ffiiMffi€|ry$Jffi b;gresErf, flilil&rilEl uPu'J$$J grti f ORIGINAL : English ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATTVE COMMITTEE (TCC) DEADLINE FOR SUBMISSION: To APOC Management by 3l January for March TCC meeting To APOC Management by 3l Julv for Sentember TCC j p-- \i-. -) .,J .i .i J]ill I i .r,) jTcc I e0I t l I BtMUP A+t BFO FA ,'Oi. :flon ro, ti J I I il- .k..,'- r ._-1_ t .Y, t v AFRICANPROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) 2 n tutt zrtrt7 COUNTRY/I\IOTF : Nigeria Proiect Name: Benue CDTI Approval vearz 1999 Launchins vear: 1999 Reportins Period (Month/Year): January 2006 to December 2006 Proiectvearofthisreport (circleone)l 2 3 4 5 (6) 7 8 9 10 Date submitted: December 2006 NGDO partner: UNICEF il l^. ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: Country: Nigeria National Coordinator Name: Mrs. Ogbu Pearce Signature P.-^ v Lt- Date. (, la ft (:-c '- Zonal Oncho Coordinator Name: Mr. John Signature Date: (+ I s) U ( This report has been prepared by Name . Mrs. BetB Jande Designatio,, C. ru.4::.'. . .C-qY'),, u,^h' Signature . -.F-: .+. . r::*.-t . . Date 3.a..'..S.. :.9.7 ,, Table of contents ACROI\TYMS v DEFINITIONS VI FOLLOW UP ON TCC RECOMMENDATIONS..... .1 EXECUTTVf, SUMMARY ..............2 SECTION 1: BACKGROUND INFORMATION....... ......................2 SECTION 2: IMPLEMENTATION OF CDTI....... ........9 Tnrzmfnrm OF ACTIVITIES............ ...........9 Aovocacy ......11 MOSILZaNON, SENSITZATIoN AND I{EALTI{ EDUCATIoN oF AT RISK CoMMUNITES 11 Comvrmury INVoLVEMENT ...............15 CapacnvBUrLDrNG .........17 2.6. TnsnrNml.rts.............. 2.6.1. Treatmentfigures 2.6.2 What are the causes of absenteeism? ..------- 2.6.3 What are the reasonsfor refusals?-.-...-.....-.. ................25 2.6.4 Briefly describe all lmown andvenfied serious adverse events (SAE| that....25 2.6.5. Trend of treatment achievement from CDII project inception to the carrent yeor 27 2.7 . ORDpRnvc, SToRAGE AND DELIVERY oF TVERMECTIN ............28 2.8. Cotwrcnury sELF-MoNTToRINGaNo SrerBHoLDERSMsgrn'rc... ..........30 2.1. 2.2. 2.3. 2.4. 2.5. 2.9. SuppRvrsroN 2.9.1. Provide aflow chart of wpervision hierarchy. 2.9.2. What were the main issaes identrfied during supervision?.................. 2.9.3. Was a supervision checklist used? 2t 2t 25 ......3 1 ......3 I ......3 I ......32 2.9.4. Whot were the outcomes at each level of CDTI implementstion supervision?.32 2.9.5. Wasfeedback given to the person or groups supervised? ..... 32 2.9.6. How was the feedback used to improve the overall performance of the project? 33 SECTION 3: SUPPORT TO CDTI....... .........34 3. l. 3.2. 3.3. 3.4. Equntmm FnqaNcnl CoNTRIBUTIoNS oF TIIE PARTNERS AND CoMMUN.ITIES OrrtR roRrras oF coMMUNITy suppoRT _. . . . . . . . . . . . . . E><pgtIDtruRE pER ACTIVITy..........,.. 34 35 35 36 SECTION 4: SUSTAINABILITY OF CDTI. .................37 4.1 . IrrrrenNal; TNDEpENDENT pARTICIpAToRy MoNTroRruc; Evat-uauoN........... .........37 4.1.1 Wos Monitoring/evaluation caried out during the reporting period? (tick any of the following which are applicable)4.1.2. What were the recommendations? . 1.1.3. How have they been implemented? 4.2. Susren-rABrLITy oF IRoJECTS: ILANAND SET TARGETS (trlANOArORy AT Yn 3) 37 37 38 39 39 lil 1. 2 . 1 . Planning at all relevant levels, 1.2.2 Funds 1.2.3 Transport (replacement andmaintenance) 4.2.4. Other resources 4.2.5. To what extent has the plan been implemented...... 4.3. IlrrpcRanroN............ 4. 3. 1. Ivermectin delivery mechanisms 39 39 39 39 10 40 40 40 40 40 40 4.3.2. Training 4.3.3. 4.3.4. 4.3.5. Joint supervi sion and moni toring wi th other programs ..................... Re lease of funds for proj ect activitie s... Is CDTI included in the PHC budget 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been lhe achievements?.........-... .....-..............41 4.3.7. Describe others issaes considered in the integration of CDTI. 4.4. OppnaTIoNAL RESEARCH 4.4.1. Summarize in not more thqn one half of a page the operational research undertaken in the project area within the reporting period. 41 4t 41 4.4.2. How were the results applied in the project? ...............-..... SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, ANI) OPPORTUNITM,S ........41 SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS............42 ........41 IY Acronyms APOC ATO AtrO CBO CDD CDTI CSM DHS DM&HS HSDP HOD HQ LGA LOCT MDP MOH NGDO NGO NID NOCP NOTF PHC REMO SAE SHM SOCT TCC TOT UNICEF UTG VAS wHo African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Community-Based Organization Community-Directed Di stributor Community-Directed Treatment with Ivermectin Community Self-Monitoring Director Health Services Director Medical & Health Services Health System Development Project Head ofDepartment Headquarters Local Government Area Local Onchocerciasis Control Team Mectizan Donation Program Ministry ofHealth Non-Governmental Development Organization Non-Governmental Organizatio n National Immunization Day National Onchocerciasis Control Programme National Onchocerciasis Task Force Primary health care Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Stakeholders meeting State Onchocerciasis Control Team Technical Consultative Committee (APOC scientific advisory group) Trainer of trainers United Nations Children's Fund Ultimate Treatment Goal Vitamin A Supplementation World Health Organization v Definitions (,) Total population: the toal population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). (ii) Eligible population: calculated as 84Yo of the total population in mesoftryper- endemic communities in the project area (iii) Annual Treatment Objective: (ATO): the estimated number of persons living in meso/hyper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. (iv) [Iltimate Treatment Goal (UTG): calculated as the marimum number of people to be treated annually in meso/tryper endemic areas within the project are4 ultimately to be reached when the prqect has reached full geographic coverage (normally the project should be expected to reach the UTG at the end of the 3d year ofthe project). (") Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). (vt) Geographical coverage: number of communities treated in a given year over the total number of meso/tryper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). ("tD Integration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) through CDTI (using the same systems, training, supervision and personnel) in order to ma<imise cost- effectiveness and empower communities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTI. (viii) Sustainability: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future, with high treatrnent coverage, integrated into the available healthcare service, with strong community ownership, using resources mobilised by the community and the government. (i*) Community self-monitoring (CSM): The process by which the community is empowered to oversee and monitor the performance of CDTI (or any community- based health intervention progralnme), ,rith a view to ensuring that the programme is being executed in the way intended. It encourages the community to take full responsibility of ivermectin distribution and make appropriate modifications when necessary- vt FOLLOW UP ON TGG REGOMUENDATIONS Ihe last recommendations received based on the Year 4 report were addressed in the 5'h year report. The project is not aware of any recommendation based on the review of the 5'h year's report. TCC session Number of Recommendd ion in the Report TCC RECOMMENDATIONS ACNONS TAKEN BY T'HE PROJECT FOR TCC/APOC MGT USE ONLY ,l IIIInl A Il/\n a ' \I^-.^-L^- ann / Executive Summary Benue State is located in the central part ofNigeria. The vegetation is forest to the south, with forest - savannah mosaic and mixed savannah grassland in the northern areas. Estimated population of the State is put at 4 million. The major ethnic groups are the Tivs and Idomas. Settlement pattern is largely dispersed. Movement of whole communities or large numbers of persons is common due to inter ethnic clashes or fear of reprisals from the army authorities. Roads between major towns are in good conditiorl but access roads to most of the endemic communities are in poor shape. The State consists of 23 Local Government Areas, while CDTI is currently being implemented in 22 LGAs with the exception of Makurdi, where the state capital is located. The total number of communities in the 22 endemic LGAS is 2,521with an estimated total population of 2,638,213. The ATO for 2006 was 2,182,262 and the UTG is 2,216,099. The project treated a total of 1,756,31 I persons actively in 2,060 communities for the period of January 2006 to December 2006 for all the 22 LGAI, this reflects 67Yo therapeutic coverage and 82yo geographic coverage respectively. The number treated means an achievement of 8l% and 79o/o of the ATO and UTG respectively. In addition, the project treated passively at the State level a total of 20,982 persons. During the reporting period, the project trained 939 health workers achieving 3lolo based on ATro of 3,004 health staff. Of the number trained, 471 werc new. A total of 3,137 CDDs were trained or re-trained during the reporting period representing 48Yo of ATrO of 6,600. 538 of the trainees were new. Most of these trainings took place in the 22 LGAs in the third and fourth quarter when treatments were already on, due to the delay in the approval of the project's letter of agreement by APOC and zubsequent release and accessibility of funds by the project. 548 communities were mobilized in the 22 LGAS for on the spot selection and training of CDDs and mop-up treatment of refusals and absentees and those persons not yet treated. Advocacy visits were made to 22 LGA policy makers earlier in the year before the commencement of CDTI activities to solicit for the funding of CDTI activities in the LGAs of the project area. The fruits ofthese visits included: printing of 2000 community registers in Tarka LG,\ purchase of 10 bicycles in Tarka LG,{ provision of hotel accommodation for field staff in some LGAs during supervision and other visits. Promises to print community registers and purchase of bicycles were made by the Chairman Ogbadibo LGA while Okpokwu LGA promised to fund CDD training. These promises were yet to be fulfilled as at the time of writing this report. The challenges facing the project are numerous. They include getting the State and LGAs to release counterpart funds, ensuring the achievement of 85% therapeutic coverage and l}Oyo geographic coverage of the population and communities under treatment respectively, ensuring proper record keeping at all levels, and increasing the number of CDDs in the project area in order to effectively reduce the work load on existing CDDs and help reduce demand for financial compensation by CDDs. Other challenges for the project include increasing level of community ownership of the project and complete integration of CDTI in the PHC structure. To address these challenges, the project mapped out and implemented an intensive and painstaking plan of action for field activities involving targeted supervision and monitoring, 2- lrryrn / A Dn^ 1, LT^-,^.-L^- ann / training of more FLHFS and CDDs, mobilization, health education and mop-up treatment in the endemic communities in the LGAs for the last quarter of 2006. Other follow up actions will be carried out during the2007 treatment rycle. On the 29n day of Novemb er,2}O6,the State Epidemiological Unit of the Ministry of health which houses the Oncho Control project's office as well as other disease control programme offices was broken into by a gangof thieves who over-powered the security men on guard, ransacked the ofiices and made away with various amount of monies and other valuables. The Benue CDTI Programme also lost monies to the tone of N214,000.00 (Two Hundred and Fourteen Thousand Naira) only. With the various challenges facing it, the project has committed staff at various levels of CDTI implementation. Mectizan is available in sufficient quantities and there is an appreciable level of awareness of the magnitude of the burden of Onchocerciasis disease by policy makers and community Leaders, opinion/religious leaders. Most people living in the endemic communities expressed overwhelming interest to take med,izan for the treatment of Onchocerciasis. 3 rlflfn /am^ a, lI^-.^-L^- ann, SECTION t: Background information 1.1. General information 1.1.1 Description of the project (briefly) Geographical localion, topography, climate Benue Stat" ir located initrJcentiat part of Nigeria. The State lies between longitude 6030' and 8020' East and latitude 7080' and 9035' North. It shares borders to the North with Nasarawa State, Enugu State on the Souttr, Kogi State on the Southwest, and Cross River State on the east. The vegetation is forest to the south, with forest - savannah mosaic and mixed savannah grassland in the northern areas. The terrain comprises undulating hills that occasionally reach 4,000 feet above sea level, to bare flat plains along the Benue River, with an altitude above sea level ofabout 300 feet. In the eastern part ofthe project area there are steep hills, cut by swift flowing streams whose banks are densely forested. The rainy season begins in March and ends in October while the dry season lasts from November to February. The State has an annual rainfall of 1200 - 9800. Pop ulalio n: activities, c ultures, language Estimated population of the State is put at 4 million. The major ethnic groups are the Tivs and Idomas. There are other smaller groups such as the Etulos, Offiahs and Jukuns, who live in Tiv areas; while the Igedes and Agatus live in areas inhabited by the Idoma. The major languages spoken are Tiv, Idoma and Hausa. The major occupation of the population is farming, including growing of yams/cassava and cultivation of cottorq Soya bean and beniseed. Fishing along the riverrine areas is widespread. Crafts such as blacksmithing, weaving of cloth etc are practiced. Some also keep domestic animals. Settlement pattern is largely dispersed. Movement of whole communities or large numbers of persons is common due to inter ethnic clashes or fear of reprisals from the army authorities. Maybe apart from the Niger Delta area Benue State is one of the States of the federation with heavy military and police presence. Co mmunication system (road... ) Roads between major cities are in good condition, but access roads to most of the endemic communities are in poor shape. Some are not passable during the rainy season. Despite this transport by road remains a major means of communication among the communities. The electronic and print media are also veritable channels of communication. Within the communities the town criers and announcements in churcheVmosques are preferred means of communication. Admi nistratio n structure The State consists of 23 local government areas with each of the LGAs having a chief administrative officer, the Chairman. A legislative arm made up of elected councilors from various wards help in regulating the excesses of the Chairman. At the State level the Executive Governor is the head of administration. There are the legislative and judicial arms. The capital of the State is located in Makurdi. 4 Ir[rn / a m^ a, \T^-.^-L^- rnn, Health system & health core delivery There is an official PHC policy and structure in the project area. It is a system of health care services where community participation forms the mainstay with support from the State, Local Government and NGOs. Levels of functionality however vary across the State. Scattered throughout the State are various health facilities ranging from health posts to hospitals. There are 889 health centers and hospitals in the project area. Table l: Number of health staffinvolved in CDTI (Please add more rows if necessary) District/L,tGA Number of heelth stefiinvolved in CDTI actiyities Totel Number of health stafrin the entire project arrce Bl Number of hedth stafiinvolved in CDTI Ba Percentage BrBz/Br'lfi) Ado 104 29 27.8 Agatu 147 46 35.6 Apa 129 40 3l Buruku 106 25 23.5 Gboko 108 34 31.4 Gwer 135 45 JJ.J Gwer West t47 88 59.8 Guma 208 32 15.3 Katsina Ala 174 26 14.9 Konshisha t7t 38 22.2 Kwande 206 42 20.3 Logo 94 94 100 obi 69 42 60.8 Ogbadibo I 7 I 49 28.6 Ohimini tt2 l9 16.9 oju 132 82 62.1 Okpokwu 153 47 30.7 Otukpo I4 I 79 56 Tarka 69 20 28.9 Ukum 149 3t 20.8 Ushongo tt4 32 28 Vandeikya 78 76 97.4 Total 2917 1,016 34.EYo 5 rrIrn /aDnn a, \T^-.^-L^- ann, The project intends to train more Front Line Health Facility Statr(FLIIFS) in each health facility available in the endemic LGAs. This will aid in sustaining mectizan distribution especially, in cases of transfer of health staffwhich is observed to be frequent in the LGAS. 1.1.2 Partnership The partners involved in project implementation in Benue State are UNICEF/Nigeria, NOCP (National & Zonal offices), the State Government, the 22 Local Governments Areas and the endemic communities. In Kwande Local Government area St. Monica's hospital, a Roman Catholic Mission hospital is assisting in the distribution of ivermectin to some of the communities covered by it. UNICEF is involved in planning, advocacy, monitoring and capacity building. It makes funds available through its Zonal offrce in Enugu to the project to carry out planned activities. However, within the reporting period no funds were received from UNICEF. The NOCP zonal office is empowered to act for UMCEF in terms of supervision/monitoring and technical support. NOCP HQs provides technical support, assists in monitoring of activities, and training of health staff. The communities select CDDs, collect their Mectizan consignments, decide on the time and mode of distribution of Mectizan, and occasionally provide materials for record keeping. Few communities support their CDDs in cash and others in kind. The LGAs have continued to provide support for LOCTs to collect mectizan from the State, and provide token amounts to aid in routine monitoring and supervision in the communities by LOCT members. The LGAs have also ensured adequate storage of mectizan in their health facilities. Other functions of LGA staffinclude mobilization/health education /sensitization of communities, training of health staff and selected community distributors, management of reactions, record keeping and reporting of treatments at the community level. The State on its part has provided logistic support to ensure the availability of mectizan in the State, provide for the remuneration of personnel and staff on the State Oncho team, supervise LGA activities and pay advocacy visits to State Policy makers. Staffat this level also assist in community mobilization, sensitization of other partners, training of health stafi and spot- check of activities at the community level. Partners are working together in relative harmony, although there was delay in the approval of the project's year six budget by APOC and the State is yet to provide direct funding of core project activities. Nevertheless, efforts were made within the reporting period to get partners to support the implementation of CDTI activities. Plans are being made to pay advocacy visits to newly elected policy makers as soon as the 2007 general elections in the country is concluded and elected leaders sworn into offrce. 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Ho 7 Hg ? p, Io z Ho D'to a9EP 54 +El oe Urt 0a a(, Et E o U(D o(D d(D r-t U(D o(D 3dor-t Uo()(D doFt Uoo(D d(DH U(D o tT dor-t U(D o(} d(D U(D oo)dor-t too(D 3do U(D o(! d(D U(D c)(D d(D U(D o(D 36(D U(D o(D dor-t Uoo(} cr(Dit ooBH9u36- I oo tt) + tr oac a, - 0a o c@d Th c oadod OQto t OQtod I ooco t 0edo t 0at0 E 0acU' 00tr a+ 0acU'+ a3 :EE.+ iil'oa U)E' tD{(a o Uoooll dort Uoo(} d .DH U tDo(D doH Uoo(D H.rt Uo c)(D d tnr-t U(ao(D dr!ri Uo c,(! crrtr-t U(D ota C'tnt Uoo(D st Uo c)(D d(D U(.0 c)(D d(a >t U(D o() r U(D c)o dtaEt oo3EEga+.D o H oFl F s) o-(D ,f 0o e(r) o oco C7id Fl p, >.t 7f c) odtr7r o o ,f o ,f{tr 9.t o ooadp o. d o oa a F =ooc(n t oa a t oat tt) t oe @ tr oata+ oa a+ oa a d o C) od @Ft oodod(D H oo o6oFt oo odoFt o .) od(D r-t oo od(D r-t oo o6(D :1 oo odor-t o a) oC(D >-t oo od(D c 0q a oa o E 0a a t 0et@+ t 0a U' t 0ad@+ oc a oa a tr oq o @ o+ Uoo(D 5d(Drt U(D o(D d(D r-t Uoo(D (t (DFt Uoo(D cr(D >.t U(D o(D d(DE U(D o(D C(Dt Uoo(D d(D r-l U(D oo dor-t (D o(D 6(DFt U(D c)(D cr'(D :.1 ? 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(D t9 Q"(D (D xtt D i sE rsfrii it $Eg*I dg 55ir E i+ $[38v [q E:*Eefr 6 FssI + d e &B sE $E rir= E*ai'A<8E a ?f iY== H€a T'Y5+5+5[ 3 E 2 B'q? 11'=is #e sgg j' I vH6 E T 5 E-€ 3A€ P a e.,BF : B:8'3 ef H: P E"AE23 6 >rarr=' "gXo(J5 e 5 3.+i.P o 3.(DEZ r Extsr 3B.E s g *Fs5 R e ir-9I a bc95 3 g.o -EB 4s.rI H S +HTH 9E 3J c0 ei 6'<o 5' a 3 5 ='@Y r :yBc = E BH sE.F: q€A H i g *+ -,2' 6 d$E iE Heg q,B =-Qs 6 gEFr i: Hii E *aroi'*l = ) E,o o-Er gE5il* N-gd *T 5gFoo-xL --E--s3 # $g E T A gE O I 'Jro Uo "o N)5 zo (D d(D H N) 5 2.2. Advocacy State the number of policy/decision makers mobilized at each relevant level during the current year: the reason(s) for undertaking the adwcacy and the outcome. Describe dfficulties/constraints beingfaced and suggestions on how to improve advocacy. Given the background of the project and the fact that CDTI implementation has been greatly hindered as a result of the problems of delays in the release of funds and many months of skeletal activity it became imperative to renew advocacy visits to policy makers. At the State level following the need for the State to release counterpart fund to complement APOC Funds most especially when APOC fund is yet to be approved or accessed, two (2) Advocacy visits were made to partners at the State. These included, the Honorable Commissioner for Health, the Permanent Secretary and Director Medical and Health Services. To this end, a 5 Million Naira budget for the revamping of the Benue CDTI Project was drawn and submitted to the Director Medical and Health Services for onward zubmission to the State Government through the Honorable Commissioner for Health and Human Services. The approval and release of this budget is being awaited by the project. Policymakers (an average of 2 per LGA) in the 22 LGAs were also visited to secure their support for the implementation of CDTI activities in their LGAs. Following the three times change in the leadership of LGAs in the state, Advocacy visits made to Policy makers in the LGAs reawakened the interest of policy makers on the need to provide financial support to the project while those who had never been in the know concerning the magnitude of the disease burden were enlightened. In Tarka LGA, Monies were released for the production of community mectizan registers and the purchase of l0 bicycles for CDDs to use for distribution of mectizan in the communities. Funds were also released by Ado LGA for the purchase of bicycles for CDDs. Records from most LGAs show the approval and release of imprests to the LGA Oncho Coordinators for carrying out supervision and monitoring activities. Equally funds were released by some LGAs for the maintenance and fueling of motor cycles. The Caretaker Chairman Ogbadibo LGA promised to purchase bicycles for CDDs to facilitate Mectizan distribution before the end of the year 2006. However, most LGA Chairmen made promises which are yet to be fulfilled. The biggest constraint is the political instability at this level which saw frequent changes of policy makers at this level. Additionally, there was difficulty meeting most of the policy makers. Logistics was a problem as the project vehicle had constant breakdowns. To improve advocacy there is need to involve the Ministry of Local Government & Chieftaincy Affairs in advocacy visits/campaigns to the LGA Chaiffnen. There is also need for high-level advocacy directed at the Governor and to pursue deduction at source of LGA funds for CDTI implementation. A sensitization meeting hosted by UNICEF/APOC targeted at key stakeholders as chairmen and presided by Governor or his deputy will also be helpful. 2.3. Mobilization, sensitization and health cducation of at risk communities The use of media and/or other local systems to disseminale information Provide information on: - The use of media and/or other local systems to dhsertnatu information - Types of IEC mderials used - Mobilizalion and health education of connunitia inclading wom,en and rtnorifies 1'l rrIrnlAl)/\- ai \T^-,^-L^- nnn/ Resp onse of target cotrunanitie{villages Accomplishmenls Suggest ways to improve mobilizotion and sensitizfrion of the target conmartties During the reporting period the project made use of the following media for the mobilization of the people:(1) Community heads, including district chiefs and opinion leaders. The project found these set of persons as effective means to reach the many community members for mectizan mop-up featment in the communities where coverage was low and in communities that were discovered not treated as at the times of supervision and monitoring.(2) Face to face meetings with the community members. This occurred in all the ZZLGAs where the health personnel went to some communities to mobilize them for the selection of new CDDs for training and existing CDDs for retraining. Communities were also mobilized for treatment and distribution of mectizan. In some communities where CDDs are available, the CDDs were used as agents for the mobilization.(3) In some areas, meetings of groups and associations such as women organizations were used to mobilize some of the community members. There is the intention to expand this medium to include other associations in the communities as agreed on at the stakeholders' meetings held in the various LGAS in 2006.(4) Church announcements - This medium had been used in some a^reas to mobilize the people especially during the Onchocerciasis day celebrations. This was also used in more areas for mobilization and was agreed on in the LGA stakeholders' meetings as an effective means of mobilization since most community members are Christians who have confidence in their priests and pastors.(5) Posters, handbills and stickers with Oncho messages were used to mobilize, sensitize, and educate community members. Mobilizotion and health education of women and minorities - method and response In the Communities where the people were mobilized, there is active participation of female members of the community at meetings. Women were always in attendance at health education meetings, and sometimes were in greater numbers than men. In several places the women were assertive and could demand that their views be listened to, respected, and decisions reached based on superior zuggestions. Generally in decision - making women make inputs before decisions are reached. In some communities women are part of those who make the actual decisions as they hold traditional chieftaincy titles. We observed that in some communities women are selected or have volunteered their services as CDDs and they are serving their people well. The minority tribes ( Igedes, Etulos, Offiahs, Agatus, Jukuns etc) in the project area were mobilized using interpreters during visits to the communities. Response of target co mma rtties/villages The responses from the communities that were mobilized show that the communities have a strong willingness to comply with Mectizan treatment, and have expressed some support for the process - not only in the selection of distributors but also in the few cases of the empowerment of the distributors to collect the drugs from the collection centers. However, a lot still needs to be done in the area of incentives for the CDDs. Quite a number of people are still ignorant of the burden of the disease. Some others still live in fear of side effects experienced and/or rumored at the initial stages. Others are not aware of their roles under CDTI implementation. The primary concerns for the mobilization of communities had been to get the people to take their Mectizan tablets every year and to sensitize and educate them on their roles to ensure that mectizan treatment is sustained in their communities for the control of river blindness. 12- rr[rnlal.n^ r, \r^-,^-L^- ^nn, Accomplishments continual intake over a long period of time. expected that positive results will be seen in the following year. provided it is available. the request for incentives by the CDDs will greatly reduce since CDDs now cover treatment for their families basically. Vl/ e ak ne s s es/C o n strai nts There are several constraints faced by the project with respect to mobilization of the endemic communities. These include: This has reduced the level of activities considerably. leading to inconsistency in the support for the CDTI programme. By the time a particular set of policy makers are enlightened on the burden of the disease and pledge their commitment to support the programme implementation, a change in management occurs and new persons are sworn in. The entire process of creating awareness and soliciting for support begins all over again. of the introduction of CDTI in the State. It was observed during mobilization that communities did not understand that CDTI is to be owned and directed by the community. In some communities there was total ignorance of what the role of the community is in the implementation of CDTI. both from the State and the LGA policy makers. This is more problematic in areas where salaries are being owed for several months. invited to programmes or visited there is difficulty seeing them. the vast expanse of land and diflicult terrain in some of the LGAs and communities. frequency of breakdowns of the vehicle has heightened thereby requiring frequent repairs and maintenance. Major repairs have been carried out on the vehicle 3 times this year. Therefore, the project vehicle needs to be replaced with a stronger vehicle that can withstand the volume of travels for mobilization through very difficult and wide terrains. Suggested ways to improve mobiliulion of the taryet communities Even though the project is technically reporting 6h year of implementation of CDTI, given that sustainable structures were not put in place in the first two years of the project at the community level which is the focus of the CDTI programme, CDTI at the community level may be said to have just commenced. Problems of delays in the approval and release of the project's budgets and leffers of agreement have bedeviled the project in the last three or four years. This resulted in many months of skeletal activities and in some cases non activity. It is as if the project is just making a fresh start, and in a way it is because a lot needs to be done in order to properly mobilize the endemic communities and set up sustainable structures to B IIIr / A nn^ a, tr^-,^-L^- ann n facilitate community ownership of the CDTI programme. To achieve this therefore the following suggestions are hereby made. These include. 1. Early release of funds by all partners. With funds, more visits could be made to the communities, IEC materials can be produced and distributed, logistics obtained and maintained and media houses approached to help disseminate information on onchocerciasis control. 2. There is a strong and passionate appeal by the project for APOC to review the project's financial year such that the year 2OO7 is considered to be the 6m year of the project and not the 7h year as it now stands. This will enable the project to recover the much lost grounds for the four years within which no financial support was received from APOC. 3. There will be need to utilize the electronic media more to reach the endemic communities. It must be noted that radio is an effective means of reaching millions of people within the Statg as almost all communities - no matter how secluded have access to radio services. 4. In some LGAs teachers have been trained as community - based supervisors, and sometimes, as distributors. The project needs to follow up by using the schools as channels of reaching the community. Several ways are envisaged. One way is to make announcements on distribution or conduct health education sessions at general assemblies for pupils to take home to their parents. Another way is to encourage the formation of health clubs. 5. Adopt the strategy of visiting the LGAs and communities for supervision and mobilization in groups of 3 SOCT members. While in the LGAs the SOCT and LOCT members divide themselves into 3 groups to facilitate speedy and wider coverage of communities targeted for mobilization. 6. The State has a large land mass with diffrcult and bad terrains. There is need for at least two project vehicles and 22 more motorcycles to ease the problem of transportation to endemic communities for CDTI activities. Its worth mentioning that the project vehicle had broken down severally despite major and minor repairs carried out on it. 7. The project has to follow up on the stakeholders meetings and the community leaders' forum about to be initiated and en@urage the involvement and participation of CBOs and various organizations that can reach the endemic sommunities. The involvement of women groups will be greatly pursued. ,{+ rr[rn rAmn n, \r^,.^-L^- nnn, N a5 a o o 3 3 E =ITt II J o o JJ o3 al l-l la)td ltDls ; o J (D .A "oS' :r o rd o) o d (D o Fl e GA V)(! $ o(\\ =a.j (! a(! V) C^ \- (/r FLo ru op t\)s zo (D d .DH N) (}J o 0qC' FDo- 6 o od -o@o X{ o, o-(D xo (r) v) F) X s) U) F) Ep oC F) o{(DFt {(! v, o{(DFt od o7ro EUE e7fC rop mA) C o-o I q. Fo \o o\ o o\ \o N)@ oo o{ 5@ N)(.) N)5 o\\o UJ@ o\ @-J \o5 \o IPYJf f E $l4a tr - E *.1-x6 t ='rtD(D[j; E! aZOEtrEtrC =6ts.oqr: Hr 50 (!='E'5 EEG= EE o< 9G .lt! r:. G3{dE: 2, z, 2, 2, 2, 2, 2, z 2, 2, z z (Jt z €PE*3d2-e;B€E TE 2, 2, 2, 2, 2. z 2, 2, 2, 2, 2, 2, I\o s 2, :d(.D il (D ID tE)o Eg{- E! E' rll o o\ o\ {o\ @u) N)\os {{ @o @t\) @ {@ N)(.){ {\o o\s (O^ Ur(, zrt !0 6 oUU E!{ z E (D o otU s { O (]) (r) N) O t\) O t, tJ e ()) N)(, OFgE ad' EEO @O @UJ @UJ tJ\o{ @o @t) @N @o @ Nso @ @N) @ @o Ho ID E, 1 E +Et (/) 5 O (.) o N) o (.) t.J (,r o O 3.? z 9tE + F B'e" l! )-: Z ca58r =.:9+ 6'=EBIrEdE ,-t E.H9. Es P rO o\ u) bo -o o\ o Os\o o\ \, @ s I{\o o\ os b.s os N)ir)s tr) L") s ! @^ rO o\ I o\ rO o\ 9\o -o o\ iu o 6 ID oEl6 t! Fs!ll E Ho E p o-(D 7r o) C(r) o ooo C7fc ts Fl F) '-t7fF' o+t7lrd o oPffo o ,f € .e E o hJ UI ha t,)(.) @{ o5 {(/r \o o\\) O @Llr (rr 2, 2, z z z z z z It95\oo\ 2, z 2, z 2, z 2, fr) \o(rr {5 @o\ o\\o @UJ \o -JN) {o\ {O \r{ { (Jr (,) l'.) @ @ 5 tJO s t)@ @ \o { N) @L,I (.){ @O @O \oo { u) s N) s N) 5 { !r) @ s P(.) s s, rO o\ \c\o 5\ t^, s t.) 5\oo\ !'J\o\o 6\ (.) b. s @ i.,\o 6\ rrrrts giiis$F$gis:$u laserr[ $$ri$:;Ys:*3 sSS*S er+*rE r r$*EF =-i 6'Y.-- E ? EEFgilAI i5 $i BEt$gCE $F $EP"E.E.rgPB: E. $$q.?lBE? * SilgeFEe.F B y$gE"il3r Y t$ ^.POQO.:r.t\SiH BAE i a$Bs Ffis $ sd3t =*E ft ,33E B3'\ X::04 < oa (!E.e6 I q $.E+ rt d68" ;S $(n--r(4(\ s?. I' (D 6 so5 roA# et u''-(D o o ts\) -] Fg \i?E 5€ efr.E ;E E5r B R(Dr+(Ds" =:r 6D)F)Ad=' 2 sa-i' h oq +ti6 ? $65" i Bsq g BH5 ^: Gt -ILa)5E i sE.? B SF5$ a3$ o\ € 'Jro to "O N)5 zo .D d(D N) O +. 2.5. Gapacity building 2.6.1. Training There were formal and informal training sessions for both health workers and CDDs. The health workers trained CDDs who were newly selected and retrained those that needed to be refreshed shortly before the distribution commenced. There were also follow up training targeted at Guma, Gwer, Ado, Apa" Agatu, Logo, Tarka, Ukum and Koinshisha in order to improve coverage. The project intends to conduct a need assessment survey to determine the number of CDDs to be trained and in what areas. - Describe the adequacy of available knowledgeable manpower at all levels. The human resources at every level are available, and that, in suflicient quantities. The problem is harnessing them appropriately for CDTI implementation. - Where frequent transfers of trained stalT occur, state what the project is doing, or intends to do, to remedy the situation. (The most important issae to describe is whot meqsures were taken to ensure adequate CDTI implementation where not enough htowledgeable manpower was wailable or if staffs arefrequently transfeted during the course of the campaign). Transfers of health staff at the LGA level are frequent, and this is part and parcel of the constraints of the programme. While efforts are made to give orientation for new ones, this is usually not enough as large numbers are involved and the terrain vast. Trained ones are sometimes lost in either remotest parts of the communities or in the large townships. Part of the challenge of the project is to train all the health workers in the State. Given the numbers involved and the large expanse which requires huge amount of resources, this is equivalent to cleaning the'Augean' stables. Even for those trained, there is need to conduct a comprehensively packaged refresher training for LOCTs and Health facility staff in the specific areas of recording and reporting and CSM. A greater proportion of existing trained Health facility staffs have received training only once and have not been adequately involved in CDTI implementation by the LOCTs as they should. The training sessions will be used to motivate them as well as build their capacity for proper execution of task. 1-, IIn-,r\ ' A Dr\ri a,t tT^,,^-L^- rnn, 0ad o) a- d o og t-o0a o X{ o: o-(D Xo v) (r) pt X o) 2. c, Ep o F) o{(DFt {(D IA o{(D odo ,fo Edtr e ,rd E F) oaF' c o- o t a f) F o 5 5 5 5 5 5 5 5 5 5 5 5 5 5 '.i ts a ztr (r (D o i@ oaot' F o U' (a tr 5 5 5 5 5 5 5 s 5 Ur 5 5 t.J N) + (JJ 5 5 5 5 5 5 s 5 5 5 5 s 5 2 h 9^* +1.,E n { o\\o \c) t\) o\ { \ts t\)@ 5{ @ o\ i.J\o s -I 5 Ft z, o Irto 't= -<5 Eqa?0 s: :i xi*r *(D -r tgto= or t)\o f.) 5\o u) N)5 t\) -I (, m t.) lJJo s N) N) N) o\ @ + [.)f.) l..J o\ 5 |.J (JJ(,r N) h.) Ul b.) (, 5(rl N.J 5 (J) 5 o UI tJ\o b.)(,r \o q) 5 ()) -l \o (,| o\ tJtJ t)O stJ 2 \f Aiie a, o Fl 6 o z +r!orti'o5*l(DQQDT -lq Y-r -Dc=' o o o SFs€ Abi'$ oE-Ot olt E: (,) O u)o u) (,o tr)oo (r) oo t, o (, o t]) u)oo (, UJoo bJ (r) Ia z do 0 o E'U arl p (D CLoO 9r(, N) { o\ L,I o Ur tJ@ -t tJ\o{ t.J o\ Ur5 6 \o o\(, -ttJ (, (JJ @ o\ u) @ o\\o @o l..JO NJf.) f.)5 € @ o\\o 6 \o € t.) 5 s OR r€ Abi' s, i'a t+J-O oilE; l-l lD)td ltDl* ;r-t o, oq o) + (D o-!t(D' Fl o + (D o t) ot o U -l o @ g) o e 6-G G $ d o € rr) (\ a(\ f.)(t$ \js- @ { rJro 'oo "o tJ5 zo tD d(D H N) UJ 1 Fl orl F E) o-(D ,f c, C u) o oao e ,fd Fl Fo>'t ,fg) odcPfio ot\.lC, o ,f{ .e O € 5 5 5 5 5 5 5 5 s .) ID (D E(! \o 5 -to\ \o 5 5 5 5 o 5 5 5 + 5 5 5 1..) (, Ut O 5 5 fJ \o o\ { @ 5 s\o o\\o s N) N) s a o o o bJ\o s lr)\o I,J 5(^ -I 65\c tJ o\ o\ o\ o\ (, t'J 5 N) Or N) N.)(]) 5 (JJ -l 5 -T (, -l NJ Ur N}J 5 -t \o N)tJ { oo @ o\ o\ o o (-) oo u)oo (, o (]) O (, -oo\ .) (! .! (D 56 (, (.) -l (, L)O b.)(\a\o @ 6 -I \o -J TQ 5 @ 6 b.)O @(,r (^ 9r -t -t o\tJ o\t.) N) O l'J \o * z €- s G o \ to 0a 6' ts ss R 3 o s : o : 6 8 ZHrwt F{ l-l 6 - H -E.&q!i.Q -o= ! sH=.q(D6 ,47 I <t-4t +ag3-:$Frl5vDtt- C) =' ='E 6ga6g *H:B'?* -'(DE Fl 8$E. ?r5=r 5'P5 0a .:- i5.36- +3Do93 E: gIJ 5! UJ UJ t9oo =. oH {E-=tYo o 0?r'+ E B* *8.d6 rrP !'o otrj=+r! e+or-loh- A) H.Ogq Fx.; - 3Ee ? i=o >.tsHq3a 5,(D-(D5 o(D r$<(J A)Frr O) iro =i+c+O (l u, o: rB' t d(D ot \o u Eo FU op NJ5 zo @ C .D f..) 5 Table 6: Type of training undertaken (Tick the boxes where specrfic training was carried oat during the reporting period) a. Any other comments Trainees Type of training CDDs Other Community members e.g Community supervisors Health Workers (frontline heahh facilities) MOH staffor Other Political Leaders Others(specifu) Program management How to conduct Health education { { { Management ofSAEs ./ { ./ CSM SHM Data collection { ',/ Data analysis { { Report writing { Others (speci&) 20 rlnr/\ raln^ a, \r^--^-L^- ann, 2.6. Treatments 2.6.1. Treatment figures If the project is not achieving 100% geographical cwerage and a mirtmam of 65% therapeutic coverage or the coverage rate islluctudrg, state the reasons and the plans being made to remedy this. The following reasons account for non-achievement of 100% geographical coverage a. Poor record keeping:- Availability of adequate, and reliable data is essential for reporting. It has been quite diffrcult to get adequate and reliable records from the Field Staffwho treat communities but do not keep adequate or reliable records due to negligence or inability to record properly. Thus, computation of geographic and therapeutic coverage becomes difficult. b. Late submission of reports by LGA Coordinators:- Untimely submission of treatment reports from the communities and LGAs sometimes makes it difficult to bring into the computation of treatment coverage, the treatment data from other communities and LGAs as at the time of reporting, treatment data is still being expected from some communities in some LGAS. c. Inadequate transport facility and bad terrain:- Most communities in the project area are located in the hinterlands where accessibility is further made difficult by bad terrains. Geographic coverage of these communities is greatly affected most especially where transport facilities are inadequate. d. Displacement of some community members during communal clashes was another major cause of low coverage. These brought about large numbers of absentees as there were large population movements. This was more intense in some communities in Gwer East, Buruku and Katsina AIa LGAs. e. Transfers of health workers which led to disruption of planned activities as it took time for the next health worker, particularly if not earlier trained, to grasp the ropes immediately. f. Lack of financial support from LGAs which led to inadequate supervision ofthe scattered communities within a huge land mass. Some communities that were not treated could not be discovered on time. g. Lack of census update in some communities resulting in inadequate Mectizan@. Most communities were discovered not to have had mectizan and in some cases inadequate requisition of mectizan due to lack of census update. h. Inadequate motivation of CDDs. Some CDDs are not given any motivation/incentive thus leading to disenchantment and in some places high rate of attrition. i. Some communities have had their treatment stopped because CDDs had abandoned their jobs. Plans are been made by the projea to improve on the level of both geographic and therapeutic coverage. SOCTs have been instructed to carry along meciizan supplies during supervision and monitoring visits, during which they are expected to ensure that mectizan is available in all the communities visited for the purpose of mop-up treatment of those not yet treated. Also SOCTs have been specifically sent out for targeted monitoring in LGAs considered not performing up to expectation to identifu communities not yet treated, mobilize such communities to select more CDDs for training and afterwards give mectizan to CDDs el rr[rn / A m^ a, \r^-.^_L^_ ann, for distribution in their communities. The trainings conducted specifically emphasized and comprehensively covered the area of record keeping and analysis. Also request has been made to APOC to provide the project with a new motor vehicle to replace the old Hilux Van that has greatly suffered wear and tear. In additioq 15 motorcycles and some bicycles are also been requested to enhance wider geographical coverage at the community level. Also, conscious efforts are being made to: a. Intensify targeted monitoring and supervision of mectizan distribution in the LGAs and communities based on need. b. Improve on early collection of reports from LGA Coordinators. c. Advocacy visits to HODs of Health in the LGAs to work out the integration of CDTI into the PHC activities at the LGA Level. d. Intensify Health Education of Community Leaders and their subjects on the need to take mectizan for the treatment of onchocerciasis. e. Advocacy visits to LGA policy makers to approve and release a monthly imprest to LGA Coordinators for fueling and other operational costs involved in CDTI Implementation. f. Mobilize and health educate and carry out mop up treatment for the endemic communities that are yet to be treated for the year. 2P. rrnr/l / a m^ a, LT^-.^-L^- ann, o o 0qd o)Bd o o g": r'i o 0ao Xt 0) o-(D xo (r) (t) c, >xFts(r, F' oC o) to(D-{3E o{ @r-t od o7fo EdE e)ft ! 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S.ES $Hr= FXis G st:F tS6 -GE. OaG ,E € * R. G d AG lll lll rll t e gl3$ al+s rl+$$l+ EEEE$EilIiEEB telH lElg " qla' Is'H sFltFHlisElt=3li E'18 lssgE ll8186 @ fh.-p-=Er S HIF^EE gl:S*g =i' 3.rrpc)Ei: aes3F83-E F3!):+(D6+2H8-=. 1+.9= *ns+ PE €68E5E(D++6i'0d(DtPrE5!Eefl5H o) NJ5 t; +{o 'do a N.)5 zo .D d(DB tJ 5 2.6.2 What are the causes of absenteeism? Absenteeism is mainly caused by reasons chief amongst which is the relocation of community members to their farmhouses during the farming seasorL and delay in returning early for treatment. Inadequate mobilization of community members on the need for them to be available during treatment period has also contributed to absenteeism. Some members absent themselves from community treatments on account of discouragement from rumors of reactions experienced earlier. Communal clashes in some communities, most especially in Buruku LGA in 2006 caused many community members to desert their communities. 2.6.3 What are the reasons for refusals? The major reason why some community members are reluctant or completely refuse treatment with Mectizan is: a. The erroneous believe in the past experience of adverse reaction of persons who had in the past complained of itching and body pains. The team hopes to overcome this believe through intensive health education and mobiliz.ation of communities. 2.6.4 Briefly describe all known and verified serious adverse events (SAEs) that occurred during the reporting period and provide (in table 8) the required information if any. At the early stages of the distribution there were reported cases of SAEs, and this is partly the reason why some community members are reluctant to comply with Mectizan treatment. However, in the past few years and within the period of this report there were no reported cases of SAEs. In case the project did not have any cases ofserious adverse events (SAE) during this reporting period, please tick in the box. No SAE case to report ./ 2s rrIrn / a n/\^ a, \r^-.^-L^- nnn 4 -l 2, z z z 2, z z V)2 * 2, 2, z 2, z 2, z z, oaoz 2, z 2, z z, z 2, z. z z aox2, z 2, 9<6'E F.D5(h(D oH, 2, 2, 2, 2, z 2, 2, z z z { zu TgB er ['(DE z z 2, 2, 2, 2, 2, 2, 2, z z 2, z 2, z z, z z, z, z or a l-t .DE (D HRF r3o 2, 2, z 2, 2, 2, z z z z V) o a 2, 2, 1 2, z z 2, 2, 2, zsgs!E$HtirgA' 2, 2, 2, z z 2, z z, z, E z E 7P U ==d.(Dq E.q o 2, 2, 2, z z 2, 2, z z z d.+guAOiao, == ts (D .5 = 6'o -ss- 2, z z 2, 2, 2, 2, 2, zAF3 i' o $ +e - d0l-o5Hta6?q z z z z 2. z z z 2, E11 €6 a3 a'(DoH) 2, z 2, 2. 2. 2, z, z 2, 2, c)r)hli'I ii'gE g @a)h, EEH. 5EEa9 IH la)l5 ltD loo os(r) @ al) o ts+) (t) (DEt o <r) F0 o- (D r.1(r)(D (D (D + rr) V) Erl(r) g) o) ooo n @ o- o. rt 0c o rt oE o J 0q tDr-t o o. et- i.r(\ a$ \(\\ Eq (\ a(\I N * f-^ G-\ Ai(\ (\ N) o\ € 'f{o FU op N)5 zo (} croE NJO + e E'>q a5 nalJags z,2,2,zzzzzz2, N) €\(,I Flrl (D r o El CD ET (D Dt.l (D (D (D -o o i -t o (D .) .!(D o o (D .) rt Ft (D (D Drl la lo)td IrD lro ; r_1 (D O) (D V)g a() o (D >1 o, oe(D t6t< lo leL IE lp- lo) l-r o F)H aFt d o (D rl (D rl -o (D t.) leEl (D P |\) .C(\ S aa G s. 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L'T N) t.J 55 N)(,rs5 {\o5 Jeo5\o N) s\o -t9O5\o {Ut\o {(Jr\o {Ur\o o o(Di] !J!d d o.X ^ 5 Elai;i;troFrE.SEeg - :5 +E *h E. >9,E'' =Doo {\o5 t) "o 5\o t.) 5\o N) o N) z z z s! 8dr eHgoHN)utJ \)(,\) N) o\ N) N) o\ {\o 5 o\o\(, N) "No5\o {(,l\o z z zE FI -Bz4}'BEa =r iE.fiEEd 6.0(!|n (,l(^ s oo s @ o\ s z E z 1aN)s Ur6 -o6\ 55 s \o(, s E,oOq-ot) if;sE s€Eor @ t-.) -o6\ o\@ s L,I F.J s \or, s Ut(,t s oo s @{ rO o\ z z z t5 s! tt il ^E o5.H d oo c (D a s =0ao@ tJ o\tj) @ N) lf) NJ N) f,)\o \ot, u) {O \o s s oo o\ (J) t))s N) o\ o\ 5{5 N) -IO "o oo o o\ ooo \o\oF\otJ{ \o{o (,t 5 \o5(^ "oo ofr) g* 'dP5 0E.q E.FHEfE:gEq g -ogB'' g, N) @ NJ tJ o\ NJ \o tr) N)N) -r9{O u) "NJ oo \oOPOOO OOO O aoPOOo (,lo o sO O o 5oIooo (, Oo tlt E$s {(,r o\(}) N)L'I (f) 5 N) tJ)(,r sO o\@ u) \o5 @t.rP NJ{ o\\o o\ "s o\o (,I\o(^ "O 56 (, N) "@m(,l O N)trtP o\@5 N) t-J{ u)(/rs F' Eflz9Edc- HEtoo o o\{ s o\ s ())\o s (, a s o\(rr s (,t 5 rO6\ (,t @ s u)(.) s N) o\ s N)5\o6\ \o F'!_ tr, lrj rll -l8r 6E!0 abocdoa. o 6 s o\u 10o\ 5 o\ -oq\ {Ol -o6\ @ N) s @{ s \o s a F'J\oo\ o\(, 9\ { o\s tr,t_lnF '1 lloo oo ^< D)Rg -l 'HO(D FU o t o) o {\o\o9\ L't{\o9\ Ur o\ s (, \o o\ (,{ s t)) s NJ{ s (, s s s .)o- d$ d oo(! 2.7. Ordering, storage and delivery of ivermectin Mectizan@ for by - Qtlease tick the qpropriate answer) wHo n UNICEFMOH Other Mectizan@ delivered MOH Other by - Qtlease tick the appropriate answer) WHO tr UNICET E specify) specify) NGDO N NGDO N Please describe how Mectizan@ is ordered and how it gets to the communities The quantity of Mectizan@ required by the project is calculated based on treatments and total poprlation from the last cycle. NOCP pro@sses the data after receiving information from other UNICEF - assisted States and submits re - application to the MDP. On approval the drugs are shipped to the country and UMCEF facilitates clearance and storage. The State or the Zonal oflice picks up its consignment from NOCP and supplies mectizan to the LGAs through the LOCTs. LOCTs in turn supply the drugs to the district health supervisors or the health facility staff in the various health facilities in the Communities who in turn make them available to the Community Directed Distributors (CDDs) in the Communities. F.LOW CHART OF MECTIZAN DELIVERY Reporting flow UNICEF/ Nigeria Delivery process MDP NOCP Zonal Office STATE LGA District Ifealth Facilities Communnities 23 rr[Tn / A Tn^ a, \r^--^-L^- ann, State/Distri cULGA Number of Mectizant tablets Number in stock Request ed Received Used Used/Per g)n treated Lost Wasted Erpire d Remaining Ado 149,0m 149,000 149,0m 68,47E 37,305 N/A N/A N/A 80,522 Agatu 70,000 70,000 70,mo 6,691 27,163 N/A N/A N/A 3 309 Apa 70000 70000 7finO 50,289 22,290 N/A N/A N/A t9.7tt Buruku 320,0N 320,OOO 320,000 300,E25 150,600 N/A N/A N/A 19,175 Gboko 585,000 585,m0 585,000 5E4,5m l84,Eq; N/A N/A N/A 500 Gwer 105,000 105,000 105,fi)o 7E,164 41,497 N/A N/A N/A 26,83s Gwer West 140,000 140,000 140,0(n 139,939 54,506 N/A N/A N/A 6t Guma 280,000 280,000 280,000 195,ffi 88,987 N/A N/A N/A 84,360 Katsina Ala 305,0m 305,000 305,000 279,722 93,823 N/A N/A N/A 25,278 Konshisha 105,000 105,000 105,000 69,EE7 m,758 N/A N/A N/A 35, I l3 Kwande 770,0U 770,W 770,W '1t6,97t 2',t2,t26 N/A N/A N/A 53,029 Logo 125,000 t25,W 125,0m t20,209 M,490 N/A N/A N/A 17,541 obi 31,000 31,0(n 31,o00 30,627 39,10E N/A N/A N/A 373 Ogbadibo 317,5m 3 17,500 3 17,500 16l,lm 107,741 N/A N/A N/A 156,400 Ohimini 70,000 70,000 70,000 69,639 43,452 N/A N/A N/A 361 ojo 120,000 120,000 120,000 64,823 34,815 N/A N/A N/A 55,r77 Okpokwu 169,000 169,000 169,000 168,900 70,102 N/A N/A N/A 100 Otukpo 2n,on 2L7,ON 2n,m 2t6,7LL 109,901 N/A N/A N/A 289 Tarka 70,000 70,000 70,000 53,62t 28,378 N/A N/A N/A 16,3',19 Ukum 120.000 120.000 120.000 6,697 56,450 N/A N/A N/A 53,303 Ushongo 435,000 435,000 435,000 399,116 t15,207 N/A N/A N/A 35,884 Vandeikya 180,000 180,000 180,000 EE,274 42,716 N/A N/A N/A 9t,726 Ref. Center 397,Om 47,ON 47,OOO ,16,980 20,9E2 N/A N/A N/A 20 TOTAL 5,150500 4"80050 0 4,t00500 4,025,054 t,777393 N/A N/A N/A 775,4# Table 10: Mectizan@ Inventory @lease add more rows if neceswry) How are the remaining ivermectin tablets collected andwhere are they kept? Ivermectin Tablets when they remain are returned to the Health Facility by CDDs where they are stored in Mectizan storage boxes in the Health facility. List and briefly describe the aclivilies under ivermectin delivery lhot are being carried out by health care personnel in the project area. aq tl[rn rAInar a, \T^,.^-L^- ann, The health care personnel at the various levels of CDTI Implementation are responsible for the following Ivermectin delivery activities. 2.8. GommuniQl self-monitoring and Stakcholders Meeting Has any training (of trainers) for communily self-monitoring been done in the project area? If so, When? No training of this nature was done. Table 1l: Community self-monitoring and Stakeholders Meeting DistricV LGA Total # of communitieVvillages in the entire project area No of Communities that caried out self monitoring (CSM) No of Communities that conducted stakeholders meetins (Sfnfll Ado Agatu Apa 9l 94 87 None None None None None None Buruku 61 None None Gboko 138 None None Gwer 69 None None Gwer West t24 None None Guma 123 None None Katsina Ala 148 None None Konshisha t07 None None Kwande 288 None None Logo 109 None None obi 106 None None Ogbadibo 96 None None Ohimini 85 None None oju 110 None None Okpokwu 67 None None Otukpo tt9 None None Tarka 75 None None Ukum t04 None None Ushongo 187 None None Vandeikya 133 None None TOTAL 2,521 None None 3o rr[rn / a mn a, ]f^-.^-L^- ann, Descibe how the results of the comrrutnity self- t*nUonnf and slaheholderr meetings have affected project implementation or how they would be utilized during the nert treatment cycle. Though Community Self Monitoring (CSM) was not carried out during the reporting period, the project intends institute CSM in the communities so that the communities can monitor and report on the distribution of mectizan in their communities. 2.9t. Supervision 2.9.1. Provide a flow chart of superuision hierarchy. SOCT LOCT FLHF STAFF CDDS 2.9.2. What were the main issues identified during supervision? Supervision and monitoring was done by both the State team as well as the LOCTs. The SOCTs monitored activities in the LGAS using checklist. Supervision was planned in such a manner as to assess project performance at the LGA and community level with the aim of effecting on the spot corrections. Various problems were identified during the first rounds of supervision. These led to the planning of targeted zupervision in the LGAs. Targeted supervision and monitoring was carried out by the SOCTs and one NOCP personnel. From these visits the following issues were identified: activities. collection of mectizan from Makurdi by some LGA Coordinators. community dialogue in CDTI community members and no mop-up treatment. disenchantment and in some places high rate of attrition. schools. 31 rrIrn, a n/\rr a , \r^--^-L^- ann i communities/ CDDs. LGA focal persons are not willing to involve the FLFIFS in supervision of CDTI activities in the communities. This placed a heavy workload on the few LOCTs willing to work. also being owed. their jobs. 2.9.3. Was a supervision checklist used? At the State level SOCTs made use of checklists and list of minimum indicators as approved by APOC for all projects. At the LGA level checklists are rarely used, but they are available. The project intends to encourage greater usage of the checklist and list of minimum indicators for monitoring and supervision exercises at various levels of project implementation. 2.9.4. What were the outcomes at each level of CDTI implementation supervision? State level health. During these visits they were briefed on the sustainability plan made by the project while the state was again reminded of their earlier participation in the drawing up of the sustainability plan and their commitment by way of counterpart fund to support the execution of the activities as contained in the plan. Following this, a 5 Million Naira budget for the revamping of the Benue CDTI Pdect was drawn and submitted to the Director Medical and Health Services for onward submission to the State Government through the Honourable Commissioner for Health and Human Services. The approval and release of this budget is being awaited by the project. LOCTs together to discuss and find a way forward for the improvement of project performance most especially in the area of treatment for the year 2006. ways of executing the remaining activities contained in the Sustainability Work Plan of Action. LGA Level. LOCTs trained. The project intends to conduct more training/retraining sessions for LOCTs written but the monies were not released. Nevertheless, the State Coordinator plans to follow these approvals up to the point of release of the funds. Following repeated advocacy visits to LGA Chairmen, some LGAs have now approved a monthly imprest for the LGA Oncho Coordinators for Mectizan distribution activities. mobilization with the little resources available to them. community level, and to restrict themselves as much as possible to the health facility level. 3P. II[rn rAm^ n, \T^-,^-L^- nnn, Health Facility level geographic coverage was very low. informal training FLI{FS. Community level the need to select and support their CDDs. selected and trained to distribute Mectizan in the communities. kindred lines to ease the workload and maybe reduce the demand for incentives. and appeal to CDDs to distribute. 2.9.5. Was feedback given to the penson or groups supervised? Efforts were made to provide some feedback about these and other issues in several ways. First, in the few mobilization visits paid to some communities these were addressed. Some of them were also raised during the follow up training sessions conducted. 2.9.6. How was the feedback used to improve the overall performance of the project? In the areas where CDDs were selected along kindred lineage, communities were given some words of encouragement, as most of their community members took mectizan this reporting period, thereby increasing the therapeutic coverage ofthe project. In some communities that initially refused treatment for fear of reaction, the elders were briefed again of the chances of those that are under treatment been re-infected. With this explanation most of these communities have started taking the drugs. Given the follow up training, the targeted community mobilization and improved supervision overall treatment coverage (geographic and therapeutic) improved compared to what used to obtain in the last 3 - 4 years. 33 Ir[r rl!"n^ n, ]r^-.^-L^- nnn tr SEGTION 3: Support to GDTI 3.{. Equipment Table 12: Status of equipment (Please add more rows if necessary) *Condition of the equipment (F=Functional, CNFR=Currently non-functional but repairable, WO:Written off). Haw futes the project intend to maintain and replace existing equipment and other materials? The State Ministry of Health sometimes services the project vehicle and also provides cash for minor repairs on request. It is hoped that this practice will be expanded and sustained. The LGAs are also being encouraged to release funds for the maintenance of motorcycles. In the meantime, the project has requested APOC Management to replace the vehicle and other logistics given to the project. Source Type of Equipment APOC MOH DISTRICT/ LGA NGDO Others No. Condition No. Condirim No. Coodition No. Condition No. Condition 1. Vehicle I CNFR 2. Motor cycle(s) t7 7F& l0 CNFR 27 wo 3. Computer(s) I CNFR 4. Printer(s) 1 F 5. Photocopier (s) I CNFR 6. Fax Machine(s) 7. Others a)Air Conditioner I F b)Electricity Generator I CNFR c) Telephone I F 31 lr[rn, a m/r a, \T^-,^-L^- ann, 3.2. Financial contributions of thc partners and communities Table 13: Financial contributions by all partners for the last three years Contributor Yeer4 (Oct.2003-Sept 2004) Yar 5 (Jan.2005 - Dec.2005) Year 6 ('Jan. 2006 Dec 2006) TOTAL AMOIJNT (CASH) Budgeted (US$) TOTAL CASH Released (us$) TOTAL AMOTJNT (cASH) Budgeted (us$) TOTAL CASH Released (us$) TOTAL AMOTJNT (CASH) Budgeted (us$) TOTAL CASH Released (us$) MOH (Central + ProvinciaUState) 30,280 1,174.65 126,030 18,000.3 0 13,273 830.03 MOH @istrict/LGA) 5 1535 1,559.1 19,524.46 6,848.22 Local NGDO(s) ( if any) NGDO partner(s) 38,375 E,t09.79 I1,000 Nil 27,664 Nil Otherc a) b) APOC Trust Fund 64,290 29626 130,550 Nit 50,514 39,920.9 4 TOTAL 1E4,43p 41,169.54 267sffi 18,000.30 11o,975.6 47599.19 NB: For APOC and IINICEF amount stated as budgeted above does not include what were budgeted for capital items just as arnount released does not include expenditure on capital items. For MO[{/LGA, amount stated as budgeted does not include personnel costs. The budget assumes an exchange rate of $l : N126.5 - If there are problems with release of counterpartfunds, how were they addressed? There are problems with release of counterpart funds at both State and LGA levels. Some advocacy visits have been paid to LGAs, but the political instability and short tenurb of the political offrce holders is a big constraint. Several memos have been written to government. The State level stakeholders meeting is being planned to take place early next year. Additional comments 3.3. Other forms of community support - Describe (indicaleforms of in-kind contributions of comtrutnifies if any) Very few communities assist their CDDs in kind by, helping them on their farm, construction and thatch roofing of their houses @ound Huts) Some communities support their CDDs by helping them on their farms especially during the planting season. Others support in some ways zuch as 2( rI[I /Al.n^ a4 lt^--^_L^-annl 3.4. Expenditure per activityl Indicate in table 14, the amount expended during the reporting period for each activity listed. Write the amount expended in US dollars using the current United Nations exchange rate to local currency. Indicate exchange rate used here $1 :0t126.5 Table 14: Indicate how much the project spent for each activity listed below during the reporting period. - Aoy comments or erylanations? Monies approved by APOC for LGA activities were released to the LGA Coordinators to carry out these activities under the supervision of the State Team members. But usage of counterpart funds from these LGAs were not ascertained as health workers are reluctant to report this - for they fear it might jeopardize chances of getting more funds. - Funds indicated as been used for the training of Health Staffat all levels were also used in the training of CDDs. However to avoid double statement of the amount, it is only reflected on the training of health staffat all levels. - Similarly, funds available for mobilization were also used for supervision and monitoring visits. - Total amount expended does not include Bank charges. Activitv Expenditure ($ us) Source(s) of funding Drug delivery from NOTF HQ area to central collection point of community Mobilization and health education of communities Retraining & Re-orientation of 10 SOCTs Training & Retraining of LOCTs in 22 LGAs Training of CDDs in 22 LGAs Training of health staffat all levels (FI-ffiS) in 22 LGAs Computer Training for 3 SOCTs Supervising & Monitoring in the LGAS & Communities Internal monitoring of CDTI activities National Review Meetings State Review Meeting Advocacy visits to health and political authorities IEC materials Summary (reporting) forms for treatment Stationery & Ofiice Consumables Vehicles/ MotorcycleJ bicycles maintenance LGA Stakeolders Meeting Office Equipment (e.g. computers, printers etc) Others (Bank Charges) 830.03 Nil 52.76 1,581.01 3,011.85 8424.26 630.83 7,588.93 Nil 515.61 468.77 492.49 2,347.82 394.66 632.41 3,162.05 2,OO7.90 1,073.91 tzt.82 SMOH Nil APOC APOC APOC APOC APOC APOC Nil APOC APOC APOC APOC APOC APOC APOC APOC APOC APOC TOTAL 32,507.08 Total number of persons treated 1,756"311 3C rr[rn /A n/\^ n, \r^-.^-L^- ann / SEGTION 4: Sustainability of GDTI 4.t1. !nternal; independent participetory monitoring; Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the fotlowing which are applicable) Year I Participatory Independent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation Internal Monitoring by NOTF ./ Other Evaluation by other partners 4.1.2. What were the recommendations? The following are the major recommendations that were made after the mid- term sustainability evaluation mission: a. Stakeholder meetings should be introduced to promote ownership b. Community self-monitoring should be introduced c. Skills for carrying out census update at the same time as drug distribution to be given to CDDs. Also training of CDDs should include the compilation of the quantity of tablets required for their communities. d. Communities should be encouraged to keep to the recommended ratio of 1:20 households or 2 CDDs per 250 population. e. Review SOCT membership and reduce the number to a total of six technical personnel- It will be in the interest of the project that majority of those who are members of the team be transferred to other units and new people with experience in CDTI implementation brought into the SOCT. There are many LOCTs that were present at the workshop who showed impressive knowledge and competence in CDTI and are articulate enough to beef up the SOCT l: to the team. f. LOCT membership should necessarily be made up of the DHS in each LGA in order to integrate activities (supervision and monitoring, and training) into the existing PHC structure at the LGA level. There is no need to create fresh positions but keep existing ones. g The training of the FLHF staff in all LGAs and orientation is crucial and should be vigorously pursued. FLHF has been ignored and has not received the required training and direction towards CDTI. The FLFtr should be involved in all CDTI activities at their level, h. The documentation of activities and maintenance of records (treatment, drugs) and such other information that are pertinent to assessing the extent of work is vital. The training curriculum will need to place emphasis on this requirement. i. The State team should work closely with UNICEF to plan how the turnaround recommendations made here would be effected. NOCP/IINICEF officers monitored the project late 2006, and made the following recommendations: 3-l rr[rn / a nr\r\ a, \I^-.^-L^- ann, i. Intensive supervision to be embarked to the LGAs and communities. ii. CBOs are to be identified and sensitized. A comprehensive list of such identified CBOs should be compiled. iii. Communities to be mobilized and health educated. More CDDs to be selected and trained. iv. SOCT should have regular meetings with the LOCTs. v. Quarterly reports need to be prepared and submitted at each level. Reports should include LGA contributions. vi. The process for release of approved APOC funds needs to be revisited, and the UNICEF A-Zonal officer sensitized on roles of all partners and the need to follow laid down procedures. vii. CDDs should be trained /retrained on CDTI with particular emphasis on census update and record keeping. viii. SOCT should advocate for replacement of LOCTs that are not performing well. ix. Copies of documents sent to NOCP HQs should be shared with the Zonal office. x. Offrcers should be given enough days for supervision. xi. The summary of the 3d quarter treatment data should be forwarded to NOCP & UNICEF by 156 October 2006 xii. The State team to focus more on ensuring that CDTI structures are in place at community level. 4.1.3. IIow have they been implemented? a. Recommendation (g) o, the training and involvement of FLTIFS and recommendation (d) on the selection and training of more CDDs was vigorously pursued. Efforts made towards this end saw to the funding of the training and retraining of FLIIFS and CDDs in the 22 LGAs covered by the project by the Benue State Health Systems Development Project II in the reporting period. AT the training sessions FLF{FS were intimated of their roles in CDTI implementation. They were taught and empowered to take up their responsibility in CDTI implementation that had hitherto neglected by the LOCT. LOCTs in the 22 LGAs all agreed to involve the FLIIFS more than before in CDTI activities. b. For the years 2005 and 2006 UNICEF did not include the Benue CDTI project in its Participatory Plan of Action (PPA) as such no funds were received from UNICEF during the reporting period. c. The SOCT Membership has been reduced from l0 persons to 7 persons as against 6 persons that were recommended this is as a result of the need for adequate personnel since the project has expanded to 4 additional LGAs. d. Proposals have been written to conduct a more comprehensive training for FLHFS and CDDs. e. Local Oncho Control Teams in some LGAS have now involved the DHS as members of the Team. With this, the project hopes to achieve the integration of CDTI into the PHC structure in these LGAs. The recommendations made by the NOCPAINICEF officers during their visit to the State will be implemented in the2007 treatment cycle. 38 llnln, a m^ a, lr^-.^-L^- ann, 4.2. Sustainability of projects: plan and sct targets (mandatory at Yr 3) Was the project evaluated during the reporting period? No Was a sustainability plan written?_ Yes Whenwasthesustainabilityplansubmitted?-December,2003- What arrangements have been made to sustain CDTI after APOC funding ceases in terms of. 4.2.1. Planning at all relevant levels At the State level, the Commissioner, Permanent Secretary, Director Medical and Health Services were all involved in planning CDTI activities with SOCT members. CDTI has also been included on the Ministry of Health 2006 budget. Also, following the Mid term sustainability evaluation of the project, a participatory planning workshop was held and a Sustainability Work plan of Action was drawn for the state and LGAs to cover a period of three (3) years. This Plan was submitted to APOC and other partners in December 2003. 4.2.2. Funds Steps have been taken to get the State release the counterpart funds. There are plans to establish a board through which the counterpart funds are released to. Also the Director Medical and Health Services at the State ministry of health has pledged to appeal to the commissioner of health to forward a direct proposal to the government in the year 2006 for funding of Oncho activities. The project intends to sustain and utilize the current approach of sourcing funds from the Benue Health System Development Project II (HSDP II) in the next years. 4.2.3 Transport (replacement and maintenance) The project requests that APOC should continue to assist in providing funds for the maintenance of motor vehicle and motorcycles as well as fueling. Further, it requests APOC to provide a new motor Vehicle to replace the old Hilux Van and 15 motorcycles, five of which will be allocated to the five LGAs that do not have a motor cycle while 10 motorcycles will be used to replace the old worn out motorrycles in the older LGAs to facilitate wider treatment coverage. Nevertheless, the project has also put across requests for the State Government to provide funds for maintenance and fueling of Motor Vehicle while LGA authorities are still encouraged to make funds available to the LGA Oncho Coordinators as imprest for fueling and maintenance of Motorcycles for supervision of Mectizan distribution activities. 4.2.4. Other resources The erratic power supply been experienced in the project area has constituted a major set back to the project's activities requiring the use of electricity. At the end most of the typing, printing and photocopying of reports and other documents are often accomplished using the services of business center operators who have alternative sources of power supply. To this end, the project is requesting APOC to provide the project with an Electricity Generator to serve as an alternative source of power for the project in frequent times of power outage from the public source of power supply. 39 rIIrnlAm^ a/ LT^-,^-L^- ann, 4.2.5. To what ertent has the plan been implemented A sustainability plan of action was drawn up and a copy of this plan was submitted to APOC Management for approval. The project received the approved sustainability plan from APOC Management in May 2006. Much has been implemented from the sustainability plan of action drawn at the State level. However much is yet to be implemented at the LGA and community levels in the area of training, mobilizatiorL monitoring and supervision. It was expected that once the second installment of the approved budget for 2006 is received these activities will be aggressively pursued. Unfortunately this came very late. 4.3. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3.1. Ivermectindeliverymechanisms The Mectizan delivery process oocurs within the existing PHC structure. Communities pick their Mectizan requirements from the health facilities, except in few cases where the drug is taken to them. During NIDs, for instance, the LGA/PHC staffs that come to pick up their vaccines also use the opportunity to collect Mectizan. Some LGA Coordinators also send summary of their treatment reports through NID Personnel. 4.3.2. Training Some other LGA/PHC Personnel, apart from LOCTS, have been trained on CDTI so that they can assist in training of lower level personnel and supervise CDTI activities. When VAS distribution kicks offtraining sessions for CDTI will be used for training on VAS. 4.3.3. Joint superuision and monitoring with other programs At the State level, there are plans for joint supervision and monitoring. Presently, arrangements are being worked out with the WHO Office in the State for SOCT Members to follow the WHO team when going out to the field for supervision and monitoring. At the LGA level we are aware that some of the LOCTs are involved in other programmes and occasionally use the opportunity of visits to the community/health facility for one programme to look into other programmes that they are handling. At the health facility level, where health personnel are involved in CDTI the situation is even more fluid. Visits to the community are used for several purposes. There is however no integrated supervisory checklists, and none are being planned at the moment. 4.3.4. Release of funds for project activities In some LGAs imprest is released for PHC activities and is controlled by the PHC director. From this a minimal amount is made available to the LGA Oncho Coordinator for some routine visits or collection of Mectizan. This practice is not evenly spread, as most LGAs do not have funds for operational expenditure. At both State and LGA levels proposals for the release of funds however must pass through the PHC director and other normal channels. 4.3.5. Is CDTI included in the PHC budget? At the State level there is a line item for CDTI in the PHC budget. At the LGA level CDTI activities are subsumed under a general PHC budget. Inclusion of the budget or the existence of a line item does not however guarantee funds release. 40 rl[rn / A mn a, \T^-.^-L^- ann, 4.3.6. Describe other health progremmes that are using the CDTI structure and how this was achieved. What have been the echievements? It was agreed at the state level that CDDs should be used as local guides during NIDs. Records within the reporting period show that in some LGAs such as Kwande and Logo some CDDs are being used as local guides during NIDs. There is a proposal to use the CDTI structure for the distribution of Vitamin A for the next distribution period. 4.3.7. Describe others issues considered in the integration of CDTI. Diffrculties have been experienced in getting other Programme Officers to work hand in hand for the integration of CDTI into their programmes. The reasons for this reluctance may be attributed to the fear of change usually exhibited by civil service personnel on such issues as integration. 4.4. Operational research 4.4.1. Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period. No operational research was carried out during the reporting period. 4.4.2. How were the results applied in the project? No such results are available. SEGTION 5: Strengths, weaknesses, challenges, and opportunities Strengths: community Weaknesses partners. Challenges communities and ensuring proper record keeping at all levels. Ll7 lr[rn / A n/\n a, \T^-.^-L^- ann, level in order to increase levels of participation by all sections of the community State and LGA levels SEGTION 6: Unique features of the proiecUother matters The Benue State CDTI Project unlike many projects in Nigeria has suffered the loss of 3 years of funding from APOC. Firstly, this was due to the zuspension of the project by APOC in 200112002. Secondly, the non-approval of funds on the proposed budget and work plan for the years 200312004 and200412005 slowed down activities for the project almost to the point of complete inactivity. For the project to recover and regain the so much ground lost, APOC and other CDTI partners should critically look into the area of funding of the project's activities as proposed in the 2007 Sustainability Work Plan of Action and further consider the review of the project age. Besides, the project has never been afforded the opportunity to completely utilize funds approved for it in the previous years. This is largely due to the late approvals and presence of bureaucratic bottlenecks in the release of funds usually experienced from APOC and other Partners. On the 29n day ofNovember,2O}6,the State Epidemiological Unit of the Ministry of health which houses the Oncho Control project's office as well as other disease control programme oflices was broken into by a gang of thieves who over-powered the security men on guard, ransacked the offices and made away with various amount of monies and other valuables. The Benue CDTI Programme also lost monies to the tone of N214,300.00 (Two Hundred and Fourteen Thousand Naira) only made up of: (a) N125,200.00 - Welfare scheme and thrift contribution made by the staffof the Epidemiological Unit, SMOH. (b) N65,600.00 - Advance to the Project by the NOCP for data collection exercise carried out in the project. (c) N13,000.00 - Thdft Contribution from Oncho Control project stafftowards welfare and purchase ofa Cow at the end ofthe year. (d) NI0,500.00 - Medical expenses refund for Late Mrs. Christiana Uti from the State Ministry ofHealth. /{z rr[rn, a n/\n a, lr^--^-L^- ann /
Organisation mondiale de la santé (OMS) · Technical Documents
Benue CDTI annual project technical report submitted to Technical Consultative Committee (TCC): January 2006 to December 2006
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