NOTF/APOC-WHO Gombe State CDTI annual project Technical report submitted to Technical Consultative Committe (TCC): January to December 2006

Ir- Il I GOMBE STATE C.D.T.I.PROJECT. ir t' t 't I COUNTRY/NOTF: NIGERIA Proiect Name: NOTF/APOC- WHO CDTI PROJECT GOMBE STATE. Anproval vear: December 1999 Launchins vear: March 2000 : L't January 2006 - 3l't December 2006 Proiectvearofthisrenort: (clrcleone)1 2 3 4 5(6)78 9 10 Date submitted: January 2007 NGDO partner: UNICEF. il:: 13 JUIN ?n ORIGINAL: English Fc Action Tol tor ktsndon ro'5ie t rt l 1 I i ! I rl1? I I r'( ) ( t,'l._t I i"\_ Hz r, 'l 0 8 JU|N 2007 *9t-r f-rDalr \- ffi'il- , d.8al6no BiH csb b? AHE gFo hANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATTVE COMMITTEE (TCC) AFRICANPROGRAMME FOR oNcHocERcrASrs coNTRoL (APOC) a 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: _NIGERIA National Coordinator \am€r P. O PEARCE (MRS). Signature: ... * Zonal Oncho Coordinator Name: P. O PEARCE (MRS). Signature: Date: ?i%l ?-ot Date: 30lrflwr7 This report has been prepared by Name : IIARUNA ALI D. Designation S Signature Date Table of contents 1. 1. t Description of the proiect (briefly) 3 5 6 )'7 28 28 28 1.1.2. Partnership. 1.2. PopuranoN....... 2.6.5. Tn\ffiLn\IE OF ACTIVITIES AovocRcv 8 ll MOENVAUON, SENSMZATION AND }IEALTH EDUCATION OF AT NTST COI'NTIUITTTMS 12 Cot cvrulrrrY INVoLVEMENT Capncrrv BUILDING TnsATr,GNrrs ...................... Treatment fi gures ............... What are the causes of absenteeism? Wnt are the reasonsfor refusals?..., Briefly describe all knovwr ard verified serious adverse events (SAEI) thot....19 Trend of treatment achievementfrom CDTI project inception to the currenl year20 2,7. OROPNN.IC, STORAGEANDDELIVERYOFTVERMECTIN 2.8. Com,ruxnY sELF-MoNIToRING axo SrerpHoLDERS IUEETnrG.......-... 2.9. Sr;peRVIsloI.I 2.9.1. Provide aflow chart of supervision hierarchy-. 2.9.2. What were the main issues identified during supervision?......Enor! Bookmark not dcfined 2.9.3. Was a rupervision checklist used? ....Enor! Boohmarh not defined 2.9.4. Whatwere the outcomes at each level of CDTI implementation supervision? Enor! Boohma* not dcfined 2.9.5. Wasfeedback gwen to the person or groups supervised? Enor! Boohmarh not defined 2.9.6. How was thefeedback used to improve the overall pedormance of the proiect? 26 SECTION 3: SUPPORT TO CDTI....... -........27 3.1. EeIrIPh,GNr 3.2. FmaNcrer coNTRIBtmoNS oF THE PARTNERS AND coMMUNTTIES ......... 3.3. OnmRToNTUSOFCOMMUNITY SUPPORT 3.4. DGENDrIUREPERACTIVITY............. SECTION 4: SUSTAINABILITY OF CDTI. ....-.-..........29 4.1. hrrenNer; INDEPENDENTPARTICIPAToRYMoMToRING;EvaruAnoN....................29 4.1. t Was Monitoring/evaluation carried out &tring the reporting perid? (tick any of thefollowingwhich are applicable) ... .Enor! Boohmarh not d$ned 4.1.2. What were the recommendations? ..-.Enor! Bookmwk not detined 4.1.3. How have they been implemented? ....................8nor! Bookmwh not deftned 4.2. SusTeNaeILITYoFPRoJECTS. PLAIIANDSETTARGETS(unNoaronYAT................30 ...... .132.4 2.5 2.6.1. 2.6.2 2.6.3 l4 l6 I6 t9 I9 24 YR3) 4.2.1. Plarming at all relevant levels.-....-.. 30 30 304.2.2. Funds 4.2.3 Transport (replacement andmaintenorce).. """"""""'3'l 4.2.4. Other res(ntrces.. """31 4.2.5- Towhat extent has the plan been implemented- 31 4.3.2. 4.3.3. 4.3.4. 4.i.5. 4.3.6. ..32 Describe other health programmes that are using the CDII structure and how thiswas achieved What lwve been the achievements? 4.3.7. Describe others issues considered in the integration of CDTI. 4.4. OpSRAnoNAL RESEARCH. 4.4. t. Summarize in not more than one ha$ of d Wge the operational reseuch undertaken in the project areawithin the reporting period Enor! Bookruuh not defined 4.4.2. How were the rewlts applied in the proiect? .....Enot! Bookmarh not deftned SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES' AI{D OPPORTUNITIES $ECTION 6: UNIQUE F'EATURES OF THE PROJECT/OTHER MATTERS............32 Acronyms APOC African Programme for Onchocerciasis Control ATO Annual Treatment Objective ATrO Annual Training Objective CBD Community Based Distributor CBO Community-Based Organization CDD Community-Directed Distributor CBIT Community - based Ivermectin Treatment CDTI Community-DirectedTreatmentwithlvermectin CSM Community Self-Monitoring GMC GombeMedia Corporation. GSWC Gombe State Water Corporation LGA Local Government Area LOCT Local Onchocerciasis Control Team MLGCA Mnistry for local government and Chieftaincy Affairs. MOA&NR Ministry of Agriculture & Natural Resources. MOH Ministry ofHealth NAFDAC National Agency for Food and Drug Administration and Control. NGDO Non-GovernmentalDevelopmentOrganization NGO Non-Governmental Organization NOTF National Onchocerciasis Task Force PHC Primary health care PHCC Primary health care Coordinator REMO Rapid Epidemiological Mapping of Onchocerciasis SAE Severe adverse event SHM Stakeholders meeting SOCT State Onchocerciasis Control Team TCC Technical Consultative Committee (APOC scientific advisory group) TOT Trainer of trainers UMCEF United Nations Children's Fund UBRBDA Upper Benue River Basin Development Authority. I-ftG Ultimate Treatment Goal WHO World Health Organization ZOTF Zonal Onchocerciasis Task Force. Definitlons (') (ii) Total population: the total population lirittg in mesoihyper-endemic communities within the project area (based on REMO and census taking). Eligrble population: calculated as 84Yo of the total population in meso/h1per- endemic communities in the project area- (iiD Annual Treafinent Obiective: (ATO): ttre estimated number of persons living in meso/hyper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. (iv) Illtimate Treatnent Goal (UTG): calculated as the maximum number of people to be treated annualty in meso/hyper endemic are:$ within the project area, ultimately to be reached when the project has reached full geographic coverage (normallythe project should be expected to reach the UTG at the end of the 3d year of the project) (r) Therapeutic coverage: number of people treated in a given year over the total population (ttris should be expressed as a percentage). ("r) Geographical coverage: number of communities treated in a given year over the total number of meso/lryper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). ("iD Integration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for [,F, screening for cataract, etc.) trough CDTI (usirrg the same systems, training, supervision and personnel) in order to morimise cost- effectiveness and empower communities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTI. (viii) Susainability: CDTI activities in an area are sustainable when they continue to function effectivety for the foreseeable future, wift high trealrnent @verage, integrated into the available healthcare senice, with strong community ownership, using resources mobilised by the community and the govemment. (i*) Commrnitv self-monitoring (CSM): The process by uihich the community is empowered to oversee and monitor the performance of CDTI (or any community- based health intervention programme), with a view to ensuring that the programme is being executed in the way intended. It encourages the community to take firll responsibility of ivermectin distribution and make appropriate modifications vihen necessary. FOLLOW UP ON TGG REGOTTENDATIONS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session (Please addmore rows if necessary) I 1 Nunber ot Reconmpndfrion in the Report TCC RECOMMENDATIONS ACIIONS TAKEN BY T'HE PROJECT FOR TCC/AP(rc MGT USE ONLY WHO/APOC, 24 November 2004 IExecutive $ummarY Gombe State was carved out of the former Bauchi State on lst October 1996.It is made up of l l L.G.As l0 of which are onchocerciasis endemic. Mectizan treatment started in the State since 1991 as part of the former Baichi State. CDTI implementation started in year 2000 and all the l0 endemic L.G.AS are incorporated. The State has a total population of about 2,353,879 while the population of endemic communities in the l0 CDTI L.G.As is 1,384,864. In the period under review a total of 1,085,776 persons were treated in 966 communities in the l0 CDTI L.G.AS while 603 persons were treated in Gombe L.G.A. (clinic-based treatment). The UTG as well as the ATO for the year is 1,163,258 The performance this year (under review) is 100% geographical coverage, 78% Therapeutic coverage and 93% of the UTG. Majority of the population of the endemic communities are peasant farmers who are always at home during the rainy season in order to cultivate their farmlands. ln the dry season most of the youths in the rural areas move to various urban centers in the State and outside in such of white kola jobs. Similarly indigenes of other States troop into the State capital and down to the endemic communities. Towards the end of the rainy season, most of the cattle rearers travel down to the Southern part of the country in search of green pastures for their cattle and will not come back until the beginning of the next rainy season when green grass is available up north. Generally there is rural - urban migration where rural dwellers especially the youths, migrate to the urban centers for government employment or private enterprises. Trainings carried out in the year under review include: - 1410 CDDs, 305 FLIIFS, 39 LOCTs and 5 SOCTs. SHM with 60 community leaders and 15 L.G.A policy makers was held in 4 L.G.As. This was carried out towards the tail end of the year when funds were available. The major problem faced by the project is lack of funds from all sources in the early part of the year, which hindered supervisioq and timely implementation of activities. However, with the availability of funds efforts were intensified to cover most of the necessary activities at the end ofthe year. 2 WHO/AFOC, 24 November 2004 SECTIOil {: Background information 1 I General information 1.1.1 Description of the project (briefiy) Gombe State was carved from the former Bauchi State on lst October 1996.It is located in the north east sub region of the country Nigeria. The State occupies a land mass of 17,048 square kilometers with an estimated population of 2-4 million. Gombe State shares a common boundary with Adamawa, Bauchi, Borno, Taraba and Yobe States. Topographically it consists of a plain land with undulating hills especially to the southern part. The entire State is drained by the Gongola river which passes through almost the entire State emptying into the river Benue at Numan (Adamawa State). The climate is mostly sudan and sahel savannah with a little of guinea savannah to the south eastern part. The people are predominantly peasant farmers or petty traders and the major religion is Islam followed by Christianity. The major tribes are Hausa, Fulani, Kanuri, Ter4 Tangale, Waja, Tula etc. Communication is mostly by road and trunk A roads exist linking the State with the capitals of all neighbouring States. Other road networks are available linking the various towns and villages but some of the rural areas are difficult to access in the wet season. Motor boats and canoes are used for transportation in the 4 L.G.As where communities are bordering the Dadinkowa dam upstream. The health system consists of Primary, Secondary and Tertiary levels. The Primary Health Care facilities are at the L.G.A level where the maternity health clinics and dispensaries are found, while the secondary Health Care facilities consists of the general hospitals located in some of the L.G.A headquarters and tertiary is the referral hospital (Federal Medical Centre) located in the State capital. The number of health staffin the L.G.As varies depending on the literacy level of the L.G.A. and some other factors. The number of health staffas well as the number of health facilities in the 10 CDTI L.G.As are as shown in the tables below :- Table 1: Number of health staffinvolved in CDTI @lease add more rows if necesswy) LGA Number of health stafrinvolved ir CDTI activities. Totel Number of health staft in thc entire project area Br Number of health stefiinvolved in CDTI B, Percentrge BfBr/Br'1(X) Akko lI8 40 34o/o Balanga 74 40 54% Billiri 158 53 34o/o Duklal ll9 35 29Yo Funakaye 50 29 s8% Kaltungo 53 37 70% Kwami 49 31 63% Nafada 29 20 69% Shongom 75 32 43% YamaltuDeba 146 52 36% Total t7l 369 42Vo Table la : showing the number of health facility by L.G.A. in the CDTI area in Gombe State SAIO. L.G.A. NO. OF HEALTH FACILruMS. 1 Akko 5l 2 Balanga 28 3 Billiri 64 4 Dukku 44 5 Funakaye 31 6 Kaltungo 37 7 Kwami 35 8 Nafada 23 9 Shongom 29 l0 YamaltuDeba 62 TOTAL 404 4 WHOIAPOC, 24 November 2004 1.1.2. Partnership The partners involved in CDTI implementation include APOC, UNICEF, Federal Ministry of Health (NOCP), the State Ministry of Healtb the 10 focal L.G.As and the endemic communities. UNICEF is the NGDO supporting the programme even before the advent of APOC. Another partner is the Ministry for Local Government and Chieftaincy Affairs (MLG&CA), which is the major link between the project and the l0 focal L.G.AS. It is also involved in advocary and mobilization of the L.G.A. policy makers as well as planning. It plays a very vital role in the release of counterpart funds by the l0 L-G.AS- The media houses in the state are always ready to help whenever they are called upon. They are actively involved in mobilization as well as coverage of all our activities. The management of the Upper Benue River Basin Development Authority, Dadinkowa Area office, is a partner in vector control as well as mobilization and education of their staff on CDTI implementation. The Ministry for Water Resources and Environment (MWR&E), Gombe State Water Corporation (GSWC), Ministry of Agriculture & Natural Resources (MOA &NR) and the Gombe Media Corporation (GMC) are all stakeholders in vector control and by inference CDTI implementation. In the l0 CDTI L.G.As, all the PHC Coordinators and the health facility staff are involved in all activities - supervision and monitoring, advocacy and mobilization. The poliry makers are involved in advocacy and planning meetings. The community members are involved in all the activities carried out at the community level particularly now that community self-monitoring and stakeholders meeting is being introduced. The National Agency for Food and Drug Administration and Control (NAFDAC) is very vigilant in checking the filtration of mectizan into the market. Efforts are still being made by the Zonal office and the Mnistry of Health to mobilize local NGOs and CBOs to assist in the implementation of the programme in the State. The table below summarizes the communities and populations covered by the programme. lFl Iloo rleNli" r lrr I Qo' 5PHI5rEDl.rsli'orr2 5p o. 'doEt o) o A'+ 0 ,f + o (D rt (D Et o tD(.! Drl(D D{ tDr+ (Di t+ (D o)Ft(D +Ft(D D' (D o- oEt or+ o- r_t 0e (D (D 13 o3 oa €oFt o o- Fl o l! o, o, tU(D(' E' a o oo ro IB z F)p o. c, 7({ c) X o, D 0q o Et s) ,fp (D Ut ,flfg EU Ed o, o) I 0q F' *tro E r8i+Ad -. Y) Ir J t H€ fsteI53 -a'* * (/)O5 a o\5 o\\o{ C)Ur @\o\o ooUI o\\o{@(Jt 5 ;JNUr\t N\o o\s t.J J-, -J@Ur o\ t o\t.) (,)(,) \o(,5 N NA\o b.J sfot){(n E EI'6 ll3 6€ g -ag.t* E"'E'tD-to =. o\ (.) Or s t.) 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I 6gA ir- 'o r_t =e)0a(D o o)F € *.o tso "o [..J5 zo .D E.Ft fJ F -l (D v) SEGTION 2: lmplementation of GDTI 2.1. Timeline of activities The timeline for activities carried out during the reporting period is as shown in table 3 below: rrrrrn rADnla ar \r^.,^..t-^- /lnn, H. o o o p) od oq2 o c, 3.o o" ot ng o o o UH i a ? o(r) o+(! TD H ld A) Ol oal0 >ltf ,flo' U , ll a F o -(IB!! U(! !c z !0 B t! X ug X ID a noo E NF t9 o Uc >+rftr t,Ho 2 A:Ho E3xle El .+ i+E'ce ? o = E'H Eo ? .3 Et tDd: !9 .: Frl tacrI A) a? ? B) o E D' AI ot b) o -9trB EElr 9.o ailooIE ES E. E. oIQ^ Ef oo orr-t zo t! cro zo g r|-t E oo od(! E oE a F * OQ 0, trt a? o -9 egEr E}.oE Fl Etp UO tt!6tn r A' !, a s hl .t c9BEE'* i+ El'oe 3 O)H c) E z A! o zo E *' fc' J. Fll (D 6 E b) a? 0) E, .? U(Doo cro E't zoo 6o at)EI ('0 5 E' o BE EEF$. E' oo at, 1r, -taFat(D U(a oo d(D r-t U tDo(D doH U tD6o E.r-t U(a r)(D er fD ? DlH c) E3 E* i+ It'oc ? ol o ? Ho Frl .D(t h: z D)H a) U(-o C)o rFl U tDoo er6Et zo g E.Ft Uo C) tD d taFl zo dE rFl EI o oo t'D o E Url nar O rl E o e, o p Eo a?BEE4 i+E'ca ? A) o (D (D Ei. oo od .Dtst qt t,(D dI A: .: Uo() o dr!Fl zo t! E6ta zo tD H. zo 6 cr tDFl o EE EEE+. E U) (D{ O o zo ta d ratsl UIt! ttoH Utal)t! drl zo (D 6 tDFt UIt! EdtaEt U(! .t(! ct6 E A#EEH $F = P.Ns='E: S=, E #rEB :s x *HHEg i* $ *E Es S$ $ H+ eH $$ r AB' fE qT5. e *E $s €s E.: Bg gH SS? aq $* ss '+S 5 d#$ ic $.t;v $= fi*E= e.A' (! -s !i!t e[ frfi € .T; PA S\= E: _ O ='a at sst ilH iSa eE .= rE Hl E5 o aC' N -}rr-Io-s g* '\$E' Ea S9' 8-U es [3 sP ;o- s.e d'5 *tno€v1 o) ;fD Sa 3* N cl +)+ GH' 98' a5 L+o (\s. $e RE' 9o \; 61 t S.d5 az s4Uag o,i sE s0 G'ts Ats fa*crSiir(Dt! * eB $it r+ (I H'E 3i tE E.a * ..a5dae' -'@ S.F ,Ei so' *'6b+ (D \o {H ,Jio Eo "c) b.J5 zo (D tt(DFl f.) a 5 ot rf o ooL5 zo (li d tDFt !i 5 2,2. Advocacy There were advocacy visits to policy makers in the 10 CDTI L.G.As in February and March by the State Onchocerciasis and Roll Back Malaria progranrme of;Ecers. During the period continuous support for the sustainability of the progralnme was solicited for. Also at the community level the LOCTs and FLFIFS paid advocacy to the community leaders in the course of delivering mectizan to them. In the process they were educated and mobilized on the need to sustain the programme. The number and category of policy makers and leaders mobilized is hereby summarized in the table below: - Table 4.Showing the number of policy makers and leaders mobilized by L.G.A. Duritg the period under review a total of 517 policy / decision makers in the l0 CDTI L.G.As were mobilized. The objective for the mobilizations is to ensure continuous support to CDTI implementation through the timely release of counterpart funds and moral support. The Honourable Commissioner for Local Government and Chieftaincy Affairs greatly advocated for the cause of CDTI during his meetings with the L.G.A. chairmen. The advocacies led to the release of the sum of two million naira (N2,000,000.00) as counterpart funds by the l0 L.G.As at the tail end of the year. The major constraint to advocacy is the frequent change of poliry makers in the L.G.AS coupled with the fact that they are not easily met on seat. S/r{ LG.A Community leaders PHC Superviso ry Councilor PHC Coordinato r LGA Chairman Secretery Treegrrrr 1 Akko 56 I I I I 0 2 Balanga 51 I 1 1 I 0 J Billiri 53 1 I 0 I 0 4 Dukku 47 I I 1 I 0 5 Funakaye 48 1 1 I 1 0 6 Kaltungo 52 I I I I 0 7 Kwami 57 1 I I I 0 8 Nafada 4l I 1 I I 0 9 Shongom 44 I I I I 0 t0 YamaltuD eba 68 1 1 I I 0 Total 517 10 10 9 l0 0 il WHO/APOC. 24 November 2004 2.3. IUlobilization, sensitization and health education of at risk cornmunities The media houses in the State are always ready to cover all functions on CDTI implementation in the State. Their reporters are present in the State capital while in the L.G.As information officers cover the functionV activities and send reports to the media houses for airing. The use of town criers and other local means is now reduced to local announcements in the villages as a result of the wide coverage ofthe State media houses. No IEC materials were produced due too lack of funds. Only a few samples of the old ones are pasted at the venues of trainings or functions on CDTI taking place. Mobilization, education and advocacy are carried out simultaneously at the beginning of the year at the L.G.A and community levels. At times mectizan consignments for the communities are also delivered. Due to the nature of the society where women groups are very rare and not easy to access in some parts of the State, efforts have been made towards sensitization ofNGOs and CBOs where women are highly involved. Mobilization of women is done through personal contacts during advocacy visits. Plans are being made to train more female health workers and CDDs to enhance the mobilization of women. The constraints regarding mobilization include inadequate logistics, lack of IEC materials and lack of commitment of some health workers. The provision of IEC materials will enhance mobilization now that CBOs and NGOs have been sensitized on the programme.. t2 WHO/AFOC, 24 November 2004 Pi o o 3l E3 lt i oI( ol o3rl (Dt! oa dFer o eha g{ >aE ' tD(Dtrl'-1 " O. 5lo:' 13. ='lc 6 C)'<llc E + s,H ii. IHFV5 0 E.5l, *) Et ts'E$tsiiq-g '* 5' gHF? E,*EEE 6 |'0ts96'ts E: iE E 3 ro.? IE Hg EETH ev?-[#s E $+ Hg * -(D +, aqo *-r| :rN vX(DEDli o.c5 ^rdg5E +aS- 3Eig(DF tlg Be EgX E: * E(D !t=' E. 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OF r{ 7E a-El'A-t 6AlO i 5 I'q:i6 oGT d.*9E.cis E fEi.;-- Brt o r-o s a E o aE o E' o s o tt UI o b.) 55 sL,I \o(Jt {Ur si5co {o\ \o@ (,t (Jr lr)tJr 5o 5 55 5o o\ 5 o\ {o N) oo \o @ (.,l O N)@ {@ sq .s3r€ 8o= a1 E z g orl o oUg t2 rt E o EL .c 61\ .)t .D .D (! E o o\ s (r) o E 5 o {o { {{ \oa @ \o oo (,r o rJl (, o (, u){ (,o { oo t.) o N) lFl UIBElo !,Itrt oa afE'o9, 'oI.(D 0qa tfooFr) H(DPEE: q(Fst ob EEts E1.x. !,xq r-t H I,rP J.i;9 l=, (,f'{ oHo) rn(D -rlB(rt iJ.(r) EOo -\ F+);io\hUpj 9HO. rOH(D -4. Et;EoC arEiioLJU{OA' .(a op t.(D o. o c) u) ra c p FI' Noo' (D o,d (D do o n I {tG s :1, s d au G ;- a s oo G\ os S 0a :\5 6 I: a G G s o s d f qa (, g Eo Eo "(-) t.J5 zo 5 d taFl N)o 5 Table 6: Showing the various aspects of CDTI implementation on which the trainings was conducted 2.6. Treetmcnts 2.6.1. Treatment figures For the year under review, therapeutic coverage is78Yo while geographical coverage up to 100%. Trainees Type of training CDDs Other Community members e.g Community supervisors Health Workers (fronfline health facilities) MOH sta^ffor Other Political Leadsrs Others(specify) Program managernent { { r' Howto conduct Healttt education ,/ ,/ ,/ Management ofSAEs / r' CSM { ,/ { SHM { ,/ { Data collection ,/ { { { Data analysis { { { Report writing / Others (speci&) I"rSUIBE E loEtEl l-r 6 oq .^a sEi-.o ? sE 5-lO0q 6'ag a.c6oPg.EE. N I jaw3.HfO iDgE{ i+ 4t-IOq:EBx -<otaitD-U=o E t'f+) +EF(2 (li'^ .?B XFi O-' -:{ocdD6ut-(D aaYO =rau, or{AE -ogs s&<idra* Lr.ElH+ p(D El$oro B.H5 \.,' * r-il lg F{ 9H6-I -J FroD@U,AL €E 'r' oo Co o Ft o €g U) s- o ,-t og ts,o# s) C')oa' raF e? t Ho E U<os,d3!, xl d (r) ETo 0ao z c, E,CL b) X 4 s) X A' oqo :tl tr hrts8' (D U ,f ,fI EU Ft Ed 0, 0) 0a$, tsf,o FA' liJ rt >e' \o o\ o\ 5N) {5 (,r {o\ @5 *5 {{ o5 uro\ @ "E g$-fiE g;'E ,.e s \o o\ o\ 5N) \t5 tjt {o\ @5 oo5 {{ 5 (Jt6 @ EgH \o o\ o\ 5N) \)5 (,t {o\ @5 oos { -J 5 (,t o\ oo O'a +<Bc' E =E Bt!3tettoe E 6Lg dlgYt t E s oo -o6\ oo rO6\ oo 10o\ oo s oo rOo\ oo s oos oo s oo s oo s a) ^6oll -a$E00 Ero?i It q- UU -rtr UJ65 € o\5 o\\o{O9r @{{\o o\\o \t @L'I s ;'l N)(Jt{ N)\o o\5 F.) 1..){@ 9t o\ 5 o\N) lJ)tr) "ro(,r 5 N) 1..) 5\o l.J 5 oo "N -J9t E'Oo(D t oEl! t:{ E gEFg3 -=.H g- Fla '+ p iE LO IE L E 6lr o\(.) t\)(, € 5 NJ (Jr UrtJ -I(Jr Ur @{ tr @ o\ \o ltJ u) o\\oUl o * 5\o{ ()) t,\o t])(-,r o\ N)\o N (Jr t.) {@ "F \o lf) N)5(Jl Ut Egr U cho(.) oO(, -J -Io\ t, (]) O(,) {t.) o\5 tJJ Ut @(,t € o\ N) o5 \o\o oo6t,) \o N) N) t95 @ tJJ{ \o(,t(,l5 L'I\o{6@ t.J5 \o{ o\ zaE ee9E FH S -l6 s {{ 6 oo5 {o\ {{ {(,I {{ al-.J {(Jr @o\ aH -g t5$* oetros, {dt c o o o o O o o e2 2ail =rc: H[+s?lt-F 'q (,5h) o\ 5 {oo \oN) (JrtJ) 5 @@ \o{ N)\ot.) \o\o eZda8EEq Orr9o o o o O o o2 EF o o o o O o o o o o Eglc E rF ? { g *o tso _o b.J5 zo (a E.Ft N.) a 5 -i oFlq, tJ(DGEg/C) c)o o o, 0q(D Ft D' ta o(D o oc g) aY.\o E. -e& oo (D Fl D' oao il ra rl o .,o \o (6O\ FtVD' ocr(D Et s, (D \o 6\ F.l op c. (D tD o. 3.q \!Ei \Ect SErr l c:r ra tE $8.t HBs 8.sT T E* *sa e. iE EI'F E'r{t F: i$ Eg8 r E$ ESr .sdE E Et$st s(!E. E fB $ $* Et* : EE$i$sr 3S$t sR ,$ i. :FsI.S. rX(t{ Hil - !!.t!-fE. SFEs!.ss EE R =B (lsG - s. tss Ot(!(ji .St3 H(} e! ilI(t -: .ll. lldt7 er. E E lg' 4tz il$ glr ts IE E.I?(DlE a, lP SE AHd lS. 7'b HF EI$FH 3I[ El$ el= g11 Etsle EE'- ,i, B.Js. o.(Dot, 5o) ts.ltc) a8aDx +HE. IEh=tDEo. tr. .xgg* EE.o5 + bJ)oS'ooa :l(D .io r=. d8E+(D nDSHlF, L-il -loIE SL8 Hl: EIi lo IoItoE ',o{sK >tzEllcE15 E.IB. elI6t+$, ltrl Hlgah' 8lil slg <lx(Dt lo t<> -lrakt, lLrr 'tJ f-r(Jl I\i oo lo\ lxl-lo lo il E -o6\ ^)lzC}+IH(DnlFtI ;tE' KEI; >sBFi -r lo o e.lg P .o'16' =,g.lH d(D16o 6le- c, alxl(Dl-(u I ^BHIB(DF) s[. Hr (D rJ)o rj(D 6 E'0.(D o A'n .D AtU' s + (D E ,_t €.(a a, $) (Dp, crl C) il \o(.) -o6\ @ 4 o I -o F.)5 zo o E.Ft h.)a 5 lr 2,6.2 What are the causes of absenteeism? The major cause of absenteeism is seasonal rural urban migration. In the dry season after finishing farm wortg villagers temporarily move to the urban cities in quest for hard labour in construction companies or petty trading and their movement back to the villages with the onset of the rainy season. 2.6.3 What are the reasons for refusals? No cases of refusals were recorded during the reporting period 2.6.4 Briefly describe all known and verified serious adverse events (SAEs) thet Occurred during the reporting period and provide (in table t) the required Information when available. In case the project did not have any cases of serious adverse events (SAE) during this reporting period, please tick in the box. No SAE case to report "/ 1n \I,rIJn/APnn 1tr \Tmzmtpr lOOl -t FU IHF E:.!e l:1al(D3. ls !'5g\EL F irr ^(DiSEFlFliiE(!Bd FIO=rB? dPYtITF -94ts Er* = Etcr;It<=r:' ls E'slg'g H ISEt9U.;d=n rrgd It- r:$ EAqo -t+tts trr \Jt,D(Dl(PaJ a3Ezi'd(D(!;'9E sd' E. ='E B"E =DBgEs' r, a|FIOi'|t3.NrsRsEEEE' Iiq Fg ='\)(\stqx' HN.3ro,E (D nD CE(D (,, * 5o e .9 NO =a FU o "O t..J5 zo g E. hJoo5 N) t'.) \o tJ € tJ -I NJ o\ l.Jo tr |.)o 5 t\)o (,) t\) N) tJ o N) \o\o\o \o\o @ \o\o -l H F \o o\ o\ \o o\o \o o\ o\ \o o\O @@ o\ ooUrUr @5\o 8 &H. B.oir(atro =l O P. l' fFX'>pEE HE rg{oo,'E Im (-) o E E o R. A) oa .D0 \o o\ o\ \o o\ o\ \oq\ o\ \oo \to o\O so ,aH .YN P *il45! \o o\ o\ \oq\ o\ \o o\ o\ {6Ur o\55 (rlo\\o str& -82H<trtEi FFET*E Eoo- 5! o s oo r-o o\ oo s @ N) s {tJ) s o\{ s L,I5 6l- t!^O Eqsfig€ =do,l, =tDlt tO o\ oo s o s -)Ur s \otJ -o5\ \oUr 6\ L'I s e#E ENt_ ta, It rll oo (,) oo5@q\ 5 t])o },J 9t oo5 UJ oot\) o\{ 5Urt\) \oo5 "N Ur{ {@IN NJ {\t L,I o\{ o\ Es EE,'E E . trEEHFB EE : -u- F0 o 'r5 o, o o\(, N(, @ L,I o\a \o\o5 €@ 5(,r o\ oo h.J o\ (Jroo (, NJ ooo Fdr ?E E.o=' t! @(n{ -Io\ @t]) t)) o\5 @\o \o { ooI *O(, o\5 L,I \o (,r (Jr Ur oo N) tf.) 5tr 55 !flz9E 3-*ditDo a. E' {@ s 6tJ) s {tJr s 6{ s \) s o\ o\ 6l. Ur5 s Ho Ef'OiD 36,8vP (D(xt doE. c, ltI a- E la! rll \o tJ) -o65\ \oa s \oO s {(, s es otJ) s 5a s 8HE E'r- E.r,ii' E \ot,\o 6\ \o @ 10o\ \oos {9l rO o\ a5 rO o\ {{ 10o\ o\ayO o\ oO- .f $ d oat! - 2.7. Orderi Mectizan@ MOH Other Mectizan@ MO and delivery of ivermectin - Project Coordinator (MOf|.Otr UNICEil by - Project Coordinator (MOH). WHOD T]MCEIf,] NGD([ NGDC Other (please specift): Please describe how Mectizan@ is ordered and how it gets to the communities Mectizan needed for treatment for the particular is applied for by the State Coordinator (based on the census update rezults or number of persons treated in the previous year. This request is forwarded to NOCP for consideration. When the tablets are available, the Project Coordinator will be invited to Lagos for collection. After collection, the tablets are kept in the State medical stores where it is entered in to the ledger. The tablets are allocated to the CDTI L.G.As based on their populations and the number of persons treated in the previous year. The L.G.As are invited to come for drugs. On arrival they sign the mectizan register and collect a note to the Store keeper where they collect and sign for the consignments. At the L.G.As the tablets are stored in the PHC store from where they are given to FLIIFs to deliver to the communities through the CDD and community leader. An inventory is also kept at the health facilities. )1 WHO/APOC. 24 November 2004 Table 10: Mectizan@ Inventory (Please addmore rarc if necessary) Lost lYasted ErpircdUsed UsedlPerson trtated Received State/District/LGA Number in stock Requested 28 0t27628 0390000 389972390000Akko 00 83489917 159788490000 490000Balanga 0 155 0297832 109554297987 297987Billri 53 0124937 0375000 374947375000hkku 00 tt2263388 92t02263500 263500Funakaye 0 92 0294908 99883295000 295000Kaltungo 0 0 193300000 299807 2004llKwami 300000 0 158 0167,405 58,586167,563 167,563 Nafada 0 99 0226,901 72643227000 227000 Shongom 0131303 0 t79386500 386500 386321YamaltuDeba 0 0 22500 2010 603 Gombe (clinic based) 1132 2500 0 tt44 03.193,408 1,0851776TOTAL It32 3,195,050 3,1951050 Number of Mectizan tablets The remaining tablets of mectizan in the field are collected by the LOCTs and kept at the L.G.A. headquarters. It is added to the consignment for the subsequent year. Activities carried out by Health Care personnel under ivermectin delivery in the project area. i). Collection of mectizan consignments for the State by the project Coordinator from NOCP Lagos or Zonal office Bauchi. ii). Offloading of mectizan consignment the PHC store at the Ministry of Health and entering into ledger. iii). Collection of mectizan consignment for each L.G.A. by PHC stafffrom the L.G.A. iv). Delivery of mectizan supplies from L.G.A. headquarters to FLUFF by PHC staff. v). Delivery of mectizan supplies to CDDs / communities by FLHF staff. Remei 0 4t! 0 0 0 0 0 0 0 0 0 0 )') WHO/APOC. 24 November 2004 2.8. Gommunity self-monitoring and Stakcholders Mceting Has any training (of trainers) for community self-monitoring been done in the project area? Stakeholders meetings were held with community leaders and policy makers in 4 L.G.As. It is expected that the communities involved will carry out SHIM and CSM before commencement of treatment for 2007. Table ll: Community self-monitoring and Stakeholders Meeting (Addrows f 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. DistricULGA Total # of communities/villages in the elrtire project area No of Communities that caried out self monitoring (CS\4L No of Communities that conducted stakeholders meeting (SHIM) Akko Balanga Billri ll8 1s6 104 Not yet ), )7 Nqt _'-r_2- - Dukku 7l ,, Funakaye 84 ,, Kaltungo 84 ,) Kwami 76 ), Nafadal 5l ,, ,) Shongom 74 ,, YamaltuDeba r42 ,, TOTAL 966 n1 WHO/APOC 74 Novernher ?004 v9l, 2.9. Supervision 2,9,1. FIow chart of supervision hierarchy' The NOCp zonal Of6ce Bauchi and UNICEF supervise the state team (SOCTs), while the SOCTs supervise the LOCTs and the LOCTs supervise the [IFS. The IIFS and some community members supervise the CDDs. This arrangement is not very rigid as the zonal office and uNICEF as well as the state team can go to the community level in order to ascertain the situation in the field. NOCP Zonal office / LINICEF SOCT LOCTs IIF'S tIF S/Community Members CDD I I I I 24 WHO/APOC, 24 November 2004 2.g.2. what were the main issues identified during supervision? The main issues identified during supervision include:- i). Delay in the disbursement of mectizan tablets to the Front line health facilities for delivery to the endemic communities. ii). Lack of comprehensive records at the L.G.A. level iii). There is no define channel of delivering mectizan to the communities. iv). Some LOCTs are still monopolizing the prograrnme- v). Integration is taking place gradually at the L.G.A. vi). Most FLIIF' staffare not participating in CDTI either because they are not committed or they have been sidelined. vii). Records on CDTI are scarce in most health facilities. viii). Most communities have forgotten about CSM and SHM- ix). Female CDDs are 0 Yo in many L.G.As and very negligible in a few L.G.As' x). CDD attrition is still very high because of them are still young school leavers. xi). The ratio of CDD to total population is still very high. xii). Census update is not comprehensive due lack of good registers. The issues stated above are so similar to those identified in 2005. This means either the project is not following up on what had been identified the previous year despite what was reported as outcome; or care had not been taken the issues peculiar to this year. Please readdress. 2.9.3. Was a supervision checklist used? Supervisory checklists were not used by SOCTs and LOCTs- 2.9.4. 2.9.5. what were the outcomes at each level of CDTI implementation supervision? The supervision revealed that CDTi implementation is sustainable but more efforts are needed to improve the process. Please readdress Was feedback given to the penon or Sroups supenised? Yes feedback was given to the CDDs, LOCTs, FLtIFs and the PHC Coordinators 25 WHO/APOC, 24 November 2004 2,9.6. How was the feedback used to improve the overall performance of the project? i). Mectizan supplies are disbursed to the FLIIFs for distribution to the endemic communities without long delays while an inventory is kept at the L.G.A. headquarters. ii). Many FLtIFs are now involved and keep records at their levels iii). More PHC staffare now involved in CDTI activities through integration. iv). Communities have been reminded of their roles in CDTI including CSM SHM and grving incentives to CDDs. v). Communities were enlightened on the need to select more CDDs including females and elder$ people who are not likely to leave the community. vi). Communities were urged to provide the correct registers or the L.G.A / State should do so. 2.9.7 Was feedback given to the person or groups supervised? Yes feedback was grven to the CDDs, LOCTs, FLIIFs and the PHC Coordinators. 2.g.8 How was the feedback used to improve the overall performance of the project? i). Mectizan supplies are disbursed to the FLtIFs for distribution to the endemic communities without long delays while an inventory is kept at the L.G.A. headquarters. ii). Many FLtIFs are now involved and have been urged to keep records at their levels iii). More PHC staffare now involved in CDTI activities through integration. iv). Communities have been reminded of their roles in CDTI including CSM, SHM and grving incentives to CDDs. v). Communities were enlightened on the need to select more CDDs including females and elderly people who are not likely to leave the community. vi). Communities were urged to provide the correct registers or the L.G.A / State should do so. This is a repetition of 2.9,6; and a repetition of what was stated last vear ).6 WHO/APOC, 24 November 20O4 Source Type of Equipment APOC MOH DISTRICT/ LGA NGDO Others No. Condit ion No. Conditioo No. Coadition No. Condition No. 1. Vehicle I F 0 0 0 0 2. Motor cycle(s) l4 6F8 CNFR 0 0 0 0l 3. Computer(s) I F 0 0 0 0 4. Printer(s) 2 F 0 0 0 0 5. Photocopier (s) 2 IF lwo 0 0 0 0 6. For Machine(s) I F 0 0 0 0 7. Bicycles 60 wo 0 0 0 0 8. Slide proiector I F 0 0 0 0 9. Standby generator I F 0 0 0 0 10. Air conditioner I CNFR 0 0 0 0 I l. Electric type writer. 1 F 0 0 0 0 12. LJPS 1 CNFR 0 0 0 0 13. Coloured Television I F 0 0 0 0 14. VCR I CNFR 0 0 0 0 15. PAS. 5 F 0 0 0 0 16. Photo camera I F 0 0 0 0 17. Filing cabinet I F I F 0 0 0 18. Safe I F 0 0 0 0 19. Writing board I F 0 o 0 0 20. Laptop (computer). I FI 0 0 0 0 SEGTION 3l SuPPort to GDTI 3.{. Equipment fa[te tZ: Status of equipment (Please addmore rows if necessary) *Condition of the equipment (F:Functional, CNFR:Currently non-functional but repairable, WO:\rl/ritten off). How does the project intend to maintain and replace eristing equipment and other materials? Maintenance ofthe present capital equipment will not be difficult because these equipments are utilized in an integrated manner by other progralnmes in the Ministry of Health. Therefore in the absence of counterpart funds, resources from the mother lvfinistry or any of the programmes benefiting from these equipments can be used for maintenance. Replacement of these equipments may not be possible except for the grace of APOC. 27 WHO/APOC, 24 November 2004 Cmdition !.2. Financial contributions of the partncrs and communities Table 13: Financial contributions by all partners for the last three years (2004- 2006). For the year under review funds were released by APOC at the end of October and mid December 2006. The 10 L.G.As. released counterpart contribution ofN2,000.000..as reflected on the table above. 3.3. Other formr of community support Another form of community support is in terms of recognition where the CDD is respected and given regard by the community members. He is given an upper hand over opponents in everything including contest for elections. 3.4 Expcnditurc pcr rctivity - Table 14, showing the amount expended during the reporting period for each activity tisted. Write the amount expended in US dollars using the current United Nations exchange rate to local currency. Indicate exchange rate used here -l US$-: N130.00 Contributor (March 2004-DEc 2004) (JAN. 20os DEC. 200s) (JAN. 2006 - DEC. 2006) Total budgeted $ Total released $ $ Total budgeted $ Total released $ Total budgeted $ Total released Ministry of Health 20,000 29,000.00 20.000.00 0.0 0.0 L.G.As 12,500 12,500 12.500.00 15,300.00 28,271.00 Communities 20,000 1,800.00 1,000.00 UNICEF 23,100 1,584 0.0 0.0 0.00 APOC. 69,156 40,000 24,043.00 10,000.00 28,271.00 28,271.00 Total 34961 36,961 34,961 52s43 21,000.00 43,571.00 44,37l.oo rr rrtn , a Dn /^ a , 'lrl^. '^-L ^- a nn ,l E Table 14: Indicate how much the project spent for each activity listed below during the reporting Period. - Any comments or explanations? The coiumn MOH / L.GA. combines funds released by the state and the l0 L.G.As whether the State has released anything or not and vice versa. As for APOC funds which were released at the tail end ofthe year (October and December 2006) a balance of fourteen thousand dollars is still in the account. SEGTIOI{ 4: SustainabllttY of GDTI 4.1 . lnternal; independent participatory monitoring; Evaluation The newly appointed UNICEF consultant.on the progralnme @r. Lola Okwuosa) together with the former ZonalCoordinator (now national Coordinator NOCP) were in the State for internal monitoring and evaluation in September. During their stay they visited the weakest L.G.As. (Nafada & Funakaye) in the project. Many weaknesses were identified and recommendations were made towards addressing them. Please check format and use here. Tick the appropriate sections and highlight the recommendations made from the visit under the appropriate sub heading. (See the recommendations below). AIso address the extent of implementation of the recommendations in the appropriate sub heading. Recommendations from the Monitoring Visit i. The State should as a matter of urgency release counterpart funds to enable SOCT implement scheduled activities, and supervise effectively. The State PHC Director and Erpenditure (s us) Source(s) of funding Drug delivery fromNOTF HQ area to central collection Point of Mobilization and health education of communities Irailr1,e of CDDs ofhealth staffat all levels CDDs and distribution hlgl4al_mprulqgqg qfCDTI activities A4yqg-qgy visits to health 4dp-ql-ili-qal 4uthgritiqs IEC materials (r9p9rtlng) forms for treatment VehicleV Office Equ!prye,qt (e. (}E. co_mputers, p.grn!ers e!e) Vector control 1000.00 3,000 2,500.00 9,500.00 1,817.00 10.00t--- 957.00 0.0 500.00 2091.00 [s9,oo lt,+oo NOII/LGAs MOI{/L. MO}I/L.G.A MOTIIL.G.A MOH/L.G.A MOH/L.G.A MOHiL.G.A APOC/A{O H TOTAL 25,575.00 Total number of persons treated 1,088,424 29 WHO/APOC, 24 November 2004 r MOWAPOC MOH/L.G.A. cState Onchocerciasis Coordinator should follow up with Nafada and Funakaye LG authorities to ensure release of counterpart funds. ii. The SOCT should ernbark on immediate supervision and monitoring ofNafada and Funakaye LGAS to ensure adequate treatment coverage. iii. CDTI personnel should be given reorientation/training on proper management of Mectizan inventory. iv. Health workers and CDDs, particularly in Nafada and Funakaye LGAs, should be trained/ retrained. The SOCTs need training on data management. v. The project should embark on a data reconciliation exercise to aszure accuracy of data submitted and reported. vi. The LOCTs need to be reorganized and made functional. vii More IEC materials should be produced to address sustainability and continued compliance to Mectizan treatments. viii. Quarterly reporting of CDTI activities should be instituted at State & LGA levels. +2. Sustrinability of projccts: plan and set targcts (mandatory at Yr 3) Was the project evaluated during the reporting period?-No.- Was a sustainability plan written?_Yes_ When was the sustainability plan submiued?_September 2004 4.3. lntegration What arrangements have been made tg,$pptq4.CDTI after APOC funding ceases in terms of: 4.2.1. Planning at all relevant levels The sustainability plans were prepared jointly with all stakeholders from all the L.G.As.and the State. 4.2.2. Funds Although plans have been made for the release of counterpart funds on annual basis as contained in annual budgets for the ministry of health and the l0 CDTI L.G.As., the release of funds by all partners has not been easy this year. Only APOC released ten thousand dollars towards the end of the year. 30 WHO/APOC, 24 November 2004 t tTransport (replacement and maintenance) 4.2.3.Maintenance oivehicle will be done by the State while some L.G.As. were able to maintain their motorcycles. Replacement of these motorcycles and vehicle is likely to be done by APOC. A request has been forwarded to APOC in the yeat 6 budgets. 4.2.4. other resources Human resources will be sustained while capital equipments may be provided by APOC in the 6th financial year. Also request forwarded to APOC in year 6 budgets. 4.2.5. To what ertent has the plan been implemented The sustainability plans were not fully implemented due to inadequacy and delay in the release of funds from all sources. 4.3. lntcgration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: Ivermectin delivery mechanisms At the state level mectizan is collected by the State Coordinator from Lagos and down loaded at the PHC store where atl PHC supplies and vaccines are kept. L.G.As collect their mectizan supplies directly from the store as they coilect other PHC materials. Any designated officer oan collect mectizan for his L.G.A. 4.3.1. 4.3.2. 4.3.3. 4.3.4. 4.3.5. Is CDTI included in the PHC budget? Yes, CDTI is included in the PHC budget. Training At the I..C.e. and heatth facility levels LOCTs and FLTIFS are involved in all training activities for the various PHC progralnmes. Likewise CDDs are trained as guides or vaccinators during most of the immunisation campaigns in many L.G.As. At State level SOCTs attend trainings on measles campaign. Joint supervision and monitoring with other programs At the State level there is integration in the use of vehicles and delivery of information to and from the L.G.As. Release of funds for project activities The CDTI project is one of the progranrmes under the Disease Control department. Prpoposals for every activity has to be forwarded to the Director Disease Control who will in turn forawrd it to the Permanent Secretary from where it is forwarded to the Honourable Commissioner for final approval.. The file follows the same route dorrun to the Project Coordinator then a cheque is signed by the Director Disease Control and the Project Coordinator for the collection of funds from the bank by the project accontant. 3l WHO/APOC, 24 November 2004 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? Efforts have been made towards the integration of Vitamin A supplementation, surveillance of Guinea wofin and measles. These programmes have been added to the jobs of the CDDs and health facility staffin addition to NPI. 4.3.7. Describe others issues considered in the integration of CDTI. The most important issue in integration is the behaviour of the personnel involved wtriih will change faster with the organisation of programmes in an integrated manner. 4.4. Operational research No operational research was carried out during the reporting period SEGTIOil 5: Strengths, weaknesses, challengest and opportunities. Strengths 1. The identification of the CDTI structure by other PHC programmes as very suitable for integration particularly at theL.G.A. and community levels. 2. The involvement ofNAFDAC in the control of mectizan pilferages. 3. Increased support and commitment from UNICEF.. WEAKNESSES. l. Lack of commitment by some heatth Staffat the State and L.G.A.levels 2. Delay in the release of funds from APOC State and L.G.AS.. 3. Inadequate logistics for LOTCs because most of the motorcycles are too\old to be maintained. CHALLENGES. l. Sustainability of CDTI with dwindling funds when other PHC prograilrmes are pumping out money at all levels.. SEGTION 6: Unique features of the proiecUother matters The unique feature ofthis project is the existence of identified permanent breeding sites for the black flies in one of the L.G.AS. The populations of the flies tend to grow excessively and the persistent bites of the flies constitute a serious nuisance to the surrounding communities. This is the basis of vector control activities through the spray of insecticides / larvicide's at the breeding and resting sites of the flies in order to reduce their population and biting menace. The breeding sites provide an opportunity for operational research and evaluation of the effects of mectizan treatment on transmission rate. 33 WHO/APOC, 24 November 2004 n