COUNTRYA[OTF: NIGERIA Proiect Name: ONDO STATE CDTI PROJECT Approval yearz 1999 Launching vear: 2000 Repo rtins Period: From: JANUARY 2007 To: DECEMBER,2007 Proiect year this renort: (circleone) I 2 3 4 5 6 (7) 8 9 10 Date submitted: DECEMBER 2007 NGDO partner: Unicef nlh - 11?t 4 T. ( l-C ONDO STATE MINISTRY OF HEALTH CDTI PROJECT ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) AFRICAN PROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) 2& loi 1o,) WHO/APOC, 24 November 2004 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 NIGEzuA National Coordinator Name: MRS. OGBU-PEARCE Signature: Date Zonal Oncho. Coordinator Name: OTUNBA .A.O. JAIYEOBA. Signature Date NGDO Representative Name: Dr. Lola Okwuosa Signature: . Date This report has been prepared by Name: MR E O ADEJAI Designation: STATE COORDINATOR. Signature: Date ll WHO/APOC, 24 November 2004 Table of contents ACRONYMS.... DEFINITIONS FOLLOW UP ON TCC RECOMMENDATIONS EXECUTIVE SUMMARY.... SECTION 1 : BACKGROLTND INFORMATION........ 1.1. GpueRer. rNFoRMATIoN............. 1.1.1 Description of the project (briefly) 1.1.2. Partnership.... 1.2. PopullrroN........... SECTION 2: IMPLEMENTATION OF CDTI. 62. l.TIMELINE OF ACTIVITIES ...... 2.2. Aovocecv COMMUNITIES 2.4 .V VI 2.6. TREarupNTS.............. 2.6.1. Treatmentfigures.......... 2.6.2 What are the causes of absenteeism? 2.6.3 What are the reasons for refusals?.... 2.9.I 2.9.2 2.9.3 2.9.4 2.9.5 3.1. 3.2. J.J. 3.4. ... 3 ... 3 5-5 6-7 ... 8 t2-t5 r6 16 17 17 29 29 25 26 MOgILTzRTTON, SENSITIZATION AND HEALTH EDUCATION OF AT RISK ..9-10 1 2 2 8 9. 11 2.5 CouvuNlrY INVoLVEMENT Cepecrrv BUTLDTNG.. 2.6.4 Briefly describe all lcnown and verified serious adverse events (SAEI that ... l8 2.6.5. Trend of treatment achievementfrom CDTI project inception to the current year l9 2.7. ORoeRrNG, sroRAGE AND DELIVERv oF IVERMECTIN .20-2r ......22 ......28 2.8. CoNaNrLrl.rtry sELF-MoNIToRING AND STAKEHoLDERS Meerntc 2.9 SuppRvrsroN Provide aJlow chart of supervision hierarchy. ............28 What were the main issues identified during supervision? .............................. 28 Was a supervision checklist used? .............29 What were the outcomes at each level of CDTI implementation supervision? 29 Wasfeedback given to the person or groups supervised?................................ 29 SECTION 3: SUPPORT TO CDTI... EqunueNr FTNIaNCTaL CONTRIBUTIONS OF THE PARTNERS AND COMML]NITIES Orupn FoRMS oF coMMUNrrY suPPoRT 25 ExpENptruRE PER ACTIVITY ..... WHO/APOC, 24 November 2004lll SECTION 4: SUSTAINABILITY OF CDTI ........ 33 4.1. INreRNar-; INDEIENDENT pARTICIpAToRy MoNIToRINc; Evnr-unrloN.................... 33 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any ofthefollowingwhichareapplicable)...... ...........33 4.1.2. V[/hat were the recommendations? ............. 33 4.1.3. How have they been implemented? ... ......... ................. 3 j 4.2. SusrarNe.etI-lTy oF rRoJECTS: ILAN AND sET TARGETS (MANDAToRY AT................ 33 Yn 3) 33 4.2.1. Planning at all relevant levels... ................. 33 4.2.2. Funds....... ............... 34 4.2.3 Transport (replacement and maintenance) .... 34 4.2.4. Other resources ...... 34 4.2.5. To what extent has the plan been implemented................ .............. 34 4.3. INrpcRarroN... .......34 4.3.1. Ivermectin delivery mechanisms............... ...................34 4.3.2. Training.... ..............34 4.3.3. Joint supervision and monttoringwith other programs........... ...... 34 4.3.4. Release offunds for project activities ........ 34 4.3.5. Is CDTI included in the PHC budget? .............. ........... 35 SECTION 5 : STRENGTHS, WEAKNESSES, CHALLENGES, AND OPPORTUNITIES. 30- 3l 1V WHO/APOC, 24 November 2004 Acronyms APOC African Programme for Onchocerciasis Control ATO Annual Treatment Objective ATrO Annual Training Objective CBIT Communi -Based with Ivermectin Treatment CBO CDD Community-Directed Distributor CDTI Community-Directed Treatment with Ivermectin CSM Community Self-Monitoring FMOH Federal Ministry of Health LGA Local Govemment Area Local Government Onchocerciasis Control Team MITOSATH Mission To Save the Helpless MOH Ministry of Health NOCP National Onchocerciasis Control Programme NGDO Non-Governmental Development Organization NGO Non- Governmental Organization NOTF National Onchocerciasis Task Force PHC Primary health care REMO Rapid Epidemiological Mapping of Onchocerciasis SAE Severe adverse event SHM Stakeholders TCC Technical Consultative Committee (APOC scientifi c advisogyglqyp) TOT Trainer of trainers UNICEF United Nations Children's Fund UTG Ultimate Treatment Goal wHo World Health Organization ZOTF Zonal Onchocerciasis Control Team v WHO/APOC, 24 November 2004 Defiinitions (v) (viii) (i) Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). (i i) Elieible population: calculated as 84Yo of the total population in meso/hyper- endemic communities in the project area. (iii) Annual Treatment Objective: (ATO): the estimated number of persons living in mesolhyper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. (iv) Ultimate Treatment Goal (UTG): calculated as the maximum number of people to be treated annually in meso/hyper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage (normally the project should be expected to reach the UTG at the end of the 3'd year ofthe project). Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). ("i) Geographical coveraqe: number of communities treated in a given year over the total number of meso/hyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). (vii) Integration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) through CDTI (using the same systems, training, supervision and personnel) in order to maximise cost- effectiveness and empower communities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTI. Sustainability: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future, with high treatment coverage, integrated into the available healthcare service, with strong community ownership, using resources mobilised by the community and the government. (ix) Communitv self-monitoring GSM): The process by which the community is empowered to oversee and monitor the performance of CDTI (or any community- based health intervention programme), with a view to ensuring that the programme is being executed in the way intended. It encourages the community to take full responsibility of ivermectin distribution and make appropriate modifications when necessary. vl WHO/APOC, 24 November 2004 vll WHO/APOC, 24 November 2004 FOLLOW UP ON TCC RECOMMENDAT'OA'S Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session 24 I Number of Recommendation in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY I Authours are advised that extensively copying from previous reports makes it difficult for TCC to assess the report and proiect performance The Project has guarded against extensively copying from previous report 2 The project achieves good therapeutic and geographic coverage and is encouraged to maintain what has been achieved while continuing advocacy on a regular basis Efforts and necessary plans have been put in place to maintain what has been achieved. 3 The project has successfu lly implemented all TCC recommendations. There is still a need to encourage communities to have supervisors and CSM & SHM still need upscaling The project has continued to sensitize the endemic communities to conduct CSM & SHM although large number of the endemic communities has Community Health Committees, whose members are supervisors of CDTI. There is a plan to upscale CSM in 2008 with support from UNICEF 4 Subsequent reports should be reviewed prior to submission for consistency ofthe data provided. Report was reviewed. WHO/APOC, 24 November 2004 E<ecutive Summary Ondo State is one of the States in the South Westem part of the country and is located in B- Health Zone. It has a population of 3.4 million according to 2006 population census and covers an area of approximately 15,600 square kilometers. Mectizan distribution in the State started in 1994 under the auspices of UNICEF in five Local Government Areas of the State. Following REMO updates, the programme expanded to cover ten LGAs. Between the periods of 1994 to 1999, CBIT strategy was adopted in project area. APOC CDTI strategy became operational in the State in June 2000. Following the review of REMO exercise carried out in the State, the number of endemic communities was reduced to 579 in fourteen LGAs. Population movement in the State is attached to various events and seasons of the year. Such events include religious activities such as Christmas celebration pilgrimage to holy land, education, farming season, etc. During these periods, there are migrations of people from one place to another. Majority of the people engaged in farming migrate from other parts of the country to the rural areas while students move in and out of the rural communities during holidays and school periods respectively. Due to political problems in some of the endemic LGAs such as Ose, Irele and Ondo East there was large population movements from the areas. Empowerment and capacity building of communities through targeted training and retraining of CDDs, community mobilization and advocacy visits to the policy makers were aggressively pursued in the designated LGAs leading to increased numbers of CDDs and treatment coverage as well as release of counterpart funds. 4,000 CDDs were trained on Vitamin A supplementation. Some were used as local guides and vaccinators during the supplementation exercise. The project trained and retrained 1,230 Health Workers, 87 LOCT Staff and 10,975 CDDs, thereby achieving 97oh overall for its training objectives. The ratio of CDD to the population is ratio 1:115. 214 targeted communities were mobilized to be more commiued to the implementation of CDTI in their communities. Additionally, 2,039 policy makers and community leaders were mobilized in various advocacy meetings to support CDTI activities in the State. As regards treatment of endemic communities, the project was able to treat 1,019,513 people in the communities with 3,070,593 mectizan tablets. The therapeutic coverage rate is thus 81% while the geographical coverage rate is 100%. The total population of the entire project area is 1,261,043 while the UTG is I,059,282 and the UTG coverage is 97%. All the 579 endemic communities were treated during the period under review. The challenges faced include increased operational costs in the face ofinadequate counterpart funding and dwindling external support, improving community participation, ensuring annual census updates, late submission of reports, and lack of incentives from the communities to their CDDs. To address these challenges continuous advocacy was made to LGA policy makers, continuous community mobilization and dialogue with health workers was done, the number of CDDs were increased, and health workers were reoriented during appraisal and management/planning meetings supported by UNICEF. 2 WHO/APOC, 24 November 2004 SECTION 7t Background inJormation 1.7. General inJormation 1.1.1 Description of the project (briefly) G EOG RAP H' CAL LO CAT I O N, TO P OG RAP HY, CLI fitt ATE Ondo State is in the South West of the Country and covers an area of approximately 15,600 square kilometers. It is bounded on the North by Ekiti State, East by Edo State, West by Osun State, South West by Og.rn State and South by Atlantic Ocean. The bio-climatic zones of the State range from rain forest to forest savannah mosaic, to guinea savannah and mountainous areas. The rainy season is from April to October while dry season starts from November to end of March. Farming is throughout the year while planting period covers April to October and harvesting period is October to March. POPULATION ACTIVITIES, CULTURES LANGUAGE Ondo State located in the B-Health Zone has a projected population of about 3.4 million. The major ethnic groups are the Akokos, Akures, Owos, Ondos, Ikales, Ilajes, Ijaws Arogbo/Apois. The major language spoken is Yoruba but there are various dialects. The occupation of the State is farming which include growing of Cocoa, Yams, Oil palm, Cassava, Maize, Beans, Pepper, etc. Fishing along the riverine areas is very common. Crafts such as weaving of cloths, using raffiato make baskets, mats, chairs etc are also practiced. Some people in the State also practice keeping of domestic animals. COMMUNICATION SYSTEM (ROAD) Transport by road is the major means of communication among the communities. Some of the roads between major towns or cities are in good condition while access roads to most of the endemic Communities are very bad. Some are not passable during the rainy season for the communities at the riverine areas. Transportation by river or water ways is used. The use of electronic and print media are also means of communication in the State. Announcements in Schools, Churches and Mosques are other means of communication in the communities. Town announcers are used in some rural areas to annource or communicate within the communities. ADMINISTRATION STRUCTURE Ondo State administration is headed by the Executive Governor. There are the legislative and judicial arms. The local Govemment with the Chief administrative officer being the Chairman supported by the legislative arm made up of elected councilors from different wards. The State consists of 18 LGAs with the State capital located in Akure. HEALTH SYSTEM AND HEALTH CARE DELIVERY The health service of the State is structured to provide health care for the people at all levels. Primary Health Care (PHC) system provides health services with the community participation and support from the State, Local Govemment and NGOs. Different levels of health care delivery and services are provided across the State and the project areas. State Specialist Hospitals General Hospitals Comprehensive Health Centre Health post- and centers 6 t2 t25 318 J WHO/APOC, 24 November 2004 Table 1: Number of health staff involved in CDTI Number of health staff involved in CDTI activities. I Number Number health staff Percentage health staff the entire area involved in CDTI B, ii iltl t) Akoko N.E. 220 l14 <, Akoko N.W 205 u6 57 Akoko S.E 210 r09 52 Akoko S.W, 215 115 53 Akure North 232 137 59 Akure South 213 tt7 54 Idanre 210 t23 58 Ifedore 201 115 57 210 Ileoluii/Okeigbo 123 59 Irele 214 ll6 54 Ondo E. 208 l16 56 Ondo W 217 t29 59 Owo 218 t24 57 Ose 2tt Total 2981 r23 - 1677 58 - 56 NB- The proportion of health workers involved in CDTI activities in the curuent year wos lower, though actual number is higher, when compared with the previous year due to fresh health workers employed by the State Government. The project intends to train and involve more of the health staff in the comingyear. 4 WHO/APOC, 24 November 2004 District/LGA I l2 Partnership Partners involved in CDTI project implementation at all level in Ondo State and their area of supports are as listed below. - World Health Organisation (WHO) - African Programme on Onchocerciasis Control (APOC) - United Nations International Children's Fund GfNICEF) - MITOSATH - Federal, State and Local Govemments. - Community - WHO/APOC: have been able to give adequate support in areas of capacity building, travels and provision of capital equipments for the implementation of CDTI activities. - LTNICEF: has given full support in the implementation of CDTI activities during the period under review especially in the areas of capacity building, monitoring and supervision. - MITOSATH provided technical and financial support in collaboration with APOC for Vitamin A supplementation during the period under review. This strengthened CDTI by providing opportunity for the training of 4,000 CDDs, awareness on the fact that CDTI can be used for other health interventions especially Vitamin A supplementation. - COMMI-INITY: The communities provide storage facilities for Mectizan and treatment data. They equally provide incentives for the CDDs. Some of the endemic communities were able to provide support to their CDDs for collection of Mectizan tablets, supervise CDDs during distribution and provision of incentive either in cash or materials. -FMOHAIOCP: assist the State in the areas of technical support and carry out monitoring and supervision of CDTI activities in the state. Advocacy and mobilization visits were also ca:ried out. -STATE M.O.H /LGAs: The State and the 14 APOC-assisted LGAs have been able to approve and release their counterpart fund and also provide logistics such as office spaces and furniture, payment of salaries and allowances for the implementation of CDTI activities. The staff at these levels train, mobilize, health educate and procure mectizan. During the reporting period the project was able to work hand in hand with other partners in the arrears of advocacy, community mobilization, training and supervision. The project in the coming year intends to carry out mobilization and sensitization of local NGDOs, CBOs and policy makers to assist in CDTI implementation. 5 WHO/APOC, 24 November 2004 +at 0) -o o z$ at B \o o 6 A Fp 6og(J 6e .= q) 9E o o\ e.l\o F-. \o @ c- a.l a.l6ltr- a o\t-. r- o\ c- o\ r-r- o\\oN o\\o @F-+F-F- $+\o 00 co a- caa(--t\o o\00 (-. 00 t o\F- N o\ r- N € et o\ o o..- .= q) (E F o\ € o\N o\ o\ oo oo o\ r- + o\ F- o\r- o\ \o$ c.l € \o NN o\ + r-\or- o\ co e.l t-. t-- t-.r-\o oa\o o\ 00 o\ $ \oN E9 EP.E afl-i.o6oE >tr a.l+c- 00\o r- \o\o a.l F- o\ F. \o\o $o\ @ s ai o\ c.) oo o\o\ c.t e.l 00 €\o € f'- $ \o \o \o\o t-. oo r-r- o\ o\r- 'E5 S €.= iE .J'I?EUI E'aE.q e o\N N \or- c-t a-$\o @ ooNr- oo el oo r- €r- F- a.l € o\ €\o +s r- o\ o\+ \o F- 00 N \o o\ c{N €+ o\ \o\o F- a^l \o$ () OI6 q) oE z o. >a= >.c3r, .=o 6Et :c 3 oo @ e.l c{ \o \o $ r- + \o 00 tet a-s 00 o\r- 'E-E e6-E 'rrtr6 o-:e .rEo g. E'g >. r- o. $ r- F.. t at €N e.l s $ t-.c.] 00 a.t E€ s €.= e ?EU3 E'a E.O L $ co a.la.l \oN $N F- ai \oat -Ec.c?.= I3Eeo?E =yo1:eo o\ @ o\N o\ o\ oo @ \o o\ r- s o\ a- o\F- o\ \os a{ € \o NN o\ s (--\o F- o\ €N r-r- r-. c-\o @\o o\ @ o\ + al q) EE >96 .9-9!.=.i EiE.;9tr tl Q 14 z .Y }Z z & -l a o&oii r.j a o&o}l z o ! oa o ! o d O o! _o OI oI o o o d tr.) o () o o J F F do Cd oO 'a Lr olr (.)() J1(h lr C6 o CB o rc (! CTO'Eit'EG=IFIE $,: dElr <dlrr Fl +o N L(.) .o a) o z$ c.l (J o. U 6()c € >,0)(! c6-tr ^E€ LAo ;,'! rE9C)9 tE -O.ch4() iFH -q 6Xo)Pt E 3.5THLH !s 6oq6 o'- X EAQP(JH-Lr E s?"8 5 = :iJ+i O -HC)^lJr '=.i V6 tj*E -E nn -'iE Eg#* .2 t Q.i I -c E X'q, cgr- tr llo tr . cg.-s 0 c> 9P E h=S E E EE -d-rL = i E >,{ rr o o'E.:oo0=Q -(utFJ -lv-iP6-=)< = :gH Etr.:^-oE ryU;: Eo > Ni ^()=":9r= € g Pdgcn o-=" -oat l' u;?v).aE tss5E 'E (-- ^X2 o ..'= ,;'5 3€5 H 9!Y^LH ts^u^a cdE ;e8 rq)arqdLLtr'-=(,idrE El(E=o 9Fod!.tsE-o-r8, E 3E€ -E ; E Ets:a ! o(i ura coHh5 3 E.s* >. e-C p ij! o - ()- '= O iE a = 'F9 P iru.!--tr !'!-F = rJre (g F ,\ J U5 .:-o o Eo .!: +i'E .Yt z:.9€EE €EEE; Ae.sY,d\Jrr-= ri a l)(- Y bo d\.HLv !.iUL ..!u-d -H!L9w d H = e,E gI q E E sEe'b SEEE ^\, * ='=t& <;E.>trtr(g oE r-E<-lcd e o()q ch C)oH a, Ho t-.1U v) rh O C) z o) C)LL 7i 0) a/ (.) o -od C) -o(B (.) I (B C6 o qi ool-r ch C) U) B o zqr o z I ^l U)o _l Io C) c\. 'i()a bo li oa() Lr o uo .E E O I(.) O 'a lra c.) Lr € U) U) C)o (g U)d r- 4 U AJ o'\ q) : u q)\ I -o SJ TB$'-o\i1u 9:l '5b \Bup ^s '\ Ss %O' 9: Bq) c\ $)is tB$<\\U!Sq: b-s%UUS lx Bi =3s* e-5Bx \i !t -S{% -$ *\S\\9\\ s\' .:\ 5p ris ss <= ll q) t\B\q) * +o cl L 0;)I 0) o z$N O o { o >. *ro t C) u.=E>E9 !l 0)t3u) u) ca 0)(B.E a'=0)! >= oocgo Aa .98\vti< o.r I ,o)!/oaro ! o-t UC,, ^q)gE e8 Eg{ao 96 ==-,U)(0!, IJ -o6tA C{)- 3 =\Jq.Teh oPc.tEE U) uiF .'.i (B u E(a9)Etrr -GIEE GICd c)H o i1a *d€ -l o.rft .i.E trCg>, .ga uGl()'2F-C c) e-.:= EYIJT)Y-v, sE8c)= -> HrcA2a4)(a cd'Eo -'a >v'o et()ac'F 6 = H.E c((-)!\ * o.l.I E EE *ac'=;\ .98trX 'rr.E 9 o -.rSF .-ra-Pg'5ts.s !{GE>. --ULt<> E L cg 0) >\ (.)Ltr O() E c.) ()tr C')d()L C6 Ola-qo: .i ii :E ,E}a .t q,tI'.= o'<o..is9O,X e3SEo9EHrl iI!r'.. cnl .qlFbt ci sl -FA -U tE o cB - o oq I - 6l z -3 Qria oo o () a ar= QO c- c.l (.) (J rr N 9o r- c.lt z r-o c{t z l.- c..l eo r- N o a- c.l a G)a t'- al o r- N € o. c;)a t'- N ea o F- c\ Io tr- c.l i z F- c.t Io \J rr c{ o o u0_E ,-!?tr c!: r- N -oq) frr c- N () L Cd 2 c- N -o() tu c- N o d r- c{ -oq) F. F- ct p q) tu F- C\l -oo F- c-t (.) tu F- cl Io r- (\.l c) tu c-o a.l -oq) frr Fr (\] p(.) F- N o P r- c.l p C) o 0 6I *o trE (J r- at ci 0) t-] F- c-l d 0.) a- c..l o 6,) IJ F- c.l o 0) t-l r- N o c) o F- c.l o 0) H r- at o(.) o c- N()() n t'- oN oq) l-t r- o.l o 0) n r- o] (.) C) IJ r- c{ o() t-l c- ol oo n r- N o(.) o oD_E+ r- c-.1 (! F- N (B F- N d F- cl ,o 0.) frr F-oo c.l 6 c- N rd F- c{ (B l.- o.l CB r- c.l cO r- c{ d F- N CB r- c{ (B rr N (d F- N (B o 6! 0 o () U EEEE U F- N >r c- c..l r- c.l >' r-o c-l C) r- c..t 0,) F- c-l >l r- c{ (B r- a,l q) r- c{ Lg F- o C.l Cd z r- c..l L a. r- oN(.) F- c.l d EO-E+ li tr 6= r-oo c.l (! t'-oo cl F- N CB r-oo anp() tu t'-oo an F- Ncd r- c..l d t'- a.l (B Fr c.l d I.- N CN r- c-.1 d F- N (B F- a.l F- al (d EI cg F EOEE Q r- oi .o C) r- N oL(B F- c.l I 0.) ,\ t-- c.l () L(B z F- a.l oL(B tr- c{ (.) d A F- c{ () L z r-oo o] -o(.) c- c.l oL c! z F- N p 0) F- c.l o 2 t.- o ct ok CE r- N (,)L Cg F- c.l oL CC z P= .=lj PE d= F- c.l -o0) t& F- o o.l oL(B r- c..l -oq) tu F-o cl oL(d r- cl -o0) F< t'-o a.lp q) tr. t-- c{ () tu r- Np(;) TI. c- c..t -oq) F- c..l (.) h F- cls 0.) frr F- a{p o r- a.l C)L c- N -oq) ao c) 6 N tl2 EE U Fo c{ ai r* o a.l >. c- ot >.(6 Fo a] >t r- c.l 9 bo F- at >. F- c.l F- c\ () F- cl 0) r- oN >.(6 F- N F- N F- a.,l bi rr N L o a0 6 C') r- N d F- N Hp. r-o c.l .cj 0) tu r- oN lj r- o] il z r- c..l -d(.) tu r- c.l Lo r- c.l -oC) E. t.- N L G z r- c\ il(B z r- c.lj() Er t- o c{ ti C! r- N g r- c.l (! j q) o tl z oJ4 o)1 t z o *ja El a o& o .\ Pa j4 J4 li o z C)L }4 oa() L x q) H (B ! () L .c) -o o0 o .\4 o(,;) 0) (.) o(B lfl C) o o () 2,2 ADVOCACY Advocacy to and mobilization of the State policy makers, LGA policy makers, Top Government functionaries, Traditional Rulers, Religious Leaders, PHC Coordinators, and some notable opinion leaders were carried out in all the endemic LGAs. A total of 35 State and 129LGA Policy Makers as well as 1,875 Community Leaders were mobilized. Advocacy and sensitization of these groups were carried out to enable them understand the concept of CDTI and the roles of partners in the implementation of CDTI project in the State. As a result of the advocacy and sensitization of the policy makers, State counte{part funds were approved and released for implementation of CDTI activities. The State Government released a total sum of :N:2m during the year under review while the endemic LGAs approved and release their counterpart funds particularly during the VAS exercise. CONSTRAINTS:- Poor terrain, high cost of maintaining and fuelling of the project vehicle and motorcycles at the LGAs. Non release of fund by some of the LGA Policy Makers and very inadequate counterpart tund. SUGGEsT'ON FOR IMPROVEMENT Local NGOs and CBOs will be sensitized to assist the project in the advocacy visits to the endemic LGAs. Adequate fund should be provided for the implementation of CDTI activities. 2.3 Mobilization, sensitization and health education ol at risk communities The mobilizationand health education of the endemic communities were supported by the use of posters and radio/television jingles developed in the Local languages. Additionally, trained health staff and town announcers were used as mobilizers. Churches and Mosques were also used as places of mobilization. The State Ministry of Health continued to sponsor a T.V. prograrnme known as "stewardship" and also a radio programme known as "Our Guest" where CDTI programme is sold to the populace. Radio jingles were also carried out to mobilize the public, especially those living in the endemic areas. There was no separate mobilization and health education of women. In addition , health educators educate women when they come for antenatal visits at the clinics. Minorities in Ondo State project suffer no discrimination or segregation in all the CDTI project areas. They all live together in peace and harmony under one community leadership. Some of the minorities are even selected as CDDs for the entire community they are resident in. As a result of the mobilization carried out on CDTI implementation, the positive responses of the communities were recognized on these areas. o More CDDs were selected by the communities o Increasing involvement of females in CDTI implementation o Usage of the CDTI structure to distribute VAS o Communities collected their mectizan from the collection points. 9 WHO/APOC, 24 November 2004 Improvement in incentives given to CDDs by the few communities that have been giving incentives Some community leaders supervised CDTI in their domains. Despite poor terrain and high cost of maintaining the project vehicle, most of the endemic communities were visited for mobilization, sensitization and health education. The leaders and members of the communities promised to ensure the success of CDTI activities in their domains. This has also resulted into increased treatment coverages and reduction in refusal rate. Suggest ways to improve mobilisation and sensitisation of the target community More time should be devoted to community mobilization, sensitization and Health education. This should be supported with adequate logistics i.e. good project vehicle, adequate fund for fueling to take care of unstable fuel prices and vehicle spare parts. Local NGOs and CBOs will be sensitised to assist the project in the mobilisation of the endemic communities. a a 10 WHO/APOC, 24 November 2004 $oo cl L C) -o () z +N d o o > 6a o€ =e L} o.- -o6tra0 7= o oo Cq o q) :'i 5 PE9 E tr: L E.o @ oo c.l C-.1 <f F.. $ \oco €c.) s c.] c*$ ooco o\r* o o o a=;o U o o z .E F +t-. r-- +t-. co r- \o €(-. o\ o\\o € co tr- o\r-F- €r- o\\o F- oo tr- \o o\ o\oo r- oot'- (a) r* o\ 9- E o r\ @ 6l €6I t-. oo\o \o G.l r-. o\ & c.l o\ € €$ c.l tr- co c.) c.l (n c- cft o\\oN o\ C.l cl t ca Q o F= + c.l F-- a.l+ o\ N 6l @ o\ str) oi\o\o N (a) c.t c.1(\\o €\o c.)t- tr- >o o'= 106 >q 8ft EOAA =Ootr o'E ze o oo €E q) o sar- t--\o € \o t-. F.- + <i t'-$ olt- oo(at \o c.) €\o sc.l\o Eakr i=E3 EEHA 28Ea + c.] \o t t.c.l e.le.l a] c.l \o(\ a.tc.l tr- (a)N \oC.l t--c.) ?oq!d'8.: Etr'EE c € E€ 3F:-L 9.- * oo @ N N \o + F- rs \oc.t ooca t c.l F-$ €ao t- J .-i 2 .ll -v B 2 .v -:z tri a v o .v Ea oja olz o z oE .tz oa o -v o q)L o .o -obo 0) -vc o C) 0) o o c B C)a o oF F oO c) ox E'.=6)8 > .L',. o.=>! - ah >r 0) Ir= E-qo\J \J -+t ot$€l NFI Comment on Attendance of female members of the communlty at health educaton meetrngs In general, how do you rate thc partlcrpahon offcmale members oflhe communrty meetlngs when CDTI rssues are bemg drscusses (attendance, partlcrpatlon rn thc drscussron etc) Attendance of female members of the Community at health education meeting is very encouraging and high Dunng Health education meetings, every group ofthe Cornmunlty is present including the children and females. As seen in the table above all the 579 commumties have female CDDs. The Akokos have a higher number of females as CDDs because they tend to leave the younger girls to tend to such issues wtule the matured men and women are busy with their farms The hrgh lrteracy rate rn Ondo West account for the rncreased number of female involvement. Overall, female involvement has been enhanced by the increasing presence offemale health workers rnvolved in CDTI. Currently, there are more female health workers than males We believe thrs may further translate into mcreasing female participation in the near future - Incenuves prouded by communrtrcs for the CDDs Some of CDTI communities provide incentives to their CDDs. rn form of money for transport, food items and statroneries. - Attrrtron of CDDs Is attritron a problem for the pro.;ect? If yes, how rs rt addressed9 The rate ofattrition is not a problem to the project because large number ofCDDs has been trained wrthin the commuruty and this give room for easy replacement. 2.5. Cape,clty bulldlng A total of 290 new health staffand 3638 CDDs were traned, whrle 940 health workers and7337 CDDs were retramed on such areas as data collectron and record keeprng. Those areas were identrfied as problematic dunng monitoring and supervisron m the previous year The trarnrng matenals used rnclude the following:- Flipcharts, Posters, CDD field guide, SOCT/LOCT freld guide, training manuals, rape measures and community register book. As a result of the training carried out, the number of trained CDDs increased. Thrs resulted in increased coverage. In the process of supervrsion the CDDs demonstrated greater understanding oftherr responsrbrlities. This explains partly the increase m coverage. Describe the adequacy ofavarlable knowledgeable manpower at all levels. - Where frequent transfers oftrained staffoccur, state what the project rs doing, or intends to do, to remedy the situatron. (The most tmportant rcsue to descnbe n whal measures were taken to ensure adequate CDTI mplenentatrcn where nol enough know I e dge a b I e ma npow e r w as av a il o b I e o r f s taff s fr e q ue ntly tr ansfe r r e d dur mg the course of the camporgn). WHO/APOC, l0 Apnl 2003 Adequate and knowledgeable personnel were involved rn CDTI acttvities at all levels Transfer of health staff is not a threat to the rmplementatlon of CDTI progamme slnce enough health workers have been trarned and more is scheduled to be tramed in the coming year l3 WHO/APOC. 24 November 2004 t oN L C) -o o z$ c.t Q(J * rr > $ + O c.l H()p () o z$ c.l B la) q) c! o (J C) z cE+t. I €;ct, S.:A<v :* \l .-z!, $ : r- @ c.] c.l co a- coN coN $F- O c.) N .€\.) F\\ an aaN \o @r- \o oo+ o co o\ o\\o o\\o$ c.)N oo co F- @ oot O c.) o\ F- F- o\$ co c.l o\6rr o\ €$ ca o\\or- o\ aa cf)N 00 a- co c'l \o o\ \o \o oO c.t o\ oo o\ ca r- €t- r- oot OOt-t ralF-lO\l ol ;l ro(r). r- 6 t?) \O^ ta s6 o\ q) q) o c) -(,F or- Ooo r- & co or- € Ooo O00 O@ O oo o\ o o\ o € CI 0 C) .='0' cEtr c) .oE LCE Xe z c+9.' = r F cco U0< : e s o c) () u \U Uk- 0 o O,Eoq) Ue ti: c) z I6+-l9Or,ri\J Fv- q : t oo $\o c.l € \o N O oo o\(\ < oo \o a.l co o\ F-\o \o C.l r- € r- \o F- \o oo o,\o r- c.)F- € r- oo \o C.l € r-\o o\ + o\ oo\o \oN o\ r- cl o\ \o r- s (ft .I = o\6l s\a o\ q) q) q) C,) v k- o\ o, € € O o\ o\ o\ o\ Oo, o, o\ o\ €C{ O o ,.] o0) o q) z orit \ ts aa N co \o co $ \o $ c.l € + N r- + + $ N co N \o \o N r- $ co r- N r-6 €l,o o\N (,F \o \o oo \o F- \o \o co t'- r- r- € j C,) 0 ._iul 2 o .v o .v B 2 -vo .v ia o .v o JZ Pa o -voI ti o z 0)L J< U) q)L JZ (.) r< (n C)Lo! e bo() .v o o() C)0) L ti ! o o - () o '] F tr o (B () o a t- oU(H o U) o O (.) t< .0) q-.i C) (! o0 (d Lit- fi1 6)l -ol cdlFI 6 $ ol Lo () z v a.l (J o. o
c.t c..l Lq (-) L./ o. > ,l, o C) (n oL C) o .ub .='g oo -7 FOLxh I >fi5 7 -z b9 GL- -c u- -.r!v!+-d x =:=0.)*v E:Y OE'gEd *7 *7 *7 boho.r ha =ei9, .HAE' E EE E EEooo!i \J\J EI,/ (, -7 l, t-l U -7 -7 b0 o.r S .). qFO c,) C) C) !B F C) t= o)ES 9c aE-€ - =='cd}EE 9 *vH9Jr () ili 6) C) i6 oo lfJs<>a AO z,a O z U) o o cg c) d= l-t o (n 0 >t 6 eOO C)L 9U (.) -v cd L 0)ro oo (B t< (rr o 0)g F \b 0) 3 F
GY =H9 o4 a -'l E O; = fAEEgS9# oao o- o o o Eo .o E z at Lg O o ir I I O rrl €?Ea2E cot\o 00 $ oo o\ c.l o\ cl \o oo co ct oo co(-- \o\o c.) co vobs Ets =-ozd r-\o F- ao + r- C{ co o\\o t-- a.l c-$ c{ r- o\ at aor- o\ (\ F- o\ E.^ 3: .E E:i e ;['E.E ol\o oo$ r- o\ o\\o 00 co r- r) € o\ a.l oo $ a{ o\ o\$$ N\ot'- oo 00 o !o =ooO d^ *ES OOEOF :: 00 N00 00 € N€ 00 00 € N00 o\c- oo 00 a o\ c.l o\ c.lF- s$ sF- r-ta F- c.l \o F- $N c.lF-r- F- co$ c- o\F-\o\o F-$r- t.- o\ oo c.l\o r- o\ cor- Nor- \o €F- o\ ao 00 $ co \o tr- a.l N co(-- ao o\ o --o=o Eb9 = o.-Z € o\F- r- o\t- o\ F-F- o\ a.l o\\o oo F-+r-r- -t\o € @r- € €r-s\o o\@ t-. oo to\ o\r- ai o\ r- N ooN ?o? 6.2 ? 9-o' LU o\6l\o r- \o € r- N c.l a.l$r- o\ @ o\N o\ o\ 00 00 \o o\ r- + o\ a- o\r- o\ \osN 00 N6l o\ + F-\o F- o\ € ct F-F- t-.t'-\o c.t €I o\ @ o\ $ \o c-.1 o CB oo .=16E. BH6-'q I o d=oE E - E€ .oF 6\ \oo\ \oo\ \o o\ .oo\ o 1Q6\ -oo\ o\ \oo\oo^\ ^-i = .9 cr _c 00AS !vo;ot ov \o o\ \oo o\ \o^\ E.9 -- -3 E go#tr c=;i =tr>!z6 o 6 oo c\ c-l \o \oc.t rf r-ao s \oc.t ooc.) $ cl r-s 00co o\r- 00 @ N N \o \o a.t $ F- $ \oc.l 00 $a.l r-$ oo o\F- =oE 6.u t utrFU th 0) b0(d th C) oO >9.'rH O= - o v!-^= = E ;.?.g . E E-E"EE- . 8= E E oo 00 c.l N \o \o co $ r-c.) $ \oca ooco $c.l tr-t 6co o\r- a oL jl q)k d a)L .q) .o bo oj1 o() 0) 0)L q(B IJ] o Oq) oE (J o B () t I Fr 3 .9<t;v H rrl z o}(o P z o}1oIZ Et a oj }. P U) o4 l( li o z (.) )( co o\ ta) f- c.i (.) (g(,)tr OlrO oq oOa ca rr) ol -iqi o H C)I (t o (g l{ N Q 0) l-1 I xL(!_y =u)A =rr!u B(h .eEBHlrbEEtr E TF1v !t!t< r\'PE()ts -c u)! oov .Eh Hi rEs ZuacEo0 GOtE Pa .\E 6F6;trtroi5 .d E E.EdF EI, .'E ol - o7l *,9F1 ot trFl I I $ (\ L a) -o () o z t a.l o N +.,() -o O o a, .. E =>N: ilooo C)-C -o> 3 e2t IH}EoEB ra0)u a iE'= ()-^trL:ii E'; o ao(d (g tr.EI orH -dl trqJ^3 0.= o.r9X tr qEOMEa d9 Nrr o o+>3E." 92 L =()>.3: c ",E E &"6i=,i ootro-c o) arOEi"rb -()ooo= (!E.tr 00 .EBE =().^ota e.I O(.) c';Eo=o'E -Ob05u(B-o;bo;n - y.2a X0.)L. =-c d r !p6tr.! o-r(trLia -.3-3! bEatI(dtrts trd H00-).ch E'E 8 ^? ciEs(J 9: c/] 8ou: ui (0- o - Oll .- HEg oxd(hP () :oE u -(g LiH9"i EEo o.cd O € eE xu? CB -.E -.-t aE c-l i Hv!i o'= rj Fr .i!lG).>E E(.)2CXE *.9 U9.trEcr AL^} =59P: E -b.o -F.:€(,=cjg- = o 2c-,EPPLVdHH vP;i+ o<-.i 9d^V> -vaF ()iiH-q€6)e^ v!-! 'LU .;()EC6 x E ds ,\ _ 9Y o-r -Ctr>oo 9lVr7)tsts q) $!I\ E$\ s a) 60 \ rt\-/ ::F.i qJ JE v! -\0,i 3L! c6{ EH(,) 's \LL:+A-XqJ osS €.:sqoos --r UBs* *Itiat)Cdsa .9.isFEiEEEO!r=l\\ osb€ r *sEB>aJyE!r(.) : 'ssE 9 !:i - 't i'5; E_ s\E T .Si3 S E*Lv-tI q a\ .8 E T\O 'iS sl € b (Jr.) arE'=^.E F €{() .: iso- s i\q s .\se : !*^,b FSSAtSs = x. 8_B = .i sPr t .s> - \oE i Es f E d 5 - .= ls oo 5 o.oo sEI! UU 's -\ € ssS tE r rr r tt E E$ OI !3 s Ft EE : I = s'i bo cd\ eb (s h o:\ Sp b X Fs Si i ! e" EE s$ ; s E' 6; ;S 'E = '{ =.s Sr ;i O- 7 L)t\ Fr=' E F U (3 + ss c g ? = X o cd(.) L o o +i o ! C) -o z o o 0) o C) (E(.) F cg d oL Po() I L(€ a.9c)(B+(.) tr o '=UVL-q2 ot! -c *. .= _o 99;e ootr :E9 v J6E6c t)LC) ! Ul.i t v ^tsFVI F o -l trF xl 3 .' Xl o o --le >' Yl o) -c -l Eb 3I E(!) bO -i =y 6t E =: =l * x\tr .;lI uoo .ql-b IC €l(h (E .. =l E Ett,. c)X Hl o e E ,EIg 8HI F rf- "l = O LI JY 0)l c Xg^l v Fl)i Ft lv d ;. =t _e = - Zl- 7 o X C) cdoL o o o L C) -o z il o (.) o F .o o\ o = C) oo !v,A arX><- () t- o dL o bo Lo o c) -c o\ (!L bo o 0) U 0) L obo L C) o O,^ .- -o €-\ oa 63tr C) F sO c.l L(.)p o zs a.l O IJ o. L' NN \ q) L.q) "a Lq)4 It -}\ 4\) c.)q) \- 4: \ q) ":S q) 4 q) eI Lr()q b0 lr o 0)tr q) b0 Lr oLrLr Qo o d U) r! a v) () ()() rh *<() (g (n o lro U) +r (h o U) (J ciir a)l -ol(Bt FI troq 0.)L Ot) o o z XoI (.) J1o ()(t) (B Oq d o lroq b0 tr o (.) C') b0 Lr r! a o () 0) U)Lro C6 0 o tro U)(+r o o(h(€ c) (h(t oo 'a trq o O C') cdo n9N o (A(! !(!a (.) a) -o(t CB N oo +< o o o o!() op (B o boE() o C) OE hdx0) AR5 ,'- bOv ;io(.)(B C( rl o -E=o99 -.caL vo= <.= E LA6 - bnq)d-'Oc-.= tr ij cg .=(gOd tr o-=a;)iEc l!()o ().9 E89Cgq0 39 l, o. 0O*(+.X oE - a .= q)o-c tr&94 ,;6(*i;q)-o.2Ee o) E E=9LL'-CBOO()NEEC oE 3= bo)'=== xE a) xIJ (d-Cq: s d €.999'l = =.O.= ogEEtg o a trE :_o Y o= 0) A>r qEla@(E E9 .!t9E;A: i qr o)oocG.- =bo ao xoa (.) bo * a $ c.l 0) -o () z +N o iJr CiN { q) trU6)l-tr(6Le =oc) c.)q)'a o9 tr:o6 a;6)rj Itr (,cs(l)o LtrA(E E F() U: T! OO -L bI)rFr (€ ;0)q).^ troo()= OPdtr 6) q)= E!) GF() l-O H6 ()Ll- Uiq CI () ooO 9aF 9;< rO O z z z o\ N \oo\ o\\o \oo\ € oo o\ oo oo -o o\ @ @ \o o\ \o a.l o\ .o o\r- o\ o 6 o o o eSaF Oo\< B-o z z z \o $ -o o\\o o\ \o o\ ^\\o o\ \o r- o\ o\ o\ \oo\r- o\ \o t-- o\ oEo =ooo (!^ d9e\ ooEoF z z z .o o\ c.)N o\ c.l\o o\r- rr o\ F-F- \o € F- -oo\ o\ F- \oo\ o\r- \oo\ oo ,o .o6!2aFC z-b \o\o^ F- * $ ('1 + N + c1 +(\ r- o\tn N €$ c.} r- c.l F- q F-N o\ F-q oo C.l o, \oO n^ ca o\ ca$ \o o\ co o\ r-r- o\ o\ :()E 6.= 4lo9' F\J z z z o \o Oo r- O{\o o. € € v} d\o o\ F- ol +\o o\ oo ca+N o\ o\ oo @ oo a.l 00 c\ o\ -i La _16 -::oL^=(-Eo)o ' a 39 o. z z z \o € cl r- c.l F-+ol c\ $ ..l N 00 oo .{ O c.)ol an+ \o a.l 0) oo(d ao (-) o o Bo.= F Oo\ <'>! -o o z z z o\ -oo\ \o .o6\ O o\ \oo\ o\ \oo\ Eo=cao:(!_ !d,:F3 95;- o9oo- z z z -o o\ .oo\r-r- .o 6\\o @ \o -oo\ O o\Oo \oo\ O \o OO qO -.= o-b = 9u tr E= U =E>Lz3- z z z oo co $ oo o\r- o\r- o\r- o\r- o\r- :od o.= 4 .o -o' -t:o z z z co t o\r- o\r- o\r- o,r- o\r- bod =a:-.r6q>ioo> 9;H + o= >.:: o=9qA , tr v yp EO o z z z o\r- o\r- o\r- o\r- o\r- o\r- o.r- o,r- r! F- o\ o\ € o\ o\ o\ o\ o\ ON c.l a.t (\ aao C.l *o N r) C.l N r- an oo O c.l o\ o o.l O c.l 2.7. Ordering, storage and delivery oJ ivermectin Mectizan@ ordered/applied for by -MOHrn WHO tr UNICEF NGDO Mectizan@ delivered by - MOH/NOCP tr t nwHo f]UNICEF NGDO tr Please describe how Mectizan@ is ordered and how it gets to the communities Mectizan ordering and delivery in Ondo State CDTI project originated from the Community through the CDDs. The Community Directed Distributors request for their yearly needed Mectizan tablets using their Mectizantreatment census register. Their request is forwarded to the LGA Onchocerciasis Control Coordinators through the FLHFS who will also forward it to the State Oncho Control Team (SOCT) who submitto Zonal office for onward transmission to the NOCP Headquarter. The National Onchocerciasis Control Programme Headquarter collates all requests for Mectizan. and makes application to MSD . On approval MSD ships the drugs which are cleared by LNICEF and stored in their storage facilities on behalf of NOTF. Drug delivery follows the ordering process but in reversed order. 24 WHO/APOC, 24 November 2003 MSD t., NOCP t., ZONAL OFFICE t., STATE tJ LGA t., FLHF tv CDD COMMUNITY 25 WHO/APOC, 24 November 2004 Table 10: Mectizan@ Inventory (Please add more rows if necessary) State/District/LGA Number of Mectizant tablets Number in stock Requested Received Used Used/Person treated Lost Wasted Expired Remaining Akoko N.E. 225,000 220 )000 219,286 72929 98 616 Akoko N.W. 225,000 224 )000 223,213 74044 52 735 Akoko S.E. 220,000 216,000 215,371 71571 r9 610 Akoko S.W. 240,000 230,000 229,351 76052 20 629 Akure North 235,000 233,000 232,412 77224 69 5t9 Akure South 225,000 225,000 224,170 74357 155 675 Idanre 210,000 203,000 201,538 66795 83 1 ) J 79 Ifedore 230,000 226,000 225,313 747tt t7 670 Ileoluji/Okeigbo 200,000 190,000 189,196 62897 48 756 Irele 225,000 224,000 222 ) I 27 73907 72 1,801 Ondo E 190,000 187,000 I 86,310 61702 106 584 Ondo W. 255 )000 254,000 252,439 83978 89 r,472 Owo 230)000 230,000 229 )204 76134 56 740 Ose ))\ 000 222,000 220,663 73212 r37 1,200 TOTAL 3,135,000 3,084,000 3,070,593 1019513 7,02 I 12,386 How are the remaining ivermectin tablets collected and where are they kept? In some communities, the remaining tablets were kept with the Health workers at the health facilities nearest to them while some communities kept their remaining mectizan tablets with their supervisors which may be CDDs, community leaders or any appointed members of the community. - List and briefly describe the activities under ivermectin delivery that are being carried out by health care personnel in the project area. The activities carried out by health care personnel in the project area include the following:- oCollection of ivermectin from the LGA o Keep records of mectizan issued to the CDDs under their health facilities. o Monitor and supervise mectizan distribution. 26 WHO/APOC, 24 November 2004 co c.l Lq) .o C) o z$ c.l * o t-N -:o CB a)!o c) bo H C) oo C) () 0) Eq) o €() oq o H d IJ () o € C) (.) L () C) ! C) 3koL q 0)() c) -o c6(! o c) o F c.i N tr C)x q) ; d o H ou.g .sFt*oeot =.sgE g;bo s.9trOE'Ts*uE [EEBHB logi i€ -YG)t.=wGHEDEi, .SEE\o(gs;ryS EESE'Et-^5hF\91ou+Ol-EF*sSliEI.E E -(E;iLtss,-5t guO bo -r1F-l '= arld.H=lsiif;l ul iJia bo o C) 9-a +c) oo '=oL _:Z =6 =aEeo!)uii -cOozo cn $ \o N ta) N ra) c.) t.) ca \o ca \o tra elcdl €^l 0*2, .96u) € a r\ '=vL=VIioo -YL9 !u5UE o z c.) N $ N c\l C.r cnN# F-N (.) ! o9)l EoE ^J ()i:= c)A >'= S[iaO'5 c)L.- L Ed E o o oo oo C.l ta) N \o(n \oca + r-ca tr)+ \oca €c.) 00cnil$ a\F-ra J o L c/) r! z ol( o JZ E z oia ol4 r.i V) J4 o .54 E a Ji oll tr o z() tr J4 oa oL J4 olr d (,)tr o e p bo c) .v o o 0) o o rl] o oo U) 0) o I Er - 2.9. Supelision 2.9.1. Provide a flow chart of supervision hierarchy. SOCT LOCT DHS HFL CSM CDD 2.9.2. What were the main issues identified during supervision? (1) Issues identified during Supervision include:- Poor quality of supervision by health facility staff. Supervision is superficial, and there are no efforts to check out vital issues. Inadequate commitment by some of the health facility staff Improving community participation in Idanre, Akure North & Akoko North west. Inadequate funds for LOCTs to properly supervise and mobilize Poor census update for mectizan distribution Poor record keeping by CDDs Lack of incentives from the Community to CDDs. Problem of data collection and reporting by the health workers. + J J J J (2) (3) (4) (s) (6) (7) (4) 28 WHO/APOC, 24 November 2004 2.9.3. Was a supervision checklist used? The SOCTs and some LOCTs utilize the checklist but other LOCTs and the health facility staff hardly make use of them. 2.9.4. What were the outcomes at each level of CDTI implementation superryision? Through the supervision of CDTI activities at each level, the health facility staffS were able to provide reports and data with correct figures. The CDDs were able to carry out proper recording and update their treatment register. Treatment coverage at the community level improved. Appropriate implementation of CDTI activities were put in place at the Health facility and Community levels. 2.9.5. Was feedback given to the person or groups supervised? Feed back was given immediately and this has assisted the project in a long way to achieve increased therapeuticcoverage 2.9.6. How was the feedback used to improve the overall performance of the project? All personnel involved in CDTI activities were able to identiff their roles and improved their performances thereby increasing total treatment coverage and reporting. The feedback was also used to develop their work plans and implementation strategy. SECTION 3.'Supporl to CDT, 3.7. Equipment Table 12: Status of *Condition of the equipment (F:Functional, CNFR:currently non-functional but repairable, WO:Written ofO. How does the project intend to maintain and replace existing equipment and other materials? The State Ministry of Health has put in place a plan to ensure that project equipments and materials were adequately maintained. The plan includes adequate budgeting and release of fund, integration into other PHC activities and periodical servicing and replacement of equipments. { urpr Source Type of equipment APOC MOH DISTRICT/ LGA NGDO Others No. Condrtion No Condition No Condrtron No Conditron No. Condrtion l. Vehicle 1 F 1 wo 2. Motor cycle(s) 20 F 5 wo 3. Computer(s) 2 F 4. Printer(s) 2 F 5. Photocopier (s) 2 F 6. Fax Machine(s) 1 F 7. Others a) NC 2 F b) TV 1 F c) Bicycles 150 wo 29 WHO/APOC, 24 November 2004 The project has requested for some capital equipments such as Motor vehicle which has not been supplied after approval in the sixth year budget. 30 WHO/APOC, 24 November 2004 SECT7ON3SupportfoCDTI 9.2. Financiat contributions ol the partners and communities Table 13: Financial contributions by all partners for the last three years Contributor Year I June 2000-May, 2001 Year 2 June, 2001-May,2002 Year 3 June, 2002-May,2003 Yeer 4 Nov 2003 - Dec 2004 TOTAL Budgeted (US$) TOTAL Released (us$) TOTAL Budgeted (US$) TOTAL Released (us$) TOTAL Budgeted (US$) TOTAL Released (us$) TOTAL Budgeted (us$) TOTAL Released (us$) Minrstry of Health (MOH) I 8750 I 25ot) 10,000 ti "0txl t 2.800 ti.0lt() l 6,000 1 6,000 Local NGDO(s) ( if any) NGDO partner(s) Frve Motorcycles Five Motorcycles 6,400 6,400 DistrrcL/LGA 8.750 3.750 8.000 5.000 8,000 5 600 8.800 8,800 Communrties APOC Trust Fund l7 I .680 1 04.1 80 135.860 l 09.860 73.032 6t.534 42.622 42,622 TOTAL r 99.1 80 20.430 1 53.860 r22.860 93,832 7 5.134 73.822 73.822 Contributor Year 5 April 2005 -March 2006 April 2006 - Dec.2006 Jen2007 -- Dec2007 TOTAL Budgeted (us$) TOTAL Released (US$) TOTAL Budgeted (us$) TOTAL Released rus$) TOTAL Budgeted (us$) TOTAL Released (us$) Mrnrstry of Health (MOH) 15,385 15,38s 16,129 16,129 15,873 15,873 Local NGDO(s) ( tf any) NGDO partner(s) 4,127 4,127 Distrrct/LGA 6,154 6,154 1,587 1,269 5,481 5,481 Communittes APOC Trust Fund 41,202 39,202 34,300 30,332 TOTAL 63,721 60,741 17,716 17,398 59,781 55,813 Release of counter part funds for the project activities are always processed and disbursed timely without any problem in the state. 3.3. Other lorms of community suPpott Some of the endemic communities provide incentive to their CDD, such incentive include umbrellas, rubber pails, paying transportation cost for collection of drugs from health facility, cash gift, food items and recognition of CDDs during celebrations in the community . 31 WHO/APOC, 24 November 2004 a3.4. Expenditure per activityt Exchange rate used: $1 : N126 Tabte 74: Indicate how much the project spent for each activity listed below during the reporting period Activity Expenditure ($ us) Source(s) of funding Drug delivery from NOTF HQ area to central collection point of Mobilization and health education of communities Ds Trqiq1ng 9 f lg4lthjtaff at_?ll level s lqrgrvisjng CqDl and distribution _Etgrqelf"omlq!llg of CDTI activities $dvogqgl,qqltrLqtq4ll@4pq!1tr4laul!9n1ieq IEC materials Sum1ryr4y ( Vehicles/ Mo to_{9y4. !4 !l"y_"_l qt *4,rt"rq!g" IOffice lquipqe4t (e.g go!npu!ep,]q!!l! 9!.cL Others 794 J,JJJ 9,127 5,397 1,984 6,400 750 4,444 3,084 20,500 MOH MOH APOCruNICEF/MoH ] MOH APOCA4OH APOCA4OH MOH MOH MOFVLGAs APOC/]vIOH TOTAL 55,813 Total number of persons treated 1,019,513 32 WHO/APOC, 24 November 2004 SECTION 4t Sustainability of CDTI 4.1. Internali independent paficipatory monitoringi Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable) Year 1 Participatory Independent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation Internal Monitoring by NOTF Other Evaluation by other partners 4.1.2. What were the recommendations? o FLHF Staff to be sensitized on record keeping and data entry. o Community mobilization towards giving incentives to their CDDs o Training of health workers and the LOCTs on the use of new format for collection of data 4.1.3 How have they been implemented? o Training of LOCTs and health staff were carried out to update their skill and knowledge on the new reporting format o Advocacy and community mobilization were carried out through visits, radio jingles and community meetings. 4.2. Sustaiaa bility ol projects: plan and set targets (mandalory at Yr 3) Was the project evaluated during the reporting NO Was a sustainability plan written?_ YES When was the sustainability plan submitted? THIRD YEAR 2003 What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.2.1. Planning at all relevant levels The Project planned with relevant partners such as LGA representatives Local Govemment Service Commission, Planning Commission and Ministry of Finance to ensure proper implementation of CDTI activities to sustain the programme. Also the state planned with I-INICEF and NOCP at the National level to ensure sustainability of the project. 33 WHO/APOC, 24 November 2004 a a4.2.2. Funds Through the effective advocacy and mobilization of the State and LGA policy makers, the State Government have been able to put in place yearly budget and release of fund for CDTI activities. Some of the endemic LGAs have been able to provide fund to support the implementation of CDTI prograrnmes. 4.2.3 Transport(replacementandmaintenance) The Project has formally requested for the replacement of the motor vehicle and motor cycles by APOC. The State and the Local Governments have been fully involved and committed to the maintenance of logistics. 4.2.4. To what extent has the plan been implemented The sustainability plans were fully carried out by the project and this includes:- - Training and retraining of health workers, LOCTs and CDDs. - Community mobilization and advocacy to the Policy makers etc 4.3. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3.1. Ivermectin delivery mechanisms The project procure the required quantity of mectizan tablet for the state through SOCT, while the LOCTs received from the state and supply the FLHF which will issue them to the selected CDDs . The CDDs who are also engaged in other health prograrnmes such as distribution of Albendazole and Vitamin A supplementation were also responsible for the distribution of mectizan tablet at their respective communities. Health workers engaged in other health programmes such as immunization, nutrition activities, disease surveillance and Guineaworm control were also involved in the process of Ivermectin delivery either to the LOCTs, FLHFS or CDDs at the community level 4.3.2. Training The training period for CDTI activities are used to highlight some important issues in other PHC activities such as identification of guinea worn, measles rash in children and use of treated net for prevention of malaria. A total of 1677 HFS involved in CDTI were this year trained on VAS in addition to retraining on identified areas of need in CDTI implementation. These health workers trained a total 4,000 CDDs on VAS. 4.3.3. Joint supervision and monitoring with other programs Supervision and monitoring of CDTI activities were carried out at different levels by SOCTs, LOCTs and Health workers during other PHC activities such as home visiting, immunizations, environmental sanitation exercise and Health education. 4.3.4. Release of funds for project activities Release of fund for CDTI activities was carried out at the same time with other PHC prograrnmes. 34 WHO/APOC, 24 November 2004 ! 4.3.5. Is CDTI included in the PHC budget? CDTI budget plan is part of the overall budget of PHC both at State and Local Government Levels. This has made it possible for the State and the LGAs to approve and release fund to support CDTI activities. 4.3.6.Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? Other health prograrnmes that are using the CDTI structure to carry out their activities are the Nutrition section of the PHC that engaged the CDDs in the distribution of Vitamin A supplementation and the distribution of Albendazole to control elephantiasis (Lymphatic Filariasis) . This was made possible through proper integration and training of Health Workers and the CDDs at the community levels. Some of the achievements include:- - Increase in the total number of CDDs trained - Increased awareness and commitment of the CDDs - The therapeutic and geographical coverage made stable. The project has been able to use the CDTI structure to carryout the distribution of albendazole and VAS. 4.3.7. Describe others issues considered in the integration of CDTI. SECTION 5t Strengths, weaknesses, challenges, and opportunities STRENGTHS State Level 1. Good political support by policy makers 2. Approval and release of counterpart funds annually 3. Committed SOCTs 4. Availability of working logistics due to good maintenance culture. 5. MITOSATH's involvement in CDTI implementation in the state is a strength to the project especially as the project is ready for scale up on co-implementation of other add on using CDTI structure LGA Level 1. Some committed LOCTs & health workers 2. Availability of annual plans of action 3. All the LGAs have supported CDTI by either lending moral support with the physical presence of Policy Makers at relevant occasions orland by giving financial assistance to the implementation process. The latter is applicable only in some places. 4. Health workers and CDDs were trained on Vitamin A Supplementation and lymphatic filariasis. This has built their capacity and therefore the project is ready for integrated co-implementation of Onchocerciasis control, Lymphatic filariasis and Vitamin A supplementation Community Level 1 . Increasing involvement & ownership of CDTI reflected in determination of time of distribution, supervision, and increasing recognition of CDDs' work even when no incentives are given. a a 35 WHO/APOC, 24 November 2004 a2. Most of the communities so far treated and where distribution is currently going on have taken on the responsibility of collecting the drug from the nearest Health facilil 3. Generally, the CDDs exhibited a high sense of responsibility and understanding of t} CDTI concept even in the absence of incentives. Most have resolved to continue doit the work with or without incentives. 4. The numbers of CDDs selected by the communities and trained for CDTI has increased thereby improving the treatment coverage. 5. Increasing involvement of females reflected in the increasing number of female CDDr WEAKNESSES State Level o Poor management of CDTI records o Inadequate number of SOCTs LGA Level o Inadequate and poor quality of supervision o Poor reporting and record keeping o Inadequate counterpart funding o Low commitment of some health workers Community Level o Some CDDs had problems in record keeping Poor record keeping o Inability of some communities to give incentive to CDDs CHALLENGES:- o Increased operational costs particularly the cost offueling the project vehicle and maintenance of old one in the face of inadequate counterpart funding and dwindling external support. . Improving community participation o Ensuring annual census updates o Late submission of reports from some of the LGA Onchocerciasis Control Teams. o Lack of incentives from the communities to their CDDs. o Involvement of CDDs in political rallies leading to delayed community treatment and reporting o Political crises in some places which delayed treatments HOW CHALLENGES WERE ADDRESSED Continuous advocacy to LGA policy makers Encouraged continuous community mobilization and dialogue with health workers. There are plans to expand CSM in 2008 Increasing number of CDDs and mobilizing communities to provide registers for census updates and treatments Reorientation of health workers on the need to report adequately and timely CDTI activities during appraisal/management meetings supported by LINICEF. The meetings were also used to address issues on commitment and planning. a 36 V/HO/APOC, 24 November 2004 gnique leatures of the projectlother matters rent has been able to maintain constant financial support for the 'CDTI activities. ll carryout more advocacy and mobilization to ensure adequate funding : and LGAs supports. Also there will be training on record keeping and a a )t WHO/APOC, 24 November 2004