NGKWA IV annual project technical report to Technical Consultative Committee (TCC): September 2002-August 2003

-Jr\ iaEoLrr iLiJ l.r^ rr\virLr, , Lvvvtr rL^Urtlg .A.N N U.A.L P F.O-I E GT T EC H N!C.A.L R.EPOR.T TO TECHN ICAL CONSULTATTVE COMMTTTEE OCe) {APoC} I ORlGlNAl, : F,nglish bx..-.-." AFRICAN PROGRAMiTE FOR ONCHOCERCTASTS COf*p6Cq Ii aEi rJ' !*- , t.alLt lt r_;'i_-tl Drs\ .C\' .-n? [r\, .F'L, COUNTRY'NOTF: NIGERIA Proiect Name: NGKWA IV Approval vear: 1999 Launchinq vear: 1999 Reporting Period ( Month/Year): SEPTETBER 2OO2 . AUGUST 2OO3 Date submitted: 6'" DEGEIIIBER,2003 NGDO partner: SIGHT SAVERS INTERNATIONAL hltt,Dttoq Lrq- 11.o 7 \ ANNUAL PROJECT TECHNICAL REPORT TO TECHNTCAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read thls report by slgnlng ln the appropriate space. OFFICERS to sign the rcPort: Country : NIGERIA/LIBERIA National Coordinator Signature: ...... ]:-:, Date: E This report has been prepared by: MR.YEMIAJAYI. Designation: Signature: DAIE ...6TH DECEMBER,2OO3. STATE COORDINATOR. A49+v Oate: ....1 ', .. I , ZonalOncho Coordinator Name: )s{1|... \ILi i rl.. .=t-7t- /1.'i i i Name: D' |,t': -)17' i G^ 2-o> ,\ rtt 'C)3 ANNUAL PROJECT TECHNIGAL REPORT Tr:r ?-,^! ta 31.^ ,i , ,-al ta! !t ? n ?tt ,- aAl tl t!7?-F t-F^\! trUnlItUAL U\J!\DLrL tra I IVE tsL,rlVtlVtt I I trtr t I \l|v, ENDORSE[IiENT Piease confirm you have reaci this report by signing in the appropriate space. AFF'A'IA t =urrruEKD ro srgn rne rePoft: Country : NiGERimLiBERiA NationalCoorclrnator Name Signature: . Date: Zonal Oncho Coorciinator Name: ...DR. yEMi FAyOMi Signature: . IJATE This report has been prepai'ed by: MR.YEivtl AJAYI Designation: Signature: Date ...6TH DECEMBER,2oo3. STATE COORD!!!,ATOR Table of contents ACRONYMSV DEFINITIONS VI FOLLOW UP ON TCC RECOMMENDATIONS i EXECUTIVE SUMMARY 2 SECTION 1. BACKGROUND INFORMATION 3 i.i. GrrueRRlrNFoRMATroN. i.i.i. Descripiion oi the project (brteiry) ........ i. 1 .2. Paftnership....... 1.2, POPUI-EION AND HCNITH SYSTEM IFI t- I -'AI T AF AA-I5trU i tuN z. irviFltrMtrl\ I A I r(Jt\ rJr uu l I o 2.1. PrRroo oF AcrvrrEs.............. 2.2. ORoERtrue, sroRAGE AND DELtvERy oF tvERMEclN 2.3. AovocncvRruo SeNstrzATroN...... 2,4, MoBILIZAT|ON AND HEALTH EDUCATION OF AT RiSK COMfuIUNITIES. 2.3. UOMMUNIIIES INVULVET\IbNI !N DEUISITJN-T,*.4AKING.... 2.6. CRpRow BUrLDrNG.... ..3 ..J ..4 ..6 rZ ii 13 4.)l\, ttl 18 1C'tL)2.6.1. Training. 2.6.2. Lqupmeni anci numan resou,'ces. ........ /,2, Coruotrtoru oF THE EeutpMENT * Pretse srATE.... ...................22 ^ - T^-.-. ^EZ. l. lKEAlMENlb....... .... z\) '^t 7 i Trooimani finnroo 1Ef.i-i. ttg(zitttviia irvurgo ............Le 2 i '1 i ronri rti iraairrta.rri arntotrarnoni irratrt i :t , i i rrrr1ta/:f ,ncqnlr(\n fO TnC euffen! year....... JZ 2.8 Supgnvtsrol.t...... .........34 Dtr,I.J I IL'IY J: DUTTL,r( I I L' tJI.J I I JO 3.1. Fnierucnt ooNTRTBUTToNS oF THE pARTNERS AND coMMUNtTES 3.2. OrnER FoRMS oF CoMMUNITY SUPPORT............... 3.3. ExprnorruRE pERAcTrvrry.... 36 37 37I I 4: SUSTAINABILITY OF CDTI 38 4.'1. irureRlreu TNDEpENDENT pARTIctPAToRY MoNlroRtNg; EvaluerloN.........."... 4.2. Coullutttw sELF-MoNtroRtNG AND SrRrEnomERS MEETING.............. 4.3. SusrnrNRetury oF pRoJEcrs: pr-AN AND sET TARGETs (unruoeronv nr Yn 3) 4.4. irurrcRRToN.............. 4.5 OPERATIoNAL RESEARCH SECTION 5: STRENGTHS, WEAKNESSES AND CHALLENGES 43 38 40 4U 41 42 Definitions il) Totai lation: the total pooulation living in meso/hyoer-endemic communities within the project area (based on REMO and census taking). ( ii) Eliqible oopulation: calculated as 84o/o of the total population in meso/hyper-endemic communities in the projeet area (iii) Annual Treatment Obiective: (ATO): the estimated number of persons living in meso/hyper-endemie 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/hyBer endemie areas within the project area, ultimately to be reached when the project has reached full geographic coverage (normally the project should be expected to reach the UTG at the end of the 3d year of the project). (v) Therapeutie coveraqe: number of oeople treated in a given year over the total population (this should be expressed as a percentage). (vi) Geoqraphicalcoveraqe: number of communities treated in a given year over the total number of meso/hyper-endemie eommunities as identified by REMO in the project area (this should be expressed as a percentage). UC AI-UU AIIJ AIIIJ CDTi l.-DlVl ut-t5 LGA Htt DD Airican Programme for Onchocerciasis Control A _-- --t T-- -a-- - -r AL: - -l:- .-Anrluai r reauileill \,ruJeuuvE Annuai Training Objectlve Commu nity-Baseci Organization Commu nity-Directeci Distributor Community-Directeci Treatment with lvermectin ---:! - A-ra t a---:r--:.- -.tJOt I lI I lU I lll.y Dell -lvlLltll[O{ lllg uls[rlcr Heartn Supervlsor Local Govemment Area Locai Ctnchocerciasis Controi Team Ministry of Heaith Non-Governmental Development Organization Non-Governmental Organization l.lational Onchocerciasis Task Force Primary health cale Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event 6a-t--L-ll--- ----a'L\Ia Ken oioers n-leeiln g State Onchocerciasis Control Team Sight Savers internationai ?- -L-:--l .tl-l:..^ n ---.^-:4-- /AnA --:--a:l:- -J-,:----r tsri!rilrcat uuilttuttauvE lJuilililtttt E (Arter\/ sutEltUilu auvltiuly group) Trainer of trainers 1t--:a_ _t tt_a:_-__ At_:t_t.-_-_t_ F.--__tunlteu r\auons urillureil s t-u!!u Ultimate Treatment Goal Vvbrla Heaith Organization TI r\r. tutoH DOll/11I\J rHU I\IJL' I\I\J I T REiviO S,qE At tl I u\!-llV! enr-T IUU -r OT I tl ttAFrUl\lt/tr1- UTG trlrHt r I I I Acronyms FOLLOI'J UP ON TCC RECOIUIiIENDATIONS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed TCC session _17_ Number of Recommendation in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY 257 TCC accepted the report and recommended that APOC reactivate funding to the project A letter was submitted to APOC through NOCP on 1lh November,2003 through an e-mail requesting immediate reactivation of funding and forwarding of the approved budget for year S(Sept. 2003- Aug.20M). WHO/APOC. 26 September 2003 Executive Summary community Directed Treatment with lvermectin (cDTl) is being implemented in all the 16 LGAs for the fourth round in Kwara State' The projected population (1991 census) is 2.5 million people. This is made up of five main ethnic groups namely, Yoruba, Nupe, Baruba, Hausa/Fulani and Bartonun' The main occupation of the people is farming, fishing and trading. population movements occuned mainly during Christian and Moslem festivals/ and school holidays. At this period most people travel to their villages from their urban locations. Training and re-training of both old and new socTs/LocTs and cDDs continued' Altogether, 130 LOCTs and additional 105 health workers were trained. The SOCTs and a staff of Sight Savers lnternational (SSl) facilitated the training' Also, 2129 CDDs of the expected 2100 CDD5 were trained by the LOCTs and supervised by the SOCTs in their various communities. Forty-eight selected traditional leaders from highly endemic LGAS were trained on all aspects of CDTI but with emphasis laid on community participation, ownership of the program and on the roles of the communities vis-a -vis selection and motivation of CDDs' 166 primary school teachers uere also trained to assist in communi$ mobilization and education and monitoring of all CDTI activities in their various locations- And to f train and educate their pupils on CDTI so as to assist community mobilization. An intensive community mobilization was canied out which ensured that all endemic communities were treated and adequate number of CDDs selected. Community mobilization was complimented with airing of CDTI radio jingles in the flve main languages sPoken in the State- Although the ratio of CDD to community is fairly good, the challenges still remained as the ratio varied from one community to another while some communities have adequate numbers a host of others still make do with inadequate number of CDDs as a result of the communities unwillingness to provide incentives. A total of 724,gO3 persons out of the total population of 818,989 persons registered in 1069 meso/hyper endemic communities were treated in year 2002. And the ATO for the year was 687,951. A therapeutic coverage of 88.3olo and a geographic coverage of 100% were achieved. The UTG for the year was 687,951' 2 WHO/APOC, 26 SePtemb€r 2003 SECTION 1: Background intormation 1.1. Generat information 1,1.1. Dese riBtion of the proleet (briefly) Kwara State was created in 1967. lt is located in the middle belt zone of Nigeria lt has 16 administrative local government areas(l GAs) namely: Asa, Baruten ,Edu, Ekiti, lfelodun, llorin East, llorin West, llorin SOUTH, lrepoclrrn, lsin, Kaiama, Moro, Okeero, Offa, C)yrtn ancl Patigi Fach l.GA is divided into 3-9 districB. The State capital llorin is 306 kms. North of Lagos and 594 kms. South of Ahuja the Fecleral capital of Nigeria lt is located on latitucle 8o and 10o 31' North and longitude 20 45' to 60 10' Fast. The state has an area of 32,500 sq.kms. lt shares an international boundary with the Repuhlic of Benin to the West, and boundaries with fre other states, Oyo, Osun and Ekiti to the South, Kogi to the East and Niger to the North. The projected poprrlation of the stat-e is 2 5 million people (1991census). Kwara State is an entity with unique culturaldiversity. This is manifested in the ethnic composition of allthe sixteen local government areas And the major ethnic groups are namely Yoruba, Nupe, Hausa/Fulani and Baruba. There are variorrs trarlitionalfestivals held in the State Some festivals are religious, ritttal or social. The people are predominantly farmers. Farming is carried out during the raining season (March t-o Novemtrer) anrJ in the dry season (Decemher to Fehntary). Fishing activities are at the peak in the latter p,rcriod Most communities have community health centers and other development/social amenities like dispensaries, schools and commttnity halls Kwara State is well linked by a good network of roads with five States. All the headquarters of the local government areas are well conneelecl with all season roads. Most of the inter communi$ roads are very accessible through out the year except those of Baruten, Kaiama ,Moro, Asa, Fdrr and Patigi local government areas which are often impassahle eluring the rains 3 WHO/APOC, 26 September 2ClCl3 1.1.2. Partnership The partners that are actively involved in CDTI activities in the state incltde Ministry of Health, allthe 16 localgovernments, 1069 endemic communities, the CBOlDe.velopment associations and Sight Savers lnternational and APOC. At the State le-vel, the MOH is re-sponsihle for the provision of office accommodation and the well trained staff (-SOCT) that is involved in the implementation of all CDTI activities and coordinates same throt.tghottt the stat-e All the salaries and emoluments of these persons who put in between 15% to 50% of their time for the execution of the project are paid by the government. . The ministry has also been involved in advocacy and mobilizes support for the project at the LGA levels. The communities have been very receptive to the drug. Majority of the communities while acknowledging the importance of the drug, still believe that government should do more by assisting the CDDs Most of these communities provide their CDDs and ensure they cater tor them either in cash or kind. They also provide height measuring devises and in some cases community registers The NGDO supervising the project in the State is Sight Savers lnternational and has been regularly involved in aspects of project implementation namely training, planning, monitoring and supervision, supply of Mectizan@ and other materials. The organization has also been actively involved in carrying out advocacy and mobilizing support for the project at all levels in the state. The working relationship among the partners has been very cordial and beneficial. 4 WHO/APOC, 26 September 2003 The local councils are regularly mobilized because of the instability in the councils. 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Ordering, storage and deliver.v of ivemeetin Mectizan@ ordered/applied for by - (please tick the appropriate answer) EIOHN WHO D UNICEF D NGDO**** f] Other (please specify) iicetizan@ delivererl hy - (,olea-se fick the appropn'afe answerf iTOH fI WHO tr UNICEF f] NGDO****** EI Other (please sBeerfy) Please describe how Mectizan@ is ordered and how it gets to the communities ReBorts o,f Meetiza@ treatment are eompiled by eaeh LGA eoordinator and sutrmitted to the State eoordtnator ln eaeh of the LGA reports the quantitie-s of Mectizan@ requir-ed by e-aeh eommunity for the follo-wing year in the tGA are indieated This information is compiled as State report and the reqttestforuvardecl to Sight Savers lnternational supervising the pro-Jeet in the State. NOCP sends +Jre order for tvermectin from lt4ectlzan Donation Committee in Paris. The drugs arrive at the port (airport) in tagos and eleared bry UNle EF Nigeria in Lagos and stored in the UNICEF offiee From there, NOCP Nigeria eollec-ts the drugs, informs NGDOs to eollect their eonslgnment and Zonal Offiees also go to tagos to collect eonsignmenh for UNleEF assisted States The States get drugs from the NGDOs and Zonal O- ffiees respectively and from the States, drugs are delivered to the tGAs by the State's eoordinators beeause of the dis-tanees of the tGAs to the State's Headquartes. The drugs are also sent to First -tine Health Faeilities by the LGA Coordinators with motoreyeles, and from First-tine Health Faeilities, the eDDs then eome to eollect drugs for their respective eommunities. Also in many instances, drugs are given to CDDs during training of the CDDs to facilitate the distribution avaraiea94Vt Vtgg. It WHO/APC(-. 26 Sentember 2003 Table 3: Mectiza@ Inventory (Please acld more rows if nece,ssary) The health care personnel in the project area carried out the following activities: o Assist in training of eDDs . Assist in community mobilization c Attenel to minor reaetions that are reported in their clinic-s o Monitor anel supervise the distribution of Meetizan@ NOTE: The remaining drugs are collected by the District Supervisors and returned to the LGA eoordinator along with the reports. These form part of the stoek for the following year distribution. State/DistricU LGA Number of Mectizan"' tablets RequesEd by LGAs Received by Gomm. Used LosU Returned YYaste Expircd ASA 1 19000 11 8975 1 18975 0 0 0 BARUTEN 250000 247',|14 243100 4014 0 0 EDU 150000 148803 148726 77 0 0 EKITI 50000 50000 45159 4841 0 0 IFELODUN 121000 120793 108/.23 12370 0 0 IL-EAST 121000 120800 108603 12197 0 0 IL.WEST 120000 107623 107084 539 0 0 IL-SOUTH 105000 74089 67351 6738 0 0 IREPODUN 150000 142125 140441 1684 0 0 ISIN 90000 87365 87290 75 0 0 KAIAMA 1 15000 111497 104102 7395 0 0 MORO 220000 216100 203403 12697 0 0 OFFA 150000 147876 147870 6 0 0 OKE-ERO 55000 52650 523il 296 0 0 OYUN 1 15000 1 1 1358 103565 7793 0 0 PATIGI 100000 97449 89817 7632 0 0 TOTAL 2,031,000 1,gil,617 1,876,263 783il 0 0 t2 WHO/APOC, 26 September 2003 2.3. Advocacy and Sensitization Allthe 16 tGA Transitional ehairmen and their eouneils were mobilized dLrring the period under reference. The reason for this continuous sensitization was because the LGAs have not been able to pay counterpart fund to the projec-t The LOeTs in most LGAs have also been finding it difficult to pefform their roles due to non - availability of fund. Henee there is the need to meet with the poliey makers to assist the LOCTS. The outeome of this exereise did not yield the required result but promise-s that as soon as the allocation of funds to the LGAS improved the counterpart fund would be paid. The difficulties/constraints being faced are instability of the local councils/high tum over rate v,,hich necessitated the continuous sensitization. Ho'+rever this rnould improve as soon as new eouncils are elected. 2.4. ilobilization and health education of at risk communities LOCTs and the CDDE eanied out the major part of communiS mobilization and health education. This task was devolved to the LGAs as part of the sustainability strategy However, the SOeTs also assisted in mobilization of some targeted communities that were identified to have low treatment coverage and where commrrnities do not sr-rppoft the eDDs. Community mobilization was complinrented with airing of CDTI jingles on Radio in the five languages spoken in the State. This assisted in reaehing out to all at risk communities. During community mobilization, representatives of allsegments of the population were mobiltzed by the village heads to partieipate at the health edueation meetings. The .response of women ancl minorities, for example the nomaclic Frrlanis have tteen good. Even in areas that are typically Moslem dominated, the women responded positively to the eommunity mobilization At any gathering betrryeen 1G30o1o of the population were women. The major aehievement of this mobifization is the 100% geographieal eo-verage of the target communities. Although the CDDS /LOCTs are supposed to be responsible for mobilization of communlties, the invoVement of the SOCTs made it to be more effective. Their participation ensured that alltarget communities were visited. And henee there was a hish therapeutie eoveraqe. I2 WHO/APOC, 26 September 2003 The major weakness or constraint is the failure of LGAs to provide necessary counter part firnds to the tOCTs for mobilization, ln order to improve mobilization and make it more effective and regular, more basic health faeilig workec and primary sehoolteaehers would be trained and get involved in CDTI activities. All stakeholderc would be involved in eommuni$ mobilization. This would be done through letters to all churches and mosques in the target communities informing them on the need for their memberc to pa-dieipate in eDTl projeet L4 WHr)/A.PC!C- 26 Sentember 2[r-13 lu!, o oj c , 6'o = o o 3o 3' EL ogg o I =!,4 , GI t-{ l0)l6 lols oo 3 3C) =oU' Eg) e 9.Eo af,of =) o o o{ t o o)(r, o o) o. a.lo (D d 6 5ooo C,,6 o)3 (.^ { \J o ; o\ ao =to d tn t) lJ) EIz a m -t oECz rlll CN oC{ - FI = m @+ I m U) TI m ooCz m E -.t moC tp nC mz a P=1d .Ert= t1;3rrFli to 6'p Jo @ I J I(,l N(,l o o) N(, JI ==-8i,s=3 =BgE =is s .E (rl(Jl (rto) (,ts {E IJ5 (r) J o cr! (oo @J gtQr8r3B -o=r3=33Fi' -E zro o olol 3l3lE5 ao a tlCIoa =. (l o 3 3 3o: E6 e Do oEta 2 6' o o CJ 5 o oo o) G) (,) (, C' Eis?Hi?* 9) @ f.lN Io Po Io s,|N) !oO) I\){ !,G) N(l, -o o- o0 E'C zlEI 3lEIolal sl o E, -o =o5: <crt= o o I3 =E3 o(o EI @(Jl l\)No {N Aoo Jo('l N o)o 5(rl I(,ro t\)oo J{S t8z oElSBOETIa=,r -4^dgtt zl cl 3lEio a o o 3 3c , it(, =l(o oo{ , oJ I o o E,oa !o oo =ooo {l ol +l r t -{ 0 o Cz ox mI mv o ol -nl 'Til oa o Bl N(,(,l J (.r) O) 5 { 5 Jo O)(o @{ (rl I{ so) A (rlo s@ o (,l s o { o I(rl Io !o@ N)s,,(rt Io 9)(r) Io N oo N N(o (o CO I\)N{ so) @(rl @@ ! o) z o{ II| t+ -t =o o 0) q) o = =oo =U' q) _+ o 3 A) 6' oooo =') o o)f. 6 t, .9. oo o 6 o) (t,) o o) g= o)o o o(t, q) ) o +. 3o o) -@' aoEo =ofo o o) o1 a 6- q) = ='o 3 0)d o = =o A' o ,ooo @oo a o a ,o oq) oC6 6' =o =o q) =.oC @ Eo aclo =q)(o oa rdEs$ P d?6 e Fl *Hf g EHiilfl t=EE-3 OE C q O H?+*B' dd a cn =9ilq = = 5 =HgB.qH$e= ?a E c5 =g'eEeHso)O.:' -)ia -q 6' P E #E a a $ fi il il g a,e; agN='ilti=roqrcoe(ooilirfi |r^ r E6' E <..P Eq.EE9..=8q6= Jg&E E fr d; -s 8.oit'a ==q,d.e3_ \ \ fr u ':U .t E ; o\(u (DE tD d(a tJ 8(JJ 2.6. Gapaeity building 2=6.1. Training Training and re-training of both old and new SOeTs/LOeTs and eDDs eontinued. Altogether, 142 (SOeTs/LOeTs) and additiona! 105 health eenter staff were trained to earry out supervision and monitoring of CDTI aetivities in their areas using the supervisory check list. This training was facilitated by a staff of Sight Savers lnternation al. 2129 CDDs were also trained by the LOCTs and were supervised by fha Q6l^Tcta l9 vvv a 9. Forty-eight selected traditional rulers from highly endemic communities were trained with emphasis laid on communig participation, supervision and monitoring of CDTI activities in their various communities, and motivation of the CDDs in cash or kind. The need for communities to be involved in self monitoring of CDTI project was emphasized so as to ensure that CDDs perform their duties as should tte done. As a way to increase the awareness of CDTI among all segments of the community, 166 primary school teachers in-eharge of health were trained on eDTl. This is to ensure that primary sehool pupils are edueated on CDTI. These pupils would in tum help in spreading the message of CDTI to their parents thus assisting in communi$ mobilization. t'7 WHOiAPOC, 26 September 2003 o .TI .1'l =ov o x az n m1' ooCz -Io oC - FI € mg) -{ F I m @I Tl mr og Cz mx{ moC E vC{ mz a, o o o o o) o CD { o o o @ Jo (, Ao Jo) { a zE ETo o +E'E.g ooo. 6' o (t, lt o (., G' o) Ol gr o ot gr @ (J s \ o) s -o s s @ o) N @ s s @ o) s o l\) (r) (rl A o) Ao (o s -- o) (r) s \t zo E Io+ -{o !T @ \t o) o) o o) (.r) { J(,l (rl o) Jo s a =o{ Io+ { o sr zc) ETo 3lo ot- -o4!lql= rDCl6-(D3 (D !, o6 o o G' Jo Jo Jo Jo Jo Jo) Ao Jo o Ao -.16 t= Eil q9 ETilc Bg ffifide. o o o G' o Jo G' G' Ao Jo Jo Jo o Io Jo o Ao Jo o o Jo o o o) o J O) Jo o Jo Jo o o o o o Jo o o =o = Io+ g nl {@ q, oo {G' @(rl N)No {N Aoo Jo(rt N o,o s(Jl A(,lo Noo J{5 a =(D{ )o+ -{o o, z 3 ETo o o tr,oo E o CL@(,l J@o { CJ @(Jl {N)NI\)o Aoo Jo(Jl N o)o s(,l -(,lo N)oo J{s l-{ l0)lu lo lotI a A) =' ='(o o)+ 5 o o o o3 o o6 o ooi =E.o 3o =o *.o)t(T' 0) C" o a) o_a i{ ed d €(rt f,ooot,bo3 a { o x 5 ; o\ aoE 63 d(t I t)I o :sl o =o o 3o = o c,s { o{ t- 1l 0 o Cz ox mI mv o (.,o { { c') o){ o)G' (,o 5 (., { Or N { N 5 o) s o =o o o5 a; -aG' Cll o) (o (,l s o =o o:' o j oos o, o) o o o (r) o) c) o)(r) * * o o Io Io o Jo Io o Jo s o =o oJo = N oo I\) I N(o (o(o @@ NNo N) N){ s o) s o, + =o € To a \r oo ol o o) 5 oUI ol 'lEI ol ao o oof(u U1Eo5 o- Q o o o :<- o,xo (n d Jo o d q 5o aocU iD oo s =-(a :t *{ =a' 6' +) o =a * 3o o A'ofo a €ocd oo ag. fo CL of oU+ 0)f o- fo o o oxEoo o o- o o-c!l c,g) o f,o Ef ='(o =. =f J 9. ro U' \ \(} { o t ; 0o t) 3do 1..) (j) Table 6: Type of training undertaken (Tick the Doxe.s where.specrfic training was carriecl out during the reBorting neriodlr-"- --, Any other eommenb Trainees Type of trainirg CDDs Other Community members e.g Community supeMsors Health Workers (ffontline health hcilities) MOH staff or Other Polilical Leaders Others(specify) Program management noofix x)ffixx xno(x How to conduct Health education xno(xxm( xnnxxil nofixxn x)ofrxxx Management of SAEs x)ofixxc x)mfircc( CSM xxnxx xnfixxx SHM nm(x nmfi x)ofix Data collection xno(xxxp( xxuxx)oofi xmxxx Data analysis xnofixmx xmfinm( Report writing xrcofix xxpux)o( xmfixxx Others (specify) fa WHO/A-POC- 26 Seotember 2003 Source Type of equipment APOC MOH DISTRICT/ LGA NGDO Others Condition of the equipment * Please state 1. Vehicle 2 Functional 2 Non functional but repairable 2- Motor cycle" 16 Funclional 13 Functional &3non functional but repairable 3. Computers 1 Functional 4. Printers I Functional 5. Fax Machines None 6. Others a)Air conditioner 1 Faulty but repairable b)Photo copier 1 Currently non- functional but 2.6.2. Equipment and human rcsourccs Table 7: Status of equipment (Plea-se aelcl more rows if nece-s.saryJ vl Lr WIIO/APOC, 26 September 2003 repairable c)TV/ VCR 1 Functional *Condition of the equipment (Fu nctional, Currently non-functional but repairable, Written off). * Three (3) NGDO iiOTORGYCIES in llorin South,lrepodun and lsin LGAs are non- functional but repairable. The LGAs have been advised to repair the motorcycles [refore the next distri[rution. Request for assistance for the repair would also be forwarded to the NGDO supervising the project in the State. The project intends to intensify advocaey at all levels of govemment to ensure that counterpart fund is paid. And also that adequate budgetary provision is made for the control of onchocerciasis in the State. Once this is made available by government, the maintenance and replacement of equipment rnrould be possible from these provisions. The State government also has been adequately informed on the need to purchase new vehicles for the program. The assistance of the NGDO partner in this regard would continue to be requested for. MANPOWER o There is adequate and knowledgeable manpower at all levels of CDTI implementation. At the community level, majority of the 2129 trained CDDs are literate enough to complete all the necessary forms. The primary school teachers in the communities are also available to assist in the project implementation. Presently, 166 primary school teachers have been trained on CDTI. . The 235 well trained health personnel in the local governments form the core team of LOCTs and the District supervisors that are directty invotved in CDTI activities. . The 16 members of the SOCT are very experienced, adequate and knowledgeable in allaspects of projeet implemention. The project has not experienced frequent transfers of staff involved in CDTI at both the tGAs and the State. However to forestallthis situation happening the projeet trained many health facility staff within each LGA who would be able to carry on projeet aetivities in case of any transfer. Advisory letters were also written to the Bureau of Localgovernment intimating the authorities of the impoftance of CDTI and the need to limit the transfer of all o-ffieers involved in the projeet to barest minimum. And this has helped in reducing transfers of these categories of staff. .% wHo/APoc, 26 Sept-embr 2oo3 ZL And also, since all the LGAs are endemic for onchocerciasis when such transfer occurred, the staff so transferred have been found to continue to work on CDTI in the new plaee of posting lt L3 WHO/APOC, 26 September 2C103 t, a TralfmanfcL.a. a lVgtaaaVarw 2.7 .1 = Treatment figures LGA TOT.POPUL. ELIG.POPUL. PERS.TREATED DRUGS USED ASA 48494 42700 42675 1 18975 BARUTEN 105788 92193 90960 243100 EDU 74667 65696 65483 148726 EKITI 26255 22895 16597 45159 IFELODUN 48773 44139 41020 108/23 IL-EAST 46196 43855 43609 108603 IL-WEST 2533/ 23915 23785 10708/. IL-SOUTH 36323 34190 33836 67351 IREPODUN 50304 48257 47026 1404r'.1 ISIN 37618 3/,497 33759 87290 KAIAMA 51750 46791 46634 104102 MORO 78458 74861 74350 203403 OFFA 68916 617il 60761 147870 OKE-ERO 27561 25558 18768 523il OYUN 52483 50336 50140 103565 PATIGI 42069 38465 35400 89817 TOTAL 818,989 750102 724803 1,976,263 rs L/, WHO/APOC, 26 Sepember 2003 6 d x E U,I z vl m 1looCz rla oc{T E m U'{ =m ct) --{ n mroocz m E{ moC (D v 5 mz U' -o54>d (,o t (,(rl E g -l$ s (,) o@ I @ H$$-E+$ oo 3 3 L = iD' aa a:6(ct o CI' olo t otor s s {$ $ (,) o@ I @ oi-sq{g3= z'o o,ol oo t (rrol s s {t s (, o@ I @ +-g€863*d€=.q*.,fr'e oo oo oo oo oo oo oo o6 oo oo oo oo _o nB -7(os0 il -oip.(o 2.o8 -{ cos C'I@ (rt -.1 Olo (, -.t CD @ (toooI od)(l)N(l) N Ot(,(,5 5(D @(D ! Co -.I -l(r) NoN otu {5 CD o) -.t o ot{ E &5 aOA t$-E* !oEcE 6' = o)NI(rl 5I{o (r) o)oo !NN(, o) (, o or N N N@ Boo(,l !o(o{o NNo(n(, oN{N cocoEN 5o{ o)(.,r €d+o== =d6OI -t5(.,(,o ! o) o)(,$ G)(,{(,l(o A -.1oN(r, o)(,o(/) o, N(,\t @(,r !(,(Do @ 5 oNo (D(,(O -.1 (n(,5 co(,) (a)o Eo 5No{ ol *Er =dE=ll,U'dsEd0ic; E{ 66. @!o{ (,s,5 (osi (o!,o@ (()Ai., B o)!, @J{ @!,l@ @Po o{3HE llto(oEo= (/) C'I 5o o NN\t @ @ oI Go@ G)N@ IOl @N o -Z&=9rH=ro66gq =s(r, N(D o) { {(, @(o{ o o ool N(,No tA6, {5 ooN (I H<(D=5('dEEe. az a*, EA E 4EBoeBfr=1gdaE*nHB t=d q t-{ llr)lo lo lo 1 o o) 3o J q, f o. U) m clt u o ct' =.o o =!L o o o)U' q) + =.axt 6- o) c, o q) a. a. 3o d d EU' -if, ooo C,, C,, 0)3 \ \\ \r'1 ui a P LJo ; o\ a a!! o d ta tu (f) {l 9l 1ri >l -{ 0 o cz ox m mno o -Tt 1I oo ro @ -l (rl { !d) oo@ @{ Ol -.1 AO) o o)(o @ -.1 (rl { Ad, oo oo oo oo oo @N -o(o @(o 5NI(o or 5 @ o) N{G o) O)o @ o) ao E(/) (,(, (l)q)o to@ O) N(, otN o o) N o {N -5@oq) (,(,!oo (,o so o\.I o) @ o,o -l CD o 60 i\) B (o lrt ol (D6b @ 9o I -.t 5 (., @ o Noqt o o)@5 -.t @ E (o o) (, qr o { o)(o lzlo rq J N@ 3f o - oq) o 6'a v, Eg. f a{o =f -(o o =5'(o €o o doo -o- oP -{J U' od a o ='oeo !)) =o U'E o N 0) =of -.1 =oao:(, --d o o\e 6' oo o q)(o o o) o o oo(o q, >RE 6' o) oo o 6(o o q) o o ood6 o(o o o) o rt rt s C o 0)o =iD' o CL !+ r| 3|ilol5 8lP 6o il @P(,l lllo = lo) Hle lllo lo Itoo BIH -N lo(o lo)(,l lxrl- loloIoi l{ lN)o) la@l@{loto lo)(,l lxrL lolo il Jo srt J \ 0() \ o .Y E ; o, t,aE o q t,.) UJ ltltI =.Loci E.n EF \oo6ss s o e.I 3ro o ! o D oIto Ia S So v, o > Eo ToI a.o 3 o o;It UI s o oU =E E.oo S. o5atn o ilo E o -\S oo S ilg;Id Itaaos ililsqcrX" d { t(DS E-\SiE E3s*oo(DE(a\ .aeq s$E3FSBlorooOrlETgt 8s\ clSooEIt.s EEs-l E$ =o EB\.€ o*rrsto =. -{olg{ =oqE HA.rI $$ a.ai B* - - _S Rdo -f\o -lo E -='l+&{ -t =eilqPd ohtglfiie o(,C$3dFilg^ oo=3o =o =ort:o'ut@Af\ooo\ E38d f1rd9(o q)9; E€EBq'!1(ooO= @=gt ,6- E)o ol= 3E(Dr'(r, oCf =ooq3 =6'Oo o-' I €= o-)o= )Jgt =. u,)o- eE =OE55--oo- =od8gE =o)o loo o- o \. N o x E ; o\ U)(D a d(D t\) r! 2.7.1 The project has achieved 100% geographical coverage and at least 63-2% therapeutie coverage in low treatment tGA. 2.7.2 The following are the likely causes of absenteeism o Poor.eommunity census resulting in some people being registered in absentia in some communities. And during distribution these people were counted as absentees. This is the situation in those LGAs with high number of absentees. . Distribution was often extending to period of farming season when most people stay in their farms and therefore missing treatment. Often when these people return home, the CDDs normally failed to re-visit such homes and carry out mop up treatment to reeluee the nttmtrer of attsentees. . Migration to other to-wns partieularly for trading and eash erop farmtng. 2.7.3. Briefly describe all known and verified serious adverse events (SAEs) and proviele in table .9 the required information when available. 21 .4. In ease the project has no ease o-f serious adverse event (SAE) during this reporting period, please tick No case to report **** p u wtlO/APrf lO Amil ?tn? a z + (o o aox q: F =(oo o 5FE .ilq.6 o)Nxo)O3 * - i FH 4-ao_r a 3E' 3 U' $3$H+ d8.P9=e =o+@-Yo,oQ.f sa^aE =lJidqilBe o, o, = v\(D t2 L cD o o(o u, o soo 3o o a.QmP3dfg=8q*da9o4 C": oootxJcrdo o- E o(cI =o at,(t, 33t r5-'d +a o l-{ lo)IU lo lco ; o)ooa o ao -.oC(n A) o- o do o oa U' U) m U' =o) oooc a o o- o-c =. =(o =o -oEo+ 5'(o !oa6' o-t 6-o U, o o)a o- 3o d d € U' aooo ct, CI' o s. o 8 _ 'EtI ; u) N\,tl) r+ : 35o Eq) o-5+ "lzzloo l-{ EIM a. oEa q) o_ o ao c)g) U'o o oE o + E\ { o itr 8 ; O,(, fD o .D N) u) !.1{ i"{!o =o. o o 0, E}3 o =q, o 6' o 3 o ao 3 ooJ !, a oo =o o!, r!: ot o o o - a = o 0l - l-.1 lo)IU lol-lo{aoq) 3of+a o)f o- oo o q)(o o IU[< lo lq)lol:,lo- lo)l- oo -+oa f o o * o !, o oo D oo Eoo u,o S ota s o a. ao €L hr\s a x H ; o\ ao 'd a H o N) <) N)oo5 N)oo(.r) NooN N)oo Nooo (o(o(o J(o(o @ + J(o @{ * m v o o)(o Jo o)(o Jo o)(o Ao o)(o Jo o)(o Jo o)(o q5 8 sg$=# fiE*gH c,o 3 3cf4o at, a: o(o (D att o o)(o o O)(o Io o,(o o O)(o @(rt o) @(rl O) E3e(Df Jo o)(o (o CDN o o)(o Jo o){ {s(o N{(,r o EB z E-a=q3E'E 5 Eo= oIo @ so(o JoIo (o{b @ >l(rl N sI{ ooo(o o,E J 6' o_ oo \oo o(o o IoIo ct, so(o IoPo (o :'to @ >t(,l G) !u oo >Pa-{ =E o o oNo(o @(o \to o)@@ @ {(o (o(..) @ o)(rt @@ I(D s o) o)@{(o J N J(r)(o5 .,A E o)fqo-J E $E r ts= &6'6 q T !o!,c !) =.o) o)q){(o(,l J (,l o,(rl(,l Io o)(r) Cr)(Jl(rt o (rl N){o(,lo (,s{ Jo(r) (o{j I(rl -.1 E+= ='o sL(Dl \t N)s@o(rt (,l(o o) O)(rl G) {ooooN (,l o) I o)(,lo c0 J o) o){ N) Jo(.r)(,l{ G) z dE=tD6s;3 @ 90N @Is @ 90(.r) o frt N) { Iu(o @ srt(}) 6;{9dsE6'dciE(oo(Dc o srt I (os\ A IIs Jo 9)(rl (o J irJ Jo 9) o) o s$:i(o o Jo $rt J ooL Ao srtl\) Jo J 5 o 9,o Jo J t, o8oE; No Jo Noo(o Noo@ Noo{ Noo o) Noo(,r * J J(o(o{ o =o- I(o(o @ Jo @ o o{o(t,) o j Eit 3of *. :f(cI oI{ { =it o :f @ o f o I o, o ct, €o o =' Eit 3of =.(o oo -{ ='J(o(o so $x, o 'U 8 ; o\ U) tn 6 3do4 t..) 8(]) 2.E. Supenrision 2.8.1. Supervision hierarchy flow chart. 2.8.2. a o a a a The main issues identified during supervision were:- Poor record keeping (only eligible persons registered in some places) Lack of counter part fund at all levels CDD incentives Register not kept with the community head but with CDDs Complaint of mild reactions such as swelling of limbs, itching and skin rashes which make some not wanting to take the drug. Inadequate supervision and monitoring by LOCTs due to lack of logistics U nder treatmenUmissed commun ities. High rate of absenteeism and refusals in some communities. Lack of standard community registers in some communities Broken down motorcycles in some LGAs Delay in distribution due to Ramadan fast a a a a a a 733 SSI SOCTs LOCTs DHS TRADITIONAL RTIT FRS CDDs WHOiAPOC, l0 April2003 2.8.3. Was supervision checklist used? Yes. 2.8.4 o a a a a The outcomes at each levelof CDTI implementation supervised ldentified communities with poor records were corrected and CDDs mandated to update such records. Advocacy carried out to solicit support for the CDDs in terms of community contribution towards providing incentives for the CDDs LOCTs directed to ensure that the CDDs carry out mop up treatment in areas of loWunder treatment of the population and Carry out mass treatment of missed out communities. CDDs were also directed to re-visit all households that were not met at home during their first visit to ensure that the rate of absentees was reduced drastically. 2.8.5. Was feed-back given to the supervised, and how was the feedback used in improving the overall performance of the project Feed back was given to the supervised and this has helped in the coverage as reflected in the total population treated (724,803) when compared to the treatment coverage of the previous year of (596,653). Correction of all identified poor records and advocary to the LGA authorities soliciting support for the repair of the broken down motorcycles. And early distribution of Mectizan@ before the Ramadan fasting and r+assuring of the people on mild reactions. Standard communi$ registers were provided in those communities by the project. 25' 34 WHO/APOC, 26 Sepember 2003 SECTION 3: Support to GDTI 3.1. Financial contributions of the partners and communities Table 11: Financial contributions by all partners for the last three years lf there are problems with release of eounterpart funds, how were they addressed? )d_ 3s Contributor Year 1 (Sep. 99-A ug.'00) Year 2 (Sep.'OG Aug.'01) Year 3 (Sep.'oi- Aua.'02) TOTAL Budgeted (us$) TOTAL Released (us$) TOTAL Budgeted (us$) TOTAL Released (us$) TOTAL Budget ed (us$) TOTAL Releas ed (us$) Ministry of Health (MoH) 6826.00 34800.00 43750. 00 Local NGDO(s) ( if any) NGDO partner(s) 17535.00 17535.00 15835.00 15835.00 203/.3 16 21231 60 DistricULGA 21070.00 21070.00 174,4,00.O 0 1744i00.O 0 218350 .00 218350 .00 Others a) b) c) Communities APOC Trust Fund 92972.OO 15000.00 80360.00 19697.00 30000 00 TOTAL 138,403.00 60,431.00 305,395 00 2M,732. 00 736,63 4.00 313,33 1.60 WHO/APOC, 26 September 2003 The government has not provided any counterpart fund but ensured that all CDTI staff salaries and emoluments are paid. This is the amount indicated under the budget for the MOH and LGAs. The project has also not been able to utilize all the approved ApOC Trust Fund since the inception of the project due to the initial problems of the State Accountant at the early stages of project who found it very difficult to make correct monthly financial returns. Hence there had always been back log of unutilized funds at the close of the project financial year. However, with a new Accountant, this situation has changed and I wish that the State be considered for extension of time for us to utilize all the funds approved for the project. 3.2. Other forms of community support The community in-kind support include:- o Prayers for all the participants who have made it possible for the community to benefit from the laudable program- . provision of snacksffood in some cases during community mobilization o provision of over night accommodation forthe teams during mobilization and health education activities- 3.3. Expenditure Per activitY - lndicate the expenditure on activities below in US dollars using the current United Nations exchange rate to local currency Table 12: lndicate how much the project spent for each activity listed below during the rePorting Period Activity Expenditur e ($ 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 1854.46 APOC 7/r' 36 WHO/APOC, 26 SePtember 2fi)3 Training of health staff at all levels Supervising CDDs and distribution lnternal monitoring of CDTI activities Advocacy visib to health and political authorities IEC materials Summary (reporting) forms for treatment Veh icles/ Motorcycles/ bicycles ma intenance Office Equipment (e.g computers, printers etc) Others 7799.99 5122.34 2123.22 288.20 187.79 APOC APOC APOC APOC APOC/MO H TOTAL 17376.00 Total number of persons treated 724803 The main source of project fund is APOC. The State has however made budgetary provision for CDTI in the next financial year apart from the salaries /emoluments of eDTl personnel and office maintenanee. SECTION 4: Sustainability of CDTI 4.1. lnternal; independent participatory monitoring; Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick where applicable) Year 1 Partic ipatory I ndependent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation X)OOOOO(X lnternal Monitoring by NOTF fi" 3,F nooc()Ofi WHO/APOC, 26 September 2003 Other Evaluation by other partners (SIGHT SAVERS TNTERNATIONAt) 4.1.2 Some of the recomrnendations . Advoeac-y for the sustenanee of the e DT! at State, tGA and eommunity levels. . The eDDs should be re-trained on the imBortanee of aeeurate eommunity census. Skills relating to the condu.et and updating of eommunity figures should be uBgraded during the training. . That LOCTs should pay regular supervisory visits to CDDs especially during eonduct of eommunity census and drug distribution= . Community education should precede each yea/s drug distribution exercise. o Ycuths in schools located in onchoc-orciasis endemic communities should be involved in CDTI activities as peer educators with responsibilities of disseminating factual informalion a[rout CDTI to their peers and families. 4.1.3 a a a a They have been implemented in the following ways Advoeaey visits to the State government were paid by the National Coordinator, NOCP and the Country Representative, Sight Savers lnternational at different times to solieit support for the payment of eounterpart fund by the State government. Training and re-training of eDDs on all aspeets of CDTI was earried out by the LOCTs before distribution and census update. SuBervisory visits were made to communities by the tOeTs. However these were still inadequate because of lack of enough logistic support from the LG,As. Primary school teachers were trained in order for them to train their pupils so as to be able to disseminate information on CDTI in their various communities. ,/ s8 WHO/APOC, 26 Septembcr 2003 ,2. Community self<nonitoring and Stakeholders Meeting Table 13: Community setf-monitoring and Stakeholders Meeting (P/ease add more rows if nece--ssa4y) CSM has just been introduced in these two LGAs hene the small number of communities taking part. The result of the monitoring has affected project implementation in the following ways . There has been inerease in the nr-rmber of persons treatecl in commnnities thus leading to high therapeutic coverage. . The communities are now more involved in the drug distribution exereise. o Awareness of the importance of the exercise now increased and the eommunities ready to provide ineentives to CDDs. 4.3, Sustainability of proiects: plan and set targets (mandatory at Yr 3) \Mtat anangements have been made to sustiain CDTI after APOC funding ceases in terms of? 4.3.1 Planning at all relevant levels. Regular meetings of SOeTs/LOeTs to plan and re-view all activities 4.3.2 Funds Plans have been made to ensure that government makes budgetary provision for CDTI at all levels and also release such approved funds. 4. 3..3 Transpnrt (replacement and maintenance) ,4 WHO/APCIC, 26 Septernber 2003 s3 DistricU LGA Total# of communitiesfu illages in the entire project area No of Communities that canied out self monitoring (CSM) No of Communities that conducted stakeholders meeting (sHM) KA!AMA ISIN 50 4 4 4 TOTAL 94 8 4.4.3. Joint supervision and monitoring with other programs A joint monitoring team with other PHC programs has been set up at the State MOH level. The team is emporered to monitor allaspects of health care delivery system. 4.4.4. Release of funds ProBosals for monitoring are made and onee apBroved funds are released aeeordingly. 4.4.5. ls CDTI included in the PHC budget? Vao af fha Qfafa larral a v9 qa rrav vgav rvYvr. 4.4.6. Other health progrcmmes that are using the CDTI structure are o Vitamin A suBplementation program in 7 of the 16 eDTl tG-As in the State. A training-of-trainers workshop on Vitamin A supplementation was organized for the SOeTs, Subsequently, the SOCTs now trained the LOCTs from the selected LGAs. After this, the LOCTs now trained the CDDs who distributecl the supplements. o Malaria Control activities- the CDDs from two LGAs (lsin and llorin East) trainecl on INSESTICIDE TREATED bed NET(ITN) 4.4.7 Others issues considered in the integration of CDTI include pooling of resources together. 4.5 Operational research 4.5.1 Summarize in not more than one half of a page the operational researeh undertaken in the projeet area within the reporting period There was no operational research conducted during the reporting period. Ho-wever, an operational research is being planned to identify the reasons for the high rates of absentees/refusals in some tGAs. 4.5.2. How were the results applied in the project? There are no results yet. ,ul 4o WHO/APOC, 26 Septernber 2003 t Government is refurbishing all project vehicles. 4.3.4 other resources 4.3.5 Please provide a written plan with set targets and achievements for so fiar. The sustainability plan include . Advocacy and sensitization of stakeholders to providing funding for CDTI . MOH to make finaneial pro.vision (budget line) for eDTl) in year 20M budget . Meeting with localCBOVDevelopment associations and formulate plans for sustainability of CDTI in the communities . lntensify health education activities through airing of radio jingles . Conduet eensus update in low coverage communities o Sensitization meeting with community associations from endemic communities with low eoverage . Meeting with LGA PHC Managers to develop strategies for complete integration ot CDTI into PHe programs. 4.3.6 To what extent has the plan been implemented The plan has been implemented as there is a budget line for CDTI in year 2004 budget. Also integrated approach to supervision and monitoring of all health programs in the State has been put in place in the MOH. 1.4, lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration 4.4.1. lvermectindeliverymechanisms The IOCTs/DHS are PHe staff in their various LGAs. These are the people responsible for collecting Mectizan@ ftom the State. However during collection of vaccines from the State Cold chain store NPI Managers have also assisted the LOCTs in the collection of Mectizan@. 4.4.2. Training Primary Health Care facility workers were trained as part of the integration strategy. *{ At WHO/APOC, 26 Septemher 2003