Annual NOTF secretariat technical report to Technical Consultative Committee (TCC): January to December 2011

NOC HQs i I I I I I I I I COUNTRY/: Nigeria NOTF: Nlgerra Ano I year: 1997 Renortins (Month/Year) : January - December 201I Proiectvearof this report: (circle) I 2 3 4 56 7 8 910 11 12 13 (14) Date submitted: June 2012 ORIGINAL : English ANNUAL NOTF SECRETARIAT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) 5o To APOC Management by 31 January for March TCC meeting To APOC Management by 3l Julv for September TCC meeting AFRICAN PROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) I!!u,-E-'= \zq tuti.zttz \__- ---- ------ rApt)C rR \ B*b;', /DIR i I I i I I ANNUAt. NO'l'F' SFlCRli-l-ARIAT TT CHINICAL ItEPORT IO -I'ECHNICIAI- CONSIJL'l'A l'lVtr CONIMl'l'l'tlE ( l'('C' ) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: L ('ountrr : NIGERIA Ntrlionrrl ('oordinator Name: Dr. Y. A. Suka Signature .{t t-- |1#7!* // IDatc Nan-rc: Dr. M. Ktbiru k ,'L'',' .H-. NO I I ('hair .-!^rr<-*lh-Signature [)atc liris lcport hers becn preparecl bt Nanre Chukw,u Okoronkn,o Desi grratio n: P ro g ro mnt e cer S iu,nat urc: . ..\ I)atc. '* ,l /--"-r >c( \\ Il() \l'}( )( i ( )rlr)l)cr '0o-l TABLE OF CONTENTS ACRONYMS DEFINITIONS...... FOLLOW UP ON TCC RECOMMENDATIONS EXECUTIVE SUMMARY........... SECTION 1: BACKGROUND INFORMATION........ Ll GeNenel INFoRMATIoN............. 1.2. Popur-artoN AND HeelrH sysrEM..... SECTION 2: SUMMARY OF CDTI IMPLEMENTATION 2.1. DrsrRrsuroNPERIoD 2.2. Aovocncv nNo SpNstrtzATIoN 2.3. INToRveTIoN, EpuceTIoN AND COMMLINICATION STRATEGY AND MATERIALS DEVELOPMENT............ 2.4. CovuunqluEs' INvolvEMENTIN DECISIoN-MAKING 2.5. CRpecttvBUILDINc.. 2.6. ORoeRmc, sroRAGE AND DELIVERY oF IVERMECTIN 2.7. TReetH,tpNTS.............. 2.8. SupenvrsroN............... 2.9. CovtvtuNlry sELF-NIoNIToRINC eNo SrarpHoLDERS Mpprmc 4.1. FrNRNcrel coNTRtBUTIoNS oF THE PARTNERS ........... 4.2. OrgeR FoRMS oF coMNIUNITY suPPoRT............... 4.3. Rrsouncp NToBILIZATIoN EFFoRTS................ 4.4. ExpeNotrLIRE pER ACTIVITy By rHE NOTF sECRETARIAT................ 4.5. Equrrr,teNr SECTION 5: EVALUATION FOR SUSTAINABILITY OF CDTI, INDEPENDENT MONITORING AND OTHER REVIEWS II v I 3 4 5 8 5 9 10 l1 t2 13 t7 l9 27 29 SECTION 3: OTHER ACTIVITIES OF THE NOTF............... .....31 SECTION 4: SUPPORT TO CDTI....... 40 5. 1 . INoeppNoENT pARTlctP AToRy N4oNlroRlr-c/eveluerloN ............ 5.2. SUSrelNeetL|TY OF PROJECTS: PLAN AND SET TARCETS (NIANDAToRY A'r YR 3) 5.3. INtscnerloN............... 5.4 OppnarroNAL RESEARCH 40 42 42 43 44 46 48 48 50 SECTION 6: STRENGTHS, WEAKNESSES, CHALLENGES AND OPPORTUNITIES 50 Acronyms AFAN AIDS ALGON APOC ATO ATrO BCC BSN CAN CBBI CBO CBM CC CDA CDD CDI CDTI CM CRUTECH CSM cwo DHS DOTS FCT FENAM FLHF FOMWAN GAELF GCR GIS GMC GPS GRBP HFS HIV HKI HMM HSAM HQs IDP IEC IEF Agricultural Farmers Association of Nigeria Acquired Immune Deficiency Syndrome Association of Local Governments of Nigeria African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Behavioural Change Communication Bible Society of Nigeria Christian Association of Nigeria Community Based Bamako Initiative Community-Based Organization Christoffel Blinden Mission Carter Center Community Development Association Community-Directed Di stributor Community-Directed Intervention Community-Directed Treatment with Ivermectin Community Meeting Cross River State University Community Self-Monitoring Catholic Women Organization District Health Staff Directly Observed Treatment Short-course Federal Capital Territory Federation of Nurses and Midwives Front Line Health Facility Federation of Moslem Women Association in Nigeria Global Alliance for Elimination of Lymphatic Filariasis Geographic Coverage Rate Geo graphic Information System Gombe Media Corporation Global Positioning System Global 2000 River Blindness Programme Health Facility Staff Human Immuno Deficiency Virus Helen Keller Intemational Home Management of Malaria Health Education, Sensitization. Advocaci, & Mobilization Headquarters Ivermectin Distributi on Programme Information, Education & Communication International Eye Foundation ll WHO/APOC. l0 April 2003 IFESH International Foundation for Education & Self Help IT Information Technology ITN Insecticide Treated Net JNI Jama'atu Nasril-lslam KAP Knowledge, Attitude & Practice LCIF Lions Club Intemational Foundation LF Lymphatic Filariasis LGA Local Government Area LOCT Local Government Onchocerciasis Control Team M & E Monitoring& Evaluation MDA Mass Drug Administration MDP Mectizan Donation Programme MIS Management Information System MITOSATH Mission to Save the Helpless MLG&CD Ministry of Local Government & Community Development MOH Ministry of Health MSD Merck, Sharpe & Dohme MWR&E Ministry of Water Resources & Environment NAFDAC National Agency for Food, Drug Administration & Control NAPEP National Poverty Eradication Programme NEEDS NationalEconomicEmpowermentDevelopmentStrategy NFO Nigeria Farmers Organization NGDO Non-Govemmental Development Organization NGO Non-Governmental Organization NHMIS National Health Management Information System NIGEP NigeriaGunieawormEradicationProgramme NOCP National Onchocerciasis Control Programme NON Newsletter on Onchocerciasis in Nigeria NOTF National Onchocerciasis Task Force NPHCDA National Primary Health Care Development Agency NPI National Programme on Immunization NTD Neglected Tropical Disease O/R Operational Research PATHS Partnership for Transfbrmation of Health Systems PEC Primary Eye Care PHC Primary health care REMO Rapid Epidemiological Mapping of Onchocerciasis SAE Severe adverse event SCH Schistosomiasis SENOES South Eastern Nigeria Outreach Eyecare Services SIZ Special Inten'entionZone SHM Stakeholders meeting SMOH State Ministry of Health SOCT State Onchocerciasis Control Team lll WHO/APOC, l0 April 2003 SSI Sight Savers International STI Sexually Transmitted Infection TRC Technical Review Committee TB Tuberculosis TBA Traditional Birth Attendant TCC Technical Consultative Committee (APOC scientific advisory group) TCR Therapeutic Coverage Rate TOT Trainer of trainers LIN United Nations UNICEF United Nations Children's Fund UNIVA University Village Association UTG Ultimate Treatment Goal VAS Vitamin A Supplementation WHO World Health Organization WHO/AFRO World Health Organization African Re gional Offi ce ZOTF Zonal Onchocerciasis Task Force IV WHO/APOC. 10 April 2003 Definitions (i) Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). Elieible ulation calculated as 84%o of the total population in meso/hyper- endemic communities in the project area ( iii) Annual Treatmenl lbi@llJe (ATO): the estimated number of persons living in meso/hyper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. (iv) Ultimate Treatment Goal (UTG): calculated as the maximum number of people to be treated annually in meso/hyper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage (normally the project should be expected to reach the UTG at the end of the 3'd year ofthe project). (v) Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) Geographical coverage: number of communities treated in a given year over the total number of meso/hyper-endemic communities as identifred by REMO in the project area (this should be expressed as a percentage). (vii) Integration: The bringing together of two or more health programs, removing barriers between/among them, in order to maximise cost-effectiveness and permit free and equal association. For example 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 maximise cost-effectiveness and empower communities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTI. (viii) Sustainabilit)r: CDTI activities in an area are sustainable when they continue to function effectively for the fbreseeable future, with high treatment coverage. integrated into the available healthcare service, rvith strong community ow'nership. using resources mobilised by the community and the government. WHO/APOC. 10 April 2003 FOLLOW UP ON TGG RECOMMENDATIONS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session 34 lVumber of Recommend stion in the Report TCC RECOMMENDATION ACTIONS TAKEN BY THE NOTF SECRETARIAT FOR TCC/ APOC MGT USE ONLY 158 The figttres given .for total population for Nigeria as a v,hole in the executive summary ( 156 million) is not consistent v,ith the figure in the general information section (160 million) The correct figure is 160 million 159 Projects with difficulties due to lov, geographic coverage are; Niger, Abia, Osun, and Kebbi btn the reasons v'ere not discussed in detail and no solutions y'ere provided. The challenge of Niger is the land mass coupled with inadequate funding for supervision. In Abia there are security challenges in the Niger Delta region which affected coverage. lnadequate supervision and poor management skills are the major issues in Kebbi and Osun States. Advocacy to State and LGAs continue in Niger to improve counterpart funding. Re- orientation and focused interventions (hands-on help) are planned for Osun and Kebbi. 159 Oyer 1700 morc CDDs v'ere lrained in .4nuntbru ,sluta than plannetl, v'hile Zuntforu, did not train emy' lruiners nor dicl thet' lruin or proviele re./rasher truining /br C'DD.s. The reu.s'ons'u'ere nlt discussed'? The major constraint for Zamfara is grossly inadequate funding including non-release of counterpart contributions by State and local governments. A contributon, factor is poor programme management skills by the State team. 159 Mectizan Inrentorl' Tolul^v v'ere nol provitled to gire the overull piclure. Kebi wu,v the onb' slute which reported expiretl drug.s. ls there on1'reuson for this'? Totals have been provided in the crlrrent report. Impropoer management (non-use of the policl' of first-in-first-out) led to expiry of the drugs in Kebbi State I 6 I IYith respecl lo c'o-intplementulion o.f NTD c'ontrol Y'ith C'DTI, in la States LF is being integrated v'ilh onchocerciasis'.,;chistosomia.sis. malaria (lTI{). I lov'eycr, morc needs to be done to ntuke procre.\s u' i t h co- impl e nta nt ut i o n. Co-implementation of LF has expanded to cover 2l States in 2011. Greater progress is expected vrith the development and implementation of the NTD Master Plan rvith support fiom WHO/AFRO. l6r RAPLOA' (q'e v'ornt) has been Verification using the 'gold WHO/APOC. l0 April 2003I reported in I5 communities with a prevalence of a0% being reported; this should be verified as it would be alarming ,f correct. The Mectizan supply chain is satisfactory standard' will be done once the necessary resources are available. However, it is pertinent to note that ivermectin treatment has been on-going in most areas where prevalence levels indicated >40yo with no reports of any serious adverse events. 161 Given the long list of recommendations by activity, perhaps NOTF should consider prioritizing recommendations using relevant criteria (priority 1,2,3) . And provide update on the achievement of priority I level indicators in the subsequent reporl to TCC. The NOTF tries to track all recommendations. Some recommendations may be crucial for some States but not for others. It is also felt that reporting only a set of prioritized recommendations may not provide adequate information on what is being done. The TCC may wish to provide further guidance on this issue. TRCS/ TCC3 4 recommendations 22r State Coordinators should be trained and retrained on data management to avoid mix-up qf CDTI and LF elimination informat i on e spe c ially w it h r e spe c t to list of communities and popul ati ons b eing c over e d. An effort was made in data management training for selected States but funding constraints did not allow for adequate training and follow up. It is envisaged that review meetings will be used to provide some form of training until funds are available to do a proper and comprehensive training. 221 In addition to the project technical reports to be reviev'ed NOCP should send to revieu'ers the electronic copies of previotts year's reports to enhance assessment. This will be implemented from the next TRC meeting in2012. 221 The C-Zone Coordinator is to .follow' up and update NOCP HQ,r on the over-repnrting of CDTI population and treatment dala in Kaduna state for 2010. The Zonal Coordinator is fbllowing up on this, and hopef ulll, this ivill be resolved befbre 20 I 2 treatments cornrnence. (Please add more rov,s if necessary') 2 WHO/APOC, l0 April 2003 Executive Summary Nigeria is made up of 36 States and the Federal Capital Territory with a population of about 164 million persons. Total population at risk fbr Onchocerciasis is about 36 million persons. In 201I total number of persons treated was 30,439,546 out of a total population of 38,332.140 persons. This represented a 79o/o therapeutic coverage rate, and achievements of 96%o and 95o/o of the ATO and UTG respectively. Overall, the national therapeutic coverage has been >65% since 1999. Details of treatments show that all the 3l States and FCT (100%) achieved > 65oh therapeutic coverage rate, and over half achieved >80%.. The other projects reported coverage rates that ranged between 74% and 79o . 36,121 communities were treated out of a total of 36,183 communities targeted, representing a 99.8% geographic coverage rate. The following States were unable to achieve 100%o geographical coverage: Kaduna, Kebbi, Nassarawa, Niger and Yobe. However, Yobe and Kebbi were the only ones with less than 99oh geographic coverage. For Yobe, the non-achievement was due to security challenges. In fact the State project was not even expected to have achieved this much given the precarious security situation in the State since 2010 which worsened in2011. For Kebbi, the poor quality of supervision led to the non-discovery of communities that had not been treated in 2 LGAs (Sakaba and Zuru) until the treatment cycle was over. During the reporting period a total of 28,983 health workers (project and health staff) and 2 I 0,3 5 8 CDDs were trained or re-trained, representing achievements of 7 lYo and 7 6oh of their ATrOs respectively. Of these 6,420 health workers (22%) and 50,915 CDDs (24oh) were newly trained. The CDD/population ratio has further improved to I CDD: 182 persons. Extent of integration of CDTI into PHC varies fiom one project to another, and from State level to the FLHF level. Generally, Mectizan processes and funding are within the goverrrment system. Joint monitoring/supervision and joint utilization of logistics/transport occur more at the peripheral level than at the project or national levels. CDTI has been used as a vehicle for VAS. PEC. schistosomiasis. Malaria and LF control programmes to the benefit of all the programmmes. In about 21 States. LF is being co-implemented with nearly 14.9 million persons being reached. In 6 and 4 States VAS and schistosomiasis are being coimplemented respectir ely. Total population covered rvere 912,164 for VAS and 661,570 fbr schistosomiasis. Over 400.000 persons rvere reached fbr home management of malaria in 5 States. In 2 States trachoma is being controlled through health education and zithromax distribution that reached736.626 persons. The CDTI structure was used to immunize 260,000 persons during the reporling year. In the course of the )'ear. the NOI'F conducted advocacy campaigns. participated in targeted training of programme stafT as u'ell as some planning meetings. coordinated procurement of Mectizan and capital items. organized supervisory. monitoring. entomological and epidemiological assessments in selected projects. and ensured transfers of APOC funds to projects while monitoring that expenditures are in line with approved budgets. The NOTF has also conducted routine programme review meetings and participated in sensitizatiorV mobilization of target populations. Outcomes of epidemiological surveys indicated good progress towards elimination of onchocerciasis transmission in Enugu and Anambra States. Results of entomological studies shou,ed absence of infective L3 head in sites in Cross River, Kaduna, Ebonyi and Zamfara States. In one site in Kaduna. infective L3 heads were seen and these have been sent to Ouagadougou fbr further anall'sis. Strengths of the country's programmes include improved CDD/population ratio. support by most NGDO partners, probable achievement of elimination of onchocerciasis in some foci, 3 WHO/APOC. l0 April 2003 commitment of some programme staff, high level of community awareness and acceptance of the Mectizan drug, and availability of a large number of trained CDTI personnel at various levels. Good working relationship of the project officers with NGDO partners, increased reach by programmes that are being co-implemented, establishment of mectizan processes within the government system, and effective coordination of CDTI implementation at national level are additional strengths. Opportunities include political support from Governments, appreciable level of HSAM directed at both increasing drugs uptake and support to CDDs by community members, increasing recognition by stakeholders of CDTI as a vehicle for the effective delivery of varied health interventions at the community level, integration of CDTI with other PHC progrtrrnmes, and increasing involvement of local NGOs, CBOs and associations in the CDTI process. However, programme implementation is being constrained by the following: poor superviston at all levels, inadequate community census registration and irregular update of community treatment registers, inadequate logistic support at LGA and FLHF levels, growing tiredness with intake of Mectizan afrer several years of compliance by community members, late submission/retrieval of treatment & training reports at all levels, and poor record keeping at various levels. Late releases of approved funds by all partners, poor counterpart funding by government at all levels; weak levels of community ownership in some of the projects; demands by CDDs for monetary incentives, and frequent transfers of health workers still constitute the pervasive threats to effective programme implementation in the country. To address the challenges the NOTF conducted household treatment coverage surveys ln addition to routine monitoring and supervisory visits to make on-the-spot corrections, paid advocacy visits targeted at some States, trained and retrained programme managers on areas of deficiency during review and planning meetings, and participated in and encouraged re- mobilization of communities in selected States. 4 WHO/APOC. 10 April 2003 SECTION {: Background information 1.1. General information 1.1.1. Description of the country program -CDTI and vector elimination (briefly) Status of National plon implementation, population at risk, number of projects being implemented, other relevant activities, infrastructure (eg. Adequate health facilities, is system decentralized or not, etc), logistics, administrutive structure. Nigeria is made up of 36 States and the Federal Capital Territory with a population of about 164 million persons (projection from 2006 census). It operates a federal system. There is a central government with the president at the top, supported by executive, legislative and judicial apparatus. Each State has its own government with the Govemor as the chief executive. He is complemented by the same type of structures at the federal level but on a State basis. The State consists of a number of LGAs with each LGA being administered by the Executive Chairman supported by its miniature legislative and executive structures. The country is divided into six geo-political zones. There are however 4 health zones for the onchocerciasis control programme and the neglected tropical diseases. Each health zone comprises eight to ten States and has a Coordinator for the Onchocerciais Control Programme as well as for a Coordinator for Neglected Tropical Diseases. There are over 23,000 PHC facilities (primary, secondary and tertiary) in the country. Most are public health facilities (about 620/o) whlle others are privately owned. The total number of health care facilities is still considered grossly inadequate and accessibility (physical and economic access) is a big problem. A majority of the rural populace is emasculated from adequate health care. Presently Nigeria has 28 projects (27 CDTI projects covering 31 States and the Federal Capital Territory. as r.l,ell as the National Headquarters Support Project. About 36 million persons are at risk of the disease. Health s1'stem & health care delivery (state any problems related to health system that i mpede p rogrom imple me ntotio n). The Nigerian government has a national health policy which targets the reduction of morbidity and mortalitl' rates due to communicable diseases to the barest minimum, reverses the increasing prevalence of non-communicable diseases. meets global targets on the elimination and eradication of diseases. and significantly increases the life expectancy and quality of lif'e of Nigerians. To achieve this. the health sector has undergone refbrms and systems are being strengthened at ever,v level of government. In addition, poverty eradication and alleviation programmes have been established. The National Health Insurance Scheme has been set up. Primary Health Care (PHC) is the strategic policy. central function and focus of Nigeria's national health system, and to this is tied the overall social and economic development of the communities. Health Care Delivery is the responsibility of all three tiers of government. with each tier taking care of its ler,'el. The Primary Health Care facility is the t-rrst level of contact of the community members i,r'ith the health service. and referrals are made upwards from that level. 5 WHO/APOC, l0 April2003 Provide map locating all projects (CDTI and Vector Control, tf any) within country. Yobe Kano Bomo Kaduna Niger Taraba Benue Shaded areas indicate the combined projects 1.1.2. Partnership Indicate the partners involved in project implementation at all levels (MoH, NGDOs - n intern 6 CDTI Project Partners Adamawa MOH, APOC,WHO, HKI. CBBI, LGAs,Communities Akwa Ibom MOH, APOC,WHO. HKI. LGAs,Communities Bauchi APOC. LINICEF, State Government, LGAs, Communities Benue LINICEF. NOCP. SMOH. LGAs. Federation of Nurses and Midwives (FENAM). Catholic Women Organization (CWO). Benue State Agricultural Development Fund. Agricultural Farmers Association of Nigeria (AFAN). Nigerian Farmers Organization (NFO). r,'arious communitl,& development associations. Communities Borno MOH, APOC,WHO. HKI. LGAs.Communities Cross River APOC.WHO, SMOH. LGA. LINICEF. . South Eastem Nigeria Outreach Eyecare Services (SENOES). Ogo.ia Catholic Ey'ecare Senu,ices. Cross River National Park. Cross Ri,u'er Forestry'Commission. Tulsi Chanrai Foundation. Great Friends of Obudu, Pacesetters Klub Exclusive of Calabar. Calabar Leo Club. Catholic Nurses Guild, Youth Care. Opthalmologl' Dept of l-lniversity'of Calabar. Cross River State Universitr, (CRUTECH ). Con.rn.runities Edo WHO,APOC. NOTF. LCIF. Carter Clenter. MOH, LGAs, Communities Delta WHO,APOC.NOTF, LCIF. Carter Center. MOH, LGAs, Communities Ekiti MOH. APOC. WHO. NOCP. UNICEF. LGAs. NGOs/CBOs [Kids & Teens. Boys Brigade. Girls Guide. Bo1's Scout. Centre for Society reconditioning and Development, Lif-e & Peace Development Commission. Farmers Congress. New Initiative for Social Initiative. Busy' Bees and Life Centre Foundation]. communities Enugu WHO, APOC, Carter Center. NOCP. SMOH. LGAs. Communities Anambra WHO, APOC, Carter Center. NOCP. SMOH. LGAs. Communities Ebonyi APOC, WHO, Carter Center. SMOH. Communities APOC, NOCP, CBM. State Govemment. l-GAs, CommunitiesFCT WHO/APOC. l0 April 2003 Gombe WHO, APOC, UNICEF, FMOH ,SMOH, LGAs, Communities Imo APOC, NOCP, LCIF, TCC, SMOH, LGAs, Communities Abia APOC, NOCP, LCI, GRBP, SMOH, LGA, ABHSDP II, Communities, Girls Guide, Girls Brigade, Boys Scout, Boys Brigade. Jigawa FMOH, CBM, SMOH, PHCA, WHO, APOC, LGAs, Health Facilities, FOMWAN, CBOs, Communities Kaduna SSI, NOCP, State MOH, endemic LGAs, Communities Kano WHO, APOC, CBM, FMOH, SMOH, LGAs, Communities Kebbi SSI, NOCP, State MOH, endemic LGAs, Communities Kogi SSI, NOCP, State MOH, endemic LGAs, Communities Kwara SSI, NOCP, State MOH, endemic LGAs, Communities Niger APOC, WHO, LINICEF, FMOH, SMOH, LGAs, Jama'atu Nasril-lslam (JNI), Nigeria Red Cross Society, National Union of Road Transport Workers, endemic LGAs, Agric. Cooperative Groups, Trade Unions, Age Grades, Communities Ogun UNICEF, NOCP, State MOH, Christian Association of Nigeria (CAN), Bible Society of Nigeria (BSN), NASFAT, DAWAH, NAWA-RU-DEEN, Christian Corpers' Fellowship (CCF), Market Associations, Commercial Motorcycle Riders Association, endemic LGAs, Communities Ondo WHO, APOC, UNICEF, MITOSATH, FMOH, SMOH, LGAs, Communities Osun APOC, UNICEF, NOCP, SMOH, LGAs, Communities oyo UNICEF, WHO, APOC, NOCP, MOH. LGAs, Civil Defence Corps, Boys'Scout, Girls Guilds, Lydia Groups, Man O War Groups, Community Development Associations, Commercial Motorcycle Riders Association, Communities Plateau NOCP, MSD, TCC, APOC, LGAs, Communities Nassarawa MDP, APOC, WHO, FMOH, Carter Center, SMOH. LGAs, Communities, NURTW, Women in Health, Jamaatul Nasirul Islam, Women Fellowship Groups Taraba MITOSATH, MOH, LGAs, CBOs, Communities Yobe MOH, CBM, NOCP, LGAs, MLG &. CA, Community Development Associations (CDAs), Communities Zamfara SSI, NOCP, State MOH, MLG & CA, endemic LGAs, Communities Describe overall working relationship omong partners, clearly indicating specific areas of project octivities where oll partners are involved (planning, supervision, advocacl,, resources mobilization, endemicity mapping / ossessment, development of IEC materials, slrtdies or survel,s etc). Overall rvorking relationship among partners is good. All partners are involved in planning. advocac-r'. supervision. resource mobilization and sensitization. State plans rf sry to solve any issues arising as regards CDTI implementation, l-he NOI-F is concemed that leadership changes and inadequacl' of resources have affected CD-fl implementation in the States being supporled b1' HKI viz: Adamawa, Borno and Akwa Ibom. Meetings were held with all stakeholders concerned. and some resolutions reached. A new country leadership has pledged to find ways to improve support to these States, a pledge the NOTF has accepted. 7 WHO/APOC, 10 April 2003 Ultimate Treatment Goal (UTG) by 2010Name of CDTI Project Total communitiesin meso/hyper- endemic zone Total population in meso/hyper-endemic zone 1,714,764 1,440,402Adamawa 2851 l3 29,358 24,661Akwa Ibom 1,475,788Bauchi 998 1,756,890 2382 3,4649,15 2,910,530Benue 1 ,1 60,1 53Borno 1660 1,381,135 958 1,252,219 1,051,905Cross River 780,595Edo 530 975,744 632,814 531,614Delta 470 Ekiti 422 277,3474 1,738,779 1,008,851 847,435Enugu 1373 Anambra 1062 755,018 615,709 628,482 502,186Ebonyi 973 426,624FCT 559 507,886 1,909,032 1,604,235Gombe 1024 Imo 1647 842,593 707,778 476,231 401,035Abia 564 Jigawa lll 357,517 300,314 2.777.849 2,333,393Kaduna 2677 Kano 810 987,921 829,859 208,279 174,954Kebbi 204 1.789,685 1,559,492Kogi 2544 Kwara 1 069 1,512.636 1,243.029 2,659,049 2,127.241Niger 3027 9s2 344.493 289,374Ogun I ,l 51.046Ondo 579 1.370,293 1582 1.616.644 1,357,982Osun 926.120Ovo 23 85 1 .102.528 2q6 463.819 37r.055Plateau 909.863Nassarar.va 589 1.060.797 Taraba 1 509 1.667.928 I .401 .06 r 61 6.884 518,182Yobe 247 Zamfara l16 286.292 240,482 38,332,140 31,952,876TOTAL 36,183 1.2. Population and Health system Table 1: Projects and population at risk in the entire country whether they are treated or not the 'ease add more rows neces, Source: From Oncho Project reports: National census: Other source, specify- Year UTG: Calculated as the maximum number of people to be treated annually in mesoihyper endemic areas within the project area. ultimatell' to be reached u,hen the project has reached full geographic coverage (normalll,the project should be erpected to reach the UTG at the end of the 3'd year of the project). 8 WHO/APOC, l0 April2003 SECTION 2: Summary of CDTI lmplementation 2.1. Distribution period Chart the actual distribution period for each CDTI Project in the country in the table below Table 2: Overview of distribution undertaken I rov,s os ne Briefl1' note any problernsiissues (one paragraph). Late receipt of drugs and inadequate mobilization of communities due to late release of funds as rvell as inadequate funding tend to cause extended periods of distribution. Late receipt of drugs was a critical issue in the 1'ear being reported. 9 Jr \J.t s Project Name Distribution Period Jan Feb Mar Apr May Jun Jul Aug sep Oct Nov Dec Adamawa Akwa Ibom Bauchi Benue Bomo Cross River Edo Delta Ekiti Enugu Anambra Ebonyi FCT Gombe Imo Abia Jigawa Kaduna Kano Kebbi Kogi Kwara Niger Ogun Ondo Osun o)'o Plateau Nassararva Taraba Yobe Zamtara WHO/APOC, 26 September 2003 2.2. Advocacy and Sensitization a) State the number and type of policy / decision makers mobilized ot the national and lower (state and districl level) during the current year; the reasons for the sensitization and outcome. b) State progress made towords internal resource mobilizotion. During this year. a fbrmer Minister of State fbr Health w'ith support from APOC. continued her visits and fbllor.v up activities to selected States that have not been releasing counterpart funding. At the national level. an NTD Plan of Action and policy document have been developed to be utilized in advocating fbr resources at national and international levels. c) Describe on1, policy-reloted constraints being faced by any particular project ond describe what was done to assisl the project (outcome). Explain any plans on how to improve advocacy. No policy-related constraints are being experienced. It is envisaged that the NTD plan will be utilized to approach donors lbr support tbr NTDs programme implementation which includes onchocerciasis control. Level No & Type of Policy makers mobilized Reason for Sensitization Outcome of Mobilization National 3 (Ministers and, Permanent Secretary) Support for all activities for the elimination of onchocerciasis as a disease of public health importance. Release of some counterpart funding, and approval of all activities for onchocerciasis elimination within the country State 356 (Commissioners for Health & Local Government, Permanent Secretaries, Directors for Health, other Directors, Members of the House of Assembly, Members of LG Civil Service Commission) a a T o acquaint them with the sustainability plan developed by both the state and the LGAs and remind them their roles and responsibilities in CDTI for improved delivery of service. To create more awareness on CDTI implementation Releases of counterpart funds in some States and continuous increase in awareness of the CDTI programme. LGA 2,171(LGA Chairmen, PHC Directors, councilors, other policy makers at this level) Health education and sensitization on Onchocerciasis disease and mobilization to support the programme. The rapidity in turnover of policy makers at this level is is unbelievable! Awareness of the Mectizan distribution programme and release of counterpart funding by some Local Government Councils. l0 WHO/APOC. l0 April 2003 2.3. lnformation, Education and communication strategy and materials development Briefly describe the IEC strategy being used in the countryfor CDTI. The State projects develop their own IEC materials based on what have been done before, and some have gone ahead to develop new ones with input from both the NGDO partners and the NOCP HQs. With the increasing emphasis on NTDs, a group has been set up within the NTD Steering Committee to look at training and IEC materials but the group has been unable to work due to funding constraints. Note d any nelr) IEC materials were developed or revised, the type of the materiol, the message and target audience, and where they were distributed. How were the IEC materials developed ? The process for the development of new materials, which started in2009, was revitalized. At the Jos meeting in 2008, a sub-committee of the NOTF had met and reviewed existing materials and came out with concepts for new ones. These concepts were developed, reviewed and some of them field-tested during the current year. Some States have made use of the cameo-designs to produce new IEC materials. Are the materials reviewed to address upcoming issues (like decreasing refusals, s ustainability, maintaining complionce to long-term treatme nt, SAEs) ? The new materials were developed taking into consideration the need to improve compliance, ensure sustainability, engender community support for CDDs, and improve community participation. Report tf any KAP surveT,s have been done and how their results were used? No KAP survey was carried out within the reporting period S ummarize info rmatiot, o r, : - The use of appropriate ond innovative media and/or other strategies to disseminate information omong the projects; To disseminate intbrmation among the various projects, the fbllowing strategies/channels of communication were utilized : o Radio and televison messages/programmes 0 Posters/Handbills o Bill boards o Community meetings o Announcements in churches and mosques o Health workers sensitization meetings o Local Town criers a Workshops for various target groups at both State and National levels o Identification. sensitization and mobilization of local NGOs and CBOs. To disseminate infbrmation to the various projects, the following strategies/channels of communication were utilized: ll WHO/APOC, l0 April2003 per zone) '/ Supervisory visits to projects - Mobilization and health education of women and minorities - method and response ln the southern part of Nigeria (eastern & western), mobilization and health education of women are part and parcel of the community mobilization and health education by health workers and CDDs. This is strengthened using family support programme advocacy groups, community women leaders, trade women associations and faith-based women societies. In the northern part of the country (and some sections of the West) where women seclusion is practiced, Muslim teachers. the public-address system, female health workers, traditional birth attendants (TBAs) and family heads constitute means of health educating and mobilizing them. Consequently, while overall there is an increasing level of participation of women in the country, this is more pronounced in the south than in the north. Minorities are usually mobilized along with others, and where there are language differences appropriate persons are utilized to do the mobilization. Major accomplis hments ; number of female CDDs available We a knes ses/C o nstraints ; / Inadequate funding for community dialogue. 'r Preference of health staff for clinical duties to field work. except when the incentives are sufficiently inviting as in immunization campaigns. -r Poor logistics especially at the local government and health facility level Suggest wq:s to improve mobilization of the target communtties omong proiects '/ Management training fbr health rvorkers at various levels to improve skills on communitl, mobilization '/ Engagement rvith partners to improve lunding for community mobilizalion / Mobilization and involvement of more local NGOs. CBOs. age grades, religious/ cultural groups. women groups etc in community mobilization. 2.4. Gommunitiest involvement in decision-making Comment on community participation making comporisons among proiects Community participation is reasonably good in Cross River, Kaduna, Taraba, Ebonyi, Anambra and Ondo. In most other projects community participation is waning. To inject new enthusiasm in the implementation process, co-implementation (especially with lymphatic lilariasis) has been introduced and expanded in various projects. The projects where community participation has been poor include FCT. Osun, Ogun. Kwara and Benue. t2 WHO/APOC, l0 April 2003 - Participotion of female and youth members of the community at health education meetings; This varies from one part of the country to another. In the southern part of the country (most sections) females and youth have the freedom to attend health education sessions with other community members. In some of these parts they can be more vocal than the men. However, in the south east, the youths do not attend as they see the programme as belonging to the adults. Moreover, the youths believe they will be more rewarded for their time if they are engaged in some activity that will generate money. In the north, women are usually not allowed to attend any gathering with the men, including health education sessions. In order to reach women, separate health education sessions are organized, and their participation in such sessions can be uninhibited. - In general, how do you rate the participation of minority groups andfemale members in community meetings, decision-making, (ottendance, participation in the discussion etc.) other issues. In most communities women are not part of the decision processes. They can contribute but final decisions lie with the men. With the expansion of co-implementation (especially with LF) and increased sensitization on the need for female participation, there has been a general improvement although a lot of improvement is still needed particularly for projects in the northern part. There have been no reports of marginalization of minority groups. In most parts they become assimilated into the host community and play the roles expected of all community members. 2.5. Gapacity building Training of national, district level staff in CDTI and general management skills (computer applications, project planning, etc.) BrieJly describe any training done by the NOTF for specific CDTI or Vector Control Proj ects (O bj ectives, participonts, o utcomes, any follow-up needed). No training activity was organizedby the NOTF at the national level in the course of the year. but review meetings were used for training in areas of deficiency identified. Moreever. NOTF members participated in various State/project-level training where it was deemed appropriate. Table 3: Type of training undertaken at national level by the GTNONOTF ck the boxes v'here c lrai was carried out lhe re ot'l ri T1,pe of training Proiect staff MOH staff Opinion Leaders Others(specify) Program management conduct HealthHow to education Management of SAEs CSM SHM {Data collection Data analysis Report rvriting Others (Operational Research) l3 WHO/APOC, l0 April 2003 BrieJly describe any technical assistance provided to the CDTI projects. Technical assistance has been extended to projects in the following areas: o Preparation and review of technical reports . Co-implementation o Conduct of Community Self Monitoring . Rendition of accurate financial returns. This is applicable to projects that have new accountants or have problems in usage of the WHO imprest system. Fill in table 4 on the next page. t4 WHO/APOC, 10 April2003 ca N () -o o o.()a o.l Q o I rr) q) -a o\ 4 U s_q) a)\ V) q) *t \ \)\ -() t)\ q)\ bO \ q) q q) .L\\UF ! 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(-.l al co\o : alf) -: (.r F- ra o\ r- f.) F- q) q) q) c) o\ oo \or- = \o \o v $ oo t-- ca c.l : c.l ca O C\ (..l : (..l O (.l O O O O c.l : f co tr- : \o : t--\o \o = =1- a_r cl \oO GI (-.l $ s t--s O$ $ al : tr- oo t-- aar- .f,(..t \o o\ o. .:l c..l ca al t--\o r- co aa \o \o \o : 00 oo o\\o F-\o (\ Osl O : Or- s$ O ao\o N 6l6 o\ o\ o\\o t)F- () (] q) \e \o 00 o.\o c\ =\o re (s oo v o M -ooV oo V H v tr 0) bo 2 oo c/)(J >'o (g 0) (s k tr a ./)(u z (s -o(!tr F o L .(s (! N '] F 3 2.6. Ordering, storage and delivery of ivermectin Please describe how Mectizan@ is ordered and how it gets to the communities. The assisting NGDOs/States complete the re application forms for Mectizan and albendazole needed based on datalrequests collected and collated from the projects/LGAs, and forward same to the NOCP HQsA{OTF Secretariat. The National office/HQ reviews and collates these into a single re-application which is forwarded to WHO and MDP. On approval Mectizan shipments are received through TINICEF while the WHO country office clears the albendazole consignments. From the NOTF store, the drugs are lifted by the assisting NGDOs, or Zonal offices or by the States. Where the former applies, the States get their supplies from the NGDOs or Zonal offices and make them available to the LGAs. The LGAs in turn send the required quantities to the health facility centres/collection centers from where the communities pick up their drugs. In some cases the LGAs make the drugs available to the communities directly. Please comment on whether ivermectin delivery has been integrated into the essential drugs delivery system at the national and lower levels or not. State activities under ivermectin delivery thal are integrated into the national heulth care system in the country. Nigeria is yet to have a national integrated essential drugs delivery system. Several agencies responsible for health care delivery such as the NPHCDA have set up drug supply/delivery channels to cater for the services that they render. Ivermectin and albendazole delivery at the national and zonal level operates independently of these channels. However, when States and LGAs receive their drug supplies, some keep their consignments in the PHC stores with vaccines and some other essential drugs. It must be emphasized that all the processes except procurement are within the government system. Moreover, there are several instances where LGA personnel utilize the opportunity of vaccine collection at the State level to pick up their dru gs (Mectrzan/Albendazole), and vice versa. Pleose state where ony remaining Mectizan@ is stored ofter the distrtbution cycle. In some States the remaining Mectizan (and/or albendazole) after distribution is retrieved and stored at the State level. In other cases they are left at the LGA level and whatever is left is deducted from the quantity requested for the next distribution cycle. Attention is howel'er paid to expiry dates to ensure that expired drugs are not distributed to communiry" menrbers. Projects also share/exchange tablets rvhen the expirl,' dates for a particular batch are close. and treatments have been concluded or about to in the particular project having the drugs. It is the policy of the NOTF that all expired drugs be retrieved and fonvarded to the NOTF Secretariat where they are properly disposed of. t7 WHO/APOC, 26 September 2003 oaa o a U) c aa o o oN o o z. o oN 'r o mQ C) N f o 2 r) (-) (J z O(-) o z coQ l, a V) o mU o v IJ I(, Q O c UU o 0) oN o (-) (-) o O(-) o z. UQ a q) q) o v I(-, v L,) 0) oN Fr. o o z. E. rrlO 7D :t o z trl(-) zD o E. rrlU z f o tl. rr.lO zD o z. E. HU 7f o z. IJ. s.lO z) c tr. rr.l 9 7f \J z Ir. 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C) U) 0) .E E E o C) (') h9 -otrx 0.)rUr: o)o=tao LFP \q ^.o ()Et 3 S -l F xl : 's -t -\9l '- 69l oo .9lBl c .! vt -9t .t - orl - ; -l-LEI.g E .rluU XJ iR .t-qEI Jolo- vt^LbtK qt !l - tltrlo trl )la-lZI? AI 6l orl$ ul atUI ol (6l ol .rl -clOIgl o0 ^lvt(-)l s El ol .-l il aldt bl -lPI od trl PI =tal EI :l €l (gt EI ol tr. I I a) (d 0) oo L o oo O^ P^\ 0.) a-(! C) t- - If the projects are not achieving 100% geographical coverage and minimum of 65% therapeutic coverage rate or if coverage rate is Jluctuating, state reasons and plans being made to remedy this. The following States were unable to achieve 100% geographical coverage:Kaduna, Kebbi, Nassarawa, Niger and Yobe. However, Yobe and Kebbi were the only ones with less than 99oh geographic coverage. For Yobe, the non-achievement was due to security challenges. In fact the State project was not even expected to have achieved this much given the precarious security situation in the State since 2010 which worsened in 2011. For Kebbi, the poor quality of supervision led to the non-discovery of communities that had not been treated in 2 LGAs (Sakaba and Zuru) until the treatment cycle was over. All projects achieved more than 650/o therapeutic coverage. 19 (59%) of them reported coverage >80%. The other projects reported coverage rates that ranged between 74oh and79%o. 2.7.2 In general, what are the causes of absenteeism and refusals and how is the NOTF dealing with them? The causes of absenteeism have remained as follows: l. Late arrival of Mectizan to the community and its distribution during the rainy season/ farming period when some. community members are already in their farm settlements. 2. Temporary registration of non-residents/migrants whose names are retained even when they have gone back to their permanent abodes. 3. Inadequate mobilization of communities leading to lack of community decision on time/period of treatment. The CDD distributes whenever the drugs arrive without recourse to community mobilization. 4. Shortage of Mectizan which was not discovered and remedied on time. Those who could not be treated are recorded as absentees. The major causes of refusals too have remained the feeling of well being by at - risk populations and treatment fatigue following years of Mectizan treatment. Additionally, some have refused due to fear of reactions which took place in the past after Mectizan treatment. To deal with these. the NOTF continued tn: l. Sensitizing project rnanagers and partners on improved community mobilization and participation, 2. Sensitizing projects and partners to ensure selection and training of additional CDDs and health rvorkers. 3. Encouraging initiation and expansion of co-implementation in order to re-kindle enthusiasni fbr both the health system as well as communities 4. Conducting supervisorl, r'isits based on available resources n'hile requesting States and zones to improve quality of supervision. ,5. Submitting earll' application tbr Mectizan to ensure earl1,' receipt lbr timely delivery to endemic cornmunities. 2.7.3. BrieJly describe all known and verified serious odverse events (SAEs) and provide in tuble 7 the required information when ovailable. The NOTF Secretariat has receir,'ed no information on an1' known and verified serious adverse events. 2.7.4. In case the country has had no case of serious adverse event (SAE) during this reporting period, please tick in the box. 23 WHO/APOC, l0 April2003 No case to report Table 7: Cases of Serious Adverse Events (SAEs) that occurred during the reporting period 'lease add more rows neces * SAEs should be verified by project coordinator Sequelea is deJined as those cases that have not recovered fully from the SAE and are left with lasting neurological or other debilitotirtg effects. Name of project Number of verified* SAE cases reported Action taken Number of cases with sequelea Number of deaths 24 WHO/APOC. l0 April 2003 0,) oo t-- ox - >-v U \o c.ls ca ca\o tr-\o r-r- ca00 00 \oco oooo ano\ o\ a_ '=D!? 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E () ti 0) U)th C€qqr () a o tr) O c\ g ao l-r o0 H 0) E ol<I col 2t ; a C) L(B 0) 0)t- () (H a 0) (d C) C) o o. o o. 0) U) 0.)Lr oo tu l+ o\ tr)o\ oo O.F- r- c.] oo ooN \o+ ta) o\ ca .+ ca € 6 c.l \o\oq (..l ootr) tr) co \o ca co$ 00^ co ooq + N ca ca oo ca o\ ooO. o. O t-- aa c\ \o aa r- \o ca ca oo \o ca a.l (\ 2.8. Supervision 2.8.1 Note the supervision thot was undertoken by the NOTF (Project supervised, date, by whom, objective of supervision mission, outcome,follow-up needed) Table 9: Supervision undertaken by te NOTF (Please add more rov,s if necessary) Some communities were discovered not to have been treated in 2010 and adverse drug reaction reports affected compliance. There is need for comprehensive community mobilization and improve supervision. Huge balances observed in allthe States visited; there is need to up-scale implementation especialll' for LF elimination in order to utilize effectivell' the balances rvith the current requirenrents. Project Name Supervisor Date Objective of supervision Outcome/follow-up needed Taraba Mr Ekpenyong, Ms Leticia Nwafor, Mr F Bitrus & Mr A Adeyemo Dec 20tl To monitor MDA implementation 2 communities were not treated ; inadequate drug supply. Improved drug supply and community mobilization needed Ekiti Mr F Bitrus Mr Ekpenyong Mrs Adenigba Ms Leticia Nwafor Mr. Mike Igbe & Mr. Jones, May 2011 To monitor MDA implementation oyo Mr Okoronkwo Mrs A. Nyior Mr Adeyemo & Mrs Famakinwa May 2011 To monitor MDA implementation Relative good coverage in 2010 but a few settlements are being missed out. Improved community mobilization and standardization of number of communities needed. Osun Mr. E. Davies, Mrs. G.E. Wilson Dr. O. Ogunmola Mr. S. Akofe & Ms Adebimpe May 20tt To monitor MDA implementation Some communities were discovered not to have been treated and there was inadequate community sensitization. Comprehensive communiry mobilization required Krvara. Kogi, Zamfara. Ondo. Ekiti. and Kebbi Mrs. M. Adenigba gtn - 26't' Nov 201 I To validate excess mectizan drugs Osun Dr. Y. Saka & C Okoronkrvo Jull'. Nov 201 I To monitor CDTI/ MDA irnplementation Poor community sensitization; CDD attrition Cornprehensive communiry sensitization and mobi I ization required. Ebonvi Mr John O Eluwa. Miss Salome Enyioke. & Miss Rose Itumoh -rh 10'h .lune To monitor CDTI implementation Low quality supervision. non-use of trained FLHF staff as TOTs for CDDs, inadequate coordination of HSAM. There is need for management training for SOCTs. Plateau Shehu Jubrin l gth - 21" July 2011 To monitor CDTI implementation Poor commitment of health workers, inability of some communities to access Mectizan on time due to strike action by health workers. inadequate sensitization of community leaders on CDTI. More sensitization required for communities and adequate plans for mop up treatments 27 WHO/APOC, l0 April2003 2.8.1. ll/hat were the main issues identiJied during supervision? o Huge balances of Mectizan outstanding in some States o Poor drugs management and inventory-keeping . Inadequate and poor quality of supervision by project managers and health workers o Some communities/settlements not being treated o Poor quality training thus creating knowledge gaps o Logistics in deplorable condition in some places . Poor community support to distributors in some cases leading to CDD attrition o Late arrival of drugs and, consequently, late treatment of community members . Inadequate awareness of roles and responsibilities of communities in some areas o Counterpart funding remains a big challenge at both State and LGA levels. o Inadequate community sensitization and mobilization 2.8.2. Was a standard supervision checklist used? In most instances checklists were used but in other cases where some zonal personnel carried out supervision alone such checklists were not used. 2.8.3. What were the outcomes at each level of CDTI implementotion supervised? TOTs during planning and review meetings were carried out. Advocacy was carried out with policy makers for improved counterpart funding to enable improved interaction with communities and quality supervision. Planning and debriefing meetings were held with programme managers on the way forward. NOTF members participated in various CDTI activities such as training, community mobilization and sensitization in selected States to ensure some of the issues were addressed. 2.8.4. Was feed-back given to the supervised, and how was the feedback used in improving the overall performance of the project? Feedback is usually pro'n,ided to those supervised during debriefing meetings or at rel'ierv meetings as well as circulation of reports of such activities rvhere this was documented. Outcomes of assessments have led to improvements in project implementation in Osun and Taraba States. The validation of drugs inventories has also led to some improvement in drugs management in those States visited. 28 WHO/APOC, l0 April 2003 Project Name Total # of LGAs or districts in the entire prolect area No. and % of LGAs or districts that carried out self monitoring (CSM) No. and % of LGAs or districts that conducted stakeholders meeting (SHIvt) Adamawa l8 t8 n00% 17 I 94% Akwa Ibom 2 21100% 2 I 100% Bauchi ll lt I 100% 0/0 Benue 22 14 I 64% 0/0 Borno t2 t2 I 100% 12 I 100% Cross River 15 ts I r00% 15 I 100% Edo t2 t2 I t00% t2 I t00% Delta 9 9 I r00% 9 I t00% Ekiti 16 0/0 0/0 Enugu l5 6140% 5133% Anambra l6 16 I 100% 16 I t00% Ebonyi 10 t0 I 100% 10 I 100% FCT 6 6 I r00% 6 I 100% Gombe t0 r0 I 100% r0 I 100% Imo t6 16 I 100% t6 I 100% Abia 8 81100% 8 n00% Jigawa 8 I I t00% 8 I 100% Kaduna t6 16 n00% 16 lr00% Kano l8 t8 I 100% 0/0 Kebbi 6 0/0 0/0 Kogi 2t 2U 100% 2U 100% Kwara 16 6t38% 6138% Niger 21 21 I 100% 2r I 100% Ogun 8 8 I 100% I I 100% Ondo 14 14 I 100% t4 I 100% Osun 28 28 I 100% 28 I 100% oyo Z) 23 I 100% 23 I 100% Plateau 5 s I 100% 5 I 100% Nassarawa 7 0/0 0i0 Taraba l2 8167% 0/0 Yobe 12 12 I 100% t2 I 100% Zamfara 5 5 I 100% 0/0 TOTAL 418 358 t86',/, 300 I 720h 2.9, Gommunity self-monitoring and Stakeholders Meeting Table 10: Community self-monitoring and Stakeholders Meeting (Please add more rows if necessary) Describe how the results of the community self- monitoring and stakeholders meetings have affected project implementation or how they would be utilized during the next treatment cycle. It has been observed that a number of States do not adequately implement CSM. and where CSM and SHM have been implemented there are hardly reports. This has constrained tracking of what have been reportedly achieved. However. where these concepts have been adequately implemented the following are observed: 29 WHO/APOC, l0 April2003 '/ Improved knowledge of community roles in CDTI 2.1O Gompliance to long-term treatment with lvermectin Mention specific activities in Table ll that the NOTF has done to ensure that CDTI projects comply with long-terrn mass treatment with ivermectin? (For projects 4 and above years old) Table l1: Activities of NOTF that promote compliance to long-term treatment with lvermectln 0bjective Specific Activities Proiect targeted l. Promote Integration of CDTI with other health care services a Conducted training for co- implementation with LF Ondo, Ekiti, Plateau, Nassarawa, Osun, Kaduna, Kogi, Kebbi, Kano, Kwara, Zamfara, Jigawa, Taraba, Yobe and FCT 2. Maintain high therapeutic (>65%) and geographic( 1 00%) coverage o Appraisal Meeting /Management Training for SOCTs/LOCTs All CDTI States 3. Promote strong community ownership o 4. Promote high government commitment o Advocacy Visits by NOCP & NGDOs o High-level advocacy visits by APOC's Special Advocate All CDTI States Benue, Kebbi, Kogi, Kwara Niger, Osun, and Zamfara 5. Support strong partnership Periodic meetings with NGDO partners both fbrmally and informally to address developing issues AII CDTI States 6. Put in place a strong IEC strategy that encourages continued treatment Review and development of new IEC materials based on issues earlier identitled in 2008 All CDTI States Other 30 WHO/APOC, l0 April 2003 SECTION 3: Other activities of the NOTF 3.1 Describe any additional activities undertaken by the NOTF (REMO, RAPLOA, KAP studies, vector elimination where applicable, etc). a. The B-zonal office with support from LINICEF,I{igeria conducted a rapid epidemiological assessment for onchocerciasis in Ogun. Oyo and Osun. The results were validated by Prof Otunbanjo of the University of Lagos. The outcome of the study indicated that some LGAs currently not being treated, especially in Ogun State, qualiff for mass treatment. The NOTF Secretariat is considering initiating treatments in those sites from 2012. b. Geographic coverage surveys were conducted with support from APOC in 5 additional States (Plateau, Yobe, Kaduna, Nasarawa and Cross River) in 2011. However, the security situation in Yobe and Kaduna states did not allow for the completion of the survey in those States. Key findings in the 5 States are reflected below : Plateau A majority (81.3%) of the communities had their last treatment in 2011. l4 communities did not take treatment in 2011. On the average, all the communities visited have treated for 15.6 years. Yobe 75o/o of all communities visited had been treated with mectizan in 2011. One of the communities was last treated in 1995 and had not been treated ever since. Most communities had received treatment for a minimum of l0 years Kaduna 88.3oA of communities were treated last in 2011. More than 70oh of the communities visited have been receiving Mectizan treatment for upwards of l0 years. 5 communities had not received treatments with one being treated last in 2005. Nasarawa 91o/o of all communities visited had been treated with mectizan in 2011,6.18o/o received last treatment in 20 I 0 and 0.56% received last treatment in 2009. One of the I I communities that received last treatment in 2010 has only received treatment for 2 years. More than 95o/o of communities have been receiving treatment for 10 years and above. Cross River The results are not yet to be presented to the NOTF The results have been shared with States and partners so that appropriate follow up can be done. c. Entomological studies. with support from APOC. have commenced in Cross River, Ebonyi, Kaduna and Zamfara, which constitute the follow up to the epidemiological studies earlier carried out. The aim is to determine whether the threshold that would warrant stoppage of ivermectin treatment in the selected sites has been reached. Interim results indicate as fbllows: No L3 head has been recorded in the 2 sites in Cross River sites No L3 head has been recorded in Ebonyi site 3l WHO/APOC, l0 April 2003 and none in the Kauru focus A training in cl,totaxonomic identification of members of the Simulium damnosum complex within Nigeria was held in Abeokuta, Ogun State, August to September 2011. This training has the main objective of building capacity to initiate mapping of the distribution of Simulium damnosum complex s.l. in Nigeria which is expected to commence in 2012. A total of 1l persons were trained, with support from the Management of APOC. d. An epidemiological assessment, also with support fiom the Management of APOC, was carried out in Enugu and Anambra States with the following objectives: distribution. The study's outcome showed that treatment coverage was low in both States, but better in Anambra (56%) than in Enugu (23%). There were still high discrepancies between reported and surveyed coverage. The skin-snip results were also better for Anambra than in Enugu. However, both States showed significant progress towards elimination. e. Additional RAPLOA surveys, supported by UNICEFAIigeria, were conducted in Cross River, Ekiti, Osun and Oyo States. A total of 143 communities were surveyed during the exercise. The least prevalence of 3.75% was found in Anantigha in Calabar South LGA in Cross River State while, Moba LGA in Ekiti State had the highest prevalence of 69Yo. A total of 20 (13.9%) communities visited had>40oh prevalence of loiasis, while 123 communities had a prevalence of <40%o a level. Incidentally ivermectin treatment has been on-going in areas where prevalence levels indicated >40o/o with no reports ofany serious adverse events. 3.2 LVhat was done to coordinate CDTI Project activities? The following was done as part of efforts to coordinate CDTI Project activities: . Conduct of review meetings for all assisted States where status of implementation was assessed and suggestions made. . Review of reports. treatment and training data: and feedback is provided to projects. o Visits to some projects for on-the-spot assessment of situation of things and provision of corrections where needed. . Periodic zonal meetings where status of CDTI implementation and issues therefrom are discussed and addressed. Significant issues are brought fbrward to the NOTF meetings for further deliberation. Feedback is given through the zonal office. o Zonal coordinators' r'isits to projects within their areas of oversight. Issues they cannot address or that needed more input are referred to the national office. o Correspondence (by email or courier) with projects on salient points . One-on-one meetings with project staff at national HQs to resolve technical, managerial or financial issues 32 WHO/APOC, l0 April2003 3.3 Note meetings convened for the NOTF. (objective of meeting, issues addressed, date, participants, o utcome, constraints faced follow-up needed) Two meetings of the NOTF were held to review CDTI implementation in the country. Participants included members of the NGDO Coalition, Zonal Coordinators and NOCP officers. The meetings were held March 22,2011 and October27,20ll. At the first meeting there were deliberations on issues such as the elimination of transmission of onchocerciasis infection, support by HKI to its assisted States, mapping of loa loa, utilization of govemment counterpart contributions, LF mapping, holding of Zonal meetings, and finalization of the development of IEC materials. There were presentations and reports from Zones A and B, NOCP Headquarters and the NGDO Coalition. At the end of the meeting, the following resolutions and recommendations were made: a. The NOTF reiterates its call to NOCP to fast-track the process of auctioning obsolete and non-functional equipment in projects in collaboration with APOC Management. b. Participants agree to the revitalization of the process for the development of revised IEC materials commenced in Jos in 2008. Partners agree to make contributions before mid-April 20l l after reviewing the budget circulated by the sub-committee to continue this process.. c. The meeting notes NOCP's intention to invite HKI, coordinators of its assisted States and the Chair of the NGDO Coalition to a meeting to discuss the issues relating to HKI support to its assisted States in Nigeria. Participants request NOCP to conclusively resolve the issues urgently. d. The NOTF notes the TRC recommendation on the concern over poor status of CDTI implementation/delay in reporting from projects in the northern part of the country due to civil unrest coupled with persistent health workers strike and endorsed that Zonal Offices collaborate with identified local NGOs and CBOs already supporting CDTI in those states for the retrieval of outstanding treatment data. e. The meeting notes the template developed by NOCP for monitoring of counterpart tunds usage at the State level and seeks further inputs from partners befbre its finalization and utilization. f. The NOTF calls for refinement of REMO in areas previously classified as hypo- endemic in which current information and reports suggest meso-endemicty. g. Members request NOCP to compile and share with partners a comprehensive list of all local NGOs and CBOs involved in Onchocerciasis control in Nigeria. The zonal offices should come up with ways of encouraging such CBOs and NGOs to enable them improve their support for the CDTI process. h. The NOTF notes the role being played by APOC's Special Advisor in carrl'ing oul advocacy visits to some States with problems of counterpart lunding and recommends the extension of her mandate to cover additional States, and to include eye care and other NTD programmes. For such visits, the NGDO partners that are responsible for those States should be part of the team. i. The meeting notes that results of baseline surveys in some areas where Mectizan treatment has been ongoing for more than l0 years shows that lymphatic filariasis may' not be of significant concern while this scenario is different in a f'ew other sites, and calls for the conduct of an operational research to investigate this. 33 WHO/APOC, l0 April 2003 j Participants express concern over the delay in Mectizan shipments for 201I and urge NOCP to take urgent steps to fast track and resolve all outstanding issues resulting in such delays. k. Members note the recommendations from the International NGDO coalition on the legal issues involved in the endorsement of DFCs for APOC-supported projects by the Chair of the NGDO Coalition on behalf of all NGDOs in-country. The NOTF reiterates its belief in the NOTF structure which has successfully supported all programmatic and administrative (signing of DFCs inclusive) issues related to Onchocerciasis control and APOC partnership, over the last l3 years and recommends that the status quo be maintained. L The meeting notes the election of a new vice chair for the NGDO Coalition Group, in the person of Mr. Sunday Isiyaku, and the assumption of Mr. Christopher Ogoshi as the chair of the group. The meeting congratulates these two persons and expresses its sincere appreciation to the erstwhile Chair, Mrs. Francisca Olamiju, for her commitment and services. The second meeting deliberated on delays in the shipment of mectizan, epidemiological evaluations, twice-yearly mectizan treatments and other activities in line with elimination of onchocerciasis transmission in Nigeria in addition to outstanding issues. The conclusions and recommendations reached were as follows: a. In view of the declining quality of projects technical and financial reports and outcomes of recent household treatment coverage surveys, NOCP is requested to strengthen the capacities of Zonal offices (in terms of personnel, logistics and funding) and devolve appropriate functions currently being carried out by NOCP Headquarters to them. Additionally, the NOTF requests NOCP to follow up on earlier vehicle request for the Zones which was made to APOC. b. APOC is urged to assist projects implement CSM/SHM in all CDTI communities by 2012 lo improve project implementation. c. NOCP in collaboration with partners should arrange for special intern,entions lbr projects where personnel require training on technical report writing. financial accounting. mectizan inventorv management etc. d. NOTF expresses serious concern over the huge balances of mectizan and albendazole Nigeria has been carrying tbrward lbr the past 2years. and calls fbr urgent steps to reduce considerably the quantity carried over in 2011 and 2012. NOCP is also urged to follow up on the 2012 re-application to MDP to ensure early shipment and receipt of mectizan and albendazole consignments by December,2012. e. The meeting reiterates the need for NOCP to take the lead role in initiating operational research on varying prevalence levels for LF in some places after several years of mectizan treatment. Meanwhile, NOCP is encouraged to publish relevant information at its disposal. A 3-man sub-committee comprising an NOCP representative. Mr Sunday Isiyaku of Sightsavers and Mrs Francisca Olamiju of MITOSATH was set up to address this. f. NOTF requests the regional office of HKI to provide clear indication of their continued support to onchocerciasis control in Nigeria for a specified period of time as 34 WHO/APOC, 10 April2003 recommended by the meeting of HKI with its assisted States and representatives of the NOTF. g. NOTF requests the Federal Ministry of Health to issue a policy statement that recognizes the movement from control of onchocerciasis to its elimination. h. NOTF expresses concern over the delay in renewing the existing National Eye Health Strategic Plan due to expire in December,20ll and requests the Federal Ministry of Health to fast track the process of developing a new strategic plan. i. NOTF notes the new name for the NGDO Coalition Group which is NGDO COALITION FOR NTD AND EYE HEALTH as well as the election of Dr. Emmanuel Miri of the Carter Center and Dr Sigh Gadok Sudeep of Tulsi Chanrai Foundation as Conveners of the sub groups on NTD and Eye Health respectively. NOTF recognizes the implication of the change in structure of the Coalition and requests NOCP to initiate the process of restructuring the current NOTF to accommodate this development.j NOTF expresses concern over the low coverage in Ekiti and Osun States following the report of the LTNICEF-funded household treatment coverage survey conducted recently. The meeting therefore recommends that the proposed epidemiological evaluation in Ekiti State be postponed and urges NOCP to intensiff effort at ensuring improved treatment coverage in the affected States. Meanwhile, NOTF commends Benue State for achievi ng 100Yo geographical coverage for the first time. k. Given the progress made in eliminating onchocerciasis transmission in Kaduna, Ebonyi, Zamfara, Cross River and most parts of Taraba, NOTF accepts in principle twice yearly treatments for areas where compliance is sub optimal. A sub-committee comprising an NOCP Headquarters representative, Mr John Eluwa (Zone A Coordinator), Mrs Francisca Olamiju of MITOSATH, and Mr Christopher Ogoshi (Chair of NGDO Coalition) is set up to work out the modalities before end of November,20ll. Mrs Olamiju is to Chair this sub-committee. I. The NOTF commends the Jigawa State Government and especially the State Oncho/LF Coordinator for their hospitality and successful hosting of the annual review and the 37'h NOTF meetings. 2. A review meeting for APOC - assisted States u,as held October 17'h - 19'h. 2011. in Dutse. Jigarva State. The major objectil'es were: o Assessment of extent of implementation of recommendations lbr last revierv meeting. . Review of CDIi Co-implementation activities b),state projects. . Review of guidelines for preparing 2012 PABs o Analysis of CDTI data on treatment. training. counterpart contribution and co- implementation. o Provision of guidelines for technical report rvriting and analysis of issues commonly associated with this. . Analysis of the project supervisory visits and rvays to improve it. o Re-conceptualization of new IEC materials. Key recommendations from the meeting were: a. To ensure the success of the forthcoming epidemiological evaluations in Enugr:/Anambra and Ekiti/ Kogi States, adequate arrangements should be made by 35 WHO/APOC. 10 April 2003 these projects in terms of logistics and mobilization of all the communities involved. b. In finalizing their 2012 PABs, Projects are advised to prioritize activities and budget accordingly. One priority area is CSM and SHM for improved community participation in CDTI. Projects are to provide strong narrative justification where proposed expenditure exceeds amount allocated. c. The meeting is commended for the improvement in the quality of reports presented. d. NOCP and NGOs operating in C Zone are urged to provide additional support to the new Zonal Coordinator to enable her resolve outstanding issues in the zone. Additionally, NOTF should look into strengthening the zonal offices to improve performance. e. Participants emphasize the critical need for regular zonal review meetings for effective programme implementation and coordination. f. To ensure presentation of accurate reports at annual review meetings, projects are requested to forward updated reports of programme activities to their zonal coordinators by 3Oth of September of each year. g. NOCP is requested to revise the format for presentations for a more meaningful analysis of and comparisons in project implementation. The tables on counterpart contribution should reflect in-kind contributions by NGDOs. h. The meeting observes that the Kwara State Project Coordinator has not participated in annual review meetings for several years. The meetings therefore urge NOCP to request for change of leadership of the project. It also requests NOCP to resolve constraints hindering access to APOC funds. i. In view of the fact that FCT annual technical reports have been rejected by the TRC for 2 consecutive years, and the absence of the Coordinator at reviews, the meeting urges that NOCP and the supporting NGDO (CBM) to visit the FCT Director of Public Health to ensure improved leadership.j HKI should assist the Akwa/lbom CDTI project to reactivate its account as soon as possible to enable access to approved funds for 2011. States that are yet to submit to NOCP treatment data are requested to do so before end of November, 2011. k. Zonal coordinators in collaboration with supporting NGDOs are requested to assist all the States that are having issues with their data. to resolve them once for all. on or before 3 I't December. 201 I . l. For improved implementation of programme activities, Special Country Initiatir,e proposals with strong justification are to be developed by Projects that have not benet-ited from the scheme and submitted to APOC management through NOCP HQs. m. The meeting views with concem the reported huge mectizan balances at the end of 2009 and 2010 treatment cycles and requested States to recheck their in,u'entories fiom 2008 to 2010 and validate the balances reflected against them by the end of November 2011. Consequently, NOCP is requested to make available the inventory records to the States as soon as possible. n. Projects teams are encouraged to validate reported coverages by conducting household treatment coverage surveys in their States. NOCP should share with the States the protocol and tools for this exercise. Zonal coordinators should organize a one day training on this for project coordinators in their zone. o. NOCP is requested to organize refresher training on financial management should for State Coordinators and accountants for improved financial accountability and reporting. Moreover, NOCP should assist States resolve outstanding issues with their financial retums as soon as practicable. 36 WHO/APOC, l0 April 2003 p. NOCP should make available to projects and partners for their records the capital equipment inventory compiled by APOC/WHOAIOCP on or before the 3l't October, 20ll.ln-addition, progress made on disposal of old APOC capital items should be shared. q. NOCP is urged to request the former Minister of State for Health, Arc. Halima Tayo Alao to assist follow up on counterpart funds release in Benue, Osun, Zanfara, Kebbi and Kogi States which she had visited earlier. r. The Federal Ministry of Health is requested to expedite action on finalization of NTDs training manuals and reporting manuals forms to enhance co- implementation. s. NOCP should follow up with National Schistosomiasis Control Program for feedback on the surveys done in Enugu, Ebonyi and Osun States. t. The meeting noted the formation of a group of local NGOs supporting the control of onchocerciasis and other NTDs in the country. As a follow up on the resolutions of the meetings, NOCP did the following: o Revitalized the process for the review and development of new IEC materials with support from all partners o Held meetings with HKI representative and the coordinators of its supported States to resolve future support by HKI o With support from LINICEF and through the B-zonal office undertook additional rapid epidemiological assessment in Oyo and Ogun States. The outcome of the validation of the exercise will be reflected in the 2012 report. o Held discussions with several partners on how to resolve the now perennial late supply of Mectizan to the projects . Approached APOC Management to provide logistic support to the 4 zonal offices, and current indications are that the request will be approved. o Commenced processes for initiating an operational proposal on varying prevalence levels for LF in some areas after several years of mectizan treatment o Conducted focused intervention in Osun State and plans to do same in a few other States where low coverage rates have been reported or suspected in 2012, subject to availability of funds. . Requested projects to reflect appropriatell,the use of counterpart funds received in the annual technical reports. . Embarked on household treatment coverage surveys lbr validation of reported coverage results. and encouraged States to do the same. o With support from APOC and WHO ofllce in Nigeria improved capacity at NOCP headquarters on the new accounting procedures and commenced the process of doing the same at State level. o Is following up on issues regarding NTDs programme implementation and coordination 37 WHO/APOC, 10 April 2003 3.4 Note meetings attended to provide technical input to other projects, other or other sectors. J.5 BrieJly state any administrotive duties undertaken - Number and type of reports reviewed (technical, tinancial) Technical reports and financial returns from all projects were revierved. and lbrrvarded to APOC Management/Technical Review Committee. - Reports forwarded to APOC managemenl, All reports for review either by TRC or TCC are forwarded to APOC Management. In the year being reported repons from all projects (though for different years) were forwarded to APOC management. Place/Project/ Country Responsible PersonMeeting/Mission Nigeria Dr. Y. A. Saka, Mr. E. Davies C. Okoronkwo, Mr. M. Igbe, Mr. F. Bitrus, & Mrs. A. Nyior Development of NTD Master Plan Otunba A. O. JaiyeobaChild Health Week Campaigns in B-Zone Edo State, Nigeria NOTFs Meeting & Meeting on Epidemiological Evaluation Ouagadougou, Burkina Faso Dr. Y. A. Saka & C Okoronkwo Meetings on Information Preparedness and Response Scheme (IPRS) organized by NHMIS, FMOH FCT, Abuja Dr. James Balami Surveillance coordination meetings FCT, Abuia Dr. James Balami Southem Sudan C. OkoronkwoEvaluation of East Bahr El Ghazal CDTI Project, Southern Sudan Geographic Coverage Survey Cross River, Kaduna, Nassarawa, Plateau, &.Taraba Mr. E. Ekpenyong, Ms L. Nwafor, Mr. F. Bitrus, Mrs. M S. Ekundayo, Mrs. G. E. Wilson & Mr. A. Adeyemo FCT, Abuja Dr. James BalamiMeeting on Disease data harmonization with Disease control programmes in public health dept. & partners. Federal level stakeholder's forum on zero draftofM&Eframeswork FCT, Abuja Dr. James Balami Entomological Studies for evaluation of impact after years of Mectizan treatment Cross River, Ebonyi. Kaduna & Zarnfara Mrs. A. Nyior, Dr. O. Ogunmola, & Mr. M. Igbe Training on NHMIS (DHIS) Software Kaduna Dr. James Balami Cross River, Ekiti Osun. & Oyo Dr. Y. A. Saka. Mr. E. Davies C. Okoronkwo, Mr. M. Igbe. Mr. F. Bitrus. Mrs. A. Nyior. Mr. E. Ekpenyong. Mr. S. Akof-e. Dr. O. Ogunmola. Ms L. Nwafbr. Mrs. G. E. Wilson & Mr. A. Adeyemo Loa loa surveys Epidemiological Studies Enugu & Anambra Mrs. A. Nf ior. Mr. M. Igbe. Dr. O. Ogunmola. & C'. Okoronku-o 38 WHO/APOC. l0 April 2003 - Administrative assistance or trouble shooting for projects. Following concerns on the extent of support of HKI to its assisted States a visit was paid to Borno. The outcome showed that CDTI implementation was sub-optimal and comprehensive shake-up was needed. Further meetings were held with HKI but changes in leadership and a lacuna created delayed follow up. 3.6 Insert the Plan of Action for the NOTF activities for the current year indicating activities by month, which were implemented. This is included. The activities done are clearly marked >>. See Annex I 3.7 Insert the Plan of Action for next year. This is attached as Annex 1 39 WHO/APOC. l0 April 2003 N L a. I - $ L 0) ) trd C) tr H cr) o C) F L.lU (d a o -o ti o o +i oL o tr#L agc oa +a h o o E o J3! L +, E o o .E '6 tr G tr !-E tF { F o(, o +, +,L occ -) o aat zIF(, lrJ o a c-i q) -o(cF o\tr) o\ oo oo $ oo r- C. 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(F o r 2 O $ $ N \o O$ oo c'l\o O co aa aa ca ca co co a-) C.t-- tr- \D t-- & al C..lr- N N co ...l tr- o.l aa \o t-- co aa \o aa\o ca oo 'e L A.({< o C)(1 (d z (o (B E -o iz o EA 0.) o c0 ,- oo t) /, a(h l<U o tr.l 0) i-1 r! oo tr.l -otr (s >\ -o tr.l FU ff. o -o o\, ca c.l Liq 4 O (J o oFri $ q \) qJ t) .a Yra{t o\ q) 'E q \ .s I a$ q !\ q \J > U1 U a a :. -a' q .a q.) $It\lS'q! qJ ,% SHd; caN ca C.I Nr-+\o r-$s oo$ rtr)(r) 6 o\O co ca @ aa ca$ o\ <f, + oo ca tr) tr) oir- $tr) F-- $$ o\N \o t-- on N$ co $ oo N\o t*rr-$\ o\(\ a\\o\o NN r t/.) ra) r-- ca aa o\ \o6l c'l \otr) cas oo <+ (n o\ oo F- oo rn ca ca co $r- cat oo (r) onN v\o ca\r) o\ co \o N\o tr) o\ c'l ca oo ca r co oo o\ ca N o\ C. ra € ra N t tr) oo oo N o\ aa C\ 6l6lt rn F- c\\oOt \f, C\C.\o $ t-- o $ oo @$ o tr- ol C..l =f,ta) \o \o tr- rr)\o <f, OO co oo N ra) oo t--F- c.l r-vq € €\o ca ca aa aa ca (r) ca O \o $ co co t-- -f c-l V-) aa v a.l\o \o aa @ tr- N tr- -t (..l\o c.lON aa r-t C' -f 'f A O co oo aa ca aa c.) t/')6 F- t-- (-- o. oo\o \o o. t-. co aa r- ?a .+ 6l d -o ? oo E V o V 5 -ooV oo V L 63 V tr 0) oo z oo o E o a U 0)(d r (s cha z -o L F () -oo (d N F If there are problems with releose of counterpart funds, how were they oddressed? - Comments o Routine advocacy visits were paid to policy makers o A special advocate, the former Minister of State for Health, paid and followed up on top-level advocacy visits to 7 States o Integrated approaches were encouraged State the number of projects that had nofundingfrom APOC Trust Funil Ntl State the number of projects that had no funding from any outside source? Nil All projects had some funding from their assisting NGDOs, but the degree varies. State the number of projects that are late in submission of the Jinancial reports to APOO Not Available 4.2. Other forms of community support Describe (indicateforms of in-kind contributions of communities if any) Communities made 'in-kind' contributions in the following ways: i. Community members volunteer to help the CDDs on their farms. ii. Recommendation for inclusion of CDDs for other incentive giving social services like Polio Eradication and Guineaworn surveillance. iii. Exemption of CDDs from some community levies or dues. iv. Provision of food to CDDs during distribution v. Provision of venue for CDD training. vi. The purchase of hard cover note books for the registration of the population. vii. Prayers for distributors viii. Special recognition during celebrations or festivals in the community. ix. Provision of refreshment during CDD training or visits by health workers/ monitors x. Provision of foodstuff/farm produce to supervising health workers 4.3. Resource mobilization efforts Describe activities undertoken by the NOTF to roise funds or mobilize in-kind resources and the outcome of those efforts. A Special advocate with APOC support went and tbllowed up on visits to 7 States where she met with the Chief Executives or/and other top policy makers to solicit for counterpart funding. The States targeted were Osun. Kogi. Kebbi. Kwara. Niger. Zamfara and Benue that had contributed very little to CDTI implementatation since project inception. Kogi and Niger States responded with releases of some counterpart funding. l-here is an approval in Osun for N3 million but the funds are yet to be released. The NOTF followed up on the meeting rvith local NGOs that came from Imo, Kwara. and Delta States to further encourage them support CDTI in their respective areas. 42 WHO/APOC, l0 April2003 4.4. Expenditure per activity by the NOTF secretariat Indicate the expenditure on activities below in (15 dollars using the current United Nations exchange rote to local curuency (=N=150 to l$) Table 13: Indicate how much the NOTF secretariat project spent fbr each activity listed below during the reporting period *Attendance at JAF in Kuwait Activiry of NOTF secretariot Expenditure ($ US) and So,rrce(.) of furding APOC MOH NGDO OTHER Drug delivery from NOTF HQ/entry point to districts, etc 3,384,27 Monitoring & supervision of CDTI ects* 2,453.31 24.000 13,740.18 Training of Project officers, TOT, NOTF etc 17,841.90 5,518.18 Advocacy /Sensitization & Mobilization visits to health and political authorities at national level 13,093.10 IEC KAP studies, materials development, 4,603.38 Annual review wor 7,239.92 32.693.32 Bi annual NOTF 7,482.44 Fuel and maintenance of Vehicles, Maintenance/Procurement of offi ce equipment 16.666.67 Stationery Others U ank S 12,639.79 Specific Activities Technical Revierv Committee (TRC 6) Technical Review' Committee (TRC 7) Epidemiological Evaluation & Treatment coverage in EnuguiAnambra Cy'toxanomic Identification Training and tield practicals Workshop on CDI strategy inclusion Taraba planning session in Nigeria Geographical Treatment coverage in 5 States 9.973.99 9.973.99 39.551 .78 46.r05.46 5.251.59 7.090.3 8 111 .456.7 4 aa aal 11* , r--)-)J.JJ' TOTAL 288,763.77 74,000 51,952.68 Total number of treated 30,439,546 Comments 43 WHO/APOC, 10 April 2003 APOC MOH Other donors NGDO Private Type of Equipment Source Condition of the equipment * Please state l. Vehicle 2 (F) 2. Motor cycle 3. Computers (Desk top) I (F) 2 (F) l (NF) 4. Computers (Lap top) I (F) I (F) 5. Printers I (F) 2 (F) 2 (NF) 6. Fax Machines 7. Others a) LCD I NF) b) Copier I (F) r (NF) c) Generator 4.5. Equipment Table 14: Status of equipment of NOTF Secretariat Project (Please add more rows if nece, +Condition of the equipment (Functional, Currently non-functional but repairable, Written off). How does the project intend to maintain and reploce existing equipment and other materials? The NOCP HQs Support Project has been maintaining and replacing existing equipment by: l. Requesting further support from APOC before devolution. Other partners, especially with the increasing emphasis on co-implementation and collaboration, have been approached for logistic support. 2. Seeking the federal government's increased support for the maintenance of the equipment and replacement of computers and printers. This strategy will continue. Describe the adequacy of available knowledgeoble marrpower at all levels. The country has sufficient manpower. though there are concerns on how knowledgeable some are. The problem, particularly at the health facility level. has been the under - utilization of the manpower available 1br CDTI implementation. Affected projects are however being encouraged to ensure that staff at this level are llell utilized. The challenge however is in providing incentives and motivation. In an increasing number of States the number of SOCTs managing programme implementation is dwindling due to transt'ers and retirements coupled with non-recruitment of nerv health u'orkers. . Where frequent transfers of trained staff occur, stote what project is doing or intends to do to remedy the situation (The most irnporlunl issue is v'hat meastil'es v'ere taken to ensure adequate CDTI implementation v'here not enough knov'ledgectble rnanpotuer v,cts atailable or staff often transferred during the course of the campaign). Projects are advised to either train as man)' of the available health staff present so that transfers will not hinder project implementation or reach agreement with the policy makers in charge to ensure that trained staff are not arbitrarily transf-erred. Where transfers result in the removal of trained personnel and emergence of those outside the CDTI cycle, the replacements are usually trained by the assisiting NGDO personnel in 44 WHO/APOC, l0 April 2003 collaboration with the Zonal office or the national office personnel, particularly if this is at the State level. Some times the SOCT/State Coordinator provides the needed orientation. At lower levels the immediate higher level ensures a quick orientation or training. 45 WHO/APOC, 10 April 2003 SEGTION 5: Evaluation for sustainability of GDTI, lndependent monitoring and other reviews 5.1. lndependent participatory monitoring/evaluation 5.1.1 Was any independent Participatory monitoring and/or evaluation carried out during the reporting period? None Table l5: Overview of when monitoring and evaluation undertaken (Please add more rov,s if Project Name (After Year l) participatory independent monitoring Mid-term sustainability evaluation , rrd(J year) Independent monitoring after 4th year Evaluation For sustainability (5'h year if necessary) lnternal monitoring by NOTF Other evaluation by partners & monitoring implementation of sust. Plans Adamawa Akwa Ibom Bauchi Benue Borno Cross River Edo Delta Ekiti Enugu Anambra Ebonyi FCT Gombe Imo Abia J igarva Kaduna Kano Kebbi Kogi Kwara Niger Ogun Ondo Osun oyo Plateau Nassarawa Taraba Yobe Zamfara 46 WHO/APOC, l0 April2003 5.1.2 In general, whot were the recommendutions? o Request for both Albendazole and Ivermectin tablets should be done on the basis of calculation from total population of the previous year. o LOCTs and health workers should be trained and retrained on proper record keeping procedures. o Timely supervision at all levels is required to ensure proper project implementation. o Community mobilization, health education and sensitization should be intensified. o All recommendations from previous monitoring exercises and evaluations should be compiled and disseminated to all levels and extent of implementation monitored periodically. o Both States and assisting NGDO should make efforts to ensure provision of adequate transport at all levels, especially in Benue State. o Standardized list of target communities per LGA for each state should be produced and shared with LGAs. . There's need for census update. . There is need for proper record keeping at all levels particularly tracking of Mectizan usage 5.1.3 In general, how have they been applied/ implemented? The monitoring exercises were conducted towards the end of the year, and the recommendations are expected to be implemented in the 2012 treatment cycle. 5.1.4 Any other comments? 47 WHO/APOC, l0 April2003 5.2. Sustainability of projects: plan and set targets (mandatory at Yr 3) What arrangements have been made to sustain CDTI after APOC funding ceases in terms of 5.2.1. Planning at all relevant levels. All the projects in the country have developed sustainability plans. The work plans are revised annually by the projects. At the federal level there is an annual planning of activities. A 5-year strategic plan has been developed with input from all partners. An NTD Plan of Action which incorporates onchocerciasis control has also been developed but yet to be finalized. The weakest level as far as planning is concerned is the first line health facility level. The reason is 3 - fold: lack of adequate empowerment, low levels of commitment, and inadequate educational background of staff. 5.2.2. Funds Partners have paid several advocacy visits at all levels. To ensure availability of funds for the LGAs, there have also been advocacy visits to the LGAs and in some projects advocacy workshops have been held. These will be followed up especially with changes in administration. 5.2.3. Transport and equipment (replacement and maintenance) In several projects, maintenance of existing transport and equipment is gradually being sourced from Government funds, but APOC Management has been requested to replace and have replaced logistics where necessary. Most States have benefited from replacement of motorcycles and bicycles by the supporting NGDO. 5.2.4. Human resources There are enough human resources at all levels. In fact several projects have had to rationalize their State and LGA teams to make for more cohesion and effectiveness in programme implementation. However, in recent times State teams are getting smaller in number due to retirements and transfers, and non-replacement of such officers due to inadequate recruitment. In some projects, staff at the FLHF level are yet to be adequately mobilized and utilized. 5.2.5. Which projects have submitted sustainabili4, plan? All have submitted sustainability plans. 5.2.6. To what extent have the plons been implenrcnted? In ntost of the States implementation of plans is reasonablv on course. Generally it is being hampered by inadequate funding and late releases of approved funds. 5.3. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration. 5.3.1. Ivermectin delivery mechanisms In several projects. LGAs take the opportunity of picking their vaccines for immunization or offlcial as well as private engagements by its officers, who may not even be LOCT members, at the State capital to collect their Mectizan tablets. With current co-implementation with lymphatic filariasis in a number of projects, albendazole is usually picked with Mectizan both of which are used for mass drug administration. At State and national levels, ivermectin/ ,18 WHO/APOC, 10 April2003 albendazole delivery stands separate, but all the processes are within the government system. Where praziquantel is also being distributed, sometimes the same mechanisms have been used for collection and delivery. 5.3.2. Training In several States CDTI training is carried out with that for Lymphatic Filariasis. In such States such as Taraba, Ondo, Plateau, Nassarawa, Zamfara, and Kebbi training sessions focus on integrated delivery of drugs targeted at LF, trachoma, schistosomiasis and VAS. 5.3.3. Joint supervision and monitoring with other programs In many States, project personnel take opportunity of involvement in other programmes such as VAS, immunization, sanitation, to monitor and supervise CDTI activities. What is more common is the sharing of transport in programme monitoring and supervision. In some instances other programme staff request CDTI personnel to collect important data for them when they are out on field activities, and this is vice versa. With co-implementation there is, in the States applicable, monitoring of both MDA for LF elimination as well as Mectizan distribution for onchocerciasis control during one supervisory visit. 5.3.4. Release offunds Fund releases at all levels follow normal channels within the Primary Health CarelPublic Health department. 5.3.5. Is CDTI included in the PHC budget? At national and State levels, CDTl/Onchocerciasis control is reflected in annual budget estimates. At the LGA level, some LGAs reflect CDTI in budgets but in majority of cases CDTI is subsumed under a general health line item. 5.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What hove been the uchievements? The Lymphatic Filariasis Elimination Programme is utilizing the CDTI structure for MDA wherever this is ongoing. There have been discussions for the National Malaria Control Programme to use CDTI in its World Bank-assisted booster States for home management of malaria. and a strategic document is being developed in this regard. Earlier CDTI was accepted as one of the strategies for delil'ery of VAS nationwide but there are issues. and it is now left with individual CDTI partners to push their way through. 5.3.7. Describe other lsslres considered in the integration of CDTI A major consideration is the similaritl, of the programme being integrated to the Onchocerciasis control programme. The intervention measure must be relatively simple e.g. administration of annual dosage of tablets or distribution of a commodity or health educatiory' mobilization of community members to take preventive measures for improved health. 5.J.8. Describe the integration of other programs into CDTI in your country and the results of this integrotion on CDTI (e.g. Is Vitamin A supplementation integrated and what are the results, is screening for cataract of primary eye care interventions integrated in all or some projects, d no integration has taken place, are there plans to pilot test a strategl,, etc?) In about 21 States. LF is being co-implemented with nearly 14.9 million persons being reached. In 6 and 4 States VAS and schistosomiasis are being coimplemented respectively. Total population covered were 912,164 for VAS and 661,570 for schistosomiasis. Over 400,000 persons were reached for home management of malaria in 5 States. ln 2 States 49 WHO/APOC, l0 April2003 trachoma is being controlled through health education and zithromax distribution that reached 736,626 persons. The CDTI structure was used to immunize 260,000 persons during the reporting year. 5,4 Operationa! research 5.4.1. Summarize in half of a page the operational resesrch undertaken in the country area within the reporting period. We are not aware of any OR that was carried out in the course of the year 5.4.2. How were the results applied in the project? NA 5.4.3 Note the issues that have been identtfiecl by the NOTF for future operational research. The issues have remained as follows: o Causes of CDD attrition o Best ways for CDDs compensation o Enhancingcommunityparticipation o Reasons for poor sensitization of communities o The role of CBOs in sustaining CDTI o Causes of poor participation of females in CDTI o The role of add-ons as a form of motivation of CDDs 50 WHO/APOC, 10 April 2003 SEGTION 6: Strengths, weaknesses, challenges and opportunities List the strengths, weaknesses, opportunities and threats of CDTI implementation process. Strenqths . lmproved CDD/population ratio t Support by most NGDO partners a Probable achievement of elimination of onchocerciasis in some foci I Commitment and dedication of some SOCTs, LOCTs, and Health facility staff t Community awareness and acceptance of the Mectizan drug remains high . Availability of a large number of trained CDTI personnel at various levels o Good working relationship of the project officers with NGDO partners a Increased reach by programmes that are being co-implemented, particularly LF t Huge workforce at the community level and health system level for CDTI implementation as well as for other add-on interventions. a Mectizan processes, apart from the procurement, are well established within the goverrunent system, and are working perfectly. t Effective coordination of CDTI implementation at national level. Weaknesses a Poor supervision at all levels, partly due to inadequacy of funds t Inadequate community census registration and irregular update of community treatment registers o Inadequate logistic support at LGA and FLHF levels t Late submission/retrieval of treatment & training reports at all levels. t Poor record keeping at various levels Opportunities t Political support from Govemment o Appreciable level of HSAM directed at both increasing Mectizan/Albendazole uptake and support to CDDs by community members o Increasing recognition by stakeholders of CDTI as a vehicle fbr the effective deliverl' of varied health interventions at the community level o Integration of CDTI rvith other PHC programmes like. malaria control progralnme. fuberculosis and Leprosy programme o Increasing international focus on integrated control of Neglected Tropical Diseases (NTDs) t Availabilitl, of abundant human resources for CDTI implementtion at all levels. o Increasing involvement of local NGOs, CBOs and associations in the CDTI process. o Involvement of CDTI personnel in other PHC and social service activities. Threats o Low levels of Community participation and ownership of CDTI in terms of conduction of CSM and CDDs compensation o Growing tiredness with intake of Mectizan after several )'ears of compliance b-v-' community members. . Inadequate counterpart funding of CDTI activities at all levels. t Frequent transfers of health workers experienced by projects 5l WHOiAPOC, l0 April 2003 t Demand for incentives by Mectizan distributors leading to attrition of CDDs t Late release ofapproved funds by all partners List the strengths, weaknesses, opportunities and threats of the veclor elimination project (where opplicable ). N/A Indicate how challenges were addressed. o Supervisory visits (with emphasis on household treatment coverage surveys) to make on the spot corrections in targeted States o Training and retraining of programme managers on areas of deficiency during review and planning meetings o Re-mobilization of communities in selected States. o Advocacy visits targeted at some States. o Promotion of integration of CDTI with other community - based programmes Indicate how opportunities can be utilized to improve CDTI. o Increased involvement of human resources available particularly at the FLHF level and delineation of areas of oversight for each FLHF trained will improve quality supervision. o Increased involvement of NGOs will result in better community mobilization, improved support for CDDs, and increased level of community-level supervision. o Recognition of CDTI as a vehicle for the delivery of other interventions will improve integration and leverage resources to sustain CDTI operations in the face of dwindling extemal funding. o Increasing international focus on NTDs will result in improved funding and streamlining of implementation efforts for NTDs that will impact positively on CDTL 52 WHO/APOC, l0 April 2003 c.) 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