RES-EiT Y/E D F OR PRC,IE C T LO G O/TT EAD I NG J COUNTRY/T.{O1'F: ORIGINAL : English Proiect Name: 'TARABA STATII CDTI PROJECTNIGERIAI Arlroval year: Launching year: 19971997 Repot'ttng Pqriod: Januar-v/2044 Decernber/ 2004 Project ycar ofthis report: (circleone)l 2 3 4 5 6 (7)B 9 l0 Date subrnitted: June 2005 NGDO partncr: MITOSATH "k*u- For Acri-,ir.../ To: t(t-u, :3Lo J.F l't, !- ci: t 9t'ibf. t. ,,:) For lnformEilon To, [:, 1.,- ,i*' Alill".' \ h {l 2 SiP zllfi5 WI iO/APOC. 24 Novembcr 2004 AFt I{UAL PITOJ iicf ' TECIINICA}., I].8 PORT . l.o 'I'ECI INiCAL CON Slli.'i',/r'fl VE COMMII 1'1,1, (I'CC) ENDGRSEh4TNT Please confirm you have rcad this report by signing in the a FIlrotr rizzt e grl2. ce. Ol-FICtiRS j.o:rign the report: Llountt')z: National Coclrdirra-tor N !fq n PQ$.u. fsece \ Zonal Oncho Coordi nator *2) Tloslzoar Sign Date Date: I'JG.DO Representative Name: .flf*.n.E.;.G Dlam5u( Signatrrre Date: rP'idq5" ' This report has been prepared by Narne 1{*f,t.,v.* 6*A Designaticr, : .$ 9=.7.. lat**z- tx{- o7s-t-*e(s PP*t&ritrt Iil Wi-iO/APO(1, 24 Novcrnber 2004 ANNUAL PROJECT TECHNICAL REPOITT SUBMITTED TO TECIINICAL CONSULTATIVE COMMITTEE (TCC) DEADLINE FO SUBMIS ON: To APoc Management by 3I Januarv for March rcc meeting To APoc Management by lt July for September 1'cC meeting AFRICAN PROGRAMNIE FOR ONCHOCERCTASTS CONTROL (APOC) WFIO/n POC, 24 November 2004ll , Table of contents ACRONYMS.... DEFINITIONS FOI,LOW UP ON TCC RECOMMENDATIONS VI VII 1 EXECUTIVE SUMMARY ) 2.1. TivpLlNs oF ACTrvtrrES .............. ......................g 2.2. Aovocacy ..................10 2.3. MogtI-IzartoN, SENSITIZATIoN AND HEALTH EDUCATToN oF AT RISK couuuurlps 10 2.4. Covnuuxrry rNVoLVEMENT............ .................1I 2.5. Capacn'y BUTLDTNG ...................... 13 2.6. TRlarLasNrs................ .................15 2.6.1. Treatmentfigures........... .....15 2.5.2 What are the causes of ab.senteeism? ............. ............ t g 2.6.3 Vy'hal are the reasons for rer'.,sa\sz................ ............I92.6.4 Briefly describe all known und verified ,serious adt erse events (,SAEs) thot.... I9 2.6.5. Trend of treotment achieventent from CDTI project inception lo the current year2l2.7. ORoERING, sroRAC;E AND DELIVER.v oF IvERMECTIN......... ...................23 2.8. CouvuNrry sEt.F-MoNtroRrNc AND S'TAKEHoLDERS MpprlNc ...........24?..9. SupsRvrsroN............... .................25 2.9.1. Provide aJlow chart of supervision hierarchy. ..........25 2.9.2. What u,ere the main issues identified during supervision? .. ........25 2.9.3. lYas a supervision checklist used? ......... ....................25 2.9.4. What were the otttcomes at each level of CDTI implementation sqservision? 25 2.9.5. llasJbedbackgiven to the person or groups xtpervised? ... ........25 2.9.6. Hou, was the feedback used to improve the ovcroll performance oJ'the project ? 26 SECTION 3: SUPPORT TO CDTI........ EqurrvreNr FruANc-IaI CoNTRIBUTIoNS oF THE PARTNERS AND CoMMUNITIES OrueR FoRMS oF coMlvttNlry suppoRT ExpeNntruRE PER ACTIVITy SECTION 4: SUSIAINABILITY OF CDTI.. 4.1. INrenNnl; INDEeENDENT pARTtclpAToRy MoNrroRINc; EvnluenoN ........ 4. l.l Vlas Monitoring/evaluation t'arried out during the reporting period? (tick any of the./bllotuingwhich are applicable)............ ........29 4.1.2. Whot were the recommendations? ..........30 4.1.3. I'Iou, have they been implen.'. nted?......... ...................32 4.2. SusrerNRert-rry oF pRoJECTS: pLAN AND sEt'TARGE.Is (MANDAToRy AT ...............32 Yn 3)......... ...........32 3.1 3.2 3.3 3.4 lv WHO/APOC, 24 November 2004 ....26 ....27 .,.,28 ....28 4.2.1. Planningat all relevantlevei,s ....................32 4.2.2. Funds ........32 4.2.3 Transport (replacement and ntaintenance) .........32 4.2.4. Other resources... .................32 4.2.5. To what extent has the plon been implemented .-........32 4.3. InrpcnartoN............... .................32 4.3.1. Ivermectindeliverymechani,sms ....'........3-l 4.3.2. Training.... ........33 4.3.3. Joint supervision and monitoringwith other programs........................---.-.-- -- 33 4.3.4. Release offunds for proiect ,tctivities ...... -13 4.i.-5. Is CDTI included inthe PHC budget? .....33 4.3.6. Describe other health programmes that are using the CDTI structure and how thiswas achieved. lYhathave beenthe achievement,s?............. .'...'...'........J-3 4.3.7. Describeothersi,ssuesconsideredintheintegreilionof CDTI...'....-.............-.33 4.4. OpEnaroNAL RESEARCH.. ..............-..34 1.4. t. Summarize in not more than one half of o page the operational research undertaken in the project areau,ithinthe reportingperiod. .....-.-------.31 4.4.2. How were the resulls applied in the project? .........--.... ...--. i4 SECTION 5: STRENGTHS, WEAKNESSES, CHALI,ENGES' AND OPPORTUNI'IIES.... SECTION 6 : UNIQUE FEATI]RES OI,' IHII PROJECT/OTHER MATTERS ........... 35 34 WiIOiAPOC, 24 November 2004 Acronyms APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT UNICEF UTG wHo African Programme for Onchoqlrciasis Control Annual Treatment Objective Annual'I'raining Objective Commur-rity-Based Organization Community-Directed Distributor Community-Directed Treatment with Ivermectin Community Self-Monitoring Local Government Area Ministry of Health Non-Governmental Development Organization Non-Governmental Organization National Onchocerciasis Task I'orce Primary health care Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Stakeholders meeting Technical Consultative Committee (APOC scientific advisory group) Trainer of trainers United Nations Children's Funci Ultimate Treatment Goal World Health Organizatio vl WIIO/APOC, 24 November 2004 Definitions (i i) TS1allgpdation: the total population living in meso/hyper-endemic communities witlrin the project area (based on REMO and census taking). Eljgruls_-papulalrg!. calculated as 84Yo of the total population in meso/hyper- endemic communities in the project area. (iii) Annual Treatment Objective: (ATO): the estimated number of persons living in meso/hyper-endemic areas that a CDTI project intends to treat with ivermectin in a giveu year. Ultirnate Treatment Goal (UT'G): calculated as the maximum number of people to be treated annually in meso/hyper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage (normally the project should be explctld to reach the UTG at the end of the 3'd year ofthe project). 'Iherapeutic coverage: number of people treated in a given yeal' over the total population (this should be expressed as a percentage). Geographical coverage: number of communities treated in a given year over the total number of meso/hyper-endemic communities as identified by REMO in the project area (this should be exoressed as a percentage)' Integration: delivering additional health interventiotts (i.e. vitamin A supplements, albendazole for LF, screening tbr cataract, etc.) through CDTI (using the same systems, training, supervision and personnel) in order to maximise cost- eif-ectiveness and empower communities to solve more of their health problems. This does not include activities or interventions carried ctut by community distributors outside of CDTL (iv) (v) (vi) (vii) (viii) Sustainabitity: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future, with high treatment coverage, integrated into the available healthcare service, with strong community ownership, using rcsources mobilised by the community and the government. (ix) Community self-monitoring 9SM): The process by which the comtnunity is emporvered to oversee and rnonitor the performance of CDTI (or any community- based health intervention programme), with a view to ensuring that the programme is being executed in the rvay intended. [t encourages the community to take full r.rponribility of l.rermectirr distribution and make appropriate modifications wlten llecessary. (i) i vll WHO/APOC, 24 Novenrber 2004
FOLLOW UP ON TGG REGOMMENDATIONS Using the table below, fitl in the recommendations of the lastTCC on the project and describe how they have been addressed 2OTH TCC session Number of Recommendation in the Report TCC RECOMMENDATIONS ACTIONS TAKIiN BY THE PROJECT FOR TCC/APOC MGT USE ONLY 8 Use the most recent reporting format New Repor:ting format is used for the Year 7 A totalof 91,993 people out of a target of 312,328 received Vitamin A caPsule, giving an overall coverage of 61 .47'Yo. Coverage percentage for the differsnt age groups is: 6- I l'months 62.59'0, 2-59 months 58.7% post partum mothers .62Yo. Total population li gtrre for 2003 was 1,085,257 however because of the census validation on going it is 1,129,489 as indicaied in this Total population figure for 2003 rvas 1,085,257 and Eligible PoPulation was 9l I 616 LITG recalculated as 948.770 c'rn page 7 Report of Vitarnin A coverage figures F-, Clearly indicate total population figure Clarity the total PoPulation and the eligible poPulatior ' Recalculate UTG Recalculate theraPeutic coverage Therapeutic coverage for 2003 was 85%o while in 2004 it is 80.5%, this drop was as a result of the Shendam /Yelwa crisis Clarify CDTI strategY for supervision Already included in the 7th ycar report Advocacy to ensure that MOI{ maintains trained health rvol'kers This was done LGA bY LGA by visiting rvith tlre Permanent Secretary MOH at ihe State levcl and the Director PFIC at the LCA level Recruitment of more CDDs, particularly females Mobilization is been carlied out to imProve on this (Plea.se add more rows if necessary) WHO/APOC, 24 November 2004 'Executive Summary Prepare an Executive summary of fhe report in not more than one page. L Background on treatment and population data - fotat communities, communities' treated, total population, UTG, ATO and persons treated. 2. Background on population movements 3 Training data - CDDS-, health workers, Totalpopulation (community) per cDD trained 4. Challenges and how they were over,come. Mass Mectizan distribution started eleven years ago in the State. Then the distribution was the CBIT approach with the State being assisted by the NGDO, Africare. Prior to the withdrawal of Africare from the State in 1996, Mectizan was being distributed in only 280 communities in 4 LGAs. Foltowing Africare withdrawal, two other NGDOs, Christoffel Blinden Mission (CBM) and Mission io Sun. the Helpless (MITOSATH) were assigned by NOCP to assist the itut.. 3in.. then, distribution had extended to over 1,500 communities in l2 LGAs' Out of a total of I 543 communities in the 12 endemic LGA, 1367 communities were treated in 2004 giving a geographical coverage of 88.5%. Taraba state has a total population of l, 129, 489 out or wnrcn grc, n+ people were treated to give a therapeutic coverage of 80.5%. The UTG of the project, which is now the /rTo, is to treat 948,770 persons in allthe endemic communittes. One of the strong issues on population movement is the movement of the Fulani's especially during the dry s"ison, in searcir of pasture for their cattles. During the rains, community ,"16'"r, move to their farms to stay, almost through out the farming season and might not be available for treatment. 1g03 CDDs and 339 health workers were trained in the year under review with a total population of 1,129,489. 'Ihis gives a ratio of I CDD|626 Community members' The main challenge we had in 2004 was that of census validation. Data collected from the LGAs were inconsistent especialty totalpolulation and total number of communities. This was overcome bY *producing community registers that had enough space to accommodate additional household members. *Requesting that old registers be left with the HFs until census updating is completed to ensure compliance. *Visiting and valiclating total number of communities in all the endemic LGAs' *Compiiing and makin! available to all endemic LGAs hard copies of agreed-census information to enable tf,em verifli treatment records before forwarding to the State' 2 WIIO/APOC, 24 November 2004 SEGTION {: Background information 1.1. Genera! information 1.1.1 Description of the project (briefly) Geographical location, topography, climate Population: activitds, cultures, language Communication systerns (roads.. -1 Ad m in istration structure Health system & health care delivery (provide the number of health posts/centers in the project area if the information is available). Nurnber of health staff in project area and number of health staff involved in CDTI activities. Geosranhical location Taraba state is located in the northeastern part of Nigeria. It lies roughly between latitude 6o30 and 9o36 north and longitude 9ol0 and 11o50 cast with a landmass of approximately 55,000 square kilometers. The topography is made up of undulating hills and mountains interwoven with marshy and swampy land being drained by many tributaries of the Benue River and its two main tributaries (Taraba and Donga) .'rovides conducive breeding environment for the black fly (simulium SPP). Much of the S;ate is very much endemic for Onchocerciasis as twelve out of the l6 LGAs of the state have been determined by REMO to be Meso and hyper endemic for the disease. The LGAs are: Ardo Kola, Bali, Donga, Gashaka, Ibi, Karim Lamido, Kurmi, Sardauna, Ussa, Yorro andZing. Population More that 75%o of the over 2 million populations reside in rural areas where the main occupations are farming, fishing and catlle rearing. Taraba State is a multi lingual state comprising of the .lukuns, Mumuyes, and l'ivs among others. Communication System The road network in Taraba State is not a very good one. The major roads that connect to other statcs are fairly all right but the intra-state terrains are bad and worse during the rainy season. The mountainous areas are not motorable except on foot and makes interventions even more difficult. Most times the LGA workers comes to the State headquarters once every month for their salaries, this opportunity is used to get across to the LGA workers in whatever capacity especially to the health workers. Administrative Structurc Taraba State has a Governor who overseas her affairs. The State has 16 LGAs. Each LGA (comprising of several communities) has a chairman while each community has a councilor. Health Svstem and Health Care deliven' Collection centers are Health facilities that supervise smaller Health facility outlets under them. Drug collection for the different communities takes place at the collection centre. The centre also serves as a reporting for all the CDDs in that area. It is difficult to estimate the total number of Health Staff in the project area especially at the LGA level where all staff in the PHC department is ret'erred to as Health workers. 3 WHOiAPOC. 24 November 200;1
Estimate is only available for those involved in CDTI. These Health workers are 333 in number as shown in Table l. *Record for all health workers can only received after going through the Government's bureaucratic process and might still not be available unless a letter of Authority written to them is received Table l: Number of health staff involved in CDT'I (please add ntore rows if necessary) District/LGA Total Number of health staff in the entire project area Br Ardo Kola 24 Bali 29 Donga 28 Gashaka 27 rbi 2'7 Karim Lamido Kurmi 32 28 Sardauna I 29 Takum 3r Ussa 25 Yorro 26 Zing 27 Total 333* ,r The 6 SOCTs from the state headquarter in Julingo are not included lo make 339. 1.1.2. Partnership - Indicate the partners involved in project implementation at all levels [MOH, NGDOs(national/international), commun ities, local organ izations, etc.] - Describe overall working relationship among paftners, clearly indicating specific areas of project activities (planning, supervision, advocacy, planning, mobilization, etc) where all partners are involvlC. - State plans, if any, to mobiliza the state/region/district/LcA tlecision-makers, NGDOs, NGOs, CBOs, to assist in CDTI imptementation. Partners involved The panners involved in Onchocerciasis control in Taraba state are CBM, MITOSATH, MOH, LGAs and Communities. The partners have a gocd working relationship with one another and join hands together to (in terms of finance, manpo*eiand logistic support) to ensure the success of the programme. 4 WHO/APOC, 24 November 2004 Number of health staff involved in CDTI activities. Number of health Percentage staff involved in CDTI * 100 Partners working Relationship Planning of project activities is done jointly by the project staff (MOH/LGA) and the NGDO partners. The partners provide technical ass,stance, vehicles, Health education/mobilization materials; assist with training and advocacy to governments. The MOH/LGAs are responsible for the implementation of the programme activities and provide funds for them as well. The communities are responsible for ensuring distribution of the drug within their communities by selecting and supporting their CDDs and ensuring that the selected person is trained by the health system. They are also responsible for monitoring of the distribution process in the communities, but this is yet to comlnence fully in the 12 LGAs though it has started in 2 communities in both Tacoma and Ussa LGAs. Mobilization for Support 'Ihere are plans to identiff localNGDOs, CBOs in the communities and subsequently to mobilize them to support the programme in the communities in the forthcoming year as part of the planned stakeholders meeting. This .* already on going. 5 WHO/APOC, 24 November 2004 !+ O c.l o -o tr z sf a.l (J o A. Io z I I I I I I6 0) E .9 r<() a. bo Eo a-or() bn .E € 0) o o 0) 'a La. 0) k .o a a C)o a Cd 6 $ \ q) \s$\ $ \ $ U !)t- s \ \ eL x $ -s .: o .\ L\ $ s =o bo L u L boos!O si\ \ s U o' L\ s s \ s t\ -a o 5U ci s L L$\5t T a s \ B L *o o $s ,\ q) -s kU $ ci q) (J () il I\ \ \ q) q L qJ E q) 4 q) u ..: o L()g bo L oa 0)L o bo L o E 0) C)k oL >' o) l- C) o 63(.) d c) c) q) () }zq q (g o d a. o o. d a 0.) E E oQ e.ir 6)l -oldlFI E o {a(E Ir or c,i !F \o ooN\o $ € <i' oo r-r-o\\o N o\ta) \at c.l a'l oo$ =f,c-) o\s cn$\o a.lNc.l o\\o o\ ra) F- oo co c-l oo ca co otOtr) F- $ co o\ $ F = ri = Es]L \o ca c.) \o s ca oo$F- t-r o\ o\ (t\(.l \o o\ oo ce ra) c.l\o tr- o\ t'- oo$\o (r- O +(r) c- ra) t-. cn c.l t*^ ra)$ $ cn co I <l + I .o -oo .= o.N s <'Ei E3 ooo\ o\s \o o\ t-.6 a\ .I r- oc$\o tr- ca ca \o ca r-. $ $ o* , oE E B.E.Er >.rO o 4) *6Ag ca o\\o (f) ar-o\ $ co oo .t r- F- o\$ ca o\ oo \o \o o\a o an N\o oo o\ o\$ r- rn r- ca 6 o 'E:3 ?,5 oF: 2 O o, ca C\ fr) .+ ra -1-$ \o c.lco (\t-- ca\o\o N $ $\o I o >x o.= -o 6O ot- ll tat tal ca(\ $\o 4 o .9O H9 ;a. Eo:\ !JE i l*c oE >ioFI:Ho N o\ co c{ ro $+ \orr} Nco Nr-\o\o o =f \ ahq) () o Lr e) z o 'EgE ot ! ?oE 3RT 2, \o c.) ca \o $ c.l oo -+ r- t\ o\ o o\6$ o\(\l$ co o\ oo \o \o o\ oo ca ral (...l\o or- o\ F- oo$\o c- oo o\o\s .f, r- ta) r-C.O c.tr-la) s clt i O,) oo= .- L rY -$s -=i(J? = 6.9E 3e e'F AE A bO s F] F F- (d d da E i/dF ) o L o(! c0 d bI) H dizd (, o .o o dJ E dv E v o v o! E,t .:E.g !-Y-E; iH R-r E $ cl d) -o O o z <f c.l q -) :r ()k(.) oE o da(H Cd(.) L(! o() 'a L o. C) o d) p. O o -o(\t a c)L(.) qr o .9 (o E o( L() o d (.) () a .l @ oo()q. oo I () G) c)p () oo 6J() CB l<d o g' o()g a C) oL o a L 0) o I I I I I I t-.1 c-.u0) r\ o -oldl q)l -ol(!l o)l ;-l (do (g 6)!o C)-d(g '*O ,'dyz) o () .e3 di Svt d z ;i te AE6)(s €E-. oPY00) -a a'- €C)iL'rrxo sE() TEb 9-cL2= o-(ie0)x € d'r ACE Fod 6 C) E-x vl6 A))o9 ^-G da* boCd = .Eq)B €s Lq OD6) *- "o o) () YPS h5 .i16 = =9,(J* -=10 =(do 6-E ,I -9LP9o ^^oo t'-0)'-t _cde .co6 -vtO o.) dr'lE ;i- ar=o e EBr ,r P ^-=(D5 -q-o € 5C) L2 -q oo(d -aoi bO= '-|; il2a)>>r .-!bo.= ^L()cCJgo cE = 50x o=CB -oa I'A *Ae)tr)-E o.< -!fftros 5 tXbo b Eos I -ST I or]-=o .E =\ai- = ESo tr*: 6Bo-3r<8 -r()(+< l- F- SEGTION 2: Implementation of GDTI 2.1. Timeline of activities Fill in table 3, timeline of activities for areas treated in current year, indicating when the key activities were implemented by the month they began and the month they ended. 8 WHO/APOC, 24 November 2004 =J c-'l c) .o E 4) o z + o.t O o\ ID o Lo (d 'o C) a Cd c) o o o t-l -o o a G) a o 6 6J C)L o F ah q) oO -:\ q 4 U q: o\ t\ 'd \Jq q) U (0 o ok o o) ;() 0) od o) d (.) L € a 0) ! o o() (.) E F c.ir o-,l -oldtFI U) c) (A or Etr U x Cd 2 x z xd z (B * >td d 2 !o. cn z >\d x ADEE litr a- Lo. Lo. Lo. o- * o.o- L o. o. o. o- U) bt o9 *o EE Q .} >. >. >. >. >. >. b.0EEItr o. Ea La o. o- o. Eo. o. Eo. o. o. o) d p q) U' o)U o9 o.EEE (J a >\ h a t >r >. hl)TE 1ntr 6d: a- Lo. o. o. o. o. o- o. o. o- o. o. a. u( GI F{ tro o! o6EEo O o ! o. o. o- o. o- a o. q o. Lo. L o. o. L a. hotrt o. o. L o. o. o. a o. o o. o.:Etr €= !troor39a of *6EEo U (-) E o CI o CI z o(, od oEd z oL(, 2 o 2 o Cd o z o d z o cd z a0AE '!i tr(!: o cl z E(J (d o d 2 Eo d o d I El=I l9d ld C)d 2 o 62 o d z o d z (J d 2 I F] q) ar) a d o v o 'o cl (d bo H ad -vG, 6o -o EdJ E dV E v (, (n(A xdF (0 o o bo .EN F] H o t'r 2.2. Advocacy State the number of policy/decision makers mobilized at each relevant level during the current year; the reason(s) for undertaking the advocacy and the outcome. Describe difficulties/constraints being faced and suggestions on how to improve advocacy. The SOCTs whom were used as TOTs for Vitamin A distribution were involved in advocacy in the l2 endemic LGAs. In each LGA, the Chairman, Secretary and councilors were briefed on the programme and the roles of the various partners. Support for the programme was solicited. The reason for the advocacy and sensitization was because of the previous low level of financial support from the various LGAs a-,d also because of the Vitamin A Supplementation introduced. In addition most of the chairmen were newly elected and didn't know about CDTI OUTCOME All the LGAs pledged to support the distribution exercise. In a few cases the chairmen called for the budget to be presented to them immediately for action. Actual releases by the councils even though still low were much better than the previous years. CONSRAINT There were no significant problems encountered during the advocacy visits, as the officials met were quite receptive and keen. SUGGESTIONS Efforts are being made to contact the Ministry of local Government and Chieftaincy Affairs to discuss on possible ways to ensure actual release of funds for CDTI. 2.3. Mobilization, sensitization and health education of at risk communities Provide information on The use of media and/or other local systems to disseminate information Mobilization and health education of communities including women and minorities Response of target communities/villagr, Accomplishments Suggest ways to improve mobilization and sensitization of the target communities. Use of Media and/or other local systems to disseminate information Usually mobilisation is carried out almost entirely on person-to-person basis using the Paramount chiefs, community leaders, elders and influential members of the communities. ln some instances, town criers were used to disseminate information. The electronic media in the state is not often used, as area of coverage is very limited. WHO/APOC, l0 April 2003 Mobilization and health education of communities includins women and minorities Health education/mobilisation is targeted at the entire community. With the add-on of Vitamin A and Nutrition Education access to women has improved. Response of target communities/villages Most communities have been receptive and willing. In many Communities, it has been possible to get CDDs selected during suc,l'mobilisation visits, resolved issues such as CDD non-re-numeration etc. However in some communities the issue of CDD support and incentive still remains unresolved. Accomnlishment and Suspestion The current approach at mobilisation seems to be effective enough. However the response of the communities might improve further if Stakeholders meeting (SHM) is finally initiated. 2.4. Gommunityinvolvement Table 4: Communities participation in the CDTI (Please add more rows if necessary) lDistricuLGA Number of communities/villnges with community members as supervisors Total no. Number with Percentlgc communities community in the entire members as project area supervisors Bo= *100 Number of CDDs and the communities involved Nunrbcr of communities /villagcs with femalc CDDs Nunrber of communitics with female CDDs Pcrccntage Brr= B B 100 Malc CDDs Br Fenrale CDDs Br Totrl Bo= B7+B3 Ardo Kola 66 98 0 98 0 o Bali l2l 219 0 219 0 0 Donga 140 148 0 148 0 0 Gashaka 64 84 0 84 0 0 0 0rbi Karim Lamido 144 188 0 188 156 262 3 265 86 J 20 0Kurmi 132 86 0 0 Sardauna 1'.t2 201 0 201 0 0 Takum 135 t46 I 147 I 0'1 0Ussa ll0 90 109 0 109 0 Yorro I t3 0 I l3 0 0 Zing 213 t45 0 t45 0 0 Total I 534 1799 4 1803 4 0.3 Comment on lt WIIO/APOC. 24 November 200'l Attendance of female members of the community at health education meetings In general, how do you rate the participation of female members of the community meetings when CDTI issues are being discusses (attendance, participation in the discussion etc). Incentives provided by communities foi the CDDs Attrition of CDDs. Is attrition a problem for the project? If yes, how is it addressed? Other issues Attendance of l'emale members of the comm unitv at health education meetinss In the past women do not participate in most health education meetings but with the add-on of Vitamin A and nutrition education their participation has improved. Female particirration Health Education specifically targeting women is organized separately because of the Vitamin A add-on. This opportunity is used to discuss other CDTI issues. Incentives Some communities on their own have started giving monetary incentives to CDDs rvhile others give in-kind incentives like farming for them, exempting them from some community tax and levies and even recommending them for political appointments. Ds Attrition There are still some communities who do not give incentives to CDDs. Attrition of CDDs is still a problem in the project especially those communities who do not support CDDs. An operational research proposal titled; the issue of CDD attrition is currently put together as an operational research question. A proposal on sustainability of CDTI using Sustainability of Ivermectin Distribution System at Community Level Based on the Hamlet System: A Study of Selected Cornmunities in Taraba State has been forwarded to APOC for funding. Other issues Another issue is that of inaccurate treatment record especially among the non-literate CDDs.It appears that the non-literate tally sheet used by them is still not addressing the issue of accurate record. 'Ihey find it difficult to tally and summarize accurately. This also aft'ects selection of additional CDDs by the community because they do not have any other literate person available l2 WHO/APOC, 24 November 2004 2.5. Gapacity building - Describe the adequacy of available knowledgeable manpower at all levels - Where frequent transfers of trained staff occur, state what the project is doing, or intends to do, to remedy the situation. (The most intportant issue to describe is what measures were taken to ensure adequate CDTI implementation where not enough knowledgeable manpower wa,s available or if staff is frequently transferred during the course of the campaign). Availabilifv ble manoower The programme has already on ground a la"ge number of trained and experienced staff in both Mectizan distribution and Vitamin A supplementation. Only new CDDs were trained at the Mectizan collection centers by the health facility staffs. Transfers of trained staff The project does not experience frequent transfer of trained health workers to the point that affects CDTI implementation. r3 WHO/APOC, 24 November 2003 () 6 a Q 6) z ell I o -a +Ll, f .U b. ,:qv t* =v oo oo oo o\ : t-- C.l c.l oo : ! s : tr-r- f-. € co oo @ \o c.l t-. ol € \o co +\o ol(\ c.l o\ F- .+ F- \o o $ $ ?o € ra ?al @\o s e66 Ao o o o s QF oo o\ caat N c.l o\@ Ol N oo c.l oo cq $o a.l r-. N ao * tf, a.l o 6) .Z'q' cq[i 6) o0) .6) L€ of< z 6ll I L\J 3 U e.v .: [: o € € oo o. 0\ o\ s o\o\ o o o \o o\ (.)F O o\ al q) dl- !s Q)0 -a? E --- Z-, q)(J s,i?" -u (.) U_ e< <f, c.l N <f, + m aa c.l \o a.) o.l \o c.) o m o\o ro o\ al slotol * 9 o o .9 s ULF I st a.l \o \o sf \o (ia cq O q J 3oq) q.) o t- c) a z E,rfF-d d U o< = + st c.) l + + at s t+ * t ra ?t) ra s o o o \c ULF + <t <f I $ s tf, Vt *l 0 ov o! CC c0 (, ho o c,j (! Cd -o 'o E J dv d da E .tZdF o bI) N J F< Fr 6 N () -o E 0) oZ$al oil o .$ oo o € o * .:, a oo a- s a a\ a l3 ! o a -:\ q 4q) U\) q i L q) U ^E \Ja s o (d 0) E C) a" F aO q- q o C) C)L .c)E -o () bo .= (gLF .i'i r -l -ol FI :f, Trainees Type of training CDDs Other Community members e.g Cornmunity supervisors MOH staff or Other Political Leaders Others(specify) Program management ,< * How to conduct Health education {< * * Managemeut of SAEs *CSM it SHM * {< Data collection * {< ,< Data analysis * :r {< Report writing * Others (specify) Table 6:Type of training undertaken (Tick the boxes where specific training was carried out during the reporting period) Health Workers (frontline health facilities Any other comments 2.6. Treatments 2.6.1. Treatment figures If the project is not achieving 100% geographical coverage and a minimum of 65% therapeutic coverage or the coveragi, rate is fluctuating, state the reasons and the plans being made to remedy this. Reasons for not achieving l00yo geographical coverage and a minimum of 6570 therapeutic coveraqe Some Communities were not covered because of the extremely difficult terrain (especially thosc in Takum and Sardauna) where some mountainous communities who did not collect their Mectizan could not be reached as the rains had approached making access almost impossible. In future it is planned at the annual review meeting that the needs of those difficult areas will be considered early. l5 WHO/APOC. 24 November 2003 Secondly some communities were displaced as a result of communaI conflict this affected Ibi LGA. Some of these communities have resettled. Census updating as well as training has been carried out there. ^', l6 WHO/APOC, 24 November 2004 <. 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KE6d\4J E v ('J ! da IdF (o ;l o br) is F] F oF +c.l (f -o E 6) o z s a{ O IJ o. U oo bo(l\s s $\ ho s ho ,iq\J\ilul_+3H(d\ 0)qtsG o9().Y UL!(\ u>.i ESs -Y! '=bo1Es\>r! aEScdld(l)|q\ LQ(vt€ .9!s L'ri'i c t' €.EE --i HE .r \x\Xss OExOSY c) = .Y.. =a -q*'=: s *x. 6) a- =:d F S.E =I E F EF -l ", b BIYESs vl # - S ail o E \-r';il - S u*rr-l o) .- '=uEIE s ss!l I 5 :\.0)l o- u Y\Ets S [i 8l a : sstsl€ i Bi bl = * EF -ol - S rDtrl E i I u =l 6 s Nsz ? s ss bo sPES^ '= oi ,, := *\ll q eg !\ o$ ^E B.+ -\ Lq :a s'aI L€S Ux! 'OS E \: = ='Q! tr :-q0) \ \E (.) ! ss' = .s 'E\o ; tsu(d !i s< o ql9 S SSF n rSD s s!\o t\ l-: o\ \ aS. c)lOI -l o.rxl > EIE ulRet v ,lE Ol c)ot trot 15Ol .d!l I :IF -8lE Hl c zl< (d()Ld c.) 'a L o-() :(J rl]/, -o .o 6)q= () E od 0) .E aol tr xl 3 El gEl tr 9l uPl -o ol COl 0bIl i sl b =l o>t >- >ls0l > .:I C)il E trl e El o!l s 513 ol H -l I0)l Cpl _trl cB =l oZI? {) d C) bo(6^bs' oo F o dr bO cd o oo Eo,] '= :< dk bo () o 2.6.2 What are the causes of absenteeism? The causes of absenteeism are: (a) People travel for their business, some for employment; some go to schools (b) Persons displaced over the years as a result of communal unrest yet to return (c) Some CDDs don't revisit houses to treat later. 2.6.3 What are the reasons for refusals? It was observed quite lately that the CDDs in their collation recorded those who were absent as refusals. This is been carefully sorted out. Efforts are in place to avoid the same repeating it self. 2.6.4 Briefly describe all known and verified serious adverse events (SAEs) that Occurred during the reporting period and provide (in table 8) the required Information when availablti ln case the project did not have any cases of serious adverse events (SAE) during this reporting period, please tick in the box. No SAE case to report I * l9 WHO/APOC, 24 November 2004 *C..l oE () o z + c.l Q o c.l \ q.) 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E,h,; ootrl oo € o\ + o\ \o o\ € od o\ \ o\ o\ vl oo € rrl o:E 3* E 5 SE c tr= i;I E.i !206 oo 6 co c.lN \oF- +$ rr\o ri tso do=2E6b=ot uEFIJ s \o $ \o co oo c.l F- o\ F-o\ F-o\ ca+ s t2ts* s E E * o= tr6 E.E.= = E rd O=aaaF tr bO9E 5oa st \o $ \o oo o\ ae.l a-o\ F-o\ r-o\ * * $ F- o\ o\ oo o\ o\ d^55 O c.l o ct c.l N ON st c.l N \o (\ r- N €o N o\ c.l c.l $ N q) 3 o o z <f, c.l \_, o r o (\c{ !S\ a4 .jt\ t a) Cra\i: \q) a) -6' q) () ,q)\ !: l q) b0 BLq) u u SL bo oq)() .13 -q) U € : Q q) oo d Lq) -U c) rhv3 D = .<L ls' h tvv! tr Clldtr .r 'ESHEUUriLC) =ue:'i 'S c) -E .>= :.sqb\NL€6rtr-fL v o=aD odlE t&.2v I ;.P 6{6)5E25(q2C.el c)(JlcJc)l .='al!!l(.) ui i .gel It- .a-j Io.trlHo)lC-/ 6i Ih€ Iuxl tr.qilkLt()6ll .r.o)l :iliitrEl I9el E6sl E c)ol -t oEllL() -ol o. !Ebg x!w9bL 9nla<c!5!,) - q,iEt-( +rcgDo?.) LAtr()€C)tr6) L-!F-{ ii cq -0)() in-15 vi '- tr6i orl '; o)l 0 -t €l -uFI A <. O o.l a) -o o oZ$ c.l (J. o ts ('.- Uq ^tr t-)\\- (J> as \J ..: nQs ^a\F\ 'i: xY *s' \* Ys EiU uea :h 85 -q ilji ^gaB\) >tPbo boP 'E f, *: rr 3s alaSG?{ !q) $Q -s\\or hn -hs-x ss -s= :% qr\ "rS .x! I -qr \\ u=\BI sr S \P\s:\s*::\\ts *\N% r.s = os * !N U%:J eR i *:= * \.)\ Nc\ 2.7, Ordering, storage and delivery of lvermectin Mectizan@ ordered/applied for by - Qtlease tick the appropriate anstver) MoH tr wHot] I,INICEFE *NGDd] Other (please specifu): _. Mectizan@ delivered by - Q:lease tick the appropriate answer) MOH E* wHoN I]NICEFtr NGDOE Other (please specify) Please describe how Mectizan@ is ordered and how it gets to the communities How Mectizan@ is ordered and how it gets to the communities Usually the NGDO partners order for and collect the drugs on behalf of the project. which then collects the drugs (from the NGDO head office) for delivery to the various LGAs. In most cases the drugs are collected by the LGAs and delivered to the collection centers. The communities collect the drugs from the collection centre. However as a result of lack of funds rnost LGAs could not delivir the drugs ti ttre collection centers, a situation that made the NDGO partners to intervene in that regard. Table l0: Mectizan@ Inventory (Please add more rows if necessary) How are the remaining Ivermectin tablets collected and where are they kept? Storage of Mectizan The remaining Ivermectin tablets were returned by the LOCTs to the SOCTs in charge of a particular LGA.The remaining tablets are kept in the State Onchocerciasis Control office store and later carried over for Year 2005 treatment. 4 State/District/ I,GA Number of Mectizant tablets Requested Received Used Lost Wasted Expired Remaining Ardo kola 126000 126000 110437 0 0 0 0 1s563 Bali Donga 260000 260000 259119 0 0 88r 250000 2s0000 204400 I 40000 l I 4689 0 20 0 45580 253|lGashaka rbi I 40000 0 0 0 220000 220000 69875 97000 0 0 53128 Karim Lamido 430000 430000 423843 0 30 0 0 6127 Kurmi r 40000 140000 133842 0 0 61s8 Sardauna 370000 370000 364577 0 0 0 5423 Takum I 45000 145000 144414 0 0 0 0 586 I 38,Ussa l 3 0000 I 30000 128617 0 0 Yorro Zing 200000 200000 I I I 73043 238000 23 7732 0 0 0 0 0 26957 23 8000 268 0 TOTAL 2,649,000 2,649,000 2,364585 97000 3r8 0 t87097 23 WHO/APOC, 24 November 2004 List and briefly describe the activities u,lder Ivermectin delivery that are being carried out by health care personnel in the project area. Activities under lvermecti4 deliverv that are beinq carried out by health care personnel in the proiect area. Health workers are involved in planning, community mobilization, training, supervision and data collection. PLAIINING Towards the end of the year the healthcare personnel at the State and LGA plans the Ivermectin distribution activity for the preceding year and submits the budget to the state or LG A policy makers as the case may be. COMMMTINITY MOBILISATION The healthcare personnel mobilize the comrnunity under their supervision .The CDD guides them on issues of concern which becomes the main focus during the mobilization with the aim of solving problems where they arise or commending the community for their supporr. TRAINING Training is usually carried out in a cascaded manner, SOCTs trains LOCTs, LOCTs trains DHS who in turn trains the HFs.l'he HFs trains the CDDs. fopics covered during trainings are overview of the disease, signs and symptoms, sustained compliance, record keeping, sustainability, and involvement of CBOs. From the Year 2000'2003 training has been targeted rather than routine, however programme managers realized that the quality of report coming frorn the field had dropped as the years of distribution progressed. This was attributed to poor cascaded training in some LGAs, where the Health worker that is suppose to train seems not to be qualified. Plans are in place to do a massive retraining at all levels during the 2$,05 distribution exercise. SUPERVISION Health workers supervise the work of the ones under thern. Supervision is also carried out in a cascaded manner as described in training above. We have also witnessed poor supervision of' Ivermectin distribution due to poor funding by Government at state and I-GA as well as drop in the quality of the skills of Health workers to supervise. DATA COLLECTION The CDD collates the community treatment data and subrnits to the HFs in charge of his collection centre, The HFs submits to the DHs who then collates for his ur"u and submits to the LOCT. The LOCTs collates for the LGA, summarizes it in an LGA summary fonn and submits to the State. Any other comments * ''2.8- Gommunity self-monitoring and stakehorders Meeting Has any training (of trainers) for community self-monitoring been done in the pro-ject area? If so, When? Commu nity Self Monitorine State Onchocerciasis Coordinator has been trained, who in turn trained LOCTs during the 2003 Annual Review Meeting. The LOCTs were encouraged to go to their LGAs and implement it in some communities at least for a start. An incentive was promised the hest perfonning LOCT. So far Takum emerged jhe best and will be rewarded at the next review meeting. Table 1l: Community self-monitoring and Stakeholders Meeting (Add rows if needed) 24 WHO/APOC, 24 November 2004 District/ LGA Total # of communities/villages in the entire project area No of Comrnunities that carried out self monitoring (CSM) No of Communities that conducted stakeholders meeting (SHM) Takum Ussa Donga 135 109 140 135 109 * 2 2 TOTAL 244 43840 Describe how the results of the community self- monitoring and stakeholders meetings have affected project implementation or how they would be utilized during the next treatment cycle. +ln Donga efforts has been made to use Village health committees as monitors. Plans are at an advanced stage but yet to yield the desired result. The geographic coverages of 'fakum and Ussa are 100%. The therapeutic coverage of Ussa is 83%. Therapeutic coverage of Takum is70o/o; more work is been done to see how the CSM and SHM can further improve the therapeutic coverage. How the results of the communitv self- s and stakeholders meetinss have affected nroiect imnlementation '!. The CSM allows the community to be the owners of the programme even when external monitors are not around they ensure that their communities are being treated. 2.9. Supervision 2.9.1. Provide a flow chart of supervision hierarchy. SOCT's--- LOCTs-,DHS+HFS--+ CDDs---COMMUNITY MEMBERS 2.9.2. What were the main issues identified during supervision? Spot check supervision was carried out by SOCTs. Issues identified were, Training of more CDDs. Retraining of some DHs and HFs. 2.9.3. Was a supervision check-list u."ai In some areas there was limited supervision by LOCT. checklists even though available were hardly used. 2.9.4. What were the outcomes at each level of CDTI implementation supervision? Usually, tlie LOCT supervise activities of the DHs and the Heatth facility stafT while the health facility staffs in turn supervise activities of the CDDs. However, during the period under review there was little or no supervision from the LOCTs and Health facility staff as a result of lack of funds for the exercise. The main outcome of the supervision at the LGA level *Timely retrieval of treatment data t) *Successful census Validation exercise. *ldentification of non -performing LOCTs and recommending their removal. At the Community Levelthe main outcome: *Confirmation that Census Updating has been carried out at the community level. *Observation that measuring sticks were not used to decide dosage (especially by 'experienced' CDDs who rely on experience). 25 WHO/APOC, 24 Novernber 2004 2.9.5. Was I'eedback given to the person or groups supervised? Feedback when given is on the spot instruction of the CDDs. Revisits were made in areas where problems are noticed especially as regards compliance with treatment. General findings are usually discussed at the Review meetir,1, which the Project now carries out at the LGA level. 2.9.6. How was the feedback used to improve the overall performance of the project? As CDDs were given on the spot instruction, they were carried out immediately for example, some of them had to go back to find out the actual population of the community they were treating. SEGTION 3: Support to GDTI 3.'1. Equipment 7 Table l2: Status of equipment (Please add more rows if necessary) *Condition of the WO:Written off). equiprnent (F:Functional, CNFR:Currently non-functional but repairable, APOC has purchased additional 5 Yamaha motorcycle, computer and printer, and a .photocopier which is yet to be collected from WHO/Lagos. How does the project intend to maintain and replace existing equipment and other materials? Regular servicing and use of Log book will be employed to make sure the available equipments last lor,g. The State has plans in place to replace the vehicle but this can only happen if funding is regular from the Government. Source Type of equipment APOC MOH DISTRICTi LGA NGDO Others No Condrtron No Condruon No Conditron No Condrtron No Condrtron L Vehicle J F I F I F 2. Motor cycle(s) l5* l2-F 3-WO I F t4 F 3. Computer(s) l* F 4. Printer(s) I F I f I F5. Photocopier (s) _* 6. Fax Machine(s) I F 7. Others a)FILLING CABINET I F b)BTCYCLE 20 F c) 26 WHO/APOC, 24 November 2004 I Contributor Year 5(2002) Year 6 (2003) Year 7 (2004) TOTAL I L I I TOTAL Cash Released (us$) Cash B udgeted (US$) TOTAL Cash Budgeted (US$) TOTAL Cash Released (US$) TOTAL Cash Budgeted (us$) TOTAL Cash Released (us$) MOH (Central + Provincial/State) 27,980.0 0 0.00 I 7 9,178.5 0.00 000 MOH (DistricVl.GA) LocalNGDO(s) ( if any) 49,790.0 0 10,526.0 0 I1,955.6 4 1,837 .14 NGDO partner(s) 40,892 86,812 MITOSATH 70,689 54 CBM 36.125 46 Others a) b) 6,700* * + 000 Communities APOC Trust Fund 49,288.0 0 20,267.8 6 000 0 00 TOTAL I 13,5 t5 l 06,81 5 3.2. Financial contributions of the partners and communities Table l3: Financial contributions by all partners for the last three years 70,689 54* CBM 125 46r* *MITOSATH contribution is for Ivermectin distribution, Vitamin A add-on and Nutrition Education. **CBM's contribution is for both Onchocerciasis and other primary Eye Care Programmes. **+This fund was not released as a result of delay in the retirement of the previous year's fund +x{'** Record forthe funds budgeted foranrr released can only received aftergoingthroughthe Covernment's bureaucratic process and might still not be available unless a letter of Authority wriften to them is received to that regard. If there are problems with release of counterpart funds, how rvere they addressed? Addressins problems with counterpart lunds There had been several advocacy visits to the MOH by the partner NGDO on the subject. We are soliciting for High level Advocacy ma1'be the APOC advocacy team to see the Governor ofthe State on behalfofthe project. Additional comments Comment There had been difficulty in obtaining funds from the Government over the years due to what was describcd as lean resources of the state and LGA. 27 WHO/APOC, 24 Novcmber 2004 3.3. Other forms of community support Describe (indicate forms of in-kind contributions of communities if any) In-kind contributions In-kind contributions are many and varied. They could be foodstuffs, assisting the CDD on his farm, donation of some gift items, nor.rinations to represent community in duties where momentary compensations are given e.g. the National Immunization exercise and occasions etc. In about cases, grateful communities nominate CDDs to serve as Local Council councilors and eventually go on to vote for them into that position. 3.4. Expenditure per activity lndicate in table 14, the amount expended during the reporting period for each activity listed. Write the amount expended in US dollars using the current United Nations exchange rate to local currency. Indicate exchange rate used here $ 28 WHOL\POC, 24 November 2004 Expenditure ($ us) Source(s) of fundins Drug delivery from NOTF HQ area to central collection point of community Mobilization and health education of communities Training of CDDs Training of he_alth staff at all levels Supervising CDDs and distribution Internq! monitoring ofCDTI activities. Advocacy visits to health and political authcl ities IEC materials Summary (reporting) forms for treatment Veh icles/ Motorcycles/ bicycles maintenance Offi ce pqu ipp-e1t (_e g.- cgrypulers, pri nters etc). Others 600I , 17,466 22,625 10,646 to,gzo ** 6,700 2,657 * 1 1,520 0 26,525*** MITOSATH and CBM MITOSATH MITOSATH MITOSATH MITOSATH 14ITOSATH APOC MITOSATH MITOSATH and CBM CBM TOTAL I 10,615**** Total number of persons treated Table 14: lndicate how much the project spent for each activity listed below during the reporting period 6 *Summary forms were produced along witi' other lEC materials' **lnternal monitoring was grouped together r.vith supervision. *x* CBM's suppoft to Primary Eye Care. +{(**A few related activities like attendance of meetings in the state and Review Ineeting was not included in the listing on Table l3 as part of NGDOs contributions that is why the expenditure is greater than the contribution. - Any comments or explanations? SEGTION 4: Sustainability of GDTI 4.r1, lnternal; independent pa(;cipatory monitoringl Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable) Year I Participatory Independent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation* Internal Ivlonitoring by NOTF 29 WHO/APOC, 24 November'2004 aOther Evaluation by other partners 4.1.2. What were the recommendations? Recommendations Below is the conclusion of the recommendation given by the Monitors of the imptementation of GDTI sustainability plans for Taraba State, Nigeria carried out in May 2004. It is the opinion of the monitors that a substantialnumber of recommendations made in the 2002 evalnation have been addressed at the state, LGA and community level and there is an effort to implement the sustainability plans"prepared at the time. The SOCT and state team leader have been trained on SHM and CSM and have briefed other team members and LOCTs during the annual review meeting. Actual training of SOCTs and LOCTs has not taken place and implementation is yet to start. HSAM and Mectizan procurement are satisfactory. There is however much room for improvement in other areas without which the expected levll of sustainability may not be reached by the end of the eighth year in 2005. The major problem areas are as follows: ' Financing is still a major problem at all levels, with the exception of the community. o Transport and material resources: transport is in short supply and running and maintenance costs generally not provided for. IEC and training materials are also in shoft supply. ' Monitoring and supervision has been non-existent at the SOCT level and inadequate at lower Ievels, all linked to lack of fu",ds o Communities to be treated are still not well listed and record keeping is not satisfactory from the community level upwards, .r.vith implications foi calculating geographic and therapeutic coverage rates. ' Political commitment has not yet translated into flnancial support for the project. High-level advocacy would be needed to address this issue. . The partnership issue with the NGDos shourcr be resorved speedily. t_ $ 30 WHO/APOC, 24 November 2004 Pleonrng o LOCTs should follow the plans which rvere developed with, and agreed by the LGA authorities ' The SOCTs should support the LOCTs in carrying out advocacy visits to the newly elected LGA chairmen and councilors for health o LOCTs should, as much as possible, integrate implementation of their CDTI activities with their other health responsibilities eg. carry o,;r integrated supervision ' LOCTs should carry through the impler^rentation of SHM and CSM for which they have been trained. Supervision Provide funds to ensure supervision by SOCTs SOCTs should prepare, train on, supply and ensure the use of supervisory checklists by LOCTs Increase the number of LOCTs where necessary to reduce distances traveled and improve on supervision LOCTs to carry out integrated supervision Provide all LOCTs with training manuals and IEC material a a a a a a Mectizan procurement and distribution o Ensure that all LGAs have complete lisi of all commr.rnities rvhich qualify fcrr CDTI o Reconcile the existing discrepancy in list of communities between the LGA and State levels Megtizan Storage and delivery o LGAs to provide funds for delivery of Mectizan to the health centers Ge-qgaphts raysragq o Ensure correct, consistent definition of communities e Ensure treatment of all qualified communities, paying special attention to communities in conflict areas which were not treated in 2003. o Innovative method employed in one LGA of using personnel indigenous to an area to engender trust is highly commendable. A sirnilar system could be employed in other LGAs, especiilly those in conflict. Thera coverage o Recover all old community registers and ensure their safe custody in health centres. . CarrY out targcted training on census update, correct recording and reporting ofdata, and correct calculation of therapeutic coverage. Comments and Recommendations in2004 , . Prepared plans should be implemented. r NOTF to re-emphasise to the state government the importance of releasing counterpart funding tbr the programme. o It is recommended that APOCAIOTF support a high-powered advocacy visit to the State Governor for release of counterpart funding and long-term political commitment. . Funds should be made available urgently for the purchase of the remaining tyres so that training, supervision and monitoring and other activities can take place as planned. . The copy of the ZONE D supervision ;hecklist found with state coordinator should be revised by - the team to include only essential points for each level of supervision; and the agreed checklist for each level should be used for supervision at the appropriate level. o Dr Apake to ensure supervision by SOCT in2004 and subsequent years. :e 3l WHO/APOC, 24 November 2004 4.1.3. IIow have they been implemented? Implementation of Recommendations Yes the recommendations has been implemented as follows Finance: lssues that bordered on finance was overcome by supporl from the NGDO while Advocacy is still on to ensure release of funds by the Government. Transport: The NGDOs supplied l4 motorcycles and 20 bicycles in 2004 to ease transport problem.APOC also provided 5 Yamaha motorcycle for the project in2004 which is yet to be collected from Lagos. IEC Materials 4 More IEC materials has been produced and distribr,rted. Listing of endemic Communities The list of all Onchocerciasis endemic communities has been compiled and shared at LGA and District Levels. Release of Counterpart funds by Government Advocacy targeted at the release of counterpart fund by the Government has been carried out but is yet to yield the desired result. The project will appreciate a high level advocacy by the advocacy team to the Governor of the State. Partnership issuc with the NGDO r Partnership issue with the NGDos has been resolved. MITOSATH supports the implementation of CDTI in the 12 endemic LGAs since Year 2005. 4.2. sustainahility of proiects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period? NO Was a sustainability plan written? YES When was the sustainability plan submitted? What arrangements have been made to sus'+ in CDTI after APOC funding ceases in tcrms of: 4.2.1. Planning at all relevant levels This is already been carried out as part of year 8 plans. 4.2.2. Funds Advocacy to both the State and the LGA policy makers are in place to solicit support 4.2.3 Transport(replacementandmaintenance) As reflected in 4.1.3 4.2.4. Other resources 4.2.5. To what extent has the plan been implemented The plans are already being irnplemented 4.3. lntegration 32 WHO/APOC, 24 November 2004 Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3.1. Ivermectindeliverymechanisms The storage of Ivermectin as well as the release to the LGA is carried out by the state. 4.3.2. Training Training involves both the Onchocerciasis and Nutrition unit of the pHC 4.3.3. Joint supervision and monitoring with other programs Supervisory visit for Vitamin A is usually used to monitor Ivermectin distribution. 4.3.4. Release of funds for project activities Advocacy has been carried out; however is yet to bring about the actual release of funds. 4.3.5. Is CDTI included in the PHC budgetr Yes. 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have becn the achievements? Vitamin A supplementation activit;*.s were carried out by MITOSATH/MOH in Taraba State using CDTI structure. o Children 6-59 and postpartum mothers in the first weeks of childbirth in 1534 ccommunities of l2 LGAs of the State received Vitamin A supplements. a A total of 191,993 people out of a target of 312J28 received Vitanrin A capsule. giving an overall coverage of 61.47Yo. a Coverage pel'centage for the different age groups is: 5- I I months 62.5yo, I 2-59 months 58.7Yo and post partum mothers 70.620/o. . In addition l0 TOTs, 54 LOCTs, I l9 DHs, 160 HFs and 1794 CDDs were retrained. o Census validation of communities covered by the supplementation exercise was also carried out. a Supplementation exercise was supe"-,ised and monitored alongside training and distribution while External evaluation by NPHCDA was carried out between 19 - 23rd of September 2004 4.3.7. Describe others issues considered in the integration of CDTI. Other issues in in of CDTI CDTI was also used for the distribution of Iron-Foliate to only pregnant women in their second and third trimesters. Some of the agreernents reached before thc Implementation of the Supplementation were: The following were agreed to be used for mobilization: - *Courtesy visit to the mai angwin telling him about the need for supplementation +Inviting the elders and husbands in the community and also briefing them so that they can ensure compliance by their wives. *Inviting the CDDs for training on the supplementation with emphasis on supplementing healthy pregnant women in their second and third trimester. l JJ WHO/APOC, 24 November 2004 aIron-Foliate supplementation coverage in most communities monitored improved with the cDD bridging the gap between the community and the Flealth facility. The actual coverages and other lessons learnt will be reported in Year 8. 4.4. Operational research 4.4.1 summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period. None 4.4.2. How were the results applied in the project? SEGTION 5: Strengths, $veaknesses, challengGsr and opportunities - List the strengths and weaknesses of cDTI implementation process. - List the challenges and indicate how they were addressed. STRENGHT a. CDDs despite their demand and wishes to have incentives, still willingly'clistributed the Mectizan/Vitamin a supplementation. b. Census updating has been carried out alongside with Mectizan. c. New community registers, which accommodate Mectizan and Vitamin A, have been produced and used in 12 LGAs. . d. There was awareness of the progranrmes at community levels. WEAKNESS a. Some CDDs still complained aboul lack of incentives from their community membersb. f iming of the supplementation also affected the accessibility of some communities because of the raining season. c. The Vitamin A supplementation started very late in the year, when Mectizan distribution was at the tail end in must of the communities. d. Lack of incentives to LOCTS in some LGAs resulted in to the delay in the retrieval of year 2004 reports. e. Lack of release of counterpart funds by the Government. I REGOMMENDATIONS a. The proposed operational research on the use of Hamlet system for the selection of CDDs is the step that has been taken to address CDD demand for incentives. b. A stakeholders meeting for Vitamin A Supplementation partners has been held and late supply of the supplements has been addressed. c. Advocacy 'risit has been carried out but has not yielded the desired result yet. This is still continued while request is forwarded to NOTF to include Taraba project in the next batch of projects slated for High-level advocacy. ? 34 WHO/APOC, 24 November 2004 +$EGTION 6: Unique features of the proiecuother matters The Project has embarked on the identification, training and Mobilization of CBO's resident in the endemic communities to suppoft the CDTI programmes far the response and training has becn very successful. The details on this will be reported in year 8. a t 35 WI{O/APOC, 24 Novcmbcr 2004 tl I