Gombe State CDTI Project year 4 annual project technical report to technical consultative committee (TCC): March 2003 - Feb 2004

ORIGINAL : English COUNTRY/NOTF: Nigeria Proiect Namez Gombe State CDTI Project ABproval year: 1999 Launchins vear: 2000 Reportins Period (MontnrYear)z March 2003 - Feb 2004 Date submitted: July 2004 NGDO partnerz UNICEF YeaT 4 ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ,eur,Bb4 Ltr L -\Lc /9 AFRICANPROGRAMME FOil ONCHOCERCTASTS CONTROL (APOC) "'Cs"cl ts5I/t CF,f CCP Btn ArtL tSFctro AL \ '& I AO 2 0 l,li' :il$-{ WHO/APOC, 26 September 2003 DT! P i I rt.NI{I-]^-L PRO,TI'CT TFCIINIC {L REPORT TO Ttr,CHNIC AI CONSI II,TATIVF, COTilI\4ITTF,F TCC) Ei\ifrOR SEivIEi\iT Please confirm you have read this report by signing i- $!.^ anqaF^Er.lo4a q-e:'+irr t,irr/ dl,P. t lrr i.tr,! .,P.rr,L. ^FF!^-F^ lt rlrlLlLl(D [U SrB,Il rlre rcpurt: Country: NIGERIA National Coordinator Name: Dr. J lya Si Date Sisnafirre W* (Lp ""'t' a_a, t ) Zonal Oncho Coordinator Name: Princess Patricia Ogbu- rtralutr L O()I(Irlratot Date: {* l5te-9 This report has been prepared hy Narne : Hantna Ali Dadinkowa Designation : State Onchocerciasis Sionah Date tr ) Table of contents ACRONYMS IV DEFINITIONS v FOLLOW UP ON TCC RECOMMENDATIONS......... EXECUTIVE SUMMARY SECTION I: BACKGROUND INFORMATION 1.1. GpNsRaL TNFoRMATToN ............... l .l .l . Description of the project (briefly) I . I . 2. Partnership........ 1.2. PopuletoN eNo HseLrH sysrEM SECTION 2: IMPLEMENTATION OF CDTI........ 2.1. PsRroooFAcrrvrrrEs............... 2.2. ORoTruNc, SToRAGE AND DELIVERY oF IVERMECTIN 2.3. ADVocACY nNo SBNsrrrzATroN 2,4. MoBILIZATIoN AND HEALTH EDUCATIoN oF AT RISK CoMMTINITIES 2.5. CoIrIutnqIrIES INVoLVEMENT IN DECISIoN-MAKING........ 2.6. CRpnclry BUILDING 2.6.1. Training..... 2.6.2. Equipment and human resources... 2.7. TRgeti,rpNts................ 2.7.1. Treatmentfigures........... Plans for remedy...... 2.7.3. Trend of treatment achievement from CDTI project inception to the current year 2 32.8. SuppnvrsroN I 7 3 J J 4 5 7 ..7 ..8 ..9 l0 t2 t4 14 16 l8 1B 2t ..2s ..27SECTION 3: SUPPORT TO CDTI 3. I. FnaNcInL CoNTRIBUTIoNS oF THE PARTNERS AND CoMMUNITIES TOTAL 3.2. OTUSR FoRMS oF CoMMTINITY SUPPoRT 3.3. ExppNorrunE pcRAcrrvrry................. SECTION 4: SUSTAINABILITY OF CDTI ... 4.1. INTcRNaL; TNDEIENDENT pARTrcrpAToRy MoNrrozuNc; EvaruarloN TRANSPORT AND OTHER MATERIAL RESOURCES ................. LEADERSHIP............ MECTIZAN ORDERING AND DISTRIBUTION Human Resources .. 4.2. CoNTNaUNilTY SELF-MoNIToRINGaxoSTITBHoLDERS MEETING 4 .3 . SusreNRstLITy oF pRoJECTS: pLAN AND sET TARGETS (MANDAToRy Ar yR 3) 4.4. INTEGRATroN............... 4.5 OpEnerIoNAL RESEARCH SECTION 5: STRENGTHS, WEAKNESSES AND CHALLBNGES 27 27 27 28 28 28 32 ......33 35 36 36 37 38 38 lll WHO/APOC, 26 September 2003 Acronyms APOC ATO ATrO CBO CDD CDTI CHEW CSM FLHF HFS HSAM IEC JCHEW LGA LOCT MOH NGDO NGO NID NOCP NOTF PHC PHCC REMO SAE SHM SOCT TCC TOT TINICEF UTG wHo African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Community-Based Organization Community-Directed Distributor Community-Directed Treatment with Ivermectin Community Health Extension Worker Community Self-Monitoring First Line Health Facility Health Facility Staff Health Education, Sensitization, Advocacy & Mobilization Information, Education & Communication Junior Community Health Extension Worker Local Government Area Local Government Onchocerciasis Control Team Ministry of Health Non-Governmental Development Organization Non-Governmental Organization National Immunization Day National Onchocerciasis Control Programme National Onchocerciasis Task Force Primary Health Care Primary Health Care Coordinator Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Stakeholders meeting State Onchocerciasis Control Team Technical Consultative Committee (APOC scientific advisory group) Trainer of trainers United Nations Children's Fund Ultimate Treatment Goal World Health Organization IV WHO/APOC, 26 September 2003 Definitions (i) Total population: the total population living in mesoftryper-endemic communities within the project area (based on REMO and census taking). (ii) Eligible population: calculated as 84oh of the total population in mesoftryper- 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. (iv) Ultimate Treatment Goal (UTG): 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 expected to reach the UTG at the end of the 3'd year ofthe project). (v) Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). (ri) 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 expressed as a percentage). V WHO/APOC, 26 September 2003 FOLLOW UP ON TCC RECOMMENDATIONS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session 17 (Please add more rows if necessary) Number of Recommendatiott in tlte Reporl TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY 264 (i) Therapeutic coverage was low in spite of high geographic coverage. This happened because the HFS gave inadequate quantity of mectizan to the communities and the shortage was not reported. The monitoring and supervision process has been strengthened to ensure early detection of shortages In the meantime adequate mectizan tablets are being made available at all levels.. 264 (ii) The project did not use the new reporting format. New format now used 264 (iit) Data and information presented were not coherent. More care and time is being devoted to preparation of technical reports to ensure coherency. 264 (iv) CSM not carried out This happened due to late arrival of funds but it has been conducted this year. 264 (v) ATO and UTG were not clearly indicated. The ATO and UTG were all the same since we were expected to reach our peak in treatment as from that very year which is 84% of the total population. WHO/APOC, 26 September 2003I Executive Summary Gombe State is made up of I I L.G.As and occupies 17,048 square kilometres of landmass. It is bounded by Bauchi, Borno, Yobe, Taraba and Adamawa States. The State lies within the Guinea savannah and the Sudan savannah belt of Nigeria. The topography is characterised by undulating hills, sandy rocks and a few igneous rocks. The State has an estimated population of 2.5million persons. The culture of the people has religious and tribal linkages. The major tribes are Hausa,Fulani, Tera, Tangale, Waja, Bolewa, Tula, and Kanuri. A common language is Hausa, but each ethnic grouping speak its own language as well. The major occupations of the people are farming and fishing. There are quite some numbers who engage in trading of farm produce, pottery making, wood carving and cloth weaving. Based on the recently completed census update there are 960 meso and hyper - endemic communities with a total population of 1,167,452 in the l0 CDTI L.G.As. in the state. Out of these 786,803 persons were treated in 785 communities. This gives a geographical coverage of 82% a therapeutic coverage of 67oh, and a75 %o achievement ofthe UTG/ATO. Due to the inflow of immigrants from other parts of the country the population of the state is generally on the increase. Although there is seasonal rural - urban migration this does not contribute significantly to population mobility. Most of the trainings planned were not canied out in the early part of the year due to scarcity of funds. With the availability of funds towards the end of the year the following trainings were carried out: - 3l I LOCTS/HFS were trained on census update, 200 HFS trained on record keeping and CSM, 30 LOCTS trained on use of monitoring checklist and 1500 newly selected CDDs trained on CDTI implementation. Also 500 community members were trained on CSM in the 10 L.G.As. 60 members of various community based organizations in the l0 L.G.As. were sensitized on the programme. The major challenges faced in the year were the changes in administration at State and LGA levels, general redeployment/ retrenchment of staff, non-payment of salaries to workers and non - release of funds to the LGAs. These slowed the pace of activities as staff morale was low. These were overcome through dedication and personal sacrifice by most of the HFS and the SOCTs and repeated advocacy to the newly appointed leaders at the State and L.G.A. levels, which led to the release of counter part funds at both levels. 2 WHO/APOC, 26 September 2003 SEGTION 1: Background information 1.1. General information l.l.l. Description of the project (briefly) Geographical location, topography, climate Gombe state is made up of I I L.G.As. l0 out of which are implementing CDTI and have all completed the 4th yeai. The state occupies 17,048 square kilometres of landmass and is bounded by Bauchi, Borno, Yobe, Taraba and Adamawa states. The State lies within the Guinea savannah and the Sudan savannah belt of Nigeria. The topography is characterised by undulating hills, sandy rocks and a few igneous rocks. There are some small portions of flat surfaces. The rainfall averages about 40 inches per year. There are two distinct seasons - the dry and the rainy seasons. The former begins late October to April. The rest of the months constitute the rainy period. Population: activities, cultures, language The state has an estimated population of 2.Smillion persons.The culture of the people has religious and tribal linkages. The major tribes are Hausa,Fulani, Tera, Tangale, Waja, Bolewa, Tula, and Kanuri. A common language is Hausa, but each ethnic grouping speak its own language as well. The major occupations of the people are farming and fishing. There are quite some numbers who engage in trading of farm produce, pottery making, wood carving and cloth weaving. Cattle rearers can also be seen, moving to areas where the pasture is green. Communication system (road..,) The predominant means of communication is by road. More than half of the communities are accessible by road. Although the rail line passes through the state it has been seriously affected by erosion. Communities along the river Gongola from the Dadinkowa dam upstream use canoes and motorboats as a means of communication. Communication channels vary. Some usually governmental, follow the traditional authority structure, i.e. from Emir to the districts heads, then to the village heads, ward heads and heads of households. The village head or ward heads may also communicate to the heads of occupational groups (e.g. heads of farmers association or market traders). At the community level, town announcers and musicians communicate to members of households. Administratio n structure The State has traditional and Modern administrative structures. Under the traditional administrative structure, the State is divided into emirates and chiefdoms with each emir/chief having some districts under him. The district head has some village areas under his control while each village area is made up of several hamlets or wards which are headed by ward /hamlet heads. In the modern administrative structure, the State consists of I I LGAs. The LGAs are further sub divided into political wards, which in furn are made up of Communities. The State has an elected Governor as the head of the executive arm while there ts a house of assembly made up elected representatives of different LGAs, which forms the legislative arm. The same applies to the LGA level where the head of executive is the chairman and the legislative made up of Councilors from different Political wards. 3 WHO/APOC, 26 September 2003 Health system & health care delivery (provide the number of health posts/centers in the project area if the information is available). The ministry of health oversees all health activities in the state and is directly controlling the 7 general hospitals in the state and the school of health technology. Health activities in the local governments are coordinated by the PHC Coordinator who receives instructions from the ministry of health through the PHC Coordinator ministry for local government and chieftaincy affairs. 1.1.2. Partnership Indicate the partners involved in project implementation at all levels (MoH, NGDOs - natio nal, inte rnatio nal) The partners involved in CDTI implementation include APOC, LTNICEF, Federal Ministry of Health (NOCP), the state Ministry of Health, the focal L.G.As and the endemic communities. Describe overall working relationshtp omong partners, clearly indicating speciJic areas of project activities (planning, supervision, advocacy, planning, mobilization, etc) where all partrrers are involved. The NGDO usually assist in advocacy, provision of funds for training and supervision. The State performs such functions as training and re-training of LGA health workers, Mectizan procurement and supply to LGAs, monitoring and supervision of mectizan distribution, formulation of operational guidelines in order to ensure good implementation of the programme, and community mobilization and education. The LGAs are responsible for training and re-training of health facility staff and CDDs, Mectizan procurement and supply to communities, community mobilization and education, monitoring and supervision of mectizan distribution. The endemic communities collect their yearly mecttzan supply from the health facilities, ensures distribution of mectizan to eligible persons, selects distributors and determines times and methods of distribution. They also minimally monitor and supervise the distribution exercise. The NOCP provides technical and moral support to the programme, supervises the activities of the State of Oncho Control Programme, and pays advocacy visits to policy makers to solicit for support to programme implementation. Overall working relationship has been cordial. State plans if any to mobilize the state/region/district/LGA decision-makers, NGDOs, NGOs, CBOs, to assist tn CDTI implementation. Already sensitization workshops have been conducted for CBOs and local NGOs in order to encourage their participation in CDTI implementation. Arrangements have been completed for the training of 300 CBOs on community self-monitoring. Advocacy visits will be paid to the newly appointed policy makers in order to educate them and also solicit for their support. 4 WHO/APOC, 26 September 2003 c.l ! 0) (.) oott) \o 6l (, o o. o B q qJ q) a) \) i q) U p a) E s8 $L!a. .Y\\S :\\B$9 -t >\ tP qo' p: Bq)UqJ'rs -tB s (\ Su \< sY $ts^E! sPs* S*{x x-s *B.!-L3\\!:\ -i!EI =60t(J- 9- ss s: !(l TLi.ibnio- BqJ :bo -: .\ ild t\S\U la) q o ct c! z o =q{6> a aI c! tr F qJE = q- E tq9 oo oo ce C\O t rr F-NN t-- $ ooC\ oo o\ o.l C\ \o\oc\ t--r- N oo oora) t-- F-la) lr)$q r- N ra)( N .{' 6t@\o in$ .oitr -6)o .= o.N ij< i F 8; a o\ oo c\l o\ aa tr- N oo o\ tr) an \o c.) oo tr-\o t--\o\o o\ t-- oo t-. 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(u-: .EL.,r e= baqi i:NE Ec ! %oc -tua'? v u :i S! x* .s ;o5lr) ^;icv=ti ,S E9Ui (rr * 6>, $ Hi si r= $Qotr\ 1al.* .t' 55 -sS0)o !^.\IHE6 =(HO$I o- \S 3E Ev .rS 5ri t"S o6- =\(*OS vvk\ .RaB E,s a$ S'iia1 ;.'rrqrO0T.U}E T! -Rt'= o .s -<=o ts\ATTSQ\ tr tr ^ S.$ 5E €oq , <3 \o t-- a.t !o -o 0) o.o(n \oN U o o ts 0) o a \o ! o () a(!() oH o c)Lr C) O o o -L U) t& o ooE o0 (! -L U) +r o ol-rd o ch a CO C)li C) trd ox 0.) qi o 0.) -o E -(, (n ! o.%- sq) s0.)G.C L r: P cdVaO - q 4\) U a!) b L p o \ a!)4 q) s lr 0.) 0)liL o C) C) olr a o L<(n C) H _o U)() od({< o q) C) E F C..ir 6)l -ol(gl FI q.) q,) \) a p '\g{: .a' 4q) os oxo fi ar\ tJ .s 'EsIiSoE E.Bo:r Lo\trt q,) riNT Fo(, I. o E .9{J t!fl E o E .gc! !tN z 9F(, lrJ o o an q)q a o o5trEo U $ JoEi .T:?E d: a- aa (o A o at o a.6trE o U lio ,.'o oo() n EDiE .!jE 61 : a- oH(6 a c) 6l c D (t) U) q) Q o.6trEo U ho -o c) oo o a0EE a' L C) -o o o z a0 c! 3 o o5 o U Lo -o (,) o 0) o k(.) ! C)oo o lr C) -o 0) oo o bt)eE rrq C(: aE H C) ,.o C) z lr O -o o o. 0)a Lr o) -o C) o z U) bo rjE61 5 oor-92 o EO I lro ,o C) o 0) o ooEE?c a- otr A J () a) & 6 oo G c! tr 0) cq G fr o oo 6l V cg 6 cll G z oo a G q) 2.2. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - Qtlease tick the appropriate answer) V MOTUNOCP tr WHCtr - UNICEF f] Other (please specifo) Mectizan@ delivered by - Qtlease tick the appropriate answer) V MOIUNOCP ! WHCN UNICEF! NGDOtr NGDOtr Other (please specifu) Please describe how Mectizan@ is ordered and how it gets to the communities Mectizan (for all the L.G.As.) is applied for by the State Coordinator, based on population figures generated at the community level and submitted to the health system. Mectizan, on arrival into the country is stored at the NOTF central Store, from where the State's consignment is collected by the D - Zonal Coordinator. The State takes delivery of their consignment from the Zonal Office in Bauchi. Mectizan request for each community (based on its population) is forwarded to the L.G.A Oncho Coordinator through the health facility staff. The Oncho. Coordinator compiles the request for all the communities in the L.G.A. and forwards it to the State Coordinator. Ivermectin reaches all the communities through the same route but in the reverse order. Table 3: Mectizan@ Inventory (Please add more rows if necessary) 8 State/District/ LGA Number of Mectizano tablets Requested Received Used Lost Waste Expired Akko 275000 275000 274937 0 63 0 Balanga 320,000 320,000 319,919 0 81 0 Billiri 231,000 23 1,000 230,937 0 63 0 Dukku 155,000 155.000 154951 0 49 0 Funakaye 210,000 210,000 209,943 0 57 0 Kaltungo 200,000 200,000 199,952 0 48 0 Kwami 200,000 185,000 I 8495 I 0 49 0 Nafada 110,000 1 10,000 109,954 0 46 0 Shongom 128,000 128,000 127952 0 48 0 YamaltuDeba. 281,000 281,000 280925 0 75 0 Gombe based) (clinic 3000 3000 2978 0 22 0 Total 2,098,000 2,098,000 2,097,399 0 601 0 WHO/APOC, 26 September 2003 State uctivities under ivermectin delivery that are being carried out by health care personnel in tlte project area. Gombe. endemic areas. communities. time beginning from the health facility to the state headquarters. Any other contments 2.3. Advocacy and Sensitization State tlre number of policy/decision makers mobilized at each relevant level during the currerfi yearl tlte reasons for the sensitization and outcome. Describe difjiculties/constraints being faced and suggestions on how to improve advocacy. Within the period of report efforts have been made to educate and mobilize the policy makers at the state and L.G.A. levels (most of whom are new in office) through advocacy visits and meetings. The number and category of policy makers and leaders mobilized is hereby summarized in the table below: - Toble 4.Slto the number makers and leaders mobilized. The L.G.A policy makers were mobilized due to the fact that they are new in office and there is strong need to educate and mobilize them for their active support for sustainability of the programme. The outcome is very encouraging as demonstrated by the release of counterpart funds by all the l0 LGAs and the State government itself. The community and religious leaders were mobilizedto further encourage them to support and own the programme. 9 SAI L.G.A Relrgrous leaders Communrt y leaders PHC Supervrsor y Councilor PHC Coordrnator L.GA Charrman Secretary Treasurer I Akko l5 29 I 2 1 I I 2 Balanga 27 35 I aJ 2 I 1 J Billiri 20 29 1 2 2 1 I 4 Dukku t9 2l I 3 2 I I 5 Funakaye l8 23 1 2 2 I I 6 Kaltungo 2t 29 I 3 J I I 1 Kwami 20 22 I 2 2 I I 8 Nafada t7 20 I I I I I 9 Shongom l8 27 1 2 2 I I 10 Y/Deba 26 34 I 4 3 I I Total 201 269 t0 24 20 10 t0 WHO/APOC, 26 September 2003 2.4. Mobilization and health education of at risk communities Provide information on : The use of mediu ancl/or other local systems to disseminate information The state - owned media houses and the NTA are always involved in covering CDTI activities organized at the state and L.G.A. levels. In the communities, the town criers are used in announcing the arival of mectizan, date of distribution and inviting community members to nreetings. Mohilizutiott urtd lrculth education of women snd minorities - method and response Mobilizatiou and education of women is normally through involvement of females in the activities of the programme so that they can influence the acceptance and participation of other fernales. Whenever the females are involved participation of other females is always greater. The minorities usually comprise of immigrants either from another state or another part of the state. This group are easily mobilized through involving some of their members. Respo trse oJ' target communities/villages The target comrnunities have responded favorably by fulfilling their roles expected of them under CDTL Consequently, they have selected/changed their CDDs, determined periods/nrode of distribution, and in most places made efforts to contribute towards offsetting local costs of distribution. However, in such areas, which affect religious and cultural values such as involvement of women in CDTI activities there has been a lot of reticence. A number of conrntuttities have also not been forthcoming on the issue of compensation of their CDDs. Accontplisltments ' Increasing compliance to Mectizan intake. Refusal rates are continually on the decline. ' The nuntber of communities that have selected more CDDs in order to lessen the w'olhload has increased. ' The uuntber of communities that are compensating their distributors are also on the increase, although it is still afar cry of what should be. lYe u li n e s s es/C o n stru i nts l. Lorv literacy of women in most of the endemic communities. 2. CLrlture of most communities does not allow free movement of women and their rurixrug with men. 3. Lack of funds (from all sources) for mobilization activities in the first three-quarters of tlre year under review. 4. The polio vaccine contamination controversy and involvement of many foreign faces made some communities skeptical of the programme. 5. The payment of allowances to community members selected as guides in the NIDs affected the efforls of some community members in giving incentives to CDDs. Suggest wttys to intprove mobilization of the target communities. ' Involvement of more women and the mobilization of women groups in the programme at alI levels so that they can interact with the community womenfolk and enhance their participation in the programme. . Early release of funds by all partners. l0 WHO/APOC, 26 September 2003 a-l 0) o a(.) a \oN O o o< o > { il Sqqq) Qq) S, ? u)6trr- .tiG: F=ENt-iE:o:OE o*o5!;- ,SE +,Utr9OE L! Oc .E Ocn E.9 troqor+ a *J 0,)trE E= F! O ("t(, :. =f,1 . (Jl n5l . c5lNFI b! = ug i E Ei( E =EE: =E9Zo> l= rl 9q =i:Z= t-- $ $N F-N \oC\ lr) @c\ \nc.l N NN \o6l N co.{' lr)c\ o\ N cO* t-- co NN $ o\tN F I e- > -E- U o a. U I Z o\ oo cO lr) s $\o co l-- * c.l cOl-tN ceca oo$ c.l o\ N F-r-N \o\o co 6(\ ra oo$ co\o (-- eoN aa cto\ NN r.- \o|'- F-\o 00 F-t $ co CN\n co F- co $NN \oN 6 cON \o NN N N c..l o\ o\N ia\0 N >o "';Ui .-L o- ze EO L o\t-- \o o\ o\a-N o\ ra) N s(n o.t s N o\l.i N \o N .o o\ N co s co aO s ra6t v AZ ? a'= 0 o . = L.9 ; e! L zac- c!N co coN @ t-- oo o\ caN t--\t (\l$N !!o6 ^..Y L o E'==d -!6r-:;bYo -E-9 oo \ota) $ r- @ .+ oo t-- t-- (n $(-- N$ \o o\ F H(.) I .= ,; .o E9 z c! e q o\$ cn \o .{- 1Oo\\o co \o cO s \o s$N -o o\ @|r) yO cO t-- \o N\o o\ c.) ce s ra e c.- L:EF -Os i)rtr!=- z 2.= $ .{- c.) cO o\N r-cO aO Oaa c!cO Nrn N!+ (?) :? E 3E;E: Za o ?.E 9i'3 c.) c.l o\ t---6l \ooo \oo\ oo$ o.l( co ra) $ c\lr) o\o o\ (J J o o JZ * oo m ti J< .Y a q) (€ JA cd fJ. o oo M B v (n .E z o bo o a ; -o0) o 6l - Comr-nent on: Atterulancc of female members of the community at health education meetings The attendance and participation of females in health education meetings depends on the age group and the cultural background of the community. In most communities elderly men and women never sit together to discuss on any issue regardless of their cultural backgrounds. In rare cases male and female youths of some organizations do sit together to discuss on issues affecting thei r organizations. ht getrcrul, hotp do you rilte tlte porticipation of female members of the community nteetirrgs rt'lten CDTI rcsrtes are being discusses (attendance, participation in the discussion etc). To be candid it is very difficult to find a community where females attend meetings together rvith other members of the comrnunity. If it happens, their contribution is very little. Other issles The nrajor lactor affecting the participation of females is cultural variation, which is linked to religion. A), WHO/APOC, 26 September 2003 2.6. Capacity building 2.6.1. Traiuing During the period of report 3 I I health facility staff have been trained on census update while 200 of them were furlher trained on community self-monitoring and record keeping I data analysis in separate training sessions. 1500 new CDDs were trained in l0 L.G.As. in order to enhance mectizan treatment coverage. 500 community members selected from 100 communities wele trained on comnlunity self - monitoring (50 persons from each community in the l0 L.G.As. The report on the training carried out is hereby summarized on the table below. Ab WHO/APOC, 26 September 2003 6l o -o E(.) o. 0)o \oN OU B bO o e o .k B s o s a so -E' o \j o \ p\ a' a B ! B o * F z F U q) z tr- t-- co oo V)\o ra)\o tr) tr) tr) (n r/) \n tr) Ir-- : tn r- ra) ra) lr) (n n I rn o\l,o : o o\ ra \o q) 6) q) o\ t/.) tr) V) ra) ln Ln tr) \n rr) ln L ssF -tr ts o _q? LF Z F z : : oo N c.l @ N c.l oo OI : oo o\ : : t-- N I co oo : o\ N r- : : @ : : @ r- o\ eGI r-r- € o\ q) o q) -oo\ F C{ N c.l c\l ON N c\l c\ o.l c.l N F a< F q) ()Z N ra) ta) N c.l \o lr) O(\ tr) la) O : lr) tr) oo lr) co : lr) ra) c.l lr) lr) @ : tr) : co N (n : \n N C..l \o : \o 6l N[n : t 4) q) () 4 .\ N Nc.l c{ ON oo N (\ € N c\c.n N J (.]CJ o!s q) Z F c< = a ca N tr)l co : C\ co N O : ao : Ir- ao V-i N lr) co r/) N \o : $ ol \o O : trl N ( c-) (n N lr} ra)l lr) : ra .- inin : \o r- o qJ o -o o\ F ao r/) sf, Oca ca co aa co co oco lr) =t (-)(r) J o .l< cS oo cd ca p ca .\1 -V t-.1 C) fJ. oo COV V -o .,9 Cd z oo o a .o 0) o clo3 :\ q qj Q U 6 EJ o \ q)q q) a*! o () E() a F t-.,t(, o a C) 0) () ! -G)!H 0) .q o0 !F 6; 0)I _ot(dl FI I I Table 6: Type of training undertaken (Tick the boxes where specific training was carried out during the reporting period) - Any other comments 2.6.2. Equipment and human resources Table 7: Status of equipment (Please add more rows if necessary) Table 7: Status of e ul Trainees Type of trainrng CDDs Other Community members e.g Comn-runity supervisors Health Workers (frontline health faci Iities) MOH staff or Other Political Leaders Others(speci&) Progran.r managerlent How to conduct Health education V V Managemcnt of SAEs V CSM V V SHM V V V Data collection V V Data analvsis V Reporl wntlllg Others (spcc i fy) V V APOC MOH DISTRICT/ L.G.A TINICEF OTHERS Type of Equipment. Source Condition of the equipment xPlease state. Vehicle (1 ) functional Motorcycle (14) functional 4 functional Computer ( I ) functional Printer ( 1) functional Fax machrne (1) functional Laptop ( I ) functional Air conditioner (l) functional Television ( I ) functional Photocopier (l) not functioning Safe (I) functional ,L5 WHO/APOC, 26 September 2003 Filing cabinet (1 ) functional I functional Electnc type writer ( I ) functional Voltage regulator (l) functional UPS I functional Bicycles (60) functional Refridgerator I functional V/Cassette recorder (1) functional Photo Camera (l) functional P/Address system (5) functional Overhead projector (l) functional Telephone line I functional Stand by Generator (1) functional *Condition of the equipment (Functional, Curuently non-functional but repairable, Written off). How does tlte project intend to maintsin and replace existing equipment and other muterials? In the 5th year of CDTI implementation maintenance of existing equipment will be from funds froni APOC as well as from counterpart funds. Thereafter, they will be maintained from the coutrtetparl funds. Given the fact that for several years both State and Local Governments have been paying their counterpart funds, it is not likely that maintenance of the capital equipments will be difhcult. However, for replacement, the project has forwarded a request for the replacement of the essential capital items from the APOC Trust Funds. The remaining items can be procured using State counterpart funds. Describe tlte aclequctcy of available knowledgeable manpower at all levels, i). State level: The manpower at state level is adequate but there is need for further lnanagement training for the state Coordinator and his assistant. ii). At the L.G.A level the situation varies from one place to another. Some have adequate number of CHEWs and JCHEWs; while some have inadequate numbers. ll/here frequent transfers oftrained staff occur, state what project is doing or intends to do to remedy the situation (The most important issue is what measures were taken to ensure odequate CDTI implementation where not enough knowledgeable manpower was available or staffofterr trartsferred during the course of the campaign). Transfers are not frequent. Even when they occur they hardly affect implementation of CDTI activities as either trained personnel are put in place or the replacements are given quick orientation/training on the job. The project is., however, planning to train more health facility staff in all the LGAs before the end of the 5"' year so that when transfers occur there will be no need for training. td WHO/APOC, 26 September 2003 2.7. Treatments 2.7.1. Treutmetfi Jigures Within the period under review the project has collected a total of 2,098,000 tablets of mectizan. A total of 786,803 persons were treated in 785 communities in the l0 CDTI L.G.As. using 2,097,399 tablets. The number treated is inclusive of the clinic -based treatment canied out in Gombe L.G.A. There were no SAEs recorded. /w WHO/APOC, 26 September 2003 e.l O -o 6) C)a \o a.l O oA ,ri \ (.) H o() 'a La() .D o L) otro o!cx()t9H0)C)! t4 6)AH\ _,9()alqAl ol 6J ;i -l tr = !l .; >gl bo oHI.E =Ht trel .i 4 ol - = -ttuEI.g F;\leUxl (d o El a o r.l I bvt r tt)H ,t b =Zll- a al ol brl(Bl bl >l !t(6l ol -clol(6l !l brl ol ol 5 EI <.rl =lol 3tLI 0)I -tr1 $ :l 6l EI :l €l -l il EI ol rr.l v)q qJ U e,) ? \ C,) o \ qJ h q) o_ v JZ a ti a(d C)! rl J ! a -o a r! cn (! () C)!F cidr ,l _l -ol FI C) dh 0) bo L C) o(.) do o. H b0 o() O C) H() bo(nko oo o^ P-\ 0) o.(! C) ? qe u4^-= at^-u6o-E:: o>.- o;:sE:F=iod o>aoOL o o o -o c z 9 IrJP<aaZZ o O O O o o O o ot LO 6E ADzd o 3 -Y>z:6 ^ze ,g ':E EETi"!Eo! a o H o '.= o =boO 6^ Fuo\tr )-oo F o\ F- o\ v 6 o\@ o\r o\ r o\ o\r\o o\$ o\\o c-- sr-\o o 6_b:U truY z @@ € .f, r € t- N \o t+rr 6l c- t o\ o\ t \o @ N € \o €t- €$ daa Etgri9s' FU € € c.l $ F- r N N r s € CI I o o\(\ N \o c.trr- N € 6 rr- $ o\ t-- N N$ \o\o ts-r- o\ =16E ;9 r o Pd += E.9 6 llE eo F o\@ N o\ r a.l \o € r r\o @r N @ o\ Or a] N o\ F- €\o o\tt\o € t-r o\\o al rat+ r-\o a ob{ a 0) O(-) E9g^ ^ 6^ u 90\oo< - 6\r o\ o\ @ o\O o\ € o\ \o o\ o\ @ € \o o\ € o\ s N € E.u .- -.= U!a c ooy =F>JZd O ct s \o .+ € rc \o F- $ r o\ ta €t- = 6.> t9-' F9 € € r $€ $€ €t- sr- N$ \o o\ \OAoF.rd =.q=; $) ". c frE - - a- v.- i; E P8 E v>o € \o $o r @ $@ F- $r c{v \o o\ Ot !r: aY 6oo €E ca a o E bo 6 c6 v d .6 Z o oo U) 6Doo oF 9 E 9^ -lJ'dEo \J3 I c.l O -o o o- c)(n \oN (-) a< - \) Co \ aO !O ! c) \ B h E\ :- 'ut >: t.a!o st' ttr *=c.: :d{\ -F -rY !\!' ': $':\ vsv \.iu\ <ss '-=t. ! 3:hU:ls \: s \Jr o .Yia i ti .Y nJ S' r !:.\r \si 3$u ss b i: i .:5qj \$i *s .{ u{ MEtr '!.Q\S ss S \i%s9i \H. ,\ (*- i-l \ oiv 5 9N : .o\ = :s \ i!s _!u: .s'st !\T U\ sSrl\ t\=' il ll :o uiI\ F\S OF () d (.) 0) H a.() q () H o E(.) (.) IL() A oq o !(.) ^, 0)9l ! ot ! -i o:xl P -l o .91 .()t tl -l oC)l o ^l L5l oC)l !Ol aJ ul .ool trt=(.)t c -oltrl c6 =l ozt? (.)E !!vr- oOgoE - i:': oX (,X cd 2vP\J 9) o o 0) .F c) E C)!F (c R{ cCq) H cd () 'a p. 0.) o z tr.l& -o!(.) () a a C) = E o(.) (.) E 0) Oa()- *x o(g(., I qio rOoo -oo =+r - c-) -af-z If the project is not ocltieving 100% geogrophical coverage and minimum of 65% tlterapeutical coverage rule or coverage rate is/Iuctuating, stote reasons and plans being made to remedy this. The geographical and therapeutic coverage have fallen as a result of the increase in the total population and the splitting of some communities that were formerly merged as revealed by the recently conducted census update. The communities split are reported separately as target cotntrunities but rnerged when treatments are reported. Other reasons include: i). Till of recent, lack of reliable census update to determine the actual number of persons needing treatment and the quantity of mectizan needed. ii). Piece -tneal delivery of mectizan supplies to the project such that not all the communities needing the tablets have it as at when due. Plans for remedv i). Unicef provided support for the censlrs update, which is now completed and reflected in this reporl. There are areas still that need fine tuning, especially with regards to the harmonization on the number reported as target and the number treated. ii). Frorn 2004 onwards the State's mectizan requirement for the year will be supplied at once. 2.7.2 Whut are tlte causes of absenteeism? The major cause of absenteeism reported stems from the failure of the CDDs to carry out mop Llp treatlnent for the persons either absent or ineligible at the time of treatment. 2.7.3. BrieJly describe all krtowtt and verified serious adverse events (SAE| ond provide in table 9 the required informotion when avoilable, No serious adverse reaction was ever recorded in the state since the beginning of the programme. 2.8.ln cuse the project ltus no cuse period, please tick in the bo-r. of serious udverse event (SAE) during this reporting No case to report 20 WHO/APOC, l0 April2003 a.l o. O =t?N q) a, \) \ Lq) -a \ ,qJv) IT %a aJ(-) \) -S aa qJ\ s t q aJ\ .9 L() o- bo 0)L (.) oo '= -o !oLL o Cl lJ..,l U) C 0) (.) otnL c.) ! Cd 6 o L() o o a o Q o.r o-,l -t -ol cdlFI (_)tr.-E09 -.c2L o>a dE= 'boc,il- I 6oo 6 =:l qoo trq q 5,J f9 9'o ,.- Q aD^ 6 .= 0)o_c tr q;o- o.d -c .? 6, - e=J C C.- -@ooA=.L.6 C * - !, oo.: (u ! rY .- x )-6-082. E o Exa !o ll Il I 0ltf 0\ _E! U:} U:FO_ g i1 :Z .!d o>, bOeG.l =bo?a I O () bo * U) I c.t ! 0) -o o o.oa \o o.l U o o B dh \) 6cs =ado)e'- 9^ o' a.(! ^-lvEl trtr| :d)lEEIol -x :-oI eO >o0 E i.-qV(q> otroo-E9 G(g9a = CU ri r9t '-tNI ol -olal #t o 00rld^ F o>< - >:- -o (, -o o\@\o o\ t-- tr- o\$ @ \o t-r -o^ F US -o o o\ + \a coO \o @O o\ t-- a !O =coo G^ cL.o o 9o\ ootoF o\$ \o \o @ \o tr- o\ tr*\o ,o .o654- =Q29,o o. O$q O $ caN 00- Oq $\o c.)O@ \o oo tr-- EoE U.Z /9s'FU OO dN co OO O^ O O o O\o N 00 \o^ $ -t o q o H qa e :iia xL *6Sioi.. ' a 3s o \o tr-\o t-. a- N c\ \o oo F- tr-- ot s o\ cn n" F-\o --:. o ^boUSo-F UN<'>J -o a o\ o\ \a N o\ o\ N@ iac- ood- d^ il)"1 oo\ oo o\ co \o \o\o o\NF- \o N oo aoo.!-8- U E SE ts t,- o = tr< E2Ad @|r)\i- o\ $ .f,\o cotr- =oa 4 .ao 9' FU O$ OO\o O tr- \o C) bo o E E (-) bo6 =a+5 *3 .-Oi.E FE ='E.E * E *o=?aaF = U 9! EO o o\$ oo @ \o @ @ O El OO N OO(.n NO a] OON 2.A. Supervision The NOCP zonal Office Bauchi and IINICEF supervise the state team (SOCTs), while the SOCTs supervise the LOCTs and the LOCTs supervise the HFS. The HFS and some community members supervise the CDDs. This arrangement is not very rigid as the zonal office and Unicef as well as the state team can go to the community level in order to ascertain the situation in the field. 2.8.1. Provide aJlow chart of supervision ltierarclty. NOCP Zonal office / UNICEF SOCT LOCT Heulth Facility Stoff HFS/Community Members Community D irected Distrib utors 2.8.2. Vl/hat were tlte msin issues identiJied during supervision. Drug shortage at the community level but not reported by the CDDs. Delay in forwarding reports by CDDs. Poor supervision by HFS. CDD attrition as a result of admission into schools or gaining employment. Lack of mop up treatment (follow up of absentees, sick and breast-feeding). Records are either very scanty or not available in some health facilities and some LGAs. Sometimes the health facilities are by-passed when mectizan is delivered to the communities 23 WHO/APOC, l0 April2003t\{J!) 26 facilities. 2.8.3. ll'as supervision cltecklist used? Yes, at the State level supervisory checklist was used, but at the lower levels they are utilized on limited occasions. 2.8.4. Wltat were the outcontes at euch level of CDTI implementation supervised Conrmur-ritv level 1. Cornmunities are being mobilized to select more CDDs where there is attriction. 2. CDDs are being encouraged to request for addtional tablets when shortages are noticed. They have been asked also to conduct comprehensive census update and report appropriately to the health facility supervisor, sp that adequate Mectizan tablets can be provided to them. This has been done. 3. CDDs are also being encouraged to report treatments as soon as they finish a round of distribution. This however is being hampered by lack of or inadeqaute incentives being given to the CDDs by the communities. Health facil ity level. l. More health facility staff have been trained on CDTI implementation, although presently only a few of them are directly involved in CDTI activities. The additional training is to ensure better supervision within a limited area. 2. Health facility staff are being encouraged and empowered to keep records of CDTI activities, and to assist CDDs in recording and reporting of treatments. L.G.A . level. LGAs have been requested to dispense Mectizan tablets to health Facilities based on the total populattot-ts as soon as they recieve their consignments from the State. They have also been informed that the HFS are to collect the tablets meant for the communities under them from the LOCTs, except where distance necesitates delivery of the tablets to remote communities. LOCTs have been requested to make copies of reports sent to the State for their records. 2.8.5. lltas feed-back given to the supervised, and how was the feedback used in improving the overall performance of the project Feedback was given to all the levels supervised so that the shortcomings identified could be addressed properly. 2€ 2 J,\ WHO/APOC, 26 September 2003 I 27 SECTION 3: Support to CDT! 3.1. Financial contributions of the partners and communities Table I l: Financial contributions by all partners for the last three years Contributor Year 2 (March 2001 Feb 2002) Year 3 (March 2002 - Feb 2003) Year 4 (March 2003 - Feb 2004) TOTAL Budgeted (us$) TOTAL Released (us$) TOTAL Budgeted (us$) TOTAL Released (us$) TOTAL Budgeted (US$) TOTAL Released (us$) Ministry of Health (MOH) 20,000 20,000 20,000 0.0 19,277.11 19,277.11 NGDO partner(s) (LrNrcEF) 24,420 3,121.28 23,100 1,584 24,820 19,566.26 District/LGA 12,500 12500 12,500 1,666.66 12,049 12,048 Communittes 1,285.14 1,584 1,604.43 APOC 95,960 45,000 69,156 40,000 40,510 20,000 TOTAL 155,880 81,906 127,756 44834 74,417 72,495.9 Ifthere are problents witlt release ofcoanterpartfunds, how were they addressed? The problerns encountered with the release of counterpart funds is the excessive delay which is largely due to bureaucratic procedures and the financial stand of the government, but with persistent follow up the funds were released. - Comments 3.2. Other forms of community support - Describe (indicate forms of in-kind contribtttions of communities if any) ) Special recognition v J5 WHO/APOC, 26 September 2003 28 3.3. Expenditure per activity - Indicate the expenditure on activities below in US dollars using the current United Nations exchange rate to local currency Table L2: Indicate how much the project spent for each activity listed below during the reporting period Comments SEGTION 4: Sustainability of GDTI 4.1. Internal; independent participatory monitoring; Evaruation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick where applicable) _Year I Parlicipatory Independent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation Internal Monitoring by NOTF Other Evaluation by other partners 2K r6 Activity Expenditure ($) Source (s) of Funding Drug delivery NOTF HQ area to central collection point of community 401.61 APOC/State/ local Govemments. Mobilization and health education of communities 1,606.43 APOC/ State/ Local governments Training of CDDs 2,779.12 Local Governments Trainings on CSM. 8,481.93 Unicef/ APOC/ State/L.G.As Supervising CDDs and distribution 1,204.92 APOC/Stat elLocal governments Internal monrtoring of CDTI activities t397.59 TINICEF Advocacy visits to health and political authorities 562.25 APOC/State governments Sensitization of CBOs 3,679.52 Unicef Census update 5,991.97 Unicef Vehicles/motorcycles/bicycles maintenance 6500 APOC/State/local government. Office Equipment (e.g. Computers, printers etc) 320 State Government./APOC SHM 5,421.69 Unicef TOTAL 38,346.93 WHO/APOC, 26 September 2003 4.1.2 What were the recommendations? 4.1.3 Implementation of recommendations State level 29 2,r *t- Recommendation Implementation Planning: . A 2 - Year sustainability Plan needs to be developed. The plan should cover the remaining year of APOC funding and indicate clearly how resources can be sourced in the 6th year for carrying out specific activities. The PIan should be detailed and reflected in the overall MoH rolling plan. Planning workshops were conducted for stakeholders at state and L.G.A. with the facilitation of 3 consultants delegated by APOC. During the workshops sustainability plans and budgets for the state and L.G.As. were drawn up and these were refined later. Supeniision & Monitoring: . State level officers have to be trained to enhance their supervisory skills. During the training there must be clear role definition and role differentiation. . SOCTs should utilize checklist developed during supervi sory visits. SOCTs have been reoriented on all the roles expected of them in the programme and the importance of using the supervisory checklist already developed. Mectizan Procurement & Distribution LGAs are to fetch their Mectizan supplies from the State. Mectizan requirements should be clearly based on estimates from last year's treatment data or realistic population projections. LGAs are fetching their Mectizan tablets from the State. No of Mectizan requested is based on population estimates/census updates from the community level Training & HSAM: . SOCTs should only limit themselves to training of LOCTs and FLHF staff. 'Spot checks' may however take place. The recent training of FLHFs, CDDs and community monitors was facilitated and managed by LOCTs. The SOCTs were present as mere observers. WHO/APOC, 26 September 2003 Integration: . In one visit several tasks should be performed. SOCTs are utilizing a visit to an L.G.A to tackle everything related to CDTI implementation in the L.G.A. Financial resources: . Budgets for CDTI should be realistic based on justified needs and what the Govt. & UNICEF can disburse annually . Funds budgeted by State need to be released as approved. The budget for counterpart contribution paid by the L.G.As. as well as that of the State's were based on activities expected to be carried out. It is a little bit difficult getting expected contributions from TINICEF during the budget/ workplan preparation. Repeated advocacy visits are on to State policy makers to ensure that approved funds are released as at and when due. I Transport & Other Materials: l. The State should have a specific, realistic, dependable plan for transport & equipment, when the present programme vehicle & other equipment come to the end of their life. This could be finding funds for new transport& equipment; using pool vehicles & other resources. 2. State and NGDO partner should part fund production of IEC materials. APOC funds can also be accessed ifjustified well. In the Plans developed, provision has been made for maintenance of logistics from the counterpart contributions by the L.G.As. and the State government. In some LGAs, some amount has been budgeted for the purchase of motorcycles. There is integration in the use of PHC programmes motorcycles in all the L.G.As. This implies that new motorcycles procured for other programmes will also be used for CDTL In the meantime, APOC has been requested to replace existing logistics/ equipment in the 5th year. Provision has been made for the production of IEC materials from State and LTNICEF sources. Human Resources SOCTs need to be retrained on report writing and data management; and their computer skills updated. Training workshop on computer and report writing will be carried out in the 5 th year. This is provided for in the workplan. Coverage: . SOCTs need to have an up-to-date list of the communities and populations of endemic communities . State should order for their 2004 Mectizan requirements using 2002 updated census data, and previous year's treatment records in subsequent distributions. A census update has been carried out and the list of communities compiled with their populations. This is being refined. Mectizan request for year 2004 was based on census update and treatment results for last year. 30 )4 *T3 WHO/APOC, 26 September 2003 I L.G.A, level 3l 2r \q -(..l-J Recommendation Implementation Planning . Development of planning skills of LOCTs in a workshop forum . LGA PHC co-ordinators, LOCT leaders and Supervisory Councillors for Health draw up a detailed, integrated and participatory plan and budget for CDTI in the LGA, for 2004. These were initiated in August2003 when a planning workshop for LGA. PHCC, LOCTs, PHC supervisory councilor were invited for a 2 day planning workshop held at the MLGCDCA conference room. The workshop was facilitated by 3 consultants sent by APOC. During the workshop, planning skills of LOCTs were developed and sharpened. Detailed workplans were developed and later refined, then integrated into the health budget for 2004 at State and LGA levels. Leadership . LOCTs should initiate CDTI activities LOCTs have been oriented and given the go a head to initiate and manage CDTI activities at the LGA level. Monitorins Supervision Statistics at LGA must be aggregated in such a way that it is possible to get coverage figures for each District and community The 2003 statistics must be used to identify districts with low coverage. When planning for the 2004 distribution these districts should receive attention. LOCTs should not routinely visit communities - that is the responsibility of the FLHF staff. LOCTs should use the prescribed supervisory checklist systematically, for each visit. a The recently conducted census update has provided the basis for accurate determination of coverage at community, district and LGA levels. Areas with low treatment coverage are now clear with the census results and are now recieving attention. The State intends to train LOCTs on data management to build their capacity in data collection, collation and analysis. Each level has been repeatedly informed of their roles, and the need to empower the level immediately below to initiate CDTI tasks. It has been emphasized that each level should not go beyond the immediate level below on a routine basis. The already existing LOCT supervising checklist will be put into use during subsequent supervisions. Mectizan procurement/ distribution . LGAs should order for mectizan using 2002 updated census data or previous year's treatment records in subsequent distributions No of Mectizan requested is based on population estimates/census updates from the community level WHO/APOC, 26 September 2003 32 Training & HSAM . The LOC/LOCTS should plan and conduct training for level below. . Such training should be targeted - i.e. particularly focused on those FLHFs & CDDs who really need it. LOCTS have been empowered their level. The last training of them. to conduct training at FLHF staff was done by Financins/ fundins . The :N: 150,000.00 provided by the LGAs as counterpafi funding should be used to fund CDTI activities at the respective LGAs. . CDTI activities should be costed in an annual plan. . The political leadership should approve proposed budget. . A sub head for CDTI needs to be created within the LGA annual budget. at source from the LGAs is used uniformly in all the LGAs. LOCTs request for the release of funds for specific activities. All CDTI activities are costed in annual plans developed at the workshop, which was attended by the L.G.A. policy makers and have been encouraged to make the sustainability plans part of their respective plans budgets. Most LGAs have CDTI subsumed under the health budget. This is not peculiar to the Onchocerciasis control programme alone. a The N1.5m deducted Transport and other material resources , The LGA should have a specific, realistic, dependable plan for transport, when the present programme motorcycle comes to the end of its life. This could be finding funds for new transport; using public transport; using LGA pool vehicles. . LGA and NGDO partner should parl fund production of IEC materials. maintenance of logistics from the counterpart contributions. In some LGAs, some amount has been budgeted for the purchase of motorcycles. There is integration in the use of pHC programmes motorcycles in all the L.G.As. This implies that new motorcycles procured for other programmes will also be used for CDTI. In the meantime, APOC has been requested to yplace existing logistics/ equipment in the 5th year. Provision has been made for the production of IEC materials from counterpart sources. In the Plans developed, provision has been made for Coverage . LOCTs need to have an up-to- date list of the communities and populations of endemic communities . LOCT must maintain accurate population and treatment records for use at their level communities compiled with their populations. This is being refined. LOCTs are encouraged and advised to keep records of the population and treatment data submitted to the State. t A census update has been carried out and the list of .9 30 WHO/APOC, 26 September 2003 I I FLHF level 33 23 JL Planning . FLHF staff need to prepare a timetable for key CDTI activities e.g. Mectizan procurement, training of CDDs, Distribution and census update, monitoring & supervision, collection and analysis of data. FLHF staff have been alerted on these issues but more emphasis will be placed in planned re - orientation and training of health workers at this level Leadership . FLHF staff should be allowed to assume responsibility for managing the CDTI programme in their catchment's areas. Monitoring and Supervision . FLHF officer in charge of CDTI at this level should analyse village coverage figures for 2002, and identify those that are struggling. When planning for the 2003 distribution these villages should receive targeted supervision, and less for those which are doing well. . FLHF staff should empower communities to deal with problems identified during distribution. Mectizan ordering and distribution . The amount of drug required should be estimated on the basis of the community population that is updated during each annual treatment. This is done from 2003 onrvards . Proper inventory should be maintained for all mectizan tablets received and issued to communities The treatment results for 2003 and the results of the last census update were used for ordering mectizan for year 2004,. FLHF staff are being encouraged to keep accurate. a Trainine & HSAM FLHF staff should undertake CDD training, mobilization and sensitisation of endemic communities. Yearly training of CDDs should be targeted - i.e. particularly focused on those who really need it. The FLHF staff are being empowered to conduct training where there are replacements or new ones are selected where the existing number is too inadequate WHO/APOC, 26 September 2003 Transport and material resources . LGAs or NGDO partner should provide bicycles for FLHF staff in charge. APOC can assist also in this. . LGA and NGDO partner should part fund production of IEC materials The provision of bicycle to FLHF staff may not be relevant any more because most of them feel this is below their status. They will prefer motorcycles Provision has been made at LGA level for IEC materials to be produced from the counterpart funds. a Human Resources . FLHF staff need to be re - oriented to perform targeted supervision, CDD training and maintenance of Mectizan inventory At the last training conducted with funds from APOC and UNICEF, FLHF staff were made to know the need for targeted supervision and training. These will be further stressed in future training/ re - orientation/ review workshops. Coverage . Copies of reliable CDTI records from the Health center catchment area must be retained at the respective FLHFs. . FLHF staff must be enabled to calculate the coverage rates for their areas, as a tool for monitoring their own performance and planning their work. FLHFs have already been trained on record keeping and encouraged to keep records of CDTI activities in their catchment areas. FLHF staff are being trained to calculate coverage rates, but for some due to literacy level this is a problem. 34 -24 29 .,<-) WHO/APOC, 26 September 2003 I I Community level Recommendation Planning: . CDDs should combine update of census records and distribution of mectizan in one visit to the households. census was done seperately partly because funds were provided for census update when treatment was over in most communities. Both activities are now carried out at the same time. Update of The amount of drug required should be estirnated on the basis of the community population that is updated durir-rg each annual treatment. This is done from 2003 onwards Mecti orderins and di ts of the recent census update was used in determiming the quntity of mectizan required by each endemic community for year 2004. The resul Communities should make provision for collection of Mectizan and submission of repofis Financing: ome communities have made provision for mectizan collection and submission of reports while some are still adamant. Mobilization efforts shall still continue S Human Resources Communities should select more CDDs so as to obtain a ratio of I CDD to 250 persons of the communities on the need for selecting more CDDs to obtain the I :250 ratio for effective coverage. Communities will continue to be sensitized by FLHF staff to select more CDDs where the need is apparent. Community self-monitoring has enlightened some Coverage: . Treatment registers should be well kept and census updated during Mectizan distribution. Community members/CDDs the need to always keep their treatment registers in the community and to update the registration during each treatment round. have been educated on ur 2a WHO/APOC, l0 April2003 I 36 4.2. Gommunity self-monitoring and Stakeholders Meeting Table l3: Community self-monitoring and Stakeholders Meeting (Please add more rows tf rtecessary) Describe ltow tlte results of the community self- monitoring and stakeholders meetings have uffected project implementation or how they would be uttlized during the next treatment cycle. CSM and SHM have enabled the community members to know their responsibilities in CDTI better. The community members have demonstrated their willingness to carry out the responsibilities expected of them in CDTI implementation to the best of their ability. SHM and CSM have proved to be effective ways through which the communities identify problerns and proffer solutions. 4.3. Sustainability of proiects: plan and set targets (mandatory at yr 3) What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.3.1 Plunning at all relevant levels. A team of three consultants were in the state in August 2003 after the mid term evaluation in order to assist the state in drawing up a sustainability plan for running the project after the eventual withdrawal of APOC. During their stay meetings were held with the stakeholders at the state and L.G.A. levels where sustainability plans were developed. We are optimistic that these plans will form the bedrock for realistic and integrated planning at State and LGA levels on a continuous basis. 4.3.2 Funds With an annual countetpart contribution of Nl.5m and N2.4m by the 10 LGAs and the State govetnment respectively, there is good hope that these will be increased on devolution by APOC. LTNICEF, the assisting NGDO, has indicated its continuous support for CDTI activities although the level of support is not fully known. District/ LGA Total # of communities/villages in the entire project area No of Communities that carried out self monitoring (CSM) No of Communities that conducted stakeholders meeting (SHM) Balanga Billiri Akko Dukku Funakaye Kaltungo Kwami Nafada Shongom Yamaltu Deba 156 104 lt8 7l 84 84 76 52 74 142 10 10 10 l0 l0 10 l0 10 10 10 10 10 10 10 10 10 10 10 l0 10 Total 960 100 100 x '1,\,e/t WHO/APOC, 26 September 2003 I a 37 4.3.3 Transport (replacement and maintenance) The project has requested from APOC Management the replacement of capital items before it finally devolves. Some LGAs have made provision for the purchase of motorcycles in the sustainability plans. These items will be maintained by funds from counterpart sources, although during the 5'h year some funds from APOC Trust Fund will also be utilized for the maintenance of existing equipment and logistics. 4.3.4 Other resources Provision has been made for the production of IEC materials from several sources in the 5th and 6tL years if the State and the LGAs maintain their present level of funding, and there are indications that they will, it may not be difficult to utilize part of these to source for IEC and other materials needed. 4.3.5 Please provide a written plan with set targets snd achievements for so far. The 3 - Year Sustainability plan for the project has been forwarded to APOC Management. However, we are attaching the State's work plan for the 5th year. Some of the achievements so far nrade have been indicated in 4.1 4.3.6 To what extent has the plan been implemented Implementation of the plans made has been difficult due to excessive delay in the release of counterpart funds from the state / L.G.As and delay in the release of the approved budget and funds by APOC. 4.4. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration 4.4.1. Ivermectirtdeliverymechanisms Mectizan when collected from the Zonal office is delivered directly to the PHC store and if LOCTs come to the State Coordinator for their consignments they are given a note to go to the PHC store officer to release the tablets to them. At the L.G.A. the drugs are delivered to the PHC store from where they are given out to the HFS for delivery to the communities. 4.4.2. Training Training of CDDs is carried out by LOCTs and HFS who are equally involved in other PHC programmes. At the state level the facilitators for LOCT/HFS training usually include officers from other PHC programmes. 4.4.3, loint supervision and monitoring with other programs There is integration in areas of sharing one vehicle and delivery/collection of information from the field. Departmental monthly meetings are held to discuss on the activities of all PHC programmes. Efforts are also being made towards developing a general checklist for supervisiou and monitoring. Curuently, the capital equipments are being used for other PHC activities in addition to CDTI implementation; likewise capital equipments for other PHC programmes are utilised for CDTI activities whenever the need arises. 4.4.4. Release offunds Before funds are released for any activity proposals/requests are forwarded to the Permanent Secretary through the Director PHC/DC. It is only after the Permanent Secretary and The Honourable Commissioner's approval that funds are released for activities. )7 35 WHO/APOC, 26 September 2003 4.4.5. Is CDTI included in the PHC budget? CDTI has always been included in pHC budget. 4.4.6. Descrtbe other health programmes that are using the CDTI structure and how this was achieved. what have been the uchievements? At the moment there are no programmes using the CDTI structure except NpI that uses some of the CDDs as guides during NIDs. Also eye care services (screening oi.y. cases) is carried out by the SOCTs. Plans are being made to add on the treatment of lymphatic filariasis and control of trachoma in the 5th year. 4.4.7. Describe other issues considered in the integration of GDTI. The most important issue to be considered in the integiation of Cott is Understanding between the programme Coordinators and other field staff, and the need for proper, integrated planning. 4.5 Operational research 4'5'1 Summarize in not more thun one half of a page the operational reseurch undertaken in the project area within the reporting period. No operational research was carried out during the period of report. 4.5.2. Not applicable How were the results applied in the project? SECTION 5: Strengths, weaknesses and challenges List tlte strengths and weaknesses of GDTI implementation process Strengths High level of commitment from the state and local governments as demonstrated by the release of counterpart funds in spite of their economic status. Committed and dedicated SOCTs and LOCTs. Readiness of cDDs to continue treatment regardless of incentives. Willingness of all communities to continue swallowing mectizan as long as it is available. support frorn unicef and APOC, which motivate our policy makers. Weaknesses. l. Excessive Delays in the release of funds.. 2. Lack of commitment from some HFS.3' Low literacy level of many CDDs in some communities that hinders them from compiling their reports. 4. Lack of compensation of CDDs by some communities. bt 36 2 3 4 5 WHO/APOC, 26 September 2003 39 List the challenges and indicste how they were addressed, 1. Frequent changes in government at State and L.G.A. levels 2. Lack of regular payment of salaries in most L.G.As. 3. CDD attrition in some L.G.As. These challenges were overcome through the followings: - i. Mobilization and education of the new policy makers each time a change is effected. ri. Personal sacrifice from the side of LOCTs and HFS implementing CDTI activities. iii. Mobilization of the communities to select elderly persons especially married women as CDDs. )e "v WHO/APOC, 26 September 2003 GOMBE STATE CDTI PROJECT YEARV BT]DGET Submitted to APOC MANAGEMENT r_Y -.1(.) GOMBE STATE CDTI PROJECT. UMMARY ET I - ++12 BUDGET LINE ITEM APOC MOH NGDO TOTAL Personnel 3,430 112,900 I 16,330 Capital Equipment 71,000 71,000 Supplies 1,600 2,480 4,080 Training 6,500 3,1 00 35,700 45,300 Education Mobilization 4,000 13,500 3,600 21,100 Travel 10,600 6,380 500 17,480 Communication 900 660 1,560 Consultants 500 500 2000 3000 Other Expenses 6700 300 9,700 Total 106,230 139,820 41,800 283,850 % Input 36.02% 49.26% 14.72% 100% 35 - JUSTIFICATION OF YEAR V BUDGET Personnel. Salaries of project implementers at State and LGA levels remain the responsibility of the various tiers of govemment. As for APOC, the usual top up allowance for motivation in lieu ofthe vigorous activities remains the same as in Year 4. Capitd equipments. The request for the replacement of most of the capital equipments is based on the fact that presently most of these equipments are ageing and in the near future they may be demanding frequent repairs so that the cost of maintenance amidst scarce resources will be too high. Presently the computer is giving problems that sometimes documents are lost or are difficult to retrieve. The printer is also giving problems and now can only print one page at a time. Some of the motorcycles are already too weak and worn out as a result of the bad terrain in some of the LGAs. Supplies. The government will provide supplies for general office maintenance and for field activities. APOC is requested to provide diskettes, toner and printer ink for storage, photocopy and printing of documents respectively, Training. There is need for training of new FLHFs and LOCTs and retraining of the already existing ones on identified areas of weaknesscs. The training sessions will be utilized to give orientation to health workers on expected roles after devolution of APOC. The SOCTS need further computer training on Microsoft excel and power point for presentation and data processing. Education and Mobilization. Continuous cducation and mobilization is needed in order to maintain the level of awareness and support to the programme at all levels. The production of simple IEC materials like pocket and wall calendars, as well as the holding of advocacy workshops for prominent community/ opinion leaders, LGA and State policy makers, will facilitate this. Provision has also been made for identification and mobilization of local NGOs who will assist in the implementation of CDTI at all levels. The project also intends to produce some needed IEC materials and develop radio/TV jingles which will be aired, all from government sources in order to sustain present programme L\O awareness. The government will be responsible for vector control in Dandikowa to reduce the menace and nuisance of the blackfly, and in collaboration with IJNICEF to use the CDTI structure to scr@n for eye cases. Travels There is an increase in the cost of fuelling due to hike in the price of petroleum products in the country. The cost of maintenance is also increasing due to ageing of the vehicle and motorcycles. Amounts budgeted are modest since attention will be given to essential activities and problematic areas only, as other levels are increasingly empowered to effectively manage their levels. It is also anticipated that with the new capital items less maintenance work will be done. Communication. This line item is needed for urgent transfer of documents and information to and from the project site. APOC is requested to subsidize government efforts in payment of telephone/fax and courier pouch. Consultants. Amount budgeted under the APOC Trust Fund is required for computer maintenance. Other expenses This line covers payment of C.O.T., reproduction of MIS forms, repairs and maintenance of equipments. Additional funds are also sought for initiatior/ expansion of community self - monitoring and stakeholders meeting to cover most parts of the State and enhance community ownership and participation. u{ GOMBE STATE CDTI PROJECT 51I{ YEAR BTJDGET PROPSAL LINE ITEM-PERSONNEL SAI Position Source Annual No Of Staff Total Cost Rationale 1 State Coordinator SMOH 8,000/YR I 8,000 Full time position 2. State Oncho Team SMOH 6,000/YR 6 36,000 Full time position J PHC Director SMOH 9,000/YR I 2,400 Part time (25Yr) 4 Driver SMOH 3,6001yr I 3,600 Full time position 5 Utility Statr SMOH 2,400n4R 1 2,400 Full time position 6 LOCT Leader L.G.A 4,000/YR l0 20,000 Part time position(5 07o) 7 LOCT Members L.G.A 3,600/YR l0 18,000 Part time position(5 07o) 8 utiliry statr L.G.A 1,800/YR 10 9)000 Part time position(50%) 9 HOD PHC L.G.A. 5,400/YR 10 13,000 Part time position (25Y") SUB-TOTAL APOC MOH ll2,9m I State Coordinator APOC 55o/YR I 550 Managerial Assistance 2 State Oncho Team APOC 385/YR 6 23t0 Managerial assistance J PHC Director APOC 165/YR I 165 Managerial assistance 4 Driver APOC 255lYR I 255 Managerial assistance 5 utility statr APOC 15OAaR I 150 Managerial assistance Sub-total for APOC 3430 TOTAL 116,330 \g GOMBE STATE CDTI PROJECT 5TIT YEAR BUDGET PROPOSAL LINE ITEM _ CAPITAL EQUIPMENTS. S/N Erpense/Item description. Source Unit cost of item Units Total cost Justification / Explanation I 4-wheel drive vehicle with spare parts kit. APOC 36,000 I 36,000 Monitoring and supervision and locaVdistance travels 2 Motorcycles APOC 2,400 l0 24,000 Monitoring and supervision J Computer, printer and peripherals. APOC 3,000 1 3,000 Typing, printing, storage and sending of documents 4. Generator APOC 4,000 1 4,000 Stand by power source. 5 Laptop APOC 2,000 I 2 000 Data entry at field level 6 Video and TV monitor. APOC 2,000 I 2,000 For training, advocacy and mobilization. Totals 71,fi)o \3 GOMBE STATE CDTI PROJECT 5TH YEAR BUDGET PROPOSAL LINE ITEM SWPLIES S/N Item Source Unit Cost Unit Total Cost Justification 1 Papers MOTYLGA 1O/Reams 60 600 Report/Documentation 2 File Folders 1/unit 60 600 For holding document J Pencils/pen 0.5/unit t2 60 Writrng of drafts 4 Files/tags/punches aa 2lset 30 600 Organization of files 5 Papers MOH l0/reams 25 250 Report/Documentation 6 File Folders MOH l/unit r25 t25 for holding documents 7 PencilslPens 0.5/unit 60 30 Writing of drafts 8 Files/tags/Punches 2lset 60 r20 Organization of files 10 Note books 3/unit 25 75 Note taking Sub-total for MOII/LGA 2480 I Diskettes APOC 2Olunit 20 400 Computer file storage 2 Photocopier toner <a 10O/unit 6 600 Photocopy of documents 3 Printer ink T5luntt 8 600 Printing of Computer work APOC sub-total 1600 Total 4,080 \\4 GOMBE STATE CDTI PROJECT 5T1{ YEAR BIJDGET PROPOSAL LINE ITEM TRAINING s/N Description Of Activity Source Unit Cost Units Total Cost Justification I CDD Training workshop MOTYLGA 200 l0 2000 Facil itylRefr eshment for workshop 2 LOCT Training workshop MOFYLGA 100 t0 1000 Facility/Refr eshment for workshop 3 SOCT Training workshop MOH 100 I 100 Facil itylRefr eshment for workshop Sub-Total for MOH 3100 I SOCT Mgt workshop LINICEF 1200 I 1200 Facility/Refr eshment for workshop 2 SOCT/LOCT Review meeting 1500 2 3000 Biannual review meeting for State J CDD Training/ Retraining on c€nsus update 5000 I 10,000 Facility/Refreshment for workshop 4 LOCT/I{FS Training on census update/eye care 20,000 I 20,000 Facility/refreshment Sub-Total For UNICEF 35,70O I LOCT Training workshop APOC 1500 I 1500 Orientation for LOCTs on post - APOC roles 2 Training/Retrarning of Health facility staff (( 2000 I 2000 Technical training for PHC staffat health facility level 3 CDD training /retraining workshop 2000 1 2000 Distribution training for CDDs 4 Data Management Training for SOCTs APOC 1,000 I I 000 Computer based data management training for State level staff Sub-total for APOC 6500 TOTAL 45,300 \5 GOMBE STATE CDTI PROJECT 5'h YEAR BI.JDGET PROPOSAL LINE ITEM.HEALTH EDUCATION AND MOBILIZATION s/N Activity Source Unit Cost Unit Total Cost Justification I Oncho Day Celebration LGA 15o/LGA 10 1500 Facility/refr eshmenUpress coverage 2 LGA Training 1500 1 1500 Presentation/fu cility/refr eshment 3 Marking of Oncho Day MOH 500 I 500 Facility/refreshmenUpress cov 4 Prod. of IEC materials MOH 2,000 I 2,000 Increased awareness of programme 5 Production & airing of jingles MOH 1,000 I I 000 Production costs and airing on radio/TV 6 NGO Mobilization MOH 1,000 I 1,000 Part funding for ldentification & mobilization of local NGOs 7 Vector Control & Eye Care MOH 6,000 I 6,000 Control of vector in Dandikowa & screening for eye cases Sub-total for MOIULGA 13,500 1 Oncho. Day Celebration T]NICEF 600 I 600 Support to State/LGA 2 LGA Tratmng orientation 1 000 1 1,000 Support for advocacy visits to LGA policy makers J NGO Mobilization TJNICEF 2,000 I 2,000 Part funding for Identification & mobilization of local NGOs Sub-total for UMCEF 3600 I Advocacy workshop at LGA level APOC t0/ Person 100 1000 Mobilization of DistricUclan heads and opinion leaders 2 State advocacy progftrrnme 20/ person 50 1000 Advocacy for State /LGA Leaders 3 Calendars-pockeUwall 2llurlrtt 500 1000 Message calendars 4 NGO Mobilization APOC 1000 1 1000 Part funding for Identification & mobilization of local NGOs Sub-total for APOC 4000 TOTAL 21,100 \+6 GOMBE STATE CDTI PROJECT 5M YEAR BUDGET PROPOSAL LINE ITEM.TRAWL siN Activity Source Unit Cost Unit Total Justification I Motorcycle Maintenance MOTV LGA 60ly|LGA 10 600 S ervicing/tires/tubes 2 Motorcycle fuelling 6O/YR/LGA (Part Funding) 10 600 Fuelling of motorcycles 3 Public transport 6OIYR/LGA l0 LGA 600 Taxis/buses 4 Accommodations 6O/YR/LGA l0/ LGAs 600 Travel/tndging 5 Per diem/Travel allowance IsO/YR/LGA l0 LGAs 1500 Feeding/rncidentals 6 Vehicle fuelling 1240lyrlvehicle I t240 Fuelling of project vehicle. 7 Vehicle maintenance 1240/YR Vehicle I 1240 S ervicing/tyres/tubes Sub-total for MOH 6380 Public transport I.JNICEF lftrip 30 300 Taxis/Car hire/buses Per diem/Travel allowance 5O/day 40 200 TraveL/Lodgrng/feeding Sub total For UNICEF 500 Vehicle Maintenance APOC 10O/lV[onth t2 1,200 S ervicing/Tires/Tubes Vehicle Fuelling 200/month t2 2,400 Fueling of vehicle Motorcycle maintenance Part Funding t4 2000 Servicing/Tires Tubes Per diem 3000/YR I 3000 Lodgrng/feedrng Vehicle insurance" 2,000 I 2000 Comprehensive cover for vehicle Sub-Total For APOC 10,600 TOTAL 17,48O \+ a GOMBE STATE CDTI 5II{ YEAR BUDGET PROPOSAL LI N E ITEM-COMMTTNICATION S/N Activity Source Unit Cost Unit Total Justification 1 Telephone/fax MOH Month I 300 Communication with state NGDO/ LGAs /NOCP 2 Comier pouch MOH 15 1 300 Sending ofurgent documents J E-Mail MOTV LGA 5/lVlonth 10 60 Normal mails to and from the field Sub total for MOH 660 I Telephone/fax APOC 50 t2 600 Urgent exchange of information 2 Courier pouch 25lmonth t2 300 Sending ofurgent documents Sub-total for APOC 900 TOTAL 1560 \\r GOMBE STATE CDTI PROJECT 5M YEAR BUDGET PROPOSAL LINE ITEM-CONSULTANTS S/N Activity Source Unit Cost Unit Total Cost Justification I MOH Statr Consultation MOH 50/Cons. 10 500 For project integration enhancernent Sub-total for MOH 500 2 Evaluation team UNICEF 50/Day 20 1000 Payment for evaluation team members 3 Computer consultants 500 I 500 Computer maintenance/training/production of FIEC 4 Health education consultants 500 I 500 RefreshmenVproduction of materials Sub-total for Unicef 2m0 I Computer consultants APOC 500 I 500 Basic Computing/maintenance Sub-total for APOC 500 TOTAL 3,000 tS GOMBE STATE CDTI PROJECT 5.i'YEAR BUDGET PROPOSAL LINE ITEM.OTHER EXPENSES S/N Activity Source Unit Cost Unit Totd Cost Justification I Office Utilities LGA 200/lVlonth 12 2400 Office up keep 2 Office utilities MOH 50/month 12 month 600 Utilrty bills/office up keep Sub-Total For MOtI/LGA 3m0 1 COT APOC 500 I 500 Bank charges 2 Equipment repairs 1O0/month 12 month 1200 Equipment repairs/servicing ) Expansion of CSM & SHM aa 2000 I 2000 Community empowerment for greater participation 4 MIS Forms aa 1500 I 1500 Printing of relevant forms 5 Review meeting aa 1500 I 1500 Attendance of various review meeting/special assignments Sub-total for APOC 670,J TOTAL 9,7N s0 oAV?Hhl\,\J Fq arl Flt! 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