]er^,2, r".,1-i.,r,,. TCC 2l /1,'v^ g l-oo T OSUN STAIE CDTI PRUECI (r *TB c '!lt ORIGINAL: English ANNUAL PROJECT TECHNICAL REPORT 5UBMITTED TO TECHNTCAL CONSULTATTVE COlAl,trrrEE (TCC) DEADLINE FOR SUBMISSION To APOC Management by 31 January. 2008 for March TCC meeting To APOC ltflanagement by 31 Julv, 2008 for September TCC meeting AFRICAN PROGRAMME FOR ONCHOCERCIASIS CONTROL (APOC) COUNTRYAIOTE: Nigeria Proiect Name : Osun State CDTI Approval year : 1998 Launching year : 1998 Reporting Period From: 1"Jan., 2OO7 TO:31'tDec., 2007 (Month / Year) Proiectvearofthisreport: (circleone)l 2 3 4 5 6 7 8 (9) 10 Date submitted: February 2008 NGDO Partner: UNICEF lv /, i /u') Wtl() ,,\['( )t'. .lautrarr . )()ll- ANNUAL PROJECT TECHNICAL REPORT TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: try: NIGERIA National Coordinator Name: Signature: Date: Name: Signature: Date: Mrs. P. Ogbu-Pearce Zonal Oncho Co ordinator Otunba A. O. Jaiyeoba TO Coun This report has been prepared by State Coordinator Name: Mrs. F. S. Adetifa Designation: Signature: Date: I ll \ /HO i APOC. Januan. 2007 ACRONYMS DEFINITIONS FOLLOW UP ON TCC RECOMMENDATIONS EXECUTIVE SUMMARY SECTION 1: BACKGROUND INFORMATION 1.1 Table oJ Contents 1 VI vii 2-3 10-12 13-14 15-17 18 18 19 19 4 4GENERAL INFORMATION 1.1.1 Description of the project (briefly) Number of Health Staff involved in CDTI 1.1.2 Partnership POPULATION AND HEALTH SYSTEM 4-5 1.2 2.4 o 7 I o o SECTION 2: IMPLEMENTATION OF CDTI 2.1 TIMELINE OF ACTIVITIES ADVOCACY MOBILIZATION, SENTIZATION AND HEALTH EDUCATION AT RISK COMMUNITIES COMMUNITY INVOLVEMENT CAPACITY BUILDING TREATMENTS 2.6.1 Treatment figures 2.6.2 What are the causes of absenteeism 2.6.3 What are the reasons for refusals 2.2 2.3 10 2.5 2.6 2.6.4 Briefly describe all known and verified serious adverse events (SAEs) 19-20 \\ II() .\['( )('. .l.rnrrtrr. ]ll(r-ul 2.6.5 Trend of treatment achievement from the CDTI project inception to the current year 21 2.7 ORDERING, STORAGE AND DELIVERY OF INVERMECTIN 22 2.7.1 Mectizan inventory 23 2.8 COMMUNITY SELF-MONITORING AND STAKEHOLDERS MEETING 24 2.9 SUPERVISION 25 2.9.1 Provide a flow chart of supervision hierarchy 25 2.9.2 What are the main issues identified during supervision? 25 2.9.3 Was a supervision checklist used? 25 2.9.4 What were the outcomes at all level of CDTI implementation supervision 25 2.9.5 Was feedback given to the person or groups supervised? 26 2.9.6 How was the feedback used to improve the overall performance of the Project? 26 SECTION 3: SUPPORT TO CDTI 26 3.1 EQUIPMENT 3,2 FINANCIAL CONTRIBUTIONS OF THE PARTNERS AND COMMUNITIES 3.3 OTHER FORMS OF COMMUNITY SUPPORT 3.4 EXPENDITURE PER ACTIVITY SECTION 4: SUSTAINABILITY OF CDTI 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) 4.1.2 What were the recommendations? 4.1.3 How have they been implemented? 26-27 28 28 29 30 30 30 30-31 32 \\ il(i \l)(X . llr|rr.rr', 'rt()-lv 4,2 SUSTAINABILITY OF PROJECTS: PLAN AND SET TARGETS (MANDATORY AT YR 3) 4.2.1 Planning at all relevant levels 4.2.2 Funds 4.2.3 Transport (replacement and maintenance) 4.2.4 Other resources 4.3 INTERGRATION 4.3.1 lvermectin delivery mechanisms 4.3.2 Training 4.3.3 Joint supervision and monitoring with other programmes 4.3.4 Release of funds for project activities 4.3.5 ls CDTI inclined in the PHC budget 4.3.6 Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? 4.3.7 Describe other issues considered in the integration of CDTI? 4.3.8 Operational Research SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES AND OPPORTUNITIES SECTION 6: UNIQUE FEATURES OF THE PROJECT / OTHER MATTERS 33 33 33 33 33 34 34 34 34 35 35 35 35 35 35-36 36 \\ I I( ) .\l'( )( . .lrrrruJrr. 'r)()7V
Acronyms APOC African Programme for Onchocerciasis Control ATO An n ual Treatment Objective ATRO Annual Training Objective CBO Com mu n ity-Based Organization CDD Com mu n ity-Di rected Distri butor CDTI Community-Directed Treatment with lvermectin CSM Commu nity Self-Monitoring FLHF First Line Health Facility FMOH Federal Ministry of Health GCCC Government Cash Counterpart Contribution lFESH lnternational Foundation for Education and Self Help LGA Local Government Area LOCT Local Government Onchocerciasis Control Team MOH Ministry of Health NGDO Non-Governmental Development Organization NGO Non-Govern mental Organ ization NID National lmmunization Day NOCP National Onchocerciasis Control Programme NOTF National Onchocerciasis Task Force NPI National Programme on lmmunization PHC Primary Health Care REMO Rapid Epidemiological Mapping of Onchocerciasis SAE Severe Adverse Event SHM Stakeholders Meeting SMOH State Ministry of Health SOCT State Onchocerciasis Control Team TCC Technical Consultative Committee (APOC Scientific Advisory Group) TOT Trainer of Trainers UNICEF United Nations Children's Fund UTG Ultimate Treatment Goal WHO World Health Organization \,\ I 1( , \l)( )( . .l.Ljr l.i,-, 'r)(r--VI Definitions (i) Total Population: living in meso / hyper-endemic communities within the project area (based on REMO and census taking). (ii) Eliqible population: calculated as 84% of the total population in meso / hyper-endemic communities in the project area. (iii) Annual Treatment Obiective: (ATO): the estimated number of persons living in meso / hyper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. (iv) Ultimate Treatment Goal (UTG): Calculated as 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 it should be expressed as a percentage). (v) Therapeutic coveraqe: number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) Geoqraphical coveraoe: 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) lnteqration: deliverin g 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 maximize cost-effectiveness and empower communities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTI. (viii) SustainabiliW: 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 services, with strong community ownership, using resources mobilized by the community and the government. (ix) Communitv self-monitorinq (CSM): The process by which the community is empowered to oversee and monitor the performance of CDTI (or any community-based health intervention programmed), with a view to ensuring that the programme is being executed in the way intended. lt encourages the community to take full responsibility of ivermectin distribution and make appropriate modifications when necessary. \\ I I( ) .\1,( )( .llr]rnrr. -lr()'vll FOLLOW UP ON TCC RECOMMENDATIONS Using the table below, fill in the recommendation of the last TCC on the project and describe how they have been addressed TCC session - 25 - Number of Recommend ation in the report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY Commei6 oie Year Report 226 Sort out the issue of CDDs demand for incentives. This could be done by training more CDDs per population treated. UNICEF sponsored the training of additional 1785 CDDs in August 2007.The CDDs /Population ratio is now 1:178.|n the meantime communities are being sensitized to fulfill their roles which include giving of incentives to their CDDs Conduct Census Update A proposal to pilot test for effective ways of conducting Census Update in 3 LGAs has been approved by UNICEF. lt is expected that the experience from the pilot testing will be used in the update in the remaining 11 LGAs. Make an effort to repair or replacement of project equipment such as motorcycle The available motorcycles are not repairable. Two new motorcycles have been supplied by APOC while the project will approach UNICEF/Nigeria to assist in the procurement of additional logistics. Ensure availability of treatment records by community in the project The community treatment data has been collected, with support from APOC Management. I \\ i ;1 t \ ir1 \( l,rIr 111 i )( )- Provide reasons why a large number of UTG (180034 people) was not treated. Raise more funds for CDTI activities from State and LGAs Large numbers of people were not treated due to the following: - poor commitment of CDDs due to lack of incentive - lnadequate community mobilization. ln order to increase coverage, more CDDs 1785 were trained in 2007 with support from UNICEF. An additional 1,666 will be trained in 2008 to achieve CDD / Population ratio of 1:125 and consequently cover all eligible persons. Advocacy visits were conducted at all levels to increase support. More have been planned for 2008. Comments on /' Year Report 228 The project should respond to TCC 21 recommendation on the reduction of the treatment period from January to April Reduction of treatment period is one of the challenges facing the project. This has been constrained by inadequate funding, late releases of approved funds & consequently late implementation of planned activities. The project has been making efforts with support from UNICEF and the State to ensure planned activities take off early and distribution time is harmonized within a 4-6month period in the dry season. This harmonization is becoming increasingly necessary with the planned introduction of albendanzole for LF in 2008. The data on table 13 should be checked and funds from other sources should be Data on tables 1 3 and 14 had been checked. Funds from other sources reflected. 2 \\ il() ,\l'( )('. .l:rrrrrrn. l()( ,' shown in tables 13 and 14 Check table 3 for accuracy because supervision goes from October to August (1 l months) Table 3 had been checked. What is reported - 11 months for supervision - is as a result of inadequate funds and late funding. 229 The project should improve on the maintenance of motorcycles and bicycles ( 52 motorcycles and 83 bicycles grounded) The LGAs are being mobilized for the maintenance of motorcycles and bicycles procured. lt has been reflected earlier that some of the motorcycles have been written off. lntensify sensitization and advocacy to communities and community Leaders to support the CDDs Funds have been the major constraint. There are plans to mobilize NGOs and CBOs who will assist in sensitization and mobilization of the communities. Conduct formal training to reduce maladministration of drugs and poor record keeping. The training conducted for SOCTS, Health workers and CDDs in 2007 addressed the issue of keeping of appropriate drug inventories and usage of the revised MIS forms for proper record keeping. This will be further pursued in 2008 with support from UNICEF. Review the timeline of activities to reduce training and drug distribution time. The timeline was reviewed but implementation is a function of timely availability of funds. Previous experiences guided the planning of activities. Train Communities on CSM The communities will be trained on CSM in 2008 with UNICEF support. lntensify advocacy to LGA and State authorities for early release of fund High level advocacy by UNICEF/NOCP to be embarked upon to State and LGA in first quarter of 2008 J \\ Il( ) .\lr()( . .lulir:rrr .lt)(tl Executive Summary Osun State is one of the States in the South Western part of Nigeria and is located in the B Health Zone. Though it is a predominantly Yoruba State, other ethnic groups like Hausa, lbo, Fulanis and Agatus also reside in all parts of the State. lt has a population of about 3.4 million (2006 census). There are 30 LGAs, 28 out of which are endemic for Onchocerciasis. The target population at risk is about 1,300,000 people in 1,500 communities. 15o/o of this population is estimated to be children less than 5 years, while 26.3 o/o are children between the ages of 5 and 15 years old. However, only 14 LGAs out of the 28 are being assisted by APOC. The estimated population of people at risk of river blindness in these 14 LGAs is 700827. During the year under review, all the 724 endemic communities in the 14 APOC assisted LGAs were effectively mobilized and treated, resulting in sustaining 100o/o geographical coverage while the therapeutic coverage is 71o/o. The Annual Treatment Objective (ATO) and UTG is 588,685. A total of 498037 people were treated during the period with 1,185,810 tablets in the 14 APOC assisted LGAs. Additionally, 133910 people were passively treated with 410153 mectizan tablets in the township and in other non-assisted 16 LGAs. lvermectin distribution commenced in 1992 while CDTI started in the State in 1999. Osun State is in the ninth year of CDTI implementation. Emphasis was placed on grassroot community involvement, with a view to enhancing full empowerment and sustenance. lntegration was up-scaled with the development and use of an integrated monitoring and supervisory checklist. Eightythree (83) LOCTs and 320 Health workers were trained or retrained in 2007.1785 CDDs were trained, out of which1,020 were newly trained while 765 were retrained. The existing number of CDDs in the project is 3,941 and the present CDD/population ratio is 1.178 4 \\ I1() ,\l'(')L'. .lrlnrr:r,r. :(,t(r- The challenges confronting the project during the year were a) lnadequate and untimely release of government cash counterpart fund at the State and LGA levels. b) CDDs attrition c) Declining interest of CDDs in CDTI due to lack of provision of incentives by the communities. d) Poor involvement of CBOs and NGOs for programme support and commitment e) Poor attitude / commitment of FLHF. 0 lnadequacy of Census Update g) Non-availability of good project vehicle for monitoring and supervisions, as well as non-functionality of other capital equipments like Desktop Computers, Printer, Laptop Computers, and Photocopier thus impeding both technical and administrative performances of the CDTI project in Osun State. ln view of the above challenges, the following steps were taken: . Advocacy was paid to members of the State house of assembly to solicit for programme support at all levels. r Mobilization of community leaders in order for them to fulfill their roles in giving incentive to the CDDs . With support from UNICEF more CDDs were trained, and a managemenU appraisal meeting with LGA Onchocerciasis Coordinators with their assistants was held. . Funds were obtained from UNICEF to do census update in 3 LGAs. 5 \\ I l() \1)( )( . .i;1rr11rrr 'rt(' ' SECTION 1: BACKGROUND INFORMATION 1.1 General information 1.1.1 Description of the project (briefly) Geographical location, topography, climate Osun State is one of the states in the South Western part of Nigeria and is located in B health zone. lt is bounded by Kwara State to the North, Ekiti and Ondo States to the East, Ogun State to the South and Oyo State to the West. Osun State project covers an area of about 8,602 square kilometers. The topography is plain and undulating with thick forest and Savannah vegetations. There are many rivers, streams and ponds such as Osun, Oba, Owena, Oora, to mention a few that serve as potential breeding sites for the Blackfly. The State has a land mass of about 8572 square kilometers. The State has two distinct seasons, dry season and rainy seasons. The rainy season begins in March and is heaviest from June through September / October after which the harvesting is carried out. The dry season begins in November and ends in Mid March. Population: Activities, culture, language Osun State has a population of about 3.4 million (2006 census). Yorubas constitute the major ethnic group, although some minorities such as the lgbos, Hausas, Fulanis and Agatus exist and cohabit peacefully with the indigenes. The State is essentially an agrarian State with about 70o/o of its population engaged in one form of agriculture or the other. ln addition, it is a State that is internationally recognized for its rich cultural and tourism potentials. Tourist attractions include Erin ljesa water falls in Oriade Local Government and the popular Osun Osogbo festival in Osogbo Local Government. 6 \\ tl( ) .\l'( X' .lltnLrlrrr. r' )(.rr Due to the presence of river Osun that runs round the State, it is known as the State of Living Spring. This has created tourist attractions to people who visit from all over the world annually. Co m m u n ication Sysfem (road...) The major roads in the State are tarred but access roads to most of the endemic communities which were poor before have been improved upon. Some are only accessible during the dry season. Despite this, transportation by road remains the major means of communication among the communities. l. E. C materials, electronic media and the use of community town announcers, announcements in Churches, Mosques and Schools also form effective means of reaching the populace. A d m i n i strativ e Str u ctu re Osun State was created on 27th August, 1991 out of the then Oyo State. The seat of Government is at Osogbo. The State was created initially with 23 Local Government Areas but due to the creation of more LGAs in 1996, the LGAs were thus increased to 30. The latter were divided into six geo-political zones for administrative convenience. At LGA level the Chief Administrative Officer is the Chairman. A legislative arm made up of selected councilors from various wards supports him. At the State Level, the Executive Governor is the head of administration supported by an elected legislative arm and the judiciary. The capital of the State is located in Osogbo. Health Sysfem & Health Care Delivery There is an official PHC System and it is implemented in the project area. lt is a system where health care services are taken to the doorsteps of the nooks & corners of the rural populace. lt is a system where community participation forms the mainstay and thrust of health care delivery with support from the UN agencies, the State and Local Governments. Levels of functionality however vary across the State. Within the 7 \\ I l() \f'}()( ..llrrrr.rr', -')(); project area, there are 3 teaching hospitals, 9 State hospitals and 330 health facilities scattered throughout the entire State. NUMBER OF HEALTH STAFF INVOLVED IN CDTT Table 1: Communities participation in the CDTI (Please add more rows if necessary). District / L.G.A Number of health staff involved in CDTI activities Total Number of health staff in the entire project area B1 Number of health staff involved in CDTI 82 Percentage B3=B2lB1 *100 Atakunmosa / W 70 70 100 Ayedaade 74 74 100 Ayedire 86 68 79 Boripe 137 95 69 Egbedore 118 89 75 lfe Central 68 67 99 lfelodun 78 57 73 lfe East 86 86 100 lla 72 72 100 lsokan 81 58 72 lwo 79 67 85 Obokun 83 83 100 Oriade 84 72 86 Orolu 60 60 100 TOTAL 7r176 7rO78 87% 1.1.2 PARTNERSHIP ISSUES The partners involved in project implementation within the project area are APOC, UNICEF / Nigeria, NOCP (National & the B-Zonal Offices), the State Government, the various Local Governments and the endemic communities. 8 U Il( ) ,\P( )('. .lrrr.rrlrrr . )()l)l OVERALL WORKING RELATIONSHIP AMONG PARTNERS Overall working relationship among all partners is cordial. UNICEF supported and sponsored training programmes during the period under review and these were Management / Appraisal training SOCTs and LOCTs; Training of new FLHFS and Training of 1785 CDDs. The zonal and national offices assisted in supervision, monitoring, training, advocacy and mectizan procurement. Similarly, the State supervises and monitors the activities of LOCTs and first-line health facility staff (FLHFS); trains health workers; conducts advocacy visits; collects Mectizan meant for the State from NOTF store; and coordinates local government CDTI activities. The local government played such roles as training, supervision and monitoring of field activities; mobilization of Local Government Authority for the approval / release of Government counterpart fund and hosting of monthly rotational meetings. The communities fulfill their much expected roles most especially in selecting CDDs, giving them incentives, coordinating the CDDs activities, ensuring prompt rendition of reports, collection and distribution of mectizan. PLAN TO MOBILIZE NGOS/POLICY MAKERS There are plans to continue mobilization of the policy makers occupying local government positions. The project hopes to mobilize CBOs so that they can actively assist in sustaining CDTI in the State. 9 \\ I l( \l)()( ..1.111r1,11.. -')(tl th c r^-o= f 11 = €,- '=E A -EX . IocsE - .L([:- o@EC J =oa U i(5Co e. '; H',oo= '6,() <o OLL; E; -cEo*=c *$sE; } fv-- oZ'= E E EP= U €8fi HEH =6oP,5 e =EI;o)\cP6; =zE ef,$EE> g E E69t;.8 bfvathao clo8eE -ooEP;.io-c:-EFEE=o-(5EEEE80 E Eb H =oEOEEE35FU'O Eo L oo Eo o- o o o) - .E JE oC o Eo (5 oL oLo oE LoE o ! =(U o([ o G) 'd L o. oLEC o) o) .C .Eia 'E (5 a(E .t, E.lagle E6 :^-=LgE= .,tf|/) 5 8.9EeEo:o -;E OEY UL.=(E(E=ru trE9,O EB: -rvA(E(J9 = CL oo- ::Ng ct€ FF E2 (H Cg o (d o,R P(tl rlv .=oF rj C ---)L - v)cd 0.)L $6 ao ( cil o\ s € o\ o\$ N $ oo o\ tr- coN o\ c.) co ca $ F- $ oo c.lclN$ o\\o \os co ta)( ta)$t--( ta) r-- co a.t\o \o co cn c\ cn rl)o @- @@ ro Lfrts &Rf(!S.C-iE9HL F- rn$ c.lt*@$ t--tf) €(A \o\o o\s c.t co cn € ol s t-. o\ co t'-s oos cl c*N lr) $\o o\t cn co\o\\o $\o ao\o\o oo\o t--\o c.l oo c{ c- a.t c.l\o $ Nodo o 'Eooo b€gE-(! 0()or7 ,r()()PEP' >\ t\ O. oo c'l $ cn\o o\(n s(al o\ta) co o\\o\o$ @(n \o o\ a.)\o c.l N o\ o\\o € c.) o\$tr- ol$ o\(A \o c.t cnlr) $N co I-r ?aa ra r- oEPEo=L -*q';8< vLi.ERX coc.lc.l $ oo r t'-N$ \o \o a{$ 00 tr- c- co ao C\l cn o\ \o o\s (" o\a \o $ s$\o \o o\ c- aa\o c.)$ o\\o$ c.la\o oo \o c.l \o ooN$ c.) ca € trr o\(f) N o\\o a) C) bod a(.) E o(H o L 0) -o z a)r()L- =N+6AEiiF P € € 0.) lr) t--\o c-.1ao @ c.tc.l sN c{N cna o\$ cloo o\\o s Nc* a.) t ctt-- o tr6)(n v!H v-(vCLdd)'-i)4 -r(D6) xos, *xr a an r* a r- a.l a r- t--$ t-- oo co N6l ar CE .-Yc)+L 2,trtr'=ooYNii I-r$ \o $c.l $r-- aoc\ $c.l c.l \at.- a.l$ \acn $ra) anc-) $\o t-N No(o -()()rLL =,O'5(s LP -odoHF=o';o.s9 oe=A \n r- rns c.l F- 00$ t-r r 00 \o\o o\$ N ao an@ c.l $ (-- o\ cn r--$ oo$ c]t--N ra $\o o\$la) cn co\o\n\o $\o c.)\o\o oo\o r*\o c.l@ c'l F- co c.l\o $ N@do a) r--Lo !L H6qUv.Eij.a 7,trh H E o ct c) 6l c! c) o c) q) 0)U .0) .q) q) o o0 tr1 ah c! frl .0) c! ah B q) c! F C .o .9. z o CLfa o .E 3b Oc tl, J o)) o) o)) of o)) o =o)) o :l o)) a)(,,) af o) = of o,) a J o)) a) o)) o) o,f of o,f of o)) a =o)) o)C_C 'EP L-!q6 t' of -o o) LL a,(5) -oo LL b([) -oo LL e. of -oolr z" o) L -oo LJ- E o) -ootL b(Ef -oo LL b(Ef -oo LL h o) -oolL E(5) -oo LL l.(5J -ooII b$ =L -oo LL F(!) L -oo LL z.(!) -oo tL C o) -o ,oo o)f o .o o!35b>OC o) o) :, o) o)) o =o,f o) U'f a) o)f o) o)) o =o)) o) o)) o) o) f o f o)) .o) o) = af o)f o J o,) o =o)f o)C-C '=r-cAo -C() L(o = oL(o = o (5 !oL o -c() L([ -c() (E = -c(J L([ soL(U -c(J L o = .Co L(5 -c() (U -c() o = o L([ () o o $E o-f o) oE o(.) .9 o!3bb=()c a) o) f o =o)) o f o)) o) o)) a) o)f of o)) o) o)) af o)f of o,) o =o) = af o) - o) o)) o f o)f ah) o,f o) .C -g l-c(5O -coL o = -coL([ (J (E () o -co (E = .C() L(6 oL o .CoL o = -co (5 = o L o so o = -CoL(5 .CoLo -c() L o = o) .=E 'd LF C o o o-! FC6o oL(5 = () L(U = () (U -coL(I, -co Lo -go L(U = s() L(I, -() L([ ()Lo = -co (E -coL(, oLo = -c() L(5 -C(J (U = o)C- r-cAo F o) -oo LL z-(E f -oo LL b([ JL -oo LL D o) -ooIL E. of -oo LL b(E) -oo]L b(U) -oo LL E. of -oo LL Z.(5 f, L -oo LL h o) -oo LL l.(! J -oo LL t,(5 f -oo LL b(U) -oo tL h o) -oo LL oEO .9=(5=N= L -otOO o Co ot-c FC6o o f o)f o) o)l a =o)) a J o)) o =o) f o) o)) qt =o)f o =o,) t,) o)) of o, J o f o) f o) o)) af o)f o f o) f U) .EEr-c 8S b(5) L -oo TL b(Ef L -oo TL b o) -ooIL b o = -oo LL b(U f L -oo LL t(U) -ootL E. of, -oolr z.(5 JL -oo LL F o) L -oo LL Z^(5 f -ool! b(E)L -oo LL h(Ef -oo LL b o f -oq) LL b of L -oo]L (9 J o L .oo = o U'o EEftz o oE([([ !o o .= !o o o- L o co 6 c oo o cfEo o = o oEo -o o) I.IJ a(U ]U o o C(E .!aoa o 3 c) .V o -oo oE(5 L o )6L o z a N (f) $ r.r) (o r- c; o, o Nr (a rt f- .l = = -:: c) Cg o. .h(t o c.) LL o C)!o rh c.) o cq X 0) q) uh CE 6) d 0) CE a t, 6l 6) 6t q) q)l- e a() c) cl G q) a) ao 6l 0) Cr I t-(u a(r, oo oC := a =ot- ot- o E Eo(E oa(E o o- v t-(E o c ot-L =o o .C .E E o G ot- a oF9O<uOo rF -Co t-co .9:EU+, = o:> oxLVLs ,r .- rv EL:EOFoo =(ECtF :=oo o.El:r- N6 zErigFu FJoo O c\r F Advocacy and Sensitization At the State level 3 Commissioners and 4 Permanent Secretaries were mobilized while 14 Chairmen and their deputies were mobilized at the LGA level to support the CDTI implementation. During the monthly rotational meetings of the LOCTs with the SOCTs, LGA Chairmen are usually invited to give the key note address. The meetings provided an avenue for interaction with the Chairmen and for them to recall what they had done for the implementation of the programme. Some LGAs have responded with government counterpart cash contributions being made available. The fora were also used as mini-training for educating and updating the knowledge of LGA coordinators on proper record keeping and other CDTI activities. At the State level, the project has relied on external bodies like UNICEF and NOCP otficials who came to visit the project to pay advocacy visits to the policy makers. Difficulties encountered include absenteeism of the policy makers at times of visit and non release of the approved counterpart fund promised by some policy makers 2.3 Mobilization, sensitization and health education of at risk communities The Use of Media for Mobilization The Communities were mobilized through jingles on Local Radio/TV Stations i.e. Nigerian Television Authority, Radio Nigeria & Radio Osun; announcements in mosques and churches; through town Announcers, public address systems mounted on moving vans, IEC materials like posters, handbills, manuals. Village meetings with community leaders were also used to mobilize the endemic communities. \ FI() .\l'(ii .l Itttitirrr . lt )(t2 1 Mobilization & Health education of woman and minorities The involvement of females and other minority tribal groups had continued in no small measure to the optimum support being received to sustain CDTI programme over the years. Women are increasingly participating in CDTI activities more than hither-to, excepts in some few LGAs. Response of tarqet mmunities / villaqes The Community members / Villagers mobilized responded positively to the mobilization and health education carried out by the SOCT, LOCT, First Line Health Facility Staff and the CDDs. Some community leaders (Baales) provided lunch and snacks for CDDs during the training. They assisted in the collection of Mectizan and in some cases gave incentives to their CDDs. There is more awareness on lvermectin benefits, more involvement in decision making and community members make more efforts to encourage potential refusals to take lvermectin. Accomplishments: (a) Female members of the community are becoming more involved in the decision making and Mectizan drug distribution. (b) The responses of the Community members to yearly Mectizan usage increased tremendously during period under review especially amongst the community leaders who supported the programme in their various communities. Community members came out enmass to take their yearly Mectizan tablets better than previous year. (c) Refusal rates decreased. \\li(r \1,(x -.liilt,r,'.i'rx)l3 To lmprove Mobilization and Sensitization of ta communities Mobilization and sensitization could be further improved through the following ways: - Procurement of functional logistics. - Sharing of transport with other PHC programmes - Greater involvement and participation of Health facility staff especially the FLHS. - Utilization of LOCTS / SOCTS monthly rotational meeting for community mobilization. - Usage of treatment data as a tool for monitoring and follow up of mobilization activities. - Capacity building of health staff / FLHFS to increase their skills and knowledge on etfective mobilization, monitoring and supervision of CDTI programme. \\ LI(),\T'}(X'. .lur.rr-rarr. 1t)t)'t4 ! oq) a0 e0 .:; EV =s o .o) a)E z o -'b0 .L tr> ico ^oil cn c{ r-- Frtf) o\ clca ra) NN $rn ra)cn ra)c\I € \oN 6 r- \o+ st = rFBe r'!EoE=EE=LE;E=vz5> \o ca la) c.l o\N \oc..l |r) c.) o\C\ N ra) oo c..lca rn + \o ra !9 .=z o7AE Q.9 OE .tE zQ € :: r- Fil o\ ce c--\o c..l @ c.l \o+ ca o\ c.l r- c.) \o\o N o\ N oo o{$ +6 co\o o\oo$ (n \o C.l +lr) c.l r- do\(o 9o EAEa) r\ No\ \o(n + Noo \oo\ $+ r-o\ c- car- cor- cOc- o\ tr)t- (.I\o!+ at2 =lrr-2u l r- € o\ ta) lr)caN r- lr) r- cA c.l + o\ \o co N o\ co\o \oo\ o\ r-.tN o o0 to 'F \oqa =c) U q) z 00xg;= 9ll * ^- C0 oor- (n r-- + +tr) ta)\o \no\ cn (a)\o 6l+ f- C.la N+ ca+ tra ''E"9I giE -FLVEtriEL2 3 E =. o\6l + $o1 aOc.) N tr) aOc.l \oN NaO +cO \oen cncO aa c.) l*.ro q) ..:a?oEoCa Z.=L tsro :EocE ,-Y9 ta) c-\o c\ca oo clo1 c.)N +N cooo o\$ N6 o\\o + NF- aO t GI r-. rl I ah cE ah q) C! cl c) ()L 0) C) L EA q) L o q) o! ri (,) U .o .0) rr) G ri e cl ,jl at) B q) CE 6l 3 tr) s o U) to ooo l+_ q =e o o b!o oq GI o- =oO o .E C +, .9 L(EOo-E:qoE Oa tr=C *,LtrE =oEo E oo+ Ia€NF Health Education Meetings. 2.4 More females are attending health education meetings and participate fully in discussions and decision makings. The issue of provision of incentives to the CDDs varies with different social- political areas of the State. ln some areas, people contribute either in cash or in kind which is handed over to the CDDs at the end of distribution. lncentives to CDDs ranges between physical cash, assistance with farm work, provision of foodstuff, recognition with gifts during village festival, election into political post and support with prayers. The attrition problems are now being addressed by making use of CDDs as Local Guides and recorders during LlDs implementation. Additional new CDDs have been selected. 1785 CDDs were trained. 2.5 CAPACITY BUILDING Describe the adequacy of available knowledgeable manpower at all levels There is availability of knowledgeable manpower at every level of CDTI implementation in the State. Where frequent transfers of trained staff occur, state what project is doing or intends to do to remedy the situation (The most important issue is what measures were taken to ensure adequate CDTI lmplementation where not enough knowledgeable manpower was available or staff often transferred during the course of the campaign) When trained staff is transferred or when new staff is employed training is usually organized for those that replaced them or the newly employed ones \I I I( ) .\|']( )(' .l.rnrnr,,, l()()"t6 .1 a - 0) 0 U oE z E il- (r,- -"u- st- No) t-N \ts o or^() t-(o t (f,@ (o(o (f, rr)oN (o O) @o) t-(f) ina Fr 6o\ +.- qv ra) ca r- c.l \oO C.lN o\(-- N c.l\o + +co \oc.l \o c- +\o (n\o lr')\o t-. 0) c) o) () o\ =*.a .i<v o\ c.) r-\o lr)\o Nc.l ca en (n $r- o\cn caco o\N o.lc.) c.l tr-co N o- ,L: ?U + r-- No\ t--c.l $$ rr) t-\o + co\o \o\o co (a NN \o o\ \oo\ r-co ra 6 ,h 9n !U EQE.v9^ tt) bEJQ9 EIE z \o I \o +.- q !,, rr) I I \o c) c) o c) s =L/ I FU I I \o 0) o(J HG o!- Ld6)! Eo) ze (, Fil(, coN cnN coN c.)c..l $c.l c.)c.I cac.l NN caN coc.l elN aaN caN Ncn c,lra 6N .L co ca co ca + co co N ca co N aa ca N € 0) o) q) O s O s r- o\\o \ooo tr) ca € oo\o oor- €r- o\\o oo o\r- oo $@ €\n t ra th >F .ex '0 l-. Qr tr tE0)L Err =98z6 O o L,lFil (.) \o \o \o \o ra) (-- tr) c- \o \o \o tr) \o fa€ (or-- A< !/ O OI q) 0) 0) c.) s \o \o \o (n ra) t- s r- \o \o \o tr) 6 9- ?(, € o\ o\ o\ € oo oo oo oo o\ o\ + (a) oo ah F] 0 q) th qq U) o <u 0) cq cl 0) oL q) q) L ()L 0) EO ri d c)U .c) q) t) E] 0) 6l B cll5 at) q) L t- F] 3 F f-. oaa oo oC := a =ot- oL o E EE(o oa o o)d C o (U c o E o o- E troo rF o a a, o c oL 0)EE o -c (E o) .Cc '6 LF irig tt GF I I I Table 6: Type of training undertaken (Tick the boxes where specific training was carried out during the reporting period) Trainees Type of training CDDs Other Community members e.g. Community Supervisors Health workers (frontline health facilities) MOH staff or Other Politica! Leaders Others (Specify) Program Management { { How to conduct Health Education { ^/ { ^/ Management of SAEs ./ { CSM SHM Data Collection { ^/ ^/ Data analysis { { { Report writing { ,V Other (Specify) \\ II() .\l'()L. .l.lnirrrn.'()l)'18 cEgt*Err:; ! Ex aetg.e I I I E{ =oz I I I I bs E=E * o)o@ o$ lo @N(f) (f)(oN c{oo N ro t- O) r rt- Nr-N r.c, o)@N r\@ (o @ rr) rr) o)c,Nd !EiE o) rO (o @o(o r o)N (a o(o t- r N o|r) o) ror CD CC c o s CL o o. E$ h g88HE -c9 @Ftr O (f) N or\ c{t- (o(o $r- o,N @(o (o(o (o(o o@ (o(o rot- !tF- ro(o E* BE* E " Ag" s@ r.c) (f) (f) (ao t (f) r- F*oN$ (o @(a N (f) ro(oo(o (f) $ (f)rt NN @oot-N o@ -(f) (f) (ot-N(o (f) (oolr) N rO oo@ (f)t ro(f)olr) o(o Nr\N c{(o l.r)(o N (to@ o)t ?o rE o.= =E-o@ EEa*" c.ts € a.t ol o\o$ oo o\ o\$ (a) c-l $ € o\ tr- co c.l o\ a.t co c.) + F- $ 00NNN$ o\\o \o+ c.t ta)$trr r* co c.l\o\n \o a-t ca c.l $ a.t lo 00(o od @lo i- c o ..9P f E EEE E35 0,.o t- <f, N F-6$ F- oo \o o\$ N cn co oo c.l $ t-- o\ c.t tr-$ oo$ c.lr-(\ ra) $\o o\$ co c.t\o ra)\o t c.)\o\o oo\o (--\o c.l € c.ltr- co c.l\oo$ N @_ oo too EDg 5 oo .E E E oo .:t, i $Esfi=86 goE o oo oo oo oo r oo r oo oo oo r oo r oo oo oo r oo r oo oo o I€ eBt5P8 - E=e 5 E'r Iz o-E o olr) t-(o N(a @ NN (oN $N (f)@ O)s N@ o)@ o$ c{t- o(r) t(\l EoE 6.: E€Es "86 o r.c) t-@ N(f) r@ NN cf)N sN (f)@ CDt N@ o,(o os Nt- o(f) t6l lEgEcs s o rf) t-(o N(f, @ NC\t (f)(\t sN (f)@ o)$ N@ o)(o os Nt- o(f) tN .9<!(9 .9r o = ooo EC -:zG o)o(U oE o o) oq) o o. o tr) o oE o -oo, lrJ E E oO I(I) cl o o o = o(U LIJ o = _(E E Gfz oI o_= C .Y o -oo o)E .E o =6 o E o o o)(! L o oo o -J8.8(5(!Laoa -co o\ooo\E; -AdB -co LEEooEE roEEE(o(o ooo)o(I,(5 Latei ovo-Y a(U.= .9r -c(5Rntsi58!o)E Sco (, CJ \EP(!oo'=f;E trD: ->\ -=aP; .9 tJJ ov) L., I'ioc(J' '= (5 oX= -a l. E =trtroyoosEE EFE *, +, q)6(E.LooFLLFF'n- oqq €(\t(\tF I NB -The reduction in the total CDTI communities from 997 to 724 communities and the total population from 868091 to 700827 was borne out of the recommendation given by the NOTF that large urban communities should be removed from list of CDTI communities. ln such places, it was advised that passive treatment be instituted. 2.6.2 What are the causes of absenteeism? Occasional festivities, communal crises and nomadic migration accounted for the absenteeism. 2.6.3 What are the reasons for refusals? Fear of reactions, religious belief and dismay over the long years for Mectizan administration (25 years) were recorded to be the causes of refusals. Community mobilization and health education were intensified in the churches, mosques and among the community members in addressing the problem of refusals. 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. . ln 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 { \\ [{( ) .\]'( )('. .l.r,rr.rr'.. lrr(tl20 r- al = - U I c.,l C o (5 o- o o oo E JC G L o U) a Eoqq ooq) tL qi o o o EE o a)to$o o- Eo L o o- o)C E o o- oL o o)c L =E' E' o L)ooo (u o tu a o c o q) oa o E(5 a) o L oa o ooo(! o ririt ol -ololFI E EEr;oa52 -ago .= b oE P.E E .=G(E E.e 6 : cLt f;E: 8ry rylR-f- . h.at^ ee Eccs H ET -=a * EEEE !, iE=r E O O EDG = =: c.N $nEEE o E o CL E o o- oEo --9 ho, oo E 1E otu tr e.E s E 8E Hi = oE' .=(!= ED 5o xoo o CD *z o I.l : -1 = E oE JE .E oC o)L(5 U'fc o E (o o o a(r,(o(L aC .9 (E o (5 o o o)o o oo oFl (5 .c L o (U .E EoC oE oE aG o) o)iE .9t oaf uit6l(oJ @lol rol([ oL o () o .o. L o- o o oFl o o (E .()io .= o at,(5 o(L 6. (EE Eg JUo o s =iE oq LPG .lcEg =dYO =(tOre8 oo: troo.= 8:bootrE EE'gE cLo FLo(5oEEoo(6 .!o e6g; 9Eoo) E8Ecc9(!E9(ECcro o(!Egc1- o Foi oto=etNF en c-.1 aEa P Tt ,6 t, N(r) orJ) @(o o(o rJ)d F- ot- lr)@ lr)o r()t- lr)@ c o g J CL or ottQ o 83i k fi$H s @t- rOo $rJ) l{)ot\ s@ lOo, (ao r.()N l()@ i $sF!8.9 huJaoE-;sHF o-l! F-N (9s @l() rr) (f)+(o ot- N@ o)@ s(o t- =6Y 9UJ6 hr E f fi o o)s(o\tN @(o o) o) @(o s@NT\N l{) NNo@t-(f) oNNF-t-s (o (f) (f) lr) @ o o,(o(o s(o(') NNt- N@(f, Ns r() t-(v) o@ o)$ -;D.EOO :EE :Eaq ooooo(o ooooo rr) ooooo rO oooooN ooooo(o N(o o st(f)(o ooo ot- (f) (f)t-N t- (o sNN F* rJ) @(o @@ l() E gE-E E'BE eE o f.- o) o F- o) ot\ o, N(osN$t- N(f)sNst- N(osNst- o(f)os @ (Y)o(f) @ t- o)(os@ NN @ooN ooog 5 o .9 = J E E oo o B, tlfr[ uc.Q 9ofr (f) (f) rJ) (o(o No, o)t- oo oo oo oo oo E $+E E EIIJ L P.g SH6t rrr (o rr)N @N @(o o)r\ Oo oo oo oo oo E:g Efi E E+E , E;s F-N @(O (ot-\i @t-N (o o,@ (f) t\o) o) t- o) o) t- o) o) $NF- rE .3 EE-rEo N(o @ oNt- oNt- oo@ (f) (f) I\ o) o) T\ O) O) T\ O) o) $Nt- iE $es;: E E=EEE E; Ea E es @@(o @@(o @@(o (f) (r) (O F- O) o) t- o, o) t- o, o, $Nt\ tr. I.IJ F* o, o) @ o) o) O) o, o) oooN ooN NooN (r) ooN sooN r()ooN (oooN t-ooN al .: s co c.l (t o I L(€ C) o F-- cn lr) N co en li c!q) N o\ o\o\ 99V uvv 9VV 99VO\ \O c't Ec o Pc o E (u ot-F pelBerl uopslndod 2.7 Ordering, Storage and delivery of lvermectin Mectizan@ ordered / applied for by - (Please tick the appropriate answer) MoHt{l wHotl uNlcEFt{l NGDO [ ] Other (please specify): Mectizan@ delivered by - (Please tick the appropriate answer) MOHt{l wHOtl uNlcEFtl NGDO [ ] Other (please specify) Ordering, storage and delivery of lvermectin is basically carried out by NOFT via UNICEF based on requests from each State. The State project takes delivery of drugs from the FMOH through the zonal coordinator. LGA coordinators get their consignments from the State store based on their respective estimated requirements in accordance with the specific target population. ln like manner FLHF takes stock of their own drug consignment from LGA coordinators for onward delivery to CDDs in endemic communities. \\ I lt I ,\l't tr . .lrrlrtrtr'.. -ttit-24 2.7.1 Table 10: Mectizan@ lnventory (Please add more rows if necessary) How are the remaining ivermectin tablets collected and where are they kept? The remaining lvermectin on the field are retrieved to the FLHF store and finally to the LGA coordinator and kept in LGA's store for the next distribution. List and briefly describe the activities under ivermectin delivery that are being carried out by health care personnel in the project area. The activities carried out by health care personnel under ivermectin delivery include: . Receiving and Storing of Mectizan (Collection and storage of Mectizan) . Proper record keeping . Distribution of Mectizan to the eligible populace . Supervision and monitoring of Mectizan distribution . Collection, Collation of data for onward transfer to the appropriate quarters /.) \\ll(' \l-tr\-.r('llr[l.r' r\r a State/District/LGA Number of Mectizan t tablets Requested Received Used Lost Wasted Expired Remaining Atakunmosa West 105000 105000 101399 16 3585 Ayedaade 1 1 0000 1 10000 102309 8 7683 Ayedire 105000 1 05000 104692 11 297 Boripe 91 000 91000 80958 2 1 0040 lfe Central 75000 75000 67282 4 7714 lfelodun 80000 80000 78088 6 1906 Egbedore 100000 1 00000 99507 1 492 lfe East 90000 90000 83499 14 6487 lla 70000 70000 69948 7 45 lsokan 145000 145000 115007 12 29981 lwo 75000 75000 74967 13 20 Obokun 90000 90000 88191 4 1805 Oriade 85000 85000 84963 8 29 Orolu 35000 35000 35000 TOTAL 1,256,000 1,256,000 I ,185,810 106 70,084 o 2.8 Gommunity Self-Monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? lf so, When? YES, 2004. Table 11: Community self-monitoring and Stakeholders Meeting (Add rows if needed) lnterest of people increased in the communities where CSM and SHM have been established. This eventually led to provision of incentives to the CDDs in such communities. District / LGA Total # of communities / villages in the entire project area No of Communities that carried out self monitoring (CSM) No of Communities that conducted stakeholders meeting (sHM) Atakunmosa West Ayedaade 50 5 1 67 7 2 Ayedire 32 2 2 Boripe 81 I 4 lfe Central 23 4 3 lfelodun 24 2 2 Hgbedore 22 5 2 lfe East 83 5 4 lla 49 3 3 lsokan 82 12 8 lwo 69 6 4 Obokun 40 8 3 Oriade 72 I 2 Orolu 30 1 TOTAL 724 77 40 \\'t l( ) i r\[)t t(-'. .lrrnrrrl r. l(;,1-26 2.9 SUPERVISION 2.9.1 Flow Chart Federal t Community 2.9.2 lssues identified during supervision include: . The registers were not updated in some places. ' Community members were not adequately mobilized by the LOCT for the fulfillment of their partnership roles. . Poor record keeping and incorrect dosage administration. . lnadeguate number of CDDs. 2.9.3 Yes, designed checklists are being used for supervisions. 2.9.4 Drastic improvement was observed on the part of FLHFs and CDDS during the follow up of supervision. This is in area of good record keeping, correct dosage administration and filling of reporting forms 2.9.5. Feed back is usually given to person or group of persons supervised. 2.9.6. The feedback provided assisted significantly in correctinrg the anomalies detected in the area of Mectizan drug accountability and record keeping. Communities that required additional CDDs were informed through feedback. The concerned communities were urged to select more CDDs who have been trained accordingly. State A + L. G. A. + \\ I l( i \, i)( )(-'. .lartr'.,ilr-'. - ){) -' NOCP/ NOTF SECRETARIAT NOTFNGDO SOCT LOCT FLHFS CDDs 27 SECTION 3: SUPPORT TO CDTI 3.1. EQUIPMENT Table 12: Status of equipment (Please add more rows if necessary) Source Type of Equipment APOC MOH DISTRICT/LGA NGDO Others Condition of the equipment *Please State 1. Vehicle (1) Nonfunctional (1) Grounded 2. Motor Cycle (20) Allgrounded (2) Functional(newly supplied) (3e) Allgrounded 3. Computers (1) Table computer & a laptop. Both Grounded 4. Printer (1) (Non functional) Grounded 5. Fax Machines Not Supplied 6. Bicycles (70) (Functional) (50) Newly supplied (functioning) (1 05) Allgrounded 7. Others a) Photocopier b) Projector c) W Monitor d) Generator e) Video f) Magnetic board g) Public Address system h) Flip chart i) Air conditioner (1) nonfunctional (1) functional (1) functional (1) functional (1) functioning (1) functioning (2) functioning (1) functioning (1) Grounded \\ H( ),\['( )(' .lrrr.ttrlrt'.. ]rli)-28 How does the project intend to maintain and replace existing equipment and other materials? At the LGA level, the Local Government sometimes gives imprest for the maintenance of the project motorcycles in their respective Local Government Areas. Storage facilities were also provided for the safe keeping of all equipment. They are also being encouraged to provide the necessary materials for CDTI implementation. LGAs, such as Boripe, have been in the forefront in meeting most of the needs of the programme within its area. lsokan LGA repaired a motorcycle and promised to procure additional motorcycle for CDTI activity. At the State level, continuous advocacy will be directed at policy makers to release counterpart funds. Capital items equipment will hopefully be repaired from these. \\ I i( ) 1 It( )('. .l(rttLr,''- '{i(r-'29 3.2 Financial contributions of the partners and communities Table 13: Financial contributions by all partners for the tast three years lf there were problems with Release of Counterpart funds, how were they addressed? Advocacy visits were paid to policy makers in the concerned LGAs, (the Chairman, Secretary, Director of Finance, PHC director) and the community leaders to further educate them about the benefits of the programme and solicit for funds Year 7 (provide the Jan - Dec. 05) Year 8 (provide the Jan - Dec 2006) Year9(Jan-Dec, 20071 Contribution Total cash budgeted 1us$) Total Cash Released (us$) Total cash budgeted (us$) Total Cash Released (us$) Total cash budgeted (us$) Total Cash Released (us$) MOH (Central + Provincial/State) 75758 76781 1022.7 1459 1459 (DistricVLGA) 29167 10833.30 33542 3371.2 481 0 4810 Local NGDO(s) (if any) NGDO Partners (uNrcEF) 700 6389.6 6389.6 Others a) b) Communities APOC Trust Fund 1 9596 19596 19596 TOTAL 124,521 10,833.30 131319 23,989.90 12658.6 12658.6 \\ H() /,{l'( )('. .lrrnUa|r. li)()-30 3.3 Other Forms of Community Support: -Some communities gave gifts like wall- clocks, plastic buckets and T-shirts to show appreciation to CDD. Some community leaders entertained the participants during CDDs' training. 3.4 Expenditure per activity lndicate 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. lndicate exchange rate used here $+1 25 Table 14: Financial Contribution by partners 1US$ = Nl25.00 Activity Expenditure($us; Source(s) of Funding UNICEF MOH LGA UNICEF MOH LGA Drug delivering from NOTF HQ area to central collection point of community 120 720 Mobilization and health education of communities 1 100 1862 Training of CDDs 2463.2 72 694 Training of health staff at all levels 3926.368 500 Supervising CDDs and distribution 167 1034 lnternal monitoring of CDTI activities Advocacy visits to health and political authorities IEC materials Summary (reporting) forms for treatment Vehicles/Motorcycles/Bicycles maintenance 0 Office Equipments (e.9. Computers, Printers etc.) Others TOTAL 6389.6 1459 4810 Total number of person treated 498,037 \\ I i( ) \, I)( )( . .l.lr't i;1,-, '/)()3l SECTION 4: SUSTAINABILITY OF CDTI 4.1. lnternal; independent participatory monitoring; valuation 4.1.1 Was Monitoring / Evaluation carried out during the reporting period? (Tick any of the following which are applicable) YES (UNICEF) Year 1 participatory lndependent monitoring Mid Term Sustainability Evaluation 5 Years Sustainability Evaluation lnternal Monitoring by NOTF Other Evaluation by other partners 4.1.2 What were the recommendations? - The report of the monitoring carried out by the B-Zonal Coordinator with support from UNICEF is yet to be made available to the State. 4.1.3. Based on some feedback obtained so far the following were done by the project: (i) The CDDs were enjoined to carry out census update alongside with the treatment. (ii) The LGAs were encouraged to produce community registers and IEC materials. (iii) A high level advocacy visit that targets the chief executive of the state needs to be undertaken early 2008. (iv) Oncho extension worker at all levels are recommended to be trained on good record keeping and supervision. (v) The avenue of monthly rotational review meeting was recommended to be used for constant knowledge updating of the LGA Oncho coordinators and their assistants. \\'tlt I ,\l)( )('. .ltrnr(r|r. lt)tt-32 4.2 SUSTAINABILITY OF PROJECTS: PLAN AND SET TARGETS (MANDATORY AT YRS 3) Was the Project evaluated during the reporting period? No Was a sustainability plan written? YES When was the sustainability plan submitted? The sustainability plan was submitted on the 14th of June, 2004 What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.2.1 PLANNING: lntegrated planning is being done annually within the PHC departments at state and LGA levels with the objectives of sustaining the strengths, improving on the weakness and taking advantage of the opportunities presented through implementation of integrated action plan 4.2.2 FUNDS: There was unrelenting efforts both by the SOCTs and LOCTs in mobilizing the policy makers at all levels on the need to provide government counterpart contribution for the continuity of implementation of onchocerciasis programme activities. ln the meantime, UNICEF has renewed its support. 4.2.3 TRANSPORT: The project's motorcycles will be maintained with counterpart funds. LGA administrators will be encouraged to purchase motorcycles and bicycles for the programme whenever necessary. At State level, efforts will be made to ensure full integration of CDTI into active programmes like AIDS control, NPl, malaria control etc. so that there will be central maintenance of all participating PHC vehicles including CDTI vehicles. UNICEF will be approach to assist in provision of motorcycles. \\ I i( ) \1,(X'. .lllrr'-.ilr. . ){r(} -55 4.2.4 OTHER RESOURCES: UNICEF has promised continuous support to the project. Government along with other NGOs would have to sustain support in the absence of additional external funding. Other sources like the local NGOs and CBOs are being identified for sensitization in order for them to be for involved in CDTI implementation 4.2.5 Most activities especially at LGA level were conducted by taking advantage of opportunity provided through integration with lmmunization programme. 4.3 INTEGRATION: 4.3.1 IVERMECTIN DELIVERY MECHANISMS: There is collaboration with other programmes in terms of Mectizan collection and delivery e.g. NPI vehicle was used to collect Mectizan from NOCP Lagos store to the State. Other LGA PHC Programme coordinators are supportive by bringing the LGA Oncho Coordinators to the State capital during their meetings to collect their Mectizan consig n ments. 4.3.2 TRAINING: The training sessions on malaria and Vitamin A, attended by members of SOCT were utilized for educating co-participants on the rudimentary knowledge of CDTI programme. 4.3.3 JOINT SUPERVISION AND MONITORING WITH OTHER PROGRAMMES The integration of CDTI programme into the functioning PHC programme activities is of enormous assistance in sustaining the programme through joint supervision of CDTI activities. The strategy gave other programme officers avenues for the inspection of CDD registers and collection of raw data from the field in order to accelerate data rendition as well as conducting on the spot training to correct errors where necessary with minimal resources. \\ tI( ) ,\['t l('. .lrrr.rin|r. 2r)(r-34 a 4.3.4 RELEASE OF FUNDS: There is allocation for CDTI project in the State's yearly estimate budget. The project will continue with its advocacy to policy makers for actual release of funds. 4.3.5 The CDTI was included in the PHC budget to the tune of 3 million naira 4.3.6 a a a Some other health programmes that use CDTI structure include Guineaworm Eradication, VAS and NPl. lssues considered in integrating were: Formation of Health Committees in the state and Local Government Areas: this affords the Project Coordinators to interact and share experiences on integration. CDDs were used as guides during vitamin A distribution. Hence, there was opportunities to identify defaulters of Mectizan during the time. Onchocerciasis Coordinators are invited to monthly surveillance meetings for sensitization and mobilization for programme integration with other PHC programmes Awareness / Acceptance of Mectizan in all CDTI communities 4.3.7.The application of CDTI structure is being considered as the best option for the vitamin A administration and lymphatic filariasis treatment and control. The later is expected to begin by 2008. 4.4 OPERATIONAL RESEARCH: None SECTTON 5: Strengths, Weaknesses, challenges and Opportunities STRENGHTS: Availability of Mectizan tabletso \\lr() \,i'}()( lir.r1,1', -'()ll- a 35 a lncreased Support from UNICEF Committed CDDs in some communities The rotational, monthly LGA co-ordinators' meeting among all the 30 LGAs in the State lncreasing Political support for programme activities from Chairmen of LGAs Moral and administrative support from the authority of State Ministry of Health lntegration of Onchocerciasis into other PHC programmes WEAKNESSES a lnadequate logistic support lnadequate CDD to population ratio a a a Low commitment of health staff Lack of involvement of CBOs/NGOs for project support. Poor record keeping /Reporting at LGA & community levels o Aging of motor vehicles/motorcycles and other capital equipment like computer, printer and photocopier. lnadequate supervision due to lack of good vehicle a a I a a a a a a Poor funding of the project at both the state and LGA levels CHALLENGES: lnadequate counterpart funding CDDs attrition Lack of support from the local NGOs and CBOs 36 a a a a \I/ll(l r \l)( )('. .llruir:rrr. lt)rr- a a OPPORTUNITIES lntegration of CDTI into other PHC programmes Advocacy to the policy makers and mobilization of the traditional leaders and community members. lnvolvement of CDTI staff and CDDs in some PHC programmes Establishment of an ideal Data Bank for Osun CDTI project to eliminate inconsistencies in Data Management. Through the pilot test census update that will be conducted in three LGAs, strategies will be discovered and used for the remaining 11 assisted LGAs Resuscitating the annual commemoration of Onchocerciasis day activities at the state level. lnauguration of CSM & SHM in all the endemic communities of the new 14 assisted LGAs. a a aa a a a CONSTRAINTS: LOGISTIC Problem - Grounded vehicle, computers, printer and photocopier machine Non-release of fund budgeted for the CDTI implementation activities by the State Government. FOLLOWED UP ACTIVITIES: The aged project vehicle has been repaired and can only be used for local activities. UNICEF and APOC have been approached for the replacement of the irreparable \\ li() \l'()(..llrrr'.ri|'.- - t()-37 o at capital items. More CDDs have been trained to reduce attrition problem, advocacy was carried out at all levels to enhance release of counterpart funding while the local NGOs / CBOs have been identified for sensitization in order to gain their support on CDTI. SECTION 6: UNIQUE FEATURES OF THE PROJECT/ OTHER MATTERS I \\ I{( ) ,' .\J)( }( .llrntrrr'r . ltlt)-38 It a