Northern Osun State CDTI project year 4 technical report to Technical Consultative Committee(TCC) : October 2001 to September 2002

Cs uil iIT CD'll Prajec!'rJ) ItJ JJ,c ORIGINAL: English i t { COUNTRYNOTF: NIGERIA Proiect Name: Osun State CDTI Approval vear: 1998 Launching yea r: 1998 Reporting Period (Month/year): October 2001 - September 2002 Date submitted: DECEMBER 2OO3 NGDO partner: UNICEF ItIt i (9) YEAR 4 ANNUAL PROJECT TECHNICAL REPORT TO TE CHNICAL CONS ULTATIVE COMMITTEE Ir,)r i^.t ii' I oc) i-o: cr [il For ir:l-.r ro,"h(/\r \u i'cnr c,s\ Cev Gor 5ril 5l"c L0. AFRICAN PROGRAMME FOR ONCHOCERCTASTS CONTROL (AP RECU 2 6 FFV 2001 APOC/DIR -rl \ l U qer:F! srrd 'i 5 i'1,11'. .111116 C()Oltlj t t\E,aL l%*<+-r WHO/APOC, 26 September 2003 i., - lion i I i i I i I I I li I I ! aANTNUAL PROJECT TECHNICAL REPORT TO TECHI\iICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMEI{T Please confirm you have read this report by signing in the appropriate space. OFFICERS to si the report: country : NIGERIAA,IBERIA National Coordinator Name: Dr. J. y. Jiya Signature Date: ...*?..,...'L .-...4:.?? Zonal Oncho Coordinator Nam e: Mr. A. O. Jaiyeoba Signature Date This report has been prepared by Name : Mr. Matthew Leroboye Designati on : State Coordinator I I I I I I I I I I I I I I I I I I I I i I I I I I I I I I I I I I I I I I I I : I I I I I I Signahre Date Table of contents ACRONYMS........ DEFIMTIONS..... FOLLOW UP ON TCC RECOMMENDATIONS EXECUTIVE SUMMARY SECTION 1: BACKGROUND INFORMATION I.l. GpNEnaltNFoRMATroN............... 1.2. PopuLarroN RNp HeaLrH sysrEM SECTION 2: IMPLEMENTATION OF CDTI 2.1. PeRroo oF AcrrvrrrEs ..............2.2. OnDTRING, sroRAGE AND DELIvERy oF IVERMECTTN2.3. Aovocncy eNo SrNsrrrzATIoN 2,5. Con,tnauNITIES INVoLVEMENTIN DECISIoN-MAKINC 2.6. Cepncrty BUTLDTNc 2.6.I . Training..... 2.6.2. Equipment and human resources... CoNorrtoN oF THE EeurpMENT * pLeass srATE 2.7, TRearrrapNrs ................ 2.7.1. Treatmentfigures............ IV v I ) aJ 6 ...3 ..........8 .........8 ....... l0 .......11 ....... l6 ....... I 8 .......18 .......20 .......20 .....,,22 .,,..,,22 .......32 .......32 .......33 ...,.,,34 .......35 OROLU 24 2.7.3. Trend of treatment achievementfrom CDTI project inception to the cttrrent year27 x 3 LGAs (lre Souru, Ipe NoRrH & Eoe SourH) wERE LATER FouND To BE Hypo ENDEMTc AND EXCLUDED FROM MASS DISTRIBUTION OT MPCTIZAN IN ENDEMIC COMMUNIrIES..........272.8. SupeRvtsroN................ ................. 2g SECTION 3: SUPPORT TO CDTI........ .....................30 3.l. FtNnNctRr- coNTRTBUTIoNS oF THE pARTNERS AND coMMUNITrES............,..,.......... 303.2. OrHen FORMS oF coMMUNrry suppoRT ....,......3l3.3. ExpgNorruRE pER Acrrvtry ............. ......,...... 3l SECTION 4: SUSTAINABILITY OF CDTI ,,.,.32 4.1. INTeRNaI; INDEpENDENT pARTrcrpAToRy MoNrroRrNG; EvaLuerroN..........4.2, CovuuNIrY SELF-MoNIToRINc aNo STarguoLDERS MEerINc 4.3. SustnlNegrLITy oF pRoJECTS: pLAN AND sET TARGETS (MANDAToRy Ar yR 3)..4.4. INrecRarroN................. 4.5 OpenarroNAl RESEARCH ..... SECTION 5: STRENGTHS, WEAKNESSES AND CHALLENGES ...........36 lll WHO/APOC, 26 September 2003 aAcronyms APOC ATO AtrO CBO CDD CDTI CSM FLHF FMOH GCCC IFESH LGA LOCT MOH NGDO NGO NID NOCP NOTF NPI PHC REMO SAE SHM SMOH SOCT TCC TOT UNICEF UTG wHo African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Cornm unity-Based Organization Community-Directed Distributor Community-Directed Treatment with Ivermectin Community Self-Monitoring First Line Health Facility Federal Ministry of Health Government Cash Counterpart Contribution International Foundation for Education and Self Help Local Government Area Local Government Onchocerciasis Control Team Ministry of Health Non-Governmental Devel opment Organization Non-Governmental Organ ization National Immunization Day National Onchocerciasis Control Programme National Onchocerciasis Task Force National Programme on Immunization Primary health care Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Stakeholders meeting State Ministry of Health State Onchocerciasis Control Team Technical consultative committee (APoc scientific advisory group) Trainer of trainers United Nations Children's Fund Ultirnate Treatment Goal World Health Organization lv WHO/APOC. 26 September 2003 Definitions (i) (i i) (iii) (iv) (v) (vi) Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census ta[ing). Eligible population: calculated as g4yo of the total population in meso/hyper- endemic communities in the project area. Annual rreatment objective: (ATo): the estimated number of persons living in meso/hyper-endemic areas that a CDTI project intends to treat wiih ivermectinln agiven year. Ultimate Treatment Goal (UTc): calculated as the maximum number of people tobe treated annually in meso/hyper endemic areas within the projict area, ultimately to be reached y!9n the project has reached full geographic coverage(normally the project should be expected ro reach the urG ut t[. lnd of the 3%year ofthe project). Therapeutic coverage: number of people treated in a given year over the totalpopulation (this should be expressed as a percentage). Geqgraohical coverage: number of communities treated in a given year over thetotal number of meso/hyper-endemic communities as identifi.-o uy nruo in theproject area (this should be expressed as a percentage). WHO/APOC, 26 September 2003 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 13 Number of Recommendalion in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT ASE ONLYlil (i) Concern over low coverage and lack of specific strategy to increase coverage With the assistance of NOCP and LINICEF, the project did the following to increase coyerage : (a) Involvement of FLHF staff in CDTI activities rnore hitherto. (b) Encouraged LOCTs at monthly meetings to be more committed and ensure adequate coverage of endemic communities (c) Held advocacy programmes for policy rnakers to gender release of counterpart funds for supervision, training of CDDs and Health Workers. (d) Procured adequate number of Mectizan tablets (e) Initiated CSM & SHM in some endemic communities. 111 (ii) Inclusion of those with mild reactions with number of severe reactions. Ifsevere reactions have occurred the project should also include actions taken. Reactions reported were actually all mild. Project has taken nore that only cases of SAEs should be reported. Where they occur, the project will use the appropriate forms to report them as well as how they were managed. r l r (iii) Clarification on the number of tablets received being exactly the same as number of tablets used. The project was concerned over this but the records submitted to us indicated that the 1,400,000 tablets applied were all used to treat 52'7,264 persons. 111 (iv) Technical assistance be provided from NOTF to address low coverage and assist to develop strategy to increase coverage The State received advocacy visits from the NOCP National Coordinator, his deputy and the National Project Accountant. Other officers of NOCP National office, the Zonal office and UNICEF have given series of technical assistance to enable the project increase coverage. (Plea.se add more rows if necessary) WHOiAPOC, 26 September 2003 Executive Summary Osun State is one of the states in the South Western part of Nigeria and is located in the B Health Zone.It is a predominantly Yoruba State. Otherethnic groups like Hause, Ibo, Fulanis and Agatus however reside in all parts of the State.The State has a population of about 2.0million (1991 census). However. 742,432 is estimated to be living in 1,131 communities in the l4 endemic LGAs in the state. Population movements occur due to the following reasons: population displacements ancestral places thereafter. Of the total population of 742,432, 487,220 persons were treated during the period. This represented a 66% therapeutic coverage. With regards to trainings conducted,2,503 CDDs were trained of the 3,165 persons planned to be trained. This was a79% achievement.423 of 490 Health workers planned to be trained were trained/retrained. These represented an achievement of g6%. Strengths of the project include availability of committed staff, some support by the LGA policy makers forCDTI, integration of CDTI activities into other PHC activities, particularly at the LGA level, and appointment of some CDDs as top political functionaries in some assisted LGAs in the State. Greater support is therefore anticipated from such LGAs, if they continue in office. Other strengths include good level of awareness of the magnitude of the Onchocerciasis problem by the community and inauguration of CSM & SHM in ApOC assisted LGAs which is translating into increased levels of participation and ownership. The major challenges that faced the project are incessant transfer/posting of all categories of health workers, scarcity and high cost of petroleum products due to preparations to liberalize the downstream sector. Funds were therefore spent increasingly on purchase of petroleum products, and were used for Iimited activities. Other challenges were inadequate motivation of CDDs by the communities and lack of adequate census update. To address these challenges communities were re - mobilized to contribute more to the CDTI process especially with regards to incentives to CDDs. A census update is being planned as soon as funds are made available. On scarcity of petroluem products there was nothing for the project to do except to cut down on number of trips made. 2 WHO/APOC, 26 September 2003 SEGTION {: Background information 1.1. General information l.l.l Description of the project(briefly) Geographical location, topography, climate Osun State is one of thestates inthe South Western partofNigeriaand is located in B Health Zone. It is bounded by Kwara State to the North, Ekiti and Ondo States to the East, Ogun State to the South and Oyo State to the West. The State has a land mass of aboutg,5T2square kilometers' The State has two distinct seasons, dry season and rainy season. The rainy season begins in March and is heaviest from June through September/October. Farming generally begins in April, most farm work is cornpleted by October, after which the harvesting is canied out. The dry season begins in November and ends in mid-March. Population: activities, culture, language Osun State has a population of about2.2million (1991 census), Yorubas constitute the major ethnic group, although some minorities such as the Igbos, Hausas, Fulanis and Agatus exist and cohabit peacefully with the indigenes. The State is essentially an agrarian state with about 70%of its population engaged in one forrr of agriculture orthe other. In addition, it is a State that is internationally recognized for its rich cultural and tourism potentials. Communicotion system (road...) The major roads in the state are tarred but access roads to most of the endemic communities are in poor condition. Some are only passable during the dry season. Despite this transportation by road remain the major rneans of communication among the communities. I.E.C. materials, electronic media and the use of community town crier, announcements in churches and mosque also form part of the communication system used. A d mi nistr at ive s t r uct ure The state is made up of 30 Local Covernment Areas with the Chief administrative officer being the Chairman. A legislative arm made up of selected councillors from various ward supports hirn. Atthe State level the Executive Governor is the head of administration supported by an elected legislative arm and the judiciary. The capitalof the state is Iocated in Osogbo. 3 WHO/APOC. 26 September 2003 Health system & health care delivery There is an official PHC system and it is implemented in the project area. It is a system where health care services are taken to the doorsteps of the rural populace. It is a system where community participation forms the mainstay and thrust of health care delivery with support from the UN agencies, the State and Local Governments. Levels of functionality however vary across the state. Within the project area there are 3 teaching hospitals, 9 State hospitals and 330 health facilities scattered throughout the entire State. 1.1,2 PARTNERSHIP Indicate the partners involved in project implementation at all levels (MoH, NGDOs - natio na l, i nter nat io nal) The partners involved in project implernentation within the project area are UNICEF/llligeria, NOCP (National & the B - Zonal offices), the State Government, the various Local Governments and the endemic communities. An internationalNGDO, IFESH is a partner in lrewole LGA where it oversees mectizan distribution, together with other programmes aimed at educating and empowering communities to develop themselves with little assistance from outside. Describe overall working relationship among partners, clearly indicating specific areas of proiect activities (planning, supervision, advocacy, planning, mobilization, etc) where all portners are involved. Overall working relationship amongall partners is cordial. However, the project personnel at State level is not fully involved in the activities in Irewole LCA being supported by IFESH. This has been brought to the attention of both LG authorities and IFESH officials. The State and LGAs through their various units 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, UNICEF is involved in supervisory, advocacy and training roles and assists in logistics provision. The Zonal and national offices assist in supervision, monitoring, training, advocacy, Mectizan procurement and evaluation of the programme. The communities play such roles as selection and remuneration of CDDs, collection of Mectizan, determination of mode and period of drug distribution, census update, Mectizan distribution and recording and reporting of treatments. 4 WHO/APOC, 26 September 2003 State plans tf any to mobilize the stote/region/district/LGA decision-makers, NGDOs, NGOs, CBOs, to assist in CDTI implementation. It is pertinent to mention that community Based organizations (cBos) have rekindled their interests to collaborate with Local Covernment Political functionaries in their areas of jurisdiction to boost drug distribution coverage at grassroot level. It is hoped that the potential resources are tapped by the LGAs. 5 WHO/APOC, 26 September 2003 N o -o Eo o-oa N o o q \ \U t ! q) 4 N. a-\l L oo oo F o.() L C) bo L o l- o q) Cd G)L C)L o c) 0.) q) L 6t (.) o q) q) o -V(t) L (n a. o- Etr(g tt1 C) () 6)l -ot(Bl FI E oIJ o o t fl -t! o -I 1' E o tr o l-fl G Jc oI a 0! F \o\otr) la) aa v\o co t-- ao (\ ca $ c.t o\ t-r o\a .f, $(\(ns(\ o\!+ o\ ca ca .f oo o\lr) o\ (t.l aa aa r--\o $\o F- an tr- oo oo co lr) o\t-- ao o\(\ oo o\o \o (oo (v)(o c.l$ oo tt !f, aalr) rf, \l aa .t tt- $ o.] co r+ Nlr) oo @ a-l o\ \f,\o$ =f, s t-- Nl-- co It- a.) c.l$l--\o\o oo t--la) o\ \o t-t oo o.t\o ra)\o w\o ra)$ aa v l-. tr- N(e\tN r{. cn ta) a.l \o oo ca \o oo .f, .f,aa oola) ca aa aa c-\o a.) 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S ts E ,(:Sq=Io\i S : eL<\ \. s0= d - .iti s 9. t,sb t bo =i e d S\!\Se- qJ E 'i .sy s u GIi is E Ia! .=i e e3c, 3s > .s:- -=r\\ =\ p \.i .2' Lii- !$ = sSt'It E s:c{ X^. tr }sB \s g \ ll : "Pmrr \ t\G\s tr- ,. o 3q 5 I I -,-I ul :N -Nclzl I I I (, LLjd SEGTION 2: lmplementation of GDTI 2.1. Period of activities Insert Plan of action indicating activities by month, which were implemented 8 WHO/APOC, 26 September 2003 ca a.l Lo -o E 0) o-oa \o a1 L) o o, V) () E U I (\ Uaq Q ,a: p p U t \)q ! a,) a* v t< c,) C)LL o 0) o CO C)L lr1 0)L(! o L ,o .9 .= o (H o o C) E F c-ir (Jl -l cdlFI a *oEE I >' 2 >'(! 2 2. x(d z. z (d 2 Cd 2 6J 2 (! 2 E0 L C) .o o \-, L C) -oo o - l. O -o O(J L 0) -oo O o l- o o oc o -oo oc L o o o L o -oo oc L o -o oc L o -oo o o L o ,o o P C) L C) -oo o o -oo Oc L.() -oo o o U) EE(, (n2 6c 2 (B (n z, 2 (d z z z (c z botrE L >tLd 6 t,(0 r- t h - h(! (! L xL C! L h (! L (o >' o \a 0l ol UI I *oEE U h(o L -o c)a L t- -o C)fr. h L -ooq. L L (.) E. L L -ooE h L -oO L .o 0) E. l- -o0) fJ. a, L -oO tt t' € L ^o0) E. i,(! L -oo E l-G L -ooir- L -o c)f! h(! -oq)Ir o0 Lo -o EoOo L 0) -o E() o 0) o 0) E o o C) C) -o oo o L o -o E C) o 0) IJ 0) -o E C)o o ! 0) -o oo 0) IJ L 0) E() o 0.) o L o -o E o oc H o -o E C)o C) IJ q) -o q) o C) LJ 0) -o E C) Oo o L 0) -o 0)o o ! () -o Eoo() c b! F] *oEE(, t L .oo TJ. -ooE h(B L -o C)I! b L -oo tr- L L -o0) tr- (o L. -o0) tr. L L ot! xL L -o 0,)L L(t L (,)ft L L -o a) tJ. L L -o()tr L L 0)f! >.L(g L oIL t 6d .oot! a0 0) -oo o o L C) o o L o -oU o o L o ,o o c) 0) -oo o L 0) -oo oc L C) -o o L o -o o o L o -o o o -o o o L o -oo o L C) -o o o L o .o o o L C) -o o !E ao!t g)2 EE (.) L c) -o E(.) oZ L() .o 0) o z L 0) -o 0) o z tr C) -o o UZ L C) -o 0) oZ 0.) E o o z L C) o Z LO E o oZ rr 0) E o z L. 0) -o E(.) o z L o -o E C) z Lo -o o z L 0) o o z L o ,o 0) o z ao a- L(-) -oo oc L C)3 o oc 0.) -oo() IJ rO -oo oC L C) -oo o l-) L o -o o o 0.) o o o o l- 0) oc C) o oc L C) -oo o L O -oo o o -o o C) -oo O j Q U) a C) > U) .V C) (! !() >r (.) .! 'oq) () a. L r 0)L o (.) -ooor! L oQ .o .c) C)(n E] ,o (! (d .Y q o .Yo -oo o L Lo F] F tr 2.2. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - Qttease rick the appropriate answer) MOH/NOCP./tr trwnO EUNrCnr XNCoo Other (please specify): Mectizan@ delivered by - (please tick the appropriare answer) MoH/NoCp{tr Iwuo fuNrcrr, tr Ncoo Other (please specify) Please describe how Mectizan@ is ordered and how it gets to the communities Mectizan is basically ordered by NoTF via UNICEF and based on requests from the State. The State Project takes delivery of drugs from the FMOH through the Zonal Coordinator. LGA Coordinators get their consignments from the State store based on their respective estimated requirements in accordance with their specific target population. In Iikemanner FLHF takes stock of their own drug consignment from LGA Coordinator for onward delivery to CDDs in endemic communities. Table 3: Mectizan@ Inventory (please add more rows if necessary) State/District/ LGA Number of Mectizan tablets uested Received Used Lost Waste Ex red Atakunmosa West 125526 75000 74264 I5 Ayedaade 133602 80000 76033 27 Ayedire 122229 80000 78691 8 Boripe 144630 I 12000 1il t08 H Egbedore 21t212 78000 77129 30 Ife Central 86s56 70000 62887 t6 Ifelodun t39377 r 05000 73163 8 Ife East l t 3616 r 30000 85932 4 Ila 200226 70000 64071 14 Isokan 178734 82000 81770 3l Iwo 260298 70000 52981 9 Obokun 195486 80000 72085 l3 Oriade 103692 90000 8r886 2 Orolu 212n2 70000 59108 25 TOTAL 2227296 r r 92000 1051 108 203 l0 WHO/APOC, 26 Septernber 2003 State activities under ivermectin delivery that are being carried out by health care personnel in the project area. The health personnel at the various levels have been responsible for the following: Any other commenls 2.3. Advocacy and Sensitization State tlte number of poticy/tlecision mokers mobilized at euclt relevont level during the current year; the reasons for the sensitization ond outcome, Describe dfficulties/constraints being faced and suggestions on how to improve advocacy, During the period being reported an advocacy workshop was held for policy makers at the LGA level and attended by MOH policy makers. Those invited include: The Kabiyesi (the highest ranking oba - traditional ruler- in the LGA), LGA Chairman, his DpM, Secretary and PHC Coordinator. Those who attended from the Ministry of Health include the Hon. Commissioner for health and the Director, PHC. Participants were sensitized and mobilized to support the CDTI implementation process. During that workshop the following suggestions were made and agreed on: (l) Statutory monthly imprest to be given to oncho. Programme officers in each Local Government where such has not been in practice. (2) Motorcycles should be provided for oncho. Programme officers where none exist for now to facilitate their assignment. (3) a' Each Local Government to have a separate Oncho bank account with a suggested minimum deposit of N200,000 on annual basis. First instalment Iatest by March and second one in July of each year. b. Suggested signatories to the account are : (i) The State Coordinator (ii) The pHC Director (iii) The Oncho programme Officer ll WIJO/APOC, 26 September 2003 (4) Local Governments should render logistic assistance to the oncho programme within the limit of their resources each time such reqeusts are made.(5) Today's advocacy carnpaign should be launched in each local government(6) The oncho day to be marked annually and rotated among the constituent communities of each local government. (7) The 3rng Mectizan Tablet to be launched in the Local Governments that have not done so to date. Some of these decisions have been implemented while issues relating to funding have been problematic' Policy makers at all the l4 endemic LGAs were also paid advocacy visits during supervisory trips to the LGAs by prograrnme staff and external persons. In addition during the monthly rotational meetings of the Locrs with the Socrs, LGA chairmen are usually invited to give key- note addresses. The rneeting provides the forum for interaction with the Chairman, and for him to show case what he has done for the implementation of the programme. The greatest difficulty has been the frequent changes in policy makers so that by the time decisions reached could be carried out there is a change of leadership and advocacy stafts all over again' This calls for greater and more frequent follow up with policy makers. At the State level, the project has relied more on external persons like UNICEF and Nocp officials who came to visit the project to pay advocacy visits to the policy makers. Not much have been achieved in this regard except promises to give counterpart funds which has not materialized. The project believes there is need for a high- powered delegation from ApOC management to visit the State and solicit for government cash contribution. 2-4 Mobilization and hearth education of at risk communities Provide informatio n on : Media Used For Mob tion The communities were mobilized through jingles on Local Radio stations i.e. Radio Nigeria & Radio Osun. Town criers, Public address systems mounted on moving vans, IEC materials like posters, handbills; and village meetings were also used to mobilize the endemic communities. Mobilization And Health Education of women And Minorities Generally, there are no problems with minorities within the project area. They participate actively in all community decision making processes as they have been accepted as being part 12 WHO/APOC. 26 September 2003 of the community they live in. There are the Agatus in oriade LcA, who travel out after the farming season back to their places of origin, to return at the beginning of the farming season. However' treatments are arranged before they depart, and they participate actively in health education and mobilization sessions. Women participate in health education and mobilization sessions, but in smaller numbers than their male counterparts. This is because they are constrained by domestic activities they are engaged in' There is also the impression for those married that once their husbands participate in the meetings their interests are taken care of. women also have respect for their men when they participate in meetings, and therefore limit their contributions. Respect for tradition and culture demands that men should be allowed to have their say over the women and to take the necessary decisions' Despite this women still participate, and many have been appointed CDDs' The project is actively encouraging the participation of women, especially with the inclusion of females in the mobilizing teams. The communities/villages mobilized responded to the mobilization and health education carried out by the Socr, Locr, First Line Health Facility Staff and the cDDs. They came forward to collect their mectizan,and in some cases gave incentives to their cDDs. Some gave funds for cDD training. There is more awareness of ivermectin benefits, more involvement in decision making and villagers make more efforts to encourage potential refusals to take ivermectin. Accomnlishments (l) More community involvement in decision making (2) Increased levels of awareness of ivermectin benefit (3) Villagers make more efforts to encourage potential refusals to take ivermectin (4) Communities came forward to collect their drugs. Weaknesses/Constraints The majorconstraint is inadequate funding from all sources forconstant interaction with the communities by FLHF staff and LoCTs. While some of the FLHF staff and LOCTs are doing their best they are being hampered by insufficient funds to carry out all that needs to be done. This is coupled with the inadequacy of motorcycles fordistrict supervisors and First line health facility staff so that theirmobilization visits would be made easier. In areas of conflict, no mobilization could take place. There is need also to rvork on greater involvement of women in the GDTI process within the ambits of the socio - cultural setting. t3 WHO/APOC, 26 September 2003 (particularly women groups) with necessary mobilization skills will help a great deal in improving mobilization of the communities. Initiation and expansion of cSM and SHM in all endemic communities. t4 WHO/APOC, 26 Seprember 2003 o 61 Eo oa \o a-'l Q > = q) au cai oL p o N$ q) FJ!q) FoQ c) .; .9 .9 E E o(-) o, tr l-I .E E I E o II o l- o oE .E fl E o E oi o .E o ,9g t- E a E E o(, ui, c.i o0! c! L o r- \o \o(n \oca c.)c.) aON 9N o, 9 c-l(n c.lr \o v q)\o \oaO 6i f?)ra 00fr q6 .= \J = .19tri 6c z ='i I3=YE E: ==6>EE - Ee o \ aa c.l co \o\o $ aa o.l a.laa \oa.) coaa \ocj s a r-(-) 6 I ci3EA o- c.l o, C-l $ o. $ aO F-\o s aa o.l \o 00tr) c.l $ c\ ao ra) o\ o,c\ $ c.l N\o \ot- ra)$ aO aalr) \o aa o.l N(t.l s t-- N CO\o aa aa (f) iaN q) E-Z €y OE EoJ9 z oP 2l) F- ra) O\o \oN lr) oo N NN \o\o c'.1s an \o \o aa (-t a- $s o\ o\ m o\ o0 G t oo =q $ e oo\o aa \o =q F- q \o t-- \\o\o aa \o o\ o] c.l oq aa tr)\o aa F c.n \al c- aa Y o\N .:."Er?'i e .Z # E€ !i69= zuE4 coN \ocO Nc\ ca aa oo c\i ooc..l |r) \oN aa aa rA ?.) ?.) = f_ e>o ?'i =o Br 'a? Eo E9 OE 3 =z G eE.E: - E E!i{=o:{ .a @ a'laa $ oo c-lt ao c-.N \o o\\o aao.l $ oo a.) 0! 11 '' 9 a..l c..l f- \o :f, c\ aa n c\t aa l'- c.i\o cl ao co 9 oo tr) coa.l \ la) c.l .f,(r) 9 oo .t \\o ca NN v LEc!:.9=E ots! il fr >A5;'9uz.= $ ooc.l $N n \o N $ caaa r-- oo o.ca .a o\a! ra = F (, o o .=o ,a 6.- a,E EE n o z ch 9 Glia L o ET!E5tEE+ 3z; .= .o c\\o \o l-rr- oo \o c- \o \o t-- (-.]F- alF- t-- ra) r- J 3 o E C)!(! C) o .: -t, C) >. o L C)L o o ..o ooq.l oQ ,o o ,0) a q.l .() cn (g}( o C) .v o -o (.) L o G F e.l Lo -o Eo o- 0)a a.l O o o F- L = C) (.) (.)t2 !.9 oii(dc) 10Es()Etc)(ts(.) ooL EEs97)a tro E-O J0.)oc) 09)' c.r 2= _^ o)Y) tn tr cr-()u Fo os 6hrtrn (F 5o ac) cd" -\o .Ya !()(dE .=^(,) - L= or(! oAg ()o)otr Uo 90J 0,)\v fc a,'E()(,>oc)o. <E qJ (,) q) ? v 0o q,)s \) \i ? .{\ !\l qJ !n qJ >. %: ss 6ssv Eb SS i.,i.4{-\ as\J ^,.s{ €E tr.: v.s \JU .\T \h.-E;\ ! \:.f hqJ-:{ s * q.,'i PTS\:.I s€s \Q'-st t raqJ-.S ql c, \.i ssr!e * : .:*'*r -=u\\v.\6rs %is\-E\\ 'i {.o 2.6. Gapacity buitding 2.6.1. Training t8 WHO/APOC. 26 Septernber 2003 N L() -otr C) ()a \o c.l o r o o q > r- r* o N ! q) F.i (! () E() F iJ() C) C) o () L ,o () 63 q ) a tt a. G o bo E o\ P o o t q LF C) ----t F { q a o\ :. o\\o : .f, !f, o\ : s : .f, aa t--\o : t'r :. lo aa c\ :. O$ a\ oonI oo aa : <f N ca : a.t o\ tr) tr) o\ :. s $ v : :f,\o O co \o : \os ca \o\o : \o ao aa ao ao T ra) c.lNN c.lr- I't i t-- $ t^ lco .: : aa fa in _1 (., o\6 : \0 q U q) z 0,) ct F \otr)N $a-l $ c.l t--l-. c..t r.) ao o\ F- c.l$ o.l (n N r- aO N \o o\\o N $ r(-'t t-. F- ra\o r.) q) q) o (,,) o\ Fr F e< I -----t O q) .s F< 4J' o ;a? LGIqJL z F c) q) o I \o o\J F a< -s $ \o ao : aO aa o\ \o i- lrn l= : \o \o rr) \o aO ao co c.l l-- : $ o\ ..l \o c.) 1..t: :. cO .f, aa : aa c..l N C. ao oo s(*.l ca r- $ ca l?oll,a?a (aia : (\l 6lq) o q) z q) o G q q) q) I F $ ooN .+C'l r--ca \o\o N N.+ saO co o, O$ ce o\c..l N Nt .+ € q) q) q) (.) e : a.) C\I : ao (-.l N : aa s c'l o.l : N a.l N v N N c.{ -= co on N q o .l .?rc(,) q,) o q, 2l LF .d- ra) tr) $ $ $ $ .f, !f, .f, $ J to E v(t () (! E o () .= -(, 0) >t C) o- L gl C)Lo (.)o oot! ()I ,o o ,C) lll(! trl .o (! -\z U7 .Y -o o L o oL e q) q) I \o -l t-r F \o : \o : .+ N ca $ : C. l N s -= aa $ Table 6: Type of training undertaken(fick the boxes where specific training vvas carried out during the reporting period) - Any other comments 2.6.2, Equipment and human resources Table 7: Status of equipment (please add more rows if necessary) nal, Currently non-functional but repairable, Wriften off) Trainees Type of training CDDs Other Cornmunity members e.g Community supervisors Health Workers (frontline health facilities) MOH staff or Other Political Leaders Others (specify) Program management ./ How to conduct Health education { ^/ ^/ Management SAEs of ^/ i CSM -V ./ SHM I Data collection ./ { i/ Data analysis { ./ Report writing I Others (specify) Source Type of Equipment APOC MOH DISTRICT /LGA NGDO Others Cond ition of the equipment * Ptease state l. Vehicle I (Functional) I 2. Motor cycle 20 (15 non - functional, but repairable) 39 (2 functional; others grounded) 3. Computers 2 (Functional) 4. Printers I (Functional) 5. Fax Machines 6. Bicycles 70 (Functional) 105 (22 functional; others grounded) 7. Others a) Photocopier I (Functional) b) Projector I (Functional) c) TV Monitor I (Functional) d) Generator I (Functional) *Condition of the equipment (Functio fo WHO/APOC, 26 Seprember 2003 How does lhe proiect intend to maintain and replace existing equipment and other materials? At the LGA level, the Local Government sometimes give imprest for the maintenance of the project motorcycles in their respective Local Government Areas. Storage facilities were also provided for the safe keeping of all equipment. They are also being encouraged to provide the necessary materials for CDTI implementation. LGAs such as Boripe have been very forward in meeting most of the needs of the programme within its area. Atthe State level, the capital equipment and other materials available for the project will hopefully be maintained from the counterpaft funds from the State Government. In the meantime funds from APOC will be used to maintain existing equipment. On the issue of replacement the project intends to request APOC to replace the project vehicle and other capital items supplied earlier while efforts continue to get government or UNICEF to replace them on the long run, - Describe the odequacy of availabte knowledgeable manpower at all levels. There is abundant knowledgeable manpower at every level of CDTI implementation in the State' but notall are being utilized. There is need to train more health facility staff to be involved in the programme. ' Where frequent tronsfers of trained staff occur, state whot project is doing or intends to do to remedy the situation (fhe most important issue is what measures were taken to ensure adequate CDTI implementation where not enough knowledgeable manpower was available or staff often transferued during the course of the canpaign). Whenever new staff was employed or when trained staff was transferred, training was usually organized for those that replaced them or the newly employed one. The State project also intends to liaise with Local Government Service Commissioner for the retention of Oncho. Programme Officers forlonger periods of time the purpose of continuity. On the long run the best thing is to troin oll heatth workers on CDTI. 21 WHO/APOC, 26 September 2003 2.7. Treatments 2.7.1. Treatment figures 22 WHO/APOC, 26 September 2003 al Lo .o E() o-oa \o c-t (-) o ca c.l aq a) qJ U q r. \ o .: q) ca \) 5 .Va .E U) C) : J o L t) >. .o tht! a (B () EE 0)LF #1 o.l I EI r-l ao ,;i! d9( o- a ,a-,a 2 c 9r US 9d 569 0 o o Lq E =z I I I Qll,,l2<1 >u) zz !:o co z6 oor- C'l o.\o tr) co a.l oo\o a.l(r) o,(-- a-(n(-- oo$ \oo, o.l $ oo N ca o\ \o t o\N o.l a.) aa ^Y- o = O-: !,r: o LEh,qE =6- d!,704 aa r.) <t N\o tf,s oo C.l c.l t-- c-) ooco t-* co aa \o a a_LcY 90:J!_?oF..ro = 3-!z -E.od u.= 493' FIJ Eaa *! .c"9 oF 0 '5o 9!r ooEOF cO o aO oo aa co tf, co $ oo ca oo N oo (-- c<il-* aa ra) cl ca\o ooaa \o <fco co ooI-t$ ca t--$ tr- co vv c-tv ao $ co N $ o\ C-lt- !f, aO c.lt- ao a.l N c.) ca ao o\ t-- o\N + caN@ a.t .f,N ca \o F-N c.l $ o\ c.ls (n o\ co c.l \o\o ca $ oo c- co N cO\otf, aa o.t-- o. *f, cas oo o\tr) $ a.l v c.] $ o\ ao o\ N c.) ca a-\olr) \f,\o (/._) tr) l-tC. F- oo @ cola) ta) o\ a- a.)N aa (-.l :f, co $ s aa $ .f, .a$t-r $ N oo+ $ s t-- c'l oo co N r/)$ vs N t-- oo(-- co (..l$l-t\o\o oo r- l/) o\tr) \o\o t--\o oo N\o (.)\o $\o s ca \oh = o=:: o 6 - O> -* = tr oO!? tr L E:- U; vlO .9o -U i: -o o'boa- (J qq o.Y .-L.= [.; !q c oJrll € =s r =:-L o _E!/d q.a -E? ilos' FV C) .9 '= E o() O O O !.) aaco a.laa +@ c..ls ao I-rN \o o\\o caN o\ s o oo N aa $ oo N$ C.) r-N \o .aa\ o, $ oo o.l aa s oo c.l$ c.) I-*c'l \o o\\o a.)N o\ $ OJ o\ q E C = -JOiB () 'o(!(n o (J .= C) 0) o c0 C) C) -o oo tr./ tr 0) Q ,o ,0) CN(n lrl ,C)I v o rll .v -oc 0) rc o.l o tr a) o-oa C.l O (J vN sL\ SU !\ .9s$\ 0o o AJ 0O\ .t\ sr'1 .=FE U)L v6 dBii< L\(du oo'(.){\ 'asJ g 6)!s -c.tP3fs hS\()i.a =!s tr'ie P F.S;-(=i\ o\: *t s -ci> 4 'i s-{ o F \!-tr ! \u; 'P S'S' *r+ -O :\ .iug ! ss ^E U Ib5l ! ., 3: -l q E tSxl : s !=' El : s itEIE i !FLl O u S>, -l dr '=orl o s h:ol! t it 8l : i seOl 0 i qi!!l€ R !E .t=gl d E ss EIE i ESzt; .s it:p :s 6f € ss ., 3 aJ\il : -\aJ[ *[$ i ttt E! : E€\-b ; t !$\?\ .E i d\9 S ir u qJIfi S rl rY l\ t\\' !-lrllir o ()t .o tr i\ Ao\ \ -S olol -t IC)xl > El I 9lx "l ;OJ. oJol c ol l- o.l Et*l !.1 ot .- -l -9lE Et- zl< (! q) L(! O C) 'a L o-() ; i! .o 1J o .E tr() =(0 q .9 =ld o O E() -o o I C) a. >. q(-) E o C) -o E = = ot- olol -lxl 'ol C)I (6l 0Jl LI sl oo cdl =l -alql 6JI 'El 'El =l EI EI ololql ol bl -ol , EI =lzl (!()L(d o C) 'a ! o. 0) =.; ah() .E E E oo o Eo o IL 0) o. >' o() E oo ,= .9 (! a a. o o. E ot- ol ol -lxl !lol RJI0lLI C)t ol ol ol ol El d.)l -ol EI zl 0) L() b0 !u^()\ o \JF () (dL C) b0(!L() o (! .Y roEo- o--(nr bo oo r '') C) (dL C) oo 0) oo O^ Eo\d-o-(t L C) l- L .o \o € a.l oo o.l oEIll:,!o rf co (0(\t oo +s q to @ c-- aa oNN ot co o, \o @os(Y)(o $ r.. l-- (\ c/)t(\tt oo oo (v) oo (t oo (Y) IJ I oL o Fl F oF (! - If the project is not achieving r00% geographicar coverage and minimum of 6s% therapeutical coverage rate or coverage rale isJluctuating, state reosons and plans being made to remedy this. The State is now achieving 100% geographical coverage and more than 65%otreatment coverage. 2,7.2 What are the causes of absenteeism? The absenteeism experienced in the treatment is characterized by. community have gone to their farm steads or other engagements. 2'7'3' Briefly describe all known and verilied serious odverse events (sAEs) and provide in toble 9 the required information when ovailoble. There has never been a period when sserious adverse reaction occurred in the state since the programme inception. 2'7'4' In case the proiect has no case of serious qdverse event (SAE) during this reporting period, please tick in the box No case to repoft ./ 25 WHO/APOC, l0 April 2003 a.l L o. O \o N q) q) \ -a v \. q ?\ qq q,) Qq) .\ q l o\ p t q) N s L o o- b0 L o o- 0)L (,) o0 l- 'o ! oL oo cd (nql a a o q) oth (,) U7 o L o C) t) C) U'' O o.f orl -oldlFI -EOooct>Lo= o ii >:l <.= b Aa ;Po8 639 =-,b 9=iEc rJtoo cq o=^ (J00- q 6Jr(* !i qS ^ 6 .= C)O.cE&34 rI]I .E964.2 -c 6o tr E==(!oo!Yo A €,:; e -I I ( :t 6i Xvod!'o'= 0J = I( ) 03 € - 9r oo.N(! Lo.= !.)fsEi: I I I .J arr II o- >r(n I -- _Ev o=o HOOG I ( ) s ss:r I t - I I 0) bOe ?o x()a o0( o.l z A* lt <a 5 N L 0.) -o Eo o.oa o{ U o o- > f- a-.1 c!N Qq) =2 o o L U) U) U) G q) IXq) 9 q,) q) o .o q) c{ o o a c) t{ dt oz .() t)jo) .o= vo UD C) {q)ri'1 El 0, \q,) -tr 9i3p oGl =aJA ) o^' €q) o'* aul r\ (6lv -ol 5 orlrEt!ol o<1 er() >o0 .o(! v96a !Otro E9 CE(!Pa != :6 L0) F.L .t- r- al . -t6l Iorl -l -ol t-t (f): 'r q) 0) oo F- 6.S O o\ .+ oo o\\o \o oot-r ;$* s cooo lat sf, t-rr- o -oO G^O-rro6 9o'9a F v 00\o ootr) tr) \o\o ,o ,o6L zi co o\$ .d$ c\ o.(-- ra) oi cart !f, oo c.l r.i(t.l c\lN cot'- cO NN t\. ootf, d o.a =En; E.sr+ P.o' -FO O \o r- t-- F-\o =fca\o GA : bE 3 Eeie* ts.UCF QC o \o ra)\o (-- o\ c.l aO .f, N!f, r- N a.)$ e.] .+ c- o ^boU tr-F 6"\d)- -o o o, ca o. \o\o t--o\ EO:- t)J] ;''i o o\o - >-* -ooa't o o\ C.o\ coc.t \o o'a q q = #9 e==!, 2Oti o\(-- .f, \o \o l--v oo F- a-. aa Eod o.a 19)bFU rcOtr) c- c.lc- oo a.) (.) oo =l- oo '= E E (-) F bD =qie s.H lE c .c.9 --ACSoXhtr a 9iE E5 I ao r/^) t-r co oo\o .tt co aa I! @ o\ a.t O a.l N c\l oa.l a{ o.l \o N t-- N 00 a.l c.l c.l 2.8. Supervision 2.8.1. Provide a flow chart of supervision hierarchy. 2.8.2. Issues ZONAL CEOFFI I STATE MINISTRY OF HEALTH + LOCAL ERNMENTS FIRST LINE LTH FACI (FLHF) COMMTINITY SELF MONITORS COMMUNITY DIRECTED DISTRIBUTORS (CDDS) What were the moin issues identified during supervision. identified during supervision include: Poor entries into community log books of some treatments done Inadequate counterpart contributions by the LGAs No support for the health facility staff to carry out their routine duties Inadequate registration of community members Lack of or inadequate motivation of CDDs by communities Poor record keeping at LGA level Professional rivalry among health workers, sometimes to the detriment of the work; as there are disagreernents over who should do what. 2.8.3. lYas supervision checklist used ? Efforts were rnade to use the checklist at the State level though not at all times. The LOCTs in most cases did not use any checklist during their supervisory visits. 28 WHO/APOC. l0 April 2003 2,8.4. Llthat were the outcomes at each tevet of CDTI implementation supervised The project is encouraging the use of CDDs as guides during immunization campaigns and communities have been re - mobilized to take on all their roles under CDTI including giving financial suppofi to CDDs for their tasks and motivation. At the LGA level efforts have been made to emphasize importance of good record keeping, and several discussions have been held on the need to update census at the community level. LG authorities have been sensitized on the need to support financially their workers to enable proper implementation of CDTI at the grassroot level, 2.8.5. Was feed-back given to the supervisecl, ond how was thefeedback used in improving tlte overall performance of the project Usually, when SOCTs go on supervisory visits they go with the LGA Coordinators or one of the LOCTs so that whatever is found out is discussed. LOCTs are encouraged to go with the health facility staff in charge of the area they are supervising so that they can discuss what the findings' There is also a monthly meeting of LOCTs with the SOCTs, which is rotated among the different LGAs. This provides the opportunity to share the outcome of supervisory visits with all the LGA coordinators for their further action. It also provides the forum to review programme implementation and discuss the way forward. Community leaders are informed of what needs to be done where there is need. 29 WHO/APOC, 26 September 2003 SEGTTON 3: Support to GDT| 3.1. Financia! contributions of the partners and communities Table ll: Financial contributions by all partners for the last three years * Figures reported by LOCTs. Deta reporting. ils of expenditure were not given as at time of If there are problems with release of counterpartfunds,ltow were lhey addressed? The release of counterpart fund by partners to the project remained the bane for the smooth programme implementation. This is being addressed through an advocacy workshop, routine advocacy visits and constant memos to the policy makers. Comments There is absolute need for high- level advocacy visit by the NOTF and if possible representatives of APOC Management to further sensitize the State & LGA policy makers on the need for counterpart funding. Contributor Year 2 (Oct. 1999 - Sept. Year 3 (Oct. 2000 - Sept. 2001) Year 4 (Oct. 2001 - Sept, TOTAL Budgeted (us$) TOTAL Released (us$) TOTAL Budgeted (us$) TOTAL Released (us$) TOTAL Budgeted (us$) TOTAL Released (us$) Ministry of Health (MOH) 9.455.00 r0,289.00 r0.289.00 LocalNGDO(s) ( if any) NGDO partner(s) 48,070.00 48,070.00 2,622.54 47,390.00 District/LGA* 35,443.00 33,991 38,3 r3.00 6,940.00 38.313.00 2,6 r8.00 Others a) b) c) Communities APOC Trust Fund 93,440.00 r 06,733.90 9s,860.00 79,891 .00 58,780.00 56,709.00 TOTAL 186,408.00 140,724.90 192,532.00 89,453.54 r54,772.00 59,327.00 30 WHO/APOC. 26 September 2003 3.2. Other forms of community support Describe (indicate forms of in-kind contributions of communities tf ony) Non - financial incentives to CDDs come in such ways as : - food stuff - exemption from community labour - clearing of CDD plantations by the community members - selected for and elected into councillorship positions at the LGA level - recognition at annual events, sometimes where special gifts are presented to some CDDs. Such gifts include wall clocks and plastic buckets. 3.3. Expenditure per activity - Indicate the expenditure on activities below in US dollars using the current United Nations exchange rate to local currency Table l2: Indicate how much the project spent for each activity listed below during the reporting period A Expenditure (S US) Source(s) of fundins community Mobilization and health education of communities Training of CDDs Training of health staff at all levels Supervising CDDs and distribution Internal monitoring of CDTI activities lAdvocacy visits to health and political authorities I IEC materials Summary (reporting) forms for treatment Vehicles/ Motorcycles/ bicycles maintenance Office Equipment (e.g computers, printers etc) Others Managerial Allowance Drug delivery from NOTF He area to central collection point of 2,393.53 2,999.43 13,599.07 799.29 16,250.48 2,294.53 1,900.00 2,602.00 500.00 9,905.59 2,897.79 1,617 .39 8,943.41 APOC APOC APOC Aloc APOC APOC APOC APOC APOC APOC APOC APOC APOC TOTAL 56,701.49 Total number of ons treated 487220 Comments 3t WHO/APOC, 26 September 2003 SEGTTON 4: Sustainabitity of GDTI 4.1. lnternal; independent participatory monitoringl Evaluation 4.Ll ll/as Monitoring/evaluation carried our during rhe reporting period? (tick where applicable) Year I Participatory Independent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation Internal Monitoring by NOTF Other Evaluation by other partners None was carried out during the reporting period 4.1.2 What were the recommendations? N/A 4.1.3 How have they been implemented? N/A 4.2. community self-monitoring and stakeholders Meeting Table I3: Community self-monitoring and Stakeholders Meeting (please add more rows if necessary) Atakunmosa West Ayedaade Aiyedire Boripe Egbedore Ife Central Ife East Ila Isokan 50 83 32 t84 42 l3 6l 69 231 78 l0 r0 t0 l0 4 6 4 5 IO 6 46 20 20 DistricU LGA Total # of communities/vil lages in the entire project area No of Communities that carried out self monitoring (CSM) No of Communities that conducted stakeholders meeting (SHM) 32 WHO/APOC, 26 September 2003 Iwo Ifelodun Obokun Oriade Orolu t09 27 40 ll0 80 l0 8 l0 8 t2 l0 5 10 8 TOTAL 1131 126 95 a t Describe how the results of the community self- monitoring and stakeholders meetings have affected project implementation or how they would be utitized during the next treatment cycle. The CSM & SHM helped in monitoring CDDs before, during and after mectizandistribution Errors in updating were corrected. They equally sensitized the community heads, clubs and associations to fund Oncho. programme. Overall these have led to increased community participation, maintenance of 100% geographic coverage and increase in treatment coverage 4.3. Sustainability of projects: plan and set targets (mandatory at yr 3) What arrangements have been made to sustain CDTI after APOC funding ceases in terms of : 4.3.1 Planning ot all relevant levels. Although the State project is yetto be evaluated the State is in the process of preparing a 3 - year sustainability plan which will be incorporated into the State health budget. The project also intends to facilitate a workshop for the LGAs where they will be taught on the preparation of sustainability plans. Advocacy visits, if funds are available, will follow to the LGAs to ensure the incorporation of such plans into LGA health budget. 4.3.2 Funds Advocacy seminar were organized for the LGA policy makers of Osun State for the provision of counterpart funds to the tune of at least N250,000 by each of LG in Osun State in pursuance of programme implementation and its continuity. 4.3.3 Transport (replacement and maintenance) The inclusion of money in the yearly estimate of the State and Local Government for vehicle and motorcycle replacement and maintenance for the programme continuity in order to reach JJ WHO/APOC, 26 September 2003 the nooks and crannies of the State is being pursued and forms a major part of discussion at every advocacy meeting/vis it. 4.3,4 Other resources What is stated under 4.3.3 is also applicable here 4.3.5 Please provide a written plan with set targets and achievements for so far. 4.3.6 To whot extent has the plan been implemented 4.4. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration 4.4.1. Ivermectin delivery mechanisms Ivermectin delivery has been fully integrated into the Primary Health Care structure. pHC facilities are used for drug storage, delivery and as well as for supervision. The CDDs go to the nearest health facilities to collect mectizan. 4.4.2. 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 4.4.3, Joint supervision and monitoring with other programs Atthe State level, there have been discussions on joint supervision and monitoring at present, and a joint monitoring committee exists under the M & E section. However, not much has come out of it. 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 which 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 are however no integrated supervisory checklists, and none is being planned at the moment. a ! 34 WHO/APOC, 26 September 2003 a4.4.4. Release offunds Release of fund CDTI activities has been integrated into the existing PHC structure. Budgets are prepared and funds released within the overall pHC framework. 4.4.5. 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. 4.4.6. Describe other health programmes thal are using the CDTI structure and how lhis was achieved. llhat have been the achievements? No other programme is using the CDTI structure at present but the State Coordinator and his deputy have attended prelimniary workshops on Vision2020 and lymphatic filariasis elimination. At the community level, some CDDs are used as Local guides and vaccinators during NIDs. 4.4.7. Describe others issues considered in the integration of cDTI. 4.5 Operational research 4.5.1 Summarize in not more than one hatf of o page the operational research undertoken in the project orea within the reporting period. None was carried out during the reporting period 4.5.2. How were the results applied in the project? N/A a t 35 WHO/APOC, 26 September 2003 !sEGTloN 5: strengths, weaknesses and chaltenges - List the slrengths and weaknesses of GDTI implementation process - List the challenges and indicate how they were addressed. STRENGTHS l. Committed staff at various levels of CDTI implementation 2. Availability of mectizan. 3. Good level of awareness of the magnitude of the Onchocerciasis problem by the community 4. Inauguration of CSM & SHM in ApOC assisted LGAs 5. Political support for programme activities from chairmen of LGAs 6. Improved Monitoring and supervision by SOCTs 7. Appointment of some CDDs as top political functionaries in some assisted LGAs in the State. WEAKNESSESS I . Poor funding of the programme by government 2. Inadequate understanding of their roles under cDTI by some communities 3. Inadequate/poor motivation of CDDs in many communities. 4. Absence ofupdated census figures 5. Late rendition of returns from LGA Coordinators CHALLENGES - Incessant transfer/posting of all categories of health workers - Scarcity and high cost of petroleum products due to preparations to liberalize the downstream sector. Funds were spent increasingly on purchase of petroleum products, and were used for Iimited activities. Some travels could not be embarked on as there were no funds to fuel the vehicles. - Inadequate motivation of CDDs by the communities. - Lack ofadequate census update - Rekindling the interest of Local NCOs and CBOs and enlisting their maximum participation/involvement in sustainabi I ity programme activ ities. The ways some of these were addressed have been highlighted in preceeding sections of the report. A census update is being planned as soon as funds are made available. On scarcity of petroluem products there was nothing for the project to do except to cut down on number of trips made. I t 36 WHO/APOC, 26 September 2003