Zamfara CDTI sixth year annual project technical report to Technical Consultative Committee (TCC): January to December 2005

ZAMFARA STATE CDTI PROJECT Proiect Name: Zamlara CDTI Project Launchins vear: 1998Approval vear: 1998 Proiect vear of this reporfi (circle one) I JANUARY TO DECEMBER 2OO5 CheckBoxl 789102 3 4 Reportine Period (Month/Year): I aa iiTRY NIGERIA Date submitted: JANUARY 2006 ORIGINAL: English NGDO oartner: SIGHTSAVERS INTERNATIONAL 5o ?r 't(L^ r$h ,/$ r+l) ceu BIM tnP- EW TA l: I r., fin 7.7 Jt'ltl ,llltt7 k4, *AIMW, ti-$aAX,A I I I I I I I I I I I I I I I I I i I I I I I I I I I SIXTH YEAR ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) AFRICAN PROGRAMME FOR ONCHOCERCIASIS CONTROL (APOC) L--____.._ _,-_--_-,_. 1t ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE(rcc) DEADLINE FOR SUBMISSION: To APOC Management by 31 January for March TCC meeting To APOC Management by 31 July for September TCC meeting AFRICAN PROGRAMME FOR ONCHOCERCIASIS CONTROL (APOC) I iii ANNUAL PROJECT TECHI\ICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) DEADLINE FOR SUBMISSION: To APOC Management by 31 Januarv for March TCC meeting To APOC Management by 31 JuIv for Sentember TCC meeting q9, AFRICAN PROGRAMME FOR ONCHOCERCIASIS CONTROL (APOC) IV ANNUAL PROJECT TECHNICAL REPORT TO TECHNICALCONSULTATIVECOMMITTEE(TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to the Country: I\LL\E P-LA National Coordinator Name: .'Pfi.f*t.tt lx' 'CLdl= ,6\ Signature: W r-":r..!'{'-" Date >3.lul lzec-\ Utr I I ,r !tJ I .-.4r:4ttr- I t Zonal Oncho Coordinator Name: a Signature Date: .. NGDO Representative Name- -Plu"r.l^*"'No''"''i'' Eet€. W*, n<-.. Date tltil ?lef This report has been prepared by Narne: Abdullahi Labbo Designation Signature Proiect -&, Coordinator Date !k1 kle? V Table of contents Acronyms viii Definitionsir FOLLOW UP O}I TGC RECOTITENDATIONS i Executive SummarY i SEGTION 1: Background information iii GENERAL INFORMATION SEGTIOII 2: lmplementation of GDTI i 2.I. TIMELINE OI. ACTIWNES 2.2. AovoclcY 2.3 2.4. CorravrumrY INVoLVEMENT 2.5. CapaCrrY BUILDING 2.6. TREATIVM{TS 2.6.1. Treatment.figures......-.... 2.6.2 What are the uuses qf absenteeism? """""' 2.6.3 yf/hat are the reasons.br re.fusals? """""""" 2.6.4 Brie.fly describe all known and venfred serious adverse events (SAE|) tlnt..--. 2.6.5. Trend o.f treatmmt achievement from CDTI project inception to the affrent year' OnopRnrc. sroRAGE AND DELIVERY oF IVERMECTIN CoMTTNUTY SELF-MON]TORING AND STATBHOTOERS MEETINGERROR ! BOOKMARK iII iir .v ..I 2.7. 2.8. NOT DEFINED. 2.g. SupBRvtstoN............. "'..""""""" " I 2.g. t . provide a.flow chart o.f supervision hierarchy. . Enor! Bookmark not defined 2.g.2. VIlhat were the msm issues identified during supervision? ......... 2.9.3. Was a supervision checklist used? ......... 2.g.J. V[hat were the outcomes at each level of CDTI implementatnn supervision? "' 2.9.5. Was.feedback given to the person or groups supervised? 2. g.6. How was the iedback usecl to improve the overall performance of the proiect i sEcTloil 3: support to GDTI Error! Bookmark not defined. J.i. EQuPPmrr 3.2.FruaNcrarCoNTRIBUTIoNSoFTHHPAR.INERSANDCoMMtINITIES..............,, 3. 3. Orrmn FoRMS oF coMMUNITY suPK)RT................ 3.4. E)GENDIUREPERACTIVITY SEGTION 4: $ustainability of GDTI Error! Bookmark not defined. I i i i 7 I aA J J 4. 1. IN;ERNAL; INDEPENDENT PARTICIPAISRY MSNIT6RING: EvatunrroN 4. 1.1 Was Monitormg/evaluation carried out dunng the reporting period? of the followingwhich are applicable) . -.....1.1.2. Vllhat were the reiommendations? .. Enor! Booknurk not 1" 1.3. How have they been implemented?................... Ertor! Bookmank not 4.2. SUSTanIABILITY OF PROJECTS: PI-AN AND SET TARGETS (rrAaNOarORY AT . .. - - . Yn 3) 1.2. 1 . Planning at all relevant levels -. .. 1.2.2. Funds........ 1.2.3 Transport (replacement andmaintenance) 1.2.1. Otherresources... ...........4 (nck anlt ...........1)^ti--) ucJ atacaL deJined ...........4 ...........4 ...........1 ...........5 .'..,......5 ...........5 VI 1.2.5. To what extent has the plan been implemented " """" 4.3. IlruecRartou 1.3.1. Ivermectindelivery mechanisms 1.3.2. Trammg.... 1.3.3. .Ioint supervision and monitoringwith other programs J 3.J. Release oJ.funds for proiect activities 1.3.5. ts CDTI mcluded in the PHC budgetT 1.3.6. Describe other health programmes that are using the CDTI structure and how ihis was achieved. Whnt have been the achievemenrs? ."""""" """"""""""6 1.3.7. Describe olhers issues considered in the integration o.f CDTI. """'6 4.4. OPERAI'IoNALRESEARCH.. """" """" 7 -t.1. t. Summrtnze in not more than one hatf of o page the operational researcit unt)ertaken in the project area within the reporting period. """"7 1.1.2. Howwere the results applied in theproiect?..........'.. """" """""'7 SEGTIOiI 5: Strengths, weaknesses, challeng€s, and opportunities 7 SEGTIOI{ G: Unique features of the proiecuother matters 8 5 5 5 6 6 6 6 vtt Acronyms APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC RAM P.EMO SAE SHM TCC TOT LTNICEF UTG wHo African Programme for Onchocerciasis Control Annual Treatment Obj ectile Arurual Training Objectir e C ommunity-Based Orgamzation C ommunity-Directed Distributor Communitv-Directed Treatment with Ivermectin Community Self-Monitoring Local Govemment Area Ministry of Health Non-Govemmental Development Organization Non-Go vemmental Organi zation National Onchocerciasis Task Force Primarl'health care Rapid Assessment and MaPPing Rap id Epidemi olo grcal M ap ping of Onchoccrci asis Severe adverse event Stakeholders meeting Technical Consultative Committee (APOC scientific advisory group) Trainer of trainers United Nations Children's Fund tlltimate Treatment Go al World Health Organization vill Definitions (r) Total population. the total population living in meso/hyper-endemic communitios within thi project area (based on REMO and censrs )' (i, Eligible population: calculated as 84Yo of the total population llr meso/hyper- endemic communities in the project area' (iiD Annual Treatment Objective: (ATO): the estimated number of persons living in ,**m@ 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 r"ffiso/h1per endemic areas within the project atea. ultimately to be reached when the project has reached full geographic coYerage (normally the project should be expected to reach the UTG it tt" ina of the 3'o year ofthe Project) (r') TheraErerfic coverase: number of people treated in a given year ovsr the total population (this should be expressed as a percentage)' (vi) Geographical coveraqe: number of communities treated in a given year over the tota ffiGlf r*-*trye"r-endemic communities as identified by REMO in the project area (this should be expressed as a percentagei- (vii) Integration: delivering additional health interventions (i.e. vitamin A supplem€nts, albendazole for LF, screening for cataract, etc.) through CDTI (using the same systems, training supervision and personnel) in order to maximise cost- effectiveness -d *po*"r communities to solve more of their health problems' This does not trclude activities or rnterventions carried out by community distributors outside of CDTI. (r'iii) Sustainability: CDTI activities in an area are sustainable when thery continue to function effectively for the foreseeable future, wrth hlgh treatment coverage, integrated into the available healthcare service, with strong community orvnership' using resources mobilised by the community and the government. (i*) Community self-monitorine (CSM): The process b}' which the eommunity is "*po*ffi to *see and monitor the performance of CDTI (or any community- based health intervention programme), with a view to ensrning thd the programme is berng executed in the way intended. It encourages the commuryli to take full ,rrpo*Ibifity of Ivermectin distribution and make ipptopt at" modifications when necessar). tx Number of Recommcndation in the Reporl TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FORTCC/AN)C MGT ASE ONLY t The project integrates traimng of communi$' supervisors into the stratePY to increase communitY olmership, if fimds are available. Otherwise APOC should provide fi.rnds. There was no nmd made arailable bl'the State and LGAs. The training cotrld therefore not take place. 11 There is only one CDD Per 540 persons in the Prqect; however the range across LGAs is from l CDD/227 to 1 CDD/over 950 peoPle. Project should train at least double this hgure, but preferably three-fle times the number of CDDs depending on the LGA (along kinship lines) to reduce the workload of CDDs and better ensure sustainabrhty. During visits to commurutles they were rnformed to select more CDDs for better coverage. 111 Local Govemment should try to hnd frrnds to enable more training and supervision activities. During advocacl' rnsits LGAs were requested to contribute counterpart funds to the Project. The State and LGAs Promised to contribtile cotmterPart fimding, little u'as howwer lV Prolect should ensure rmproved integration into public health service to better sustain onchocerciasis prolects after the end of APOC Project is maliing etlort to ensure rmproved integration mto public health service to better sustain orrchocercrasis projects at the end of APOC $pport. FoLLowuPol{TGGREGottENDATIo]ls Using the table below, fill in the recommendations of the last TCC on the project and describe horn,the-v have been addressed. TCC session 21't (Please add more rows if necessary) Executive SummaJY Prepare an Execative summary of the rqort in not more than Wpage t. Background on t'reatment and population data - Totat commurutrcs, communities treated, total population. WG. A7'O and persons treated. 2. Backgrourul on population movement* 4 - WHO/APOC. 24 Novernber 2004 3. Traming data - CDDS'. healthworfters. Total populafion (communitlt) per CDD troined. 4. Challenges and how theywere overcome EXECUTIVE SUMMARY Support from African Programme for Onchocerciasis Control (APOC) Community Directed Triitment with Ivermectin (CDTI) project in Zamfara State is in its sixth year of implementation. The state is made up of fourteen administratil'e Local Govemment Areas G.bes) with five identified to be meso-endemic with Onchocerciasis. These LGAs (Anka. Bukkul"um, Bungudu, Maru and Zurmi) have 12O endemic communities, and a population of 2Ol,2l0 was obtained as an updated census from CDDs for the year under review. Out of this population (2Ol,2lO people), 163.780 people were treated from an annual treatmert objective of i70,000 using 415,210 tablets of Mectizan@ tablets with a geographic and therapeutic coverage of 93o/o and 8l% respectivell'. People in the state are predominantly Moslems. Over 70o/o of the population are in the rural areas. Thme are predominantly farmers and some nomads. They usually migrale to southem part of the country during the dry season seeking for pasture, though they retum at the .o--ence-ent of the rains to either same or different locations. This has a resultant effect on therapeutic coverage. During the dry season there is a high migration of male youth to urban areas-to engage in pet[, tradng and other unskilled professions to eam a living, horvever, the'}' return to their communities in the rainy season for agricultural activities. The project was faced with challenges- which actually served as hindrance to the full implernentatlon of the programme; these include poor government financial support by the state and endemic LGAs, non-inclusion of females as communit-v distributors due to a religious belief, and non-compensation of most selected CDDs. As a result of the above issues advocac_v visits were camed out at the LGAs seeking for funding for the implementatron of CDTI activities in the year under review. Unfortunatel,v no fund was released thus accounting to non traimng and re-trairung of health staffand CDDs. Reaching women in purdah had been slow due to cultural and religious hindrances. Advocacy to community leaders was done tou,ard compensating their selected CDDs. As a result some communities responded positiveh,to the prograrnme and that quite yielded a good result in some communities. L - WHO/APOC. 24 November 200't SEGTIOil {: Background information {.1. General information Ll.f Description of the project (briefly) - Geographical location, topography, climate - Population: actwities. cultures. language - Communication sYstems (roads ) - Adminisfrationstructure - Health $)stem & health care delivery (provide the number of health postsicentre!; in the project area if the informatton is available). - Numbir o.f health staff in project area and number o.f health sta.ff involved in CDTI activities. The State is located in the North-westem region of Nigena and shares boundaries with Sokoto State and Niger Republic in the north, furiit a State in the east, Kebbi State in the u'est and Kaduna and Niger States in the south. The State is made up of 14 Locat Govemment Areas. The vegetation of the State is mainly Sudan and savannah grassland. There is a vast land of agnculture and two main rivers (River Bunsuru and River Ka). About 80% of the population lives in rural communities. The State has two seasons namely the rain;v and the dry seasons. the rairry season cornmences from Mav to November, while the drv season starts from December to April. The State has a population of over two (2) million people with Hausa and Fulani being the main ethnic groupr. and Islam is the predominant religion. The main activities of the people are crop production and animal husbandry. The advent of the Global Satellite Mobile telecommunication system in the State has improved communication tremendously. The State populace also has access to the electrontC media through the radio and television stations - Nigerian Television Authority owned by the Federal Government of Nigeria, the State owned radio station known as Zanfwa Radio and the Kaduna State Radio Station. The State has an established Ministry of Information with other local means of disseminating information to its people in rural communities- Eighty percent (S0%) of communities are diffrcult to access during the rainy season. The road netw,orks to some of the local govemments are feeder roads with diffrcult terrains. Patients travel long distances for health services. Public means of transportalion to most of these communities are available only on market days. the cost of which is high (about $8) for an average communitv member, During the dry season there is a high migration of male youth to urban areas to engage in petty trading and other unskilled professions to eam a living. They however retum to their communities in the rainy season for agricultural activities. There are two main tiers of government operating in the State - the State and local governments. An elected Erecutive Govemor and elected Chairmen and Councillors at the State and local govemments govern respectively. There are also the traditional and religious 3 - WHO/APOC- 24 November 20O4 institutions of leadership. which have an influence on the administration d the local goremment. A General Hospital is based in each of the 14 LGA headquarters and in the sunounding districts. There are sporadic pnmary Health Care delivery infrastructures, rarging from comprehensive health centres to neatf chnics. There are 496 health facilities in the state The pnmar-v Health Care facilities serve as training centres for CDDs and other trainings as well as Mectizan@ collection points. The project area has a total number of 101 health staff and 64 are currentlv involved in CDTI activities. Table l: Number of health staffinvolved rn CDTI (Please add more rows i.f necessary) District/LGA Number of heelth staff involved in CDTI activities' Total Number of health staff in the entire pr<rject area Br Nurnber of health staff involved in CDTI Percentage r,2i ,B2l Br '100 Antrra l3 8 620/o Bungudu 2l l3 620/o Bukkul,um 28 t7 6t% Maru 16 11 690 Zwmt 17 l0 59o/o Sta.te MOH 6 5 83% Total 6 101 &l 630/o q - WHO/APOC- 24 Novernber 2004 l.l.Z.PartnershiP - Indicate the partners involvecl in pro.iect tmplementation at all levels IMoH' NGDOs (na ti onali'interna t ional), commurut ies, local or ganizations, e tc. l - Describe overall working relationshrp among'partners, clearly indicating specilic areas of prolect acti4ie; (planning, supervision, advocacy, planning, mobilimtioti' etc) where all partners are involved. - State plans, -tf any, to mobilize the statetregion./district/I'GA decision-mokers, NGDOs. NGOs. CBOs, to assist in CDTI tmplementation' l. 2 Partners in the zanfara CDTI project comprise of the following: - Zamfara State Ministrv of Health The Ministrl' for Local Govemment and Chieftaincy Affairs (representing the five endemic LGAs) 3. African Programme for Onchocerciasis Control, (APOC)'4. Federal Ministry of Health 5. Communities in endemic LGAs 6. Sightsavers Intemational All the parbrers play roles and perform their responsibilities in the implementation of the projcct activities based on CDTI stratery. Zamfara State Minishy of Health Tne Zarnfara State Miniitry of Health is structured in line with the Nigerian Health Structure that is based on the concept of the Alma Ata declaration of 1978. Based on the above the National Health Care Delivery System is structured into primary- secondary and tertiary levels of care assigned to the local, state and federal govemments respectivl$ . The Zar11f25;a State Ministry of Health is therefore responsible for the provision of iecondary health care, supervising LGAs to provide primary health care_ services to its population. There are eight departmeits in the ministry; each of which has a role to play in the p.orision of ey,e car" Jervices. The eight departments are Administratioq Public Health Services- Primary Health Care, Pharmaceutical Services, Nursing Services, Planning, Research and Statistics, Finance and Supplies and Inspectorate Services. The ministry S'riperrises three parastatals - Hospital Service Management Board. School of t{calth tectrnologp and geam System Development Project. the-activities of the Ministry and health services piovided are funded fiom budgetary allocation from the state govemment' The Ministr"v is involved in planning, advocacf to the LGAs. monitoring and provision of iogistic r.rppo.t for implementation of CDTI rn the State. However, provision of counterpart fundtng by the State and LGAs has been Poor. Sightsaveru International Silhtsavers Intemational has been supporting Onchocerciasis control rn six Local G|vemment Areas (Bukliuyum, Bungudu. Tsafe. Ank4 Maru and Zurmi) with Tsafe LGA as non APOC LGA. This has been since 1996. The organisation has provided technical support rn terms of training of project staff, planning and reporting including logistics support 5 - WHO/APOC. 24 Norrember 2004 (vehicles, IEC materials, spares. monitoring, advocacy etc). The organisation also supports trachoma control using the Safg strategy and provision of cataract services in the State' Ministry for Local Government and Chieftaincy Affairs fhe Ministry is the supervisory organ of the lotal govemment areas in the state and the endemic local govemments fali *d., them. The Ministry has assisted the project through communication and advocacy towards ensuring that the local govemments provide the necessarv support for implementation of CDTI. The local governments under the ministry inl.olved in CDTI through planning, advocacy to ffaditional/community leaders, monitoring and supen'ision, health iducation and mobilization of communities, reporting and management of adverse reactions as a result of treatment with Mectizan@. The State Minist[ of Health and the LGAs provide office accommodation, pa1' salaries and emoluments Of SOCTs/LOCTs. During the treatment year under review the,y promised during an advocary yisit to give their poliical and financial support for project activities; unfortunately no fund was released by either the State or LGAs' African Programme for Onchocerciasis Control (APOC) The African P.ogramme for Onchocerciasis Control (APOC), which is a WHO organ, was established rn 1995 with the sole objective of supporting the control of Onchocerciasis in sub Saharan Africa using the Community Directed Treatment with Ivermectin (CDTI) stratery' ApOC has support.d tt " Zamfaru CDTI proiect uith funds for implementation of project activities since 1999 and also provided capital equipment and logistic support for the project' During the year under review no fund was released to the project by APoc. Federal IVlinistry of Health This is the orgalof the federal govemment that is responsible for formulatingnational health policies. Tf," Nut onal Onchocerciasis Control Programme (NOCP) is a unit of the icpartment of public health and is headed by a National Coordinator. There are four zonal offi"es - Zonei (pnugu), B (Ibadan), C (Ituduna) and D (Bauchi), which are headed by zonal coordinators and have the responsibility of monitoring CDTI activities in their catchment States. ZanfuaState is nZoie C. TheNOCP on behalf of federal govemment endorses all letters of agreements with APOC and monitors implementation of CDTI in the State including advocacy for support to the States. Endemic Communities A communitv or village nZarrrfua State refers to people in either small or large groups' who live in the iame place, share the same culture, customs and traditions with a common leadership. ln the project area there arc l2O endemic communities that fit these descriptions. These communitre. har" been receiving Mectizan@ for 9 1'ears. The communities are responsible for the selection of volunteers as distributors, provision of incentrves for the volunteers, collection of Mectizan@ from central points. distribution of Mectizan@, monitoring and supervision and reporting among other responsibilities. 6 - WIIO/APOC. 24 November 2004 EE F ,f Fat A 5 FU .lArl -. a) t Ee d r; E= I.X a:J* I?'3 *'a(D+ *a J Fl F N Ft5J z sttt ED 0q a- E =E '-JA--citoE=i6'e c gar= =+'6Oda {\o t'J -I o, 5 (,l O t\)5 bao { t'.) tJ N) +. t\) (,|(+) (,\)o \o O EoF *'E ? E rg No:5 iri(!< 5(! rc -Tl5d) =c9.5r! =' z E(D crr (, Fl o 619 a>i NO :.< (Drl I II h.) t-Jo\ (,l N5 b.) N t..J { N \o +- {)o t.J -l )o o\ts +. O .5-F I3.q B -* 'iBts .E.3 g:c * (D (! o.<<rsE'gE E e'- *g:r n'd =' e? il + o !t oB = lI+ o\ Ur O { O (.,l A(,t I aN a ! o! 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G a s G\ a et O \o Lrr(,) O \o o\ UI c ( t-s B=i m anir:, :=' o gRrw EFr_-l J dr,3 ;[i = 1: 7 =S= = Eii ii6 N E= ' - S A rt a-l-: i*i,Es[ E giq +i+ t q_ar +8 3 Exe : O e.D(D = I J\l.l.i-@^it, S t F+F : $ 5ed ] rt -.\Fxrr=-K = a -S(\ !t fG1 ] r e:5 ,t <\: a i Bi; t o ;-i .: s x: '6 I { ?:O) -r I ='S-: = dt : o- qr]6h.uA.)r\.! i5 gG -ar\ =' ,)iR 6 ett ,. dd =(DFrNo5:. ='S(i\ 6 .5< cj * oQ'!EtD=. qiqiJg.s(\2'*()i. Fg= .\t\ €zDs 6l a3J9E(DAro3(D6S5!l- (D(Da-H do ='(D(Da-B3op+E J,/(D _(D(J !o -od(D D'= i.a =' i+ ='ofi =;{rg(D=(Dte a) 5' 3.p-t! 034:+o d.6 :1 cE.(D oa''xe5- aD+o tDHa=9D(9E tsaur s)E oa r', E. F= 4= ='o'-a !)a1oF'(Du)x g @ o, *(D a F0 (D o- 0- (D o o7 o+) C)o (D - A) p to-rtt ) +d '(D?)O !-rEE. =flr(!5 =(Da5 0q o ten \o u c LT P 'U I E t-.JI z o o o NJ ,-j Ft o -i l. N t ? F: ED oa o EU f ,(c Fso g O a: rr t.,l o o (D (D (D =9 5* 5E z8i =.t33trs =3. t!- (D (0 o (Dd 'itDd oo 9-o _v, !J+ +E' H DE o 3s -6 z i z z 8CI 3 7l!it _o 5*iiE oo ra t, e !e (D ri a9Ft z a9 rtD rt|.1 3Ft oo 3E a =9:!e rE 0a o to l- T o 9ro a E =k:'* +E' a t! IJ lu) to I I rt I il o 9!5 hG!rg oI 2.2. AdvocacY state the number of polic.videcisian makers mobtlizetl at each relevant level dunne the current year; lhe reason(s) .for untlertahng the advocacl' and the ourcome' Descrfte dtfficulti'es;constraints being.faced and suggestions on how to improve advocacl" Advocacv being an essential aspect of cDTI was camed to policl maliers in all the endemic LGAs. This was to solicit for support particularly release of counterpart funds and other CDTI responsibilities bestowed to the endemic LGAS. All together 5 Directors of Primary Health Care (pHC) in the endemrc LGAS, the Director of Primarl' Health Care in the Ministrv for Local Govemment and Chieftarncy Affairs, Commissioner of Health and the Permanent Secretar), Ministrl, of Health rvere visited for advocacy. All the policy makers promised d0!]1g ail that -is within their influence to see that counterpart ftrnds based on the sustainability budget are released to the project. It was ill fated that at the end nothing was released to the pr$a despite all efforts Uv in" SOCTILOCTs. This was unlike the good outcome of suoh u.tiurty, in 2004 when fund was released for the project. This limited monitoring and ,up"*irio., of activities. More advocacies would be carried out to LGAS and State govemments (the State Govemor and Honourable Commissioners of Health anci Locai Govemment and Chieftaincy affairs), religious and traditional leaders to solicit for lncreased flnancial support. A staff oi the Stale Ministry for Local Govemment and Chieftainc,y affairs will be part of ttre advocacy team. Advocacy to the Ministrl' for Local Govemment and Chieftainry Affairs is anticipated to influence the LGAs Chairmen to release funds for project actinties. 2.3. tobilization, sensitisation and health education of at risk communities Provide information on. The use o.f media and/or other local $)stems to disseminate iryformation Types of IEC materials used tttoOitiiation and health education of communities includingwomen and minorities Re s ponse oJ' tar ge t co mmuni t ie s /vi I I age s Accomplishments Suggest wa))s to improve mobihzation and sensitisalion of the target communilies' The project has not used the media for mobilization and health education of the population on CDT1. iather front line health staff in collaboration with CDDs and local town criers were used to disseminate information on CDTI in their respective endemic communities. Zamfara State people are predominantly Moslems and women are usually in purdah" as such the project made efforts to hold special health education sessions for them at the communitv leaders' houses. Most of the women are howel,er not reached due to cultural and re'liglOUS hindrances thus making information dissemination on CDTI slow despite the Islamic scholars trarned on CDTI in the year 2OO4 to mobilize women in purdah during school hours liOtwithstanding response from communities was however encouraging, as most of thc communities have iontinued to respond positively to the prografirme through annual compliance to treatment using Mectizan@) tablets- The communities in all the endemic LGAs were re-mobilised on what the disease is (the causative agent, sigrs and symptom and the use of Mectizan as the drug of choice for the WHO/APOC. ! 24 November 2003 I control of onchocerciasis). How communities should take ownership of the programme wiN also stressed. Posters. flip charts and brochures developed by NOTF were us.ed as IEC matenals for mobilization ireatttr education and sensitisation of endemic communities' The project intends to henceforth continue the use of audio and audio-r'rsual means to disseminate CDTI information to all endemic communities prior to release of fund to the project. Communifies will be visited when other health related programmes eg' Tuberculosis and Leprosy Programme (TBLP) are working there. This will afford an opportunity to share me-ans lf transportation eg. motorrycles and vehicles used by the programmes to mobilize and sensitize communities' 40 - WHO/APOC- 24 November 2004 D....-.. i,.DUTBUUU Total 2.4. GommunitY involvement Table 4: Communities participation in the CDTI (Please add more rows i-f necessarlt) Comment on: - Attendance offemale members of the communitv at health education meetings - In general, hiw do you rate the participation offemale.members of the commuruty *ilting, when CDfiI issues are'being discusses (attendance, participation in the discussion etc). - Incentives providetl by communities.for the CDDs - Atftttion of CDDs. Ii attrttion a problem-for the proiect? If yes. how is it addressedT - Other issues As earlier stated involvement of female members in all endemrc communities has been an issue due to the culture and religious belief of the people who are predominantlv Moslems' and this means partially o, n-o., involvement of women in decision taking generalll'' Attendance and participation of women during CDTI discussions were poor. because younger and active women are in purdah. Mectizan@ reached these women only when approval was grven by their husbands or head of the cluster. The project experienced problems of grving incentives to selected distributors b}' their commuruty members. Thii was due to ott.i community health based progfailrmes where those selected were paid i.e. the Polio Immunisation Programme' The 9DD: that are dedicated to implementation of CDTI activities expected pa5'T nent based on the responsibilities given to them on them also. This is one of the major factors among others srrch a-s seeking for menial job, business and schooling that caused attrition of communiqv distributors to the project annualll'. Number of communities/villages with communit5i' memtrers as superrisors Number of CDDs Female CDDs Total Number of commrmities /villages uith female CDDs Nurnber of commrmities with female CDDs Bro Percentage Brr= *100 Total no. cornmunities in thc entire project area Br Nrrnber with comrnunity members as supervisors Bs Percentuge B; Anka Ti 9 69n," 39 0 39 0 0ob Bukkuyum 53 i9 l8 l3 340zo 680,o l0l 81 0 0 101 8l (, 0 09o 0o,o Maru 26 10 389 o 86 0 86 0 0oo Zurmi 9 E 899o 5t 0 51 0 ue.o 120 58 48o/s 3s8 0 s58 0 OYo 4'l wHo/APoc- D 24 Novernber 2oo3 2.5- GaPacitY building - Describe the adequac,v of available knowledgeable manpow-er at all levels. - where frequent transfers of trarned staff occur. state what the project is doing' or intends to do. to ,"-"dy the situation. (The most important tssue to describe is what megsytts y''31'9 taken to ensu're atlequate CDTI implementation where not enough knowledgeable manpower was available or if ita-ff are frequintly transferred during the course of the camparyn\' There is a State rro3eit Team with l,ong teim experi"rtl itt coordination of activities' Loeal govemments' onchocerciasis control t"atn. work with train health workers to ensure co mmunities treatment. During the treatmentyear there was a plan to train and re-train more health faciliS' staff and communitv volunteers, but as a result of non release of fund this could not be done' Health stalf at the frontline health facilities and active CDDs were used to see to the success of this year.s treatment ,ourd. It is hoped that when fund is available all health staff in the State would be trained /L WHO/APOC. ! 24 November 2003 FF o F e w p .ra p. w Fx tr 3 Ft oH F N l-.Jl'.) >.H 6 z : ^+liE z tD ^: a,Z-+ (?a F ot>a l+IEl=e OC o\ tD rD Gc Fl O N)o\6 ^-l ils 6- e z t! o a D? =q Ai o a t? tD O O O O O O O O O s t G t! (! E att-Jo\ \otJ \o O O O O zl H(D!, rt ==.Bo' ^H:l'l V t'fFa !9 0'=' o O ,< :l o A- [tr O O O -c o\ t! .! t! -Il-J f.-J O o\O \oO z 6 o O t! s-{ .d o Ip-o O O O l-l lD)ld taD l,-r, ;t ED oa g) rD a- !i(D' Ft .DE (D (D o+) o J .-1 E o (D A) Q (\ N(\ a- \ \(\ h\ o G !j \qI o a as -G ! d G" 6l cil \ o =00 S a a .: S- o s c 0! o (D n 19 ort a o oo LQ' {(Drt (D - D (D -P (D 19(a o o x t o o (D r (D o (D u2 o Ft \ tN 'o -p I l.JA zo o 6 TJOO B a c\ =tD G (D t-J O O Trainees Type of training CDDs Other Community members e.g Community supervisors Health Workers (frontline health facilities) MOH staff or Other Political Leaders 0ther (specify) Islamic Teachers Program management How to conducl Health education Man-agemart ofSAEs CSM SHM Data collection Data analysis Report writing Others (specrfy) Table 6: Type of trarning undertalien (Iick the boxes where spectfic trainingwas carried out during the reporting penod) Any other comments /+ WIIO/APOC- fl 24 November 2003 2.6. Treatments 2.6.1. Treatment figures lf the project is not achieving l}Oyo geographical coverage and a minimum of 65o/n therapeutic coverage or the coverage rate is fluctuating, state the reasons and the plans being made to remedy this, The project has a total of 120 communities and from the treatment report sent by the endemic LGAs 93Vo geographical coverage was obtained. The communities were merged by CDDs to form 116. This was done in Bukkuyum and Maru LGAs by'CDDs during ffeatment: this was due to CDDs attrition where neighbouring communities without CDDs had to be assisted to distribute the drug. The CDDs eventually could not separate treatment report where such cases occurred. The project looked into this issue and planned to continue advocating and training of more CDDs to address such issues. The therapeutic coverage attained was 8l%. 45 WHO/APOC. ! 24 Nor,'ernber 2003 Fl Fl F N ? gr e wc oa o- w t ,f xg) ^9 N) \o t)o\ Lrt(f) lJ) I = j.Q _sEti F -v;' ja g -.'u r., + 6 d * 5'Y.Br6q o o c (D U) o, se(D a t\)o N) o\ (,| UJ u) ^-lo'6i P oH= ;.6 F'dt o\ \o l..J v (^ (]) oo, -<JE *oa 5 5 @v \o(.) s {{ o\ 6\ \o o\ 9\ OQ ^:04s.i I da=.o6 t\)o b.) { t..J l.) t\)O \o +- -J N.J{ o\)o o\ 5 (,,r t'Jr Jo^' o.';^-3a+P6'.7 AEpi o =-aE e 5 FU o tr o o\o \o(I(,) I{()) o\ I o\(..l \o o\I 00 @ @ (,l o\ O\o @ P({^t') A, .o- di P aJ= zsg o\(,) -I6 (,l UJ 5 o\ tlJ @ o\ @\) Utr oo(,l{ s(,{ _z o)i:J0tui+ xf o 6X5r *t a 6 s oo\o @ @s\o {t, \oLar ^\ aofO@ ritrpa0atro ='.o \oyJ/ !.) \o (, t.)\o \o \t o\ o\ 14 :6'(Jc-i5;rE3 H &=6 F 5+a^ '' o 5 o{ o\ (])(^ t'.J o\ o\ (J.) (]) UJ(]) {\o "^7q3 a!- O !z a= **i,- i o ao 3r* H +q iX D X^.i l(' € =;vav,i = d9 li lo, tv- l(D l-, i o, (D A) o a Elrla d o t. g) F' (D o,lr) E9 (/)F E(! 4(! R" o\ € V1 6a e! 4 rrl lo tEt O) IB t;I tt, IE ool- (D ls) l(D lo lo- 0a l(D to IE ltl lOl l()lo loiIEItr 0a l(Da -l (! ED o -oa :/o c)o (Dt F) oe(} B E) o o .D o oat O) o. ?: oo ot B) oc(D ts(} -,o c)o a{\o (Do\EvED oo(D s: (D A\6eili ! =i L{J G!)BQ.i. Er.s(DS/Gfli\o. i$q tR-l s h;.: -llzi 9lEu $tcs -lats =t6r< E r * Eloi ar l-)a (Dlo + e,l8 s .616{' Ql* - olls gtEF 016'i 6ia-S -lx\ ol-s -loO AIO va\5\= ^*= "{ aD@ *a *dRE +9 qo s.o !D) dta\E:StaG-6Z S*E.e dfd aaDss (D S) e -]o t { :E o t o ,o E IJ z d oE tJCO 412 412Olc' OIE o)lc t$lc -lar -ld5l(D '6toElr olr3lo 'dlo:l- l+, (: I+, E 18 El8 e^lH E {a -'l= - I(DJ tt r.tr aD lE. < l=P lE. ='ltsS lt; da 16d l} ='iori l= 'ltglEi Bl-r'ho (D IOgl-E 6ro EE EJIP9 olP li8F EIl- 6-Els s E.os.a69 a= ) ap 6-=o=' *(D (n iti r'D e + vi F= I rl ta >9o-a =g+i'!,@e Po) €.(Do t(D !) >tz5lc E l8' -r l: d lFiF' TE'trt t(D :Jtoia lcl = liaqle a16 >4 lo. <lxol- IOlo ;.i sll FSiF N.r A{= s: iS\s u.s Nq. ,J( \' q,t \E' d's\s *-s$xCEL -tr.iTr] !sUrss.i '!*GX \A .ss -\ *'s i,st: sH -st\\'s* :s .Ci GI\ -"{. . O{ s F F s. E - €. : E$ E. s- GI s \ s s Gs$\ 0q R 90 tt s di Oe a \ uJ 'Uop i-)J- z o' C. C0 NJOOJ- Z.+.; =,i'irart ai-e iire taiiscs ui ai;stiitc=is*r';' iVlost causes oi absenteeism were as a resuit of mor,ements of nomacis w'ho move to the .,oiliiraiit ilii-r .tf il'ta a\juiltr, afi,j i;;ar -;r-rillatiiil!-.i siar ii,i' -i ur r' itrr19 ilCiii!(js' i'r-t'i'rii'= arcii=r-iiies ior cominuirtries ihar ciid rreatment ri-,-rnfig raii-rv seasoll: iike-r":se some votlth go tn search oi'meruai lobs. As such the proJeci iook a dectslon io contlnue ensurlng that i:]up i-:il i.\=i'aisgj ii,ere Cgri're..l +'ri. ! rris :i 2: 'pu't- +i li-lt :33r S ""L\Il. i-1i3.i1. LIJUs ',t*r* ^^i ^i '^ i^ rL^' '^^-ite ihe stress a,rd non-comiiensation bi mosi commtinities&\l\ru L(] u(] ilrdt ur]!r{tE LllE 5UE:\ dlu lltrlt' L-iu.i ii iriir iii L itii.- i t.isiiiir rrlr i Lia^asiiis - Cases of refusais rvere ciue to either personai or reiigious beiieis b1' some people; some iiiuuui;i;i;.r, =rir..: ii,,rg i: i;.,1 iiici;- ;iiiii;criiatu itr;ri- r,.itiio- .;.rii,; icci ii,ar ii,c ii.'rat. is iltrt rii eiisrer,ce ii,:<lire rire liieairir eiiucariiiir an iire oisease. -iire isianiic sciroia,-s ti'aitied oii L'L) I i pur rn thelr besi lo ensure thai reiusal ls io a mlnlmum ievel. lt ls hopeci thal tn lu'ruis :.ll p3optg ii) Uis c'ii:ilii'riiittles "',:ll 3ccsp'. treSti:i3ili. -i-+.-i ii.ir.iir drs{i-ib{ oii ii:rc.;ir:ind *.:i=iiitti sriiot ";iiirtist trriits i3..Ls; tiriii oeeurred during the i'ep.:r'ting pertod ano provrrie iirr ta-bie 8i tire ieqtii'ed inib rmaiion when available. lii ,rt:rt iilt ili ttt.;i "it,i ;tci iir11;i .iii.1 cJSes ti .tLi'ifiLr.i .Ttirii'.;i ti;ctri) iiri.iE) Lt'iti ili\ tiii.; ' o--\E ii{'k iil tiie hot-1' tliQ r I t i7,q li !' ! r)Lt " j) ! € :."+ f s-t i-a.:: !a i-p!_1^n r--l ,i -:iIYii 48 @ a a IE i q- l- + [-! u(D @I (t cs a\ ; -i ot -- f ..i, 2-, f/ t-L-r l I -1 F h - a a !_l (D P!+Ai,:- ifta!+ ;\ L v o;55=+ -=" a; -n?4' ! o .)f)t ,_e.fi -.i={;.t == r -<- '-1:"a- .! I I I I =a = S s S e C a1 a= (g LL _l Ltl i I ! I t tJ5. ..o I I ! I I 2 I ! I It' , + I I ! I I I iIi I IJ IJ \e LrC) JI I ,* I I It It- . - t.. i- -ja - Co_= o-; ^ 3 -joi;;r9. o-,= ,-a =|: -d4..r4 e - '= at i - a -l .i :. i = i =tu, = Yi&'6 1:l " -,=, F'.i; o 4.:- rE =: + E bl I I I IPI =!vi t i 5 ) ET G o ,-', - .tE > -_ - S C,a = 1i = { { {ap -Ja 5 I I i I lp !-- I I Ii-Ir I-^ .J (= t'J O M +. a rc, -i o i I =; ==r!f '4 -l i I TJ .\='.\ i ^\ .-r _\ = i.-- A t-- O I(DtD t- ': -- a=t ra i?qrH'' i== .: +(}= -tio cP+ -i!- ! v- -E-a- tnl;, -.E!UA -rJd -t t- t9l^-. -- l1i G -r:-t -lrDo tl- =lfea I-1 -- = '--:i! !H-j"i.-t\i.- o'tC)HA -trvE tiz 3E +:,r i=' oea l- -:oo=.E -ri'j --d+?4,(A +\;E E@+o EF\rcs=5Roa! i =. (*- -iJif{l +q *r.)oE+ Fryii* i='AFr v) S 3$ t'"- (D ?, BT e =? o g laii= lol-;- t ^\^\ l-_, l--i- ia lrl-r^\ L- a\ '.o lc-!?i:\t- I I I I I !t I I I i I I I \o ^\A,o I I I rl ,,;a1 tu- -j 7a ? a4= +5- r6 o -* n o "i? o =. =/) tJ z a -3 F) }J L -..1\o \o 6 ui: \o a-I \D 6 q - aJ\ .E o!J iu :: i J I I I I I ! ! , I I ! I I I i t I I t t t 2-7. Ordering, storage and delivery of lvermcctin Mectizan@ ordered/applied for by - (please tick the appropnate answer')' --- - *roH I wHO[ tlNlcr:'il NGDG./ Other (please speciS ) I\,Iectizant<. rleiir ered b:' - ipiease tick tiie dpPrapriate cinst er i DIOH I_] WHOil UNTCEEI riGDG./ Other (please sPeci$): Please describe hoii'I!{ectizail@ iS ordered a''rd hou'rt gets to the communtttes The NGDO (SSI) procured Mectizane for the project based on the requiremetrt froirr all en,lemic conrnrunities census up,jated. Tire Srate Mirustry- of Heaith coiiecte'l tlte prc'.iect's allocation from the NGDO and delivered it to endemic LGAs from where all lront line health facilities informed endemic corrrmunities. Communities collected their shares fr+nr agreed colleciion points. The number of tablets ordererl r":as lrased otr ^,Jre lotal polrulation of people multiplied b1' a factor of 3. ln the future, the State will be expected to completely talie over the task of orderurg Mectizan'B' tablets meaut tbr therr colrunluxtles Tabte i0: Mectiza,ir€' [nr,eniory {Ptease cclcl ntore rows tJ necessari) - iii;..+ it;'t tite re*e*itii;it: iier;;;a;ii;i i,ii;iei:; tiiiiecisti {itiLi'iit,1 { Lii't iiiu'i'i:efii'r After the cirstnbuuon. balance of the N{ectrzan@ tabiets was retumeci to the fiont hne health r'--i. r-. -i.. i.--.-),-.'-.-- -+--i-t-:-i -'::i-'i--'-'--:---i'-4 -lri.liiiai.ji-.iir.;il;riii,i-a!l'i''i;tii-a,i,ir ili riii fii-iri-irrdirli-.>. i iir'r is isL!i h) lltL !iit"!LLr l-\I/1 Lr ifr" ,:i., ,, ,1. Stat" Onch+cerciasis ClEce ie-i safe keeping at the state medi'rai sterre' The baiance returned rvili be useri ibr nexi treaiment round' 7" ' j'-':-'= ';sc;':i;;;iia.t.t;t';;;;'iLLiiL;'i'il';;;;i;c;i;i'i;it"t;i;i;'t;;';-'i;e;;'i'tii;iitirliti - !-:.r! LtrlLL i'; a1.... !IL.:LI:t.'L lftl (:Lat"l'L') i,.' hurt!tit atrr-s !)ersutina! tn liiY ptro-i!':! 4194. -"' - t- - iiic .,ui,I.ii',iiif iri;UiJ i;iacr.l iit .'iiatr'.; ni,icf i,i iviccii,=li,;i. ii;i,,.=ir iii;( i' 'i: ,'lt' don+rs ba-sed on ar! updatai census of all endemic comn-tunities r",-:thrin the prolect area, after approval and shipping NGDO collected MectizanG) meant for the State i,.,i;; i,\ii'Eti ;i.,,i, -n-.;-r;r"j ti;c ::=t; ;;ccircti ;t'; aii';cati;it Ii;; ciltit';ri' Li'i co,-ridinators g+t biectizanE, froin tire State's medicai store and iG ftrix gale tJie frotti line health f-aciiities their ailocations. it was at these agreeti points of coiiectron that all 'i'l'/),..f./]j- :!'.f... -.,,!.-' i.':,^t-' iiri:-i-rlrer o f lt'i eetiza tt ia iiit.iS RernainingExpircdlYastedLcstPcrscn treated UscdRcqucsted RcceivedN"-lur in stockState/DistrictiLGA lulUr+_J/L'5 JU.UUU 4-i-60U 138,314 I +,)_L-} I .1 50,857 {-'6-871 0 ii 0 il 0 9.438 102 487 0 i 147 (-)r)(-) i t-15-714 150,000 147,752Bukkulum Br,:rgudu l6-36845.273 0002745^300718 46-000Maru l5=3 t-11t 67() r) (t.i i 8()o+i {xxiN, -392Zurritr l9!t4t 5,210 762t)(l16J ?804J6 t126,1ffiI'O'IAL 24 I I aa seiected distri-irutors fiom the eirdetnic cotntrtuttities catne and collected therr Mectiziul,B' iolJ is trib uti on b as e'l on cens us upd ate c''-rrrd uc ted' The obiigatioir of lvfectizan@ order is to the state i.e. from FLHF to LGA tl'r€t; to State. Collection of Nfectizanro for fi'ontline healtir faciiitr br LGA coordinators at tire state's medical store. Collection of Mectizanr& for endemic contntunities tlr FLHF' ireaith ricrkers at the LGAS' irtedical siore. Notifl,communities to come for the coliection of ifiectizanG'at FLFIF ''o1 their selprted CDDs. Anr other commerrts a 2Z - -V\,Ti()iAI'OC. rn }r"t-r-eri-rltt 21i(i'l 2.a.Communityself.monitoringandStakeholderstleeting Has any training (o.f trainers) for community seff-monitoring been done in the prolect area? I-f so.l{hen2 Tabie i i comn1unih seif-monitoring and stakeholders Meeting (.4dct ro'/Ls il-ileedeLl) Desirihe liou.. the resztiis o{ the commtmifi' se'i.f- manitoriiig arid stakeholders ifieetings i'tttt'e of.fci-,|eul prrljei.t iiltpleruientaiit-ltt tlr ho.w the},-watit] he' tttilie,l ,]tiring, the next fi.eo.tttttnl eyc,lc District/ LGA Total # ofcommunities/villages No olCommunities that carricd out scllin thc cntirc Projcct arca No of Commuruties that I conductcd st alichoiders ,rreetBglSHM) None None None None TOTAL Z3 - 11Ti(lii\ll)Ll. 2:l l.iinriiiher 2tx)4 NOCPIZOTF 2-9- ,{tl Supervision Provide a flow chart of supervision hierarchy' NGDO STATE ONCHO TEAM LOCAL ONCHO TEANIS FRONTLINE HEALTH FACILITY COMIVII]NITY LEADERS I DISTRIBLTTORS (CDDs) COMML'-N{ITIES 2q V\,r i ioi A f.ixl . . l :l l'.Ii-,r-einher 2 () (l -l 2.g.2.Whatwerethenrairlissuesidentifieddur.irrgsuFeivision? o There rvas non-release of counterpart funds at state and LGAs lel'els' c poor support to CDDs bY some communities ieacing to attrition of distributors' . Non-selection of female as distributors' o Cases of few refusa]s in sotne ier'- coi-tliiuiiities' o Partial commitment to cDTI activities in some few endemic communities' 2.9.3. Was a superuision checkiist used? The developed checklist for supervision by APOC lvas used during supen'ision and mo ni torin q of pro gramme i ilt l-rlententation' 2.g.4. Whatwerc the outcomes at each level of CDTI implementation suPer*;isian? . The State leve! was sLrpervisecl by the NGDO/|JOCP and poor fi'mding tc the prc-ieci $,as noterj oespite inciusion oi cDTi burigei into rne Primary Heith Care marn butlget, and ellbrt was inade tbr tire State arrri LGAS to support the pioject but u'as not successful during the reportjng penod' o supervrsion at the LGAs and community levels did not cover most .orlnlrrniti.s. Feu u'ere oirl-,,'si;ot-cl;eckeii. Recorri keepine of IIDTI actirities in sonre LGAS and comtrruruties r.r'as not properly done w'hile sonie nere' community involvement as a w'hole to GDTI was partial in some feu' cornrnuntr-ies- 2-g-5- Was feedhack given to the penson or groups supervised? o Observations were discussed with all the supervised leveis' The recommendations *'ere foilo'r'ved throug! during subsequent CDTI aeti';ities' Iniplemei-itatron of these recommendatrJrs **.* ho**''er madequate, thus the overall performance was not as planned. The project attained its treatment niriar-t i'-p vul!!!r t !' 2,9.6. How was the feedback used to improve the overall performance of the ----:^-rOpi uJrtt i o parmers concemed ivere given feedbacks stressing on areas that the Proiect is rn,eali ur and the hkelv consequences and soluttons o[',he w'eakness- Ther" rvere at last encouraged to fully participate and carry out their roles and resilonsibilities a.Jstated ln ti-,e dn'rl sirategr. This is particularlv'oecause it is parl of the front line iredtir facilrty rrorkers:'prirnarv assi€lntnent. This resulted to a successful treatment )'car' - \\1IO/nPa){'. lJ }'Iorembei' :0r r'i SEGTION 3: $uPport to GDTI 3.1. EquiPment Table 2.Statusofequipment(Pleaseatldmorerowsi-fnecessarll) d) Generator +Contliticn of the equipmenl iF-Functi onul, CNFR-Current lj, nun-fitncl iona! btt rePui r*b ! e, lilO-Written o/l). IJou, <ioes the project intenci rc mainmin anci repiace e:tisting, equipmeitt and other Hiateriais;) c Usine these equiprrrents for CDTI actirittcs oni-r *iii be mainiaiiied tluougirtlreuseofcorrrrterpar.tfurr.jsifrrradeavailable. Source Type of Equipment APOC MOH DISTRICT/LGA NGDO Others No. Condition No Condition No. C<xrdition No. Condition No. Crmdition I. Vetucle I Farly fi.rnctional 2. Motor cvcle 5 Fairlv lunctional I Fairlv functional 3 Non l'unctrcmal .1 Computers I Fairly f,rnctronal 4. Printcrs Fairi.v fi-uictional 5 Fax Machines Fairly ri'*.ti,rnql (r Others Fari_y functional 'r'r Ilr,"r-rle !a '[airl].- functrona! Nan t-r;nctronal b) I.Vi Videtr I Fairiy hrnctiona'l r t ()ri.r hea,l l'rri I c'ctrrrr' licrer'u I:airly fr-inctionai I F'airly lirnr'tir.rna1 26 1\,1 Ia)iA lf)C. .r 24 Ncn'eil-rl-€r l('x-)4 I 3.2 Financial contributions of the partners and communities Table 13: Financial contributions by aII partners for the last thrce yean (Year 6) Contributor the project. - Additional comments - If there are problems with release of counterpartfunds, how were they addressed? Major issues accounting to non-release of counterpart funding-have been the regular changing of policy makers at tile State and LGAs govemment- levels. bureaucracy and lukewarm attitudes by some of the stakeholderr. --rfr" project however in collaboration rvith the supporting NGDO poiO * adyocacl' r'isit to tf'" omciats of Minisqv of Health and liaised u.ith Director of pHC in Minist' of Locai Govemments so that counterparts can be release to Yeer { Year 5 Year 6 ) TOTAL AMOL]NT (CASH) Budgeted (us$) TOTAL CASH Released lus$) TOTAL AMOUNT (cASH) Budgeted (us$) TOTAL CASH Released (US$ TOTAL AMOI.INT (cASlr) Budgeted TOTAL CASH Rcleased (us$) MOH (Central + Provincial/State) 3,703.70 0 3.62318 1,521.73 10.669 0 MOH (District/LGA) 0 0 0 0 5.023.62 0 LocalNGDO(s) ( if 0 0 0 0 0 NGDO partner(s) 2,415.63 2,639.39 5,371.31 5,581.25 6.362 4,989.77 Others APOC Trust Fund 0 0 0 0 0 0 9,645 20,265 14,7tJZ 10,000 108.834 0 TOTAL 15.,794.33 22,9A439 23,696.49 17,102.98 130,888.62 4989.17 21 - WHOiAPOC. 24 November 2004 3.3. Other forms of community support - Describe (indicate forms of in-kind contributions of communities if any) The communities have been supporting the progranlme as much as they can through re- selection of most distributors that do refuse to'con"tinue u'ith the distribution or go1 a worli or have to relocale. some few members do assist their cDDs wrth tittle funds n'hile others do appreciate or motivate CDDs verbally. Distributors during the year under review gave mArimum support to the programme by distributing the drug u'rth little or no compensation from membeisof their respective communities' 3.4. Expenditure Per activitYr Indicate in table 11, the amount expentled during the reportingperiodfor each actNio' lnted. Write the amount expendid in US dollars using the current Uruted Nattons exchange rate to local curreniy' Indicate exchange rate used here Table !4: Indicate how much the project spent for each activity' listed belo6' during the reporting period. Source(s) ofExpenditurc US SSI SSI SSI SSI SSI SSI SST SSI $ 29.976 $ 29,300 $ 50,000 $ 57.900 $ 51,477 .6 $ I 16,798 s 119,729 $ 178,520 $ 633,701 commurutY Mobilization and health education of communities Training of CDDs Training of Islamic scholars (Re-Training) Training of health staff at all levels Supervising CDDs and distribution Intemal monitoring of CDTI activities Advocacy visits to health and political authorities IEC materials Summary (reporting) forms for treatment Vehi cl es7 M oto rq'cles/ bi c1 cles maintenance (Maj or parts replacement, RePairs, Fuel) Ottrce Equipment (e.g. computers, prinlers etc) C o mmunication (TelephonelFai, Post/C ouri er) Travel to project areas for various CDTI activities central collection Point ofDrug delivery from NOTF HQ area to dataandOthers - TOTAL ZE - WlIO/APOC- 24 November 2ot)4 163,780 trcatedTotal number of SEGTIOII 4: SustainabititY of GDTI 4.1.lnternal;independentparticipatorymonitoring;Evaluation 4.1.1 was Monitoring/evaluation carried out during the repofiing period? (Tick any of the foltowing which are applicable) Any comments or exPlanations? Yes Yes 4.2.1. a Yes Other Evaluation by other partners 4.2. sustainability of proiects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period?NO Was a sustainability plan written? Yes When was the sustainability plan submitted? What arrangements have been made to sustain CDTI after APOC funding ceases in terms o[: Yes Year I Participatory Independent monitoring No mid Term Sustainabililv Evaluation 5 year SustainabilitY Evalualion Intemal Monitoring bY NOTF a Planning at all rrclevant levels planning meetings at both the State and Local Govemment levels u-ill be carried out before ah" "o***cement of subsequent treatment rounds' Advocacy to stakeholders will be carried out regularly to ensure total commitment at all leveis to the sustainability of the work plan developed on CDTI activities. Mobilisation, health education and sensitisation of endemic communities shall be of priority for communities to take ownership of CDTI programme' a 23 - WHO/APOC- 24 Novernber 2004 4.2.2. Funds Advocacrr visits to relevant partners will be carried out for release of counterpart funds towards sustaining the project' 4.2.3 Transport (rcplacement and maintenance) oTheMinistryofHealtharrdendemicLocalGovemmentAreasrvill c,ontinue to maintain tt " "*i*iirrg proi*", vehicles and motorcycles provided bY the suPPorting organisations oEffortwillbemadetoensureprovlslonofadditionalmeansof transportati'on to the project at State and LGA levels' 4.2.4. Other resources o Other resources would be maintained and replaced as counterpart fund is released b1'the State and the LGAs' o Health workers from non endemic LGAs wrll be trained this is to eripose them to CDTI activities in event that they are posted to endemic areas' 4.2.5. To what extent has the plan been implemented o SOCT/LOCTs developed a comprehensive GDTI work plan' This was follorled through. o Monitoring and supervision was carried out in areas where problems \^'ere anticipated using the checklist developed by NOTF' r Frontline health facility workers supervised project activities at their own levels' o Mectizan/B tablets rvere collected by the endemic communities at agfeed points' likevise I-GAs. o Endemic communities were mobilised, health educated and sensitised on how to take up CDTI responsibilities at community level' . The release of counterpart funding is hoped to improve as advocacy visits are on going both at the state and LGA levels' .TherervaslullusageofvehiclesandequipmurtforCDTIactil,ities. ^-.3. lntegration outline the extent oJ integration of CDTI into the PHC structure and the plans Jbr complete inlegration: 4.3.1. Ivermectin delivery mechanisms 70 - WIIOiAPOC. 24 Novernber 2004 vehicles for other health progrilmmes such as disease sun'eillance' NPI and staff were used bv the project 111 ,t. l.ti..y of Ir..*..iin to the endemic LGAs and for collection of reports and balance of drugs. r-itewrse Front Line Health staff carried out cDTI u"tiuiii", when implementing other community based health programmes' 4.3.2. Training Primaryeyecarewasintegratedintothepasttraining.oflg":*forlvermectindeliverl' in the year zoo+. ne-trainlng and t rr.glJtg-.*iU alltributors for identification of individuals with eye problems in their respective communities rvas scheduled again for year 2005, but due to lack of fund this was not implemented' The project plans to caIry but thrs activity next year with the avarlability of fi'rnd' 4.3.3. Joint supervision and monitoring with other progranrs NpvDisease surveillance and CDTI staff help one another in supervision and ,roriio ""g, thro u gh inter pr o gl amme co I I ab o rati o n' 4.3.4. Release of funds for project activities A combined budget for all programmes under the Department of Disease control had been established, but as ii o"",ried no fu.d-*as released during the year under *]::]:^ Nevertheless it is hopJ that money *,ll be released to the programme as the needs anses for subsequent trealment year rounds' 4.35. Is CDTI included in the PIIC budgett Yes 4.3.6.DescribeotherhealthprogrammesthatarrusingtheCDTIstructureand how this was achieveO' Wtrat have been the achievements? Health workers in other community based healtl proglammel and c.oos were trained on the CDTI stratery * *.il as Primary Eye Care' This is anticipated to help them ,r. tt" stratea in other related programmes and in screening' identihcation and referral of eye puti*tt in their communities using the GDTI structure. 4.3.T.DescribeothersissuesconsideredintheintegrationofCDTI. The strategy is cost effective; people at the grassroots can easily be reached by primary health .u* ,"*i."s. This will help ttreri take certain responsibilities towards sustarning and developrng health prograrnmes' 34 - WHO/APOC- 24 Novembcr 200'1 4.4. OPerational research 4.4.l.Summarizeinnotmorethanonehalfofapagetheoperationalresearch ,r.O"Juf."" in the project area within the reporting period' There was no operational research carried out within the project area during the vear under revierv. 4.4.2. How were the results applied in the proiect? SEGTIOI| 5: strengths, weaknesses, challengest and oPportunities -ListthestrengthsandwealmessesoJ.CDTIimplementatioltproCeSS. - List the challenges and indicate how the-"- were addressed Strength: - Severe adverse reactions continued to decrease' - Integration of Primar,'Eye Care into-CDTI' - Trained and committed SOCT/LOCTS' - Commitled NGDO - Selection of distributors by a good number of communities' - Collection of Mectizan@ by commumttes' - Distribution of Mectizan@ by most cDDs despite less or non-compensalion b1'their communitY members. \JVeekness: - Non-release of counterpart funds for the year under review both at state and LGAs level' The need to continue training Islamic scholars |{on availabilitY of female CDDs Frequent movement of the nomadic population' Non compensation to CDDs in most communitiet , nr^^+i-o-rpr tn ' Reluctance by head of households to allow selected cDDs to dispense Mectizan@ to thetr wives inside the houses. Advocaq, visits to key stalieholders to solicit for the release of counterpart funds; creatlng awareness for female 6On, to be select.i -O sensitisation for CDDs to be compensated are still on. Likewise, emphasis is still on horv CDDs rvill conduct mop-up treatmenl for a good therapeutic coverage. 3L - WIIO/APOC- 24 Novcmber 200'l SEGTION 6: Unique features of the proiecuother matters 33 - WHO/APOC. 24 Novr'rnbcr 2004