Report of independent monitoring of CDTI activities in Delta State, Nigeria, 15 August to 5 September 2000

jDELTA STATE . WHO/APOC/CDTI PROJECT i|IGB REPORT OF IT\IDEPENDENT MONITORS OF CDTI ACTTVITIES IN DELTA STATE, NIGERIA T]NDER THE EDO/DELTA PROJECT 15 AUGUST TO 5 SEPTEMBER 2OOO SUBMITTED TO AFRICAN PROGRAMME ON ONCHOCERCIASIS CONTROL (APOC) SEPTEMBER 2MO I t fllfi0n lrrmilomfl tllt'l0lt ufioft u0l, uarfi*MHw$l txlrfrLliourH luilfiu PINK GREEN WHITE BLACK HTPER MESO }TYFO LGA BOT'NDARY RE9U I 7 0CI. 2000 APOC/DIR i, )I _t REPORT OF II\DEPENDENT MONTTORING OF COMMT]MTY DIRECTED TREATMENT WTTH TVERMECTIN IN DELTA STATE, ntlGERIA T]NDER TIIE EDO/DELTA PROJECT 15 AUGUST.5 SEPTEMBER 2OOO DR JOSEPH OKEIBUNOR Department of Sociology/Anthropology University of Nigeria, Nsuktca Enugu State, Nigeria DR. (MRS.) EDrTrr NNORITKA Department o f Dermato lo gy College ofMedicine University ofNigeria Enugu Campus, Eougrt Nigeria DR ODU BAMGBO$E National Onchocerciasis Control Programme Primary Health Care/Disease Control Federal Ministry of Health Lagos/Abuja Nigeria Submitted to: TEE DIRECTOR, APOC African Prograrnme for Ochocerciasis Control Ot agadougotl Burkina Faso By ( t 3TABLE OF'CONTENT I I List of Acronyms Acknowledgement Erecutive Summary Introduction Methodolory Results Discussion and Conclusion Recommendation Appendir 4 5 6 E 11 t6 33 35 i) ii) Study Instruments Samples of CDD Treatment Registers t 4LIST OX'ACRONYMS t t 4WD f.i. Ag. APOC CBIT CDD CDTI FGD HS II)P IEC LCIF LGA LOCT MIS NID NGDO NOCP NOTF' OCP PHC RBF REC REMO SOCT SPO TB TOT vHw wHo Four Wheel Drive ad interim Acting African Programme for Onchocerciasis Control Community Based Ivermectin Treatment Community Directed Distributor Community Directed Treatment with Ivermectin Focus Group Discussion Household Survey Ivermectin Distribution Programme Information, Education and Community Lions Club Internafional Foundation Local Government Area Local Onchocerciasis Control Team Management Information System National Immunization Day Non Govenrmental Development Organization National Onchocerciasis Control Programme National Onchocerciasis task Force Onchocerciasis Control Programme Primary Heahh Care River Blindness Foundation Record (CDD Treatment Record) Rapid Epidemiological lvlapping for Onchocerciasis State Onchocerciasis Control Team State Project Officer Tuberculosis Training of Trainers Village Health Worker World Health Organization I 5) v ACKNOWLEDGEMENT The tearn would like to extend its sincere gratitude to all those that assisted it dwing this mission Of special mention are the following: o The Honourable Commissioner for Healtb Detta State, o The Permanent Secretary, Ministry ofHeafth, Detta State o The DirectorofPublic Health, Detta State, o Chairmen of all the Local Government Areas visited o The Primary Health Care Coordinators ofall the LGAs visited o Honorable Councilors o Members ofDelta Stde Onchocerciasis Conhol Team o Coordinators and Members of Onchocerciasis Programme in the LGAS visited o The l,eaders and members of communities visited o The Community Directed Distributors ofthe communities visited [9 Edo/Delta Project Adminishator, Mr. J.O. Eguagie, and the entire Statrin the project 9ffice ar9 also appreciated for all the wann hospitalrty that was accorded the team ailrg the mission t 6I (: EXECUTTVE SUMMARY The Independent Monitoring Team that was constituted by APOC lvlanagement to visit Delta State Community Directed Treatment with Ivermectin (CDTI) p.3""t, Nrgerie lory lS August to 5 Sepember 2OOO, had Dr Joseph Okeibunor of ihi liepartnent of lociology/Anthropology, Universrty of Nigeria Nsukka as the Principal Monitor. DrMs.) Edith Nnoruka of the Department of Dermatology, University oitligeria Enugu Canrpus and Dr O Bamgbo$e of Federal Ministry of Health, Nigeria were the other monitors in the team- The team had the Delta State SOCT and LOCT members as local ryrq":. The assignment commenced with a bniefing of the Project AdministratorGLOBAL 2000, State Onchocerciasis Control Programme and HealthPolicy }dakers, on the terms of reference of the Independent Monitors and the areas u&ere their cooperation would be required. The methodology and instruments adopted were the same as those 9.:.t"p.a inOuagadougou and finalized in IGbale, Ugandi The objectives were eqtrallyleft as stated in Kabale, Uganda Six Category 4 and 24 C-ategory B, villages were selected through an elaborate, multi- {1g9 sampling procedure. The findings show varying degrees ofthe establishment of theCDTI prccess in the APOC LGAs of Delta State. Some serious elements of the CDTI process were noticed in the communitieVvillages visited. All the same, empbasis still needs to be placed on the sensitization of all the communities toward their responsibilities and the full involvement of the health service personnel and the utilization of pHC facilities in the planning and implementation of CDTI activities to engender ownership and sustainability of CDTI. The key findings in Delta State under the Edo/Delta CDTI project include the following: o CDTI bas taken offonly in seven LGAS out of nine eryected to be implementing the programme in Detta State. Ika soutu which is hlper endemic, has not implemented the CDTI process due to lack of training from the SOCfs. o Some CDDs were not fully conversant with the CDTI concept. They were not able to recold correctly in the registers, understand the concept of lousehold. This could be an element of quality of training and supervision o The standard of haining, in tenns of quality and quantity, was good but still has t991ts for improvement. Training was at community lwe[ as -recommended by APOC. Training materials were adequate and trainee-trainer ratio was managsafls. o Most supervisions were done before distribution and without any standard checktist o The issue of counterpart fundlng by the State and some LGAs is still problematic. o Reasonable integration of Onchocerciasis control into the other primary health care programme/activities was observed in a majority ofthe LGAS visited. I 7, I Generally, CDTI proqragme implementation in Delta was reasonable. Deqpite the Fr9i*p in logistics, |OCTs show high enthusiasm in the success of the CDTI approachin the State. Faced with late release of funds and unavailability of transpor! one of theSOCTs used his personal car to train five LGAs under his jurisdiction This was confirmed from interviews with the SpO and some CDDs. A high level of awareness on the disease and benefits of the drug bas been created by theDelta State prcject. Communities showed appreciable terlt of zupport for theprogrammes and willingness to monitor the implementation of CDTI. The policy makers also expressed similar political will and support. The CDDs exhibit nign fiteracy levels, necessary for accurate-record keeping and reporting, crucial for the -CO11 process. A conscientious prcsecution of the CDTI pnocess, niog.a on these positive features and some determined efforts by the Detta State prroject will no doubt yie[a tne desired frgits. Based on these finlinqs the following recommendations are being proposed to enhanceCDTI implementation in this project area: Continued reorientation, training and involvement of the health service personnel atpo!:v and implementation levels on the APOC philosophy and theh roles in'the CDTI as well as its integration into the pHC system shouid be intensified. Adequate time should be devoted to the project for proper dialogue with community leaders on the benefit of the Ivermectin treatment, their roles aoJ commitment in thelong-term sustenance of the treatment process. They should be rnade to be aware of their ownership ofthe progr€unme and right to rnake the necessary decisions. More personnel from other cornponents of the PHC, media and educational institutions with skills in health education, mobilization, and gender issues should be co-opted inCDTI implementation activities at all levels. Steps itoUA be hken to increase puUti"ity of the CDTI programme as in other disease control progftunmes. A^d:li!g9 attempt must be made to imFrove the quality of record keeping at all levels ofthe CDTI implementation in the State. a o D rI 5 8a I INTRODUCTION 1.1 General Background Ntgeria, which is Africa's largest and most populated county, with well over 100 million people, still remains the worst affected with Onchocerciasis. An estimated 30 million persons are at risk. The burden of Onchocerciasis is high and is a major contributor to the low socioeconomic status of the agarian population-lirring *o*d the numerous frst- flowing streams and rivers in the country. In Nigeri4 mass treatment with retizan@ (ivermectin) has been on-going since 1991, with the assistance of LJMCEF and various NGDOs, like River gtindness foundation(RBF), AFRICARE, Sight Savers, Rotary International and Lion Club. These agencies are now partners with the African Programme for Onchocerciasis Control (ApOC). APOC was established in December 1995 with the main objective of setting up an effective and sustainable community directed treahnent *ith ivermectin tCbnlprogramme in 19 endemic countries. APOC's stratery is based on the mectizan@(ivennectin) donation programme of the Merck Company Inc. Studies have shown that mectizan@, is well tolerated and effective in reducing microfilarial load, improving ocular lesion, skin lesions and reduction of transmission The studies further .".t *t it has anti-helninthic, anti scabetic and anti pediculosis effects, ufiich will increase its acceptability in the endemic communities. Ihe CDTI project proposals are based on a partnership between APOC, the National Programmes and several NGDOs. The first grants were awardet, n lgg7. Each project is funded for a maximum of five years. During this period, it is expected that ApOa support willdecrease proportionately to that of the othei partners and-that the cost of treatmentper individual will reduce by 90 per cent. tn additioru it is eryected that the National onchocerciasis control Programme (Nocp) will continue to manage their CDTI activities for up to 15 years after APOC, in order to guarantee effective control of Onchocerciasis. APOC's philosophy for CDTI is to ensure that the recipient communities own theprogamme in order to sustain it. The communities themseives detennine the activities. They determine where to obtain their mectizan@, ufuen and how to distribute it. They select their community directed distributors (CDDs), collect information about coveragethat help the determination of programme success. Unlike the community b"*d ivermectin treatment (CBIT), the CDTI is a process building up based solely on the experience ofthe community members, and consequently, enhancing the decision making and problem solving capacity ofthe communities. I t 90 I 1.2 Delta Background Delta State is located in the southern part of Nigelia. The State lies between longitude 50 00r and d +st East and latitude so o6t and d Ioi N"rtl" It is bounded on the North by Edo State, on the northwest by Ondo, Anambra on the east and Rivers on the souheas. On the southem is the Bight of Benin, which covers approximately 160 kilometers of the State's coastline. Dgltu is generally low lyrng without remarkable hills and has wide coastal belt interlaced with rivtrlets and streams which form the Niger Detta The River Niger washes the eastern and southeastem boundaries of the State, with Asaba, the capital bcated at itsbaok. Detta State has an estimated population of 2,570,181 persons with 25 localgovernment areas (LGAs). Out of these LGAs, ten are hyper/meso endemic. It is estimated th^t 565,M0 persons are at risk of Onchocerciasis in ihese twenty-five LGAS. Following the Federal Ministry of health's inaugnration of NOCP and the nationwide v@tor parasite studies in 1988, the then Delta State was identified to have an endemicity level of concern Th1 Rapld Epidemiofogical Mapprng of Onchocerciasis (REMO) of indicated high prevalence of the disease in the *"*. - - -CPT is being imPlemented in seven of the ten hlper/meso endemic LGAs. Idassdistribution with ivermectin started in the State in i-gg+ *oo after the REMO was completed. This was initially by the River Blindness Foundation (RBF) and later byGlobal2000 River Blindness Programme. Distribution has been in collaboration betw,een the State Govenrment and Lions Club International Sightfirst project, *ho" community based distributors (cBDs) were paid )+1.00 per person tr"ut.a. - ln 1997, the Lions Club International started a devolution process, which is considered similar to the APOC CDTI approach- Training of LOCTs was left to the State. The LGAs carried out taining of cDDs by Locrs/DHS at the district level In 1998, tlc programme submitted a CDTI proposal to ApoC, which was approved fortunding. Global 2000 River Blindness Foundaiioq which is ihe i.pb;.tirg NGDOpartner, decided e1 sp5tzining the devolution process started n lgg7. ite projeci has just completed its first year of implementation oreon in Delta state. Currently, the nine hlper/meso LGAs are eryected to be implementrng CDTI but only seven have commenced CDTI implementation The present report outlinis the findings of an independent monitoring mission of APOC supported COn project io O"ft" State,Nigeria It must be noted, however, that Ika South, one of the hperLndemic LGAs tbathas not commenced the implementation of CDTI fell into ttre ranaom *-pd of LGAs studied. , al l0 1.3 Team Composition The independent monitoring team that was constituted by NOTF, Nigeria, on behalf of APOC to visit Delta State CDTI project, from 156 Augustto S6 SepteiUer'2OOO,had Dr. Jgsenh Okeibunor, of the Department of Sociology/Antlropology, University of Nigeria Nsukka as its Principal Monitor. The other monitors included p. Crr,arl rditr, Nnoruka, 9f the Department of Derrnatology, College of Medicine, University oi Nigoiu, Enugu Campus and Dr. O. Bamgboge, of the Federal MinistrJr ofHeahb Niieria t[" t"u- "t*bad members ofthe Deha socr and some Locrs asiocal guides. 1.4 Terms of Refercnce The team was constihrted with the fouowing terms of reference: l. S-uccinctly document how ivermectintreatments were undertaken in a sample of communities with approved CDTI project in Delta state, Nigeria 2. Assess community involvement in drug collection, decision making on the period and modes of distribution, the selection of distributors, and the wil'lingness of the community to accept and bear these responsibilities designed in ttre CDTI process. 3 Document community perceptions of CDTI processes especially the issue of ovrnership, and expectations for onchocerciasis contril, h*d on theseperceptions and eryectations determine the degree of satisfrction of the community with the different progamme activities ard o.rt.o-r. Assessthe quality of training received by CDDs and health personnel involved in the project. E)Gmine the record books of the CDDg and assess the quality of record keepifg and-^their ability to keep accurate records. The same applies to the heatth scrvioos, staffon the project Determine the number of communities and eligible treated ana corafii*ffitfirigs with records of the CDDs and the records at the other levelr OC&trc:St"" -level records.) Determine whether the health personnel participated in ivermectin distribution and assess the degree and quality of supervision by health staff (and the quality and orientation ofthe health staffto the CDTI) Identi& constraints in the distribution and recommend appropriate measures toAPoc management to be taken before the next round oftr;atments. 4 5 t , 6. 7 8. o11 9 Discuss the prospects of sustainability based on the findings above. 2. METHODOLOGY The. npthodology used for the selection of the villages was a follow-up of the methodology that was developed during the meeting of trc nine monitoring team members in Ouagadougou in 1998. In a review of the tools, in a tool development workshop in Kabale, this was firrther refined to include a few oith" things tbat were not pr-eviously taken into account. It was therefore decided during tnat meetiig that selection of villages would be based on both the endemicity and distan; from the l&tn services. 2.1 Study Design For the monitoring conducted in Delta State of Nigeria in August-september 2000, a cross-sectional research design was adopted. This desrgn ** *^idered the rnost appropriate to generate the needed data and meet the rtudt (monitoring) objectives. Thedata collection exercise consisted of a triangulation oi qualitative-and- quantitative instruments designed to collect inforrnation tom different segments of -tfr. targetpopulation 2.2 Population Jn9 tarcet population for the monitoring exercise consisted of four broad groups. Theseinclude: l) Health Personnel involved in the CDTI process at various levels;2) 2) Village leaders; 3) 3) Community Directed Distributors (CDDs); 4) 4) Household members in the hper and miso endemic Local Government Areas(LGAs/communities contained in the REMO result for Delta State. On the ufuole, there were four meso and six hyper and fifteen hlpo endemic LGAs.However nine, with a populationof 424,516 persons, out of the t"" frl,pol-"* endemic lGS were expected to imFlement CDTI in-Detta State. These ,r"-U* Northeast, IkaSouth, Aniocha Nortb, Aniocha Soutb Oshimili Nortb and oshimili South- others areNdokwa East, Ndokwa West and IJkwuani- The tenth, which is Isoko was not covered in the proposal. All the same, only seven of the nine LGAS have actually commenced CDTIimplementation in Delta State. The seven LGAS oover a population 291,527 persons in354 villages. t a t oa D t2 2.3 The Sample and Sampling procedure A study sample of thirty villages was chosen usrng an elaborate, multi-sage, random sampling procedure. The sampling process began with strati$ing the LGA5 by levels of endemicity. Since treatment focus is prioritized based o, [1rp"r and meso, the hypo endemic LGAS were excluded from the sampling. Consequintly, four hyper and rwo meso endemic LGAs were chosen through a simFle random *pti"g pro"rs (balloting), utui-ch yl applied 1o *l *qpling stratunr The hlper endemic I,Cas sampled inchdiOshimili North, Aniocha Nortb Ika Northeast and Ika Souh- The samPled meso endemic LGAS were Ndokwa East and t kmrani. Ttre communities in each selected LGA were listed on pieces of paper and one community was randomly selected by balloting. The communities sampieOlbrough this process were Illah, Abavo, Owa Aleru, Ezi, Iselegu aod Obi-Obeti from Qshimili N"rtn,Ika Soutb, Ika Northeast, Aniocha Nortb Ndokwa-East and Ukqnrani LGA5 respectively. However, from Ndokwa, Aniocha North and Ika East, a second community was selected to make up the number of vilIages for the study, because these communities had less thanfive village. Thus, in addition to the initial selection Owa Oyibo in Ika Northeast, Onicha Olona in Aniocba North and Oloa Ossissa in Ndokwa East were equally selected for the study. One village each was taken from these communities tbrougL u *,rrdo- sampling process. Category A and B Villages: tlavitg selected the six communities, one from each of the earlier sampled LGAs to be Y"lt"a, the villages in the chosen communities were listed and classified according totheir proximity to health facility that serve the respective communities. This was to enstue the selection of Categories A and B villages on the basis of near and frr. Villages were considered near to heahh frcilities if they are located within eight kilometers from health frcilities. Conversely, villages were considered frr if they i. -or" ttr, .igltkilometers from any health facilities. In two of the communities, namely Owa Alero and Adonishaka, viltages far from thehealth center were selected as category "A" vitlages. [n other communities villages close to the heatth center were taken as category *A" villages. The reason for this variation isfound il the simple logic of all the 'rritt"g"r in the Lmmunity being disadvantaged in terms of the non-existence of a community health frcility. It was also reasoned that the {arthest village might be much mote dira<ivantaged in this circumstance and thus calledfor an in-depth understanding of its situation Mor*rr"r, such communities may sufferpoor coverage in heahh related progammes and also lack adequate heahh education Next was the selection of the Category "B" villages. To do this, other villages in the !o,T*ity were plotted on sketch rnaps ofthe community and categorized in; near andfar from the chosen Category *A'tflage. Two villages in eactr community were sampled by simple random sampling process from the villages near to, and frr from the It3 CaPggry "A" village. This gave a total of four Category B villages for every Category "A" village chosen for the study. (See Table lA below for a listing of the *-pf.a villages) Table A1: Local Government Areas (LGAs)/Communities and Viltages Coverrd: Households: I1-eacn Category "A" village sampled, fifteen households were chosen To do this, the village is carved into tluee clusters guided by the village head and local guides. The systernatic sampling approach was then applied to selecifive dwelling unitJ from each cluster. lhe samrling intervals were determined tbrough a quick istirnation of theou-F. o_f dwelling unils ineach village-cluster. This ditrered from one village-cluster to another. In each sampled dwelling unit one household was randomly chJsen for the lreatment coverage study. Furthermore, to check on the correctness of treatment, one household was randomly chosen, and the dosage for one household member, randomly selected and crosschecked. t ' Locel GovemmentArers (LGAsVCommunities cA'Vilhgcr sB'Vilhges Oshimilif{sfth Glrh) Eyper OgbeObi Umuagwtr Ajaji Ukwumege Umutei Anioche North (Ezi) (OnicheOlone) OgbeObi Ogbeofu Umuokoko Ishidrye Umuolo Ike Northeast (Owe ehro) (Owoyrbo) Alegwe Alionye Alugba Ebotr Ezomoh Ike South (Abavo) Hyper Ekwuoma Igbogili Oyoko Ekwueze Okpe Ndokwa Eest (Iselegu) (Olm-Ossisse) Meso Ogbe Okpala Ikolobia Ogbe Eboh Ogbe Obha Oloa Ossissa Ilkwueni (Obi-Obeti) (Obinoba) (Adoni-Shaka) Meso Azungwu Obei Aja-Obeti Emektme Obinoba Adoni-Shaka Hyper t4 a a o CDDs and Vtllage Leaders: I" *.h Category "A" village sampled, the village leader was purposively selected andinterviewed. The village CDD was also ptrposively sampled *a i"t"*i"wed. In cases where there were two CDDs both of them were interviewed, but where there were rnore than two CDDs, only two were selected by balloting. limilarly, the village leaders of the C-ategory'8" villages were purposively chosen and interviewed. The village CDDs were also purposively "hor"o and interviewed where the CDDs were one or two. In some villages with more itran two CDDs, two were randomly selected for the Category'B" villags CDD interview. In some villages, however, CDI1 interview could not hold because of the absence of any CDD figure duriry the study. Heakh Personnel: Various cadres of health personnel involved in CDTI process were purposively selected and interviewed. These included Supervisors, focal OnchocerciasG Control Team(LOCT) members and Coordinators. The Coordinators of Primary Heahh Care and Health Offrcials at the State leve[ involved in the CDTI process were also purposively selected and interviewed. The purpose ofthese interviews was to e)@mine the orientation to CDTI process and provide information on the records and quality of training they receive and/or give on the CDTI process. Instruments Eight instruments were used to gather information from both Categories (!{', rurdl c.3rr villages. Copies ofthese instruments are included as appendices to this report. l5 Table A2: Summary of Instruments and Sampling Issues * fnstrument Category of Village/Unit Sample Sampling Procedure In-depth interview & Record review with CDD A&B l -2per village Purposive (Simpte randorn, where there are more ttan 2 CDDs) Household coverage survey A l5 households per village Mufti.stage (i.e. cluster, systematic 4fl simple random Key informant interview of village leaders A&B I village leader per village Purposive Group discussion A 3 groups per village (ie. I male and I female adult; and I female or male youth groups), G8 Ersons in each goup Convenience Health personnel interview A I PHC coordinator I Oncho coordinator I LOCT member I health centre staff Purposive Programme manager/Policy maker interview Project, State & National levels Project administrator I Director, Disease Control per State I Assistance National Coordinator, NOCP I Assistant National Director of Global 2000 Purposive a .o.o El Q?A99 B tr.EH.Fd t 0'e.BE'P n'dE 1F3: EHA9E E F.E.fE E -T o.oo U HFF: s.r3 FV ;a FtoqP ^- O. t'D g i. r^xsef i,HFd VGEPEU 9 .. .5 tr F 1f Eg qFH'E 3AfrE g^gHE'3t I8.4;wPS oc(! U) o tn 66: oooo oo Ho\(, €AA O\OOi9b(, ov o\{o rJr (,r t, u) o\ r,(r{(, FSg5' E'q3 I I (rl: o\) tr{o\ HNN)orro o(ro tt<t=l 8ff II lttt !iH (, L,) o<qF o !io\ oo t, t,GAoy:.otiv Noo O\ N)\9v{ gfr $B P .J (r! o'Fo(, b\J E QFS EBFtr.- o II N){ II5 (, L,J E gs BEiHfttr.(D I I tI (J) o\ 5SS u) u) (, frr L,J LJ o o O\ O\ O\ oooooo N) O\ O\@A, HOOoooo \-/ \-/ (, (, (.)ooo oooooo 2, ilc'o *E (, F ENO FH -Ia flE o d trj a HD ET G t.Dt: a o EI EtF E' OQ tu rt o(?(Daa Ec; It (.D oo EE E F(D (D s E Ep Et (D E F(D U2 t2 FU FU FU EHHoodEEE :r:r=1 oooiJtr!J !, a) o,lJtsttoo.o. EIEEtrdcruttP99(t er. i:fo(D(nFt l-t Frooot Ft F+tooooootsEEtsEEg.tr dIJ I' E,F. 8.9.a6+ H. H. J.o(DtDv, u2 u) <. ,AA<,-.JEf F:. r:.O EE6d# r+.(D (D =F u, u)6v.t "r* S. * E f s E r$ 9 (f H.q.BF' i^- Sg io Elr5'6(Do.-Ic HB8E'5 E o o.o{oJ sg$ ilOfi -E* ll6ll -9=3qG !,Xorur "sd tr,I hJ f o\ I I i t II tI D t7 The decision-making processes on iszues sf liming and mode of distribution as well as CDD selection were erqployed to gauge the level of community involvement and ownership ofthe programme that exist among the communities. Here, decisions that were reported to have been taken in village meetings were taken as indicative of the ownership of the programme. Looking at Table l, village leaders, CDDs in categories A and B villages were interviewed. Focus goup discussions (FGDs) were also held with people in category "A" villages. The Table shows varied responses on who decided on the mode 6d liming of distribution as well as selection of CDDs. For instance, only a third (33.3%) of the village leaders reported that decisions on fiming of distribution Decisions on mode of distribution(56-7%) and selection of CDDs (53.3%) were taken in village meetings in about balf of the cases respectively. A look at other segments of the village leader iote*ie* however shows that in some villages, the village elders, and village heafth committee took the decisions. On the other han4 50 per cent and 100 per cent of the CDDs interviewed indicated that decisions on timing and mode of distribution were made in the village meeting. From the FGDs, it is observed that a majority (100.0%) of the communities had the decision on mode of the distribution made in the village meeting. However, one hundred per cent of the communities indicated that the health worker took the decision sn fiming of distribution According to one of the participants in an FGD, "it is not for us to decide. Why should anyone worry about when it is brought to us free? We are gettlng the drugs free, and are willing to take it whenever we are called upon to come for it. Those who spent their hard eaqed monies to produce the drug for us should eqioy the privilege of delermining when it is convenient for them". This is typical of all the groups. A sarnpte of the very common responses to this question is as follows: ...Whenever the drug is available, the heafth people will inform the CDDs who goes to bring the drug for our village. ... When the drug arrives, the town crier is made to inform us. ... We cannot detennine when the drugs should be brought because we do not know when the heatth people have it. Consequently, the communities were a$@t on the frct tbat zuch decisions are always, and better taken by the heahh workers, who are providing the drugs. Some village leadirs oppose this. Most of them indicated that such decisions are often taken in the village meeting and/or the village heahh committee meetings. All the sanre the six communities, in which FGDs were conducted, indicated tbat the selection of CDDs was done in the village meetings. This is in confonnity with the responses of the CDDs and about half the village leaders on this issue. a c, at l8 In measuring the indicators @-l and E-2), the responses of the village leaders were used. This is because the village leader information appeared more representative by virtue of its geographical coverage of categories A and B villages, and the three subjects, namely, decision on mode and timing of distribution, as well as the selection of CDDs. The FGDs were limited to category A villages, while the category B village CDD interview did not ensure the collection of information onthe timing and mode of distribution Following from this therefore, it is observed that 53.3 per cent of the communities indicated that the selection of CDDs was done in the village meeting, while 56.7 per cent each indicated that the decision on rnode and timing of distribution respectively were taken in the village meetrng. Fig l: Decision-making in Village Meetings and Source of Responae oo ED(E tr o(, o CL 100.00% 90.00o/o 80.00o/o 7O.OOo/o 60.00o/o 50.00% 4O.O0o/o 30.00% 20.OOo/o 10.00% 0.00o/o !Tim e IM ode El S election Village CDD FGD Leader Source of Response t trg q) Ao ;(l) I clt o & U)tr ott) E o -oU) o\!.)NS+ €\oLi \./8o\ksE.? ,g G '.Fift^EbeHg Fsgf; leg{s €? HfiE f!;-ts; #E}EFf EE E€E q td.st E E E -E eB j - x EpE6 .dcl A 5 .^ > E H ES Ig '- I f E- =orri .9(D9=f+ gEEE :B s€ 8.3Hr E:E rEE EEET:E EEEEaE daa=r-E ppsE S A ! I E:kE 5 5 5aa)€.-.-.-\- --'€4.J^\3i eeErE E H H ggX.:l AAOr\o oQ& Xr F{Gl 6(rYlltI E OOO o\ B Eae< zrA eoEqs CA s oz c'! .+ € oi6l C-(fl t- \o ra Nr- o\ N3 r- (';F9 7) r- IE F- Oro>6\ q ra r- S) q ra r- S! o .+ i6 n KE $g =EE ZE3 oqoE\o .+ s oz f- ot € $ €-lRtr o\ ^\d c"l\O -iR5 \t C-\o oi o\6 a Orotz o\ c{ c?l (.1 o,$ v)h GlHs9 f- -d\ov E- E EH8zo.R <zQ (.) &n$ OroZO ca o f-o' oiHC a s9 6Aco |d a \o oGFz o\ o rn oo =t S) g .aP \xs9 r.l$g l+(ts{ Fr) oao <E E€ ,9S c.l oGto\ *61(noi \o s$ oro(aciFt\ -ClSe ooOAR5 aFO Oroza r- *9 qE6 v? s6 o 99 oi(J t\ q $3 I'(a frlF, JE$ElZ< () q) a( oGtsz o\ II II \o o\ a O:oFz o\ !f ra cl ,o3 $ oI a- t crl a. € -oiG9 2 SEB9t5DO eE Oro|z o\ clot o\ ss o\ €-irx C?T \J o\ -i$U !Qoits9 aE.a 10o\ oz q ca o\ ca ci co 9 c-fr cl R8 € +c-\ooo * GI o F. 4) c4' E €)& U'q)(l) tr(9 a2& a,L(l) o E(l) cl(DL oz Eo 6l6)h t'r 4' aD(l)E E €)L ctt( E s L.c E E (O Eq) E at(Df(H GI (l) E G,F i I I a 20 80. Fig.2: Treatment Summary By LGA g E EE 8 (U oLF o CDo CooL o(L 40.00% 30.00% 20.OOVo 10.00o/o 0.000/6 =E€ -co8z Eo E .Yf, (U .v, (U -EoEz an6 lU LGA I The Table (2) above presents no definite pattern in the comparison between the results from the sample survey of household treatment and the treatment summary fiom the CDDs' records. In some cases the records show higher proportions than the sample survey resuhs and vice vers& Treatment records were generally poor. In one LGA/community, namely, Ika Northeast treatment summaries were totally absent. The excuse given, however, is that the LGA has not commenced process of implementrng CDTI. Comparing the results of the household survey and the treatment records of the CDDs showed great disparities. For instance, in Ukwuani, the proportion reported to have refused treatment is2.2 per cent in the CDD record. This is much smaller than what was obtained in the survey (31.0%). The same is the case with the other LGAs with respect to the recording of refusals. In some cases too, there were under reporting of treatment rates. Thus while the household survey indicated high treatment coverage, the CDD record showed lower treatment coverage. This is because in some the CDDs had not actually updated their records. Furthermore, the lumping of households was observed, because the concept of households has not been clearly understood. IHH Survey f CDD Rec -! 1,-,, .,i' i,tI i'.tr. r * i, IIL.tL. F-,- 1i 5 t- F g t'ii'" -. '.\'," a2t Table 3 Proportion of Villages treated and in which CDDs were changed after the lirst treatment o-5 Proportion and number of at-risk villages treated = 24 (80.0%) Proportion and number of communities where CDDs were changed by the community after the first teatment = I (3.3%) Table 3 above shows tbat teatment has taken place in all the 24 otrt of the 30 at-risk villages visited. It also shows that CDDS have been changed in I (20.0%) of the communities, after the first treatment. In the FGD the discussants are often argue that, "there is no need to change the CDDs since they are doing their jobs very well. Table 4. Proportion of villages which received health education, and in which CDDs were supervised by health care personnel o-7 Proportion and number of communities in which the CDD is supervised by the heahh care (communities scoring 50% and above): 5 (83.32o) Proportion and number of target communities which received health education(i.e. 50% or more of the different segments in Category A vitlage received health education) :5 (83.3%) o-3 I o-6 LGA Villages (Both A and B) Treated gp) shanged Llkwuani 5 5 (100.0/0) 0 (0.r2) Ika Northeast 5 3 (60.@/o\ I (20.V/o) Ika Sotrh 5 2 (20.U/o\ 0 (0.0plo) AniochaNorth 5 5 (1007o) 0 (0.tr/o) Oshimili 5 s (100%) 0 (0.0/o) NdokwaEast 5 5 (10070) 0 (0.0/o) LGA Villages (BothA and B) Received health education (Yes/It{o) CDD Supervised by health system LJkwuani 5 5 (100.0%0) 5 (100.0plo) Ika Northeast 5 5 (100.tr/o) s (100%) Ika Sotrth 5 2 (40.U/o\ 2 (40.U/o') AniochaNorth 5 5 (100.0%) lal0070) Oshimili South 5 5 (100.0/0) e (100%) NdokwaEast 5 5 (100.0%0) s (100%) t22 Table 4 above shows that more than fifty per cent of the villages in the five communities visited received health education In one, nanrely Ika Soutlu only two villages indicated that they have received health education Similarly, one hundred per cent of the CDDs in five LGAS, reported that health personnel supervised them- On the other hand, only 40 .0 per cent of the CDDs in Ika SoutlL where CDTI has not commenced indicated that health staff personnel supervised them during the last distribution t I I zro ,f{ D' EI A)lt) o U) U) od oo le zo :+lf ,f ot ao ,f D) zo =tt(D o)t) tf{c h,k r{ o L'T Ur L'I ra lrt (,t F< EF oa 8 G Ur oo sO 6\ (,r oo 5 rJt oo s (, o\Ios l.rl oos Ur oos ()H \J A:UE.U)oo I I NIo I t I t I a II ca r{trDtE6 II aI tJPo t\)Po I t tJIo g?U otr :1 oc D) oao (, oo s l.J 5Io\o 6\ Ur oo s t, o\Po rO 4| tJ 5Po10o\ Ur ooqO o\ YBS' HtsFD,() o NPo s (, oPo 1oo\ N) 5Po\o o\ N s>orO 6\ (, OlPos l.^) Orod p< xg(DE 0a L'I oo\o 6\ (,l oo 10o\ (/I oo rO 6\ t\) 5o\oo\ N) 5o10o\ N) 5o\oo\ F*l €.8gs E6 o P \oo\ o o s o o 1.Oo\ o I 1O o\ o o rO 4\ o o s >a 6 s?E.gE*F66'cr5 (D Ur oo L'I oo (Jl oo (, oo L'I oo L'I oo o ca+1 u) ff$ B EtsE - HE5 (D Ut -EE E .| tsr t:Ecio d oo B EEE * (D o llltlt{g\ur5 t9ri E'I'EEEEEAtsts6EBBEEEEEEE:r=:l=r=t==1 F' ts. H. H. E. B. B.oooooooil!rtrPtrut, DDEq,A'SOts5tststsbbo. o. o. t1. aa. o. if.!JI'E'I'E'EI5E E cCCeeEEEHHHHcr cr cr cr cr cr cr(D(D(!(D(nr!aD r-t r-t Ft rt| Ft Fl l.l ooooooo -) E) F) E) E) E) E)H8AS888 FEHEEEE*l - o d e doEJto5tJ5 E B:EjE H:H:F:Fl?rlJ=vru2u)VcdE*c< 8.il83-. EE*5'=E[BooL rgf,*EEH116 g 5.E g o. 5 rH sIE g EE.TgE.E;, Ege*FrA E,TRg 3gE D) a\./ P F) -- -=3.8 HX'Y"o6 b E'5 Z'e.8 FrH I3- g 3.H6' :891 ti ll E' * FX,,i.) X(,H(D X'OaI E b= : EdSHl. o\oi+vPo t-t \o lf .o) ln:- a) + H) oo I+(DFt lt 5 o\9{ 1oo\\J , i I a tJu) r, t t a 24 In the Table above (Table 5) shows that all the communities indicated that the CCDs were trained. It also shows that they collected drugs from a designated point and presented some form of treatment registers. AII the communities also indicated- that they have not ocperienced lateness or strortage in drug supply. The perceived pronptness in drug supply was attributed to thee frct that they did not decide on when tne arugs should be brought. "...Whenever the drug is brought by the district health stafi, through the CDDs is the accepted time'. Others argued that, "the drug came the same time thly got the previous years". However, half (50.0%) of the CDDs, in tbree of the communities visited were without treatment registers. Furtherrnore, most of the CDDs interviewed could not produce their measuring device on demand. None of the communities showed reported cases of severe side reaction Understandably, therefore, no records of side reaction were se€n. Furthermore all the communities visited had a completed summary foml for at least one month between Japary and June in the State office. B Constraints Managemcnt Support at the State level has not been impressive. Nothing concrete has been given by the State to support the implementation of the programme except the provision of personnel, that is the State Project Officer for Ochocerciasis control. Thi Director of Public Hedth the Permanent Secretary and Commissioner for health all argued that they have not been briefed on the CDTI project. When asked if they have-any plan foi Onchocerciasis control, the Director argued that, "since this CDTI is in place'wi do not need to bother for another, ...we think CDTI is good enot gh to meet ti" *. needs.,, According to the Director of Public Health, *CDTI follows the current concept of community involvement in health care". However, he argued that, .'it should be the responsibility ofthe LGAS to maintain assistance forthe various communities". On the specific issue of counterpart firnding, one finds that this is still lingering. According to the Director for Public Health there is a budget within the State for counterpart funding for all internationat agencies supported projects. The fund is however under the office of the Secretary to State Government (SSG). We draw from it if we know what is expected from us and which is normally budgeted for during the budgeting period". The Director and the Permanent Secretary thus requested for i for.rl l"tt". asking for counterpart fund to the CDTI project. According to the Director, .bnce we get a leffer from APOC/NOTF with regards to the counterpart und we shall not hesitate to act". t25 Though the SOCT members are willing to work for the success of the progftunme within their respective domains, as demonstrated in the execution of training """i i" the frce ofnon-release of fun4 there exist some trace of low morale among theL According to one ofthern, '\re loose from both ends. The Local government has seconded us to thiJproject and as such does not give us the benefits of being their staff, On the other hand, the Siate does recognize us as bonafide member oftheir staff'. He argued firther by saying that ..ifyou go to the Director now and ask questions on any one of us, he will-sinoply-tell you that he does not know us". Some Incal Governments demonstrated zupport for the programme by releasing fund forq}nir8, supervision an! monitoring activities. However, 6th"r, *"i. r"po.tk to bave qiven mere verbal promises and approval of request, without actual release of the fimds. Accordrng to one ofthre HoDs in charge of heahh in one of the LGAS ririt"4 *tn" health department in the LGAs should be funded separately, because the Chairmen do not likeinvesting in heahh. This is because they all want to erect tangible stnrcture tbat will leave alegacy of their tenure in office". On the other hand, the Onchocerciasis coordinators in ft- " !C4 level argue tbat while the Chairmen may release funds, this may not let down tothe Onchocerciasis units, as "the intermediaries tamper with such released funIs,'. The Project Adminisftator on his part complained of the delay in receiving fund. Hehowever stressed that he does not know the ievel where the delay occurs. fte ilso argued that, *the funds released for both Delta and Edo, the tw'o States under the Edo/Deltaproject is not enongh for one State". He also argued that the State has not shown sufficient commitment to sustainability in spite ofthe numerous advocacy visits. t a The health staff in the field also has frced logistic constraints due to inadequate motor lYcles, This applies to the LOCTs and the Oistrict Health Supervisors. the State with 9hlper/meso endemic LGAs bave jus was give few only ,i* o* -otoi"v"r"s, whichcreates the problem of sharing without causrng discontent in some LGAS. Thi shortage ofpgtor cycles may hav-e informed the pooling and rotation of the motor cycles amoog tn"LGAS $enendins oo q" urgency of the need. It needs to be remarked however that piper supervision should be a continuous process. It may be necessary to reconsider thepractice of rationing rnotor cycles. The SoCT members_also highlighted the logistic problems. They argued tbat, .\ilith the withdrawal of the LCIF vehicle they had beiore the arrival of the ooi fron1 Aboc, th"y were constrained to rationalize movement in a way that impinges on the smooth execution of the CDTI activities, particularly monitoring and supervislod,. The NGDO has also started the process of decentralizing the projects into the respective states. In an interview with the assistant National Directir or-cnua zooo,tnt i, aim at ensuring efficient management ofthe resources for the respective States *a Uy tn" Statesinvolved. t26 Technical A few LGA health staffand the CDDs interviewed showed poor knowtedge of the APOC philosophy and the right process for the CDTI implementation This ,uy huu" adverse effect on the quality of CDTI implementation in these LGAs. C Community Perception Community perception of CDTI programme varied geatly among and within the LGAs, communities and villages. While some segments, particularly women and youtbs exhibited total ignorance and lack of knowledge on ro[e of the community in the CDTI process. There was a good knowledge of the disease and the drug il most of the communities. However, in all the communities and within the differeni grcups the e:<act role of the community with regards to ownership ofthe CDTI programme-was still poorly understood. Village leaders and elders reiterated that they *er" irlto position to know if the drugs arrived on time or not, our own is only to take the drugs *d"ou", we are told that they availiable". The programme is being perceived as govemment prograrn, where they can make litt!9 or no inputs especially in decision ,.kl"g aboui tf,e timing of trearment. Worse still, the women who argued that they are rrrcre "slaves to men' thirks it is the duty of the men to take any necessary decision, particularly on the selection and compensation of CDDs. All the same, tittually all groups within the communities visited exhibited positive disposition towards CDTI. They even demonstrated their preparedness to educate and mobilize reluctant members of their respective communitLs by testifring to the usefulness of the drug. They also wondered if it would be possible to take th" d*g twice I yeT. According to some of the participants in FGDs, "considering the immense benefits of this drug to farmers it will be nice to have it distributed at least twice in one year" , t l Ft,(t (.D$o E'F -.EO i-.l.l.€ ET LA ii. E.OE aE t;,. g E'EEDFL'tsFEi.69EYsg!t^EU oHHt El E6 t?o E:1, o E(D E a o)i| o UFl trlp Eo F o O N){ (1 AiiE \r,, o -I o o E cHl OH EE vd) E oe ol{l ,trHisE.FFE. doQ oxl ooU9HEFT E'oEo E al.a oHf F-E F H(DX uBg !r v)8._t !'t< at rH ilE H6H$ E 3H iE,E E** $g[*F EHgfflE5sfsg E;' EE'*E Ellz >6IE s sE.Fg HF$ F{ IrE t, d Boo.Er :tAF(D sooo}{.r ,f rB E t: rFriEsH.hLH .2 C.'- E -;t c , I$a $F13e5 r:[BgE l-l F zc * =oEaC} ,E# Eq u)oP !oo =. g.EEfrgg -v-.ttqE H. 56Erb" '?o.HEP Ee q -.i$ (2 .3a fisI HH g FHg IJEr FlF 19 ao a|t ../r1141 E"H i 358 =r-\< - lJr,)6 -'6' sei(D EI< E r$fi g E:Hse.+ s *i o,Erd !,(Dta A. *gHE sEE $$ E 6 6'9.. oErir$eE: # oE' 8E rEfi aEr$Br E c(?ItE zo *E ssFts-H'o.no- a6 Eg-EgE; ir. E.sqE Et$Es1s5 ",Fr tf+' o Ox' r-F$Bi g $fl;eHFur*BF=:s F fg'q*f e q o.ir oaE E zo *7 (.)I FrJ H.H S'HE H. U, 1 at) o gs6sFfig=,, E *:;ff rE'Fe *+ilE.; Iss zo o, o) o)d (D zro {E trJE U2 I 5 lrl H ogit 19 o EI IJ o 8.E O 6 sE EFEtr 9.=.E€ Ellr *P >g E-s E=t9(!=trFI' {T E: Fqel ?93(D 'o E€El.EEE EL 0 t9F € letrta8lrQLO Cr. Ert Et E.E 0a P l-t(? :- ssii+teEa; -E .| HgqF*lH. J13 B -.ai e lE*6*l IBg s rg;$s l? e"H sE H kE agg*€ =r ._ o o- E €'8 gE id Er.g ='ea=rXD €fi€$FFr PEEo. < :!,(DE.J € E=6pcr ot'Dt (! r-tol EIEAI E<l E$E HBE" eF, CfOeEr Ouz+rOr* FF.fr] >rlp D)Hor,Pg DIJ(!o { ot TA O tszt u, Eas E !D'3aEslI 8.H HEi FJHA'o:g+>j:E - E,(D +ari !tE{otsB -FeB as6-80 BX I E =EorE*&8. =qN 8. BSA. L) P;U5-r, =E.+G .DE f,x sElito(! E-Esi 9FOD(at,D pa o. E oaU, o F<8Eo< 6- U2 Eoo zo oocH E) (D t-t os (D (D Fo (D (D oE =:9 =(Doq9{gB E'.P<do () (D !J Ellr =r3#93(D')P =o iE s€ H'€ 5.=o. ooa'F 9 o t! g) o 0a rt, eeuax =F€q € *3 3 Fo'r o Xl ?*Fo!o aD ra C)o o-HEq o ru 8 oo o r ,rooE 0q i"3g(D+E FI(D F) tse(Do) i+lJ q'g [E: g'"f]3.8 =.d g '36# I SFE 3 Spif. o'oq E 6-lEqE'E EI ? g PEH aE;IF ',€H -oEE -$e o o F ta td Ur-t c(Ia U) {or-t tD og,o E'So<taE tr iloo?d oaD pIt o. =oo ul F gEE H BT Bq? 9a "?.Frgqr€ Fg oo Ioio. 7r .Dol 'lrl 5l oel Et FUoioF'O Erf+ Fr ?H 8F e3 o U) ot o. Ho. o oo 'fu) E: g e.,r *3.d =.d +8gF=' fEIF 5Elia. ooq E 6-Iq='E f,l 6' o a .sg E Fi ;.E H T= *.T6" E =F'@o 8" E r"EH. c)o t PDH (DEi Esu(Do€ ta '-to oEPE o.< i FEE HBF Bq? 9a FFta =rpo !)ga+rU) (D a 8e+a) o o. c)ooo s>g8 HBf5' gFB F+(D rs€g€t.S.6g Eo-r o a i tJ6 |a'l e. Io o.1 Fr @ooo. F58A E FF; qsE S *EE {(D (D E 3 g sH.a8 fsEn s*E6' 9&8.a. qE'EE} H€ Fd-CPE=r ='o o t' vi =, ta s='q# P c:o Ern E= g: EEIt0a= grEtll,l'14 EE e"S=B:r.g 6#€5g B' tr69&s€ ts s*f;$[ P <t'trlg i-: E' =: tiE E tgEE' o(! =' -p (') ,v ts =: L.i6A =:U 8 ia*E $g aEHits S= -qBq'H E 5 <<<ls.EFsUg 93 qt-'oo tac$[o!J5d eHdJ =o aa. H {EP. *s'6 E aA:F. e gHd oo -- (1 'v F=L.,,6H =e E <<, :E.HFgU0 ts qt-1 (!0 ae8$Bo!,tr6 g H+JI+o o. D9 <'cr.Et 3:s€ s tgHE ra(D -- o'v H=L.' RE = l E qs^ =ta5c)0q(a o \JDFl !!Fi O. EH gEAEF=68 Yts F'< fi =.-E.t!Y (DN+e R $' * fg.a 5'oE tJ\o o 30 Table 7: Quality of CDD Training in Category cA, villages LGA No. of CDDs No. Trained Length of Training No. Trained ina session ukwuani I I (100%) 3 davs 20 Ika Northeast I I (1007o) 3 days 8 Ika South 2 2 (100%l 2 days >100 AniochaNorth I I (1007o) I day 20 Oshimili South I r (100%) 2 days 6 Ndokwa EaS I I (1007o) 3 days l5 Another issue that c.rme up as an area of concern in the success and sustainabitity of the CDTI pnocess. This is presented on Table 7 above. The Table shows that the quality of training varied arnong the communities, both in terms of length of training and the number of CDDs trained in each training session All six communities reported of CDDs having been trained. However, in Ika South, it was observed that the implementation of lhe CDTI process has not commenced. The SOCTs and community."--b"o in separate in-depth interviews and focus group discussions attested to this. with respect to the length of training in the communities, ufuere CDTI has commencd it lasted for between o1e to three days. Thee communities indicated tbat the taining lasted for three days. One indicated that it lasted for one day while the remaining two reported that training was for two day. With regards to the number of CDDs trained in each training session, it was observed thatit ranged from 6 to 20 persons per sessioq with the exception of Ika Soutb, where the people operated last on the principle of CBIT under Lions' Club lnternational No pattenred relationship between length of training time and number of participants involved in a training session could be discerned here. For instance, ,rni" Aniocha Nortb within one day trained twenty CDDs, Lllovuani trained the same number of CDDs in tbree days. Within the same number of days, as in Ukwuani, Ika Northeast and Ndokwa East trained eight and fifteen CDDs respectively. a I Ea 31 UNIQUE I'EATURES OF'THE PROJECT AREA Strengtla There is a high literacy level among the CDDs. A good number of the CDDs are retired civil servants and teachers, which will facilitate the assimilation of ApOC philosophy and enhanced the process of mobilization and implementation of the APOC CDTI if adequately trained. This definitely had impact on recordiqg and reporting as can be seen in some sample treatment register attached in the appendix. There is also an observed evidence of commitment on the part of the SOCTs. Some ofthem used their personal cars and monies to organize field activities such T lraining and supervision in an effort to prevent frilure of the programme in their own dsmain- Ttre zral to succeed is further demonstrated irthJ quest for knowledge in CDTI approach, vfuen the team invited their Imo State counterpart !o give them some preliminary soashing before they were finallytrained in Ibadan by the ZOTF. The communities visited showed appreciable level of support for the programme and willingness to monitor the implementation of CDTI. Awareness has also been created on the disease and the benefits of the treatment. The people seemed very enthusiastic to receive and swallow the drug. The drug has been associated with the rnanagement of other ill health conditLns by the communities and in some, like Illah in Oshimili North it is associated with fertility. It was alleged to have caused a previously barren woman to become pregnant and bear children after passing out wonns due to her consumption of the drug. Thus they were very eager to accept the drug. some even advocated the distribution of the drug, twice a year. Moreover the rnembers of the various communities visited have been mobilized to inform others of the benefits they derive from the drug. This approach will enhance cornpliance and minimize refusals. The training of cDDs at community level, as recommended by Apoc have increased the number of CDDs trained at reduced cost to the communities and also created much aw.[eness in the communities. There is also evidence of integration of CDTI programme in pHC at the LGA level, in terms of sharing logistics and planning ofCDTI activities in line with PHC prograrnme in the areas. The presence of monitors/monitoring teams has helped to create further awareness. This awakened the SOCTs to certain salient areas where they had been weak According to one of the socr member, "...the presence of monitors bas helped to open our eyes very well on what we should do and what rle should not a ' 32 a do. We can make our correctiod'. It also opened opportunities for educating the communities further on their roles and creates the sense of community o*nerJhip. o Weabtesses One major wealness of the CDTI planning and implementation in Delta State is the perceived threat to a sense of belonging arnong the SOCT members secondedfroq th9 Local government service cormmission They complained of some magiaalization by the State Ministry of Heatth. This can weakencommitment and cause poor implementation of the CDTI stratery in the target areas. There is also trncertainty in roles and financial regulations. This affects the number of days dedicated for training, monitoring and supervision among SOCT members. The frequency and duration of training can be improved upon if the Socr members are well motivated. In relation to poor taining there is also poor zupervision No effort is made to use any sandard checklist in the zupervision exercise. These, poor levels of training and supervision have led to poor record keeping, census taking and reporting. 1"_t: is also the problem of logistic encountered in the field by at all levels. TheSOCTs are constrained to operate with only one vehicle, following the withdrawal ofthe LCIF vehicle they used before the arrival ofthe Apoc vehicle. Much as the communities are aware of the importance of the disease and the efficacy of treatment with ivermectiq the level of mobilization of the different segmgnts of the populations of the difrerent communities on the CDTI process remains poor. The people still lack knowledge of their ownership of theprogftllnme. This inhibits sustainability of the progftlrnme and the ability of the communities to make major decisions. There seem to be elements of confusion in the management of reaction to ivermectin- In some cases, treatment was repeateA immiiately for individuals with severe reaction i 33 DISCUSSION ATID CONCLUSION Generally, there appear to be good levels of awareness on the importance of Onchocerciasis as a disease and the effectiveness of ivermdtin in the management and control of the disease across a broad spectrum of partners in the treatment progralnme. Ftrthermore, the soCT and NGDO, as wellas LGAs andDHS show appreciable knowledge of the Apoc philosophy and the CDTI strategy, designed for a sustainable programme for the management and control of disease. Furthermore, there is a remarkable level of enthusiasm among the SOCT members for the suogess of the progranme in their dsmain, and an appreciable willingness to take the drugs among the communities who have associated the drug with solution to many heatth problems, including reproductive heahh- Sorne levels of integration of CDTI with other health activities, at the different levels of partnership seem noticeable. The health workers who are designated to oversee Onchocerciasis, the LOCTs, are also involved in other public health activities- The same goes for other health workers' participation in Onchocerciasis programmes. However, gettrng pimary heahh care facilities for theimplementation of CDTI, particularly for supervision remains to be fully rc,alizaA in Detta State. Ho-w9ve1, an important element of sustainability in the programme is missing.ffi: it the ability ofthe communities to take important decisio-ns bordering on 1169 implementation of the programme in Detta State. For instance, the peolh still harbour the idea of the progftunme belonging elsewhere. Much as they appreciate the change in the supporting organizatien, that is from LCIF to ApO'C, iiey stilt see it as a govenxnent project, thus will not make decision on the cutturally, and ycioeconomically convenient time for distribution to achieve effective *lr.og".In line vffi this, they also argue tbat the govenrment, ufuich assigned the role of 9irtriu"t-g the drugs to the cDDs, should also support the cDDJin carrying out the assignment. With respect to some gther key components of the CDTI imFlementation, namely monito^ring and supervision, there is much room for improvement. This is becauseit is often left to the LOCTs who often complain of lack of fueling -a iogirti" :uppg{s from the policy makers at the LGA level. According to oie u.o.d. ror health in one of the LGAs visite4 argued that, "the Chairmen -irrespective of their background, medical or otherwise, will not willingly support n"*n activities whirch neit6sl tangibly ylsible for the people for thJ i*piJ to see,,. epart tom embarking on project for the politicat points they co-nfer, they also prefer activities that are income earning. Thus leaving them with the entire r.rp"fi*ry an! monitoring roles during supervision will b€ problematic. The SOCfs, on the other hand, complain of the constraints of operating with only one vehiclg which was recently donated by ApOC. t 34 t As a result of the poor supervision some CDDs who have not understood the CDTI philosophy still operate on very wrong premise. Some do not ensure that those they treat take the drugs in their presence. This creates noom for the very 'taring'mothers sharing their doses with their under aged children who were not given drugs by the CDDs. The record keeping, also needs some improvement. Even though evidence exist of ceryus taking in many places before teatment, mmy house-holds living in one building ryere lumped as one. This manifests their lvrong understanding of the concept of "household'. This is even observed arnong some of the Socrs. ln view of these findings, the following recommendations are made both to sustain the commendatle steps taken so frr and make amends where necessary for full and effective implementation of GDTI in Detta state. RECOMMENDATION I To the Project: Training of Health Staf o The initial training should be for a minimum of 3 days, whilst retraining should be for 2 days. During the training, a day should be set aside for practical work and assessment. o { schedule with the content for training of health personnel, as well as for training of CDDs should be rnade available. The content of the training should include sessions on the APOC philosophy, techniques on advocacy, mobilization and health education, with special emphasis on community responsibilities as well as the specific roles of other partners in the CDTI process, supervision, recording and reporting to effectively address the requirements for CDTI implementation o More health staff should be trained on CDTI progranrme to further enhance integration in PHC. Traintng and Supervision of CDDs o This should continue within the communities. Initial training should be for at least tbree days, while retraining activities can be for two days. During the first three-day training, aday should be set aside for demonstration on record kCpiog, census,rkl"g and reporting. o The current trainee-trainer ratio should be encouraged and sustained .l 35 The involvement of literate members of the communities, zuch as teachers and retired civil servants CDTI implementation at the community level should be encourage4 to help re-enforce training and record keeping at community level More attention should be paid to the aspects of record keeping and reportrng dr:nng training, particularly with regards to household composition and documentation of colour for easy assessment oftreatment accuracy. Training and supervision checklists should be made available and used to assist in these activities. Supervision should be emphasizrA at all levels, especially during and immediately after distribution for the CDDs. Record Keeping and Reporting a a o a a The quality of record keeping at all levels of CDTI implementation in the State still has room for further improvement. Review of the process of census taking in the viltages to determine accurate population to enhance adequate planning for ivermectin piocurement and distribution as well as effective deterrrination oftreatment coverage. Adequate training on household recording and recording of treated persons immediately after adminishation ofthe drug should be emphasized. O Approaching the Health Services and the Communtty To-ensure a proper transition from CBIT to the CDTI approach by the project, precise and concrete steps must be taken to conduct proper orientation of the n*ftn personnel and community. It is recommended that the project intensift the following: Training and orientation of health personnel on the policy and implementation of the APOC philosophy and their roles in CDTI should be encouraged. More healthpersonnef at all cadre, should be involved and made to understand that more commitment is expected of them with respect to mobilization, health education, training, zupervisioL monitoring and reporting of GDTI activities. Continued dialogue should be held with community leaders on the benefits of ivermectin treatment, their roles and commitment in the long-term sustenance of the treatment process should be emphasized. 3 o c c 36 o Mobilization should continue to target everybody, including women, youths and rglj-Sious groups, as they have been found to lack good knowledg. of th. CDTI philosophy and process. More personnel from the components of the PHC, media and educational institutions with skills in heafth education, mobilization and gender issues should be co-opted into the mobilization of communities and introduction of CDTI activities to this level ofpartners. Supervision should be enhanced and budgeted for in the APOC budget, if not done already. o Supervision of the community by village leaders and heahh personnel should be directed more to periods during and after dishibution These zupervisors need training for at least 2 days as TOT and supervision in CDTI. Integration of CDTI into the PHC System o The current level of integration of CDTI into PHC in Detta State is good for this sar.1y stage. o CDTI activities should be included in the PHC budget plans at State and LGA levels. To State: o The State must be very active to ensure that the frcilitative role of ApOC is felt in theflrst and second years of implementation of CDTI. This will afford a great opportunity ofre-orientating the CBIT progamme into CDTI. In this early stage of funding from APOC, the State must ensure that APOC funds are rapidly utilized to train CDDs. Ifthis is not done, there will be great variation of entry of CDTI and exit of CBIT in the different LGAs. Some LGAS have had no naining using APOC funds. Training of CDDs should be budgeted for in the APOC budget, f not already done. t a a a State should make proposals to purchase more durable motor cycles and bicycles to enhance zupervision and monitoring by health personnel and districi heafth supervisors respectively. Demands from State Ploject officers (SPOs) to LGAs must be done cautiously and more resolutely. Lack of support from LGAs could also be an element of excessive or unrealistic demands by health personnel. a r) 37 To National Onchocerrciasis Taskforce o NOTF should ensure project activities are fully decentralized and budget lines should be related to the different State requirements. This will further pro-Jt" the sense of ownership by the States. o NOTF should ensure greater monitoring of the various CDTI projects to ensure that they conformto agreed guidelines and processes. o NOTF should send ortr high-powered advocacy teams to the State to properly sensitize the Government on the APOC philosophy and CDTI strategy. This will-go a long way to elicit corporate support and promo6 sustainability. o Letters should be sent to the State policy makers on counterpart funding for the CDTI project in the StAe. o Greater efforts should be put into plans for mobilization of the communities. Relevant radio jingles and public address systems should be put in place. To APOC Management o APOC should consider procurement of motorcycles and bicycles for LOCTs and DHS respectively to frcilitate their zupervisory roles in the CDTI process. The independent monitoring should be encouraged. It creates more awareness for the progftunme as well as confers credibility on the Socrs and LocTs. a I(cy Inforrnunt lutcrvlcw: Villagc "A"l.curlcr Ttris irctrunuttt ts to be adnilrktered on ilrc vitlage head or a represetrtative of tle village heod. Tln lud can ask another person to assist with the inlen'iew and to even lnvu a say &trilry tlrc iltc'yiant. Do ttot refwe. Most of the questio,lts are stnrclured. Circle approprialc codes. Do ttot pronqtt lhe responses; ratlrer allor the respondent to ct tswer while you circle the appropriate option to the resportdent's answer. Listen to tlrc chief and choose anro,tg tlrc itens provided. If hc says sorneilring dilferent select 'Other' and write tlrc actual reEponse teqronse in llrc space provided. Vlllege Nanre: Village Code:_ DistricUState:Subcounty/LGA Country: Montlr end year o[ lost distribution l. Please tell us about arry progranulrc concenritrg oncltocerciasis treatnrctt( in this village? (PROBE THE FOLLOWING ISSUES ARE ADDRESSED) wlto btougltt the idea of the onchocerciasiqpograilu,re to iltis village? ' wlrcn did thc persou(s) co,t,e to tak wilh you alnu onclwccrciasis? - Did rlu lrl.ut(t) rue. vith yt d alur villcrc ldcn lirst? ' Did tlr, rrl.lor you to anoiltc arrrlting? ' wlrut did they tell you about conmtruilty respotsibility 2. How waq tlrc tiirre (morrth/season) for distribution decirletl? rt r village meeting vilhge elders nrccting villrge cltief/leader lrcrltlr rvorker village health couttttittee village conuttittee nrceting other (specify ) 3. Wlrat tttorle of rlistributiolr was decidetl? L lrouse-to-lrouse 2. central place (specify) 3. both housc-to-ltouse atd cetttral place 4. otlrer (sp."ify)_ l. 2. 3. 4. 5. 6. 7. 7Morriloring lnsl.urrcnts Krnprh, Mey 1999 4. How was tlrc nrode of distritrution dccided? l. at a villagc tlEcting 2. village eltlers nrcting 3. village chicf/leadcr 4. lrcaltlr worker 5. village health conttttitlcc 6. village cotttlttitlee nrceting 7. ollrcr (s1rccifY) 5. llorv nrany persons (CDDs) irr tttis village give out tlrc drug for otrcltocercirsis? 6. How matty nrale CDDs?-llow nrany fenmle CDDs? 7. llow rvere ttte lrcrsotts (CDDs) selectcd to do the work? l. at a villagc nrceting 2. village elders lrrceting village chief/leader I lealtlr rvorker Village lrcaltlt conunittee Village cottttttittcc ttrcetittg Otlrer 8. Why dirt you cltoose tltese persotr(s)? (Probe for criteria) 9. Have tlre CDDs received any trainitlg? l. Yes 2. No 3. Don't kttow 10. lf yes to Q9, rvlrert did lhey receive trairring? l. lJcfirrc thc first tlistributiorr 2. Durirrg tlistributiort 3. Soort aftcr the lirst distribution 4. Dorr't kttorv/Catt't rettrctttber 3 4 5 6 7 I 2 t 4 lt llorv well have tltc CDDs tlolrc dte work? l. rvell 2. fair 3. Poor (Erplairt) I lavc you cttattgcd arry of your CDDs? l. yes 2. No 3. Don't kttow 8 t2 Mooiloring lnslrun*nlr Kmplh, Mry 1999 a14. Have yoil (the cotnntuttity) received education ott tlre itrrportance of takirrg ivernrcctin/rnectizrn/ Orrclro tablet annually for several years? l. Yes 2. No 3. Dur't know/Can t rerrrcrnber 15. lf yes to Q14, ask: When dirl you receive the erlucati<ln? (circle all ttrat apply) l. During tlre first rrreeting 2. Before tlre first digtribution 3. During distriburion 4. Soon after distribution 16. If yes to Ql4, what were you told? (lrrobe for artnual treatnrcnt for several benefits conununity Was tlrcre any conlnlurrity decision on how the drug should be cotlecterl lroln a collection point? l. Yes 2. No 3. Dorr't know 18. Did arry tttetnber of the comnrunity coltcrt lhe drug fronr a cotlection poilrt? l. Yes 2. No 3. Don't krrorv 19. lf no to Ql8, *l,y? 20. Where is the collection point? 2t Ditl you experiehce lale suppty of drug tlurirrg ttre tasr rlistributiori? l. Yes 2. No J. Dou't ktrow Please explai lt 22a. Did you experience shortage of drugs tlurirrg the tast distributigrr? l. Yes 2. No .3. Don'tkrrow I 22b. Ityes to Q22, trow was ttre probtern sotvetl? a l) c, t7. I I It 9Morritoring lnslrunrnts Katrrllala . May 199(,1 i I 23a. Was the cetsus o[ your village undertakett? l. Ycs 2.No 3' Don't klmw 23b. Does tlrc coltttttutrity lrave a treatllrctlt register? l. Yes2. No 3' Dott'tkttow 24. lt yes to Q24, wherc is the rcgister kqrt? 25. How wete you involved in nrobilisation? 26. How were you iltvolvcrl ilr suprvision? 27. Wlrat arb your suggcstiolls olt ltow llte cottu:rutrity crrulrt be ttxrre irrvolved itt treatittg ttrcutbers witlt ivertrrcctitt for several years? 28. ls tlrere arything you witl like to tell/ask us? aG ltoul' DlscussloN cutDli AMONG coM t\,t uN I'l'y Nt ttM tililts.vlt,t,AG tt A ln each categoty A vilhgc. one Mule uul urc l;enmle ulult gtoup di.rcrrssroa nwst be ctttulucted. ltt thrce of the sk category A vilhges. group rli.rcrr.rsirlrs nrust lre anulw:ted witlt male youths-utd in the renmining tlrce villages, dist'ttssiotts t,,ust be hekt witlt fcrrrule youtlts. For uonibrttry CDTI projects, yotttlts ure dcfined os itulit'idtutls between lS <ttul 24 yeurs. lhe cDD ,tuutt artange [or a antfottoble. plot'e tlnu o![ers sonrc pt.ivttcy and erung1 placcs to sit , &rch groult ,,tttst co,rsist of 6-8 people. l)eparling ut trtlturc, the gtnnqt rlriorsr'ors nmy need sepilutc ,,,eeting ploce [or nuile uul fetrutle so tlnt peqile cunqteukfiedy. Oue of the iilenrul monikrs sltoukl he the fir:ilitiltor nthile a ktcul gttide. takes notes (rccotder).'lhe gnnp tliscuisiott nmst lrc krye-t.eonled. At tlrc entl of the seJstorl, ploy back ilrc tope fitr o [en' ninures to be snre fuot the rt.scrs.nnz ryc.r poperly recottletl. I-obel the cossettolNotes (Nune o.f tlle filluge, ilrc goup idcnlily, dale). TARGET GRoUt's: ADUUr MALLS; ADUUT'I;DMAt-L.s; youNc MALt-:.s otr TE,MALES l'leasc tell us lvhat you ktxlrv atxul ltrc orrctrrrccrciasis tleatnrcn( l)t'()granutrc (lrl-En.SE PROIIE roR ililt FoLLOWING ts.St'tis.) tlrc persorr(s) wlro brougtrt ltre ittca of llrc orrclrrrccrciasis progranmtrc 16 tlis vilage tlrc tirrrc wlrcrr tlrc lrcrsorr(s) carrrc t(, talk with you alxrut orrctxrcerciasis wlrcllrcr tlrcre rvas a village rrrcctirrg at lhnl tirrrc Issues lhat rvere tliscussetl at tlrc urcelirrg . owrcrship of tlre progranuuc . erpGctalion lr(xn tlre prograrrrrrrc o rcsporrsibility of tlrc corrrrrrurrity 2. l'lease tlei,cribe ltow tlrc corttttttutily trxrk docisiorr orr tlre tirrrc (rrxmrh/scasorr) arrl rrnxle of distribution. I'L|]ASE PllOllE l;0(: lbrsurs irrvolvcrl in dcrcisirrr-rrml irrg 'l'hrrc of tlistributiurr lVhy tlre tirrrc was choscrr Malxxl of rlistributirlr Why the trrcthxl of rlistritrutirlt rvas clroscrr l'leasc rhscrilrc lrrrv llrc cotttttturrily trxrk ttccision orr ttrc trcrs(xts rcs;xrrrsibte firr diuributing the rlrugs to corrrrrrurrily rrrcnrlrrs. I'LliAsE I'llollE ].oll: o |tersons itrvolvcd irr decision-rtrakirrg o Wlrr will lrc responsibh for rlistrilxrtion 3 Mtnitci6 lnlrun:ntr Krrr?.!r, Mr,y, IVN il a ) I ) : ; a5 (r. o ltrlw tlrc;rcrsuts wcl'c sclLttc(l . WhY tlre;rcrmrs welc shcted . Mctlrrxl o[ tlrug collar:tiott 4a. llas tlere 5ecrr a:ry clrarrge hr ttrc pcrsrrr reqxtsible tor rlrug rlisrib'tltion (CDD) since rle lrcgi,rring,f rlie ,r,giarrrrrrc? (PI-EASE'ttl-L US WllY) 4lr. I las tlrere beett a:ty cltattge ilt tltc pnrgranutrc? . Wlto brouglrt tlrc clutrgc o Wlrnt was tlrc clmnge Wlut were ygu toll alruut tlrc rreetl for conututtity lreatlllcllt qirh ivcrtrrcctin? (ltROBB Fotr ANN0AL'tltEA'tMENl l:oR SEVERAL YEARS,'l'l lE BENEFIT' soURc_E oF lNl;ol(MA'l'1()N, cOMMUNrl'Y l(lrsl'oNslulLrrY AND llE LTll EDUCA'I'ION) llow is t1e rlrug trrrlratlly lrrought inro rtre cottttttuttity alrd distributetl to sollllllullity rrrctrrbers? I'ltOllli l;Olt: r ;xrittt o[ collcctiorr . persorr rcslx,ursible fior brirrgirrg it to tlrc cotttttuttily, . lrcrson reqrorrsible frlr tlistributiul within tlrc cottttttuttilyb tttule o[ tlislrihrtiott . wlrctt was tlte rlrug srvallowctl 7. Woultl yrnr plcasc tcll us llrosc wlxl shouttl not lrc trcalcrl witlt ivcttrrcctitt (crclusir.rlt critcria)? 8. llorv rvas dosage tlctcrrrrirrcd by the CDDs tlurilrg tlrc last distribution? PROBE rOR MEASURINC DDVICI] 9. Wlrat pro5tcrrrs lravc you lratl rvittr rcslrcct lo the tlistributiott o[ ttrc dnrg? PROIIE l;OR o tirrrclitrcss o[ supllly to tltc ctlttttuunily . atlequacy of su1ryly . st(,rilge 10. Wlrat problens lmve ytru harl aftcr tnkirrg lhe tlrugs? I l. t.low prepared is the colrnrurrity, to take corilrol of iverrrrcclirr rlklril4ltirnlnrgreluttrc? (1ow docs ttrc ctxrrnrurrity irrtcrrtt lo suslaitt tlte exercise ltrr sevc[l rErl!?) 12. Wtrat support fias rtre cottttttuttily givett to flrc CDD? PROI|E t.QR : trrccrrlivcs itr caslt or irr kilnl t'nrvisiut o[ ttrcets of trenqrlrl Mobilizatiort o[ cotnttruttilY a a a MrnikrinS trnlrrlttEnlt Kutlnh. May !9Il l2 aErrsurirrg corrrpliarrcc \ l3' could you. ptease tell us trow you would rrrca.sure trrc success of rtre cD,ft prograrrurrc? 14' llow *ctt h.s ftc cDD prfornred? (pRoIrE FoR ATTr.r.uDE). 15. Wlrat suggestions do you trave to intprove the prograrrune? a Mmitorlng tnslrunrntr t(rnr;nh .Mry IVN t3 IN-DET'['IT TNI'ERVIEW OF VTLTAGE'A" CDI) To bc &tdtigercd onlY fu grouP 'i'villages. lttcniclrl 2 CDDs Pr villagc d tlrcre arc ,rwre tlnn otu CDDs. At entl ol tlrc interview uk tlrc distributor lo lcl Yott scc his tols: trundng devise, registers, renruililttg drug if it is tltc atse' Wlrcn u quesliott nniltiple resPo,tses' do not lorget to l'ttt u circle u'ourul euch rcqurcs t applictble rcsPot$e eode. l'xilte where aPP xryriote. Nattrc of Village Villagc crxle: SubcrxrrtY/l'GA DistricUState Nanr of CDD Sex: l. l;etttale 2. Male Main Oc,cupatiott: Morrtlr and year of first cD'l'l distrilrutitltt in tlrc village -l- Month atrl year of last cD'l'l ttistriburion in tlre village -l- l.tlowwasttrctinrc(lnrrrrtlr/seasolt)tortlistrilrutiontlccidetl? l. at a village trrceting 2. villagc ettlers' ttrcetittg 3. villagechief/leadcr 4. health worker 5. village lrcalth cottttniltee 6. village cotutttittee llrceting 7. otlrcr (sPecifY) 2. What mode of tlistribution was decided? l. ltouse-to-ltouse 2. ccntral Place (sPecityl - 3. Both house-to'ltouse arrl ccntrrl place 4. otlrer (sPecity) 3. l{ow was tlrc nprle of distribution rlecided? l. at a village tlrcetills 2. village elders' ttreetitrg 3. village chief/leader 4. healtlr worker 5. viltage healtlr cotntttiltee 6. village cotttntittee nreetills 7. otlrcr (sPccifY) ,t Monitoring tlrslrunEnls Krmpah , Mry 1999 l4 4. llow were you selected to do tlte work? l. at a village meeting 2. village elders' nreeting 3. village chief/learlcr 4. health worker 5. viltage ltealtlt comtttittee 6. village cotttttlitlce Itrcetittg 7. otlrcr (spccifYl -- f t 5. ltas arry cDD beerr clralrged after tltc lirst distrilxrtion? l. Yes 2. No 3. Dott't kttow 6. lf YES to Q5, Wlry was thc CDD clrarrgctl'l 7. l'lave you evcr l-lcett sttlrcrvisctl ? l. Yes 2. Ntr 3. Dolt't kttttl 8a. lf yes to Q7, wlto supervised you ? (ll: NAMti WAS MliN'l'lONED, I'}LUASII ASK l;Ol{ IDIINTITY/POSITION/STAI'US OF'l'l Ilj Pl'll'SON) I. llealth staff 2. Village ltealtlt cottttttiltec lttctttlrcr 3. NGO partttcr 4. Cotntttuttity tltctttlrcr/clticl' 5. Otlrer (specitY\- 8tr. What ditl the supervisor tlo? Checked tlte ivcrtttcctitt ittvctttory Checketl tlte records/trcallllcllt rcgister Collatcd tltc relxtrts Advised ott tlte tteatlllcllt oI absctttecs othcr (spccifY) (). At rvhat occasiorrs were )'or.r sultcrviscd'l (Cll{CLE Al-L'l'lln'l'n l'l'LY) I 2 3 4 5 l. Ilc[orc distrittution 2. During distributiorr 3. Stx-rtt aftcr distributiolr l. Ycs l. Ycs2 I . Ycs2 2. No No No l0a. llave ypu rcceived ctlrrcatiorr orr (lrc itrtltorlattce r.lI takirrg ivcrttrcctitt lablcts annualtY lor sevcral Ycars? l. Yes 2. No 3' Carr't tcttlelttlrcr Mrrrritorrrrg lnslrunrcllts Krrrrpala , May lt)t'X) t5 !lOtr. lf yes, wlut were You told? I l. Dkt you provide ilrc cotnmunity with crtrcation on iverrrcctin treetnrcnt? l. Yes 2. No 12. llyqs to Ql l, wfuen rlirl you provide rhe erlucation to tlrc coltrrnunity? (CIRCLI] ALL TilAT APPLY) l. Durirrg tlrc l-trst nreeting 2. Bcfore the first distributiott 3. During distributiott 4. Soon after distribution l. Takirrg ivernrcctitt anttually for several years 2. Bcnefits of treatttrcttt 3. CotntnultitY resPonsibilitY 4. Side ehects 6. Otlrer (sPecify) - l. Yes l. Yes l. Yes l. Yes No No No No 2. 2. 2. 2. 5. Otlrer (specifY) 13. If yes ro Ql l, what dirl you rell the cottttuurtity? (clRCLE ALL TIIAT APPLY) Yes Yes Yes Yes 2. 2. 2. 2. No N<r No No t 14. Did yor receive any training ott ttow t() treat cotnntunity ttrctntrcrs? l. Yes 2' No l5.IfYestoQl4,whenrlidyoureceivetrairrirrg? 16. Who tnined Yott? l. Health personrrcl/Onclrc coorditutor 2. NGDO staff (sPec 3. Another CDD 4. Other (specify)- 17. Horv lorrg did the training last? ll trainhtg- 2d training- l-asl training 18. t{orv nratry cDDs rvere traitted togetlter (size o[ tlre group)'l l" training- Last tra Monitorinq lns(tutllcllls Kattqrala . May 1999 t6 I I I I 19. Wlrere was tlte vettuc o[ tlre last trailrirtg? Withirr tlrc communitY Outsitle tlrc cotntnunitY I lealthcare facil itY/hosPital Otlrer (speci(yl - 20. Was tlrc venue of training lrcar to yrnr cururrunity? l. Ycs 2. No 21. Whar were you tauglrt tluring training about onclxrcrciasis (ClRCl-E ALL'l'llAT API'LY) 2. 2. 2. 2. 2. I 2 3 4 l. 2. 3. 4. 5. 6. l. 2. 3. 4. 5. 6. Cause Syrnptotus Socio-ecoltontic intPortatrce Comtttunity nrobilisatiur antl etlucation lverrrrcctin as treattlrcnt for a lottg tittrc l. ' Duration of trcatttrcttt 2. Coveragc of tlistributiott '3. Dosage tteterntirtation by ttrcasuring lreigltt 4. Expiration of rlrug after retnoviltg container seal 5. Treatttrcnt of absettlees atrl refusals 6. Side ettccts (counscling arrd refcrral) 1. Erclusion criteria E. Record keeping 9. Census 10. Other (spcify)- l. Yes l. Yes l. Yes l. Ycs l. Yes l. Ycs L Yes l. Yes l. Yes l. Yes l. Yes l. Yes l. Yes L Yes 2. 2. 2. 2. 2. Nn No No No No No No N<r No No No No No No 2. 2. 2. 2. 2. 2. 2. 2. 2. Otlrer (spcify) 22. Whar wcre you raughr alxrur rtrc drug? (clRCLll ALL'[[lA',l'APPLY) 23. Whar rvcrc you tau-ultt alxrut rclxrrtirrg? (CIRCl-U ALL'l'll['l'Al'l'LY) Nunrber o[ pcrsotts trcatcd l. Yes Nurrtlrcr of rcfusals l. Yes Nurrrlrcr uf allscttlces l. Ycs Nurnlrcr of exclutlctl persolls l. Yes Nurrfuer rvillt sevcre sitlc eflccts l. Yes Other (slrccity)- 24. Dhl rrry rr1glrrlrcr p[ thc cornrnurrity collect llrc rJrug frottt a collection grirrt duri[g tlr last tlistributiott'l t. . Ycs 2. No 3. Don't know ir I I I I I a I I I I I I No No No No No ?5. lf 'tkr' to Q24, rvhy? M<nit<rin3 htflnrtrEnls Krnplo . ltllty l9!Xl l7 2(r. Wlrere is the collectiorr lxrirrt? 27 Didyouexperietrcelatesupplyofrlrugsr'lurirrgtltelastdistribution? l. Yes 2. No Please e 28. tlow rto you nortually rletertttine the qualrtity of tlrugs reqUirett by the cottttttuttity? Census/registration record Previous treatnrcttt recortls By counting tlte ttutttber of lrousehokls Other (specifY) 29a. Did you experierrce sltortage of <lrugs durirrg the last distribution? l. Ycs 2' Ntt 29b. lf yes, please exPlain 30. How tto you delerrrrine rlrc nunlber of rablets to give to arr inrlividuat? (clRCLE ALL THAT APPLY) Take heiglrt llrcasutetlrcllt Use weight Visual observation ABe Otlrcr 3l . What rlo you do aSout individuals wlro are absent tluring ttorttnt tlistributiorr periotl? 32. Wlrat do you <lo atrcUt irrdividuals wlto refuse (rcattttcttt? 13. Which caregories o[ people rvould you rrot givc tlrc tablets (PLEASE Cll(CLE ALL'l'llA'r AI'PLY) I 2 3 4 Ycs Yes Yes Ycs I. lrxlividuats below 5 years of age/ lrelow 90cttt 2. Pregltattt wollletl 3. Woure[ wlio rlelivered less fltalt otte weck bcltlle tlistributiolt 4. Sick intlividuals 5. Visitors 6. Otlrer (sPecitY)- 34. llow rJo you etrsure tltat tlrese categot'ics ot';rcqrlc cvetttually reccive t. 2. 3. 4. 5. 2. 2. 2. 2. No No No No I l. l. t: l. l. Yes Yes Yes Yes Yes 2. N<r 2. No 2. Ntr 2. No 2. No trcatttrcttt? tr,f nrritntirrs lnslrurncnls Kanrpale ' May 1999 l8 a35a. llow long do you rrunrmlly keep tlrc tablcts irr thc conrrnunity? 35b. How many days dirl you take to currpletc the last distributiorr? 36. Where do you norrnally keep the tablets? 37. Do you lrave drugs to take care of lrrinor side effecls? l. Yes 2. No 38. What kind of support do you receive fronr the corrrnrunity? l. Transportation for drug collection 2. lncentives (sp.cify) 3. Otlrer (specify) 39. Do you lnve problerns with record keeping? l. Yes 2. No 40. lf'yes to Q39. pleaso expla 41. Please tellus how you feelabout tlrc progranrnrc with respect to: a) sustaining the progralnrrrc i,i a lr) conurrunity resporNe c) constraints 4L.Wtrat tlo you rhink shoul<l be done to inprove [rc progranrrrrc? a 43. Are you willing to contirrue as a CDD? l. Yes 2. No Pleasc PLEAGE ASK FOR REGISTER AND MEASURING DEVISE'IO PROVIDE FOLLOWING INFORMA'I'ION 444. ls rrrcaslrirrg device for height presetrt? ij Moitorh3 lmrrun:ntl Krnprh. Mry 1999 t9 Yes, seetr Yes, but not scelt (ExPlaitt) . No, 44b. Ilow do you use it? 45. ls treatrrrcnt register preserrt? Yes, seett Yes, but not s€en (ExplaitD No, 46. lf Q45 is "Yes, seen" EXAMINII lltliA'l'MEN'l' If UGIS'l'EIf AND OUTAlN 'l'llE I;OLLOWINC INFOITMA'I'ION ON : Total popu lation Age corupositiorr of people: Below 5 years_ 5 years atxl ,tru.- I 2 3 I 2 3 I 2 3. 4. 5. 6. 7. 8. 9. Sexconlpositiorroftlrepopulatiott:Male- Nunrber o[ persorts treated_Male_ l;errmle Ferrule Nurnbcr of persotts urxlcr-5 yea rs who receivetl lreatrrrcnt Nunrber o[ refusals Nuurber absettt during last trea(nrcnt_ Nunrber witlt severe side effccts Nurnber of tablets received 10. Nurnlrcr o[ tablets used I l. Nurnlrcr of tablcts leli irr the drug kit_ aU r. E t' I Moniloring lttsltuttrcttts Katnpela , May 1999 20 ;5. I'low rnarry persons itr ttris villagc (CDD) give out thc drug lor otrcltcrcerciasis? IV llory rcre llrc pcrm(CDD) sclected to do tlrc work? l. at a village nrcting 2. villageelders'ttrceling 3. village chief/leabr 4. healtlr worker 5. viilage heatrlr conynittee 6. village comrnittee rEctins 7. other 7. Have tlre CDDs receivcd any trainittg? l. Ycs 2. No 3. Dott't krrow/ Can I rcttrcrttlrcr 8a. l'lave you charrged auy of your CDI} l. yes 2. No 3. Dott'l kltow 8lr. lf yes, lvhy? 9. Ditl any rnenrber o[ tlrc courmunity collect tlre drug frotn a collection point? l. Yes 2. No 3. Dou't kttow 10. Did you experience late supply of drug durirrg thc last distribution? l. Yes 2. No 3. Don'tkttorv I I . Ditl you experierrce slrortage of drugs durirrg tlre last tlistribution? l. Yes 2. No 3. Dtrt'l kttow 12. Does tlrc comrnunity have a treatttrcnt register? l. Yes 2. No 3. Don't kttow 'r7..-- -:. --:-- a--.-...-...- V-.---a- la-.. iafrl I ,i Iit i t E r I t\lo l3 IE IE ls Elx IR F 9o t:h F E ? rrFa s 3 aiiEE, T JF9E Q 6€ dg, o )il 6fr. iE $ s E I;E5 5 ETBFcr 6-9 - -l * 6€ Xi I iBEFi gEtSlt. i-lli T E;H liIB liir 5 ;. E.s6 FE.tr E.E FS lgrr?8tr5 EIilDc)tr;s gof,guoP EE + z 6'!*JEo6>d *,* Fs* -5x r 8g Bh e"9d :E g= , 5068sr $Bg =.>o-B ae ;t(,a(D z o, ts(D 6t 0:l(D o & l" z o 5 o it2 I(D A' c(D5 I ocUt(D o E U z 9 IoUq o !, o e77 *E <6 Trn a =-? t-t- o ln \1 7A ..-A.D ,5r" (r.l (D z<8agE;iu ssf 8.?H# 535 3 H gdd =ER-a'(! FA C trt,aIo'z E.TE3T< o (rlD og 6 E'€ {(<t oc 'rt rd t-r, -io oC mt,J o z tr o9E € R,d..:.! (! =J H F.1 a s Elltt Nx z<8 *2 <O$If .,*P' ._, { -< ='EHpo:3*t *8'o. -E 8E 3 B ? S. r; .i" EX " gE* o.- ts {ilg IsFq:Ei ;;.* a o fi zo -lo a C mIA :l Z<g 9.8 BE E$np"Frftg; ? Z<*RXRUsrali;5Esxgei rpF octd artj oz t\, H'S'FF.EggET a a ii g,iggr*? r g=.E <'9,! ts;-rO g OHrP EE> rt5 o< -q o =.of. a 0o 5 EI: 65 €Dt D €6\c c l.Jtr t(\t 66 o. ;a E ; d o, EItv t E E s C! E 'E o c o, = o lt oU'o! 8n koT8 .=E a, (, EE *t8 T * * *:ll n?.tg.rg IiAt:;gt c"| rIo'$ ,frEI Ei'toc X I EEEE i;Eo(, I \oi?s e d'gB[.$ fcig*r d-:oo u I .BE {EfrE*Ic' o o q.5 air El El .=E-ct II * a rlI LtI I ; i i 't 1 I J i .) It x .; .: i I .: : I , t t. , i t tI Narrrc of Village Distrkt/Srate Naure of CDD Scr: l. Female 2. Male Mein Occupation Month and year of last ttistribution I l. tlow were y(ru selecred to rlo ltre work? l. at a village nrebring Z. village elders, nrcerinn3. village ctrief/leatler 4. lrcaltlr worker S. village health corunilttee6. village conurriuee meefing6. other (specify) 2. lles rny CDD been clmngerl afrer rlre first digribution? l. Yes 2. No 3. Don't know/can,t rerrrcmber 3. llave ytxt ever been supervise<l ? l. Yes 2. No 3. Dur'l know l. Healtlr statf 2 Village lreatttr conrruittee nrcnrber NGO partrrer3 nrcrrrber/chief To ln adnitistered onll in Sroup "8" villages. ltueniew 2 cDDs per village if there are ,,rore thatt onecDDs' rlt tlrc end of ttie inin'ii, osk tlrc iiltrit won ii tu, y* ,u, his tooli: nieasuring devke, registets,ramhing drug tJ available' when a q,istiou,requiris ,r,iiit, resporses, do not forget b put a circreororuul each oppticable respo,rse rntr. i,it, rulrcre op1tro1triate. 4' lf yes .o e3, wtro supe-rvise<r you ? (rF NAME wAs MEN.T,NED, pLEAsE ASK FoRIDENTITY/POSITIoN/3T^Ti,i or rrrr PERsoN) 4. Conrrnunity 5. Orlrcr (speci lr:';',tlilreceival erlucation ott ltrc inportarrce of rakirrg ivenrrccrin rarrrers anrrualy for Yes 2. No 3. Can't rqnernber (r' Did you rcrceive a,,y rrainirg o, rr,w ro rrear corrr,rurriry ,rcrrrbers? 2. Nol. Yes Moritrring tnslrunrnts Krnpeh. Mry ttDr) 1 ls ttteasuring device for heiglrt llresettt? l. Ye.s, scctt 2. Yes' but rrot secn (fxPlaitt) 3. No, (ExPlain) 8. ls trcaunent register Present? 9 l. Yes, seett 2. Yes, but ttot seen (ExPlain) 3. No, (exPlain) lf Q8 is .Yes, sce[' EXAMINII'lltli^lltDsn' Ruclst'tjR AND OB rAlN'l'llE TOLIOWING INFORMATON ON: l.Total 2.hgecolrqlosirion of people: lhlow 5 years- 5 Years aml above- 3. sex contposition of tlre population: Male- Fcmrlc- 4 Nurrrber of persotts treated-Male- rtrrnlc- 5 Nurnbcr o[ persotts aged 5 years alxl alrcve who reccivcxl tlcatlnent 6 Number of refusals 7 Nunrber absettt rluring last treattttctlt 8 Nurrrber witlt scverc side cl'fects 9 Nurnber o[ tablets received l0 Nurnbcr of tablcts usctl I I Nunrber of ublets left in the drug kit 12. Updale of records Moniloting lnstrurrnls Knnrpah ' May l(X)9 2(t ,l ts OUESTIONNAIRE FO$, IIEALTII PERSONNIIL This questiotunirc is afunhistered on ony hcalth vorkcr in lhe area wlw is directll ittvolved fu CDl'l progmnane i.e the health stalf nearcsl lo lhe vilhge. Tha nuntber of health pcnonnel to ln iueniewect depads o,, tlre situatiott o,t tlre grouul. A ntininnun of 3 health persorurcl who'ore ntpenimn d CDOs sltottld be imeruiewed witltitr lhe project urea. After the interuier ask tlrc healtlt persorurclJor lhc docuuems used for CDTI activilies. LGA/&rbcounty: State/District Country Nattrc of health personrcl_ Scx: l. Mate 2. Fetmle No, of Orcho. No. of CDDs in villages coverctl Itii ttl' | )'.t Position; Qualification Rcspottsibilities in Onclro control Prograrrurrc: I Olrch<l Crxrrdinator 2 CDD supervisor 3 otlrcr (spccity 1. Did you receive any general orientation on CD It? l. Yes 2. No 2a. Did yor reccive rraining ou lrcrv to trrir CDDs? l. Yes 2. No 2b. lfyes, how 2c. Lis ilrc nuin topics covercd iI lrt, il ) 2tl. Wcre you taught lrow severe sidc eflccts drurkl lrc lrunagcrl? l. Yes 2. No 3.|'krsc tellus what you kuow about trrc cD'r't progmnurrc witlr respect to: I 1. Cmurruniry 2. lrryolvcnrcnt of tlre trealth systcnl in CD l'l 4. ltr tlrrc m hitirl nrcetiry ritlr the comnnrnity wlrcre CDTI ums irrtroducetl? l. Yes 2. No Mtnil<ri4 lnslnrnrnls (rnqnh. May lgltt 21 5. lf yes to e4, wlnt role rlirt tlre treattlr stafl'play in arrarrgittg ftrr the lirst lrrcetittg? (CIRLCE ALL 'nrAT APPLY) 1. Facilitatert the nreeting 2. Mct with village leader to alrangc for tlre llEetills 3. Otlrer (specity) 6. Wlro led the facilitratirrg teattt lo tlte cr.utrnrunity? l. lrcalth staff 2. goverriment adntinistrative staff (Iron-lrealth) 3. NGDO staff 4. otlrcr (specify) 5. Nobody 7. Were llrc comrnunities (where you workal) tablets? alucatgt on tlrc inrportance o[ treatment wiilr ivertnectin l. Yes 2. No 3, Don't ktr.rw 8. lf yes to Q7, rvhat were they told? (CIRCLE ALL THAT APPLY) 1 2 3 4 Annual treatnlent for severgl years Ilenefits of treatrrrcnt Comnrunity. responsibil ity Others (specify)_ l. Yes .1. Yes l. Yes 2. No 2. No 2. No t 9. Were CDDs irr tlre corurrrunities (wlrere you worked) trairretl for the CDI'I progratntne? 1. Yes 2. No 3. Don't know l0a. lf yes to Q9, did you participate in tlre training of CDDs'l l. Yes 2. No l0tr. lt yes, how tong ditl this trainirrg session last? lrritial traittiltg_ Ite(ra lla. Who superviserl the CDDs l. Not supervisetl 2. Village heatl 3. Village health corruuittee nrember 4. .lrcalth personrcl 5. Otlrcr I I b. lf supervised, how rnany CDDs did you sulrcrvise tlurirrg tlre last distribution? l2 lf rxx sulrcrvised, wlt t3. .nt which occasions rlid you visit the CDD? (Cll{CLll n LL'l'llA'l'APPLY) I Beforre <listriburion l. Yes 2. No Morrikrrirr8 lnslntnrclrts Kanrpala . May l9)9 28 2. Durirrg distribtrtiott 3. &lon after rlistrilrution Collection of unuserl rlrugs after distribution Review o[ records Metmgettrcnt of side. ellccls Supervision o[ drug tlistributiorr Otlrcr (specity)- l. No constraints 2. irrahquate/lack o[ lneals o[ transport/fuel 3. Too tnuclt work 4. lnadequate/lack of supervisiott allowatrce 5. lnaccessibility l. Ycs 2. No l. Ycs 2. No 4. Otlrcr Gpecify)- 14. what funcriols rlo you perfirrrrr durirrg your visir to tfte cDD? (CIRCLE ALLTtIA'l'APPLY) l. Yes 2. No l. Yes 2. No l. Ycs 2. No l. \'es 2. No r5 Whar cotsrrainrs rlo you have in suprvisirrg tlrc CDD? (Cll(Cl-U ALL'nl^l'API'LY) l. 2. 3. 4. 5. l. Yes 2. No l. Yes 2. No l. Yes 2. No l. Yes 2. No l. Yes 2. No 6. Otlrcr l6a. l{ave there been any delays in receiving iverrlrectin? ll Yes 2. 'No l6c. llave tlrcre been arry rlelays in cotlecting iverttrcctitt by the coltutruttity? l. Yes 2. No 17. lf ycs to Ql6c, please 18. Wlrat consrraiuts have you experiencerl in gettiug tlre drug? (ClI{CLE ALL'illn'f AI'PLY) l. Norre 2. Transport problettt 3. lnadequate supply L Ycs l. Yes l. Ycs l. Yes 2. Ntr 2. Nrr 2. No 2. No I 4. Delay in supply 5. O0rcr (spccity) 19. llow rlo you estirnate tlre quarrtity of drug rerluiretl? , Not responsible , Nurrrber used durirtg last treatllrcnt . F.se.l on requests frottt tlrc CDDs . 'lbtalpopulation (witlr the [orrnula) Other (spcrci 20. Did you get the drugs wltett requiretl? l. Yes 2. No l I I I 2, 3 4 5 Morrikrring tnsltttnrcnls Katrrlala . May l$19 29 21. lfrck e20,why? l. Shorhge al S.b, trjiuul hvel 2. Means of tranqrort 3. Otlrcr (specify) 22. h you have facility for storage of ivenrrcctin? l. Yes 2. No 3. Don't krxrw 23. Have yo experienced los of tabtets due to pilGrage? l. Yes 2. No 3. Don'tknow 24. Were cases o[ seyere side cffecs rcportcd to yan? l. Yes 2. No 25. (CHECK AVAtLABtLt.t.Y): l. Available 2. Nor avrihble 26- What otlrer lrealtlt activities do you continc with Onclro Control prqgramrne acrivities (pRouE FoR HEALTH ACnVry N Tilti cDn couxunmEs)? 27. How do yur feel about tlre CDTI programme? 1 \t; i t Mmitrriq lnlrun*rrs l(rn;ah -Mey lrrrt 30 I NTERVI EW G UI DE FOR I'OI,ICY-MAKIIRS/ WI IO RI'PRI'SI'N.I.ATIV Ti/I,ITOGIT A I\{ M I' MANAGBRS/ COORDINATOIIS Tltis inrerview is adrninistered on Co-onlinators, Progtanmrc nriltayers, rqrrese,rtatives of NGDOs involved irt CDTI, Mirtistry of heatth poticyrtrukers and the WIIO representutive fu tlrc courttry. lt is similar to the iueniew of heattlt personnel. Docunwils such as registers sltould be requested before tlrc fonnol i,tten'iew so tllat infornntiott can be extractec! for tlrc repon SECTION A: PROCRAMME MANAGERS/ ONCllo COORDINATORS t. Please <tescribe trow tlrc CDTI prograrume is being inrplertrcnterl itt your area PROBE FOR The approactr used for introrlucirrg CD'l'l lo tlrc ctutttnunities Elernents of collaboratiorr between Conrnunity, llealth sysletll arnl NGDOs (lDENl'lFY SPECIFIC ROLES) Gencral re-orientation of lrealtlt persontrel towards CD'l'l progralllllrc Mobilisation of tlrc contmunities Trairring of healtlr staff as traitrcrs Please explairr process of receivitrg iverttrcctitt PROBE FOR : a Delays in supply . at rvhat level arrd rvhy? Adequacy of tlte quantity receiverl/sltortnge Storage '. '.' 'ri ' t " "' Distribution to' conlnrunities a. b. c. d. e. 2 c, d :Q. f. ,1 .')!l ,ir. I I g. Pilferage 3. , ' !'.IiUNDING: Please probe [<rr ] .^ ,, , a. Delays in endorsetttettt of letters of agrectlrcttt 'lrirl'r'Wlty? Corstrairtts.(storage, transport, etc) I b. Delays irr receivirrg [unds o at rvhat level arul wlry? . Delays in disburscttrcttt of futds . At what level arrd wlty? c Mtrrillrrirrg lnslrunrnls Kanrpaln . May 1999 _1t SECTION C: WIIO COUN'IRY RBPITESIiN'I'A'I'IVB I l.What is your perception about tlrc APOC strategy ftrr iverttrcctirr distributitllt ( Probe for teasibility'of the CD'tl approaclr in solvitrg otlrer health problettts) 12. Wlut is the relatiorrship between ilre WllO office arrd the Nalional Orrchocerciasis'[ask Force (NOTF) with rapocr to CDTI inrptiruentarion. (Probe for issues relatirrg to lrattsfer o[ futttls, support to NO'I'F and rrnrritoring) tt a Monilorirrg lttslrtllllcllts Kltrrr;lala, lvl;ry l()(l() t3 '1 )A / r.to€/ 1J t I u t' r f A I tt t') Lq-si Nnqe pti t'lame Yea< 'ts t4 sr;,1 Lo- -C wuLg T 'jn.esFdstt'r 4.%1*,q +7qo l+9-9.1".tRtr4 \l6(l: )cl tty? I\/t)-/ru _L__ _2_ 3_ 2Ilo q 6ntq\ (6 .L tt!istELoM v2(o"'n3sC I I IVLthT8M q-vtg t+\/ 3 3lo sch)tF b ?FrY?tnqoSJz lil;^3 lf_,t- t.- R )7t/ (^ aPM A 54 yDlr/ .} rL 11,tl r. )-Jcht0 3lrt)nlf) t{ b."tr !{3r 3o Nq-l^.( V tt-Q.a -Nt Eh-.'cr Res-a- V t/9{OtP 9.L,(5 n SGls- I )- I I N I I I L 9- ;t t c_( v 4E ( l (> + lh t-- I tl ) O> I 7 3 T s ? 7 8 1 "o\^i b 4 ru{A* {o fr* ,"rl I: rYl ,(T LtF 6I q ut_ rn rq a I ) 0oQ- 0\5.R- 64"r*, -'-J - s<r o tt 2<- kN A vLes U*.* @a J*,ro4 C*-r{"" lt1a,r,--q I 3 + 5 t) 7 8 f\l N (r\fiI lg,^+ 0,*ri{o 0^o;f. C^r4" 0"^ip<,gyn{. tnal,tr Unou./i Oy-Pu AykA A-Ez 6L 31 tt l3 l0 /3 3t_ SCXI -l Irlfl t:l Fl tnl -l,l ,t1.1 '1 I I I I I 00l7s-o9 3 -t- =.-a l .l I n .1., !i 'i 1..: 1., !,* ',, li:, --C'Al I J I 7 3 chI s ? 7 8 7 ;({ l-icJ;KJ^,'{ ..J"i 0oQ- 6l rn q ) Coh C-l^Aru, Ndqdj US'q Ut_ 1o{ 1o rrl -@q,tl "*lft tr) F rYl (lJ r(r{. P-Lr- I I -J--6.K-r, '--J' 8 (- 4 ri .t- kt N$rue5 N f\l 4se 66 3_q t+ t3 la /3 3J Llso,*., Art -1.*,-oA C*-{"" n*r* lg.^+ (0,^^r{u 0^o;f- C^rr,{" O^^r;.{- @!^nf- lna4 U^-o-adi U\rq a Qr-.p" Ayl@ S 3 r 1: F F M t: t) 1 3 + 5. 7, I R r'i _t , ",,: ". orl/nle (o.r iuor/n le-o 7 I zdnmc pr pt, N4rte L e o(,'t',. ' I 7i t.a...1.qA(-L'"i Y'r" c&,t e.4i L*t, -J _t-_ .) {EY X'b *' ( R n8- as Teu -\;It, t R l^lSEI- tf A2- .li,"tlt4 l521-0t) + (l$h5LolYt tt-)oL')f,,r,,,,-" A 4..,vv(_frrl?r.rl q^735 2-?C f2- q-od-9- --1- I -t- a t entfnle (o'io.or/n le-o 9- I?A a {hY *'tt' d*t'lt= B''7 Nane AC -(enc _9-s St4rlT+&s I Itt tf t-\{eto,ttlw_ ly')30t: n$h3_0_lYl + Q)-2oJ, lA73€ +-2.?C {-2-}} 4-od-3L A l-, 4u, (' lrr', r, u..r!, c Larrltrtrl < o(,',:'t--[ e4,; , ljovct> vv. 'L-t t h n

jDELTA STATE . WHO/APOC/CDTI PROJECT i|IGB REPORT OF IT\IDEPENDENT MONITORS OF CDTI ACTTVITIES IN DELTA STATE, NIGERIA T]NDER THE EDO/DELTA PROJECT 15 AUGUST TO 5 SEPTEMBER 2OOO SUBMITTED TO AFRICAN PROGRAMME ON ONCHOCERCIASIS CONTROL (APOC) SEPTEMBER 2MO I t fllfi0n lrrmilomfl tllt'l0lt ufioft u0l, uarfi*MHw$l txlrfrLliourH luilfiu PINK GREEN WHITE BLACK HTPER MESO }TYFO LGA BOT'NDARY RE9U I 7 0CI. 2000 APOC/DIR i, )I _t REPORT OF II\DEPENDENT MONTTORING OF COMMT]MTY DIRECTED TREATMENT WTTH TVERMECTIN IN DELTA STATE, ntlGERIA T]NDER TIIE EDO/DELTA PROJECT 15 AUGUST.5 SEPTEMBER 2OOO DR JOSEPH OKEIBUNOR Department of Sociology/Anthropology University of Nigeria, Nsuktca Enugu State, Nigeria DR. (MRS.) EDrTrr NNORITKA Department o f Dermato lo gy College ofMedicine University ofNigeria Enugu Campus, Eougrt Nigeria DR ODU BAMGBO$E National Onchocerciasis Control Programme Primary Health Care/Disease Control Federal Ministry of Health Lagos/Abuja Nigeria Submitted to: TEE DIRECTOR, APOC African Prograrnme for Ochocerciasis Control Ot agadougotl Burkina Faso By ( t 3TABLE OF'CONTENT I I List of Acronyms Acknowledgement Erecutive Summary Introduction Methodolory Results Discussion and Conclusion Recommendation Appendir 4 5 6 E 11 t6 33 35 i) ii) Study Instruments Samples of CDD Treatment Registers t 4LIST OX'ACRONYMS t t 4WD f.i. Ag. APOC CBIT CDD CDTI FGD HS II)P IEC LCIF LGA LOCT MIS NID NGDO NOCP NOTF' OCP PHC RBF REC REMO SOCT SPO TB TOT vHw wHo Four Wheel Drive ad interim Acting African Programme for Onchocerciasis Control Community Based Ivermectin Treatment Community Directed Distributor Community Directed Treatment with Ivermectin Focus Group Discussion Household Survey Ivermectin Distribution Programme Information, Education and Community Lions Club Internafional Foundation Local Government Area Local Onchocerciasis Control Team Management Information System National Immunization Day Non Govenrmental Development Organization National Onchocerciasis Control Programme National Onchocerciasis task Force Onchocerciasis Control Programme Primary Heahh Care River Blindness Foundation Record (CDD Treatment Record) Rapid Epidemiological lvlapping for Onchocerciasis State Onchocerciasis Control Team State Project Officer Tuberculosis Training of Trainers Village Health Worker World Health Organization I 5) v ACKNOWLEDGEMENT The tearn would like to extend its sincere gratitude to all those that assisted it dwing this mission Of special mention are the following: o The Honourable Commissioner for Healtb Detta State, o The Permanent Secretary, Ministry ofHeafth, Detta State o The DirectorofPublic Health, Detta State, o Chairmen of all the Local Government Areas visited o The Primary Health Care Coordinators ofall the LGAs visited o Honorable Councilors o Members ofDelta Stde Onchocerciasis Conhol Team o Coordinators and Members of Onchocerciasis Programme in the LGAS visited o The l,eaders and members of communities visited o The Community Directed Distributors ofthe communities visited [9 Edo/Delta Project Adminishator, Mr. J.O. Eguagie, and the entire Statrin the project 9ffice ar9 also appreciated for all the wann hospitalrty that was accorded the team ailrg the mission t 6I (: EXECUTTVE SUMMARY The Independent Monitoring Team that was constituted by APOC lvlanagement to visit Delta State Community Directed Treatment with Ivermectin (CDTI) p.3""t, Nrgerie lory lS August to 5 Sepember 2OOO, had Dr Joseph Okeibunor of ihi liepartnent of lociology/Anthropology, Universrty of Nigeria Nsukka as the Principal Monitor. DrMs.) Edith Nnoruka of the Department of Dermatology, University oitligeria Enugu Canrpus and Dr O Bamgbo$e of Federal Ministry of Health, Nigeria were the other monitors in the team- The team had the Delta State SOCT and LOCT members as local ryrq":. The assignment commenced with a bniefing of the Project AdministratorGLOBAL 2000, State Onchocerciasis Control Programme and HealthPolicy }dakers, on the terms of reference of the Independent Monitors and the areas u&ere their cooperation would be required. The methodology and instruments adopted were the same as those 9.:.t"p.a inOuagadougou and finalized in IGbale, Ugandi The objectives were eqtrallyleft as stated in Kabale, Uganda Six Category 4 and 24 C-ategory B, villages were selected through an elaborate, multi- {1g9 sampling procedure. The findings show varying degrees ofthe establishment of theCDTI prccess in the APOC LGAs of Delta State. Some serious elements of the CDTI process were noticed in the communitieVvillages visited. All the same, empbasis still needs to be placed on the sensitization of all the communities toward their responsibilities and the full involvement of the health service personnel and the utilization of pHC facilities in the planning and implementation of CDTI activities to engender ownership and sustainability of CDTI. The key findings in Delta State under the Edo/Delta CDTI project include the following: o CDTI bas taken offonly in seven LGAS out of nine eryected to be implementing the programme in Detta State. Ika soutu which is hlper endemic, has not implemented the CDTI process due to lack of training from the SOCfs. o Some CDDs were not fully conversant with the CDTI concept. They were not able to recold correctly in the registers, understand the concept of lousehold. This could be an element of quality of training and supervision o The standard of haining, in tenns of quality and quantity, was good but still has t991ts for improvement. Training was at community lwe[ as -recommended by APOC. Training materials were adequate and trainee-trainer ratio was managsafls. o Most supervisions were done before distribution and without any standard checktist o The issue of counterpart fundlng by the State and some LGAs is still problematic. o Reasonable integration of Onchocerciasis control into the other primary health care programme/activities was observed in a majority ofthe LGAS visited. I 7, I Generally, CDTI proqragme implementation in Delta was reasonable. Deqpite the Fr9i*p in logistics, |OCTs show high enthusiasm in the success of the CDTI approachin the State. Faced with late release of funds and unavailability of transpor! one of theSOCTs used his personal car to train five LGAs under his jurisdiction This was confirmed from interviews with the SpO and some CDDs. A high level of awareness on the disease and benefits of the drug bas been created by theDelta State prcject. Communities showed appreciable terlt of zupport for theprogrammes and willingness to monitor the implementation of CDTI. The policy makers also expressed similar political will and support. The CDDs exhibit nign fiteracy levels, necessary for accurate-record keeping and reporting, crucial for the -CO11 process. A conscientious prcsecution of the CDTI pnocess, niog.a on these positive features and some determined efforts by the Detta State prroject will no doubt yie[a tne desired frgits. Based on these finlinqs the following recommendations are being proposed to enhanceCDTI implementation in this project area: Continued reorientation, training and involvement of the health service personnel atpo!:v and implementation levels on the APOC philosophy and theh roles in'the CDTI as well as its integration into the pHC system shouid be intensified. Adequate time should be devoted to the project for proper dialogue with community leaders on the benefit of the Ivermectin treatment, their roles aoJ commitment in thelong-term sustenance of the treatment process. They should be rnade to be aware of their ownership ofthe progr€unme and right to rnake the necessary decisions. More personnel from other cornponents of the PHC, media and educational institutions with skills in health education, mobilization, and gender issues should be co-opted inCDTI implementation activities at all levels. Steps itoUA be hken to increase puUti"ity of the CDTI programme as in other disease control progftunmes. A^d:li!g9 attempt must be made to imFrove the quality of record keeping at all levels ofthe CDTI implementation in the State. a o D rI 5 8a I INTRODUCTION 1.1 General Background Ntgeria, which is Africa's largest and most populated county, with well over 100 million people, still remains the worst affected with Onchocerciasis. An estimated 30 million persons are at risk. The burden of Onchocerciasis is high and is a major contributor to the low socioeconomic status of the agarian population-lirring *o*d the numerous frst- flowing streams and rivers in the country. In Nigeri4 mass treatment with retizan@ (ivermectin) has been on-going since 1991, with the assistance of LJMCEF and various NGDOs, like River gtindness foundation(RBF), AFRICARE, Sight Savers, Rotary International and Lion Club. These agencies are now partners with the African Programme for Onchocerciasis Control (ApOC). APOC was established in December 1995 with the main objective of setting up an effective and sustainable community directed treahnent *ith ivermectin tCbnlprogramme in 19 endemic countries. APOC's stratery is based on the mectizan@(ivennectin) donation programme of the Merck Company Inc. Studies have shown that mectizan@, is well tolerated and effective in reducing microfilarial load, improving ocular lesion, skin lesions and reduction of transmission The studies further .".t *t it has anti-helninthic, anti scabetic and anti pediculosis effects, ufiich will increase its acceptability in the endemic communities. Ihe CDTI project proposals are based on a partnership between APOC, the National Programmes and several NGDOs. The first grants were awardet, n lgg7. Each project is funded for a maximum of five years. During this period, it is expected that ApOa support willdecrease proportionately to that of the othei partners and-that the cost of treatmentper individual will reduce by 90 per cent. tn additioru it is eryected that the National onchocerciasis control Programme (Nocp) will continue to manage their CDTI activities for up to 15 years after APOC, in order to guarantee effective control of Onchocerciasis. APOC's philosophy for CDTI is to ensure that the recipient communities own theprogamme in order to sustain it. The communities themseives detennine the activities. They determine where to obtain their mectizan@, ufuen and how to distribute it. They select their community directed distributors (CDDs), collect information about coveragethat help the determination of programme success. Unlike the community b"*d ivermectin treatment (CBIT), the CDTI is a process building up based solely on the experience ofthe community members, and consequently, enhancing the decision making and problem solving capacity ofthe communities. I t 90 I 1.2 Delta Background Delta State is located in the southern part of Nigelia. The State lies between longitude 50 00r and d +st East and latitude so o6t and d Ioi N"rtl" It is bounded on the North by Edo State, on the northwest by Ondo, Anambra on the east and Rivers on the souheas. On the southem is the Bight of Benin, which covers approximately 160 kilometers of the State's coastline. Dgltu is generally low lyrng without remarkable hills and has wide coastal belt interlaced with rivtrlets and streams which form the Niger Detta The River Niger washes the eastern and southeastem boundaries of the State, with Asaba, the capital bcated at itsbaok. Detta State has an estimated population of 2,570,181 persons with 25 localgovernment areas (LGAs). Out of these LGAs, ten are hyper/meso endemic. It is estimated th^t 565,M0 persons are at risk of Onchocerciasis in ihese twenty-five LGAS. Following the Federal Ministry of health's inaugnration of NOCP and the nationwide v@tor parasite studies in 1988, the then Delta State was identified to have an endemicity level of concern Th1 Rapld Epidemiofogical Mapprng of Onchocerciasis (REMO) of indicated high prevalence of the disease in the *"*. - - -CPT is being imPlemented in seven of the ten hlper/meso endemic LGAs. Idassdistribution with ivermectin started in the State in i-gg+ *oo after the REMO was completed. This was initially by the River Blindness Foundation (RBF) and later byGlobal2000 River Blindness Programme. Distribution has been in collaboration betw,een the State Govenrment and Lions Club International Sightfirst project, *ho" community based distributors (cBDs) were paid )+1.00 per person tr"ut.a. - ln 1997, the Lions Club International started a devolution process, which is considered similar to the APOC CDTI approach- Training of LOCTs was left to the State. The LGAs carried out taining of cDDs by Locrs/DHS at the district level In 1998, tlc programme submitted a CDTI proposal to ApoC, which was approved fortunding. Global 2000 River Blindness Foundaiioq which is ihe i.pb;.tirg NGDOpartner, decided e1 sp5tzining the devolution process started n lgg7. ite projeci has just completed its first year of implementation oreon in Delta state. Currently, the nine hlper/meso LGAs are eryected to be implementrng CDTI but only seven have commenced CDTI implementation The present report outlinis the findings of an independent monitoring mission of APOC supported COn project io O"ft" State,Nigeria It must be noted, however, that Ika South, one of the hperLndemic LGAs tbathas not commenced the implementation of CDTI fell into ttre ranaom *-pd of LGAs studied. , al l0 1.3 Team Composition The independent monitoring team that was constituted by NOTF, Nigeria, on behalf of APOC to visit Delta State CDTI project, from 156 Augustto S6 SepteiUer'2OOO,had Dr. Jgsenh Okeibunor, of the Department of Sociology/Antlropology, University of Nigeria Nsukka as its Principal Monitor. The other monitors included p. Crr,arl rditr, Nnoruka, 9f the Department of Derrnatology, College of Medicine, University oi Nigoiu, Enugu Campus and Dr. O. Bamgboge, of the Federal MinistrJr ofHeahb Niieria t[" t"u- "t*bad members ofthe Deha socr and some Locrs asiocal guides. 1.4 Terms of Refercnce The team was constihrted with the fouowing terms of reference: l. S-uccinctly document how ivermectintreatments were undertaken in a sample of communities with approved CDTI project in Delta state, Nigeria 2. Assess community involvement in drug collection, decision making on the period and modes of distribution, the selection of distributors, and the wil'lingness of the community to accept and bear these responsibilities designed in ttre CDTI process. 3 Document community perceptions of CDTI processes especially the issue of ovrnership, and expectations for onchocerciasis contril, h*d on theseperceptions and eryectations determine the degree of satisfrction of the community with the different progamme activities ard o.rt.o-r. Assessthe quality of training received by CDDs and health personnel involved in the project. E)Gmine the record books of the CDDg and assess the quality of record keepifg and-^their ability to keep accurate records. The same applies to the heatth scrvioos, staffon the project Determine the number of communities and eligible treated ana corafii*ffitfirigs with records of the CDDs and the records at the other levelr OC&trc:St"" -level records.) Determine whether the health personnel participated in ivermectin distribution and assess the degree and quality of supervision by health staff (and the quality and orientation ofthe health staffto the CDTI) Identi& constraints in the distribution and recommend appropriate measures toAPoc management to be taken before the next round oftr;atments. 4 5 t , 6. 7 8. o11 9 Discuss the prospects of sustainability based on the findings above. 2. METHODOLOGY The. npthodology used for the selection of the villages was a follow-up of the methodology that was developed during the meeting of trc nine monitoring team members in Ouagadougou in 1998. In a review of the tools, in a tool development workshop in Kabale, this was firrther refined to include a few oith" things tbat were not pr-eviously taken into account. It was therefore decided during tnat meetiig that selection of villages would be based on both the endemicity and distan; from the l&tn services. 2.1 Study Design For the monitoring conducted in Delta State of Nigeria in August-september 2000, a cross-sectional research design was adopted. This desrgn ** *^idered the rnost appropriate to generate the needed data and meet the rtudt (monitoring) objectives. Thedata collection exercise consisted of a triangulation oi qualitative-and- quantitative instruments designed to collect inforrnation tom different segments of -tfr. targetpopulation 2.2 Population Jn9 tarcet population for the monitoring exercise consisted of four broad groups. Theseinclude: l) Health Personnel involved in the CDTI process at various levels;2) 2) Village leaders; 3) 3) Community Directed Distributors (CDDs); 4) 4) Household members in the hper and miso endemic Local Government Areas(LGAs/communities contained in the REMO result for Delta State. On the ufuole, there were four meso and six hyper and fifteen hlpo endemic LGAs.However nine, with a populationof 424,516 persons, out of the t"" frl,pol-"* endemic lGS were expected to imFlement CDTI in-Detta State. These ,r"-U* Northeast, IkaSouth, Aniocha Nortb, Aniocha Soutb Oshimili Nortb and oshimili South- others areNdokwa East, Ndokwa West and IJkwuani- The tenth, which is Isoko was not covered in the proposal. All the same, only seven of the nine LGAS have actually commenced CDTIimplementation in Delta State. The seven LGAS oover a population 291,527 persons in354 villages. t a t oa D t2 2.3 The Sample and Sampling procedure A study sample of thirty villages was chosen usrng an elaborate, multi-sage, random sampling procedure. The sampling process began with strati$ing the LGA5 by levels of endemicity. Since treatment focus is prioritized based o, [1rp"r and meso, the hypo endemic LGAS were excluded from the sampling. Consequintly, four hyper and rwo meso endemic LGAs were chosen through a simFle random *pti"g pro"rs (balloting), utui-ch yl applied 1o *l *qpling stratunr The hlper endemic I,Cas sampled inchdiOshimili North, Aniocha Nortb Ika Northeast and Ika Souh- The samPled meso endemic LGAS were Ndokwa East and t kmrani. Ttre communities in each selected LGA were listed on pieces of paper and one community was randomly selected by balloting. The communities sampieOlbrough this process were Illah, Abavo, Owa Aleru, Ezi, Iselegu aod Obi-Obeti from Qshimili N"rtn,Ika Soutb, Ika Northeast, Aniocha Nortb Ndokwa-East and Ukqnrani LGA5 respectively. However, from Ndokwa, Aniocha North and Ika East, a second community was selected to make up the number of vilIages for the study, because these communities had less thanfive village. Thus, in addition to the initial selection Owa Oyibo in Ika Northeast, Onicha Olona in Aniocba North and Oloa Ossissa in Ndokwa East were equally selected for the study. One village each was taken from these communities tbrougL u *,rrdo- sampling process. Category A and B Villages: tlavitg selected the six communities, one from each of the earlier sampled LGAs to be Y"lt"a, the villages in the chosen communities were listed and classified according totheir proximity to health facility that serve the respective communities. This was to enstue the selection of Categories A and B villages on the basis of near and frr. Villages were considered near to heahh frcilities if they are located within eight kilometers from health frcilities. Conversely, villages were considered frr if they i. -or" ttr, .igltkilometers from any health facilities. In two of the communities, namely Owa Alero and Adonishaka, viltages far from thehealth center were selected as category "A" vitlages. [n other communities villages close to the heatth center were taken as category *A" villages. The reason for this variation isfound il the simple logic of all the 'rritt"g"r in the Lmmunity being disadvantaged in terms of the non-existence of a community health frcility. It was also reasoned that the {arthest village might be much mote dira<ivantaged in this circumstance and thus calledfor an in-depth understanding of its situation Mor*rr"r, such communities may sufferpoor coverage in heahh related progammes and also lack adequate heahh education Next was the selection of the Category "B" villages. To do this, other villages in the !o,T*ity were plotted on sketch rnaps ofthe community and categorized in; near andfar from the chosen Category *A'tflage. Two villages in eactr community were sampled by simple random sampling process from the villages near to, and frr from the It3 CaPggry "A" village. This gave a total of four Category B villages for every Category "A" village chosen for the study. (See Table lA below for a listing of the *-pf.a villages) Table A1: Local Government Areas (LGAs)/Communities and Viltages Coverrd: Households: I1-eacn Category "A" village sampled, fifteen households were chosen To do this, the village is carved into tluee clusters guided by the village head and local guides. The systernatic sampling approach was then applied to selecifive dwelling unitJ from each cluster. lhe samrling intervals were determined tbrough a quick istirnation of theou-F. o_f dwelling unils ineach village-cluster. This ditrered from one village-cluster to another. In each sampled dwelling unit one household was randomly chJsen for the lreatment coverage study. Furthermore, to check on the correctness of treatment, one household was randomly chosen, and the dosage for one household member, randomly selected and crosschecked. t ' Locel GovemmentArers (LGAsVCommunities cA'Vilhgcr sB'Vilhges Oshimilif{sfth Glrh) Eyper OgbeObi Umuagwtr Ajaji Ukwumege Umutei Anioche North (Ezi) (OnicheOlone) OgbeObi Ogbeofu Umuokoko Ishidrye Umuolo Ike Northeast (Owe ehro) (Owoyrbo) Alegwe Alionye Alugba Ebotr Ezomoh Ike South (Abavo) Hyper Ekwuoma Igbogili Oyoko Ekwueze Okpe Ndokwa Eest (Iselegu) (Olm-Ossisse) Meso Ogbe Okpala Ikolobia Ogbe Eboh Ogbe Obha Oloa Ossissa Ilkwueni (Obi-Obeti) (Obinoba) (Adoni-Shaka) Meso Azungwu Obei Aja-Obeti Emektme Obinoba Adoni-Shaka Hyper t4 a a o CDDs and Vtllage Leaders: I" *.h Category "A" village sampled, the village leader was purposively selected andinterviewed. The village CDD was also ptrposively sampled *a i"t"*i"wed. In cases where there were two CDDs both of them were interviewed, but where there were rnore than two CDDs, only two were selected by balloting. limilarly, the village leaders of the C-ategory'8" villages were purposively chosen and interviewed. The village CDDs were also purposively "hor"o and interviewed where the CDDs were one or two. In some villages with more itran two CDDs, two were randomly selected for the Category'B" villags CDD interview. In some villages, however, CDI1 interview could not hold because of the absence of any CDD figure duriry the study. Heakh Personnel: Various cadres of health personnel involved in CDTI process were purposively selected and interviewed. These included Supervisors, focal OnchocerciasG Control Team(LOCT) members and Coordinators. The Coordinators of Primary Heahh Care and Health Offrcials at the State leve[ involved in the CDTI process were also purposively selected and interviewed. The purpose ofthese interviews was to e)@mine the orientation to CDTI process and provide information on the records and quality of training they receive and/or give on the CDTI process. Instruments Eight instruments were used to gather information from both Categories (!{', rurdl c.3rr villages. Copies ofthese instruments are included as appendices to this report. l5 Table A2: Summary of Instruments and Sampling Issues * fnstrument Category of Village/Unit Sample Sampling Procedure In-depth interview & Record review with CDD A&B l -2per village Purposive (Simpte randorn, where there are more ttan 2 CDDs) Household coverage survey A l5 households per village Mufti.stage (i.e. cluster, systematic 4fl simple random Key informant interview of village leaders A&B I village leader per village Purposive Group discussion A 3 groups per village (ie. I male and I female adult; and I female or male youth groups), G8 Ersons in each goup Convenience Health personnel interview A I PHC coordinator I Oncho coordinator I LOCT member I health centre staff Purposive Programme manager/Policy maker interview Project, State & National levels Project administrator I Director, Disease Control per State I Assistance National Coordinator, NOCP I Assistant National Director of Global 2000 Purposive a .o.o El Q?A99 B tr.EH.Fd t 0'e.BE'P n'dE 1F3: EHA9E E F.E.fE E -T o.oo U HFF: s.r3 FV ;a FtoqP ^- O. t'D g i. r^xsef i,HFd VGEPEU 9 .. .5 tr F 1f Eg qFH'E 3AfrE g^gHE'3t I8.4;wPS oc(! U) o tn 66: oooo oo Ho\(, €AA O\OOi9b(, ov o\{o rJr (,r t, u) o\ r,(r{(, FSg5' E'q3 I I (rl: o\) tr{o\ HNN)orro o(ro tt<t=l 8ff II lttt !iH (, L,) o<qF o !io\ oo t, t,GAoy:.otiv Noo O\ N)\9v{ gfr $B P .J (r! o'Fo(, b\J E QFS EBFtr.- o II N){ II5 (, L,J E gs BEiHfttr.(D I I tI (J) o\ 5SS u) u) (, frr L,J LJ o o O\ O\ O\ oooooo N) O\ O\@A, HOOoooo \-/ \-/ (, (, (.)ooo oooooo 2, ilc'o *E (, F ENO FH -Ia flE o d trj a HD ET G t.Dt: a o EI EtF E' OQ tu rt o(?(Daa Ec; It (.D oo EE E F(D (D s E Ep Et (D E F(D U2 t2 FU FU FU EHHoodEEE :r:r=1 oooiJtr!J !, a) o,lJtsttoo.o. EIEEtrdcruttP99(t er. i:fo(D(nFt l-t Frooot Ft F+tooooootsEEtsEEg.tr dIJ I' E,F. 8.9.a6+ H. H. J.o(DtDv, u2 u) <. ,AA<,-.JEf F:. r:.O EE6d# r+.(D (D =F u, u)6v.t "r* S. * E f s E r$ 9 (f H.q.BF' i^- Sg io Elr5'6(Do.-Ic HB8E'5 E o o.o{oJ sg$ ilOfi -E* ll6ll -9=3qG !,Xorur "sd tr,I hJ f o\ I I i t II tI D t7 The decision-making processes on iszues sf liming and mode of distribution as well as CDD selection were erqployed to gauge the level of community involvement and ownership ofthe programme that exist among the communities. Here, decisions that were reported to have been taken in village meetings were taken as indicative of the ownership of the programme. Looking at Table l, village leaders, CDDs in categories A and B villages were interviewed. Focus goup discussions (FGDs) were also held with people in category "A" villages. The Table shows varied responses on who decided on the mode 6d liming of distribution as well as selection of CDDs. For instance, only a third (33.3%) of the village leaders reported that decisions on fiming of distribution Decisions on mode of distribution(56-7%) and selection of CDDs (53.3%) were taken in village meetings in about balf of the cases respectively. A look at other segments of the village leader iote*ie* however shows that in some villages, the village elders, and village heafth committee took the decisions. On the other han4 50 per cent and 100 per cent of the CDDs interviewed indicated that decisions on timing and mode of distribution were made in the village meeting. From the FGDs, it is observed that a majority (100.0%) of the communities had the decision on mode of the distribution made in the village meeting. However, one hundred per cent of the communities indicated that the health worker took the decision sn fiming of distribution According to one of the participants in an FGD, "it is not for us to decide. Why should anyone worry about when it is brought to us free? We are gettlng the drugs free, and are willing to take it whenever we are called upon to come for it. Those who spent their hard eaqed monies to produce the drug for us should eqioy the privilege of delermining when it is convenient for them". This is typical of all the groups. A sarnpte of the very common responses to this question is as follows: ...Whenever the drug is available, the heafth people will inform the CDDs who goes to bring the drug for our village. ... When the drug arrives, the town crier is made to inform us. ... We cannot detennine when the drugs should be brought because we do not know when the heatth people have it. Consequently, the communities were a$@t on the frct tbat zuch decisions are always, and better taken by the heahh workers, who are providing the drugs. Some village leadirs oppose this. Most of them indicated that such decisions are often taken in the village meeting and/or the village heahh committee meetings. All the sanre the six communities, in which FGDs were conducted, indicated tbat the selection of CDDs was done in the village meetings. This is in confonnity with the responses of the CDDs and about half the village leaders on this issue. a c, at l8 In measuring the indicators @-l and E-2), the responses of the village leaders were used. This is because the village leader information appeared more representative by virtue of its geographical coverage of categories A and B villages, and the three subjects, namely, decision on mode and timing of distribution, as well as the selection of CDDs. The FGDs were limited to category A villages, while the category B village CDD interview did not ensure the collection of information onthe timing and mode of distribution Following from this therefore, it is observed that 53.3 per cent of the communities indicated that the selection of CDDs was done in the village meeting, while 56.7 per cent each indicated that the decision on rnode and timing of distribution respectively were taken in the village meetrng. Fig l: Decision-making in Village Meetings and Source of Responae oo ED(E tr o(, o CL 100.00% 90.00o/o 80.00o/o 7O.OOo/o 60.00o/o 50.00% 4O.O0o/o 30.00% 20.OOo/o 10.00% 0.00o/o !Tim e IM ode El S election Village CDD FGD Leader Source of Response t trg q) Ao ;(l) I clt o & U)tr ott) E o -oU) o\!.)NS+ €\oLi \./8o\ksE.? ,g G '.Fift^EbeHg Fsgf; leg{s €? HfiE f!;-ts; #E}EFf EE E€E q td.st E E E -E eB j - x EpE6 .dcl A 5 .^ > E H ES Ig '- I f E- =orri .9(D9=f+ gEEE :B s€ 8.3Hr E:E rEE EEET:E EEEEaE daa=r-E ppsE S A ! I E:kE 5 5 5aa)€.-.-.-\- --'€4.J^\3i eeErE E H H ggX.:l AAOr\o oQ& Xr F{Gl 6(rYlltI E OOO o\ B Eae< zrA eoEqs CA s oz c'! .+ € oi6l C-(fl t- \o ra Nr- o\ N3 r- (';F9 7) r- IE F- Oro>6\ q ra r- S) q ra r- S! o .+ i6 n KE $g =EE ZE3 oqoE\o .+ s oz f- ot € $ €-lRtr o\ ^\d c"l\O -iR5 \t C-\o oi o\6 a Orotz o\ c{ c?l (.1 o,$ v)h GlHs9 f- -d\ov E- E EH8zo.R <zQ (.) &n$ OroZO ca o f-o' oiHC a s9 6Aco |d a \o oGFz o\ o rn oo =t S) g .aP \xs9 r.l$g l+(ts{ Fr) oao <E E€ ,9S c.l oGto\ *61(noi \o s$ oro(aciFt\ -ClSe ooOAR5 aFO Oroza r- *9 qE6 v? s6 o 99 oi(J t\ q $3 I'(a frlF, JE$ElZ< () q) a( oGtsz o\ II II \o o\ a O:oFz o\ !f ra cl ,o3 $ oI a- t crl a. € -oiG9 2 SEB9t5DO eE Oro|z o\ clot o\ ss o\ €-irx C?T \J o\ -i$U !Qoits9 aE.a 10o\ oz q ca o\ ca ci co 9 c-fr cl R8 € +c-\ooo * GI o F. 4) c4' E €)& U'q)(l) tr(9 a2& a,L(l) o E(l) cl(DL oz Eo 6l6)h t'r 4' aD(l)E E €)L ctt( E s L.c E E (O Eq) E at(Df(H GI (l) E G,F i I I a 20 80. Fig.2: Treatment Summary By LGA g E EE 8 (U oLF o CDo CooL o(L 40.00% 30.00% 20.OOVo 10.00o/o 0.000/6 =E€ -co8z Eo E .Yf, (U .v, (U -EoEz an6 lU LGA I The Table (2) above presents no definite pattern in the comparison between the results from the sample survey of household treatment and the treatment summary fiom the CDDs' records. In some cases the records show higher proportions than the sample survey resuhs and vice vers& Treatment records were generally poor. In one LGA/community, namely, Ika Northeast treatment summaries were totally absent. The excuse given, however, is that the LGA has not commenced process of implementrng CDTI. Comparing the results of the household survey and the treatment records of the CDDs showed great disparities. For instance, in Ukwuani, the proportion reported to have refused treatment is2.2 per cent in the CDD record. This is much smaller than what was obtained in the survey (31.0%). The same is the case with the other LGAs with respect to the recording of refusals. In some cases too, there were under reporting of treatment rates. Thus while the household survey indicated high treatment coverage, the CDD record showed lower treatment coverage. This is because in some the CDDs had not actually updated their records. Furthermore, the lumping of households was observed, because the concept of households has not been clearly understood. IHH Survey f CDD Rec -! 1,-,, .,i' i,tI i'.tr. r * i, IIL.tL. F-,- 1i 5 t- F g t'ii'" -. '.\'," a2t Table 3 Proportion of Villages treated and in which CDDs were changed after the lirst treatment o-5 Proportion and number of at-risk villages treated = 24 (80.0%) Proportion and number of communities where CDDs were changed by the community after the first teatment = I (3.3%) Table 3 above shows tbat teatment has taken place in all the 24 otrt of the 30 at-risk villages visited. It also shows that CDDS have been changed in I (20.0%) of the communities, after the first treatment. In the FGD the discussants are often argue that, "there is no need to change the CDDs since they are doing their jobs very well. Table 4. Proportion of villages which received health education, and in which CDDs were supervised by health care personnel o-7 Proportion and number of communities in which the CDD is supervised by the heahh care (communities scoring 50% and above): 5 (83.32o) Proportion and number of target communities which received health education(i.e. 50% or more of the different segments in Category A vitlage received health education) :5 (83.3%) o-3 I o-6 LGA Villages (Both A and B) Treated gp) shanged Llkwuani 5 5 (100.0/0) 0 (0.r2) Ika Northeast 5 3 (60.@/o\ I (20.V/o) Ika Sotrh 5 2 (20.U/o\ 0 (0.0plo) AniochaNorth 5 5 (1007o) 0 (0.tr/o) Oshimili 5 s (100%) 0 (0.0/o) NdokwaEast 5 5 (10070) 0 (0.0/o) LGA Villages (BothA and B) Received health education (Yes/It{o) CDD Supervised by health system LJkwuani 5 5 (100.0%0) 5 (100.0plo) Ika Northeast 5 5 (100.tr/o) s (100%) Ika Sotrth 5 2 (40.U/o\ 2 (40.U/o') AniochaNorth 5 5 (100.0%) lal0070) Oshimili South 5 5 (100.0/0) e (100%) NdokwaEast 5 5 (100.0%0) s (100%) t22 Table 4 above shows that more than fifty per cent of the villages in the five communities visited received health education In one, nanrely Ika Soutlu only two villages indicated that they have received health education Similarly, one hundred per cent of the CDDs in five LGAS, reported that health personnel supervised them- On the other hand, only 40 .0 per cent of the CDDs in Ika SoutlL where CDTI has not commenced indicated that health staff personnel supervised them during the last distribution t I I zro ,f{ D' EI A)lt) o U) U) od oo le zo :+lf ,f ot ao ,f D) zo =tt(D o)t) tf{c h,k r{ o L'T Ur L'I ra lrt (,t F< EF oa 8 G Ur oo sO 6\ (,r oo 5 rJt oo s (, o\Ios l.rl oos Ur oos ()H \J A:UE.U)oo I I NIo I t I t I a II ca r{trDtE6 II aI tJPo t\)Po I t tJIo g?U otr :1 oc D) oao (, oo s l.J 5Io\o 6\ Ur oo s t, o\Po rO 4| tJ 5Po10o\ Ur ooqO o\ YBS' HtsFD,() o NPo s (, oPo 1oo\ N) 5Po\o o\ N s>orO 6\ (, OlPos l.^) Orod p< xg(DE 0a L'I oo\o 6\ (,l oo 10o\ (/I oo rO 6\ t\) 5o\oo\ N) 5o10o\ N) 5o\oo\ F*l €.8gs E6 o P \oo\ o o s o o 1.Oo\ o I 1O o\ o o rO 4\ o o s >a 6 s?E.gE*F66'cr5 (D Ur oo L'I oo (Jl oo (, oo L'I oo L'I oo o ca+1 u) ff$ B EtsE - HE5 (D Ut -EE E .| tsr t:Ecio d oo B EEE * (D o llltlt{g\ur5 t9ri E'I'EEEEEAtsts6EBBEEEEEEE:r=:l=r=t==1 F' ts. H. H. E. B. B.oooooooil!rtrPtrut, DDEq,A'SOts5tststsbbo. o. o. t1. aa. o. if.!JI'E'I'E'EI5E E cCCeeEEEHHHHcr cr cr cr cr cr cr(D(D(!(D(nr!aD r-t r-t Ft rt| Ft Fl l.l ooooooo -) E) F) E) E) E) E)H8AS888 FEHEEEE*l - o d e doEJto5tJ5 E B:EjE H:H:F:Fl?rlJ=vru2u)VcdE*c< 8.il83-. EE*5'=E[BooL rgf,*EEH116 g 5.E g o. 5 rH sIE g EE.TgE.E;, Ege*FrA E,TRg 3gE D) a\./ P F) -- -=3.8 HX'Y"o6 b E'5 Z'e.8 FrH I3- g 3.H6' :891 ti ll E' * FX,,i.) X(,H(D X'OaI E b= : EdSHl. o\oi+vPo t-t \o lf .o) ln:- a) + H) oo I+(DFt lt 5 o\9{ 1oo\\J , i I a tJu) r, t t a 24 In the Table above (Table 5) shows that all the communities indicated that the CCDs were trained. It also shows that they collected drugs from a designated point and presented some form of treatment registers. AII the communities also indicated- that they have not ocperienced lateness or strortage in drug supply. The perceived pronptness in drug supply was attributed to thee frct that they did not decide on when tne arugs should be brought. "...Whenever the drug is brought by the district health stafi, through the CDDs is the accepted time'. Others argued that, "the drug came the same time thly got the previous years". However, half (50.0%) of the CDDs, in tbree of the communities visited were without treatment registers. Furtherrnore, most of the CDDs interviewed could not produce their measuring device on demand. None of the communities showed reported cases of severe side reaction Understandably, therefore, no records of side reaction were se€n. Furthermore all the communities visited had a completed summary foml for at least one month between Japary and June in the State office. B Constraints Managemcnt Support at the State level has not been impressive. Nothing concrete has been given by the State to support the implementation of the programme except the provision of personnel, that is the State Project Officer for Ochocerciasis control. Thi Director of Public Hedth the Permanent Secretary and Commissioner for health all argued that they have not been briefed on the CDTI project. When asked if they have-any plan foi Onchocerciasis control, the Director argued that, "since this CDTI is in place'wi do not need to bother for another, ...we think CDTI is good enot gh to meet ti" *. needs.,, According to the Director of Public Health, *CDTI follows the current concept of community involvement in health care". However, he argued that, .'it should be the responsibility ofthe LGAS to maintain assistance forthe various communities". On the specific issue of counterpart firnding, one finds that this is still lingering. According to the Director for Public Health there is a budget within the State for counterpart funding for all internationat agencies supported projects. The fund is however under the office of the Secretary to State Government (SSG). We draw from it if we know what is expected from us and which is normally budgeted for during the budgeting period". The Director and the Permanent Secretary thus requested for i for.rl l"tt". asking for counterpart fund to the CDTI project. According to the Director, .bnce we get a leffer from APOC/NOTF with regards to the counterpart und we shall not hesitate to act". t25 Though the SOCT members are willing to work for the success of the progftunme within their respective domains, as demonstrated in the execution of training """i i" the frce ofnon-release of fun4 there exist some trace of low morale among theL According to one ofthern, '\re loose from both ends. The Local government has seconded us to thiJproject and as such does not give us the benefits of being their staff, On the other hand, the Siate does recognize us as bonafide member oftheir staff'. He argued firther by saying that ..ifyou go to the Director now and ask questions on any one of us, he will-sinoply-tell you that he does not know us". Some Incal Governments demonstrated zupport for the programme by releasing fund forq}nir8, supervision an! monitoring activities. However, 6th"r, *"i. r"po.tk to bave qiven mere verbal promises and approval of request, without actual release of the fimds. Accordrng to one ofthre HoDs in charge of heahh in one of the LGAS ririt"4 *tn" health department in the LGAs should be funded separately, because the Chairmen do not likeinvesting in heahh. This is because they all want to erect tangible stnrcture tbat will leave alegacy of their tenure in office". On the other hand, the Onchocerciasis coordinators in ft- " !C4 level argue tbat while the Chairmen may release funds, this may not let down tothe Onchocerciasis units, as "the intermediaries tamper with such released funIs,'. The Project Adminisftator on his part complained of the delay in receiving fund. Hehowever stressed that he does not know the ievel where the delay occurs. fte ilso argued that, *the funds released for both Delta and Edo, the tw'o States under the Edo/Deltaproject is not enongh for one State". He also argued that the State has not shown sufficient commitment to sustainability in spite ofthe numerous advocacy visits. t a The health staff in the field also has frced logistic constraints due to inadequate motor lYcles, This applies to the LOCTs and the Oistrict Health Supervisors. the State with 9hlper/meso endemic LGAs bave jus was give few only ,i* o* -otoi"v"r"s, whichcreates the problem of sharing without causrng discontent in some LGAS. Thi shortage ofpgtor cycles may hav-e informed the pooling and rotation of the motor cycles amoog tn"LGAS $enendins oo q" urgency of the need. It needs to be remarked however that piper supervision should be a continuous process. It may be necessary to reconsider thepractice of rationing rnotor cycles. The SoCT members_also highlighted the logistic problems. They argued tbat, .\ilith the withdrawal of the LCIF vehicle they had beiore the arrival of the ooi fron1 Aboc, th"y were constrained to rationalize movement in a way that impinges on the smooth execution of the CDTI activities, particularly monitoring and supervislod,. The NGDO has also started the process of decentralizing the projects into the respective states. In an interview with the assistant National Directir or-cnua zooo,tnt i, aim at ensuring efficient management ofthe resources for the respective States *a Uy tn" Statesinvolved. t26 Technical A few LGA health staffand the CDDs interviewed showed poor knowtedge of the APOC philosophy and the right process for the CDTI implementation This ,uy huu" adverse effect on the quality of CDTI implementation in these LGAs. C Community Perception Community perception of CDTI programme varied geatly among and within the LGAs, communities and villages. While some segments, particularly women and youtbs exhibited total ignorance and lack of knowledge on ro[e of the community in the CDTI process. There was a good knowledge of the disease and the drug il most of the communities. However, in all the communities and within the differeni grcups the e:<act role of the community with regards to ownership ofthe CDTI programme-was still poorly understood. Village leaders and elders reiterated that they *er" irlto position to know if the drugs arrived on time or not, our own is only to take the drugs *d"ou", we are told that they availiable". The programme is being perceived as govemment prograrn, where they can make litt!9 or no inputs especially in decision ,.kl"g aboui tf,e timing of trearment. Worse still, the women who argued that they are rrrcre "slaves to men' thirks it is the duty of the men to take any necessary decision, particularly on the selection and compensation of CDDs. All the same, tittually all groups within the communities visited exhibited positive disposition towards CDTI. They even demonstrated their preparedness to educate and mobilize reluctant members of their respective communitLs by testifring to the usefulness of the drug. They also wondered if it would be possible to take th" d*g twice I yeT. According to some of the participants in FGDs, "considering the immense benefits of this drug to farmers it will be nice to have it distributed at least twice in one year" , t l Ft,(t (.D$o E'F -.EO i-.l.l.€ ET LA ii. E.OE aE t;,. g E'EEDFL'tsFEi.69EYsg!t^EU oHHt El E6 t?o E:1, o E(D E a o)i| o UFl trlp Eo F o O N){ (1 AiiE \r,, o -I o o E cHl OH EE vd) E oe ol{l ,trHisE.FFE. doQ oxl ooU9HEFT E'oEo E al.a oHf F-E F H(DX uBg !r v)8._t !'t< at rH ilE H6H$ E 3H iE,E E** $g[*F EHgfflE5sfsg E;' EE'*E Ellz >6IE s sE.Fg HF$ F{ IrE t, d Boo.Er :tAF(D sooo}{.r ,f rB E t: rFriEsH.hLH .2 C.'- E -;t c , I$a $F13e5 r:[BgE l-l F zc * =oEaC} ,E# Eq u)oP !oo =. g.EEfrgg -v-.ttqE H. 56Erb" '?o.HEP Ee q -.i$ (2 .3a fisI HH g FHg IJEr FlF 19 ao a|t ../r1141 E"H i 358 =r-\< - lJr,)6 -'6' sei(D EI< E r$fi g E:Hse.+ s *i o,Erd !,(Dta A. *gHE sEE $$ E 6 6'9.. oErir$eE: # oE' 8E rEfi aEr$Br E c(?ItE zo *E ssFts-H'o.no- a6 Eg-EgE; ir. E.sqE Et$Es1s5 ",Fr tf+' o Ox' r-F$Bi g $fl;eHFur*BF=:s F fg'q*f e q o.ir oaE E zo *7 (.)I FrJ H.H S'HE H. U, 1 at) o gs6sFfig=,, E *:;ff rE'Fe *+ilE.; Iss zo o, o) o)d (D zro {E trJE U2 I 5 lrl H ogit 19 o EI IJ o 8.E O 6 sE EFEtr 9.=.E€ Ellr *P >g E-s E=t9(!=trFI' {T E: Fqel ?93(D 'o E€El.EEE EL 0 t9F € letrta8lrQLO Cr. Ert Et E.E 0a P l-t(? :- ssii+teEa; -E .| HgqF*lH. J13 B -.ai e lE*6*l IBg s rg;$s l? e"H sE H kE agg*€ =r ._ o o- E €'8 gE id Er.g ='ea=rXD €fi€$FFr PEEo. < :!,(DE.J € E=6pcr ot'Dt (! r-tol EIEAI E<l E$E HBE" eF, CfOeEr Ouz+rOr* FF.fr] >rlp D)Hor,Pg DIJ(!o { ot TA O tszt u, Eas E !D'3aEslI 8.H HEi FJHA'o:g+>j:E - E,(D +ari !tE{otsB -FeB as6-80 BX I E =EorE*&8. =qN 8. BSA. L) P;U5-r, =E.+G .DE f,x sElito(! E-Esi 9FOD(at,D pa o. E oaU, o F<8Eo< 6- U2 Eoo zo oocH E) (D t-t os (D (D Fo (D (D oE =:9 =(Doq9{gB E'.P<do () (D !J Ellr =r3#93(D')P =o iE s€ H'€ 5.=o. ooa'F 9 o t! g) o 0a rt, eeuax =F€q € *3 3 Fo'r o Xl ?*Fo!o aD ra C)o o-HEq o ru 8 oo o r ,rooE 0q i"3g(D+E FI(D F) tse(Do) i+lJ q'g [E: g'"f]3.8 =.d g '36# I SFE 3 Spif. o'oq E 6-lEqE'E EI ? g PEH aE;IF ',€H -oEE -$e o o F ta td Ur-t c(Ia U) {or-t tD og,o E'So<taE tr iloo?d oaD pIt o. =oo ul F gEE H BT Bq? 9a "?.Frgqr€ Fg oo Ioio. 7r .Dol 'lrl 5l oel Et FUoioF'O Erf+ Fr ?H 8F e3 o U) ot o. Ho. o oo 'fu) E: g e.,r *3.d =.d +8gF=' fEIF 5Elia. ooq E 6-Iq='E f,l 6' o a .sg E Fi ;.E H T= *.T6" E =F'@o 8" E r"EH. c)o t PDH (DEi Esu(Do€ ta '-to oEPE o.< i FEE HBF Bq? 9a FFta =rpo !)ga+rU) (D a 8e+a) o o. c)ooo s>g8 HBf5' gFB F+(D rs€g€t.S.6g Eo-r o a i tJ6 |a'l e. Io o.1 Fr @ooo. F58A E FF; qsE S *EE {(D (D E 3 g sH.a8 fsEn s*E6' 9&8.a. qE'EE} H€ Fd-CPE=r ='o o t' vi =, ta s='q# P c:o Ern E= g: EEIt0a= grEtll,l'14 EE e"S=B:r.g 6#€5g B' tr69&s€ ts s*f;$[ P <t'trlg i-: E' =: tiE E tgEE' o(! =' -p (') ,v ts =: L.i6A =:U 8 ia*E $g aEHits S= -qBq'H E 5 <<<ls.EFsUg 93 qt-'oo tac$[o!J5d eHdJ =o aa. H {EP. *s'6 E aA:F. e gHd oo -- (1 'v F=L.,,6H =e E <<, :E.HFgU0 ts qt-1 (!0 ae8$Bo!,tr6 g H+JI+o o. D9 <'cr.Et 3:s€ s tgHE ra(D -- o'v H=L.' RE = l E qs^ =ta5c)0q(a o \JDFl !!Fi O. EH gEAEF=68 Yts F'< fi =.-E.t!Y (DN+e R $' * fg.a 5'oE tJ\o o 30 Table 7: Quality of CDD Training in Category cA, villages LGA No. of CDDs No. Trained Length of Training No. Trained ina session ukwuani I I (100%) 3 davs 20 Ika Northeast I I (1007o) 3 days 8 Ika South 2 2 (100%l 2 days >100 AniochaNorth I I (1007o) I day 20 Oshimili South I r (100%) 2 days 6 Ndokwa EaS I I (1007o) 3 days l5 Another issue that c.rme up as an area of concern in the success and sustainabitity of the CDTI pnocess. This is presented on Table 7 above. The Table shows that the quality of training varied arnong the communities, both in terms of length of training and the number of CDDs trained in each training session All six communities reported of CDDs having been trained. However, in Ika South, it was observed that the implementation of lhe CDTI process has not commenced. The SOCTs and community."--b"o in separate in-depth interviews and focus group discussions attested to this. with respect to the length of training in the communities, ufuere CDTI has commencd it lasted for between o1e to three days. Thee communities indicated tbat the taining lasted for three days. One indicated that it lasted for one day while the remaining two reported that training was for two day. With regards to the number of CDDs trained in each training session, it was observed thatit ranged from 6 to 20 persons per sessioq with the exception of Ika Soutb, where the people operated last on the principle of CBIT under Lions' Club lnternational No pattenred relationship between length of training time and number of participants involved in a training session could be discerned here. For instance, ,rni" Aniocha Nortb within one day trained twenty CDDs, Lllovuani trained the same number of CDDs in tbree days. Within the same number of days, as in Ukwuani, Ika Northeast and Ndokwa East trained eight and fifteen CDDs respectively. a I Ea 31 UNIQUE I'EATURES OF'THE PROJECT AREA Strengtla There is a high literacy level among the CDDs. A good number of the CDDs are retired civil servants and teachers, which will facilitate the assimilation of ApOC philosophy and enhanced the process of mobilization and implementation of the APOC CDTI if adequately trained. This definitely had impact on recordiqg and reporting as can be seen in some sample treatment register attached in the appendix. There is also an observed evidence of commitment on the part of the SOCTs. Some ofthem used their personal cars and monies to organize field activities such T lraining and supervision in an effort to prevent frilure of the programme in their own dsmain- Ttre zral to succeed is further demonstrated irthJ quest for knowledge in CDTI approach, vfuen the team invited their Imo State counterpart !o give them some preliminary soashing before they were finallytrained in Ibadan by the ZOTF. The communities visited showed appreciable level of support for the programme and willingness to monitor the implementation of CDTI. Awareness has also been created on the disease and the benefits of the treatment. The people seemed very enthusiastic to receive and swallow the drug. The drug has been associated with the rnanagement of other ill health conditLns by the communities and in some, like Illah in Oshimili North it is associated with fertility. It was alleged to have caused a previously barren woman to become pregnant and bear children after passing out wonns due to her consumption of the drug. Thus they were very eager to accept the drug. some even advocated the distribution of the drug, twice a year. Moreover the rnembers of the various communities visited have been mobilized to inform others of the benefits they derive from the drug. This approach will enhance cornpliance and minimize refusals. The training of cDDs at community level, as recommended by Apoc have increased the number of CDDs trained at reduced cost to the communities and also created much aw.[eness in the communities. There is also evidence of integration of CDTI programme in pHC at the LGA level, in terms of sharing logistics and planning ofCDTI activities in line with PHC prograrnme in the areas. The presence of monitors/monitoring teams has helped to create further awareness. This awakened the SOCTs to certain salient areas where they had been weak According to one of the socr member, "...the presence of monitors bas helped to open our eyes very well on what we should do and what rle should not a ' 32 a do. We can make our correctiod'. It also opened opportunities for educating the communities further on their roles and creates the sense of community o*nerJhip. o Weabtesses One major wealness of the CDTI planning and implementation in Delta State is the perceived threat to a sense of belonging arnong the SOCT members secondedfroq th9 Local government service cormmission They complained of some magiaalization by the State Ministry of Heatth. This can weakencommitment and cause poor implementation of the CDTI stratery in the target areas. There is also trncertainty in roles and financial regulations. This affects the number of days dedicated for training, monitoring and supervision among SOCT members. The frequency and duration of training can be improved upon if the Socr members are well motivated. In relation to poor taining there is also poor zupervision No effort is made to use any sandard checklist in the zupervision exercise. These, poor levels of training and supervision have led to poor record keeping, census taking and reporting. 1"_t: is also the problem of logistic encountered in the field by at all levels. TheSOCTs are constrained to operate with only one vehicle, following the withdrawal ofthe LCIF vehicle they used before the arrival ofthe Apoc vehicle. Much as the communities are aware of the importance of the disease and the efficacy of treatment with ivermectiq the level of mobilization of the different segmgnts of the populations of the difrerent communities on the CDTI process remains poor. The people still lack knowledge of their ownership of theprogftllnme. This inhibits sustainability of the progftlrnme and the ability of the communities to make major decisions. There seem to be elements of confusion in the management of reaction to ivermectin- In some cases, treatment was repeateA immiiately for individuals with severe reaction i 33 DISCUSSION ATID CONCLUSION Generally, there appear to be good levels of awareness on the importance of Onchocerciasis as a disease and the effectiveness of ivermdtin in the management and control of the disease across a broad spectrum of partners in the treatment progralnme. Ftrthermore, the soCT and NGDO, as wellas LGAs andDHS show appreciable knowledge of the Apoc philosophy and the CDTI strategy, designed for a sustainable programme for the management and control of disease. Furthermore, there is a remarkable level of enthusiasm among the SOCT members for the suogess of the progranme in their dsmain, and an appreciable willingness to take the drugs among the communities who have associated the drug with solution to many heatth problems, including reproductive heahh- Sorne levels of integration of CDTI with other health activities, at the different levels of partnership seem noticeable. The health workers who are designated to oversee Onchocerciasis, the LOCTs, are also involved in other public health activities- The same goes for other health workers' participation in Onchocerciasis programmes. However, gettrng pimary heahh care facilities for theimplementation of CDTI, particularly for supervision remains to be fully rc,alizaA in Detta State. Ho-w9ve1, an important element of sustainability in the programme is missing.ffi: it the ability ofthe communities to take important decisio-ns bordering on 1169 implementation of the programme in Detta State. For instance, the peolh still harbour the idea of the progftunme belonging elsewhere. Much as they appreciate the change in the supporting organizatien, that is from LCIF to ApO'C, iiey stilt see it as a govenxnent project, thus will not make decision on the cutturally, and ycioeconomically convenient time for distribution to achieve effective *lr.og".In line vffi this, they also argue tbat the govenrment, ufuich assigned the role of 9irtriu"t-g the drugs to the cDDs, should also support the cDDJin carrying out the assignment. With respect to some gther key components of the CDTI imFlementation, namely monito^ring and supervision, there is much room for improvement. This is becauseit is often left to the LOCTs who often complain of lack of fueling -a iogirti" :uppg{s from the policy makers at the LGA level. According to oie u.o.d. ror health in one of the LGAs visite4 argued that, "the Chairmen -irrespective of their background, medical or otherwise, will not willingly support n"*n activities whirch neit6sl tangibly ylsible for the people for thJ i*piJ to see,,. epart tom embarking on project for the politicat points they co-nfer, they also prefer activities that are income earning. Thus leaving them with the entire r.rp"fi*ry an! monitoring roles during supervision will b€ problematic. The SOCfs, on the other hand, complain of the constraints of operating with only one vehiclg which was recently donated by ApOC. t 34 t As a result of the poor supervision some CDDs who have not understood the CDTI philosophy still operate on very wrong premise. Some do not ensure that those they treat take the drugs in their presence. This creates noom for the very 'taring'mothers sharing their doses with their under aged children who were not given drugs by the CDDs. The record keeping, also needs some improvement. Even though evidence exist of ceryus taking in many places before teatment, mmy house-holds living in one building ryere lumped as one. This manifests their lvrong understanding of the concept of "household'. This is even observed arnong some of the Socrs. ln view of these findings, the following recommendations are made both to sustain the commendatle steps taken so frr and make amends where necessary for full and effective implementation of GDTI in Detta state. RECOMMENDATION I To the Project: Training of Health Staf o The initial training should be for a minimum of 3 days, whilst retraining should be for 2 days. During the training, a day should be set aside for practical work and assessment. o { schedule with the content for training of health personnel, as well as for training of CDDs should be rnade available. The content of the training should include sessions on the APOC philosophy, techniques on advocacy, mobilization and health education, with special emphasis on community responsibilities as well as the specific roles of other partners in the CDTI process, supervision, recording and reporting to effectively address the requirements for CDTI implementation o More health staff should be trained on CDTI progranrme to further enhance integration in PHC. Traintng and Supervision of CDDs o This should continue within the communities. Initial training should be for at least tbree days, while retraining activities can be for two days. During the first three-day training, aday should be set aside for demonstration on record kCpiog, census,rkl"g and reporting. o The current trainee-trainer ratio should be encouraged and sustained .l 35 The involvement of literate members of the communities, zuch as teachers and retired civil servants CDTI implementation at the community level should be encourage4 to help re-enforce training and record keeping at community level More attention should be paid to the aspects of record keeping and reportrng dr:nng training, particularly with regards to household composition and documentation of colour for easy assessment oftreatment accuracy. Training and supervision checklists should be made available and used to assist in these activities. Supervision should be emphasizrA at all levels, especially during and immediately after distribution for the CDDs. Record Keeping and Reporting a a o a a The quality of record keeping at all levels of CDTI implementation in the State still has room for further improvement. Review of the process of census taking in the viltages to determine accurate population to enhance adequate planning for ivermectin piocurement and distribution as well as effective deterrrination oftreatment coverage. Adequate training on household recording and recording of treated persons immediately after adminishation ofthe drug should be emphasized. O Approaching the Health Services and the Communtty To-ensure a proper transition from CBIT to the CDTI approach by the project, precise and concrete steps must be taken to conduct proper orientation of the n*ftn personnel and community. It is recommended that the project intensift the following: Training and orientation of health personnel on the policy and implementation of the APOC philosophy and their roles in CDTI should be encouraged. More healthpersonnef at all cadre, should be involved and made to understand that more commitment is expected of them with respect to mobilization, health education, training, zupervisioL monitoring and reporting of GDTI activities. Continued dialogue should be held with community leaders on the benefits of ivermectin treatment, their roles and commitment in the long-term sustenance of the treatment process should be emphasized. 3 o c c 36 o Mobilization should continue to target everybody, including women, youths and rglj-Sious groups, as they have been found to lack good knowledg. of th. CDTI philosophy and process. More personnel from the components of the PHC, media and educational institutions with skills in heafth education, mobilization and gender issues should be co-opted into the mobilization of communities and introduction of CDTI activities to this level ofpartners. Supervision should be enhanced and budgeted for in the APOC budget, if not done already. o Supervision of the community by village leaders and heahh personnel should be directed more to periods during and after dishibution These zupervisors need training for at least 2 days as TOT and supervision in CDTI. Integration of CDTI into the PHC System o The current level of integration of CDTI into PHC in Detta State is good for this sar.1y stage. o CDTI activities should be included in the PHC budget plans at State and LGA levels. To State: o The State must be very active to ensure that the frcilitative role of ApOC is felt in theflrst and second years of implementation of CDTI. This will afford a great opportunity ofre-orientating the CBIT progamme into CDTI. In this early stage of funding from APOC, the State must ensure that APOC funds are rapidly utilized to train CDDs. Ifthis is not done, there will be great variation of entry of CDTI and exit of CBIT in the different LGAs. Some LGAS have had no naining using APOC funds. Training of CDDs should be budgeted for in the APOC budget, f not already done. t a a a State should make proposals to purchase more durable motor cycles and bicycles to enhance zupervision and monitoring by health personnel and districi heafth supervisors respectively. Demands from State Ploject officers (SPOs) to LGAs must be done cautiously and more resolutely. Lack of support from LGAs could also be an element of excessive or unrealistic demands by health personnel. a r) 37 To National Onchocerrciasis Taskforce o NOTF should ensure project activities are fully decentralized and budget lines should be related to the different State requirements. This will further pro-Jt" the sense of ownership by the States. o NOTF should ensure greater monitoring of the various CDTI projects to ensure that they conformto agreed guidelines and processes. o NOTF should send ortr high-powered advocacy teams to the State to properly sensitize the Government on the APOC philosophy and CDTI strategy. This will-go a long way to elicit corporate support and promo6 sustainability. o Letters should be sent to the State policy makers on counterpart funding for the CDTI project in the StAe. o Greater efforts should be put into plans for mobilization of the communities. Relevant radio jingles and public address systems should be put in place. To APOC Management o APOC should consider procurement of motorcycles and bicycles for LOCTs and DHS respectively to frcilitate their zupervisory roles in the CDTI process. The independent monitoring should be encouraged. It creates more awareness for the progftunme as well as confers credibility on the Socrs and LocTs. a I(cy Inforrnunt lutcrvlcw: Villagc "A"l.curlcr Ttris irctrunuttt ts to be adnilrktered on ilrc vitlage head or a represetrtative of tle village heod. Tln lud can ask another person to assist with the inlen'iew and to even lnvu a say &trilry tlrc iltc'yiant. Do ttot refwe. Most of the questio,lts are stnrclured. Circle approprialc codes. Do ttot pronqtt lhe responses; ratlrer allor the respondent to ct tswer while you circle the appropriate option to the resportdent's answer. Listen to tlrc chief and choose anro,tg tlrc itens provided. If hc says sorneilring dilferent select 'Other' and write tlrc actual reEponse teqronse in llrc space provided. Vlllege Nanre: Village Code:_ DistricUState:Subcounty/LGA Country: Montlr end year o[ lost distribution l. Please tell us about arry progranulrc concenritrg oncltocerciasis treatnrctt( in this village? (PROBE THE FOLLOWING ISSUES ARE ADDRESSED) wlto btougltt the idea of the onchocerciasiqpograilu,re to iltis village? ' wlrcn did thc persou(s) co,t,e to tak wilh you alnu onclwccrciasis? - Did rlu lrl.ut(t) rue. vith yt d alur villcrc ldcn lirst? ' Did tlr, rrl.lor you to anoiltc arrrlting? ' wlrut did they tell you about conmtruilty respotsibility 2. How waq tlrc tiirre (morrth/season) for distribution decirletl? rt r village meeting vilhge elders nrccting villrge cltief/leader lrcrltlr rvorker village health couttttittee village conuttittee nrceting other (specify ) 3. Wlrat tttorle of rlistributiolr was decidetl? L lrouse-to-lrouse 2. central place (specify) 3. both housc-to-ltouse atd cetttral place 4. otlrer (sp."ify)_ l. 2. 3. 4. 5. 6. 7. 7Morriloring lnsl.urrcnts Krnprh, Mey 1999 4. How was tlrc nrode of distritrution dccided? l. at a villagc tlEcting 2. village eltlers nrcting 3. village chicf/leadcr 4. lrcaltlr worker 5. village health conttttitlcc 6. village cotttlttitlee nrceting 7. ollrcr (s1rccifY) 5. llorv nrany persons (CDDs) irr tttis village give out tlrc drug for otrcltocercirsis? 6. How matty nrale CDDs?-llow nrany fenmle CDDs? 7. llow rvere ttte lrcrsotts (CDDs) selectcd to do the work? l. at a villagc nrceting 2. village elders lrrceting village chief/leader I lealtlr rvorker Village lrcaltlt conunittee Village cottttttittcc ttrcetittg Otlrer 8. Why dirt you cltoose tltese persotr(s)? (Probe for criteria) 9. Have tlre CDDs received any trainitlg? l. Yes 2. No 3. Don't kttow 10. lf yes to Q9, rvlrert did lhey receive trairring? l. lJcfirrc thc first tlistributiorr 2. Durirrg tlistributiort 3. Soort aftcr the lirst distribution 4. Dorr't kttorv/Catt't rettrctttber 3 4 5 6 7 I 2 t 4 lt llorv well have tltc CDDs tlolrc dte work? l. rvell 2. fair 3. Poor (Erplairt) I lavc you cttattgcd arry of your CDDs? l. yes 2. No 3. Don't kttow 8 t2 Mooiloring lnslrun*nlr Kmplh, Mry 1999 a14. Have yoil (the cotnntuttity) received education ott tlre itrrportance of takirrg ivernrcctin/rnectizrn/ Orrclro tablet annually for several years? l. Yes 2. No 3. Dur't know/Can t rerrrcrnber 15. lf yes to Q14, ask: When dirl you receive the erlucati<ln? (circle all ttrat apply) l. During tlre first rrreeting 2. Before tlre first digtribution 3. During distriburion 4. Soon after distribution 16. If yes to Ql4, what were you told? (lrrobe for artnual treatnrcnt for several benefits conununity Was tlrcre any conlnlurrity decision on how the drug should be cotlecterl lroln a collection point? l. Yes 2. No 3. Dorr't know 18. Did arry tttetnber of the comnrunity coltcrt lhe drug fronr a cotlection poilrt? l. Yes 2. No 3. Don't krrorv 19. lf no to Ql8, *l,y? 20. Where is the collection point? 2t Ditl you experiehce lale suppty of drug tlurirrg ttre tasr rlistributiori? l. Yes 2. No J. Dou't ktrow Please explai lt 22a. Did you experience shortage of drugs tlurirrg the tast distributigrr? l. Yes 2. No .3. Don'tkrrow I 22b. Ityes to Q22, trow was ttre probtern sotvetl? a l) c, t7. I I It 9Morritoring lnslrunrnts Katrrllala . May 199(,1 i I 23a. Was the cetsus o[ your village undertakett? l. Ycs 2.No 3' Don't klmw 23b. Does tlrc coltttttutrity lrave a treatllrctlt register? l. Yes2. No 3' Dott'tkttow 24. lt yes to Q24, wherc is the rcgister kqrt? 25. How wete you involved in nrobilisation? 26. How were you iltvolvcrl ilr suprvision? 27. Wlrat arb your suggcstiolls olt ltow llte cottu:rutrity crrulrt be ttxrre irrvolved itt treatittg ttrcutbers witlt ivertrrcctitt for several years? 28. ls tlrere arything you witl like to tell/ask us? aG ltoul' DlscussloN cutDli AMONG coM t\,t uN I'l'y Nt ttM tililts.vlt,t,AG tt A ln each categoty A vilhgc. one Mule uul urc l;enmle ulult gtoup di.rcrrssroa nwst be ctttulucted. ltt thrce of the sk category A vilhges. group rli.rcrr.rsirlrs nrust lre anulw:ted witlt male youths-utd in the renmining tlrce villages, dist'ttssiotts t,,ust be hekt witlt fcrrrule youtlts. For uonibrttry CDTI projects, yotttlts ure dcfined os itulit'idtutls between lS <ttul 24 yeurs. lhe cDD ,tuutt artange [or a antfottoble. plot'e tlnu o![ers sonrc pt.ivttcy and erung1 placcs to sit , &rch groult ,,tttst co,rsist of 6-8 people. l)eparling ut trtlturc, the gtnnqt rlriorsr'ors nmy need sepilutc ,,,eeting ploce [or nuile uul fetrutle so tlnt peqile cunqteukfiedy. Oue of the iilenrul monikrs sltoukl he the fir:ilitiltor nthile a ktcul gttide. takes notes (rccotder).'lhe gnnp tliscuisiott nmst lrc krye-t.eonled. At tlrc entl of the seJstorl, ploy back ilrc tope fitr o [en' ninures to be snre fuot the rt.scrs.nnz ryc.r poperly recottletl. I-obel the cossettolNotes (Nune o.f tlle filluge, ilrc goup idcnlily, dale). TARGET GRoUt's: ADUUr MALLS; ADUUT'I;DMAt-L.s; youNc MALt-:.s otr TE,MALES l'leasc tell us lvhat you ktxlrv atxul ltrc orrctrrrccrciasis tleatnrcn( l)t'()granutrc (lrl-En.SE PROIIE roR ililt FoLLOWING ts.St'tis.) tlrc persorr(s) wlro brougtrt ltre ittca of llrc orrclrrrccrciasis progranmtrc 16 tlis vilage tlrc tirrrc wlrcrr tlrc lrcrsorr(s) carrrc t(, talk with you alxrut orrctxrcerciasis wlrcllrcr tlrcre rvas a village rrrcctirrg at lhnl tirrrc Issues lhat rvere tliscussetl at tlrc urcelirrg . owrcrship of tlre progranuuc . erpGctalion lr(xn tlre prograrrrrrrc o rcsporrsibility of tlrc corrrrrrurrity 2. l'lease tlei,cribe ltow tlrc corttttttutily trxrk docisiorr orr tlre tirrrc (rrxmrh/scasorr) arrl rrnxle of distribution. I'L|]ASE PllOllE l;0(: lbrsurs irrvolvcrl in dcrcisirrr-rrml irrg 'l'hrrc of tlistributiurr lVhy tlre tirrrc was choscrr Malxxl of rlistributirlr Why the trrcthxl of rlistritrutirlt rvas clroscrr l'leasc rhscrilrc lrrrv llrc cotttttturrily trxrk ttccision orr ttrc trcrs(xts rcs;xrrrsibte firr diuributing the rlrugs to corrrrrrurrily rrrcnrlrrs. I'LliAsE I'llollE ].oll: o |tersons itrvolvcd irr decision-rtrakirrg o Wlrr will lrc responsibh for rlistrilxrtion 3 Mtnitci6 lnlrun:ntr Krrr?.!r, Mr,y, IVN il a ) I ) : ; a5 (r. o ltrlw tlrc;rcrsuts wcl'c sclLttc(l . WhY tlre;rcrmrs welc shcted . Mctlrrxl o[ tlrug collar:tiott 4a. llas tlere 5ecrr a:ry clrarrge hr ttrc pcrsrrr reqxtsible tor rlrug rlisrib'tltion (CDD) since rle lrcgi,rring,f rlie ,r,giarrrrrrc? (PI-EASE'ttl-L US WllY) 4lr. I las tlrere beett a:ty cltattge ilt tltc pnrgranutrc? . Wlto brouglrt tlrc clutrgc o Wlrnt was tlrc clmnge Wlut were ygu toll alruut tlrc rreetl for conututtity lreatlllcllt qirh ivcrtrrcctin? (ltROBB Fotr ANN0AL'tltEA'tMENl l:oR SEVERAL YEARS,'l'l lE BENEFIT' soURc_E oF lNl;ol(MA'l'1()N, cOMMUNrl'Y l(lrsl'oNslulLrrY AND llE LTll EDUCA'I'ION) llow is t1e rlrug trrrlratlly lrrought inro rtre cottttttuttity alrd distributetl to sollllllullity rrrctrrbers? I'ltOllli l;Olt: r ;xrittt o[ collcctiorr . persorr rcslx,ursible fior brirrgirrg it to tlrc cotttttuttily, . lrcrson reqrorrsible frlr tlistributiul within tlrc cottttttuttilyb tttule o[ tlislrihrtiott . wlrctt was tlte rlrug srvallowctl 7. Woultl yrnr plcasc tcll us llrosc wlxl shouttl not lrc trcalcrl witlt ivcttrrcctitt (crclusir.rlt critcria)? 8. llorv rvas dosage tlctcrrrrirrcd by the CDDs tlurilrg tlrc last distribution? PROBE rOR MEASURINC DDVICI] 9. Wlrat pro5tcrrrs lravc you lratl rvittr rcslrcct lo the tlistributiott o[ ttrc dnrg? PROIIE l;OR o tirrrclitrcss o[ supllly to tltc ctlttttuunily . atlequacy of su1ryly . st(,rilge 10. Wlrat problens lmve ytru harl aftcr tnkirrg lhe tlrugs? I l. t.low prepared is the colrnrurrity, to take corilrol of iverrrrcclirr rlklril4ltirnlnrgreluttrc? (1ow docs ttrc ctxrrnrurrity irrtcrrtt lo suslaitt tlte exercise ltrr sevc[l rErl!?) 12. Wtrat support fias rtre cottttttuttily givett to flrc CDD? PROI|E t.QR : trrccrrlivcs itr caslt or irr kilnl t'nrvisiut o[ ttrcets of trenqrlrl Mobilizatiort o[ cotnttruttilY a a a MrnikrinS trnlrrlttEnlt Kutlnh. May !9Il l2 aErrsurirrg corrrpliarrcc \ l3' could you. ptease tell us trow you would rrrca.sure trrc success of rtre cD,ft prograrrurrc? 14' llow *ctt h.s ftc cDD prfornred? (pRoIrE FoR ATTr.r.uDE). 15. Wlrat suggestions do you trave to intprove the prograrrune? a Mmitorlng tnslrunrntr t(rnr;nh .Mry IVN t3 IN-DET'['IT TNI'ERVIEW OF VTLTAGE'A" CDI) To bc &tdtigercd onlY fu grouP 'i'villages. lttcniclrl 2 CDDs Pr villagc d tlrcre arc ,rwre tlnn otu CDDs. At entl ol tlrc interview uk tlrc distributor lo lcl Yott scc his tols: trundng devise, registers, renruililttg drug if it is tltc atse' Wlrcn u quesliott nniltiple resPo,tses' do not lorget to l'ttt u circle u'ourul euch rcqurcs t applictble rcsPot$e eode. l'xilte where aPP xryriote. Nattrc of Village Villagc crxle: SubcrxrrtY/l'GA DistricUState Nanr of CDD Sex: l. l;etttale 2. Male Main Oc,cupatiott: Morrtlr and year of first cD'l'l distrilrutitltt in tlrc village -l- Month atrl year of last cD'l'l ttistriburion in tlre village -l- l.tlowwasttrctinrc(lnrrrrtlr/seasolt)tortlistrilrutiontlccidetl? l. at a village trrceting 2. villagc ettlers' ttrcetittg 3. villagechief/leadcr 4. health worker 5. village lrcalth cottttniltee 6. village cotutttittee llrceting 7. otlrcr (sPecifY) 2. What mode of tlistribution was decided? l. ltouse-to-ltouse 2. ccntral Place (sPecityl - 3. Both house-to'ltouse arrl ccntrrl place 4. otlrer (sPecity) 3. l{ow was tlrc nprle of distribution rlecided? l. at a village tlrcetills 2. village elders' ttreetitrg 3. village chief/leader 4. healtlr worker 5. viltage healtlr cotntttiltee 6. village cotttntittee nreetills 7. otlrcr (sPccifY) ,t Monitoring tlrslrunEnls Krmpah , Mry 1999 l4 4. llow were you selected to do tlte work? l. at a village meeting 2. village elders' nreeting 3. village chief/learlcr 4. health worker 5. viltage ltealtlt comtttittee 6. village cotttttlitlce Itrcetittg 7. otlrcr (spccifYl -- f t 5. ltas arry cDD beerr clralrged after tltc lirst distrilxrtion? l. Yes 2. No 3. Dott't kttow 6. lf YES to Q5, Wlry was thc CDD clrarrgctl'l 7. l'lave you evcr l-lcett sttlrcrvisctl ? l. Yes 2. Ntr 3. Dolt't kttttl 8a. lf yes to Q7, wlto supervised you ? (ll: NAMti WAS MliN'l'lONED, I'}LUASII ASK l;Ol{ IDIINTITY/POSITION/STAI'US OF'l'l Ilj Pl'll'SON) I. llealth staff 2. Village ltealtlt cottttttiltec lttctttlrcr 3. NGO partttcr 4. Cotntttuttity tltctttlrcr/clticl' 5. Otlrer (specitY\- 8tr. What ditl the supervisor tlo? Checked tlte ivcrtttcctitt ittvctttory Checketl tlte records/trcallllcllt rcgister Collatcd tltc relxtrts Advised ott tlte tteatlllcllt oI absctttecs othcr (spccifY) (). At rvhat occasiorrs were )'or.r sultcrviscd'l (Cll{CLE Al-L'l'lln'l'n l'l'LY) I 2 3 4 5 l. Ilc[orc distrittution 2. During distributiorr 3. Stx-rtt aftcr distributiolr l. Ycs l. Ycs2 I . Ycs2 2. No No No l0a. llave ypu rcceived ctlrrcatiorr orr (lrc itrtltorlattce r.lI takirrg ivcrttrcctitt lablcts annualtY lor sevcral Ycars? l. Yes 2. No 3' Carr't tcttlelttlrcr Mrrrritorrrrg lnslrunrcllts Krrrrpala , May lt)t'X) t5 !lOtr. lf yes, wlut were You told? I l. Dkt you provide ilrc cotnmunity with crtrcation on iverrrcctin treetnrcnt? l. Yes 2. No 12. llyqs to Ql l, wfuen rlirl you provide rhe erlucation to tlrc coltrrnunity? (CIRCLI] ALL TilAT APPLY) l. Durirrg tlrc l-trst nreeting 2. Bcfore the first distributiott 3. During distributiott 4. Soon after distribution l. Takirrg ivernrcctitt anttually for several years 2. Bcnefits of treatttrcttt 3. CotntnultitY resPonsibilitY 4. Side ehects 6. Otlrer (sPecify) - l. Yes l. Yes l. Yes l. Yes No No No No 2. 2. 2. 2. 5. Otlrer (specifY) 13. If yes ro Ql l, what dirl you rell the cottttuurtity? (clRCLE ALL TIIAT APPLY) Yes Yes Yes Yes 2. 2. 2. 2. No N<r No No t 14. Did yor receive any training ott ttow t() treat cotnntunity ttrctntrcrs? l. Yes 2' No l5.IfYestoQl4,whenrlidyoureceivetrairrirrg? 16. Who tnined Yott? l. Health personrrcl/Onclrc coorditutor 2. NGDO staff (sPec 3. Another CDD 4. Other (specify)- 17. Horv lorrg did the training last? ll trainhtg- 2d training- l-asl training 18. t{orv nratry cDDs rvere traitted togetlter (size o[ tlre group)'l l" training- Last tra Monitorinq lns(tutllcllls Kattqrala . May 1999 t6 I I I I 19. Wlrere was tlte vettuc o[ tlre last trailrirtg? Withirr tlrc communitY Outsitle tlrc cotntnunitY I lealthcare facil itY/hosPital Otlrer (speci(yl - 20. Was tlrc venue of training lrcar to yrnr cururrunity? l. Ycs 2. No 21. Whar were you tauglrt tluring training about onclxrcrciasis (ClRCl-E ALL'l'llAT API'LY) 2. 2. 2. 2. 2. I 2 3 4 l. 2. 3. 4. 5. 6. l. 2. 3. 4. 5. 6. Cause Syrnptotus Socio-ecoltontic intPortatrce Comtttunity nrobilisatiur antl etlucation lverrrrcctin as treattlrcnt for a lottg tittrc l. ' Duration of trcatttrcttt 2. Coveragc of tlistributiott '3. Dosage tteterntirtation by ttrcasuring lreigltt 4. Expiration of rlrug after retnoviltg container seal 5. Treatttrcnt of absettlees atrl refusals 6. Side ettccts (counscling arrd refcrral) 1. Erclusion criteria E. Record keeping 9. Census 10. Other (spcify)- l. Yes l. Yes l. Yes l. Ycs l. Yes l. Ycs L Yes l. Yes l. Yes l. Yes l. Yes l. Yes l. Yes L Yes 2. 2. 2. 2. 2. Nn No No No No No No N<r No No No No No No 2. 2. 2. 2. 2. 2. 2. 2. 2. Otlrer (spcify) 22. Whar wcre you raughr alxrur rtrc drug? (clRCLll ALL'[[lA',l'APPLY) 23. Whar rvcrc you tau-ultt alxrut rclxrrtirrg? (CIRCl-U ALL'l'll['l'Al'l'LY) Nunrber o[ pcrsotts trcatcd l. Yes Nurrtlrcr of rcfusals l. Yes Nurrrlrcr uf allscttlces l. Ycs Nurnlrcr of exclutlctl persolls l. Yes Nurrfuer rvillt sevcre sitlc eflccts l. Yes Other (slrccity)- 24. Dhl rrry rr1glrrlrcr p[ thc cornrnurrity collect llrc rJrug frottt a collection grirrt duri[g tlr last tlistributiott'l t. . Ycs 2. No 3. Don't know ir I I I I I a I I I I I I No No No No No ?5. lf 'tkr' to Q24, rvhy? M<nit<rin3 htflnrtrEnls Krnplo . ltllty l9!Xl l7 2(r. Wlrere is the collectiorr lxrirrt? 27 Didyouexperietrcelatesupplyofrlrugsr'lurirrgtltelastdistribution? l. Yes 2. No Please e 28. tlow rto you nortually rletertttine the qualrtity of tlrugs reqUirett by the cottttttuttity? Census/registration record Previous treatnrcttt recortls By counting tlte ttutttber of lrousehokls Other (specifY) 29a. Did you experierrce sltortage of <lrugs durirrg the last distribution? l. Ycs 2' Ntt 29b. lf yes, please exPlain 30. How tto you delerrrrine rlrc nunlber of rablets to give to arr inrlividuat? (clRCLE ALL THAT APPLY) Take heiglrt llrcasutetlrcllt Use weight Visual observation ABe Otlrcr 3l . What rlo you do aSout individuals wlro are absent tluring ttorttnt tlistributiorr periotl? 32. Wlrat do you <lo atrcUt irrdividuals wlto refuse (rcattttcttt? 13. Which caregories o[ people rvould you rrot givc tlrc tablets (PLEASE Cll(CLE ALL'l'llA'r AI'PLY) I 2 3 4 Ycs Yes Yes Ycs I. lrxlividuats below 5 years of age/ lrelow 90cttt 2. Pregltattt wollletl 3. Woure[ wlio rlelivered less fltalt otte weck bcltlle tlistributiolt 4. Sick intlividuals 5. Visitors 6. Otlrer (sPecitY)- 34. llow rJo you etrsure tltat tlrese categot'ics ot';rcqrlc cvetttually reccive t. 2. 3. 4. 5. 2. 2. 2. 2. No No No No I l. l. t: l. l. Yes Yes Yes Yes Yes 2. N<r 2. No 2. Ntr 2. No 2. No trcatttrcttt? tr,f nrritntirrs lnslrurncnls Kanrpale ' May 1999 l8 a35a. llow long do you rrunrmlly keep tlrc tablcts irr thc conrrnunity? 35b. How many days dirl you take to currpletc the last distributiorr? 36. Where do you norrnally keep the tablets? 37. Do you lrave drugs to take care of lrrinor side effecls? l. Yes 2. No 38. What kind of support do you receive fronr the corrrnrunity? l. Transportation for drug collection 2. lncentives (sp.cify) 3. Otlrer (specify) 39. Do you lnve problerns with record keeping? l. Yes 2. No 40. lf'yes to Q39. pleaso expla 41. Please tellus how you feelabout tlrc progranrnrc with respect to: a) sustaining the progralnrrrc i,i a lr) conurrunity resporNe c) constraints 4L.Wtrat tlo you rhink shoul<l be done to inprove [rc progranrrrrc? a 43. Are you willing to contirrue as a CDD? l. Yes 2. No Pleasc PLEAGE ASK FOR REGISTER AND MEASURING DEVISE'IO PROVIDE FOLLOWING INFORMA'I'ION 444. ls rrrcaslrirrg device for height presetrt? ij Moitorh3 lmrrun:ntl Krnprh. Mry 1999 t9 Yes, seetr Yes, but not scelt (ExPlaitt) . No, 44b. Ilow do you use it? 45. ls treatrrrcnt register preserrt? Yes, seett Yes, but not s€en (ExplaitD No, 46. lf Q45 is "Yes, seen" EXAMINII lltliA'l'MEN'l' If UGIS'l'EIf AND OUTAlN 'l'llE I;OLLOWINC INFOITMA'I'ION ON : Total popu lation Age corupositiorr of people: Below 5 years_ 5 years atxl ,tru.- I 2 3 I 2 3 I 2 3. 4. 5. 6. 7. 8. 9. Sexconlpositiorroftlrepopulatiott:Male- Nunrber o[ persorts treated_Male_ l;errmle Ferrule Nurnbcr of persotts urxlcr-5 yea rs who receivetl lreatrrrcnt Nunrber o[ refusals Nuurber absettt during last trea(nrcnt_ Nunrber witlt severe side effccts Nurnber of tablets received 10. Nurnlrcr o[ tablets used I l. Nurnlrcr of tablcts leli irr the drug kit_ aU r. E t' I Moniloring lttsltuttrcttts Katnpela , May 1999 20 ;5. I'low rnarry persons itr ttris villagc (CDD) give out thc drug lor otrcltcrcerciasis? IV llory rcre llrc pcrm(CDD) sclected to do tlrc work? l. at a village nrcting 2. villageelders'ttrceling 3. village chief/leabr 4. healtlr worker 5. viilage heatrlr conynittee 6. village comrnittee rEctins 7. other 7. Have tlre CDDs receivcd any trainittg? l. Ycs 2. No 3. Dott't krrow/ Can I rcttrcrttlrcr 8a. l'lave you charrged auy of your CDI} l. yes 2. No 3. Dott'l kltow 8lr. lf yes, lvhy? 9. Ditl any rnenrber o[ tlrc courmunity collect tlre drug frotn a collection point? l. Yes 2. No 3. Dou't kttow 10. Did you experience late supply of drug durirrg thc last distribution? l. Yes 2. No 3. Don'tkttorv I I . Ditl you experierrce slrortage of drugs durirrg tlre last tlistribution? l. Yes 2. No 3. Dtrt'l kttow 12. Does tlrc comrnunity have a treatttrcnt register? l. Yes 2. No 3. Don't kttow 'r7..-- -:. --:-- a--.-...-...- V-.---a- la-.. iafrl I ,i Iit i t E r I t\lo l3 IE IE ls Elx IR F 9o t:h F E ? rrFa s 3 aiiEE, T JF9E Q 6€ dg, o )il 6fr. iE $ s E I;E5 5 ETBFcr 6-9 - -l * 6€ Xi I iBEFi gEtSlt. i-lli T E;H liIB liir 5 ;. E.s6 FE.tr E.E FS lgrr?8tr5 EIilDc)tr;s gof,guoP EE + z 6'!*JEo6>d *,* Fs* -5x r 8g Bh e"9d :E g= , 5068sr $Bg =.>o-B ae ;t(,a(D z o, ts(D 6t 0:l(D o & l" z o 5 o it2 I(D A' c(D5 I ocUt(D o E U z 9 IoUq o !, o e77 *E <6 Trn a =-? t-t- o ln \1 7A ..-A.D ,5r" (r.l (D z<8agE;iu ssf 8.?H# 535 3 H gdd =ER-a'(! FA C trt,aIo'z E.TE3T< o (rlD og 6 E'€ {(<t oc 'rt rd t-r, -io oC mt,J o z tr o9E € R,d..:.! (! =J H F.1 a s Elltt Nx z<8 *2 <O$If .,*P' ._, { -< ='EHpo:3*t *8'o. -E 8E 3 B ? S. r; .i" EX " gE* o.- ts {ilg IsFq:Ei ;;.* a o fi zo -lo a C mIA :l Z<g 9.8 BE E$np"Frftg; ? Z<*RXRUsrali;5Esxgei rpF octd artj oz t\, H'S'FF.EggET a a ii g,iggr*? r g=.E <'9,! ts;-rO g OHrP EE> rt5 o< -q o =.of. a 0o 5 EI: 65 €Dt D €6\c c l.Jtr t(\t 66 o. ;a E ; d o, EItv t E E s C! E 'E o c o, = o lt oU'o! 8n koT8 .=E a, (, EE *t8 T * * *:ll n?.tg.rg IiAt:;gt c"| rIo'$ ,frEI Ei'toc X I EEEE i;Eo(, I \oi?s e d'gB[.$ fcig*r d-:oo u I .BE {EfrE*Ic' o o q.5 air El El .=E-ct II * a rlI LtI I ; i i 't 1 I J i .) It x .; .: i I .: : I , t t. , i t tI Narrrc of Village Distrkt/Srate Naure of CDD Scr: l. Female 2. Male Mein Occupation Month and year of last ttistribution I l. tlow were y(ru selecred to rlo ltre work? l. at a village nrebring Z. village elders, nrcerinn3. village ctrief/leatler 4. lrcaltlr worker S. village health corunilttee6. village conurriuee meefing6. other (specify) 2. lles rny CDD been clmngerl afrer rlre first digribution? l. Yes 2. No 3. Don't know/can,t rerrrcmber 3. llave ytxt ever been supervise<l ? l. Yes 2. No 3. Dur'l know l. Healtlr statf 2 Village lreatttr conrruittee nrcnrber NGO partrrer3 nrcrrrber/chief To ln adnitistered onll in Sroup "8" villages. ltueniew 2 cDDs per village if there are ,,rore thatt onecDDs' rlt tlrc end of ttie inin'ii, osk tlrc iiltrit won ii tu, y* ,u, his tooli: nieasuring devke, registets,ramhing drug tJ available' when a q,istiou,requiris ,r,iiit, resporses, do not forget b put a circreororuul each oppticable respo,rse rntr. i,it, rulrcre op1tro1triate. 4' lf yes .o e3, wtro supe-rvise<r you ? (rF NAME wAs MEN.T,NED, pLEAsE ASK FoRIDENTITY/POSITIoN/3T^Ti,i or rrrr PERsoN) 4. Conrrnunity 5. Orlrcr (speci lr:';',tlilreceival erlucation ott ltrc inportarrce of rakirrg ivenrrccrin rarrrers anrrualy for Yes 2. No 3. Can't rqnernber (r' Did you rcrceive a,,y rrainirg o, rr,w ro rrear corrr,rurriry ,rcrrrbers? 2. Nol. Yes Moritrring tnslrunrnts Krnpeh. Mry ttDr) 1 ls ttteasuring device for heiglrt llresettt? l. Ye.s, scctt 2. Yes' but rrot secn (fxPlaitt) 3. No, (ExPlain) 8. ls trcaunent register Present? 9 l. Yes, seett 2. Yes, but ttot seen (ExPlain) 3. No, (exPlain) lf Q8 is .Yes, sce[' EXAMINII'lltli^lltDsn' Ruclst'tjR AND OB rAlN'l'llE TOLIOWING INFORMATON ON: l.Total 2.hgecolrqlosirion of people: lhlow 5 years- 5 Years aml above- 3. sex contposition of tlre population: Male- Fcmrlc- 4 Nurrrber of persotts treated-Male- rtrrnlc- 5 Nurnbcr o[ persotts aged 5 years alxl alrcve who reccivcxl tlcatlnent 6 Number of refusals 7 Nunrber absettt rluring last treattttctlt 8 Nurrrber witlt scverc side cl'fects 9 Nurnber o[ tablets received l0 Nurnbcr of tablcts usctl I I Nunrber of ublets left in the drug kit 12. Updale of records Moniloting lnstrurrnls Knnrpah ' May l(X)9 2(t ,l ts OUESTIONNAIRE FO$, IIEALTII PERSONNIIL This questiotunirc is afunhistered on ony hcalth vorkcr in lhe area wlw is directll ittvolved fu CDl'l progmnane i.e the health stalf nearcsl lo lhe vilhge. Tha nuntber of health pcnonnel to ln iueniewect depads o,, tlre situatiott o,t tlre grouul. A ntininnun of 3 health persorurcl who'ore ntpenimn d CDOs sltottld be imeruiewed witltitr lhe project urea. After the interuier ask tlrc healtlt persorurclJor lhc docuuems used for CDTI activilies. LGA/&rbcounty: State/District Country Nattrc of health personrcl_ Scx: l. Mate 2. Fetmle No, of Orcho. No. of CDDs in villages coverctl Itii ttl' | )'.t Position; Qualification Rcspottsibilities in Onclro control Prograrrurrc: I Olrch<l Crxrrdinator 2 CDD supervisor 3 otlrcr (spccity 1. Did you receive any general orientation on CD It? l. Yes 2. No 2a. Did yor reccive rraining ou lrcrv to trrir CDDs? l. Yes 2. No 2b. lfyes, how 2c. Lis ilrc nuin topics covercd iI lrt, il ) 2tl. Wcre you taught lrow severe sidc eflccts drurkl lrc lrunagcrl? l. Yes 2. No 3.|'krsc tellus what you kuow about trrc cD'r't progmnurrc witlr respect to: I 1. Cmurruniry 2. lrryolvcnrcnt of tlre trealth systcnl in CD l'l 4. ltr tlrrc m hitirl nrcetiry ritlr the comnnrnity wlrcre CDTI ums irrtroducetl? l. Yes 2. No Mtnil<ri4 lnslnrnrnls (rnqnh. May lgltt 21 5. lf yes to e4, wlnt role rlirt tlre treattlr stafl'play in arrarrgittg ftrr the lirst lrrcetittg? (CIRLCE ALL 'nrAT APPLY) 1. Facilitatert the nreeting 2. Mct with village leader to alrangc for tlre llEetills 3. Otlrer (specity) 6. Wlro led the facilitratirrg teattt lo tlte cr.utrnrunity? l. lrcalth staff 2. goverriment adntinistrative staff (Iron-lrealth) 3. NGDO staff 4. otlrcr (specify) 5. Nobody 7. Were llrc comrnunities (where you workal) tablets? alucatgt on tlrc inrportance o[ treatment wiilr ivertnectin l. Yes 2. No 3, Don't ktr.rw 8. lf yes to Q7, rvhat were they told? (CIRCLE ALL THAT APPLY) 1 2 3 4 Annual treatnlent for severgl years Ilenefits of treatrrrcnt Comnrunity. responsibil ity Others (specify)_ l. Yes .1. Yes l. Yes 2. No 2. No 2. No t 9. Were CDDs irr tlre corurrrunities (wlrere you worked) trairretl for the CDI'I progratntne? 1. Yes 2. No 3. Don't know l0a. lf yes to Q9, did you participate in tlre training of CDDs'l l. Yes 2. No l0tr. lt yes, how tong ditl this trainirrg session last? lrritial traittiltg_ Ite(ra lla. Who superviserl the CDDs l. Not supervisetl 2. Village heatl 3. Village health corruuittee nrember 4. .lrcalth personrcl 5. Otlrcr I I b. lf supervised, how rnany CDDs did you sulrcrvise tlurirrg tlre last distribution? l2 lf rxx sulrcrvised, wlt t3. .nt which occasions rlid you visit the CDD? (Cll{CLll n LL'l'llA'l'APPLY) I Beforre <listriburion l. Yes 2. No Morrikrrirr8 lnslntnrclrts Kanrpala . May l9)9 28 2. Durirrg distribtrtiott 3. &lon after rlistrilrution Collection of unuserl rlrugs after distribution Review o[ records Metmgettrcnt of side. ellccls Supervision o[ drug tlistributiorr Otlrcr (specity)- l. No constraints 2. irrahquate/lack o[ lneals o[ transport/fuel 3. Too tnuclt work 4. lnadequate/lack of supervisiott allowatrce 5. lnaccessibility l. Ycs 2. No l. Ycs 2. No 4. Otlrcr Gpecify)- 14. what funcriols rlo you perfirrrrr durirrg your visir to tfte cDD? (CIRCLE ALLTtIA'l'APPLY) l. Yes 2. No l. Yes 2. No l. Ycs 2. No l. \'es 2. No r5 Whar cotsrrainrs rlo you have in suprvisirrg tlrc CDD? (Cll(Cl-U ALL'nl^l'API'LY) l. 2. 3. 4. 5. l. Yes 2. No l. Yes 2. No l. Yes 2. No l. Yes 2. No l. Yes 2. No 6. Otlrcr l6a. l{ave there been any delays in receiving iverrlrectin? ll Yes 2. 'No l6c. llave tlrcre been arry rlelays in cotlecting iverttrcctitt by the coltutruttity? l. Yes 2. No 17. lf ycs to Ql6c, please 18. Wlrat consrraiuts have you experiencerl in gettiug tlre drug? (ClI{CLE ALL'illn'f AI'PLY) l. Norre 2. Transport problettt 3. lnadequate supply L Ycs l. Yes l. Ycs l. Yes 2. Ntr 2. Nrr 2. No 2. No I 4. Delay in supply 5. O0rcr (spccity) 19. llow rlo you estirnate tlre quarrtity of drug rerluiretl? , Not responsible , Nurrrber used durirtg last treatllrcnt . F.se.l on requests frottt tlrc CDDs . 'lbtalpopulation (witlr the [orrnula) Other (spcrci 20. Did you get the drugs wltett requiretl? l. Yes 2. No l I I I 2, 3 4 5 Morrikrring tnsltttnrcnls Katrrlala . May l$19 29 21. lfrck e20,why? l. Shorhge al S.b, trjiuul hvel 2. Means of tranqrort 3. Otlrcr (specify) 22. h you have facility for storage of ivenrrcctin? l. Yes 2. No 3. Don't krxrw 23. Have yo experienced los of tabtets due to pilGrage? l. Yes 2. No 3. Don'tknow 24. Were cases o[ seyere side cffecs rcportcd to yan? l. Yes 2. No 25. (CHECK AVAtLABtLt.t.Y): l. Available 2. Nor avrihble 26- What otlrer lrealtlt activities do you continc with Onclro Control prqgramrne acrivities (pRouE FoR HEALTH ACnVry N Tilti cDn couxunmEs)? 27. How do yur feel about tlre CDTI programme? 1 \t; i t Mmitrriq lnlrun*rrs l(rn;ah -Mey lrrrt 30 I NTERVI EW G UI DE FOR I'OI,ICY-MAKIIRS/ WI IO RI'PRI'SI'N.I.ATIV Ti/I,ITOGIT A I\{ M I' MANAGBRS/ COORDINATOIIS Tltis inrerview is adrninistered on Co-onlinators, Progtanmrc nriltayers, rqrrese,rtatives of NGDOs involved irt CDTI, Mirtistry of heatth poticyrtrukers and the WIIO representutive fu tlrc courttry. lt is similar to the iueniew of heattlt personnel. Docunwils such as registers sltould be requested before tlrc fonnol i,tten'iew so tllat infornntiott can be extractec! for tlrc repon SECTION A: PROCRAMME MANAGERS/ ONCllo COORDINATORS t. Please <tescribe trow tlrc CDTI prograrume is being inrplertrcnterl itt your area PROBE FOR The approactr used for introrlucirrg CD'l'l lo tlrc ctutttnunities Elernents of collaboratiorr between Conrnunity, llealth sysletll arnl NGDOs (lDENl'lFY SPECIFIC ROLES) Gencral re-orientation of lrealtlt persontrel towards CD'l'l progralllllrc Mobilisation of tlrc contmunities Trairring of healtlr staff as traitrcrs Please explairr process of receivitrg iverttrcctitt PROBE FOR : a Delays in supply . at rvhat level arrd rvhy? Adequacy of tlte quantity receiverl/sltortnge Storage '. '.' 'ri ' t " "' Distribution to' conlnrunities a. b. c. d. e. 2 c, d :Q. f. ,1 .')!l ,ir. I I g. Pilferage 3. , ' !'.IiUNDING: Please probe [<rr ] .^ ,, , a. Delays in endorsetttettt of letters of agrectlrcttt 'lrirl'r'Wlty? Corstrairtts.(storage, transport, etc) I b. Delays irr receivirrg [unds o at rvhat level arul wlry? . Delays in disburscttrcttt of futds . At what level arrd wlty? c Mtrrillrrirrg lnslrunrnls Kanrpaln . May 1999 _1t SECTION C: WIIO COUN'IRY RBPITESIiN'I'A'I'IVB I l.What is your perception about tlrc APOC strategy ftrr iverttrcctirr distributitllt ( Probe for teasibility'of the CD'tl approaclr in solvitrg otlrer health problettts) 12. Wlut is the relatiorrship between ilre WllO office arrd the Nalional Orrchocerciasis'[ask Force (NOTF) with rapocr to CDTI inrptiruentarion. (Probe for issues relatirrg to lrattsfer o[ futttls, support to NO'I'F and rrnrritoring) tt a Monilorirrg lttslrtllllcllts Kltrrr;lala, lvl;ry l()(l() t3 '1 )A / r.to€/ 1J t I u t' r f A I tt t') Lq-si Nnqe pti t'lame Yea< 'ts t4 sr;,1 Lo- -C wuLg T 'jn.esFdstt'r 4.%1*,q +7qo l+9-9.1".tRtr4 \l6(l: )cl tty? I\/t)-/ru _L__ _2_ 3_ 2Ilo q 6ntq\ (6 .L tt!istELoM v2(o"'n3sC I I IVLthT8M q-vtg t+\/ 3 3lo sch)tF b ?FrY?tnqoSJz lil;^3 lf_,t- t.- R )7t/ (^ aPM A 54 yDlr/ .} rL 11,tl r. )-Jcht0 3lrt)nlf) t{ b."tr !{3r 3o Nq-l^.( V tt-Q.a -Nt Eh-.'cr Res-a- V t/9{OtP 9.L,(5 n SGls- I )- I I N I I I L 9- ;t t c_( v 4E ( l (> + lh t-- I tl ) O> I 7 3 T s ? 7 8 1 "o\^i b 4 ru{A* {o fr* ,"rl I: rYl ,(T LtF 6I q ut_ rn rq a I ) 0oQ- 0\5.R- 64"r*, -'-J - s<r o tt 2<- kN A vLes U*.* @a J*,ro4 C*-r{"" lt1a,r,--q I 3 + 5 t) 7 8 f\l N (r\fiI lg,^+ 0,*ri{o 0^o;f. C^r4" 0"^ip<,gyn{. tnal,tr Unou./i Oy-Pu AykA A-Ez 6L 31 tt l3 l0 /3 3t_ SCXI -l Irlfl t:l Fl tnl -l,l ,t1.1 '1 I I I I I 00l7s-o9 3 -t- =.-a l .l I n .1., !i 'i 1..: 1., !,* ',, li:, --C'Al I J I 7 3 chI s ? 7 8 7 ;({ l-icJ;KJ^,'{ ..J"i 0oQ- 6l rn q ) Coh C-l^Aru, Ndqdj US'q Ut_ 1o{ 1o rrl -@q,tl "*lft tr) F rYl (lJ r(r{. P-Lr- I I -J--6.K-r, '--J' 8 (- 4 ri .t- kt N$rue5 N f\l 4se 66 3_q t+ t3 la /3 3J Llso,*., Art -1.*,-oA C*-{"" n*r* lg.^+ (0,^^r{u 0^o;f- C^rr,{" O^^r;.{- @!^nf- lna4 U^-o-adi U\rq a Qr-.p" Ayl@ S 3 r 1: F F M t: t) 1 3 + 5. 7, I R r'i _t , ",,: ". orl/nle (o.r iuor/n le-o 7 I zdnmc pr pt, N4rte L e o(,'t',. ' I 7i t.a...1.qA(-L'"i Y'r" c&,t e.4i L*t, -J _t-_ .) {EY X'b *' ( R n8- as Teu -\;It, t R l^lSEI- tf A2- .li,"tlt4 l521-0t) + (l$h5LolYt tt-)oL')f,,r,,,,-" A 4..,vv(_frrl?r.rl q^735 2-?C f2- q-od-9- --1- I -t- a t entfnle (o'io.or/n le-o 9- I?A a {hY *'tt' d*t'lt= B''7 Nane AC -(enc _9-s St4rlT+&s I Itt tf t-\{eto,ttlw_ ly')30t: n$h3_0_lYl + Q)-2oJ, lA73€ +-2.?C {-2-}} 4-od-3L A l-, 4u, (' lrr', r, u..r!, c Larrltrtrl < o(,',:'t--[ e4,; , ljovct> vv. 'L-t t h n