Enugu/Anambra/Ebony CDTI project technical report submitted to Technical Consultative Committee (TCC): October 2003 to September 2004

E,NUGU STA'IE CDTI YEAR 6 ANNUAL, TE,CHNICAL RBPORT I ORIGINAL: English ANNTIAL PITOJtrCT TECHNICAL RtrPORT SUBMITTED TO TI'CHNICAL CONSULTATIVE COMIVIITTEE (TCC) DEADLINE FOR SUBMISSION : To AI']OC Management by 31 January for March 1'CC nreeting To APOC Managernent by 3l July for Septernber TCC rneeting I 7 0rT 2005(9/ AFRICAN PROGRAMME, FOR 1 ONCHOCERCTASIS COI\TROL (APOC) : kAtf lro/o1 COUNTRY OT : NlGlllLIA Launclti4g year: 1998 ENUGU/ANAMBRA/EBONYI NOTF/APOC .WHO PIIOJECT Proiect Narne: Approval year': 1998 lleportins Period Frorn: OCTOBBR 2003 To: SEPTBMBER 2004(Month/Year) (ffontlt/Year')(circleone)l 2 3 4 {,01 8 9 l0Proiect year of this report: NGDO Dartner: Global 2000 Date submitted: 21 July 2005 't L L r- i t .f 4 T Wl-lO/APOC-. 24 November 2004 L, t. I I I ANNUAL PR.OJIIC'I' TtrCIINICAL REPOIT'I 1'O TECIJNTCAL CONSUL.TAT'IVE COMMII"fEE (]-CC) EI{DORSEMENT Please conlirnl you itave read this report by siglring in the appropriate space. OFFICBRS to sign tlte repnrt: Country: NIGEI{IA Natior-ral Coordinator Name: Dr. J.Y..llYA Signatr-rre )..Q-s-Date: Zonal Oncho Coordinator Name: .l Signatu OI-IN EI-U Date: ,*t 21*r NGDO Representative Narne: C.U a Signa Date Cs- o -.o J- This report has been prepared by Name : L.N. Nweke Designation : State o Signatu Date 2l J 2005. ator ll Wl IO/APOC,24 November 2004 _'l I i ! ? Table of contents ACITONYMS ............... DEI|INI'l'loNS ......... FOLLOW UI' ON I'CC R.I,CONIMENDATIONS '". E,X[,C]UTIVE SUNIMARY ............ SEC'I'ION l: IIACKGROUND lNliOltMATlON ""' ........ vI ........... I ..,....,.,.2 .......... J l. GgNrnRl tNF'ol(MAl'loN'....""""""""" 1 .1 .1 De,scriptiott of tlrc projecl (briefly) L 1 .2. PurtncrsltiP .2. PopulaltoN SIiCTION 2: IMPLEMENTATION OF CDTI"""""' 'Itut:t-txtl oI nc-l'lvl l'l lis ..,.......' ADVOCACY MoBlLtzA't t(-)N, SliNSl llZr\ ll0N AND llLAL',l ll lrl)tJt \ lloN (Jl; n I t{tsK c()NllvltJNIl'lF's' Covttvtt-tt tt't Y lNVOl-.V l,MllN l'..... ".. CzrPnCt'rY BUlt,DlNG TnservteN t's.........,... 6.1. Treatttrctilfigure'\... 6.2 l\ltat ure the catt.tes of absenteeisnt? "' ""' 6.3 What ctre the rect.trtrt.s for refusols'/ "."' 6.J BrieJly 4escribe trll kntnvrt ctrtd veriliecl.scritttr:; utlver,ve e\tenl.\ (Si/Es) thul"" 6.5. TrentJ if-trecttmenl uchieventertl front CDTI prttlacl inceptiorr to lhe currenl year 3 3 1 5 ......7 L 2. 1 ,4. .5. .6. 2. 2 2 2 2. 2. 2. 2. 2. 2. 2 z 2. 7. 8. ,9. 2 2 ,7 ',9 ,.9 t2 l4 t7 17 20 20 20 22 ...28 ...29 ...30 ...3 1 ...31 ............33 33 33 9.1 2.9.2. 2.9.3. 2.9.4. 2.9.5. 2.9.6. 28 SI,CTION 3: SUPI'ORT TO CDTI.. 3.r EQUIPMENT...... 3.2, FITIRNCIAI CON'[IUBU I.IONS OF .IHE PARINERS AN I) COMMUNI,IIES 3.3. OTuen F0RMS olj colvlMUN tf i suPPoRT 3.4. ExPlnutluRE PFlll AC llvllY SECTION 4: SUSTAINABILITY OF CDTI OnoentNc, s1'oRAcE z\ND DITLIvERY oF IvERMEC'I lN ' COMMUNI-IY SE,LF-MONI]'OITING AND STAKETIOLDI:I(S MggTTIC ""'"'' SupnRvrstoN ........,...... Provide a Jlotv clrurl of supervisiort hiet'arclt.t'' lVhcil were llrc ntain issues idenlified during rutrtervision? I(as o .strperttisiltn checklist used? .'. " "' Wlrctt wei-e lltc ttttlcotrtc,s ol eoc'h le',,el o/ CDl-l itnplentetrlttlirttt s I4/asJbedbttck given lo llte persort or gr()ttPs ttryervised'? Hoi rvrs the Jtetlback tr,secl to intprove ll*verall perfonnance lrt i- ". L rI lt I l , 4.1 .3. How have lheY ltcen imPlernented? SUSTaNnSILITY OF PIIO.IECTS: PLAN AND SE'l' rAlt(jlrl'S (MANDAI'ORY A't' WHO/APOC. 24 November 2004 4.2. ................. v Yu 3)......... .. ... .,..33 1.2.1. Planning at ctll rclevtmt level.s .............. Jj 1.2 2. Futtls ......34 1 2 -l T'rertt.sltrtrl (reltlu<,cntt'trl trttd tnoittlatttutr,c) . . . . . ... ..31 1.2 4. Othcr t'e,\'0ur(v,\' ...31 1.2.-5. 'l'o vhcu extent lttrs tlrc ltlurt bean ittrytlatttctttt,,l . .... .. . .... J1 ,1.3. IN'r'rcnn'r.tctN............... ........34 4.3.1 lvarttrcclin clelivt't'1, nrat'ltuti.ytrt.r'. ........ .. .....'34 132 Trairtirtg .......35 -1.3 3. ,loirtl .strpert,i.yirtrr tutd urortilttrittg tlith rttlte t' 1tt'ttgr'otn.\'.., ... . JjI 3.1 Releo,se o/.-funcl,s /or'ltrolect crcti,ttitre:; ..... .. .. ... Jj 1.-1.5. Ly L'D7'l ittcludctl ttr tlrc l'llL'budget/. ... ....... JjI -1 .6. Describe other ltcoltlt prograttttltes lhut ut't' tr.sirrg the CDT'l strtrctttrc und ltoy, lhis wcts ochievetl. lVhat Jtote been lhe achieventuttsl . ... ............... Jj 4.3.7. Describe otlters issrre,t considered in thc intcgrotion of CDTI. . . . . jj 4.4. OpsrrzuroNn L ru1suARcn................. ....,...........,....36 4.4.1. Suntmorize in nol ntot'e than one half o/ o pu4p llrc operotionul reseorclt undertuken in lhe pro.lecl ureu wilhh tlrc reporlittg, parrod.. ........... .... j6 1.1.2. IJoty wcre the results upplied itr llte prolect') . . .....36 SllC'l'lON 5: S'IRIINGTIIS, WIIAKNESSIiS, CIIALLIiNGIIS, ANI) OPPOITTUNITIBS..... 37 SBCTION 6: UNIQUItr IIBA'I'UR[,S OF TI{E I,I{0.rB("I'/O'IHBR MATTBRS...........38 a- , L t I rt lv WIJO/APOC. 24 Noven.rber 2004 Acronyms AP()C] A-IC) A1'rO CBO CDt) CI)'f I CSN4 F'l.t-l Irs CI.IAI{IT HOD LGA LOCl' MO}I NGDO NGO NO'I'F PIIC I{EMO SAti sl-lt\,1 SOC'f l'CC 1'Or' UNICEF UI'G wHo All'ican Prograttttue lot' Ortcltocerciasis Cotrtrol Annual'ft'eatment Ob.iective Annual'l'rairring Objective L'ornrn unity-Based Ot'gan izat iott Cornnrun ity-Directed Distributor Conr rn urr ity-D i rectecl l-reatntent tr' ith I verttrcct i tt Conrrn un ity Sc I l'-Morr itoring Irrontlirre I tealth Facility Staff' Clobal I'lealth atrd Awarettess l{esearch Foundatitlrr l-lead ol- Departntettt Local Coverntnent Area Local Onchocerciasis Cotttrol l'eattt Ministry of Flealth Non-Governrnental Developtnent Organization Non-Governtnental Orgart izatiorr National Onchocerciasis J'ask l--olce Prinrary llealth Care Rapid Epiclenriological Mapping of Oncltocerciasis Severe adverse event Stakelrolders nreeting Slatc Onclrocerciasis Cotttrol'l'eatrt 'fechn ical Consu ltati ve Com nr ittee (A POC scienti fi c advi sory grotrp) Trainer of trairrers United Nations Children's Fund U ltirnate Treatment Coal World Health Organizatiori L , L I I I Wll()/APOC, 24 November 2004 Def initions (i) I'otal pqzlllaliqtri the total popLrIation Iiving irr tneso/lryper-endetrlic cottttllut-tities 1ii) within tlre pro.iect area (basecl on ILllMO attd cerrslts takirrg). Eligible populatiorr: calculatecl as 84% of the total popLrlatiotr itr tneso/hyper- endetttic conrnttutities ilr the plojcct area. (iii) AnnLral'l'r'eatrnerrt O ective (A'l'O): the estitttated nttntber oI pet'sotls living in rneso/hyper-enclerric areas tlrat a CDI-l pro.iect itttends to treat tvitlt ivernlectin irl a given year. (iv) L]ltirnat.e l'reatrnent Goal (Ul'G): calcLrlated as tlte tnaxitnrtrtt trtttttber of people to be tleated arrnually irt rneso/lryper endernic areas r.vithirr tl're project area, ultirnately to be reached when the pro.lect ltas reached frrll geographic covetage (norrrallytlre pro.iect should be expected to reach the I.JTC at the end olthe 3'd year olthe project). (v) Therapeutiq ErygIagg-lrttmber of people treated in a given year over tlre total (vi) population (this should be expressed as a percentage). Geoqraplrical coverage: lrumber of contmunities treated in a given yeat' over tlre total nunrber of meso/hyper-endetnic conrtnunities as identified by REMO in the pro.lect alea (this slrould be expressecl as a percentage). (vii) lntegration: delrverirrg aclclitional healtlr interventions (i.e. vitantin A strpplernents, alberrclazole for LF, screening for cataract, etc.) thlor,rgh CDTI (Lrsing the satne systenrs, training, supervision and personnel) in order to ntaxitnise cost- el'l-cctiveuess arrcl crrrpclwer conlr)ruuitics to solve tttorc ol tlteir lrealth probletns. This does not inclr-rde activities or interventiotts carried out by contnrunity distributors outside of CDTI. (viii) Sr"rstaiuability: CDTI activities irr an area are sr-tstainable rvhen they continue to l'unction eftectively tbr tlre lbreseeable litture, witlr lriglr treatntent coverage, integrated into the available healthcare service, with strong cotnnrttnity ownership, using resources mobilised by the corntnunity and the governmellt' (ix) Cornnrunity self-monitoring (CSM): The process by which the comntunity is empowered to oversee and monitor tlre performance of CDTI (or any community- based healtlr intervention prograrnrne), with a view to ensuring tlrat tlre progratnme is being executed in tlre way interrded. lt encourages tlre conrtnunity to take fi"rll responsibility of ivernrectir.t distribr-rtiou and nrake appropriate rnodiIlcations wlren necessal'y. ,L t- I I I vl WFIO/APOC. 24 November 2004 FOLLOW UP ON TCC REGOMMENDATION$ 'fhc table belorv shorvs the lccornnrendatiorrs of the lasl"'fCC orr the pro.iect and ltorv they liave beerr addressed. 'I'CC session _20 Nrttnbar of Ilcc'rt tt nt tctt tlu liott itr lltc Il l6 (i) 7'CC R E CO lII IIT D N D.I 7' I O N,I tl('TlONS TAI(EN I]I' T'IIE I'IIoJECT' IIOR 1'CC/APOC MGT Lt,tE 0Nt,t, Subnrit separate tcchnical reports tbl each state irr tlre lutule usirtg lhc ncrv repolting li>rnrat Eaclr state has rtolv subrtritted a separate techrrical report using the riew forrnat as eviclenced here. l(,(ii) '1'lre NOCP reacl (hc rcport bclbre serrcling it in olde r to ensule that clarta ale acculate and consistent NOCP has gone tlrroLrgh the report l(.(iii) Intensify advocacy at all levels lbl releasing lunds frorn the states and I-CAs Advocacy visits were paid to top ministry oI health officials to explain the post APOC sustainability plarr for Enugu state. 'ilris rvas lollowed witlr a well-prepared rnerno lbr the l-lon. Cornrnissioner for lrealth for plesentation to His Excellency, Goverrror ol'Enugu state. Unfortunately, there was no positive financial outcome. Advocacy meetings with sorne LGA Chairnren to solicit for CDTI suppom at the LCA level. Letters were also sent detailing their roles and responsibilities. This effort yielcled clividend as they provided various surrs to support the CDTI activities.I Wl-lO/APOC. 24 November 2004 t Executive Summary a l'his report is airned at covering activities executed by Entrgrr state CDTI pro.lect in l5 otrt of l7 LCAs in its 6th year tio|n october 2003 to Septenrber 2004. The project was evaluate<J in J,ne 2003 ancl its tiincling for phase I ended in Septernber 2003' The partners for tlre cDTI irnplementatiot.l are tlte APOC, Clobal 2000, health services at the F-ecleral, State and l,GA Levels and the onchoccrciasis aff'ectecl villages. The activities, wltich were implementecl during the period under review, inclttde Aclvocacy, mobilization/ Health EclLrcation, tr.ain i ng, clrug d i stri bution, nron itori ng and superv is ion. The population of the state lvas estitnatecl to he 3,041,959 people with only 897,088 people registerecl for ivermectin treatnretlt. A total of 1373 llyper/rneso endemic villages were under treatment. Village was usecl as a basic unit tbrtlie selection of CDDs irr Enttgtt State' All the 1373 villages were treated witli iverrlectin ancl this represents 100% geographic coverage' The Ultimate l'reatment Goal (uTG) being sanre with Annual Treatment objective (ATO) was 753,552. Therapeutic coverage und utc coverage stood at 84'2%o and 100'3% respectively. . A total of 2,287,215 Mectizarr tablets were received bythe state projectduring tlre period uncler revielv and out of this qttantity, 2,27!,9!5.(99'6%) tablets were used' There was t1o report of any case of seriorts adverse events (SAEs) due to Mectizan treatment The popLrlation rmoventents accounted for a nutnber of absentees recorded in this report' The creation of adclitiolal 39 LGAs precipitatecl heavy nrovement of worl<ers following transfers especially that of LOCTs and health facility stall-' Targeted training of CDDs, health facility staff and LOCTs was conducted' Out of ATO of 3,432 CDDs, orrly 2,547(74.2yo) we re trained. And of the nunrber of cDDs trained, 1,176 were new. 93.3%(353) hLalth facility staff received training out of 390ATO 199 of trained health facility staff were new. Orrly 42 newly LOCT/heads of health departrrrent were irrcl,ded in the total of 90LGA stafi trained. The total population (conrnrLrrrity) per CDD trained was 352. Major clrallenges facing the project include coping with advocacy at LGA level dtte to frequent changis of the authorities, continuous health education and rnobilization for a long- term compliarice to treatment, sustainirrg entliusiasms in the cornrnunities to contintre taking the drug despite improved health status, iraining of health workers in the LGAs occasioned by the new LGA creation and staff transfer, effective distributiorr of Mectizan in event of integration of other programmes into the CDTI structures and ftrnding the training of new CDDs as a result of tlre introduction of the kindred distribrrtiorr systeln. Wl lO/APOC, 24 November' 20042 t- q t t' u I { !.. . 1It aSECTION 1: Background information 1.1. General information l,l.l Description of tlre project Irrrugu State rs geograplrically locatcd in tlrc SoLrthertt zone of-Nigeria betrveen 7o l0'N ancl 7o 45'N of equator, and on longitude o17.4878"E arrd latitLrde of 6.4231"N. L,nugu state is bounded on the North by Kogi/Benue States. on tlte Sotrth by Abia/lnro states, orr the llast by Ebonyi State arrd West by Atrarnbra State. 1'he topography,of tlre state has trvo marl<ed zones, hilly or tnotttltainotts and flat zones. 'Ihe hilly zone stretcltes throtrglr six LCAs (Arvgtr, Udi, Ezeagu, Oji-River,Uzo- Uwani ancl parts of Igbo-Etiti) rvhile the flat zone covers the rernairrittg part of tlre state. The hill1, p21,,,'. of the areas mentioned above gives rise to rapicls and rvater[alls that exist irl rnost rivers especially Oji, OgLrrugu, Ajali, Duu and Kalawa rivers. The bioclimatic zone is rainforest in nature r,vith annual rainfall between 152 cm arrd 203crn. -l'lre clinrate is conrparatively equable and the tentperature ranges frorn 72.4oF (22.2"C) to 87.5'F (30.6'C). lt is the hurnidity rather than tlre ternperature that causes discornfort to ltewcomers and is betrveen 78%o and95%. lt is generally cool during the rai6y season while the rlearr temperatute in the hottest periods of Febrtrary and April is abor-rt 30.6"C. l"lre state has a land area of 7,617.82 square I<ilotneters and a population of 3,041,958 people. The activities of the population of Enugu state are farlning, fishing, hunting, petty trading, wine tapping, basket rnaking, poultry keeping and rearittg of dornestic anirnals. With regards to the main occupation, whiclt is farntitrg, the periods of tttajor cornlnercial activities run flronr November to February, wlrich is the period for harvesting and land clearing for cultivation. 'l-he people of Enugu state are of lgbo etlrnicity herrce speak lgbo language. It is a tribe with hornogeneous cultural and linguistic origin. 98% of the population practices Christianity as their major religion wlrile the renraining belorrg to the idol worshipers and other religious sects. J'lre communication systents available irr the state are post olfice, courier services, telephone, and Internet services such as e-nrail for both day and night browsing in various cyber chafe centers in tlre state. 'fhe state has l7 adrninistrative local government council areas (LCAs) of which l5 LGAs are hyper/meso endenric for onchocerciasis while the rentaining two is hypo endemic. Each LGA consists of communities with adrninistrative head called lgwes or traditional leader. Further, community consists of several villages with administrative head called village head. The basic adnrinistrative structures are the state, LGAs, communities and villages. The state health care system is built on the basis of the responsibilities for state and local governments. ln Enugu state, the health system is evolving into district health system with 7 district health authorities but still based on Prirnary Health Care (PHC). 'l-he state governnlent upholds the systern as the main focus of governlnent intervention for meeting the health care needs of the rnajority of the people without under rating the inter-linkages with secondary and tertiary health care levels. The PHC systeln operates at state, local government, district and community levels hence the integration of onchocerciasis control activities into tlre system. PHC services in Enugu state are delivered through health posts, healtlr clinic arrd health centers. In the project area, there are a total of 332 out of 355 health centers/postsiclinics irr tlre state. L I , J t- I I n Wl-lO/Al']Oc. 24 November 2004 'l-able l: Nurnber olhealth stal'l-irrvolved irr CD'f I t,(;A Nurnbe l ol'heultlr stufl'involved in CD'l l Irr:tivities. 'l o(al Nunrbcr ol' heulth stnfl'in tltc crrtilc ploicct itlcir ll' Nunrbcr ol lrealth stufl'irn'olvcrl in('l)'l'l l|, l'c rc c n tit gc ll:=1117 trt ",U,, Aninri 48 lt3 30 62.3 6l,lArvgLr 69 F,nugu lrast 8l 5l 63.0 llzeagu il9 80 612 7s 0 70..1 lgbo-Etiti Igbocz.c North 5(r l0lr 42 '76 lgtroeze Soutlr '73 43 589 lsi - Uzo 4) Itt J2 L) Nkanu East t09 66 60.6 Nkanu West 8-s 72 847 NsLrl<ka |7 '73 62.4 52.9Oji River t2t 64 Uclenu n7 '10 5 9.8 udi t6t 82 50.9 Uzo Uwani 159 '79 49.7 'l'otl I I 509 842 55.8 I .1.2. PartrterslriJl Partners involved in Enugu State CDI'l project itnplenrentation are APOC (external donor), Clobal 2000 (NGDO), health services at Federal, State and Local Government levels, and oncho affected cornrnunities/villages (1373 in nuttrber) The overall working relationship among all the paftners was satisfactory and cordial as evidenced in the achievements made in sustaining the cornnunity-directed ivermectin treatment thror.rghout the project areas. The specific areas of project activities where all tlre partners were involved are planning. training, mobilizatiorr, advocacy, drug procurement and storage, distribution, supervision and record keeping arrd reporting. l'here is a plan to continue to rnobilize the tlecisiotr nrakers at the state and LCA level including the WHG-assisted healtlr Systen, Development fund ll Enugr.r, NCDOs such as Partnership lbl Trarrsfornration of I-lealtlr Systenrs (PATHS), credible NGOs such as Global Health and Awareness Research lrourtdation (GFIAIf F). CBOs arrd individuals that , 4 WllO/APOC, 24 Novenrber 2004 I ? tl can assist in CDT'l iniplernentation as cotttaitted in the developed 2004 -2006 sLrstainability plan of the project in 2003. rt I{- 5 t- {I ii I I WllO/APOC, 24 November 2004 l-l 'tINlcr- N lo ls-r .. rE?o :1' =F E!, =Fl9-oUT tr) o- o -o Eil3. o =.th =' o o =.-.tf! .l o G .) 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D' -o' I NQ.(!d (! -I il + z (D r) o ot, D' IEIGt) {t, 5 oo\o o o trJ UJ { {O 5 o\\c) o\\o A bJ -I\o \o 6\o -to66 (, ! +\l.J (rl{ s N) Ul{ 55 ;{ A5 ;tJ oo LA\] 5 N) oo Lrl\] !(}J @ {(,J oo O u o\ LAA oo (, o\tJtA oo {O t.Js L,I{ N)5 o\(,.) tJJ t,(J) us o\ -l (Jr A o\{ o\ o\ o\ o\{ o\ o\ o\ o\{ (rr(-,t UJ(rr{ (-^(n UJ(.,r{ { o\o\{ { o\ o\{ A 5{ o\ o\ oo oo o o\ oo oo o o\ -l(,r OO o\{(, OO Eri ;.5 0q,D* x E'=P;Fg;E. :JN <i99+{ o 6 cL<rB5'gE E r' *B +Xoo =.>sN 'E' ='o6- 6r il + FU E !t o o o\5 oo o\ o\AUt oo o\ o\ UJ UJ UJ UJ 5o5{ o\ {(,I(, Urrn b,J (,r 5tJ(rr tJ s ooOOO 5 ooaoo UJ o\oOo o\l.J Oa s{(,rOO 5{\ooo (,) N)O 5utq oo ( o^\o O 5 o\(.|! oo o\o t.Joo tJJ5o P (,{ ooOa (,a! o\{OO e[5 "-E IHo o\ l- a .\ -> as- l-J -5, =a.< G q t..J -s L I I tf S\i-i :F \]sil *r =*oqtAR)Xl\ -i\ €sSs R= SH oa= S=XcF :.l\ =i6\ sR :.86.(\ <o3rx\ -G\5 SFs] rl.::dsDSNA si ^i :!dRe)b Sgot dsss -! *E GE ^st\ ,O !4 BS: :r t1 sdl!q\ e,* i\iq :(t .osRspsI a G 'i o s(\\G or\ S(\ s (\ .T G c: B a DD o tD ?,h (, o €. o .) o oq a! (D o >l oq o o .\9 o(/, l' z o +- zp a1. ^3. =o) =;+() -, .D(, 5 o ln o 2.dtro o+, 005 3* olD C. tJla lf- lrDlo)Io- lole- ^<i--i (Dl,i .-rU l I I I , I I I o .D o ao r} U) 13 CDo o PJ :1 6 il EE - Ar/ - rL. AH-Vo .D;!! E .AJQ ao-lD*A)P :.E H; .i 5i Q c - n>"l,a Y*U+ J ^ -]'(D:i.oQ(DA)= r O- (rq ii ='NE(DH:36F o-o id IJ rpJ19 0+ f)3..05o ai = -Erc E UUA+ '-h,-. = -aD,J J I' - ,aa o 3:i=i UHi'lotrno=t, E-F d +vLJ + o-5 O. =tJn.DrD tsIo=o P :oqA ,o; - =a:o+t: =59 t xxl, -{ J.+3=6(D= O-o =6't,i++ o0(!o5+J:: --o)eP3;s= :.e5= LEH 1.7 -8gq 9 tFA3ri9rD5'(e +?Fl 5XI'qEa' lD<4 -. -(D +rdartr r:Eor3(DJ5ti)+EA)5=, dr1.,. -+sr0aHo={/i+tE6,oHr * o z :E o -tr t t.J5 z o5 q (D }J A L t- I L I l t { 6- q SECTION 2: lmplementation of CDTI 2.1. Timeline of activities Irill in table 3, lintelirte oJ'erctit,ilie.sJitr areos lrealed incurrent-),(,ia., indicating rvhen the key activities were itlpletnented by,the rnonth they began arrd the nrorrth they ended. i d , 8 WHO/APOC, 24 November 2004 I J 9- (! o tr)o =f, 5'a a (D FD CD tr) (D tr) (D o- <D QE = (D I o ^(Du)) <A NO a ta. o< :rD .)=' O+ o-5 ^. aD .D(D(Ds =.ro--()o.^ O-^ AE -i o_dqE(D x'rDYX CT FD\/=jo-Pa0 =o-5o rD(-q !ro ,>a <o =a =.>oi, u)= I 4 7 rt-t *IozOFT -o DJoo 2. o U rD r) NJOOt, \o < + =-\,ar) r.-J -sz 5 =q ]'.J: -s. {- t II u I t 0a o. o oNo 2. o35- UA(t o I rrj rrl No FD 0q rrl Uq FN FJt/) (rq '-l t-oa F.l r< C No C DJ C ET C o- f) a) ,-Y.i rD a za E 7i FD z/, F) t .Da z lo J rx c0o 2. C N o Uq(t (D No QN o z- H8(, z o CJ C,) o o o(, )_- (f o r) o(, _a :il 0q a) o o OJ Z o o CJ o O(, z o (,) o o a+ O(,.) )__ o oo O(^) o o (, U o O(, 33o(oAC9 a oE a+ NoO .5 N>OCo(oSC(t a o! ai No a)A N} 3E5b l\, P 3Esb NP 3E5a N} 3Es; 1 N} 3E(,A Hg c(o c @t* o5 c(o c at) ?+ o5 o o3eo* = g.+. ?aioo =5 ES5+ =6(D' A) os N<o0,8+ N) >r 8Es= _a i= 0e N(-ocol5(D FE NLoco:lAO FE N) (-ocof,5(D -n og o5 N)LocO:f5(D (_ c N)oo5 N) (-ocof5(D c-c :J o N)O os (- c :f(D Noos 1' -1.NOo .s z_ o) o .s o o339'o +O53. o -l D' ,q (_ C) o NoO5 (-- c =o Noo5 c :l o Noo .s (- f, o NOos (- f o No(f5 fl o I O ,s C- =o N)oo5 (- c N)OoA I U o s, o()) (- o)f Noos o o9 O(, lr) eodo=s oo s, o(, 1 (f o9 o(, oo s, O(, H8 oo r) o(, N(_O o.r RP (f o9 o(, z o s ci(r) =9o= =4+5 oq (- c N)oo5 (- C :f,(D N oo5 (- c :J o Noo .A E -1. N) oo5 1 o) Noo5 o 33 ;'3. o o(D ta I' Eo E' (D (- Cf o Noos (- c a o N)oo5 (- cJ(D Noos (_ Cf o Noo5 (- c) o N)oOs I frC)I o .r (- cf, o NO o5 { l$ c-oco:,5(D N(-ocof5(D 8*ox{b! : ts<8e -ad95t +l' oq N(-oco:,5(D N) (-ocOJ5(D N) (-ocofso N(_ocof5(D N) (-oco:lAO N) >> 8E as!: N(-oco:,so (- c Noos a o!t-| NooA a ool+ Noos @ oo a+ Noo5 a oEt+ Noo5 -P8Esb { ruP 8E5a; o 333s;o o r. rc a tn E' o a olf :-| Noo .s U) o 15 !-r Noo5 a o -o :-l NJoo5 o oo a+ Noos a olJ!+ Noo5 1 @ o 1f, a+ N)oo .r HF N(_oo, R7 tu3oo)8+ 1 Hr =9 =B5.+ =l oe N, (-Oo, R= NcOo,Oa!- (f of, o(rJ N<_O0)O-S- oo r) o G) -n oI o5 (f o9 o G) HE 1 r.-t I 8Eaa *D 8G5ii -P8Esa; N)>oao(o5c an -P8qsb f.., P 8E5b U) oE :-r Noo5 uP8q5u; f., P 3E56 I r.o P 8Esa r'r I 8E5b -P8Esa; o 3g Oi o t a 1Jo 0 o - --=-r=--Fru!i: I2,?, Advocacy 'l'he project rnobilized foLlr l<ey policy rnakers at the state level, rvhiclt incltrded tlre I.lon. Corlrnissioner for health, Perntanent Secretary, Directors of prirtrary health care attcl Iinance/supplies. At the I.GA level, 15 LGA chairtnen were rtlobilized. The rcasons for undertakilrg tlte advocacy ilrc as ftrllorvs ' Most LCAs arrd State policy nral<ers wcl'e rlcw and thet'elbl'e l<new ltttle or rtothirrg about the prograrntne's philosophy. ' 'l'o brief thern on the sLrstainability plan cleveloped by both the state ancl the LCAs at tlre eud of the progranmre everluatiou in 2003, anci their roles and responsibilities. ' 'l'o seel< their suppolts towards lirllillirrg tltcit'own part ol'thc sustaittability plarr. Tlrc outcornes of the atlvocacy are that the prtr.iect st"tcceeded in getting filtancial sttpports fiorn the LGAs notably Uzo-Urvani, Oji-River ancl Udenu for tlre itnplementatiorr of CD'fl. activities. Although there was no release of fund at tlte state level, the decision mal<ers appreciated the problent of the prograrnme ancl promised to assist rvhenever fund rvas available. Apart from thc financial conttibLrtion, awareness and populariLy about the CDTI activities iu the state has increased. Diffi culties/Constrairtetl being faced r Frequent charrge of policy nral<ers at both the state and LCA levels. For instance, within two nronths (May-June) in 2004, the rninistry of health hacl three comrn issioners. . Logistics ploblenrs and lack of lund to repeat visits at tlre LCA level. Suggestions ou horv to irrt;rrove advocacy , llepeat visits to the decisiorr nral<ers whcrtever there is a cltange of leadership at LGA and state levels. . Sustairred high-level advocacy visits by various partners - APOC, Lions Club and NOCP to the state governor alrd top govenunent officials at the state and LCA levels to solicit for support toward tlte.pt'ogratnlne. 2.3. Mobilization, sensitization and health education of at risk communities The use of media artd/or other local systems to disseminate information During tlre period under review, radio was the only nredia used flor inlornration dissenrination. For instance, radio Nigeria Enugu interviewed the state onchocerciasis coordinator during the onchocerciasis day in February 2004. The use of radio was very eff'ective as eviderrced by the large turnout of people living within and oLrtside tlre state to inquire of Mectizan treatment irr our office.'l'he few calettdars provided by Clobal 2000 were distributed to the top nrinistry of health officials and some LGA personnel. Other print media such as posters, brochures, flipcharts, handout and handbills were used but inadequate irr supply. Other local systems used to disserrinate information at 1373 villages were town criers, church announcements, sclrool anllolmcelnents, village/comnrunity lreads, village/group rreetings and market announcernents. These were usually used at the beginrring of tlre distribution or at any stage of the distribution where necessary. a l0 WllO/n POC, 24 November 2004 lVlobilization and hcalth etlucaliorr of connrtunitics ilrclrrtliltg *'otttelt altcl lttittorities Bef,ore the contrnencement of drug clistribution, intensive rtrobilization arrd healtlr edttcation were cal'ried out in all tlre villages. I'he airn was to elicit their ittterests in pal'ticillation by senditig their CDDs lbr clrug collection and distributiolt, support the Ct)Ds attcl actual intake of tlre drug. Also, the adverse reactions issue was addressed and how best to Ittatlage them. Wornen were charged to errcourage their chilclren to palticipate irt tlre yearly treatlnertt. They rvere educated about rvho rvould be eligible for tt'eatntelrt, They rvere flrther renlinded tlrat pregnzlnt wonten and lactating rnothers shoulcl participate afterexclusiorr;leriod had elapsed and that sicl< persons slrould also tal<c Mectizau as soon as tltey rccovel'ecl. Response of target contntultities/villages -['here was high turnout of target villages for the treatnrettt. All the villages ensured that they received treatrnent by serrcling their CDDs.Atrcl sonte villages also replaced sotne old CDDs particularly those CDDs tlrat have lett thc progranlrne fbr greelrel pastttres. lltlusclrold hcads ensured that their hoLrsehold members received treattnettt. Lactatirrg nrotlrers ancl pregnant wotlten later sought and received treatnrent aller expiration of exclt"tsion period. Sorne villagers rvho considered it unnecessary to receive treatntenl becattse tltey were no longer lraving the syrnptotns submit thentselves to treatlnent. Acconr plishments . Tlre project attained a therapeutic coverage of 84.2'h dtrrirrg the period rtnder review as against 78.23% in tlre year 2003. A total of 755,674 persotls were treated out of 897,674 persons registered in all 1373 nrobilized villages' . 100% geographic coverage was sustained as all 1373 villages received treattnent. . The nulnberof persons wlro refused treatment reduced frorrt 175 in 2003 to 58 irr 2004. . Irnprovement in Cornpliance rate to receive treatnrent after the expiratiort of exclusion pcriod by lactating tttothers and pregnant wotnen' Suggest rvays to irnprove rnobilization and sensitizntiorr of tlte target cottttltttnities . Promoting the use of video films for health education at conrmttnity level. . PosteLs and flipcharts should be redesigned to show pictures of those wlro got well after treatnrent rvith Mectizan. . Providirrg bicycles to health facility staff to enable tltem access difficult retnote areas especially now that kindred systerl of distribution has been introduced in solne villages. I tL t il I 1 lt WHO/n POC. 24 November 2004 I! x "I -l 1 ,, -t q) -c E(.) z $ cl U o o :E c\ a ll + c0< co ca ! 8se'5 €i =885 Etuz. e'= loiDo lcq ;L a oO 'Ev EEtrE Ot: v) 9q Eb6 =sZ.F 1 o, ootr) rn $\o c] o, ca co$ =q F-. tr- O.\o ,..j a@ q a.l v-t o9 c.ltrl n t-- n \o CN \o oq @ .(- cO tn =q c\lr) \it(o (o|t- oN r.-$ CO$ rr)cf) N(o cr)c., N]t- rr)l'- ro(o cf)$ $$ $@ $ o, r.- co + qi I la ca c0 H H() I ( 'F ij l I iE 'oilr ,U I .9 tr E o €= (9 HU L I E z. r.o r N r.o f.-- o@ cf) @ o) l.I., N Oo(o o ro O O)N (o .t (o N (o co f.-NN (o(o o cf) - .t rOoN .t |t.- t-r CE rf)6 oo N @tr) r--\t r bs o O) o,v o CO$ f-- @ of.-r o\t c..l co .{- cO \o co cf) co ost - t-- O)N co r-- C) r.O N $$N O) @ (o r O) cf) r N co N $v ro r s co$ cO o cf) r tr-\o (-.{ .=f q'= qp; D= .- LEq Eq o- 'za o1 ll + co cQ d ca H >,2 ? =t-2 =e!>F! L =co 9Eo ?qF;.: .L I - f 9lGeuX ,-Feo o!t! L o L 'Z O Or- OF- o :_ c.) aO OO :: C. ca O -l O(-l : O c.l OO OO O o.\r -:l OO co o.@ o -t =t U \o c.) \o c.) O a.l\t c.l$ O t-- F- F- t-- a.l (..l\o aar- c.) F- O a.lt-- cl : Oo l- O oo O ao r)r-fa a.t rr ra O J .T tr tr br) (6 IJ-] =bI) =E tl-l =br) d() NI! .= r! Io -o br.) (J Nu,q VL Al) -7 (.) N0),C g,; o N) '- <h d LL] cd z b(J tr cd Z (! Z L a) .a d, \J E Oro3 E) .E d , oN) NF F !U (J .E E .9 6J .go .E c0 o- (J :E =E C oQ -rt ol 5l colFI +, tr o E(,i o .E E trf E E o o q N II x :l .F +ooc.t L0) F(,) Z $GI OOo- o = a-t o0)'(, '= q)9()a€oo '. .E(JE d9 a?(UA vE Hg L.t c(-); 0J -q o.tr E'oE< oh c.r:l boF(d q=(!>to 9-(.) ol)!s.g '= q<2(d E o-r()- d :ifEl >. '-.o C)PC)E 'a9 LEo. 0) ar9 Po' LdJ _oL 6.-=E HG fr8 PEo O'.= l)t rE#Er.,:,Tat6Ioro, .i,- '= ro 6t'o .to7a Bo:cdO!LJ os PO = .h a\) A()cduC .>.8I bE oE 9 .- u \w +.5 o.rE! - A,o;F - iR t:LH o *o-LJ () q) 0,, !.9 b+ " z€;39>_(:.= oJ n H!^tr H P L-.]6Igu -o a'; hQ>-" , ? -=aqi H 6loJ6lO :P(g\w9-to ! bn- tv 'i='r, IE I 6'q, rv u - ..A)V ,!<E€ \oo\9(.a g<cao C'FboE(oA =_';q uD (s0)-b0d GIPE5 Etroo .l- () s6 .tro so LOo- =Pocg6 -C,c()c) >o. 6)Fo;ig5 e(UCIE QA o;(Jo o8 b9pO-= 5>c()a -33ciFFA "; dj L)QETrl i; o-(J =o,I bON 'ii 5 tr)Y c'7XErlrTl-l '15 a h6 ().=:UE: = or O-t, oE Q= ce3XL . 6l:-(g €378,, n P{)0, E .y-: h oe= Y >> dta>tw =RQ'E;THg EE9 9 - -c\ 6)AL.^L l^+g -^Y;.:;::v:srU r^ U'- -a.;€ Y () o-oE d.r E o- \o nndJ 0r-* .= s=;F=Xo.UT-HA:;a6i<Qz U)ot, UI (') .2 v oo L '6 a ,o) l- G U)o -an U) .- F aU t o - rn a0 EEa(u E I 'E \do\ = t^..ll-N8oE! .Ee5?av^9ig) ol EEE E -8E<Dha) .98 ; J=9-l-u6l!c)C):.ts € EEE E E -e€ E H =oo6r -E= H 'uldj-0)q)aerHLi'9 E?if .rE-!.-Er E I r -:E cc.! >j b .*3 eoE(J5luuts'Ea5q)oL.9^Eb E_rb!€ ,9€9 E EE tr rnQ)!(JI e cr.E E .5a, EruEC L.9Ec)E=eE:q i +gv.=:C!oJEr-"troo-1.:cE+ E EE .:'= E O P i 9.-tr crN F tr.gO Um - (! P --gdk ;VHrs- b F n9:E oo.y o_r E e s s Ef _a<l.),, ,t- 2.5. Gapacity buildirrg l)escr-ibc tlte adequacy of availablc knowledgeable nlilnl)o\vcr at all levels. At tlre state level, tlre available l<norvleilgeable SOC'l'rvas adequate.'l'he state teanr conrprised the state coordinatorattd four SOC1'rnembers. All lrave been in thc progranrnte since its inceptiorr in 1998 hence rvell l<nou,leclgeable abotrt the CDTI activities. At the L.Cr\ level, thcre vvas a shortage of knorvledgeable r)1anpo\\'er. T'his rvas as a rcsult ol'creatiorr of 39 additional LCAs/nrany conrrnunities in 2002 b1,the Governor of l:rrugu state. N{ost of LOC'Is alrd I-lealth facility Staflrvere either transferred to anotlrer LGA or l-lealth Facility or proltrotcd aud tlrerefbre hanrlrrver to inexperienced staff'or even conrpletely leli tlre health departtttent. Sotle LOCTs rvere rnade heads ol'lrcaltlr departrnerrts irr sonte l,CAs. At the comtttttnity, the ratio of CDD to household was still inadeqLrate. Sonre old knor,r,ledgeable CDDs had disengaged frorn the prograrnrne due to green pastures, old age, death, and ,..i,,-,,+i^.. ^- ri-,-l ..,irl. rl.^llIlE;l(ttlUlI uI Lllll'J Wltll LlIL PltJBldllllllL. Wltere frequettt transfers of trained staff occur, state rvhzrt the project is doing, or intends to do, to rentetly tlre situation. (The ntosl irttltot'lutrl issuc lo describe is wltut trte(sures were luken kt ensura tdequule CDTI itnplenrcnluliutt nthcrc nol cttouglt knowledgeuble munpon)er x)os ottailuble or iJ'slnff ure Ji'equentl), trunsferred during the co urse of the cunrpaign). ' Heads of health departtnetrts (HOD) slrared tlre cornrnunities arnong the rernaining LOCT tttenrbets. Through sheerdedication arrd hard work, they rvere able to cover those conrrnunities durirrg the period urrcler review. ' LOCTs assisted tlte ttew untrained llFS. Besides, those untrained llFS were given a rvritten guidelines ort what to do to reach the CDDs without fbrmal trairring in order to fill the vacuurn. ln some cases. the old HFS before leaving trailred the HFS. ' The retnaitting CDDs lrad to reclouble their efforts in order to cope with the workload. ' ln future, the project would involve all the health staff by training them on CDTI activities. The I'lODs would appoint nerv LOCTs arrd more CDDs would be recruited based on their kindred. t4 WliO/APOC, 24 Novenrber 200J 2.6. Treatments 2.6.1.'l'reatrnenl ligures 'l hc ;lt'o;cct ltas tttaintairtcd a tl,critpctttic covcragc ol ahovc (r,5')ir sirrcc lt)98. Also. it Itarl strstairrcrl 100'Zr gcographic c()vctagc attairrcrl ovcr tlrc 5 _r'cirrs t7 \A llO',\l)( )( . 2J Nor crnhcr 2()l)4 t l-l lpDlc]- lro l-r -l - cD 3 o CD o- v) trj6 o- f. o - LJ 5' g A)a(D tDo t') :. U,x f,r fnFJ :] e,E 10q I -o - ,9 ry (.D z. U)C 7: ,z , o z vi lD ra CD C N o iq a- oo N G o 7 lta o- o @ N o z c 7 0a o I rn =i.i. rd N rD tD(ra -l -l t- -No C 1 FD C o-o' Oo IJO UJ UJ {O Az^h'tlF=tr5;qa 5 = -i 10 j o _ ,,< _ f tP!==^ o - -ft:.60\ (,{ UJ co o -_l IJ -lUJ a TJ {! 5tJ (! J: co,o +,\o \o OO N)O UJ UJ --]o - ^*lqd P oEI ;ON rif- t,{(, co ! TJ !U) tJ --l! 5t.) UJ 5 oo t\)O UJ (/J ! oO- i.i- = Xii8 =:ga (, -J UJ co \) N) ! UJ 01 tJ {{ A NJ UJ o\ 5 @\o A\o O ,v ^"* ll o oQ ^ i'E ::g qi o6' !L Oo O O oO O O O O O Oo o o 3 3 5 6'6\ s TD(ra rDa Oo O o O o o\U) UJ(! UJ LA5 o\{ o\ o\ o\ o\ -] Ur UJ{ -J o\{ 5 s{ o\ oo oo o\{ JO ^' +o L o,a i9g-o o Lt6D H, 6 = €\o -J e6 o\A co -J At,) ! .sA 5tJ coUr{ --J UJ a o Ur o\(JhA oo L,rI\t t.J5 s{(.,r Oo s{\ooo L'I()J l.JO 5 LA LA O (rr o\o o s o\ LA o o\ tJ o (, 5 ()r{ oo o L'r o\{ O t ^-l#E 5o5= =.d 6o* -lUI(r.) Ul() b.J Lfr5 N)(^ t.J 5 ooOOO A @ o UJ o\ Oo o\ NJoOo z --O c =o=69dod o N) \o {{ -J@ 5 6 5 UJ IJ 6 6]:\o 5 oo o\5 E{@ N)5 l.J l.J\o 5 .l: +: 6 o\ o, oc \o o\ U) 6 @5 o' IJ { o\\.1 5 @ 5 YY *ll o -to=CG s8€vN O0ac o aA io oo o\ oo O. oo ! oos\ \o l.J io @ 00 io @t, o\ @I @ItJ @5L oo IJJ Lr oo !., oo :r' 'ooEE A) o 6 6 l'.J tJ { NJ d1 It$r,E55 8_*6 r o_-Ji5+O^ o5 o\\o st) -J 5 5co {o\ o\ { { ool.J \o i'JtJ o\ \o pZ6tr335d6qo^ O O a- U'1 H* o o O o O Bsta*si €.+a f * E i6rg a oo < -t-\_J B...- -E -tss -)> 6- (.tS 3 rb l'\) =: L i-r r u I I f , *t =rDI ED -o rD \-d v.) o o Cot A) OQ(D 5 D) o o o o r,a -A) 'd f-:_ -, -'_ o -!D; o (DI FJ(ra (D gl .D -lo o o ,.: < ^{o:.il frq rD Ig) o FS \ s:: Aa \l ( E,, ll ; .=\ ! A - ={ i. q/\\ G o:Rl 3 t1\F E. 5:E. I x'[s \ h h{ -i s\= I\$ d -G \x\ ^-.s qYU\ !' _!x NRq X ltr-a:= ::t. rG- -I a-Q \ : JI' =i d E15ij S tE nX X 11"-!qtot,:s * ottr F*' F ilg X. $ I !'la;' ^G')!!td:X. : AIERs ' (D16 uX' - *lo.\s = - lxxR i El-lF { -loi: e $,ors s H.\\ : -.\>Ls5tt a i >-q = @G=oes> e *q3sH :n!rDs_43 ='-o-iEia .\>J. -\.r)sqPBX s\AA6{ s=.='G{5-\s;.EoaS NXJis(D\'='O :GI{ S€. .oo 6NN\r FA)\-G(-trJqA { :-i OA G nt € tr;o q tr OO G \o o o a IJ .I\ z rD =cr rDa N) o5 i_ ,{. .L { _! .L I l 11 '> tz 1lz. 1tz.rlE 9l= 9lejlj DJIJ FolSE_ls ;lr ;H ,l- c lr O lr -rlo : lo -o lo ni l-*, + l--., c l-tBIH E18 [13dE ql= slg =l(D =lE --loL, l:t (D ll. < l! .o- lR ? l=+. ='llla'lH' 3ls fi leI.lo € l> r'lo<lx -ol= *lx al^l;-51l5 ilB dloro Elg 3ro(}lx a3 IF' 1Jx'16 (D' lo-81" EIl- o-<lo rD Jt9)/) a.o =+. oroOq3 )B3 Lt .D=' =(D 6 qT =X-rr, d o .8. =' rDro da rlq roR I €. og D)I rD PJ I l''r1lol-l5lJ t=- lN la la l8t3 t6lclr.l= Iroldl= l(D IE lrD l=. lo la)l=lo-l. l.Dto l,q IEl5 lst;lol< l.Dl- Itr)ta l(Dlv, 2.(t.2 \Ylrat are tlte causes of nbsertteeisnt? Falnring activities by villagers oLrtside tlreir villages r,vitlrout cornirrg back clLrring tlre period ol' d istribLrtiorr. I Nligration of villagers to towrtslrip probably itt scatclt ol'.jobs Traveling to townships by sonre \\/onren in order to attend to tlte uervly delivered chilclrerr of tlreil daughters or daughters' irt-larvs. 2.6.3 What are the reasons lbr refusals? , Due to either adverse rear:tions otte suffered ol seen itr sorneone alter tal<en ivernrecti n. . Due to one's religious laitlr , Negative attitudes to anything 'fi'ee' . Poor healtlr education by health workers or CDDs to conrrnLrnity rnernbers concernilrg the Mectizan. . Fatigue in tahing the drug since he/she was no longer lravirrg the syrnptoms 2,6.4 Ilriefly describe all known antl verified serious adverse evenls (SAEs) that occurred during the reporting period antl provide (in table 8) the required ilrfornration when available. There was no case of any l<norvn serious adverse events dLrrirrg the reporting period. I I d i a In case the project did not have any cases ofserious adverse eveuts (SAB) during this reporting periotl, please ticli in the box. No SAE case to report L t- tu il I I 20 Wl-lO/APOC. 24 November 2004 \t- l I --l lD)lo lo lco f:^ i\,' -:hho ^- (,!rD 5 0.sc .jo =FJ o (D-. a rD o (D LN rr, FO r) o aI(D o o- E -.,:-. UA rD (D .If, oL oa !o =.o o-t c! F a $ I s Gi J( l .^o a 5, C$ ,ct\ a\\ .n = t..) I o rco r) tJ5 z o .D 3(,(D -t.J 5 I i_ {' .L I .L il l II i zuigBDi.'(Di: f }gE E $.lE8@e E'E B.g.N I 4=q 6' = =' ;I++?aO@ O =qiSnl = a 3 'o U 9) (D o DD -o -o o IDa o o- V)2 * UA rD Y 3 -o 3 (, A) o U A) o (n rDI o? (ro. =JTE rD o 9;FJ;to s dEa';d ;io 6*to-6 -- ;- o(rct ao rD o o 9.4d3E€ o(-,SB 8(E I 5'> o:o r z=X.iox3- (D fr2. oa ,E -JF ,l rn I t --t __ - __1. I l I I I I I I I I .! I l I I _-t-_ tJ t) \o t.)C oo IJO{ l9C o t'JO IJO5 l.J TJ oIJ IJO tJ O \o ',o oo \o\o -l frl o.) --t(/) OJ --t(, (,) --J(, (, -J -.t (, *_t ! (,)\l ! J(, --t --l o o6f, h'3 s:;qo-=- .,2 =O 1t-?9 d r-o b= N oo o 5 3E ="rD s A) 0a(} (,\|(, (,-.t(, (r)--tCl) (l)--l\l (})--.t\t o)*.1\l J o)\l{ ^-JC6P o5= :NN o)- ln (,) --t C^) (^) --J(, (,_,tOJ Cr){ --t (,) ! --l I(,{ --t (,{! o'.- c >3 Eo =3 5 E.H 5 Tro a.^ It1 Oo Oo Joo oo oo oo (o :J @N l4oO ut'tG5 ndd -*-il9ILil = (ro rdtso= Oo oo oo oo oo oo (o --l boN oo- ^< J> .oG Je,# o n rrl l'l trt *ll oo @(o --to @@ (o o, (oso o5(o! \,1 o @ss o)(,r o(tl5(Jl @ (o --t o @5 -t| (oos Js@ OH)J oE.E E. E=.>3.N O; og o q.6 eTi I -s9 ; a- '1JoEE E 6',5 {(,l(, ul(rr N --t(n o)5(Jlo {5 o,s @{ --l N @N @o --t 5Ooo O)(,loo c)o o)5 ooo ^-{.;e >EBExltr:'o D c) Itt ttl(,l(Jl o) --ts --l(,r N(n @ --tqlsA(o(o { G) .tr JAI\) -.1N m(o5A o)(,t(o N @(,l o)oN{ --l\t -d o ^Ed,+ aodrDO6ro- I' @5 i.J { @ i.J C^) --l bo@ o, :No o) lrt(os o)l(o o) o) b, --l -loyoo o\ li T!vp o oqEo=. o t! I., .}, -r ll oI(/) (o(o bo @ o b --t oo boo o l$o(o o J LN (oIo(, a ^< >\oo J :- ai aim-o (t rr: Itt ![ o (]) \o \o { \oI{ 6{A {p\o\o O5$ d 0a(D bJ (Jl rt rD (D}) (! t! (! o o -J -l (! l.) t1o o o (! a o o!, \ l-lS lo' .F lv -lol\O -la CD A) o5 PD :J () o oI A) UA(D l(tl< I lc) lA) lr!l:] lrlf t< cD F0n +o' rD tD o o o .) D) (! P' e(\ tr(\ i s.(\ G ,a c!\ o N(, o r, ID (D o rl (! o a p o l.lutIt lur lurl' o o U) 0q o A)t, o o D -t !0 e -l o (D oqt! o .) D9 It t.J NJ J ^ o a I,JA z o 6t 3 (! t..) o .r a -.nL { l" ilI u I I 2.7. Ordering, storage and delivery of ivermectin \4 cct rzan'Rt ordelccl/a MoH lrcd lor hr, !vHo tleu,st,trck tll( Ltl)Pt'( ) l)t' t Lt I c tt tt.t tI c t' I TINICIiPtr N'lccti/irlr(r( tlcltr'crcrl br \1tlatt,tt, tit k tltc (tl)l)t'()l)r't(ttc rlr.rrlcr') NtoH {-l !\/t{oE trNtctiFI NGDOtr N(;I)O IDlcasc tltscribc ltow'iVlcctiztrr(D is ordered arrtl hon it gcls lo thc colrnrrruritirs lhc statc pro.lcct subrnits Mcctizarr rccluircrnerrt to (jlollal 2(X)0. rrhch collates rcqucsts Itorrr othcr l-rroiccts Lrndcr its control. (ilobal 2(XX) ortlers lirr Mcctizarr. collects arrcl tlcltrcts Ihcrtt lo thc l-.rrugu/z\rtanrbrail-.trort-vi ( l) ll proicct rr, ltcrc tltc_r urc stort:d tcrnporalilr lor thc statcs to collcct their cprota as arrd rvherr requiretl. l.(iz\s collect liorn the state hasecl on rerluests rvhilc tlre lrealth care pcrsorlnel at health lacilit-r lcvelcorne to thc l.(iz\s to collcct lirr the corrnrurritics under its corrtrol. lt is liorn lrcrc that tlrc eoru ttrun it ics col lcct thc ir rcrlu ircnrents throLrgh the i r' (' l )l )s t ; { .L l l f, 2.1 \\'l l( )r.\l'( )( . 2J Nor crrrlrcr 2(X)4 a )-l r. C N o C Cg C (-D C I v. o zat z- PJ z .Da z 7r CD rrl FOa 2. CN o flq o- o rD N rD a o ,ro o rDN rD z o3 0a o I trJ rr1N CD t0(,q tn = -(,a tn FJa UA =:. t o tJ t-) co -li-) ( IJ O It- -cC {:AOOO o ooOO 6 o, O f, Oo l- C OOO o\ Oo o\6 5cO O @OOo Ot: o ! o \j O Foc o o I z ox o r- oo N ,a FDc'(!|, NIJ -tl-.J ur t'JN -Ico\o UI o. N)o s .t:oCO t-]\coC c 5 55 ca O q o\ OO E 5 O c +:tJ a +- @ o.OO aO €\o o\ l! o\ o\@OoO 5OOO oaO O {\o{5 5 Oo {U) OO -J O \o\o F(! o l! o. o\o o\tJ { \o oo 6 { o. +- l.J{ 5t.J TJ {\o \o\o\o -.I \o o\ \] \o C .D IJ O O O ,- - 6 01 o o oo oo A' lto o o trl x! o 6 hJ A A oo o @tJ5 { IJ E \.100 N) 5s Fo D ,o o'- .D P 7 rD c) N D) @ (D o a t- G -I(\ u N- \a\ o (\ cJ 44s\J l.JA o o a tJ5 z .D =oG IJ o5 L a, L JI u g I t L- t- q l" il I I Ilorv arc tlte relttaining iventrectilr tablets collectc(l an(l !vhere nrc the\ kcpt'.'] lltc lottainrng ii'e rrrree tirr tablcts arc collcctcrl irr the rcvelsecl ortlcr ol'distlihutiotr I lre Cl)[)s at thc crrtl ol'clistntruti()n rctunr tltc urtused or t'ernainitrg tablcts to tlrc hcalth care l)crsr)rrrrcl at tlre lrcaltlrlircilrtr.uhornturrrscndtlrcnrtothcsupcrrisirr-ql,(X'lsatthrl.Cz\ \llthcunuscrl tithlctr errllectcrl irt tltc l.(iA lcvcl arc \cn[ (o lhc slatc. llrc state ctrottl nlatol scrrrls allthc rcnrainrng tablcts to (ilobal l(XX). rrlrcrc thcr arc kcpt. l,isl arrrl bricllr tlcscribc thc actil'ities untlcr ivrrrrrcctin tlclive r-t' llral lrc lrr:irrg carrictl orrl lrr lrcllth cal'c l)crsolrne I irt tltc pro.iect arca. , ( ollcctrorr ol thc iVlcctizarr tal"rlt:ts liorrt Ilrc l.(X"l \lolasc ol'Nlce Lrzun tatrlcts at tlrc hcaltlr lae ilit_r. . ( rlrrrtrrurrrtl IVlobilizatiorr artd llcalth cdtrcatiort on thc availabilrt_r'ol ilrrrgs arrcl rrlro arc cligiblc to takc thc drug. . l rai rr ing/retra irr i rrg o l' selcctcd C'DDs b1' cli l'f'ererrt v i l lagcs. . l:rrsurrng thc c()nclucl. ol'cerrsus update ol'ccttstts (lropulation) ligLrres hr ('l)Ds. . I)istribution ol'lVlcctiz.an tablets to ('l)l)s basetl otr upclatcd populatiorr ligurcs ol'villages rtrtdcr eovcragc. . Supervisiorr ol'('I)[)s. . Marragernerrt ol'case s ol'scrior-rs adversc evcnts duc to IVlectizarr. , ('ollectiorr and ('trllatrurr ol'Mectizan treatnlerlt surnnrarics ll'onr ('l)[)s and rc;tortirrg it to thc lrrghcr lcvcls z\ rrt othcr cottt tttcrt ts -l he statc ol'llcc sorrrctirncs carrie'-i out vct'il'icatiorr ol'data rlr tttlortuatitln aitrrccl at cr.rsurilr-rl c()rrectncss ol'clata or infirrtration providctl b1'the lorrycr lcvels 2.A. Gommunity self-monitorang and Stakeholders Meeting Has arn training (of trairrers) lbr conrrnunit)' self-nronitoring rvas done in the project area? Il'so, When? Ycs. lrainirrg ol'trairrcrs lirr cornrrrtrrritl scll-tttottitorittg ltas trecn donc itt thc proicct. l)r Anrirz.iso carricd out llris irr April/l\4a1 20()2 at (ilotral 2(X)0 prcrniscs irt l,ttugu lirr allstatc coordirrators and thcil assistarrts irr all zolres irr Nigeria. S llO,'r\1')(X.'. l.l Norcrubcr 2(X)4 , 25 { OJ C)o 3 =E ='v qg ? 3 tr, o a F) (D od(D t/1 .D :i'-1-1 e LJd e'e 3 33 a ^ ;'3U) +( I A -.:, .I 3 9 ;.r 6.,A5=:-i-6Ea e6o d7 ,,,8 F E * rfls- gd =='< a tL J A E Hvr+ ='.Da(,)Ur^V - ) \v - A , o-3 ':- "' |,DDi'.'Jaqro*:.o 6' t 6 +6 -v)6o- X: :r*d ': =E o ^ 7=-i16o9E; i 3 =.7A6-4(t)ea== :* € i"< :L-(o = ;-5 FD.O I S.o141 H =.3 5 + ;A ;D:1-rr G- I -', ='0qto -=' oa D)a6*d. o ==a)9!1+='.oae E.-+, - * *" 6' 6 DeE&o 1a +Oa+=;-5 d e *< 5:;' ts6-1?,< 3a =(D > (D -H JoO)rr54ie+tDsEe €9. E E H F6t6t, )5'{ g ? ao O- (D -'N7a6 a F'= E Boqd6 Bo* o ,6 t.J o\ J o r) TJ5 zo =o- rD I i-) O5 tI_ f ,L -{ a, IT tl u I Uqq o oNo z I (rq o-o I tn rnNo FD 0q Aa r{d6 0! clL Iirl r FDtn -o (. N o C D' C * C o- o I 4 o z a 7r CD z7i F)5 o z 7: F0 rr, F0 9. N UAct o rDN(D (t) o Fl Fl t- \]O io ;. A: d+{q9o aDt5 :;'3.o(D nr)(D- UC(} o\ l.J { -.1 J:tJ UJo\ 5 oo\o 5\o O tJ UJ -T(, @ -J NJ { UJ o\5 o.(,r @ L'IN) 5ur(,J U) (JltJ z -o o.);.3io3,[5 EsEO- a'trg6' f.- !a)Its \o €6 o l..J o,O \oUJ o\oo tJ{ UJ{ \oUJ \ooo oZoo31qgBt = o.!lrrco5 asEEe =. =5 6';j=q aD ii. ui A) (rl o' LA o\O l.JA UJ5 ooUJ { o\o (rloo { so\ t}JtJ\OO ${ {\o -I { i I 2.9, Supervision 2.1).1 . l'r'ol'irlr u llow cltat't ol'su;lct'r'ision lticrarcllr Supcrvisron rrl'C'l)l'l actrvitics is bcirrg carrierl out at [-(iA. I rorrtlirrc healtlr Iae ilrtl atrtl cottrrtttruitr lcvcls. Supcrvisiott at allthesc lcrcls arc rrtrt tllrll titlgctctl. but ott spccilic itrcas idctttillcd. llrc \Lal,c tcanr \r-rpcr'\'rsc\ tltc irrrrrrecliatc Iorvcr level. i.c.. tlre l.(iA rvltilc tlrc l-O('ls supcrviscs activitrcs ol thc I l-l"lliS rv'ho in Iurtt supcrvises the C'])l)s.( onttrttnitics als() providccl itttcrtal sttpcrvisiott ol'lltc cl istribrrtion rncchitrrisrl o l' thc clrrrg and thus act us clrcck to ulrc\pcctcd dcllcicncics. N( itx ) N( X'I' DC MOt r l.(x LGA PH('DI.IPARI-MENT I trt .t I l;s I ('t)t)s +-crnautJNt't Y 2.9.2. Wlrat rvcrc thc rnain issues identilied during supervision? Vlosl l.(iAs clicl not ['rudgct lbr ('l)l'l activil.ics ('crrsus registration ltas rrot beerr valirlated arrtl u;;dated irr sonre villagcs in [-.rrugu State. C'orl p la i nts o l' rron-corr-r pensation ol' C DDs. Sorle olcl ('DDs have withdrawn liorn the progranrnte due to age. long stay, in tlrc prograrnrnc and non compensation 'l'rarrsl'er and shoflage ol'[.OC'l- and health carc personnel. Postcrs w'erc rrol available irr rnanr areas in [:nugu statc Attendancc ol'pregnant w()rnen / lactating rnotlrcrs lirr trcatrncnt alicr the , expiration of' the exclusion period 2.9.3. Wrs a supervisiolr checklist used? Ycs. the supcrvisiorr cL:ckiist rvas used. \tr ll( )r,\l'( )( , l.l Nor cnrl'rst' l(X),| S( 7 a. oft L rI I I 't1 2.9.4. Whal nerc tlte outcomes at each level ol'(lDl'l irnJllerncntatiolr sugrervision? S(X"ls ilttlttovcrl ort tlteit'ilttiturlc ttr tt'acl,.irrg arrd rapicl e ltccl'.ing Nlectizan cltstlthtttion to tlrc lovvel lcvcls. l.(X'Is ltectltttc nr()rc a\\arc ol' thc Arcas ther rrccclecl nnpl()vctnclrt ;lat'trcttlarl-r itt clossche ckittg sunrnrarr lirrrns lronr tlrc ( l)l)s via the lrealtI lacilitr stal'1. llealtlr lacilitr \tal'l' [)cttcr ttttdct'stood the ncccl Io rcscrvc drugs alier tlistribtrtirttt lirr sick pers()n r,"lrrr recove recl. rrrolhcrs rvhosc lactating lter iod havc cxpirccl . ,'\t thc cotlttttuttitr lcvcl. lVlcctizart rclirsals lrc nrorc a\\atc ol thc danger tlrcr at'c crcittit.tg to otlters atttl tlttts ilccrtlcrl to [rc rcccrvirrg trcal"rncrrt rvith rvelnrectin at evcr\, vear distrr[rLrtiorr.('l)l)s agrecc'l to bc upclating tlreir reqisters arrd to go liorr lrorrsc to lrouse to treat abscntces in older ttl irnprovc theraperrtic c()\,et'agc.('ottttttttnity tttctnbers agreccl to sclect rrcrr, ( l)l-)s and thcr, dernorrstrated nrorc \villirrgrrcss to support the C'[)l)s. C'ttttttttttttitl tnelttbers becatnc rttorc irrLcrestcil ur ct.rrrducting colrrrnunitl self- r-nonitoring at the cr:d of'distribution Stakeholders nreeting strengthcncd through rnorc crrlightcrlrrcrrt on the part ol- eonr nr urr ity nrerrr bers.. l,(iz\ authorit),hetter irrlorrned aud rc-orierrtatcd tora,ard thc nccd to Lrudgel lbr' ('t)'l'l activities. llcalth lacilit-r rtal'l' resolvctl trl hc counsclirrg tlrc prcuntrrrt rrorncn arrd lactitting ttrttthcrs ott tlre ttcccl to courc lirr trcal.ntcnt alicr tltc crltiratiorr ol'thc cxcItrsit,ln period. Ilcaltlr lacilitl stall'arc looking lirrrvartl lirr tlrc provisiorr ol postcl's. a I I I I a l 7 2.9.5. Was l'eerlback given to the persolt or groups supervisetl? Ycs. l'cedbztck rvas given to the supervised through ()ral c()nlr.lunicatiorr durirrg stlpervisitttt and in writing ott tlte llndings arrd necessarv tneasures to urrdertake with vicw to irrrprovernent. 2.9.6 How rvas the I'eedllack usetl to im;lrove the overall ;rerformance of the llro,iect ? ,,\ strong lirllrlrv - tr1'r nrCchi.rtristrr rras dCvclopcd [r, g1151sl-c lnll)r()vcnlctrl. tll- [he ovcrall pcrlirrrnarrcc rll' thc ltro.jcct. L aI t- q' l. I tI 28 \! I l()iAl,( )( . 2.1 Nor cnrhcr 20t)4 I SECTION 3: Support to CDTI 3.1. Equipment I ir_blc_!2' StatLrs ol'ccpuilrtlcnl (['lcu,st, utltl nrora turr: rf nc((\.\ut't ) *('orrclilion ol'tlrc cc;triprncrrt (l".ljtrrrctiurral. ('NIrR'Ctrlcnlll'trott-litnctional but rcllailablc W() Written ol'l'). Hurl tkrcs thc pro.iect intcntl to ntaintailt and re;llace existing equipmcrrt nnd other ntr tcrials'l llre proicct rladc provision lirr the rnainterrarrcc itnd replacenrctrt tll' sorne tll' thc cristing ci;uiprnerrt ancl otlrer rrraterials irr tlre -;ustainatrilitl plan lor 2004 2006. Alrcadl. Al'(X'has agreed to replace tlrc vehicle. nrotorcvcles arrd tlre cornputcr. Cilobal 20()() and Statc are cxpected to assist irr providing otlter equiprnerti a .t, , -{_ 1 T t' l, I rt Sotrrcc I r grc ol' ['.r;tripnrent AI'O( tvlotI D tsT'tr t("t7 l,(iA N(;DO Others No ( ortrltlttttl No ( ()il(lrlrr)rl No ( oltltlrrn Ntr ( otttlrl ron Nrr ( oild rtrorr L Vehiclc 2. lVlotor cyclc(s) -3. ( orrrllutcr'(s) 0 0 0 I CNFII 0 7 ,1 - I' -l c'N FIi. 2 (-NHr I CNTTR 0 0 0 0 0 .1. I)r'rntcr'(s,1 I t'NlrR 0 0 5. Photocr,rpier (s) I wo 6. l"ar Maclrine(s) 0 'd 0 0 0 7. Othcrs a )(icncratur I lr b) l'v 0 0 0 I t c)Vidco I ('N l;ll d)) Air conditioner I Jr 29 W I l( )i A l'( )( . 2.1 Nrx crtrhcr' 2004 (r, tN a tt J!l J o ql o o J .+ .l CTtt o J o o -lr 4 J o E!lrt d J orl o o a oo JC -ari -lo UI l.n lor-la lo t; 'rj A) c) E' o o =.C =f.o q .o A)I .DIa o' I J o 6- U) aoo (D 0l)a v\ Fl a F oo .J U) 'r1 o- o o 3 3t5 6'l, o. p0 (! a z o U o -o po f, :l .D I - o P z c a ;; A) 7 o +< -6' :. c) ro rc7 Or-<x r)aIh'\5ai;-hJ FD .D vT o @ i.J U) 6 tJ{ +: 5 l..J{ z 2- z '> z z z z o\ b.. ,'o J' € '2. ^9 -rCLQQ@ugd-e'J=b -(D o- _^)-l 'r9oo s[4E !lI N ot) 9 6O Ut {I66 -t € u { I u z @@ 5 z z z z z z z z 6 bo t'.J 4 ^tr -JCAQOt,oa l: i(,g:i> vrD o- cf;aE 4. E a hJ thJ o 6 6 -I 90{\o = z z z z J6{ 9.{\o 'z (,tJJ cA.)oEEEIv(D i< o- 19 I N A o\ z n o,{ U,q\ z IJ 6? 6 z i5\o5 bo\) cf;sE omFl ++ Xf rD llh-la- G ,26 P <ni .!rD_ rJv doi J*4rDrD= 5d(D tYqthag t -c-:'I : +oni lr5oo -r -. A fDr)'=o)ao;U lD -JA) - t9 H (9(y Jtdq,^o 6E r U X o .DX -lU AtP5-v)t+ 6O*a+Cd'Ioo = V- *lro r (t ".D ,U rDdo =rD"= 4Ho).D 3o t! .D5i+ ido gH + ;^JbS:<oh trt =;'.D (lta!6' 3 J^- =L '-e e. 6' =.o aDeroQ :$o -d =t(D5o)o o (n (, aq(n detsrDJrD ='('3 no 5X' -.i! to i.rulo5:r croa i c :].rD6(D=N;o-5. -qss aiiq -+)J o- il.? 9. *H.E a.=. ,i =o6d!,JrDo Oa-, .i'::r - =^H -.i: .DFH= ?;- ',too ArJa)(D6 uqoOo<^rD; .-! tA JL .D.)3d;+ 6' <J =D) ='o- +:JLD) E5 rDo ol:ig5 a8 +a)Jao/35 rD p) A0t e.o c) (rJ c, :\ .> -! n N) -A z.c G =<J-(D tJ <> -E il. , i\-- {- IL J a L lft g I 3.3. Other forms of community support [)cse ribc (nrdicatc lorr)rs ol rn-krrrd corrtritrLrtiorrs ol'cor.rrn.rtrnitics rl arri ) L onrrnurrities lravc dil'tercrrt ivavs ol' su;rportirrg their ('l)l)S apart liorrr tlte llrrattcial asllcct. 'l hcsc ltlrrrrs ol irr-Lirrd corrtrrbrrtiorr rrrclrrdc. ' Sctr'rtrq rrl ttrrtlirrtns lirr ilistri['rLrttlls: A villagc called Urnuagarna irr l-.ssodo conrnurril.r,'. lgbocz.e Nortlr l.(iA scvr unilirrrrr ltrr thcir sir (6) ('l)l)s ancl irr atlclitiorr provicletl lrartlcuvcr rrotcbooks arrd tlistri[rutiorr sticks. ' ljood: C'otttntuttities itr Anittri. Arr,gu. t-Jdcnu and st'rnrc otlrer l.(iAs trll'er crrtcl'ta inrlent tc, ('DDs duri rrg d istribLition. ' l'.renrption fiorn conrrnunitl, levies: t..lrnuaganra Village in I:ssodo conrrnulritl, ol'lgbo F.ze North l,GA exenrpted tlreir six ('l)l)s ll-orr con.rrrrurral levies. . l;anrring: Sorue conrrnurritics assist the ir ('DDs in l'arrrr r,vork during the l'arrnirtg seas()r'l as compensation lbr of'l'ering liee scrvice Lo Ihc cortrrnurrities, l'ol irrstarrcc. Nerrrve ('ornrnurrities irr Arrirrri l.(;4. 3.4. Expenditure per activity Inrlicatc irt tablc l.l. tlrc aln()ulrI cr'peridccl durirr!.r thc lcportirru 1'rcriocl lirr caclr acti,. it\ listcd \\'r'itc tlrc lnror-rlI cxpcuderl irr t lS tlollars using tlrc ctrrrcrrt tlrritctl Natiorrs crclrarrgc r:.ltc t() Iocul curtenc_r. lrrdicatc cxcharrge rate usecl here N 132 _- _l IJS dollars U ll(),'n l'(X'. 2.1 Norcrnhcr 2(Xl4 , 3l --- L a ll I I I lal-rlc I t lrrtl rcatc how rlrrch the prolect sport lirt'cach activitv ltstctl lrcltlrr tlttt'tlrs tltc rclltrt'ting pe t'iotl Arrt' cornrncnts r)r cx;llanations ?. lhc lLncl liont (ilobal 2(XX) lirr sup;rorting C'l)l)s arrtlilistributiott rvas uscd lirr lircling ol' proicct velriclc. l'lrc proiect'lelcphorre rvas ttrssed litr I vcar trou dtte to litck ol lirnd ttlpitl lil'bills. Ihc cost ol'('alendar providerl b1,-ulobal 200() rvas ttot tttadc kttorvtt to the pro.icct. a ,i- Actir itt l)r'ug tlelivct'1 tt'otn NOI'l- ll() arca to cettttal collectiott poittt ol' c()n lnl t"ln lt\ IVlobi I izatiott and lrcalth etlttcation rr l' cottt ttttt tt i t ies -l-rainirrg ol ('t)L)s 'l raining ol hcalth stal'l'at all lcvcls Supervistrrg C' I)l)s arrd rlistr ibutiolr lrrl.crnal nronitoritrg ol'('l)'l I activitics Aclvocaer visits to hcalth atncl political atttltoritics ll.( rrratcrials Surnnrarl (r'cportirrg) lirrtns lirr treatlnent Vchiclcsi Motorcvcles/ bicycles nraintenancc ()l'llcc l-quiprrerrt (c.g c()nr[)utcrs. ;lt'inters ctc) ( )thcls ( Sta I l' \uppoll") .I'OTAL -fotal nurnber of persons treated Expentliture ($ tls) 757 5B 37 8 .71) 2651.-52 I 08 5 .7ti 6(Xr.06 Source(s) of l'unding (ilobal 2000 L(iA t,cn l.(;n LCi A/( i loba I 2000(227.27) (i loba I 2(XX)t5 t.52 45.J-i -14().9 t Clobal 2000 (ilttbal 2000 36-5.45 (ilobal 2000 40,63J. t 5 755,614 12 \[ I l( )i,\l)( )( . ]J Nor etnhcr2tX)4 SEGTION 4: Sustainability of GDTI 4.1. lnternal; independent participatory monitoringl Evaluation 1.r.t Was Monitoring/evaluatiorr cnrrietl out during the reporting period? (tick anl' ol'thc lbllorving rvirich are applicable ) Nrr __\/car I l)articipaton lrrdepe ndcnt nronittlrirrg Nti IVI rcl I curr Sristairrahilitt [.valrratirrrr No 5 vear Sustairrabilitr l'.valuatiorr Nu______ _ lnte rnal Monitoring b) NO'l'F' No Otlrer ['.valuatiott [r1 other partners t.1.2 What rvere the reconrntettdatiorrs ? Not appropriate as thci' had prcviousll becrr lcportctl in 2(X)i 1. t.J Horv have they beerr implemented? Not Approltriatc. 4.2. Sustainability of projects: plan and set targets (mandatory at Yr 3) Was tlrc proicct cvaluatcd durirrg tlre reporting period ,) t t- W'as a sustairratrilitr plarr written'.) Yes When rras thc sustairrabilitl' plan sutrmittecl 2003 Wlrat arrarrgenlcnts ltavc beerr rnade to sustaitt ('l)-ll alier AP(X' lirrrdirrg ceascs in terrns ot: 4.2.1. Plarrrring at all relevant levels lhc StaLe and all tlre ('[)-l'l [,Cu\s clcvelopetl susterirrabilitl plan. I'lre stakelrolden rlcetirrg ol'all lrrograrlnles in the tninistry ot'health rr,as lteld [r1 the Statc Covclnlllent. rvlriclr involvcd all thc ('l)'l l arcas. lltc rrrcctirrg rvotrld l'rc translatctl to tlrc l,ocal cortrrnunitics.-l'ltere was also plan to tnect with l-lis lrrcellencl tbr rnore brielirrg. \\ I l( ),,\l'( X . lJ Nor onhcr 2(X),1 L l L I I l 11 -) .) !{ t 4.2.2. F-unds ,\ilcrlui.rtc plarr has also bccn rrrutlc lirt lirnd rclcitsc br thc Statc attcl l.(iAs. [Vlcartwhilc. il. is corrtairrccl in thc Statc budget-rollirrg plarr lirr tltc ttcxt l01cals. ()Ltt'1;at'tncr. (ilohal 2000. is expccted to cotrtiltttc ltct'sttpltort to thc pt'oiect, {.2.J'I-r':rrrsgrorl (re;tlacelttcltt and lnaintenance) l{cplaccrlcrrt arrd lVlairrtcnancc ol'logistic (transport) are cxpectcd to lrc carried oLrt throrrelt thc lirrrd prcvisiott irr'l.l I ilbttt'c ,Also. l.(iAS are c\pectcd to provrdc ncccssar'\ lirttd to ntaitttaitt itlttl t'eltlacc ttttltttrcy'clc. 1.2.3. Otlrer resourccs lvlarrporrcr alrtl llclcl stal'l'arc e\llcctcd to Lre stablc irr thc proiect itt lttLttre 1.2.1. 'l o wlral exte rtt ltas thc ;llatt beett intplclttctttetl Out ol'u total ol'20 activities plartttctl irr thc n l']O(' ltosl sttstaitrabilill plan lirr l(X).1. l9(9591) activitics rvere inrplerncnted. lhc pro.icct \\as rtol aLrle to orgattize orierrtatiorr workshop lirr l.(iA leaders. traditional rulers attd identiliecl('UOs due to non- av'arlabilitl ol lurrd. 4.3. lntegration Outline tlre cxtent ol'irrtegration ol'(.1)'l'l into the Pll('structurc itnd the ;'rlans lirr corn plctc i rrLcgratiorr : {.J.1. lvermectin delivery mechanisnts At the state level. onchocerciasis control stal'l'(SOC'Is and SPO) is part t-rl'the l'ublic I lcalth Serviccs Departrrrurt ilr the Statc lVlirristrl'ol'llcalth. At tlre l,ocal (iovernrnent Level. tlre oncltrlcetciasis ctlolditratot'as wcll as thc l.OC l's is respolrsihle to the PHC coorclinatot'rvho irr tnost cascs is also the l1ead ol' [)epartrnent (l-lOD) oi Health. At the ('olnrnurrity l,cvel where the l-lealth ljacilitics are situated. the Health lacilitr stafl'is stal'l'ol'.tlre l.(iA llcalth Departnretrt under thc l'H('coordirrator. z\t tlris level also. orrchocerciasis control activities arc part ol'tlrc reslxrrrsibilities ol'village health ctrnrrrrittees. , l'lre Sl'O. the S(X"l's. thc I'}llC'coordittatot'. tlrc l,(X"ls arrtl lllrS arc all involvcd irr otlrcr health prograrlrmes urrdcr I'tl('. l'hc SOC"ls deliver ivcrtttectitr to the l.(X"l's who deliver to the lll:S. D { ri t- I l- f' It I l l4 WllO/n l'O('. 2.1 Nor cnrbcr 2{X)4 a1.3.2 'Iraining l)trrilrg trairtings at caclt lcve l. otltcr topics rclatctl ttr othcr rl iscascs- arc includcd tn thc Iraittittg corttcnt. l]or cratnplc. tlrc Sl)O rvho is also thc l)loglanlntc ot'tlcer lirt'gultca wortn Lt'adicatiott cotlbines Ottcho arttl guitrea rrolnl cndcrrric [.CA.s ol tlre State. 'l-his rs also applicable to malalia corrtrol plt)srat)lle. 'l'he sanre socs l()r l,O('ls at l.(iA level tvho arc ittvolved in othcr activitics sLrch as Roll [rack tnalalia. guitrea wonn eladication. leprosr arrrd tuberctrlosis corrtrrrl. lirod trnd Nutrition irnrrrurrizatir)n etc. 1.J.J. .loint supcrvisiolr antl ,nottitorilrg rvitlt otlter l)rogrilnrs .lorttt su;lervisiott and rttortiLot'ittg r,ritlt othcr progranlnlcs ale rcgular l'caturcs ol'( l)'l I itnpletnetttatiotr in thc pro.iect. .l-hosc ol'llcers involvcd irr Oncho l)r()sranu'nc also sttpcrvise attd nrrlttitor othel'activitics ol ()thcr pt'()gt'anrrncs irr rvhich (hcv are involvcrl. -1.3.4. l{elease ol'lhntls lor llnr.iect activitics In atldition to tlre existing hudget linc lirrotrclrocerciasis in the [ruclget. lirnds releasecl by the govcrrlrnent at state arrd [,(jA levels l'or health activrt.ies arc sornetirnes slrarcd anr()ng progranmlcs basecl orr rreccl . ls Cl)1'l irtclutlcd irr tltc PHC budget?('l)'l-l is irrcluded in the I'}HC'budget at the statc atrtl in sornc [.(iAs l)escribc other health pnrgrarnnres that are using the CD'tl slructurc and how this was achievetl. What have been the achievements? llrc trsc tll' ('l)'l'l structttrc lirr otltcr hculth pr'()grilnlnrcs lras ntlt -lct bccn cstahlished irr thc statc. -lltcrc is plarr t() usc tlre ('t) I I lirl administcring vitamin A supplenrerrt and l-llV/AIDS in the statc. 'l'lris approach is part of'tlre rnethod of buiIding sustainable iverrnectin distlihutiorr s]'stern. l)escrille others issues consideretl irr the integratiorr ofCDTI. Otlrcr alea u'lrerc arrangcrrent is being rrrade to intcgrate ('Dll is thc issue ol' rrnururrizatiorr. Sornc l.(ir\s. during the last inrtrrutriz-atiorr crcrcisc uscd sol'lrc C'l)Ds as guicles. Also. irr guinea worrrr cndcnric aleas. ('Dl)s scrvc as village lrased health rvorkers (Vt]HWs) lbr guinea \\'onlr survcillancc. r.J.5 4.J.6. 1.3.7 { l_ I L. a 35 Wll(rn l'(X . 24 Norcrrrhcr2(X).1 , 4.4. Operational research {.4.1. Sunulrarizc irr not rnorc thiur one hall'ol'a;lage tlrc opcrational researclr rultrlcrtal<cn ilr tlrc ;lroiect n rca lvithitt tlte reporting ;tcriotl. No lrlvcplliorral rcscerrclr rras uttdcrtaketr itt the Ptoicct alea tvrthin thc rcpor-tilrg 1.rc rrtlil r..t.2. lI'lun'r'erc lhc results aplllierl irr the pro.icct? Not apltlrcablc ! a a(L ,t. { L t E It l .16 \\ I l( ),,\ P( )( . lJ \or cnrhcr l{Xl4 bSEGTION 5: Strengths, weaknesses' challenges, and opportunities l,ist tlre stl.crrgths antl wcaklresses of Cl)Tl ilnplctnclttatiolt proccss. STRENGTHS ('oltrrrritrlent arrd clcclication ol'sotnc l.(in. llcalth cctltcr stal'l'arlcl ('[)Ds irr gtar.ticrrlar towarcls Mcctiz.arr rlistritrtrtion cvcn \\ itlt()tlL ll)()llctAlv ittcctttivcs ll'orrr Ilreir e()tllllll-l'l iIie\. Irrvolvetttettt rrl cttttttttrtttity sttpcrvistlrs at thc ctltllttlttttitr Irnl-rrovcntent ol'lirrrd releasc br l.CAs ('harrgcs irr tlrc rnanagentent ol ('t)'l I at thc state attd l,(iA lcvcls. WEA E,SSES l,ow levels ot' ('c'rtttttltttrrtl' pat'ticipation and orvttcrship ol'('l) t I Vehicle availability is rrot steacly. Ngrr-rcleasc gl'c6untcrpart tirrrd b1 tlle State attd sgrtte l-(iAs l,isl thc clrirllelrgcs alrtl irttlicate h0n' tltcY wcrc itdtlressetl CHALLENGES . (rrpmg \l,,,ttlr aclvocr,;y at l-CA level tlttc t() c()tlstalrt chattge tll'dccisiotl rurakcr.s.'l'hc statc pro.icct lratl cnrbarl<cd ttrt advtlcilcl'tll'tltc ttcu'lr clcctctl or apppintctl l.(.iA clrairrrrcrr [o lrricl'thcrrr orr ('l)-l l progralllllle attd also ttr solicit lbr their stlPPorts . ( orrtinuous lrcalth education- rlobilization attcl scnsitiztttion lbr lotrg tcrtn cprlpliancc t() tt'cattltent.'l'his rvas carried otrt by both tlre stalc. l.(iA and health laciliti.stalf tt-r etlucate conrmunity tttctnbers to cotttittttc recciving ivernrectin yearly to prevent the possibilitl ol'one bect'rtttittg a rescrvoir ol' irrl'ectiorr to otlrers in llture arrd thus waste the gains already tnade. . Sustaining cntlrusiasrns in tlre ctlttttttttnities to continttc taking the drtrg dcspite irrrprovcd health status. l-lealth education was carricd otlt at corrrrlunitl level hy SOC'I. l.(X'l'. IjLl-l[jS arrtl C[)Ds to cncottragc those rvlto itrc ttow lrealtlty ttt cotttittttc taking tlre drtrg' ' lraiuilrg ol'health rvorkers irr tlrc l.(iAs occasiottcd b) llrc ttcu I.(iA creation arrcl stall' tratts l'cr. . l:l'f'cctive distribution ol'Mectiz.att itt cvent ol'irttcgration ol tltlrer prograllltes irrto th:. CD'f I structurc. Sonre C'Dl)s irttervicrvcd agreed tlrat thcy,would cgrrtinue to distrihute Mcctizan evett il other lll'()gl'allllllcs ale trttcgratccl irrto ( I )'[l . . lucrLasing thc lcvcl ol'c()nluunrt)' l)at'ticipati()tt atld ttrvtte rsltip ol'( l) I I' l-his is atldressetl througlr upscalling CSM and Sl{M at ctrtntlrttnitY levcl. , Nou-releasc ol'ct'runterpart lirnd b1 the statc Goverttnlcnt and stttttc l,CAs. l'his rratter lvas discussed at the aclvocucl.ttrectittg held rvith the state and l.(iA authorities. . l:undinB tlre training oIrrew C'DDs as a result ol'the introductiotr ol'thc kinclrecl distritrution systern.-l-he issue ol'lirndirrg ltas ttol bcen propcrll'taken rup as the trairrecl cornnrunity' supervisors rr,crc ttscd irr trairring the new CDDs. 3'7 \\'l l( )/Al'( )('. 2.1 Nrrr cnrhcr l(X)4 { SECTION 6: Unique features of the project/other matters I ltc ttrtirltrc lirtLrrc ol tltc prof ect ts thc ittttorlucttort ol'krndrecl s,\stenr trl'distribution. rrhcrebl caclr kirrdrcd ts tcqurrcrl to sclect at least one ('t)l) lbr tirrclr dislribLrtion ol ivcrnrectin arrd e ()\'crutgc ulpr'o\,cnlcnt, z\ villagc ctlrrsists ol'rnarrr ktntlreds WllOin l'}(X . 24 Nor crll'rcr l(X)4 .* . {' -t .! l" I I I I I 3n --rr