Edo/Delta CDTI project annual project technical report submitted to Technical Consultative Committee (TCC): from December 2003 to November 2004

tEDO IDELTA CDTI PROJEGT f,{ a ORIGINAL : English ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) DEADLINE FOR SUBMISSION: To APOC Management by 31 Januarv for March TCC meeting To APOC Management by 31 Julv for September TCC meeting AFRICAN PROGRAMME FOR ONCHOCERCIASIS CONTROL (APOC) ? ' rr,; ?fir}l Proiect Name: EDOIDELTA CDTI PROJECT NIGERIAOUNTR Launchingtgar: 1999Approval Yearz 1999 From: DECEMBER 2003 To: NOVEMBER 2004Reportins Period ear) ( Month/Year) (circleone) I 2 3 4 Q,SProiect Year of this renort: 678910 GLOBAL 2OOO/THE CARTER CENTER NIGERIA NGDO nartner:Date submitted: DECEMBER 2OO4 I WHO/APOC, 24 November 2004I ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) E,NDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: t Country: NIGEzuA National Coordinator Name: DR. J. Y. JIYA Signature: ... Date Zonal Oncho Coordinator Name: OMOBA A. JAIYEOBA Signature Date NGDO Representative Name: MR. J. O. EGUAGIE Signature: .... Date This report has been prepared by Name : PAUL UGBADAMU Designation : Project Secretary Signature Date ll WHO/APOC, 24 November 2004 o a Table of contents SECTION 1: BACKGROUND INFORMATION 1.1. GBNenel INFoRMATIoN............. 1.1.1 Description of the project (brie/ly)...... 1.1.2. Partnership 1.2. Popu1erroN............... SECTION 2: IMPLEMENTATION OF CDTI....... .....10 2.L TrvpI-nn oF AcTIVITIES ............ ....... l0 2.2. Apvocecv ... 13 2.3. Moerr-rzetloN, sENSrrrzATIoN AND HEALTH EDUCATIoN oF AT RISK coMMuNtrms 13 Wevs ro IMpRovE MoBILIZATIoN oF THE TARGET vILLAGES:................. ...........14 4 4 4 7 8 2.4. CouuuNtrY INVoLVEMENT...... 2.5. CnpecrrvBUILDING.. 2.6. TRpervBNTS.............. 2.6.1. Treatmentfigures............ .........20 2.6.2 What are the causes of absenteeism?.......... .................23 2.6.3 What are the reasons for refusals?................ ...'........... 23 2.6.4 Brie/ly describe all htown and verified serious adverse events (SAEs) that ... 23 2.6.5. Trend of treatment achievementfrom CDTI project inception to the curent year26 2.7 ORtERrNc, sroRAGE AND DELIVERY oF IvERMECTIN............ .,...,.27 .......29 .......30 2.8 CouvuNrry sELF-MoNIToRING AND STAKEHoLDERS MpPrrNc 2.9 SuppRvrsroN........ 2.9.1. Provide aflow chart of supervision hierarchy. -........... 30 2.9.2. W'hat were the main issues identified during supervision? .............................. 31 2.9.3. Was a supervision checklist used? Yes............ ............ 31 2.9.4. W'hat were the outcomes at each level of CDTI implementation supervision? 3l 2.9.5. Was feedback given to the person or groups supervised?................................ 312.9.6. How was the feedback used to improve the overall performance of the project? 32 SECTION 3: SUPPORT TO CDTI ..............32 3.1. 3.2. 3.3. 3.4. EqurueNr FrNeNcnl coNTRIBUTIoNS oF THE PARTNERS AND coMMLINITIES...... Orgen FoRMS oF coMMUNITY suPPoRT............. ExpeNo[uRE PER ACTIVITY 32 34 34 36 SECTION 4: SUSTAINABILITY OF CDTI....... ..........37 4.I. INTERNaI; INDEIENDENT PARTICIPAToRY MoNIToRING; EvALUATIoN.......... ..........37 4.1 .l Was Monitoring/evaluation carried out during the reporting period? ............ 37 4.1.2. What were the recommendations? ............. 37 WHO/APOC, 24 November 2004 r't 4.1.3. How have they been implemented? ....... SUSTIINaeILITY OF PROJECTS: PLAN AND SET TARGETS (MANDATORY AT............ 1. Planning at all relevant levels.... 2. Funds....... 3 Transport (replacement and maintenance) 4. Other resoltrces 5. To what extent has the plan been implemented................ 37 39 39 40 ,.,40 ...40 40 4.2. Yn 3) 4.2, 4.2, 4.2, 4.2, 4.2, 4.3. INrpcRartoN....... 4.3.1. Ivermectin delivery mechanisms .. Training.... Joint supervision and monitoring with other programs.. Release offunds for proiect activities Is CDTI included in the PHC budget? Yes..... 4.3.6. Describe other health programmes that are using the CDTI structure and how 4.3.2. 4.i.3. 4.3.4. 4.3.5. this was achieved?. 4.3.7. Describe others issues considered in the integration of CDTI. 4.4. OpBnnrIoNAL RESEARCH. 4.4.1. Summarize in not more than one hatf of a page the operational research undertaken in the project area within the reporting period. 4.4.2. How were the results applied in the proiect?..........." SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES' AND OPPORTUNITIES.... SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS...........41 a lv WHO/APOC, 24 November 2004 37 37 38 38 .i8 ....... i9 .......39 ..,.,., j9 ....... 39 ...38 38 38 Acronyms a wHo APOC UNICEF MOH FMOH LGA NGDO NGO NOTF NOCP RBF G2000 LCIF LCI CDTI CDD HFS DHS CDHS ATO ATrO UTG CBO CSM SHM PHC REMO SAE TCC TOT NPI DSN SPIC PMRC World Health Organization African Programme for Onchocerciasis Control United Nations Children's Fund Ministry of Health Federal Ministry of Health Local Govemment Area Non-Govemmental Development Organization Non-Governmental Organization National Onchocerciasis Task Force National Onchocerciasis Control Programme River Blindness Foundation Global 2000 lThe Carter Center Lions Clubs Intemational Foundation Lions Clubs lnternational, District 404 Nigeria Community-Directed Treatment with Ivermectin Community-Directed Distributor Health facility staff District Health Supervisor Community Directed Health Supervisor Annual Treatment Objective Annual Training Obj ective Ultimate Treatment Goal Community-Based Organization Community Self-Monitoring Stakeholders meeting Primary health care Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Technical Consultative Committee (APOC scientific advisory group) Trainer of trainers National Programme on Immuni zation Disease Surveillance Notifi cation State Programme Implementation Committee Project Management & Review Committee v WHO/APOC, 24 November 2004 Definitions (iv) (") (vi) (vii) (viii) (ix) (i) Total population: the total population living in meso/h1per-endemic communities within the project area (based on REMO and census taking). (ii) Elieible population: calculated as 84o/o 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 given year. Ultimate Treatment Goal (UTG): calculated as the maximum number of people to be treated annually in meso/h1per endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverag-e (normally the project should be expected to reach the UTG at the end of the 3'" year ofthe project). Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). Geographical coveraqe: 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 expressed as a percentage). Integration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) through CDTI (using the same systems, training, supervision and personnel) in order to maximise cost- effectiveness and empower communities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTI. Sustainability: 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 resources mobilised by the community and the government. Community self-monitoring (CSM): The plocess by which the community is .-p"*.r.d to oversee and monitor the performance of CDTI (or any community- based health intervention programme), with a view to ensuring that the proglamme is being executed in the way intended. It encourages the community to take full ,..pon.ibility of ivermectin distribution and make appropriate modifications when necessary. a v1 WHO/APOC, 24 Novembet 2004 ! aFOLLOW UP ON TGG REGOMMENDATIONS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session 15TH (Please add more rows if necessary) 1 Number of Recommendation in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY 78 The issue of incentiveto CDD and an examination of rate of refusal and absenteeism over time in relation to the statement that "it may be due to post- honeymoon effect". A research fellow at the Universityis currently handling the proposal. WHO/APOC, 24 November 2004 Executive Summary 1. Background on treatment and population data Sponiorship of 2l endemic LGAs out of 43 LGAs in Edo and Delta States started in June 1999. The hyper / meso endemic LGAs are2l LGAs (12 LGAs in Edo State and 9 LGAs in Delta State). Treatments have consistently been carried out in the 2l endemic LGAs since 1999, while passive treatment is under the sponsorship of Global 2000 lThe Carter Center. 2. During the period being reported on, a total of 965,149 persons were successfully treated with 2189,719 tablets of Mectizan in 991 endemic villages of 21 LGAs. The total population of the 2l LGAs stands at 1,374,785 persons. The ATO was 937,873 p.rronr. See details in section 2.6.1. This active treatment respectively gave geographic coverage of 99.1o/o, ATO coverage of 102.9% and therapeutic coverage of 70.2% for the 12 months dating from December 2003 to Novembet 2004. Treatment data for the past fives years up to 2OO4 have also been enumerated. People absent from treatment accounted for 4.2%o of the total population, while 2.8o/orefused to be treated. 3. There was no serious population movement except for the migration of people to the northern part of Niger Delta from the southem part where crisis was ongoing during the period. This did not significantly affect the number of people treated. In Edo State, the only area of population movement was by the present farmers who migrate from one area to another seeking more fertile ground to sow their crops. Also some people that were retired from government service moved from the urban areas to the rural areas to settle down. 4. Sections 2.4 and 2.8 show level of Community involvement in CDTI and CSM activities. The health staff were involved IOO% in CDTI activities. 99.2% of the villages had Community supervisors; 13.6% of the 1,000 villages had female CDDs. In another developmeni, SZ4 villages conducted CSM during the period. All the staff involved in CDTI activities were duly trained as appropriate' 5. Training was conducted for different categories of staff that were involved with IDP activities. According to section 2.5 - Capacity buildin g, l00oh was achieved in the training of LGA staif; training of Health center or post staff; training of TOTs and CDDs. Training data that weie not available for some LGAs when the six months report was submitted have now been updated accordingly. Ratio of trained CDD to population is I :797 . 6. passive treatments were carried out during the period under Global 2000 sponsorship. A total of l25,084persons were treated in 411 hypo endemic villages in Edo and Delta States, using 467,77ltablets of Mectizan in22 hypo endemic LGAs. 7. The total Mectizantablets of 3,257,000 that were released to the project from Global 2000 National Office, Jos, were fully utilized for treatments during the period except for ten tablets that were reported wasted at Igueben LGA of Edo State during treatment exercises. a 2 WHO/APOC, 24 Novembet 2004 i Challenqes and how they were overcome. The starting date of the project's operation/financial year was changed from June 2003 to Decemb er 2003. But for the support from the NGDO, the period June 2003 to April 2004 could have been a period of idleness. Delayed funding. First installment of fifth year was received in April 2004, i.e. five months into the fifth year while the last installment came one month to the close of the financiaVoperation year. Getting State and LGAs to budget and release counterpart funds for Oncho control. Obtaining a realistic estimate of total population of endemic villages. Add-on intervention programme being vigorously pursued to enhance commitment of field staff. High cost of purchasing fuel for vehicles and motorcycles and their maintenance. g) The inability of some villages to own the programme' h) lntensification of CSM and encouragement of the villages to conduct SHM IOO% geographic coverage was not achieved in six LGAs of Edo State. Findings indicated that it was due to CDDs' refusal to distribute Mectizan in some villages because of non- compensation. In Esan Southeast LGA, 20 additional villages were treated due to pressure from politicians to convert Wards or hamlets into villages for political reasons. The total villages treated there amounted to 58 instead of the previous 38 villages adopted in the LGA. Edo and Delta States remain grateful to WHO/APOC for the sponsorship which has created immense awareness and enabled the treatment of thousands of people for Onchocerciasis. 8. a) b) c) d) e) f) 3 WHO/APOC, 24 November 2004 SECTION {: Background information 11.1. General information 1.1.1 Description of the project (briefly) Geographical location, topography, climate Population: activities, cultures, language Communication systems (roads. . .) Administration structure Health system & health care delivery (provide the number of health posts/centers in the project area if the information is available). Number of health staff in project area and number of health staff involved in CDTI activities. Geoeraphical location. topoEraphy. climatge. population. etc' iao ana Delta States (both formerly called Bendel State) are in the Mid-western part of Nigeria. They have 43 LocalGovernment Councils, and a combined total population of 4,i30,OZg (1991 census), in an area of about 39,000 square kilometers. Both states were carved out of Bendel State in August 1991. The two States are among the youngest States in the country. Edo and Delta States still retain the original boundaries of Bendel State except for minor adjustments. They are bounded to the North by Kogi and Benue States; to the West by Kwara urd Ordo States; to the East by Anambra and Imo States; to the South and Stuthwest by the Bight of Benin on the Atlantic coast. Edo State has 18 Local Government council areas of whiin p are meso/hyper endemic, while Delta State has 25 Local govemment council areas of which 9 are also meso/h1per endemic. The two States lie approximately between longitudes 5o East and 60o 45' East and between Latitude 5o North ani 7o 30' North. The area is generally low lying except towards the North, where there are some highlands that form the old AfemaiA(ukuruku hills. The coastal belt is interfaced with rivulets and channels that form the Niger Delta. The existence of many rivers in both States particularly rivers like Osse, Siluko, Okomu, Ossiomo, Ojirami, Etirope, Jamieson, Oke and their tributaries and Niger, Koko to mention but a few, piovide fast fiowing rivers and streams that are ideal for the breeding of black flies. the vegeiaiion varies from the impenetrable mangrove swamps along the coast, relieved Northrvards, by a wide belt of deciduous and evergreen forest and terminated by Savannah in the North. The three vegetation belts are prominently noticeable as one travels from the South to the North. The two States enjoy a tropical climate that is marked by two distinct seasons of dry and rainy seasons. The dry season ii from November to April, while the rainy season is from April to October. However there exists a brief dry spell in August commonly referred to as "August break,,. From December to February, the dry harmattan wind blows over the States. During the rainy season some of the rural roads leading to at-risk villages are not accessible thus makingbnchocerciasis activities difficult to execute during such periods. The project area spans iire North and East area of Edo State, while in Delta State, it covers the Northeast and South. Communication. roailnetwork anal aalministrative structure: ln Edo and Delta States, the road networks in and out of the States are good. The communication system boasts of digital telephone system through NITEL (Nigerian Telecommuncations PLC) with other parts of Nigeria and intemationatty. There are radio and television facilities in the two States. There 4 WHO/APOC, 24 November 2004 are also facilities for e-mails and internet browsing. The postal system operated by NIPOST (Nigerian Postal Services) and other Courier service companies, are also reliable and efficient for delivery of mails. The administrative structure of the project area flows naturally from the State, to the LGA Councils and then to the Districts, Communities and Villages. At the State level, the Governor is at the head with Commissioners and principal officers forming the State Executive Council where State policies are formulated. There is a State House of Assembly made up of elected representatives of the people, which enacts laws and oversees the activity of the Stut" E*..utive. At the LGA level, the Council Chairman is at the head, from where directives and administrative power flows to the District Heads, Communities and Villages. Village is the lowest point or the smallest unit of reaching the people. In Edo State, the common languages spoken are Bini in the South, Esan in the central & Afemai in the North. The culture is homogeneous. In Delta State, the culture is heterogeneous and different languages are spoken, viz: Urhobo, Itsekiri, Isoko in the South and central areas and Ika and Anioma in the Northern areas (where Ibo is the common dialect). Farming, fishing, trading and office work are the major occupations of the inhabitants of the two Staies, and they live in permanent settlements and practice a communal system of living. However, during farming periods, some people live nomadic lives as seasonal migrants. Authority is vested on any person chosen by the entire people of the environment, to lead' The person so chosen becomes the leader and administers authority over others. The project's financial / operational date for the fifth year was changed from June 2003 to December 2003 and this consequently caused delay in APOC's timely remittance of fund to the project. The fifth year first instalment fund was received in April 2004; i.e. five months into the fifth year while the second and last instalment was received in October 2004, i.e. one month to the end of the financial year. APOC is assisting 21 endemic LGAs that currently have a total population of 1.,314,785 persons in the two States and there are 1,000 endemic villages under treatment. At the LGA level, leadership is a big problem due to unstable political structure in Nigeria. Proper election for Local Government Chairmen was not conducted for a very long time. The nominated caretaker committee leaders were frequently changed and this affected our advocacy and mobili zation strategies. In Delta State, there was a split of Primary Health Care (PHC) Department in the Local councils into PHC and Environmental departments. This gave the progralnme a lot of problem and friction between the two departments, especially in the area of willingness of staff to run and manage the programme in various LGAs. However, the State Oncho team members have resolved the crisis by recognizing the two departments and getting the CDTI programme on course. Number of health staff in project area: There is approximately 1,119 health staff in the project area out of which 477 are involved in CDTI. Health care delivery: There is an average of 14 health centers in each LGA in the project area. This translates to 2g4healthcenters in the 21 oncho endemic LGAs of the two States (Edo, 168; Delta 126). A Midwife or Nurse is the head of each health center under the PHC where health service is 5 WHO/APOC, 24 November 2004 rendered to the villages. The two States parade a reasonable number of tertiary health care facility that are strategically located to meet the health care needs of the people. These range from General hospitals to University teaching hospital and Federal Medical Center. Table 1: Number of health staff involved in CDTI (Please add more rows if necessary) District/LGA Number of health staff involved in CDTI activities. Total Number of health staff in the entire project area Bl Number of health staff involved in CDTI B2 Percentage Br=Brl Br *100 Akoko Edo 52 21 40% Etsako East 52 21 40% Etsako West 52 21 40% Owan East 52 21 40% Owan West 52 21 40% lgueben 52 21 40% Esan Southeast 52 21 40% Esan West 52 21 40o/o Esan Northeast 52 21 4lYo Uhunmwode 52 21 40% Ovia Northeast 52 21 40% Ovia Southwest 52 21 40% Aniocha North 55 25 45% Aniocha South 55 25 45o/o lka Northeast 55 25 45% lka South 55 25 45% Oshimili North 55 25 45o/o Oshimili South 55 25 45% Ndokwa East 55 25 45% Ndokwa West 55 25 45% Ukwuani 55 25 45% Total 1119 477 42.6% Note: Approximately 477 health staff are involved in CDTL (This excludes State MoH staff in each State that are assigned to CDTI) 6 WHO/APOC, 24 November 2004 1.1.2. Partnership - htdicute the partners involved in project implementation at all levels IMoH' NGDOs (national/internatio nal), communities, local organizations, etc.l - Describe overall working relationship among partners, clearly indicating speciftc areas of project activities (planning, supervision, advocacy, planning, mobilization, etc) where all partners are involved. - State plans, if any, to mobilize the state/region/district/LGA decision-makers, NGDOs, NGOs, CBOs, to assist in CDTI implementation. Between 1992 and 1994,the River Blindness Foundation (RBF) funded the programme in collaboration with the State Ministry of Health and the benefiting LGAs. Between January 1995 and May 1999 funding was provided by the Lions Clubs lntemational, District 404 with the Technical support of the Global 2000 lThe Carter Center, in collaboration with the State Ministry of Health. From June 1999 to-date, WHO/APOCA{OTF took up sponsorship of the programme in collaboration with LCIF, Global 2000lThe Carter Center, the Ministry of Health and the benefiting LGAs. All the aforementioned partners are involved in planning, supervision, advocacy, mobilization and health education. Mobilization strategies that were used include radio and television broadcasts, jingles and production and circulation of IEC materials. The partners involved in the project's implementation at all levels are the NGDO, APOC, MOH, LGAs, Villages/Community Religious groups and Opinion leaders. The working relationship among partners has been very cordial as it relates to planning, supervision and advocacy visits/mobilization. Some difficulties are being experienced on supervision due to lack of support from the govemment. APOC, NGDO and NOCP are being urged to embark on a high powered delegation on advocacy to visit the two States' project and their LGAs. 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'5X e d H 8q il nE > 1f E H Egloe -bEE;;sEf'2 :I C)'5'-r € € 5'E.9'e <o B. ;,.E B0 I gO. G) i i bOaS€ H-s.E-EI st;EE i E E ?r"en .EepE:i.,E :E E gJ E: PU.iHV>!.- o e (.).i:-d E E-? 3a I() !) H I ooIE X Eg H6EA.E' ,t h o-r-l }.zj oEqYHeeliI nno- H H){ E E"E re333E9a> 'r6E o.) Q o.> 5 E # e6'6 U) q) oU I h Pa 0)a lio q) o o)a d d h oL ct -e >' F- Eq)s Eo o z Lq)E q) o z cd d z 0) F- L 6E li c)fr o 0) L{o (.) o z Lo o oZ l<d ! li o frr Lr t< 0)t\ 0) l- L G Lr o) tu Otr C) tr Pa0)a q)U) !o .F a. F- lr L!() C) c) Po 0)a €)a o lid otr \3Z 0) h L cl L q) tu a(d E] B .v oE z v) o) (! B J4 oE z (B B)1D Fl Fr o t-( N 2.2. Advocacy State the number of poticy/decision makers mobilized at each relevant level during the current year; the ieason(s) for undertaking the advocacy and the outcome. Describe dfficulties/constraints being faced and suggestions on how to improve advocacy. At the State level, the Honourable Commissioner, Permanent Secretary, Director and Deputy Director of PHC/DC and some other key players were mobilized during advocacy visits in respect of creating more awareness and release of counterpart cash contribution. At the LGA level key policy makers, notable politicians and newly appointed Chairmen were visited. The major objective was to create awareness, sensitize and health-educate them on the disease pattern, re-emphasi ze the need for LGA support to the programme especially as APOC sponsorship is coming to an end. Below are some of the difficulties / beine faced: 1. Some policy makers at State level were not available at the time of visit; 2. Some LGA policy makers are working to assist but due to the alleged shortfall of revenue to the LGA, they claim to be handicapped. 3. lnconsistency of the leadership at Local govemment level as well as their tenure; 4. Transfer of health staff from one LGA to another hampers continuity of the job. To improve advocacy, visits were made to the Directorate of Local Government in the two States. lnterestingly, the Directorate of Local Government in Edo State has given an approval in principle for the 12 endemic Local Govemment Council in the State to release a specific amount of money yearly to the CDTI progralnme. When implemented, it may ease the problem of funding CDTI activities the local level in Edo State. 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/villages - Accomplishments - Suggest ways to improve mobilization and sensitization of the target communities. a) The importance of the broadcast media or other local systems to disseminate information cannot be over emphasized, as it remains the best way of reaching the people both in the urban and rural communities. b) In the foregoing year, Health education, Sensitization, advocacy visits and Mobilization were equally carried out through TV, radio broadcasts and jingles. Public address system was used for the people that could be gathered on market days or those living in densely populated areas. c) Posters and handbills suggesting the signs and symptoms of Onchocerciasis and the use of Mectizaninthe treatment of the disease were also distributed. Apart from these, local town criers/announcers were employed to inform the people about CDTI activities. 13 WHO/APOC, 24 November 2004 s) d) The response of the people in many endemic communities was impressive. There were expressions of delights in being better educated on Onchocerciasis control as well as up- coming add-on programmes like Lymphatic filariasis, Schistosomiasis (terminal blood in urine). People got reassured that they would not get blind of Onchocerciasis; that the signs and symptoms of the disease would heal provided they took Mectizan at least once every year for up to 15 years. e) During health education sessions, the position of women and minors (children) were also emphasized. That though pregnant women, nursing mothers and children of less than 5 years were not to take Mectizan, they should/ nevertheless be reflected in the CDD register. Again it was explained that women could/ play active roles in CDTI activities. Such women could be CDDs and they could form part of the opinion leaders in every community. f) The outcome of these activities resulted in good level of Mectizan distribution, compliance and acceptance of CDTI Onchocerciasis control There were pledges to support CDD with incentives. Mobilization and sensitization of target communities can still be improved upon by: Placing frequent TV and radio broadcast and jingles; Carrying out high powered advocacy visits to community heads and opinion leaders; Training more personnel (e.g. CDDs) especially in areas of poor drug distribution and low awareness; Improving our logistic support (field vehicles, motorcycles and bicycles)'. Accomplishments: The 1,000 endemic villages in the two States (Edo 530; Delta 470) were fully mobilized during the fifth year operations. Weaknesses/ Constraints : a) Some villages are complaining that the burden of the programme, which they perceive as govemment responsibility, has been placed on them; b) -So*" villages lack cooperation due to chieftaincy and other communal disputes; .j Mectizan distribution was not carried out in some villages due to CDD refusal to do so because of non-payment of incentives. d) Fuel scarcity and the consequent high cost of purchasing it; e) Lack of commitment by some SOCTs and LOCTs 0 Transfer of trained health staff. Ways to improve mobilization of the target villages: Continuous mobilization would be intensified provided logistics are available or provided by the appropriate quarters; - Putting up frequent TV and radio broadcast and jingles; - Crrri;g out high-powered advocacy visits to Village heads and opinion leaders; - Training more fersonnel (eg CDDs) especially in areas of poor drug distribution and low awareness - Improving logistic support (field vehicles, motorcycles and bicycles). APOC's assistance in this regard is still expected. t4 WHO/APOC, 24 Novembet 2004 45 2.4. Gommunity involvement Table 4: Communities participation in the CDTI (Please add more rows if necessary) Comment on: Attendance offemale members of the community at health education meetings In general, how do you rate the participation offemale members of the community mietings when CDTI issues are being discusses (attendance, participation in the discussion etc). Incentives provided by communities for the CDDs istrict/LGA Number of communities/villages with community members as suPervisors Number of CDDs and the communities involved Number of communities /villages with female CDDs Total no. communities in the entire project area B1 Number with community members as supervisors Bs Percentage Br= By' 84 *100 Male CDDs B1 Female CDDs B8 Total Be= B7*Bt Number of communities with female CDDs Bro Percentage Brr= Blo/B1* 100 Akoko Edo 47 47 r00% 83 9 92 7 t5% Etsako East 55 47 85% 70 6 76 5 9% Etsako West 36 36 t00% 40 5 45 J 8.3% Owan East 38 38 r00% 67 5 72 4 t05% Owan West 40 40 100% 74 6 80 J 7.s% Igueben 40 40 100% 70 9 79 6 t5% Esan Southeast 36 36 t00% 80 10 90 7 t9.4% Esan West 55 55 r00% 90 5 95 2 3.6% Esan Northeast 37 37 r00% 63 13 76 13 3s% Uhunmwode 42 42 t00% 80 5 85 2 4.7% Ovia Northeast 45 45 r00% 81 5 86 J 6.6% Ovia Southwest 59 59 t00% 80 4 84 2 3.3% Ika Northeast 46 46 100% 68 8 76 8 t7% Ndokwa East 54 54 100% 74 13 87 6 11 % Ndokwa West 4l 4T 100% 90 5 95 5 r2% Oshimili North 57 57 r00% 65 20 8s 10 t7.s% Oshimili South 46 46 t00% 45 18 63 18 39% Aniocha North 50 50 t00% 70 t6 86 7 t4% Aniocha South 62 62 t00% 80 9 89 9 t45% Ika South 65 65 t00% 86 8 94 8 12.3% Ukwuani 49 49 r00% 76 13 89 8 16.3% Grand Total 1000 992 99.2% t532 t92 t724 136 13.6% t6 WHO/APOC, 24 November 2003 Attrition of CDDs. Is attrition a problem for the project? If yes, how is it addressed? Other issues 1. In Edo and Delta States, attendance of female members at health education meetings, though minimal, is very encouraging. tnformation about decisions arrived at is also spread round to those who did not attend such meeting. During mobilization, the female groups can also be addressed. 2. In male dominant communities some women actively participate in CDTI activities as CDDs. Compensation of CDDs is expected to improve with increasing Community awareness of CDTI ownership but it is yet to be fully accepted. Some communities have not fulfilled their pledges of providing incentives and many have not made a statement towards doing so. 3. The lack of sustainable incentives for CDDs causes loss of morale among nominated CDDs and reluctance for would be CDDs. 4. Attrition is a problem in the project area, because it amounts to retraining of CDDs. However, such affected villages would be quickly remobilized to select a replacement CDD. ln recognition of this problem, it has been decided that many CDDs would be trained henceforth to absorb any vacuum created by a withdrawing CDD' t7 WHO/APOC, 24 November 2004 coo N H 0) -o 0) o zsN Or |r{ B @ a\ Bqq q) Uu q- t4 > oL p \ q) V) q)g o GI C) tr o o. F aU(H o a (.) () 0)li .UE € o (! bI) (! 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'i 0-) =€ydt6 AA(.) =E o\./)FH E YALr.r-bO Era O=liL{-(!p. E=E H.9 + .ek4 ^vF* Jt-i! YoHPtoobo .29trv)s .r.1 (i =F.i:g BEI o*tioc)I -q-q9()€E 5E 3-.: H Or9 .9 HpOerX o: -c -li-r€>l(9.= o c ,r'ldpd €3!*atrtr'!{: .E E HIe8 E99 -D bo:tr oo tr-Y -Q'=ot-J-lr* -o'S 6J c) ^a E ILh.-)6-E I9 -a; a: < tr ?-otJ 0 'E.rJb =E €9 EpCo-E: SqCg c H.=!v- i-ut (d po.aqrE 5ti €9 oF!- € i dH^U;-o tr.b9:E € 8<?.ssoSI F riri E = <g s a\!H.r,\;9 E E5E r H lY o <d-CX^3 O.(J3a,^CU.s ftOEg eE -!AYFi d= Hll O.-C s.E P 3dbocdu) otrooqL'= lrdo l- C)-l -tr F -(UF 5 FF.l aF z riiaa raa o U bo g -o o I aL x b0 \ I L o a a 't I\ ,L ts > =+ -t : =t : \or- : tn F-@ tr- @ ra) 1 r.) 1 (n T $ oo co\o ca\o \or : \o o\ @ r- oo t o\ @ F- \o o\r N oo Ir- $6t rr : !+(n\o o\ \o : o c) Q,) o o\$@ \oI-* t-*00 \.)Ol rn@ co\o \ooo o\@ $o\ o\@ $NF- ot .1 (f) : ?a) : soo q) (u q) CJ s c.l (a ?a tat $ : r- co 00 N o\ O : (.) (.} t-- co \o $ r- ca Or r-N rr N (aia ^\ q) q) q) e) (.} O rrN \o \o (.} .t \n ca c.l rr) rn l.i co ol \ (a) ra s (.) ca N \n \o (a) (n O r- .: r- -: o s q) €) q) ()\o rn (.) \.) tn (.} (n (n |r) t.| r- ao oa o cn(o C) ! o z dJl at)(d r!(! B o € z (/) o B d B JZ -9 z E o z an o oa (n o L o z d o o tr oa (! o o oa d J4 d B]zD j Fr otr N Table 6: Tlpe of training undertaken (Tick the boxes where specific training was carried out during the reporting period) 2.6. Treatments 2.6.1. Treatment figures - If the project is not achieving 100% geographical coverage and a minimum of 65% iherapeutic coverage or the coverage rate is fluctuating, state the reasons and the plans being made to remedY this. NOTE: Reasons for non attainment of 100% geographic coverage in some LGAs in Edo State 1. 2 At Owan East LGA, five villages bluntly refused to participate in the annual distribution of Mectizan, despite series of mobilization carried out. This was specially due to non payment of incentives to the CDDs. At Owan West, Esan West, Esan Northeast, Ovia Northeast and Ovia Southwest LGAs, the targeted villages were not fully covered because of some CDDs refusal to distribute Mectizan in their villages due to non-payment of incentives. The State Oncho team visited such villag., ,i.. LGA staff and HFS succeeded at last to get them to distribute drugs, after a long try. In order to avert this trend in future, meetings will be held with ttre-viitage heads and opinion leaders and mobilizationof all stakeholders will be intensified to solve the problem. It is important that CDDs are compensated' At Esan Southeast LGA, the villages targeted for treatment was 38 but some politicians demanded that the area they are representing must be treated as villages. There was nothing the LGA Coordinato, couid do but to comply with the political demand. This is ..rporiibl" for the rise in number of villages treated in this LGA from 38 to 58 villages' J Trainees Type of training CDDs Other Community members e.g Community supervisors Health Workers (frontline health facilities) MOH staff or Other Political Leaders Others {specifu) Proglam management ,/ How to conduct Health education ,/ ,/ ,/ Management of SAEs ,/ ,/ ,/ CSM ,/ ,/ ,/ ,/ SHM Data collection ,/ Data analysis ,/ Report writing ,/ ,/ Others (specify) 20 WHO/APOC, 24 November 2003 $oON k C) ..o () o z$(\l Or \J B c.l E;€ea6g€= o O g rrl cn\a zz o to YO (! r-\o ca o\ ca ca oo rr) N ca o\ No\ tr- ca o\ =t o\ o\N \o ca(.) co F- caON t-- oo @r- c.l .t(.}(.} ca \o(r) N O o\ qo O.^ E=LE^-aD .3 g.EE E EE.}EE -u! t-- ca @$ rc @Nr- @ ca oo c.l oo c.l o\ ca co@ Nol @ oo N $$ 00 ol @\o F- \o o\r- @ cn o\ (n tn o\ C.l$ o\ o (d p. o F< o ll i an o5o =oo()c! 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'd* LTo.6 a9s'EI 'H Ea €q .:s >,i -r ct tJ0)q) \u\ox tr.r .D .EEids9E L\9: -c \i>s E.EFrH(J aalH.\ .- G' E ,-\ cd l\ ot gR ^l !V ..Hl (U)EX xle t tsEl ;; 3 EIEiI 61 8..: H 51 ot -Eol Ls s :t-8 iF3I E\ E gl! r'E EI S 8tr rl oE < zlF .i 0o sils a'q) +|*. G' b € t 'utOd .9i ! ^'.i bsH : -o st-lPo -o t\ ^\s ol#l xl €g dd) LI C) alo o3 o lrO .o z C) cd l-r C)bo CBLo oo oF C) F<(B o C) 'a lr C) o a rq p 0.) o) u)(B ao P tr oo o C) € C) Ilr o) o, oa C) (H o Lo ($ oF s olol -l xt EI olPl cil slpl al 0)l oX(dt '-\ G) tr a E Eoo (H o L 0.) -o z il o(tlr c) 00dlr 0) o(.) o a(rl Lr bo o o \J (B(.)lr(! €oo 'a lr0. C) I d = € ' a C) I - E F oo o FF 0) t o Ilr 0) o.x d\ otIol 0) at -l Eol xl"o0 *l .Hsil 6l ^"(Dl idl c >l (.)l '!-ot Et.aol orl -EI EIEol ol .=EI PI E -cit ,-1 =Pl ol o-$ de0)l .!l -b4 Hl A *l Jl o cl Al3dt ,rl 3l iDlal ,dt tilol -Cl9lbd9al 6 .=l ti =l c)EI E'trl o ol o .t od sGsl BeJl a. -l cdEl bol -crJ.I F O O o o co o\\o co @@ o\N (.} $ ra, rat\o o\ rat$ \o N\o \o ra ra6to \o t.)\o \o o.l I-r \o \o .t .t oo -f,\o t--$ o\$r.) c.) ra\o o\(a s r @ s r.) s@ ral s9(.}\o o\ ol \o s F$ st oo s N r- co r o\$ $ \o \o N t-- \ot o@ n^ =ft sq ra)d \o tr} rn c.) N t--vI oo(.) a\$ in\o o\ o\ r- \o$ @ ta) $ $@ t,- t-- r.) OrN\o^ @$ $ tn sf, o\ o\\o^ t--(.) o\ ca o\ F- rr) (-) r- € r-(.) o\ ca o\q$ ta1 N\o\r*t1 rnN$ @ $O co" F.\o \o oo o\ $r- (n ca(n r- t-- c\l oi\o raar-tr* C') -oo\ \eo\ \oo\OO \o o\O o\ \o s o\ o\ \o$ (.}\o st\ <t r-ra \o$ o\$ o\o\ \o <t (a|\o +r.) $ F-rr) \o$ o\=f o \o\t (\o t(.) .t F-(.) \os o\$ oa (n (B o L(dofrz oa d -!4 d B .\z €EZ tt) d B -Ve',; C/) -Y()zf %6oz tr-tr l)a ) B)z El H o3 2.6.2 What are the causes of absenteeism? Farming and fishing activities which takes the people away from their habitat for several months Academic pursuits by "still active" people Search for "greener pastures" outside the communities Better medical treatment in urban centers Migration of inhabitants in times of communal clashes/conflicts 2.6.3 What are the reasons for refusals? Refusal of Mectizan intake is simply a human reaction to the kind of information or mis-information received from those who experienced mild reactions to treatment. However, increased and improved mobilization, health education and sensitization for awareness and reassurances about the efficacy of the drug, will continue to help in reducing the level of refusals in the project. 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 available. In 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 ffi 23 WHO/APOC, 24 November 2004 z4 so c\ ko ,o 0) o z * c.l Ci oA IJ 'JrB lr)N q) q) \\) !\q)q tf c) o9H u95 <.E E P E'Hp(ri:(goia 8tr5 ,XEE i* o c.r .9E2oi!3.5A q q()mPX 9 9:- cii (0'6 .= L)0)-q tr *v@ 'ioqr;o-o.9s co d trEd@ooO E .lr,E oE7=a()'=== A€gE (! €. g spE = 2_o.H of;EEtE +jo C) CB (.) o I! a) -o cd C) aA.(c {-)o a r! a a o atr x(h -E E -vkC,) l+ o.) 6F= *l)q0<l E!,N= ()o-- AS i qr o 0)o0tr =boao x 0)a o bo * a -. 4hq) U v b q)\ v t a,) v1 q)g E o L{oa bo tr Loa() l< q) oo L € o!L ooo (n an r! a (n () o() U)lio (n (n o L C) tn +< o o C) U) U #r o.ll -l -ol(Et FI $ooN ko -o E()I z .+ o.l (J o E B \oN oL(d g =ocrro(Booad.= =p>I .>d .n3 Eb0hi9 o'6 q)eEtr laHL P8o od9rl ar - o)xEoo .EHb cx>o= oo.= () E Oro -.!o\JP(-)OsO)-C-I.$t=li= eH!. € sEt!- E .i9 U9pr 6!u o'=6Et >:Yd X- o)V:L oXj 'E'= ?o..= ii(n o.^LAUbo"-OEEotroO ot= -" E'6o\6)EO.d cD 9(Vd .i - O.!;i Et-ESHE:bE 'iEdd) o'a dr9rg()sP^C) > o 9yt .)d9P bd.a-(haE- es g B OeHCE QE OlU-.- ='=rO!P HI iii A .^.d <a o-r E'iE€ bUSotEE .E€ E()- l< U) B E;,H -ootr;rv:cDE 0) (,.= dSIEg -ar) .9 iJ s - .9 LY C) (l) oo GL ^(l)ba +le9 7b\VPq 'i)&=\) fit .Lts--I UU{rL :.sHflE.=l.E =96o3E3s€+'3c) v- +4.{J E9gu) o;Gt 'Ecc)BE = (Jooo rlErrE 1.2 .:q){.e'E sqtr= E4)vt,, 9 =atjidUr6itqY.<ftr,Fle E j -h-E€I HtrHl €q)-Yl ofi 3'3(.) -ol o.S9,e H!9UZoL rralHGr 5 7rEEErrtdD v6 €CECo!q)troJ Lli! Edt$ '. 0 .gU]FP\o .=6i o'l ,()l .n =l GH.9Fl tr ri3 o z C) bo P ts -oO -oo\\o O oo s9 ra 6 s oq r-@ s oj o\ oo -o 6\9 00 00 s oi o\ o\ tro oopr ili tri tr ri o9SaF ()o\< e-o s\o c.i o\ s oq r o\ s n r- s9 r o\ -oo\st o\ sN +O oo ll { f.l l{ ld o!o ,boo(! *b oo -EoF s c.l tn oo s\o t-- s9 t.} r- s r.) oir- -oo\ o| ra r-- s n N@ li ,o .o6lj9--EtrJO Z,,o oo rn\o 6l o\ \tNq t--r- o\ tr* o\ o\ co O (n co trr o\ OrN@ C.l $$ tr- ca ca El tso6 0.= atr o ==oi eFFU O O c.l o $ o ca O $ \o\o ca tr- tr-r- co t.-@ t-- @ b *H -E FK .3Es€:": - a rEE EE o\ o\r- o\ c- \o tr- o\t@ c.l \o$ .ir r- c..l crl co tr- ol@N oo c.l\o^ \o$ ca [n @ r-- .t tr- ca a 0) oo c! ea 0) tr oO ll r rI]td El o ^ bI)9 g.etr Oo\4' >! o s\o oi o\ s oq rn s n t-- o\ s\? r.) o\ s+ o\ o\cl$O Eo=o.oo=d* !E-il i FB 9u;o ()oEl s@ o\@ -oo\ ,.,? r- o\ -oo\ n @ o\ -o 6\\ oo o\ s s o\ -oo\ oi o\ ri qo oaQg =E'E tr tr= o;Etb20a @ o\@ rn t-r o\ co @ o\ F- @ o\ tr*o\ o\Or f.l =od o.=?tr-o tEa OO O )9., HL O= H OO=-XE * = rE:o E E!"p{6't L 6 O o o O & H o\ o\ o\ O c..l oN N c..l co oi o.l *N :+ 2.7. Ordering, storage and deliYery of ivermectin Mectizan@ ordered/applied for by - (please tick the appropriate answer) MOH tr WHO tr UNICEF E NGDO tr Other (please specify): Mectizan@ delivered by - Qtlease tick the appropriate answer) MOH N WHO ! UNICEF N NGDO tr Other (please specify) Please describe how Mectizan@ is ordered and how it gets to the communities The Oncho Coordinators in the Local Government areas make their requests for Mectizan after getting CDD requirement through the HFS, based on census updates in village registers. This application is forwarded to the State Coordinator through the SOCT in charge of such area. The sum total of the estimated number of people to be treated from all LGAs are collated and multiplied by 3 to arrive at the approximate number of Mectizan tablets needed. This final figure is forwarded to the NGDO project office for further action. On arrival of the tablets from Mectizan Donors, they are allocated to each LGA based on the original application. The tablets are delivered to the LGA and it follows the same process down the line to the Frontline health facility, and finally to the CDD with the consent of the Village leader. Table 10: Mectizan@ lnventory (Please add more rows if necessary) 27 WHO/APOC, 24 November 2004 State/District/ LGA lf,rr"f .r "f tvt*tizanctabletsRequested Received Used Lost Wasted Remai AKOKO EDO 167,500 167,500 167,500 0 0 0 0 ETSAKO EAST 170,000 170,000 170,000 0 0 0 0 ETSAKO WEST 120,000 120,000 120,000 0 0 0 0 OWAN EAST 100,000 100,000 100,000 0 0 0 0 OWAN WEST 110,000 110,000 110,000 0 0 0 0 IGUEBEN 90,000 90,000 89,990 0 10 0 0 ESAN S/EAST 161,544 161,544 1 6 1 544, 0 0 0 0 ESAN WEST 120,402 120,402 120,402 0 0 0 0 ESAN N/EAST 93,380 93 J 80) 93 J 80 0 0 0 0 UHUNMWODE 105,000 105,000 105,000 0 0 0 0 OVIA N/EAST 105,298 105,298 105,298 0 0 0 0 OVIA S/WEST 110,000 110,000 110,000 0 0 0 0 EDO hlpo LGAs 338,376 338,376 338,376 0 0 0 0 ANIOCHA NORTH 140,000 140,000 140,000 0 0 0 0 ANIOCHA SOUTH 175,000 175,000 175,000 0 0 0 0 IKA NORTHEAST 140,000 140,000 140,000 0 0 0 0 IKA SOUTH 174,339 174,339 174,339 0 0 0 0 NDOKWA EAST 142,269 142,269 142,269 0 0 0 0 NDOKWA WEST 140,001 140,001 140,001 0 0 0 0 OSHIMILI NORTH 139,996 139,996 139,996 0 0 0 0 OSHIMILI SOUTH 109,500 109,500 109,500 0 0 0 0 UKWUANI 175,000 175,000 175,000 0 0 0 0 DELTA LGAs r29,395 129,395 129,395 0 0 0 0 TOTAL 3,257,000 3,257,000 3,256,990 0 10 0 0 28 WHO/APOC, 24 November 2004 [E-prE - How are the remaining ivermectin tablets collected and where are they kept? This was not applicable in the project during the reporting period' - List and briefly describe the activities under ivermectin delivery that are being caruied out by health care personnel in the project area. a) The movement of Drug delivery started from SOCTs to LOCTs, then to DHS, HFS and to CDD. b) Monitoring / supervision of drug distribution were duly carried out. Other activities closely related to drug delivery in which the health workers were involved were: c) Training of CDDs d) Conduct of CSM/Stakeholders' meetings e) Mobilization and advocacy visit to LGA policy makers. 2.8. Gommunity self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? If so, When? Yes it was done in 2003. Table 1 1: Community self-monitoring and Stakeholders Meeting (Add rows if needed) District/ LGA Total # of communities/villages in the entire proiect area No of Communities that carried out self monitoring (CSM) No of Communities that conducted stakeholders meetins (SHM) AKOKO EDO 47 18 0 ETSAKO EAST 55 22 0 ETSAKO WEST 36 2t 0 OWAN EAST 38 T6 0 OWAN WEST 40 23 0 IGUEBEN 40 25 0 ESAN S/EAST 36 25 0 ESAN WEST 55 34 0 ESAN N/EAST 37 18 0 UHUNMWODE 42 26 0 OVIA N/EAST 45 24 0 OVIA S/WEST 59 27 0 ANIOCHA NORTH 50 29 0 ANIOCHA SOUTH 62 26 0 IKA NORTHEAST 46 32 0 IKA SOUTH 65 JJ 0 NDOKWA EAST 54 32 0 NDOKWA WEST 4l 27 0 29 WHO/APOC, 24 November 2004 OSHIMILI NORTH 57 24 0 OSHIMILI SOUTH 46 24 0 UKWUANI 49 28 0 TOTAL 1000 534 0 Describe how the results of the community self- monitoring and stakeholders meetings have affected project implemeniation or how they would be utilized during the next treatment cycle. 1. To a large extent, community self monitoring has been quite useful to the programme, in timely resoluiion of operational and logistic problems. The application of CSM will be intensified in the next treatment cycle. 2. It should however, be noted that CDDs do not readily release information that concerns CSM or SHM, as they are afraid of the consequences of such action from their Communities/ villages towards them. 2.9. Supervision 2.9.1. Provide a flow chart of supervision hierarchy' NOTF/ZOTF NGDO - Global 2000 DIRECTOR OF PHC/DC STATE COORDINATOR SOCTs LGA ONCHO COORDINATOR DHS HF'S CDD 30 WHO/APOC, 24 Novembet 2004 The SMOH Director of PHC/DC and the Project Administrator of the Carter Center/Global 2000, jointly or separately, do carry out supervision visits to LGAs, following the above flow chart. -Theywould select some villages in the LGA for scrutiny when distribution is ongoing. Occasionaily too, the SOCT and LOCTs carry out spot checks in some villages at least twice during Mectizan distribution activities. It is the DHS and HFS that actually supervise such activities, using the approved checklist. 2.9.2, What were the main issues identified during supervision? a) Some CDDs are not committed b) Minimal LGA suPPort c) LOCTs are not showing the desired commitment and drive d) The DHS and HFS equally complain that the means of movement to supervision sites are not available; hence they cannot walk the long distance to supervision sites. The bicycles that were provided have proved inadequate while the motorcycle assigned to each LGA is being used by the LOCT. 2.9.3. Was a supervision checklist used? Yes' 2,9.4. What were the outcomes at each level of CDTI implementation supervised? The outcomes of supervision carried out were normally discussed at the State LGA review meetings. Some of the outcomes are as follows: 1. LGA level: Though fund released were inadequate in many LGAs, a few of them are doing well. Staff do carry out CDTI activity while awaiting reimbursement from their LGAs. Frequent supervision is limited by fund availability. The effect of staff transfer poses a little problem here but training is continually conducted to cushion the effect of staff transfers. 2. FLHF level: There is need for more motorcycles. Transfer of staff is also a problem here; but training is done to cushion the effects. Inadequate bicycles also constitute a problem as there is need for more bicycle for new health center that are opening up in the LGAs. More bicycles are required. 3. Villaee level: Willing and functioning CDDs maintain good records and distribute Mectizan. CDD attrition due to non compensation remains a problem although there is increasing awareness of community ownership of the CDTI. There is need to train more CDDs and provide incentives for them. 2.9.5. Was feedback given to the person or groups supervised? Feedbacks were always given to the people supervised as debriefing at the end of supervision. Sustainability of the programme is the all-time message. The peoples; response is good and there is hope for improvement with time. The feedbacks were also further discussed in State and Local government review meetings. 3l WHO/APOC, 24 November 2004 2,9.6. How was the feedback used to improve the overall performance of the project? The feedbacks are passed down the line to CDDs with instructions that improvements should be effected in the identified areas of shortcoming. a. There is hope for improved overall performance in EdolDelta project b. There are better drug delivery methods now; improved drug storage and administration. c. There is hope for improved community participation. d. There is hope for improved release of LGA fund to support CDTI implementation. SECTION 3: Support to GDTI 3.'1. Equipment Table 12: Status of equipment (Please add more rows if necessary) NOTE: lnformation is not availab le to the project about LGA equipment set aside for Oncho activities. *Condition of the equipment (F=Functional, CNFR=Currently non-functional but repairable, WO:LTritten ofJ). Three ApOC motorcycles are not repairable due to lack of spare parts. The motorcycles are currently at Esan West, Llhunmwode and Etsako West LGAs of Edo State. ln Delta State, or. epOC Suzuki motorcycle was stolen from the Stores of Ika South LGA and the theft was reported to NOCP and the Police. The four motorcycles have been classified as "WO" and therefore need replacement from APOC. How does the project intend to maintain and replace existing equipment and-other materials? The MOH and the NGDO will be depended upon for maintenance of existing equipment and other materials. However, the issue of local replacement of APOC equipment will be far fetched. Source Type of equipment APOC MOH DISTzuCT/ LGA NGDO LGA Functi uonal Non functiona I Fun ctiu onal Non functiona I Fun ctiu onal Non functiona I Fun ctiu onal Non functiona I Fun ctiu onal Non function al 1. Vehicle 2 0 0 0 0 0 2 0 0 0 2. Motor cycleG) t7 4 0 0 0 0 10 0 0 0 3. Computer(s) 2 0 0 0 0 0 2 0 0 0 4. Printer(s) 2 0 0 0 0 0 2 0 0 0 5. Photocopier (s) 2 0 0 0 0 0 1 0 0 0 6. Fax Machine(s) 2 0 0 0 0 0 2 0 0 0 7. Bicycles 105 0 0 0 0 0 0 0 0 0 8. Generator 2 0 0 0 0 0 1 0 0 0 9. Overehad projector 2 0 0 0 0 0 1 0 0 0 1 0. Radio/Tape recorder 2 0 0 0 0 0 0 0 0 0 32 WHO/APOC, 24 Novembet 2004 aIt is our recommendation that NOCP/APOC undertakes a high powered advocacy visit to the two States to clearly define the responsibility of the State and/or LGAs, in maintenance andL/or replacement of bad equipment. An MOU will have to be drawn up like it is done for other health programmes, (e.g.UNFPA) which the States honour by providing counterPart funds. Above all, APOC is expected to fulfill her earlier promise to replace capital equipment before pulling out of the programme. Describe the adequacy of available knowledgeable manpower at all levels. This is relatively adequate. JJ WHO/APOC, 24 November 2004 atO N k 0) -o () o z tN (J o H o E B t co o.) b0Lr d -o € i)BO\-- -C €$'E .: ,;sq){a so- N /VAUtstb .g'tS rEo.r 9+: =F trO H -,.Y -SoaflErE8!rs X Er: E,$*Hs E t 5 eEO\tr 9JILl t Etti=h 3 bX;:o ruti = EIEB E EEEEE .i!!-d:33S vL!.! -*OAi0)l5 u,rfr6 ,P aaa FiLld'ood, oo oli o Cd E o -O v)L Yo) o=Ea EHoc c) t-.i -'tr >,2 As LC) €EbB L< 6)9E9Etdth *rO!;a69 N-aij+jo-i< &pu q *J I >rud$'o) HSEEp(, 9)3ts ^E(,aoo *.E E \i ahS ooHc,5 .gtscEBrr tr$E€ u,;ie =(gtr oatr(.)HCh3 b "-c >9; o € be\EN -(l)kEc€lcia - tf Ot' o'5 Sqri .o i'5 Io2\u 6 uv(,L CasoE $iri(E$>a *sO:lBrg -li ?t 'FE atr cd C) o rE an o lr € cnli C) li da 63 h a tro E oo (o o d tri c.it -l()t -oldIFI o .!l =EI E E o IJ E E o oL o Et IEc oE#|l. o o E o a-fl a! a-L{a E ot, -IE '6 Et! .EE aN ct I ooSS!'\ Q\L' AndLN o) ge$3 r- o\@ N c.l r.) coN oo" @(n r- \o N r- =f o\ ra \o o\ ra ,EFl o^< .q :.i eA tE€'3 Fa^ @ oo o^ ca co N ca r- ca co C\ oo" oo(n o $r- !t\o t")arr(a o\ Io\ s ail s$sLN cq c) gs$3 OI\o r- o\r- =l:@ t-- r- ca =f ol o\ c.l r- TA$ o\ 3r ga9o6gFd o O .f,r- t*- oo .f, o\ N ia o a\ I SSNS !(.)s La\ (D gsfa s(.) N\o(.) oi rr} N co @ cn c.{\o $ l,a $ \o (a Fl 6-)^<.ex(,ti 3 Xou)boE) O ol\o ,.I o\(al o\(r)\o @ NN €\o ISsRs -oalQ Le\ q) -€F.] o^ TEEAO(JEP,F 6- ca\o a.l \o\o ra c.l Oa cot t$ ia -rdF.] o ^8tE6O()E;JF 6- \o\o \nN O ca =fO^ rn c.l t r- ra Io\ o\ o\sS --SFrslN cl() gs#3 rn oo$(n @ ca sf N co Or o\ (n (.rJia rr o\r- r-l O^4EX6il P;09?OOEP @ ca$ N o\ (n @t) ra rn r* lr o ! tr o Q C) d a (B o okA + (o L{ 0)O rri o e F.l o L th o o cd +r a oA() z d() o F.] C') H(.) !rd o ao z a 0) o0 an C) ) o() l4i tt d Fr O o 0r Fl Fr o t'r -t 35 D3.4. Expenditure Per activitY - Indicate 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: Nl36 to US$1.00 Table 14: tndicate how much the project spent for each activity listed below during the reporting period Any comments or exPlanations? a) The above treatment figure excludes passive treatment ) Expenditure ($ us) Source(s) of funding Drug delivery from NOTF HQ area to central collection point of 0 Mobilization and health education of communities r,706.21 APOC of CDDs 913.00 APOC of health staff at all levels 2,473.2r APOC CDDs and distribution 3,972.72 APOC lnternal of CDTI activities 183.00 APOC Advoc visits to health and tical authorities 365.00 APOC IEC materials 0 forms for treatment 0 Vehicles/ maintenance 15,869.00 APOC Office etc 0 Others 33,205.38 TOTAL 58,687.52 Total number of treated (active) 9 149 ons 36 WHO/APOC, 24 November 2004 aSEGTION 4: SustainabilitY of GDTI 4,1. lnternal; independent participatory monitoring; Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable) Year 1 Participatory Independent monitoring Mid Term Sustainability Evaluation '/ 5 year Sustainability Evaluation lntemal Monitoring bY NOTF Other Evaluation by other partners a 4.1.2. a. b. c. d. e. f. ob. h. What were the recommendations? Improved and integrated PHC planning for CDTI. Develop short and long term sustainability plans. Strong advocacy to the State to convince Government to approve funds for programme implementation. An MoU was advocated. Improved Monitoring and supervision. Provision of transport and other materials resources at State and LGA levels. Conduct training need assessment and focus future plans for training on such needs. Improper training of CDDs Inadequacy of IEC materials Community yet to grasp the philosophy of APOC Community not supporting CDDs. 4.1.3. How have they been implemented? 1. The independent monitors recommended the initiation of Community self- monitoring (CSM) and Stakeholders meeting (SHM), as means to overcome some of the problems that were identified in the Communities. 2. Restructuring of training curriculum and the methodology of training. a) CDDs are now to be trained along family lineage from village to village by DHS and HFS. b) lncreased mobilization of villages and by gathering the people together , thus giving room to address the issue of incentives and other problems. c) More IEC materials are to be produced and provided to the appropriate places. d) Communities / villages are slowly but gradually responding to the call for compensation of CDDs. 4.2. Sustainability of projects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period?- Yes 37 WHO/APOC, 24 November 2004 a aWas a sustainability plan written? Yes When was the sustainability plan submitted? This is yet to be submitted to NOCP/APOC. V[/hat arrangements have been made to sustain CDTI after APOCfunding ceases in terms of: 4,2.1. Planning at all relevant levels The monitors found some reasonable level of planning at the State and LGA levels. They recommended that Planning should be embraced as an important tool for effective programme implementation. The two States are embracing integrated planning for all PHC components that includes CDTI. 4.2.2. Funds The provision of funds was recognized as a problem at State and LGA levels. However, ..ro.. u**eness and enlightenment will continue to be created at the various levels for compliance. In Edo State, the Directorate of Local Government and Chieftaincy Affairs has given an approval in principle for Local Government councils to allocate a specific amount of money for Oncho activities. Its implementation will be an achievement for sustainability. In Delta State, the government is already providing logistic support in the form of an imprest for the Oncho department. It is hoped that the funding will improve with time. 4.2.3 Transport (replacement and maintenance) The Ministry oiHealth and the NGDO will be depended upon for maintenance of existing equipment and other materials. However, replacement will not be easily realized,due to paucity of financial resources. The solution is to get an MoU signed with the State to overcome this problem. 4.2.4. Other resources Efforts will continue to be made to attract support and provision of other resources from the NGDO, as required from time to time. A clear definition of the State's responsibility towards CDTI will solve this problem. 4.2.5, To what extent has the plan been implemented The plans are gradually being implemented subject to the prevailing economic of the Country in genlral. As at the time of this report, Sustainability Plans are being finalized.in the two States for submission to NOCP/APOC' 4.3. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3.1. Ivermectin delivery mechanisms It is intended that CDTI will be fully integrated into the Primary Health Care structure, such that Ivermectin delivery will flow unhindered from the State office to Communities. Apart from LGA programme officers coming to collect the drugs, the State Medical Stores or Drug Revolving Fund delivery vehicle could as well deliver the drug to the Communities. The drug consignment for any LGA is safely delivered and D 38 WHO/APOC, 24 November 2004 aa proper inventory taken on arrival at the LGA office. Each consignment is packaged and moved according to requisition to each FLHF and subsequently to designated communities. The process may be slow but it meets the desires of the State. 4.3.2. Training The trainings are fully carried out for staff without previous knowledge of CDTI and targeted or according to need for the old CDTI staff. The training is usually conducted by officers of higher hierarchy to the one immediately below. With the ongoing integration plan, more officers in other programmes are expected to be involved in training activities.. 4.3.3. Joint supervision and monitoring with other programs Supervision and monitoring of CDTI activities are usually carried out side by side with other diseases such as Schistosomiasis control, Lymphatic filariasis elimination, NID, etc. The program officers at State and LGA levels are involved in more than one programme. 4.3.4. Release of funds for project activities The release of fund is still a bottle neck to effective implementation of CDTI. However, much improvement has been recorded recently. Delta State government now provides her Oncho project office with monthly imprest and there is hope for inclusion of CDTI in the budget for forthcoming years in Edo and Delta States. 4.3.5. Is CDTI included in the PHC budget? Yes 4.3.6, Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? So far no other programme uses the CDTI structure wholesale, but officers involved in CDTI activity are entitled to take part in other programmes such as NID, Health education in HIV/Aids, UNFPA suryeys, LF survey, etc. The officers have always performed well. The plans to integrate Schistosomiasis and LF programmes have begun to yield fruits. In Delta State, treatment for Schistosomiasis was launched in Octob er 2004 and it has been added to the CDTI structure. Treatments have been carried out in Ndokwa East and Oshimili South LGAs with Praziquantel tablets supplied by Chevron Nigeria Limited. The treatments will continue and be extended to the 9 oncho endemic LGAs kr Edo State, FMOH has conducted surveys for LF and Schistosomiasis. The results are being awaited. 4,3.7. Describe other issues considered in the integration of CDTI. Other issues considered in the integration of CDTI are joint and multipurpose training. Disease surveillance and notification officers as well as other programmes are going to be involved in monitoring and supervision plus retrieval of data from the field. a 39 WHO/APOC, 24 November 2004 a4.4. 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. The operational research that was planned is yet to be carried out. 4.4.2. How were the results applied in the project? Not yet applicable. SEGTION 5: Strengths, weaknesses, challeng€sr and opportunities List the strengths and weaknesses of CDTI implementation process List the challenges and indicate how they were addressed. Strengths 1. 2. Availability of Mectizan drug. Some CDDs are committed to high productivity despite no incentives from their communities/villages. The financial support by some LGAs enhances CDTI activities in such LGAs' Some LGA policy makers demonstrate desired interest towards the programme. The motorcycles provided by APOC & NGDO enhances monitoring and supervision of CDTI by the LGA staff. Some villages are appreciative of their involvement / ownership of the programme. The NGDO is committed and dedicated to a successful program implementation. J. 4. 5. 6. 7. a W, ses: Lack of counterpart cash contribution from the State and some LGAs. This does not facilitate sustainability of CDTI. Lack of commitment by some LOCTs to the programme' Non-initiation of CSM and SHM in some LGAs/villages' Fuel scarcity and its high cost following government's deregulation of the oil sector. CDDs regularly comparing Onchocerciasis programme with other health progru-ri", *h".. incentives are paid and government recognition is accorded to participants. This development discourages CDDs from exercising full commitment and dedication to CDTI programme. Some Communities/villages are paying lip service to their involvement and ownership of the programme. Constraints 1. The starting date for the financial operational year of the project was changed from June 2100ito Decemb er 2003. This was not known to the project until February 2004 after waiting without any information about this for 8 months. Z. Late release of fifth year funds by APOC. First installment arrived in the last week of Aapilz}Oiwhile the second installment was received at the end of october 2oo4 - one month to the end of the financial year. 3. High cost of fuel and vehicle maintenance' 1 2 J 4 5 6 a 40 WHO/APOC, 24 November 2004 t (, Ssome villages are yet to come to terms with the call for their ownership of the programme. Some CDDs are completely uninterested in the programme 1 To implement within seven months (May to Novemb that were planned for twelve months of the ftfty year, er 2004) alal the activities as a result of the delay in remitting fund to the project. 2. Intensify advocacy I mobllization to the States and LGAs for counterpart fund to the programme. 3. Empowerment of LGAs to initiate and execute programme activities without the involvement or prompting of the State Oncho team members. 4. lntensive distribution of Mectizan tablets in all the endemic LGAs // villages in the project area. 5. lnauguration of CSM and SHM in all LGAs and Villages. 6. lncreased monitoring and supervision of targeted LGAs and Communities by the relevant field staff. 7. Intensification of Health education and community mobilization. 8. Continuation of targeted training and retraining of LOCTs, HFS and CDDs. the challenses : 1 Continuous mobilization, advocacy and sensization at all the levels : CommunityA/illage, LGA and State levels. This also involves regular review and restructuring of styles, methods of work and strategies tro meet with the evolving challenges of sustainability. Work closely with Edo and Delta State governments to ensuring the inclusion of budget line for Onchocerciasis in the State's yearly budget. APOC, NOCP and the supporting NGDO are being requested to carry out a high powered advocacy and sensitization visit to Edo and Delta States to press for counterpart cash support to the programme. The effect of item 4 above when realizeed, will positively spur the interest and commitment of LGAs in carrying out their responsibilities towards the progralnme SEGTION 6: Unique features of the proiecUother matters None 4. 5. Challeuges How to address a, I 2 J 4 a 4l WHO/APOC, 24 November 2004I