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

ADAMAWA CDTI PROJECT _ AN\YUAL REPORT. ORIGINAL : English t\N:*."Us t .-"i $HL \r. o[.cF "-*'" .4 /', ,ts'fo l\ C(.!.,O qgrti ".-,. I l, f.-,1 't t: i^3i Ici i,-i::rr'.; 'or i , t,r, \Ifu t, 'f ,?' ,,t,,,, ' n q iAil. 2005 }T COUNTRYAIOTF: NIGERIA Proiect Name: ADAMA\ilA CDTI PROJECT. Approval Year: MAY, 1999 Lt Year: MAY 1999 Reporting Period: From: Decemberr 2003 To: November, 2004 Month/Y Proiect vear of this report: (circle one) I 2 3 4 (s) 6 7 8 e l0 Date submitted: Decemb er, 2OO4- NGDO nartner: Helen Keller International. WHO/APOC, 24 November 2004I ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMIVIITTEE (TCC) D FOR S ON: To APOC Management by 3l January for March TCC meeting To APOC Management by 3l Julv for September TCC meeting AFRICANPROGRAMME FOR oNcHocERcIASIS CONTROL (APOC) ll WHO/APOC, 24 November 2004 Helen Keller International, 1A Akila W.Machunga Road, Jos. 20ft December,2004- Mr. Chukwu Okoronkwo, National Onchocerciasis Control Programme' Federal Ministry of Health, Federal Secretariat Phase ll, Room 956, IKOYI _LAGOS. Dear Sir, I am enclosing herewith two copies each of the above reports for Adamawa and Borno States. Thank you and God bless MI W Elisho Agagak Project Officer, Onchocerciasis' ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: Country: National Coordinator Name J J Ir. Signature: Date: .h Date zonaloncho c oordinator Nam ", P.ffL *t.?/.* . . 9.6 &u.. 7€*{c€ Signature .!+ Yq Date: Dg. g:..*C ?f:Tt NGDO Representative Name: t,{../lJt u*. FUA*/; signature, .... //X/frUa.... *:rl: */o'/- This report has been prepared by Name ' !\r.=-f.f.l..lt'ylt t+o^tq DesignatiorN Ct sfrA I r$Arf'rq- Signature S\ o^.A,{"- ' Date 111 WHO/APOC, 24 November 2004 VI DEFINITIONS......... "'VII FOLLOW UP ON TCC RECOMMENDATIONS EXECUTIYE SUMMARY Table of contents SECTION I: BACKGROIIND INFORMA'TION""""" 1.1. GeNeRal-INFoRMATIoN......-...... l.t.I Destiption of the proiect (brieJly) 1.1.2. PartnershiP 1.2. PoPuu.uoN............... SECTION 2: IMPLEMENTATION OF CDTI"""' TrvrpI.tNe oF ACTIVITIES I 2 3 ) 3 5 7 9 92.1. ')) 2.3. 2.4. 2.5. 2.6. 2.6.1 2.6.2 2.6.3 2.6.4 2.6.5, 2.7. 2.8. 2.9. t2ApvocecY MOSlLtZnrtON, SENSITIZATION AND HEALTH EDUCATION OF AT RISK COMMUNITIES l3 CouuuNtrY INVoLvEMENT........ Cepectrv BUILDING.......-.. Treatment figures ....... -... --. What are the causes of absenteeism? What are the reasons for refusals?.-.. serious adverse events (SAEI that...26Brielly describe all btown andverified Trend of treatment achievementfrom CDTIproject inception to the current year 28 OnoeruNc, sroRAGE AND DELIvERY oF IVERMECTIN ..30 CopttvtuNtrY sELF-MoN IToRING AND STAKEHoLDERS MBerrNc ......32 SupeRvlsloN....... JJ 2.9.1. Provide aflow chart of s upervi s io n hi er ar chY - 33 2.9.2. What were the main issues identified during supervision? " 34 34 4.1.1 2.9.3. Was a suPervision checHist used? 2.9.4. What were the outcomes at each level ofCDTI implementation supervision? 3 4 2.9.5. Was feedback given to the person or grouPs suPervised?' 2.9.6. How was thefeedbackused to improve the overall performance of the project? 34 SECTION 3: SUPPORT TO CDTI 3.1. EqutrueNr 3.2. FrNeNCnl CONTRIBUTIONS OF THE PARTNERS AND CoMMLTNITIES"' 3.3. Oruen FoRMS oF coMMUNIT suPPoRT """ 3.4. ExprNPtruRE PER ACTIVITY SECTION 4: SUSTAINABILITY OF CDTI. 4.1. INTTRNEI-; INDEPENDENT PARTICIPATORY Was Monitoring/evaluation carried of the following w hich are applicable) . -. - 34 34 36 36 36 37 MoNIToRINc; EvelunrloN ......... -.. - - - -. - - - 37 out during the reporting period? (tick any 4.1.2. 4.1.3. What were the recommendations? ' How have they been imPlemented? SuSrerNeetLITY OF PROJECTS: PLAN AND SET TARGETS (MANDATORY AT4.2. Yn 3) 1V WHO/APOC, 24 November 2004 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES' AND OPPORTI.]NITIES...... SECTION 6: tjNrQUE FEATURES OF THE PROJECT/OTHER MATTERS.--......-.41 40 v WHO/APOC, 24 November 2004 4.2.1. Planning at all relevant levels"" """""""" 38 4.2.2. Funds -.-.... """""""' 38)o 4.2.3 Transport (replacement and maintenance) "" """"' "" Jo 4.2.4. Other resources """ 38 4.2.5. To what extent has the plan been implemented"""""""' """""""' 38 4.3. INrBcRertoN............ """ 39 4.3.1. hrr*r"rii delivery mechanisms """""""' """""""""' 39 4.3.2. Training*-. """"""" 39 4.3.3. Joint stiptervision and monitoring with other programs "" """"""' 39 4.3.4. Releasi offunds for proiect activities """""""' """""' 39)n 4.3.5. Is CDTI included in the PHC budget? """"""" """""' r' 4.3.6. Describe other health progro**is that are using the CDTI structure and how this was achieved. What have been ihe achieyements?.........-.-. """""""""" 39 4.3.7. Describe others issues considered in the integration of CDTI' ""' 39 4.4. OpenerIoNAL RESEARCH ""'39 4.4.1. Summarize in not more than one half of a poge the operational research undertaken in the proiect areawithin the repirting period. """" 39,o 4.4.2. How wire the results applied in the project? """"""' """""""""" )v Acronyms APOC ATO ATrO CBO CBBI CDD CDTI CSM LGA MOH NGDO HKI NGO NOTF PHC REMO SAE SHM TCC TOT UNICEF UTG wHo African Programme for Onchocerciasis Control Annual Treatment Obj ective Annual Training Obj ective Community-Based Organization Community Based Bamako lnitiative Community-Directed Distributor Community-Directed Treatment with Ivermectin Community Self-Monitoring Local Government Area Ministry of Health Non-Governmental Development Organization Helen Keller Intemational 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 v1 WHO/APOC, 24 November 2004 Definitions (i) Total population: the total population living in meso/hyper-endemic communities *itttin tti project area (based on REMO and census taking). (iD Eligible population: calculated as 84%o of the total population in meso/hyper- endemic communities in the project area' (iii) Annual Treatrnent Objective: (ATO): the estimated number of persons living in meso/hyper-e-rxlemic 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 urnuutly in meso/tryper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage (normally the project should U" "*p""tLO to reach the UTG ut tt " ind of the 3d 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 r**ltryper-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, 3lfusndazole for LF, icreening for cataract, etc.) through CDTI (using the same systems, training, supervision and personnel) in order to maximise cost- effectivener, "nd 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) Sustainabilitv: CDTI activities in an area are sustainable when they continue to fu*tio1 effectively for the foreseeable future, with high heatment ooverage, integrated into the available healthcare seryice, with strong community ownership, using resources mobilised by the community and the govemment. (ix) community self-monitorine (csM): The process by which the community is @ monitor the performance of CDTI (or any community- Uasia health intervention programme), with a view to ensuring that the programme is being executed in the wry intended. It encourages the community to take full ."rponJibility of ivermectin distribution and make appropriate modifications when necessaD/. vlt WHO/APOC, 24 Novembet 2004 FOLLOW UP Oil TGG RECOTTENDATIO]IS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session -15- (Please add more rows if necessary) 1 Number of Recomnendolion in lhe Report TCC RECOMMENDATIONS ACTIONS TA-KEN BY THE PROTECT FOR TCAAPOC MGT USE ONLY 11s(D Increase the number CDDs with particular atention to the male/female ratio The project has noted that and action taken. It will be reflected in the next 11s(ii) Identif, the villages not being reached Yet and achieve 100% geograPhic Communities and villages not reached have been identifred. 1ls(iiD Upscale CSM and introduce SHM. Arrangements are on to upscale CSM and SHM. WHO/APOC, 24 November 2004 Executive Summary/ Prepare an Executive summary of the report in not more than rypage. Adamawa State is located south of Bomo State at the north eastern part of Nigeria and shares intemational border with the republic of Cameroon' The State has a total population 2.14 million people (1991) National Population census (figure), 2l LocalGovernment Areas (LGAs) of which 17 LGAs are Onchocerciasis endemic' The State is multi-ethnic with varied cultures, languages and dialects. Their rural settlements are in large and small satellite groups, which are often than not along socio-cultural, and language lineage. Some of t}re ethni" groups include Higi, Chamba, -Vera, Yandang' ga;a;a, L*goaa Kilba Hausa and FJani, The main occupations of the people are farming, cattle rearing and hading. The distribution of Mectizan corlmenced in 1992 as a pilot project in nine LGAs but later expanded to the 17 LGA. In 1999 a new approach called Community Directed Treatrnent with Ivermectin (CDTI) was developed to -make the community a major partner in th9 implementation oi CDTI. In 2004 a total of 2,537 out of 2,980 communities with a total (cersus) population of 1,193,635 of which 972,122 people were treated' The project's ultimate treatnent goal is l,Ol3,g4l and the ATO for 2004 was 1,013,941' The geographic and teatrnent coverage of 85% and 80-8% respectively was achieved' A total of 2,781cDDs out of a target of 3,315 were trained. Also, 572 out of target of 666 Health Personnel were trained foi prografllme implementation, thus, achieving an annual training objective of 83.8% and95-9Yo respectively' The project has also been faced with some challenges/constraints which include fluctuation in treatment coverage due to refusal of some .o--*ities (especially, chuncha village areas of Koma) to take Mectizan tablets because of reactions; high rate of cDDs attrition; displacement of some communities due to armed banditry. Seasonal community settlements where members move out to neighboring states in search of fertile lands, and cattle rearers (herdsmen) who move from place to place in search of pasture for their cattle are also causes for fluctuation in treatrnent coverage. These challengevconstraints have been systematically addressed fu9"*n intensified community mo-bilization and sensitization to encourage those communities in Koma to take the drug; arrangements also concluded to identifu the displaced communities and treat them' Communities where CDDs have left have been contacted to select new ones for training. For the migrating communities, plans were put in place to track and treat them as soon as they return to their near pennanent locations of residence' 2 WHO/APOC, 24 November 2004 SEGTION {: Background information 11.1. General information 1.1.1 Description of the project (briefiy) - Geographical location, topography, climate Adamswa State, created from the defunct Gongola State in August^1-19,1 is located at the northeastern prn oiNig"iia ana "hei betwe"n lotitrd, f 281 and lf 55' and longitude I1% o and 14 %o East:. Adamowa State has 2l Local Government Council areas (LGAI spread across two notable vegetation zones, the sub-Sudan Sovannah with short grasses and Sparse trees in the northern port and the Guinea Savannah marked with tall grittrt in the southern zone' The State shares international border with the Republic of Cameroon and from the border run three major rivers. Their sources hove given the land undulating landscapl as thc water courses with their tributaries have traversed and turned almost the entire land area into arable place for agricultural activities and suitable breeding sitesfor the Similium Damnosum' There are two seasons, the dry and the rainy secnons. The rainy seoson begins in April and ends in mid october with average rainfall of 759 mm in the northern parts and l0t lmm in the southern part, partiiularly-around Ganye and Toungo LGAs' The wettest months, which tisnrfyihe period of heaviest rainfalls, are Augus-t and September. The dry season starti from the yd of-October to April, with the driest minths beingJaniary and Februnrywhen humidity is as low as 13%o' - Population: activities, cultures, language The state is multi-ethnic with varied cultures, languages and dialect groups with a population of 2.14 million people (1991 National Population Census figures). Their rural settlements are in large and smill satellrte groups, it itn ore often tian not olong socio-cultural' and language lineage. Some o7 the- ethnic groups tnclude Higi, Chamba' Yera' Yandang' Bachama, Lunguda, Ktlba, Hausa and Filani. rn, main occupations of the people are farming, cattle rearing and trading' - Communication systems (roads" ') Hausa andfalfulde are widely spoften, however, English has been adopted as the official medium of communication. other forms of communication, include fairly good road networkfrom the state headquarters to most LGA headquarters- Most of the communiti^ L* hard to reach due to bad terrain, rivers or rocl<s' The only means to reach such areas is either by boat, bicycle or foot. Even 4 wheel drive vehicles can not reach them, especially during the rainy season' - Administrationstructure There are three levels of administrative structure in the project state. These^include the state' LGA and community. ihe Executive Governor is the Chief Administratiue Oficer of the state' There are three arms of government that run the state affairs with the Executive Governor as the head. These are Executive, Legislative and the Judiciary. J WHO/APOC, 24 November 2004 At the LGA level, there are two arms of government, i'e' the Executive and Legislative who run the affairs at this level with the fxeiuive Chairman as the Chief Executive Offcer' The community level comprise the district, villages and/or wards' The Lawans (Hakimis) ore'the heads, while the Jauros or Mit Angwas are the leaders at the communities or village s -Healthsystem&healthcaredelivery@rovldethenumberofhealthposts/centersin the project area if the information is available)' Health care is delivered at two level in the project state, i-e. the state attd LGAs' The state provides secondary care where there are tie General Hospitals an!-Comprehensive health centers. The locsl level has the primary health centers, c-linics, and dispensaries' There are 179 health Districts; 882 health irntrri/dinics and o total of 2,208 staff:. onchocerciasis is prevalent in 17 out of the 2t LGAs in the state- There are nine hyper- endemic LGAs and eight Meso endemic-LGAs. In some of the Meso-endemic LGAs only few heovyfoci have been noticed' The number of communities receiving Mectizon since the commencement of CDTI implementation are 2,537 as against 139, who were under treatment before APOC support' 4 WHO/APOC, 24 Novembet 2OO4 Number of health staffin project area and number of health staffinvolved in GDTI activities. Table 1: Number of health staff involved in CDTI (Please add more rows if necessary) DistricULGA Number of health staff involved in CDTI ectivities' Total Number of health steff in the cntirc project arel Numbcr of hcalth Percentege steffinvolvcd in CDTI Madagali 129 2t l6 Michika 123 28 22 Maiha r95 27 13 Hong 230 46 20 Gombi l6l 44 27 Song 120 37 30 Girei 67 2t 3l Yola South r56 l9 t2 Fuforc tt2 20 17.8 Demsa 152 25 t6 Lamurde 88 25 28 Guyuk r98 40 20 Mayo Belwa 142 29 20 Toungo 42 23 54.7 Ganye l15 28 24 Jada 140 36 25.7 Shelleng 38 24 63 Mubi North 129 t4 10.8 Mubi South ll0 l3 I 1.8 Total 2,447 520 2l 1.1.2. PartnershiP - Indicate the partners involved in project implementation at all levels [MoH, NGDOs (national/intimational), communities, local organizations, etc.l The partners involved in project implementation include: the endemic communities; LGi Heolth Departmeni (iOCfttN"trition fficers); Community Based Bamako Initiative Committees GBhD; State Onchocerciasis Control Unit and; Helen Keller Internntionnl. Describe overall working relationship among partners, clearly indicating specific areas of project activities (planning, supervision, advocacy, planning, mobilization' etc) where all partners are involved. 5 WHO/APOC, 24 November 2004 (1) Communities: The community members are involved in mobilization of themselves for Mectizan uptake; selection of the distributors; collection' storage' safe keeping and distribution of Mectizan; monitoring and supervision of the mectizan distribution' (2) At the LGA level, the LoCTs and Nutrition offcers are involved in the planning of activities in collaboration with the state team, mobtlization of endemic communities; training of community distributors; collection of Mectizan and vitamin A from the state and delivery at the collection points; provision of storage facilities and storage of Mectizan (vitamin A; monitoring and'sipervisio, i7 tt t distribution; and collection of treatment rePorts. (3) The state onchocerciasis control Team draw up plan of activities to be corried out in collaborotion with the LGA teams and NGDO partner (HKI); conducts the ToT training for the LGA fficials; carry out advocacy visiis to the endemic LGAs to solicit the LGA Executives support to the proiect; colleition of Mectizan/Yitamin A from the NGDO for the endemic LGAs; Monitoring and supervision; collection and analysis of treatment reports, provision of the necessary data io the NGDOfor re'application of Mectizan' (4) The NGDO provides technical assistance by training of state team as trainers; re- application of Mectizan for the project; higi advocacy visit to the s-tate MOH fficials and LGA Executives. Advocacy visits to paramount community leaders' CBOs and influentialcommunitymemberstosolicittheirsupport. )BBI Committees are an organized community Development organimtion involved in self hetp programmes. This could be in the area of health, agriculture and other social sctivities. In the areo of health, they do raise funds t9 run clinics such as drug revolving. part of their activities incluie mobilizotion of community membe-r1 for Mectizan uptal<e, entertainment of CDDs during training, collection of N20 per household iurtng Mectizan distribution to support the cDDs. - State plans, if any, to mobilize the state/region/district/LGA decision-makers, NGDos,NGOs,CBos,toassistinCDTIimplementation. - The pioi"i, intensified advocacy visits to the LGA Executives, especially now that nei ifficrals have been elecied into ffice, to solicit their support for the programme- - The support from the State has been appreciable in-terms of provision of prrror,ii"l, logistics and funds. There is need to continue with advocacy visits in -order to sustain the good working relationship' - The CBBI committees need to intensifu their efforts in mobilizing the community members for mectizan uPtake' 6 WHO/APOC, 24 November 2004 J aN I ! oE E -Dt, o = ta IB l(a Ito oo Ed d o u) FI o. 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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, 24 November 2OO4 -lo z o o U o ED rflt- U rrj U) 4cFrl oFfrl o - (r) oC -l o F rr, (r) o z. o o o ED Eoz o J< oE X 3 U o E Q rt () F o T EJ I F.l il 'J F] E i 'J = E z os -o!D 5; sE' AF5E DNtrEE9. (DP Ph^ Hf = i F.l ! T i H F{ i F.l T E = Frl rf, Ed os oo =e3g o I El E = = Fl l-.,1 HH = = El tJ ,fl EI ID o5 -oEE =.ieE' El t-l T tJ E El E FI = t-.1 I Frl lrl @ os ooBE9gi+(D o Et FJ I Fl F.t F.l Fl r-1 = T Fl = = v o5 =9EP5.i LiE oo Ea EIOt\le IE'lcl,IB l.' E Fl I rJ = rJ = i El FJ H = E Fo5 oo3E9to ;(D o F..l I tJ Fl r-.l = I l-l I Fl I i F.l FU v t- os a95e5.i eE' Ftt 0q E r, lFl tdIE lo I' FI I El = i El T E HH 'J I Fl El o5 oo ro (! oll o a = H t-l El E = Fl = F.l T F.l l-1 E Fd v -o5 -a =p5* sE' atE(D{ o lo lP = = Fl = = t-.1 = tsJ EJ = T = Fl 3 o5 oo3EOFr1F o l-l lD)td l(Dl- ; a)(D (D o F+) s)() d (D U) o'Ft (D B(D FD V) Ft(D o) (DE + (D otFtFt(D (D s)Ft e(\ r-a G s N o\(\\o Va G c)(\ Ua U) +s- O o FU "r)tJ5 zo (D croI N)oos Fl a F ED v) oc .l E TD z oFFl FL (/) IE rr,t-r rnzo oC CX t- CF U frl o z rrj = El El tsl F.l I t-.1 F.l t-l F.l i F.l 'J 'J I 'J T E FtH El ! = F] n = I = = I = I H = E I i El El F.l I = lJ I = = ! i E H = Fl E = = I H t-.1 = E I o o) p (D 5 (r) FU _o N)5 z o (D 3 d(Dt N) 5 2.2. AdvocacY State the number of policy/decision makers mobilized at each relevant level during the current V"*,fr" reason(s) for uniertaking the advocacy and the outcome. Describe iiffrcutties/constraints being faced and suggestions on how to improve advocacy' The number of poticy/decision makers mobilized at relevant level during the current year are as follows: state Level: Advocacy meeting with four (4) senior government officials in MoH o Hon. Commissioner for Health o Permanent Secretary, MOH o Director, Disease control and Public Health services o Director, PHC, Local Government and chieftaincy Affairs. Reason: To maintain the goodworking relationshtp with the state MOH decision makers and ensure continuous material, logistics andfinancial support. Outcomc: The state has continued to release her counterpart financial contribution. LGA Level: Advocacy meeting with four (4) LGA top officials on the need to support the programme by the State Co-ordinator and HKI representatives for every LGA. Those met include: o Clnirman o Councilorfor Health o PHC Director o DeputY PHC Directors Reason: The support by some LGAs hwe beenvery minimal, thus, the need to continue to vfsii ind encourage them to step up their financial support to the programme. Outcome: The LGAs have responded by making some financial contribution towards the programme in thi areas offueling and repairs of motorcycles usedfor supervision. Communitv Level: The followings were visited at the community level: o CommunitY Leaders : 3!;i;:::';::;;, o Development Association leaders Reasons: o To embrace the programme , (take ownership of the programme). o Encourage them to support the CDDs o provide storage and safety of Mectizan toblets and Vitamin A capsules. o To monitor and supervise the distributors. t2 WHO/APOC, 24 November 2OO4 Difficulties/constraints in carmins out the Advocqcv:- ^ . Mostofthedi6,ult-i,,ond*nstraintsoT,,'unottlntGAandCommunttyLevels.Whilethe LGA Executives will promise to support the project througlt the release offunds for fueling' maintenance of motircycles, and iome alloiances to LOCTs when contacted during advocacy visits, but di not always honour their pledget, O! the other hand some of the ,o**uiity leaders hnve the ferilng, that the prijects should provide poyment or incentives to CDDs. Outcome: o About 70%o of the communities have accepted the programme and are givingsome"tokentotheCDDsasasignofappreciationoftheir commitment tow ards the distribution' o The CBBI committees in some LGAs do provide refreshment to the CDDs during training- o Some CDDs iere providedwith measuring sticks by their communities' How to Imorove on Advocacv: . ffiisiting the LGA Executives, advocacy workshops hove been oilanired to enlr{hten them on the grovity of the problems in their areas and solicit for suPPort' o The communities arefully informed of partnership in GDTI and are encouraged to contiiue with community self-monitoring ond support to their CDDs that theY hove started' 2.3. ilobilization, sen3itization and healllr educati'on of at risk communities Provide information on: The use of media and/or other local systems to disseminate information o Radio jingles and W spots aiout the disease and needfor control were done- periodicallY. o Town criers were used to disseminate information and to call community gatherings where the members were neittn educoted about the disease and need for treatment- o Announcements are done in the churches, mosques, during community associations or cooperative societies me etings' o Use of healthworkers, and CDDs to health educate community members' Mobilization and health education of communities including women and minorities In areas where there were womenfellowship groups, they are mobilized' but where there are none, they were mobilizedwith other community members or development associations Response of target communities/villages oCommunitymembersaresupportingtheirCDDsthroughtolren contribution of N20 by each household' l3 WHO/APOC, 24 November 2004 Treatment coverage have imProved. Entertainment of the CDDs by some communities duringtraining. Accomplishments o Mobilization and health education of 2,537 endemic communities. o Treatment of 964,960 community members oorganizationofstalreholdersmeetingwhereLGAPHC C o o r dinat o r s / b eput i e s, LOCT Le ader s, Nutr it i on Ofi c er s at t e nde d. Suggest ways to improve mobilization and sensitization of the target communities. o Encourage PHC staff at community level to visit their community members more frequentlY- o More advocacy visits to the LGA executives by the state team to solicit their support to the Programme. o Community to be encouraged to conduct community self monitoring regularly' o a t4 WHO/APOC, 24 November 2004 15 l-l NBL15- . l-s "^oq)o(JTTSE3EE)- H-.' ) IJ. IE€ -P= 9.O -e.o83 ='oe=Fr)o o U -l --. "'\J(\ (\ s$ \(\ d a(.) \ (\ a(\ a4q s \!j o\ o FU _C) I.J5 z o (D 5CoB N)oo(, z oE X z H o t. oo7 ED ? Lt. a oe -l F rn aozo t. z FU rn t!,? v) rrj 4oF Fr, -loe 2. 7 o ED lnt. oe X -,=i E 33 3 rc13.=; ='Fe!coi; @ @ l.J 5 55 o\ (,)o\ -J o {o\ o\@ N)p@ o\\o Ut Eii?;Bq+ nZOE iEr =o =.o<<a EO c=' EI 3C,,E(D= B8 a< EFi.a o< a-+ o\ Fg G O D 0eo EE I* o t-,\o N) ir\ !.,5:Ja tJ ).l5 tpi@ {ir.l @iro l-)5 53 !D 2. o D)o.(Do D o z l0 6 o UU z, o opu39rcoc rl o D z 5o o ol, AE ==5o .D o o NJ5 N)(,{ NJo\UJo\ 5o --t 6\o5 o\ o\{5 a \o@ \o@ z, o D)o.o -o D o <82 erE? * t'g 3.2 D= ao =l8r{r EA ;19 ts36-E ,-r =.xs. E8 a l! IE il oo E6 - (D D oeO Ho D 7 ED U) o -l z c @ 2, oF *l aE tnr.t. fr1z o U o z rn J.J\o €o -T NJ N) l.J\o -J @ @ t,, @ F\o b\ t,{ N) -l -T i.) o o o\ o o no o o>5T 5>f E E Fq frH A 9 () r Y 'H.4J.UAa'9 i'T E EvrPa=o)iJC ^ th;i. l-()Ele9"r3 ti? E': trUil+o"9'!" g5.g B F.e rE I a)-c)FFI a8fHgi'. 3 X'o -,-9 ts E +EiEobiriP P dH ^H.AVU 'O d-ti Do r+)Ftl^.Ft-B3 Ar(Do-tlo ilFtD)O))dH *B.9a6 I E - I +U qE. *i u a.?5.' $ nI 5'F$ Es(agE ts_;x Eg .?@o D)5 B8'{ EiEd' its =' 6En g|.a 5b+ EU(DiJ aH'EqqT .JP (D (D 9. E 0a(r) { 9(D I o U -l H.(n v)t(D(r) SDFl o d 9.) oa * U)()tU) U)(D (n F)+ d(D PA A))o _(D OOF-i S vs?\ G5s o\ X(\\= ^OQdts'sssu. =.' ot S.* q(\ ,(\ *. Qs(\O -O. =Ei:a N' N'oa(\?Ae\o \(t OQS \\G;\'Ebs\ooo :FSr'S sq'(\(\ Gh ^s EJua*%R <'s d= (\S(\ ut d.o(\\<{. (\g\ oo SORS \N GGJ (\ a r-) \ h (\ %(\ ,o A (\ \t o FU _o N)s z o (D d(! N)o 5 2.5. GapaciQr building - Describe the adequacy of available knowledgeable manpower at all levels' There is avaibf,k btowledgeable manpower at the State level. However, at the LGA and community levels, there are available manpower but not all are trained in CDTI implementatiin. There is need to train more Front Line Health Facilities staffand more CDDs. - 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 meosures were talren to ensure adequate CDTI implementationwhere not enough lvtowledgeable manpower was available or if itaff are frequintly transferred during the course of the campaign). The Project hwe not experience ony cases offrequent transfer of trained staff- 18 WHO/APOC, 24 November 2OO3 IH lD)td laDl* ;Ft DD 0a D) (D G H*(D'Ft(D iJ (D (D U) o+, oU -l E @ 5 @ F) o e(\ !(\ a$ S\(\\o a V1 (\ aG aA aa u U O tt F o o z lrl tl o z o o rr) E rrlt-t-frlz o o ED fElt- U U rrlz(, t- C7 U rn oq CX o F rn Frlq Frl oFlrl ot- (, oCa E o o td (, oz oorl X E '!o z oU o E II o 5 tJl\) 5 st.J 5 (])tJ UJ N)5 55 5 55 z 6(Drt o -EJiq (Drti* F o o O E !B 5 5 !.J \r' o I 'lo l0 s- h.J N) 5 s s 5 N) N 5 5 u) UJ N.) t.) (, u) t.) N.J 5 5 5 5 5 5 5 5 5 s 5 tJOt -l o tJq (l) t)o\(J)o\ 5tJ b.Jo\tJ5 l..J(, Nlrro (,)l..J NtJtJoo (.)N) l..J@ o\ tJo NJo h .G o il FJ o E z z tr 5oFt o o D = Op * .tp t,D EI, \o tJ5 N)5 (I (.) (JJ -l tJ(]) tJ(r)tJo [..)o u)o\ NJo (^) o\ tJ t\) @ o\ o\ o\ { o\ \o t.J NJ b.Jt') N.Jo ;\o UJ\o (l) N.J o\ u NJ o\ @ 6 { o\ N) u) l.JtJ tJ l.J N.J tJ o\ 5 s 5 tJ o\ , z ;i .D !i 't 8;'O4 -rErt Y ,.rHEo. ='o d o o lt o h + .l o E G- @ o o t'J (,| 5 UT o\o\o \o@ \o@ o Ot \o @ N.)5(/)5O { Ao(,)o\\o N.Ju) -l I.J5 o\ z GFl o o U U(, D (D -ls -I5 \ o G- :'o llt o o (,) (J) (,) u) (]) (,l (,) o. o\ L'I s (s^ \o@ \o @ \o @ \o @o\ o\ o\ o\ o\ o\ N)5(]) N)s(, @\o @\o -J -l 5o 5o N) o\ tJ) b.J o\()) -u){ N)(J) -J \o FL o FU o _o N)5 z o (D d(D N)oO(,) tJ s .) I p + o o + o o o + o: \oo\ a (D (! .! o Fl oFt F C Ed (A oC H C t0 z, oF -l 'Jr o\ t'J ()) o\ o\ ----l NI h.) (r) (}) s a 6 (D E (D -I\o -t Ur(np o o NJ -.r bJ(,(, 55 o o O o s .) (D (! =o oo \o \o \o -oo\ a ('D (! (.D O5 tn (, hJo(, tJ(^ o hJ{tt }.) 5(, lbr t----- IPl-tlo l." t)(n NJ o -----l ;l L'Io * z =- b \ o a n- o o a d o $ B o rc N)O Fd o _o N)s zo (D d(DI tJ 5 Trainees Type of training CDDs Other Community members e.g Community supervisors Health Workers (frontline health facilities) MOH staffor Other Political Leaders Others(speciff) Program management II How to conduct Health education II rI II fI rI Management of SAEs II CSM II II fI n fI SHM II rI II rI Data collection II II II Data analysis II Report writing II Others (specifo) Table 6: Type of training undertaken (Iick the boxei where specific training was carried out during the reporting period) Any other comments 2.6. Treatments 2.6.1. Treatment figures The project was able to treat 964,960 people out of ATO of 1,013,941 with 2,516,027 Meitizan tablets. There was also clinic based treatment where 7,162 people were treated with 17,108 Mectizan tablets. Thus, a total number of 972,122 people were treatedwith 2, 5 3 3, 1 i 5 Mectizan tablets. - If the project is not achieving lO0% geographical coverage and a minimum of 65%o therapeuiic coverage or the coverage rate is fluctuating, state the reasons and the plans being made to remedY this. The coverage rate is fluctuating because of some of these reasons: o Few communities in Hong LGA were disploced due to activities of armed banditry. These communities had to move to other communities in search of protection and safety of their lives and properties. 2l wHo/APoC, 24 November2oo3 a Some CDDs have gained employnent and have left the communities. This has resulted in the inability of the remaining CDDs to cover the entire communities. Plans to remedy the situation: o The members of the displaced communities have been locoted in the other c o mmuni t i e s and r e gi s t e r e d for Me c t iz an up t ake' communities hsve been contacted to increase the number of cDDs to replace those who hove leit. 2.7.2 What are the causes of absenteeism? Some of the causes for absenteeism are as follows: There are seosonal community settlements which members do migrate to neighboring states in search of fertile lands for ilry seasonfarming and at the end of harvests they do return back before the commencement of Mectizan treatment. Another category of people that migrate are the cattle rearers (herdsmen) who movefiom place to place in search of good grass for their cattle Remedv: @oir"t hos concluded arrangements to be tracking these categories of people and a*iiOite the drugs to them. Mectizan and Vitamin A would always be made ovailable to them as Soon as they are around whether treatment hsve commenced or not. a 22 WHO/APOC, 24 November 2004 l-l lD)td laD l-r ;Ft(D D) 3(D p A(A rnt, d o- t) tst o t- o F) A)Ho D)U' D) d ,_t U)F e Gs4(\ a * o\(\\o s a4 GaG U1 U)$ a: U lil z rn -lo zoo EDZ !:t > r5 oC x - z eFU rn ln?(r) 4l o 41 eFE u)1 8Pi> o Fln a 2. o o o7 ID ozo 3 o X o t- -u5a >B' tJ\o -a @ a u) t\)o @ o o\\o o\ o\@ i.J o\{ o -J @\o NJo5 55o\ ,fsEa e HE *[* I o o tst (D U) = FD oa(D v) N)\o --t @@ o l.JO@ orr, o\\o o\ o\6 NJ o\-J o --t @\o i.Jo5 s5 o\ Sdr9tsE ='s ELo* U N) o\ 5o\ o\o o\@ \oo o\ o\ o\@ t-J o\{ 5o -J @\o NJos N)-I t)o\ o9z +(5c o =5 3AIDtrCT sE +it:i U @ 90 \o :J6 @ bo @ \ @-I \o oo oo Oo oo \o oo o o €i o oQ ^:qesE-dvF):a rcPo6' E:. t il* o o\ oo --t6 o\FN) o\ _@ o\ o\&i, o\t\) o\o -o l.Jo -J -@ \o5 {{ 5 "ro 5 @ 5 5 "9 @o\ -t9 -J@ @ o\\o @ -Jn @\oo o\P o\ tJ 5 \o -J5 -\o -to -l9n S o.6 F)o6^3e:i:6'g 9!BE'iA) r' =' U I N) 6{ tJ{ -o\tJO ;-I N) -Jo -@o\{ @ 5 ;.J o\o P{ -J5tJ @co-J ;.I o\ o\ 5 -r9 t) o\ -t9 N)6 -{F5\o 5)oO@ o\ s o\5 \o /^r *l *s fo5= ='a 89(D14 t -Jo 5 -6655 -\o 5 -.1 Ft\)\o\o J\.) @ o\P6@ o\ 5 \o o\ Fa{ -O5o\ \ \o @ o { s @ o\J'@t,o 5 ;l o\ -ThJ @ \o55 o\o -.1 z a'6 teE3 A; gt @9 -J @:J6 -I\o @@ -_l :{ @ @ @ -Ii -J @ @\ @ -J @tJ @ -J 90 o\ @ ao @ -lofoo SE€vA, Ooac(D g'. o U I N)@ *J N) \o@ tf)oo\ \o5 h.) \o \o a5 -l *E*E*1r -g o\ @6 o N) 5\o N)\o\o5 \o6 N)a o o\\o O 5 o\ UJ t\) \o t) -lo\o o o\ o5 5 o\55 pZ dcE3 6q9o z, o :]o od C"Eh* 2, oi,o E i3 z EsiarH?ETE:i N)U) Eo FU "r) hJ5 z o (D d(D I.J 5 Fl orl t'. (n?o= t1 tDEE z?OFEE FIH a t!,r -frjzo h) \o @o -t tJ ot) b.) \oao -J N) t) }J (,l(, -t -J l.J { -l Ot, oo oo -Iu \o UTtr -I(, h) "9o5 o\ -6 o\o 5 -I o(, \o5 t\)PO o 5 o ;.Jo\@@ \o o\5 \o o\o NJ 19 @ 5 00 -s tJ 6ob @I -I o\ o\ @ --r t)5tr (, t\) i.J\o \o\o 5 .J oFtp 'o(D \o= vC) o o oEt F) 0q(D r-t A) (D ooo 0aFt F) '.ci :t9a'p) o o oFi F' oao -t o)a(D rl o o o -<x9va) oq(D ,.t O) (D o\ -lo o,() o (DE il - lrO "O IR J- l8\o los -x oo \o L'T -oo\ \ !S I s G G s GF. :i+G .o !Go! G Oa s(! a .ti EG]G E.G 6 S GF sE E a ! .6(\6 Gs * GE t F dIsG(: Oa G \< GEI il 4tz.9lEsl* '6 lo €l;C l+) ts18 =. log lc,al- -l(Ds.h5 lD) oa 16 =. la-llxil-olo8ro 16 or-t a(D 0-(D o oo 3 =, o U){ o EF.l €.(D o F]r.t(D F) rl* EE5 lo (/''eP x EIUdl3 =*, lB3ls(D l=.a16 e 16'tle- l< l<. a lii r' tio(Dttl :Jl(, 6aH 3 -{ loo o\ ='16tq8lx El=ila iJ 5' v) F)a o-o 9.+ (D o- d F trj? o +o €Ft9.oo F)Ho FD J., P" 'o lS@ l-IO x oo @(-,r -o o\ >lz,5Itr ak' -r l: e lY', F) td9l()3lo(D tc, =l(D .Y IE slE <lxol-lolo - lrOblR ur lro E13 X OO 4lzolc stE -tdpl(DCIr3lod l+,(D lc,rl(D sl3 '6 laD(al- olH E.IEo166lo cr lx(Dl- *loAIO A) o o. 5 ts(D o o :( (D Ito E o-o () teE(D s)a 3. ='3 (D 'ot €.o C) F)to F9 e -lo \o(,r -o o\ t.)5 o "c) 1...)s z. o (D C'ot t..)o 5 illl il =\StsEr €= tGEt!F s-I3S{s +=StsRIga rt Q. '11 r'XG RgEG sts\sGR R++Fs* GF!\= Bx S6 SSG;s SN\{ ,s=i:sl.i:G:l Es ^-GHB -si\*s*t\=\s .SGx\ e*. 6 S GF S F = s sG GS6l. GF. EsG: ! G\ €.G(\ !rE Gs(: +GE. OOt\S OO Es 6 E (} s G E OAt! tJ(.,1 o FFU o _o tJs z o o tsd(D - N.) 5 2.6.2 What are the causes of absenteeism? Some of the causes for absenteeism are as follows: i. There ore seasonal community settlements. The members do migrote from neighouring states in search offertile lands, for dry seasonfarming and at the end of harvests they do migrate back before the commencement of treatment' ii. Another category of people that migrate are the cattle rearers fterdsmen) who movefrom ploce to place in search of good grass for their cattle Remcdv: fn proirct hns concluded orrangements to be tracking these categories of people and distribute the drugs to them' Mectizan qnd Vitamin A will alwoys be made available to them as soon as they are aroundwhether treatment hsve commenced or not. 2.6.3 What are the reasons for refusals? There are insinuations in some communities that Mectizan tablets arefor family ptanning, thus, their reasons for refusals-'Somi other people do refuse due to reactions associated with taking the tablets. 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. No serious adverse events (SAEI hsve been identified sofar in the proiect. * In case the project did not have any cases of serious adverse events (SAE) during this reporting period, please tick in the box. (i) (i, No SAE case to rePort x 26 WHO/APOC, 24 November 2004 U) 2 * oqo v)(D X o1l-: d,o =F.N =(h(! o # FH rN5r so@H:UVE iB a E(DH E-=g5 (/) id o()a \ ?sq3E 5'5bBS_ Fi.d6 6 - + A) b \ \ PTB.P:l.p 5:i ===.(Dq E.g o E' r\ \ > f\ E}+gUbOi2F) -5 5 (D5:v 6'o -ss'' * i* Itr zAFrJ i'aE5E .t.^ = -dq5s B(D @ o EO SEtg a.o o F{) ooEi EgH =! 3@ c) i:r EE=i' HEE I 5'> e a5 ^69 =3-(D l-l ls)td l6-le ; D) U)(D U) o H) U)oFt ota F0E (DFt U)(D (D (D U) a tn U) 3) D' o()()tEFl(D o- o-tH E 0a d o Ft oEo = 0a E(DH oo e(\ s4(\ :.),- N. o G\o a4 (\ c)(\ u, t-2 s \J zo !t A- G a U) * 14(\\ (\\ \ (! N){ t= o _o N5 z o (D d(Dt t..J 5 l-l ls l(Dl.o !', o\ =r irr6p- * Ft-5(D(DE'EO FD HIEl6iL;8E E6F)EOa -;oD tdtil'< E l.)(D l5slO. iDlHlkr+(DFtD)O q'o *U iDE I TDEE .; El d?' -ttr-t (!() a(! -; rop9. F!O8E' .+ oEFG-(DBee=EidE ,S. i+ s.dE-E (!s G\ E.E e- FE Gp ar)(D uo .)D (D I(D Fl o 6"Et (D EFt o (Dtt (r) (D a =toa Et (D p ar) o o(D o E Ep oFt E H o(i o (D El D oq(D() D t!t tr oItO N)@ u ,rl o FU o "c)tJs 2, o (D d(D f.Jo 5 N)oO\o b.J o @ NJOo -J Noo o\ tJOo b.J o5 NJoo u) NJoo N) tJ o tJooo \o\o\o \o\o 6 \o\o -J lrl F -N\o @o -t9@ o -19@(Ilo J') 01oo -N( o^5 N -o l-llo oo oi *B o E ar o --5 f -ot7+X'+ HE B'3qB,' =g) oa oo =5Fp (D0 : D) oa(D @ b.J \o ooo tJ -t -I tJ @oo N) s -Nuo5 -NoOo -1 -l6d PE.P, =o5=?'s g o14 E' J')(r (j)\) tJ "tJ 6N -b.J{(rr -l -r9 o5 J')(Io5 @ o\ UJ OaaOz.c>tsEg =3 a6# E E*3 aoiD r+) F' @ @o \oo\ \oo\ o \o(,) EoOr-oa{fr8$ sE =da'd -oit 6 \o(,) bo \o o\ oo oo \ou) o a{ }\oo J -#ao F' e_ E lr, "* it a \ot, (,l -l9t t) o\(,\o "o u)PN s \oUrI Or N) \o(,\o sUr(l -l(l)P 6 oo 9s Eb"q E -F,:ifBB Eq 5 -6:lBrY., o UJ \o5 \o o "o oo 6L'IPooo \o o\ u {@ Or ,_! -l .ss 5gaE ='@ pc= ta, JJ6 O\ ='N=.va) Y\oao, .D5 rr "ro ., o\o @\o u)o o\ @(r) o\N)(r -l{Oi 6 (]) \t b.J o\ (, o\ b. 9l €9 .,'a7ie@-6 glo .iBpo6*,a tr, 6 {\o @o 6 -Jb. -t-J -lo=oir 6EDrooatro g'. o \oo\ F' a_ Er !t,tit o6 \o(JI \o(, bo \o @ @5\ \oN I oo- ^< 9\o (D ;.1e# cj o F' 5rF ,1 llt \o 6\o 6(, ii { -Ib\ {tJ 'o\ 9o\ oOa ds B oa(D N.Jo o I tJ\o FU o "c) h..)s zo (D d E b.J os 2.7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - Qtlease tick the appropriate answer) MOH tr WHOE UNICEFtr Other (please speciff): -SOCT THROUGH NGDO TO NOCP Mectizan@ delivered by - Qtlease tick the appropriate answer) MOH tr WHO tr UNICEF tr Other (please speciff): TO NGDO, THEN TO SOCT NGDOtr NGDO tr Please describe how Mectizan@ is ordered and how it gets to the communities Ordering of Mectizan begins from the community where after community registration, (census) have been conducted and number of eligible people obtatned. These are sent througit the LGAs and the state to the NGDO (HK\. HKI then used those information to opptyTo, the Mectizan. Where distribution has been going on the information is obtained ioi in, ffeatment reportsfrom the community summaryforms. On the other hand, when - Mectizan reaches the port of entry, HKI will collect it to her store. The state now collects from HKI and later distribute to the various LGAs who deliver it to the designated PHC centers which are collection points for the CDDs to collect for distribution. Inventory process was maintained at every level of the drug transfer- Table 10: Mectizan@ Inventory (Please add more rows if necessary) 30 WHO/APOC, 24 November 2004 Number of tablets RemainingExpiredLOSt WastedUsedRequested Received State/District/ LGA 8,659I 500169,341 500190,000MADAGALI 180,000 12,l16800317,084330,000330,000MICHIKA 8,500545145,000 135,955145,000MAIHA 3,166176,834180,000 180,000HONG 2,000741157,259160,000 160,000GOMBI 13,002101,998I 15,000I 15,000SONG 38,s0085100,000 61,415100,000GIREI 5,0002034,98040,000 40,000YOLA SOUTH 9,54090,458 2100,000FUFORE 100,000 20,150t7129,000 108,833DEMSA t29,OOO 4,10025135,000 130,875135,000GUYUK 740l5145,953146,708 t46,708LAMURDE 4007789,52390,000 90,000SHELLENG 2,0001000I 5 1,852 148155,000MAYO BELWA 155,000 3,30083270,OOO 266,617JADA 270,000 39,146970150,000 109,884150,000GANYE 21',l87,000 86,78387,000TOIjNGO 12,0005231r7,47',1130,000 r30,000MUBI NORTH 37,0009662,9M100,000 100,000MUBI SOUTH 1 7,1 08 17,108ONCHO. OFFICE 17,108 219,319 6,6942,533,133 6702,759,816 2,759,816TOTAL How are the remaining ivermectin tablets collected and where are they kept? The remaining lvermecttn tablets are collected during retrieval of treatment reports and are lrept at the state Onchocerciasis ffice store. List and briefly describe the activities under ivermectin delivery that are being carried out by health care personnel in the project area. Health care personnel are involved in the following activities: Collection of the required Mectizan/Vitamin A Capsulesfrom the state. Delivery of Mectizan/Vitamin A to the designated PHC centers which are collection points. Provision of storage for safe lreeping of lvermectin/Vitamin A. Maintain proper inventory for them. Collectton of treatment reports and left over tablets/capsules and return to the state. Any other comments 31 WHO/APOC, 24 November 2004 2.8. Gommunitlr selfrmonitoring and Stakeholders teeting Has any training (of trainers) for community self-monitoring been done in the project area? ' Tr aintng for C ommunity Self-monitor ing w as c onduct e d in s ome communitie s - If so, When? During 2003 treatment Year- Table l l: Community self-monitoring and Stakeholders Meeting (Add rows if needed) 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. o Communities where CSM hwe been carried out, oppreciated the programme andfeel sense of belonging and are participotingfully in monitoring and supervision of activities caruied ouL Treatment coverage has improved over the previous years. DistricU LGA Total # of communities/villages in the entire project area No of Communities that carried out self monitoring (CSNI) No of Communities that conducted stakeholders meeting (SEnf) TOUNGO GANYE JADA 130 183 297 5 5 5 M/BELWA 208 5 DEMSA 6l 5 GUYUK 103 5 SHELLENG 102 5 YOLA S. 25 5 FUFORE 68 5 GIREI 67 5 SONG 150 5 GOMBI I 7 I 5 HONG 189 5 MAIHA 204 5 MICHIKA 446 5 LAMURDE 69 5 MADAGALI 3ll 5 MUBI NORTH r25 MUBI SOUTH 7T TOTAL 2,980 85 a 32 WHO/APOC, 24 November 2OO4 2.9. Supervision 2.9.1. Provide a flow chart of supervision hierarchy' NGDOA{OCP sTArE (SOCTS) LGA (LOCTS) DISTRICT SUPERVISORS CLINICS i/c COLLECTION POINTS COMMUNTTIES/ CDDs 2.9.2. What were the main issues identified during supervision? - Inadequate logistics to the LOCTs for effective supervision at the community level - Unwiliingnesi to take Mectizan by fe* community members claiming that it is for fomily planning (or birth control). - Needfor more CDDs to reduce the burden of work on some CDDs' - Non provision of allowances for LOCTs and other health workers iwolved in CDTI activities by the LGA executives. - Poor record keeping in some of the healthfacilities and LGAs- - Lack support to the CDDs by some communities- I I 33 WHO/APOC, 24 November 2004 2.9.3. Was a superuision checklist used? Some supervisors used the Supervisory Checklist' 2.g.4. What were the outcomes at each level of CDTI implementation superuision? - Logistics support was solicitedfor the LOCTs from LGA executives- -Assurance was given to the community members that Mectizan is not for birth control -Communities with no orfew CDDs were requested to select morefor training' 2.g.5. was feedback given to the person or groups supervised? Feedbackwas given to the supervised and necessary corrections and action taken to put in place what was deficient- 2.9.6. How was the feedback used to improve the overall performance of the project? - So*e LGA Fxecutives saw the need to support their staffwith logistics during supervision. - As communities were enlightened about the dffirence between the ffict of Mectizan toblets andfamily planning pills, more members are motivated and willing to take the drug- - More CDDs were selected and trained- SEGTIOII 3: SuPPort to GDTI 3.{, Equipment Table 12: Status of equipment (Please add more rows if necessary) *Condition of the equipment (F:Functional, CNFR{urrently non-functional but repairable, Source Type of equipment APOC MOH DISTRICT/ LGA NGDO Others No. Condition No. Condition No. Condition No. Colrdition No. Condition l. Vehicle 2 F 4 F 2 F 2. Motor cycle(s) 9 F 3. Computer(s) I F 4 F 4. Printe(s) I F 5. Photocopigl{s) I F I F 6. Fax Machine(s) I F I F 7. Others a) Telephone I F I F b) Bicycles 90 F c) WO:Written off). 34 WHO/APOC, 24 November 2004 How does the project intend to maintain and replace existing equipmgnt-and other materials? The project intend to maintain and replac, ,iirting equipment and other materials with the ,ouirriport funds from the state government and some support from HKI. 35 WHO/APOC, 24 November 2004 Contributor Ycar3 (Mry,200l-APril 2002) Yeer 4 (Moy, 2002 April, 200!)- Yar S(December, 2003- November,2004) 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) 45,454 27272 39,370 r8"t97 39,682.s3 MOH (District/LGA) 38,580 r,363 34,r60 1,244 Local NGDO(s) ( if anY) NGDO partner(s) 20,355 9,1l5 20,461 16,461.93 16,740.6 16,740.6 Others a) b) Communities APOC Trust Fund 80,606 40,000 62,348 30,000 62,856 20,000 TOTAL 184,995 77,750 135,878 66,602 119,279.19 36,740.ffi 3.2. Financial contributions of the paltners and Gommunities Table 13: Financial contributions by all partners for the last three years If there are problems with release of counterpart funds, how were they addressed? Advocacy visit to the Chief Executive of the state have been intensified to solicit for the release offunds. - Additional comments 3.3. Ot{rer forms of community 3upPort - Describe (indicate forms of in-kind contributions of communities if any) !.4. Expenditure Per activiq/ - Indicate in table 14, the amotrnt 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. Indictate exchange rate used here 36 WHO/APOC, 24 Novembet 2004 Table 14: Indicate how much the project spent for each activity listed below during the reporting period Any comments or exPlanations? SEGTIOil 4: Sustainability of GDTI 4.1. lnternal; independent participatory monitoring; Evaluation 4.1.1 was Monitoring/evaluation carried out during the reporting period? (tick any of the followingwhich are applicable) Year I Participatory Independent monitoring Mid Term Sustainability Evaluation x 5 year SustainabilitY Evaluation lnternal Monitoring bY NOTF Other Evaluation by other partners Source(s) ofExpenditure HKI/}{OH MOTYHKI APOC/HKI APOC/HKI APOC/HKI APOCiHKI HKIA4OH APOC/HKI HKVAPOC 3,039.68 9,650 8,341 . 1 9 4,381.93 2,630.16 347.22 1,931.40 5,632.77 785.7r community Mobilization and health education of communities Training of CDDs Training of health staff at all levels Supervising CDDs and distribution Internal monitoring of CDTI activities Advocacy visits to health and political authorities IEC materials Summary (reporting) forms for treatment Vehicles/ Motorcycles/ bicycles maintenance Offrce Equipment (e.g computers, printers etc) Others central collection Point ofDrug delivery from NOTF HQ area to 36,740.66TOTAL 9 64,960 (Mass treatment) 7,162 (Clinic base trx.) 122Total number of treated 37 WHO/APOC, 24 November 2004 4.1.2. What were the recommendations? Evaluation of the project just ended on the 5'h of December and the reports are Yet to be received- 4.1.3. How have they been implemented? RePorts are Yet to be received' 4.2. Sustainability of proiects: plan and set targets (mandatoly at Yr 3) Was the project evaluated during the reporting period? Not evaluated inyear 3' Was a sustainability plan written? Year 5 sustainability plan is yet to be completed' When was the sustainability plan submitted? What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.2.1. Planning at all relevant levels A revieimeeting is always held eachyear where the State, Local Governments and NGDO fficials do particif,atu. During these revieys planning of routine activities to be carried out eich yeo, o)" drawn up. At community level meetings ore held and decision taken on how to sustain the programme annually. The State and LGAs arefully aware that external support will ceasein ti" nearfuture, thus, alternative source of support is being put in place th)iugh sustaining government contributions; contacting prominent individuals and groups in the State for suPPort 4.2.2. Funds The Slate and local governmenfi have been encouraged to maintain and sustain lheirfinanciol contributions lowards the pmject in view of thefact lhat,qPOC osiistance will soon ceuse- sensilizttion and commtfrnent of the polity naken at the SuL oni te,q kvels will continac h order to huease lheitfnancful confiibulions to tie pioie"t HKI on the orher hand have assured the proieA of her conlinaous suppotl 4.2.3 Transport (replacement and maintenance) - The projeit have iequested APOC to replace the vehicle and motorcycles supplied though no irrtien plans ari yet to be drann rp on replacement of existing transpolt- The state has started mnkfngfinancial allocatiin, for the maintenance of existing vehicles- Most LGAs are fueling and maintaining their motorcycles' 4.2.4. Other resources - HKI has been assisting the State with LE.C. ond training materials, whey required and will continue with thiiassistance. The CBBI committees in some LGAs have began to provide entertainment during CDDs training; writing materials and measuring sticl<s for the CDDs. 4.2.5. To what extent has the plan been implemented The sustainability plan is yet to be completed and put into use. 38 WHO/APOC, 24 November 2004 4.!. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3.1. Ivermectin delivery mechanisms PHC staff now takes responsibility of Mectizon and-Vitamin A' The LOCTs who are staffof the pHC Department ro, ,o[ltit Mectizan and Vrtamin Afrom the state' Also the District supervisori do collectfrom the LOCTs and deliver them to Front line health facilities which are collection centers for the CDDs' 4.3.2. Training The SOCTs and Onchocerciasis Co-ordinator are always invited to make some presentations during workshops on other health programmes such Leprosy' NPI etc' 4.3.3. Joint supervision and monitoring with other programs Supervision of ither PHC activities is done simultaneously with Onchocerciasis supervision, eipecially at the district and community levels. 4.3.4. Release of funds for project activities The routine procedure is followed in the release offunds iust like other projects at the state and LGA levels. 4.3.5. Is CDTI included in the PHC budgetr At the LGA level, it is included in the grn ril budget items, while at the state level it is in the Department of Disease Control Budget' 4.3.6. Describe other health p"og""--es that are using the CDTI structure and how this was achieved- what have been the achievements? The CDTI sffucture is ieing used to deliver Vitamin A to the community members' This was achieved by communi{, mobilization and education of community members to see needfor Vitamin A supplements. The CDDs were also trained on the supplementation' The achievement include high coverage in both Mectizan and Vitamin A supplementation. 4.3.7. Describe others issues considered in the integration of GDTI' Other issues considered in the integration of CDTI is that through its implementation communities have been motivated to carry out other health and developmental activities such as establishing drugs revolvingfunds and so on' 4.4. Operational le3earch 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. Nonc hos bezn condaaed in the proiecl 4.4.2. How were the results applied in the project? 39 WHO/APOC, 24 November 2004 SEGTION 5: Strengths, weaknessesr challenges' and oPPortunities - List the strengths and weaknesses of GDTI implementation process' STRENGTHS: 1. STAFFING: o The project is happy with the commitments of the :DTI personnel' especially at the state level whiie the SOCTs are dedicated to duty. olnvolvementofnutritionfficersandCBB|committeesintheprogramactivities n*, ,t rngthrned the stali capacity and program reach by offering assistance in the area o/ro**rnity mobilization, program self monitoring etc. 2. LOGISTICS: o partners such as the Ministry of Health and Helen Keller International have continuid to support the proiect in various ways including technical, managerial, lo gis tic s and financ ial as si st ance' SUSTAINABILITY: The program reach and mectizan coverage are quite inspiring' With the implementation of CSM, community participation and mectizan/VA uptake have improved during the period under review' 3. a o WEAKNESS: I CDDS ATTRITION: Some of the CDDs dropped out of the program because of unfulfilled promises by their communities. soii left theii ,o**uiities for greener pasture/employment in cities. 2. LGA SUPPORT: During the pertod under review Local Governments Executives were replaced thereby creatingavacuumofwellmobilizedLGAauthorities. - List the challenges and indicate how they were addressed. The project has also beenfaced with some challenges/constraints which include fluctuation in treatment coverage due to refusal of some comminities (especially, chuncha uillage areas of Koma) to tape Mectizan iablets because of reactions; high rate of CDDs attrition; displacement of some communities due to armed banditry. seasonal community settlements where members move out to neighboring states in search of fertile lands, and cattle rearers (herdsmen) *t o *oi" from plari to ptaie in search of pasture for their cattle are also causes for fluctuation in treatment coverage' These challenges/constraints have been systematically addressed through intensifie-d community mobilization and sensitization to Lncourog" ihot" communities in Koma to tale the drug; arrangements also concluded to identifl the displaced communities for treatments' Communities where CDDs have tefi were contacied to seiect new ones for training- For the 40 WHO/APOC,24 November20o{ migrating communities, plans were put in place to track and treat them as soon (N they return toiheir near permanent locations of residence' SEGTTON 6: Unique features of the proiecUother matters some of the unique features of the project/other matters are: (a) The communities have shown high acceptance of the program which hsve resulted to htgh coverage at the end of every treatment year' For - instance, the comiunity leaier Laide in Mayo Belwa LGA was aslced d the community will like to continue with the treatment and he stated that ,,even if the drugs will not be brought to us here, we can arrange to collect it in the state Ministry of Health ourselves" '(b) Most CDDs hove complatnid iuring distribution exerctse that they will not participate again, but during proceeding year they are found to hwe decided to itstrtbute again even though no incentives of any kind were given to them. fhey will always soy "I wont t9 lyln my people"' @BoththecommunitiesandtheCDDsarehappywithVitaminA supplementation os an add-on, because those on the exclusion criteria for'Mectfzan (children under five yeors and mothers who delivered'within aweekreceive Vitamin A, thus, every member of thefamily is talren care of. CDDs on the other hand look at themselves as doctors' and highly respected by community members' 4t WHO/APOC, 24 November 2OO4