Cross river NOTF/WHO-APOC CDTI PRJ. six months progress report to APOC management: July-Dec. 2003

MIIilSTRY OF HEALTH, CALABAR, NIGERIA, 6TH YEAR PROGRESS REPORT COUNTRY/NOTF : NOTF NIGERIA Proiect Name: CROSS RMR NOTF/WHO-APOC CDTI PRJ. Approval yearz 1997 Launching year: 1998 Reporting Period (Month/Year) : JULY _DEC.2OO3 Date submitted: NGDO partner: UNICEF CROSS RIVER STATE 1 lYal I l-- I f ,| Dttt- I?r a "'.-,-',-,.-, To: To6. .r.-. rr^n<J b.l-AP.x t r,'.'c'ir'* (.. ri; D r" -$J i !t t 1 I i l i ! IL{: I 5rt: C.rr tlbo \lq.-re,u I ln, 1*il For Ic. Lii,t" WHO/APOC, 26 September 2003I SIX MONTHS PROGRESS REPORT TO APOC MANAGEMENT \, v AFRICAN PROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) ll WHO/APOC, 26 September 2003 ( SIx MONTHS PROGRESS REPORT TO APOC MANAGEMENT E,NDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: Country, NIGERIA National Coordinator Name: D6-Jonathan .Y. Jiya signutu#l /iI{* Date, ) le/zln Zonal Oncho Coordinator Name: Dr. U.E. Udofa Si Date >L e1) This report has been prepared by Name : Adie, Hilary Adie Designation : Coordinator Signature t- Date llr WHO/APOC, 26 September 2003 a/ ..{.. Table of contents ACRONYMS V DEFINITIONS ........... VI FOLLOW UP ON TCC RECOMMENDATIONS.. ........I EXECUTIVE SUMMARY SECTION 1: BACKGROUND INFORMATION 1.1. GpNERal rNFoRMATIoN............ l.l.l. Description of rhe project ftrieJly) l. l. 2. Partnership........ 1.2. PopulerroN AND Hnnt.ru SYSTEM SECTION 2: IMPLEMENTATION OF CDTI 2.1. .PeRroo oF AcrrvtlEs............. .............7 2.2. OnorRrNG, sroRAGE AND DELIVERY oF IVERMECTIN ............10 2.3. Apvocncv nNp SeNstlzATIoN..... .....................11 2.4. MoetLtznrroN AND HEALTH EDUCATIoN oF AT RISK coMMUNITIES..........................12 2.5. CovirauNtuEs TNVoLVEMENT IN DECISIoN-MAKING ..............14 2.6. Cnpe.Crry BUILDING ........EnnOn! BOOTIARK NOT DEFINED. 2.6.1" Training.... .....Error! Bookmark not deJined. 2.6.2. Equipment and human resources.. ..............18 CoNoruoN oF THE EeurpMENT * PLsRsp srATE .............18 2.7. TnearueNTs ............. ......20 2.7.l: Treatment figures ........... . Error! Bookmark not defined. 2.7.3. Trend of treatment achievement front CDTI project inception to the curuent yeqr 24 2.8. SupeRvrsroN............... .....25 SECTION 3: SUPPORT TO CDTI....... 3.1. FrNRNcrnl coNTRIBUTIoNS oF THE pARTNERS AND coMMUNITIES 3.2. .OrHen FoRMS oF coMMUNITy suppoRT................ 3.3. ExpENotruRE PER ACTIVITY SECTION 4: SUSTAINABILITY OF CDTI..... 2 3 J 3 4 5 7 28 28 28 28 29 4.1. INrEnNal-; INDEIENDENT eARTICIIAToRY MoNIToRINc; EvRlunTIoN......... 4.2. CovvruNtry sELF-MoNIToRING eNo STnTEHoLDERS Meprnc 4.3, SuSTaINaSILITY oF PRoJECTS: PLAN AND SET TARGETS (MANDATonv eT YR 3) 4.4. INrpcRattoN............. 4.5 OpenauoNAl RESEARCH. SECTION 5: STRENGTHS, WEAKNESSES AND CHALLENGES 29 30 3l 3l 32 33 lv WHO/APOC, 26 September 2003 Acronyms APOC ATO ATrO CBO CDD CDTI CSM FLHFS LGA MOH NGDO 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-Directed Distributor Community-Directed Treatment with Ivermectin Community Self-Monitoring Frontline Health Facility staff Local Government Area Ministry of Health Non-Govemmental Development Organization Non-Governmental Organization National Onchocerciasis Task Force Primary health care Rapid Epidemiological Mapping of Onchocerciasis 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 V WHO/APOC, 26 September 2003 Definitions (i) Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). (ii) Eligible population: calculated as 84oh of the total population in meso/hyper- endemic communities in the project area. (iii) Annual Treatment Objective: (ATO): the estimated number of persons living in meso/hyper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. (iv) Ultimate Treatment Goal (UTG): calculated as the maximum number of people to be treated annually in meso/hyper endemic areas within the project area, - ultimately to be reached when the project has reached full geographic coverage (normally the project should be expictld to reach the UTG at the end of the 3'd ' year ofthe project). (v) Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed 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). vl WHO/APOC, 26 September 2003 FOLLOW UP ON TGG RECOMMENDATIONS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session t7 Number of Recomntendal ion in lhe Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROTECT FOR TCC/APOC MGT USE ONLY )'r1 Why counterpart contribution was not paid by the Government and the delay in scaling up csm. The advocacy visit by APOC delegation that came to the State in Feb.2003 yielded positive results as Government released the sum of two million, one hundred thousand Naira (N2,100,000) and LGA Councils released One million, four hundred thousand Naira (N I ,400,000) for oncho. activities in 2003. The delay in scaling up CSM was not deliberate, the concept of CSM and SHM are difficult and time consuming to irnplement, LOCTs were told to implement the concept in a gradual manner and learn from mistakes in the field before expanding to other communities, during this reporting period, CSM was implernented in 508 comrnunities.b 223 Clarification on reduction of communities from 932 in 2002 and reduction in population from 926,091 in 2001 to 902,544in2002 Two communities in Biase and Akamkpa LGAs are no longer in existence due to communal clashes.these communities are Itan and Isoba communities respectively, so the total number of communities in the two LGAs reduced from 33 to 32 and94 to 93 respectively in 2003. there was good population update in2002, the unit noticed low therapeutic coverages in Obudu and Ogoja LGAs and embarked on spotchecks in the communities in these LGAs, it was noticed that community members were unwilling to exclude their relatives that were not living in the communities out of the register, mass mobilizatior-t irt the two LGAs and proper enumeration reduced the population to 902,544 in 2002 from 926,091 in 2001 WHO/APOC, 26 September 2003 1 2Executive Summary ln 19g7, APOC approved the commencement of the Cross River State CDTI project and in 19-98 implementation of CDTI commenced in five LGAs. Currently the project is in 14 out of the 18 LGAs. This first six months were to consolidate the gains made in the fifth year, through empowerment of all CDTI communities and ensuring practical integration into PHC system. The project treated a total of 534,781persons in 692 communities during the reporting period, geographical coverage for reporting period is74o/o while therapeutic coverage is 57%. The total population of meso and hyper communities is 930,951. The UTG is 781,999, At this stage of the project life, the ATO and UTG are the same. The relocation of three campuses of the Cross River State University of Technology to three core endemic LGAs has caused movement of people from the Capital city to Ogoja, Bekwarra and Akamkpa LGAs. During this period, 570 peripheral health staff were trained on CDTI, Community self monitoring and organization of stakeholders meetings, A total of 956 CDDs were trained during the reporting period. the CDD ratio is 1 :385 persons. The major challenges in the CR- CDTI project are Ensuring the continuation of counterpart funding by Government. Collaboration with other service delivery organizations in promoting total blindness control in the communities. The involvement of women in CDTI activities. On counterpart funding, there is a budget line item for onchocerciasis control activities in the state plan, Government has already approved the sum of Two [Villion, Eight Hundred Thousand Naira for requirements of the project for 2004, the release of the furids is been awaited. The unit has good networking with eyecare providers(optometrists and opthalmologists) and is working towards greater involvement in a comprehensive eyecare package for the State. On involving women in CDTI acitivities, the project is mobilizing community members to hold their meetings on neutral grounds where women also can attend instead of in Ekpe halls or other Sacred places where women are fordidden by tradition to attend, moreover an operational research proposal to study factors militating against the full participation of women in CDTI activities has been sent to APOC management. 2 WHO/APOC, 26 September 2003 )SEGTION {: Background information 1.1. General information l.l.l. Description of the project (briefly) STUDY AREA Cross River State is one of the 10 states in South Eastern Nigeria Primary Health Care (PHC) zones. The State is situated within the Cross River Basin between latitude 50 32' North, and 40 27' East. Ebonyi, Abia, and Akwa lbom States bound the State in west, in the North by Benue State. The Southern boundary is the Atlantic Ocean and it has international boundary with the Republic of Cameroon in the East. The main occupations of the people are farming, fishing and hunting. The state is situated within the tropical rainforest, one of Africa's most dense forest found on the eastern borders with the Cameroon and the secondary forest and guinea savannah in the western and nofthern part of the State. The climate is tropical, however temperate climate is found in Obudu plateau where altitudes are in the region of 1,500metres above sea level. The topography is mountainous in the Cameroon border, plain fields are found in Yala and Ogoja axis. The population is approximately 2.4 million as projected by the 1991 population census. The State has three main languages, Efik, Ejagham and Bekwarra. One major festival celebrated in the state is the new yam festival which takes place in th rainy season. There is a good road network which links the State with other parts of the country. The state can be accessed through land, air and water. There is a two tier administrative structure at this level. The State executive council is headed by a democratically elected Governor. The local councils are headed by the local Government chairmen who are also usually democratically elected. aJ WHO/APOC, 26 Septernber 2003 4The health system is divided into the primary, secondary and tertiary levels, the primary level which is community base is run by the Local Goverment administration in conjunction with the State Ministry of Health. The secondary level is managed by the State Ministry of Health and takes care of referrals from the primary level. The tertiary level is managed by the federal Government and comprise of the teaching hospital in the university college where special cases are referred to for special care. There are 296 health centers and posts in the project arca. 1.1.2. Partnership The project is implemented by the Federal ministry of health, APOC-WHO, State Ministry of Health, The LGAs, the communities. TINICEF and several other NGOs which include: South Eestern Nigeria Outreach Eyecare Services (SENOES), Youthcare, Ogoja Catholic diocese Eyecare services, Opthalmology Department University of Calabar, Cross River National Park, Cross River Forestry Commission and'Tulsi Chanrai foundation. The CBOs who are working in partnership include: Great Friends Klub of Obudu, Pacesetters Klub Exclusive of Calabar, Calabar Leo Klub and Catholic Nurses Guild. The State Ministry of Health provides the manpower needs for the implementation of the project, provides counterpart funding for activities and monitors overall implementation strategy and administration. The NGDO (UNICEF) partner provides part funding, logistics and expertise advice for proj ect implementation. The local NGOs and CBOs have been of tremendous help to the CDTI project, the Cross River National Park are responsible for delivery of mectizan, training of CDDs in the enclave communitics of Belegette and Okwa where the terrain is very rugged because of mountains and forest. The project has also identified other service providers working in the same area. The Cross River Forestry commission also have rangers working in the rugged terrain of Akamkpa. The project is collaborating with the commission in delivery of mectizan and training of CDDs in their area of operation. The project has up scaled activities and is looking at integrated eyecare service now. Over 1,200 Cataract surgeries were done by the Tulsi Chanrai Foundation with the patients mobilized by the State CDTI unit. The unit also participated in the Loiasis survey in Kogi State to delinate areas where precautions should be taken in administration of Mectizan. There are people from endemic areas residing in Calabar and other major towns in the state. These people are treated in churches by other CBOs like the Catholic Nurses Guild, Archdiocese of Calabar, the Great Friends Klub of Obudu, The Pacesetters Klub Exclusive of Calabar. A good number of policy makers worship in these churches also. 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Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - Qtlease tick the appropriate answer) MOH OCP) tr wHo tr UNICEF tr NGDO Other (please specify) Mectizan@ delivered by - Qtlease tick the oppropriate answer) MOH (NOCPf tr WHO tr UNICEF NGDO Other (please specify) Please describe how Mectizan@ is ordered and how it gets to the communities NOCP orders the total drug requirement for the whole country, LINICEF facilitates clearing of the drugs from the ports and storage in the central stores in Lagos. The State Ministry of Health authorities collects the State consignment from Lagos and the drugs are stored in the Onchocerciasis control unit stores in Calabar. The LGA councils sponsor the collection of the drugs from the central store in Calabar. At the LGA level, the drugs are stored in the LGA central drug store. The drugs are distributed to the health districts in the LGAs. The communities around the districts come to the District headquaters to collect the drugs for the end users. 10 WHO/APOC, 26 September 2003 ll Table 3: Mectizan@ Inventory (Please add more rows if necessary) State/District/LGA lnrnuxpn AKPABUYO I errwRRRn BIASE I sorr ETUNG I rxou OBANLIKU ODUKPANI OBUBRA OBUDU OGOJA YAKURR YALA Clinic base SOCU UNIT TOTAL Health staff request, collect and deliver Mectizan to endemic communities, they also get returns from CDDs after treatment. 2.3. Advocacy and sensitization A delegation from the sight savers international were in the state for the planning of an integrated eyecare programme for the state, the team seized the opportunity of the visit to pay a courtesy call on the Governor and advocate on the need to support all issues. concerning the control of blindness. A letter from the permanent secretary Federal tMinistry of Health was also received, the letter reminded Government on the need to continue the support of the control of River blindness in the state. During this period, the policy makers in the Ministry of Health were mobilized on the need for increased funding for field activities since the unit has taken an additional role of Vitamin A supplementation. The Primary Healthcare coordinators were also mobilized ontheir new roles with the addition of Vitamin A. The constraint faced now concerning mobilization is the high turn over of policy makers and frequent tqansfers in the Local Government system thereby requiring remobilization of new I I WHO/APOC, 26 SePtember 2003 Number of Vt..tiiurrntunt.ts Waste ExpiredUsed LostRequested Received 0220,000 r 99,503 94220,000 096,000 90,735 15596,000 700114,072 2r 20,000 120,000 0228,353 68228,505 228,50s I 000323 10,000 310,000 299,647 0 129,650 93,636 1014129,650 l 000 120,325 30168,700 168,700 0 95,000 92,170 1695,000 0 70,853 7585,890 85,890 56 3,3 00 I 3 5,000 r 35,000 86,456 1,068 86,237 51,237 7586,237 1,300 119,341 4',71s0,000 150,000 2,000 '74,918 55,955 6674,918 596 0 245,000 245,000 l 93,33 8 75,373 75,373 75,373 10,3681,890,994 2,2572,220,273 2,220,273 l2 set of policy makers, this is time and fund consuming. But with the new changes where LGA councils will soon be democratized, the tenure of the policy makers will be up to three years. of the CDTI project in the C Honorable Commissioner was mobilized on the 2.4. Mobilization and health education of at risk communities The project intensified mobilization and Health Education of endemic communities on the need for them to continue treatment even when the symptoms of the disease may have subsided, the addition of vitamin A as responsibility of CDDs was also highlighted in the health education messages. Mobilization was done through the media, with production ofjingles in the three major languages in the State, Government subsidized the airing of the jingles on the State owned media houses located in Calabar and Ikom for State wide coverage. Recently another form of moLilization of policy makers and church congregations was the inclusion of good will messages in annual harvest bulletins. The use of media houses has advantages of covering a large portion of the population and women and minorities who are usually side lined because of cultural beliefs. There is awareness on the need for treatment compliance for the required number of years, this is translated in the great demand for the drugs by the communities. The CBOs(Great Friends of Obudu, Pacesetters Klub )have also been useful in mobilization of people and treatment of people from endemic areas residing in Calabar. The only constraint is the limited funds available to carry out theatrical drama on need for sustained treatment and need for Vitamin A supplements by the target groups(post paftum mothers and children 0 to 59 months on the television. 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N$ @ @ o\$ o\Osr- \o OOr- Eo 6 O.= e d.=.? 9-o' FU $ @ $N o\ $s N o\ o\o ca o\ $r- co o\$ o\\o \o t-- r-t ca t-- d o.l(-r(-- o\ tro (d a. o 6;a .r (€ --o _= EEEEolo - a rE o. -d s o\ o\ o\o\ \or- r-o\ \ocoo o &o-F 6X -o o \o 00 s o\ o\ o\o\ \oo\'Eoobo cd-qg- bI);'i o o\ o9oo t-- o, r- o\ aaN o\ o\oo .f, o\\o r-r- $ oo t-- F- @ (\ @ aO v.= o<b E 9PU C E= o =q>L706 o\ o\ t ca o\ rf, co o\ cl co o\ c.to\EoE 6.= !=o < 9€'FU o\ r- co @ N o\ cao\ o\ a-. ca @ o\ o\ -f, c.) o\ $ ao 0) oo(d 0) (.) ood =6 .,€q>-oo>_3 EEIt u - ^,. a 1A 6 ^\I: E o 9i EO o r- oN oo N o\ c.l N (\O N c'l s N OON \o O N F- o\ o. @ o\ o\ o\ o\ o, N Oo.t & IJ.] 2.8. Supervision 2.8.1. Provide a flow chart of supervision hierarchy SUPE ON HIERACHY IN CR.CDTI NGDO UNICEF NOCP NOTF Zonal Onchocerciasis Control Team (ZPM, consulltrttts, & stalfl State Onchocerciasis Control Team (Slate Coordinulor, SOCT, Dir. PHC, PHC Coordinator) Local Government Onchocerciasis Control Team (LOCTs Leader, LOCT, PHC Coord-, Heoltlt Supervisor, Dislrict Supervisor) Com m unity-Directed Treatment with Ivermectin (Comnrunily Leader(s) Village H ealth Conunillee, Communitv ntemhers. C DDs) 25 WHO/APOC, l0 April2003 26 2.8.2. What were the main issues identified during supervision. Routine supervisory visits are duties of the LOCTs at this stage of the project life but where very serious issues concerning the overall CDTI implementation were detected, the SOCTs intervened with the LOCTs to curb the problems. Such supervisory vists identified the following: The population of reporting communities was higher than the population reported in2002 for Ogoja LGA and therapeutic coverage was low for Obudu (less than 65%) The total number of people treated in Obubra LGA was seen to be more than the UTG. A number of people that are enumerated during census update in January in Yala LGA are usually not available for treatment when treatment is given later in the year. In Yakurr LGA, migrant fishermen that are not usually available during census update are treated. 2.8.3. Was supervision checklist used ? Yes, supervisory checklists were used and trip authorizations also contained other salient issues that were not reflected in the checklist but were pertinent to be checked. 2.8.4. What were the outcomes at each level of CDTI implementation supervised Spot checks on the communities where population increase was noticed in Ogoja revealed that with the establishment of the satellite campus of the University of Cross River State, most of the indigenes who were usually not listed during census had come back home and also, whole families who were workers in Calabar have come back to their communities. The LOCTs were advised to be careful not to enumerate students who are temporal residents but bonafide indigenes were enumerated and treated. The low therapeutic coverage noticed in Obudu was discovered to be from Alege District where census update was faulty. Some persons residing in the towns were enumerated and were not available for treatment. The community leaders have been mobilized on the importance of accurate census figures for planning in CDTI and have resolved to strictly list only persons present in the community during the next distribution. High therapeutic coverage (8S%) in Obubra LGA which is more than the UTG was also queried and was discovered to be due to treatment of migrant fishermen who were not present during enumeration but came in during treatment. The communities have been mobilized to treat the fishermen under Clinic base, since they are not members of the community. In Yala LGA the communities in Ukelle axis which has three health districts have been mobilized on the need to change their treatment period to coincide with the period their kith and kin are back from Western Nigeria where they go for jobs and come back only during December period. The same scenario is applicable in Yakurr LGA. It can be appreciated that 10 out of the l4CDTI LGAs in Cross River State are riverrine and have population of fishermen who come during the dry season which is also treatment period in most communities for fishing, they are equally treated in these communities. Where there are clinics or health posts and a clinic based distribution exists, the persons are advised to take their treatment there but most of these communities do not;sually have health facilities, the communities have all been mobilized to open up separate treatment registers for such persons. 6 26 WHO/APOC, 26 September 2003 21 2.8.5. Was feed-back given to the supervised, and how was the feedback used in improving the overall performance of the project Feedback was given to all the levels and the communities have deliberated on some of the issues in their stakeholders meetings. Intervention measures that have been done will manifest during the next treatment season when population and treatment indices are supposed to change for the better. 27 WHO/APOC, 26 September 2003 28 SEGTION 3: SupPort to GDTI 3.{. Financiat contributions of the partners and communities Table 1 1: 'Financial contributions by all partners for the last three years Note that the 3 year inputs are for UN ICEF and Government alone, APOC inputs had ceased at this stage. Efforts have been made to remind Government on the need to continue the payment of counterpa(t funds which they started in 2003,this year, Government have approved the sum of 2.8million Naira already for activities on CDTI and Vitamin A supplementation. The funds will be conscientiously and judiciously used to encourage Government to continue funding of the project. 3.2. Other forms of community support - Descrrbe (rndrcate tbrrns of tn-kind contrlbutlons of communtttes tf any) Communities in Yakurr (Asslga communities) have actually given land to CDDs to cultivate cassava as a form of incentive to motivate them to work. There are'also a good number of communities who are giving yams to their CDDs after harvest. Other communities have excluded CDDs from communal work and levies. 3.3. E4penditure per activity - Indicate the expenditure on activities below in US dollars using the current United Nations exchange.rate to local currency 28 WHO/APOC, 26 SePtember2}}3 Contributor Year I (JULY 2001 TO JUNE 2002') Year 2 (JULY 2002 TO JUNE 2003) Year 3 UULY 2003 TO JUNE 2004) TOTAL Budgeted (us$) TOTAL Released (us$) TOTAL Budgeted (us$) TOTAL Released (us$) TOTAL Budgeted (us$) TOTAL Released (us$) Ministry of Health (MOH) r0r,9l3 950 128,082 3,383.33 25,000 17,500 Local NGDO(s) ( if any) NGDO partner(s) I 8,083. I 8 2,049.2',7 37,870 15,833 10,935.82 District/LGA 427 92.50 16,000 1 r,700 Others a)Cross River National Park 56 t.03 t,t2r r5 b)Youth Care 397.83 c)Great Friends of Obudu 354.33 Communities r 36,100 l,030.94 I 65,500 2.435.54 3,334;12 APOC Trust Fund 79,950 4l .008 59.875 56.925 TOTAL 336,046. I 8 46,029.24 391,327 64.709.68 56.833 43.4'70.54 29 Table l2: Indicate how much the project spent for each activity listed below during the reporting period Comments SEGTION 4: Sustainability of GDTI 4.1. lnterna!; independent participatory monitoring; Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick where applicable) _Year 1 Participatory Independent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation _ Internal Monitoring by NOTF Other Evaluation by other partners Expenditure ($ us) Source(s) of funding Drug delivery from NOTF HQ area to central collection point of 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 Advocacy visits to health and political authorities IEC materials Summary (reporting) forms for treatment Vehicles/ Motorcycles/ bicycles maintenance Office Equrpment (e.g computers, printers etc) Others 3,753.21 6,753.33 1,416.66 3,483.50 690.83 859.37 STATE GOVT. UNICEF UNICEF STATE GOVT. STATE GOVT. STATE GOVT. TOTAL 16,951.90 Total number of persons treated 732,941 29 WHO/APOC, 26 September 2003 Activitv 30 4.1.2 What were the recommendations? NO MONITORING TOOK PLACE DURING THE PERIOD UNDER REVIEW 4.1.3 How have they been implemented? NO MONITORING TOOK PLACE DURING THE PERIOD UNDER REVIEW 4.2. Gommunity self-monitoring and stakeholders Meeting Table 13: Community self-monitoring and Stakeholders Meeting (Please add more rows if ' necessary) 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 cycle. Community self monitoring exercise in Yakurr LGA identified reasons for inconsistency in the population figures of Assiga district. The monitors identified that fishermen from the neighboring Ebonyi State usually come to the area for fishing in the dry season after census update .uri huu. been completed in the first quarter of the year. The fishermen were treated within the community so the number of people treated is usually almost as the total population. The communities in Assiga district have decided to direct the people to take their drugs under clinic based. DistricU LGA Total # of communities/villages in the entire project area No of Communities that carried out self monitoring (CSfvf) No of Communities that conducted stakeholders meeting (SHIvf) AKAMKPA AKPABUYO BEKWARRA 93 32 32 33 l0 6 25 t2 1 BIASE 46 9 ) BOKI 129 90 23 ETUNG 29 10 8 IKOM 94 4 10 OBANLIKU 67 'r) t6 ODUKPANT o5 7 5 OBUBRA 24 20 8 OBUDU 39 20 9 OGOJA 50 18 5 YAKURR t4 t4 13 YALA 210 100 5 TOTAL 930 363 143 30 WHO/APOC, 26 September 2003 3l 4.3. Sustainability of proiects: plan and set targets (mandatory at Yr 3) 4.3.1 Planning at all relevant levels. There is joint planning for all PHC programmes and an integrated monitoring checklist is on field test, this is aimeJ at reducing cost of monitoring and ensuring that there is sustainability in terms of monitoring and strpervision of PHC activities since any programme with funds to be in the field can monitor all aspects of PHC with the integrated checklist. Joint planning on utilization of vehicles, motorcycles and other resources has been discussed in recent PHC for a in the State to encourage sustained and reduced running cost in PHC programmes. 4.3.2 Funds Resources have been got either directly or indirectly from local NGOs and CBOs, A list of areas where iocal NGOs and CBOs can help in directly without providing physical funds have been made and circulated, trainings and supervision in the National Park and Cross River Forestry Commission operation al area are done by the forest rangers, the Cross River broadcasting corporation are willing to air jingles at subsidized rates to mobilize the populace. fn... are budget line items specifically for CDTI activities at the LGA and State levels and there is a standing order by Government on contribution into an account of the sum of 200,000 Naira by all the 14 endemic LGAs in the State for CDTI activities and that has been implemented this year with the approval for 2004 given. 4.3.3 transport (replacement and maintenance) About 5,l6OUS Dollars from the State counterpart funds were devoted to maintenance and servicing of the vehicles at the State and LGA levels, two 4WD Toyota hilux vehicles donated by LINICEF and APOC were serviced and maintained at the State level though the UNICEF hitux has broken down again as at the time of this report, 43 motorcycles were refurbished with the funds provided.Outright replacement of the logistics will be diff,rcult because there are no conbrete plans on ground to replace the existing ones especially now that the APOC vehicle is six years old and the UNICEF vehicle is 9years old. 4.3.4 Other resources Local CBOs have been mobilized to provide or fund some activities for the project, the Great Friends Klub of Obudu produced community mectizan retirement forms for the LGAs of Obudu and Obanliku.T- shirts worth 424U5 dollars were produced by the same Klub with health education messages. 4.3.5 Please provide a written plan with set targets and achievements so far. The projebt has submitted a three year sustainability plan already to APOC management. 4.3.6 To what extent has the plan been implemented The first six months post APOC have seen the project implementing the initial key aspects of sustaining the projeci, the logistics have been improved with the repairs of the vehicles at the State and Local levels, the planning meetings, All the items for the last part of July to Dec. 2003 have been implemented. 4.4. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration 3l WHO/APOC, 26 September 2003 32 4.4.1. Ivermectindeliverymechanisms plans have been made with the PHC directors of all the 14 LGAs on the need to seize the opportunity of collection of supplies for routine immunization in the first part of every year to collect their Mectizan, so mectizan drug requirements for the following year are got by December, for proper requisition. 1.4.2. Training. The state unit participated jointly with the nutrition unit and the ministry of education in training of health workers on integrated health packages which CDTI was one. 4.4.3.' Joint supervision and monitoring with other programs There is in place an integrated monitoring checklist which is under test run for refinement. This checklist contain supervisory indices for all components of PHC. This is to help joint supervision at the State, LGA and Community levels. 4.4.4. Release of funds There is a poll of funds that is approved every year for all I-INICEF assisted programmes which onchocerciasis is one. The state unit also benefited to the tune of 1,336 US dollars from the funds. 4.4.5. ' Is CDTI included in the PHC budget? The project is in the post APOC era. The rolling plans for the ministry of health contain a budget line for the control of onchocerciasis. 4.4.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? The Project successfully distributed Vitamin A to 175,312 children under five years and 30,374 post partum mothers. 4.4.7. Describe others issues considered in the integration of CDTI. Joint advocacy and release offunds for integrated approaches in health interventions are planned for the coming year at both state and LGA levels. The CDDs are also going to identify cataract cases in their various communities fbr the ophthalmology society of Nigeria who are having their annual conference in the State in October 2004. The society will use the opportunity to operate the identified cases of cataract. 4.5 Operational research 4.5.1 Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period. No operational research was carried out during this period but two proposals on integrated ' health approaches using CDTI structures and factors militating against the involvement of women in CDTI are before the APOC management for approval. 4.5.2. How were the results applied in the project? The repults of the operational research that was carried out on the involvement of CDDs in other health and development activities were positive, i.e communities agreed that CDDs )Z WHO/APOC, 26 September 2003 JJ are able to add on other activities to their distribution activities and that provided the indicators that encouraged the project to add on Vitamin A supplementation' SEGTION 5: Strengths, weaknesses and challenges STRENGFITS . Clear vision and dogged commitment of the implementers at all levels o Prudent utilization of the counterpart funds provided by the state. o Commitment of the stakeholders to the success of the project' o Addition of Vitamin A which is now given to people who were excluded before now o Good working relationship between the project and the NGDO partner UNICEF' WEAKNESSES Inadequate manpower and absence of health facilities in some remote areas of Akamkpa and Obanliku LGAs. Communal clashes and distortion in population Weak community structures in the heterogenous area of the southern senatorial area of the state. CHALLENGES AND HOW THEY WERE ADDRESSED' o To achieve IOO% geographical coverage, other service providers who are _ offering communiiy sirui..r in the rugged areas where the health service is absent -were used in the delivery of mectizan, training of CDDs and retirement . ofdrugs. . . Mobilization, advocacy and prudent management of released funds have promised to be the ,ur. *uy 1o achieving early release of counterpart funding and that has been pursued vigorously' o The southern senatorial area where stranger elements abound have had low indices in community participation generally, efforts were made to Lrst the strengths and rveaknesses ofCDTI llnplementatlon process List the challenges and tndtcate how they were addressed a a a JJ WHO/APOC, 26 SePternber 2003