Assessment of the sustainability of the Kogi CDTI project: November 2002

*World Heatth Organisation African Programme for Onchocerciasis Control ri :, Assessment of the I "i..! sustainabilitY of the Kogi CDTI project 'November 2002 Oladele B. Akogun Paul Bukuluki Edith Nnoruka Patricia Ogbu-Pearse Chris Ogoshi Joseph Okeibunor Eleuther Tarimo (Team Leader) l l" t, Ii', I I ir I I I l i TABLE OF CONTENT ................6 3.1 SUSTAINABILTY AT STATE LEVEL........ ......................7 3.2 SUSTAINABILTY AT THE LGA LEVEL ....................... I I 3.3 SUSTAINABILTY AT THE HEALTH FACILITY LEVEL......... ......... 15 3.4 SUSTAINABILTY AT THE COMMLTNITY LEVEL..... ....................... I7 ASSESSMENT OF THE APPROPRIATENESS OF AND EFFECTIVENESS OF THE REVISED EVALUATION INDICATORS, GUIDELINES AND INSTRUMENTS................ ...................2I Advocacy Visits to the Policy Makers and Sustainability Planning Meetings .......................22 APPENDIX l. STATE LEVEL WORKSHOP PROGRAMME.................. ..........................23 APPENDIX 2: Sustainability of CDTI for LGAs in Kogi State............. ......'..................25 APPENDIX 3. PROBLEMS IDENTIFIED BY THE LG TEAMS AND SOLUTIONS IDENTIFIED DURING THE APPENDIX 4. PERSONS THAT WERE INTERVIEWED DURING THE EVALUATION ...................29 APPENDIX 5 STATE LEVEL SUSTAINABILITY PLAN 200212003.... .......31 APPENDIX 6. LOCAL GOVERNMENT WORK PLANS........ ......................35 APPENDTX 7. LrST OF EVALUATORS.......... ..........................56 ii Abbreviations/ acronyms APOC African Programme for Onchocerciasis Control CDD Community directed distributor (of ivermectin) CDTI Community directed treatment with ivermectin DHMT District Health Management Team CHEW Community health extension worker LG Local Government LGA Local govemment authority " LOCT LGA onchocerciasis control team NGDO Non-govemmental development organisation , NOTF National onchocerciasis task forcePHC Primary Health Care SOC State onchocerciasis co-ordinator SOCT State onchocerciasis control team WHO World Health Organisation ZOC 7-onalonchocerciasis co-ordinator lll Acknowledgements We would like to thank the following persons and organisations for their help: ' The staffat APOC Headquarters in Ouagadougou: The Director Dr Seket6li, Dr Amazigo, Mr Aholou and Mr Agbonton for making available the necessary financial and logistic requirements for the success of this assignment. ' The WR, Lagos and his staffcontributed to the smooth functioning of the evaluation team. ' Staffof the Ministry of Health in Kogi: Dr Fayomi and his zonalteam; Mrs Amdife and her State team provided information and prompt support. ' Sight Savers International, Health workers and communitymembers in the Igalamela, Olamaboro and Kogi LGAs provided information and contributed to the success of This mission. IExecutive summary Introduction The Kogi CDTI project has been supported by APOC for the past 4 years, and is in its last year of agreed funding from APOC. An evaluation of the sustainability of the project was carried out in November 2002,by a team of external evaluators from Nigeria, Tanzania and Uganda. The evaluators were charged with three tasks: . Evaluating the sustainability of the project. . Pre-testing an instrument to evaluate sustainability of CDTI projects, which had been developed by a team of experts and modified after use in evaluating some projects within and outside Nigeria . Support the State and endemic LGA personnel in developing post APOC sustainability plans. The evaluation was carried out in October and November. Information was gathered using the standard sustainability evaluation instrument from review of relevant documents and reports, interviews and field observation of sampled sites at the State, LGA, health centre and village levels. Findings The evaluators's findings are that all communities that have been identified as needing treafrnent are receiving it. Therapeutic coverage of the three LGAs evaluated is over 65Yo and mostly on the increase. The communities expressed willingness to continue with treatment for as long as necessary. Communities have been empowered to play a leading role in CDTI at the local level. The current satisfaction of communities with CDTI has potentials for creating demand for continuation of the project and thus enhance sustainability. Finally at community level, various measures to enhance sustainability of the CDD program are being implemented. The evaluation Team concludes that CDTI at the community level is sustainable, provided appropriate and adequate support continues to be provided by the higher levels. The relative neglect of the role of LGAs is a weakness of great concem in the support chain. Most neglected has been the lower level of LGAs, FLIIFs. This deficiency is mostly due to inadequate empowerment of LGAs through training and devolution of authority to this level. Strong centralized direction of the project from the _State was justified in the initial stages of the projept but its continuation is not good for sustainability. Recommendations of the evaluation team call for LGAs to take leadership and ownership of CDTI anddevelop realistic and costed plans. Funding for CDTI by LGAs has also been minimal and sporadic. Correction of these and related deficiencies will enable LGAs to provide adequate support to CDTI at the community level. The State level has spearheaded the development and implementation of the project. APOC has provided technical and financial support of about II7 million per year in the five years of the project. SSI support has been about lt2 million per year during this period. SSI has also informed the Ministry of health in writing that similar support per year will be continued until 2008. Ministry of health financial support to the project started in 2000 with a release of l*500000 followed by release of one million Naira in 2001. The approved budget for 2002 is 2 million naira but only I million has been released. The Commissioner for Health showed the team a document indicating that the remaining Nl million was on the way to being released. The Commissioner and Permanent Secretary for Health and several other leaders outlined innovative sdyscac) strategies to raise additional resources for CDTI, both financial and material 2from the private sector. These leaders also informed the evaluation team that the Kogi State will maintain the present level of funding, and increase it as necessary, to sustain the project. The evaluation team is pleased to note the high level of political commitment as evidencld by increasing levels of financial allocation to CDTI. Leaders at the State level are also highly knowledgeable on and playing an active role in mobilizing action for CDTI. On financing, the evaluation team believes that arrangements set out by the State supplemented by budgetary allocations by LGAs and resources raised from other sources, on the iines indicated above, will be adequate to sustain CDTI. High levels of funding were essential at the beginning of the project when investment for the development of an infrastructure was necessary. More modest levels of funding will be adequate to sustain the project. Using the four tier schedule of: Excellent; High; Moderate and Low, the evaluation team judges Kogi State CDTI to be at the level of 'Moderate'. The project is potentially sustainaUte, but riitt require rethinking and restructuring of the SOCT *O I.OCfs to small functional teams and mobilisation of high-level support at the LGA levels to get CDTI on the road to sustainability. Training also needs to be more targeted and authority devoived to LGAs. Inadequacy of devolution of authority is evidenced by SOCTs training, supervising and monitoring CDTI activities down to the community level. The Abuja meeting decided that fifth year projects should be classified as fully sustainable, making satisfactory progress towards sustainability and not making satisfactory progr"r. towards sustainability. Based on the positive and negative findings outlined aborri, tf,e evaluation team concludes that the Kogi project is MAKING,slz,sll4 cToRy aRaGRESS TOWARDS SUSTAINABILITY. Three Feedback/Planning meetings, one hr State and two for LGAs staff were successfully organized. Details of issues discussed and of sustainability plans are contained in reports oithe meetings. Regarding the pre-testing of the instrument to evaluate sustainability, the team found that it was in the main workable. Some changes were still found necessary, but these were not substantial. More importantly, the team found the new instrument more friendly but noted that there is need for evaluators to use the data collected with respect to '\vhy the iituation is" and "steps taken to remedy situation" into consideration while making judgements. Way Forward State and LG project staff need to follow up seriously and implement the post-ApOC susiainability plans developed during the feed back/planning meetings. These plans have indicators and targets. The State level will develop a joint comprehensive, costed post APOC plan, involving all pu,in".., building on the recommendations of the evaluation team and other experiences. The Commissioner for health indicated that while the State will take all measures to sustain CDTI, his hope was that APOC support should not end abruptly, some backstopping may be needed. The evaluation team recommends that APOC and NOCP participate actively in tte development of the State post APOC plan. Such participation will enable APOC to identify key areas for sustainability where backstopping support is best provided. For example LGA, particulaily the FLHF level remains weak- The FLHF level has a critical role in the sustainability of CDTI. It is also the level rvhere several programmes plan to add onto GDTI. Thus APoc may have to target and reorganise its support arrangements, for example adjust the MOU with the State to focus on the LG level. 3Three other interrelated activities are recommended for APOC support. First APOC and NOCP should organise a forum involving key staff and leaders from the States where CDTI evaluation has been carried out. Such a forum will facilitate the exchange and pooling of experiences, thus enabling future action by individual projects to be based on lessons from the pooled experiences. Secondly another forum to facilitate exchange of information on sustainability plans between LGAs in Kogi State is also recommended. The two activities will enhance follow up action after the evaluation and sustainability of CDTI. Finally it is recommended that APOC support operational research on difficult issues, of concern to many CDTI projects, emerging from the above activities. Example noted by the evaluation team include the role of FLHFs and of transportation for CDTI in the'tiverine" areas.

1. INTRODUCTION The earliest recognition of onchocerciasis was made in Lokoja, Kogi State capital city in 1907 by Blacklock. Subsequent surveys place Kogi State zN one of the most highly endemic in Nigeria with over one million persons at risk in the 2l local government areas (LGAs) of the State. Mectizan @ distribution started in the late 1980s in the former Benue State of which Kogi was part. With funding from African Program on Onchocerciasis Control (APOC) the Community Directed Treatnent with Ivermectin (CDTI) strategy was adopted in May 1997 for the delivery of onchocerciasis. The Sight Savers Intemational (SSD a Non-Govemmental Development Organization (NGDO) provides support to the Kogi State CDTI project where 2490 communities are under treatrnent. The project, which is now in the fifth of funding from APOC, is being evaluated for its sustainability as APOC winds down its five-year support. Furthermore, the sustainability instrument that had previously been developed by an expert team, meeting in Ouagadougou and recently revised following experiences from using the first set of instruments developed is also being tested using the opportunity provided by the evaluation of the Kogi CDTI project. 2. METHODOLOGY . Evaluation question: How sustainatle is the Kogi CDTI project? . Design:Cross-sectional, descriptive. . Population:The Kogi State project, including: its SOCT; its NGDO partner; its LGAs with their LOCTs; the project communities/villages and their CDDs. . Sampling: fletails of the sampled Districts and villages are contained in Table t below. 2.1 SAMPLING A multi stage sampling approach was adopted in selecting the sample for the evaluation. First the average treatment coverage rate for three years was computed for each of the twenty-one LGAs, where treatrnent is currently taking place. The average coverage rates of the 2l LGAs were then sorted in a descending order from lowest to highest. These w.ere divided into three strata of seven LGAs each. One LGA was then picked from each stratum by balloting in order to determine the three LGAs that will be used for the evaluation. Kogi, Olamaboro and Igalamela LGAs were thus selected. A similar approach was used to select two Districts frorn each of the LGAs except that in this case the districts were first divided into two categories qf ssi.'erage rates. One community with low coverage and another with high coverage were likeu,ise selected in each of the districts. 6Table 1: Distribution of Samples in LGAs and Districts: SAI LGA R, (Coverase Rate) District Villages (R, Coverase Rate) I Kogr (Meso) I-ow (69%) Irenedu t. Akpaku (96%) Adaeima (38%)2. Chikara l. Aseni (93%) 2. Omoko (71%\ 2. Olamaboro (H1per) Medium (83%) Olamaboro l.Iboh (9s%) 2. Ogba Ade (45%) Ogugu l. Ihangbe (98%) 2. Okegbi Alumaji (56%\ 3. Igalamela (Htper) Hish (e0%) Igalamela 1. Ajaka Centre (93%) 2. AiakaWest (89%) Odolu 1. Agbed Central (92%) 2. Agbedu South (95%\ 2.2 SOURCE OF INFORMATION Information was collected from interviews, verbal reports and documents. Various categories of people were interviewed at the Zone (Co-ordinator), State (SOCT leader, team memberi, policy- makers, management), LGA (LOCT leaders, management staff, heath technical staff), the froniline heath facility level and the community. Information was recorded on the evaluation instrument and discussed extensively before grading the performance of the relevant level on the indicator. 2.3 ANALYSIS Based on the information collected, each indicator is graded on a scale of 0-4, in terms of its contribution to sustainability. The average 'sustainabilityscore' for each group of indicators is calculated, for each level. A graph was plotted for the level being assessed. The evaluators discussed qualitative description of problems, and likely suggestions for solving the problem deliberated upon. 3. EVALUATION FII\IDINGS 3.1 SUSTAINABILTY AT STATE LEVEL Fig. 1: Kogi Project Sustainability at State Leve! 4.5 4 3.5 ri =qtI z.s =o, ED(\ti ,.u 1 0.5 0 ,ru.t$*o.itaosq Nrud@n *^sF'lt "."st.** "5llr.**t $"** Gorerase Group of lndicators 1. PLAI\MNG (2.5 Moderate) CDTI activities were integrated into normal health service plan. Yearly Plan of activities exists with key activities, time frame and those to accomplish the various tasks. A draft plan for Sustainability for Year 2003 has been written by the State team and the NGDO parfirer, SSI, has prepared a financial plan fur the support of the project from 2003-2008. However,-the yearly plan is brief, unfocused and routine. The planning does not involve other partners at the LGA level artd is not participatory planning. NGDO partner develops its own plan, which is not embedded in the overall plan of the State. Despite the fact that Sustainability has been discussed in several forums, there is no detailed plan as of yet for this. 2. MONITORJNG AND SUPERVISION (2.3 Moderate) Once problems are identified, urgent measures are taken by SOCT members in charge of the LGA to solve them. Leadership in the MOH occasionally helps in solving problems. There are systems for recognizing successes such as monetary rewards and commendation by SSI for Data management in the LGA. This has discontinued since 1999 by SSI. The SOCT still carries out routine supervision at all levels even to the community level. LOCT members are not empowered to carry out supervision at the frontline level. The NGDO also carry out supervision at all levels. 8Thus personnel at the lower level are not empowered to manage problems. The main reason for this is that the supervisory checklist is not used for identifying problems. The monitoring and supervision methods do not have as its objective the intention to identtfu areas that would require attention or further input from the State team. Thus, the parroting approach is the norn. There are no infection of innovations and lessons are not picked form the NGDO partner, for example to institute the Awards and Recognition Initiative as a method of motivation and fund-raising for the program. There has not been an award since SSI discontinued this practice in 1999. 3. MECTIZAI\ ORDERING AND PROCUREMENT (3 High) Mectizan ordering and procurement system is good and has been facilitated by SSI. KOGI CDTI State team collects Mectizan from Kaduna and the LGAs collect from the State. A register is maintained for drugs received and those glven out. The State does provide funds for fueling to collect drugs if APOC funds is not available but the collection of Mectizan still depends largely on APOC funds. 4. HEALTH EDUCATION, SENSITIZATION, ADVOCACY AI\D MOBILIZATION (2.6 Moderate) Health education and sensitization is at its highest level. The Honorable Commissioner for Health is actively involved in mobilization of communities and LGAs to continue to support the program. There are jingles in eight languages and information, education and communication materials are available. Routine advocacy is done and not directed to solving specific problems. State does not empower LGAs to carry out health education; sensitization, advocacy and mobilization and IEC materials are insufficient. Advocacy objectives and strategies-are yet to be developed for post-APOC challenge. Integration of Support Activities (2 Moderate) All the LOCT members are involved in the National Program on Immunization but there is no formal integration with the CDTI program. There .re no plans to have officer in one health program undertake CDTI activities while out in the communities for other health activities and vice versa. Although the same individuals carry out these activities the activities themselves are not integrated. There is need to move from same person being involved in other programs to ensuring that the programs are integrated and that dual activities are carried out during one mission, €.g. training on CDTI record keeping when training on NPI. Financial resources (2.8 Moderate) The documentation system of funds received is properly done at this level and the accounting procedures followed at this level. State budgets and releases funds for CDTI activities annually but these in an increa.sing manner even though this is not proportionate to the decrease in APOC releases (as contained in the MOU). Other partners do :rot appreciate the magnitude of deficit. The field evidence shows that additional resources are required to ensure effective CDTI implementation Statewide. Other Material Resources (2.3 Moderate) Transport and materials are available but many are not functional and are inadequate. There is no contingencv plan for replacement of the transport and material resources. The repair and maintenance plan fbr the vehicles is not clear. 9Human Resources (3.5 High) There are 23 members of SOCT. They are many and are too many for the required task. Members of the SOCT are located in different units of the Ministry of Health and are very stable, skilled and committed to CDTI activities. The staff strength is rather large (23) and it is recommended that a small size of 5-6 persons is enough to carry out the activities of the Unit while the others should be re-deployed to other units. Those retained should have the skills for health education, sensitization and advocacy; monitoring and supervision; training; planning and for Mectizan handling/record keeping. This will make the team more efficient than it presently is. Coverage (a FuU) The coverage rate is high and all the LGAs within the State have over 65Yo coverage rate and this has increased steadily over the years except in a few LGAs where reactions to the drug discourage people from taking it. The main recommendation to the State team besides the specific ones discussed above under each indicator is the development of the capacity of the lower levels (LGA) for monitoring and supervision, training and HSAM Recommendations at this level Recommendation Imnlementation Plannine The state and other partners should jointly develop a comprehensive costed and sustainable 3-year plan for CDTI, building on plans developed during the planning meeting. The plan should be realistic;based on govemment resources and other sustainable sources Prioriv: HIGH Indicators ofsuccess: . 3-vear nlan available Who to take action: . SOCT Deadline for completion: . January2003 Trainine: through training on HSAM supervise and monitor CDTI activities at the next level (FLHF). However, spot checks can be carried out where necessary. - Prioritv; HIGH Indicators of success: Training (Report, agenda, participants list), Devolution (MoH circular to all stakeholders stating roles of the SOCT, LOCT, FLHF in CDTI imolementation) Wo to take action'. . SOCT for Training ' Director PHC for Devolution Deadl ine fo r contp let io n : Januarv 2003 The practice of recognizing successes should be revived. The pa:ameters for assessing success should be broadened b,:yond quality of data collection to include other CfTI quality indicators Prioritv: \ll l)lt \l Indicators ofsuccess: List of beneficiaries Who to tuke'octiott: NOCP/SOCT Dead I i n e .fo r co nt p I c t i o n'. Three nronths after the next distribution 10 HSAM, training, monitoring and supervision should be targeted, based on and in response to deficiencies previously detected in the field. Priority: Hieh Indicators ofsuccess: Evidence of training, monitoring, supervision, HSAM AND justification of need for them Who to take action: SOCT Deadline for completion: Next Distribution exercise SOCT personnel should plan and carry out this activity with intensive advocacy to mobilize resources Priority: Medium Indicators ofsuccess: Quantity of resources mobilized Who to take action: PS, PHC Director, NOCP, SOCT. Deadline for completion: Aueust 2003 PHC Directors, at the National, should formulate a clear policy and state levels to integrate PHC programs. Priority: Medium Indicators of success: Policy on this available Wo to take action: NOCP, Perm Sec. (Federal, State) Deadline for completion: November 2003 The SOCT team is too large. The present number of 23 should be reduced to a manageable size that could be more effective and efficient in the implementation of CDTI program. Priority: High Indicators of success: Document to NOCP reconstituting the SOCT, iustification for membership Who to taEe action: Director PHC Deadline for completion: January 2003 The project should consider as a priority in their sustainability plan the need to carry out regular maintenance and repair of existing transport and equipmant. Partners should work out norrns for key equipment-and transport at different levels. This should take into consideration inadequacies and future replaeements. Priority: Medium Indicators of success: Availability of maintenance schedule lI/'ho to take action: Director PHC and Perm. Sec Deadline for completion: End of next distribution Fig.2: Kogi CDTI Project. Susutainability at LGA level 4 3.5g3 fr z.s o32 o E,(!.'tE oil 0.5 0 o*tf*o*o\.0.."N.0""'o'" "*"t $::"."'e' $"'n""o."""q' GrouPs of lndicators 1l 3.2 SUSTAINABILTY AT THE LGA LEVEL PLANNING (1 Slight) Some of the visited LGAs had plans for CDTI activities for Years 2000, 2001 and 2002. The PHC Coordinator and the LOCT leader drew the plans and neither involved members of the LOCT nor took into consideration the needs of the community. The other PHC departments made other parallel work plans. Howwer, many of the LGAs had not got any work-plan and those that had were not integrated. The major problem here is the lack of planning at this stage. LEADERSHIP (1 Slight) There are CDTI Management teams (LOCT) in some of the LGAs comprising both technical staff and politicians. They *" r"rpor,rible for both supervision of the frontline health facility level and management of the activities-at the LGA level. However the teams are usually too large to exercise any team responsibility. The monthly top-up at the onset of the program was responsible for the attraction to " l31.g" unryieldy team and the usurpation of the health facility qole by the LGA. In many LGAs ttre iOCr seemed to be a one-man show with decisions of the LOCT leader passed down to the numerous supervisors (health personnel) in the frontline healt! facility often referred to as members of the LOCT. The result is an undefined and indistinguishable role definition between the LOCT and the health personnel at the peripheral health facility. Since an active team is non- existent the LOCT leader became dependent on the State for initiatives and planning serving as a rnere implementers of directives rather than providing leadership at that level. MONITORING (2.3 Moderate) Reporrs are subrnitted by the CDDs to the Supervisors at the FLHF, but at times collected by the Supen,isors thernselves who in turn submit them to the LOCT leader. Govemment system is utilized for onw ards transmission of information to the State level. ln a few cases the PHC coordinator carri:s out spot checks at the health facilities and communities. The same people who monitor CDTI are also involved in other programs. Although supervisory checklist is available they are hardly used a^ed in a few situations where attempts were made to use them they were not applied in identiiling problems in the field, which will require attention. Supervision is therefore routine and carried out .;rhen funds are sent from APOC for that purpose. The LOCT members visit the communities thu.:; taking over the responsibility of the frontline health facility. t2 Supervisory Checklists are available in a few LGAs but not integrated for use by other programs within the PHC. There is a system for managing problems identified in the field (particularly refusals and other causes of low coverage). Successes are also acknowledged and in some instances to compensate they pick the CDDs as local guides for NID. MECTIZAI\ (3 Highly) Mectizan is sent to the LGA on request and on receipt of the refurns from previous treatments cycles. Adequate Mectizan is made available to the LGAs from the State based on this calculation. Shortages at the LGA level are rare. Mectizan order forms were seen at most of the LGAs. These are supplied by the State and reproduced by LGA. At most of the LGAs Mectzan is stored at the LGA Medical stores. It is dispensed using a project designed conhol system that is uncomplicated, effective and dependable. At the moment the delivery of the drugs to the LGA is still dependent on APOC funds and not funds provided by the LGA. TRAINING AND HSAM (2 Moderate) First the LOCT is improperly constitufed at the LGA level. The present practice is that the LOCT comprised all the peripheral health personnel and the LOCT leader. The team should be a small number of personnel with specific skills for CDTI. Training of the supervisors (who are also LOCT members) is performed within the community every year in a routine manner by the SOCT. LOCT leaders and SOCT routinely train supervisors every year. It is not focused to needs. Training is also carried out at levels below the FLHF. LOCT leaders feature in all training sessions in all the districts. Training is not integrated and training materials and IEC material are very scanty and not readily available. SupervisorS/staffat the FLHF are not given free hand to train CDDs. This is partly due to the perception of the SOCT that the LOCT would be unable to accomplish these tasks. LOCT leaders and the PHC technical committee of the LGA routinely do HSAM. There is no evidence of HSAM plans or objectives and the outcome could therefore not be assessed. FINANCING (0.8 not at all) Costs for CDTI activities are not quantified at this level nor are they reflected on the Estimates of Recurrent expenditures for each year in the LG books. Some LGs have releases that are arbitrary estimates independent of systematic plan while others are not even sure if they have any releases at all. Relative contributions of the LGA and other partners to CDTI are not clearly spelt out. In one of the LGAs there is a monthly imprest of N1000 for the Onchocerciasis unit. There are no specific or realistic identifiable plans on ground for Post APOC funding at this level as well. Some LGs make releases for travel allowantes for LOCTs and for maintenance of transport. Funds released are justified and accounted for as part of other govt. expenditure in some LGAs. Many LGs do not have documented cost of CDTI activities and the exact expenditure is difficult to compute. Many LGs are unable to pay salaries and do not often place priorities on the CDTI expenditure. Most activities are therefore dependent on funding from APOC and the partner NGDO. During interviews many LOCT leaders, Heads of the PHC unit and Directors of the Local Governments claim that the political leadership of the LGs (now run by civil servants) did not see the need for planned expenditure and appropriate budgeting for services. The financially handicapped LOCT did not use HSAM to source materials (such as ,bicycles and motorcyclei, funds) from local philanthropists and associations who abound in large numbers in many LGAs and could be willing to contribute to the program at the local level. 13 TRANSPORT AI\D OTHER MATERIAL RESOURCES (2 Moderate) Motorcycles and bicycles are used by LG personnel who are involved in monitoring and supervision of programs such as CDTI and NPI and the use of this transport is integrated in such a way that the same NPI motorcycle is used for both CDTI and NPI activities. In some LGAs, maintenance and fuelling are mainly dependent on APOC funds complemented by funds from LG resources while in some others the user of the transport facility is responsible for maintenance and fuel since they are used for personal activities as well. Logbooks are non-existent but the HODs are always informed of movements. There are no dependable plans to affect major repairs or make replacements when they go bad. In effect, available logistics are not effectively managed in some LGAs. Training and HSAM materials are in place but grossly inadequate. HUMAI\I RESOURCES (3 High) Personnel are skilled, knowledgeable and fairly stable. New and unskilled personnel are trained by SOCTs and on the job. Remuneration is a problem since salaries are not regular and in some cases unpaid for the past 12 months in some LGAs causing low morale. However the distribution of bicycles to some supervisors has a motivating effect in some LGA. COVERAGE (3.s High) All districts are under treatment. Geographic coverage has remained consistently at 100% for some of the LGAs, since the Year 2000, apart for one LGA that had no information on this. Therapeutic coverage is increasing for some of the LGAs and ranges from 84% - 92.3% for the years 2001 and 2002 respectively. Two of the LGAs had incomplete records for 2002 as treatment is still ongoing and therapeutic coverage could not be properly assessed. In another there was decreasing therapeutic coverage. Recommendations at this level Recommendation Imolementation PLAIITNING: There should be formal 3-Year sustainability plan beginning with 2003 CDTI work-plans, developed before being integrated into an LGA/PHC work- plan. Such work-plans to be made by LGA coordinator with other members of the LOCT should focus on problems identified during the monitoring and supervision exercises. PriOriN.. HIGH Indicators of success: CDTI work-plan. olan was develooed Who to take action; . LOCT and PHC Co-ordinator D e ad I ine for comp I et ion: . January 2003 LEADERSHIP: Leadership should be able to initiate key CDTI activities at this level. PHC Coordinator should constitute the LOCT. Priority: li IGH Indicators of success: Document to SOCT reconstituting the LOCT, justification for membership with regards'to sustainability. Who to take action: PHC Co-ordinator and LOCT D ead I i ne for co mp let ion : February 2003 t4 Monitoring and Supervision: integrated with other health activities. focuses on key sustainability issues such as targeted training and supervision needs to be developed and used. supervisory and other roles of LOCT should be made available Priority: MEDIUM Indicators of success: Supervisory visit reports, and iustification for supervision Who to take action: PHC Co-ordinator, LOCT Deadline for completion: End of next distribution Training: Training at the health facility level should be based on need. Priority: High Indicators of success: Training report, justification for trainine Who to take action: LOCT Deadline for completion: June 2003 Financing There should be advocacy visit targeting new council members, LG authority and other sources to give financial support to CDTI activities at this level should be carried out. Amounts budgeted for CDTI should be clearly in relation to resources realistically expected to be available. Priority: High Indicators ofsuccess: Amount of resources mobilised Who to take action: PHC Director Deadline for completion: August 2003 Other Resources: The LGA/LOCT should develop a clear, realistic and well-costed plan for operation, maintenance and replacement of transport. Prioritv: Hieh Indicators of success: Availability of Log Books/ movement Registers, Maintenance schedules, documented plan for maintenance. Who to take action: PHC Co-ordinator, LOCT Deadline for completion; March 2003 15 3.3 SUSTAINABILTY AT THE HEALTH FACILITY LEVEL Fig.3: Kogi CDTI Project. Sustainability at FLHF Level t t, ,,E .9 o =o E"(E o 4.5 4 3.5 3 2.5 2 1.5 1 0.5 0 .o'Nno*."d'["."od Ot$o' GrouPs of lndicators PLANNING{0 not at all) There are no written plans or timetables for CDTI activities at this level, although schedules exist at some FLIIF for other health programs such as NID and TBL. Although personnel awareness of roles and responsibilities is high there are no documented work-plan and there is dependence on the LG for directive LEADERSHIP (3 Highly) Mobilization/advocacy visits are usually the first activities to be conducted. Political heads at this level (usually the Village heads) together with other senior politicians at this level show some moral commitmedt to CDTI activities. CDTI activities are initiated by district /LGA staff in collaboration with the SOCTs. MONITORING/SUPERVISION (2 Moderately) CDDs submit reports of distribution to the FLHF, who in turn reports to the LOCT leader. Data is routinely. collected and transmitted within the government. Also depending on the season, CDTI data reports are at times submitted together with other health reports. Supervision is sometimes integrated. Supervisory checklists are not used in many cases for visits for CDTI activities are frequent and dependent on APOC funds. Copies of treatment reports are usually not retained at this level. There is no docurnentary evidence of visits (reports/checklists) MECTIZAN (2.5 Moderate) Yearly orders are based on quantity of tablets used in previous cycles and update of community census. The Supervisors in collaboration with LOCT leader fetch the Mectizan from the LGA, l6 while the CDDs collect them from the FLHF. Mectizan tablets are usually adequate and available at periods acceptable to the villages. Where shortages occur fresh supplies are made. The drugs are stored in the FLHF and dispensed from there. Stock control system is simple but records are not left there. Copies of order forms were not seen at the FLHF level. TRAINING (2.5 Moderate) Relevant staff is involved in training but training is not targeted but routinely done. Training activities are not justified or based on findings from the supervisory checklists. The CDTI supervisors have not been given free hand to conduct CDD training. Training and promotional materials are available but not in sufficient quantities. Cost of activity is solely dependent on ApOC funds. FINANCING (0 not at all) The costs for CDTI activities are not quantified at this level and there are no budgets for CDTI activities at this level. Implementation of key CDTI activities at this level is still heaiily dependent on APOC funds. TRANSPORT AhID OTHER RESOURCES (0.8 not at atl) Transport at this level is generally insuffrcient. The Bicycles are well out of order in many cases and where available are inadequate. In some cases where the supervisors are allowed to use the transport facility for personal activities, they take up the responsibility for maintenance and minor ."pui.r. Maintenance is mainly from APOC funds until it winds up and becomes abandoned. There u.e ro dependable sources for replacement of transport facilities. In many LGAs the transport facility is used for several health services delivery at that level and is therefore integrated. Integrated hips are carried out and are dependent on personal transport of the Health worker in most LGAs. Maintenance is often from personal funds of Health workers. Recommendations at this level Recommendation Implementation Planning FLHF personnel should develop yearly plan Priority; HIGH Indicators of success: Availability of a yearly plan W'ho to take action: . FLHF Staff and LOCT Deadline for completion; . January2003 Training. _ Training of frontline health facility staff should be based on need. Priority: HICH Indicators of success: Report of training indicating need for the training Wo to take action: FLHF Staff Deadline for completion: April2003 Monitoring and Supervision. Supervision and rnonitoring of CDD by FLHF staff should be based cn identified need. Checklist should be developed and used. Priority: l{lGIl Indicators of success: Supervisory checklist Wo to take action'. FLHF Staff Dead I i ne for comp letion'. November 2003 Kogi State: Sustainability at Village level t EIo! o CD(! o 4 3.5 3 2.5 2 1.5 1 0.5 0 n rnd$*.outN *oNN Nreowas -t-t- r..n"n"ta .^o$to 6s{e@99 Group of lndicators t7 3.4 SUSTAINABILTY AT THE COMMUNITY LEYEL PLAIINING (3 Hishly) Census update is routinely done after taining just before distribution, while in some communities they are done alongside distribution. LEADERSHIP (33 Highly) Community leaders mobilize and sensitize the communities for distribution. Leadership is aware of problems (low coverage and inadequate incentive to CDDs) and is involved in management through mobilization/sensitization. - MONITORING/SUPERVISION (3 Moderately) Registers are fairll' well kept and appear complete. Reports are sent in reasonable time to health faciliry using local resources. MECTIZAN (3 Highly) Adequate number of Mectizan tablets is received at convenient time for the communities. Calculations are based on past treatment records and population update. This is done at times by the CDDs and in most instances by District Oncho Coordinators. TRAINING AND HSAM (3 Highly) Community leadership and CDDs are routinely engaged in sensitization of relevant persons where problems have beea identified. Promotional materials are very scanty within the community. 18 FINAI\ICING (4 FUIIy) Communities show understanding and appreciation of the costs involved in CDTI and are aware that such costs are met from extemal sources. Most communities are willing to contribute and, in some cases, have made arrangements to sustain local costs of distribution. HUMAN RESOURCES (3 High) CDDs demonstrated they have received appropriate training and are willing to continue. Villagers value Mectizan due to perceived help in expelling worns and restoring vision and increasing their strength. They express willingness to continue treatment. Recommendations at this level Recommendation Imnlementation CDDs should keep a copy of the annual treatment summary form. Priority: MEDIUM Indicators of success: Availability of teatment summary form at the communiW level Who to take action: CDD, Supervisot Villaee Leader Deadl ine for compl e t ion: . November2}O3 incorporate CDTI in their usual festivities and use opportunities provided by community gatherings for appraising and recognising those who contribute towards the CDTI promotion in the locality. gatherings in order to motivate them. Priority: MEDIUM Indicators of success: : Feedback from CDDs, community leader Wo to take action: Community Leader Deadline for completion: December 2003 19 4. CONCLUSION 4.1 Overall Sustainability grading for Kogi State. All communities that have been identified as needing treatment are receiving it. Therapeutic coverage of the three LGAs evaluated is over 65oh and mostly on the increase. Ivermectin treatment is becoming part of the culture of communities who expressed willingness to continue with treatment for as long as it is necessary. Communities have been empowered to play a leading role in CDTI at the local level. The current satisfaction of communities with CDTI has potentials for creating demand for continuation of the project and thus enhance sustainability. Finally at community level, various measures to enhance sustainability of the CDD program are being implemented. The evaluation Team concludes that CDTI at the community level is sustainable, provided appropriate and adequate support continues to be provided by the higher levels. The relative neglect of the role of LGAs is a weakness of great concern in the support chain. Most neglected has been the lower level of LGAs, FLHFs. This deficiency is mostly due to inadequate empowerment of LGAs through training and devolution of authority to this level. Strong centralized direction of the project from the State was justified in the initial stages of the project but its continuation is not good for sustainability. Recommendations of the evaluation team call for LGAs to take leadership and ownership of CDTI and develop realistic and costed plans. Funding for CDTI by LGAs has also been minimal and sporadic. Correction of these and related deficiencies will enable LGAs to provide adequate support to CDTI at the community level. The State level has spearheaded the development and implementation of the project. APOC has provided technical and financial support of about II7 million per yeil in the five years of the project. SSI support has been about N2 million per year during this period. SSI has also informed the Ministry of health in writing that similar support per year will be continued until 2008. Ministry of health financial support to the project started in 2000 with a release of 11500000 followed by release of one million Naira in 2001. The approved budget for 2OO2 is 2 million Naira but only 1 million has been released. The Commissioner for Health showed the team a document indicating that the remaining lll million was on the way to being released. The Commissioner and Permanent Secretary for Health and several other leaders outlined innovative advocacy strategies to raise additional resources for CDTI, both financial and material from the private sector. These leaders also informed the evaluation team that the Kogi State will maintain the present level of funding, and inciease it as necessary, to sustain the project. The evaluation team is pleased to note the high level of political commitment as evidenced by increasing levels of financial allocation to CDTI. Leaders at the State level are also highly knowledgeable on and playing an active role in mobilizing action for CDTI. On financing, the evaluation team thinks that arrangements set out by the State supplemented by budgetary allocations by LGAs and resources raised from other sources, on the lines indicated above, will be adequate to sustain CDTI. High levels of funding were essential at the beginning of the project when investment for the development of an infrastructure was necessary. More modest levels of funding will be adequate to sustain the project. Using the four tier schedule of: Excellent; High; Moderate and Low,. the evaluation team judges Kogi State CDTI to be at the level of 'Moderate'.The project is potentially sustainable, but will require rethinkir.g and restructuring of the SOCT and LOCTs to small functional teams and mobilisation of high-level support at the LGA levels to get CDTI on the road to sustainability. Training also nee;ds to be more targeted and authority devolved to LGAs. Inadequacy of devolution 20 of authority is evidenced by SOCTs training, supervising and monitoring CDTI activities down to the community level. In line with the Abuja meeting classification for fifth year projects, (fully sustainable, making satisfactory progress towards sustainability and not making satisfactory progress towards sustainability), the evaluation team concludes that the Kogi project is MAKING SATISFACTORY PRO GRE S S TO WARDS S AS TAI NAB I LI TY. 4.ZTlvee Feedback/Planning meetings, one for State and two for LGAs staffwere successfully organized. Details of issues discussed and of sustainability plans are contained in reports of the meetings. 4.3 Regarding the pre-testing of the instrument to evaluate sustainability, the team found that it was in the main workable. Some changes were still found necessary, but these were not substantial. More importantly, the team found the new instrument more friendly but noted that there is need for evaluators to use the data collected with respect to'\vhy the situation is" and "steps taken to remedy situation" into consideration while making judgements. s.WAY FORWARI) State and LG project staff need to follow up seriously and implement the post-ApOC sustainability plans developed during the feed back/planning meetings. These plans have indicators and targets. The State level will develop a joint comprehensive, costed post APOC plan, involving all purtr,".r, building on the recommendations of the evaluation team and other experiences. The Commissioner for health indicated that while the State will take all measures to sustain CDTI, his hope was that APOC support should not end abruptly, some backstopping may be needed. The evaluation team recommends that APOC and NOCP participate actively in the development of the Sfate postAPOC plan. Such participation will enablsAPOc to identiSkey areas for sustainability where backstopping support is best provided. For example LGA, particularly the FLHF level remains weak. The FLHF level has a critical role in the sustainability of CDTI. It is also the level where several programmes plan to add onto CDTI. Thus APOC may have to target and reorganise its support arangements, for eximple adjust the MOU with the State to focus on the LG level. Three other interrelated activities are recommended for APOC support. First ApOC and NOCp should organise a forum involving key staff and leaders from the States where CDTI evaluation has -been canied out. Such a forum will facilitate the exchange and pooling of experiences, thus enabling future action by individual projects to be based on lessons from the pooled experiences. Secondly another forum to facilitate exchange of information on sustainability plans berween LGAs in Kogi State is also recommended. The two activities will enhance foito* up action after the evaluation and sustainability of CDTI. Finally it is recommended that APOC support operational research on diffrcult issues, of concern to many CDTI projects, emerging from the above activities. Examples noted by'the evaluation team include the role of FLHFs and of transportation for CDTI in the "riverine" areas. 2t ASSESSMENT OF THE APPROPRIATENESS OF AND EFFECTIVENESS OF THE REVISED EVALUATION INDICATORS, GUIDELINES AND INSTRUMENTS Methodology: After the fieldwork exercise, where the instruments were used for data collection for the purposes of , evaluating the sustainability of Kogi CDTI project the evaluation team sat to analyse the data with a view to assessing the instrument as well as evaluating the Kogi State CDTI project. The method entailed: Findings: data for the evaluation of the CDTI projects. deficiencies and remedial steps. The evaluation had not used much of this information in arriving at judgement. Although, this addition has made the instruments slightly more bulky, the team concluded that the information obtainable from it is potentially useful. Evaluation teams in future should 'integrate' such information in their Judgement'. On Indicators: On Human Resources: Replace "Level of skill: i ' with "!q trainins snecificallv for that skill Instrument 2: Indicator 7.1: Rework the section on HSAM to read "appropriateness and adequacy for CDTI. lnstrument 3: DHMT in-the text. Instrument 4: '/ What happened to self-monitoring? Efforts should be made to make the griding for therapeutic coverage synchronise with the 4 point grades for other indicators especially geographical coverage. 22 Advocacy Visits to the Poticy Makers and Sustainability Planning Meetings As part of the fulfilment of the second task of the evaluation team, the team paid advocacy visits to the Commissioner for Health. The team leader briefed the Commissioner on the activities of the team before and after the evaluation data collection exercise and the planning of the sustainability meetings. The Commissioner pledged his support for the programme and even made efforts to get the team to meet His Excellency, the Executive Governor of the State. Next the team went on to plan and undertake sustainability planning meetings with the SOCT and the LGAs respectively. 23 APPENDIX 1. STATE LEVEL WORKSHOP PROGRAMME Sustainability of CDTI in Kogi State 65F eedback"/Planning Meeting AGENDA I Openine prayer l0:00 - l0:05 To be aooointed 2 Welcome 10:05 - l0:10 Director PHC, Dr Banji Yeve-Asba 3 lntroductions l0:10 - l0:15 SOC (Mrs Amdife) 4 Inhoduction to the workshop; What are the objectives What is sustainability l0:15 - 10:30 Dr Tarimo SOC, Mrs D.J. Amdife 5 "Feedback" on achievements, issues and lessons from the Kogi evaluation on sustainability of CDTI 10:30- ll:00 Ogoshi 6 Discussions on problems identified ll:00- ll:30 Prof. Akogun 7 What could be the solutions to these problems to the problerns identified Group work Group l: One set of problems Group 2: One Set of problem Grouo 3: Ore set oforoblem I 1.30 - 12.30 Prof. Akogun 8 LUNCH 12.30 - 13.00 9 Feedback from group work r3.00 - 1330 Team leaders for Grouo Discussions 10 Rethinking roles of the different levels and oartners 13.30 - 14.00 Dr. Okeibunor ll Plannine for sustainabiliff in this proiect 14.00 - l6:00 Dr. Okeibunor l3 Reoort back from erouo work l6:00 - 16:45 Dr. Nnoruka l4 The way forc/ard: inplementing sustainability (what to do now) 16:45 - 17:15 Director, PHC Dr Banji Yeye-Agba SSI Rep Dr. Tarimo l5 General rnallers 17.15 - 17.30 Ososhi/Okeibunor l6 Closine Prayers 17.30 To be appointed 25 APPENDTX 2: Sustainability of CDTI for LGAs in Kogi State "Feedback"/Planning Meeting AGENDA Facilitators for small groups in Session 7 . Grouo l: Plannine. Trainine. Mobilization and Mectizan * PaulBukutuki * JosephOkeibunor . Group 2: Monitorine. Supervision- Iradership * DrNnoruka * Princess Ogbu-Pearce . Group 3: Finance. other Resources. and Transport * Fayomi " Mr.Ogoshi Assignment: Group work: Identify solutions to the problems Identifl' resources needed for these solutions ldentifl' resources available Identifv other dependable sources for resources I Openine prayer 10:00 - l0:05 To be aooointed 2 Welcome l0:05 - l0:10 Mrs Amdife 3 Introductions l0:10 - l0:15 ProfAkosun 4 Introduction to the workshop; What are the objectives What is sustainabiliw l0:15 - l0:30 Dr. Fayomi 5 "Feedback" on achievements, issues and lessons from the Kogi evaluation on sustainability of CDTI State LGA 10:30 - I l:00 Ogoshi Nnoruka/Akosun 6 Discussions on problems identified What could be the solutions to these problems to the problems identified l1:00 - 12:00 Prof. Akogun 7 Lisht Refreshment 12.00 - 12.10 SOC 8 Rethinking roles of the different levels and partners 12.10 - 13.00 Bukuluki 9 LUNCH 13.00 - 14.00 Mrs Amdife 10 Planning for sustainability in this project By LGA teams 14.00 - l5:00 Dr. Okeibunor t2 Reoort back from grouD work l5:00 * l5:45 Dr. Nnoruka t4 The way forward: implementing sustainability (what to do now) l5:45 - l6:15 SOC SSI Rep LGA Rep Dr. Tarimo l5 General rnatters 16.15 - 16.30 Oeoshi/Oke ibunor l6 Closins Pravers 16.30 To be aooointed 27 APPENDIX 3. PROBLEMS IDENTIFIED BY THE LG TEAMS AND SOL,JTIONS IDENTIFIED DURING THE FIRST WORKSHOP. The main problems that were identified during the first LGA planning workshop by the participants (facilitated by the evaluators) were deliberated upon and suggestions made for removing them 1. Planning was not a tradition of the various levels. It was recommended that every activity be properly planned beginning with the annual plan, which will have a budget line. a. Planning would be participatory involving all the members of the team. b. Planning should be detailed and budget made c. A copy of the plan should be kept in the file while the others sent to the Chairman, the HOD (health ) and other supervisors should have access to it. 2. Leadership does not encourage team building and all supervisors are regarded as the team where as the team is a small goup which is responsible for planning and supervising the supervisors. The recommendation a. A team should comprise of people with special ability for (i) Mobilising/health educator (ii) Monitoring and Supervision (iii) training (iv) Mectizan procurement and storage (v)Team leader b. The team should not have between 5-7 persons including the Team leader and the Assistant 3. Monitoring and Supervision was not focused but routine and therefore could not identify the problems at that level. a. Plan the supervision and how it will be carried out in details b. Supervision checklists should be used when sending anyone to go for supervision. c. Every supervision visit should involve the completion of a supervision checklist. d. The number of checklists should be enough (at least 200 supervisory checklist forms e. The Team leader should clearly state the objective of the supervision and give - supervisory forms, and other resources that may b€ required to carry it out. f. The supervisor should sign the visitors book before leaving the community g. The person being supervised (community leader or CDD) should be requested to sign the supervisory checklist 4. Records: there are virtually no records at the LGA and the records that are there are not properly kept. Seven files with tags are recommended for the CDTI team and would be purchased by December - a. Training file b. Treatment file - c. Mectizan lnventory d. Reactions file e. Correspondence file f. Finance file g. Monitoring and Supervision file Every CDTI team should have copies of every memo in the relevant file 5. ' Training is not focus, everything that is known is repeated thus wasting resources (time, money and effort) a. Use Supervisory checklist b. Analyse (go through carefully) the checked supervisory forms to identify areas of weakness c. Write out the areas that need training and identify the Supervisors that require training d. Make a plan (see planning above) to train the FLHF supervisor on the weakness that was identified. 28 e. Seek resources for the training (persons to do it, what to use for training) f. 6. Finance is a major problem since people are not paid, irregular funds to the LGA, disinterest of the heads of the service a. Identify what resources are required and for what b. Identify all the different people and sources that could be used to obtain resources c. Plan how to approach the sources of finance including the LGA management (TNNOVATE) d. When resources are provided, show recognition in different ways i. Immediate commendation ii. Create forum for recognising those who contribute iii. Inscribe names of those who contribute on the item they donate e.g. a bicycle donated to the health clinic should be marked as "CDTI Programme: Donated by Hon. Y{2" iv. Make an Honours List where names of contributors are listed 7. Transport replacement and insuffrciency not addressed and those that were available were not a. Advocacy-for replacement outside government b. Organise activities that raise awareness to needs for transport c. Display openness and 29 APPENDIX 4. PERSONS THAT WERE INTERVIEWED DURING THE EVALUATION STATE l. Alhaji Suleiman Baba Ali. Honorable Commissioner for Healttr, Kogi State 2. Mr. Daniel Akubo. Perrnanent Secretary, Kogi State Ministry of Healtlr, Lokaja 3. Dr. Banji Yeye-Agba. Director PHC and Disease Control, Kogi State Ministry of Healttr, Kogi. 4. Mrs Dorathy Amdife. State Co-ordinator Kogi State Project Lokoja. 5. Dr. Elizabeth Elhassan. Country Rep. Sight Savers International. 4. Dr Yemi Fayomi Zonal Co-Ordinator, NOCP Zpne C. KOGI LGA l. Chokara health Clinic- Abubakar Yususf Omuba 2. Aseni Health Centre- Mundi Za Idris 3. Yahaya Adam Adam-CDD Omokoro Village 4. CDD of Chikara OLAMABORO LGA l. Director of the Local Government- Mr J.I. Abu 2. Umoru Awulu-Protocol and Information Officer 3. Mr Sunday O. Abogede- District Health Supervisor 4. Mr John Abogede- District Health Supervisor 1. PHC Coordinator-Mr Patrick Ela 2. [ncal Govemmenf Jsg25ursy-name not known 3. LOCT leader-Hassan Abogede 4. Mr Henry Ochai-i/c PHC Clinic Ogugu 5. Mr Eneche Yunusa--- i/c Adum Health Health Centre 6. Gago of Ihangbe Community 7. Gago of Okegbi Alumaji Community 8. Gago of Iboh Community 9. Gago of Ogba Adeh Community 10. Mr Andrew Umoru-CDD Iboh community 11. Mr Tahiru Sule-gago-{DD Iboh community 12. MrAdjo--4DD Okegbi Alumaji community 13. Mr Omale {DD Okegbi Alumaji community 14. Ms Johnson -{DD Ihangbe Community 15. MrOmaale-CDD Ogba Adeh community 16. Ms Sara Adukwu-CDD Ogba Adeh community IGALAMELA LGA l. Mr. Aduku Musa. Oncho Co-ordinator 2. Mr Piu^s Idoko. Assistant Oncho Co-ordinator 3. Mr.Peter Ejibo lbrahim CHO (LOCT Member) Igalamela Ajaka Centre. 4. Alhaji Yurnucha Abdulahi. Ajaka West Senior Gago 5. Alh. Shaibtr Ibrahiim -LG treasurer6. Alh. Adarnu Muazu Mohammed- Head Primary Health Care 7. Alh. Ahme.d Saihu -Asst. Planning Offrcer8. Mr lge D. Joseph - Planning Officer 9. HOD Heai:h Igalamela PHC-John Manyiyebo Ejimatsuwa 10. LOCT mernber Peter Ejibo lbrahim I l. EtemahiDrstrict Head- Chief Abel Etuh 12. Ajaka Wes,r Sendor Gaagel- Alh Yunucha Abudullahi 13. Idolu Heal']r Clinic-Moramu Umoru 14. .A,kpaka Vrllage CDD-Salim Musa 15. Ada.;r Corr-rmunity CDD-7-akari Mohammed and Ahmed l6 .{gbedu Central Health Clinic-Mal Umarume 17. Abuka We'st CDD- Steven Itanyi 18. Agbedo Ccntral Chief--Sir Anthony O. Abah 6l 6t z Ir frl(J o le O o) o 9O O\JOA Gl -> TE HE e^ Ea Q() 8X(a< 89ovOpio< ^O 5Ro46i (, rl II a) 6! 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'ELd '=d, L :r bf) '=;1() -r-FF J.= q- O r(-oo0Joo '.= E .9 --=! zva .l: epH 6): E A6 o o- aiE€,X€ EE(q =- --i up. -o (J ' 2:E o.sp o ^ '.d Z*a :',i o .:o r3 g >59 (€ =L-Laau - a.a uaza)6h;;AEE-gE;3 H€ o .Y(, .eE Oo o. cQ oz r- oo o\ O c.l ca 33 WAY FORWARI) On the way forward from this point, the Director for Primary Health Care (PHC), who represented the Honourable Commissioner for Health, the developed sustainability plan will be presented to the Hon. Commissioner for Health who will in turn present it to the Governor with the intention of incorporating it in the budget plan for the next year. This will be defended before the House of Assembly and the Executive will ensure it approval. After that the Ministry will work for the releases to ensure the sustainability of CDTI in the State. The Director, PHC, also argued while responding to questions on how to ensure that the LGAs, which have been assigned roles are carried along, one percent of the money allocated to the LGAs is usually retained by the LG service commission here at the State Capital. They will be ready to support training and whatever plans we have now will be made known to the LG authorities. The Stakeholders meetings will also be used to sensitize them and harmonize intentions between the LGA and State level players. On the part of the supporting NGDO, SSI, the representative noted that the plan has outlined responsibilities for the NGDO and these will be met. The NGDO will be active in advocacy to other stakeholders. The evaluation team leader, Dr. Tarimo promised that the evaluators will complete their report containing appropriate and necessary recommendations to the APOC management. 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F 9i.- c<oo> o. -o^A =tr.t,A= : \-,/ .= ,(o ^ o!; H-52 d 6 0')=t() 5 (.) ..o oo -o -.(nYtr EtuEo d.r bo(!' ^oblF o-o o=()3 -k -v a ua.-Q 'r, (u !, .r L r H;3I&6Oi6 .OP €E ." f.o.1o3Fo.FoE Ld oe'€o= Lcd ir. 0..)Qc tr Or!-O trE,1a L C-.J .= a. {.) (gq)J oo (! F bO ll. 'lf (n .J) dtro oa Eo)oo- z6 o z c\l aal .<f (al olol6rl\l6rlol fl s il ,ll -lr^ fQln2l ?l3l u)l DIa, rl ril EIrl 6l ,ll 56 APPENDIX 7. LIST OF'EVALUATORS SAI Name Address 1 Prof. Oladele AKOGUN Parasite and Tropical Health Federal University of Technology Yola, NIGERIA +234 75 626467 akogunb(dskannet.com 2. Paul BUKULUKI Makerere University SWSA Department P.O. Box 7062 +25677 462100 pbukuluki@hotmail.com 3. DrEdithN. NNORUKA Department of Dermatology University of Nigeria Teaching Hospital, Enugu Enugu State, NIGERIA +23442 452549 nkechi nnoruka@yahoo.com 4. Patricia OGBU-PEARCE NOCP ZnneD Jahun Road, P.M.B. 0291 Bauchi, Bauchi +234-77 540091; +234-73 461607 Mob.0803 7000214 5. Christopher OGOSHI Christoffel Blindel Mission (CBM) 3A J.D. Gomwalk Close +234-7 345657 8; +234 -7 345 4230 Mob.0803 7269619 Cbmios(n)hisen.ore 6. Dr, Joseph C. OKEIBUNOR Department of Sociology/Anthropology University of Nigeria, Nsukka Enugu State, NIGERIA +23442771168 jokeibunor@yahoo.com 7 Dr Eleuther TARIMO 8ox33277, Dar es Salaanr, TANZANIA +0255 742 605025 eleuther@ud.co.tz