Akwa Ibom State CDTI annual project technical report submitted to Technical Consultative Committee (TCC): August 2005 to July 2006

I I I I t AKWA IBOM STATE CDTI PROJECT ORIGINAL : English rlz- For Action To: v r{ pl(" I ,l .L r ir r Ib !t CCSS Bttt 15b 60P All€ rrfi,, to i- ! For lnformgtlon To' }>rlt Ao 4 t d, I COUNTRY/NOTF; NIGERIA Proiecf Name: AKWA IBOM Approval vear: APRIL 2003 Launchins vear: SEPT. 2003 Reportine Period: From: AUGUST, 2005 To: JULY' 2006 Month/Y, Proiect vear this reoorf, (circleone) I 2 (3) 4 5 6 7 8 9 10 Date submitted: DECEMBER, 2006 NGDO partner: HELEN KELLER INTERNATIONAL 0 8 iljril 200/ fm; tI eI ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) DEADLINE FO SUBMISSION: To APOC Management by 31 Januarv for March TCC meeting To APOC Management by 31 JuIv for September TCC meeting AFRICAN PROGRAMME FOR ONCHOCERCIASIS CONTROL (APOC) I a .l + iL ff b rII * {F u, 3ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the apProPriate sPace. OFFICERS to sigu the rePort: COUNTRY: NIGERIA/LIBERIA AG National Coordinator: Zonal Oncho Coordina tor Name: MR. .f. O. Elpwa Signature: l', .| '-lv-" "---T------- __-) -t Date: _2__ e. NGDO RePre sentative Name: DR. Musa A. diah Signature: Date: [) a Ttris report has been prepared by Name: Veronlca I' Itina (Mrsl Designation: Sta t: O ncho Coot'<litrittor Signaturc: MRS. PATRICIA OGBU.PEARCE Signatur r, - - -ffi- el-A=; - - - - - - -' o^t., L1lg3-l->Pt:v-l------- l, I t \ L rl tn Date: --- __D_- -:a'----- Table of contents DEFINITIONS ..........- ........vII FOLLOW UP ON TCC RECOMMENDATIONS EXECUTIVE SUMMARY ..-...- t 2 3 3 I 6 t SECTION 1: BACKGROUND INFORMATION """"3 L l. Gnvenal INFoRMAnoN t.l. t Description of the proiect (briefiy) 1.1 .2. PartnershiP 1.2. PoPt t-ATloN SECTION 2: IMPLEMENTATION OF CDTI......... """"""""""'7 2.1. TIMELINEOFACTIVITIES ..............'..7 2.2. AovocRcY """" " "'9 2.3 . MoBrLZATION, SENSITIZATION AND HEALTH EDUCATION OF AT RISK CO}"fi\,ftINIIES I O 2.4. com,nxlrv D.TOLVEMENT -.........12 2.5. CnpecrrvBUILDING """" ' 13 2-6. TREATMENTS ........."....15 2.6.1. TreatmentJigures........--- ""'15 2.6.2 Ll/hat are lhe couses of absenteeism?..........-- "" " """"' lB 2.6.3 llthat are the reasonsfor refiisals? -.-.-.----.--..- " """" 18 2.6.4 Briefly describe all btown and verified serious adverse events (SAE| rhnt.... 18 2.6.5. Trend of'treatment achievemenl from CDTI project inception Io the anrrent year 20 2.7 . ORoetrNc, sroRAGE AND DELTVERY oF IVERMBCTIN...---.-.---. .....--..-...-.21 2.8. COlvftflI.[TY SELF-MONITORING AND STAKEHOLDenSMEETI.IG............... .. ..........22 2.g. SupeRvtstoN .. -.........23 2.9.t. Providea/low chart of supervisionhierarchy- """"'23 2.g.2. Ilhat were the main issues idmtrfied during supervision? .............................23 2.g.3. Yl/as a supervision checHist used? .-.---..- """""' """" 24 2.g.4. Yflhat were the outcomes at each level of CDTI implementation supervision? 24 2.g.5. lltas feedback given to the person or groups supervised? ... .......21 2.9.6. How was the feedback used lo improve the overall performonce of the project? 24 SECTION 3: SUPPORT TO CDTI 3.1 3.2 3.3 3.4 EQLrPl"EI.rr FNANCLAL CONTRIBUNONS OF THE PARTNERS AND COMMUNTTIES OTHSR FoRMS OF COMMLINTTY SUPPORT... -. EXPENDTTRE pm. ACTMTY .... -......... 24 24 26 26 26 27 t- SECTION 4: SUSTAINABILITY OF CDTI 4.1. INTERNAL; INDEPENDENT PARTTCIPATORY MOI'IITORING; EVALUATION....................27 l. 1. t Was Monitoring/evaluation carried out during the reporting period? (tick any of the followingwhich are applicable) ..-....--.-. ...----.27 4.1.2. llhatwere the recommentlations? - ......."28 1. t.3. How have they been implemented? .--...-.28 4.2. SUSraNaStr-IryOFPROJECTS:PLANANDSETTARGETS(MANDATORYAT..............28 YR 3) .............-..-.28 T' ti L {r , .ttr rFt a4.2.1. Plarming at all relevant levels """"""'"'28 4.2.2. Funds........ ..---..-..28 4.2.3 Transport (rephcemenl andrnaintenance)-- -.--.----- .--------............28 4.2.4. Other resources... ..........-.......28 1.2.5. Towhat extent has the phn heen implemenled.--.-.... ...................28 4.3. INtscRanoN ............... ............-...28 4.3.1. Ivermectindelivvrymechanisms ......-.....-28 4.3.2. Training..... -------.28 1.3.3. Joint supervision and moniloring with other progmms.-------........-..-...-.--.-.-...28 1. 3.4. Release offuttds for proiect aclivities - ... -. 28 1.3.5. Is CDTI included in the PHC budget? ..-..29 1.3.6. Describe other health programmes tlat are using the CDTI strucrure and how this was achieved. Wlwt hove been the achievvments? .-...-...----. ....-...-..-.....29 4.3.7. Describe olhers issues considered in the integration of CDTI- ...'.29 4.4. OpERAnoNAL R8SEARCH................ ......................29 4.4.1. Summarize in not more than one lnlf of a Ftge the operational research undertaken in the project area within the reprting period. .....29 1.1.2. How were the results applied in the proiecl? ............- ...-.......-......29 SECTION 5: STRENGTHS, WEAKNESSES' CHALLENGES' AND oPPoRTUNITrES..... ..............29 SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATIERS...........30 ls t- q tr L t";-{. Acronyms APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO HKI NGO NOTF PHC REMO SAE SHM TCC TOT UNICEF UTG wHo African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Community-Based Organization Community-D irected Distributor Community-Directed Treatment with Ivermectin Community S el f-Monitorin g Local Government Area Ministry of Health Non-Govemmental Development Organization Helen Keller International Non-Govemmental Organization National Onchocerciasis Task Force Primary health care Rapid Epidemiolo gical M ap pung of Onchocerci asi s Severe adverse event Stakeholders meeting Technical Consultative Committee (APOC scientific advisory group) Trainer of trainers United Nations Children's Fund Ultimate Treatment Goal World Health Organization f* a {Definitions (i) Total pqpulation: thc total population living in mcsdtryper-cndernic communities within the project area (based on REMO and census taking). (ii) Eligible population: calculatcd as 84% of the total population in meso/}ypo- endemic communities in the project area- (iii) Amual Treatment Objective: (ATO): the estimated number of persons living in meso/hyper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. (iv) Ultimate Treatment Goal (UTG): calculated as the maximum number of people to be treated annually in meso/byper endemic areas within the project area, ultimately to be reached when the projecr has reached full geographic coverage (normally the project should be expected to reach the UTG at the end of the 3'd year of the projec$. (v) Therapeutic coverage: number of people treated in a given year over the total population (this should be expressod as a percentage). (vi) Geographical 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). (vii) Integration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataracl, etc.) through CDTI (using the same systems, training supervision and personnel) in order to maximise cost- effectiveness and empower communities co solve more of their health problems. This does not include activities or interventiors carried out by communily distribtrtors outside of CDTI. (viii) Sustainability: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future, with high treatment coverage, integrated into the available healthcre servicg with strong community ownership, using resources mobilised by the community and the government. (ix) Community self-monitoring (CSM): The process by which the commurity is empowered to oversee and monitor the performance of CDTI (or any community- based health intervention programme), with a view to enstu'ing that the programme is being executed in the way inlexded. It encourages the community to take full resporsibility of ivermectin distribution and make appropriate modifications when nec€ssary. tFOLLOW UP ON TGG REGOMMENDATIONS Using the table below, fill in the recomrnendatiom of the lsst TCC on the project and describe how they have been addressed. TCC session - (Please add more rows if necessary) Note: Thae are issua raised in Year I Rqort dtich hate been addresed in Yanr 2 Report l- L Nunber of Recanmqtdation in the Repod TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR rcC/AruC MGT USE ONLY Allow communities to make the decision on treatrnenl timing Sigrratories should read ald vet ttre report before endorsirg the rcprt Executive summarY should be presented in anarrative form. Backg5ound information should be more compretrensive No of CDDs tr"din€d arxl active What will happen to the remaining tablets Issues identi fi ed during supervisioru outcomes and feedback The prolect should train more health offrcers The project should train more CDDs The polect should commerrc€ SHM ed CSM WHO/APOC- 24 November 2004 ! 1 tExecutive Summary Prepare an Executive summaty of the report in not more than one page. Akwa Ibom State is located in the south eastern part of the country and shares border with Cross river state on the east, Rivers and Abia states on the west and the Atlantic Ocean on the south. The State has a total population of 2.3 million people (1991) National Population Census(figure), 3l Local Government areas (LGAs) of which two (2) are Onchocerciasis endemic. The Ibibios form the majority ethnic group in the state. However, there are the Anangs, Orons Efiks and Ika Ibos. There are other settlers such as the Ijaws, the Hausa and from the neighbouring Cameroon Republic. The distribution of Mectizan commenced in2004 after Rapid Epidemiological Mapping of Onchocerciasis (REMO) and Raploa survey using the Community Directed Treatment with Ivermectin (CDTI) approach. In 2006 a total of 13 communities with a total population (census) of 25, 067 of which 15,554 were treated. The project's ultimate ffeatment goal is 20,104 and the ATO for 2006 was 20,104. The geographic and treatment coverage of 100% and 620/o respectively was achieved. A total of 39 CDDs, and 69 Health Personnel targeted were trained for programme implementation, thereby, achieving annual training of 100%. Some challenges/constraints of the project include: Frequent transfer of trained CDTI personnel at the LGA level; non involvement of CBOs and VHC in the planning and implementation of the programme; Lack of incentives to the CDDs by the communities. These challenges/constraints are being addressed through: Liaising with the Local Govemment Service Commission to solicit their support by not transferring trained CDTI personnel from the endemic LGAs; connecting the CBOs and VHCs and creating awareness about the disease and the need to be involved and support the CDTI activities. t_* 2 WHO/APOC, 24 November 2004 l." {- ; L t*t t" u aSEGTION {: Background information 1.1. Genera! informatlon 1.1.1 Description of the prcject (briefly) - Geographical localion, topography, climate Akwa lbom creatdfromformer Cross Rivers State in 1987 is located at the South eastern part of Nigeria and lies between tatitude 7 25' and Y 25' and longirude 4, 32'and 5o 33' east The srarc has 3t l,ocal Government Areas (LGA|). Il is sifinled in the rain-.forest bio-climatic zone. The soulhern and eastern part o-f the slate consists of mninly mangrove and cmstal vegetation. The rtorthern Wrt is.forest kwnnah due to agriculrural activities with dotted undulating hills while the rest of the state is covered by rain forest and dry lowland. There are two marked seasons in the slale. The wel season starts -from March to October and dry season from Novvmber to Febnnry- Population: acti vities, cultures, language The State has a total population of 2.j million people (1991) Nationol Popularion Census (igure), 31 l.ocol Government areas (LGAs) of which two (2) are Onchocerc ia s i s endemi c. 7'he lbibios .form the nnjority ethnic group in the state. However, there are the Anangs, Orons Efil<s arul lka lbos. There are olher setllers such as the liaws, the Hausa andfrom the neighbouring Cameroon Republic- Communication systerns (roads... ) Ibibto is widely spoken. However, English has been adopted as the official medium of communication in the state. Other forms of corununiulion are fairly good tarred road network linking the major cities from the hudqwrlers. Other roads are laterite and sandy. During lhe rainy seasons most parls of the state are dfficult to reach due lo the muldy slale of the roads. Administration structure There are three levels of administrative strucntre in the project state. These include the state, LGA and the community. The Executive Governor is the Chief Administrative O/ficer of the stale. There are lhree arms of governmenl lhan run the state a-foirs wilh lhe Execulive Governor as the hmd. These are lhe Exeanltve, Legislative and the Judiciary. Health system & health care delivery (provide the number of health posls/centers in the project area if the information is available). aj ? WHO/APOC. 24 November 2004 Health mre is delivered at two levels in the projecl slate, lhat is, state and LGAs. The state provides secondary drrewhere there are the Gercral Hospitals and Comprehensive health centers. The loal lewl has lhe Primary health centers, clinics, and dispensaries. There are hulth districts; health centres/clinics and a total of stafl. Onchocerciasis is prevalent in lwo out of the il LGAs in the state. They are Meso- endemic LGAs. The number of ammunities who are receiving Mectizan are 13. Number of health staffin project area and number of health staffinvolved in CDTI activities. Table l: Number of health sta(f involved in CDTI (Please add more rows if necessary) DistricULGA Numbcr of hcdth strfrfupolvcd in CDTI ectivities. Totel Nurnbcr of hcelth stalfin thc mtirc project ucr & Numbcrof hcdth stelTinvolved in CDTI b Pcrccntegc &:&/& ^100 Ibiono Ibom 159 35 22 Ini t20 27 22.5 Total 279 62 ')') 1.1.2. Partnership lndicate the partrrers involved in project implementalion at all levels [MoH, NGDOs (n at i onal/intemat ional ), co mmuni ti es, I ocal organi zati on s, etc. ] The parlners inwlved in the project implementation are the endemic communities; LGA Health Departments (LOCTsNutrition Officers): State Onchocerciasis Control Unit and Helen Keller Internationol. Describe overall working relationship among partners, clearly indicating specific areas of project activities (planning, supervision, advocacy, planning mobilizatiorq etc) where all partners are involved. (l) Communities: Communitlt members are inwlved in the mobilization of themselves for Mectizon uptake; selection of the Community Directed Distributors (CDDs); collection, storage, distribution, monitoring and supervi s ion of Mect izan di st ri bution.L 1- t {- 1L fF I{ L WHO/APOC. 24 November 2004 (2) The LOCTs and Nutrition Officers at lhe LGA tewl are involved in planning of activities in collaboralion with the state tearL mdilization of erdemic communilies; training of community distributors; alleclion of Meclizsn and Vitamin A from the-state and delivery al the collection points; provision of sbrage Taiitities and storage of Meaimn ard Yitamin A; monitoring and supervision of the distibution and collection of the treotment reports.(3) Tie State Onchocerciasis Control Team plans activilies to be urried out in collaboration with lhe LGA teams and Helen Keller Inlernationol, the NGDO partner; conducts the TOT training for the LGA offcials; Larry out adwacy 'visits to rhe endemic LGAs to solicit the LGA fuecutive support to the proiecl; collecrion o! Mectimn and Yitamin A -from the NGDO for the endemic LGAs: monitoring and supervision; collection and analysis of treatment reports, provision of the necessary dato to the NGDOfor Mectizan re<ppliution.(4) 'The NGDO provides technical assistance by training lhe state team as ffainers; re-application of Mectizan for lhe project; high level adwcacy visit to the state MOH officials, LGA Execatives, Wramount community leaders and inJluential community members to solicit their support- State plans, if any, to mobilize the statdregion/district/LGA decision-makers, NGDOs, NGOs, CBOs. to assist in CDTI implementation. Intensify advocflcy visits to the LGA Exeantives to solicit their support for the proSramme. The state has continude to provide support to lhe proJecl in-lerms o.f personnel' logistics andfunds. {- i.5 WHO/AIOC. 24 November 2004 Fl oH F o o o o ii{ oo d o o d g r,93.AFll\'t :€ asDe:E3J.*'t rDE ='(t6x b,J5 5(,{ (Jr t\)\o 00 \o UJ\o 'g =E FlrJA.' €.3E ss3E =do6i=!? -. (, \o s :sF a g.E i rg N 5;{o(< EOi +ILx(DE -E B €.Et.)" (, \o s -l o OB 6'8 NO o,a (D il + z r(D Et o t)o EI (Dt, D ,qoo bJ5 5(, -I (, l.J\o @ \o (/.)\o EsFI9.6 P =FgEE. E.! s. *(!(D0.<f,3;'gE il r;'' h,J5 5(, -I o\ u)O Lar l..J\o oo \o u)\o qI + o- *8 'l;iooE.>B Nrd ='o6r(Dr bJ o5 (JJ t)qrrs I N) N)o eFl o eEF *[B FU o 15 tr o o rl aN I ! oE tr I Dt Il ot lFl la)td t.D lsr o o 3t (D (n p ila. oEtr A' o A' Et U) 7\' o o EI rt (D Ft oo D9Ft o DT{i'o oFt o F'Ho{(D A) o o- oFt o o- ,.t oq + o it o "oo1 E oc IoFl o a- s$ \ d afa o il os C) s(!{I (\ s B ! s o $(! G a(!\ as oq s Gho\ CJ!o\ G *s o cS s6 s G\ Go a d s s! G = o G ci s cls(\ G G\ .o G s F <NprHU) S-O:R oqo{ ET(,o ro\H€ +S6l -oo E< r=. \ fl€ oB es o- R- L=3.*6t (Dt. ai :' 90 3.*d6p (D .r< F\ oii -(!.vI '4tsax IG t*ts. .X: rs o s(\(\ \ .o (t i. d o\: 6 a zo *E z "9fr*HE+'8a' ....9 xrSooAvto x'oo\Y tr6A .)^E Y,., a=. 0;olo-lP) IA'l='l*l:'t(Dl- (f- I{ s, .\'i Olto ,x5t-' o ,oFt(, o ,i C)I (hio (DI. rP A'HU)E+t + (Dv!tp)Ao:ts1r s. E .E€ r 3\dU a S-S g-;iAS |Jils s Btu€ 39's a' E3 ts 3 B iE g : N-€ Ef,Ne. 5 B'i \' .?' r!.o t I:r>E. i *tis =gss € Isfi gE\ * eE.€q {B.Fs ile $[\(J5= \a+G3. aD\]JEse €.s3otri'4.3-os€'8FLq = dE =c)5 t.rdE.,v{US =.N.H;\ a- |.r a)3. S' qB!dsssD:6'S{AJIR\=is *.5SB -:. rdH'Ne €f$Eqe lirq sos+;S(DS'oo!F Ci.oHg G t c "ot.)5 z E x l..)oo5 o\ t, : ti L 1-ib rt t! E ; SEGTION 2: lmPlementation of GDTI 2.1. Timeline of acthrities Fill in table 3, timeline of acrivities for areas trealed in anrrent 1re'ar, indicating when the key activities were implemented by the month they began and the month they ended' t i-i 1 LJ a tD I t rr|} 1^ l* WHO/APOC- 24 Novembcr 2004 l-l IA'IC lo 1,, rl T (D o oH) FDo o .A a o c,E o B Ft o D' (D o. (D o >1 Ho o o) E(\ N V2(\ 6 * o .:(\\ o{la G a(\q h e I o o (D (n Ft ori F NJ F c. do 6 o U o J. tt F o ril EOI -oE:E* -E -oe za)-oo5r EN 1E' tD' ? F o o\ ooBE OH o E' F o o\ -o E* 5d6 Fl A3 DC Or oo339'o F o\ -o 5"+ +=. -oa o(D rt, o C1'a t0 o 2 O o\ oo3EO+r o c 2 O o\ _ (r, :tD 5* FE' U ,cl c u, ET ooo\ oo3eoi ol, O o\ -a :r! E'* rrE (r7 E'(D 4 0 oo O o\ o EE9'o oc t i* 6 (J x 6 ;A z o G r N.) 8s r + tr {- L {- L r L { 2.2. Advocacy State the number of policy/decision makers mobilized at each relevant level during the current year; the reason(s) for undertaking the advocary and the outcome. Describe difficulties/constraints being faced and suggestions on how to improve advocacy. Policy/decision mokers mobilized al each reletnnl level during the currenl year are as .follows: State Level: Hon. Commissioner for Health Permanent Secretary, MOH Director, Disease Control and Public Health Services Reasons: To sustain good working relationship and support lo the proiect through provision of rnterial, logistics arul firwncial support. Outcome: The State level continued to release her counterpart.financial conlributio,l. LGA Level: Chairnnn Councilor.for Health PHC Director Deput.v PHC Directors Reason; To encourage them to step-up lheir fnoncial support lo the programme. Conununitv Level: . Communily Leaders . Opinion Leaders . Religious Groups To encourage them to embrace lhe programme To support their CDDs Provide storage and sa-fely qf mectizan To monilor and supervise the distributors Outcome: The communities have accepted the programme and agreed to supryrt the CDDs. D ifficu lt i e s/Co nstrain ts : Some of the community leaders and their members are still not willing to support the CDDs. How to Imnrove on Adwcactt: o Adwucy visil and community mobilirution lo be intensified at the communilY level. a a a a a a a Reasons a a a a L o WIIO/APOC- 24 Nor,ember 2004 q- jfr rt IF L 2.3- illobilization, sensitization and health education of at risk communities Provide information on: The use of media and/or other local systems to disseminate information Use of CDDs to educate community members Announcements are done in the churches, mosques, and during community associations or cooperative societies meetings. Use of town announcers to disseminate information to community members Radio jingles and TV spot obout the disease and the needfor treatment periodically. Mobilization and health education of communities including women and minorities Iil'omen and minority groups are mobilized during theirfellowships, associations, and other meetings. Response of target communities/villages Acceptance of the programme which have ensured high coverage. Accomplishments Mobilization and education of l3 endemic communities Treatment of 15,554 community members Training in Community Self-monitoring at State and LGA levels, Constraints: Sustaining the continuous acceptance of the program by the minority groups Support of the CDDs by the endemic communities. Suggest ways to improve mobilization and sensitization of the target communities. PHC staffat the community level should be encouraged to sustain the mobilization of the communities where they live and work. Community to be trained in Community Self-monitoring (CSM in order to conduct it. Frequent advocacy visits to LGA Chief Executives by the State team to solicit for support. a o a a a a a o a ! ar a a a l0 WHO/APOC, 24 November 2004 Fl o t, d o do5 <. - \o 5 Ed f.*= 3xeE- i if,F Eg :iEi a aq+ E o E mo IE c_ Eg EE +ll oo nZOE =oql EO 6= ot B80< EFl6 :.4 o< zE: \o t.Jo\ zD o (J 6 9!eod' \o t.Jo\ lt EE + EO r'l o 19 z o o =o;D =!5a o F e8., s$E+ "" i'q rE 6 D 0eo lsi rll ;Jz oo !, h5 ,a F9 =t ElB3Fe E8 N h o o 3 3 E = -t -5 o? o 3 o3ti oo 5 t (Dlt) 3 (D oU -.1 s * So rs\o €4 ro o x 5kE$Gid(D s' N- e:+ort Q- iD otrSS!J sR 8 '' 8 S.,9, R S'q,\.x.9 a' \! (Df s a:lso \N rN"ias.o ^(j \.- t{ cj q'-s:E SE :<qo) N5SQ\P (\-$& xbdA' UA ii(Dn(D i:oa -a H o (\ G =.\(\ O1 Ua N .(\V \(\ a .S Gi\ o V1 o sE =x doa x E: giEqP*P k o" .tS;l{ S *o-S5 oY o-.< (!LD=\9 = =6o) -" g.BPO*s=!' * *€s.ti o)g.E FO 'cl =.0, 'l 5ti =. 6', 'E:Ca-() so )gdqo bFtOu\ oa +)Y+ @ C)s'9 oat 3-q qp oosa49.\5doaOa t7a{$t6 :,,o i-j Ll EJfl; RA =.o:. u):1. F)36 C'o 0c *(A o U) v)o o- D) o a-g o JD B Sr -r%(D =' B5 ^ dY \<; Sg3 irvvt/ s < \.J S o-(n=(D ' \o th S: .yA'(\ *c.:()TAUA: t*tsg EEp iE.E XH. =<(,urD X\o' J)a NrI No -qHo xE X u2 (/Ddl. o(DIN\ +)O "sy I(\ G u) 'l NAo-xo.U (D89oo- t-;-r S' S. -s N\.FR S$ o \q !i'l. s u'S'E; FS ENS 3 Q sl:$dS+s"GOS=\'r s ^aS -(l^Rr-: H" O E.Y sFocs\ =. <.SRO"iSs"e(\\Ani5&;R.A \\Y N!? BSO(\ €^S r-:sv\U 6%\- \Nfi'uS.N$.xe:h6ks.\ .oX -\- SS(\3 A\ :' H.SN =istsSF Ytr :3b(\G $\ S.=(\t: %s tst b\dRGi' toa(\< S.S ES!v dA RS Aq\:'sa6 .o' ra'(ishu.\-lS^SX RS N\ -! *\' *X' N.H t) o '! _o N+ z o o o N oU) i,. Lr L lTIt lr u I. t- 2.5. Gapacityr building - Describe the adequacy of available knowledgeable manpower at all levels. The project lavv avsilable and lotowledgectble manpower at all levels, however, not all have been trained for CDTI implementation. Where frequent transfers of trained stalloccur, state what the project is doing, or intends to do, to remedy the situation (The most importanl issue to descrtbe is what measures were tal<en to ensure adequate CDTI implementationwhere not enough knowledgeable manpower was atailable or if staffare frequently transferred during the course of the campaign). The pro.ject continues lo experience the problem offrequent ffans.fer of trained health staff at the LGA level. The l,ocal Government Service Commission has been contacted to either leave them out of the transfer or tansfer them to CDTI LGAs. L I l3 WHO/APOC. 24 November 2003 l-lls16 l(t t,, ;r-t ar 0a D) (D o- ;{(D' (D o o u, o+) o U -t (D o FD o e(\p la(\ il is o(\ ci G (\ n oqq rJ s- \\ s I o ss 6 D o 'l E d : oq o ui- o qa 5 ts(J oo ;5 z o (D s i') il- I L L !- L rIb g? li E. Eo o do E U - ?2 F o H orl F o .o v .t ! o s It(! (D .D a oo o s F € Q. S^+ :'; i. z .D a E.3 t!a) F 6) a O DrB o -l o (, -t IJ i.J -o c\ .! (! (D (A -t a -I tJlJ t-J}J o e. Sr 9^-r+ i'9 ofla .)(! =e= ST;B s:i 3g (D IJ o v -l o o\ u (D rD Gc hJ N .oq AZ s{ o = A-l z rr(! a3ni'o 8o' ^E'rl 'r HD9o='(! (,\o }J o\ oB,a-oo\ I (D o (! o L)(,r (,\o hJ o\ hJ o\ E OE o=ii oi ari+ ;'o olL z 5t! ot Ua a! \o -t* L Table 6:Type of training undertaken (Iick the boxes where spectfic taining was arried oul during the reprting perid) Any other comments 2.6. Treatments 2.6.1. Treatment figures The project was able to treat I 5,554 people out ofan ATO of 20, 104 with 4 3,667 tablets ofMectimn. If the project is not achieving 100% geographical coverage and a minimum of 77o/o therapeutic coverage or the coverage rate is fluctuating state the reasons and the plans being made to remedy this. The project achieved l00oz5 geographic coverage and 620/o lherapeutic coverage. The project could not achieve a minimum of 77% therapeulic @verage because of the following reasons:(a) Community members have refused to provide incenlives to CDDs because they felt the project should do tlnr. @ CDDs refused to distribute Mectimnwithout comrynsation. Plans to improve the coverage include:(a) Continuous community mobilimtion of community members to see lhe need and accept the programme as their own.(b) Encourage communities lo selecl more CDDI to be troined in order lo reduce the burden ofwork. This will put off their chmor for denand for incentives. t Trainees Type of raining CDDs Other Community members e.g Community supervisors Health Workers (frontline health facilities) MOH staffor Other Political [,eaders Others(specify) Program management { How to conduct Health education ./ ',/ -,/ -'/ -,/ Management of SAEs ! CSM ./ ./ SHM Data collection { { { { Data analysis ./ Report writing ",J Others (specify) l5 WHO/APOC- 24 November 2003 l-lloET l(! l-r -lrt(D A' (D o) o- V) E U2 q o. (ag| J.o l. o 3 to o) (D H O) tJ)r e(\ <4(\ N o\ \ € a4 (\ o(\l-q + H o:i F oo BEoltoo V. aI o d o E -U5S >d' lrJ \o 5 I s s-8 "[gE E+ eT +[* sl3l d l(Da .\ <1 o, oa t(D l- I r, \o 5 ^-lve > :+ae \o A oo, +<5c o =5 3FTET i5- Q ='r" [q o OO OO o88 ^ >Gt ^s0 EBrg Uq- ,il t l.)( o\ -l o\ O hJ @ @ @ \o ,lO^' a= l, 3Li q! siirEaI IBJ i o a) o I'JI ot- ie ! I i.J t-..)O A-lte > o== ?'6 Eo= crr(, ?rrA o O F @ -ts z aE iEgI -- o o\t) o o\ o, {o='ooi€E6GIEo=. o v .UPttl t € \J tJ TJ\o -J hJ :+ 'otr- 5A+E +I +- 7I o6 hJ -t}JO \oO -J @ tJ *-7 E3 *E9o zo (a zo tD o, a= HT z o o zo <l E qg z E$iar;rIEfe,B 3(! A'E() REvo o o (D t9 0a @ H o, (D od o oe D, ^E'-d !t :i- 6' o, o o (DI o, oo(D Fl o, o 4tz.o lE' 0, l:J -ldE16oF 'o loC lHr 5lE9E _l(D =:lB5lDoo lA -.lo-rlx (Dlo @l^o'- ro (D Io a-(D o c)o E. (D o (D t €.(D C) !) (D A) UF OluO\ l5{l 4lz.o lc' 0, 13 -ld5lo rto Xla -r l:z s,l= =luo l=.6la a16'ito <t< ElrI lrEt(a 163loa-laEE r{ lO) =.t; ., 18" 81" tsl= i.oa lelh d(a g. (Dp- € vEz o o t €.(D o H(D ol -l-t)lu x O6 x il oO o\ h,J €+ .E o "o l'Js z o @ * t-J 8A L t- 1- L t t? IE -{ I il ll I-lo 8a<X(1i<,8 oco o, 6' s c_l .{ o D)r) 6' (D o- >tz5lc Els =lld l*)!:16g18(Dlo Zl(D sla r= - 16) fltE <lx(Dl lolo il tc \SB tsEl ll -Es N -!. !rrs ;\F :r. *s i .it G{l \ !.! t a! aRr ss"& i ^'.s {i. R$t s-o s.RF ds.r :$s xa\ k :: sdr Es-8 e:s d:..tr =$x $\{ h'Si sl.l- NAE. E ii r9\Eqq r .SiNts$ iG: !:r *I'\ {SQ, =.XG{t sF- Fs E\F! ES. .N. S ssrx\xG{ $ G:\s{oc+=- sx\;st Gq li& G F6>G\\ E OeGI € I 9dIt tJ lHo lL^ E l(, O l9t5ls N,J F o15s x O {{ 1tzol< eL 13 -lqPtoEtr :J lOd l+r(Dlo :18 +10:o 16-8lc .d lo -ts3ls *lx ol- (D lv o) (D o. o0o o I(D o-(D =.o o)I(a o) 1 7' (D !t €.(D o !ot(D t0 -loI X { {{ { o .o "ol95 zo d r }J 8A a- L I L t^ L I !Yt_ LE I 2.6.2 What arrc the ceuses of absenteeism? o Some of the community members were away to their farms during distribution 2.63 What arrc the neasons for refusds? o Some community members felt they do not have the disease. o CDDs refusal to go back and treat lhe urununity members who were not in when distribution were canied out due to lack of incentives 2.6.4 Briefly describe all known and verified serious advene events (SAEs) that occurred during the reporting period and prcvide (in table 8) the required information when available. 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 x ti ll WHO/APOC. 24 Nowmber 2004 l'{ lot 1(, Ira lo ; Boa ot ah(D ottn D' o- (D th o o o U\ a Fr, t/) t0 o oo xoo o oo o (D ro o ='(lo :o o 6o \(\ q $ \ G o €4 oGh % L.!\:- 3I V1t\V) * t\(\-\ a (!\ .o (\\ (\ 1- {. E "o t-.)5 z o d r tJ 8J. L LE t- *L t t?li 1' t a I (Ia (D wx 9< oa= !Jd6 o o EEF rE 6A@-tJ <Y a=o Ei ar- s3 (, '1c o <6Y-& $,F r; g i:i' ,i X \J ;=!.o ='Ja ^ o ;P+gU oObF -5 5 @ .U=ao 'RBh 2^F3 it(! E AE - 60 :.oilsa EO YJP ^=6A63 oot-r!5'9 X sag @()Ao E'Bg-d l,rB(Doa ^ lEL : +gX.itox3- FHh 9.lp 'tiiE 993oB-r *(D+ rBE ee t!aHljo !l a? 3ll(Da r€ s'Esg €-ld sslE-i P E3dP=p [) - tsgu Px= |: oE.6qg =. ='='urdl,3- iri ao =Ecdf, aitl; -!ootg* Ca HE5 =.sEP:$X gR' eil -ftoi. SR 0B' D5s0Qv(D ag a E' o o i- hJo O i.)oo\o hJoo € nJ 8 -J hJoI hJoo tJoo5 hJoofr) No N) t\)oo E \o\o\o \o\o @ \o\o{ #x (, a oo5 E,ff E E A' n i.3 s'i g -'< 10 ltHt a 1e,ei =IDoa o o c5 o e. lo 0aoq n-lye > -^'D >o5: ?'d Eo) l!, "82g<-3 =I =3 *6''f; 5 I ii =.oOD rt oO @ @ It,oO s'F,R 6 I € , ll </ai -oJ =(x)'oE05 oo O ^Q "9o,J 'frd It' 16 F' ,I 6 FJ o\ -t -t o\5 N) },J \o GH E'q E. r" ;5 r 1B',6; V -iY=8t q o 'rC o, o3 IJ s ! 5 "t'J a\ -l €6 P :Eeo= A { -l6 \o oaz ^co-a =GdrDO o' e Irl o\ .J 5J. { ,-.1 Oo ."9€vFO(Ft o=. o It, Irl 'll -II\o O,\o 01 o ^? >\oo it#o o Itl t! sJjil s EI ts oOaa5::'ts o oa tJ { o 'Uooi.5 zo d * tJ 8A L ! tr f-L f- L fr lr ,- 2.7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - (please tick lhe appropriate answer) MOH X WHOtr UNICEFE Other (please speci fy) : Mectizan@ delivered by - (please tick the appropriate answer) MOH X WHOtr UNICEF X NGDO X NGDO X t- Other (please specify) Please describe how Mectizan@ is ordered and how it geS to the communities The ordering of mectizan beginsfrom the communily where ofter community registralion (census), have been corulucted and number of people obtained. These are senl through lhe LGAs and the State to the NGDO (HKI). HKIwill then use those information to opply.for the mectizan. Where distribution has been on-going, inforntation is obtained-from the treatments reports from the comrmtnity summaryforms. On the other lnnd, when mectizan reaches the port o_f entry, HKI will collect it to her store. The Stale now collects from HKI store and later distribute to the endemic LGAs who deliwr it to lhe designated PHC centers which are collection points for lhe CDDs to collect for distribution inventories are properly kept at all lewls. Table 10. Mectizan@ Inventory' (Please add more rows if necessary) How are the remaining ivermectin tablets collected and where are they kept? The remaining tablets of Mectimn are collected by the Front Line Health Facilities and LOCTs during collection and allation of treatment reports. These are in-turn senl to lhe state Onchocerciasis Control Ofie at lhe slale headquarlers Ior safe keeping and use during the next treatment cycle. List and briefly describe the activities under lvermectin delivery that are being carried out by health care personnel in the project area Health care personnel are involvud in the following activilies - Collection of the required mectimnfrom the state ; at L L L l: E State/District/ LGA Number of Mectizano tabtets Requested Receivcd Used I,tl$t Wested Erpired Remaining Ibiono Ibom 21,000 21,000 4t,500 13,615 r85 7,2W 12,'70()Inr 4l,500 28-@2 r58 TOTAL 625O0 62500 42,L77 343 19,900 ,,1 WHO/APOC- 24 November 2004 q Deliwry of mectimn to the designated PHC centers which serve as allection points Provision of slorage for nfe kceping of lvvrmectin Maintain proper inventoryfor them Collection of treatment reports and left over tablets and return lo the Stale Any other comments 2.8. GommuniQr self-nron'rtoring and Stakeholderc Meeting Has any training (of trainers) for community self-moniloring been done in the project area? If so. When? Trainingfor Community Self-monitoringwas conducled in the month of JulytAugust 2006 at the state and LGA levels. Table I l: Community self-monitoring and Stakeholders Meeting (Add rows tf needed) Describe how the results of the community self- monitoring and stakeholders meetings have affected proJect implementation or how they would be utilized during the next treatment c1'cle. 2.9. Supervision 2.9.1. Provide a flow chaft of supcrvision hierarchy. District/ LGA Total # of oommunitieVvillages in the entire project area No of Communities that carried out self monitoring (CSM) No of Communities that conducted stakeholders meeting (SHM) Ibiono Ibom Ini 4 () None None None None TOTAL l3 NGDO/NOCP WHO/APOC- 24 Nwcmber 2004 -i, L 1- j l- {- L {-L F TE STATE (SOCTS) LGA (LOCTS) DISTRICT SUPERVISORS CLINICS i/c COLLECTION POINTS COMMUNITIES/ CDDs 2.9.2. What werc the main issues identified during supervision? Non provision of allowances for the LOCTs and other health workers inwlved in CDTI activities by LGA heantives. CDDs refused to distribute because the ammunities are not supprting them. Due to\erong limingfor the distribution (farming season) some people were nol awilable. 2.93. Was a supervision checklist used? Supervisory Checklists were used during lhe supervision. ai t- 1?, WHO/APOC- 24 November 2004 , {g It- 2.9.4. what were the outcomes at each level of GDTI implementation superrision? - The LGA F,reantives were requesled to be providingollowances lo the LOCTs to enable them carry elfective suryrvision. - The communities were encouraged to select ttore CDDr and support them during distribution. - Frint Line Health Facility staffwere requested to increase their supervisorlt visits to lhe nmmunities lo ensure complionce- 2.g.5. Was feedback given to the peruon or groups supervised? - There was feedback lo the supervised arul action tal<en to address what was deficimt. 2,9.6. How was the feedback used to improve the overall performance of the prciect? - the LGA Executiws agreed to support the LOCTs to enable them carrv out effectiw supervision. - More CDDs were selecled- SEGTION 3: SupPort to CDTI 3.1. Equiprnent Table l2: Status of equipment (Please add more rows i.f necessarl) *Condition of the equipment (F=Functional, CNFR{urrently non-functional but repairable, WO=Written ofD. How does the project intend to maintain and replace existing equipment and other materials? The project intend to mointain and replace the exisling equipment and other materials with funds provided by the State and NGDO Source Type of equipment APOC MOH DISTRICT/ LGA NGDO Others No. Conditim No. Cnnditirn No. Condirim No. Conditim No. Coodition l. Vehicle I F 2. Motor cyclds) 2 F 3. Computer(s) I F 4. Printer(s) I F 5. Photocopier (s) I F 6. Fax Machin{s) I F 7. Others a) b) c) )l WHO/APOC. 24 November 2004 7 t+ 3.2. Financial contributions of the partnens and communities Table l3: Financial contributiom by all partners for the last three years If there are problems with release of counterpart frrnds, how were they addressed? The problems with release of counterryrt funds by conlinuous advocaq visils lo solicit lheir supgtrl- Additional comments the slate and LGAs were addressed bv 3.3. Other forms of community suPport Describe (indicate forms of in-kind contributions of communities if any) The in-kind contributions of communities to cDDs is by way o-f pra.vers. 3.4. Expenditure Per activitlr 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 currenry. lndicate exchange rale used here L I Contributor Yc.r i ('pattub tln wid) Yar2 ('ptovi& tlc Derid') Yart ('pra,i& ilc prid) TOTAL Cash Budgeted (US$) TOTAL Cash Released rus$) TOTAL Cash Budgeted (us$) TOTAL Cash Released rus$) TOTAL Cash Budgeted 6US$) TOTAL Cash Released (us$) MOH (Central + ProvinciaVS tate) 13.774 7917 No fuodsrclcccd by MOH this ycar _ No funds providod by t GAs No funds rclcascd by MOH this ycar MOH (District/LcA) Local NGDO(s) ( if any) NGDO partne(s) I t,328.37 I1.328.37 Others a) b) Communities 44.5 44.5 APOC Trust Fund 443t2 29.461 29.461 TOTAL 40,789.37 40,789.37 ,< WHO/APOC- 24 November 2004 t. tr Table l4: Indicate how much the project spent for each activity listed below during the reporting period Any comments or explanations'l SEGTTON 4: Sustainability of GDTI 4-1. tntemal; independent participatory monitoring; Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable) No Moniloring was carried oul during the period Year I Participatory Independent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation Intemal Monitoring by NOTF Other Evaluation by other partners Activi Erpenditurc ($ US) Source(s) of funding Drug delivery from NOTF HQ areato central collection point of 99mE!!!_ry_ Mobilization and health education of communities I_fatnitg_q{-CDDI of hedth staff al all levels Uptt_n_Ls 4_g CDDs and {iqlrlbqliol Intemal 9 f CDTI activities Advocacy visits to health and political authorities IEC materials S.yq1r_ngry Gepgrting) foryls lgt treatment Vehicles/ Motorrycles/ bicycles maintenance OIIicg Equipment (g.g computers, printe-rs etc) Others 6,939.75 2,562.50 i,r lz.so [6,ott Ir,or.az i 7,173 lf ,3m I r,+so lgsz l,n *o I ls,aas APo_c_1uEl APOC/HKI APOC/HKI APOC/HKI HKI 4P_qc_415r*_ HKI UE.I - HKI !6I APOC TOTAL 40,78931 Total number of persons treated rs5s4 )A WIIO/APOC. 24 Nor.ember 2004 , 4.1.2. What were the rccommendations? 4.13. How have they been implemented? 4.2. Sustainabitity of proiects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period?-No Was a sustainability plan written?---N o When was the sustainability plan submitted?-No- What arrangements have been made to sustain CDTI after APOC funding ceases in terms ofl To what extent has the plan been implemented - Treatmenl coverage has improwd greatly. - All the communilies lnvv bem treated. - Additional CDDs trained. 4,3. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complele integration: Planning at all relevant levels Plon of activities were drawn during the review meeting with the LGA officials at the state level. Funds Nofunds were released by lhe stale and lfiAs during the reytrting peid. Support came ti'om APOC and the NGDO Transport (replacement and main tenance) Mointenonce and replacement were done by the state and NGDO Other nesounces Ivermectin delivery mechanisms The PHC staflare involved and take responsibilily of Mectizan and Vitamin A by collecting them and allo@ting them to CDDs for distribution. - Supervises the dislribulion and collects rePorls. - The SOCTs and LOCTs are involved in NID activities. Training The SOCTs and LOCTs attends u,orkshops on other health programmes, and supervises NID activities. 4.33. Joint supervision and monitoring with other programs 4.2.1. 4.2.2. 4.23 4.2.4. 4.2.5. 4.3.1. 4.3.2. t- L. Mectimn distribution and Yitamin A supplementalion supervision are carried out by the LOCTs and Front Line Health Facilities Snff along with other PHC activities. Release of funds for project ectivities Lilre other projects at the state and LGA level, the same routine procedures are followed in the release offunds. 4.3.4. )7 WHO/APOC. 24 November 2004 t 1, t* 4.35. Is CDTI included in the PHC budget? At the state level it is included in Deprtmenl of Public Health Services Budget. while at the LGA level it is included in the general budget' 4.3.6. Describe other health prognammes that arr using the CDTI structure and how this was achieyed. What harrc been the achievements? The CDTI structure is used to deliver Yitamin A to the communitv members. This is achievd by elfective mobilization and education of the community members on the imJnrlance of the supplement. 4.3.7. Describe others issues considercd in the integration of cDTI. Integration ofCDTIwith other health programmes have created awareness of olher programme to the community members and encouraged them carry out o lhe r d eve lopmen I a cl ivi I i es. 4.4. Operational rresearch 4.4.1. Summarize in not morc than one half of e page the operational research undefiaken in the prcject area within the reporting period. 4.4.2. How werc the results applied in the prcject? SEGTION 5: Strengths, weaknesses, challeng€sr and opportunities - List the strengths and weaknesses of CDTI implementation process. - Awilability of trainedand committed health workers at all levels' - ,4wilnbility of literate CDDs - Strong backing by HKI thefacilitating NGDO. List the challenges and indicate how they were addressed. Inadequate support by LGA Exeantive to the progromme H e a I th w o rl<e r s a sh ng _for increa sed a I lowanc e Transfer of CDTI peionnel to non CDTI LGAs ond oreas- Non identification and inwlwment of CBOs and WCs in CDTI activities. Inadequate logislics. How the challenges were addressed. - Local Government Service Commissionwos contocled and appealed lo nol lo transfer stalf inwlved in CDTI activities out of the CDTI LGAs. - HKI brings additional vehicle during CDTI activities. Jntensify adwcacy visits lo the LGA F.xeantives to solicit their supprt to the programme. 19, WIIO/AFOC- 24 Norrcmber 2004 , -Efforts are being made to identify and @ntact CBOs and YHCs in order to involve thern in CDTI activities. SEGTION 6: Unique features of the proiecUother mattens l+ ,o WHO/APOC- 24 November 2004 a L 1 it- t t !! le 2.9.3. Was a supervision checklist used? Supervisory ChecHists were used during the supervision. 2.9.4. What were the outcomes at each level of CDTI implementation supervision? 2.9.5. 2.9.6. (a) LGA Level - It was discovered that the LGA Executive were not adequately supporting the LOCTs withfundsfor ffictive supervision at the community level, and the following measures were taken. - There ware nofrequent visits to the communities by the FLHF staff to ensure compliance. Action taken - The LGA Executives were requested to be providing allowances to the LOCTs to enable them carry effective supervision. - Front Line Health Facility staffwere requested to increase their supervisory visits to the communities to ensure compliance. (b) Communitv Level There was needfor addilional CDDs. The communities were not supporting their CDDs. Action taken - The communities were encouraged to select more CDDs. - The communities were made to understand that the programme is their own, thus, the need to support their distributors during distribution. Was feedback given to the person or groups supervised? - A meetingwas heldwith those concerned to deliberote on the supervisory report. How was the feedback used to improve the overall performance of the project? - The LGA Executives agreed to support the LOCTs to enable them carry out ffictive supervision. - More CDDs were selected. - The communities agreed to support their CDDs during distribution. il- 5l . t- t t.L t=it I ri lE 24 WHO/APOC, 24 November 2004 l- t SEGTION 3= Support to GDTI 3.{. Equipment Table 12: Status of equipment (Please add more rows if necessary) + Condition of the equipment (F:Functional, CNFR=Currently non-functional but repairable, WO:Written off). How does the project intend to maintain and replace existing equipment and other materials? The project intend to maintain and replace the existing equipment and other materials with funds provided by the State and NGDO { Source Type of equipment APOC MOH DISTRICT/ LGA NGDO Others No. Condition No. Conditron No. Condition No Condrton No. Condrtion 1. Vehicle 1 F 2. Motor cycle(s) 2 F 3. Computer(s) I F 4. Printer(s) I F 5. Photocopier (s) I F 6. Fax Machine(s) I F 7. Others a) b) c) 25 WHO/APOC, 24 November 2004 3.2. Financial contributions of the pailners and communities Table 13: Financial contributions by all partners for the last three years If there are problems with release of counterpart The problems with release of counterpart funds , funds, how were they addressed? by the state and LGAr were addressed by t- continuous advocacy visits to solicit their support. Additional comments 3.3. Other forms of community support Describe (indicate forms of in-kind contributions of communities if any) The in-kind contributions of communities to cDDs is by way of prayers. 3.4. Expenditure per activiQr - 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: Nl26: $l Contributor Yerr I ('provde the period') Year 2 ('provide the period') Ycrr 3 ('provde lhe period') TOTAL Cash Budgeted (US$) TOTAL Cash Released rus$) TOTAL Cash Budgeted (US$) TOTAL Cash Released rus$) TOTAL Cash Budgeted (US$) TOTAL Cash Released (us$) MOH (Central + ProvinciaVState) 13,774 7,917 No funds released by MOH this Year No fimds released by MOH this year MOH (District/LGA) No fundsprovided by LGAs Local NGDO($ ( if any) NGDO partner(s) I I,328 37 11,328.17 Others a) b) Communities M.5 44.5 APOC Trust Fund 44,312 29,461 29,461 TOTAL 40,789.37 40,789.37 26 WHO/APOC, 24 November 2004 Table 14: Indicate how much the project spent for each activity listed below during the reporting period Any comments or explanations? SEGTION 4= Sustainability of GDT! 4.1. lnternall independent participatory monitoring; Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable) No Monitoring was carried out during the period Year I Participatory Independent mon itoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation Intemal Monitoring by NOTF Other Evaluation by other partners t- t, { Activity Expenditure ($ us) Source(s) of funding Drug delivery from NOTF HQ area to central collection point of community Mobilization and health education of communities lrqining of CDDs Training of health staff at all levels 6,939.75 2,562.50 4_BoclHSl APOC/HKI APOC/HKI3,137.50 Supervising CDDs and distribution Ilt!.-U ql qo_! {glirls _o { QpJt acti v i ti e s... _ {lvqcaqy ylsits tg heallh and litical authorities IEC materials 6,073 1,036.82 l,tii 1,300 APOC/HKI EKI APOC/HKI HKI _[U4-eV(tep_qrttgg) forms for treatment Veh ic I e s/_Motorgyc I e _sl pi91c !-e_g maintenance qE9"_ESUlp1!-e"{r!_G".gc.q$putglq,pIinlgl_s__e19) Others 1,450 952"-" 7iq.8o 9,445 H_KI H[I HKI APOC TOTAL 40,789.37 Total number of persons treated 15,554 27 WHO/APOC, 24 November 2004 4.1.2. What were the recommendations? 4.1.3. How have they been implemented? 4.2. Sustainability of proiects: plan and set targets (mandatory/ at Yr 3) Was the project evaluated during the reporting period? No Was a sustainability plan written? NO When was the sustainability plan submitted? NO What arrangements have been made to sustain CDTI after APOC funding ceases in terms ot 4.2.1. {- 4.2.2. 4.2.3 4.2.4. 4.2.5. To what extent has the plan been implemented - Treatment coverage has improved greatly. - All the communities hqve been treated. - Additional CDDs trained. 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 PHC staffare involved and take responsibility of Mectizan and Vitamin A by collecting them and allocating them to CDDs for distribution. - Supervises the distribution and collects reports. - The SOCTs and LOCTs are involved in NID activities. 4.3.2. Training The SOCTs and LOCTs attend workshops on other health programmes; and supervises NID activities. 4.3.3. Joint supervision and monitoring with other programs Planning at all relevant levels Plan of activities were drawn during the review meeting with the LGA fficials at the state level. Funds No funds were released by the state and LGAs during the reporting period Supporl came Jrom APOC and the NGDO Transport (replacement and maintenance) Maintenance and replacement were done by the state and NGDO Other resources Mectizan distribution and Vitamin A supplementation supervision are corried out by the LOCTs and Front Line Health Facilities Staffalongwith other PHC activities. Release of funds for project activities Like other projects at the state and LGA level, the same routine procedures are followed in the release offunds. L I 4.3.4. 28 WHO/APOC, 24 November 2004 a{, L !- L I il f? 1$ 4.3.5. Is CDTI included in the PHC budgefl At the state level it is included in Department of Public Health Services Budget, while at the LGA level it is included in the general budget. 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? The CDTI structure is used to deliver Vitamin A to the community members. This is achieved by ffictive mobilization and education of the community members on the importance of the supplement. 4.3.7. Describe others issues considered in the integration of CDTI. Integration of CDTI with other health programmes hqve created owareness of other programme to the community members and encouraged them carry out other development ac tivitie s. 4.4. Operational research 4.4.1. Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period. 4.4.2, How were the results applied in the proiect? SEGTION 5= Strengths, weaknesses, challengesr and opportunities - List the strengths and weaknesses of CDTI implementation process. - Availability of trained and committed healthworkers ot all levels. - Availability of literate CDDs - Strong backing by HKI the facilitating NGDO. List the challenges and indicate how they were addressed. Inadequate support by LGA Executive to the programme Health workers askingfor increased allowance Transfer of CDTI personnel to non CDTI LGAs and areas. Non identification and involvement of CBOs and VHCs in CDTI activities. Inadequate logistics. How the challenges were addressed. - Locsl Government Service Commissionwas contacted and appealed to not to transfer staffinvolved in CDTI activities out of the CDTI LGAs. - HKI brings additional vehicle during CDTI activities. -Intensify advocacy visits to the LGA Executives to solicit their support to the programme. 29 WHO/APOC, 24 November 2004 a.L I -Effirts are being made to identifu and contact CBOs and YHCs in order to iwolve them in CDTI activities. SEGTION 6: Unique features of the proiecUother matters tr t 30 WHO/APOC, 24 November 2004