Bauchi State CDTI annual project technical report submitted to Technical Consultative Committee (TCC): March 2001 to 31st February 2002

--J I l I I I I I I ORIGNAL: English .f COUNTRY/NOTF : lYigeriu : Buuchi StuteNameProi CDTI Pro ect ar: 1999IyeApp ear: 2000YLaunchins 2OO1 _ FEBRUARY, 2OO2ear)Renortins Pe d (Mon : MARCH tner: LTNICEFNGDO ParDate Re-submitted : Januury 2003 I I I I I I I I ! I I I I I I I YEAR 3 ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ,r[il o ,{, , For lnioinr<iilon To: trr'- f\ 1 i I i i I AFRICAN PROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) i forrg rlJ) '$*nr ? n ].i,-) y.,_) I '\r ' ri-z rans- euol A?{t,l t [-rlR 6t H c [.,[ ) erWHOiAPOC, 26 Septemb 2003 A. ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: country NIGERIA/LIBERIA National Coordinator Name: Dr. J. y. tiya Signature: Date: . zonal oncho coordinator Nam e: prtncess p. ogbu-peurce Signature Date This report has been prepared by Name : Abdulkartm D. Dunjebu Designati on : Proj ect Coordtnator Signature DateI I 1t WHOiAPOC, 26 SepternbeL 2003 I I Table of contents acRoNyrus DEFINITIONS........ FOLLOW UP ON TCC RECOMMENDATIONS.. EXECUTIVE SUMMARYAMEND SECTION I : BACKGROUND INFORMATION.......,. 1.1. GeNEnnl rNFoRMATroN............. I . I .I . Description of the project (briefll . I . I .2. Partnership ... . . .. . 1.2. PopulerroN AND Hpelrs sysrEM SECTION 2: IMPLEMENTATION oF CDTI 2.L. PrRroooFACTrvrrrES.....,....... 2,2, ORoentNC, sroRAGE AND DELIVERv oF IVERT\,IECTrN2.3. Aovoce,cy,cNoSpNsrrrzATroN 2.4. MogtlIzerroN AND HEALTH EDUCATToN oF AT RISI( coMMUNTTES2.5. CovvuNIrIES iNVoLVEMENT IN DECISIoN-MAI(II.{.C 2.6. Cnp,qcrryBUrLDrNC... 2.6.1. Training.... ,.....IV V I ....... .....b.... 2 3 J aJ 4 5 7 ,,7 ,9 10 11 14 16 162.6.2. Equipment and human resolffces CoNotrroN oF THE EeutpMENT * pLpasE srATE ........2.7. TRpnrvpNTS.............. 2.7.1. Treatmentfigttres............ 2.7.3. Trencl of treatntent achievententfront CDTI2.8. SupeRvrsroN............... : .....i; ,,,.,,...,,.'..,.1,,.' ] 9 project inception to the current 1;ear 24 ( -., SECTION 3: SUPPORT TO CDTI 3.1. FtN,cNcreL coNTRTBUTToNS oF THE pARTNERS AND coMMUNTTES3.2. OrHen FoRMS oF coMMUNrry suppoRT.....,..........3.3. ExpeNotruRE pER AcTivrry SECTION 4: SUSTAINABILITY oF CDTI 4.r. INreRN,+r-; TNDEpENDENT pARTrcrpAToRy MoNrroRINc; EvnlunroN..............4.2. covn,tuNrry sELF-MoNrroRrNC nNo srnrcHoLDERS MeErrNc4,3. SusralNesrllTy oF PROJECTS: ILAN AND sET TARCETs (vnNoaroRy ,AT yn 3)4.+. INrpcRerloN............... 4.5 OpenerroNAL RESEARCH SECTION 5: STRENGTHS, WEAKNESSES AND CHALLENGES llt WHO/APOC, 26 Septenbet 2003 t 28 28 29 29 30 Acronyms apOc ATO ATrO CBO CDD CDTI CSM DHS FLHF HFS LGA LOCT MDP MO}J NGDO African Programme for Onchocerciasis ControI Annual Treatment Objective Annual Training Objective Community-B ased Organization Community-Directed Distributor Community-Directed Treatment witl-r Ivennectin Community S elf-Monitoring District Health Supervisor First Line Health Facility Health Facility Staff Local Government Area Local Government Onchocerciasis Control Team Mectizan Donation Program Ministry of Health Non-Govemmental Development Organization Non-Governmental Organization National Onchocerciasis Control Programme National Onchocerciasis Task Force Primary health care Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Stakeholders meeting State Onchocerciasis Control Teanl Technical consultative committee (Apoc scientific advisory group) Trainer of trainers United Nations Children's Fund Ultimate Treatment Goal World Health Organization NGO NOCP NOTF PHC REMO SAE SHM SOCT TCC TOT LINICEF UTG wHo WHO/APOC, 26 September: 2003 Definitions (i) Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). (ii) Eligible popurlation: calcr.riated as 810/o of the total population in meso/|ryper- endemic communities in the project area. (iii) Annual Treatment Objective: (ATO): the estimated number of persons living in mesoftryper-endemic areas that a CDTI project intends to treat with ivermectln in a given year. : (ir) al calcuiated as the maximum number of pe(ple to be treated annually in ultimately to be reached (normally the project sho year ofthe project). meso/hyper endemic areas within the project atea, wiren the project has reached full geographic co verage uld be expected to reach tire UTG at the end of the 3,d (r) (vi) Therapeutic coverage: number of people treated in a given year over thq total population (this should be expressed as a percentage). Geographical coverage: number of communities treated in a given year- over the total number of meso/hyper-endemic communities as identified bv REMO in the project area (this shor-rld be expressed as a percentage). a-': WHO/APOC, 26 Septernb er 2OO3 FOLLOW UP ON TGG REGOMMENDATIONS Using the table below, fill in the recommendations of the last TCC on the project and describe how fthey have been addressed. TCC session _ t7 (Please add more rows if necessary) 1 Number of Recommendatiort in tlte Report TCC RECOMMENDATIONS ACTIONS TAI{EN BY THE PROJECT FOR TCC/APOC MGT USE ONLY 2s3 (i) Elaborate more on CDTI implementation, training, mobilization, supervision This has been done ir-r the present report. 2s3 (ii) Improve textual reporting This has been done in tl-re present report. 2s3 (iii) Clarify the figurres for treatment and CDD training Figures clarified and presented in tl-re report. 253 (iv) Increase advocacy at the State and LGA levels in an attempt to assure the release of counterpart funds This is noted. Efforts made and the results will be presented in the year 4 report. WHO/APOC, 26 Septernber 2003 CExecutive Summary Bauqhi State is geographically located at the north eastern section of Nigeria. It shares border withiPlateau, Kano, Jigawa, Yobe, Borno, Gombe and Taraba States. The vegetation is mainly of the savanah type with variations in ecological conditions depending on geography. Estimated population of the State is 4.8 mrilion being a projection from the 1991 census figures. There are numerous ethnic groups, although the Hausas and Fulanis are the largest gloupings. All however speak Hausa as a common language. Vast majority are indigenous and sedentary. Population movements occur when significant numbers of nomadic Fulani's rrove from place to place in search of virgin land for their crops or rvater and fresh fodder for their animals. There are also fishermen some of who migrate on a seasonal basis along the river systems. Farming is the major occupation in the State, and some relocate to their farmhouses during the farming season. 633 communities with a population of 609,092 are targeted for CDTI implementation rvitl-rin the State. Within the reporting period all the comurunities were covered and 468,677 persons treated, showing a77% treatment coverage. With regards to training the project trained 226 health workers, which is more than 1 lQ% of treatment objective of 173 persons. However, only 540 CDDs were trained out of i,300 intenSed to be trained. This indicates only a 42o/o traintng achievement. The challenges faced by the project include lorv involvement of more female CDDs, inadequate release of counterpart funds by govemment, and inadequate compensatign of CDDs by the communities that selected them. Others are lack of an authentic and .rliubl. census figures of endemic communities, inappropriate CDD to popuiation ratio and lack of institution/expansion of community self monrtoring and stakeliolders rneeting at community Ievel in order to increase levels of participation by all sections of the community. The project could not do much as funds were not available to tackle most of the challenges. There are however plans to conduct a census update, mobilization workshops for policy makers and key traditional rulers. However, all these depend on availability of funds. The project staff has tried to sensitize the communities to select more CDDs, include females in the persons selected and ensure that they are appropriately motivated. 2 WHO/APOC, 26 Septembet 2003 SEGTION {: Background information 1,1. General information 1.1.1. Description of the project (briefly) G e o g r ap lt ical I o c atio rt, top o g r ap \ry, c I i nt at e Bauchi State is geographically located at the nofth eastern section of Nigeria. It shares border wjthiPlateau, Kano, Jigawa, Yobe, Borno, Gombe ar-rd Taraba States. ThJ vegetation is mainly of the savanah type with variations in ecological conditions depending on geography. Th! soutlpern and western parts of the State is sudan and/or guinea savannah, having a ielatively higher rainfall, with numerous rocky outcrops and hiliy terrain. The northe* pu.t of the Statl is sahel savannah, with much drier conditions and fewer hills. The State has two distinct seasons - dry and rainy seasons - each lasting approximately six months. Rainy seagon is from May to December and conesponds to the farming season whiie the other months 6f tn. year form the dry season. Populatiort: activities, cultures, language Estimated population of the State is 4.8 million being a projection from the 1991 census figures' There are nltmerous ethnic groups, although the Hausas and Fulanis are the largest gronpings, Others include the Jarawa, I(irfau,a, Bolarva, Sangawa, Ribtna, Zal<shr, Ningiva, Warjawa, Sayawa Fa'awa among others. A11 however speak Hausa as a common langirage. Vast majority are indigenous and sedentary. There are however significant numblrs "of nomadic Fulani's who move from place to place in search of virgin land for their crqps or water and fresh fodder for their animals. There are also fishermen some of rvho migratej^on a seasonal basis along the river systems. Fanning is the major occupation in the State. Anir-pal husbandry, fishing, craft making are also practiced. Tl-re later include mat and basket r,veaving, cala!ash carving and blacksmithing. l Co)mmttnication system (roacl..,) Roads between major cities are in good condition, but access roads to most of the endemic communities are in poor shape. Some are not passable during the rainy season. Despite tl-rfls transport by road remains a major means of communication among the communities. The electronic and print media are also veritable channels of communication. Generally, the channels of communication follow the leadership structure. Chiefs communicate to district heads, who then inform village heads/councils of cornmunity elders, then to family heads and then to the entire commurity through town criers, arlnouncements in schools, assoclatlon meetings, and churches/mosques. Adm i n istr atio n st r u ct u r e The State consists of 20 local government areas u'ith the chief administrative officer being the Chairman. A legislative arrn made up elected councilors from various wards supports him At the State level the Executive Governor is the head of administration. There ur. ihr legislative and judicial arms. The capital of the State is located in Bauchi. Heglth system & health care delivery (provitte the number of health posts/centers in the _.prOject area tf the information is available). Thero is an official PHC policy and structure in the project area. It is a system of health care service_s where community participation forms the rnainstay rvith .rppoit from the State, Local Government and NGOs. Levels of functionality however vary across the State. Scattered throughout the State are various health facilities ranging from health posts to hospitals. J WHO/APOC, 26 September 2003 Describe overall working relutionship (tt,tong ptt,'rners, clearly itttlicating specific ctreas o/.prbject octivities (planning, strpervisio,r, orlvocuc1,, prurtrtirtg, ntortiliz,utiort, etc) tvrtere uilpilrttters ure involved. The State and LGAs through their various r-rnirs are involved in training of fielci perso,,el,coinmunitl' rnobilization & health eclucation, managemeut of sicle ,"o.-tiorr, planling andmanagement of project implemetttatiou, superviiion and rnonitoring, and Mectizar-rprocurement arld deli'er1'. LbJICEF is involv.,l in ,,,p"r'isory, uduo.u.y"urd training rolesand assists irl logistics provision. The Zonal antl national offices urrirt i,., supervisior,mqnitoring, training, advocacl', Mectizan procrrrement and evaluation of tiie programme.The communities play sr-rch roles as selection anci rernuneration of CDDs, collection ofMectizan' detennination of mode ancl period o1- drus distribution, censlrs ,far,., Mectiza,distribution and recording and reporttng of treatrnenti. l:*:pl:':t^if ttnl' to mobilize thc state/regiott/ctistrict/LGA clecisiott-ytokers^, NGDos, *.NG,Os, CBOs, to ensist in CDTI implententcttiort.Plansrhave beeli put in place to carry oLrt mobilrzation, acivocacy workshops and visits to LGApolicl' makers to se,sitize trreur ou ihe ,eed to slrpport CDTI. i 1.1.2. Partnership Irtclicqte the pctrtners ir,riolvecl in proiect irttplerrterrtcttiott ctt all levels (MoH, NGDOs - rt atio tt ul, inte r nil io n al) Partners ir-ii'olved in CDTI project implenrentrLtron at all levels in the State are: 1 lfrican Programme on Onchocerciasis Conrrol (APOC){ United Nation Intemarional Cl-rildren,s funcl (UNICEF) 'i National o.chocerciasis Contror progra,rnre (Nocp)J fne Bauchi State Govenrment r The endemic Local Govemments r Cor-nmunities in the endemic Areas. 1 \\/HO/APOC. 26 September 200J oFp e- ::c6 = tlU L Foo .= aN csE.= t-38 a a?) v ca C. O c.t .a (.l \t & ca O d, \t \D ,'o -t ,q r- \o $ ta) l-- co Ir- $$ a) t--f\ + =f 6 @ c.t .i- N $@ c.) cO -t N\ N \o N o\ $ ',c NI-r s N o\ o\ \o r9rL L'=e 6 :-ie *9.- o >.rC qJ o 'r,689'N: @ \o c.l ca ca oo $N O <f, co^ aa c'r \c aoN $Nr- N \o v ca O Nt--d .a \o ro- @ cav g! h eL! ioo JN: a O C O O \9 O ,\o r-t t-* .; 0) bd Cg \q a)l I z I >,Y ON c! q) F. car m oo ca F- t-- rc @N a$ $ car I rtra\o o .9 qr q): >> 0)rrC N :! k =.=?i(Jq) JN: a @ O co r- O t-- a c-, co C.l =$ $ O C. aa @ (\t m lrre G id) 9Yi .- L lvt.r 63e: -sv66 I 0l.LX *ar 9' ,YU-L !A-^ @\o car \o Nd-i c.) C .'1. -t @ ca\c. \c \D =tvl F-- a) t--r: <f\r oo @ n <l6l .f, co" C. C-r .t N t--. N \o (-r N -$c'r \o o\\c Nr- $ (\l la ro\ ii q,) q) freP*5'; aE ^jua tt1J v F.l4 N rt Z z o oF r!& < z z4 gi V 4 lfl ..1 ca F g N QD F a aa c & i.] F F c.l a) -o af u r\ (, al o. o AJ L. \ a,)q \) u -.;o +< 0)p. b/) L o c.() l< 0) b,) l< L o C) 0)L C) U Lo (.) q,) cq (J o () 0) il c/) t- o p. c- -:\ 'on q(hh ocu gY E? Oc) -11 0Jl -l -ol c-lLI E o +. o o tg t! o E ! E G tr .9 +. s Jc otr iN a F ON (J -o E O o. (h 6l o c. c Q z O-q SEGTION 2: lmplementation of GDTI 2.1. Period of activities Insert PIan of action indicating activities by nronth, u,.hich q,ere implemented 1 WHO/APOC, 26 Septemb.r,Z0O3 O 6t o .o U o. OJa N a o a. o @ o 'a (H C) c0 1- o o () fr (J H O o O C) O O o .(] 0) - O I q.) a 0) () (J a z tn () E E oU I q (h qf! a !() -o q) 0)a L() q) a O q) a Li(_) (J 4)a l- O -o () 0)a L 0) -c u a(t L() t) ua ! a 0-) aa L a) .o C) a) '/) AJ -o c) O 'J) li a) -o O 0) C) li .D q) o. o a !(.) -o E I 0)a b! (a- l- z OL (J! c3 z, L z Z. ? e ! a ! z (, L I OL Z. OL O! z ti a a o!l -l c- U z a z ). aaZ.z I I l z d z L z z b.0 a- OL a O t< z tr Oli a OL z (, ! z O Li z OLr Z p z Oi< Z (-) ! Z Otr a li(! a q) p (a U) OJ v Ori ()Li Z Olr a I c3tsa O li e U 0: a <) i /t- ,., l,- Ci a -=Oii O;r (.)L z O i-< Oii a0 a- r L -o 0.) tu H -o0)lr tr t -o0)a h = -o() E :i a! L .9 a)lA , q.) ! ! -o4) t& ! .i - -o CJ ! ! C) tJ. li .3 L< (-) h i CJt! Lr6 L -o() 3. b L 0) t& oo :. I til't I U 0) ,! O .J c Ii 0) -o () c tr 0) O Oc l.(-) c lr 0-) -oo <)c li() () c !u a ,) ! a) .a a tJ !i 0) c O o L u -oo ,) c ! u o rJ c Lq) o ! 0) () c bn a- t' = .o(J t- L .oq) l+r =tr -o C) tJ. =li ,oq) tJ. li ! -oO E" a' i AJ Lr- l- ).rIU tL :- f- (.) lr. !i L .o 0) gi l.- C) li 53 ! -o() lrr h =L -oq) lfr h li -o0) IJ. (!- N= e F= L= U (.) ! z U a (-) I'r z o li z (J li z ! z (, I< 2 Otr ti (.), z, () li a (-) L O! 0! a- h 0) li ! o E. h l- qJ t i,< .c CJ IJ. .9 CJ 14 .C u fJ. a fJ. =! -ou IJ. L .c c.)t! a :i ^oOJ tr. j.i =t- C)lA f ! .o(_) tr. t ! -o0) Ir. -l Q 0 '- 0) J< 4 co z * li M aa c U) cN L t-.,1oN a c3 a! oF OJ li 0) E.t (r3F -.1 3 F -:\ I A1 v) au! eu .-- ? O !J a Cu o-\- (.) 0)|- O() 0) oH a () i< (-) ti a O O (H o o () F NI OI ^l 'rlc1t 2.2. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for b5, - Q:lease tick the appropriate answer) .lproslNocill wHo E uNrcEF I Other (please specify) Mectizan@ delivered by - Qtlease tick the uppropriate answer) ./rrrounocil wHo E uNrcEF tr NGDO L] Other (please specify) Pleose clescribe how Mectizan@ is ordered ancl how, it gets to the communities The quantity of MectrzancB) requrr-ed by the prolect rs calculated based on treatrrents and total population from the last cycle. NOCP llrocesses the data after recervrng rnformatton from other UNICEF - asststed States and submrts re - applrcatron to the lr{DP. On apltroval the dnrgs are slnrpped to the country and IINICEF facrlrtates clearance and storage. The Zonal office prcks 1-rp rts consignment from NOCP and releases to the State, rvhrch, rn tllm releases to the LGAs throulh the LOCTs. LOCTs release drugs to the district health sLrpervrsors or the health facrlity staff w'ho r,n turrn make them available to the communities. FLOW CHART OF NIECTIZAN DELIVERY Reporting flow UNICEF/ Nigeria Delivery process NGDO x I 9 MDP NOCP Zonal Office STATE LGA District Health Facilities Communnities WHO/APOC, 26 Septembel 2003 Tablb 3: Mectizan@'Inventorv (Pleuse orlcl nror.e rcty,s rf necessurl,) STate activities under lvermectitt deliverl'thut rtre being carriecl out by heslth cctre persortnel in the project orefi. The llealth personnel at the various Ievels l.iave been responsible for the following. 'r' Storage of ivennectin '/ Supply of ivermectin - Alr!,olltercomrnenls 2.3. Advocacy and Sensitization State the rtumber of poliq:/decisiort ntuliers nrcbitircd ot ectch relevant level during tlte currettt yeur; the reasons for the sensitil,utiott cutd outcome. Describe dfficfulties/constraints being facett and s'uggastions on ltotv to intprove advocacy. Trvo advocacy visrts rvere paid to each LGA lor the pLrrpose of soliciting their support for tl-re CDTI process. Those r,r'ho canieci out the visits u'cre the Deputy Director, Disease Control; the N,{OH Information Officer; tl-re State Coorclinal.or; tiie Coordinator, Public Health; and staff frorn lbeZonal office. Informatiou reaching tl-re project office indicates that tire LGAs respoirded by gir,'ing some miuimal support, sornetinres by pro.,,idir-rg fuel for supervisory Visits by LOCTs, and sometimes by paying allou,ances. Amounts given could not be obtained lhe ma.;or constraint faced was the gross shortage of funds to entbark on other advocacy State/District/ LGA Number of N{ectizant tablets lLequested Receivc.d Used Lost Wnste Expired Alkaleri 16i,109 161.103 116,161 38 0 0 Dardzo 62,000 62.000 6t,966 )+ 0 0 Nin!i 1 05,545 105,545 100,455 18 0 0 Toro i 08,074 180,074 l7 5,510 49 0 0 Jarna'are 112,000 112.000 105,360 10 0 0 Gamhu,a 42,000 42,000 11.709 97 0 0 Kirfi 43.000 43,000 12,ggl 13 0 0 T/Ba[erva 80,3 g0 80,3 80 7r) l5r) 48 0 0 Zal<i 61,166 61,166 56,154 32 0 0 Itas Gadau 63,000 63,000 51,1 65 t9 0 0 Shiri Yana 85,000 R5 000 83,748 t2 0 0 Dass 55,000 5 5,()00 _5.18 7;1 aJ 0 0 Warji 61,000 61 .000 _s 9l36 16 0 0 TOTAL 1,117,,273 l,lll,273 1,062,925 tt77 0 0 1o WHO/APOC, 26 Seprer-nber 2003 programmes and to follow up on tlie visils made. To improve advocacy there is need for a well thought advocacy plan to be in place, r,vhich has to be backed by availability of fLrncJs. 2.4. Mobilization and health education of at risk communities ] Provide information on : The use of media and/or other local systetns to elissentinate informatiort l During the reporting period the project made use of the following media for the mobilifation of the people: o The electronic media - raclio ancl televrsion. This was done principally during the Oncho Day celebratior-rs. . commnnity heads, inclr"rdrng dislrrct chiefs and opinion leaders. . Tor.vn criers - this is the prrncipal means of inforn-ration dissemrnation flt the community level. o Face to face meetings rvitli the communitv mernbers. o Announcements in mosques and churches. Mobilization and health educatiort of +uomen artd minoritics - methocl onel response In the State there is a culture ri,hich ensures that u'omen and men do not ntix together. Except in areas inhabited by Christians worren are generally kept in the pLrrdah and defencl, on Jh.' men foll< to get information on the happenings in tlie conrmunity. Consequently, during llealth education and mobilization sessions only the men are present. To overcome this great hindrancetheproject has encouragecl the selection of iemale CDDs who rvill..uJh th. l women folk. Son:retimes it is stressed to the rnen folk the need to inform theirwives of tlie programme adequately. l Respo n s e of target co m m u nities/villug es The cornuunittes have expressed w'illingness to comply witli Mectizan treatment, and have expressed some sllpport for the process - not only in the selection of distributors but also in tlre etnpowerntent of tire distribr"rtors to collecl the drLrgs fi'oni the collection centers. Some are giving incentives to their CDDs. i Accomplislrments . There is some increase in awareness of lhe comrnunities of the benefit of Mectizan, and its continual intake over a long periocl of tirne. . There is an increase in au,areness of tl-re roles of partr-rers/cornmunities in CDTL o The communities are strll very much ri'illing to keep or-r taking on N{ectizan proviiJed it is available. i Ll/eakn e s s es/C o n st r ai nts The constraints facing the project with respect to mobilization of the endemic comn.r include: tres Gross shortage of funds. APOC did not release a cent to the project for tl-re entire11,ear. What the government released ',r,as grosslv insufficient. Inadequate logistics to enable healtl-r worl<ers at the LGA and liealth facility ler,el to interact nrore with tlie coninrrrnlties. o l1 Septembei 2003\A/HO,/APOC fo al r Inadequate tnvolvement of health facility staff ir-r programme implementatiol. suggest ways to improve mobiliz.atiort o/'trte t(trget cotrtnturtities. i :11{ t:lease of funds by allpartners. wrth funcls more IEC materials can be producecli and dtstrtbttted, Iogistics maintained and media houses approacl.red to help drsseminateinfonnation on onchocerciasis control. t Greater involvement of the FLHF stalf in programme implementation.I Identification, mobilization and usage of teachers as cornlnunity - based supervisors.J Identification and mobtlizatron of more Local NGOs & CBOs as well as Marl<et\\/omen aud \\romen Religions groups to assist iu mobilization of the communitiesI Regular meeting with the contmunitl' leade'rs by tlie FLHF staff, and occasiolally byproject staff at LGA and State ievels r Encouragement of First line health Facilirv stalf to organizestal<eholders meetirlg at communitv level periodicaily. 2 WHO/APOC, 26 September 2003 t3 c.l O(\ q,) -o a.) p.() U) @N (-) o E o -r\ -). : aa! : ? =g)ptr: !J:l!: aF -l\s: -JO! os .r!(r^-o\1r-- ,FE^ I +, t'/ ?Ao -o=7E.=O= i.-o7 tr.2 o=OL rr ia +, 1) ?.= E=tr= -a o: tl .rllo7 c,i Il .a o'. n N o'c f c\ - A -'t O .C c\9 \a ct. .1 \o t-- r-- .o o\ o\ .o O o\ .1 N .\ rn ra O O -l 'l N C' O N \o tnc?) F (, t => -)- L Z @N 'f "tt-- t <t @ :rN O oo N $ .(- \o c.l co tf) N s f-- ca) N cr) co rnrt \, -l -t t\ -t C\ f-r .:1- O N t-* O t-- \n\o oI 5' q i = y', -C .i: |: zuE- :,: L q ='! E r: -=o: -E-9 L Z ..d l I -l I ca t-- I I I @ t-- @ N @ ca \c co ca !f, o\$ m cO bt eG- a-c. =,=-/-=.= !:9 i -Fd S;-e' F c'- t L F z ;l ---l r= d) ca .:t a: O o.l c-) stOv1 lc l-L I I l ',tr,1* I l l \D f-- \t @ N c.l t-- =l CO ca :f @C.) coca CO c.) Ov (n o\ @ v s cov co ra\o .2 u lt tr z -l ,": ! ;4 T - ,a N L aL oF (-)L c: a q a e (d .V oJN ? O cJ aF F l! a -A I I c CI ! b =c, 't AI a o qi Q\F rr* os iJ\ Ioovaqo!t< v) -c ,2 =IJ) QE€U!Ebo -\tr'toPt.+ P ,) ;etrqo\o -EA .hHN Ac.li.l ,o\J o= qJ3{Buj ioE qH=oo :i6 .s F!\ cF:,,,oY \ c '-r^OEE .s' '6HoEObEiaC)$ .5* : atr- =E \ cE .=o s .9N AE 8 Es iE \r -F T= S E .:t:L.E EE 9 f()coF(! :r6C)tC)N 10; d -EVHYF >s 8s x eE$ r;\ -qJ a- 's EE t '6\(J.,H,;U:FrlFtLs sE t $s Eo : IitAtr Eij .a oH€.<.bS TE E :u -83 .$ 5 * EA E Et, #c \g q ,,,a(.)q;ausJS EE Ss i 'a tr E sr'I trs se Ea =i il.E :I Ee t: s.t 3 R EH €'* €Si c? is = \-€0JA.\:Uo' gE i- (, :{ ,Es !$ s 2Es 5€ $.t E EE$ FF sS t = a \ x! \ \ ; v- =Y..Atrx -x= oU r IJ.,l -C , E r a .6. Gapacity building 2.6.1. Training ,)6 WHO/APOC, 26 Seprember 2003 l I l I I LIulrl t:i- l.d l,+ 't Ell : :] =r.rQ .D ^t+ at ts-.l a -.i -+o o (h _+1 .l U -l =1,l a ?e = 5) S] a 4 { \ ^l \)l q ,*1 -'i i -J e,. h v rl '.1 F + { ID EE .D{ A) N x L,) OJ 3{p) (, PJ D rD lJ a t o '74 :I p q) N o d 0a x (.D Lh b.J 5 5 A }. +' +! NJ IJ +- l.) +- O l.J 5 l.J J. O l.J l.J +: NJ NJ s l.J N.) 5 l.J NJ z o .!.) lL II vtl'-Jl : l -----l b -l h) o\ b.J o\ l..J N) l.J O -----l NJ N) NJ \o UI [.J t-J \U .) r! (D (! UI (,fl (,l z o o a! r! f l- -l (.h (,! (,l O c N) O lv ^l9 O * -l,al o O (, (, b.J o\ -oo\ .) (D tD o N) NJ NJ N) NJ N) N) t.J NJ C N) NJ N.) z tt0 .G 'J aj a i ? a h :, E O O O o O O c O O O O O O O (,II A ^-. Q'IA \o (,) (D tD (D A h.J 5 (! (! CA NJ O NJ UJ (_h(/J ^ 5 -J ;\.1 l.) .a N.) O { \c 6\o +, ^ r! CA oo \](}J cot, 5O s ()) UJ N) NJ 5O O J.O 5 s N O NJ A o\ A *{{ \ + o : o 6 6i {^ i\i o 0a o o :- :-lit I o o o Oa \ \-1 - E a- "O N) o\ U)o .D o t! UJ O tv O NJNJ Ta le6 Tlpe of training undertaken r'Tick tlte boxes v,ltere spectfic truLtttutg tv'cts carrred out clurtng the reporting period) Any'other comments 2.6.2. Equipment and human resources StatLrs of equipment (Pleuse udtl ntore rov's tf necessarSt) tron of the equtpment (Fr"rnctronal, Currentlv non-functronal but reparrable, Written off). \8 wHo/APoc, 26 September 2oo3 Trarnees T),PC of {rarnurg C'DDs Other Communrtt' members e.g Communrty' superVlsors Health \\'orl<ers (fi'ontlrne healtir fac r lrtres ) N,IOH staff or Other Pohtrcal Leaders Others(specify) Progran-r malragement Hofrv to coriduct uehttn edrf catron M{nagement of beEs CSN{ sqNr DaIa coilec tron Data analvsrs I{eport u'ritrng Others ':(sllecrl\,) APOC MOH DISTRICT/ LGA NGDO Others Tvue o1' '1 erlUlpment Source Condition of the equipment * Please state 1. \/ehicle 1(functional) 2. Nlotor o,clc 13(functional.1 1(functional) 1(functional) 3. Compr-rters 1(functional) 4. Printers 1(functional) 5. Fax Nlachines 1(fLrnctional) 6. pthers a) Photocopier 1(fi"rnctional) b) Qenerator 1(functional) C) i\/CR 1(functional) d) f,ir conditioner 1(functional) * How does the project intencl to maintain ancl replace existirtg equipment uncl othci. materials? l The State Ministry of Health has requestecl the rrallttenance section to oversee the adeqr-ratd functioning of project equipments. It has hower.'er been seen that adequate funds and ntaterial$ are not usually available to them to carry' out effective sen,tcing and repairs. Sonte of th,l repairs cannot be undertaken by the unit and govenunent finds itself unable to pav tbr oLrtsrcle consultants due to tigl'rt br-rdgetary constraints. Eflorts ',vill horvever be made to ensLrre tha[government lives up to its responsibilities. At the LGA level sorre of the policl' ntaker{ release minirlal amounts for motorcycle nraintenance ancl repairs. In ntost cases thd responsibility of keeping the motorcycle on the road ls the responsibility of the LOCT to whom it has been delivered. The project intends to recluest fbr replacemenr ol capital itenr$ from APOC. i Descrilte tlte adecluacy of avuilable knovvledgeable muilpower at qll levels. The State CDTI projects have quite a number oIskrlled and kriorr,'ledgeable manpori'cl at ali levels. - Ll/herefreq,tenl transfers of trainecl staffoccur, state h)lrat project is doing or irrterrds to do to remedy the situation (The most importantisslie is v,httt mectsures were tcLlcen to enslLre adequate CDTI implementation where not enough lototvleclgectble ntctnpow,er y)(ts tn,Ltilrtble ol staff often transferred during the course of the crunpcLigrt). To ensure continuity and proper irnplementation of CDTI, quite sorne number of the Healtll staff has been trained, but there is need for retiesher training as a majority of thenr haq received training only once. More (if possible all) health facility staff u,ill need to be trair.redi In the meantime time whenever there are transfc-rs a cluicl< orientation is undertahen. 2.7. Treatments 2,7.1. Treatmentligures 19 WHO/APOC. 26 Septenrber' 2003' ON q) ,o o o.o U) \o N (, Fi o ;I B N t/) O CN o. a o u O a L(.)q o a C) (! 0)t- a ti (.)p oo () H N O z C) r< o0 o() a. x o a.Oiz o th 0 0) O () a 'o(! oo J (! tr(, o o o a a() (U 0 O o ,'oYO -o (J> u- e(J -ooEo '=q O-(J i': agU(n: +9 u! XorH>. aO(ntr7-0Jx a? *UFO. O O C O O O O O O O -= 'i ZZ - C C c O -otr z- O O O O O O O O O O O - J,: Z =;L/-t,t 2a= O O O O -u sJ 4,. tJ;u = 1-Z ,v. Ltj c aq a=.= - a o \o^\ -j- vt ..o o ,n a-l \c qi t- @ t\ c/) o. -t o\ \o o\ o\ -i 6\ aO @ \o o\ n \oo\ F- ca \oo\ r_- t--. t-- s F- r-. O(..1 tat rc Oq C! V')o -i st 't 't C, O N -4. -t -t cl r- al -t -l C ., a =t 'fF- .$" N N ..i $ a\l @ N tr-r-\o €\o!f, ,\c C t-- CI OO 11 01 -l OO C, o\ C -t c - 'r'. ar, ccO ...l -l O "lt\N OOO. -l OOO" c\N O r- l--N m rn m a.l O ^l -t ,-' -t r- '"/3 .a rO r) r- t--i -t tJ cO al t a.l O -t @. :i- C! I--. N o\ $ O \o o{ d -I I t\ o\ o\ \oi !o ! a" u') = -- I Z-a =:) 4 a3a . =* O J * I = I"2,.-a :;:,,- i e=ay)p u U) A) u ") O >" = ..o OC .c o\cC O ..c c'Oc a c \o o'\OO s O \o9\O \o OO o\OO o\ \re U) @ t-- f\ V) tta.l o-t -t ol \o co ctm\o a 7a t\ r- cat .a ^.1 o -t -f u)ca (f) a.)\o U) v) t-- r-. tr 6Jal o\ -J t co co ?a\o q, a N o blj a 6F 1) a - - CJ () ! u !..1 F t CJ N CN OJ Ii (n oa 'f- 7 F] ti F -:.\ U) ? ^! U ? v ! o U w, q\- .Va L a U Q I tt -a a ttJ a u LIt- C'I l(., I 5l r-l Cc o.l 1)s c) .* L ., c.l o a- .< C 0c s i slJ \q\ 0nt-! bo \ r1 : /: G%q)q (g- !o.l()e' .. \ Yq ** u: ,;i! PiU ; 2.:: oE-(!qr\ =\ 'els -1F<F.!Eu.ltr -ri.:VP\ (ro^jg\>{ i oi! a'i. ->\>tr u \i a 5 !'5 .= i si a\-c{X-.:! u i: 'i\!Y: : 3:U!!^Y *::L, a t lr{: q .:L, + t -\i? ! tFU'\o. ! i\I * i.i F \o \<s? i s\ '=:uetr :: rr- - i' rV = \ =F-HSE ! \,, : a i<UH .= Fs - b& i! .s tr € ss3 sI s Q-i%s! ! \\ ,\ \.\i t.3t :'ts :ai \< --%\ s\ rE9 c =': = ': P '* ci\ s \: \S1f\ l'\ =',rr e o oit\ Ho \!S O C)>X :.o o,JJ '= c0x9) (Jo" 5C,csQ] !,r <* aul LIE9l cHl (c(') l- I Oq) 'a tr(! o.oLU F VLoaotso.z o ir.lEN I ; 'rj E 'io5lE 0);< €U H Efttra! (.) IOE Jtr ol trE =I EE xl eo -l etvt..L 6JI 9g EI E -q !l '6 -.- 0l t "I E 8J? Avt vdl HU -lC=lOr:l; Els 1gl "o 3l: ENl tr 'El . i!q)l 'a =l 0) 0JHlr'Ll-LPt.! {t E J 9l - EI .'. o.ltrlE -l o ciRl'; bl r exld olx YFIH ,. lP B(*l 5=l CL9l* :15 0blE Pltr bflx El= €llE ^te 2 () r 0) b0 N^os o o oF C)(! C) oo L 0.) o(.) GO- E<-(! l-. bo 0) o C) (g! C) o0(, H() (.) O^ '5 roio\ CJ o. 6dli(.) t- t^t 0)l Ht bl BI :l(Ul ol -clotdt E{ ol b4 EI EI ,-: I )t C)l atdlLl()l od cl =lol EI :l €l .ol EIAl fr.l ilII o () F o\ As highirghted earlier tlie CDD dicl not bother recordir.rg absentees as there was shoftage ofNleictizan in ahnost all the communities, ri,hich highligited that there is need for a censusi-rpdate' HolYet'er, on a gelleral note, abseriteeisrn is mainly caused by relocation to farmhottses or fishing areas, and inadeqr.rate mobihzation of community members on the need forthem to be available dr-rring treatment periocl. - IJ'the proiect is ttot uchieving 100% geographicul coverage and minimum of 65% therupeutical coverage rate or cot'erage rile is fluctuating, state reasons ancl plansi being mode to remed): this. Ft'$mtiierecordstheprojectisachiel'inga l00g6geographiccoverageandmore than65% treItment co\/erage. l2.7.2 lVhat are the causes of absenteeism? 2'7'3' BrieJtl'describe all krtowrt antl vcriJied serious aclverse evetxts (SAEs) u,dprovicle itti toble 9 the required inforntqtiort when at,ctilable. The prolect ls ltot a\\,are of an1, r,'erillecl SAE. 2. ,1. In ctse the project hets no case period, plense tick in the box. of serious trdvers'e event (SAE) during this reporting No case to report 22 WHO/APOC, 10 April2003 o-E: €9E o<o?F; - bDq)or)d o !6X(lO'o E s5TFCE] U'6 qi o ol .2 E^oEq b.,))- u) o. q9^ 6,= Ao-.c tr (F(;o-O,2EC 9HL-PHL'F(i@O(.)n€re o(H '-o 3,.c Co E=;5 ,xt a-' X{-.1 (E -C C: d (g € e I90!'n; 3,o.= 99s;*€Ao-Or:A o o. 5, U) dr -iJ rC)!+ (J €E6(lF= l-] o @ cg .Nt a> x C)b,l) cG.- =o0 ao x() U) (.) bo * z Q l--_L_ _t.__-_ I - -. I _-_l I I -_l al 4. a o c.{ o ^l !e tr Q a- .F -t- l l -+ ?\ q 6$ CJ a) 14} v v v B q)q q) E o 'F p" bo t- o o Lr() bo L C) litr o O o 6d v) r4 a t) q) C) C) t/)Ho U) o L(.) ag< t)) 0)t/)(! O oil ol -ol(sl FI ca N !(J ! C) p. U) \o c\ (, a.{o > tf, N .\ Ca S (., O l- ,o i 4) !l 'Jl FI ,J) -l <rl >i .ol a) .t La E a .) .o t- 0) LF ^'lvl o qJ q, (, a U A) L r- al O or) (, o <>--o F. '.o da !O = bllI i:r t >- .o -, F \o \o F-r- =,.o LU s.- Z2O o- .4 ^l x) c.l ; r- r-r 7a! 'o .t t uE' FL,) COO O O O O O !a - a9) '-v;'o FrAC6- {* o v, F- o\ 6] o\C. O a L|:9 c 6\ O O -AO- Et) \o o'OO \c OO .o CO ca6 - o- -/'' \c .c 9 =-> ? US' .o € u "I)- 'tu 7. r rlvl b,J € =a\--:ai!; x 5_k =:E+-;lic-AE '-=ai,i =ao \o \o \o E ttj O ^.1 O al -lOC ^.1 OO ^.1 tOC c\ cl OO OC c...t Ir-OOdl coOO c\ o\OO a-l O c-.1 2.8. Supervision 2.8,1. Provide aflow chart of supervision hierctrclry LOCT DHS/HFS I CDDS ' Poor involvement of frontrine health facility persorner. o Inadequate support by LGAs. This led to poor inrplementation of CDTI activitieso Lack of census update in communities resr-rlting in inadequacy of Mectizar-r,li;.o Inadequate motivation of CDDs. o Low CDD to population ratio. o Poor record keeping at various leveis o Poor supervision of communities b1, health staff due to lacl< of funds. 2.8,3. ll/as supervisiort checklist usecl? At the State level efforts were made to use checl<lists, but tliis was not clone all thetime. At the LGA level checklists were not used. 2'8'4' What were the outcomes at each levet o/'CDTI implementation superviseey? At the State level the SOCT has met a few times to cliscuss the best way of conectrng the anomalies. A major hindrance has been tl.re unavailability, of funds. At the LGA level, health workers at the LGA and health facility level r,u.ere requested to doproper mobilization with the little resources avarlable to them. Efforts r,vere also made ro correct poor record keeping through on the spot training. S 2.8.2. The issues identified tluring supervisiort irrcruded: Not much supervision was done by both the State team as u,ell as the LOCTs clue to shortage of funds' At the LGA level the supervision carried out was rvith fuel provicled in some casesby the LGA supplemented by funds from private pockers. At the State level all the supervisory activities undertaken by the SOCTs were funded from their perso.al resources.The following issues were identified i, the course of supervision: 25 WHO,/APOC, J0 Apul 2(J03 a Table 1 I At the l-realtl-r lacilitl'level, health facility'staff rl'ere encouraged to be more involved in CDTI Sopre 200 health facility' staff u,ere retrainecl orr CDTI. At the conrmutrity'level, communities hal'e been vrsrted to mobilize them on CDTI intplententatton and tlie need to support their CDDs. T1-re project staff has also encouraged cor]umunities to select more CDDs. In Faggo Comn'iunity in Shira LGA the acting district he$d volr-u-rteered his tu'o sons to be trained as CDDs. 2 8.5 ll'us feed-back given to the supervisetl, ortd hott' was the feedback used in improvirtg tlre overall performunce of the project During the feu niobilizatior-r visits paid to sonre cor-nmunrties issues as affecting them were highlighted.'fhe LGA coordinators \\,ere at various times informed also of the findings made b),the State teant. SECTION 3: Support to GDTI 3.{. Financial contributions of the partners and communities Finar-rcial contribritions b1'all partners for the last tl-rree years *What the LGAs contributed could not be ascertained. Not available If ihere are probletns with release of counterpurt fitncls, how were they adclressed? Thcre are probleurs ri'ith release of counterpart fimcls at both state and LGA levels. Some aclt'ocacl r isits har e been paid to LGAs, but thc political instabilrty and short tenure of the Contributor \ctr I ('prot rlc' tltL' pertod'1 Y ear 2 ('provde tlte pertod ') Year 3 ('prowde the period') TOTAL Budgeted (uss) TOTAL Released (US$,I TOTAL Budgeted (us$) TOTAL Released (us$) TOTAL Budgeted (us$) TOTAL Released (US$) N,Iinistrp, of Health (MOH) 23,070 a 1 l?(i 16,59t Local NGDO(s) ( if an1,) NGDO partner(s) 163,976 21.610 5,650 16,905 6,340 Districd/LGA +-s,98-s N,'A 5 6.9 80 t,625 22,195 N/A Others a) b) c) Comm!rnrtres APOC llrr.rst Fund 98,89 r lr)2.86r 99,7 80 5I,t4C) '7 t,040 TOTAL 336,9?.2 0 7,8b7 201 ,61 0 58,4 t 5 126,731 7 ,710 2b WHO/APOC, 26 September 2003 a 1 political office holders is a big constraint. At the State level several advocacl, visrts rvere paid by both the NOCP and LINICEF officials. Several memos have been written to govenrlrent. - Comments 3.2. Other forms of community support - Describe (indtcate forms of in-kinct contributiorts of contnturtities if uny) Some communities support their CDDs by helping therrr on therr fanns especrallr,clLr,.g the planting season. Others support in sonte ways such as o Exception from soffle conlnLrnity levres ancl dues. o Offering prayers for them o Giving foodstuff to the CDDs. 3.3. Expenditure per activity - Indicate the expenditure on activities below in US clollars Lrsing the cLrnelt Upitecl Natio.s exchange rate to local currency Table 12: Indicate how rnuch the project spent for each activity listed below ci,ring the reporting period Some of the activities carried out rvere funded from personal resources. Some, like CDD training and community mobilization, were funded from LGA and private resources Some maintenance carried out by MOH, but reco rds of expenditure could not be obtained. a D Activity Expenditure (s us) Source(s) f'undin TF HQ area to central collectron point of community Mobilization and health education of comuruniries Training of CDDs Trainin_g of healtli staff at all levels Supervising CDDs and distribution Internal monitoring of CDTI actir,,ities A_{yg-cac_y v-iqitg tg hgalth and political aurliorities IF.C materials S Ufn1pe_ry (Igp_o4i! g) {o rm s__fo 1 tre atm ent Vehicles/ Motorcycles/ bicycles maintenance Office Equipment (e.g cornputers, printers etc) Others Drug delivery frorn NO N/A t.3t 0 N/A N/A NiA 6,340 FIVIOH/LG LGA LGA UNICEF \,IOH NIOH A TOTAL 7,710 Total number of ersons treated 469,677 Comments 21 WHOIAPOC, 26 Septenrber 2lt0_l EGTION 4: Sustainabitity of GDTI 1' lnternarl independent participatory monitoring; Evaruation '1 ll/as Monitoring/evaluatiorr ccrrriecl otft clurittg the reportitrg periotl? (tick wttereapplicable) )'ear 1 Partrcipatory Independent monitoring N I icl Tenn S Lrstarnability Evaluation 5 1,ear S ustainabiiity Evalr-ration hiternal Monitoring by NOTF Other Evaluation by other partners Noue u,as carried out cir-rring the reporting penod. 4.L2 Ll/hot were the recomtnendrfiiorts? i\/A How hove they been inrplemented? 4'2' Gommunity serf-monitoring and stakehorders Meeting r9iil :|j:',lljlllji'seir-monitori,g arcl Stakeholcters jVreeti,g (ptease uctct more rows if None u,as carried oLrt d the rtirr eriod $ 7. 4. a I 1.li 3 N/.4. Describe hou, the results of tlie comrnunity sell._ liildteO projecr i,rplementation or h"r;;,h;;:r; cy'c19. ntonitoring and stakeholders meetings have uld be r.rtihzed dLrring the next treatm"ent Drstrrct,'LGA T,ota # of C notTll't1u tr \,'les/ ages lll the tlen C 'ear ap roJ No of Conrmunrties that carrted oLrt self monttorln No of Communi ties that conducted stakeholders mee TOT .d WHO/APOC, 26 Septemb er 2003 l I t 4.3. Sustainability of proiects: ptan and set targets (mandatory at yr 3) What arrangements have been made to sustain CDTI after APOC funding ceases rn terms of ,4,3.1 Planning at s.ll relevant levels. At the State level, CDTI activities have been irtegraterJ rnto rhe pHC r^,,ork pla,. Efforts arebeing made to get all stakeholders at all reievant Gr,'els to be involved in the preparation of work plans. At the LGA level project still plans to get LOCTs to do rourine plalling tbrCDTI. 4.3.2 Funds a I The State and the endemic Local Gol'emment Areas are berng nrobrlized to rnclucle Onchocerciasis control funding in their yearly' budget u,hile t6e comurunities har.e bce, sensitized toward ownership of CDTI project. 4,3.3 Transport (replacement ancl maintenance) At the State level maintenance of the existing logistics and equiprnent has beel gil.eq ro the maintenance unit, but there are problems with fLrnds. When the project vehicle brealcs dorr,,,State policy makers have assigned other project vehicles to the SOCT to make irse o1. Thisindicates that transport managemetrt remaini tlie responsibility of the State, and as long astransport is available it could be made use of in an integrated manner. At the LGA level maintenance of motorcycles is mainly,the responsibilitlrof the LOCT to whom it is assigne<lThe State intends to request for replacement of capital lt.,r, from ApoC manaserrelrr. 4.3.4 Other resources The State and LGAs are being sensitizecl on the neecl to procure needed resollrces tbr CDTIimplementation, but the response has been poor. lvfore etforts u,.ill be made i1 t6is reqarcl. 4:3'5 Please provide a written plcut with set turgets und acltievemerils for so fctr.A year 4 plan is attached. 4.3,6 To what extent has the plan been implententecl The implementation will be addressed in a year 4 report. 4.4. lntegration Outline the extent of integration of CDTI into the PHC stn-rcture and the plans tbr co,rpleteintegration 4,4.1. Ivermectirt delivery mechunisms The Mectizan delivery process occurs u'ithin the existing PHC structure. Communities picl< itheir Mectizan requirements from the healtl-r facilities, eicept in feu, cases rvhere the drLrg istaken to them. 4.4.2. Training Some other LGA/PHC Personnel, apart from LOCTs, har,,e been trained on CDTI so that rhe), can assist in training of lower ievel personnel anci supen,ise CDTI activities. When VASdistribution kicks off training sessions for CDTI rvill be used for training on VAS. 29 WHOiAPOC, 26 Scptenrber 2003 at a a ' 4'4'3. Joint supervisiort sttcr tnonitoring witrt otrrer programs I $:'l': State le'el' there are no plans for joinr supervision and monitoring at present. At theIGA lei'el \\'e are a\\/are that some of the LocT; are involved in otherprogrammes andc]ccasionally use the opportunitl'of visits to the .on-,*unuyhealth facility for one programmetb look into other programmes which they are hanclling. ai,rrc health facility level, where Itll f:onnel are involved in GDTI the situatio,r isire,i rnore fluid. visits to thecomulutltty are used for several pllrposes. There are hor.r,ever no integrated supervisorychecklists. and none is being planned at the montent. 4.4.4. Releuse offunds In some LGAs rnrprest is released for PHC activities and is controlled by the pHC director.Flonl there mtnimal amounts are macie al'ailable to the onchocerciasis coordinator for somergtrtine'tsits or collection of Mectizan. ,{t both State ancl LGA levels proposals for therelease of firnds horvever must pass tlirorLgh lhe pHC clirector and other normal channels. 4.4.5. Is CDTI incluelecl in the pHC buctget? At tl-re State leVel there is a Iine itenr for cDTI in the pHC budget. At the LGA level CDTIacti'ities are subsltt-tlecl uncier a general PHC buclget. n-,ctr,rron of the budget or the existenceof a line iten-r does not holvever lr_rarantee funtjs release. 4'4'6' Describ.e other health progr{unntes tltat are trsirtg tlte GDTI structttre ancli how this wss achievei. wrtat rtave beert trte acrrievemetrts? cDTr strllctllre nlay be used for the clistribution of Vitarnin A, most likely in the nextdistribution periocl. 4'4'7' Describe others issues cortsiclerec[ itr tlte itrtegratiott of CDTL 4.5 Operational research i 4'5'l Summariie in not more tltcut orte ltulf of ttpage tlte operatiortal researcltturrdertokert in the project ore, x,itrtin tiu ,Lpirtirtg periocr, None rvas unclertalcen clr-rring the reporting perioci. I 4.5.2. How were the results applied in the project? N A 30 WHO/APOC, 26 Septemb er 2003 IsEcTIoN 5: strengths, weaknesses and challenges - List the strengths and weaknesses of cDTI implementation process - List the challenges and indicate how they ri,ere addressed, Strengths: o Most of the communities so far treated and w,here distribution is currently going o, ha'etaken on the respot-tsibility of collecting the drug h'om rl.ie nearest Health facrliry..o Generally, the cDDs exhibited a high sense of responsibility.o committed staff at various levels of GDTI inrplernentatront Good level of awareness of the rnagnitr-rcle of the oncliocerciasis pr.oblenr by thcommunity o some level of support by the LGAs lor GDTI implen-rentation Weaknesses e lnadequate census update o Shortage of Mectizan o Poor record keeping at all levels o Poor fundi,g of the programme by both state and Local go!,ernmentso Inadequate understanding of their roles uncler CDTI by,some communities.o Inadequate/poor motivation of CDDs in manv cornrnLrnities. List the cltallenges and indicate how they were ucrcrressccr o lnvolvement of more female CDDs o Getting the State and LGAs to release counterpart fir.ds.o Getting all the communities to compensate their cDDso obtaining an autlientic and reliable estimate of the total populatron of e.denric communities and ensuring proper record keeping at ail Ievers.o Increasing the number of CDDs in the project area in orcier ro effectively reduce the *,orl<load on existing CDDs. o Kick starting community self monitoring and stakeholders rneeting at communitr,, le'el inorder to increase levels of participation by all sectiols of tlie communitv. The project could not do much as funds were not available to tackle most of the challenges.There are however plans to conduct a census update, nrobihzation rvorlcshops for policy makers and key traditional rulers. However, ali these depend on availabiliti of funds. Theproject staff has tried to sensitize the cornmunities to seiect more CDDs, inclucle l-enrales inthe persons selected and ensure that they are appropriately motivated. a 31 WHO/APOC, 26 September 2003