Kano State CDTI project annual project technical report to submitted to technical consultative committee (TCC): January-December 2004

RESERYED FOR PROJECT LOGO/IIEADING OIUGINAL: linglish COTI NTRY/N OTF : Nigeria Annroval ycar: l()1)g Ilenorti Pe riod: From: .lanuary To Decemberr2hD4 Month/Yca Month/Y Proiect vear of this report: (circleone) I 2 3 4 5 (6) 7 8 9 t0 l)atc subnrittctl : March 2005 NGDO nartner: CBM ANNUAL PROJECT TECHNICAL REPORT stjIlM l'l"l'llD 'l'o I'ECTINICAL CONSULTATIVE COMMITTBE (TCC) I I) EA t) I,INIi FO SLIBMI ION: I'o AI'oc Managenrent by 3r Januarv fbr March't'cc meeting 'lo AI'(Xj Managcnrcnt by 3l .lulv lilr Scn lrcr'l'CC meeti AFRICAN PROGRAMME FOR oNCr{OCERCIASTS CONTROL (APOC For To: Tux //i .,i ,i i CDoaa CSD GD+ At/F C,E 1," .}lh JFotro 5RECU 0 7 FEt/ 2005 APOCIDIR btAt : Kano State CDTI Pnrject l,aunchinu vcar: 1999 Proiec t Name For Tor ko on I ANNUAL PROJECT TECHNICAL REPORT TO TECF{N ICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to s the re Country: National Coordinator Name: Dr. J. y. Jiya. Signature Date Z.g.'..t..:.Q.>- 7,onal oncho coordinator Name: princess p. ogbo pecrce Signature:..... Date NGDO Representative Name: Chrisropher Ogoshi Signature Date: .... This report has been preparecl by Name : shehu Musa rshaq Designation Signature : J '\" ":,- 4<,/ 3 aa- r )-- 2 Cro Table of contents V VIDEFINI'I'IONS - FOL WUPON TCC R .ECOMMENDA TIONS EXECUTIVE SUMMARY I 2 3 3 3 5 7 It GuNgnaLrNronue.rroN +4 Description of the oroject (briefly.t1.1.2. Partnership SECTIO 1.2. Potut.attoN........ N 2: IMPL ENTATION OF CDTI -f rtianr.rNe oR ncrtvrres Aovocacy Capacr'ry ButLprNc Tn,eatveNTs Trealment.figures What are the causes of absenteeism? What are the reasons-fitr re.fusals? t:gui lYat u rupervi,yion checkliltl u,yed? a.aaaaia..a.aJ.a....aaa....aa...a a.a....6.aaJl..ra..a....a.a...aaa 9 2.!, 2.2. 2.3. 2A. 25- 2.6. 2.8. 2,9_ 2.6.1. 2.6.2 2.6.3 2.6.1 2.7. 2_2L 2.9.2. 2.e.L 2.9.4. 2.9.5. 2.9.6. 28 SECT ION 3: S ORT TO CDTI 3.!- 3.2. 3.3= 14, ExpeNorntRe psR Rcrrvlry "d""""""'.........da.............a......dai.............aa..d.a.."aa...aa...28 ..........29 ..........29 ..........30 ..........30 ION 4: SUST ABIL ITY OF CDTI. 3l 4.t. 3t aut duriag the reportingperiod? (tiCLgLy 3t 3t LlJ Was Monitoring/eyaluulign curried dh$rt,ilowtnr whl 4 l_ 1 What were the recommendalions? ...4.1.3, flerafisusthey bcen iu.t2leaerlr,dl .. 3t 4.2. SusreNeetury oR pRotecrs: pr-AN Rllo ser reRcers (MaNoerony et...i............1t Yn 3)...... 314.2.1. Planning at all relevant levels. ..32 I i I I 4.3.1. 4.i.2. 4.3.3. detined 4-3-4. Release otfunds Jbr project activities Error! Bookmark not defined.4.3.5. Is CDTI included in the PHC budget? ...............Error! Bookmark not dilined.4.3.6- Describe olher health programmes that are using the CDTI structure an-d hot! this was achieved. What have been the achievements? .....Error! Bookmark not deJined.4.3.7- D"scribe oth"rt issres "onsid"red i, the integralion of cDTI.Elor!Bookmark not detined , 4.4. OpenarroNer- RBseencn E nnon! BooxruanK Nor DEFrryED. 4.4. l. Summarize in not more than one half qf a nrge the operational research undertaken in the proiect area within the reporting perTod.Error! Bookmarh not detined 1.4.2, How were the results applied in the project? .,,,,Error! Bookmark not deJined Iyermeclin deliverlt mechanisms ,......Enor! Bookmark not deJined.Training... ......Error! Bookmark not d;Jined. Joint supervision and monitoring wilh olher programsError! Bookmark-not 34 SECTI 6: UNIOUE FEATURES OF THE /OTHER MATTERS ...........35 4.2.2. Funds....... ......Error! Bookmark n'gt defined.4.2-3 Transport (replacement and maintenance.l ........ Eruor! Bookmark ntot diJined.4.2.4. Other resourcqs Error! Bookmark not d;fined"4'2.5. To what extent has lhe plan been implemented..Error! Bookmark not dilined.4.3. INTecRenoN ...................33 AND OPPORTUNITIES Acronyms APOC ATO ATrO CBO CBM CDD CDTI CSM FLHF FMOH HFS IDP I.GA LOCT MDP MOI{ NGDO NGO NID NOCP NOTF NPI PHC REMO SAE SHM SMOH SOCT TCC TOT UNICEF UTG wHo ZOTF CAPA MFU PLACO African Programme for Onchocerciasis Control Annual Treatment Objective Annua! Training Objective Community-Based Organization Cristofell Blindenmission Community Directcd Distributor Community-Directed Treatment w ith Ivermectin Commuqity Self-Monitoring First Line Health Facility Federal Ministry of Health Health Facility Staff Ivermectin Distribution Programme Local Covernment Area Local Onchocerciasis Control Team Mectizan Donation Program Ministry of Hcalth Non-Governmental Development Organization Non- Govcrnmental Organization National Immunization Day i National Onchocerciasis Control programme iNational Onchocerciasis Task Force i National Programme On Immunization Primary Health Care Rapid Epidemiological Mapping of onchocerciasis l Severe Adverse Event Staketrolders meeting State Ministry of Health State Onchocerciasis Control Team Technical consultative committee (Apoc scientific advisory group) Trainer of Trainers United Nations Children,s Fund iUltimatc Trcatmcnt Goad World Health Organization Zonal Onchocerciasis Task Force Catchment Area Planning and Action Medical Field Unit Participatory Learning and Action Committee Definitiohs ( ii) ( iii) (iv) (v) (vi) (vil) (viii) (ix) (i) I'qtalpopulation: the total population living in meso/hyper-endemic communities within the project area (based on REMO and "ensus takingy. Ijligitrlc populution: calculatcd as 84Vu of thc total population in maso/hyper- endemic communities in the project area. [1nu0l-'l'rcutmcnt.-O-bjcctiyc: (A't'{)): thc estinratetl number ol'fers6ns living in meso/hyper-endemic areas that a CD't'l project intencls to treat wiih ivermectinln agiven year. Ultimate'l'rcatmcnt Goal (.U't'G): calculated as the maximum number of peopte tobe..heated annually.in- meso/hyper endemic areas within the projlct area, ultimately to be reached when thi project has reached full geographic coveraee(normally the pro.iect should be expectcd to reach the \JT'G It tt" tnJ"iilr" i;year ofthe project). 'lheraFqutiq .cpveragq;. number of people treated in a given year over the totalpopulation (this should be expresse<I as a perccntage). Geosraphical coverage: number of communities treate<l in a given year over thetotal number of meso/hyper-endemic communities as identified try nnfUO in ttreproject area (this should be expressed as a percentage). Integration: delivering additional hcalth interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) through CDTI (usini'the same systems, training, supervision and personnel) in o-rder to ,"*iiri* cost_ effectiveness and empower communities to solve rnore of their health problans.This does not include activities or interventions carried out by community distributors outside of CDTI. $ustainability: CD'l'l activities in an area are sustainable when they continue to ll^,jT,".tctively for the foreseeabre future, with high treatment coverage,tntegrated into the available healthcare service, with stronfcommunity o*n".rhTp, using resources mobilised by the community and the govelnment. community sellmonitoring (cSM): '[he_ process by which the community is empowered to oversee and monitor the performance oicnrt (or any .ornrrnity_ based health intervention programme), with a view t" il;;irut tfi" prigriii"is being executed in the way intended. It encourages the community to take full responsibility of ivermectin distribution and maLe ippropriate moditication, *t.n necessary. FOLLOW UP ON TCC RECOMMENDATIONS Using the (able below, fill in the recommendations of the last TCC on the project and tlescribehow they have been addressed. TCC session 20 I'CC accepted the report and recommended the project to: (Please add more rou,s if necessary) Number of Recommendotion tn the Repitt TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR rcC/APOC IWGT USE ONLYt. I I Provide details of integration of CD'tl in pHCl in the next report. C DT I ect I S wel I integratedproJ n the State considering the fact that the proJ ect coor dinator ls also the coordinator of other d isease intervention programme i.e. Guinea worrn. Moreover, SOC'I'& LOC'I'are aspect of health services and this apply to first line health facility staffand CDDS. Descritre any plans foi adil ofl interventiofls in future y€ars. Prov more details about State and LGA contributions. 'l'here is potential to extend CDTI as the CDD are involved in other activities i.e. to. State government ease some amount for the project while respective LGA sponsor the CDTI activities at their domain base on their budget. Refer to table t3 for more details lU tv Prov evidence, if an v of the impact of lack of CDDs on heatment coverage. female Our coverage without femal is high even e CDDs because female members of the community do comply with annual treatment. II Executive Summary Kano State is sifuated in the northern part of Nigeria and falls in the Sudan, and sahel zones.However, the endemic areas u." g"r".rlly locatei in the Suclan savannah. The terrain in theseareas is generally flat or srightry unduratirrg with sarrdy soi[. The State has 44 local government areas with a popr-rlation of about 7.5 million people basedon the l99l-population census. The people of the area are mainly Hausa/Fulani with few othertribes usually found in urban ur"u. *ho serve as the rninorities in the state. The vast majority of the population of the cornmunities are settled agriculturist, keeping herbs l"t#[;ll::: *o goats. There are numbers of pastoral Fulani som-e of who mnue according CDTI is however being implemented in 18 LGAs in the state with a target p'pulation of590,978 person living in977 enrlemic communities. The training objectives for year 2004 were 474 for health workers and I ,267 for cDDs. Bythe close of the vear it was able to train 464 health workers and 1267 cDDs thus achieving97o/o and toobrlspectively. The ratio of cDD to community population stand at l:466. Treatment was conducted in all the 977 endemic communities of the lg CDTI LGAs. Thisgiye.s a lo9% GeoBraPhic coverage. A total numbcr of 491,945 persons werc treatc<l out of thetotal population of 590,978. This gives an overall therapeutic coverage of g3%o and an ATocoverage rateofBTo/o for the State. The major challenges that facecl the project include inaclequate support to cl)Ds by thecommunities and the payment of inceniives to village *o.k.., by some p.og.r*.s such asNPI' which has affected.the cDTI implementation negatively. participation Ji*o,,"n groupsin the CDTI process-within the projeci is still no, "n.iurujing,there is also poor participationby localCROs and NGOs. The challenges encountered were addressed in the following ways (but they still remaine<lcurrent challenges): - qr-o-ups to support CDDs. This is still being pursued. - gd generally increase female participation. e - -r- To address low female participation the project intends to do the folt,:wing in the coming o Mobilize Islamic scholars and use them as mobilizers and health educators of women.o Make use of women vaccinators/guides used during MDs (generally accepted) inreaching women in purdah. o use of government ^and non governmental organisation and community basedorganisations such as CApA, pLAtO and MFU. SECTION 1: Background information {.i. General information 1.1.1 Description of the project (briefly) Geographical location, topography, climate Kano State is situated in the northcrn partof Nigeria and falls in the Suclan, an<t sahel z.ones. However, the enclemic areas are generally located in the Sudan Savannah. The terrain in these areas is gencrally flat or slightly undulating with sandy soil. l'here are occasional rocky out crops and granite inselbergs. 'I'he rainy season begins in May and ends in mid October while the dry season lasts from early October to late April. Population: octivities, cuhures, and languoge ( The State has 44 local government u."uJwith a population of about 7.5 million people based 9T.thS I99l-po-pulation census. The people of the ui"" rr" mainly Ilausa,/Fulani with lew gthertribes usually found in urban areas who serve as the minorities in the State. At the community these elhnic groups (both from within the country ancl from neighboring countries such asNiger Republic) are more or less assimilated into the local popuLtions. -Hurru is the majorlanguage of communication. Islant is Lhc religion that clominate the State with a tittlepcrccntagc of Christians, who are mainly lbuntl in thc cities. 'l'hc vast majorities sf thepopulation of the communities are settled agriculturists, keeping herbs of catite, sheep andgoats' There are numbers of pastoral Fulani some of who move according to the seasons.There are fishermen along the river valleys. Craftsmen of various descri"iptions exist and traders abound. Some of the traders are itinerant seeking markets for their goods an<l s€rvices. Communicotion systent (rood....) The road connecting the towns and major cities are in relatively good condition, but the roads to the communities are in varying shapes. While a few are in gooa "onaition, some others arefull of potholes. others still are lateriie roads and can be impissible during the rainy season.Communication channels are many and varied. Some follow the traditional authority structure(from the Emir to the district heads, to villages heads, then to ward heads and lastly tohousehold heads). At the community level town- criers, local musicians an<l drama groups are veritable means of communication. Radio is a medium that is widely listened to.as Hausa istfre mljo-r language of communication and used for most programmes. Newspapers especiallythose in llausa are also read and television is a mediuln that some listen to. The Administrative system in Kano State is of two folds - the modem administration system and the trdditional administration system each of which exert some level of influence on thepeople at community level. The traditional structure is closer to the pcople una tfr"r.fo;;;ij nature, large areas are under the authority of a District head, who i. ,"rponriUt. to the Emir.Under the district held 1e village heads, and under them, the ward heads, who related directlyto the heads of houseltolds in thi communities. Under the moclern administrative structure theState consists of 44 LGAs. The LGAs are further subdivirled into wards, which in tern are made up of communities. The state has an elected Governor as the head of the executive arm while there is a house.of assembly made up of elected representatives of the diflerent t.GAs. J'h':. t.q: the legislative arm. 'l'he same pattern applies at the LGA level where thelegislative is made up of councilors from the different potitical wards. Ilealth system & heallh care delivery (provide lhe numher of heallh posts/centerc in lhe project areai dthe information is avaitahle). 'Ihe state operated two l<rrms <ll'lrealth care systern. 'l'lrc first is the primary health care services which takcs carc of thc hcalth of thc pcoplc at the grass iogt through hcalth e<lucation, eirvironmental sanitation, provision otesienfial tlrugs and control of communicable diseases. The services are provided to the community through health posts, health clinics and comprehensive health centers. T'his level of care is opeiated by iocal'governments antl community throughout the State. Professional health staff as community health extension workers mainly stafls these facilities. Further still, out side the health institution there are other health professional who are found in the communitics as environmental health workers. These groups are engaged in health eclucation/mobitization, water and basic sanitation in the communities. The other slstem of health services is the secondary health care, which is more specialized that serves as a rcl'crral to the lowcr lcvcl of hcalth carc. Sccondary health scrvicc is only available in'cottage hospitals and gencral hospitals that arc mostly locate<l in towns an<l cities.This level ig largcly the responsibility of the Stut". There are about 300 health facilities spread across the 977 endemic communities of the lg effected LGAs in the state. Tablql: Numhcr of hcalth staff invblved in CI)'l'l (l,le ase udd more row,s if nece.;,rury) Numbcr of henlth stalT involvcrl fr COft rclivitics. Totnl Number of hcrlth stnllin the entirc project ATCfl Numbcr of hcelth staff involvcd in CDTI Perccntrge Bs=B:/ Br rl00 30 30 lO0yo 1000h'['udun Wntln 35 28 35 28 100% t9 100% Kura Garun Malam t8 2t 2l l00Vo Madobi 23 l00o/o Kiru 30 23 30 100% 24 25 t00% 25 25 l00o/o G*&rro m n l;r Kabo 27 27 1000h Dawakin Tofa 28 23 82o/o Dambatta 25 24 960/o Mnkrxln 2t). 2t 1007o ,I 35 32 9lo/o 24 23 960/" la 28 28 to0% 25 22 e6% Tottl 474 464 97o/o 1.1,2. partncrship Indicate the partners. involved in project implementation at all levels (MoH. NGDos - national, international) r -' The partners involved in the implementatiorr of cDTI project in the state include:I Communities(endemic)2. Thc cndcmic localgovcrnnrcnt (l,GAs)3. The state Ministry of Health (SMOH)4. The Federal Viinisrry of Healih en{ory ,5. Christofell Blinden Mission tCfifral6. WHO/APOC DistricULGA Bl B2 iirc lodcral Nlrnrstry ol llcalth (r\ULl') provrdc pollcrcs, opcratronal gurtlclrrrcs, arrd Lraurs the state level workers. -I'he State pcrforrn suclr function.s as training and re-training of LGA hcalth workers. Ivlcctizan procuremcnt and supply to LGAs, monitoring and sugrervision of mc.ctizan distribution, formulation of opcrational guidelines in order to ensure gcrod implementation ofthe programme, and community mobilization and education.'The LGAs are responsible for training and re-training of health facility staff and CDDs, mectizan procurement and supply to communities. community mobilization and education, monitoring and supervision of mectizan distribution. The assisting NGDO, CBM, support in the production of IEC materials, provision of technical zupport to the project, advocacy for financial support and supervision of CDTI activities in the State. The endemic communities collect their yearly mectizan supply from the health facilities, ensures distribution of mectizan to eligible persons, selects distributors and determines times and nrethods of distribution. They also minimally monitor and supervise the distribution exercise. The partners enjoy cordial working relationsh ips. State plans if any to mobilize the state/region/districtil.GA decision-makers, NGI)Os, NGOs, CBMs, to assist in CDTI implementation. The newly elected LGA policy makers were mobiliz.e on the CDTI process with the aim of knowing their roles. Also in the current year more advocacy activities will be organit* for local NGOs and CBOs members. To c'l "E E oz f(-{ L)o o. 0 > t- -()q, '6. L\ !, t' L ctq, I" *S r '1, tr :(! L,FJ q, -t I P o\q) Uq) a.il 1, .o \;!I aa bq, r a. tr e, cl FI P" Eq) o() .c -!$L oo oq) bo =e. .\t qr ()g q)L s I P'\ !, Et) E\ n (, B P o t. 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'53irotrKFboxd:r ut .= co tiC)E Et !jLioh>..EH Ccll-i L =o,tr.q oer\ aA ci!) H o(u 'a a. o) I +r o q) E oLo. G) 'lcl CU v,l<ot a a 0) B a F ci oI) rd ko d a Eoo os o!) a tn TIoo d B otr o "o (l) bo d l.o x E1 tr Eoo arLi(1, 0) ht)tr t) o)L GI aox(l-< L. GI G) g' oo a. u, 0) c)L. oU' t{ o) -t o -o) o €a o-r E) J) \-,g o .E sd\, €H tsE 'o'-!)cd!it5.9AD P.6 &4 .e8 eHs67;a dzH* oz \.1 (l) E .9 l.r(u o. !P Eoq o)F. (D -g ;tr 5 -o 0)tro .(, c)(D 'a l.{O. o) I k .oH IA U)d c)(J (tI an ct € SECTIOI{ 2: Implementation of CDTI 2.1. Timeline of activities Fill intable 3' limeline of acliviliesfor area,s treatetl in current yearq indicating when the key activities were implemented by the month they began and the motr{ti,fr"r""aJa Periods of Activities: 2004 Activities l. Mectizan Procurement 2. Ad and Sensitization of Endernic Area Month I lqmqttq{__ lfebruary, March April I May/April Jglv August Marlh-May-_Juqe, December December December $oo c.l 3 El) oz t(..l Uoa. o > o 'r )'o6 .: HEI -o. tr-cOaii u,BE rl.l'U - -.E'BB 1A}E?,t sscB(l)c96 6E tGl6-' >r ts-o5tEl oCE8B EY,OO. BgE; =clBBio'^ lr)x c.) 8ao(u L.ocl €r tsggtr =o)EX 3EGts TE\.,, o, -rg(ubo ERI AEcogqs€ >-'1JbE >sl '6+g€ E(l)=ij Ho>E o'f;8t Io(1 AS'I ot .r hOb'=.E '5 BEEE g(rl (l) .= d(ue <€.E an tr(u Ed oU I .\t cl4v,q) q) q) .S rat\ q) Lat \B q) a4 Bq) U L G,(Dx o) H o() 'lJq) ctq) l-. vtd(l) Lr G' (l) ,q l{ € d,o o GI(+< o o B c) F-{ ..ir o-rl5l({t F.ll Eo zhtq)c a I Eo5E a6 EEI rf,O bi rt O C,oo \f,O =b .to $O .{-O bi a -tO t oz \f,Ot oz tO $O oo $ 'f, i oz vo v $ I() o r+o RIts- $O oo vO .cjor! .+ P() o +a C) &r cl z !f, \tO otr Rt2 bnd- .tJ E d=ac +o GI z $O (ll z +o (ll z $ ((t z to GI $O GI z vO GI 2 t ((l z st Ji c)L(d 2 $o Ei clEr !+ O l'o fJ. $ $ -fO oL(d z rto C) li rd z o E ti qh .1, b! ? a E o5Eo!E5 EEI $O bt) \i- C) dq) a .to F- $O bh) +O bi) * bh a $O t o z $ t o z $O =f- $O (J o +O ooa \f,O t oz $O bi a +O =h so C)o +o c)o +O c)o $o aoa EDEEI LE qi= \f,O o al- \to C) th .tO l.{ CI .+ O cd z \fo d z $o cl a tO() trah $O (.) $o (d 2 +o (B z *o (\l z so Cd d vo cl z +O (\l 2 !f,O GI z !t cl a !to cd I .+O GI z q) 6l1'o q1 rh EeU EGEo'5 =EEr. 6 EEQ \f,O tht b( $Ot oz *o t vO .rl b[ a .+o bi vO bta $o > oz rfo > oz to 3h +O oo I IBo U) if,O i oz \t ota $O a $O c)o $o oo *o oo 8 E(.1a a0E€ PE il= u)- +o cl z $o o) J tO Lro *o cd +o cd +O cl $O o $O q) trt -fO cl z .+O (B =a .fo (tl .+o c(I +O cl z so d $o cd 2 .fo GI z u0 E tr GILF E5!ETEOEE o(J $O tro .flo' d z !fo ol.i RI sflo' (rl a *o ctl vlol -jLro +o cd d $O cd a so -iEro $o l.ro -+lO -il<o *lol -.iL o. \+ O Cd z so lro $o (d $Io' cl $o tro -tl C} GI €Eo E o0 E t-il a .+O oL. c, z .fO L o. ta () L cl z $o t<o +O Lo sa oLr GI z +o l-{o $o t<o $o t<o $o oLr al z vo E C)L G, z \fo c) &2 .+o t<o .t O l-a rf,o l.a $o Fro .t O ka $o Fro ql rC) .9 .:ijES=5EEEooEr q)a s Eo E E .9 a, EL E oQ \f,O l'q) fr< $o o ts{ ct z !f,Odor! $o oLd z $o okd z $O ljo fr< $o o li CU z $O o h z $o oL. GI z +od(1) rq $o c) E z +O .cjot! -f,O oLd z \to C)td z .t o oLd z .tO (.) L 63 \f,o () L.d e sO c)Li ct an .EfI,E 6a= tfO iftlts- $o (d +O -dofr{ \f,o .o(u $O -d(l) tr{ .t O dl- \f,O J5 Q)t\ t+O -d(Dtr +o s C)L G' .+O crl $O -d(l) tr< r+ O tr 6J vO toL cl -$o c)tr RI e tO clF-l -fO -dott{ +o oh cl $o o H o F] I t- ra e (B B ol oo rdE ct EF '6 -oo @ Es <, E() GIh M .o o1' CI z 3 V C) GIk(ll V oh!oil oNL rd 3() o -o(0 v .(d o o GI uql IE C,o ct1, ol( ctl Cdl( CtF GI ct E a c(l (d L) h!tr ? -l F oF 2.2. Advocacy 19:TuJ, andscnsitization visit was conductctl in all thc l8 l,(iAs ft)r ncwly elccte<l council T:Lb".i l$.ut 54 policy makers wcre sensitizcd. 'l'he main reason for advo.u"y"unJ r"*iti-timwas.to solicit support for CDTI pro.iect in areas of vehicle maintenance, fueling per diem for localworkshops antl scminari on cr)'r'r antl othci krtistics ;6;;; The ou(come -f-or the advocacy was good as all LGAs Le providing motorcycle fueling andmaintenance allowance with monthly salary to LGA oncho coordinatois. At the State levJ, theGovernment is taking care for maintenance of the project vehicle from the MOH central pool.Already the statc Govcrnmcnt has relcased its counterpart [un<t for 2004. Some of the dlfltcultlcs faccd arc: o Frequent change of council especially at LGA level. o Too much commitment ofthe policy makers makes it difficult to pin them down for advocacy. Some suggestion to improve atlvocacy: o Hon. Commissioner for local government should be fully involved in sensitization of policy m:rkcrs al LGA lcvcl; r Plan should be nrade to sensitize the State Executive C<luncil and the t,egislators.o Invdlvement olcommunity based organizations. 2.!. tloblll2etloll' seniltlzetlon thd health educaflon of rt rlck communities The u.se of media in mobilization Other local strategies used in Community mobilization -Use of traditional and religious lcaders -liacc to lhcc discussiug with conrnrunity nrcnrbcrs -Town announcers mobilizing community members -Posteri -Public address systems ( Mobilization and lrealth Education of women and Minoririe.s Mobilization and health education of women and minorities was conductecl through their husbanct and other relatives. They were also mobili zed at clinics for those who attended health talks duringpre natal visits' So.:.gglCDTI messages.through listening to the public address systems or readingthe posters made available at communiiy level. Response of target comntunities The various communities have demonstrated their commitment to the implementation of CDT'I, and are actively participating in the CDTI process. A ccontpl i sltntc nt of Targc I Conrmu n i t i e,t The project succeeded in mobilizing all the endemic communities and these has resutted in overallhigh treatment coverage. I r'rrr Weakncss/Constrainls The women in purdah sometimes are deprived from getting the correct information on CD'l'l during mobilization as the messages get to them only through their husbands and grown up children. Participation of women as CDDs remains a challenge but treatment coverage remains high because compliance is adhered to annually by both male and female eligible. Suggeslion to improve rnobil izat ion The quality of information that gets dowrr to wornen in purdah is of serious concern in predominantly Muslim comrnuniLies. The project will co-opt female PHC workers to be part oI the teams both at state and local government levels to open up better and easier ways of interacting rvith this important group of people. The project will also identift female community based organizations to assist in educating this group people to continued taking their drugs yearly as tlre ('l)l)s are their children and menrbers of such community. The project also intends to target the men to educate them on the need to have tlrc women to be involved in the programrne either as distributors or as mobilizers. Effort is being intensified to use community based groups such as Participatory Learning and Community Ownership(PLACO) and Catchment Area Planning and Action( CAPA) available in many endemic LGAs for increased community members participation. (. I i I I li l, I I t t I t+ i : I i I I laNIto algDl(Drls':o !-) o53E3HEE*'J (Dt(/, <E=HJ9.(g.o E(39IrJ E.E *a oUH e(! s k tr & tt o\ l\ 3sq (! r)t\ 91 tr\f *- s i{ /l '1 I o Eo _o hJ+ zo g rt,otfl+, -lo IL H6)F F U 'D s - O) it. Do- o CT o{ BNo X F s ad B s) o r- A) F) 5 7( a 7ibl-t o) (D H U Boil ?ts\ n) ><o o.!o Uo rra E{b) iltct o co FO Fo 0qo ,(cr.l o, g il. h, 5 },J \o 6,5 hJ 5 5 tt? .iIEd ETAF I .ol{l{ o\ }J t\o t,\o t,\o -l h) -! \o * s B\o h.) I 6,o s F F + o\ t\) o\ o\ \o 6hJ\oo\ .l cti6 l"' I I =l -.1U\o TJ 6 s ..1\o -l{ hJ a t_, $\o {o $6 s $ A s F O c,\ ,l c}l s +. E i6 o\ 6 \o o t\.,IJ\oo\ Etirla;q# !D IE 'h -! o aEin l! 'q- ID *t aZOEEE ETi.i<a' E9otrdcetcOE Eqr<c4!r J.831A-* hJo\ h.)5 5 01 o\o s \o6 co{ 6 -l -t \o\o t.)-.1 o 5o F o>F+ U tt) bJ ch! tJ){ hJ+ 5I5 o\ +-I I 5 \o166 6\t tdG) @ {(, -JA I E h.J{ U I 5 T EE a E' lE!E { Ba ssi z ,q C c U zvg.: 5a cl.-r ao 3E = (l tJ !! a *i*U8:t 1.o ET P s 1Q I I I t., -oo\ t a I , 'Eo l'E ffo .F FyjIt ze Era o rEE:l *2 rr E.).i Er.E86\ , B6{ E t i Comment on: - Attendance of female members of the community at health education meetings - In generaf how do you rate the participation of female members of the community meetings when CDTI issues are berng discusses (attendance, participation in the discussion etc). Female are generally not allowed to attend health education sessions with dre men, and communities have refirsed requests for their women to assemble at a common point to be educate by female health workers. The men have insisted on being conduit of whatever inforrnation that needs to be passed on to their women folk. In very few places as could be seen in the above table were females selected as CDDs. Given the background of the community this is a good starting point. - Incentives provided by communities for the CDDs - Report of token remuneration to CDDs by community members in group or as individuals is being received, also CDDs are assisted on their farms but such contribution are suppressed by the CDDs in anticipation of better gesture from LGAs. Others contribute with prayers and political campaign for CDDs when they indicate their intention to contest for elections. All CDDs are satisfied with prevailing conditions and are happy to serve their communities. Attrition of CDDs. Is attrition a problem for the project? If yes, how is it addressed? Majority of the CDD are either primary or secondary school leavers, and there is tendency of leaving the job to further their education and this warrant targeted training for new CDD selected by the community members. Attrition by CDDs is a course for concern but is quite minimal and there are always people to continue when a CDD withdraw or absent. Other issues The state project is happy with the exisrng cordial relationship that existed between CDDs,FHLF and community members in their respective areas. , 2.5. Gapacityr bulldlng { - Descrlbe the edequacy of available knowledgeable menpower et all levels. There's adequate manpower at state and LGA levels, these are adequately trained to perform theit roles as SOCTs, LOCTs or FLHFS.. Training for various categories of CDTI personnel envisaged for the reporting period couldn,thold due to the d"lay in the release of funds. However, LOCTs were re-trained on calculation of mectizan requirement and mobilization, but more training is required in the subsequent years to improve pCrformance. (?)tal "u E oz tFI H D > E, Ioa st € P ID {E I EI' a S)qr q) Eb h s P qrLo Etq, P{ s, E. tr .Q(t E H c,a .E trA L)(1-. 0 ut c) JI t 0) .c) tE .E' a) .El H boa tJ .E lit- ,iir r)l €tFI t- s{ E 6E s !< Gr; E fa Er. E6 ar o Lt E Z 3 CT !r- s i ?F (JeH N .t \o \o ot rt \o r- cil \o t\ N r+ 'f \o \o ?.1 r+ \o N + \o a.l .f \o c.l .+ \o c{ s \o \o l-("|. rf D-a \o N t \o OtrIF IE at fri(t ET) E2 tro E €)e r!i ,g li #o ol : \o \o \o s$ ()'T Eui C'r o\ (> : @ : =lEil6rlEtsI EglLrl tEl EE] EI E,j 1/):l l ra l 3 a{f{ s _.1 t\6l o\ I g\ q\ o\ ch q\ rFI 1/) : rtt : a E I cO o\ vN ..: !f ol .+ ol or7l ofI ot c\l N al \D o.| \ot\l \oN td rf c{ tol .+ 6l { r-{ b.q\ a E('I +. e' i Ei I : :- t : tt : tf : ts5O t U ts a, L - .aaqr o lrt Ez ?t t f?) (fI ia tfl * tn t?r I + tn (J H ^9t .!A dL.5 M (l €o * do Ho € ct B F d u E c(l Ez(5 d GI Eda 3 cl M H 7(, 5oE CI 6n 5g Eo Et-{ rt Fr ot II Tl 7 =a o E d EI arl EI ;l \o N FItt o(^a q\(.1 Nol 6l t\ o.l +$ + ra\o \o \o \o { I t t+ ln t I + !t t t s : (.l tl s o E!o& c, cl() b& trl ? G, B R oo 6) stg Table 6: Type of training undertaken (Tick the boxes u'herc specific training u,as carried out duririg the reporring period) i Any other comments Trainecs Type of raining CDDs Other Community members e.g Community supervisms Health Workers (frontline health facilities) MOH staffor Other Political Leaders Gher(speci&)Program man4gement V How to - conduct i Heahh education ManagernCnt ofSAEs CSM SHM Data collection Datr analysis l./ Report :rit!!g \./ Others (sleci&) 2,o,. Treatments 2.6.1. Trertment figures *oot\lI E E oz t6l do o- o o c.l s, Q)l. rd () 6) 'a l.o. |l) .; -Ev 't IA .9 trt E Eo L) .9 Eq) "otr ? ER ,\ € BE ;I EEl '=9l oo sl.Ebl.I0rl: Pl 6[lE EE .HA EIEZ.ll- I C) €tr q, u) cl q, oo()A Eo\d- CL G, rt) t-(- .l Fi o F- s € s trl d a 5ot RI o N cl!() IdV d E 5 E r{ d E( ''')fi GI .13 d E .ft!(.l.i o( dt oJ rdrl cl E M .9< E3Q\ Ag E t t?Et t PE]t<ba AO (F o g Ez (l)tz l'll' I J (,Iz o8 xf;J-ozd o rn al $a'l cn@an \oa.) 6oF- \oC.l \ooo\ \ot1.,.t ooa.l \o€F- tlo \o 006 N c.l6l tn$ an 6 F- o\ l.) h \o r o\ \o\o 6o\at C.l Ia-fiE t c.l oo I o\oo rn c..lFr c.lN o €oO cn(> t-- e.l oo$ o\N c-00 o\ ia)t cno r.l oc.l \o$F- ol t'lol ttl co \o € tr o cl a O. o or t ll rtd o I€sFEfs 1Oo\ o\ € 10o\ € \o6\ o\ 10o\o o\ \0o\F6 \o6\lat o\ \oo\$ oo 1Oo\ 6 \0o\ ort-. 1Oo\ o\r) 1O6\o o\ 10o\F- € I I 10o\ cn o\ s o\\o \o5\ri6 \oo\ o\ oo 10o\t- \co\a6 s(n @ d b -_E5E E IE NF-\o c.lt -ra) o\\o c.l oo a.l r.l oF- c.l @ eaNoo t-- e.l c.lo o\ t'l \oN R €rnN t-o F-\o arrt c') o\ $taloo\ t-)o C..lin an e.ll'- 1.. o\ c.lr) r{- ot t- \o N c.ln i/)riN aoifi €6tl o.ttn ra$o\ o\iC d 6) .B (, 5',o H F E E rt\o int otn6tt- rn o\ ?7t c.l ta-l ta l-,. oo o\ rr.l$ F. or. C.l o\ eotal r 6 ol r")o 3 c.l € o\ r.- oo \o(> c.l h € o\ \o r-. r- c.l (A (> o.l o$ cht) oo ol o\ o.| o.l aIt') c.l tt) oot- o\ It-tl rrl F-. c.l r!t c.l rat a 3,9$ €\o oo F-!+ \o\o rr) € NIh ail (O c.l(\ito c.l o' t?roo € !f e.l$o\ o\+ c.t € c.l(.t oo cil o\toa c.t o\ \o a.lio c.l cn int'l N o\r- a '+ o\6 c{ o\\o o\r- r.t atat c.l lo I c.l ta,tl\olf.t oial at\o c\.l I\oint'r €r- Cho o,la) EI d E E o() t ll r o'd\ a \oa\ Es \oIo 10to EI 10t = \o ts3 rOI = 1Ot = 10 Eo \oIo 10to E = 10 Eo \o So 1Ot3 \oto so do 1(iE(, 1OE dE;si in -f o + CNc.l \ooO rt o\c.l oF- r-Ftt t) cn CNN + r-(\I s \oci o\cn rn(\t q\ra F-Fc dE E]fl - F:' o rrr -J. o .t tn ct \o00 $ o\("1 or. Ft?l e71trl t{1ot + r'.N 3 Itn Ch lf)c.l Cht1 |.-r-c ! E i$9" . 8E E E t o + c.)c.l \o€ t o\ oF- F-. r.-t1 r.t a.t (.l ol !t N \o+ \o o\ \n(.l o\FT t-.t-o\ CI -tdGI F- s' ,.; s)uq) Ehi 3o\ Po E \tr (U 3s U )a ttt U' GI 0, H cl d o Fl o bIA 'E, >\ .Dq IJ.I a € E Eo E tl)tiF f-f ol €lt-l I qt oo c{ .E Et, oz -t r.{ riI e > tr s!I !t .9c s bl) Oo\$ tt EI! E 'ts rst{iE rxPs i$e$TE .l.$o t' $$\ Err- H EBI ET IE$ $IE I trIF tTI es IEB itiT SET it' R BS ol- eI H I 'a a. ll, € tr E .Ad 1) E .9 Eti, 'o I b o. >\ o E E tr €!, =r E il.9 3l :8IEfl[ HT H€ .,EI E EIEZlt- et cl H (-) $a. 'c) € Ie rrl& xs -c, o rE trq) P 3 U' rt) E RI E =l Erl 3 El.g EI E $c a* E€ flE Els glE srsElE ll Eo o rl c)6t oF.D 1Qo\ i I o) GIL C' EO Es5\' L) oF {.) tdL. It)o ad b o c) GIoa 5.\ clbot)o lt 2.6.2 Whet ere the ceuses of ebsenteeism? a o 'l'he people of Kano State are pre<tominantly farmers and, some are n<lmadic herdsmen and itinerant traders who may not be around during distribution. o Movement from rural to urban areas in search of better opportunities when treatment with mectizan or CDTI is being implemented. 2.6.3 What are the reasons for refusals? i Refusalc are among women in purdah due to absent of their husband to cities forgreener pusture immediately after crop harvesting and few are from men of conservative idea's. 2.6.4 I Brielly describe all known and verified serious edverse eventr (SAEs) that occurred during the reportidg period and provlde (ln teble g) the required in formation when available. In casi the project-did not have any cases of serious arlverse events (SAE) <luring this reporting period, please tick in the box. No case to report c c : I ( t c tq) E a, q) "s o' Lq) -s Es B L 't.t 'i. olr?t utq) aq) sS ? -o\ qr\o E E cr q) 14 ctq) *. 1,o B. b0 IT Eo o.l) tt DIrE a! 5 C)f{ Eo() o GI5 ta EI u) qt trIq) o) TAt 1) €6l (r)3o l.{I(H o (A ru6d() #r 6)l -olqll t-l l-r"lo t, trl-clu ]-E 9 .:t<.s b FgH gEE I q 6o E,oL o. ti o c) Eoo a o i I B Esl-PI .:tleD^ e3I a.t -E Ee9'; \ i- c? I ) \ zZ -eEQ E E== EgET.E l=f*"o'= G' =lH I t'6lO E.E,! s-p--E sgffg v\d E o- E!F C'7 - ( A -DJLL a , \ I Yfrr -a t D s \ iE*B= r!:* \ ) I az ) o q) Ua ct-.F = bt) >b IG- t a0dor xt)(r) 1 a/) t too6t 3 E oz t C\l (J o O. d 7 rn 1, o -.:t\ E P.Et.- c\, (D !i EE€; *I:Ek-E Uf;81I,Ss€' Hgsag .E.B B 6 EEE8sf t € og>. ;IfE 'EEEe E€E'E sgE; €r€s EI EE o.E€ or .EEe€ -o U 9t=lDuiile $€eeg€ hf EAod '!i ttl H ur5 3 -h'o e tE8 i$H9!r ri.l: trH'6€ (g H;Eg €HE BEIEp grE 3 E :EH E" E E .E.E SH!EE rTEE A9HJ *.H $; *'=7 9P 1 .8 {'Ecl .tl >< O .a)9A .E 56r il .E ES HF C)c,\ (D a EIo .-)s - - .gcI C) e!dLq) o() 7h\J t'{ r) - t 6lB.E €E\E s.EEEF*Eg.s:EE E3 $E €N.n o>#!.! E gsael(l)olC).Dl .E'elEF I .F.E ILtaIELEl -olEs I(J.5 IE; I& g, ..r e .l 6E€I HEII EEfl}E B: 56rI86o5EH!crp; €.tEc)eEEgtrEi6 -(D9 vif:Ex ?r ';EJ .EFl tr $ C.l sss o s(f) @ s\o o\ s o\a s o\ o\ \o O o\ s o\ o\ \o o\c\ \oo\(r) @ (D(5 n-i trll. ts pB- r H" \oo\ rr)o so@ s(\I o\ -oo\ * sc\ sco \oo\r*@ s(.)q\ I o(t ll rtl EI E o 89"ud' r9E8t- \oo\ o\\o soo s *@ -o o\ * CD s @ s(.^, @ \o o\\c € s(a) € Irl 9q.9 oinr() ,IE =0E6zL rn(r) o\O(\I 6 rr) t+(\t F- o\ o rr) c.l r- o\(ao!f(r) C{ o\N@\c(?) t+ rO(\t + ()o rO rt)N\t lr)+ o\ o\+ r.IEE5 ooOoo(\I oooo(f) GI OOoNt,- ot ooo@ o\ct oooo (r) oooorf)(f) oooo6(r) F--GI 1r)$(\I rrl tro .G oo trr -; ilgEE#SEu ' d. BgA EE (?i(\I rr o\6$I (n\co o(r) @+ rr)\o o\C\ 6 Ororoorf 5 o\$ (4, t-tf:t o\+ ro co C)F-6 * @t- o\oOrtr) G(t ll r rf t'5 H p$- = H" soo soo sg sE \oo\ 8 \oo\ 8 \o oo s o E'HssigB E soO \o Oo \oo\oo \6o\ O € oo \o o \oo\ o soo IrtEEss3EQ!z8- o o\ 6to\ @o\ ro rrr- t') t--F- rr) o\F- 6 t--F- o\ f.l €E$ Oo\ C\lo\ @Or rrt I-*r- |J) l--F- rfl6 r-- O t-- r.- o\ 6 n) o0 cl i) E E EI Eo bo6 iEe tE EE;EE''E HE 8 o6\ No.\ @o\ 1r) r* r-- tr) F- tr* ro6F- @ r-r-o\ & lI] t\o\o\ a o\6 o\o\o\ ooot\ ooN (\Ioo(\.l droo c.l ril'ooGI rrloo al E(\l t\oo ol o\8(\l o o C\l €I c.l 2.7. Orderlng, storagc and dellvcry of tvermecfln Mectizan@ ordered/applied for by - Qtlease tick the appropriate answer)MOII fI wHo D UNICEF D Other (please speciff): DO i NG V Mectizan@ delivered MOH NIl by - Qtlease tick the wHo D approprialQ unswer) UNICEF'D NGDO fI Please describe how Mectizan@ is ordered and how it gets to the communities The .st1c compiles population figures and determines total number of tablets that will berequired for the next-trealrnent cycle. lt provides this information to cBM who fills the reapplication forms and submits tluough th; NorF to MDp. on receipt of the drugs, the statecollecte the nrectizan from cBM headquarters in Jos. The r.GA coordinators pick thecoruignmcnls from ttre State while the rrealth facility riurf firt"tr their mectizan from the localqo^v:rnTent headquartets. These then inform the cbDs of the avaitauiiity oi mectizan. ThecDDs picks their consignments and distributes to the community members. Other (please specift): Table l0: Mectizan@ Inventory (please add more rows if necessary) Strte/Dirtrict/ LGA Nu mber of Mectlzan blets Rccclved Uscd Lct Wested Kura I10,000 105,000 104,731 269 20,000 ___!9,000 16,gg2 8 200065,000 60,000 _59,977 r23A 60,000 _54,000 53,791 ll 198l-80,000 165,000 164,437 563 Makoda 25,000 20,000 19,960 140D/Tofa t0,(m 70,(mo 69,950 50 -Eeq"ji 80,000 70,000 69,946 54TlWada 180,000 172,000 170,107 446 1447Warawa 60,000 50,000 50,000 Kiru 60,000 50,000 _ 4g,ggl 9 G/Malam I10,000 100,500 98,597 3 1900Sumaila 60,000 53,000 52,639 361 Kabo 40,000 35,000 34,419 582 Gwarzo 60,000 54,000 53,195 ls9 565Madobi 60,000 55,000 54, I 60 840Dambatta _40,000 37,000 37,000 I Takai 100,000 80,000 80,000 TOTAI, 1,390,000 1,249,500 l,239,6gl 2638 1 7l8l - How are the remeining Ivermectin tablets collected and where are they kept?'lhc renraining not uscrt by cl)l)s is rctricvctl hy l;l,rii,-rrofra*d lu'd ovcr to t,GAs foronward transmission to the state. lf the quantity is much cBM collect for reallocation to otherstdc in nccd, but if thc quantity is not much is ieft to conduct mop-up trcatmcnt activities. Rcqu6tcd Rogo Gaya Doguwa (r) (ii) List and bniefly describe the activities under Ivermectin delivery that are being carried out by health care personnel in the project area. FLHF $affput up requisitionto the LGA FLIIF collect the supplies and informs the community memberdCDDs of mectizan availability in his facility. CDD put up requisition to FLIIF staffand collect supplies signing mectizan inventory. CDD disfibute to all eligible rmder zupervision of FLIIF stafi, LOCT and community members. After completing the distribution CDDs retums all remaining drugs to FLHF staff. (iii) (rv) (v) LC. GornmunlQr selfrmonttortng end St kclroldcrrs f,eetlng Has any training (of trainers) for community self-monitoring been done in the project area? Yes,Community self monitoring and stakeholders meetings are yet to be conducted althotrgh LGA have been trained on it. If so, When? 2003. Table l1: Community self-moniloring and Stakeholders Meeting (Add rows if needed) Districu LGA Total # of communitios/villages in the entire project area No of Communities that carried out self monitoring (CSIO No of Communities that conducted stakeholders mceting(SHM) Kura 45 Rogo l0 Gaya t4 Aiinsi 23 Donrwa E5 ldakoda 4 D/Tofa 39 B€beii 70 T^ffad^ 3n Karaye 33 Kiru 23 Gfvlalam 4l Sumaila 27 Ikbo 46 Gwarzo 36 lvladobi 39 Dambatta 25 Takai 39 Total g'.n 2-9,. $upcrvlrlon 2.9.t. Provide a flow chart of supervision hierarchy. 2.9.2. What The 2.9.3. 2.9.4. Frlost community leaders process. a a o were the main issues identified during supervision? main issues identified during supervisory visits incrude: Inadequate contribution by LGAs Poor participation of CBOs appear committed to the implementation r No drug slurtages rccordcd or reported.o Incgrrect registration and poor entries of dosages given by new cDDs with low literacy levels. o Determination of dosage by use of caribrated corn sticks by some oldCDDs where wooden sticks aren,t adequate.o Inadequate support to CDDs. ' Low level of participation of women in the CDTI process. Was a supervision checkliit used? socrs used supervisory checklist but such is rarcly the case with Locrs. whet were the outcomes at each lever of CDTI imprementation supervirion? o Health facility staffare being encouraged to supervise more thoroughly, although there are complaints of inadequate lojisics.o Policy mz*ers at LGA level are routinety visitecl to splicit support forCDTI o The Locrs were requested to organize retraining for cDDs on recordkeeping and entries into the community log books" Coordinator SOCTs I,OCTS Health Facility Staff CDDs/Communities 2.9.s. 2.9.6. o Durlng, supcrvision some eflbrts were made to correct cpDs on poor entries made . Was feedback given to the person or groups supervised? Efforts weremade to give feedback io Uoitr health workers at the LGA arul Irealth Facility. revers- as ,well as tlrc comrnunities. .I1e .r,qj"; emphasis wasi on the health tfuorkers for those issues s€en at ihc community level, as they are expected to follow up on them. How wee the feedbeck used to improve the overall performan{e of theproject? 1r{ning was organized at state level for local government oncho teams. While at the LGA' level a similar training *^ org*ir"d for FLTIF staffwhich apparently transcends down to community ievels. SECTION 3: Support to CDTI t.l, Equlprrrcnt Table l2: statw ofequipment (prease add more rows if necessary) t Condition of the equ ip ment ( F-Furrctional, CNFR=Currently non-fu rrctional but repairablqWO=WritEu off). [Iow does the projcct intend to maintain and replace existing equipment and other materials? &z Flnenclar contrrbuflonr of the pertnerr and communr$m Table 13: Financial contributions by all partners for the last three years Sorrcc Type of Equipmerr AFOC MOH I,GA NGDO Others No. No. Cooditioo No. Conditior No. Condifio No- Conditio l. Vc[iclc I Frmbml I furrctb nal 2- fro.or l9 Fumiml 3 t 4. I 5. 1 CNFR. 6. I Flrrctbml 7. er,lmt &v I Furrctional Generator I Furrtional c Coutrlbulor J.. - T(}I'AL Crsh Iludgeled (us$) TOTAL C.sh Releascd - (us$) TOTAL C.sb tludgeterl (us$) TOTAL Crth Released __1qs$) TofAL C.sb Budgded (us$) TOTAL C.sh Released (us$)MOH (Central + Provinciaystare) MOH (Di$rict/LcA) 54,150 0 49,236 0 2!p50 ?8,qto 66,(nO 0 66,0m 0 1t,735Local NGDO(s) ( if any) t{illoFhcr(r) J2.M Tdug I ry5 40flioOtlcn a) b) APOC Trust Fund 44,25t 44,258 38,585 20,0q0TOTAL 256.70t 51,65r 24t,t2t 34.qgQ I l7,tt5 E7.J,t7 3r,$7 I- Ifthere are problems with release of counterpart funds, how were they addressed? - Additional comments 3.3. Otfrer forms of communiQl support - Describe (indicate fonns of in-kind contnlbutions of communities if any) The communities support the CDDs in kind by giving them some measures (mudu) of n:m;izelmillet/guinea corn/beans, or give them other farm products in appreciation of their work. During farming sorne communities assist their CDDs by rnobilizing some members to work on their farms. 3.4. Expenditure per activiQl Indicate in table 14, the amount expended during the reporting period for each activity listed. Write the arnount expended in US dollars using the current UnitedNations exchange rate to local currency. Indicate exchange rate used here Nl00/$ US Table 14: Indicate how much the project spent for each activity listed below during the re,porting period t Activity Erpenditure ($ us) Source(s) of funding lprug delivery from NOTF HQ area to central collection point of lcommunity lMobilization and heahh education of communities lTraining of CDDs Training of health staffat all levels Supervising CDDs and distribution Internal monitoring of CDTI activities Advocacy visits to heahh and political authorities IEC materials Summary (rep"rting) forms for treatment VehicleV MotorcycleV bicycles maintenance Office Equipment (e.g cornputers, printers etc) I I I 5,000.00 0,000.00 5,000.00 200.00 10,700.00 9,000.00 15,087.00 1,000.00 10,000.00 1,000.00 500.00 SMOH CB}WLGAY SMOH LGAs SMOII/LGA s SMOH/LGA s SMOTI/LGA SMOH SMOTYLGA SMOH SMOH TOTAL t7,4t7.00 Total number of persons !rcated 491,945 Any comments or explanations? SEC t rON 4: Sustainability of CDTI i i +1,- lntcrrrel; rndcpcndont parttciprtory nronltorrng; Evarr.iror, 4'l't Wns Monitoring/evaluation carried out during the reporting period? (tick eny of the following which are applicable) r ---o 4,1.2. What were the recommendations? r corrclude work on the Apoc sustainability plans for a[ levers;o sensitize all stake holders at state, LGA and'c."r**itv level, on the need for increasedand continued support ofthe project; o Ensure that GDTI continues to be budgeted for within pHC , VBDC and donor projectsbudgets; o Facilitate integration throughjoint training, monitoriqg and supervision;r Rctrain members oflocrs, staffof FLHFs and GDD"S on calculation of coverage anddetermination of regular tablets; r Improve on CDD/community population ratio;o Sustain the present impressive leadership, good mectizan requisit ion/co llection/distribut ion ana good maintenance culture ; 4.1.3, How hrve they been implemented? The evaluation was done in late NovemLr to early December, and it was not long the projectreceived the rcport of the exercise. Iszues raised will be addressed in 2004. However, draftsusainability budgets for 20c4 has been submitted ar; included in trre- MoH budgetestimates' The same is also true of LGAs.All the recomrnendations *o r"fl""ted in the plans 'already 2004 plans were approved by state and LGAS and many have released f,rnds andimplementation is underway. Year I participatory independent monitoring M id Terrn Sustainability Evaluation 5 year Sustainability Evaluation Internal Monitoring by NOTF C)ther Evaluation by other partnen 4-2- E,rHnabllttt of profccts: pran and set targct (mandatorlr atyr C) Was the project evaluated during the reporting period? No Was a sustainability plan written? yes when was the sustainability plan submitted? December, 2004 what arrangements tr'ave been rnade to sustain CDTI after Apoc funding ceases in terms of; {.,(.1. l,lanniug at all relcvant levels Rcpresentatives from the Stare & LGA have developed realistic 3 years sustainability plansbased on basic CDTI activities and recommendations made by the evaluators. These plans arebting fine tuned, but- draft plans have been submitted to ih" poticy makers and used inpreparing t}rc 2004 estimates. 4,2.2 Fuads The state and LGAs were rnade td realise that external sponsors(ApoC) ceases afterexpira.tion.of 5 years period whicir terminated in Des.'o3,they have been requested tocontribute increasingly to the implementation of the series of activities.The rt"t" ;iJr*l;il;of the LGAs have responded byieleasing funds for this year's CDTI implementation. Effortswill be made to continue sensitization of the policy makers at these leveis to increase supportand eventually fully fund the progralnme. tn ttre-npantime the project h^ L" assured ofcontinued support uv tF assisting NGDO, cBM, although the Lvel of support and itsterminal end have been given I2.3 Transport (replacement and maintenance) There are no written plan to replace existing transport. The project is requesting ApOC toreplace the vehicle and motorcycle supplied- Meanwhile the State has started giving someinput into the rnaintenance of existing trarnport and this expected to continue. At the LGAlevel, upst LGAs have started giving-rnainte'narrce and fueling allowance with the salaries ofLOCTs leaders. , 1.2.4 ofher rcsources sorrp LGAS have been -providing training and mobilization materials. The project willcontinue sensitization and mobilizition of ihe endemic LGAs and the State to ensure thatmaterials needed are procured when required. rn" f.o1""t also expects in the short-term assistance from the supporting NGDO. This area is ttre traaitional area or.rpport. l2's Pleqse provlde o wrttten plan wlth set torgets and achlevetnsntsfor solanThe sustainability plan is affached. 1.2.6 To what ef,ent has the plan been implementeil Implemcntation of plans has commcncod, so far specil-rcally the following wcre conducted: 2004 work plan was imptcpncntccl, 0 Relcase of StatellGAs counterpart funds for 6th year sustainabilty budgetso strenghening advocacy among readers an<r rocal NGo/cBo groups.o Targeted retaining LGA pHC personnel on cDTr data managemento Procurement ofadditional capital equipment. 4.3. tntcgration outline ore e*ent of integration of cDTI into the PHC structure and the plans forcompletc iruegration: , 4.3. 1 lyermectln collection I* LGl focal persons who are part of PHC departrnent normally come to collect theIvermectin whenever they come to collect NPI vaccine or other pHC logisiics for their LGAs.Also at LGA level Mectizartcollection is with PI{C structure because LoCTs, first line healthfacilities and staffare all with pHC department. 1.i.2 Trglntng There has been an instarrce where training on GDTI was infused into the programme oftraining for the immunization campaigru. There were also occasions where onchocerciasiscoordinators have been invited to live lectur"rlpm.n utions on CDTI during trainingworkshops for other programme. 4.3.3 Jotnt supemision l An integratcd checklist for supervision of PHC activities ha1 been developed by tlre Ministryand is being used for supervision of all PHC activities including onchon control. l 1.i.1 frclease offundx lllttle PIIC programme have a conurron account where pHC funds are lodged and releasefollows routine procedure- However, there is a State oncho account where state counterpartfunds are lodged 43.AIs CITTI tnctuded h the pHC budget? At the state level CDTI is included in thJPHC budget. At the LGA level it is subsumed in most cases in general line items. i4'1'6 Dxrlb other health programmes rhat are using rhe GDTI struclure andhow thrc wos achieved what have been the ochievements?National Programrne on Immunization (hIPI) t r riurt"o using GDTI struc(uresthrough involvement of community members to as local guidJs and community supervision in their respective polio campaign. 4.1.7. Describe otherc issaes considered rn the integration of GDTI. with the assistance of cBM the fust line health.facility are being used to serve as primary eyecare csntre following an intensive training in blindnes. in ,o*" pilot LGAs. However, there isa plan to integrate vitamin 'A' supplemeritation i"to "*irtio! CDTI structure. 4,5. Operetionel reseerch 1.1,1 sunmarize in not more rhan one half oJ a page the operationor research undertaken in the project or"o ni[hii fii ipoiing perrod. None was carried out during the reporting plrioA. - 4.4.2. How were thc rcsults applied in lhc prr-rjcct./ N/A SECTION 5r strengthE, weakresses, challenge$, and opportuuities Strengths I i: Iligh comrnitment by community learlcrs and CDDsiL Training of CDD$ at a locationclose to them is a good strategy as other communitymcmbsrc watch training event and this boost thc knowledgc of cornmunity mcmbcrsregard to CDILiil Corrunitted staffat both state, and LGA level.iv. Iligh trcatnrnt covcrage. v. cD'|] srrarcgy wiil bc an inroarl to othc'r pHC programmcs. Weaknessei I I Delay in the release of counter. part funds by both state and Local Governmcnt .- hampcrs the srmoth implementation of CDTI. e+.*v ..u lveuii' Payment of rnonetary rewards by other programme i.e. polio eradicatiori campaignlower thc rnorale of CDD. Challenges o lnarlequate support to CDDs by the comrnunitiest Payment of incentivcs-to village workers by some prograrnmes such as NpI has affoctedthe CDTI implementalion negativcly o Low participation of women and community basecl groups in the CDTI process is still noterrcouraging. Lht how the challenges were ailtlressed. 'l-he challengea encorurtcred were addressed in the following ways (but they still remainedcurrent challenges) .'..'" 'r.rs \vur 1'v/ o lnteruified targeted npbilization of-community membcrs, influential persons and interestgroups to support CDDs. This is stifi being pursued.r Effort made to identifi and mobilizS.*or*r, groups to sensitize/trealth educate womenard generally increase F*1" participatio.. 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