Osun State CDTI annual project technical report submitted to Technical Consultative Committee (TCC): January to December 2006

OSUN STATE CDTI PRO.JECT , ORIGINAL: English ANNUAL PROJECT TEGHNIGAL REPORT 5UBMITTED TO TECHNTCAL CONSULTATTVE COi ttrrrEE CrcO DEADLINE FOR SUBMISSION To APOC Management by 31 Januarv, 2007 for March TCC meeting To APOC Management by 31 Julv. 2907 for Seg]em,EI TCC meeting AFRICAN PROGRAMME FOR ONCHOCERCIASIS C0NTROL (APOC .s t t il r I I :t, o r*l tst) B.o9 + ar ry rt e'il v da' ' r.o-. tr1 2 n LUtt 2007 + t COUI-.{TRY/NOTE : Nigeria Proiect Name : Osun State CDTI Approval vear : 1998 Launchins vear : 1998 Renorting Period: From: I't Jan., 2006 TO: 31" oecTooo (Month i Year) Proiect year of this report : (circle one) I 2 3 4 5 6 7 (8) 9 l0 Date submitted: February 2007 I\GDO Partner: UNICEF f? --{ > T B 3 o ttt o I I1 ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSI]LTATIVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate sPace. OFFICERS to sign the rePort: Country: NIGERIA National Coordinator Mrs. P. Ogbu-Pearce Zonal Oncho C oordinator @*'c- 0jl oT1 ut* Otunba A. O. Jaiyeoba Name: Signature Date: Name: Signature Date: 2 c 0,,", This report has been prepared by Name: Mr. M. E. llelaboye Designation Signature: Date i9 ,t-^.}lJx/ znD> .,1 L f. TT t* [? .I I l I I I I I I I I I I QlU I I t I I I I I I I I I I I I I I I I I I I t I I I T I I I I I ! I I I I I I I 'rl TABLE OF CONTENTS ACRONYMS DEFINITIONS FOLLOW UP ON TCC RECOMMENDATIONS EXECUTIVE SUMMA]TY SECTION I : BACKG]ROLIND INFORMATION t.2 GENERAL INFORMATION 1.1.1 Description of the Project (bnefly) 1.1.2 Partnership POPULATION AND TMALTH SYSTEM SECTION 2: IMPLICNIENTATION OF CD'II 2.1 TIMELINE OI] ACTIVITIES 2.2 ADVOCACY 2.3 MOBILIZATI(]N, SENTIZATION AND HEALTH EDUCATION 2.4 AT RISK COMIVIUNITIES COMMUNITY INVOLVEMENT CAPACITY BUILDING TREATMENTS 2.6.1 Treatment figures 2.6.2 What are the causes of absenteeism 2.6.3 What are the reasons for refusals 2.6.4 Briefly describe all known and verified serious adverse events (SAEs) 2.6.5 Trend of lreatment achievement from the CDTI project 2.6.6 inception to the current year 2.5 2.6 1 2 J I 4-5 6 6 6-7 8-9 10 11 1l I2 L2-14 l5-16 I7 -t9 ? 20 20 2t 2t ,l 2I-22 a a ! 5 23 2.7 ORDERING, STORAGE AND DELIVERY OF INVERMECTIN 2.7.1 Mectizan inventory 2.8 COMML]NITYSELF-MONITORINGANDSTAKEHOLDERS MEETING 2.9 SUPERVISION 2.9.I Provide a flow chart of supervision hierarchy 2.9.2 what are the main issues identified during supervision? 2.9.3 Was a supervision checklist used? 2.9.4 What were the outcomes at all level of CDTI? i mplementation supervi sion 2.9.5 was feedback given to the person or groups supervised? 2.9.6 How was the feedback used to improve the overall performance of the project? SECTION 3: SUPPORT TO CDTI 3.1 EQUTPMENT 3.2 FINANCIAL CONTRIBUTIONS OF TFIE PARTNERS AND COMMLINITIES 3.3 OTHER FORMS OF COMMLINITY SUPPORT 3.4 EXPENDITURE PER ACTIVITY SECTION 4: SUSTAI]\ABILITY OF CDTI 4,1 INTERNAL: ]NDEPENDENTPARTICIPATORY MONITORING I]VALUATION 4.ll Was monitoring/evaluation carried out during the Reporting period? (tick any of following which Are applicable) 24 25 26 27 27 27 27 28 28 28 28 28-29 30 30 31 32 32 a tr i I k, I 32 4.12 What were the recommendations? 4.13 How have they been implemented? SUSTAINABILITY OF PROJECTS: PLAN AND SET TARGETS (MANDATORY AT YR 3) 4.2.1 Planning at all relevant levels 4.2.2 Funds 4.2.3 Transport (replacement and maintenance) 4.2.4 Other rosources INTERGRATIO]\I 4.3.1 Invermection delivery mechanisms 4.3.2 Joint supervision and monitoring with other programmes 32-33 37 37 -39 34 4.2 4.3 35 35 35 35 35 36 36 36 37 37 4.3.4 4.3.5 4.3.6 Release of funds for project activities Is CDTI inclined in the PHC budget Describe other health programmes that are using the CDTI stnrcture and how this was achieved. What have been the zrchrevements? SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES AND OPPOR'TUNITIES SECTION 6: UNIQUU FEATURES OF THE PROJECT/OTHER OTHER MATTERS 39 l+ t, t I I a; Acronyms APOC African Programme for Onchocerciasis Control ATO Annual Treatment Objective ATRO Annual Training Objective CBO Comm unity-Based Organization CDD Comm u nity-Directed Distrib utor CDTI Comm unity-D irected T reatment with lve rmectin CSM Community Setf-Mon itoring FLHF First Line Health Facility FMOH Federal Ministry of Health GCCC Govemment Cash Counterpart Contribution IFESH lnternational Foundation for Education and Setf Help LGA Local Government Area LOCT Local Government Onchocerciasis Control Team MOH Ministry of Heatth NGDO Non-Govemmental Development Organ ization NGO Non-Governmental Organization Nationat lmmunization DayNID NOCP National Onchocerciasis Task Force NOTF National Onchocerciasis Task Force NPl National Programme on lmmunization PHC Primary Health Care REMO Rapid e*terniotogical Mapping of Onchocerciasis SAE Severe Adverse Event SHM Stakeholders Meeting SMOH State Ministry of Health SOCT State Onchocerciasis Control Team TCC Technical Consultative Commiftee (APOC Scientific Advisory Group) TOT Trainer of Trainers UNICEF United Nations Children's Fund UTG Ultimate Treatment Goal w-ro World Health Organization t .) i& lr J, I lv I {; Definitions (i) Total Popglation: living in meso / hyper-endemic communities within the project area (based on REMO and census taking). (ii) Eliqible population: calculated as 84% of the total population in meso / hyper-endemic communities in the project area. nual Treatment (ATO): the estimated number of persons living in meso / hyper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. Ultimate Treatment Goal (UTG): Calculated as Maximum number of people to be treat annually in meso / hyper endemic areas within the project area, Ultimately to be reached when the prolect has reached full geographic coverage (normally the prolect should be expressed as a percentage). Therapeutic coveraqe: number of people treated in a given year over the total population (this should be expressed as a percentage). Geooraphical coveraoe. number of communities treated in a given year over the total number of meso / hyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). lnteqration: delivering additional health interventions (i e vitamin A supplements, albendazole for LF, screening for cataract, etc.) through CDTI (using the same systems, training, supervision and personnel) in order to maximize cost-effectiveness and empower communities to solve more of their health problems. This does not include activ*ies or hterventions canilad out by cornmunity distributors outside of CDTI. Sustainability: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future, with high treatment coverage, integrated into the available healthcare services, with strong community ownership, using resources mobilized by the community and the government. Community self-monitorino (CSM): The process by which the community is empowerdd" to oversee and monitor the performance of CDTI (or any community-based health intervention programmed), with a view to ensuring that the programmed is bein g executed in the way intended. lt encourages the community to take full responsibility of ivermectin distribution and make appropriate modifications when necessary. (i ii) (iv) (v) (vi) (vii) (viii) (ix) I li I I ! 2 FOLLOW UP ON TCC RECOMMENDATIONS It is pertinent to note that the anticipated TCC Recommendations in the year 2005 and 2006 Technical Report would be duly addressed in the year 2007 Technical Report. I L J l& t t Executive Summary Osun State is one of the States in the South Western part of Nigeria and is located in the B Health Zone. The State has a population of about 2,244,000 million (1991 census). About 846917 people are at risk of Oncho infection in the project area. The State is a predominantly Yoruba state. Other ethnic groups like Hausa, lbo, Fulanis and Agatus however reside in all parts of the State. Osun State is in the eight year of its implementation. As usual, emphases were placed on grassroot community involvement with a view to enhancing full empowerment and sustenance of integrated monitoring and supervision by the use of the newly revised integrated monitoring and supervisory checklist. During the year under review, CSM and SHM were expanded to 100 endemic communities in 10 LGAs. So far, CSM and SHM had been initiated in 387 and 162 communities respectively in the project area. Ten (10) SOCT/LOCT monthly rotational meetings were held. All the 997 endemic communities were effectively mobilized and treated accordingly resulting in sustaining 100% geographical coverage. With a total population of 846917 and an Annual Treatment Objective (ATO) of 722416, the project was only able to treat a total of 542,382 people during the period with 1 ,292,185 tablets in the 14 APOC assisted LGAs. However, 276,366 people were passively treated with 701,3O9 metizan tablets in other 16 LGAs. This meanta640/o therapeutic coverage. As per training / retraining, One Hundred and Twenty (120) LOCTs were either trained or retrained in 2006 while 878 Health workers were either trained or retrained. These constituted 2OOo/o and 95% of ATrOs for LOCTs and frontline health workers respectively. 265 CDDs out of the existing 3,053 CDDs were retrained while 66 CDDs ta 4 I .) i were newly trained; thus bringing the total number of the CDDs trained to 331 during the reporting period. This constituted a mere 11o/o achievement of ATrO. The major constraints that faced the project during the reporting period were the massive transfer and redeployment of health workers in the entire project area, and lack of functional logistics and capital items. This affected implementation of most planned activities. The challenges confronting the project during the year inctude the estabtishment of a data bank at State level to eliminate inconsistencies in data reported, expansion of CSM & SHM, conduct of census updates, ensuring adequate releases of counterpart funds, increasing number of CDDs and reducing CDD/poputation ratio, increasing pace of integration of CDTI into PHC at all levels, and ensuring proper managerial and technical training for the newly appointed LocTs. The project tried and is trying to address these challenges by doing the following: . With APOC support a data cotlection process is being initiated with which the project will be able to have a community CDTI data base at the State level . There are plans with UNTCEF to ensure proper training of health staff to increase their managerial capability. . There are also plans by UNICEF to support training of additional CDDs in 2007 5 SECTION 1: BACKGROUND INFORMATION 1.1 Generalinformation 1.1.1 Description of the project (briefly) Geographical location, topography, climate Osun state is one of the states in the Southern Western part of Nigeria and is located in B health zone. lt is bounded by Kwara State to the North, Ekiti and Ondo States to East, Ogun State to the South and Oyo State to the West. The State has a Iand mass of about 8572 squares kilometres. The State has two distinct seasons, dry season and rainy season. The rainy season begins in March and is heaviest from June through September / October. Farming generally begins in April; most farm work is completed by October, after which the harvesting is carried out. The dry season begins in November and ends in Mid March. Population: Activities, culture, language Osun State has a population of about Z.24millton (based on 1991 census). Yorubas constitute the major ethnic group, although some minorities such as the lgbos, Hausas, Fulanis and Agatus exist and cohabit peacefully with the indigenes. The State is essentially an agrarian State with aboul TOo/o of its population engaged in one form of agriculture or the other. ln addition, it is a State that is internationally recognized for its rich cultural and tourism potentials. Comm unication Sysfem (road.. ) The major roads in the State are tarred but access roads to most of the endernic communities are in poor condition. Some are only passable during the dry season. Despite this transportation by road remain the major means of communication among the communities. l. E. C. materials, electronic media and the use of community town 6 :& qI l crier, announcements in Churches and Mosques also form part of the communication system used. Ad mi n istrative Stru ctu re The State is made up of 30 Local Govemment Areas with the Chief Administrative Officer being the Chairman. A legislative arm made up of setected councilors from various ward supports him. At the State Level, the Executive Governor is the head of administration supported by an elected legislative arm and the judiciary. The capital of the State is located in Osogbo. Health System & Health care delivery There is an Official PHC System and it is implemented in the project area. It is a system where health care services are taken to the doorsteps of the rural populace. It is a system where community participation forms the mainstay and thrust of health care delivery with support from the UN agencies, the State and Local Governments. Levels of functionality however vary across the State. Within the project area, there are 3 teaching hospitals, 9 State hospitals and 330 health facilities scattered throughout the entire State. ,,L T T t NUII'IEER OF HEALTH STAFF INVOLVED IN GDTI Table 1: Communities participation in the CDTI (Please add more rows if necessary)- 1.1.2 PARTNERSHIP ISSUES The partners involved in project implementation within the project area are UNICEF / Nigeria, NOCP (National & the B-Zonal Offices), the State Government, the various Local Governments and the endemic communities.* 8 District / L.G.A Number of health staff involved in CDTI activities Total Number of health staff in the entire Project area B1 Number of health staff involved in CDTI B2 Percentage B3=82lB1 *100 Atakunmosa / W 62 60 97 Ayedaade 70 64 91 Ayedire 77 58 75 Boripe 128 85 66 Egbedore 110 79 72 lfe Central 60 57 OA lfelodun 70 47 67 lfe East 79 76 96 lla 66 62 94 lsokan 70 48 81 lwo 72 57 67 Obokun Oriade 78 73 94 75 62 83 Orolu 54 50 93 TOTAL 1rO71 878 82o/o OVERALL WORKING RELATIONSHIP AMONG PARTNERS Overall working relationship among all partners is cordial. However, only APOC among other major partners provided funds for programme implementations. UNICEF and others did not support during the period under review. The zonal and national offices assisted in supervision, monitoring, training, advocacy and mectizan procurement. Similarly, the State supervises and monitors the activities of LOCTs and First Line Health Facility Staff (FLHFS); trains health staff, conducts advocacy visits, collects Mectizan meant for the State and coordinates local govemment CDTI activities. The local government plays such roles as training, supervision and monitoring of oncho field activities; Mobilization of the communities to fulfill their much expected roles most especially in giving incentives to CDDs, and finally in coordination of the FLHFS reports and ensuring prompt rendition of same. The communities play such roles as selection and remuneration of CDDs, collection of mectizan, distribution and reporting of treatments. PLAN TO ASSIST IN IMPLEMENTATION There are plans to sustain mobilization of existing policy makers occupying local government positions. 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'n (D o _1 0, .2 -n (D cr -cq, a -Tl o(t acll, a 'n oUac o, a -Tl o(, 1c 0, a 'Tl oU ac o, .z 'n ouacll, a? -TI (DU ac 0, a -r'l oUac 0, a? -Tl o cr a L ID a -r1 oo -c o, .z o6i J ==.J= (o _J il =' ='(o o) a = o) B = o) d) o, d = = 'Da = =ll) a = 0) d J =o)ao = o) a = 0, a:' o, a = 0, a = o) a o) d5 =ooO]J =6it -o' = 6-6 **.Jl (o oo :la C @ C! o- o) o OO =f =6o- ato5 0, -o = o) a = ql a = o) -c) = o, -c) = =g) a) A) d J It) ao = 0) d = 0, df ll) aJ 0) a) o, a = o) 1 c) J oil =*.(o o e(o o6' =.oC =.o J (- c l(D (- c =to L.c =(D (- c5(D (- L =o (- c =o C- L f o (- c) o (- c =o (- Efo (- C, f(D C-c f o (- L =o (- f o OO =rI =dat *o l .T oUac o! a? 'Tl oq -g o, a? 1I ou ac o) a -n ou -c o, e 'Tl ou -cq, € .TI ou -c 0, e 'n ou -cq, a? -I1 oUtc 0, a? Tl (D o e 0, a? 'n oq acq, a -n (Du -c 0, a? 'Tl (D(, ac o, € 11 o ct -c ID a .TI o ET E o, a o6i =Jf (o (t CEo 3 @. of,c(o c tn c(o c ah E(o E U, c(o co c(o c U, c(cI Eo E(o Eo q(o E U, c(o c.o c(o co c(o ca c(o c ah c(o c an c(o Eo =oOO ={ =56- =.o f F F n a2.2 Advocacy and Sensitization Policy makers in all the 14 endemic LGAs were sensitized and mobilized to support the CDT! implementation process through advocacy visits during supervisory trips to the LGAs by programme staff and external persons / evaluators. ln addition, during the monthly rotational meetings of the LOCTs with the SOCTS, LGA Chairmen are usually invited to give key note address. The meetings provided an avenue for interaction with the Chairmen, and for them to recall what they had done for the implementation of the programme. The forum was also used as mini-training for educating and updating the knowledge of coordinators on proper record keeping and other CDTI activities. Sorne LGAs have responded with government counterpart cash contributions being made available. At the State level, the project has relied on external bodies like UNICEF and NOCP officials when they came to visit the project and pay advocacy visits to the policy makers. Constraints experienced were lack of logistics (the aged prolect vehicle can hardly move around without breaking down), change of political functionaries at the LGA level, and lack of IEC materials targeted at policy makers. To improve advocacy, high level visit need to be made to the State Chief Executive and a new project vehicle procured. 2.3 Mobilization, sensitization and health education of at risk communities lnformation on: The Use of Media for Mobilization The Communities were mobilized through jingles, on Local Radio Stations i.e. Radio Nigeria & Radio Osun, Mosques, Churches, Town Criers, Public address systerns 72 mounted on moving vans, IEC materials like posters, handbills, and village meetings were also used to mobilize the endemic communities. Mobilization & Health education of women and minorities The involvement of females and other minority tribal groups had continued in no small measure to the optimum support being received to sustain CDTI programme over the years. Women are increasingly participating in CDTI activities more than hither-to. Response of tarqet communities / villaqes The Community members / Villagers mobilized responded to the mobilization and health education carried out by the SOCT, LOCT, First Line Health Facility Staff and the CDDs. They came fonarard to collect their Mectizan and in some cases gave incentives to their CDDs. Some gave funds for CDD training. There is more awareness of lvermectin benefits, more involvement in decision making and villagers make more efforts to encourage potential refusals to take lvermectin. Accomplishments: (a) Female members of the Community are becoming more involved in the decision making and Mectizan drug distribution. (b) Refusals to takirB of drugs has decreased owing to (i) the regular interventions of our respected village heads, Bales & Kabiyesis, (ii)Programme integration into other PHC Sister Programmes e.g. National Programme on lmmunization (NPl). (c) Adverse reactions: Cases of mild reaction like itch ing, general weakness of the body and swelling which were being properly handled by the Health's workers were noticed during the reporting period. lt could as well be noted that no single severe adverse reactions recorded. i 13 iTo lmorove Mobilization and Sensitization of tarqet communities: To improve mobitization and sensitization of target communities, the project initiated/continued with the following strategies: - Sharing of transport of sister programmes (PHC functioning programmes) for advocacy visit to policy makers and community leaders. - Greater involvement and participation of Health facility staff. - Utilization of LOCTS / SOCTS monthly meeting for community mobilization. - Usage of treatment data and as a tool for monitoring and follow up of mobilization activities. - Emphasized on integration at all levels. - Equipping of health staff on effective mobilization skills particularly on CDTI activities. t4 {NBb 6'Io o 3o3oc3= =.8==-tE5 =(D0: 3Eg 6' Fi J =':, o o o -lto A)q o 0) o- a- fo (d o E6\ f, ooo ca C"q) 3 Lfr (.J 6 Fl o t9 o -o o p CD o o {o lt)o p (D'Fis ah (D' o CL (D. oo A, L^J ooE(Dg or! o Egort o (D El o (D l) o B ot,s = a, rt a F o \o\o -t @o N) A \o Nt'.) o\\o @U) N) -I tJ l, 5N (,l (})t) o\ -I o '.iJO 6rE <tZ!ro ra6irw5 iE (.1 xO {(DEAEpa .6 9.rgG,a z Grt o oo E r!a le OQGG{ a t G t! 4 o q o .a a d At\) o\ lJ) lJ) (-}l tJ lJ)(JJ tJu) t,(, u)NJ h.JO @ tJ)o () N)N) 5 N)oo =Z:itr ;e 4i rlB = =9 .D !lIE d.z 5(, s 5 oo\,(,t N) (, sl*) (JJ |..,{ G 9\\) s5 ! UJ(f) o\ 90 oo o\ o\ H3 *ll,l =EEE a -U Ffi t\) ba[.J oo\o s 'J) oo o\ {O \o5 tQ{ {u.) NJ N.)NJu) N)5 tJU\ o\5 o\ o>EEUiY6- o7EiE95o :t i?6'o <oOE.T ao\o o\ 5Ur 6O UJ A(J.) o\5 o\ { A o\ NJ& (-rlo\ (,O l..J arl BEi g uEi u)E t\)(.) u.) N.J ul(/.) \o (])5 (, (JJ 5 (JJ{N)5 UJNco(JJ @ NJ5 N)N)@ EE\o ll rl {f EE € As6 t)E o\o\ UJN N)@ (,lq NJo\ u)\o N)(JJ \o N){ o\Llr b.) N)(, A =t5',z EH E +e-=.9 n3.oii(!ir Ua 2 ojrr i.O 6'O E5 cE r\I D 0a Gq A\o s g) O o\ @ l-.Jo\ s(j (])@ s{ @(, u)\o Ot5 (,Lrr \o (f)o @o w -^vr'lle =EEC =B) R* Health Education Meetings: 2.4 More females are attending health education meetings and fully participating in discussions The attrition problems continued to be addressed by making use of CDDs as Local Guides and recorders during LlDs imptementation. I6 2.5 CAPACITY BUILDING Describe the adequacy of available knowledgeabte manpower at att levels There is knowledgeable manpower at every level of CDTI imptementation in the State. where frequent transfers of trained staff occur, sfate what project is doing or intends to do to remedy the situation (The most important rssue is whatlneasures wete taken to ensure adequate CDTI lmplementation where not enough knowledgeable manpower was avaitabte or staff often transfened duing the course of the campaign). \l/henever new staff was employed or when trained staff was transferred, training was usually organized for those that replaced them or the newly employed one. '.8 fat fg fl, T * I7 {!l cr o !T -l ts) ='J(o o J o o- =o o = o o @ o ogI =' E 6- 3 o :f o =o J ! 6- 0) @ o o)o o. 3 o -lo -to{ @ {r =oo oaa o) a? s a (D o (D Fl oFl F To ort s EL(! o o -(, o !e -{o -19 (!'F'$0 (D, o - tD' o(D Ft 19 TtJ OQ o trL o t! EE (D GE .6 (D te t9 o te o u, D, = U 0 (,) O F o a o\o 5 (, 5 5 A A A A A A (, L,I (,,l 5 OBU 4,1 A)L +36(t:t t!l! -r oHr O i .) 0 F o a o\o 5 5 L,T (.,r LN 5 (rn 5 5 s 5 5 5 5 ^:Nf o\o 5 t, 5 5 5 5 s s s s Lrr Lh (, 5 ^x,j'Q l.)oo N @ \o \o \o \o oo \o @ @ @ \o \o \o @ o ll -lC]o o s a (D o (D (.) o\ (,o -lL'I {b..) -I {t..) o\\o {o o\o o N@ {{ o\o o\N O'l-a E-zol:ae tei *50 s*5'gQ=*= t! (D (, o\ N) NJ N) t9o\ \o t..)o N)oo t'.JL'I N)\)rr [.J t\) N)gJ l'.Jtr) N)5 o3 ( o\}.) b.J\o s s{ (}Joo b.J00 UJs (rr UJ{ l+)tJ Ur5 o\ rJo s lJ)o\ \o5 o\ s -I6 o o\t') -l(J.) (,{ soo t.J {o\ 5{ (,t -I { @ L'T oo o\5 o\ (.) ll 'l ..)oaso s a (D (D o rl! o\ I o\ C)i U z tD do 6t! aD -t tD O I I I n2 o* o\ I I o\ ab:\ o\ I I o\ a) i-li r(J - +:I t.J o UI OJ (J){ tJt.)o\ Nu)o\ UJ -I o\O (rtoo u)(,o N\) so Noo ()J{(J) oo(, N){ t-.Ju) OB;a z tD o a F' tD o\ o\ b.J o\ (, s o\ { Lal N) (JJ t.) @ UJ b.) ^2:'a N o\UI t.)a N s o\ (, N\o oo t.J \o (JJ(, { 6 @ ab;'$ (,(,J { N(rt No, @ NN NN (.)5 Nct (rr U) + @ N) N)o o 6ll g \l o s.E o G h I :r 'l {I I I L I t t I I I I T I I I Table 6: Type of training undertaken (Tick the boxes where specific training was canied out during the reporting period) Trainees Type of ] training GDDs Other Community members e.g. Community Supervisors Health workers (frontline health facilities) MOH staff or Other Political Leaderc Others (Specify) Prcgram Management How to conduct Heafth Education Management of SAEs csM SHM Data Collection Data analysis Report writing Other (Specrty) i_: iH !1 s t il 19 NN!" b, I {{ oo!ro+=iJ3oo Ft ai =!oGI c -o o {$r o -l -{aoo)-r ==d(D =Eil.0 =oo-9g6' md2 ,E. l(o =0)w =.(Do0) o-\= rf,Or ofsg(o ruP a,qEg o)= -o' a' !!-xO o 6'Eo)o)tn (ooo$o)o=o-o33oo oa, OJt0)U'f, =o)(Jl)-oOo\oo=Eq0) o)3Ec o oo o -0)(o o o)rC f 3o a ll) = tr,r6' tr, a >6' (D o (D o .L 0) o) o- o (D Io oa Et 9_ m GIu ooo o (E o aE(D o o 6ox o, f Do t, o- o o6 oxca sirf,Ei*o,{ (rlo$N) (,l (l)NI\){ N)(,)I19N ct(o o(r)IoN) 5o J o(O (o(o{ @o oJ- s"qgE ='o Doa o,{ (,osN J(rl (r)N)l\){ I\)G)NT\) CD(o @(r)o,\) 5o o(or0(o{ @o =-8 zs-=15 8.85 E BB Hi o){ (rlo5N) (JiA G)N)@c, N{ l\)G)o(o N)T\' o,(o@o oN so(o.D o o 3 3 3 o o s q, rEt o o EHEq#g -l= E'cr+or Ioo oo oooo oooo oo oooo oo oo JoooC' oo oo [ltt*Es (,{ 5 1\) s{(Jl(r) G) 55 CD C^)(rl 5(o ct,o(o (, N(r) G) (Jl Cr) s@ { NN <tr {(,r N G) {(rlo{@ G)o ct,(,r o, o,(,ts(, t\) (o o,{(,l o) CDso(l) N) oFolio {{NNC' -t g: ='o )D 1- s(,(rl(.) @ 5os J Ctr 5(r) 5(O @ (r)(o{(r) @ 5s o,(o5 l\)(o N)(rt(tl o,s o) J N (rls (Jl(o (rr(o(O ct, CT, o)o cto(o NNb (D o)o{{(o (, CDo ct,@ (, @(, @ { o,(rl o,{ =EE -? (,)o@(o o G) Ct) N CD -.to@(.) G)ol\)ol\) N{ ct,5(, s (o 5o so G)o N) (,) o)No C" (r)(rl(o N) @ s(,) s Or$NtcN 5No (rr (, sq) N 5NsoN (, o(r) ! oEtr t o = {(o @o, Eg: ts6d :l--C BBE i-= olo o,(r) <rro (o \tcDo @o(rl{ {CD a{ (rl(rt (rr(O (,lN)(D.F $,8;Eif s ooNNl\) ()) s 5 (rl BEgr gaG) t\, G)N) G) N)(., N) (.) ,\) A oz -EO= ilE = 3a8",=OEoo-=CllD= €.idaegsf '- -=af,o " qg it li t I E N.B: Low treatment coverage rates in some LGAs reflected in the table above was due to complete change of tralned and experienced Oncho coordinators as a result of mass transfer / movement of former Oncho coordinators to recenly created Water & Environmental Sanitation (WES) department, which invariably gave rise to the new set of Oncho coordinators. The latter are being subjected to training on CDTI's activities. ln addition, the declining interest on the part of some CDDs occasioned by lack of incentive contributed to sharp decline in treatment coverage when compare with that of year 2005. However, the project is working assiduously in addressing this issue by remobilizing the communities and encouraging increased usage of CDDs as guides and recorders during NlDs/LlDs. 2.6.2 What are the causes of absenteeism? Occasional festivities, communal crisis and normadic migrants accounted for the absenteeism. 2'6'3 What are the reasons for refusals? Fear of reactions, religious belief and long years of administration (15 - 25 years) were recorded to be the causes of refusals. Community mobilization and health education were intensified in the churches, mosques and among the community members in addressing the problem of refusals. 2'6'4 Briefly describe all known and verified serious adverse events (SAEs) that occurred during the reporting period and provide (in table g) the required information when avaitable. ' ln case the project did not have any cases of serious adverse events (sAE) during this reporting period, please tick in the box. t- No SAE case to report { a& $ n il 2t o z * rEt o (t, ox os (o :i0) =' tcl)O =s=8p g il ilH fiE s EBqo=oed * o 3!, o 36 refrs J rlis =a 6'dEiE q CLilr-6'9 *qo=3 tB giEil$ I'q IP:B IE =t,,=.4,sii =.6 ='ro8.9 ='o6>r =cl =iose aI I{l3rlu l.Dlo o o) CD(D U' o U'(D -t.oc U' o) o- (D d(D (D (D3 (t) CN m CI' f o) oo c)c =(Do- o_C -t -)(o =(D dEo = ='(O E(Df,.o o_ t(D o)(rt(D q) o_ o_ =od d € a, -r =oC)(D a, a, a)e @ o .t P- f,c 3uo1 oJr =o E o) =of a l..J l.J Ir rit t I { I\tgF, =oro 9{ .e =l=dcL0r* g. l-gE 6=iodf= o-8a5;.EEoil O= 83ir3aooO OEE .d.qa J=oc,E3 ='oOJEdoEil r,OEat1"5 rf o-g$(t, o =r 5 o da Ba ao o) =!o(Doll'$B Of =:qaoE!, oo !r=!od il5 CLOga Oa =+:rot E _d. =.lDJ() tt- -il?e =!,6j * c)Jo+6t !t GIo5 oglD(,gF o,iE6'ro :!,oovO 0o Eo(D !,tT' oE -4.3' (D !, CT o C'o o{ I NJ UJ : L ff il t No o Noo ro Noo6 Noo _.t Noo o) Noo(,r NooS Noo(, N)ooN Noo Nooo (o(o(o (o(o @ (o(o{ m 7 (o(o{ (o(o{ (o(o{ A o, A G' A A(r) o,@o cr) c,o o,@@ [$g,Eii o o 3 3c5 ci o(,t = !, GI ou (o(o{ (o(o{ (o(o{ IG) IG) @oo {No {No @Oti\) o {- .r 6P sg -B=? EE-o5 (o(o -l (o(o{ (o(o{ J G) o(o C" {{@ 5{(D coo N){ r3q = o<=r E=E F EE*i oo oo oo oo {(o o)@ N@ T\)(rl P Hs qttrnb B B hfi.E oo oo oooo {(o (o{ ctct Qll(r) G) ;fr* = @s o, @{ @ G)o(,) @ so(r)o {s N)s o)l\) {5N)s CJt\) {sN 5(r) t\) (o {o (o {o (o {o o- P e -:6 a$EilEa E otc o, o5 \.1l\)l\)5 o, { N) *.t (l)(rJ {o ooo o)(r)Ao o){ ctooooo {ooooo (,l ooooo (,r ooooo o,ooooo -g $:eq g oJ- CttEt\) (l)oI\) -.1N)]\) G) o,s (rt G) G) o, CD o,(o o J @ 5\l{t\) N)o (r){ooNt\) (, N\t N @s G)@(o(o CD O) T\)A o,A(o @ *$E-5 o.d q ct)s @{ @l\) \lo o,A L-, (rl (Jl @ 5 G) N{ E$E-$ \l C" o (o(rl cos {(o ttt (rrs Jo(Jr -_t@ sJ gR8 E;E TitscoEro \t o) oN) (os {(rl ct){ (rrG) {5 (,t(rl Cr)(rl o ^9 c5$ da o I2.7 Ordering, Storage and delivery of lvermectin Mectizan@ ordered I applied for by - (P/ease tick the appropriate answe) MOHlr'] wHO[] UNTCEF[] NGDOtI Other (please specify): Mectizan@ delivered by - (Please tick the appropriate answell MOHlr'] wHOt] uNtcEFtl NGDOtI Other (please specify) Ordering, storage and delivery of lvermectin mectizan is basically ordered by NOTF via UNICEF and based on requests from each State through the Zonal offices. The State project takes delivery of drugs from the FMOH through the zonal coordinator. LGA coordinators get their consignments from the State store based on their respective estimated requirements in accordance with the specific target population. ln Iike manner FLHF takes stock of their own drug consignments from LGA coordinators for onward delivery to CDDs in endemic communities. r& ff il, t 21 State/District/LGA Number of Mectizan - tablets Requested Received Used Lost Wasted Expired Remaining Atakunmosa West 105000 1 05000 91861 1 13138 Ayedaade 100000 100000 99369 631 Ayedire 101000 101000 100213 5 782 Boripe 121000 121000 120960 4 36 lie Central 73000 73000 72700 300 lfelodun 91 000 91000 90823 3 174 Egbedore 98000 98000 97142 2 856 lfe East 105000 1 05000 92920 8 12072 lla 74000 74000 73596 404 lsokan 66000 66000 65200 800 lwo 105000 1 05000 1 031 53 7 1840 Obokun 106000 106000 105472 8 520 Oriade 80000 80000 79200 800 Orolu 100000 100000 99576 4 420 TOTAL 1,325,000 1,325,0OO 1,292,195 42 32,773 1./.f Table 10: Mectizan@ lnventory (please add more tows if necessary) o How are the remaining ivermectin tablets collected and where are they kept? The remaining tablets are on the field, at the various LGAs, for the next year distribution. List and briefly describe the activities under ivermectin delivery that are being carried out by health care personnel in the project area. The activities carried out by health care personnel under ivermectin delivery include: ' Receiving and Storing of Mectizan (Collection and storage of Mectizan) . Proper record keeping . Distribution of Mectizan to the eligible populace ' supervision and monitoring of Mectizan distribution ' Collection, Collation of data for onward transfer to the appropriate quarters l) L2.8 Community Self-Monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? lf so, When? YES, 2OO4 Table 11: Community self-monitoring and Stakeholders Meeting (Add rows if needed) The community interest increased more than hitherto due to expansion of CSM and SHM as reflected in the table above and this eventually led to the claiming of ownership of the CDTI programme. lncentives in kind are being offered to the CDDs. The community members now realize that mectizan drug distribution has no political undertone and is not a birth control pill. Solutions to problems encountered on the field were provided at stakeholders, meetings. 26 District, LGA Total # of communities / villages in the entire project area No of Communities that carried out self monitoring (CSM) No of Communities that conducted stakeholders meeting (sHM) Atakunmosa West Ayedaade 50 22 14 67 36 15 Ayedire 32 22 I Boripe 151 70 25 lfe Central 23 23 14 lfelodun 27 16 5 Hgbedore 42 24 7 lfe East 83 26 I lla 69 26 15 lsokan 122 35 10 lwo 109 22 I Obokun 40 22 10 Oriade 102 25 15 Orolu 80 18 5 TOTAL 997 387 162 I ri I t I 2.9 SUPERVISION 2.9.1 Zonal Office I SMOH I Local Governments I First line Health Facility Staff Community Self Monitors Com nity Directed r Dist butors Commun 2.9.2 lssues identified during supervision include Declining interest of CDDs in some communities in CDTI due to lack of incentives Poor entries made in the registers lnadequate counterpart funding at all levels. lnadequate or poor census update. Poor follow up by FLHF staff on CDTI activities and issues identified earlier on Mass transfer of health workers, particutarly to the newly created Ministry of Environment. lnadequate logistics for LOCTs to mobilize communities and supervise activities due to the breakdown of available motorcycles. 2.9.3 Designed checklists are being used for drug supervisions. 27 2.9.4 The outcomes at each level of CDTI implementation supervision were as follows I lncorrect mectizan dosage administrations noted were corrected immediately o Community members were mobilized to correct their poor response in the fulfillment of the much expected roles, especially in the area of incentive provisions to CDDs. o CDDs were advised to update their registers alongside with the treatment. o Newly appointed LOCTs were trained on CDTI. I Policy makers at the LGA level were further sensitized on need to support CDTI . Facility staff were adequately instructed to intensify their follow up activities in correcting the anomalies detected in the area of causes of absenteeism and refusals 2.9.5 Feed back usually being given to person or group of persons supervised. 2.9.6 The feedback provided assisted significantly in correcting the anomalies detected in the area of Mectizan drug accountability and record keeping. SECTION 3: SUPPORT TO CDTI 3.1. EQUIPMENT Table 12: Status of equipment (Please add more rows if necessary) 1. Vehicle (1) Nonfunctional MOH (1) Grounded 2. Motor Cycle (20) Allgrounded (3e) Allgrounded 3. Computers (1) Table computer & a lap top. Both Grounded 4. Printers (Non tunctional) Grounded (1) 5. Fax Machines Not Supplied 28 u uonortron ot 6. Bicycles (70) (Functional) (105) All grounded 7. Others a) Photocopier b) Projector c) TV Monitor d) Generator (1) nonfunctional (1) functional (1) functional (1) functional How does the proiect intend to maintain and replace existing equipment and other materials? At the LGA level, the Local Government sometimes gives imprest for the maintenance of the project motorcycles in their respective Local Government Areas. Storage facilities were also provided for the safe keeping of all equipment. They are also being encouraged to provide the necessary materials for CDTI implementation. LGAs, such as Boripe, has been in the forefront in meeting most of the needs of the programme within its area. At the state level, the relentless and optimum dedication on the part of SOCTs assisted greatly in keeping the programme going during the reporting year. By and large, the state project resulted to the option of utilizing business centres for typing printing and photocopy of rnaterials and document because the eapital equipment like computer, printer, photocopier including project vehicle are grounded. These equipment will hopefully be repaired from the state purse when funds are released for that purpose. ln the meantime, the project is requesting APOC to replace the project vehicle and other capital items supplied earlier 29 {: i J- ;i i IL It F b3.2 Financial contributions of the partners and communities Table 13: Financial contributions by all partners for the last three years lf there are problems with Release of Counterpart funds, how were they addressed? Advocacy visit were paid to policy makers in the concerned LGAs, (the Chairman, Secretary, Director of Finance, PHC director) to further educate them about the benefits of the programme and solicit for fund release for implementation of the programme. 3.3 Other Forms of Community Support: - Some communities gave gift like wall clock, plastic buckets and T-shirts in appreciative of CDD roles. Some provided registers and refreshment during CDD training. Year 6 (Oct 04 - Sept. 05) YearT(Jan-Dec. 05) YearS(Jan-Dec 2006) Contribution Total Cash Budgeted (us$) TotalCash Released (us$) Total cash budgeted (us$) Total Cash Released (us$) Total cash budgeted (us$) Total Cash Released (us$) MOH (Central+ Provincial/State) 11363.3 40333 75758 76781 1022.7 MOH (DistricULGA) 26515 5076 29167 10833.30 33542 3371 .2 Local NGDO(s) (if any) NGDO Partners 47727.3 s113.2 700 Others a) b) Communities APOC Trust Fund 83332.9 1 9596 1 9596 19596 TOTAL 168,939.50 50,522.20 121,521 10,833.30 130,619 23,989.90 30 \3.4 ExPenditure Per activitY lndicate in table 14, the amount expended during the reporting period for each activity listed. write the amount expended in uS dollars using the cunent United Nations exchange rate to localcunency. lndicate exchange rate used here N Table 14: Financial Contribution by partners 1US$ = Nl32.00 Any comments or explanations? The State Ministry of health and SOCT sourced a total of 668.2 dollars for the implementation of the activities above white the remaining 4634.7 was contributed by assisted LGAs' The amount specified above was utilized between January and April before the release of APoc fund. Note that Apoc fund provided was used for the extension of cDTl programme activities during the period under review. I i r I ! b I Source(s) of Funding Expenditure ($us1Activity MOH100 community I collection Point ofOTF HQ area to centraDrug delivering from N SOCT200 LGA303Training of CDDs ucation of communitiesMobilization and health ed LGA3409Training of health staff at all levels SOCT&LGA300Supervising CDDs and distribution SOCT68.2lnternal monitoring of CDTI activities SOCTAdvocacy visits to and political authoritieshealth 0materials 0Summary (rePorting) forms for treatment MOH & LGA922.7Vehicles/MotorcY cles/Bicycles maintenance 0Equipments (e.g omputers, Printers etc.) 0 5302.9 Otfiers TOTAL 722364Total number of Person treated rI L I SECTION 4: SUSTAINABILITY OF CDTI 4.1, lnternal; independent participatory monitoring; valuation 4.1.1 Was Monitoring / Evaluation carried out during the reporting period? (Tick any of the following which are applicable) YES (UNTCEF/NOCP) Year 1 participatory lndependent monitoring Mid Term Sustainability Evaluation 5 Years Sustainability Evaluation lnternal Monitoring by NOTF Other Evaluation by other partners 4.1.2 What were the recommendations? - They were as follows: i. Project should ensure and emphasize that CDDs carry out census update while treating households. Realistic ATOs should be obtained from the outcome of the census update. ii. The project should liaise with the department for community development in the Min of Local Government, Chieftaincy & Community Development (MLGC&CD) for the mobilization of community development associations (CDAs) to take concrete actions on incentives for CDDs and generally improve community ownership. iii. The State Ministry of Health should write urgently to the Ministry of Local Government Chieftaincy & Community Development intimating them of fonner LOCTs who have refused to hand over their records and balances of Mectizan following their transfer to the newly created Ministry of Environment. 32 A t r t I I E iv. The SOCT should utilize the monthly meetings of Obas at the State level to sensitize them on the CDTI programme and the difiiculties being experienced especially with regards to CDD incentives. The LOCT should do same at the meeting of traditional rulers at the LGA level. v. The NOCp Zonal office and State Ministry of Health need to give the Ministy of Local Government Chieftaincy & Community Development information on the amount of money needed to be contributed by each LGA for cDTl implementation so that these can be discussed and, possibly, included in the 2@7 budget. vi. LGAs are to be encouraged to produce community registers and IEC materials. vii. A high-level advocacy visit that targets the chief executive of the State should be planned and implemented after the general elections' viii. To access ApOC funds as approved in its 6h year letter of agreement, the project 's requested to urgently address the concems that have been raised over the utilization of initial installments and write a brief report of the activities the funds were used to imPlement. ix. The project in collaboration with NOCP should approach UNICEF to consider procurement of motorcycles especially for such LGAs as Obokun. x. ln Obokun and other LGA5 where an LOCT is not in place, the State should urgently ensure its formation and functionality. xi. Health stafi at all levels need training on good record keeping, particularty with regards to Mectizan inventories, and supervis'ron. Checklists available are to be utilized during supervisory visits at all levels. xii. The right format for Mectizan inventories is to be circulated to all levels. xiii. passive treatnent should be instituted in lkirun, a town of relativety large heterogeneous population. The reported data for 2006 is to be treated therefore as passive treatments. xiv. The State and LGAs should develop work plans for 2007, and these should be shared with the Ministry of LocalGovemment. xv. As agreed on at earlier meetings with NOCP and APOC officials, the project should report and have copies of treatrnents BY COMMUNITY. Copies of such _13 -L t it [' t r L are epected at the LGA and health facility levels 4.1.3 How have they been implemented? - The supervision was done at the tail end of the year and therefore most of the recommendations will be fully addressed in the coming year. However, the project has done the following: - The CDDs have been reminded to update their registers during distribution' - Shorly after the visit of the monitors, the zonal coordinator - Otunba Jayeoba - took up the issue of hand over by former Oncho coordinators and wrote a tetter on behatf of the Federal Ministry of Health through the State Ministry of Health requesting for appropriate handover of CDTI documents and mectizan drugs to the new LGA coordinators. The said letter was addressed to the ministry of local government civil service commissions, The zonal officer equally assisted the project in writing a letter to the ministry of local government intimating them on the need to earmark the minimum of $1500,000 per local government in the year 2OO7 budget estimate and to which they comPlied. - The LGAs functionaries have indicated their willingness to release substantial amount of money for the procurement of IEC materials. - At a meeting held in Zaria, provisional approval had been given to supply Osun with a new project vehicle and few motorcycles out of which Obokun will be one of the beneficiaries. - Functional LOCTs had been inaugurated not only in Obokun local government but in Boripe, lfelodun and lsokan local governments. - ln a training session conducted in 2006, emphasis was laid on data management and good record keeping. A new revised integrated checklist is ;= il- "1 ,I I I s- now rn use A format for mectizan inventory had been circulated to LGA coordinators 34 4.2 SUSTAINABLITY OF PROJECTS: PLAN AND SET TARGETS (MANDATORY AT YRS 3) Was the Project evaluated during the reporting period? No Was a sustainability plan written? YES When was the sustainability plan submitted? The sustainability plan was submitted on the 14th of June, 2004. What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.2.1 PLANNING: The State CDTI proiect, since the sustainability planning exercises have been updating their annual plans and integrating them with the MOH plans. At the LGA level, this is also being encouraged. Unfortunately, these have not resulted in appropriate and adequate release of funds. 4.2.2 FUNDS: There was unrelenting efforts both by the SOCTs and LOCTs in mobilizing the policy makers at all levels on the need to provide GCCC for the continuity of implementation of onchocerciasis programme activities. UNICEF and NOCP plan after the generat elections to pay high-level advocacy to the Chief Executive of the State. Last year, the advocacy team could not meet with the State Governor. 4.2.3 TRANSPORT: The State and LGAs are being sensitized on the need to replace and maintain logistics. ln the meantirne, APOC has been requested to replace some of the logistics earlier provided. The project has got indications that UNICEF might be willing to provide some motorcycles. OTHER RESOURCES: The high level commitment and the team spirit to the programme implementation by SOCT members are being sustained. Apart from the salary of LOCT staff, majorig of 35 , 4.2.4 APOC Assisted LGAs gave imprest to Oncho coordinators to keep the CDTI programme activities going in their respective LGAs. lt has equally been advocated that substantial amount should be provided in the year 2007 budget estimate of each of the APOC assisted LGAs for the implementation of CDTI programme activities. 4.3 INTEGRATION: 4.9.1 TVERMECTTN DELIVERY MECHANISMS: A total of one million, flve hundred thousand (1,500,000) mectizan tablets meant for the state distribution for the year under review were collected from the NOCP Lagos with the use of NPI vehicle because the project vehicle is in the state of disrepairs. 4.3.2 TRAINING: The project conducted the on the spot training for the Oncho extension workers during the reporting period. The regular monthly rotational meetings among the SOCTs and LOCTs serve as avenues for mini-training to update their knowledge. The training avenues on malaria and Vitamin A, which was attended by members of SOCT was utilized for educating co-participants on basic CDTI principles. 4.3.3 JOINT SUPERVISION AND MONITORING WITH OTHER PROGRAMMES The integration of CDTI programme into the functioning PHC programme activities is of enormous assistance in sustaining the programme through joint supervision of CDTI activities. The existing joint supervisory and monitoring checklist in the PHC Department, which is currently being used would soon be revised and updated to accommodate some suggestions and field observations to further enhance efficiency of affected PHC programmes. The strategy gave other programme officers avenues for the inspection of CDD registers and collection of raw data from the field in other to accelerate 36 -t- l ti data rendition as well as conducting on the spot training to conect erors where necessary with minimal resources. The LOCTs has been enjoined to emphasis the need for programme integration and that their health talk should encompass maternal and child health, malaria control, TBL control, Oncho control, guinea worm control and measles. 4.3,4 RELEASE OF FUNDS: Release of funds where and when dUe follow the routine PHC channels within the Ministry of Health or the LGA. 4.3.5 The CDTI was included in the PHC budget at the State level 4.3.6 The national programme on lmmunization NPI is currently using the CDTI structure for their programme implementation in all the 30 LGAS in the State by making use of house to house approach as well as using CDDs as their local guide and vaccinators. 4.3.7 The application of CDTI structure is being considered as the best option for the vitamin A administration and lymphatic filariasis treatment and control. 4.4 OPERATIONAL RESEARCH: None SECTION 5: Strengths, Weaknesses, challenges and Opportunities STRENGHTS: (i) Good commitment by the SOCTs. This is witnessed in their personal contributions to ensure programme success in the absence of counterpart funds or late release of approved funds. (ii) lnstitution of an imprest by some Chairmen of LGAs for CDTI activities. ) JI a(iii) lnvolvement of the Ministry of Local Government and Chieftaincy Affairs in the planning of CDTI activities at LGA levels' (iv) Moral and administrative support from the authority of State Ministry of Health. (v) Usage of other programme logistics for CDTI implementation, and the involvement of other programme officers in supervision & monitoring of CDTI activities. CONSTRAINTS: LOGISTIC problem - Grounded vehicle, computers, printer and photocopier machine Non release of fund budgeted for the CDTI imptementation activities by the State Government. CHALLENGESMEA KN ESSES : (ii) Establishment of a Data Bank for Osun CDTI project to eliminate inconsistencies in Data Management. (iii) Resuscitating the annual commemoration of Onchocerciasis day activities at the state level. (iv) lnauguration of CSM & SHM in all the endemic communities' (v) Conducting census uPdates (vi) Ensuring adequate releases of counterpart funds (vii) lncreasing number of CDDs and reducing CDD/population ratio (viii) Increasing community participation and ownership through full sensitization of their roles and responsibilities. (ix) lncreasing pace of integration of CDTI into PHC at all levels. , a 38 I ; I { ! (x) Ensuring proper managerial and technical training for the newly appointed LOCTS. (xi) lnvolvement of identified local NGOs and CBOs in the CDTI process to aid mobilization of communities and procurement of resources. HOW THE CHALLENGES ARE BEING ADDRESSED o With APOC support a data collection process is being initiated with which the project will be able to have a community CDTI data base at the State level. o There are plans with UNICEF to ensure proper training of health staff to increase their managerial capability. . There are also plans by UNICEF to support training of additional CDDs in 2007 . . High level advocacy to the State Governor is being planned after the 2OO7 general elections. lf met, the issue of deduction of LGAs contributions at source as well as direct funding of CDTI activities will be raised. SECTION 6: UNIQUE FEATURES OF THE PROJECT/ OTHER MATTERS , t , , b i 39 j .I a