Benue CDTI project technical report submitted to Technical Consultative Committee (TCC): January 2011 to December 2011

aS-.izr -L a9 /c t 1/;F+E"DE- BJ ENt Ut E SIIS:1[ E @ sjXfi', !t P BJStlt E@'-!r e anetel ahoo.com)@ta ORIGINAL : Enelish ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) DEADLINE FOR SUBMISSION: To APOC Management by 31 Januarv for March TCC meeting To APOC Management by 31 Julv for September TCC meeting AFRICAN PROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) COUNTRYAIOTF: NIGERIA Proiect Name: BENUE CDTI Approval year: 1999 Launching vearz 1999 From: JANUARY 20ll To: DECEMBER 20ll(Month/Year) ( Month/Year)Reporting Period: APOCfundinqvear: (circleone) 1 2 3 1 5 67 (8) 9 t0 1l l2 13 APOCProiectimple arreport: (qlrcleone) l 2 3 { 5 (t 7I 9 10 (ll) l2 13 Ministry of Health African Programme for Onchoccrciasis Control (APOC) Mectizan Donation I'rogram (MDP) UNICEF 2,382 C)ncho communities Partners: I WHO/APOC, 14 September 2009 ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) E,NDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: Country: NIGERIA National Coordinator Name: Dr. YISA SAKA Signature: Date Zonal Oncho Coordinator Name: Mr. JOHN ELUWA Signature: ... Date NGDO Representative Name Signature Date This report has been prepared by Name : Mrs. BETTY JANDE Designation: Signature : ..... Date ll WHO/APOC, 14 September 2009 1.1. GpNpneLrNFoRMATroN................. 1.1.1 Desuiption of the project (briefly)... 1.1.2. Partnership 1.2. Popu1erroN................ SECTION 2: IMPLEMENTATION OF CDTI ........................9 2.1 TIUpLINp oF ACTIVITIES 2.2 Aovocacy 2.3. MoetLlzartoN, SENSITIZATIoN AND HEALTH EDUCATToN oF AT RISK coMMLrNITIES,2.4. Couuuurry rNVoLVEMENT............ 2.5. CapecrryBUrLDrNG... 2.6. TREATMENTS................. 2.6.1. Treatmentfigures.............. 2.6.2 LV'hat are the causes of absenteeism? .............. 2.6.3 Wrhat ore the reasons for refusals? ..2.6.4 Briefly describe all known and verified serious adverse events (SAEI that........ 2.6.5. Trend of treatment achievement from CDTI project inception to the current year .....2.7. ORDERING, SToRAGE AND DELIVERY oF IVERMECTIN 2.8. CoUITITTITY SELF-MoNIToRINGAND STAKEHoLDERS MpETmc 2.9. SupERVrsroN ................ 2.9.1. Provide aflow 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. ll'hat were the outcomes at each level of CDTI implementation supervision?..... 2.9.5. ll'as feedback given to the person or groups supervised?2.9.6. How was thefeedback used to improve the overall performance of the project? 4 4 5 7 ..9 12 t2 l3 t6 l9 19 24 ..24 ..24 ..26 ..28 ..30 ..31 .. 31 .. 31 .. 31 .. 32 .. 32 .. 32 3.1. 3.2. J.5. 3.4. 32 34 38 38 EqureveNr FTNaNcIaL CoNTRIBUTIoNS oF THE PARTNERS AND CoMMUNITIES..... OrupR FoRMS oF coMMriNrry suppoRT ................ EXPENDITURE PER ACTIVITY 4.1.2. What were the recommendations? .. 4.1.3. How have theybeen imp\emented7.................. 4.2. SUSTaTNaSILITY oF PRoJECTS: PLAN AND SET TARGETS (MANDAToRY AT .. SECTION 4: SUSTAINABILITY OF CDTI ........39 4.1. INTERNAL; INDEPENDENTPARTICIPAToRY MoNIToRING; EVALUATIoN................ .,.,,.....,..394.1.1 Has the project ever been evaluated/monitored? Sick any of the following which areopplicable) .................. 39 Yn 3)....... 4.2.1. 4.2.2. 4.2.3 4.2.4. ;i;;, ;;; ;, ;: i i ;;i;;; ;;*; ; i;: ;;i; Funds Transport (replacement and maintenance)...... Other resources .,.......,.......39 ................. 40 ................. 40 l1l WHO/APOC, l4 September 2009 4.2.5. To what extent has the plan been implemented """""""' 4.3. INTEGRATIoN................ 4.3.1. Ivermectindeliverymechanisms 4.3.2. Training..... 4.3.3. Joint supervision and monitoringwith other programs " 4.3.4. Release of funds for project octivities..... 4.3.5. Is CDTI included in the PHC budget?...... 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. lt/hat have been tie aihievements? .."""" """"""""""" 42 4.3.7. Describe others issues considered in the integration of CDTl.........-..........-...............42 4.4. OPERATIONAL RESEARCH .....,.,.,..46 1.4.1. Summarize in not more than one hatf of a page the operational research undertaken in the project area within the reporting period. """"""""""" 46 4.4.2. How were the resilts oppiira in the project? """""""" """" 46 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AND OPPORTUNITIES........ 46 SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS """47 lv WHO/APOC, l4 SePtember 2009 Acronyms APOC ATO AtrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT TINICEF UTG wHo African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Commun ity-Based Organ ization Community-Directed Distributor Community-Directed Treatment with Ivermectin Community Self-Monitoring Local Government Area Ministry of Health Non-Governmental Development Organization Non-Governmental Organization National Onchocerciasis Task Force Primary health care Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Stakeholders meeting Technical Consultative Committee (APOC scientific advisory group) Trainer of trainers United Nations Children's Fund Ultimate Treatment Goal World Health Organization WHO/APOC, l4 September 2009 Definitions (i) (ii ) (iii) (iv) (v) (vi) (vii) (viii) (ix) Total population: the total population living in mesoAlyper-endemic communities within the project area (based on REMO and census taking)' Eligible population: calculated as 84o/o of the total population in meso/hyper-endemic communities in the Project area. Annual Treatment Objective: (ATO): the estimated number of persons living in @thataCDTIprojectintendstotreatwithivermectinina given year. Ultimate Treatment Goal (UTG): calculated as the maximum number of people to be t.*t"d """*lly in meso/hyper endemic areas within the project area, ultimately to be reached when ihe project lras reached full geographic coverage (normally the project should be expected'toieach the UTG at the end of the 3'd year of the project). Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage)' Geographical coverage: number of communities treated in a given year over the total *-b.. "f ."so/hypE-endemic communities as identified by REMo in the project area (this should be expressed as a percentage). Integration: delivering additional health interventions (i.e. vitamin A supplements, utU"ra-ot" for LF, screening for cataract, etc.) through CDTI (using the same systems, training, supervision and personnel) in order to maximise cost-effectiveness and empow", "o*rnunities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTI. Sustainabilitv: CDTI activities in an area are sustainable when they continue to fun.-tion efiectively 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. communitv self-monitoring (cSM): The process by which the community is "rp"*"*d t" or"rr"" und .onitor 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 respJnsibility of ivermectin distribution and make appropriate modifications when necessary. vl WHO/APOC, 14 SePtember 2009 FOLLOW UP ON TGG REGOMMENDATIONS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC/TRC session: TRC 5 & 7 Sessions in the Number of Recommendation TCC/TRC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY I Do Census update Census update is ongoing in some communities. CBOs and communities have provided treatment registers for this exercise. Results from this exercise shall be reflected in the 2012 2 Implement CSM and SHM in all communities The project trained 98 Health workers on CSM and SHM in 14 CDTI LGAs in 201L This was followed up with scale up implementation of CSM & SHM from 25 communities in 2010 to 95 Oncho endemic communities in 2011.The2,382 target communities for CSM & SHM are many and the funds provided for this activity could barely carry out the activity. However, the State Government, NGOs and CBOs have been approached to support the implementation of CSM & SHM in 2012,while APOC is been requested to approve a special initiative to support CSM & SHM implementation in the atea. 3 Repair/replace non- functional equipment with funding provided by State The State provided N600,000.00 for the repair of the broken down Project Vehicle. The project intends to intensifo advocacy for counterpart funds so as to channel this WHO/APOC, 14 September 2009 funds to the repair and replacement of some equipments instead of being solely reliant on APOC funds 4 Provide information on a. Health turnover mlsslng staff b. CDD attrition An Operational Research has been approved for this purpose. Implementation will be done in2012. Information on CDD attrition is reported in 4 LGAs. It shows an attrition rate of l.6oh. Health staff turnover information is not 5 Train more communitY based supervisors This is proposed to be done in 2012 2 WHO/APOC, 14 SePtember 2009 Executive Summary Benue State is located in the central part of Nigeria. The vegetation is forest to the south, with forest - savannah mosaic and mixed savannah grassland in the northern areas. Estimated population of the State is put at 4 million based on the 2006 National Population Census. The major ethnic groups are the Tiv and Idoma. Settlement pattern is largely dispersed. Movement of whole household or large numbers of persons is common due to quest for farm lands. Roads between major towns are in good condition, but access roads to most of the endemic communities are in poor shape. Benue State consists of 23 Local Government Areas; however CDTI is currently being implemented in 22 LGAs. The total estimated number of communities stands at 2,382 with an estimated total CDTI population of 3,464,916. In the year 201l, the project treated a total of 2,761,592 persons in 2,382 communities and a total of 29,153 persons passively. This brings the total number of persons treated to 2,790,745. However, therapeutic coverage is calculated at 79.7%o excluding passive treatment and a geographic coverage of 100Yo.In addition, Mectizan tablets used stands at7,829,633 tablets, while cost per treatment is estimated to be M.88K per person. Population growth in the project area is based on an estimated population growth rate of 3Yo as indicated in the 2006 National population census. The project carried out the following activities: Training and Retraining of 1,523 Health workers in identified areas of weakness, Training and retrainin g of 26,79lCDDs in 22 Oncho endemic LGAs to reduce the CDD:Population ratio from l:174 to l:l I l. Summarily, the project trained 88 LOCTs from an ATro of 88 LOCTs in 22 LGAs thus achieving 100% ATro. 1,523 FLHFS were trained out of an ATrO 2,916 health staff in the project area. This represents 52Yo ATrO achievement. Also 26,791 CDDs were trained and retrained out of an estimated ATrO of 33,797 representing 79%o achievement of ATrO. The project has 31,332 CDDs available for mectizan distribution giving a current CDD/Population ratio of l:1 I I persons. Community Leaders were mobilized and trained as supervisors in 22 LGAs. Mobilization visits and Sensitization meetings were held with Community Leaders and Traditional Rulers inthe22 LGAs. Advocacy visits were made to Principal Officers at the LGA level in April to June 201 1 by the State Oncho Control Team. These visits elicited commitment from the LGA Principal Officers. The State and Local Governments released the sum of 700,000 and 161,000 naira respectively for CDTI activities in 201 I . Current challenges faced by the project includes: carrying out census update in the endemic communities, scaling up of CSM and SHM in all the endemic communities, securing the release of the promised imprest as LGA counterpart funds to facilitate supervision, obtaining information on CDD attrition, increasing the level of involvement and commitment of FLHFS in the CDTI process. Other challenges include ensuring proper record keeping at all levels, and increasing the level of community participation. Addressing these challenges, the project emphasized on; Targeted mobilization, health education and sensitization in some endemic communities to encourage drug uptake. Advocacy visits were made to Principal Officers of the LGAs by the State Team. The LGA Executives promised to approve imprest as counterpart fund to support CDTI activities. The project scaled up the implementation of Community Self Monitoring and Stakeholders' meetings to additional communities. The challenges notwithstanding, Mectizan and albendazole is available in sufficient quantities and there is improved grasp of awareness of the burden of Onchocerciasis disease by policy makers, and community Leader J SECTION l: Background information WHO/APOC, 14 September 2009 1.1. General information 1.1.1 Description of the project (briefly) Geogrophical locotion, topography, climate Benue State is located in the central part of Nigeria. The State lies between longitude 6030' west and g%0, Bu.t and latitude 70g0' and 90'35' North. It rhu..s borders to the North with Nasarawa State, Enugu State on the South, Kogi State on the Southwest, and Cross River State on the east' The vegetation is forest to the south, with forest - savannah mosaic and mixed savannah grassland in the northern areas. The terrain comprises undulating hills that occasionally reach 4,000 feet above sea level, to bare flat plains along the Benue River, wiih an altitude above sea level of about 300 feet' In the eastern part of the projeclarea there are steep hills, cut by swift flowing streams whose banks are densely forested. The lainy season begins in March and ends in October while the dry season lasts from November to February. The State has an annual rainfall of 1200 - 9800' Population: activities, cultures, language Esiimated population of the State is puiat 4,219,244 by the 2006 National census exercise' The major ethnic g.orp. are the Tiv and ldoma. There are other smaller groups such as Etulo, -Qffiah and Jukun, who live in Tiv areas; while the Igede and Agatu live in areas inhabited by the Idoma' The major languages spoken are Tiv and ldoma. The maj-or occupation of the population is farming, including g.o"*irr"g of yams/cassava and cultivation of cotion, Soya bean and beniseed. Fishing along the riverine freas is"widespread. Crafts such as blacksmithing, weaving of cloth etc are practiced. Some also keep domestic animals. Settlement pattern is largely dispersed. Movement of whole household or large numbers of persons is common due to inter ethnic clashes or quest for farm lands' Communication sYstem (road...) Roads between major cities 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 print media are also veritable channels of communication. Wittrin the communities, the town criers and announcements in churches/mosques are preferred means of communication' Arlministratio n str uct ure The State consists of 23 local government areas with the chief administrative officer being the Chairman. A legislative arm madJ up of elected councilors from various wards help in regulating the excesses of the Chairman. At the State level, the Executive Governor is the head of administration' There are the legislative and judicial arms. The capital of the State is located in Makurdi. Health system & health care delivery There is an official pHC policy and structure in the project area. It is a system of health care service where community participation forms the main stay 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 ptsts to hospitals. There are 889 health centers and hospitals in the project area. 4 WHO/APOC, 14 SePtember 2009 Table 1 : Number of health staff involved in CDTI (Please add more rows if necessary) 1,1.2. Partnership District/LGA Number of health staff involved in CDTI activities. Total Number of health staff in the entire project area Br Number of health staff involved in CDTI B2 Percentage B3:82/ Br *100 Ado 124 120 97 Agatu 147 109 74 Apa 129 108 84 Buruku 106 100 94 Gboko 125 115 92 Guma 208 r3l 63 Gwer 147 132 90 Gwer West 175 164 94 Katsina Ala 174 118 68 Konshisha t7r 105 61 Kwande 206 128 62 Logo 113 108 96 obi 109 94 86 Ogbadibo 1 7 I ll0 64 Ohimini 112 99 88 oju 149 139 93 Okpokwu 153 105 69 Otukpo 172 162 94 Tarka 108 98 91 Ukum 149 124 83 Ushongo r28 118 92 Vandeikya 78 78 100 Total 3154 2565 81% Indicate the partners involved in project implementation at all levels [MoH, NGDOs(nationaUinternational), communities, local organizations, etc.] Describe overall working relationship among partners, clearly indicating specific areas of project activities (planning, supervision, advocacy, planning, mobilization, etc) where all partners are involved. State plans, if any, to mobilize the state/region/district/LGA decision-makers, NGDOs, NGOs, CBOs, to assist in CDTI implementation. 5 WHO/APOC, 14 September 2009 The partners involved in project implementation in Benue State are UNICEFA{igeria, NOCP (National &Zonaloffices), the Benue State Government, the 22Oncho endemic Local Government Areas and the 2,382 endemic communities. Also partnering for CDTI implementation in the communities are 59 Community Based Organizations (CBds) and Faith Based Organizations (FBOs) that cut across the 22 endemic LGAs. Paftners have worked together in relative harmony. LfNICEF roles include, planning, advocacy, mobilization and training.-UNICpp fund is made available to the project through the UNICEF 'A' Zonal office Enugu ,o Ju.ry out activities. Within the reporting period, funds were received from UNICEF to carry out, Train'ing and retraining of Health workers and CDDs on co-implementation-o-f Oncho and Lymphatic Filariasis in 3 CDI f-bas and Oncho /LF endemic communities. The NOCP zonal office is empowered to act for UNICEF in the area of supervision/monitoring and technical support. The NOCp Headquarters' roles include provision of technical support to the Benue CDTI p.oj""t with the view of strengthening the implementation of activities and ensuring adherence to set standards. On the other hand, APOC funded the training of additional FLHFS, training of community Leaders, Advocacy meeting with principal officers in the LGAs, Sensitization meeting with community leaders, State Oncho/LF Review *""iing, Printing of IEC/BCC Materials, Training and implementation of CSM/SHM and Supervisory visi6 to oncho endemic communities and carried out High level advocacy visits to State and LGA policy makers. The endemic communities selected CDDs for training to distribute mectizan in their communities, they decided on the time and mode of distribution of mectizan in their communities, and a few communities supported their CDDs in cash and in kind. The LGAs perform the role of supporting LOCT to collect _m ectizan from the State, released token imprests to aid in routine monitoiing ani supervision of FLHF and communities, and ensured the adequate storage of mectizan. The State on itr part has the role of providing logistic support and programme personnel, release funds for travels and collection of mectizan and capital equipment, carry tut"supervision of LGA activities and pay advocacy visits to State Policy makers' Community Based Organizations (CBOs) and Faith Based Organizations (FBOs) were involved injoint SOC}A1GO/CB5 supervision and monitoring exercise. They also, carried out community mobilization and sensitizati'on, provided over 120 community treatment registers to some endemic communities. 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Timeline of activities Fill in table 3, timeline of activities for areas treated in current year, indicating when the key activities were implemented by the month they began and the month they ended. 9 WHO/APOC, 14 September 2009 o, (\ 0) -o 0.) o. C)a$ O tu \J -:\A qq q) Uq) v) o\, q)\ o -: 5 tr(n o >' C)LL o q) E o(!()L a(! 0)L 0) L ,o a 0) od (F o C) C) F ".irol .ol FI o P q) a EOEtr tr c)p oo C) o L 0)! 0)oo o trop () c)o a L C) E C) a 0)a L 0)p oo 0) o C)s C)o 0) o L 0)3 o) ooa L(.)p (D o C) Lop oo o) o trop 0) a C)a C) -o C)o 0) t-.,t tro 0)(.) 0) o L(.)I 0) c)a L 0.) ooo L 0)I (.) aoa Lo -o (.) o 0) n Lo! 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IJ o z 0) o a o z C) o n z (.) o n o z o o t-1 o z o o o z 0) o t-.1 o z 0) o t-l o z x - >t >t >, >' l- >t CB (d Cd 0)p o o LO o o o L 0) -oo o o L 0) -oo o o li 0) -o oo oL(0 oLd otr(! ocg oL(o a o o_lzf o (o .YL(U F Ef -Yl o o)co .Cal (s =oEc(U 2.2. 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. Describe difficulties/constraints being faced and suggestions on how to improve advocacy' Foltow up on the high level advocacy made by the APOC Advisor in Nigeria, the UNICEF Consultant and Noip officerJin 2010 was carried out at the State level where enquiries were made from the APOC Advisor, NOCP Officers, the Honorable Commissioner for Health, The Permanent Secretary Health, and Director Public Health, to find out the extent of implementation of the p_romise made by the Benue State Government. The Project is yet to receive any positive response. APOC and NOCP is been urged to initiate a follow up on this. Furthermore, Advocacy visits were made to over 132 Principal Officers at the LGA level to solicit financial support to CDTI activities in the endemic LGAs. Prespnt at these visits were the Honorable Chairmen, iire Deputy Chairmen, Directors General Services & Administration, Heads of Personnel Administration (HPA), Supervisroy Councellors for Health, Head of Department for Health' The visits advocated for their rrppo.t in facilitating the provision and release of fund for the implementation of CDTI activities in ttreiilCas. This meelings raised the consciousness and interest of Officers on the need to provide financial support to the project. Records of funding from some LGAs show the approval and release of imprests to the LGA Oncho Coordinators for the maintenance and fueling of motor cycles and to support routine supervision and monitoring of CDTI activities by LGA Coordinators. Less challenges were experienced in the area of advocacy this year since the State Oncho Control Team moved out to meei with the Principal Officers and LGA Chief Executives at their duty posts. Most of the Officers were met. However, for follow up of the High level advocacy visits, the project suggests that, a specific and comprehensive memo should be initiated by the APOC Advisor in Nigeria anilubmitted to the State and I--Cn Cnief Executives as a reminder of the commitments made during the high level advocacy visits. 2.3. Mobitization, sensitization and health education of at risk communities Provide information on - The use of media and/or other local systems to disseminate information - Mobilization and health education of communities including women and minorities - Response of target communities/villages - Accomplishments - Suggesi ways to improve mobilization and sensitization of the target communities' During the reporting period the project made use of the following media for the mobilization and health education of the persons and communities: 1. Key NGOs, CSOs and CBOs mobilized endemic communities for mectizan uptake in Guma, Tarka and other LGAs. Z. printing of T Shirts, Face Caps and Posters distributed to CDDs, community members etc 3. FLHFS facilitated at health education sessions held for community members who come for services at the health facilities and during their visits to the communities. 4. Community Heads Meetings, including district chiefs and opinion leaders were also used to reach many community members. They were sensitized during their council of chiefs meetings on the need ior mectizan mop-up treatment in the communities where treatment was low and on the need for support to CDDs. t2 WHO/APOC, 14 SePtembet 2009 5. Face-to-face meetings with the community members. This occurred in all the 22 LGAs where the FLHFS went to some communities to mobilize them for the selection of more CDDs for training and old CDDs for retraining. Mobilization at community meetings was an effective means of mobilization since most community members were present.6. Church Announcements - This medium was used in many communities to mobilize the people, especially during the mectizan distribution rounds. Church announcements made great impact on the response of community members to drug uptake. Mobilization and health education of women and minorities - method and response Targeted mobilization and health education of female members of the co--rnity was carried out in some communities. This triggered selection of more women for training as CDDs. Iordaa, Igede, Etulo, Uffiah, Agatu, Jukuns minority tribes were reached through their traditional leaderi for communal activities. The project hopes to continually utilize these systems. The Catholic Women Organization (CWO), Federation of Nurses and Midwives (FENAM) and Methodist Women Fellowship are currently engaged in the mobilization of women in the project area. Response of target communities/villages There is an increase in the level of Mectizan intake, and communities expressed willingness to support the CDTI process. They selected CDDs along kindred lineage while several communities agreed on the sum of N20.00 as incentives to be given to CDDs by each Household. However, a lot still needs to be done in the area of incentives for the CDDs. During HSAM Sessions, the project emphasized the roles of communities under CDTI implementation most especially the need to *pio,t CDDs in cash or kind for collection and distribution of mectizan. Accomplishments There is increase in the number of persons swallowing mectizan in the communities. Increased involvement of Female cDDs and FLHFS in the cDI process. There is also increase in awareness of the roles of communities in supporting some aspects of the CDTI implementation financially and in kind. Community Leaders provided treatment registers in some LGAs. More have agreed to pay a token of N20 as incentives to CDDs by each household Improvement in the CDD: Population ratio from I :176 to l: I I l. Improvement in the Male CDD: Female CDD ratio from l:6 to l:3. Provision of Community treatment registers by some CSOs and CBOs. Active involvement of CSOs and CBOs in mobilization, Health Education, monitoring and supervision of treatment. Suggested ways to improve mobilization of the target communities I ' Scale up of Community Self Monitoring and Stakeholders Meetin gto 2287 communities.2. Use of community theater for drama, role plays and dances during mobilization sessions3. Training of some school teachers as community - based superviiors, and effective mobilizers in the LGAs and communities both at the school and general community level. The project plans to expand on the use of the schools as channels of reaching more communities. Heatth education messages shall be passed on at general assemblies for pupils to take home to their parents. Also formation of oncho health clubs shall be encouraged.4. Ensure that health workers trained are adequately involved in CDTI Implementation in the endemic communities in their various LGAs. 2.4. Gommunityinvolvement Table 4: Communities participation in the CDTI (Please add more rows if necessary) District/LGA Number of communities/villages with community members as supervisors Number of CDDs and the communities involved Number of communities /villages with female CDDs 13 WHO/APOC, 14 September 2009 Total no. mmunitie s in the entire district/LG A area Number with community members as supervisors Bs Percenta ge Be: By' Br *100 Male CDDs B7 Female CDDs Ba Total Be= B7*Bg Number of communities with female CDDs Bro Percentag e Brt: Bro/84*10 0 Ado 1 0 1 0 0"/, 1,055 216 1271 83 82o/o Aqatu 86 0 0. 832 159 991 42 48% Apa 85 0 0"/o 679 110 789 73 85% Buruku 61 0 0./, 1317 344 1721 31 50% Gboko 132 0 0o/" 2,122 599 2721 34 25o/o Guma 125 0 0t/" 835 325 '1160 40 32o/o Gwer East 69 0 0"h 623 131 760 13 18% Gwer West 124 0 0,/o 665 2r0 875 15 12% Katsina Ala 148 0 0t/" 1,679 719 2398 42 28o/o Konshisha 107 0 0"/" 1,541 272 1813 21 19% Kwande 288 0 0o/" 3,081 1,517 4598 49 17o/o Logo 116 0 0'/, 857 317 1174 40 34% obi 86 0 0"/" 612 163 775 44 51o/o Ogbadibo 96 0 0"/" 969 340 1 309 47 48% Ohimini 73 0 0o/o 594 139 733 33 45% Oiu 110 0 0o/o 743 222 965 58 52o/o Okpokwu 80 0 0./, 797 326 1123 77 960/o Otukpo 120 0 0rh 1,019 479 1498 73 60% Tarka 75 0 0.h 542 181 722 43 57o/o Ukum 104 0 0,/" 1151 447 1 598 50 48% Ushongo 120 0 0o/o tl32 357 1489 24 20o/o Vandeikya 76 0 0'/" 662 187 849 45 59o/o Total 2,382 0 0'h 23,565 7,767 31,332 977 41.h t4 WHO/APOC, 14 SePtember 2009 Comment on Attendance of female members of the community at health education meetings In general, how do you rate the participation of female members of the community meetings when CDTI issues are being discusses (attendance, participation in the discussion etc). Incentives provided by communities for the CDDs Attrition of CDDs. Is attrition a problem for the project? If yes, how is it addressed? Other issues Attendance of female members of the communities at health education meetings continues to improve This is reflected in the improvement in the male to female CDD ratio as well as selection of men and women at par as community monitors in the communities where CSM & SHM is being implemented. Information on CDD attrition is reported on in 4 LGAs. It shows an attrition rate of l.60/o. More communities seem to have agreed on incentives for their CDDs by way of monetary contributions of ),I20 per household. This is a slight improvement from previous years. However some community members do not make good this contribution. AIso the project still needs to effectively track CDD attrition. To address this, the project encouraged selection of more CDDs along kindred lineage. During the trainings, community leaders and other community members were also trained. With the aim of increasing the community's understanding of their roles in CDI implementation. 15 WHOiAPOC, 14 September 2009 2.5. GapacitY building - Describe the adequacy of available knowledgeable manpower at all levels' - where frequent transfers of trained staff occur, state what the project is doing, or intends to do, to remedy the situation . (The most important issue to describe is what measures were taken to ensure odeqrlrc CDTI implementation wiere not enough lcnowledgeable manpower was available or if stoffs arefrequently transferred during the course of the campaign)' Training and retraining ofpersonnel has been identified by the project as a continuous exercise, first to train niv personnel j"oinirg the project and secondly to update the knowledge of old and existing personnel.'Trainings-were-car.ied out in the 22 on.ho endemic LGAs during the reporting period' th.r" trainings involved: 741 new and782 old FLHFS,4 new and 84 old LOCTs,ll'954 new and 26,79l old CDDS in the 22 CDTI LGAs. The project has 2,565 trained Health workers involved in CDTI and 31,332 CDDs Trained for distribution of mectizan and albendazole. In addition, over 300 community leaders were sensitized and trained on their roles as community Leaders. Knowledgeable manpower is available at the State and LGA levels' However, the capacity of LOCTs and FLHFS needs to be built most especially in the area of data management, analysis and project planning' Health workers were trained on Co-implementation of Oncho, LF and malaria, Community Self Monitoring and Stakeholders Meeting, case identification of Leprosy and Tuberculosis' Training of CDDs was handled by the health *orf"r, earlier trained by the project. There is also the need to train .o*rllrnity supervisors to further encourage community participation and ownership' The project has ensured the training of a considerable proportion of existing Health facility staffs to address issues of frequent staff transfers. t6 WHO/APOC, 14 SePtember 2009 q) 6l 0 aU t- o! z c!ll+h9E!- F cuc'' bd t, : S) e Flr\o- r{ o|(O ot c!o Fl rl o) @ $ O)(O F\ Or ri O)N F. 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Treatmentfigures If the project is not achieving 100% geographical coverage and a minimum of 65% therapeutic coverage or the coverage rate is fluctuating, state the reasons and the plans being made to remedy this. Communal clashes involving some endemic communities and Fulani herdsmen leading to fleeing of the communities by community members. Some community members are yet to return to their communities. Non involvement of the Traditional Rulers in the mobilization of their subjects for the selection and support of cDDs as well as for the intake of mectizan tablets Lack of census update in some communities resulting in inadequate mectizan requisition. Some LGAs requested for mectizan tablets that was far too low to cover their communities and population. Plans are being made by the project to improve on the level of both geographic and therapeutic coverages. Trainees Type of training CDDs Other Community members e.g Community supervisors Health Workers (frontline health facilities) MOH staff or Other Political Leaders Others(specifu) Program management { { How to conduct Health education ./ ./ ^/ Management ofSAEs ./ { ./ CSM { { SHM { ./ Data collection { { { Data analysis { ./ Report writing ./ { Others: Supervision of mectizan distribution (speciff) ./ t9 WHO/APOC, 14 September 2009 Ensure the involvement of Traditional Rulers, more CBOs and CSOs in mectizan distribution activities in addition to scaling up of monitoring and supervision of CDTI activities jointly by SOCTs, CSOs and CBOs. 20 WHO/APOC, 14 SePtember 2009 o\ c.lko -o () o. 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C)k(0 .9 C)E 0) ILo -as 36)tr$ 'E rr !) ^\it= ot U- 9l E * vl -o tr:^l ^.+!l Y t--9l o-r dEla= -l oa{ol a> al! oi()vh Ol siolo-ol -o \oiil tr r-^ -l3otPl tr Ft (g 5t hzli il Eo C) o(! (JF s 2.6.2 What are the causes of absenteeism? Absenteeism is caused mainlY bY: l. Faulty timing and mode of distribution in some communities makes community members miss out on distribution' 2. Relocation of community members to their farm houses during the farming season, and delay in returning early enough to catch up with treatment' 3. Another reason is inadequate mobilization of community members on the need for them to be available during treatment period and/or round' 4. Spill over from communal clashes and political unrest in some communities caused *uny "o*.unity members to delay returning to their communities thereby missing out on treatment. 2.6.3 What are the reasons for refusals? The major reason why some community members are reluctant or completely refuse treatment with mectizan is: The erroneous believe in the past experience of adverse reaction and rumors of death due to intake of mectizan by persons who trad in the past complained of itching and body pains. The team hopes to overcome this believe through intensive health education and mobilization of communities while reassuring them of the safety of mectizan' 2.6.4 Briefly describe all known and verified serious adverse events (SAEs) that o""r..Ld during the reporting period and provide (in table 8) the required information when available. . Parasitologisttrained? o Existence of microscope? r In case the project did not have any cases of serious adverse events (SAE) during this reporting period, please tick in the box. 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Ordering, storage and delivery of ivermectin for by - Qtlease tick the appropriate answer) WHO E UNICEF EMectizan@MOH Other (please Mectizan@ de livered by - Qtlease tick the appropriate onswer MOH wHo UNICEF Other (please Please describe how Mectizan@ is ordered and how it gets to the communities ) NGDO E NGDO E The quantity of Mectizan@ required by the project is -calculated based on treatments and total population fiom the last cycle. NbCp pro".r."rih. dutu after receiving information from all UNICEF - assisted States and submits re - appiication to the MDP. On approval the drugs are shipped to the country and UNICEF facilitates clearance and storage. The State or the Zonal office picks up its consignment from NocP and supplies mectizan to the LGAs through the LocTs' LocTs in turn supply the drugs to the district t eatttr supervisors or ihe_ health facility staff in the various health facilities in the communities who in turn make them available to the Community Directed Distributors (CDDs) in the communities. FLOW CHART OF MECTIZAN DELIVERY UNICEF/ Nigeria Reporting flow Delivery process MDP NOCP Zonal Office STATE LGA District Health F acilities Communnities 28 WHO/APOC, l4 SePtember 2009 Table l0: Mectizan@ Inventory (Please add more rows if necessary) How are the remaining ivermectin tablets collected and where are they kept? Ivermectin Tablets when it remains are returned to the Health Facility by CDDs where they are stored in Mectizan storage boxes in the Health facilities.: List and briefly describe the activities under ivermectin delivery that are being carried out by health care personnel in the project area. The health care personnel at the various levels of CDTI Implementation are responsible for the following Ivermectin delivery activities: Storage of ivermectin State lDistrict ILGA Number of Mectizan" tablets In stock from previous year Requested Received Used Lost Wasted Expire d Remainin o Ado 7,100 280,000 287,100 286,589 0 56 0 455 Agatu 1,210 240,000 241,210 239,658 0 79 0 1,473 Apa 1,200 200,000 201,200 195,679 0 58 0 5,463 Buruku 2,000 430,000 432,000 431,320 0 76 0 604 Gboko 6,600 710,000 716,600 715,652 0 80 0 868 Guma 4,000 280,000 284,000 282,986 0 68 0 946 Gwer East 7,500 200,000 207,500 196,465 0 60 0 10,975 Gwer West 1,200 210,000 211,200 209,650 0 88 0 1,462 Katsina Ala 9,1 00 560,000 569,1 00 568,210 0 77 0 813 Konshisha 5,400 450,000 455,400 454,123 0 78 0 1 ,199 Kwande 1,000 1,300,000 1,301,000 1,300,562 0 86 0 352 Logo 5,1 95 288,000 293,1 95 292,650 0 67 0 478 obi 3,340 160,000 163,340 161 ,987 0 51 0 1,302 Ogbadibo 7,000 320,000 327,000 326,111 0 66 0 823 Ohimini 3,009 160,000 163,009 162,568 0 50 0 391 Oiu 0 200,000 200,000 199,970 0 6 0 24 Okpokwu 2,000 300,000 302,000 301,240 0 59 0 701 Otukpo 2,566 400,000 402,566 368,732 0 83 0 33,751 Tarka 4,000 127,000 131,000 130,659 0 48 0 294 Ukum 0 400,000 400,000 399,1 23 0 72 0 805 Ushonqo 10,000 320,000 330,000 330,000 0 0 0 0 Vandeikya 4,000 191 ,000 195,000 189,320 0 62 0 5,618 Ref Center 18,580 74,000 92,370 86,380 0 32 0 6,088 Total 106,000 7,800,000 7,905,920 7,829,633 0 1402 0 74885 29 WHO/APOC, 14 September 2009 Supply of ivermectin to the communities Record keeping of drugs distributed and number of persons treated. Supervision of CDDs. Assist in the training/ retraining of CDDs. Treatment of any SAE patients referred Any other comments 2.8. Gommunity self-monitoring and stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? 98 persons were trained as trainers of trainees for Community Self Monitoring (CSM). In December ZOit, CStvt was initiated and implemented in 95 communities of l4 LGAs in the project area. Monitors were selected and given indicators for monitoring. Reports indicate that the monitoring process has been completed in some communities. However, report of the Stakeholders Meeting held in the communities and decisions reached is yet to be received' If so, When? Table I l: Community Self-Monitoring and Stakeholders Meeting (Add rows if needed) DistricU LGA Total # of communities/villages in the entire district/LGA area No of Communities that carried out self monitoring (ClM) No of Communities that conducted stakeholders meeting (SHIvt) Ado Agatu Apa 101 86 85 None Nor" 5 None None None Buruku 61 5 None Gboko r32 None None Guma 125 l0 None Gwer 69 5 None Gwer West 124 None None Katsina Ala 148 5 None Konshisha 107 None None Kwande 288 10 None Logo ll6 5 None obi 86 None None Ogbadibo 96 None None Ohimini 73 10 None oj, ll0 5 None Okpokwu 80 5 None Otukpo 120 10 None Tarka 75 5 None Ukum 104 5 None Ushongo 120 10 None 30 WHO/APOC, 14 SePtember 2009 Vandeikya 76 None None 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 cycle. Decisions reached by the communities at the Stakeholders meetings will be used for planning of interventions in the communities in the year 2012. 2.9. Supervision 2.9.r. Provide a flow chart of supervision hierarchy. SOCT LOCT FLHF STAFF CDDS 2.9.2. What were the main issues identified during supervision? mectizan distribution with ease. Hence, the insistence of community members to use house to house distribution method. large terrains. of frustration have refused to make any more requests on the LGA Councils. the LGAs. entire LGA rests on the shoulders of only the LGA Coordinators. communities/ CDDs. This placed a heavy workload on the LOCTs. CDI implementation by LOCT Coordinators. 2.9.3. Was a supervision checklist used? Supervision checklist was used at the State level by SOCTs and NGO/CBO representatives to carry out joint monitoring and supervision. Although copies of checklist are available at the TOTAL 2382 95 0 31 WHO/APOC, 14 September 2009 LGA and Health Facility level, supervision checklists were only used occasionally for the few times LOCTs and FLHFS went out for supervision. 2.9.4. level Appraisal meeting for SOCTs, LOCTs, and PHC Coordinators as well as a State Oncho/LF nevie* meeting were held in April and December 2011 respectively; at this meetings, feedback *u, gir", on issues observed during supervision, while reviewing LGA performance for the year. Suggestions were made for the improvement of project performance in 20.12. The State team also held pre activity meetings to discuss the ways of executing subsequent activities bearing in mind findings from supervision and monitoring exercise' LGA Level. and options of accomplishing mectizan diitribution for informed decision by the communities. monthly imprest for the LGA Oncho Coordinators for routine supervision. members to enhance faster and wider coverage of the LGAs during treatment and other activities. Health Facility level retrained 1,523 FLHFS in the 22 LGAs on CDTI implementation, Data Collection, Management and Analysis, but still intends to train more FLHFS in areas such as, supervision of CDDs, Data Collection, Management and Analysis' Community level commencement of mectizan distribution in 2012 demand for incentives. 2.g.5. was feedback given to the person or groups supervised? yes, feedback on issues identifLd during supervision was given to the Principal Officers of the LGA at advocacy meeting sessions held in the f-bes by SOCTs led by the State Coordinator. Also, the LGAs were briefed during the State Oncho/LF Review Meeting held for SOCT/LOCT Coordinators in Otukpo and Gwer East LbA. In addition, the State Oncho Team utilized other contact times had with LGA Coordinators for other CDTI activities to give feedback on findings from monitoring and supervision. 2.9.6, How was the feedback used to improve the overall performance of the project? Following feedback given to LGAs on issues identified during supervision, the project witnessed improverient in treat"ment coverage. In the areas where CDDs were selected along kindred lineage, "or".ug. improved. Some community members that initially refused treatment for fear of adverse reactiois were health educated on the safety of mectizan tablets and communities were re-sensitized on the danger posed by those refusing treatment as they could re-infect those under treatment. Also communit[s were educated on the need for compliance to the number of years required for treatment' With this explanation most of the communities encouraged their members to take mectizan, while more communities have spelt out sanctions for those who refuse to take mectizan' SEGTION 3: SuPPort to GDTI 3.{. Equipment Table l2: Status of equipment (Please add more rows dnecessary) What were the outcomes at each level of CDTI implementation supervision?State 32 WHO/APOC, 14 SePtember 2009 Source Type of Equipment APOC MOH DISTRICT/L GA NGDO Others No Conditi on No Conditi on No. Conditi on No. Conditi on No. Conditi on L Vehicle 2 2F 2. Motor cycle(s) 2l 4F& t7 CNFR 27 4F& 23 WO 3. Computer(s) 2 I F& I CNFR 4. Printer(s) 2 F 5. Photocopier (s) 2 lF& ICNF R 6. Fax Machine(s) 7. Others a)Air Conditioner 2 F b)Electricity Generator I wo c) Telephone I CNFR *Condition of the WO=Written off) equipment (F:Functional, CNFR:Currently non-functional but repairable, How does the project intend to maintain and replace existing equipment and other materials? The Benue State Government through the ministry of health approved and released the sum of six hundred thousand naira (N600,000.00) for the repair of the broken down Project vehicle. Some of the non functional Project equipment have been replaced by Apoc. JJ WHO/APOC, 14 September 2009 The ApOC Advisor visited the project in company of the UNICEF Consultant and NOCP Officer, the Team carried out a high l"u"l uduo"acy visit- to Policy makers at in the State and discussed exhaustively on the iss.ies of release of iounterpart funding for CDTI activities in the State' The Executive Governor made commitment on the issues of counterpart funding at the State' However, the fruits of that visit are yet to be seen. 3.2. Financial contributions of the partners and communities - Fill tables 13a, 13b and 13c - lf there are problems with release of counterpart funds, how were they addressed? Additional comments It may be recalled that the Government approved and released the sum of 5 million naira only for GDTI activities towards the tail end of the-year 2008. 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Other forms of community support - Describe (indicate forms of in-kind contributions of communities if any) Exemption from some community levies and dues' Helping them on their farms especially during the planting season. netping them in construction und thut"h roofing of their houses (Round Huts) Special recognition at community gatherings' Giving foodstuff to the CDDs. 3.4. Expenditure Per activitY - Indicate in table 13, the amount expended during the reporting period for each activity listed' Write the amount expended in US dollar, ,ring the current United Nations exchange rate to local currency' Indictate eichange rate used here @ D*I53'8: $l Table l4: Indicate how much the project spent for each activity listed below during the reporting period' Any comments or exPlanations? Cost per treatment stands at M.88K Drug collection from NOTF Stores in,L,qgos Training of Health workers Training of CDDs Mobilization of Community Leaders Advocacy Meeting with Principal Officers, Sensitization Meeting with Community Ldrs State Oncho/LF Review Meeting Supervisory Visits Printing of IEC/BCC Materials CSM/SHM in 25 Communities Communications with Partners. Baseline Survey for Co-imptementation of Oncho & LF Repair of Project Vehicle Others ank 6,718.5 650.2 15,2g4.i 13,80i.5 1,384.9 3,043.9 12,689.9 7,473.2 4,063.7 8,056.5 1,690.5 9,581 .l 3,901.2 26r.5 Source(s) of fun sMqH LTNICEF/APOC APOC APOC APOC APOC UNICEF/APOb APOC APOC APO. APOC UNICEF SMOH APOC TOTAL 88,617.3 Total number of Dersons treated in 2010 745.00 38 WHO/APOC, 14 SePtember 2009 SEGTION 4: Sustainability of GDTI 4.1. lnternal; independent participatory monitoring; Evaluation 4.1.1 Has tltc projcct evcr been cvaluatctl/ntonitorcd? (Tick any of the follorving rvhich arc applicable) Year I Participatory Independent monitoring ./ Mid Term Sustainability Evaluation 5 year Sustainability Evaluation { Internal Monitoring by NOTF (Household Surveys) -{- The Implementation of Benue State CDTI Sustainability Plan (Other Evaluation by other partners) 4.1.2. What were the recommendations? The monitors from their findings made the following recommendations reliable information of the total population of the endemic communities. more efficient in the discharge of their duties. This is to particularly address notable gross weaknesses in the areas of record keeping, mectizan computation, technical reports writing and inventory keeping. utilization). participation of external partners to improve sustainable project funding. of CDTI needs to be strengthened. transiting to the sustainability phase. This is in view of the fact that the project suffered management hiccup in the first five years of its takeoff; which inflicted almost irreversible damage in the entire structure. Even with the subsequent restructuring of the management, a period of inertia is required for full recovery. It was not so because of poor financial support from the government at the two levels and reassignment of workers to other programmes which became a serious constraint to the management team. Failure to respond to this may not guarantee sustainable CDTI activities in Benue state, with the anticipated repercussion of the project being a breeding ground for Onchocerciaisis transmission to the neighboring states like Cross River,Taraba,Nasarawa and Kogi states From the household coverage survey, monitors made the following recommendations to policy makers towards their financial contribution to CDTI project. and transfer concerned to do the right thing. preferred 39 WHO/APOC, 14 September 2009 comments on technical reports should be compiled and disseminated to all levels and extent of implementation monitored periodically. LGAs in turn should p.odr." for the various districts' supervisors, and these should be used to report treatments. 4.1.3. How have they been implemented? CDDs were trained and Lncouraged to update their treatment registers on a yearly bases before commencement of drug distribution. Census update is ongoing in some communities. CBOs and communities have p.ouid.d treatment registers for this exercise. Results from this exercise shall be reflected in the 2012 rePort. to address notable weaknesses in the areas of record keeping, mectizan computation, reports writing and inventory keeping. SOCTs have undergore irainings to man this system, while a data entry clerk has been employed to help enter CDI data collected from the field. appioach. ai tne .nJ of year review meeting, LGAs present their plans of activity based on issues identified in the communiti"r, the State Coordinator collates the plans and collapses it into one State plan for the next treatment year. This activities are subsequently included in the APOC Plan of Action and Budget and the UNICEF AWP and also shared with other partners at different levels. monitorin[ involving house hold coverage survey, while, APOC funded supervisory visits which were carried out at the LGA and Community level' implementation in the State as recommended by the Evaluators' Officers in the 22 endemic LGAs to advocate for support to the project in the Areas of supervision and monitoring, provision of treatment registers as well as treatment forms to facilitate recording and reporting of treatment. submissions of comriunity list and treatment reports by the LGAs. This will be finalized by the SOCTs and LOCTs at a review meeting in2012. 4.2. Sustainability of proiects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period? No- Was a sustainability plan written? Yes When was the sustainability plan submitted? 2004- What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.2.1. Planning at all relevant levels The department of planning at the state ministry of Health requested for and incorporated the projects work plan and budget into the state health strategic plan. A memo is to be done each year in accordance with the strategic healih plan for the project to attract funding from the state for implementation of project activities. 40 WHO/APOC, 14 SePtember 2009 4.2.2. Funds Steps have been taken to get the state to release block counterpart funds to the project. The project submitted proposals to source funds from other resource outlets like the Benue Health System Development Project tI (HSDP II) in the next years. The Benue Health System Development fund had previously funded training of FLHFS and CDDs in the project area. 4.2.3 Transport(replacementandmaintenance) The Benue State Government through the ministry of health approved and released the sum of six hundred thousand naira (N600,000.00) for the repair of the broken down Project vehicle. APOC has given a new motor vehicle to the project to replace the old Hilux Van. The project commends APOC for facilitating the release of this vehicle. In addition, APOC has released 6 Motor Cycles to the project to replace some of the old motorcycles in the LGAs. These vehicles are expected to take the project a long way. However, the project still requests APOC to provide her with 12 motorcycles, to be allocated to 12 more LGAs to replace the broken down, non functional and worn out ones. This will facilitate wider and higher treatment coverage. Nevertheless, the project has also put across requests for the state government to provide money for maintenance and fueling of motor vehicles, while LGA authorities are still encouraged to make money available to the LGA Oncho Coordinators as imprest for fueling and maintenance of motorcycles for supervision of mectizan distribution activities. 4.2.4. Other resources Treatment registers; treatment reporting forms and stationery are being sourced from NGOs, CSOs and CBOs and other well meaning individuals in the communities. However, the erratic power supply being experienced in the project area has constituted a major set back to the projects activities requiring the use of electricity. At the end most of the typesetting, printing and photocopying of reports and other documents is often accomplished using the services of business center operators who have alternative sources of power supply. This forms part of the need to replace the old and worn out electric generating set previously given to the project by APOC. 4.2.5. To what extent has the plan been implemented Appreciable efforts have been made in the area of training that could contribute to future sustainable CDTI implementation. Performance is not impressive in the area of HSAM, it therefore means that more efforts need to be directed to the LGAs with respect to HSAM activities with the aim of improving and sustaining this vital component of CDTI. Supervision and monitoring has been abysmally low and therefore there is the urgent need to strengthen it. Overall, about 65%o of planned activities have been implemented. Community Self Monitoring (CSM) is yet to be implemented in many communities. 4.3. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration 4.3.1. Ivermectindeliverymechanisms The mectizan delivery process occurs within the existing PHC structure. Communities pick their mectizan requirements from the health facilities, except in few cases where the drug is taken to them. During NIDs, for instance, the LGA/PHC staffs that come to pick up their vaccines also use the oppoftunity to collect mectizan allocation for their LGAs. 4.3.2. Training Some other LGA/PHC personnel, apart from LOCTs, have been trained on CDTI so that they can assist in training of lower level personnel and supervise CDTI activities. Similarly integrated training sessions was carried out for CDI and other PHC & Disease control programmes such as, onchocerciasis, Lymphatic filariasis, Leprosy, Tuberculosis, HIV/AIDS, Malaria, Guinea Worm Eradication, measles, VAS etc. 4.3.3. Joint supervision and monitoring with other programs At the State leveljoint supervision and monitoring is yet to be achieved. At the LGA level however, most of the LOCTs were involved in other PHC programmes and thus used opportunities of field exercises to carry 4t WHO/APOC, 14 September 2009 out supervision and monitoring of CDTI activities. At the health facility level, where health personnel are invotvid in CDTI the situation is even more fluid. Supervision visits to the community are used to achieve several purposes, checklists for guinea worm/measles surveillance as well as CDTI checklists are currently used by SbCTs, LOCTs and FLHFS during supervision. There is however no integrated supervisory checklists at the moment. 4.3.4. Release of funds for project activities In some LGAs, imprest is released for PHC activities and is controlled by the PHC director, while some LGAs release imprest directly to LGA Oncho Coordinators. In the first instance, PHC Directors from time to time release a minimal amount to the LGA Oncho Coordinator for some routine supervision visits and collection of mectizan from the State. These minimal amounts have been reflected in tables l3 (a)(b)(c). This practice is not evenly spread, as some LGAs hardly have funds for operational activities. 4.3.5. Is CDTI included in the PHC budget? At the state level there is a budget line item for CDTI in the PHC budget. At the LGA level CDTI activities are subsumed under a general PHC budget. Inclusion of the budget or the existence of a line item does not however guarantee funds release. 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? o Fill tables 14 and 15 and provide describe other programmes that are using the CDTI structure and how this was achieved. What have been the achievements? o For each intervention listed in table 15, explain what were the roles played by the CDDs (census, mobilization, distribution, data collection, storage, collection of drugs, referral of SAEs, etc ...)? o Explain what are the combinations of interventions co-implemented? o How were the interventions implemented? (at the same time?) The Tuberculosis (TB) Control Programme trained all the 22 LGA Oncho Coordinators on case identification for TB. The Coordinators in turn have mainstreamed TB in CDTI activities. From 2011, the CDTI structure is being used for the scale up of distribution of Albendazole for the elimination of lymphatic filariasis in Ado, Apa and Obi LGA. Health workers and CDDs were trained to actively participate in this process. CDDs are been used as local guides during NIDs in some LGAs such as Kwande and Logo. 4.3.7. Describe others issues considered in the integration of GDTI. Difficulties have been experienced in getting other programme officers to work hand in hand for the integration of CDTI into lheir programmes. 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E.eELLt! orEEEOs -o a C .o P(U Pc <(u cE '= oJ oX >6 a a a a a a a o a L oI o q) F a ttd oLoe-2A \ro 6 t) li(n o Cd >, rl at) t)(d lr, o (h oa Fa oL oo (d li .d d z tr oo d t< Cd d z L (d A o o CdLF a c) cd (6 O A" o C) u) (r) rr C) o t q) r. o' R s. te() 0.)L o t- a oO bo t/) th o cdl<bo oL L 0) (-, rii o c!F 4.4. Opetational research 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' proposals for Operational research areas are currently been worked on by the project and researchers from the 'University of Agriculture Makurdi and University of Jos. The areas being proposed to be studied is tracking of CbO attiition and Refusals. It is hoped that in the project yeat 20ll these proposals may be approved by APOC and work on it implemented' 4.4.2. How were the results applied in the project? No operational research results are available yet. $EGTION 5: Strengths, weakne5ses, challengesr and opportunities - List the strengths and weaknesses of CDTI implementation process. Strengths: of Community Monitors and Community Supervisors' community members. programme, etc, Weaknesses - List the challenges and indicate how they were addressed' participation by all sections of the community' LGA levels To address these challenges, the project did the following: - Carried out advo"cacy visitsio Principal Officers in the CDTI LGAs to advocate for the approval and release of counterPart fund. - Emphasized the selection of new CDDs for training so as to reduce the CDD to population ratio' - Involvement of NGOs/CBOs in joint monitoring of mectizan distribution activities. 46 WHO/APOC, 14 SePtember2009 aInvolvement of CBOs in the retrieval of treatment data from difficult to reach communities lnclusion of practical recording and reporting in alltraining contents. Training of CDTI personnel on data management Ensured participation of CDTI personnel and CDDs in other PHC programmes to achieve integration. SEGTION 5: Unique features of the project/other matters 47 WHO/APOC, 14 September 2009