Ekiti State CDTI APOC project annual project technical report submitted to Technical Consultative Committee (TCC): Jan 2006-Dec 2006

l I i I I I I I I a RESERVED FOR PROJECT LOGO/HEADIT{G COLINTRY/NOTF: Nigeria Proiect Name: EKITI STATE CDTI/APOC PROJECT Approval year:1999 Reportins Period (Month.tYear):JAN 2006- DEC 2006 Proiect year of this report: (circleone) L 2 3 4 516)7 8 9 10 Date submitted: January 2007 NGDO partner: UNICEF ORIGINAL : English 0s 'r / ,C,OAb TLL 16,i 6b-/ cillgtM fr?f,bFO i FO _-- -' - -- _1- . ,.1 -, -, 5iR, ffm,t 2 n illlt 2007 WHO/APOC, 24 November 2004 t-' Launching year: 2000 a- & {- ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) onl.or,ixn non sugvltssroN: To APOC Management by 31 January for March TCC meeting To APOC Management by 31 Julv for September TCC rneeting AFRICAN PROGRAMME T'OR ONCHOCERCIASIS CONTROL (APOC) ll WIIO/APOC. 2-l Novernber 200-l t- ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATTVE 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.. P. Ogbu-Pearce Signature: Date Zonal Oncho Coordinator Narne'. ...Otunbu A O Juiyeoba Signa wDb Date Vr-l Bvul This report has been prepared by Narne : Mrs C. O. Ogunbiyi DesignatiorLtla C*ur=/ Signature Date "') c) f.'J3'S?pl Il WIO/APOC, 24 Novernber 200-l I ,Table of contents Acronyms. .........8rror! Bookmark not defined. Definitions ................vi FOLLOW UP ON TCC RECOMMENDATIONS ,..,,..7 Executive Summary ...................8 SECTION 1: Background information......... i.l. GEuenar-rMoRMATroN............... 1.1.1 Descrtptton of the project (bruefly) 1 .1 .2. Partnershtp 1.2. PopuLarroN SECTION 2: Implementation of CDTI 2.1. Tn/ffiLhrEoFACTrvrrIES........... 2.2. Aovocacy ,.9 .9 .9 1l l3 l5 l5 l6 2.5. 2.4. 2.5. 26. 2.6. t. 2.6.2 2.6.3 2.6.1 2.6.5 2.7. 2.8. 2.9. 2.9.1. 2.9.2. 2.9.3. 2.9.1. 295 2.9.6. SECTION 3: Support to CDTI.... 3.1. EeutPr,,IENT MOBILZATION, SENSITZATIoN AND HEALTH EDUCATION oF AT RISK COMMUMTIES I7 CorrnvruLuryINVoLVEMENT................ ............. 18 CapacrrvBUrLDrNG .................20 TnsATN,8Nrs................. .................22 Treatmentfigures......... ................21 What are the causes of absenteeism?........... .................24 lV'hnt are the reasons for refusals?........... .............24 Brie-fly descrfie all known and veri.fied serious adverse events (SAEs) that............21 Trend of treatment achievement from CDTI project inception to the current year .. 26 ORppRwc, SToRAGEAND DELIVERY oF TVERMECTIN ..... ............27 COIztvrrnury SELF-MoNIToRING AND STAKEHoLDERS MEETnIG .. ...... ....,. 3O SuppRvrsroN ...... ......... ..... ... 3 I Prowde a flow chnrt o.f sttpervision hierarchy. .................. 3 I Whatwere the main issues identified during supervision?........... ............31 Was a supervision checklist used?. . ...............31 Whnt were the outcomes ot each level of CDTI implementation supervision? ........ 3l llas feedback given to the person or grot.tps superwsed? ........ 3 2 How was the feedback used to improve the overall performance ofthe project2..... 32 ...32 ... )z 3 .2, FI.IANCIAL CONTRIBUTIoNS oF TFIE PARTNERS AND CoMMUNITIES ............. ............. 3 3 3.3 OrrmnFoRMSoFCoMMUNITysuppoRT ...... ......... 33 3.4. EXPENDITUREPERACTIvITY .. . ...........33 SECTION 4: Sustainability of CDTI........ ...................34 4.1. INTERNAL; TNDEPENDENTPARTICIPATORYMONITORING, EVALUATION .... ...34 1.1 .I Was Monitoring/evaluation carrrcd out dLrmg the reporting perrcd? (ttck anlt o.f the ./bllowingwhich are appltcable) ....... ........31 1.1.2. Wlxal were the recommendatrons?. .............35 1 I .3. How hove they been implemented?............... ..... ... ii 4.2. Susran'tABILITy oF pRoJECTS: pLAN AND sET TARGETS (MANDAToRy AT............... 35 YR 3) .3s 1.2.1. Plannmg at all relevant levels ........ i5 1.2.2. Funds..... ........36 1.2.3 Transport (replacement and maintenance) ......................36 1.2.1. Otlrcr resources... ......................36 1.2.5. Towhat extent has thc plcrn been implementecl...... .............36 4.3. INTEGRATToN ........36 1.3.1. Ivermectmdeliverltmechani,sms .....................36 1.3.2. Trairung..... ........37 lv WIIO/APOC, 2-l Noventbcr 200-l \ 1.3.3. Joint superviston and monitoringwith other programs... Eror! Boohnark not de.fined 4.3.1. Release o.f.funds for project activities.... .............371.3.5. Is CDTI included in the PHC budget? .....37 4.3.6. Descrfte other health programmes that dre using the CDTI structtn'e and how thts was achieved. What have been the achievements?........ ............37 1.3.7. Descrfie others issues considered in the integration of CDTI. ............37 4.4. OPERAIONALRESEARCH............. ............37 4.4.1. Summarize m not more than one half of a page the operanonal research undertaken m the project area withm the reporting period. .. 37 4.1.2. How were the results apphed in the project? ............. ........37 SECTION 5: Strengths, weaknesses, challenges, and opportunities................................38 SECTION 6: Unique features of the project/other matters. ........38 Acronyms APOC African Programme for Onchocerciasis Control ATO Annual Treatment Obj ective ATrO Annual Training Obj ective CBO Co mmunity-Based Organization CDD C ommunity-Directed Distributor CDTI Communitl.Directed Treatment with Ivermectin CSM Community' S elf-Monitoring IEC Information, Education and Communication LGA Local Govemment Area LOCT Local Onchocerciasis Control Team MDP Mecti zan Donation Pro.qramme' MOH \!4istry of Health NGDO Non-Governmental Development Organization NGO N on-Go vemmental Organ ization NOCP National Onchocerciasis Control Team NOTF National Onchocerciasis Task Force PHC Primary health care REMO Rapi d Epi demiol ogical Mapping of Oncho cerciasis SAE Severe adverse event SHM Stalieholders meeting SOCT State Onchocerciasis Control Team TCC Technical Consultative Committee (APOC scientific advisory group) TOT Trainer of trarners IjNICEF United Nations Children's Fund UTG Ultimate Treatment Goal wHo Wo rld Health Organization \/ WHO/APOC, 2.1 Novembcr 200-1 Definitions (i) Total population: the total population living in mesoftryper-endemrc communities within the project area (based on REMO and census taking). (ii) Eligible population. calculated as 84%o of the total population in mesolhyper- endemic communities in the project area. (iii) Annual Treatment Objective: (ATO): the estimated number of persons living i1 meso/lryper-endemic areas that a CDTI project intends to treat u,ith iyermectil in a given year. (iv) Ultimate Treatment Goal (UTG): calculated as the maximum number of people to be treated arurually in meso/hyper endemic areas within the prolect area, ultimately to be reached when the project has reached full geographic coverage(normally the project should be expected to reach the UTG at the end of the j'd year ofthe project). (\,) Theraoeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). Geoeraphical coverage: number of communities treated in a given year over the total number of meso/hyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). Inteqration: delivering additional health interventions (i.e. vitamin A supplernents. albendazole for LF, screening for cataract, etc.) through CDTI (using the same systems, training, supervision and personnel) in order to maximise cost- effectiveness and empower conmunities to solve more of their health problems. This does not include activities or interventions carried out by communih distributors outside of CDTL (vi) (vii) (viii) Sustainability: CDTI activities in an area are sustainable r,vhen they continue to function effectively for the foreseeable future, with high treatment coverage. integrated into the available healthcare service, with strong communitl, ou,nership. using resources mobilised by the community and the governnent. Communit-v self-monitoring (CSM): The process by which the commrlnity is empowered to oversee and monitor the performance of CDTI (or any commurig,- based health intervention programme), with a view to ensuring that the programme is being executed in the rvay intended. It encourages the community, to take full responsibility of ivermectin distribution and make appropriate modifications rvhen necessary. (ix) VI WHO/APOC, 24 Novenrber 2tl0:t FOLLOW UP ON TGG REGOMMENDATIONS Using the table belorv, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session 23 (Please add more rows if necessary) 7 Nunfier of Reconuilendqtion in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT ASE ONLY 1ls (D Replace or repair Motorcycle Damaged Motorcycles have been repaired 11s (ii) Increase number of CDDs per population No action was taken because there is no fi.urd 11s (iii) Promote involvement of female CDDs More female CDDs were involved 115 (iv) Focus more on securing State and LGA funds Advocacy visits were paid to the Policy Makers both in the State and LGAs which vielded to the releaseC ofthe coulterpart flud by the LGAs 115 (v) Continue training involving and monitoring health rvorkers at LGA and facility levels Training were given to 447 healthworkers as against 337 ofyear 2005 115 (vi) Conduct a population census as the denominator seem not to be knorvn Census update was done in the reportitgyear 115 (vii) Continue consolidating and improving this years achievements There has been improvement in the project [improvement in supervision and monitoring, more health rvorkers and CDDs rvere trained, etcl WHO/APOC, 24 Novenrber 2004 FOLLOW UP ON TGG REGOMMENDATIONS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session _24_ (Plectse add more rows if necessary) Number of Recommendation in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY l5 The report seems to correspond with the past annual technical report, when this should not be the case. The project believes the same 5th year repoft was reviewed twice - first in TCC 23, and then in TCC24 16 (i) Before sending another annual technical report, check the report and ensure that there are no inconsistencies in the data provided. Efforts have been made to ensure inconsistencies have been eliminated. 16 (ii) Increase number of CDDs and encourage selection and training of female CDDs per population to less than 1CDD to less than 100 persons Due to funding problems this could not be tackled. r6 (iii) Focus more on securing state and LGA funds Advocacy visits have been up-scaled at various levels - details are in this report. l6 (iv) Need to begin training, mentoring and involving health workers at LGA and facility levels. With availability of funds from all partners, this will be done in 2007 treatment cycle 16 (v) The project should have a good grasp of the denominator This has been noted. Executive Summary Ekiti State is one of the States in the southwestern part of the country and is located in the B Health Zone. It has a population of 2 384 212 [as at 2005 census]. There are 76 LGAs in the state, all of which are implementing CDTI. The main indigenous population that constifutes overwhelmingly the major ethnic group in the State is Yorubas. Individuals from other ethic groups such as the Fulanis, Igbiras, Agatus, Hausas and Egedes have migrated into the State and are cohabiting with the indigenes. Christians form a high percentage of the population of the State. Population movements always take place during religious activities or celebrations like Christmas and Easter. Moreover, there are population movements during Muslim celebrations and during the farming / harvesting season. Closure and commencement of school periods also brings about some population movements in the State. During these periods, there is a seasonal migration of people from one place to another. The prevalence survey of 1988-1990 and the subsequent REMO of 1994 and 199812000 revealed that the State is endemic for Onchocerciasis. The total target population with the recent census update is 1 054 517 in 344 communities. The UTG/ATO is 885 794. Treatment commenced in the project area when it was still part of the old Ondo State with assistance from UNICEF and NOCP using the CBIT approach. CDTI strategy was initiated in 1999. The project trained and retrained 8 SOCTs,48 LOCTs, l6 PHC Coordinators,44T Health workers and I 519 CDDs thereby achieving 84%o overall for its training objectives. 344 communities were mobilized to select their CDDs and collect mectizan from designated points. Current CDD to population ratio stands at 1 CDD to 661 persons. A total of 729 229 persons were treated in 344 communities with 1 944 210 mectizan tablets for the year under review, thus giving a geographic coverage of 100% and therapeutic coverage of 690/o. The number treated represented 82o/o of the ATO and UTG. Major policy makers and community leaders at both LGA and community level were mobilized in various advocacy meetings to support CDTl project in the State. The major challenges that faced the project included the non-release of counterpart fund from both the State and Local Government, and non-funding by other partners. Other challenges were demand for incentives by CDDs, CDD attrition, and transfer of Health 8 WHO/APOC, 24 November 2004 workers from one LGA to another. These challenges were addressed by continuous advocacy for release of funds by partners, State and the LGAS, training of new CDDs. training of additional health workers. SEGTION {: Background information 1.1. General information 1.1.1 Description of the project (briefly) Geograplucal location, topography, climate Ekiti State, located in the southwestem part of Nigeria, was carved out by presidential fiat from Ondo State on October 1996. It covers an area of approximately 5,500 square kilometers while it has a bio-climate of rarn forest in the southem area and Gurnea Savarurah in the northem parts. A greater percentage of the landmass is made of rocks and mountainous regions. The rains commence in April and end in October, while the dry season starts from October ending by March. Population actit ities, cttltures, language The Yorubas constitute overwhelmingly the major ethnic group in the State and it is mainl1' the indigenous population. Hor,v ever, individuals from other ethruc groups such as the Fulanis. Igbiras, Agatus, Igbos, Hausas and Egedes have migrated into the State and are cohabiting with the indigenes. With a current projected population of about 2.9 million, the State is divided into l6 LGAs. Settlement pattem is compact with population densities of between 280 - 350 persons/ square kilometer. Farmsteads exist but are seasonal. Corrutrunicatiort systent (road... ) Roads between major cites are in good condition, but access roads to most of the endemic communities are very poor. Some are not passable during the rainy season. Despite this. transport by road remarns a major means of communication among the commuruties. The electronic and print media are also veritable channels of commurucation. Within the communities the town announcers and announcements in churches / mosques communities meetings are preferred means of communication. Adn dnistratio n structure The State is made up of 16 administrative uruts known as local Govemment areas. Each LGA is headed by a Chairman, usually elected, whom career officers assist. There is a legislative arm made up of elected councilors from the various wards that malie up each LGA. Beneath the rvard levels are the communities. At the State level, the Govemor is the chief executive, 9 b WHO/APOC, 24 Novcnrber 2004 and he is assisted by an executive council made up of commissioners in charge of vanous ministries. There is a legrslative arm comprising elected persons from the LGAs. Health system & health care delivery (provide the number of health posts i centers m the project area if the information is available). There is an official PHC policy and structure in the project area. It is a s1'stem of health care services where community participation forms the mainstay with support from the State, Local Govemment 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 552 health facilities in the project area. Nunfier of health staff in project area and nunrber of lrcaltlt staff involted in CDTI actit ities. Table I : Number of health staff involved in CDTI (Please add more rows y''necessary) District/LGA Number of health staff involved in CDTI actir.ifies. Total Number of health staffin the entire project area BI Number of health staff involved in CDTI B, Percentage Bs=Bzl Br ^100 ADO 120 34 28o/" EFON 7I 46 6s% EKITI EAST 116 25 22% EKITI SOUTH WEST l3s 42 3t% EKITI WEST 84 53 63o/o EMURE 68 15 22% GBONYIN 77 28 36% IDO/OSI 75 25 33% IJERO 207 43 21% IKERE 196 30 1s% IKOLE 105 30 29% ISE/ORTIN 85 14 t6% ILEJEMEJE 130 24 18% IREPODI-IN/ IFELODI.IN 75 27 36% MOBA t25 24 t9% OYE 106 54 s1% TOTAL 1775 514 29o/" 10 WHO/APOC, 24 Novenrber 2004 1.1.2. Partnership Indicate the partners invoh,ed in project intplententation at all levels IMoH, NGDOs (nationaUirfiernational), comnutities, local organix,ations, etc.J MOH, NOCP, LINICEF, LGAs, COMMI.]NITIES Describe overall workiltg relatiottship annng partners, clearly irtdicating specrJic areas of project activities (planning, supervision, advocacy, planning, nnbilization, etc)'tvhere all partners are invoh,ed The State and LGAs through their various teams are involved in training of field personnel, community mobilization & health education, management of side reactions, planning and management of project implementation, supervision and monitoring, and Mectizan procurement and delivery. The Zonal and National Offices assist in supervision. morutoring. trarning, advocacy. Mectizan procurement and evaluation of the prograrnme. The communities play such roles as selection and remuneration of CDDs, collection of Mectizan. determination of mode and penod of drug distribution, census update, Mectizan distribution, and recording and reporting of treatments. State plans if any to ntobilize tlrc state /regiort / district /LGA decisiort -ntakers, NGDOs, NGOs, CBOs to assists itt CDTI intplenrcntatiort. The LGA policy makers were enlightened and mobilized to support CDTI activities. The Hon. Commissioner for Health, the Permanent Secretary and the Director of Disease Control mobilized the State policy maliers so that each LGA can contribute N 50,000 for CDTI census update as a first step towards counterpart funding. The Hon Commissioner, Director Disease Control, the State Onchocerciasis Coordinator and the SOCT in-charge of each LGA moved round all the 16 LGA to enlighten and mobilize the people to support CDTI activities. The Driver's union, CBO and market women association were also mobilized. These il,ill be further pursued in the coming year. The NOTF/APOC was invited to pay advocacy visit to the Ekiti State Govemor and mobilize him to support the CDTI programme, tr,vice this reporting year. The Commissioner for Health, Permanent Secretary and Director of Disease control met the LGA policy makers and enlightened them on Onchocerciasis control and sought for their support through the Commissioner, LGA Civil Service Commission. In addition, the Hon. Commissioner for Health, Permanent Secretary are working in conjunction with the State policy makers on hon' to deduct money from source into the PHC account of each LGA. 11 WHO/APOC, 2-l Novernber 200-l As usual the communities in 16LGA will continuously be mobilized including the drivers unions, market women associations, religious Leaders and CBOs. These will be followed in the coming year. t2 WHO/APOC, 2.1 Novenber 200.1 Number of communities/villaqes in Population of CDTI Districts/ LGAs in the entire project area Total popula- tion in the entire project area Meso- endem ic zone in the project area A7 Hyper- endem ic zone in the project area A3 Total in meso / hyper- endem ic zone A.a: A1+ A2 Meso- endemic zone in the project area A./ Hyper- endemic zone in the project area AJ Total in meso/hype r-endemic zone Aa: A.,+ Ar Ultimate treatmen t Goal (urG) Ado 58 s00 l0 l0 58 500 58 500 49 140 Efon 44 654 t2 t2 44 6s4 44 654 37 509 Ekiti-East 73 464 l7 t7 73 464 73 464 6t 709 Ekiti S West 58 798 l0 l0 58 798 58 798 49 390 Ekiti West 25,246 l5 15 25.246 25,246 2t 207 Emure 6t 748 9 9 6t748 6t 748 sl 868 Gbonyin 85, 250 9 9 85 250 85 250 7t 610 Ido/Osi 82.320 ll 11 82,320 82,320 69 r49 Ijero 86,t54 58 58 86,154 86. I 54 72 369 Ikere 134 739 36 36 t34 739 134 739 l13 181 Ikole 70 315 t2 t2 70 315 70 315 59 064 Ise/Orrur 64 046 l0 10 64 046 64 046 53 799 Ilejemeje 35 788 48 48 35 788 35 788 30 062 Irepodun/ Ifelodun 31 060 2 8 l0 31 060 31 060 26 090 Moba 64 183 58 58 64 183 64 183 53 914 oye 78 252 19 l9 78 2s2 78 252 65 733 Total 1 054 517 316 28 344 961 709 92 808 1 0s{ 517 885 794 1.2. Population Table 2: Communities and population at risk in the entirrc project area whether they are treated or not during the reporting period lease add more rows neces UTG = calculated as the maximum number of people to be treated annually in meso/hypet' endemic areas within the prolect area, nltinrutely to be reached vhen the project should be expected to reach the UTG at the Was a census for the project done during the reporting period? Yes No project has reached/ull geographic coverage (notmally the end ofthe 3'o year of the project). Please tick as appropriate 13 WHO/APOC, 24 November 2004 If No, what is the source of the data in the table above? * Source: National census CDD Other source, specify Year: Please tick as appropriate If you are using the term community or village, define what constitutes the community or village. This will help understand the profile of the project area. A community/village here refers to smaller units under the ward level withrn the LGAs, the least homogenous group of people made up of households having a common socio-cultural heritage, a central meeting place and a traditional leader. It usually comprise of 500-l 000 or more people. Is there any other information of interest about the population in the project area? If so, include it here. No 14 WHO/APOC, 24 Nol,ember 2004 SEGTION 2: lmplementation of GDTI 2.1. Timeline of activities Fill in table 3, timeline o.f activrtrcs for areas n'eated m current year, indicating when the key' activities were tmplemented by the month they began and the month they ended. Table 3: Timeline of activities for the areas treated in the currentyeu (Please add more rows i.f necessary) -Please indicate if all activities were undeftaken as planned, and if not, please explain. -Further comments. District/ LGA Mobilization of communities Training Census/Update Drug distribution Superuision Start ing month Comple tion month Start ing month Comple tion month Start lng month Comple tion month Start ing month Comple tion month Start ing month Comple tion month ADO JAN MARCH APRIL MAY JUNE JULY AUG DEC. SEPT DEC EFON JAN MARCH APRIL MAY JUNE ruLY AUG DEC SEPT DEC. EKITI EAST JAN MARCH APRIL MAY JUNE ruLY AUG DEC SEPT DEC EKIN S WEST JAN MARCH APRIL MAY JUNE JULY AUG DEC SEPT DEC EKITI WEST JAN MARCH APRIL MAY JUNE ruLY AUG DEC SEPT DEC EMURE .IAN MARCH APRIL MAY JUNE ruLY AUG DEC SEPT DEC GBON YIN JAN MARCH APRIL MAY JUNE ruLY AUG DEC SEPT DEC IDO/OSI JAN MARCH APRIL MAY JUNE ruLY AUG DEC SEPT DEC IJERO JAN. MARCH APRIL MAY JUNE ruLY AUG DEC SEPT DEC IKERE JAN MARCH APRIL MAY JUNE JULY AUG DEC SEPT DEC IKOLE JAN MARCH APRIL MAY JI.INE ruLY AUG DEC SEPT DEC ISE/ ORLIN JAN MARCH APRIL MAY JUNE ruLY AUG DEC SEPT DEC ILEJE MEJE JAN MARCH APRIL MAY JUNE ruLY AUG DEC. SEPT DEC IREPO/ IFE JAN MARCH APRIL MAY JUNE ruLY AUG DEC SEPT DEC MOBA JAN MARCH APRIL MAY JUNE ruLY AUG DEC SEPT DEC OYE JAN MARCH APRIL MAY JUNE ruLY AUG DEC SEPT DEC t5 WHO/APOC, 24 November 2004 2.2. Advocacy State tlrc nuntber of policy/decision nnkers nobilized at each relevant letel during the current year; the reason(s) for undertaking the adyocacy and the outconrc. Describe dfficulties/constraints being faced and suggestiorts ort ltow to improve aclvocacy. The Executive Govemor and other top functionaries at the State level were mobilized by NOTF/APOC twice during this reporting year. Because of the political situation of the State, it rvas not possible to meet the LGA chairmen together but the Director Disease Control, the State Coordinator and the SOCT in-charge of mobilization mobilized some in their respective LGAs including the chairman, Local Govemment Service Commission. This resulted in the release of N50 000 by few LGAs to support training of CDDs, and production of some treatment registers to be used for both registration and distribution. Othei Chairmen promised to release some funds in2007. Meanwhile, despite all efforts made in the reporting year, no fund was approved or released at the State level. There is hope to get something done b1, the in-coming Admirustration by 2007. No advocacy workshop was done because of lack of counterpart funding by the State and the project was able to get only 50% of Apoc approved funds for the year. At the community level these goups of people are mobilized: The major constraint in achieving desired results is the rapidity in changes of policv makers at the LGA and State levels To improve advocacy there is need for a high-level advocacy that wrll target the chref executive of the State. Production and airing ofjingles on radio and television should be a continuous exercise. This will be complemented b)/ other Radio / TV discussions on the LGA Traditional Rulers Opinion Leaders Religious Leaders Market Women Grps Other CBOs Ado Ekiti 26 34 5 t2 3 Efon 8 4 2 7 Ekiti East 35 l9 4 15 3 Ekiti S W 2l 22 4 9 EkitiWest l7 l6 5 8 Emure 11 8 9 10 I Gbonyin l3 8 9 8 2 Ido / Osi 18 27 6 13 2 Iiero 36 38 ll 17 Ikere 14 1l 7 14 Ikole 9 l5 4 t4 Ise/ Orun 8 l5 J 4 2 Ilejemeje t6 8 5 l4 I Irqlodun / Ifelodun l5 t9 2 l5 Moba I7 2t 3 9 5 oye 8 11 4 8 I Total 272 276 81 177 18 l6 WHO/APOC, 24 November 2003 disease and control strategy. Additionally, there should be continuous advocary visits to the prominent traditional rulers and policy makers at the Local Govemment level in 2007. 2.3. Mobilization, sensitization and health education of at risk communities Provide information on: The use of nrcdia and/or other local systents to disseminate informatiort Media [Radio] and megaphone was used to disseminate information. Types of IEC nmterials used Posters were used. Mobilization sensitization and healtlt educatiort of ruonnn antl ndnorities - ntethocl and response Within the project, there is an active participation of female members of the communiq, at mobilization meetings and during health education sessions. Some of the rvomen have volunteered as CDDs whenever serving CDDs expressed unwillingness to continue due to iack of incentives. Some women have met with community leaders over incentive of CDDs while some gave out money from their personal purse to support cDDs. Response of target conurturtities / villages Communities have responded by coining forth to collect their Mectizan tablets. Members have expressed willingness to comply with Mectizan treatment. The communities have fulfilled most of their responsibilities under CDTI such as selection of their CDDs and willingness to add more each year, giving some incentive to some of them and determination of the mode of distribution. Acconrylisltnrcnts o There is an increase in awareness of the communities of the benefit of Mectizan, and its continual intake over a long period of time. o Involvement of more CBOs in the implementation process over what was obtained in the past e.g Women Leaders were involved in mobilization and sensitization of communi6, members on CDTI project. o There is an increase in awareness of the roles of partners / communities in CDTI o The commuruties are still very much willing to keep on taking Mectizan provided it is available. o More females are interested in CDTI programme. Weakn esses / constraints o Inadequate funds to have more interactive sessions with communities. o CDDs are demanding for incentives o Perception of some sections of the community that the programme is heavily funded and the community is being denied its fair share. o Comparing CDTI programme with NpI on payment of incentives. o Unwillingness of some LGA Charrmen to support CDTI project. 17 WHO/APOC, 24 Novernber 200.1 Suggest ways to intprove nnbilization sensitizatiort of the target conuttunities, . Equipping local NGOs, market women, religrous leaders, road transport workers and other community based organizations with necessary mobilization skills will help a $eat deal in improving mobilization of the communities o There should be regular meeting with the community leaders by health workers. o The project intends to collaborate with relevant sections of the ministry of information and culture in order to make use of appropriate staffwith skills in community mobilization. . More feedback should be given to the community/opinion Leaders on CDTI prograrnme going on in their community. 2.4. Gommunity lnvolvement Table 4: Communities participation in the CDTI (Please add more rows f necessary) Number of communities/villages rvith community members as supervisors Number of CDDs Male CDDs Female CDDs Total B8 Be: 87+Bs B1 Number of communities /villages with female CDDs Number of communities with female CDDs Percentage Bro Brr= Bro/B.r * 100 Total no. communities in the entire project area B4 Number with community membet's as superrisors B. Percentage Be: 85/ 84 *100 ADO 10 7 70% 45 20 65 8 80o/o EFON t2 10 83% 58 45 103 8 67% EKITI EAST t7 9 53o/o 79 40 119 17 r00% EKITI S WEST 10 7 70% 71 94 165 5 50o/o EKITI WEST l5 l5 100% 49 62 111 10 67% EMURE 9 9 t00% 30 16 46 9 t00% GBONYIN 9 4 44% 52 31 83 5 55% IDO/OSI l1 5 4s% 53 t7 70 8 73o/o IJERO 58 49 84% 198 40 238 15 26% IKERE 36 24 67o/o 78 23 101 8 22% IKOLE t2 5 42% 82 22 104 ll 92o/o ISE/ORI.IN l0 6 60o/o 34 23 57 10 t00% IEJEMEJE 48 48 l0)Yo 33 32 65 8 17% IREPODTJN/ IFELODUN l0 7 7lo/o 35 63 98 6 60% MOBA 58 53 9r% 40 37 77 t2 2t% OYE 19 13 68% 82 l0 92 l0 53o/o TOTAL 344 271 790h 1 0r9 5-/5 1 594 150 44o/" 18 WHO/APOC, 24 November 2004 Comment on: - Attendance offenrule ntentbers of tlrc conmuuity at healtlt eclucatiort meetings Female members of the community are allowed by men to attend health Education ireetings and are allowed to participate and give suggestions in the meetings. - In general, hotv do you rate the participation offentale ntentbers of the comnrunity nteetings wlrcn CDTI issues are being discusses (afiendance, participatiort irt the discnssion etc). Women are always allowed to participate and even contribute to the decisions during general community meeting But on special or key decisions on community matters, elderly men are usually the decision makers and women do respect them. - Incentives provided by conuttnrtities for the CDDs Usually, incentives to CDDs are in kind due to the poverty levels. Some communities give cash since there is comparison u'ith other incentive giving community-based programmed such as the immunization programme. Some communities are howlver yet'to give anv incentive to their CDDs. - Attritiort of CDDs, Is attritiort a problemfor the project? If yes, hotv is it atltlressecl? Attrition of CDDs occurs within the project, but the rate is not alarming. Some of the younger CDDs secure admission to higher institutions; a few leave the job duJto lack of incertives as they compare the CDTI project with immunization; some fewLlderly CDDs die; while some CDDs secure jobs and therefore abandon the distribution. Sometimes, the community leaders were mobilized to select new CDDs and the State presented an umbrella rvith CDTI printed on it as an incentive to each CDD. - Other issues l9 WHO/APOC, 2-1 Norember 200.1 2.5. Gapacity building - Describe the adequaqt of available knowledgeable nnnpower at all levels. The available manpower for CDTI implementation is enough. All the health staff needs to be trained and made to see CDTI progarnme as part of their routine daily responsibility. The project needs to train more CDDs to replace those that went arvay and reduce the workload of the existing CDDs thereby reducing demand for incentives. - Wtere frequent transfers of trained staff occur, state wlmt tlrc project is doing, or intentls to do, to remedy the situatiott. (The most important issue to describe is what measures were taken to ensure adequate CDTI implementationwhere not enough l*towledgeable manpower was available or if staff arefrequently transferred during the course of the campaign). Staffs are usually stable. During this reportingyear, some staff were transferred due to establishment of new health facilities and demands by some communities. More Health staff were trained from health facilities to ease the problem of transfers. Replacements were effected and reduction in the area of supervision by each staff ensured. More health workers r,vill still be trained in 2007 . 20 WHO/APOC, 24 November 2003 Table 5: Training at the different levels of CDTI implementation (Please add more rows i.f necessary) a 'New', 'Refr' lfdetarl not avorlable, prowde the correspondtng lotal on\' sure !hat there s no double counttng If "other trainers of trainees" were trained, please explain who they arc and their roles in CDTI. Number of Districts/LGAs staff trained Number of Health center/post staff trained Number of other trainers oftrainees ( TOTs) Number of CDDs trained District/ LGA ATr o cr New c2 CJ Refr Tota I Cr= C:+ Cs ATr o Cs New Refr Ct Ct Total Cr= C.+ C7 Cr ATrO CnCru I Cp= Cro* Ct New ', Refr ', Tota ATrO Crt CrscH Refr j Total Crr: Crr* C'. {DO 3 J ,..' 30 l0 i24 itq 90 26 i4s :6s ]FON ., 30 8 i38 :qA 100 15 iSS irO: ]KITI ]AST J J 3 30 14 25 tz0 15 104 : l19 ]KITI S WEST J 3 :3 30 10 22 r00 9 i85 l9.l ]KITI WEST J 3 J 30 l0 ,JJ23 lt5 l0 97 07 ]MURE J 1 i2 i3 30 5 i10 i15 50 46 i46 fBON flN J 3 :3 30 2818 : 10 100 23 60 DO/ OSI J 3 :3 30 253 "22 126 10 60 70 JERO J J 3 30 l1 32 i43 300 3l 207 2 38 KERE J J 3 30 u ile :30 120 23:78 il0l KOLE 3 3 J 30 7 23 30 115 104 2l:83 SEi )RLN 3 J J 30 4 10 t4 84 11 46 i57 LEJE \4EJE ., J J JU l6 8 24 80 25 40 ios REPO/ I'ELO J J 3 30 9 18 27 100 25 73 r98 \4OBA J 3 3 30 l8 6 24 100 l8 59 itt )YE J J 3 30 t2 l5 27 100 20 72 92 TOTAL 48 1 47 48 480 166 28t 147 1 800 276 1245 i 1519 1007o Achievement 937o Achievement o/o Achievcment 847o Achievement 21 WHO/APOC, 24 November 2003 -l 3 1 2 83 Trainees Type of training CDDs Other Community members e.g Community supervisors Health Workers (frontline health facilities) MOH staffor Other Political Leaders Others (specify) Progam management Horv to conduct Health education x X Management ofSAEs CSM x SHM Data collection x x Data analysis x X Report writing x x Others (specify) Table 6: Type of training undertaken Qick the boxes where specific training was caruied out during the reporting penod) Any other comments 2.6. Treatments 22 WHO/APOC, 24 November 2003 .t N O .o (,) oz t c.l o o. o { M, \ 4q e0 U A.) 4 L. \)L o t \04 \,) A. a L a Ol-(n J o ti 6 -o O rr.l (u E C) oLF r-'r crl EIdlFI h 6u.^^! -95 a?2,? 99!E= c=uoi-:L'::=\-!uc><<,o^;:;-2 9.EazEez'i' q s.l#<\cn2Z I !Ooo trooo zt n ON $ lr) tr)tn tr) \c r/.) |r)cO r-. o\ u;l ! o co^o: = sY.J _ 6 zz > 9.E E I I I p. U 0r ll * i^ H a 5 brlod^PUs F cOF- R! Ntr) c\ @ Ir- o\\o @ a! o\ t-- NQ o\r- s o\ c- *! \otr) *a6\ co tr- N c.) CO o\ o\ *atr\O\o *a Nr- rAn\ rn r-- H o a_i=u trFo z <f, N$ @ o\ o\ NN \c (r-lr) t--tr) N\o\c oIr) \o o\ o\ \o N €t oo @$ t--\o F-s co \ot tn @ \o\c O tr)$ ra)\o @ o\\c CO o\$ @ co N\ t-- o.l ca NN co c'l ! zi,.z =--u1lo3' -ao * o\ * o\ \ t-- ca o\ t-- \o CO o\$ t-- N c.l oo\o co h \o (-- o\ .+ o\\o \o ca C..lr- oo co +\o o\(n o\ o\ t-- catn c.l\o ca o\ v N H 'aL!! do!J 6-E io o-: o E 6 3l! or |r) @ $tn\o $$ $\o$ cat-. co o\t-- co \o sf,N tr)N @v t-t \c rn N @ ON co N@ -f,lr) \o @ o\ ca t-- $ aa tr) co c- \o$O$\o @ oo tr- rn co \oO co O Obo =tq O E EIHI ot "l I I ll + H- ! 9o c@o9:- trJi- *!o\ o sO Ee x!c\ O sO sOO O tr\ O *a O sO NO N O N O ! oY-^ o tr oO:J =>-Lzd O c\ Ir- trl o\ o\ tr) @tr) \oca C\l @v O E U.Z 4 lo .a' -Fo N r-- tr) o\ n @r) \ccO N @+ \oaA-.tfr =.oE d 9JveF^= G:3<:a = tr oO!? E : ES [i e o O N r- r) o'\ o\ t/) @ \c c.) N @t o o z oqr q.l '- u)\4< s.l rl.] (a F V q B F V rr.l rr.l& 2 rr.l z z H (h o - o - rr.l IJ.]& IJ.]V HJ V z & o tr.l(n El z E] IJ.]J r! J sl E s.l r', s O c.l (.) ! 0.) z sN o o I I I ?")lr) NQ r) @ *ao\ Ol t-- xao\ o\\o o\\c $ ol t--\o \o o\NN o\N rr * o\ cotn cn t-- n\9 N o\F- roa € co @ t\c Nlr) c.l @ t-- rr ro rf,ta -ii\ O i!c\ O NSs\ oo|r) o\ v!f,(') @ $s .t @tr) o\ !f,$F) o z. t! j F F a, .i Formula for computing therapeutic and geographical coverages Therapeutic coverage rate Nrunber of people treated x 100("/") Total population living in mesolhyper-endemic communities within the project area Geographical coverage rate Number of conununities/villages treated x 100 VA Totalnumber of meso/hyper-endemic communities as identified by REMO in the project area ATO coverage rate Number of people treated x 100 e/A Annual Treatment Objective % UTG achieved : Number of people treated x 100 Total number of people to be treated in mesoflryrer-endemic areas within the project area (UTG) ATO = The estinuted nuntber of people lit'ing in nrcso/hyper-endentic arcas that a CDTI project intends lo treat with i'ernrcctin in a given year. (lTG = The nntinurnt nuntber olpeople to be treated in nrcso/hyper-endemic areas within the project area, ultinmtely to be reached when the project has reachedluU geographical coverage (nornmlly the project shoald be acpected lo reach the LITG al the end ofthe 3'd year ofthe project). 2.6.1. Trcatment figures If the project is rtot achieving 100% geographical coverage ar,d a ,rdniiltr,t t of 65% therapeutic coverage or the covetage rate is Jluctt ating, state the reasorrs and the plans being nrude to rentedy tltis. 2.6.2 lYhat are tlrc causes of absenteeisnt? Some of the members in the communities might have gone to their farms or trading places. Unfortunately these absentees are not follorved later. Some non-indigenous persons also travel down occasionally to their hometowns, and are missed out during treatment periods. The major issue here has to do with ineffective or lack of mobilization of community members. 2.6.3 What are the reasons.for refusals? Refusals are not common because the community leaders always intervene. Some of the community members are even eager to use mectizan tab twice because of the effectiveness of the drug, which they have experienced. 2.6.4 BrieJly describe all htotttn and veriJied serious adverse events (SAEs) that occurred during tlrc reporting period and provide (in table 8) the reqaired infornmtion wh en at ailab le. No report ofany serious adverse event. In case the project did not have any cases of serious adverse events (SAE) during this reporting period, please tick in the box. No SAE case to report 24 WHO/APOC, 2-l November 200.1 '1 S/N* Age Sex Village of origin Date Mectiz an was taken Date Itt sym ptoms appear ed Sym ptoms Health status before taking Mect tzan Date of admiss ion in health facrlity Date of dismiss al from health facility Results of tests (thick blood smear) Outcome of prognosis Extenuat ing or complica ting circtunsta nces Alcohol involve ment or not Table 8: Cases of serious adverse events (SAEs) that occurred during the reporting period (Please add more rows if necessqry) None was reported aa* Serial number of the patient 25 WHO/APOC, 24 Novernber 200.1 2.6.5. Trend of treatment achievement from CDTI project inception to the current year Table 9. Treatments and coverage by calendar year for the entire project area. (Pleasefill in tlrc required data) Please indicate the UTG for the project area:-885 794 the denominator in alt UTG coverage calculations.) use this figure as YEAR Communities/villages Population Total no of commu nities/ Village s rn the mesoAr yper Endem ic areas E1 Annual Treatme nt Objecti ve E2 Number of commu nities/ villages treated E3 Geogr aphic al cover age l%l E3/EI * 100 ATO Cover age lo/o) E3IEz * 100 Total Populat ion of the Meso/hyp er End emic area E6 ATO E7 Number of persons treated E8 Therapeut lc Coverage l%l E8/E6 * 100 ATO Coverage t%l E8IE7 *l 00 UTG Cover a8e t%1 1997 344 344 265 77Yo 77% 600 000 493 000 t90 565 39% 21o/o 1998 344 344 276 83% 83o/o 600 000 555 785 210 845 38% 23Yo r999 344 344 320 93% 93o/o 575 000 330 819 33% s8% 36% 2000 344 344 29s 860/o 86Vo 530 685 400 000 498 127 94Vo 24Yo 54Yo 200t 344 344 204 59% 59o/o 663 356 670 000 4s6 907 69Yo 66% 5OYo 2002 344 344 294 86% 86Yo 980 487 780 000 741862 76Yo l05o/o 8t% 2003 344 344 344 l00o/o IOOYy I 005 319 750 000 741 596 79% t05% 860/o 2004 344 344 344 lOOo/o l1OYo I 091 000 '770 000 814 141 75o/o lO5o/o 89Yo 2005 344 344 344 100% 700o/o I 091 000 916 438 850 980 7\Yo 86Yo 76% 2006 344 344 344 100% l00o/o 1 054 517 885 794 729 229 69% 92% 92o/o 2007 2008 2009 2010 26 WHO/APOC, 24 Novernber 2004 t2.7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - (please tick the appropriate answer) ./vroH wHo uNICEF NGDo Other (please specify) Mectizan@ delivered by - (please tick the appropriate answer){ruOn tr wHOn UNTCEFtr NGDON Other (please specify) : Please describe how Mectizan@ is ordered and hory it gets to the contnuufities The State provides population data and numbers of Mectizan tablets it believes it will require to NOCP who processes the data after receiving similar information from other LINICEF- assisted States. The population data comes from the census update conducted, which florvs from the communities to the LGAs (LOCTs). These are compiled and forwarded to the State. NOCP submits a re-application for the LNICEF - assisted States to MDp. On approval, the drugs are shipped to the country and TINICEF facilitates clearance and storage. The State collects from NOCP while it releases to the LGAs. LOCTs release drugs to the district health supervisors or the health facility staffwho in turn make them available to the communities. FLOW CHART OF MECTIZAN DELIVERY. EF/ NIGBRIA. NAL OFFICE. DISTRICT HEALTH FACILITY I COMMUNITY N ST 27 WHO/APOC, 24 Novernber 2004 Table 10: Mectizan@ Inventory (Please add more rows if necessary) State/ District/L GA Number of Mectizant tablets Number in stock Request ed Received Used Used/ Person treated Lost Wasted Expir ed Remain- ing Ado 150 000 149 000 135 012 42491 223 13 765 EFON 70 000 70 000 68 994 22998- l0 792 EKITI EAST 242 105 000 105 000 104 t37 57 576 242 863 EKITI S WEST 968 140 000 140 000 135 529 50662 159 5 280 EKITI WEST 140 000 I 40 000 115 215 lE 961 294 24 491 EMURE 1 50 000 150 000 146 778 4&926 ))) 3 000 GBONYIN 105 000 105 000 t04 297 61 48A 494 209 IDO/OSI I 972 t75 000 175 000 180 278 46347 412 t0 9t2 IJERO 140 000 140 000 139 569 66 805 431 IKERE 7 255 140 000 I 40 000 I 35 003 45 001 57 t2 t95 IKOLE 500 175 000 175 000 169 291 69865 226 5 983 ISE/ORLIN 60 000 70 000 70 000 tt6 290 38 4S3 l3 710 ILEJE.MEJE 70 000 70 000 68 430 ?5 752 220 l3 710 IREPODUN/ trELODUN 2 719 75 000 75 000 72 485 23 22i 55 5 t79 MOBA 140 000 140 000 I 10 553 4L 969 561 28 886 OYE 17s 000 17s 000 157 028 6t 677 L7 912 STATE OFFICE 153 656 3 000 000 3 000 000 t 944 2L0 729229 3 165 I 209 146 28 WHO/APOC, 24 November 2004 - How are the remaining ivermectin tablets collected and where are they kept? The remaining tablets are sometimes kept with the LOCT leaders who utilize them for the next treatment cycle. The quantity retained is subtracted from that which will be required for that treatment cycle. At other times the drugs are returned to the State, where they are kept for the next treatment cycle. - List and briefly descibe the activities under ivermectin tlelivery that are being caruied out by health care personnel in the project area. The health personnel at the various levels have been responsible for the following: o Storage of ivermectin . Supply of ivermectin o Record Keeping of drug distributed o Supervision of CDDs. - Any other comments 2.8. Gommunity self-monitoring and stakeholders Meeting Has any training (of trainers) for community self-monitoring had been clone in the proiect area? If so, When? Table 1 1 : Community self-monitoring and Stakeholders Meeting (Add rows if needed) Districti LGA Total # of communities/villages in the entire project area No of Communities that carried out self monitoring (CSM) No of Communities that conducted stakeholders meeting (SHM) TOTAL Not done due to insuflicient funding by all partners during the reporting period. Describe how the results of the community self- monitoring and stakehollers nteetings have offected project intplementation or how they would be utilized tluring the nut treatment cycle. N/A 29 WHO/APOC, 24 November 200-t 2.9. Supervision 2.9.1. Provide aJlow chart of supenision hierarchy. NOCP ZONAL N.O.CP STATE ONCHOCERCIASIS CONTRO TEAM (SOCT) 1 CO LOCAL GOVERNMENT ONCHOCERCIASIS CoNTROL TEAM (LOCT) I + MMUNITY. CDDS 2.9.2. l4/hat were the main issues idenffied during supervision? - The CDDs were demanding for incentives or payment as obtains in the NPI programme. - Inadequate involvement of health facility staff - Transfer of health facility staff. - Improper and incomplete registration of households in the register. - Exercise books were used instead of printed register. 2.9.3. Wus a supervision checklist used? Yes, but not at the lower level 2.9.4. What were the outcomes at each level of CDTI implententation supervision?1. During registration, a lot of mistakes were made in their register, so informal training was done on the registration This made the population figures realistic and data management easier. 2. The community leaders were sensitized again on giving incentives to the CDDs. Some agreed while some did not. There is a better coverage where they agreed. 3. The health facility staffthat refuse to participate were encouraged to continue and those transferred were replaced. 4. Community Leaders selected more CDDs for distribution. 30 WHO/APOC, 24 November 2004 2.9.5. Wasfeedback given to the person or groups supervised? Yes on the spot. 2.9.6. How was thefeedback used to improve the overall pedormance of the project? The feedback was used to have more mobilization both with the policy makers in LGAs as well as community leaders and CDDs to give more support to CDTI activities. Those corrected changed for better and improve the CDTI programme by better coverage, better registration and supervision of the programme. More CDDs were selected to reduce the workload of each of them. SEGTION 3: Support to CDTI 3.1. Equipment Table 12. Status of equipment (Please add more rows if necessary) Source Type of equipment APOC MOH DISTRICT/ LGA NGDO Others No Condrtion No. Condition No Condrtion No. Condition No Condition 1. Vehicle 1 F 1 NF 2. Motor cycle(s) 7 F 3. Compu-ter(s) 1 Floldl 4. Printer (s) 1 F 5. Photo-copier (s) 1 F 6. Fax Machine (s) 7. Others a)Bicycles 50 CNF b)TV set I F c)VCR 1 CNF d)Generator 1 F *Condition of the equipment (F=Functional, CNFR=Currentll, non-fi.rnctional but repairable, WO:Written off) Hotv does the project intend to maintain ancl replace existing equipment and other materisls? The prgect repairs and rnarntains all capital equipment with the little funds provided by the State and Local Govermnents. Efforts will be intensified to convince goverffnent to release counterpart funds for maintenance of project equiprnent and purchase of various materials. The project requested APOC to provide a replacement of most oi ttre ofA^ equiprnents supplied. 31 WHO/APOC. 24 Novernber 2004 3.2. Financia! contributions of the partners and communities Table I 3: Financial contributions by all partners for the last three years Contributor Year 3 ('provide the period') Year 4 ('provide the period') Year 5 ('provide the period') Year 6 ('provrde the penod') TOTAL AMOUNT (CASH) Budgeted rus$) TOTAL CASH Released (us$) TOTAL AMOUNT (cAsr{) Budgeted (us$) TOTAL AMOUNT (CASII) Budgeted (US$) TOTAL CASH Released (us$) TOTAL CASH Released (us$) TOTAL AMOUNT (CASH) Budgeted (us$) TOTAL CASH Released (us$) MOH (Central + ProvrnciaU State) 10 000 3 6',76 2 000 7 905 MOH (District/LGA) 21 440 4 850 5 882 5 882 6 000 4 530 Local NGDO(o (if anY) NGDO partner(s) Others a)LGAs 400 381.62 b) APOC Trust Fund 107 680 57 280 42 910 25 000 ,10 65rl 16 500 TOTAL 139 120 62 130 52 468 32 882 54 9s9 21414.62 ' If there are problents with release of counterpart funds, how were they adtlressed? There is a problem because no amount of money was released in the reporting year. But the new Commissioner and the Permanent Secretary has already paid advocacy visit to the Administrator and he promised to release fund for the CDTI project in the year 2007. Advocacy visit were also paid to the LGA Chairmen, Dept of LGA and Chieftaincy Affairs. Additional contnrents The policy makers at State level were well enlightened and mobilize to support CDTI activities 3.3. Other forms of community support Describe (indicate Jbrms of in-kincl contributions of comntunities if any) Word of appreciation. 3.4. Expenditure per activity - 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 )Z WHO/APOC, 24 November 2004 Activity Expenditure ($ US) Source(s) of funding Drug delivery from NOTF HQ area to central collection point of communlty Mobilization and health education of communities Training of CQDs !r.ai!ng g_f health staff at all levels Supervising CDDs and distribution Internal m_onitoring of CDTI activitie! Advocacyrrisits to health and politicql authorities IEC materials Summary (reporting) foryns for treatment Ve hi c I es/ Motorc yc I e s/ bic yc les_m qi n t_elqrcq Office Equipment (e.g computers, printers etc) Others 15 85 2300 200 4000 400 200 MOH MOH MOH MOH MOH MOH MOH TOTAL 7 200 MOH Total number of persons treated 850 980 Table l4: Indicate how much the project spent for each activity listed below during the reporting period. Any comments or explanations? SEGTION 4: Sustainability of GDTI 4.1. lnternal; independent participatory monitoring; Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following 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 B WHO/APOC, 24 November 2004 ,t ll 4.1.2. What were the recontn endations? LOCT members to be increased to minimum of four in order to enhance effective implementation of CDTI activities. Zonal coordinator to write to the r,ninistry of Local Government to provide office space for LOCT. Selection, training and retraining of more CDDs. Provision of printed community treatment registers by the LGAs. SOCT to embark on constant advocacy to Local Government Policy makers for financial support. LOCT to follow up on the activities carried out at Health facilities and communities Quarterly report of activities to be written at all levels. List of CBOs to be identified, compiled and mobilized. Intensive and constant supervision and monitoring to be intensified at all levels. 111 iv vl. vii. viii. ix. 4.1.3. How have they been implemented? i.There is a plan to train one more Locr in each LGA in the year 2oo7ii. The letter has been sent to Ministry of Local Governmentiii. More CDDs has been trained iv. Only Ilejemeje LGA has done the printing of more Community Treatment Registers v. The SOCT has paid Ado LGA Policy Makers advocacy visit for financial support on Onchocerciasis programme "i: Quarterly report of activities at all levels would be done in the year 2OO7 .vii. Few of CBOs were identified. vlll. Intensive and constant supervision and monitoring have started and would still continue in the year 2007. 4-2- Sustainabitity of projects: ptan and set targets (mandatory at yr 3) Wastheprojectevaluatedduringthereportingperiod?No Was a sustainability plan written? yes When was the sustainability plan submitted? _2004_ What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.2.1. Planning at all relevant levels After the evaluation of the State project, a planning/debriefing meeting was conducted during which a draft 3 - Year SustainabilityPlan was developed. Present atihe,r".tirgwere representatives 34 WHO/APOC. 24 Novernber 2004 Iof the LGAs (policy makers and health workers) and the State representatives. The Plan has been fine-tuned and submitted to the MOH for inclusion into the Yearly health plan. It has been planned that at the close of each year, a review of the succeeding year's plan will be undertaken and where necessary amended. Subsequently (after the third year), plans will be developed on a yearly basis. 4.2.2. Funds At the State level, there has been some counterpart contribution, but these have been neither adequate nor regular. With the evaluation of the project, the State Government has renewed its commitment to funding the CDTI project and encouraging the LGAs to do likewise. Advocacy visits will continue to ensure that LGA keep on releasing at least minimal amounts for CDTI implementation. In the meantime, there appear indications that some financial assistance will be coming from UNICEF in the next couple of years. This is being followed up at the national level. 4.2.3 Transport (replacement and muintenance) As Stated in the earlier section of the report, the project expects APOC to replace transport before it finally withdraws funding This applies also to other capital items, which it supplied to the project earlier. At the LGA level, the National Primary Health Care Development Agency, which is supported by several international NGDOs occasionally, procures motorcycles for NIDs, which are distributed, to the LGAs. These are being used for CDTI activities. At periodic intervals some of the motorcycles are replaced buy NPHCDA. With respect to maintenance, some LGAs release minimal amounts for the periodic maintenance of the motorcycles. In the meantime, a system of strict control of transport has been put in place. Every trip and every expenditure on (fuel, tyres and repair) a logbook and monthly reconciliation of trip authorization and logbook entries has been institutionalized. 4.2.4. Other resources This has been partly addressed in the previous sections. With regards to IEC materials, the project is sensitizing the Government on the need to produce some with the withdrawal of APOC funding. TINICEF is also being sensitized on the need to assist the State in this respect. 4.2.5. To wltat extent has the plan been implemented The plan was fine-tuned during the reporting period, and nothing much has been accomplished due to inadequate funding. Mid-way into 4th year, funding from the Trust Fund to the project was suspended. In the 5th year, only 50% of the apprlved funds were released. 4.3. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3.1. Ivermectin delivery mechanisms The Mectizan delivery process occurs 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 staffwho come to pick up their vaccineJalso use the opportunity to collect Mectizan. 35 WHO/APOC, 24 Novernber 200-l t 4.3.2. Training Currently, CDTI training is not integrated into any other health programme training activities 4.3.3. Joint supervision und monitoring with other progranx At the State level, there are no plans for joint supervision and monitoring at present. A few members of the SOCT participate in other health programmes like guineworm eradication and immunization. On some occasions they take opportunity of their visits to the field for these activities to briefly look into CDTI issues. At the LGA level, some of the LOCTs are also involved in other programmes and sometimes use the opportunity of visits to community/ health facilities for one programme to look into other programmes, which they are handling. 4.3.4. Release of funds for project activities Where there are releases of fund, impress is released for PHC activities and is controlled by the PHC director. Rom their minimal amounts are made available to the Onchocerciasis Coordinator for some routine visits, collection of Mectizan or motorcycle maintenance. 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 buclget? At the State level, here is a line for CDTI in the PHC budget. At the LGA level, CDTI activities are subsumed under a general PHC budget. 4.3.6. Describe other health programmes that are using the CDTI structure ancl how this was achieved. What have been the achievements? None at the moment 4.3.7 . Describe others issues considered in the integration of CDTI. 4.4. Operational research 4.4.1. Summarize in not nnre than one half of a page the operationul research undertaken in the project area within the reporting period. None was undertaken during the reporting period 4.4.2. Horv were the results applied in the project? Not applicable. 36 WHOiAPOC, 24 November 2004 t 'a t{ SEGTION 5: Strengths, weaknesses, challeng€sr and opportunities List the strengths and weaknesses of CDTI implementation process. Strengths . Cooperation from the LGA Onchocerciasis Managers. . Regular monitoring and supervision. Some communities are fulfilling their roles under CDTI o Some LGAs made counterpart contribution of N50,000 for the training on CDTI activities and other CDTI activities. Will hope that these will yield better result. o Additional committed SOCT as being put in place. . High rate of CDD retention despite inadequate motivation Weaknesses o None release of Counterpart fund at State level o Comparing CDTI project with Immunization programme by the CDDs on remuneration o Attrition of some of the CDDs on distribution of Mectizan. o Few communities are giving incentives to their CDDs. o Low involvement of health facilities staff in implementation process. o Inadequate number of bicycles for supervision. o Demand for incentives by CDDs in many communities - List the challenges and indicate how they were addressed. The challenges include the following: o Non-release of counterpart fund from the State o Non-release of counterpart fund from some LGAs . Conduct of census update. Though. The CDDs did this but not all of them were committed to it like before and it took long time before they even compiled since they new that they wont be paid for it. These challenges were addressed by continuous advocacy for release of funds by partners; Change of leadership in the State to meet the conditions set by APOC to restore funding, conduct of census update with support from UNICEF; Advocacy visits to both the State and LGAs' Policy Makers to release funds in support of CDTI project. SEGTION 6: Unique features of the project/other matters 37 WHO/APOC, 2-l Nor,'enrber 200-l