Bauchi CDTI annual project technical report submitted to Technical Consultative Committee (TCC): January 2008 to December 2008

RESERVED FOR PROJECT LOGO/IIEADING 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 ONCHOCERCTASTS CONTROL (APOC) > COUNTRY/]TIOTF: Nigeria Proiect Name: BAUCHI CDTI PROJECT Approval vearz 1999 Launching Year: 2000 Reportins Period Month/Year)z JANUARY 2008 - DECEMBER 2008. Proiectvearofthisreport: (circleone) | 2 3 4 5 (6) 7 8 9 10 Date submitted: APRIL 2009. NGDO partner: aNICEF 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: Country: _Nigeria National Coordinator Name: Dr. Y. Fayomi Signature Date NGDO Representative Name: Mr. Mohammed Kamfut. Signature Date Zonal Oncho Coordinator Name: ...Shehu librin Signature: .. Date This report has been prepared by Name :Abdulkurim Daniebu Designation : . ..State Coordinator Signature Date ll WHO/APOC, 24 November 2004 { I I I I I I I ! I I I I I _t Table of contents Acronyms Erreur ! Signet non d6fini. Definitions vi FOLLOW UP ON TCC RECOMMENDATIONS Executive Summary 2 SECTION l: Background information 3 1.1. GpNeRalrNFoRMATroN............. 1.1.1 Description of the project (brieJly). 1.1.2. Partnership....... 1.2. Popu1enoN.............. SECTION 2: Implementation of CDTI 8 2.1. TruEr-rNp oF ACTrvrrrES .8 2.2. Aovocecv ..................... 10 2.3. MoglllzauoN, SENSITTzATIoN AND HEALTH EDUCATIoN oF AT RrsK coMMuNrrrps I I 2.4. ConauuNrry rNvoLvEMENT........ ......I2 2.5. Capacrrv BUTLDTNG.. ...... 14 2.6. TReerNasNrs.............. ..... 16 2.6.1. Treatmentfigures.......... ........... 16 2.6.2 What are the causes of absenteeism?.......... ................. 19 2.6.3 What are the reasons for refusals?................ ............... 192.6.4 Briefly desuibe all known and verified serious adverse events (SAEs) that ... l9 2.6.5. Trend of treatment achievement from CDTI project inception to the current year 2l2.7. OnoERrNc, sroRAGE AND DELIVERy oF TvERMECTTN ............... ..............22 2.8. Covuwrry sELF-MoNrroRrNc aNo SrareHoLDERS MrnrrNrc ............24 2.9. SupenvrsroN ............... ......................25 2.9.1. Provide a/low chart of supervision hierarchy. ............25 2.9.2. What were the main issues identified during supervision? ............ 25 2.9.3. Was a supervision checklist used? ............. 26 2.9.4. What were the outcomes at each level of CDTI implementation supervision? 26 2.9.5. Was feedback given to the person or groups supervised?................................ 262.9.6. How was the feedback used to improve the overall performance of the project? 26 SECTION 3: Support to CDTI 27 3.1. EqunrraeNr .....................27 3.2. FmeNcrar. coNTRTBUTToNS oF THE pARTNERS AND coMMLrNrrrES...........................28 3.3. OrHen FoRMS oF coMMUNrry suppoRT............. .................. 28 3.4. ExpeNprruREPERACTrvrrY 29 SECTION 4: Sustainability of CDTI29 4.1. INrenNar.; TNDEIENDENT pARTrcrpAToRy MoNrroRrNc; EveluarroN .......... ..........29 4.1.I Wos Monitoring/evaluation caruied out during the reporting period? (tick any of the following which are applicable)........... ............ 291.1.2. Whatwere the recommendations? .............30 4.1.3. How have they been implemented? ............. ................. 30 4.2. SusrarNeerl-rry oF eRoJECTS: eLAN AND sET TARGETS (MANDAToRv AT................ 30 1 J)J 4 6 Yn 3)... 4.2.1. 1.2.2. 4.2.3 4.2.4. 4.2.5. 4.3. INrpcRnuoN i ili "", " i ); ; ;ii ;: ; i ;;;;; i;,: ; i ; Funds....... Transport (replacement ond maintenance) . . Other resources To what extent has the plan been implemented 30 30 30 30 30 3t .......... 3 I ..... ..... 3 I4.3.1. Ivermectin delivery mechanisms WHO/APOC, 24 November 2004lll 4.3.2. Training.... .....-.-..-...31 4.3.3. Joint supervision and monitoring with other progroms.... ..-.......-.- 31 4.3.4. Release offunds for proiect activities -.-..... 3l 4.3.5. Is CDTI included in the PHC budget? ............ ...........-. 3l 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? ............. ...........-.-.-.... 31 4.3.7. Describe others issues considered in the integration of CDTI. .....31 4.4. OpenarroNAl RESEARCH -.-..32 4.4.1. Summarize in not more than one half of o page the operotional research undertaken in the project orea within the reporting period. ......-. 32 4.4.2. How were the results applied in the proiect?............. .................... 32 SECTION 5: Strengths, weaknesses, challenges, and opportunities 32 SECTION 6: Unique features of the project/other matters 32 lv WHO/APOC, 24 November 2004 ACRONYMS APOC ATO ATrO CBO CDD CDTI CSM FLHF FOMWAM GC LF LGA LOCT MDP MOH NGDO NGO NOCP NOTF NPI PHC PHC & DC POP PP REMO SAE SHM SMOH SOCT TC TV TOT UNICEF UTG wHo African Programme for Onchocerciasis Control Annual Treatment Obj ective Annual Training Objective Community Based Organization Community Directed Distributors Community Directed Treatment with Ivermectin Community Self Monitoring Front Line Health Facility Federation of Muslim Women Association in Nigeria Geographic Coverage Lymphatic Filariasis Local Government Area Local Onchocerciasis Control Team Mectizan Donation Programme Ministry of Health Non Governmental Development Organization Non Governmental Organization National Onchocerciasis Control Programme National Onchocerciasis Task Force National Programme on Immuni zation Primary Health Care Primary Health Care and Disease Control Population PowerPoint Rapid Epidemiological Mapping of Onchocerciasis Severe Adverse Event Stakeholders Meeting State Ministry of Health State Onchocerciasis Control Team Therapeutic Coverage Television Trainer of Trainers United Nations Children's Fund Ultimate Treatment Goal World Health Organization v WHO/APOC, 24 November 2004 Definitions (i) Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). Eligible population: calculated as 84%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. (iv) Ultimate Treatment Goal (UTG): calculated as the maximum number of people to be treated annually in mesolhyper 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). (vi) 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). (vii) Intesration: 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. (ii) (viii) (ix) 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 process by which the community is empowered to oversee and monitor the performance of CDTI (or any community- based health intervention programme), with a view to ensuring that the programme is being executed in the way intended. It encourages the community to take full responsibility of ivermectin distribution and make appropriate modifications when necessary. VI WHO/APOC, 24 November 2004 FOLLOW UP ON TGC 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 28 1 Number of Recommendation in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY Comments on 5to Year Report Improve CDD: population ratio The project trained 2,368 new CDDs, thereby reducing CDD /population ratio from l:261 to I ::185. It is expected that more CDDs will be trained in 2009 to further reduce the ratio. Improve on therapeutic coverage and aim for the target of80%o and above There is a slight improvement of therapeutic coverage from 64%o to 67%o in 2008. The various LGAs with low rates will get panicular attention in 2009. Train more health staff More health workers were trained and the number of staff involved in CDTI has increased from 726 in 2007 to 938 in 2008 Reduce the duration of treatment if possible Effort was made to reduce the treatment period, but LGAs did not collect sufficient quantities of Mectizan due to inadequate census update. They had to to return for more during distribution which lengthened the treatment period. Follow up on the promise of Commissioners to consider a block grant payment for CDTI activities by LGAs Commissioners were changed twice since this promise was made. As such the bulk release of fund promised was not implemented. Advocacy visits will need to be carried out by external persons to the new policy makers. Continue seeking innovative ways to reach women The community leaders were properly sensitized and the number of female CDDs selected and trained has improved. Innovative ways will be devised to reach women in 2009 treatment cycle. (Please add more rows if necessary) WHO/APOC, 24 November 2004 Executive Summary Prepare on Executive summary of the report in not more than one page. Bauchi State is located in the Northeastern part of Nigeria. It shares borders in the North with Kano and Jigawa States, to the East by Gombe and Yobe States, while Kaduna and Plateau State border it to the West, and Taraba State to the South. The State has a total population of 4.6 million according to 2006 census, and is made up of 20 LGAs. By the national prevalence survey and the results of rapid epidemiological mapping of Onchocerciasis in the country in 1999 which was refined in 2003, 11 out of the 20 LGAs in the State are endemic. These are Tafawa Balewa, Ningi, Warji, Bauchi, Alkaleri, Toro, Bogoro, Misau, Giade, Ganjuwa andDarazo LGAs. Earlier, treatments were carried out in 13 LGAs but with the REMO refine and its integration into the GIS, and subsequent production of a REMO map made available to the State in 2005 in the health mapper software, it was discovered that only I I LGAs fall within the definite CDTI area. Treatments commenced in the State since 1991 with I-INICEF assistance and number of persons treated fluctuated in the initial years, but since 2001 treatments have been on the rise. Total number of target communities is now 988, out of which 988 communities were treated resulting in a geographical coverage of 100%. 863,397 persons were treated in CDTI definite zones out of a total population of 1,296,752 giving a therapeutic coverage of 670/o, and a 85oh achievement of the ATO and 79%UTG. Moreover, 96,651 persons were treated passively. Most of the inhabitants of the State are normal settlers, but in recent years there have been some movements of immigrants from the neighboring States of Nasarawa and Plateau States due to communal clash. These immigrants have settled in Toro, Bogoro and Tafawa Balewa LGAs. Also there are movements of the nomadic Fulani who come to the State during rainy season, and seek greener pastures elsewhere during the dry season. Moreover, after the farming season, youths from the communities tend to migrate to the townships to get involved in commercial motorcycle business popularly called okada, as a means of getting extra income. The project has conducted a series of training in order to build capacity at LGA and Community levels. The training conducted involved 44 LOCTs,677 Health facility staff, and 4,596 CDDs, who were either newly trained or re-trained. The present CDD/POP ratio is 1:1 85. Challenges that faced the project and how they were addressed were as follows: - The non release of counterpart fund by some LGAs. Advocacy was conducted, and this will be intensified to solicit for support. - Lack of adequate census update. The project intends to request the assistance of UNICEF to conduct a census update of the CDTI LGAs. - Shortages of Mectizanwere reported, and additional drugs had to be requested. - Logistic support problem especially at the 5 new CDTI LGAs. The project intends to do a joint advocacy with UNICEF and NOCP Headquarters to address these issues. 2 WHO/APOC, 24 November 2004 SEGTION {: Background information 1,1. General information 1.1.1 Description of the project (briefly) - Geographical location, topography, climate Bauchi State is located in the North Eastem part of Nigeria. The State is sharing borders in the North with Kano and Jigawa States, to the East by Gombe and Yobe States, while Kaduna and Plateau States border to the West, and Taraba State to the South. The State lies in Savannah region of Nigeria with variation in ecological conditions. The South and Western parts are Sudan or Guinea Savannah, while the Northern part of the State is Sahel Savannah. Some major Rivers transverse the State, and these are Hadeja , Jama'are, Gongola and Dindima. Most of the Oncho endemic LGAs lie along these rivers. - Population: activities, cuhures, language The State is made up of 20 LGAs with the headquarters at Bauchi. The State has a total population of 4.7m people based on 2006 census. There are more than 40 ethnic groups of different cultures in the State. The major ethnic groups include the Hausas, Fulanis, Jarawas, Gerawas, Sayawas, Kanuris, and the Kare-kares. Islam and Christianity are the two major religions of the people of the State. The settlement pattern varies in different parts of the State, from nuclear settlements with surrounding farmlands to dispersed settlements. Agriculture is the chief mainstay of the people of the State. Farming season is May to December - Communication systems (roads.,) Communication is mostly by road and trunk A roads exist linking the State with the capitals of all neighboring States. Other road networks are available linking the various towns and villages but some of the rural areas are difficult to access during the rainy season. - Administrationstructure The Administrative system in the State is of two folds - the modem administrative system and the traditional administrative system each of which exert influence on the people at the community level. The traditional system is closer to the people and structured in such a way that large areas are under the authority of a District head, who is responsible to the Emir. Under the district head are village heads, and below them are the ward heads who relate directly to the heads of households in the communities. Under the modern administrative structure the State consists of 20 LGAs. The LGAs are further subdivided into wards, which in turn are made up of communities. The State has an elected Governor as the head of the executive arm while there is a house of assembly made up of elected representatives for the different LGAs. This forms the legislative arm. The same pattern applies at the LGA level where the legislative is made up of councilors from the different political wards. - Health system & heolth care delivery (provide the number of health posts/centers in the project orea if the information is available). The health system consists of Primary, Secondary and Tertiary levels. The Primary Health Care facilities are at the LGA level where the health clinics and dispensaries are found, while the secondary Health Care facilities consists of the general hospitals located in some of the LGA headquarters and tertiary is the referral hospital located in the State capital. By the national prevalence survey of Onchocerciasis and the results of rapid epidemiological mapping of Onchocerciasis in the country in 1999 which was refined in 2003, 11 out of the 20 LGAs in the State are endemic. These are Tafawa Balewa, Ningi, Warji, Bauchi, Alkaleri, 3 WHO/APOC, 24 November 2004 Toro, Bogoro, Misau, Giade, Ganjuwa andDarazo LGAs. Earlier treatments were carried out in 13 LGAs but with the REMO refine and its integration into the GIS, and subsequent production of a REMO map made available to the State in 2005 in the health mopper software, it was discovered that only 11 LGAs fall within the definite CDTI area. Number of health staff in project area and number of health staff involved in CDTI activities. Table 1: Number of health staff involved in CDTI (Please add more rows if necessary) DistricULGA Number of health staff involved in CDTI activities. Total Number of health staffin the entire project area Br Number of health staff involved in CDTI B, Percentage Br=Bzl Br *100 Alkaleri 230 108 47% Bauchi 275 99 36% Bogoro t66 103 62% Darazo 128 77 60% Ganjuwa t20 81 68% Giade 81 62 77% Misau 115 78 68% Ningi 103 66 64% T/Balewa 135 98 73% Toro 125 90 72% Warji 83 76 9t% Total 1561 938 600h 1.1.2. Partnership - Indicate the partners involved in project implementation at all levels IMOH, NGDOs (national/international), communities, local organizations, etc.J Partners involved in CDTI implementation are the National Onchocerciasis Control Programme (I{OCP), UNICEF, Ministry of Health, endemic LGAs and endemic communities. Some local CBOs like the community development associations, zumunta mata (women fellowship groups) of various churches as well as Federation of Moslem Women Association in Nigeria (FOMWAN), are also involved in some LGAs. - Describe overall working relationship among partners, clearly indicating speciJic oreas of project activities (planning, supervision, advocacy, planning, mobilization, etc) where oll partners are involved. Working relationship between these groups has always been cordial. The NOCP through the zonal office in Bauchi supervises control activities, facilitates delivery of mectizan to the State, conduct advocacy visits to policy makers at State and LGA levels, assists in training of State personnel, and gives other forms of technical support. 4 WHO/APOC, 24 November 2004 UNICEF has been the supporting NGDO partner since 1991 and provides support in the areas of capacity building and logistic support. The UNICEF has been supporting especially in area of capacity building. This year a focused intervention was conducted in the 6 old CDTI LGAs. The Ministry of Health and LGAs provide the supportive staff as well as logistics for the implementation of the programme right down to the community level. They conduct relevant training for field personnel, supervise activities at their levels, manage Mectizan, deliver these tablets through the various established channels to the communities, and keep records of CDTI data and report same to the appropriate levels. The community selects the distributors, plans the distribution schedule, makes decision as to mode and period of distribution, and provides some support for distribution and CDD training. The local CBOs, where involved, assist in the mobilization of communities, particularly women. - State plans, d any, to mobilize the state/region/district/LGA decision-makers, NGDOs, NGOs, CBOs, to assist in CDTI tmplementation. The project intends to identifu and sensitize more local NGOs and CBOs as well as community development associations and health committees to participate actively in CDTI implementation given the decreasing level of funding from all partners. The new policy makers in place will be sensitized and mobilizedto support CDTI implementation. 5 WHO/APOC, 24 November 2004 \o +o N L C) -o (.) o z$ c.l o suq) o' a. \) ,o' q)\ I q) g q) r\ N5 q) I q)\ \)!.Iq) x a) \) q I$) L. a) o q) bo\q) U U \ bo oq) b0 \q) u q)\ l"uq) \\ : q) I L .o o t' I s q)\ :!uq) L\\) * U (l U ls lq) Lq) t,\o4 S) : \) q) q)\oq) .\ q) .o il 4 \q) t9t\ lrr l) %: L q) t ! a)4 q) E o trO a. bo ti oa(,)L O b0 tr o Lr o o (s 0.)tr (,) l-r 63 O Ho (.) 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'EgE :€ G ?crUgsi ca oo ol € r-. t- o)(f, ot- o, ro_ lr)t- (o lr)t\(o lr)(o s Nt-o(f)lr, Nlo N^(0 o)(\l 6ltr9OEJ= .-Lr!!.- "i 6.EI *o I'v9--H AE A (f)t\ @ o,o t- @ 6i o, o, (o(ooN N(o o,@ s o)@ (f) o) s lo o, o) C) cd (! v) bo z (g Bo (d a F o t-roF := CB I Fr Fr ar) !iiq)cJ .9E o t-v-aElLt .A.; AE -; o d a-l F H(,) (g .\z o (d ca Ho bo oo N CdLr(B (s B '=(t Was a census for the project done during the reporting period? No If No, what is the source of the data in the table above? * Source : National census CDD { other source, specify Year 2008 If you are using the term community or village, define what constitutes the community or village. This will help understand the profile of the project area. A community or village is a clustered settlement of no less than 150 persons and no more than 1500 persons having a head or leader. Is there any other information of interest about the population in the project area? If so, include it here. As a result of the recent follow-up intervention in I I CDTI LGAs many communities in treated oreos where not included in the treated communities is going on, therefore there is possibility of increase in the population of these treated communities. 7 WHO/APOC, 24 November 2004 SEGTION 2: lmplementation of GDTI 2.1. Timeline of activities Fill in table 3, timeline of activities for areas treated in current year, indicating when the key activities were implemented by the month they began and the month they ended. 8 WHO/APOC, 24 November 2004 Or + N L 0) -o o o z$ c.l o o. o > a, q) <.) trq) tr t=l o ro E o U) H(,) t,) c/)(0 C) lr)(n o N ,o o C6 b0 lr (6 a(.) OX() oo 'a tr o >' () (E a (n (R o C) trtr(€ o otiO a N l-rd(.) >. Oo ,<E Lr -t _o qtr EOq)., Q.O Ch6) (L) .!€ Hh . 0.) AP 2 -rn d xq) q) U) ct c) G o 6l uA cl q) cl frq) q)L() E rhq) (,) 6l q) GI() o ah 63q) I U) l-{) a EOEE (.) >| >, >' H= 1iE a- oL(€ o (g o (d o (B oL(! () L(d z oL(! oC! 2 o z (J Ld (JL(€ € L at) bt L *oEE Q C) -oo o H(,) .o o o o q) -oo o ()p o o o L o) o o L 0.)p o o LJ L 6) -oo o op o o \J Lop o o o L C) .o o o IJ (,) -o o o $= 6t= oLd o (€ oH(B (J HG (.) L(B oL 2 oL(d oL Cd o(! oLCd oL(d q) cl U) U) q) Q P= ?E 6: a' ko. Lo. o. Lo. Lq o. Ha. o. Lo. Lo. Lq a! GIL Er o g: EOEE Q >l >' B. PE c: a- oL(B o!(B oL CB oL CB I (U oL(E oL(E z oL(B I (B oL(B (.)L(! -(D Etr s= !Eoo =()a 1OEE Q L d)p o o o q)p o o (.)p o o k()p o o q)p o o L G)s o (.) Io o \J Lq)p o o Lop o o L 0) o o IJ Lo!o o o .Hr c! (h- aE(B oL(B oL(€ (.) L(d oL € 2 ()(, oL(d ()(d od z o z oL C6 2 rl Fl (J L U) & rrl -] vJ O m o& o EA oN n z s.l IJ D V) z z o& F > rrlJ o frr F e > -:. 4? uq) q: L q) t\ o t B q)q q) 5 L Cd 0) >' q) Lrt< O o (,) CBoLr cn(€ oLr Cd o lr € ah 0) O(t qi o o F ..ir o.ll -ol(dt FI 2.2. Advocacy Stote the number of policy/decision makers mobilized at each relevant level during the current year; the reason(s) for undertaking the advocacy and the outcome. Describe dfficulties/constraints beingfaced and suggestions on how to improve advocacy. As the project was transferred from the State Ministry of Health headquarters to the newly created Primary Health Care Development Agency (BASPHCDA) the first thing was to pay a courtesy call on the Executive Chairman of the Agency and all directors under it. The courtesy call was paid and all the project documents were photocopied and handed over to the Chairman to study and the result now is encouraging. A similar courtesy call and action was made to the Director disease Control, as the onchocerciasis Control Unit is directly under his department to solicit his support and to ensure fulI integration of Onchocerciasis Control Unit into his directorate. The Chairman of the Agency fulfilled his promise by releasing some counterpart funds. Another courtesy call was paid to the newly appointed Commissioner and the new Permanent Secretary of the Ministry of Health. The visit was necessary as the Ministry still remains the policy making organization on health matters to the Government, ffid it still maintains oversight of all the agencies created out of it. In his response the Honourable Commissioner assured Onchocerciasis Control Unit of the Ministry's release of counterpart fund. Commissioners were changed twice since the time a promise was made by the previous commissioner to ensure bulk release of funds by LGA. As such the bulk release of fund promised could not be implemented. Another visit was paid on the new Commissioner for Local Government and Chieftaincy Affairs especially with regards to the issue of LGA counterpart funding. The Honourable Commissioner has assured the team that he will do everything possible to see that, the Ministry mandates all LGAs to release counterpart from 2009. The Chairmen of the LGAs were not left out. We seized the opportunity during our focused intervention exercise in July and October this year to advocate and sensitize them. The result was encouraging as Darazo LGA immediately purchased a brand new Motorcycle for the LGA team. Alkaleri released the sum of ninety seven thousand OI97,000) while Warji LGAs released the sum of N114,000 to complement efforts made by the State Govemment for the training of CDDs. Constraints The major constraints faced were: . Frequent changes of policy makers at all levels, so that by the time they have been mobilized and the project intends to follow up a new set will be appointed and the cycle starts all over again o Lack of standardized advocacy kits that could serve as reminders o Inability to follow up adequately and continuously due to inadequate funds. Suggestion on how to improve advocacy: o Advocacy should be carefully planned, budgeted for and executed in 2009 o Production and use of advocacy kits o High-level advocacy by APOC and NOCP 10 WHO/APOC, 24 November 2004 2.3. Mobilization, sensitization and health education of at risk communities Provide information on : The use of medin and/or other local systems to disseminate information The state primary health care development agency has established a central information and mobilization unit. This mobilization unit liaised with all programme coordinators to disseminate information through the use of electronic media like television and radio. The LOCTs liaise with LGA information officers and town announcers to disseminate CDTI activities at the LGA and community level. Other local strategies used in Community mobilization include: a Use of vehicle with public address system a Frontline Health Facility staff helped the CDDs to mobilize the Communities. They also mobilize women during ante-natal care services. a Town announcers mobilized community members Types of IEC materials used Posters were used during mobilization sessions Mobilization and heulth education of communities including women and minorities Mobilization sessions were conducted by officers from NOCP HQs, zonal office, the State and the LGAs during the special interventions supported by UNICEF. Particular emphasis during the sessions was on the need for the selection of more CDDs and for the communities to support the CDDs. Some FGDs were conducted for female members of the communities in a few places. Response of target communities/villages: There is a good response from the communities as many more CDDS were selected including women. In Darazo LGA two traditional rulers volunteered to serve as CDDs. Some communities provided community registers. They also directed their CDDs to carry out census update. In Alkaleri LGA there was a case of refusal to release census update results by some CDDs, but following mobilization of the district head he intervened and the results were made available. The mobilization of the community leaders has helped the project in the selection of more women CDDs, even though the number overall is still negligible. The use of FGD for women has fuither enlightened them to participate in CDTI. AccomplishmentsI Increasing participation of women as CDDs in some LGAs . l00o geographic coverage . Increased therapeutic coverage . Selection of more CDDs by communities Weukness/Constroints a Inability to comprehensively mobilize communities on their roles and responsibilities due to fund and time constraints a Poor follow up with communities by front line health facility staff Suggest ways to improve mobilization and sensitization of the target communities.. . Involvement of grassroot politicians and councilors and opinion leaders in CDTI r Targeted mobilization of key religious leaders and teachers. . The use of local drama groups especially during festivals 11 WHO/APOC, 24 November 2004 O() b! €E \a0a =-9tr6 EE := L}q) z ll * ^a ca te c) EO oo c) 0r -oo\+ strl o\\o sa s s .o o\ sa o\(n sr- o\\o ss EET I EEEz ?> N N \o $ c.) N f- c..l @ c..lN 6o\ o (J o q) z +F ce il6tr ct otr @(ot- o,sN oFt- t-s(o @@ N \t o lr) @ N lot-N lr)o@ o)o ro s t tNo te 9odaEA (D r\ oo N co tr) co N rn +N aN t-(.) F ca O Q 0) CE z la) r- r--$ c.'l +t- a.l$ ca (n @N + ca c.) ooN ra)\oN o\r- ra) oo$ \o € ca r- €6\o >o 6'=oau0- >0Br 4q trc) E() otro>r o= ze ll + cad c0 () bD r! C) o te E >,2 s .-elrL?'i e .E 3 EE iEEHE. 2?E=- la d s'Eg * -Etr:c!=q) '! e ar.=, F ct i C) ca €N oor- r--+ c-)1.) $ co o\ co N + \oN 66o\ rI 0 Lr C) }{ O(€ m H o0 o t+t N(B Lr IJ (B B o 0) cg (d cn z bo z Bo d t+l rg ,H(!t- olroF :3, (s c! 3 coo a.l o -o q) z$N d o { N -:. qq Uq) k- 4 L q) L *! 4 q) o- F (-) o J'-E:o.=EtrLOo'5 o'5 EH €()).= -FJ-EtrLHEE o-g):. $t . o.rltblr 6lNFI Comment on: - Attendance offemale members of the community at health education meetings: Female members of communities in the state do not attend meetings when their male counterparts are in attendance due to cultural and traditional barriers. A few are health educated at ante-natal clinics. In some areas FGDs were conducted on CDTI. - In general, how do you rate the participation offemale members of the community meetings when CDTI issues are being discusses (attendance, participation in the discussion etc). In all community meetings female members do not attend due to cultural and religious barriers. - Incentives provided by communities for the CDDs. Provision for incentives is still a problematic issue. Only in few communities are CDDs given tangible gifts in cash or kind. In other places, words of appreciation and prayers are deemed sufficient. - Attrition of CDDs. Is attrition a problemfor the project? If yes, how is it addressed? Yes attrition is a problem in the project but selection and training of additional CDDs as well as sensitization of communities to support the CDDs is expected to address CDD attrition. Other issues 13 WHO/APOC, 24 November 2003 2.5. GapaciQr building - Describe the adequacy of available knowledgeable manpower at all levels. There is availability of knowledgeable manpower at all levels from the State down to Frontline Health Facility. More health staff were trained in the current year, and there is the plan to train more to increase the proportion of health workers involved in CDTI. - Where frequent transfers of trained staff occur, state what the project is doing, or intends to do, to remedy the situation. (The most important issue to describe is what measures were taken to ensure adequate CDTI implementation where not enough lcnowledgeable manpower was available or if staff arefrequently transferred during the course of the campaign). The project has the goal of training all the health facility staff in the entire CDTI LGAs so that when ever transfer is made a CDTI knowledgeable personnel will take over. We propose the training of all health staff in all the LGAs, both CDTI and non-CDTI as this will resolve once and for all any hindrance to CDTI implementation due to transfers of trained CDTI staff.. 14 WHO/APOC, 24 November 2003 c.) c\ L 0)! q) z$ c..l o o. la) F (J ehq) L L q) !bESEsc{Po) xG \6) 3^ -s' }]ts :c B L'T ": x -{ 0)B - ar) a6ls0) PP o) iF [!lcr9Lr:osuteiE6C) :0) S.) -aGlSLE:' Rp iGt .g' o) :osc %q) (.) q) 4 L q)\o t F l-.1Oqi v) q) () oH -0)(j-.i E() c.l co co at : oN o\r- a] o\t'- c.l O o\ o\ c.)@$ c.l oo c.l h oo N\o F- co €t(ot o €(\t(\a €(0 (Y) N *-r{e iiU rTzv €$s co\o -: oN co t-- c.l cl la) cl cor- c.l co a.t F- oo $ c.tN q) E 6lL rh Q t- 0)E z ?: , r1 F- ON 00c.) o o c.l N co t- c-t €\o o) o)N(9 s o\ lfl o 0) o o $o .U (, .: =v pr)L 0) .a'o' !E t- L f-rc): yO oq) .. ql t- c!6)L z QF q) c) o O v c.t o\ o c.) a.t \o\o s N c.l o\ € o\ €\o ca co\o cos c\l (o .6fo(9 6t (r, Q JU Eit+F-d 00o cat c.t N co $ on \o F- : o\ ao @ c.t F- o co co a] $ co o\ \o\o o\ 6o\ co\o sl+ o\ o C) o I \c c) dL6)I- !+j .tE E> zEo q)(,) U3 6 € o $ Nr- co$ t $ t t $ $ d $ t t O $ $ $ O $ $ $ $ s t $ o $ s r+ r+ $N N U + Q il Q 6 d d = !H c! q2 ar) t] 3e()c) a!r Lq)E z U $ s !+ $ s t $ $ $ $ s tt J C) 0 L c) (B -v o d ca E bo ca N(6L(B ! (B '= (d(, () (B o z, bo z L F (g 0)(! m C! ,d (BF := CB Fl tr F o o o 9 Table 6: Type of training undertaken (Tick the boxes where specific troining was carried out during the reporting period) - Any other comments 2.6. Treatments 2.6.1, Treatmentfigures - If the project is not achieving 100% geographical coverage and a minimum of 65% therapeutic coverage or the coverage rate is tluctuating, state the reasons and the plans being made to remedy this. A shortage of mectizan occasioned by lack of census update which led to under-supply led to poor coverage rates in Bauchi, Bogoro, Tafawa Balewa andDarazo LGAs. The case of Tafawa Balewa was further confounded by the theft of 120,000 mectizantablets. This theft has been officially reported and is being followed up. The experience of the current year has led to the State making efforts to ensure census update and obtain more realistic target populations of endemic communities, and using these to request for Mectizan for 2009. Particular attention will be paid to the LGAs mentioned above to ensure improved coverage in 2009. Trainees Type of training CDDs Other Community members e.g Community supervisors Health Workers (frontline health facilities) MOH staff or Other Political Leaders Others(speci&) Program management { How to conduct Health education { ./ { Management of SAEs { CSM SHM Data collection ^/ { { Data analysis ./ Report writing { ^/ Others (specifu) t6 WHO/APOC, 24 November 2003 $ a-.1 Lq) -o 0) z$N O L,, o.{ oTr r- U)O atdtro o CB() o CBH bI 0) bI (d o C) (dk(.) OI o C) lr ,9 L o dp B !\!\ nI q) \ q) * s o S\ >. a.t'{ q \ AJ\ q)\Y' ta q) !) .s\Bs q) Bq)L ta ?) G a) q)s 4) x{ >. p at4 B\ a) a a.r q)\ a.r a) S!\)\ ia\o\sg\ I g g( oc'6.3.q -b e;; EEE€EHE;z 9{ o '.oo- OL O rrl u- <.E0 zz o bs -otrE9 =9zd O s$ o ! o! O^U6- -o;.E d trcr>q=5 t -E iizq! o O o (! 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GIA A oo z CB ' o d ca F o oF i H tr -:. qqq) u 4i \)\ t s q) 4 s 5 }4 cn l-< (U t)(R() Lr cS J o l-r rh >. th E] a Cg 0) OLrt- idrr-l ol -olCBIFI +oo al H 0) -o () o z$(\ o. ,Ji a \q)t tJ { A) s\x+ -\s .asoolEa .si E PS3 $YS .s'S! sN. E ES r ts S B!!|^ \i Bq)S !{tsB! !\9 \Ei *!a. s 'i: = sE :t avv .!I! EUs Es a '!i s !: .c Y:S S\Ss i*i stb 3y * s.3S' s\ ; \tI g.E s lFy i$ .a l\i *S$$ss bs! ssE S+i i!qJSO ES- e.-\s)rEE S:! ! U:is sll\ t\bO ilIis 93t\ !.:\ .q x ,N *l F- b.l N- col o, nl3 ool - C) (.) o(d F s ss .o \O9 c'l o\ o\F- OX crll -., I-l 06 ^ N,l \ orl co oor oo 991 € ool oa el a orl or -l - o\ oo ,a? \o\o tl X t- xlq .ol oo ..1 = €l - a) L c) oobs >d Oq; bo!Q^cS^ '=x eNE-a- !vo bo ()F C) L 0) bo C) oo(-) - €^\ o o. Lo t- s ll ilil lr 2.6.2 What are the causes of absenteeism? The project experienced problems with summary records from the community level as absentees were not reported in most cases. Part of the reason was the shortage of Mectizan experienced and the fear not to report those not covered as absentees. This is being followed up as validation of community data will be done to get the needed records. However, it is known that absenteeism has been due to the following: o Some nomadic Fulanis are not always available for treatment a Some of the Community members especially the youth move to the towns for Achaba (commercial motorcycling) during treatment. o Some of the eligible girls and women got married and relocate to other communities. o Inadequate mobilization of communities Solutions: o The LGAs have been urged to make proper arrangement with the traditional rulers and the CDDs of communities to ensure adequate mobilization of members. a CDDs are being trained and encouraged to follow up on absentees a Efforts are on to ensure that Mectizan gets to the community level early o Arrangement is in process to treat the nomads during rainy season, make provision for those who traveled during treatment to towns/cities. 2.6.3 What are the reasons for refusals? No case of refusals was reported, but this will be further ascertained during the data validation visits. 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 Table 7b: Passive Treatment in 7 LGAs SA[ LGA TABS USED NO. TREATED 1 Dass 40,000 13,670 2 Gamawa 40,000 14,102 J Itas/Gadau 40,000 13,804 4 Jama'ate 40,000 13,591 5 Kirfi 40,000 13,706 6 Shira 40,000 14,083 7 Zaki 40,000 13,695 TOTAL 280,000 96,651 t9 WHO/APOC, 24 November 2004 *N o -o 0) z tN O - o > N q) a, q) \.- \q) ! L.q)q +s -:. sq 4q) u a) q r- q)\ o * a vq) 5 o Loa bo L o9. 0) *<() bo H E olr *r C)o d v) rrl a .t) C) C) (,) lr) Lr(.) U) l-r(.)(/) q-r (n 0) U)(! 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NN N o) rri F- lOt- oo No(o(o @q t-t\ @q o)t- ll * !d l! ti .o6\ o =a0o6 =o()oE()F l() (f) @ (oq t-N cN@ t-o c.i F lr)q s rO rO o)(o r- o)\NlJ) (o ao(o o r.()(o(o s@(o ro (f) rr) c"j(o @ ro(o(o Ll ! ,o L9o.=2- At6 cala} oo oo\0 o\o\$ \a| caF- c.t6\o $ co co t* t--\o oo\osl t-- (a) (-- o\ r t-- c.t$ c.l .i.\o \o v1 oo^ sl\o (.*(-- ol v1 \a1 r- t- o\ cn co\o oo l.l EoE 6.> .? oF FI,/ o\ o.l c- $ o\ c.l t-- $ o\(\ c* s o\ c.l c- s o\ c..l F- s o\ N tr- $ o\Oc\ F- $ ra)\o co .d €t- \otrl \o^ F- ca\0 (--\oc\(\ It- o\ ( cl Ntr- o\ c-l c- ct o\ oo LO;.rd: beE^= E'E o )o.o (l-tr<'=lI] 'iqa * OfiE EE F- o\ o\ \o F- o\ o\ \o (-- o\ o\ \o t-- o\ o\ \o t-- o\ o\O\o t-- o\ o\ \o \os \o\o o\ (rlq c- oo o\ \o$ \i\o o\ o\ c.l o\(\ oo c- @ oo N\a) tr- \o o\ c.l q 0) bI)(g q) o C) ll * t{ Ii E] o ^oO!, gaF (.) o\d)- o o 'EoQqbo= $= Eset OoEl o o o o ti qOa'E?_ b E 9PU s E= U = E< E '70q c.l c.l\o c.t c.t\o a.t c.)\o co c.t\o cn co\o c.) cn\o a.t c.)\o ca co\o ao aa\o oo @ o\ oo oo o\ oo oo o\ ri :oE 6.2 < 9*'Fv c.lc.l\o c.) c.t\o c.) ca\o ca c.)\o ao cn\o a.) ca\o c.) c.t\o co ca\o ca ca\o ooa o\ oo @ o\ oo € o\ ho(d .r6!i,. b ev a: o-= + o= >':: O=QqaF- tr e 9.o tr() oo ea aa\o cO ca\o c.t a.t\o cn co\0 co co\o c.) c.)\o ca co\o c.t co\o co co\o oo oo o\ oo € o\ oo oo o\ r! t-- o\ o\ oo o\ o\ o\ o\ o\ N c..l c.l oN cO N $o N r (\ \o ol r- c.l € c.l o\ (\ cil -aD o 6t () 6lI q) u0EEEc) \ <,rIrr .iySF s.p\=$rB 'Sr .St =tS) .iatr SE!\ e)VE cdg q)c)OL va0 q.2 .!# EoCD U' (.)J -C 6rel\ lr 6l do\ .€ () !-r). 'l .l6l =l 0)il H(Dl '.!l -l I(!l c)ol .- -to5l i 8og 0.)lr>oOrHO 'rY-(sD .3 el oItrar i{cl9.9 o;l 'IAl u) =l ctl sFlf. L clq) q) Lt- I q) oI 9q) oLe tr U ot- E c) q) q) (, cl c) E c€ c)L q) Ltr ia \o N 2.7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - (please tick the appropriate answer) Mectizan@ delivered by - (please tick the appropriate answer) wHotr UNICETN MOH Other MOH Other wHotr UNICETE NGDC NGDC specify) specify) Please describe how Mectizan@ is ordered and how it gets to the communities The State applies and submits its request to the National Onchocerciasis Control Programme (NOCP) through the Zonal Office at Bauchi. When the drugs are ready the State collects their consignment from the NOTF Store in Lagos. Sometimes,the Zorral office assists in collecting the drug. When the drugs arrive formal notification is made to the Honourable Commissioner for Health who gives the final approval for the drugs to be distributed. When this approval is obtained from the Ministry, the endemic LGAs are informed through the department for Local Government and Chieftaincy affairs. The LGA Coordinators collect their consignments from the State office and make their distribution to the health facilities after getting approval from the LGA Chairmen. The community directed distributors (CDDs) collect their drugs from the health facilities and inform the community leaders who gave final approval for the distribution of mectizan tablets to the community members. 22 WHO/APOC, 24 November 2004 Table 10: Mectizan@ Inventory (Please add more rows if necessary) LGA Number ffi. Num ber in stock Requested Received Used Used/ Person treated Lost Wasted Expired Rema ining ALKALERI 300,000 250,000 250,000 84,972 0 0 0 0 BAUCHI 200,000 126,500 126,500 50,372 0 0 0 0 BOGORO 350,000 260,000 260,000 87,854 0 0 0 0 DARAZO 250,000 170,000 170,000 58,1 38 0 0 0 0 DASS * 40,000 40,000 40,000 13,670 0 0 0 0 GANJUWA 250,000 200,000 200,000 71,436 0 0 0 0 GAMAWA * 40,000 40,000 40,000 14,102 0 0 0 0 GIADE 250,000 200,000 200,000 71,124 0 0 0 0 ITAS/GADAU * 40,000 40,000 40,000 13,804 0 0 0 0 JAMA'ARE * 40,000 40,000 40,000 13,591 0 0 0 0 KIRFI * 40,000 40,000 40,000 13,706 0 0 0 0 MISAU 350,000 280,000 280,000 94,683 0 0 0 0 NINGI 300,000 230,000 230,000 79,606 0 0 0 0 SHIRA * 40,000 40,000 40,000 14,083 0 0 0 0 T/BALEWA 350,000 400,000 280,000 94,492 120,000 0 0 0 TORO 400,000 330,000 330,000 116,029 0 0 0 0 WARII 250,000 200,000 200,000 I I 2,29 I 0 0 0 0 ZAKI* 40,000 40,000 40,000 13,695 0 0 0 TOTAL 3,530,000 2,926,50 0 2,806,500 1,018,048 120,000 0 0 0 * LGAs where passive treatments are on. - How ore the remaining ivermectin tablets collected and where are they kept? If there are any remaining tablets, they are retrieved by FLHF staff and handed over to LGA Coordinators for onward transmission to the State. List and briefly describe the activities under ivermectin delivery that are being caruied out by health care personnel in the project area.I Request for Mectizan . Collection of Mectizan . Delivery of Mectizan to lower levels . Storage & management of Mectizan 23 WHO/APOC, 24 November 2004 Any other comments 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? Training for CSM is yet to be done. A TOT at the National level for the LTNICEF assisted states was held mid 2008 but this could not be stepped down to lower levels due to lack of funds. Table 11: Community self-monitoring and Stakeholders Meeting (Add rows if needed) Describe how the results of the community self- monitoring and stakeholders meetings have affected project implementation or how they would be utilized during the next treatment cycle. N/A 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) 24 WHO/APOC, 24 November 2004 2.9. Superwision 2.9.1. Provide a flow chart of supervision hierarchy. 2.9.2. What were the main issues identified during supervision? 1. There is inadequate logistics at FLHFS level. 2. Inadequate or lack of census updates in several communities 3. Shortages of Mectizan led to incomplete treatments 4. Majority of the community registers were in the right format, but some communities did not have registers 5. There were reports of CDDs attrition 6. In some places CDDs treat more than one community. NOCP Zonal Office Coordinator SOCTs LOCTS Health Facility Staff CDDs/Communities 25 WHO/APOC, 24 November 2004 1.9.3. Was a supervision checklist used? Supervisory checklist was used at the State level, but at the LGAs level some LOCTs are not using checklist. The SOCT has developed a simplified checklist and distributed to all the endemic LGAs to reproduce for their use. 2.9.4. What were the outcomes at each level of CDTI implementation superuision? 1. Notebooks were purchased for commencement of census update in the communities. Some communities that do not have registers and some whose registers were not in the correct format were given notebooks. The supervisory teams encouraged those they could not give notebooks to procure hard cover notebooks for fresh registration of community members. 2. CDDs and FLHFS were given orientation on the appropriate register format. 3. The CDDs, frontline health workers and community members were sensitized on the need for a comprehensive census update. 4. The communities were sensitized on their roles and responsibilities to the programme. Community health education and mobilizationwere carried out in some communities by monitors from NOCP HQs and the zonal office.. 5. In Alkaleri and Bauchi LGAs, the health facilities were encouraged to make a list of the communities under their health facility on a card board paper and paste on the wall of the health facility for reference and consistency in reporting. 5.9.3. Was feedback given to the person or groups supervised? Feed back was given to the Chairmen of LGAs supervised as well as community leaders Sometimes the feedback was given in the presence of community members. 2.9.6. How was the feedback used to improve the overall performance of the project? The feedback given has led to some improvements in some of the LGAs supervised. Alkaleri LGA printed community registers and bought a motorcycle for CDTI and released counterpart fund for routine activities. In another LGA the Coordinator was replaced for non performance. 26 WHO/APOC, 24 November 2004 SEGTION 3: Support to GDTI 3.'1. Equipment Table 12: Status of equipment (Please add more rows if necessary) *Condition of the equipment (F:Functional, CNFR=Currently non-functional but repairable, WO:Written off). How does the project intend to maintain and replace existing equipment and other materials? At the LGA level, some LGAs are releasing minimal funds to the Oncho Coordinator for the maintenance and fueling of their motorcycles. 3 LGAs each procured new motorcycles for CDTI in the last 2 years. At the State level, there is the expectation that the counterpart funds when released will be used in the maintenance of available logistics. In the meantime, the project has requested APOC to provide replacements for some of the old equipments supplied. Source Type of equipment APOC MOH DISTRICT/ LGA NGDO Others No Condition No Condition No Condition No. Condrtion No. Condition 1. Vehicle I Functi onal 1 functio nal 2. Motor cycle(s) 13 Non functio nal 1 functio nal aJ Functi onal 3. Computer(s) 1 functio nal 4. Printer(s) I Non functio nal 5. Photocopier (s) 1 functio nal 6. Fax Machine(s) 1 functio nal 7. Others a) Tv 1 functio nal b) vcR I Non functio nal c) Video camera 1 Non functio nal 27 WHO/APOC, 24 November 2004 Contributor Year 3 ('provide the Period') Year 4 ('January - December 2007) Year 5 ('January - December 2008) TOTAL AMOUNT (cASH) Budgeted (us$) TOTAL CASH Released (us$) TOTAL AMOLINT (cASH) Budgeted (US$) TOTAL CASH Released (us$) TOTAL AMOI.]NT (cASH) Budgeted (us$) TOTAL CASH Released (us$) MOH (Central + Provincial/State) 40,000 0 40,000 2,000 40,000 800 MOH (District/LGA) 40,000 3,000 40,000 8,757.89 Local NGDO(s) ( if any) NGDO partner(s) 27,664 Nil 18,650 18,649.9 8 26,470.58 19,988.9 4 Others a) b) APOC Trust Fund 82,640 30,000 74,454 39,849.8 0 TOTAL 181,290 53,650 180,925 68396.63 3.2. Financial contributions of the partners and communities Table 13: Financial contributions by all partners for the last three years - If there are problems with release of counterpart funds, how were they addressed? Continuous advocacy is on at policy makers to ensure release of counterpart funds Additionol comments a. There are some LGAs that are paying their CDDs and these include Ningi, and Warji LGAs but they didn't reflect the exact amount paid by their respective LGAs to the CDDs. b. Most of the communities compensate their CDDs in kind but the problem is that it is not regular. Some of the CDDs who got special admission into School of Health Technology were given special consideration by their LGAs. 3.3. Other forms of community support Describe (indicate forms of in-kind contributions of communities if any) r Farm cultivation for the CDDs. . CDD exemption from community tax . Provision of training venue for CDDs r Donation of foodstuff to CDDs . Prayers & well-wishes for CDDs 28 WHO/APOC, 24 November 2004 3.4. 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- Any comments or explanations? Table l4: Indicate how much the project spent for each activity listed below during the SEGTION 4: Sustainability of GDTI 4.1. lnternal; independent participatory monatoring; 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 Internal Monitoring by NOTF Other Evaluation by other partners Expenditure ($ US) Source(s) of fundingActivity 1,000 3,000 2,258 12,154 Drug delivery from NOTF HQ area to central collection point Mobilization and health education of communities Training of health sta{leLql! 19y9!q !Upg*j.!ts qpo r iq44tqll,_bqtion 9ffi qq Eqqrplqg"t G4. qoqpyJgls2glnlqr1 etc) Others IEC materials authorities Training of C_D-?,s S Lepg{qs) s/ of Internal of CDTI activities its to health and forms for treatment Vehicles/ 5,168 4poo - i24f 2,000 3,224 STATE/LGA APOCruNICEF APOC/STATE STATE/LGA APOC/STATE/LGA S LGAs UNICEF UNICEF LINICEF 38,046TOTAL Total number of persons treated 863,397 29 WHO/APOC, 24 November 2004 4.1.2. What were the recommendations? i. Communities that were not given notebooks should procure hard cover notebooks for fresh registration of community members. ii. The Front line health facility staff should assist CDDs conduct census update of the community. iii. Communities should select more CDDs which the Front line health facility staff are to train and involve immediately. 4.1.3. How have they been implemented? a Some communities have procured the hard cover notebooks for fresh registration of community members. a The Front line health facitity staff in some areas assisted the CDDs to obtain the census of the community. a Most communities selected additional CDDs and these were trained and utilized during the 2008 treatment cycle. 4.2. Sustainability of proiects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting Was a sustainability plan written?_ Yes When was the sustainability plan submitted? 2004 What arrangements have been made to sustain CDTI after APOC funding ceoses in terms of. 4.2.1. Planning at all relevant levels Planning at the state level is done jointly with the LOCTs to build their capacity. There is planning at the LGA levels as well. But there is little or no planning at the FLHF level. 4.2.2. Funds The project was transferred from the MOH to the Primary Health Care Development Agency (PHCDA). The Agency is responsible for all PHC and other disease control programmes. The transfer is expected to be beneficial to CDTI as there is more likelihood for the release of counterpart funds to the onchocerciasis project at the state level. A few LGAs are releasing counterpart funds. 4.2.3 Transport(replacementandmaintenance) Almost all the motorcycles at the LGA level have been grounded, and the project vehicle at the state level is already 8 years. Though the transfer of the project to the PHCDA has helped it to use other project vehicles as a result of integration, the need for maintenance of logistics by the goverrment is being aggressively pursued. APOC is being requested to replace some of the capital items before devolution. 4.2.4. Other resources While efforts are on to get government to live up to its responsibility to providing needed resources for CDTI implementation, CBOs and NGOs will be mobilized and sensitized to support CDTI in provision of other materials like posters, T-shirts, CDD bags, and possibly procurement of printers/computers.. 30 WHO/APOC, 24 November 2004 L4.2.5. To what extent has the plan been implemented Most of the activities planned have been executed, although objectives were not attained due to inadequate funding. 4.3. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3.1. Ivermectindeliverymechanisms All of the Health facility staff involved in the CDTI programme are PHC staff and apart from CDTI programme they are running other PHC components like immunization, health education and antenatal care. When they are collecting other materials/vaccines, they also collect Mectizan if available. At the LGA level other programme officers like the malaria Control Officer, Leprosy Control Offrcers and other staff take mectizan with them during their supervision to the health facility at the community level. 4.3.2. Training At the state level the SOCTs were trained on various components of PHC and are participating in the NPI exercise as consultants, supervisors and; independent monitors. At the LGA and health facility levels LOCTs and FLHFS are involved in all training activities for the various PHC programmes. Likewise CDDs are trained as guides or vaccinators during most of the immunization campaigns in many LGAs. 4.3.3. Joint superwision and monitoring with other programs Presently there is no joint supervision with other programmes, and there are no plans for this at the State level. At the LGA level, occasionally when LOCTs are on other PHC assignments like routine immunization they check on CDTI matters. The conscientious health workers at the FLHF level integrate a lot of their activities in visits to the communities. 4.3.4. Release of funds for project activities CDTI support funds are being released along with other PHC support funds but there is no integrated usage. 4.3.5. Is CDTI included in the PHC budget? CDTI or Oncho control programme is included in the PHC budget 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? Presently there is no programme that is using the CDTI structure, but plans are underway to use the CDTI structure for some components of the Malaria Control Programme. It is also being planned to use the structure for lymphatic filariasis elimination following the mapping of the disease in the State. 4.3.7. Describe others issues considered in the integration of CDTI. 31 WHO/APOC, 24 November 2004 4.4. Operational research 4.4.1. Summarize in not more than one half of a page the operational research undertaken in the project orea within the reporting period, None was carried out during the reporting period 4.4.2. How were the results applied in the project? SEGTION 5: Strengths, weaknesses, challenges, and oppoftunities STRENGTHS: a Increasing support to the state by I-INICEF a Increased awareness of CDTI and wide acceptance of Mectizan tablets by community members o Selection of more CDDs by communities a Increasing number of health workers in CDTI a Increasing participation of women as CDDs in some LGAs a improved support by some LGAs WEAKNESSES: a Low literacy of the CDDs . Lack of logistic support to the 5 new CDTI LGAs o Delay in report submission by the LGAs and the FLHFs a Inadequate supervision by the SOCTs and at the lower levels a Inadequate support for CDDs by the communities CHALLEN AND HOW THEY ARE OVERCOME: o The non release of counterpart fund by some LGAs. o Shortage of Mectizan a Lack ofadequate census update. o Some of the CDTI communities could not be treated due to inadequate mectizan o Logistic support problem especially at the 5 new CDTI LGAs. How Challenges have been addressed a Advocacy was conducted and will be intensified to solicit for counterpart fund support by the LGAs that are not doing so. a The project encouraged communities to undertake census update. There is the intention to request the assistance of UNICEF to conduct a comprehensive census update of the CDTI LGAs. a With the population estimates obtained during the special intervention and monitoring, enough mectizathas been requested for against the 2009 treatment cycle. a The project intends to do a joint advocacy with I-INICEF and NOCP Headquarters to address the problems of logistics. SEGTION 6: Unique features of the proiect/other matters a 32 WHO/APOC, 24 November 2004