ONCH (APOC) il- t I{! T^rItt . ?rgs CEV a ; a i L rtE ]l! fr. 8iH cs! & 6rte etu fo Itor lnbrmotton folrrF, 0 8 JU|N 2007 COTJNTRY/NOTF : NIGERIA Approval vearz 1999 Launching year: 1999 Reportins Period: From: January 2006 To: December 2006 earTth Month/Y (circleone) I 2 3 4 5 6(7) 8 9 10 Date submitted NGDO partner: UNICEF ho -, en/ll8r ,|1. BalGru, <t I I i I I I I I I ! I i I I I i I I : I I i I ANI\UAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMIT-IEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space' OFFICERS to sign the rePort: J Country: NIGERIA NationalCoordinator Name: ... Signature .Mrs.l.-Ogbu-Pearce ,....MnnH--... our",..z{{Qsf z.r*.7 Zonal Oncho Coordinator Name: ...Otunba Adekunle Jaiyeoba Signature Date: ..1. .dl4q"c.t^.?IDL NGDORepresentative Name: Signature Date:.... I I I I I I I I I I I : I I I I I ! I : I I I I I I I : I I I : I I I I I I I This report was prepared by Name : .. ....Mrs. J.A. Aliyu. Designation : State rr"y:9. , Signature , ..u./*il7u1 . Date ../..11.: ...t1*. c.l:... *pa? lL lL ? &. { { I !rI WHO/APOC, 24 November 2004 i 1Table of contents v DEFINITIONS.......... VI FOLLOW T]P ON TCC RECOMMENDATIONS ...................I EXECUTIVE SUMMARY........... ........2 SECTION I : BACKGROUND INFORMATION....... .............3 I.I. GENERAL INFORMATION l.l.l Description of the project (briefly) 1.1.2 Partnership...... I.2. POPULATION...... SECTION 2 : IMPLEMENTATION OF CDTI....... 2.1 TIMELINE oF ACTIVrrrvlES......... 2.2 ADvoCACY 2.3 MoBILIZATIoN, SENSITIZATIoN AND HEALTH EDUCATIoN oF AT RrsK CoMMLNITIES ..... 2.4 coMMUNITy INvoLVEMENT ........... 2.5 CAPACITY BUILDING 2.6 TREATMENTS............... 2.6.1. Treatment figures......... 2.6,2. What are the causes of absenteeism? . . . .. . .. . . . . . . . 2.6.3. What are the reasons for refusals? 2.6.4. Briefly describe all known and verified serious advserve events (SAEs) that...... 2.6.5. Trend of treatment achievement from CDTI project inception to the current year.2.7, ORDERING, STORAGE AND DELIVERY OF IVERMECTTN2.8. COMMUNITY SELF-MONITORING AND STAKEHOLDERS MEETINC.........2.9. SUPERVISION 2.9. l. Provide a flow chart of supervision hierarchy...... 2.9.2. What were the main issues identified during supervision ?.......... 2.9.3. Was a supervision checklist used?.......... 2.9.4. What were the outcomes at each level of CDTI implementation supervision ?.... 2.9.5. Was feedback given to the person or groups supervised? 2.9.6. How was the feedback used to improve the overall performance of the project... SECTION 3 : SUPPORT TO CDTI 3.1. EQUrPMENT........... 3.2. FINANCIAL CONTRIBUTIONS OF THE PARTNERS AND COMMUNITIES........ 3.3. OTHER FORMS OF COMMUNITY SUPPORT............ 3.4. EXPENDITURE PER ACTIVITY .............. SECTION 4: SUSTAINABILITY OF CDTI... I J J .3 4 5 5 ..,7 ...7 ,.8 ..9 .il ...11 .. r3 .. l3 ..13 .15 .16 l6 t7 t7 t7 t7 .17 t7 t7 l7 .................. l9 t8 t9 .. 19 4'1. INTERNAL;INDEPENDENTPARTICIPATORYMONITORING;EVALUATION......... l94.1.1 Was Monitoring/evaluation carried out during the report period? (tick any of the following Which are applicable).... 19 4.1.2. What were the recommendations ?. 4.1.3. How have they been implemented? 4.2.1. Planning at all relevant leve|s.......... 4.2.2. Funds.......... 4.2.3. Transport (replacement and maintenance)............. 4.2.4. Other resources .............. 4.2.5. To what extent has the plan been implemented ....... 4.3. INTEGRATION..... 4.3.1. Ivermectin delivery mechanisms.. 4.3.2. Training....... 4.3.3. Joint supervision and monitoring with other programs ....20 ...20 ....20 ...20 ..20 .20 .20 ..20 ..20 t' 4.3.4. 4.3.5. 4.3.6. Release offunds for project activities...... Is CDTI included in the PHC budget? Describe other health programmes that are using the CDTI structure and how this was Achieved. What have been the achievements? Describe others issues considered in the integration of CDTI.. ..20 204.3.7. 4.4.OPERATIONAL RESEARCH ......20 4.4.1. Summarize in not more than one half of a page the operational research Undertaken in the project area within the reporting period......... 20 4.4.2. How were the results applied in the project? 20 SECTION 5: STRENGTH, WEAKNESSES, CHALLENGE, AI\DOPPORTTIIUTIES....... 2I SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS ..2I I .20 Acronyms a AIDS APOC ATO AtrO CDA CDD CDI CDTI CBO CSM DOTS DSN FHFS HFS HMM HQ HIV IEC IFESH ITN LG LGA LOCT MDP MOH NOCP NOTF NGDO NGO NPI NURTW PHC RBM REMO SAE SOCT SHM TCC TOT TV I.JNICEF UTG wHo ZOTF Acquired Immune Deficiency Syndrome African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Community Development Association Community-Directed Distributor Community Directed Intervention Community-Directed Treatment with lvermectin Commun ity-Based Organ ization Commun ity Self-Monitoring Directly Observed Treatment Short-course Disease Surveillance & Notifi cation First Line Health Facility Health Facility Staff Home Management of Malaria Headquarters Human Immuno Deficiency Virus Information Education and Communication Intemational Foundation for Education and Self Help Insecticide Treated Net Local Govemment Local Govemment Area Local Govemment Oncho ControlTeam Mectizan Donation Program Ministry of Health National Onchocerciasis Control Programme National Onchocerciasis Task Force Non-Governmental Development Organization Non-Governmental Organ ization National Programme on Immunization National Union of Road Transport Workers Primary health care Roll Back Malaria Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event State Oncho Control Team Stakeholders meeting Technical Consultative Committee (APOC scientific advisory group) Trainer of trainers Television United Nations Children's Fund Ultimate Treatment Goal World Health Organization Zonal Task Force .L. Definitions (i) Total population: the total population living in mesoftryper-endemic communities within the project area (based on REMO and census taking). (ii) Eligible population: calculated as 84Yo of the total population in mesoftryper- endemic communities in the project area. (iii) Annual Treatment Objective: (ATO): the estimated number of persons living in mesoftryper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. (iv) Ultimate Treatment Goal (UTG): calculated as the maximum number of people to be treated annually in meso/tryper endemic areas within the project are4 ultimately to be reached when the project has reached full geographic coverage (normally the project should be expected to reach the UTG at the end of the 3'd year ofthe project). (v) Therapeutic coverage: number of people treated in a given 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/ttyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). (vii) lntegration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) through CDTI (using the same systems, training, supervision and personnel) in order to maximise 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 mobilised by the community and the government. (ix) Communitv self-monitorine (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. a aFOLLOW UP ON TGG 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 20 Number of Recommendation in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCAAPOC MGT ASE ONLY Train more CDDs per Community 1368 CDDs were trained in 2005, but in 2006 1,900 new CDDs were trained. The State is part of a special country initiative approved by APOC which targets increased number of CDDs, health workers and community supervisors. 5,700 CDDs are expected to be trained/ retrained. This will be carried out in 2007. Train more health workers to raise the no. of health workers involved in CDTI 460 health staffwere trained in 2005, and 485 health workers were trained or retrained in 2006. Under the special initiative 560 health workers are expected to be trained in2007. Target those LGAs with consistently low coverage area The LGAs with low coverage are being followed up. lmplement CSMiSHM in all the LGAs in a clearly defined phase in all the community Not much was done in 2006 as a follow up to what had been carried out in 2005. With the special initiative coming up it is expected that the pace on CSiV{/SHM implementation will be quickened. About 4,600 community supervisors will be trained. These will be utilized to implement CSM. Report on the sustainability evaluation results in the next report and how the findings will be addressed Additional follow up actions taken in the course ofthe year are reflected in the appropriate section. Provide key sustainability plan strategies especially for the low performing LGAs Under the transition plan, and given the funding available, more CDDs were trained; Mectizan tablets released relatively on time to the communities; sensitization and mobilization of communities were continued; the process of identification, sensitization and mobilization of CBOs still continued; and there was some improvement in supervision and monitoring. Again with the special initiative coming up most of these activities will be dramatically up-scaled in 2007. (Please add more rows if necessary) .l L t I I ,Executive Summary Oyo State is one of the States in South Westem part of Nigeria and is located in B Health Zone. The 2005 estimated population is 5,097,882. Yorubas are overwhelmingly the major ethnic group. Such other groups as Hausas, Fulanis, Igbos etc have migrated to the area. The partners involved in project implementation within the project area are UNICEFA{IGERIA, NOCP (National and the B-Zonal Offices) the State Government, the various Local Governments and the endemic communities. Treatments commenced in the State since l99l with UNICEF assistance and number of persons treated has consistently risen over the years. However, due to faulty census figures over time, it had appeared that treatment coverage had been low. A recent and comprehensive census update sponsored by UNICEF and commenced late 2004 showed that very large urban areas where passive treatment (and sometimes limited mass treatments) had been on-going were reflected in the data base. These, at the advice of NOCP HQs, have been excluded and passive treatment only instituted. Moreover, the project learnt from the REMO map on the health mapper application that 7 LGAs fall under the definite CDTI area, and CDTI was expanded to three of these LGAs i.e lbarapa East , Olorunsogo, and Oluyole. Population movements occur in migration from rural to urban areas in search of better livelihood or temporary relocation by farmers to farm areas during the cultivation and harvesting seasons. Total number of target communities is now 2150 in l9 LGAs. Of these 2100 communities were treated resulting in a geographical coverage of 98%o.739,602 persons were treated out of atotalpopulation of 900,236 givingatherapeuticcoverage of 82%o. 20T0CDDsweretrained or retrained out of an ATrO of 3,268. 1900 of the trainees were new CDDs. 584 health workers (475 of them new hainees) were trained out of an ATrO of 2030. The constraints/challenges faced include: political instability at State and LGA levels, Iack of willingness by some LOCTs to take the initiative in CDTI implementation at their level, CDD attrition in the light of inadequate incentives, poor mobilization of communities to fulfill their roles on CDTI, inadequate logistics, late and inadequate funding from partners, and poor record keeping and reporting in some places. The project did the following to address the challenges faced: I Continued community mobilization and sensitization to select more CDDs r Trained new CDDs to curb attrition I Conducted management training for LGA Coordinators during review meetings to ensure they take initiative for CDTI implementation at their level. r Made efforts at several occasions to improve record keeping by giving orientations and on-the-spot training to health workers. 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I I r il I I I I I oo o.t $ o\ €o o\ \o I I I so @ 1Q +00 o\\o ss oo sc!@ o\ tf \o oo\o c{$ c.lr- o\ ooN ca c.t o^t \o o\ c- o\ \o r-\o c.l t'- <f ca .+\o o\ € aa 00 r- o\o c.i @ o c..t o \o F- c.l t. O c..l c- c.) \o ca(\ o o\ soo s o\ o\t'-\o o\oo soo o\ !f N NF- c-lt'- \o N sf c.l o@ \o m\o c.t stN o€ \o \o N o c! rrl .vd V) it) o a o d r! d o"d Gt! o o0ootr5LI o Fl t-,, o Fr SECTION 1: Background information 1.1. General information 1.1.1 Description of the project (briefly) Geographical location, topography, climate Oyo State is one of the States in South Western part of Nigeria and is located in B Health Zone. lt is bounded on the South by Osun State, on the East by Ogun State, on the North by Kwara State and on the West by the Republic of Benin. The State is highly urbanized, although substantial proportions of the population still live in rural areas. The State has rwo distinct seasons, dry season and rainy season. The rainy season begins in March and is heaviest from June to October. Farming activities begin in April and ends in October when harvesting is carried out. Dry season is from November to March. Up till 2005, the number of target LGAs for CDTI implementation was 16. However, the project was shown from the REMO map of the country inthe health mapper software that 3 additional LGAs - Ibarapa East, Olorunsogo and Oluyole - fall within the definite CDTI area. Although passive treatment had been on in those LGAs, in 2006 the project began putting up structures for CDTI implementation in those 3 LGAs and included their populations and communities (those that did not fall within the large urban areas) into the data base of the project. Population: activities, cultures, language The 2005 estimated population of the State is four million, nine hundred and fifty seven thousand, six hundred and two (4,957,602). The Yorubas are overwhelmingly the major ethnic group, although some minorities such as the Hausas, Igbos, and Fulanis live peacefully with the indigenes. Majority of the people are farmers that engage in one form of agriculture orthe other. The State is noted for is traditional cloth weaving (Aso Oke). Communicatio n systems (roads...) The urban roads and other major roads are tarred though most of them are not properly maintained. The access roads to most of the endemic communities are in poor condition and most of them are not passable during the rainy season. Despite this, road transportation still remains the major means of communication with the communities. Other forms of communication include IEC materials, electronic media, print media, and community announcers. Administratio n str ucture There are 33 Local Govemment Areas in the State. The Local Government Areas are Afrjio, Akinyele, Egbeda, Ibadan North East, Ibadan North west, Ibarapa centrat, Irepo, Iseyin, Kajola, Lagelu, Ogbomoso South, Ogbomoso North, Ogo-Oluwa, Oluyole, Oni-Ara, oorelope, orire, Surulere, Atisbo, oyo west, Itrsiwaju, Saki East, Atiba, olorunsogo, Iwajowa, Ibarapa East, Saki west, oyo East, Ibarapa North, Ibadan South west, ldo and Ibadan South East. The Chief Administrative Officer of the LGA is the elected chairman. A legislative arm made up of elected Councillors selected from various wards supports him. The Administrative capital of the State is Ibadan and the Executive Covemor is the head of administration. An elected legislative arm, the Judiciary and Commissioners support the Governor. In 2006, the State witnessed a lot of political upheavals that led to sacking of some of the legislators and the impeachment of the Executive Governor. This is being coniested in court. E r Health system & health care delivery @rovide the number of health posts/centers in the project area itthe information is available) There is an official PHC policy and structure in the project area. It is a system of health care services where community participation forms the mainstay with support from the State, Local Government and NGOs. Levels of functionality however vary across the State. Scattered throughout the State are various health facilities ranging from health posts to hospitals. - Number of health staff in project area and number of health staff involved in CDTI activities. Table I : Number of health staff involved in CDTI (Please add more rows if necessary) District/LGA Number of health staff involved in CDTI activities. Total Number ofhealth staff in thc entire project area Br Number of health staff involved in CDTI B, Percentage B3=B2l Br *100 Ibarapa Central 157 30 l9o/o Ibarapa North 93 30 32o/o Atiba 85 30 3sYo Oyo East 9t 30 32o/o Oyo West 69 30 43o/o Ido 104 30 28% Kajola 159 30 l8o/o Iwajowa 142 30 2lo/o Lagelu 2| 30 14Yo Itesiwaiu 103 30 29% Iseyin 136 30 22Yo Atisbo 126 30 23o/o Orire l16 30 29o/o Irepo 8l 30 37% Saki East 77 30 39o/o Saki West 44 44 100% Oluyole 86 30 3s% Olorunsogo 7l 30 42o/o Ibarapa-East 67 30 48o/o Total 20t8 584 29Vo - L { &" lt l, ft fil 1.1.2. Partnership For implementation of CDTI in the project the following partners are involved: Communities, LGAs, MOH, IFESH, NOCP (National & Zonal) and International Organizations such as WHO/APOC and UNICEF. Some localNGOs and CBOs such as Boys' Scouts, CivilDefense Corps, Okada (Motorcycle) Riders' Associations, Girls Guilds, Lydia Groups and Man O WarUnits, community development associations (CDAs) are also involved in CDTI implementation. The overall working relationship has been cordial. The State and LGAs through their Onchocerciasis Control Units are involved in training of field personnel; community mobilization and health education; management of side reactions; planning and management of project implementation; supervision and monitoring; and mectizan procurement and delivery. UNICEF and NOCP assist in supervision, advocaty and training. There had been fears that UNICEF was gradually withdrawing its support for CDTI implementation. In 2006, this appears to have dissipated with the appointment'of a consultant who visited the project to assess first-hand the extent of CDTI implementation. She has promised increased UNICEF presence and support in the State. IFESH is a partner in one LGA where it oversees mectizan distribution. The communities ensure collection of Mectizan; determine mode and period of distribution; ensure conduct of census updates; organize mectizan distribution, record and report treatments. The identified Local NGOs and CBOs such as Boys' Scouts, Girls Guilds, Civil Defense corps, okada (Motorcycle) Riders' Associations, Lydia Groups and Man o war, and community development associations assist in mobilizing and health educating the community members on the importance of continuous mectizan treatment for at leist 15 years. State plans, rf any, to mobilize the state/regiott/district/LGA decision-makers, NGDOs, NGOs, CBOs, to assist in CDTI implementation. The project intends to identify and sensitize more local NGOs and CBOs as well as community development associations and health committees to participate actively in CDTI implementation given the decreasing levelof funding from all partners.-The generalelections are expected to take place between March and April 2007, and new administrators are to be inplace at all levels by May 29,2007. These new policy makers at State and LGA levets will need to be sensitized and mobilized to support GDTI implementation. 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I I I a ! l t I I i I I I i I I l .I I i il t] il i ll t2.2 Advocacy State the number of policy/decision makers mobilized at each relevant level during the current year; the reason(s) for undertaking the advocacy and the outcome. An advocacy/mobilization workshop was carried out in the course of the year in which 140 State and LGA Policy Makers attended. They were all sensitized on the need for continual support for Onchocerciasis control activities in their respective LGAs. In addition, the policy makers were paid advocacy visits, particularly when new ones came into office. At the State level, One Million Naira was approved in this year's budget estimates for Onchocerciasis Control activities and 827,000 Naira was released, with the various advocacy activities carried. This was an improvement over last year's release of about 400,000 Naira. This became the second time the State Government was making any significant contribution since CDTI was instituted in the project area. At the LGA level, more LG Councils started releasing 10,000 Naira monthly to LGA Onchocerciasis Coordinators TABLE: MOBILIZATION AITID ADVOCACY VISITS TO THE LGAS SN LOCAL GOVERNMENT AREA NO OF POLICY MAKERS MOBILIZED 2006 NO OF PHC COORDINATORS MOBILIZED 2006 I Atiba 5 I 2 Oyo East 5 I J Oyo West 5 I 4 Iseyin 5 I 5 Itesiwaju 5 I 6 Ibarapa Central 5 I 7 Ibarapa North 5 I 8 Lagelu 5 I 9 Ido 5 I l0 Kaiola 5 I ll Saki West 5 I t2 Saki East 5 I l3 Atisbo 5 I t4 Orire 5 I I5 Irepo 5 I l6 Iwajowa 5 I t7 Ibarapa East 5 I l8 Oluyole 5 I l9 Olorunsogo 5 I TOTAL 95 l9 The major constraint in achieving desired results is the rapidity in changes of policy makers at the LGA and State levels. This is due to the high political volatiliry of the State. To improve advocacy a high-level advocacy that will target the chief executive of the State was planned for 2006 with support from APOC Management in collaboration with NOCP, but could not be carried out due to political crises in the State that saw the Chief Executive being impeached. Subsequently, almost all policy makers at all levels were changed. a ,However, there is still need to conduct a high-level advocacy but this time after the general elections in the first and second quarter of 2007. Production and airing ofjingles on radio and television should be a continuous exercise. This should be complemented by other Radio / TV discussions on the disease and control strategy. Additionally, there should be continuous advocacy visits to the prominent traditional rulers and policy makers at the Local Government level. It is this kind of media'onslaught' that draws so much attention and funding to Npl. 2.3. ilobilization, sensitization and health education of at risk communities Provide information on: The use of media und/or other local systems to disseminate information The communities were mobilized and health educated through jingles on localradios, public address systems mounted on moving van, stakeholders meetings, town announcers and face-to-face discussions with community members. Types of IEC materials used Few hand bills and posters available at the State level, or where produced by the LG Councils were used in mobilizing and health educating community members. The posters focused mainly on disease manifestations, and this has always elicited compliance to treatment. Mobilization sensitization and health education of woman and minorities - method and response Within the project, there is an active participation of female members of the community at mobilization meetings and during health education sessions, except in areas where there are predominantly muslim populations. ln such core Muslim areas participation of women is limited and public address systems mounted on vans are used to reach them in their households. Women groups such as market women associations and religious groups were also sensitized and mobilized. Furthermore, to enhance women participation, participatory methods were used during health talks on onchocerciasis control and during meetings organised for the market women in some selected LGAs. During the meetings they were sensitized on the need to be actively involved in CDTI activities. Response of target co mmunities/villages 2150 communities/villages mobilized responded to the mobilization and health education carried out by the SOCT, LOCT, First Line Health Facility Staff and the CDDs. They came forward to collect their mectizan. The awareness of ivermectin benefits is increasing, and communities are sustaining treatments ensuring that potential refusals take ivermectin. Accomplishments(l) Increase in awareness of the disease control efforts(2) More community involvement in decision making(3) More awareness of ivermectin benefit (4) Villagers make more efforts to encourage potential refusals to take ivermectin(5) Communities come forward to collect their drug. I lL f ;I" r L lr tb tr li L Suggest ways to improve mobilization and sensitization of the target communities. The project believes that the following ways suggested earlier are time- honoured and will make for improved mobilization of the target communities: (l) Identifring and building skills of local NGOs, Market Women Associations, Religious leaders, Road Transport Workers and other Community Based Organizations on community mobilization (2) Regular meetings and greater interactions with the community leaders.(3) Production and distribution of adequate number of IEC materials(4) Greater involvement and capacity building of First line health facility staff to organize stakeholders meetings with communities within their areas ofjurisdiction periodically. a I2.4. Gommunity involvement Table 4: Communities participation in the CDTI (Please add more rows if necessary) Comment on: - Attendance offemale members of the community at health education meetings Attendance of female members of the community at health education meetings is good but the ratio when compared with that of their male counterparts is low. Nevertheless the few females that attend actively participate during the health education sessions. a I DistricULGA Number of communitics/villages with community members as supervisors Number of CDDs and the communities involved Numbcr of communities /villages with femalc CDDs Total no. communitie s in the cntirc projcct erea B4 Number with community mcmbers as supervisors Bs Perccntr gc Bo= Bs/ Br *100 Male CDDs B7 Fcmale CDDs Bs Total Be= B7+Bg Numbcr of communities with fcmele CDDs Bto Pcrcentrg C Blr= Bro/8.*100 l. Ibarapa C 122 30 250 180 t00 280 r00 8lo/o 2. Ibarapa N. 98 l5 30% 85 45 r30 45 45o/o 3. Atiba 159 30 l8o/o 160 80 240 80 50o/o 4.Oyo East 163 30 18o/" 85 79 164 79 5lo/o 5. Oyo West 9l 36 39"/" 129 40 t69 40 43o/o 6. Ido 65 25 460/o 77 53 r30 53 8lo/o 7. Kajola l5l 30 t9% 88 42 130 42 27o/o 8. Iwaiowa 79 2 t3% 9'l 68 165 68 86Vo 9. Lagelu 137 30 21Yo 60 40 r00 40 29o/o 10. Itesiwaiu 187 30 t6% t'l0 60 230 60 3lo/o I l. Iseyin 64 30 460/o r93 147 340 64 l00o/o 12. Atisbo t'19 t5 8.3o/o 266 80 346 80 44o/o 13. Orire 96 l5 l5o/o 125 50 175 50 52lo 14. lrepo 46 l5 32"/o 84 50 134 46 l00Yo 15. Saki East 241 60 40 100 40 l6Yo 16. Saki West 24 30 '1250/o 85 s0 t35 24 lWYo 17. Oluyole 80 60 40 100 40 5@/o 18, Olorunsogo 63 75 25 100 25 39Yo 19. Ibarapa -East r06 '10 30 100 30 33o/o Total 2150 391 2lYo 1944 t024 2968 I 006 460/o t9 WHO/APOC, 24 November 2003 TT E G E. - In general, how do you rate the participation offemale members of lhe community meetings when CDTI issaes are being discusses (ottendance, ptrticipation in the discussion elc). Women are sometimes- allowed to participate and contribute to ihe decisions during g"nerai community meeting. This is however does not apply in areas with muslim populati-ons. But on special or key decisions on community matters, elderly men/ward heads arl usually the decision makers. - _Incentives provided by communitiesfor the CDDs 1ft* communities give financial (cash) incentives to their CDDs - and this is the preferred optionfor most CDDs. Others g_ive in-kind support such as cultivation of farms for CDDs and exempiionfrom community levies. Incentive is an issue in the project, particularly due to payment of community-based workers by other programmes such is NPI. Moreovlr, due to withdrawal ofCDDs in some communities for various reasons, the work load has increased and this has made forlouder demands for financial incentives. Though this has somewhat mellowed down with the selection of more CDDs the demands are still present. - Attrition of CDDs. Is attrition a problemfor the project? If yes, how is it addressed?Attrition is of some concern in most communiiies. crios teane ttri work as a result of lack of/inadequate incentives, admission into schools, employment etc. To address this more CDDs have been selected by the communities and trained. The pioject intends to train more CDDs under a special country initiative package. Funds have already huu. been released for this. By 2007 about5,700 CDDs are expected to be trained or retrained. - Other isszes E. t t, I E ti tl E , ) j ! , EB ti G nl! _t: 2.5. Gapacity building - Describe the adequacy of available knowledgeable manpower at all levels. At the State level, there is inadequate number of health workers. This has affected staffing of most programmes. The CDTI programme with a staff of 4 is considered fortunate, though this number is not adequate to cover allthe endemic LGAs. Even with integration of some programmes staffing is a problem. Enough health workers used to be available at the lower levels but this was affected by the transfer of environmental health officers to the new Ministry of Environment in 2005. To compound the stafling problem, most of the health workers at the LGAs are found in the large urban cities, rather than in the rural areas. - |fherefrequent transfers of trained staff occur, state what the project is doing, or intends to do, to remedy the situation. (The mosl important issue to describe is what *"orrr", *"r" taken to ensure adequate CDTI implementation where not enough lcnowledgeable manpower was available or if staffare frequently transfened during the course of theiampaign). Efforts are being made to get more health workers - at least those available in the rural areas -involved in the CDTI process. More health workers are being trained and involved in the CDTI process, although the percentage is still low. The plan is to train all health staffso that transfers will not affect adversely CDTI implementation. Under the special country initiative, additional health workers will be trained. However, that would still not cover the entire health staff. 2t WHO/APOC, 24 November 2fi)3 u ti ti I} G E r! t i &T JI !j : a c.toO c-t L C) -o E c) o z -tN C,o o. o (\ C\ oa I o \o oo I o I oo I oo I oo I o oo o oo o.= + .Q Sur il *(j oo -: o oo : oo I oo o co :. an oO o € -: € oo : oo t oo :. oo I Oo oo I oo -: Oo I oo oo I Oo o oo oo I o oo Eo E CL a (J o t) z FO o € o.l o aa ostN +\o o,\o oca os ca co c! ta)\o ta)t-- *c.t oo oc.l c.) oo \o* c.t ao oo I I I I I I I I ir *d = o -= + - -,r= S,+ I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I o Eq e, .=a .F o' o € o! az o ? I t I rnI t \n : lr) c..l rn olral : : a ta) c.) 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V) o) tsoo (l) () .d ol- o. q.) -o(d (g cd Potr (tl (D (r : .L (.)& Bq) z * oo cF N t- s(fl\o (l) EI o q) I s o oo o\ o €\oN(?) I I I I q) (u (l) () o\ I I I r at I raat !) (,) q) I<s ro it) c\ cl rn o.l rat-t \o\o (f)o\ o c.) I o\ o\ $ sc Eo4 o 6) I s la o\ o c.t o\ o\ ob{ o0tr L o o O. Gt otr I Table 6: Type of training undertaken (Iick the boxes where specific training was caruied out during the reporting period) Any other comments 2.6. Treatments 2.6.1. Treatment figures ' If the proiect is not achieving 100% geographical coverage and o minimum of 65% therapeutic coverage or the coverage rate is/luctuating, state the reasons and the plans being made to remedy this. For the last two years the project has been making a therapeutic coverage of over 70%o. However, 100% geographical coverage is yet to be achieved as a few communities in Oyo West were not treated in 2006 due to CDD incentives/attrition. Before the situation was discovered and any meaningful intervention made, it was already late. Also in 2 of the newly added LGAs, Oluyole and Ibarapa East inadequate community mobilization coupled with poor supervision resulted in the inadequate geographical coverage rate secured. The project intends to pay closer attention to the newly added LGAs in the coming year, while strengthening the supervisory system overall. Trainees Type of training CDDs Other Community members e.g Community supervisors Health Workers (frontline health facilities) MOH staff or Other Political Leaders Others(speci&) Program management ./ ./ How to conduct Health education ./ ./ { Management ofSAEs ./ CSM ^/ { { ./SHM ./ ./ ./ ./ ^/Data collection ./ ./ Data analysis ./ ^/ Report writing ./ { Others (specifo) 24 WHO/APOC, 24 November 2003 -oI r;i E sJs9<eE'E I ;€?EE*Z 9d ot g o O rrl €?\U)EqAO I I I I I bE -otrco ,!z$ I c..l\o I I a.la\t I O...l o\oo ca N\o I N h e- r E "i E.o;.E d F Er-E.E I I I I I I I o C6 ll r o '!o =00O 6^ggt oo 'troF o\r- o\ o\(\ oo N co N oo \o N co € F- 6\ .{- co \o N co \o N 00 o\ oo c..l @ \o N oo \o N@ \o N@ ; EE '9odHio = o! z o\\o N +v + odr- c.l\$t cO ra o\ .{ r* cA o\|.-$ \o cl N o\ c.l$ N co coN 00^ eo \o co lJN @r) * q F- c-r-\o^ r- N =oE 6.2 e 6.:? 9.o'FU o\\o N s^$ \or- c.i oo \ N c.) 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Lo F al 0)l b4dtLl 6)l >l ot "l(tl ol -qlol(!tLI b0 ol ol b0 cl trl(dl ,-r I 5l(.)l ol(BlLI ol -tr19l bd .El EI ol EI :l €l .tl 5l EI til olfril I I I * oN * o\ @ o\ \o I I I o\ a.l oo \o O co $ oo \o \o\n \o $@ \oo\ c! oo c-\oq c.t o\q \o oo\o c.it c.t\ o\ ooN ca (\ \o^ o\ cOt- h o\ \o a{\o N ri+ c.)$\O^ o\ oodI co r- cO co\d o\ N@ N \o F- c.l rJ oOc\ F- co \o(\ o\ ^\ \o o\ o\r-\o \o oO \o 6\ oo o\ $N $N Nr- Nr- \o O N t a.l *N o@ \o \o N $ C...t $ ..t o@ \o co\o C...t () .Y CB(n q(! rI.] .v a o o o CN o- =6 oo q o o j F oF I I I a 2.6.2 What are the causes of absenteeism? l. Ruralurban migration in search of greener pasture 2. Farmers or others who had gone for their trades or occupation during the time of treatment, and were not followed up 2.6.2 What are the reasons for refusals? There were no reported cases of refusals for the treatment period. This might not entirely be the case, but the project intends to strengthen its reporting system to capture all the necessary indicators. 2.6.4 Briefly describe all known and verified serious adverse events (SAEs) that occurred during the reporting period and provide (in table 8) the required information when available. I In case the project did not have any cases of serious adverse events (SAE) during this reporting period, please tick in the box No SAE case to report I L L f ir, I I fil 27 WHO/APOC, 24 November 2004 I T! -E $?ooN .E '! Eol oz{ "'!L). o o. d..t aoN h a) B\ q) o'\q) .a s B\ -q) .a) * -\ B t4 q) aq) .\ q: P q) L v N q) $\) s .d o tr Q)q bo t- o o.g o botr tr .o (,) t- oo o cl an r! a C1 tr Q) o) oq) Lo t cl t, o L()t) o U) c)qt6Q #r o:l -ol(Bl FI a zEPEluo7 0 ?.E 6 l Ao ;PoBE.= EEE.sGroi,)= t E FEr! u'6 boo ao C) E o =o 9tc*9ojjq3^ 3 v'u' e= Eo-c tr&ad .Ek6o.2 -c 6o tr ciJ= E€EgE . o_cb'a*b 6).= iD =d_!- oO H.Ed t;s*! Eo o. 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P$-r: oo\< >v o \o vl o\ -o o\ @ o\ s rc o\ \o c.lq o\ o\ \oo\r) @ o\ s € o\ sF- 00 s oo o\ =oPo"oo=$e E 8,h;60->ooc \oq \o s& o. s € o\ s c-.1q o\ o\ \o c1 oo o\ s oo o\ s c- € \o6\ oo o\ H qQ) e.ts [i *b E SE tr tr= i;3 E-r CrzOq \o\o ca c.t c.)\t c.t c{ F.. o\l\- c-l rl$N t- c.l c.l \o\o o C.l rd Eod o.=2E6iE8 o$ \o N r+ c.l o, o\F e.l c- o\$ o.,l o\\o c-l c\t o o\ ra) o.t go =@TI. T Eo.u€ 5x _E.E.E -<'= r{ ,E E a E€E EEI o\ \orl o.l ot r-.1 o\ o.F- c.l r- o\ .+ ol o\\o GI c.l o o, ra) c{ il t! rr o\ o\ oo o\ o\ o\ o\ o\ OooN oN c-loo c\l oo e..t ! oN a o.l \o o c.l r\oo6l oo o o{ o\ooN o oN T3 3 ! ,l 1 i -a F $-*ar U) ..orEE €E; .EE<3uYd) EHHS: o a.Y .i 6;i ETq H E$Ebs H x.$.= =: d E:-Eo= r.Eo 9() ()ii -c l<t'+j (t! =EHgEs 'E oo =4 0EQ:E-l\OOxOr €Hss g r EEtr tr(Ei .=! Eu:SE a I E:pE : q; E .r9-+ o-rHdStt - ar, --crC)ctll ,\-i! H9 .EtsgE E 6'E I .e'E E € ! FEe!s.E:Q6)Hcd Eti $S XEEGl zr-e 6gEEO Iu E d ESEi EI H? 8:,8.E -oF =H^LGlv' .5o-5Y: c/rEc)r < 6.2 '4rEU HTa ! 2.7 Ordering, Storage and delivery ivermectin Mectizan@ tick the appropriate answer) TINICEFtr ied for by - wHo Qtleasetr I speciff): Mectizan@ by - Qtlease tick the appropriate answer)WHOtr UNICEFD Other specifo): Table l0: Mectizan@ Inventory (Please add more rows if necessary) NGDOtr NGDOf] T lL + State/District/ LGA Number of Mectizant tablets Requested Received Used Lost Wasted Expired Rcmaining Ibarapa C 135,000 13s,000 130,51 5 224 426t Ibarapa N 153,000 153,000 145,079 0 7921 Atiba 150,000 134,000 1 30,836 3 r64 Oyo East 50,000 50,000 47,222 l3 2765 Oyo West 70,000 70,000 67,391 337 't'r1', Ido l15,000 l15,000 I t 3,E78 n22 Kajola 82,000 82,000 68,045 512 13,443 Iwajowa 100,000 95,000 94,077 2 92t Lagelu 52,500 52,500 52,491 9 Itesiwaju 175,000 246,793 246,665 t28 Iseyin 350,000 105,000 97,143 820 7,037 Atisbo 238,000 238,000 215,823 22,177 Orire 175,000 175,000 r 50,6t 6 2,t37 22,247 Irepo 150,000 r 50,000 r50,000 Saki-East 203,000 203,000 200,222 78 2,700 Saki-West 52,500 52,500 45,460 49 6,991 Oluyole I 25,500 125,500 121,251 2,177 2,072 Ibarapa East 53,000 53,000 33,828 9t l9,0El Olorunsogo 93,000 93,000 90,536 2,464 TOTAL 2,522,500 2,328,293 2,201,079 6,577 120,638 3l WHO/APOC, 24 November 2004 d Please describe how Mectizan@ is ordered and how it gets to the communities The mectizan ordering and delivery in Oyo State CDTI project originates from the endemic communities through the CDDs. The populations of the treated communities from the mectizan treatment / census regislers are collated by the LGA health staff. The LOCTs compile this information from the various communities in the LGA and forward it to the State Oncho Control Office who uses the population figures to determine the total number of Mectizan tablets required. This is then submitted to the Zonal Office for onward transmission to the NOCP Headquarters. The NOCP Headquarters collate all the requests for mectizan and make application to MDP. On approval, the consignments are shipped to Nigeria, cleared by UNICEF, and stored at UNICEF Central Store on behalf of NOTF. From here the State picks up its consignments and delivers to the communities through the LGAs and the FLHFs. - How are the remaining ivermectin tablets collected and where are they kept? The remaining ivermectin tablets are collected by the Front Line Health Facilities from CDDs and initially stored at their various health posts. These are later taken to the local govemment headquarters and kept in the storage box by the co-ordinator. They become opening balances for the next treatment cycle. List and briefly describe the activities under ivermectin delivery that are being carried out by health carc personnel in the project areas. The health staff in the project pick up their mectizan supplies and deliver them to the collection centers. Then they mobiliztj the communities to collect their mectizan requirements. They also monitor and supervise mectizan distribution and send returns to the appropriate quarters. 2.8. Gommunity self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? If so, When? None. 4 I :i J 3 L Tt t t r E I aTable 1l: Community self-monitoring and Stakeholders Meeting (Add rows if needed) Describe how the results of the community self- monitoring ond stakeholderc meetings have alfected project implementation or how they would be utilized during the next treatment cycle. The implementation of community self-monitoring and stakeholders' meeting has brought about some increase in community participation and help address the issue of CDD incentive The success story will be extended to other communities. L I1. x District/ LGA Total # of communities/villages in the entire project area No of Communities that carried out self monitoring (CSM) No of Communities that conducted stakeholders meeting (SHM) IrePe- IUatqya Orire 46 79 96 5 2 5_ 5_ 5 Saki East 241 l0 Saki West 24 l5 l5 Atisbo 179 5 Oyo-East 163 30 30 Oyo West 9l 36 36 Atiba 159 30 30 Lagelu 137 30 30 Iseyin 64 3- 30 Kajola l5l 30 30 Ido 65 30 30 Ibarapa North 97 30 30 lbarapa C. t22 30 30 Itesiwaju r87 30 30 Oluyole 80 Ibarapa East r06 Olorunsogo 63 Total 2150 328 3s1 II I t l 2.9. Supervision 2.9.1. Provide a flow chart of supervision hierarchy. NOCP NOCP QUARTERLY MONITORING ZONE STATE, LGAS AND COMMUNITIES ZONAL NOCP IBADAN ZONAL OFFICE-MON ITORINGAND SUPERVISION OF STATE LGAS/AND COMMUNITIES STATE ONCHOCERCIASIS CoNTROL TEAM (SOCT) I LGA-ROUTINE MONITORING AND SUPERVISION OF COMMUNITIES - CDDS FLHFS COMMUNITY - CDDS COMMI.JNITIES _ COMMUNITY LEADERS AND COMMUNITY BASED ORGANISATION 2.9.2. lYhat were the main issues identified during supervision? The main lssues identified are: o High CDDs attrition which was due to lack of provision of incentive by their various communities. o Inadequate logistics for monitoring and supervision at the LGA level. o Defective census registration by the CDDs due to lack of supervision by the H/S during registration. In some communities the children less than 5 years were not registered. o CDDs were not selected in some communities, which contributed to the drop in therapeutic coverage. o Lack ofproper record keeping. o Mectizan distribution were yet to be commenced in the LGAs visited during supervision e.g. Atisbo and Saki-East LGAs. 2.9.3. Was a supervision checklist used? Supervision checklist was used during the supervision exercise at the State level, but hardly at the lower levels. STATE-ROUTINE MONITORING AND SUPERVISION OF LGAS AND SPORT CHECK ON COMM. NEEDS LOCAL GOVERNMENT ONCHOCERCIASIS CONTROL TEAM (LOCT) a 1 .*- 1 1 -t 1 I 2.9,4. What were the outcomes at each level of CDTI implementation supervision? o At the community level, communities were requested to select additional CDDs. CDDs were asked to register all those living in the households including day-old babies. o At the LGA level, policy makers were encouraged to provide monthly allowances to LGA Coordinators for CDTI activities. In Atisbo and Saki East, efforts were made to kick start the distribution process despite difficulties encountered. 2.9.5. Was feedback given to the person or groups supervised? Yes Feedback was given at all levels of implementation. 2.9.6. How was the feedback used to improve the overall performance of the project? Where communities selected additional/new CDDs, treatments were sustained. The quick intervention in Atisbo and Saki East ensured they did not lose out during the treatment cycle. Moreover, with the provision of some allowances to LGA Coordinators supervision and community mobilization were enhanced. SEGTION 3: Support to GDTI 3.{. Equipment Table 12: Status of equipmenl (Please add more rows if necessary) *Condition of the equipment (F=Functional, CNFR=Currently non-functional but repairable, WO:Written off). Source Type of Equipment APOC MOH DISTRICT/ LGA NGDO Others No, Condrtron No. Condrtron No Condrtion No Condrtron No, Condition l. Vehicle I F 2. Motor cycle(s) l9 16F3 CNFR 9 F 3. Computer(s) I F 4. Printer(s) I CNFR 5. Photocopier (s) I F 6. Fax Machine(s) I F 7. Others a) TV I F b) vcR I F c) Public Address System 2 F d) Air Conditioner 2 F e) Generator I F L ! L +t I E IHow does the project intend to maintuin and replace existing equipment and other materials? The maintenance of the equipment would be done out of the State Counterpart Account. The 13 out of the 19 LGAs are releasing imprest every month for the maintenance of the project motorcycles in their respective Local Government Areas. Storage facilities were also provided for the safe keeping of all other equipments. On the issue of replacement we have requested APOC to replace the project vehicle and other capital items supplied earlier. The UNICEF Consultant on Onchocerciasis has given indications of efforts being made to getthe organization to procure some motorcycles forthe project. This willbe followed up. 3.2. Financial contributions of the partners and communities Table l3: Financial contributions by all partners for the last three years - - If there are problems with release of counterpart funds, how were they addressed? The State Government has released :N:827,000 out of =N=lm budgeted for the programme but there was some delay in the release of the fund. 3.3. Other forms of community support Farm cultivation for the CDDs. CDD exemption from community tax. Provision of CDD training venue. Hosting of CSIWSHM MEETING. Contributor Yerr 5 (Aug. 2003 - July 20041 Year 6 (Jan. 2005 - Dec 2005) Year 7 (Jrn. 2006 - Dec. 2006) TOTAL Cash Budgeted (US$) TOTAL Cash Released (us$) TOTAL Cash Budgeted (us$) TOTAL Cash Released (us$) TOTAL Cash Budgeted (US$) TOTAL Cash Released (US$) MOH (Central + Provincial/State) 18,940 Nil 6,666 2,666 7,937 7,278 MOH (District/LGA) 20,t20 I 3,733 r2,800 8,800 r8,095 12,38 I LocalNGDO(s) ( if any) NGDO partner(s) 1 3,1 50 6.459 Others a) b) Communities APOC Trust Fund 55,845 30,000 26, r 08 I 3,054 TOTAL 108,055 50,192 19,466 11,466 52,140 32,713 +- i i I * L I aa 3.4. Expenditure per activitY - tndicate in table 14, the amount expended during the reporting period for each activity listed. Write the amount expended in US dollars using the current United Nations exchange rate to local currency. lndicate exchange rate used here:: NI126 to dollar. Table 14: Indicate how much the project spent for each activity listed below during the reporting period These include top-up allowances, communication and vehicle insurance - Any comments or explanations? Some of the expenditures made by LGAs based on amount contributed could not be ascertained. It is however, known that some of the funds were used for supervision, community mobilization & motorcycle maintenance. We are making efforts to encourage reporting of both contributions and expenditures by LGAs. SEGTION 4: Sustainability of GDTI 4.1 . lnternall independent participatory monitoring; Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable) _Year I Participatory Independent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation a Activitv Expenditure ($ us) Source(s) of funding Drug delivery from NOTF HQ area to central collection point of community Mobilization and health education of communities* Training of CDDs "T.gnile_ef hgplth staff at all levels Supervisilg C_DPI and distributfon I Internal monitoring of CDTI activities iA_d-vocacy visits to health and political authorities IEC materials forms for treatment Vehicles/ les/ b maintenance QSqr Eqqipment (e.g computers, printers etc) Others* 120 3,427 6,1 65 2,785 3,524 620 4,560 State LGA LGAs/ APOC LGAsT aFoel State LGA APOC/ State LGAs/ APOC APOC APOC/State TOTAL 21,201 Total number of persons treated 739,,602 l $ lnternal Monitoring by NOTF Other Evaluation by other partners 4.1.2. What were the recommendations? o Copies of the LGAs sustainability plans to be made available to the LOCTs. o The project's data manager should assist in the crosscheck, entry, analysis and summary of treatment data. To this end he needs proper and comprehensive training on CDTI especially as it relates to record keeping & collection. t Copies of the finaltreatment data by LGA are to be shared with the respective LGAs including copies of the State summarized data so that each LGA can relate itself with others in terms of performance. Additionally, copies of the community listing for each LGA should be made available to them. Each LGA will also be expected to make copies for their health facility stafffor their areas of oversight. a The SOCT need to be better organized and to do more detailed planning in order to address the many thorny issues that need resolution. o Focus in supervision should be on poor performing areas or those with coverage rates that appear too good to be true. Spot checks will be for other areas. Checklists are to be used during such visits to the field. t LOCTs in some LGAs need to be re-organized, and it may be necessary to advocate for the change of Coordinators not performing well. PHC Coordinators will need to be better involved in programme management, and provide effective oversight. The resolutions reached during the PHC Coordinators' Orientation workshop should be implemented as soon as possible. t LGAs are to be encouraged to produce community registers and IEC materials. o NOCP (both HQs &B-Zonal office) should pay closer attention to CDTI implementation in the State, and maximize the opportunity of the special initiative to ensure quality training of health staff & CDDs. o As agreed on at earlier meetings with NOCP and APOC officials, the project should report and have copies of treatments BY COMMUNITY. Copies of such are expected at the LGA and health facility levels. o Census update needs to be done within the State. At each level the registration of all household members including those less than 5 years should be emphasized. r Itesiwaju and Olorunsogo LGAs need to be given additional Mectizan tablets to ensure adequate coverage of target population for 2006. As has already been noted, LGAs are to collect Mectizan supplies based on their target populations. r The State should investigate cases like Ajagba where treatments were reported in 2005 but obviously did not take place. It should take appropriate steps to ensure that such communities are immediately followed up in subsequent distributions. 4.1.3. How have they been implemented? This section addresses additional actions taken based on the sustainability evaluation findings as well as the recommendations made above from the internal monitoring. It must also be noted that the monitoring took place in the last quarter of 2006, and so not much has been done to implement the recommendations. They will be addressed better in 2007 . r A detailed and comprehensive sustainability plan has been developed and shared with all partners. r The SOCT/LOCT review meetings were used for orientation of participants on record keeping/reporting. Time was also devoted to highlight basic principles of management, ./ a a a ia t* r L f L { L f 7'- aa with focus on the mix of men, materials and money for achievement of goals and objectives. t A meeting of PHC Coordinators was held in the course of the year to improve their involvement and oversight of the CDTI implementation in their LGAs. Several recommendations reached during that meeting are being tried out, but outcome will be clearer in2007. o SOCTs had been taken through detailed planning based on the weaknesses earlier identified in the project, and to utilize it as a tool to check on progress made on the various issues and actions to be taken. t The State project staffparticipated in a data management workshop organized by the NOTF with sponsorship from APOC. Experience and training gained from this workshop will be used to strengthen the data management process. . LG Councils are being mobilized to produce IEC (including reporting forms) and registers. oyo East and Atiba LGAs produced quite a number of posters.I There has been an increase in the number of CDDs and health workers trained and involved in the CDTI process. More will be trained under the special country initiative in 2007. Additionally, more community supervisors will also be trained. This will reduce CDD workload and strengthen the supervisory system. o ltesiwaju and Olorunsogo LGAs have been given additional Mectizan tablets to ensure adequate coverage oftarget population for 2006. r The project with assistance from NOCP and APOC will be embarking on a data collection process in2007 to collect past community treatment data and use the opportunity to further sensitize health workers on the need for improved record keeping and reporting. 4.2. 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? January 2006 What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.2.1. Planning at all relevant levels Shortly after the sustainability evaluation of the State CDTI project, partners met and came up with tentative Sustainability plan for State and LGA levels. The 3yr-work plans have been revised and shared with partners. At the State level, the work plans have bien submitted to the relevant authourities for inclusion into the State heatth budget. Advocacy visits to the LGAs will be embarked upon to ensure incorporation of their work plans into the LGAs health budgets. 4.2.2. Funds The State Government has started releasing funds for the programme. Last year it released about:N:400,000 and in 2006 the amount released doubled that of 2005. ihe project expects this to continue. The LGAs have started releasing N10,000 monthly for the p.ogrumre. Some IGAs have also released lump sums for special activities. One of the prioritiesio be pursued in2007 will be to sensitize in-coming policy makers to ensure continuous support for CDTI at all levels. t i-t {t- q lE r Ir tr Ir r i 4.2.3 Transport(replacementandmaintenance) On the issue of replacement we have requested APOC to replace the project vehicle and other capital items supplied earlier while efforts will continue to get the maintenance of equipments sourced from counterpart funds. At LGA level, it has already been stated that quite a number of LGAs has started releasing amounts monthly, part of which is expected to be used for maintenance of the motorcycles. Moreover, some of the motorcycles given for NPI, HIV- AIDs, Roll Back Malaria (RBM) activities are also being used for oncho control activities through an integrated monitoring mechanism under PHC structure. UNICEF has indicated that it might be of assistance to the project in getting additional motorcycles and bicycles. 4,2.4 Other tesources ldentification and mobilization of sources of funding from Local NGos, CBos and community development associations at the LGAs level will be pursued to enable project secure other needed resources. However, government will remain the primary focus to target for the procurement of these needed resources. 4.2.5 To what extent has the plan been implemented The 3-year sustainability work-plan for both the State and LGAs developed shortly after the evaluation has been revised. For 2006, about 60% of activities planned were carried out. The others could not be carried out, or fully implemented as a result of delayed funding by both APOC and the government. The project shares part of the blame for the delay in getting approved funds from APoc as it lagged behind in prompt financial reporting. 4.3. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3.1. Ivermectin delivery mechanisms lvermection delivery has been fully integrated into the Primary Health Care structure. pHC facilities are used for drug storage, delivery and as well as for supervision. The CDDs go to the nearest health facilities to collect mectizan. 4.3.2. Training Some health personnel have been trained on early detection and reporting of Guinea worm and some other public health diseases during training sessions on GDTI. 4.3.3. Joint supervision and monitoring with other programs Presently there is no joint supervision with other programmes, and there are no plans forthis at the State level. At the LGA level, occasionally when LOCTs are on other pHC assignments like routine immunization they check on CDTI matters. Efforts are on to get LGA DSN oflicers to be part of the supervisory and reporting system. The conscientious health workers at the FLHF level integrate a lot of their activities in visits to the communities. 4.3.4. Release of funds for project activities Funds are released through the routine PHC channels at all levels, but they are not utilized on an integrated basis. 4.3.5. Is CDTI included in the PHC budget? Yes _tLt L T ab r IL r lL l',, "tt + s I, 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? An operational research on CDI sponsored by WHO which started last year in the State entered the second year. The study seeks to determine the effectiveness of the CDI process for the delivery of interventions with different degrees of complexity, i.e. Vitamin A, Insecticide Treated Nets, Directly Observed Treatment Shorts-course and Home-Management of Malaria. There are 2 sites and in 4 LGAs pilot integration of HMM, Dors, vitamin A supplementation and ITN distribution is being tested. 4.3.7. Describe others issues considered in the integration of CDTI. 4.4. Operational research 4.4.1. summorize in not more than one half of a page the operational research undertaken in the projecl area within the reporting period. See 4.3.6 above. Overall finding so far was that the varioui interventions were effective in the LGAs they were introduced using CDI, and these interventions did not affect effectiveness of CDTI. 4,4.2. How were the results applied in the project? This is the second year of the study that is expected to end in2007 SEGTION 5l Strengths, weaknesses, challeng€sr and opportunities Streneths l) Increasing number of communities with female CDDs 2) There is a great deal of integration at most levels. 3) Increasing financial commitment of the State. 4) The level of community ownership though still not acceptable is increasing especially with implementation of CSM and SHM 5) Availability of highly committed health workers at State level and in some LGAs.6) Willingness of a lot of CDDs to continue despite the lack of incentives. 7) Awareness of the control effort by most policy makers at both State and LGA levels.8) counterpart Fund contribution by most of the LGAs where CDTI is being implemented has improved. The directive of the Ministry of Local Government that each CDTI LGAs should release a monthly counterpart fund of #10,000 and the various advocacy visits to the LGAs have yielded success as l3 LGAs have been paying their counterpart contributions. In addition some LCAs have released lump sums for IEC production and CDD training. 9) Active participation of some community based organizations in community mobilization which has contributed immensely to the successful implementation of CDTI where they are present and mobilized. Weaknesses l) Poor commitment of some health workers 2) ln adequate supervision of CDDs by LOCTs/HFS t I .t I .lt L L { L rt It, ii. at v 3) Inadequate follow up on issues identified during supervision 4) Low CDD/population ratio 5) In adequate funding from the State Government 6) Inadequate understanding of communities of their roles under CDTI, particularly in the newly added LGAs. 7) In ability of communities to give incentives to CDDs Challenses - List the challenges and indicate how they were addressed. a. Political instability at State and LGA levels b. Some LOCTs appear unwilling to take the initiative in CDTI implementation at their level. c. CDD attrition in the light of inadequate incentives d. Proper mobilization of communities to fulfill their roles on CDTI e. Inadequate logistics particularly vehicle and motorcycles. f. Late and inadequate funding from the State. g. Poor record keeping and reporting in some places During the course of the year, the project did the following to address the challenges faced: o Continued community mobilization and sensitization to select more CDDs o Trained new CDDs to curb attrition 0 Conducted management training for LGA Coordinators during review meetings to ensure they take initiative for CDTI implementation at their level. r Made efforts at several occasions to improve record keeping by giving orientations and on-the-spot training to health workers. i Requested APOC Management to replace the logistics earlier given to the State. SEGTION 6: Unique features of the proiect/other matters Oyo State has a history of political volatility. In 2006, it Iived up to its name as politicians wrecked violence in various parts of the State, particularly in the capital city, Ibadan. Several State legislators were removed and the Executive Governor impeached. The tussle to have the upper hand in the State has led to uncertainty and crises. At several times the State secretariat where the seat of government is, and where the civil servants have their offices, has been placed under lock and key. Policy makers at various levels have been changed in the same manner a lady changes her wears. Management and coordination of CDTI project implementation in the State had been adversely affected. ? I t -! t- L t t t, {r i. I