Kebbi State CDTI annual project technical report submitted to Technical Consultattve Committee (TCC): January 2004 to December 2004

KEBBI STATE COMMUNITY DIRECTED TREATMENT WITH IWRMECTIN PROTECT ORIGINAL: Enelish COUNTRYAIOTF ! I\IIGERIA Proiect Name: KEBBI STATE CDTI Annroval vear: SEPTEMBER 1999 Launching Year: DECEMBER 1999 Reportine Period: From: JANUARY 2004 To DECEMBER 2404 Proiect vear of this reporfi (circle one) I 2 3 4 6789 10 Date submitted: MAY 2006 NGDO Partner: SIGIIT SAYERS INTERNATIONAL gokob Mgcr Zotut BaD For fo: onXrtdr. KD K.d0r Neu Itm Yo0. B'd cobc ndau Tr.D. ArhEm rcTKnn oyo oru E x4l otu o!& &b ,-r'#t* I --. CB Ddt luo fl Eu rrao n* ffi FIFTH YEAR ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) AFRICAN PROGRAMME FOR ONCHOCERCIASTS CONTROL (APOC) BarE For :ormqtlon I{x Tot ll 6 ^n,^J* I 6 A0lJr 2006 5 ANNUAL PROJECT TECHNICAL REPORT ST]BMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) DEADLINE FOR SUBMISSION: To APOC Manageme,lrt by 3l Januan for March TCC meeting To APOC Manageme,nt by 31 JuIv for Spp@g TCC meeting AFRICANPROGRAMME FOR ONCHOCERCIASTS CONTROL (APOC) IL-.----. A]\NUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATTVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the reporf Country: NIGERIA National Coordinator Nane: F.-r.( r gt .ft. . . &gy +e*<<r Signature: @*--'.*. Date: 3.I|rt)z==e.$ 'Yvrt Zonal Oncho Coordinator Name: Signatrue Date: ....2.X. NGDO Representative Name Signature: out",.ZJ * 1n. a.6.I This report has been prepared by Nme : Atiyu Salisu Bunza Designation: \^, Date : eoc ) t Table of contents ACRONYMS DEFINITIONS... FOLLOW UP ON TCC RECOMMENDATIONS 2.1. 2.2. 2.3. 2.4. 2.5. 2.6. 2. 2. 2 2 2 2.7. 2.8. 2.9. SuppRvtsroN............... 2.9.1 . Provide a flow chart o/'supervision hierarchy. 2.9.2. 2.9.3. 2.9.4. 2.9.5. 2.9.6. VI VII EXECUTIVE SUMMARY......... SECTION I : BACKGROUND INFORMATION....... l.l. GpNeRer- INFoRMATIoN............. 1 .1.1 Description of the project (brieJly)..... 1 .l .2. Partnership 1.2. Popu1ertoN............... ....................... I SECTION 2: IMPLEMENTATION OF CDTI....... .....11 I 3 4 4 1 ,7 0 Tluer-rNp oF ACTrvrrrES ............ .......12 AovocRcv ..................... 13 MostltzeloN, sENSITIZATIoN AND HEALTH EDUCATIoN oF AT RtsK coMMuNtrlrs 14 CouuuNtrY rNvoLVEMENT...... Cepecrrv BUILDINc.. TREarvpNTS.............. ..... 19 61 rreatmentfig:;;;;; '...'... . 20 6.2 What are the causes of absenteeism? .......... .................22 6.3 What are the reasons for refusals?.............. ................. 226.1 Briefly describe all known andverified serious adverse events (SAEs) that ... 23 6.5. Trend of treatment achievementfrom CDTI project inception to the current year24 ORpERTNG, sroRAGE AND DELIVERY oF IVERMECTIN ...........25 CouirauNrry sELF-MoNIToRINc eNo SrerpHoLDERS Meermc ............27 16 t7 ...28 ... 29 What were the main issues identified during supervision? .............................. 29 Was a supervision checklist used? .............29 What were the outcomes at each level of CDTI implementation supervision? 29 Was feedback given to the person or groups supervised?................................ 29 How was the feedback used to improve the overall performance of the project? SECTION 3: SUPPORT TO CDTI EqunrraENr FnaNcIRL CoNTRIBUTIONS OF THE PARTNERS AND COMMUNITIES..... OrHpR FoRMS oF coMMUNITY suPPoRT............. ExpeNotruRE PER ACTIVITY 3.1 3.2 J.J 3.4 30 30 3l 3l 32 SECTION 4: SUSTAINABILITY OF CDTI 32 4.1. INTeRNaL; INDEIENDENT PARTICIPAToRY MoNIToRINc; EveluerloN.......... ..........32 4.1 .l Was Monitoring/evoluation carried out during the reporting period? (tick any of the following which are applicable) . . ....... ........... 32 1.1.2. What were the recommendations? ......... .. J3 4.1.3. How have they been implemented? ............. ................. -15 4.2. SusrarNestLrry oF IRoJECTS: eLAN AND sET TARGETS (MANDAToRY AT Yn 3)...... 35 1.2.1. Planning at all relevant levels.. .................. 35 4.2.2. Funds....... ............... -?5 4.2.3 Transport (replacement and maintenonce) .... 35 1.2.4. Other resources ...... 35 lv 4.2.5. To what extent has the plan been implemented............. 4.3. INrpcRRrroN .............. 1.3.1. Ivermectin delivery mechanisms............... 4.3.2. Training.... 4.3.3. Joint supervision and monitoring with other programs 1.3.1. Release offunds.for project activities 1.3.5. Is CDTI included in the PHC budget? ............ 36 36 36 36 36 36 37 1.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements?............. .................... 37 1.3.7. Describe others issues considered in the integration of CDTI. .....37 4.4. OppnerroNAL RESEARCH ...,...,,,.,..,.37 4,4.1. Summarize in not more than one half of o page the operational research undertaken in the project area within the reporting period. ........ 37 4.1.2. How were the results applied in the project?.... ........... 37 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, ANDOPPORTUNrTrES.... ................... 38 SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS...........39 v Acronyms APOC ATO ATrO CBO CDD CDTI CSM FLHF IEC LF LGA LOCTs MOH NGDO NGO NOTF PHC REMO SAE SHM SOCT TCC TOT LTNICEF UTG wHo African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Community-Based Organization C ommunity-Directed Distributor Community-Directed Treatment with Ivermectin Community Self-Monitoring First Line Health Facility Information Education and Communication Lymphatic Filariasis Local Government Area Local Onchocerciasis Control Teams Ministry of Health Non-Govemmental Development Organization Non-Governmental Organization National Onchocerciasis Task Force Primary health care Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Stakeholders meeting State Onchocerciasis Control Team Technical Consultative Committee (APOC scientific advisory group) Trainer of trainers United Nations Children's Fund Ultimate Treatment Goal World Health Organization VI Deflnltions (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 meso/hyper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. (iv) Ultimate t Goal (UTG): calculated as the maximum number of people to be treated annually in meso/hyper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage (normally the project should be expected to reach the UTG at the end of the 3'd year ofthe project). (v) Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) Geoqraphical 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 CDTL (viii) 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. (ix) 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. vll 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 20th (Please add more rows if necessary) Number of Recommendation in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY (i) Use the most recent version of the reporting format The most recent format (October 2005) has been used for the current report ( ii) Clari$ why no APOC funds were received The project delayed in submission of monthly financial returns ( iii) Project needs to review defi nitions and calculations This has been done and is reflected in the current report IV( ) Explain strategy and rationale for 9 months treatment Treatment was actually carried out within a period of 2 -3 months early in the year and a follow up treatment after the rains for absentees. (v) State reasons for loss and wastage of Mectizan@ tablets, indicate status of remaining tablets Mectizan loss was as a result of flood in some communities where the drugs were lost. The remaining tablets were collected and used for the next round of treatment, vl( ) Clarifl, and Provide comPlete financial data Complete financial data is provided below (vii) Should involve and train more health workers to support CDTI as only 2%o of total health staff is currently involved in CDTI Plans have been concluded to train health workers on CDTI in 2005 and 2006. The plan is to train at least 50 - 60% of health workers in endemic areas. I Table l: Financial contributions by all partners for the last three years for 2001-2003 Exchange rate; Year 1- $l : NL20, Year 2- $1 : NL127, Year 3 - $l : Nl35 Table 2: project Expenditure for Kebbi State CDTI project in 2003 Contributor Year2 (2001) Year 3 (2002) Year 4 (2003) TOTAL AMOUNT (cASH) Budgeted (us$) TOTAL CASH Released (us$) TOTAL AMOUNT (CASH) Budgeted (US$) TOTAL CASH Released (us$) TOTAL AMOUNT (cASH) Budgeted (us$) TOTAL CASH Released (us$) MOH (Central + Provincial/State) 27,500 5,553.58 23,622 10,774.5 ')) ))) 7,407.4 MOH (District/LGA) 18,534 0 18,534 0 17,777 0 Local NGDO(s) ( if any) 0 0 0 0 0 0 NGDO partner(s) 8,272.94 6,882.l0 9,462.98 9,655.77 7,311.59 8,735.68 Others 0 0 0 0 0 0 APOC Trust Fund 33.248 33,248 30,161 .90 30,161 .9 8,750.00 0 TOTAL 87,555 45,684 63,247 50,592 33,839 16,143 Activity Expenditure ($ us) Source(s) of funding Drug delivery from NOTF HQ area to central collection point of community Mobilization and health education of communities Training of CDDs Training of health s!qf{qt all levels Supervising CDDs and distribution Internal monitoring of CDTI activities Advocacy visits to health and political authorities IEC materials Summary (reporting) forms for treatment Vehicles/ Motorcycles/ bicycles maintenance Office Equipment (e.g. computers, printers etc) Others 24t.92 1,246 2,109.48 7,308.26 7,475 2,397.45 802 444.44 0 2,653.72 JJJ.J 3,131.64 SSI M9H MoHiSSI SSIAvIoH MoH MoH/SSI SSI/MoH SSI SSIAvIoH SSI MOH/SSI TOTAL 16,143.21 Total number of persons treated 154,845 2 Executive Summary Prepare an Executive summary of the report in not more than one page. ,/ Background on treatment and population data - Total communities, communities treated, total population, UTG, ATO and persons treated. ,/ Background on population movements. ,/ Training data - CDDS, health workers, Total population (community) per CDD trained. '/ Challenges and how they were overcome. Executive Summary Kebbi State is situated in the Northwestern Nigeria and has an estimated population of 3.08 million people (based on 1991 census). Onchocerciasis control commenced in the state in 1995 with Community Based Ivermectin Treatment (CBIT) with support from Sight Savers Intemational and started implementing Community Directed Treatment with Ivermectin (CDTD with support from the African Programme for Onchocerciasis Control (APOC) in 1999. Onchocerciasis is meso endemic in 6 and hypo endemic in 3local governments of the 2l administrative LGAs. APOC supports the project in the 6 meso endemic local governments of Bagudo, Ngaski, Sakaba, D/Wasagu, Zuru and Fakia, while Sight Savers supports control activities in the 3 hypo endemic local governments of Bunza, Suru and Shanga. The project completed its fifth year of CDTI implementation in December 2004. A total of 143,198 persons were treated with 412,370 tablets of Mectizan@ in 203 endemic communities with a population of 172,308 attaining 83% therapeutic coverage geographic coverage. The project is making steady progress towards attaining its UTG of 160,000. The people are predominantly Moslems and stable with nomads who move south wards during the dry season for pasture for the animals and returned at the commencement of the rains to either same or different locations with a resultant effect on coverage. Targeted trainings were conducted for twenty seven (27) health workers (First Line Health Facility Staff) and 352 CDDs from the six endemic local governments on CDTI and they actively participated in the implementation of the project. The state provided counterpart funds which were used for the implementation of CDTI activities. The project had a total of 1,133 CDDs which gave ratio of 1 CDD to 152 persons. The project has many difficult to reach areas and the project vehicle still under repairs, monitoring by the state was inadequate at the early stage of implementation. The inadequate monitoring and supervision by the health workers at the first line health facilities was also a challenge. The project could not collaborate with other agencies like Ministry of Information and National Orientation Agency due to communication problems. Other challenges were CDD attrition due to poor incentive from communities and confusion of CDTI with other community based health programmes. 3 SEGTION {: Background information 1.1. General intormation i. Description of the project (briefly) Geographical location, topography, climate Population: activities, cultures, language Communication systems (roads. ..) Administration structure Health system & health care delivery (provide the number of health posts/centres in the project area if the information is available). Number of health staff in project area and number of health staff involved in CDTI activities. (i) (ii) (i ii) (iv) (v) (vi) Kebbi State is located in the Sudan and savannah grassland of north western Nigeria covering a land mass of 36,229 square kilometres (almost same size as Guinea Bissau - 36,120 sq. km, or half the size of Sierra Leone -71,740). and is made up of twenty one (21) administrative local government areas with an estimated population of 3.08 million people based on the 1991 population census. The state derives its name It borders Niger and Benin republic both francophone West African countries to the northwest and Niger State to the south. It shares its north-eastern borders with Sokoto State and its eastern borders with Zamfara State. The state was created out of the then Sokoto State in 1991 from the 4th century Kebbi Empire, a remnant of the historical Songhai Empire (which covered northem parts of present day Nigeria and Ghana), which was founded by Muhammed Kotal Kanta a famous warrior of the Kabawa decent (an ethnic group now living in the northern parts of the state). The predominant tribes in the state are Hausa, Fulani, Kabawa and Dakarkari with Islam being the dominant religion. The tenets and laws of Islam as practiced in Sharia Law guide the people. Relative to its geographical location, the climate in the state is characterised by two seasons. Rainfall begins in April and ends in October and heaviest in July and August. The dry season is from November to March with dry Harmattan winds between November and February. The mean annual temperature is 100"F/40"C, while annual rainfall is 500mm. Most of the roads leading to the local government headquarters are motorable, but the roads to the communities are mainly laterite roads which become inaccessible in the rainy season. Access to these communities is usually by bicycles, motorcycles, four wheel drive or foot paths. The existence of many rivers in the state particularly Gulbin Ka (River Ka) and River Niger along with their tributaries provide fast flowing rivers for breeding of black flies which transmit Onchocerciasis. The main occupations of the rural people are farming (subsistence farming), fishing, trading and animal husbandry and nomadic herdsmen. Formal employment is provided by the state and local governments. 80% of the people live below $l a day which makes services such as health and other social services unaffordable and thus puts the people at the rural level at a disadvantage. The significance of this is that services have to be free or highly subsidised for them to be successful. About 70Yo of the population live in rural communities with poor accessibility particularly in most of the rainy season, while 30% lives in urban and semi urban centres (Birnin Kebbi, Argungu, Yauri, Jega and Zuru). During the dry season there is a high 4 migration of male youth to urban areas to engage in petty trading and other unskilled professions to earn a living. They however return to their communities in the rainy season for agricultural activities. There are two main tiers of government operating in the state - the state and local governments. An elected Executive Governor and elected Chairmen and Councillors at the local governments govern respectively. There are also the traditional and religious institutions of leadership, which have an influence in the administration at the local government. The Kebbi State Ministry of Health is structured in line with the Nigerian health structure which is based on the concept of the Alma Ata declaration of 1978 which states: "Primary health care os essential health care based on practical, scientifically sound and socially acceptable methods and technologlt made universally accessible to individuals and families in the community through their full participation and qt o cost that the community and country can afford to maintain at every stage of their development in the spirit of self reliance and self determination". Based on the above the national health care delivery system is structured into primary, secondary and tertiary levels of care assigned to the local, state and federal governments respectively. There is a Federal Medical Centre in Birnin Kebbi, Kebbi State which is supported by the federal government and provides services to all the citizens of the state. The state government through the Ministry of Health is responsible for secondary health care and supervision of primary health care. The local governments provide primary care in their respective areas. The Ministry has the following 8 departments (Administration, Public Health Services, Primary Health Care, Pharmaceutical Services, Nursing Services, Planning, Research and Statistics, Finance and Supplies and Inspectorate Services). Other parastatals under the ministry are School of Nursing and Midwifery, Birnin Kebbi, School of Health Technology Jega and Hospital Health System Management Board. The state has twelve secondary health facilities in Birnin Kebbi, Argungu, Yauri, Znrtt, Koko, Zuru, Dandi, Ribah, Maiyama and Jega. There are 139 first line health facilities in the six endemic local governments,T9 of which serve the endemic communities with 198 health staff with only 37 involved in CDTI implementation. The programme plans to increase this number to at least t20. The activities of the Ministry and health services provided are funded from budgetary allocation from the state government. The eye care and the onchocerciasis control programme have budget lines at the state level, while Oncho is under the PHC budget in the local governments. The state and local governments have consistently contributed between $4,500 - $10,500 annually since 2000 as counterpart contribution for CDTI implementation. One cannot discuss Kebbi State without considering the traditional structures which play a very important role in the development and lives of the people. The extended family system is the basic unit of the community structure in the state. A household head who is usually the eldest male family member i.e. the father or grandfather heads each extended family. The population in these households ranges from 5 to 40 persons per household. The head of the household takes all decisions, including finance and health issues in households while the mother ensures implementation of domestic issues. The poor and women are disadvantaged and marginahzed. Most women in the state are in purdah and are not involved in decision making. A group of households form a community in Kebbi State as in most part of northern Nigeria, which is headed by a community leader known locally as Maiungwa (Head of 5 community, names vary depending on tibes). The Maiungwas (village or community head) govem thlir communities in consultdion with and assistance from heads of households, ieligious leaders (Imams) and opinion leaders llke Magajiya Qrcad of females) nd SarHn Saiari (head of male youth) in the communities. Kebbi State has four emirales - Gwandtr, Yauri, Argungu and Zuru, headed by emirs. The community and religious leaders report to thenr, while general communal activities are carried out under the coordination of the village developmenrt committees. MRPOF TE SBIE $I3WNG CD]I LGAS I AFG txpporbd l-l NoN-Arcc srppoiled AI..GIE AreINGU XE l(Alco -reAflrtgA DAl.lDl MANMAskll rc S}IANGA YAI.R DA!.| Table 1: Number of health staff involved in CDTI (Please add more rows if necessary) District/LGA Number of health staff involved in CDTI activities. Total Number of health staff in the entire project area Br Number of health staff involved in CDTI B2 Percentagc Br=Brl Br *100 Bagudo 26 6 23% Danko Wasagu 57 8 14% Fakai 2t 4 r9% Ngaski 37 8 22% Sakaba 5) 7 2t% Zunt 24 4 17% Total 198 37 lg.60h Only staff posted to the first line health facilities in the endemic communities were trained on CDTI. These staff supervise distribution of Mectizan@. The project plans to train at least 120 other health workers in the endemic local govemments on CDTI from 2005 -2006, as part of the projects sustainability plan. l. Partnership (vii) Indicate the partners involved in project implementation at all levels [MoH, NGDOs (national/international), communities, local organizations, etc.](viii) Describe overall working relationship among partners, clearly indicating specific areas of project activities (planning, supervision, advocacy, planning, mobilization, etc) where all partners are involved. State plans, if any, to mobilize the state/regiorVdistrict/LGA decision-makers, NGDOs, NGOs, CBOs, to assist in CDTI implementation. The partners involved in the project implementation at all levels are: 1. Kebbi State Ministry of Health 2. Kebbi State Ministry for Local Government and Chieftaincy Affairs (representing the endemic LGAs) 3. African Programme for Onchocerciasis Control (APOC) 4. Federal Ministry of Health (National Onchocerciasis Control Programme) 5. Endemic Communities 6. Sight Savers International Kebbi State Ministry of Health, Birnin Kebbi, Nigeria The Kebbi State Ministry of Health and its structure including function and responsibilities had earlier been described under background. In addition it provides the project staff and 7 infrastructure for the programme, Thc staff are involved in all aspects of the project implementalion from planning, advocacy, Mectizan@ procurement, training, monitoring/supervision, community health education and mobilization (as observers) md reporting. The Ministry pay stsff salaries and allowances and has consistently contributed counterpart funds since the inception of tho Brogramme. In 2004, the state released $7,407 as counterpart funds. Kcbbt Statc Mlnlrtry of Local Gorrcrnmcnt and Chicftalncy AITairs All local governments' aptivities in thc state are under the supervision of the Ministry of tocal Crovornment and Chieftaincy Affairs, The Ministry is heade.d by a Commissioner and liaisos with the Local Governmcnt Service Commission in the employmont, posting, promotion and discipline of stalf of the local govomments and monitoring of utilization of statutory allocations from tho fedcral govemment, It also sets up general guidelines for staff rn&tters, including human rcourco devolopmont and servos as an appellato body for local government issues, Tho Ministry is involved in planning and ensures that counterpart funds are reloased by locol govemmont for implarontation of projoct activitios, The Ministry was able to get the LGAs to release $13,913 for the implementation of the project, In each of the endomic local governments thero are local Oncho control teams who are mainly responsible for training of Community Directod Disffibutors, ensuring that the communities collect and distribWo the Mectizan0 and community heelth education and mobilization. They also monitor the overall distribution in tho community, ensuring that records are kopt at the first line hcalth facilities and communitios. They treat cases of severe or mild adverse reactions and reporting, Afitcnn Programmc for Onchoccrclarlr Confirl (APOC) The African Programme for Onchocerciasis Control (APOC) which is a WHO organ was establishod in 1995 with tho sole objoctivo of supporting the control of Onchocerciasis in sub Saharan Africa using the Community Directod Treaftnent with Ivermectin (CDTI) strategy. APOC has supported the project with funds and capital equipmont since 2000. A team of indepenrdent monitors appointed by APOC carriod out an independent monitoring of the project in 2004. A management plan was dcvelopsd from the recommendations of the roport which would be usod in thc implementation of the project in 2005. It is expected that the project would be ovaluatod for its sustainability by APOC in 2005. Federal Mtnlctry of Health (Nnflonal Onchocercladr Contnol Progrrmmc - NOCP) The NOCP is an organ of the Federal Ministry of Hoalth, which is responsible for overall implementation of the prograilrme in Nigeria. The National Onchocerciasis Control Programme (NOCP) is a unit of the doparfinent of public health and is headed by a National Coordinator. Thore are four zonal ofiicos - Zono A (Enugu), B (Ibadan), C (Ifuduna) and D (Bauchi) which are headed by Zonal Coordinators and have the responsibility of monitoring CDTI activities in their catchmont states. Tho NOCP on behalf of federal government endorses all MoUs with APOC and states and roceives support from APOC. There is a zonal office in Kaduna which is responsible for monitoring the implementation of the programme in Zone C, where Kebbi State falls under. The office also provides technical support to the project. Endemlc Communltler A community or village in Kebbi State refers to people in either small or large groups, who live in the same place, sharo the samo culture, customs and traditions with a common 8 leadership. In the project area there are 210 endemic communities which fit these descriptions. These communities have been receiving Mectizan for between 7 - l0 years. The traditional structure and decision making process as explained earlier is what is found in these communities. The communities play a major role in the implementation of CDTI in their various communities. These include selection of volunteers to distribute the drug, actual collection of drugs from central collection point, distribution of the drug, provision of incentives and reporting among others. Sight Savers International Sight Savers International has supported onchocerciasis control in nine local govemments Sakaba, Zuru, Ngaski, Danko Wasagu, Fakai, Bagudo, Suru, Bunza and Shanga) since 1995. Since the commencement of CDTI, this was introduced in all 9 local governments with APOC supporting 6 and Sight Savers continued support to the programme in the other three LGAs. They have provided logistic support (vehicles, spares, transportation of Mectizan@ etc), technical support - planning, advocacy, monitoring, provision of IEC materials and reporting forms, support training of health workers and CDDs on primary eye care etc. Overall the relationship existing between the partners mentioned above has cordial and where roles/functions are cascaded for effectiveness of project implementation. Support is still being solicited for commitment to CDTI activities at the grass-root. There is also a plan to re- mobilize communities on their responsibilities as partners based on CDTI principles, so that at the end of APOC support the project can be sustainable. 9 P() 0) 'a Lr 0)d €(li oI 8I E E ^t !a(lIg, iiEodfrro;rbo li .;()EE r:b LlHr!ail=trsl .-ruEo0=ogE E 2 El .2 th o";6l 'cdbtrl F-q-c €l €0l s B r .l 8"tr€ -l :J 9l *i o. .=!t- ul ; s dXl .EO(F#l Ec-l *t ! -l F 5 a.a'f-FCo ,=l H=c)dl=)lr =t !1 C)6tt^lot.Ptrl c.)6(J C)Lt!Hr €'a -ql q.EkL/l S? 0 O,o) L' ts -D o.)e)(4.=C.C Usu.=c\' O- O .nEii-Etr '-(J(s5'5Eg€oS S'qB P * 3/.HH 'nAL,IqE+3 E E eBs5 ; : =eEni e' $ EP d)HI = .= dP€?I i E E 'E cci 5 o g €;F b E go.lEU 'E I .=lE a = 5- qi €sE E E :E; b E o. .9 .0 ocl 6 7 H ETg E $ EE;.E e 3 .E u aA E l.fE, E,T €)H 0€r; I = E Cd^+iil-i9 5ai -Hx(uF< -'OL, eFE* = HU 9 * :u tu U\ q) >\q) B a)\ u ,o o u \ssu$'N :\ -u $t'\r.\B$9 's -,S\ .S q) l,\ %O' Bq)lu qrlFs -xB sr\\rx\\qJv l\ q) I\!6-s%U$(lSP $"rs :q) TH s i.\ !uP-oB\ rxr< ^. a) *Y ':1 :|\d\\9\:: -t${E =L\s Sbo '-L5p s8 ei E: d!o Cs) :b0 *.:- .Y\ ild l\B\q) iai L \ t q) F: ! lro o" b0 tr L{ o o.q)k o b0 li ! lro C) d C) t-< oLr >' 0) Lr(.) o cl(l)l- 9() La q) li o (.) 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Timeline of activities Fill in table 3, timeline of activities for areas treated in curuent year, indicating when the key activities were implemented by the month they began and the month they ended. ll ..i o s.9 o= =EEO a()C)e .4 (h E-o obo}E .9S;t .Eg UA d :EQ-' F 'oE ox -th(g(d(/)bod,7 =0) =x;: 6-) U'P t-.1 .i "jE9H =o)d.5Ee oAd> xa v.= o- +j= d(J .E 0., cnE?oEa e q, 6-) E,E; 'dEd e at5fi6)oqH .(JP (J() -o'f, 'a(d;i u g€ C)c)-,Lr - .=0.)E l<BorI ts9c lJ-P >-^tr 9== - r) 2dr-td x69 (d=c) i<o6J =(l)Li:= IA;, 6l x C) I ra 6l 0) i! o 6l ah o5 cl l-q) q) Lq) anq) I 6l q) GI C, q) U) clq) o o ch o C) Lli L) (.) l.rO C) ! C)Lr o. ? o .o L 0)p oo 0) a I tro -o C) +r U) o tr o bobQa '- -o =d €: (! rl!)d >r (, c> ,9 .= o) P.!qc) t-'l () .tr+() =Bo.t Ec-C 9?9Ho o.E -v o. ^5 C)F >P 'E rnOO 0) in aa <3 44 v() q) 4 \ q)\ v t s) U1 t) U L(s C) q oL! o o C) d C)k (n(d C)L(6 (.) H ,a a C) C)(B q{ o o C) F e.ir o,l -ol cClFI o F Iq (o 0)€ EE o(J >' >. l- >.) >. >' 6D C! (n ok(g o l-<(6 z oLd z (J Ld z olr(! A C)t<(d z E L o E at L aZtrE I c) h (.) () C) F- 0) ts- o F- EOEEi C)Lr(d =a o li cd a oti z (.) Lr(c a oLr(t z o *r(t =a o E P ta o Aq) Q a.5EE o U >'L crd l<p ofr >\lrd Lrp otri P\ d Lr O trr H(d li -o0) tJr l< Cd Lr .o(.) fJ. x li li -o(.) F. a0EE liE >\l<(d) d >.Lr ad h cd (€ts- L Cd (s h >\ ti ,- L Cd (d F- 0! 6lL3 EE I (-)tr(d Olr(s z c)Lr A oE z C)Lr(s z ot<(d bnCA .!i tr c= ;E li t< .o(.) tu hd L -oo fJr >\l< CU k 0) trr >\L ! -oo trr >\ Lr(d5!p 0)tu lid Lr -o(.) -0) .EE s= -atroo!r(,a 9:o.5EE o U oL =z () L(d oL{ =z oL{(! z oLr Cd z ol-i(! a0_E+ 1i tr cf aE, )r ti -oq) tu >.H CB L .o o) tJ. r< Cd k -oc) tJ. k l< € 0) IJ. !rd k C) fJr >\hd ! -oC) trr J I L v) a o bo ca boda(d o .V d l-.1 (s .V(d tu J1th(d bo z (! dJ a H N F] 3 3 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. This activity is usually carried out early in the year before the commencement of activities to ensure that the project gets the needed support. In its efforts to improve advocacy in its projects, Sight Savers International organised a three day advocacy workshop (10 - 12 May 2004) which was attended by the project coordinator. The objective of the workshop was to develop partners' advocacy skills to meet the challenges of partnership development and collaboration. A similar workshop was held for policy/decision makers in 2003 and was attended by the Director PHC. These skills were used for advocacy in the year under review. Advocacy was carried out to policy/decision makers in the Ministry for Local Government and Chieftaincy Affairs, the Ministry of Health and six endemic local government areas. A total of 37 persons were mobilised to support CDII implementation and they include Hon. Commissioners of Health and Local Government and Chieftaincy Affairs, Permanent Secretaries in both Ministries, relevant Directors, Information Officer at the state level; Chairmen of the six LGAs, Directors of Primary Health Care Services at the LGAs, Councillors for Health and Information Officers at the LGA level were also visited. At the community level community leaders, religious leaders and women leaders were also mobilised.. Government support to the programme in terms of provision of counterpart funding has been encouraging, but are most times released late, The advocacy was to solicit for early approval and release of funds, political and moral support. Despite the advocacy, the local governments did not release of counterpart funds for CDTI implementation. The project plans to liaise with the Ministry for Local Governments and Chieftaincy Affairs on ways to get the LGAs to fund the project for its sustainability at that level. This very important because the inadequacy of funding at this level was discovered to be a major factor in the monitoring and supervision of CDTI by the Local Onchocerciasis Control Teams (LOCTs) in all the LGAs The traditional leaders have a big role to play in ensuring that women in purdah are reached and also get their communities to provide incentives for the CDDs and the select female CDDs. These were the main issues that were advocated for. The issue of women in purdah is religious and cultural and thus not much can be done. Most of the community and traditional rulers promised to ensure that incentives are provided to CDDs and consider the inclusion of female CDDs, but these were not done in most communities visited during monitoring and supenrision. These are challenges to the project which we would continue to advocate for. l3 2.3. Moblllzation, sensitlzation and health education of at risk communities Provide information on The use of media and/or other local systems to disseminate information Types of IEC materials used Mobilization and health education of communities including women and minorities Response of target communities/villages Accomplishments Suggest ways to improve mobilization and sensitization of the target communities. Information was disseminated to the endemic communities through the use of distributors in collaboration with community leaders (during community meetings) and town criers. Religious leaders and Islamic scholars were used to mobilise the people in mosque and Islamic schools. Sight Savers International trained Islamic scholars to health educate women in purdah who attend the schools. IEC materials (posters and flip charts) were also used extensively to disseminate information. health educate and mobilise communities. Communities in the endemic areas were mobilized and health educated annually since the inception of the project. During the year under review, targeted community mobilization was carried out to address problems identified during monitoring/supervision. In a few cases, women in purdah were mobilised separately in the community leaders' house. The turnout however was not encouraging. The communities have continued to demonstrate good knowledge and awareness of CDTI and response during mobilisation has been encouraging. This is demonstrated by the performance of their roles and responsibilities and the request for their annual treatment. The response in the provision of incentive for CDDs has continued to be poor despite the repeated mobilisation and sensitization. There is the need to use the media i.e communication within the communities communities. radio station and identiff other forms of to sensitise, health educate and mobilise 14 N 0',. 1*e I "fn ti istricULGA Number of communities/villages with community members as supervisors Number of CDDs Number of communities /villages with female CDDs Total no. communities in the entire project area B Number with community members as supervisors B Percentage Bo= B./ B, *100 Male CDDs B? Female CDDs Bs Total Be= f,r*$t Number of communities with female CDDs Btn Perccntage Brr= Brr/Ba* 100 Bagudo 30 0 0% 118 0 I l8 0 0% Danko Wasagu 83 0 0% 188 0 188 0 0% Fakai l3 0 0% 106 0 106 0 0% Ngaski 44 0 0% 336 2 338 I 2.27% Sakaba 30 0 0% 328 0 328 0 0% Zuru 10 0 0% 55 0 55 0 0% Total 210 0 0"h 1,131 2 I,133 I 2.27o/o 2.4, Gommunity involvement Table 4: Communities participation in the CDTI (Please add more rows if necessory) Comment on: - Attendance of female members of the community at health education meetings - In general, how do you rate the participation of female members of the community meetings when CDTI issues are being discusses (attendance, participation in the discussion etc). - Incentives provided by communities for the CDDs - Attrition of CDDs. Is attrition a problem for the project? If yes, how is it addressed? - Other issues Female attendance during community health education was very poor. This is due to the Islamic norms and culture, which prevents women from freely mixing with males. A few old women and young girls attend the meetings. Attendance and participation of women in the discussion and implementation of CDTI is very poor due agatn to the Islamic way of life which does not allow frowns at free mixing of males and females. Traditional Birth Attendants (TBAs) and Islamic scholars have however been trained for selected areas to ensure women in purdah who attend the schools are health educated on CDTI. Incentives to distributors have continued to be a problem in most communities. These incentives are not provided in about 50% of communities and where they are provided, they are not regular. Communities are being encouraged to provide incentives in kind rather than cash. CDD attrition is also a problem. There are however CDDs who have been in the programme for quite a number of years and have continued to serve their communities without asking for incentives. The project has continued to request communities to select new CDDs where there had been attrition. Local governments are encouraged to use CDDs for all health and development activities in the communities for example they are as guides during National Immunization Days so that they get some incentive. a a a a t6 2.5. Gapaclty buildlng - Describe the adequacy of available knowledgeable manpower at all levels - Where frequent transfers of trained staff occur, state what the project is doing, or intends to do, to remedy the situation. (The most important issue to describe is what measures were taken to ensure adequate CDTI implementation where not enough knowledgeable manpower was available or if staff are frequently transferued during the course of the campaign). Right from the inception of the project to date four (4) members of the State Oncho Team, thirty-seven (37) members of the Local Oncho Team and one thousand one hundred and thirty-three (1,133) distributors were trained and re-trained to manage the project based on CDTI principle. The counterpart funds released by the state were used for the targeted training of 27 First Line Health Facility staff and 352 CDDs in the endemic LGAs. The earlier plan to train more personnel could not be attained due to inadequate funding. Frequent transfer of trained staff was experienced by the project particularly in Ngaski and Danko Wasagu LGAs. Decision taken presently to address such issue is to train all the health staff at each of the endemic LGAs on CDTI implementation to avoid such experiences in future. The project also intends to orientate additional Islamic teachers and Traditional Birth Attendance (TBAs) on CDTI, with the aim of promoting health education and mobilization of women in purdah. This would however be subject to availability of funds. t7 oo o a d >\ 0) F J bo CC ca 3. ST sb acu3 LL '-.(d :E } 'ilr= S --E€E u t-(J gq, v !\l: xX.oINa(tl \JCqC se9 ;cqE u ao. *=tr qi e'- S-EEii =8.;raEc(,\'i'6 B i!-% B-. Oi U H€S6)>o *O'a * 8 -?.gY-\d$ aCQ ES ^t< h\tt.(Ju U$VE.E E oo =61 .^c1! [i E\ fl€€ .s388 lJ'PC :? H s =HSe\'= ;1 id$ iI- I\9(tl;JSr st{ rE€LfEX(.) ri.- .v -\, ; ^- =. i bo'o!I=s\oCo.)\E 0) ca \.! 6) r-s oE=FLE€ * -El H oo o .o o\ o B $ ,B s o I t o a. s -a B q o F =+ 4q q) Uq) q o\ q) t q) % !q) U (! 0.) o p. F t-l C)qr o t') O C) (.)k _()E E C) Cd bI) (d LrF ,;i1 ol -ol(dt FI dll+-, € cot'' $,iqv =ru ri <v o\ <. o.$ o\ a.l o\ a.l co co o' oo co a.l N Nl,o ?.! alta ?a oo oo oo \o € C. aa € c.l cn rn (.) ?o I q) 6' \c '= ?o s o Q llE o6) 6)'= .Q i:Ee z .x * ?: s.:tv o -i +F.t, = .U o o o q) 0) (, \o o ? e t!{ .v6FEv?^ usv0) rF C)otr oi: EiJ z * L O c.t c.l \o $ N h a.l N N F- F- el U u' i * E ,''r +F-d $ (\ N t-- N \o s $ oo \o $ N = \o t\o I c) O o .\ cl o ,h q qJ 6.)Eoo c!h o c)E z L U o o O o osq Ua E.'i + U N c'l N N (\ an al tr cl ah ah F] 9eoq) a!r o z '! a(B bo z (B 3(B J a rr N Fl Fr F s I o o c) s rl (,) o o bo m obo -v 9q(!i"A* (nJ a Table 6: Type of training undertaken (Tick the boxes where specffic trainingu,as carried out during the reporting period) *SAE was not identified as a problem in the pro.ject, but the community volunteers were trained on it to ensure that they are able to handle/advice when such cases arise Any other comments 2.6. Treatments 2.6.1. Treatmentfigures If the project is not achieving 100% 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 96Yo geographic coverage and consistently attained over 800/o therapeutic coverage. Some communities were not treated in Ngaski LGA because they did not come to collect their drugs from the collection centres and the supervisor did not report this neither did he take the drugs to the communities. This was only discovered at the end of the treatment round. Trainees Type of training CDDs Other Community members e.g. Community supervisors, Islamic teachers and TBAs Health Workers (frontline health facilities) MOH staff or Other Political Leaders Others(speci&) Program rnanagement Yes How to conduct Health education Yes Yes Yes Management of SAEs *Yes *Yes CSM SHM Data collection Yes Data analysis Yes Report writing Yes Others (specifu) t9 e.l F d C)LG o 0) Y(os o\ +E F> '= oo =E' ,.:I '.seu(o! ! .9p 6SEiOJEbfi o- 6Qa)Etr.itrs EEo\E\9cie(J9s A(!ES C)b -a. 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PO ,boO 6^O-!rod SJo' ootoF .o o\ n o,t-- o\$ € Fr o\$ N o\ c.l N6 o\ o, oo o\N € s (fl € o q- ox() €HE : o-!z o F-- a N\o c.l $ ca ca €\o N c.l $ t-- c"I o\ co co\o N ai € o\ rat ,uE U.= -tr o JO3' € v'L a.) N co r- \o c.tO oo ao N$s \o r+ 6 rr) Nr- .9 .'3 =xo+. Eh6-4 Ao --9?od !J'O eo F oo ,q aaN co t-- \o c.) o^ 6 co O o{$$ \o $ € t.r N r-- 0q) bod th 0) tr >{ o(-) ll *\oo\ = .9 9^cq ^G!eo blj< uo o o\ co o, 1O -oo\ o -oo\ tJ- @ -o o\ o\OO s\o o\ z9 -bESoE E E= iJ =tr>Eza- € ol ca00 a.) t--aa oc.) N tso d o.= lEo tl A3' ao oo $$ c.) N >9.,3h.oE b I ".= q o.6It tr - 2.,, - -aQI.=^ E EBEE o>*6 cO oo ca ts ca at .9<fiv o\ Eoo ca )obr -v$tA A* -V !o(! bo z d!(! ! a L N F] F F -: ! Uaq U a) U) \ q) L t q)q uq) U J4(, L (c r/)doL F] o L< cA ct) tr.l a d c) (d 0)liF r--f 6-)l -ol(gl FI o.l qJ 0oG ql S BqJ E$ 00 EO ,s\$a(.)g P ct aJ 's q q)s \)si qJ{ €I q) .o s s ql S d Pq h ql 'si\sqr"$ <l.\\ SU .is 'Eb d!PIBr(JL E\J tRiE$sQUXUcr'* El) \uS{ 9{r: 3N s\$fqJU a.R\bu b36!!{ sXsE :8s's PLd\Su;sSrl\t'Isutlis .S aa a a 2.6.2 What are the causes of absenteeism? During the dry season there is a high migration of male youth to urban areas to engage in petty trading and other unskilled professions to earn a living. They however return to their communities in the rainy season for agricultural activities. Nomads also move south wards for pasture for their animals during the dry season and return in the rainy season There are also people who have to go to schools in other towns/communities and only come back to their communities during vocation. 2.6.3 What are the reasons for refusals? There are still people who suspect that Mectizan@ is for binh control due to poor mobilization and health education and thus refuse treatment. Before the commencement of the 2005 treatment round health education remobilization of all endemic communities would be carried out. Follow up treatments would be intensified in all communities to ensure that absentees are treated. Religious belief and norms 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. a a a 2.6.4 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 was reported 22 n caN \) q) o' Lq) .a r.q)q t+ 0aq q) Uq) bq L g\ t qJq q) s t oa oo L o a.)Lr q) bI) H ol<L o C) (d o r! V) C' o C) (.)(t) ti C) Cd cn o t<o cn +< o C') o ch 63 O #r 6)l -ol cdlFI C) E09 YOXi:>-4 9u L gHH ;J (d .I:$oo == b fiEg(* X, .2 EAOEfis(J O. E ()n ext+. X (a!^i* eo .= q)0)-c Ed9a ad o.9sc o c E=9LL'T(!oo()OEGqE o3=B !H-.r :'d o xLJ d.C(i: €rgqP'S EEEEg ts(h trE -vk()!+0, A HOOG =c) .N* 99-ai i q)boco.- =bO>5 x() a q) oo * z U) .t N () oo P ES ro O o\t-' o\ .o o\ o, o\ o\ \o c-- 00 \o 00 \oo\ t-- o\ oo o\ o\ o, tr o Cd ao ll x ,5 rd l-) o o Bo=F 6.\<>- -o o o\(-- o\o, o\ \o o, o\ \oo\ o, o\(\o -o o\$ o.l o\ o, ll r rd lI1 t! o\ .9eOJ AT)od E-9 oo rcoF .o o\ F- o\ o\ o, o\ \o o\ o\ o\ ol 00 \Q N oo o\(.'l 6 o\ o\ € \oo\ oo Ll ! ,o O.d .o 2a z2 'o o r- o F- r- o\ { oo \o d} \o o\ N o\q c'.1\o t o\ r+ oo- o\ $ oo^ d oo o\ dis l-1 ?od o.= -)an' F\, o c.)\o- N a- \o a\ @ \o c.l\l-. o\ o O \o r- O N o qho hs L^= = o <r(wljSu='o*6 id.c <'= lI] ' d- 3e o. \o^ c.lt.. \o o{ 00 \o e.l\t'- o\ !f, c- $ a'l N oi ao $ \o+ N tr- ooo cn Nr- q(,) ood C) (-) ll * t5'ti ti o9ffaF Oo\<6- o -o o\ € o\ -o o\ 00 o\ \oo\ 00 o, .o o\O o\ .o o\ o\ o\ \oo\\o =oqo-oo= $= E8Slr Ookl \o \o \oo\O \oo\ o\o -6 o\ o\ \oo\\o o\ r{ Y.= oqb E EU tr E=;i =EiE>o6 ao \o oo rcoo o N o\ o. c.i E] =od o.= t ,p .a' FU o \o @ cooo c! o c.l o(\ 9'J =q;-.ld(F>::ooi_E ah +u!>-- a a A 6 Ata E o cr.6 EO o() ao ea co\o 6 a00 c.] N (\ & rr.1 r- o\ o. @ o\ o\ o\ o\9 N oo.l c.,looN c.) N $o N e.l \o o c.t Fr a{ € c{ o' N oc{ -o) v5s -I -6,(.) 0) a0 c6 LI 0) bvlr9 \rt\E .\DS-tr=qJL\tr6l tJ9.sL ,ariOE.S EEEEa 8'i -Es€:No) o\),E!!Elqv) .9iGlj6q,)tE i9orA0 E ^' (-r v eL0(Jo'= .=o+)e'E sqFz IFoe'nC==r\ - 9v=,{tr(*rn .iH-l :illiEHI E)EqhE-Ul Ea((lt c)q)ol .- 4>l trHPr n rSoPXU::oL 9ALEieLU9CF =dDE.cEE0)€9trot-9 ,;Id ;; q)ia-E 6i orl ';(Jl o =l ct.:ll o)tutFl er 2.7. Ordering, storage and delivery of lvermectln Mectizan@ ordered/applied for by - (please tick the appropriate answer) MoH f] wHOtr UNICEF tr NGDO f] { Other (please specify): Mectizan@ delivered by - Qtlease tick the appropriate onswer) MOH tr WHOE UNICEFN NGDO t] { Other (please speciflr) Please describe how Mectizan@ is ordered and how it gets to the communities The LGA Coordinators compiled the Onchocerciasis treatment using Mectizan@ in their various LGAs and submitted same to the State Onchocerciasis Offrce. The quantity of Mectizan@ tablet required by each community for the next year treatment round is based on total population of that community after the previous treatment round and multiplied by three (x 3). This is then collated at the local government level and sent to the state level then to the supporting NGDO (SSI) which in-turn places order through NOCP to Mectizan@ Donation Programme. LINICEF thereafter takes charges of the Mectizan@ clearance from the airport and its storage before collection by the supporting NGDO. The state then received its own allocation based on the total number of people to be treated likewise the local govemments and all the endemic communities. At the community level the first line health facilities received and stored the required drug for communities within their area of supervision. Communities are then informed to send their distributors/representatives to collect their Mectizan@ allocation after pre- distribution activities have been concluded. 25 Table l0: Mectizan@ Inventory (Please add more rows if necessary) How are the remaining ivermectin tablets collected and where are they kept? The balance of the Mectizan@ tablets are returned to the front line health facility by the distributors along with their community reports to the supervisor at the first line health facility who then passes same to the LGA Coordinator, who collates for all collection centres and submit same to the State Oncho Coordinator who returns them to the medical store where they were first collected for storage. List and briefly describe the activities under ivermectin delivery that are being carried out by health care personnel in the project area. Supervisors at the first line health facilities collate the drugs requirement from the communities they supervise and submit their request to the Oncho coordinator at the LGA. Based on their request Mectizan is issued to them from the Medical store. They keep the drugs in the first line health facility from where the communities come to collect their allocation, after notification of the availability of the drugs. o - Any other comments None LGA NumLer of Mectizano tablets Number in stock Requested Total Received Used Used/Person treated Lost Wasted Expired Remaining Bagudo 1,588 60,000 61,588 s6,068 2.99 0 l0 0 5,510 Danko Wasagu 2,192 120,000 722,192 121,383 3.01 0 59 0 750 Fakai 50 30,000 30,050 28,095 2.71 0 92 0 I , 863 Ngaski 641 102,000 102,641 92,184 2.94 0 13 0 10,444 Sakaba 500 105,000 105,500 105,232 2.67 0 l3 0 255 Zuru 950 I 1,000 11,950 9,408 2.88 0 0 0 2,542 TOTAL 5,921 428,000 433,921 412,,370 2.87 0 187 0 21,364 26 2.8. Gommunity self-monitoring and Stakeholders Meetlng Has any training (of trainers) for community self-monitoring been done in the project area? This was not done in the year under review. This was scheduled but could not be held due to lack of funds. There are plans to conduct this training before the next round of treatment. If so, when? 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. District/ LGA Total # of communities/villages in the entire project area No of Communities that carried out self monitorins (CSM) No of Communities that conducted stakeholders meeting (SHM) TOTAL 27 2.9, Superwlslon 2.9.1. Provide a flow chart of supervision hierarchy. 2.9. Supervlslon 2.9.1. Provide a flow chart of supervision hierarchy NGDO (STGHT SAVERS)NOCP (ZONAL OFFICE) STATE ONCHO TEAM LOCAL ONCHO TEAMS FRONT LINE HEALTH FRONT SUPERVISORS COMMUNITY LEADERS COMMUNITY MEMBERS COMMUNITY DIRECTED DISTRIBUTORS 28 2.9.2. What were the main issues identified during supervision? o Lack of female distributors in communities o Poor health education and mobilization of women in purdah. A community reported to have been treated but while on supervision it was identified as not treated. Records were fairly kept Supervision by local Oncho team was inadequate 2.9.3. Was a supervision checklist used? a The supervision checklist was not used in many cases during monitoring exerclse 2.9.4. What were the outcomes at each level of CDTI implementation supervision? LGA/T'LHF: At the LGA level it was noted that the local Oncho team could not carry out supervision frequently as expected. Community: There was compliance to treatment by community members, drug shortage was not an issue, the CDDs were poorly motivated and thus distribute drugs at their convenience. Community mobilization and health education was carried out in affected communities with emphasis was on provision of incentives in kind to motivate CDDs. 2.9,5. Was feedback given to the person or groups supervised? Yes a feedback was given to LGAs/FLHF and communities concerned. a a a a 2.9.6. How was the feedback used to improve the overall performance of the project? The feedback to partners concerned stressed areas that the project was weak, consequences and solutions. They were encouraged to fully participate and carry out their roles and responsibilities diligently. This of course resulted to a successful treatment during the year under review. a o 29 o SECTION 3: Support to GDTI 3.{. Equlpmcnt 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? There are existing plans for the maintenance and replacement of the existing equipment and materials. The project is hoping to use counterpart funds to maintain some of the equipment while it would approach partners to replace some of the equipment. a Source Type of equipment APOC MOH DISTRICT/ LGA NGDO Others No, Condition No Condrtron No Conditron No Condition No Condrtion L Vehicle I F 2. Motor cycle(s) 6 CNFR 7 wo 3. Computer(s) 1 CNFR 4. Printer(s) I F 5. Photocopier (s) I CNFR 6. Fax Machine(s) 0 7. Others a) Television 1 F b) Video Recorder 1 F c) Air Conditioner I F d) Calculators 25 wo e) Bicycles 30 CNFR 2l CNFR f) Overhead projector I CNFR 30 Contributor Year 3 (2002) Year 4 (2003) Year 5 (2004) TOTAL AMOUNT (cASH) Budgeted rus$) TOTAL CASH Released (us$) TOTAL AMOUNT (cAsH) Budgeted (US$) TOTAL CASH Released (us$) TOTAL AMOUNT (cAsH) Budgeted (US$) TOTAL CASH Released (us$) MOH (Central + Provincial/State) 23,622 10,774:5 22 , 222 7,407 .4 28,985.5 7,246.3 MOH (District/LGA) 18,656 0 17,777 0 18,260.86 I 3,913 Local NGDO(s) ( if any) 0 0 0 0 0 0 NGDO partner(s) 9,462.98 9.655.77 7,311.59 8,735.68 10,265.83 9,470.43 Others 0 0 0 0 0 0 APOC Trust Fund 30,161 .90 30,161.9 8,750.00 0 8,750.00 8,750.00 TOTAL 81,903 50,592 33,839 16,143 66,262 39,380 9.2. Financial contributions of the partners and communltles Table 13: Financial contributions by all partners for the last three years Exchange rate: Year 1- $1 : N(27, Year 2- $1 : NL35, Year 3 - $l : Nl38 If there are problems with release of counterpart funds, how were they addressed? This was not easy but when an advocacy visit was taken to the Executive Governor of the state by the supporting NGDO (SSI) and the State Oncho Team on the need for the government as a partner to take responsibilities bestows to it by CDTI towards sustaining the programme, this was achieved as the state and LGAs released some fund. The Ministry for Local Government and Chieftaincy Affairs also ensured that the LGAs release funds for CDTI implementation. 3.3. Other forms of community support Describe (indicate forms of in-kind contributions of communities if any) Incentives to distributors in kind or in cash by some communities. a a 3.4. Expendlture 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 - .$1 = Nt38 31 Activity Expenditure ($ us) Source(s) of funding Drug delivery from NOTF HQ area to central collection point of community Mobilization and health education of communities Training of CDDs Training of !ea.!1h s_t1ff a! all levels Supervising CDDs and distribution Internal monitoring of CDTI activities Advocacy visits to health and political authorities IEC materials Summary (reporting) forms for treatment Vehicles/ Motorcycles/ bicycles maintenance Office Equipment (e.g. computers, printers etc) Others 289.85 2,827.56 2,333.32 3,369.56 5,347.82 4,686.42 l,Bzz 2,405.79 543 3,448.04 0 12,306.64 MOH/SSYAPOC/LGAs SSI APOC/LGAs/\4oH APOC/LGAs APOC/SSI{vloH LGAs APOC/SSI APOC/SSIAvIoH APOC/SSI SSI APOC/SSI/MoH TOTAL 39,380 MOH/SSYAPOC/LGAs Total number of persons treated 143,198 Table 14: Indicate how much the project spent for each activity listed below during the reporting period. Any comments or explanations? SEGTION 4: Sustainability of GDTI 4.t1, lnterna!; independent partlclpatory monltorlng; 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 APOCYes Other Evaluation by other partners 32 4.1.2, What were the recommendations? General Recommendations . Communities are very receptive and therefore should be empowered through health education to promote acceptance of CDTL Electronic media especially radio should be fully employed for awareness creation and programme acceptance. o More Information, Education and Communication (IEC) materials should be produced and widely distributed in the CDTI areas o The management of the programme should be properly structured from the State to district level in order to ensure adequate capacity for facilitation of CDTI o There should be improved supervision of the programme especially at the state and LGA levels. Schools head teachers could be considered as resources persons at the community level. S ight Savers International o Given support to the State to assess the endemicity of some communities not covered but are sandwiched between treated communities and where necessary to commence treatment o Provide management training as well as training on data management for the state team so as to improve capacity in the organisation of CDTI programme o Assist the State in providing targeted training of health workers o Provide Mectizan@ tablets early enough and in sufficient quantity to enable the state commence distribution during the dry season NOCP (Notional / Zonal) o Ensure immediate follow up on the recommendations contained in this report. o Advocate for continuous counterpart funding at State and LGA levels. o Provide technical support in the management training of the project at the state level o Assist the State in the identification and mobilization of other stakeholders to support CDTI State a a a Advocate for and ensure release of counterpart funds at the LGA level Increase financial support to the project to ensure adequate supervision and monitoring of activities Develop and utilise monitoring and supervisory checklist for all levels. 70 - 80% of supervisory allowances are to be paid to personnel before they embark on such visits and the balance only after submission of completed checklists and monitoring reports. Collect and deliver Mectizan@ early enough to ensure distribution at community level during the dry season or whenever the community decides. Conduct a training needs assessment and based on the outcome plan for and provide the targeted training to programme implementers Identiff and mobilise organisations /groups for CDTI and thus broaden the support base a a o JJ . Pay close attention to the Wasagu district in Danko/Wasagu LGA and Birnin Yauri district in Ngaski LGA where treatment has stopped for sometime now and yet there are reports of treatment. Local Government Areas o Provide health education to target communities, especially on the importance of extended Mectizan treatment. o Conducted target training of district health staff who in turn will provide training of CDDs o Remobilise target communities on their roles and responsibilities under CDTI in a cost-efficient manner. o Remobilise the communities so that each community has its own CDD that resides in the community, and where necessary advocate for increase in the number of the CDDs per community o Communities should be actively encouraged to select females as CDDs even when such female are not literate. These non-literate female CDDs can distribute while their male literate counterparts will do the recording. It might be advisable where necessary to encourage the communities to utilise female vaccinators and guides whom they select as CDDs. o Staff should identiff existing CBOs and religious groups/age grades which can be mobilised to support CDTI o Mectizan@ tablets should be given to communities based on population updates and supply should not be in piece meal. o Mectizan@ tablets should remain at community level for at least two months to ensure treatments of absentees and follow up refusals and those temporarily ineligible. o Efforts should be made to further decentralise CDD training to ensure that CDDs are trained /retrained if not in their communities o Where feasible, other health issues should be integrated in CDD training o Supervisory visits should be carried out in an integrated manner for cost efficiency Gender o Use Islamiyyah (Koranic) schools attended by women as a forum for health education. o Include the need to select women CDDs in health education and use public address equipment for health education sessions especially because of the pervasive culture of secluding women indoors, i.e. in order to ensure that they also received first hand knowledge of the programme. o The idea of involving women vaccinators under the NPI at community level is a viable point of integration and collaboration o In addition, female PHC staff should be incorporated into the Oncho programme in order to create a forum for women participation through orientation of women groups in the six CDTI LGAs. The Ministry of Women Affairs in Birnin Kebbi could be mobilised through the holding of stakeholders meeting at State and LGA levels. 34 4.1.3. How have they been implemented? A workplan has been developed to address and implement the recommendations from January 2005. 4.2. Sustalnability of projects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period? No Was a sustainability plan written? No When was the sustainability plan submitted? NA_ What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.2.1. Planning at all relevant levels There will be a meeting to develop a sustainability plan meeting with relevant stakeholders Advocacy would be made to the relevant stakeholders to support the sustainability plan. Each LGA with meet with stakeholders including religious leaders to discuss and implement decisions taken on sustaining the project Communities will be educated and sensitized on their roles as partner toward sustaining the project. 4.2.2. Funds Advocacy visit will be intensified to relevant partners to release counterpart funds to support the CDTI project. 4.2.3 Transport (replacement and maintenance) It is hoped that counterpart funds would be released and used for the maintenance of project vehicles at the state and local governments. No specific plans have been made to replace the transport and capital equipment. The project would however approach partners for a one off donation to support the programme. 4.2.4. Other resources Other resources for the successful implementation of a sustainability programme will be discussed and explored during the planning meeting. a o a a a a a o 35 4.2.5, To what extent has the plan been implemented The plan is not ready, but the project has commenced sensitization on the sustainability plan and it is expected that stakeholders would buy into it. a o 4.3. lntcgratlon Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3.1. Ivermectin deliverymechanisms Ivermectin delivery has been integrated into the PHC system from the state to the first line health facility. When ivermectin is received it is stored in the state Medical store from where LGAs collect their allocations. The allocation to the LGAs goes through the PHC drug delivery system and stored in the medical stores from where the supervisors from the first line health facilities collect the communities they supervise. 4.3.2. Training Training of personnel for CDTI activities is yet to be integrated into the pHC system as all programmes hold their trainings separately. Attempts have been made to train some Traditional Birth Attendants on CDTI strategy when they are being trained on maternal and child health in a few communities. 4.3.3. Joint supervision and monitoring with other programs o There is yet to be a formal arrangement for this, nevertheless, state and local control teams are encouraged to supervise CDTI when the supervise National Immunization Programmes in their areas. It is expected that this would be discussed and agreed as a strategy for the sustainability of the programme. 4.3.4. Release of funds for project activities The spirit of commitment by the state and LGAs in the released of counterpart fund has been quite encouraging. These are however released separately and not part of the PHC budget at the state and LGA level. a o 36 4.3.5. Is CDTI included in the PHC budgetr o Yes at state and LGA levels 4.3.6. Describe other health programmes that are using the CDTI structure "od no'n this was achieved' What have been the achievements? a 4.3.7. evaluated. SightSaverssupportedthetrainingofsupervisorsandCDDson primary eye care with the hope that would help in the screening' identification and referral of eye patients in their communities' It is ..p;;i"d that the cpir structure would be used to achieve this. The ;;;f;;;r". of tt. supervisors and CDDs on this has not been a Describe others issues considered in the integration of GDTI' The government stands the chance to reach peop!: at th.e grassroots with the n...rrury- u*u"nt" related to public health and to i.,.-o.po.ut. -..b.., of the community to tak-e ownership of most primary issues regarding their health. It is cost effective for all partners it "t."y be involved inlmplementing CDTI principle' 4.4. OPerational research 4.4.|.Summarizeinnotmorethanonehalfofapagetheoperational research undertaken in the project area within the reporting period' oNooperationalresearchwasnotundertakenduringtheperiodunder review' 4.4.2. How were the results applied in the proiect? o NA. 37 SEGTION 5: Strengths, weaknesses' challengesr and oPPortunities _ List the strengths and weaknesses of cDTl implementatiorr process. - List the challeng.t unA indicate how they were addressed' ttrrngthr: o Released of counterpart funds by the state and the LGAs o continuous compliance to treatment by communities despite paucity of funds' o Good community awareness about the programme' oDistributionofMectizan@bysomeCDDsdespitenonprovisionof incentives bY their communities' Weakness: Poor involvement and participation of women in CDTI activitiesa o Lack of female distributors poor motivation and incentive for cDDs by some communities leading to CDD attrition' Inadequatemonitoringandsupervisionbythelocalonchocontrol o a 38 SEGTTON 6: Unique features of the proiect/other matters 39