NOTF/APOC-WHO/AKWA Ibom State annual project technical report submitted to Technical Cosultative Committee (TCC): Jan, 2008 to Dec, 2008

!-"-'.-"- I RESERVED FOR PROJE CT LOGO/TIEADING II ! I i _t CO /[{OTF: NIGERIA Approval year: APRIL 2003 Laun ns Year: SEPT. 2003 Reportins (Month/Year): From JAI\,2008 To: DEC' 2008 Proiect year of this report: (circle one) 1234(s)678e10 Date submitted: September, 2008 NGDO partner: HELEN KELLER INTERNATIONAL ORIGINAL :English Proi ectl\anqe : N0TF/APOC- WIIO/AKWA TBOM STATE ANNUAL PROJECT TECHNICAL REPORT SUBMITTBD TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) DEADLINE FOR STIBMISSION: To APOC Management by 31 Januarv for March TCC meeting To APOC Management by 31 July for September TCC meeting for Tor AFRICAN PROGRAMME FOR ONCHOCERCIASIS CONTROL (APOC) 6u\, For To: c.EY Est Bttt csD cop cnb TO Aoftl tl.aa.m; I 2{ A0lJr 2009 APOC / RECU LE DIR WHO/APOC, 24 November 2004 IANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: Country: NIGERIA/LIBERIA National Coordinator Name: Dr. Yemi Fayomi Signature Date Zonal Oncho Coordinator Name: Mr. J. O. Eluwa Signature: ... Date NGDO Representative Name: Dr. Steve Adah Signature Date: This report has been prepared by Name : Veronica I. Itina (Mrs) Designation : State Oncho Coordinator Signature Date 2 WHO/APOC, 24 November 2004 1. GpNpnel INFoRMATIoN............. 1.1.1 Description of the project (briefly) 1.1.2. Partnership 2. Popur-ettoN............... SECTION 2: IMPLEMENTATION OF CDTI....... .....12 ...... t2 .9 .9 10 l1 TtvelrNe oF AcrtvtrtEs Aovocecv '.............'...... 13 Moelt-IznrtoN, sENSITIZATIoN AND HEALTH EDUCATIoN oF AT RISK coMMlrNrtrtgs l4 CoNaNarNIry INVoLVEMENT......... ....' 16 Cnp,q,crrv BUILDING.. ......17 TRrerupNTS.............. ..... 19 6.1. Treatmentfigures.......... .....-.-.-. 19 6.2 What are the causes of absenteeism?.......... .. ..............21 6.3 What are the reasons for refusals?................ .........-..... 21 6.4 Brie/ty describe all known andverified serious adverse events (SAEr) that... 2l 6 5. Trend of treatment achievementfrom CDTI project inception to the current year23 ORoeRwc, sroRAGE AND DELIVERY oF IVERMECTIN ...........24 CovuurNlry sELF-MoNIToRING AND STAKEHoLDERS MpprrNlc .....-......25 SuppnvlstoN............... .........-.-..........25 9.1. Provide aflow chart of supervision hierarchy. ......-.-...25 9.2. What were the main issues identified during supervision? -..........,.................. 25 9.3. Wos a supervision checklist used? .......-.---. 26 9.4. Wat were the outcomes at eqch level of CDTI implementation supervision? 26 9.5. Was feedback given to the person or groups supervised?...................-.....------- 269.6. How was the feedback used to improve the overall performance of the proiect? 26 FrNnNctnl coNTRIBUTIoNS oF THE PARTNERS AND coMMUNITIES.... Oruen FoRMS oF coMMUNITY suPPoRT............... ExpewottuRE PER ACTIVITY SECTION 3: SUPPORT TO CDTI ..............27 3.1. EquteveNr 2.1. 2.2. 2.3. 2.4. 2.5. 2.6. 2 2 2 2 2 2.7. 2.8. 2.9. 2 2 2 2 2 2 3.2. 3.3. 3.4. 27 28 29 29 SECTION 4: SUSTAINABILITY OF CDTI........ .........30 4.1. INrpRNel-; INDEeENDENT PARTICIPATORY MONITORINC; Eve1UeTION.................... 30 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of thefollowingwhich are applicable)............ ........-..30 4.1.2. Whatwere the recommendations? ......-......30 3 WHO/APOC, 24 November 2004 4.1.3. How have they been implemented? ............. .......-...-..... 30 4.2. SuSrRNastLITy OF IROJECTS: PLAN AND SET TARGETS (MANDATORY AT................ 3l Yn 3) ....... 3 I 4.2.1. Planning at all relevant levels.. ......-.-.-....... 3l 4.2.2. Funds....... ............-.. 31 4.2.3 Transport (replacement and maintenance) .-...-.--.-........... 31 4.2.4. Other resources .. ...-........-.-.....-. 31 4.2.5. To what extent has the plan been implemented............... .......-.-.-..- 31 4.3. INrecRerroN............... ..........'........'.31 4.3.1. Ivermectin delivery mechanism,s................ ..-.--............ 31 4.3.2. Training.... ..............31 4.3.3. Joint supervision and monitoring with other progroms........... ...... 31 4.3.4. Release offunds for project activities .-.-.... 32 4.3.5. Is CDTI included in the PHC budget? .............. .....-..... 32 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements?............. .......... 32 4.3.7. Describe others issues considered in the integration of CDTI .....32 4.4. OppnertoNAL RESEARCH .....32 4.4. t. Summarize in not more than one half of a pqge the operational research undertaken in the project area within the reporting period. ...-.... 32 4.4.2. How were the results applied in the project?............. ......-.-...-....... 32 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AND OPPORTUNITIES.... ................... 33 SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS...........33 4 WHO/APOC, 24 November 2004 Acronyms APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT UNICEF UTG wHo African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Community-Based Organization Community-Directed Distributor Community-Directed Treatment with Ivermectin Community Self-Monitoring Local Government Area Ministry of Health Non-Governmental Development Organization Non-Governmental Organ ization National Onchocerciasis Task Force Primary health care Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Stakeholders meeting Technical Consultative Committee (APOC scientific advisory group) Trainer of trainers United Nations Children's Fund Ultimate Treatment Goal World Health Organization 5 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)' (ii) 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 ,* ofnyp..-endemic aieas that a CDTI project intends to treat with ivermectin in a given year. (iv) (v) (vi) (vii) (viii) (ix) Ultimate Treatment Goal (UTG): calculated as the maximum number of people to U. tt*t"O annually in meso/hyper endemic areas within the project area, ultimately to be reached when the project has reached full geographic covera8e (normally the project should be expected to reach the UTG at the end of the 3'' year ofthe project). Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage)' Geographical 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)' Intesration: delivering additional health interventions (i.e. vitamin A supplements, uru"n*uror. for LF, screening for cataract, etc.) through CDTI (using the same systems, training, supervision and personnel) in order to maximise cost- effectiveness and .*pt*.r communities to solve more of their health problems' This does not include activities or interventions carried out by community distributors outside of CDTI. Sustainabilitv: 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' communitv self-monitoring (cSM): The process uy Ytlh the community is "-p"**"d t" oversee and monitor the performance of CDTI (or any community- based health intervention programme), with a view to ensuring that the proglamm.e is being executed in the way intended. It encourages the community to take full ."rponribility of ivermectin distribution and make appropriate modifications when necessary. 6 WHO/APOC, 24 November 2004 FOLLOW UP 01{ TGC RECOMMENDATIOilS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session (Please add more rows if necessary) 7 Number of Recommendation in the Reporl TCC KECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY WHO/APOC, 24 November 2004 Executive Summary Prepare an Executive summary of the report in not more than one page. Akwa Ibom State is located in the south eastern part of Nigeria and is now a part of the south - south geo - political zone. The State has a total population of 4.1 million people (2006 Nationallopulation census figure projection). Languages spoken are Ibibio, Annang, Efik, Ika Ibom and Oro. English is generally understood. Majority of the people are Christians, a few are traditional worshippers and an insignificant number are Moslems. Akwa Ibom State is in its 5n year of project implementation. It is unique in the fact that only 2 of its LGAs are endemic. These 2 LGAs ho*.rr., are difficult to reach areas. The people are not nomadic but permanent residents as such absenteeism was largely due to farm activities. Advocacy visits were paid at both the State and LGA levels. These were both concluded with promises of support -ud.. As at the end of this reporting year however, no support came from in. tCar. At the State level on the other hand, there was an increase in the amount released as compared to that budgeted from}OOT to 2008. While 69oh was released in2007,84olo was released in 2008. At theiommunity level, mobihzatron and sensitization was carried out to the people to create greater awareness on the consequences of the disease, the importance of y"uily th.rupy with Mectizan, andthe need for community ownership. Community leaders, bpinion leaiers, and religious groups were mobilized to encourage greatet support for CDDs, provision of storage and iafety for Mectizan, and self monitoring and supervision of distributors. The project area has 337 health staff out of which 20 are involved in CDTI since only 13 communities are targeted. For this reporting year 8 health workers were targeted and trained, and 63 CDDs were"targeted and trained, thus achieving 100% and 92o/o respectively. The project intends to intensify advocacy such that greater number of health staff in the project area can be involved in cort and more CDDs can be made available for project implementation. All target endemic l3 communities were treated. This gave a geographic coverage of 100%o' With a population of 26408 a total of 17611 persons were treated, achieving 67% therapeutic coverage. Challenges faced by the project include: inadequate support by LGA Fxecutive to the progr*ri*., transfer of CDTI personnel to non CDTI LGAs and areas, non-identification and inrolr.-"rt of CBos and VHCs in CDTI activities, CDD attrition and chieftaincy tussles in several communities. To address these challenges these were done o Local Government Services Commission was contacted and appealed not to transfer staff involved in CDTI activities out of the CDTI LGAs o HKI brings additional vehicle during CDTI activities o Intensified advocacy visits to the LGA Executive to solicit their support to the progralnme o Efforts are being made to identiff and contact CBOs and VHCs in order to involve them in CDTI activities' 8 WHO/APOC, 24 November 2004 SECTION l: Background informatlon 1.1. General information 1.1.1 Description of the project (briefly) - Geographical location, topography, climate Akwa Ibom State is located in the south eastern part of Nigeria and is now apart of the south - south geo - political zone.It lies between latirude 70251-and 8025t and longitude 4032t and 5033t Eist. The State sits astride a seemingly interminable sand bank, a pasture of dominant vegetation of green foliage trees, shrubs and a vast oil palm belt. Reputed to hold the highest density of cash crop in the world, the State is bordered by Cross River State to the east, Abia State to the north, Rivers State to the west and the Atlantic Ocean to the south. In terms of topography, the State is mostly flat because its underlying geology is predominantly coastal plain sediments. Around Itu and Ibiono LGAs it is undulating, with iorn. u..as as high as 200 feet above sea level. On the basis of terrain and landform, the state has 5 major types; o Alluvial plains - with Mangrove swamp and flood plains . Beach ridge sands - with seaward mangrove swamps and flood plain zones that give way to the beach o Rolling, sandy plains - with gently undulating plains . Dissected upland belt - with steep sided sand stone hills and ridges o Obotme isolated hills - with highly dissected landscape. Being within the humid tropics and in close proximity to the sea, the State is generally humid' The ilimate is tropical ruiny, with abundant rainfall and high temperatures. Mean annual temperature is between 260C and 280C, and mean annual rainfall is between 2000mm to 300-0mm. Two main seasons of the State are wet and dry, with the rainy season covering about 9 months of the year. Maximum humidity is experienced in July, and minimum in January. - Population: activities, cultures, language. The State has a total population of 4.1million people (2006 National population census figure projection). Languages spoken are Ibibio, Annang, Efik, Ika Ibom and Oro. English is generally understood. Majority of the people are Christians, a few are traditional worshippers and an insignificant number are Moslems. Ancient religions commonly symbolized by masquerades are now displayed for leisure and relaxation. Such masquerades include Elrpo, Akata, Ekong, ElEo nyoho, Abon and ElEe. Major occupations of the people are farming, fishing, and lumbering. - Communication systems (roads...) The roads are tarred but unmaintained (i.e. the one linking major cities). Others are un-graded roads and foot paths. The roads are used with much diffrculty during the rainy season. A number of the communities are only accessible by water-ways. - Administration structure There is a two-tier administrative structure at this level. A democratically elected Governor heads the State executive council. The local Government chairmen who are also democratically elected head the local councils. - Health system & health care delivery (provide the number of health posts/centers in the project area if the information is available). 9 WHO/APOC, 24 November 2004 The health system operates at three levels, the primary, secondary and tertiary levels. The primary levei which Ir co-rnurrity based is run by the Local Government administration in conjunction with the State Ministry of Health. It comprises of the Primary Health Care Centers which ideally should be found in all communities but that has not been the case. The secondary level is managed by the State Ministry of Health and takes care of referrals from the primary level. The tertiary level is managed by the Federal Govemment and comprises of the University of Uyo teaching hospital where special cases are referred to for special care. - Number of health staff in project area and number of health staff involved in CDTI activities. Table I : Number of health staff involved in CDTI (Please add more rows if necessary) District/LGA Number of health staff involved in CDTI activities. Total Number of health staff in the entire project area Br Number of health staff involved in CDTI B2 Percentage B3=B2l Br *100 Ibiono Ibom r59 7 4 Ini t78 13 7 Total 337 20 6 1.1.2. Partnership Partners involved in project implementation at all levels include: 1. The Federal Ministry of Health (FMoH) 2. APOC-WHO 3. State Ministry of Health (SMoH) 4. The LGAs 5. The communities 6. UNICEF 7. Hellen Keller International Overall working relationshiP The Federal Ministry of Health oversees all CDTI activities at the state level. It monitors, supervises and builds up capacity of manpower at the state level for project implementation. The State Ministry of Health provides the manpower needed for the implementation of the project, provides counterpart funding for activities and monitors overall implementation rtrut.gy *d administration. The NGDOs (I-iNICEF and HKI) provide part funding - .rp."i-ully through Vitamin A Supplementation, logistics and expert advice for project irnpte111.rrtution. The LGAs plan,supervise and oversee CDTI activities at the LGA level . They atso provide counter pirt t rd.. Communities mobilize and sensitize their people to foster greater involvement, community ownership and support for CDDs' plans are in place to mobilize the local NGOs and CBOs. 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Fl H o Ei I sO N L c) Eo o z tN (J o Or o ol d q) E E oI Lq)E li h I tr cll e Xq) c)(h GIe a J d L{icd E9,Iao ct .= ah utZ IY C) o) .r)t'=ctEEoootrE'EAAtE o'or. c)oC >d?(d ?r=c)s .a(g E9 rv (d 6() ,-E o))Hgq')c) .38 lv> 'r()o.'E!t) .rGt>o5 =oT< t ah tq)g a EOEE o U g() U) aoa Err?E cX a- dz >.(d Z L U) bt li o EE Q q()a q C)a b0_E+ .!i tr a- >.d z (! z q) 6lE ah ah 4) Q a6EE o Q >.(d z Cd z P-c 1|Jtr d= a- oLrd =z o ti(6 a bd E] E d LF o.6EE o Q qr4a # C'l B0)<a - f.l oo- liq a' olrb0(g -l Je.i bo H C.I oli(! z 9r/D -6) EtrG=N;r ooE( q,)z o *oEE o(J 0.)tr -o0)tri o!- 1iE a- (d l- d:- () rl I li U' a Eo -o o o .o tr d o0 C) -o () tr o E o -oE 0) c) (.) A. E obi 7= a;0); ^:P!J '- \J P\q\-(E 0)s .yo OI\&v!\ o* *LBtboBtra)E3 .) A) .=\ 'u a*tv (! P>. '4 EG)\kq)lr \J\oFi o)YS dLnS$il NO)dH\ii %PBu)\) (Bs\ 0)GH .(! .oo\r4€ .sx S .Y, u)c0)q, t\ .i5E.F 'ar? .a Q) 'r=ir^.()()u:(€ cq .SE q<(: ':!J OUVsE()q).so.rtrtr\r= 'E --: 6' Ig '.is .E .= 7-c FF SE ..itdF o->l; =E FIN E<E FI Fa o F o E o IIfl6fl E o E .9c! IIN z o IF(, lrl o 2.2. Advocacy State the number of policy/decision makers mobilized at each relevant level during the current year; the reason(s) for undertaking the advocacy and the outcome. Describe difficulties/constraints being faced and suggestions on how to improve advocacy. At the state level, there's a history of good working relationship between project implementers and the policy makers. It is of great importance that this relationship is sustained, and further supported in terms of finances, logistics and provision of relevant materials eg. IEC are rendered. As such the following persons were mobilized; o Hon. Commissioner for Health o Permanent Secretary, Ministry of Health. o Director of Public Health Services The State has maintained continuous release of counterpart funds. There was an improvement in the percentage of amount released as compared to amount budgeted this year as compared to 2007 . This reporting year, 84o/o of the amount budgeted was released at the sum of $27,000 Last reporting year, only 690/o was released. The LGAs on the other hand, has not been rendering financial support to the project. The following persons were however mobilized in each LGA to try and reverse this situation; Chairman, Councilor for Health, PHC Coordinator and Head of Personnel (HOPs) Advocacy visits at the LGA level were concluded with promises from these policy makers. The project hopes this will foster a positive outcome by the next reporting year. At the community level, mobilization and sensitization was carried out to the people to create greater awareness on the consequences of the disease, the importance of yearly therapy with Mectizan, and the need for community ownership. Community leaders, Opinion leaders, and religious groups were mobilized to encourage greater support for CDDs, provision of storage and safety for Mectizan, and self monitoring and supervision of distributors. Some of the communities responded positively and have agreed to support the CDDs. Diffi culties/Constraints : . Inability to meet with the LGA Chairmen even when dates and periods have been agreed on prior to the visit. o Instability and rapidity of change in the appointments of those in charge of LGAs How to improve on Advocacy: The project intends to utilize top officers of the Ministry of Local Govemment & Chieftaincy Affairs for advocacy campaigns. Follow up visits will be made to ensure positive outcome. l3 WHO/APOC, 24 November 2004 2.3. Mobilization, sensitization and health education of at risk communitles Provide information on: - The use of media and/or other local systems to disseminate information The principal strategy of the project in mobilizing the communities was face-to-face discussions in community meetings, health education sessions or community leaders' forum. Health staff using posteri, flip chirts, brochures, and fliers went to all the communities to mobilize and health educate them. Other methods used were: * CDDs education of community members * Announcements done in the churches, mosques and during community associations or cooperative societies meetings. + Town announcers' dissemination of information to community members Women and minority groups are mobilized during their fellowships, associations, and other meetings. The wome*.nt back to mobilize their husbands and children and also became CDDs - Response of target communities/villages Community me-be.:s are varied. Majority expressed willingness to continue complying with Mectizan treatment. A few were non-committal - ready to take if they were around during distribution but not enthusiastic about it. Some others expressed the belief that it is the responsibility of the goveffIment to do everything for them' The following accomplishments were made; - Mobitization and education of the 13 endemic communities - Treatment of 176ll community members The major constraints experienced include the chieftaincy tussles in the communities which have spiit communities into various camps, and others outside are viewed with suspicion' This made community mobilizatio, -ori problematic, as efforts were made to mobilize all the camps without causing strife. Another constraint is the belief of the community members that government should di everything for them, being part of the Niger-Delta region - the part that produces oil for the country. Suggested ways to improve mobilization and sensitization of the target communities Toiilpror" mlUitization and sensitization of the target communities; - pHC staffs at the community level need to sustain the mobilization of the communities where theY live and work. - Empowerment of health workers, particularly frontline health facitity staff with skills for effective community mobilization - Identification, sensitizaiion and mobilization of credible local NGOs and CBOs - Usage of communitY drama grouPs - Massive use of IEC materials - coltaboration with the Department of chieftaincy Affairs and usage of their Community DevelopmeniAssociations unit to provide technical support in training health workers on effective community participation' t4 WHO/APOC, 24 November 2004 co c.l L() -o 6) o z N O H^ o \o 8oHe'! ? -EsOH€-t{O u) I -!E Y, E Etst 3, E tgE .Z A EEo E o0 qLi= bo d +OE .n .2 a*d3 c) € q.='5 E ; i€ .E fl .-., oF6 ec T So.>E E I :gI Z q isE '2 -8 Br'- o)o.)1- J)(d6H E U EEh O T, E EE#n E E H Lao0 + .,= >. g.E!r.E , g .i' f =AE $tr i* reEUE E h Eg r,8+E E u tr= --oT€ F E, q€ ?T# -{E E $ IB Ef E .=Eb E 2 ;b EEE E+g I a E! :E;A EsE E q EE E€€Est f g Er Eix €;p; E Ar *oEo o t tr tr = > - r\.-ef p s .E 8e *!EE€E; E Eg E.EEEEE H A -;E E.6EBEH E^H tEg fi38 ElE E:g ?EE EgEx EE-5 E;:i:EE EEEs iEr IgE EIF EI;e ;TE gEs E*E IEgEIis g:g E€E EEaS EE? iEs 5EF I;se E5fi iEE iEe {#f 8 !iEEigg!iEEi€ES nQ .:a rO tr6 EE =!r! -Brtru0 ZE oo lt ; dq .; q) u0 6{ o I 0r tr) c- O e6t o\ : le :.E *I =5f = E=623, cn o\ N Q o z ta + la lt ta F \n oo$ c)\o la 9- cqOEA dQ (a) tr-N N(a te a aI s c! z c..l ra o'aoa ao ..L(EX >o?* EOatEEEO otro>r o-- -aE =oze ll * cala la o o0 o Lo!r .o o\ O \o^\ \v le E.ak r !Eti $ o\ ?a ?oc ,:.: -L IE.E;; -=cIg E8 5F:.L o.- * s o\ ra F1 o t os o o I cl t-( .i 4 % s)Uq) q r_ q) t\ t \)4 q) a*U F aO o tr oO YPo(gEA u'5>'F od >4.l<n '-() AZ EE EO -o (J st o.ll{ElNFI 2.5. Capacity building - Describe the adequacy of available knowledgeable manpower at all levels. The project staff at all levels are generally knowledgeable on the disease, CDTI concept, the importance of Mectizan intake and its distribution process. However, more of the health workers still need to be trained on CDTI implementation. - 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 tmplementation where not enough lcnowledgeable manpower was available or if staff are frequently transferred during the course of the campaign). The project continues to experience the problem of frequent transfer of trained health staff at the LGA level. The Local Service Commission has been contacted to either allow them to remain or send them to the other CDTI LGA if at all they have to be transferred. Plans are in place to continue to train more health staff and CDDs so as to tackle the problem of transfer and CDD affrition. t7 WHO/APOC, 24 November 2003 q) .! 0 I L 0) z ?llQ o -: + +.:eu ir o rlzv ia $ €t \o ra : t) v Q) c) () c) v ?1FU (.i @$ ca\o rU E9 Eo. -ah c)F{oOF r-o .t .Etrc( z "rr d o -: + $e= {e= O I : c) 0) q) e) \v (JF N EIol =618!lIEEtg 3E E> zE q)() Eit+F-d (J d +. q = (\l N \o ra) € r- o q) o I \c (, (\ \o 6 e( ah ah () FI 9ooc) Ec! o 0)E z _t E &31 s o +. o( z $ N N O O t (\l ol t q) q) q) \o (JLF $ \o I Fl .9 0 o Eo -o op FI Fr oF c.tO N H C) -o o o z $N (J o. @ !! (s v) (d C) (.) Lo o bI) cd C) o -l 0) (d o 6) (/) C) >,L oa troA. (t) ol-i(s U) 0) o! l< C) d(d v)OQ rJr Fr q) t<d U)ooc 6Jk +r o ar)lr 0) (B l.< 0) F t-( U U)q) L L q) F G c)L cl q)E o B E crl xq) o) rn c!q) a E c) GIL () Lq)t U) o)q) c{L o ahlrq) c!L Le bo o s i o B o 60 * o I t o e .a s <t B o .\ ts =+ q U't q)() a) k- U't > r. q)\. t ! q) Fi a) ea o (B tro tr C)g F oOqi o C'') o 0.) iol.< .o)E o ,tr €(s ot) tr i dlrF .iir ,l .ol(Bl FI Table 6: Type of training undertaken (Iick the boxes where specific training was carried out during the reporting period) Any other comments 2.6. Treatments The project was able to treat 176ll people out of an ATO of 20499 in addition of 335 people (passive) with 47576 tablets of Mectizan 2.6.1. Treatment figures - If the project is not achieving l00o/o geographical coverage and a minimum of 650/o therapeutic coverage or the coverage rate is fluctuating, state the reasons and the plans being made to remedy this. The project achieved IOO% geographic coverage and 67oh therapeutic coverage. Issues that have affected coverage rates have been: o Community tussles over chieftaincy titles o Attrition of CDDs leading to abandonment of the prograrnme o Perception of community members that they are not sick, and therefore do not need to keeP on taking the drug. o lntra- and inter-community strife at various points in time. To address these, the project is mobilizing all camps within a community using neutral persons or those outside the project. Community mobilization will be intensified with availability of resources. Other methods that will be employed have been highlighted in suggestions under mobilization. Trainees Type of training CDDs Other Community members e.g Community supervisors Health Workers (frontline health facilities) MOH staff or Other Political Leaders Others(speciff) Program management How to conduct Health education Management of SAEs CSM SHM Data collection Data analysis Report writing Others (speci&) 19 WHO/APOC, 24 November 2003 t+ o c.l L 3 C) o z t C.l d o Pr \o 6\ il s c-\o il oQ H x H \or- q) 00 G I s s. 1o q) 0o qJ qJ .E o's\ts rs .a .cEol !\ .sI tsaJ\.t \EuE€ E:rl sr o€ EtrS!SU .s '-sE \.u 's ig \E\\ s\)E SF|.l 10'v eSE sdE (\S:L E EB .9 Yrs bs t *c,s is'*Y I:b 3€ * rys' c{ ^ 'rryts \oI Xs\ :- .S SE E. QUra €\:: ss o\ * ES E t} l ds3 tss ss : :t6 = E*\-%\r \FE TUq s'=S 'TE 's c\I Ss$ $ES:rirlt tr='r rEP HE\ ag c.t oo N cl oF D 0)L(! o c) 'a Lq c) 9 @ oLd (.) C) C) Iti 0.)o a o E O (d C)L o o a o(.)a(H o L C) -o (! F s o\r- il o x \o cr OIol -lxlrl c)I (rl 0)LP c) o o 0)oqi o L C) ,o z € C) o od oF D s C.I s\o ooI olol ;l -l o. -l o\sl3 -l N o oo5o C) ol<F O]oli1 x E 0.) d oL C) oooo(H o t<op z OIOI -lxl ca .ol --l (!'0)Ld o() il'd ! o. o 5 2 IJ]& -o 0) l{= o .; cd a o .E et E =l tr "l EEl .eEl trgl 6PI !ol trOl dJ!s J.Jl c) =l o->l >r at - .91 dPla '=l 6)leEl (HFl o EI E <*l *ol E Ll)ol c -ol _ El s =l bzt? oo $\o a.l (! C)Ld o C) 'a Lrq G) Cl)o .E E E oo o 0)E o I! oa. or Iol o -l EXl - €l .=9l oo(dl tr(Dl .-H.Z o.rl - rt.E 9l E(sl 3ol o- rl Ool o-!t _trl cd =I Ezt? 0) dL c) o0$0^ 9Eoo oF C) C)bod o) \o> 9-.o-o CIo a.(B L bo o o)(, o (dL 0) bI)(BLo oo O^ Eo\ oa(! L 0) F -o I e g{ os 6-3 d Ue;;6EH€€H:;Z HE E O rrl E3 AO EB 5"92s d \o o\ c-NO 66 o\ ao LC-'O .ts g.EE EEtr>O= = &-a u >u! tr- co .+ ca $ o\ oc il+ r o '5o =boO d^ i: >vootoF C.I\o o\ rr\o F b Eo!;g)5[EZeu cA € rr) la) @ CI N \or- r{.}ao ca \o$ o\r- I tsoE 6.2 itri)!Hot.e P f<v CAO c-. 6\o+ CO €\ o\ = N a .9 ,3E. EHFf€:d=oE E - g€ .6 E6F o\$O o\ o\tr) cn c- 6 t\o(\l t)(D I r< lr E oO il*dd a ,a \v cg .9 o.> -MEsd!d6 bo< uo O a 9E 3o € E3'fri E'5 !z g- + o\ ra tsoE 6.U aEo C (d.: -./ I -O FU .t o\ ra \OU1 ai-r6q o= x olE.s EH EE$EE- + o\ ?a .E<gq '6< otrtr pp Fl F o t'{ o Ch U)d or Rqq a) s) q- Ua o q) L \ q q) 5 JI(/) l-r d (h(€() Lr Cd d ri J o L (n t >.s U) rrl a (d C) H (d olrF rrt o-rl -ol(dl FI il 2.6.2 What are the causes of absenteeism? Some community members were either in their farms, market or prayer houses during distribution. As such they were not met during treatment rounds by the CDDs. Some of the communities made ilrangements for mop up treatment but all the absentees were not able to be treated before the end of the reporting year. Efforts will be intensified in the upcoming year to reduce number of absentees and achieve higher therapeutic coverage rates. 2.6.3(l) (2) (3) (4) What are the reasons for refusals? Some community members feel they are not sick; so why take drug Some did not take Mectizan due to religious belief Some community members could not stop taking alcohol Some women felt the exercise was for family planning 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 2t WHO/APOC, 24 November 2004 $O(\ (.)3 () o z t c.l Ci o ar o > (\ c.l q) B q) o'\ a) L a)q * -\ e Va U't a) a) kr V1 L u T\ t S v v) q) U o !q)q bn Eoa 0.)li C) o0 tr L E €(.) L{ l-<)oo o d a r! a (n c) () o v) Lr o) (d a o ko .u)(+( o u) c)(n(c U #r o)l -oldtFI =EeE a <.E E Aa " oo() H.E E P(q.5Cl,oo tr o-=f;EslLloo (H oqr .9 EOoc!? boEo6E (D*exq:i g9<' ;.9 Uq)-< tr&96 _=iGq-;o- o.9t6 o tr tr= idoa() O E 4i,E ; ,- .o =6>e o-gjt)' vti- d-=:Y (JO H .HqE *-r*'E EEEEg o o. a ! 0) do o. a.(d tr o.r 9(dt Aq H!2N* -9!2-A: E () EQtrs'io ?o x 0)a o oo * O coN s o cl Lo .ot c) o z$ c.l \J o< oir c) bD c{Lq) o C, Fr GI tr L o cl lt q) rd q) aD q) L E! rai U) c)(r) (a 6 N "l 6l(l) L 6l Io L q) L € Fr q)5 €) i!-e) .r, €5 .E's -. clqa 8.e 0rU t. E \J s<ILqrus *. .S 9Ni\6E 0)\J +.9 o ro) Oli qe6)(Jeq) EE. .ge t-{ q)L1 C) l-l eUX ILodL0) :hHEIoEltrdl6gt ool €31cl c.)fooE(u9b cr5 a)L!etr(H 6dou2 roHtr()c)El-H -i6 Itl fi\o 6i o,l()l -olcdlFI o 00 E 8s/O O oo\o Nral c-lr\ €\o o\t-- o (€ oo or o rr i ,-i ri o _ 6I)a) d ^ - Oo\ o o\r- N\o \or- c-)@ \ooo ll r QrI] H o\ oiE() =ooo(!gE ooE()F t--(n $$ \o tr-ra) I-r\o rll !q9 od .o o.=2- A6 o. o\ co o\ oor-r- oo tr-lr) co @\o co ca \ot- Eo d o.= t strFU Ntn t-r cnlr)$ c.l ca @r- c- (n\o \o o\ o\$o(\ Lq - oY - x gdEEs€go ' d. 39E EE o\ ca c.l\o N+\o F- N|.- co c.lC\ co\o$ cO c.l oo $\oN C) o0(d e6q) o() ll * rd rd ri o ^ bI)9 EG.F ()6\d >v -o o OO o o O oo o-b0= $s E 8;tt(lori la) oo (-.l o\ O O tl q() o.E g_ E 5 SE? E= 3 =Et!>oa N c.l cn cA ri =ud o.= aEo < 9€l+ Lr C\ ca co ca o0 G' =al .tG(H>:ioo?_3 Ekl+.Yelo- oaV.1 6at- tr v 928 tro oo ca co c.t eA co & rr.l t)Oo o.l \loo c.l c.l \oOO c{ t-. c.l ooOO c.l o\oO c.l oN 2.7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/ MOH NGDO Other (please specify): Mectizan@ delivered by - Qtlease tick the appropriate ff'fOff tr^/ wHon UNICEF NGDO Other (please specify): Please describe how Mectizan@ is ordered and how it gets to the communities The ordering of Mectizan begins from the community after community registration (census) has been conducted and number of people obtained. These are sent through the LGAs and the State to the NGDO (HKD. HKI will then use this information to apply for the Mectizan. Where distribution has been on-going, information is obtained from the treatments reports from the community summary forms. On arrival of Mectizan to the port of entry, HKI collects it for storag.. fn. State then collects from HKI store and later distributes them to the endemic LGAs who deliver it to the designated Primary Health Centres which are collection points for the CDDs to collect for distribution. Inventories are properly kept at all levels' Table 10: Mectizan@ Inventory (Please add more rows if necessary) - How are the remaining ivermectin tablets collected and where are they kept? The remaining tablets of Mectizan are collected by the Front Line Health Facilities and LOCTs during collection and collation of treatment reports. These are in-turn sent to the State Onchocerciasis Control Unit at the State headquarters for safe keeping and used during the next treatment cYcle - List and briefly describe the activities under ivermectin delivery that are being carried out by health care personnel in the project area' Health Care Personnel are involved in the following activities: o Collection of the required Mectizan from the State . Delivery of Mectizan to the designated PHC centres which serves as collection points o Provision of storage for safe keeping of Ivermectin o Maintain proper inventory for them o Collection of treatment reports and left over tablets and return to the State for by - Qtlease tick the appropriate answer) wHo tr uNICEF D Number of tablets RemainingExpire d Los t Waste d Used Used/Person treated ReceivedRequestedNumber in stock State/DistricU LGA s05101 3985 5s83145001450014500Ibiono Ibom 27732466 120283250032500 32500Ini 3750fi25 3351500I 5001 500Passive 90717179464757648500 4850048500TOTAL Any other comments 24 WHO/APOC, 24 Novemb er 2004 2.8. Community self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project atea-? If so, When? June 2008 Table I 1: 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. Community monitors identified several issues like absence of CDD compensation, presence of community strives that affected distribution, and acknowledged that CDDs have been skil[fu| in their assignments and no serious adverse events have resulted. They however called for state-wide enlightenment in radio and television in the way polio campaigns are conducted. 2.9. Supewislon 2.9.1. Provide a flow chart of supervision hierarchy. 2.9.2. What were the main issues identified during supervision? Non provision of allowances for the LOCTs and other health workers involved in CDTI activities by the LGA Executives Some Community-directed distributors refused to distribute because communities were not supporting them. a DistricU LGA Total # of communities/villages in the entire project area No of Communities that carried out self monitoring (CSN[) No of Communities that conducted stakeholders meeting (SHIvf) Ibiono Ibom 4 4 0 Ini 9 9 0 TOTAL 13 13 0 NDGOAIOCP STATE (SOCTS) LGA IOCTs) DISTRICT SUPERVISOR CLINICS i/c COLLECTION POINTS COMMUNITIES/CDDS a 25 WHO/APOC, 24 November 2004 Due to wrong timing for the distribution (farming season) some people were not available for treatment. 2.9.3. Was a supervision checklist used? No What were the outcomes at each level of CDTI implementation supervision? The LGA Executives were requested to provide allowances to the LOCTs to enable them carry out effective supervision The communities were encouraged to select more Community-directed distributors and support them during distribution Front Line Health Facility Staff were requested to increase their supervisory visits to the communities to ensure adequate follow up of absentees and refusals. 2.9.6. How was the feedback used to improve the overall performance of the project? The LGA Executive agreed to support the LOCTs to enable them carry out effective supervision. A few more Community-directed distributors were selected. o 2.9.4. a a a a 2.9.5. Was feedback given to the person or groups supervised? There was feedback to the supervised and action taken to address what was deficient. a 26 WHO/APOC, 24 Novembet 2004 SEGTION 3: Support to GDT! 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 off1. How does the project intend to maintain and replace existing equipment and other materials? - The Project will utilize both APOC funds and State Counterpart funding to maintain and replace existing equipment and materials. On devolution by APOC government will take over tully. Source Type of equipment APOC MOH DISTRICT/ LGA NGDO Others No Condition No. Condition No. Condition No Condition No. Condition 1. Vehicle I F 2. Motor cycle(s) 4 F 3. Computer(s) 1 CNFR 4. Printer(s) 1 CNFR 5. Photocopier (s) 1 CNFR 6. Fax Machine(s) 1 F 7. Generator I F 8. Overhead Projector 1 wo 9. Projector Screen I F IO. UPS I wo I F I l. Air Conditioner 1 F 12. Tables 6 F 13. Chairs 7 F 14. Fridge 1 F 15. Steel cabinet J F 16. Stabilizer (2) 2 F 17. GPS 2 F 18. Bicycle 5 F 27 WHO/APOC, 24 November 2004 tooN Lq) -o o o z tN U oA |l oo c.l cn C) oo CBq o E c-.E C)a(/) q)tr d >. C) I 0) L{O o rh d E(d o,L(.) P H) o +r o oad 0) otr B v) trop lia C) H C)li C) (H rn L< 0) o) '- 0) .: c) E -v,ESoo)e-cE:EEGt ql an u)bEtrllEKGo. q)d ! +r -oOu) rh ti troEE 6lC ':''l d ctE f-l cal -l,l -l.Alc! Fl(q Fl a. a\\ \$ C- rn o ''l-E^ e3$3 r-c.l \oN rr)(r) c.t \oNia(\lia )Z EE^ *d-?sE9Z (.)5=t 4 v/Y\ o\NNcn c-@c..l e\o N' c\ B n Cgo -l*E^ *?EEEa&<' OO $ c.l O \o Ot E H. 3$a O ta) c-+ c.) (\ o\t-- co co altia €\o 6 c\\ t_ G,o -l*5^ es#s @\ota) * 6\oin$ sa=$a H - v- oo\o lats €\o las a s N L .$t ct 6(, J*E^sa R2 EsiU tr)+ t--NN o(.t lr) c.} ca ia o\t\\oia saSE3 -4vi I ae\ st GIo -l".5^s6 R9 --r (.)Y:Pdp=, oo c.) O r)N € co ra -Fas rE3E,ay-ro -3 -?va No\q o\ oo li & L EI oQ E= 'd (g oc) 9..E;l^ *iYO)(, o- id z+a oEg? =og t7,a >< >r(JC?o.d(Jrhql JZ- v) Eg9EAA 0trq) o d p aaLF O E ?rt tI Fi oF 3.3. Other forms of community support Describe (indicate forms of in-kind contributions of communities if any) . Free lifting of gravels . Free land for farming ' Prayers 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: l$: II128.20 Table 14: Indicate how much the project spent for each activity listed below during the reporting period. Expenditure ($ us) Source(s) of funding Drug delivery from NOTF HQ area to central collection point of communl 9364 2137 1824 4954 Mobilization and health education of of CDDs of health staff at all leve,ls CD monl and Evaluation visits to health and authorities MOH MOH fr4OH MOH 435 MOH !.e!!glgs/Motorcycles/bicyc_lesmainteqq{89@qyip{-n9g! Salaries 3302 4984 MOH MOH Personnel Motivation S lies Training Travels 4386.51 162.89 APOC APOC 1008.87 1l2a.gt AP.OC APOC Communication 758.86 APOC Education/mobi lization 651r.67 APOC Other Expenses 967.61 APOC TOTAL 47923.32 Total number of persons treated L76IL Any comments or explanations? 29 WHO/APOC, 24 November 2004 Activitv SECTION 4: SustalnabllltY of GDTI 4.1. Internal; independent participatory monitoring; Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable) Year I Participatory Independent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation Internal Monitoring by NOTF Other Evaluation by other partners 4.1.2. What were the recommendations? 1. A 3-year detailed Onchocerciasis control plan that reflects integrated delivery of compatible health interventions should be developed. 2. Records of mectizan and other inventories should always be checked and cross-checked to ensure accuracy. 3. All SOCTs should be trained on keeping of Mectizan inventories using the appropriate booklets. 4. LGAs should include in their allocation to onchocerciasis control some amount of money for supervision of onchocerciasis control programme and release same 5. SOCTs should routinely visit only the LGA level with spot checks at other levels. Visits to levels lower than the LGAs should be geared towards solving specific problems or addressing issues 6. An integrited checklist should be developed and utilized for all supervisory visits 7. Staff at lower levels should have their skills and competencies developed in providing quality supervision 8. SOCfr and LOCTs to be trained on prograrnme management that will include planning, advocacy skills, supervision & integration.g. A reward system should be developed (e.g. letters of commendation, awards, special gifts) tO. ihe State should empower lower levels to INITIATE and conduct trainings I 1. Training sessions should be integrated for compatible health interventions. 12. H3AMictivities to be well planned to address specific needs and innovative approaches adopted. 13. Supply Mectizan to lower levels based on population figures 14. Aliow Mectizan to remain in the community 2 - 3 months subject to dates of expiry for treatment of all eligible Persons 4.1.3. How have they been implemented? The evaluation exercise was conducted in December 2008, and the recommendations will be addressed in the next treatment cycle in 2009. Suffice it to state that a 3-year sustainability plan has been developed and is being fine-tuned. 30 WHO/APOC, 24 November 2004 4.2, Sustainability of projects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period? Yes Was a sustainability plan written? Yes When was the sustainability plan submitted? Not yet What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.2.1. Planning at all relevant levels At the end of the CDTI sustainability evaluation exercise, a planning meeting was organized which developed draft 3-year work plans, which are being fine-tuned. Subsequently, annual plans will be developed /refined. 4.2.2. Funds The State Government has been consistent in its release of counterpart funds. The project plans to ensure this continues while it keeps soliciting for LGAs support. Other stakeholders like Mobil, an oil company will be identified and mobilized that will support implementation. 4.2.3 Transport (replacement and maintenance) The supporting NGDO and the State are being sensitized to ensure adequate maintenance of transport and other equipment. Replacement will be a bit a difficult but the project plans to request APOC to replace obsolete equipment before its devolution. 4.2.4. Other resources The State has been providing other resources through its counterpart funds. It is hoped that this will continue and the LGAs will also follow the pattem. 4.2.5. To what extent has the plan been implemented The sustainability plan is just being developed and fine-tuned' 4.3, Integration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3.1. Ivermectin delivery mechanisms The PHC staff are involved and take responsibility of Mectizan and Vit A by collecting them and allocating them to Community-directed distributors for distribution 4.3.2. Training The LOCTs attend workshops on other health programmes; and supervise NID activities. In the past some VAS training sessions are also used for CDTI. 4.3.3. Joint supervision and monitoring with other programs Mectizan distribution and Vit A supplementation supervision are carried out by the LOCTs and Front Line Health Facility Staff along with other PHC activities 31 WHO/APOC, 24 Novemb er 2004 4.3.4. Release of funds for project activities Like other projects at the Stati and LGA level, the same routine procedures are followed in the release of funds. 4.3.5. Is CDTI included in the PHC budgetz At the State level it is included in the Department of Public Health Services Budget, while at the LGA level it is included in the general budget. 4.3.G. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? The CDTI structure is used to deliver vitamin A supplements to the community members. This is achieved by effective mobilization and education of the community members on the importance of the supPlements. 4.3.7. Describe others issues considered in the integration of CDTI. Integration of CDTI with other health programmes have created awareness of other programmes to tf,e community members and encourage them carry out other development activities 4.4. Operational research 4.4.1. Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period. None was carried out during the year under review. 4,4.2, How were the results applied in the project? 32 WHO/APOC, 24 Novembet 2004 SEGTION 5: Strengths, weaknesses, challengesr and opportunities - List the strengths and weaknesses of CDTI implementation process. Strengths . Availability of trained and committed health workers at all levels . Availability of literate Community-directed distributors o Availability of Mectizan Weaknesses o Health workers asking for increased allowance o Inadequate motivation of CDDs . Inadequate logistics List the challenges and indicate how they were addressed. Challenges o lnadequate support by LGA Executive to the programme o Transfer of CDTI personnel to non CDTI LGAs and areas o Non-identification and involvement of CBOs and VHCs in CDTI activities. o CDD attrition o Chieftaincy tussles in several communities How challenges were addressed o Local Govemment Services Commission was contacted and appealed not to transfer staff involved in CDTI activities out of the CDTI LGAs o HKI brings additional vehicle during CDTI activities o Intensified advocacy visits to the LGA Executive to solicit their support to the progralnme o Efforts are being made to identify and contact CBOs and VHCs in order to involve them in CDTI activities. SEGTION 6: Unique features of the proiecUother matters Even though one of the smallest the project is one of the most difficult to implement in terms of unfriendly terrain and management of people. a 33 WHO/APOC, 24 November 2004