Bauchi state CDTI project, second year technical report: March 2001 to February 2002

-? 1t AFRICANPROGRAMMEFoR ONCHOCERCIASISCONTROLI NATIOI\AL ONCHOCERCIASIS CONTROL PROGRAMME, NIGERTA BAUCHI STATE CDTI PROJECT SECOND YEAR TECHNICAL REPORT (MARCH 2001 TO FEBRUARY 2002) ABDULKAzuM D. DANJEBU PROJECT COORDINATOR For Aciion To: T&ls , CE.V !60coo $ rrr BfaA'a . For !, rf*;,r.trc,iion To, &trL I''' " {-& 23Ao.,rzooz w'ffou b"'o*'* I TABLE OF CONTENTS 1 EXECUTIVE SUMMARY 2 BACKGROUND 3 IMPLEMENTATION OF CDTI YEAR 2 4TRAININGoFDIFFERENTLEVELSoFSTAFFINVoLVEDIN CDTI 5 TRAINING OBJECTIVES/ACHIEVEMENT 6 TRAINING IMPROVEMENT 7 MOBILIZATION AND EDUCATION OF TARGET COMMLINITIES 8 STATE TREATMENT FIGURES 2OO1 g STRENGTHSAMEAKNESSES OF THE PROJECT 10 COI.]NTERPARTCONTRIBUTIONS BauchiStateislocatedinthenortheastempartofthecountry.Ithasa populationof2,326,444basedonthelgglcensusandismadeup,of20LGAs. There are 13 CDTI LGAs with an endemic population of 609,911 out of which 517,2ilgare eligible persons. Mass distribution with Ivermectin started in the state in 1991 with the assistance of I'JNICEF' Proposal for the implementation of GDTI in the state was approved in December, 1999. Treatment started with 140 communities in 1991' In 1999 when CDTI was introduced the number of communities undergoing treatment rose to 633. In the year under review 633 communities selected their CDDs and most collected drugs and decided on their method/period of treatment' 8 SOCTs, 39 LOCTs and 1300 CDDs have been trained thus achieving a ll}%training achievement for all categories. 200 health facility staff from 13 CDTI LGAs were also trained on the management of adverse reactions' Mobilization was carried out in all 13 Oncho endemic LGAs with the use of posters, radio jingles, and T.v. programme on oncho day.334,685 persons in 633 endemic communities in the 13 CDTI LGAs were treated. A total sum of g28,338Mectizan tablets was used for the treatment' This gives al00% geographical coverage and 54.9Vo therapeutic coverage' LINICEF provided N452, 000.00, LGAs and communities also contributed N1,300,000.00 and N50,000.00 respectively during the reporting period. The State Government approved N3, 000,000.00 but nothing has been released. Strengths of the programme include increasing support from the policy makers in some LGAs and more CDDs are being selected by the communities to reduce workload per CDD. The weaknesses and constraints facing the project are lack of support for cDDs by some endemic communities are not supporting their CDDs, payment of community based workers by progammes like guinea wonn eradication' and late release of funds from APOC. Bauchi state is located in the north east of Nigeria. Kano and Jigawa states bounded it to the north, to the east Gombe and Yobe states, Kaduna to the west and Taraba and Plateau to the south. It has a population of 2,826,444 based on the 1991 census and is made up, of 20 LGAs. Some major rivers transverse the state, and these are River Hadeja, Jama'are, Gongola and Dindima. Most of the Oncho endemic LGAs lie along these rivers. There are 13 CDTI LGAs with an endemic population of 609,911 out of which 517,28g are eligible persons. Mass distribution with Ivermectin started in the state in 1991 with the assistance of LINICEF. Proposal for the implementation of CDTI in the state was approved in December, 1999. Funds were received in March, 2000 and the financial cycle was revised to start in March 2000 to February 2001. Even though the second financial year was supposed to start in March 2001, funds were not received until September,2001. Currently the 13 hyper/lVleso LGAs implementing CDTI are Alkaleri, Ningi, Kirfi, Warji, Dass, T/Balewa, Datazo, Shira, Toro, Zaki, Gamawa, Itas/Gadau and Jama'are. Treatment started with 140 communities in 1991. In 1999 when CDTI was introduced the number of communities undergoing treatment rose to 633. SECTION 2 TMPLEMENTATION OF CDTI YEAR TWO No. of Comm s. Which decided on Method of I I Treatment I No. of Comm s. with trained CDDs No. of I comm I Paying in I Cash/Kind No. of Comms. Which Collected Drugs Fo Of Comm s. Which decided on method of Distribution rnl LGAs Noof I rarget I Comms. I No of Comms. Which Selected CDDs 31 83 083 2A 3l 1 Alkaleri UJ 73 73 31 73 33 732 Ningi 73 28 -78 -zg WarJi 28 28 28 28 J 28 025 25 254 ) Kirfi 28 28 7l B 7l 0 Toro 7l 7l 50 IL 39 25 39 25 25g 4 6 ltas Gadau 39 53 53 0 7 Shira 53 53 'z-t 4l T 54 0 8 Zaki 54 )4 .ir 23 23 0 9. Gamawa 23 z5 LY 20 38 T 38 38 0 10 Darazo 38 JU 20 38 0 11 Jama'are 38 JU IJ 30 30 46t2 T/Balewa 46 46 20 34 36 36 0 13 Dass 36 36 34 332 442 440 633 U4Total 633 05J t TRAININGoFDIFFERENTLEVELSoFSTAFFINVOLVEDix corr IMPLEMENTATToN' No. LOCTs Trained No. of CDDs Trained To. of HealthCentre Staff trained. To. of Training Undertaken No of TOT Trained S/N L.G.A. r28 15 1 3 1 Alkaleri 1 110 t7 1 3) Ningi I 104 15 3, T. -Warji I 1 5 114 15 Kirfi 1 1 5 r24 18 1 I 35. Toro 104 15 6. Dass 1 1 5 83 15 7. ffia-lewa 1 1 J 3 80 l5 8. larnaare I 1 t 3 t02 15 9. ita;GAAu | 1 t 1 3 r06 15 10. Zaki t 3 ll4 15 11 Shira I 1 3 r18 15 t2. Duazo 1 t 3 104 15 13. Gamawa I I 13 39 1300 200Total 13 2.1 TRAINTNG OBJECTIVES/ACHIEVEMENT 6 o/, ACHEIVEMENTS/N TffiN-NBt, a.NNU^q.r,TRAINING TTRItr. TI\/ES AC'I'UAL NUMBER TRAINED 8 100 1 SOCT 8 39 100 2 LOCT 39 200 r00 3 T--rerr 200 1300 100 4 OGGintngtretraining 1300 6 75 5 Sm@-mputer training) 8 80 80 6 @ct coordinators (inter departmental worlcstrgql - 100 2.2 TRAINING IMPROVEMENT Theprojecthavetrainedl300CDDswhichtranslatesintohavingmore trained CDDs in the communities' 3gLoCTsweretrainedfromthe13CDTILGAs(3fromeachLGA).200 Health workers were trained on management of adverse reactions' These include Health staff in charge of maternities, dispensaries, health centers and other health posts.Duringtheworkshopthehealthfacilityinchargeswerealsotrainedon various aspect of onchocerciasis like mode etiology of the disease' mode of transmission, and control measure' AStatetechnicalworkshopwasconductedforHealthprogrammeofficers fromthestateMinistryofHealth,AgricultureandFinance.Theessenceofthe workshopwastoeducateandenlightentheprogrammeofficersononchocerciasis andalsoencouragethemtogivetheirsupporttowardsthecontrolofthediseasein their various dePartments' MOBILIZATION AND EDUCATION OF TARGET COMMUNITIES S/N L.G.A. No. Of Comms. Mobilized No. Of Comms. which Received H/E on CDTI No. Of Advocacy Visits to state/LGA Directors of Health No. of MOH Staff involved in Mobilization No. Of NGDO staff involved in the Mobilization I Alkaleri 83 83 4 4 2 2 Nlngl 73 73 3 4 2 J Warji 28 28 2 4 2 4 Kirfi 28 28 2 4 2 5 Dass 36 36 2 4 2 6 Shira 53 53 2 4 2 7 Z^ki 54 54 2 4 2 8 Gamawa 23 23 3 4 2 9 Darazo 38 38 2 4 2 10 Itas Gadau 39 39 2 4 2 11 Toro 71 7T 2 4 2 t2 Jama'are 38 38 3 4 2 l3 T/Balewa 46 46 2 4 2 Total 633 633 31 4 2 TABLE II Mobilization was carried out in all the 633 communities and a total of 1188 religious and community leaders were mobilized. Qut come of thp mohili?atio.n . The communities not only selected their CDDs but also tried to fulfill most of the responsibilities expected of them. . Although only 84 communities supported their CDDs, the rest of the communities are now willing to support their CDDs in cash or in kind. Mediq usqd for the mqbilization siN L.G.As No of Health workers mobilized No of policy makers mobilized No of traditional /Religious leaders mobilized. I Alkaleri l5 4 123 2 Ningi l7 4 tt4 3 Warji l5 4 60 4 Kirfi 15 4 62 5 Toro l8 4 115 6 Dass 15 4 75 7 flBalewa 15 4 102 8 Jama'are 15 4 83 9 Itas/Gadau 15 4 90 10 Zakl 15 4 104 11 Shira 15 4 ll0 t2 Darazo 15 4 80 r3 Gamawa 15 4 70 TOTAL 200 62 I 188 For every programme conducted by the unit is being aired through the State Radio and Television and the National Television Authourity in the State. Moreover a television phone - in programme was conducted on Oncho Day this Year at the State Television (BATV). The mobilization team consists of members of the State Oncho team, the information officer of the State Ministry of Health, representatives of BATV (Bauchi State Television), BRC (Bauchi Radio Cooperation), NTA (Nigeria n Television Authority) and} staff front NOCP ZonalOffice representing IINICEF. The result of the mobilization is encouraging as there is an increase in the level of awareness of the control effort in all the endemic and non endemic communities to the extent that 7 non CDTI/ hypo endemic LGAs are requesting for inclusion into the CDTI progralnme. 10 N CI (o @ CD Or 5 o) N U' zI {|. + @gL g o, (- !,3 0l o, o g o, a,tt -to o N!, c. o!, tsNo oq, 3 o, =o o,o o o,eoc U) = 0, x;I E0, 1=e. xo,6 =. r o ot ot a.l 5 C': OJ@ 6J o, { cn5 o,@ N(rl (l,(o (,ro) N@ NCD o, @(r, {covzogH= JT- m=z-{ (Do(t ro 5 @ 5@N an 5 CD(oN(o {lNNlo,(,l5(l'IN(.tlc! (, c,(,N (rq tt (., @ I @ C'I$6 N$N@@ o)5o{{ urI o, oro I-{{mc)I VUrO Bl rrfi=z (,t N@@ 5 oNI 5 o(o5 A CDN N (,l {6 J(,loN@ N o) N orlNrl@olo) ot lJ(ol5 C') o)(.,(rJN NNo(rl(o (.)N (rr(o (rtoo 8 C'r@ N m-tEOgE f, (o NoNN o)l{ *.lla olN(o lJ o,(n OrN $ @ C,:(o + (o t\, ol(r)No (c, o,(oN CttN (n NN(o @ (/, 6 5 o) arr J N5{ =-l69bP6r m (., a,5 o,@ ol o){@ @{(o N o)@{A (rt(,r or o)o 55{@ N(rr{(r, (rto o)! N@{ o,o N$(,r @s NNoo C" N@()N(D 5(o @ @ (rt(,rs $ q=qEB E Ei'6q ao$ot5(,(o {oe {otoa a(o(rr(,r @ (l)oooe! gr 5oc! 5oooo 5oooo {N(r){ CD o(0ooo o)oooo o)oooo 5 Or o)o 5ooo ild Bi U' t0Nt cD aI Oro o) o)@(r!N JN(o(IN6 sq,(r)(.) ao (, ro(('(o(o o,@ o(n I o,@N B ('(o(o or(o (n(o o)oN I(n(I(,to (., @@6 {-{ E9(/, >c1o mo (, Or o ct (o(9 &l-,,ol{ (,r .D (r: Oro $l -lO 5@ N EH3 o o o (,t o,o(,l o (.) GO5 o {(n5 (o! (^to)cn o CD(0@ c, o td FT =\z.>oEl N N N N N N N N N N N N N lEElmlz rsl { rl IEl>lclo I:E lal-{II lm l= lmlol-{ IFlzl{t, IEl= lmlzI-l l=lolclvlmla h.rlctlolr o(D o oa A)E op) () o (D s, oa(D ll lo\ CD It,o) lt(., X oo I oos F.l !t(DFt E)rd (Dt o o o oF! s) oa(D ll CDo l(, -(o lrrlstF - 'lor l6 lo, X oo il(,5 io s ACHIEVEMENT$ New Socrs appointed have been trained at the zonal level thus enhancing their technical and managerial skills. A total number of 1,300 CDDs selected by the communities were trained at the community level. A total number of 633 communities in the l3 endemic LGAs were mobilized for CDTI implementation. More cDDs were trained on various aspects of the CDTI programme. sufficient training materials were reproduced and properly used during the training sessions. Availability of a project office where all project equipments were installed. Integration of CDTI implementation into the pHC programme. Some of the CDDs were involved in NPI activities. STRpNGTHS OF THp PROJECT. l. 2. 3. 4. There is an increased awareness of the programme. The policy makers in some LGAs are supporting the prograrnme. The state govemment is giving its full support to the programme by giving its counterpart contributions. More cDDs are selected by the communities to reduce workload per CDD. Some endemic communities are not supporting their CDDs Payment of community based workers by programmes like guinea worn eradication is posing a problem to successful implementation of the CDTI programme Late release of funds from ApOC. l. 2. 3. t2 J- COUNTER PART CONIRIBUTIPNS PARTNERS Amount Approved Amount Released APOC N4,981,500.00 N4,981.500.00 STATE N3,000,000.00 Not yet released LGAs N1,300,000.00 N1,300,000.00 UNICEF N452,000.00 N452,000.00 COMMUNITIES N50,000.00 N50,000.00 13 .f BluGlil smft PBSEilI$S NHONI ilarcn 2000-rc[. 1001 $uBffiTnll mnSH 200r r0 [ml8[r Pno8nltilt ron OTG H|IGTRG IISIS GBTTTO1 T[PB8I l|UIEIIIOUGOU BURIIMHSO For Acticn 'ct) q't.O€la, flg{: 1a .1 :li )i, ,t :El|t { 1 .-t . .J +i g .u :1 i: ii -:t --t -{ :E HL.l rl 't "f ,-$ .& . ^j,r rs J# ,.,;trrr5 #"4q13 .-a .'t s .'3: * .,u li * E '& I .*l I ;l -J t , .-f .t ',! -t -t C$TI L,G,N.9 Kevffi n t -L- '. Naus f/Tt (,6, fte, SECTION ONE BACKGROUND Bauchi State project is located in the North-East of Nigerian. There are 20 local Govemment Ares in the State. The State shares boundaries *ith plateau, Kano, Jigawa, Yobe, Borno, Taraba and Gombe States. The State lies in the Savannah region of Nigeria, with variation in ecological conditions with the southern and western parts being sudan or guinea Savannah, having a relatively higher rainfall, the northern part of the State is sahel Savannah with flat lands and fewer hills. Some major rivers traverse the State. These include the river Hadeja, Jama,are, Gongola and Dindima. Most of the endemic local government areas lies alongthese river systems. The State has two distinct seasons', dry and rain seasons. There are six months of rain, beginning in May and ending in October. The farming season is from May to December. Most of the onchocerciasis endemic communities are not accessible all year round; the dirt and laterite roads to these communities are usually not motor-able during the height of the rainy season. Even in dry season, where the roads are sandy, four-iheel drive vehicles may be required in some instances along with motorcycles and bicycles. The_ settlement pattern varies in different part of the State. Generally, there is a pattem of nuclear settlements, with surrounding farmlands. In some areas there is dispersed settlement and in others a combination of nuclear and dispersed settlement is found. There are numerous ethnic groups in the CDTI LGAs, namely the Hausa Fulani, Jarawa, Sayawa, Kanwi Pa'awa and other minority nibes. The majority of the indigenous population are farmers. There are 13 CDTI LGAs with an endemic population of 964,138 persons. The LGAs are Ningi, wadi, Darazo, Alkaleri, Kirfi, Dass, Tafawa Balewa, ioro, Shira, Ganjuwa, Misau, Zaki afi' Gamawa. However, the results of the registration update are provisional and awaiting validation. The proposal for the implementation of CDTI in the State was approved in December 1999- Funds were received in March 2000 and the financial cycle-was revised to start from March 2000 to February 2001. The number of Hyper endemic communities before CDTI was 140 while there are 225 meso endemic communities. With the implementation of CDTI the number of endemic communities are: - Total - 623 communities. The State has been carrying out treatment under CBTI since 1991. DEFINITION A community is a group of people living together having the same culture and tradition while a village is an administrative area headed by a village head comprising of about 15 to 40 communities each of which has a population of about 500 to 1000 peop-le. SECTION TI4/O IMPLEMENTATION OF CDTI TYEAR ONE) S/I{o LGAs Noof Communities No of Comm. Which selected CDDS No of Comm. Which Collected Drugs No of Comm. Decided on method of Distribution No of Comm. Decided on method of TX No of Comm. With trained CDDS No of Comm. Paying in Cash or Kind I Alkaleri 31 30 30 30 0 30 20 2 Ningi 73 65 65 65 0 65 30 3' Warji 28 25 25 25 0 25 20 4 Kirfi 18 18 18 l8 0 18 t2 5 Toro 71 65 65 65 0 65 3 6 Dass 70 62 62 62 0 62 40 7 T/Balewa 34 30 30 30 0 30 25 8 Ganjuwa 9I 83 83 83 0 83 60 9 Misau 39 35 35 35 0 35 32 l0 Shira 53 50 50 50 0 50 45 11 Zaki 54 50 50 50 0 s0 s0 L2 Gamawa 23 22 22 22 0 22 20 l3 Darazo 38 36 36 36 0 36 25 TOTAL 623 571 571 571 0 571 382 S/l{o LGAs No of Training undertaking No ofTOT Trained No of Health Centre/Post staff Trained on CDTI No ofLOCTS Trained No ofCDDS Trained I Alkaleri 2 2 2 ") 143 2 Ningi 2 2 2 2 160 3 Warji 2 2 2 2 146 4 Kirn 2 2 1 2 222 5 Toro 2 2 1 2 176 6 Dass 2 2 I 2 154 7 T/Balewa 2 2 I 2 151 8 Ganjuwa 2 2 I 2 t75 9 Misau 2 2 2 2 167 10 Shira 2 2 1 2 166 1l Zaki 2 2 I 2 r59 12 Gamawa 2 2 1 2 r60 13 Darazo 2 2 I 2 153 TOTAL 26 26 18 26 2t32 * LocTs and GDDS training were undertaken (2 training in each LGAs) Annual training objective was to train 39 LOCTs of which 26 (67%) were trained and 2336CDDS of which 2132 (91%) were rained. The materials used for the haining are Brochures, flipcharts, measuring sticks, posters and registration log books. From the performance of the CDDs it is apparent that some have understood their roles while some are yet to. Intensive kaining and supervision at community level will be done to improve CDDs' performance. S/I.{o LGAs No of Comm. Mobilized No of Target Comm. Which received II/X about import of extended Treatment No of Advocacy visit to StatelLGA Directors of Health's No of MOH Staffinvolved in Mobilization No of NGDO Staffinvolved in Mobilization I Alkaleri 30 30 4 3 I 2 Ningi 65 65 6 4 I 3 Warji 25 25 7 4 I 4 Kirflr 18 18 3 3 I 5 Toro 65 65 5 2 1 6 Dass 62 62 6 3 3 7 T/Balewa 30 30 6 4 2 8 Ganjuwa 83 83 4 3 I 9 Misau 36 36 3 2 I 10 Shira 35 35 4 3 I lt Zaki 50 50 4 3 I t2 Gamawa 50 50 5 3 Il3 Darazo 22 22 5 4 I TOTAL s7l 571 62 7 3*NB At community level information are given through lectures, posters, flipcharts and discussions. not supporting the CDDS and there is political interierence in the selection of CDDS and mectizan distribution. Therefore, there is the need for intensive advocacy and mobilization to target communities by giving information through TV, Lectures, Posters, drama groups, and use of religioui and traditional leaders. SECTION THREE Achievements 1. Treatment coverage rate Number ofpeople treated x 100 : 379723 x 100 Total (census) population 964,139 1 : 40% 2. Total (census) population The total (census) population for hyper endemic communities are 4|2,9l4while for meso endemic communities are 511,224. 3. Eligible population The total population minus - the excluded. : 964,138-195,958 = 768.180 Mectizan Treatment Table S/1.{o LGAs No of Target Comm. treated No of Eligible person treated Cost per person treated No of Comm. CDDS is a Health Worker No of Distribution supervised by Health workers No of Treated Comm. With summary forms.I Alkaleri 30 52,511 NA 0 2 2 Ningi 65 62,795 NA 2 2 3 Wadi 25 15,7T9 NA 0 4 Kirfi 18 26,712 NA 0 2 5 Toro 65 63,776 NA 0 2 6 Dass 62 31,963 NA 0 I 7 T/Balewa 30 15,gg2 NA NA 0 I 8 Ganjuwa 83 l5,g7g 0 I 9 Misau 35 14,741 NA 0 I l0 Shira 50 31870 NA 0 I u Zaki 50 16,439 NA 0 I 12 Gamawa 22 15,271 NA 0 I 13 Darazo 36 15,976 NA 2 2TOTAL 571 379-72? NA 4 18 * {' The proportion of absenteeism is not higher than expected. * The most common reason for absenteeism is migration especially for cattle rearers. * The action that needs to.be taken by the project to reach absentees is to carry outtreafrnent before perennial migrations especially for cattle- rearers or nomads. 1. 2. 3. 4. 5. 6. SECTION FOUR Strengths ofthe project are: - Remote areas are reached with more CDDs Recording system is improving Increased supervision Awareness at community level is improving Policy makers in some LGAs are supporting the programme. State government has supported by giving itr "o""tripart funds to the tune ofN3million which was used for the production of calendars, T - shirts, and for holding advocacy workshops. Full support and direct supervision by NOCp Availability of logistics Weaknesses/Constraints of the project are: - 1. Not all communities accept the ownership of the project ?. cDDs are expecting incentive and employment tom tne project.3. Some communities are not supportingtleir CpOs4' Political interference in the selection of CDDs and mectizan distribution l. Inadequate support by some policy makers 9. Low literacy level within thaprojict area7. Inadequate support by assisting NGDO Future Plans: - l. Intensive advocacy and mobilizationat all level2. Intensive training at all levels Support needed from Government: - 1. frompt and regular release of counterpart fund2. Support for oncho staffto carry out their duties effectively Support from APOC Advocacy visit to the State policy makers Prompt release of funds 7. 8. l. 2. EXECUTIYE SUMMARY Bauchi State project is located in Govemment Ares in the State. the North-East of Nigerian. There are 20 local The southern and western parts being sudan or guinea Savannah, having a relatively higher rainfall. The northern part of the State is sahel Savannah with flat lands and fewer hills. Some major rivers traverse the State. These include the river Hadeja, Jama'are, Gongola and Dindima. Most of the endemic local govemment areas are situated along these river systems. The State has two distinct seasons, dry and rainy seasons. There are six months of rain, beginning in May and ending in October. The settlement pattern varies in different parts of the State. There are some nucleated settlements, with surrounding farmlands while in some areas there are dispersed settlements. In others a combination of nuclear and dispersed settlement is found. The proposal for the implementation of CDTI in the State was approved in December 1999. Funds were received in March 2000 and the financial cycle was revised to start from March 2000 to February 2001 There are 13 CDTI LGAs viz. Tafawa Balewa, Toro, Darazo, Misau, Zaki, shira, Ganjuwa, Alkaleri, Warji, Ningi, Dass, Kirfi and Gamawa. Most of the communities in these LGAs are not accessible all year round. The State has an endemic population of 964,138 persons living in 221 hlper endemic communities and 402 meso endemic communities. The training conducted so far are the training of 26 LoCTs (67%) and, 2,132 CDDS trained. So far, 571 communities have been mobilized and received health education on extended treatnrent. 62 advocacy visit to LGAs Directors of Health. The State has teated 379,723 eligible persons (40Yo coverage). The project has been able to reach remote areas with selection of more CDDs and increased supervision. There is full support from NOCP officials. Initially the project experienced late approval and release of funds from the State level, but with the change of signatories (the Permanent Secretary is now one of the principal signatories) there is no further delay for approval. The challenges/?lan of the project are to carryout intensive mobilization and intensive training at all levels.