Ogun State CDTI annual project technical report submitted to Technical Consultative Committee (TCC): from January 2007 to December 2007

OGUN STATE CDTI PROJECT ORICINAL : English COUNTRY/NOTF: NIGERIA Proiect Name: OGUN STATE CDTI PROJECT Approval year: FEBRUARY, 2000 Reporting Period: From: January, 2007 f'o: December,2007. (Month/Yea ( Month/Year) Proiectyearofthisreport: (circleone) | 2 3 4 5 (6) 7 8 9 10 Date submitted: March ,2008. NGDA partner: IFESH/UNIVA. ANNUAL I'ROJECT TECHNICAL REPORT SUBMITTED TO TBCHNICAL CONSULTATIVE COMMITTEE (TCC) .L,_ For /ic.tisarils DEADLINT] FOR SUBMISSION: AO To APOC Management by 3l January for March 'l CC rneeting 'to APOC Management by 31 July tbr September l'CC meeting Tor f'or j..i:.,...:iion R Ba.lr* \\ rltlt i : AFRICAN PROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) Launching year: NOVEMBER, 2001 D I SEP. 2OO3 W'HO/APOC. 2.1 Nor ember 2007 l ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the rePort: Country: NIGERIA National Coordinator Name: Mrs. P. Ogbu Pearce Signature UZ. I Zonal Oncho. Coordinatot Name: Otunba A. Jaiyeoba Signature Date: .1.5 9{ iqr€'fnKDate NGDO Representative Name: Mr. M. Olu Taiwo ^D Signature: Date: This report has been prepared by Name : Mr. V. O. Osikoya Designation : Project Coordinator Signature: ,,. Date &*Z S,v Q Table of contents ACRONYMS....... DEFINITIONS v VI FOLLOW UP ON TCC RECOMMENDATIONS EXECUTIVE SUMMARY .......... 9 SECTION I : BACKGROUND INFORMATION............. l.l. GeNERnr-rNr-'oRMATIoN................ l. 1. I De,scription of the project (briefly) 1.1.2. Partner,ship 1.2. PopulalroN SECTION 2: IMPLEMENTATION OF CDTI........ ....................15 2.1. TrH,tslrNp oF ACTrvrrrES .............. .................... 15 2.2. Aovocncv ............. ....16 2.3. MoeILIzaTIoN, SENSITIZATIoN AND HEALTH EDUCATIoN oF AT RISK COvUuNITIgSI8 2.4. Cotr,tvtuNtry INVoLVEMENT............ ................. l9 2.5. Cepacrry BUTLDTNG ......................20 2.6. TReR'1veN1s............... ..................22 2.6.1. Treatntentfigltre.\....... .. ..22 2.6.2 What are the causes oJ absenteeisnt? ..... ..25 2.6.3 What cu"e the reasons /or reftrsals'? ... .... .... ...... 2 5 2.6.1 Briefl1'describe all known and verified serious adyerse event:; (SAEs) that occurred during the reporting period and prot,ide (in table 8) the required information when ovai1ab1e.............. . ..........25 2.6.5. Trend o.f'lreotment achieveruentfiom CDTI pro.jecl inception to the curuent year27 2.7. ORouRrN<;, s-toRAGE AND DELIVERy oF tvERMEC'rrN......,.. ...................28 2.8. CovvrrNtt'y sEI-t'-MoNrroRrNG AND STAKEHoLDERS MEprtNc ...........29 - THe CSM AND SFIM rIAVE HELpED To rMpRovE TREATMENT covERAGE ...........29 2.9. SupuRvrsroN............... ........30 2.9.1 . Provide aJlov, chart oJ supervision hierarchy. ................. 30 2.9.2. What were the main issues identified during supervision'? .............................30 2.9 4 l4/hat were the outcomes at each level of CDTI intplementation supervision? 3l 2.9.5. Wasfeedback given to the person or groups supervised? .. ........31 YES . 31 2.9.6. Hov, was the feedback u:;ed to improve the overull performance of the prolec't'.) 3t SECT'ION 3: SUPPORT'IO CDTI 3.1. EqureueNr CoNorrroN oF THE EeurpMENT * PLERSE srATE 3.2. FmaNclal coN'TRIBUTIoNS oF THE pARTNERS AND coMMUNtrtES 3.3. OrHeR FoRMS oF coMMUNrry suppoRT 3.4. ExppNolrurREpERACTIvrry................. SECTION 4: SUSTAINABILITY OF CDTI.... -t. I . INt'r-.t{NAL; INDEpUNDEN'f pARt-t('tpAToRy MoNt'roRIN(i: Evnr.r rATIoN.................... 35 1.1 I ll'as' lllonrtoring,,gyrl,,rlion caruiecl oul during the reporting period'? (tick am, oJ the .followinEi v,hich rtre applicable) ............ ............. -i5 .............7 ...............10 .............. I 0 '.., ',........ 1 0 , . . ....,,..11 .............. I 3 .............32 .............32 .............32 .............33 .............33 .............34 .............35 WHO/APOC. 24 November 2007 4 1 2. Whal v.'ere the rec'ontnrendalions? ..... J5 1.1.3 Hotr huve they lteen iruplemented ....J-5 4.2. Sr-rstalNnsu,r'r'y or-- pRo.rri('T's: pr-AN AND sg rlARGE'f s (MANDAl-oRY AT ...............35 Yn 3) 35 1.2.1. Planning at all relevant levels. ................... J.I 3 year workplan was developed for both state and LGA levels. The annual workplun,s are reJined for each year which v,as submitted and approved. ............. . Jj 1.2.2. Fund.s ................ J-t Siome LGAs have been releasingfunds but others have nol. Ef/orts are made to use the LG department and Jbrlnn of LGA chairmen to lobby those that are not relecrsmg Jilnd.s. ['he leam v,ill keep enc'ouraging LGA,s to continue payhtg impre:;t to coordinators and ('ounterporl.fundingfor" conlinuou,y CDTI intplementution . . .... -15 1.2.3 T'run,sporl (replucenrcnt and nruintenunce) .......36 1.2.1 Other resources... .... ..36 T-he project intends to mobilizefundsfrom government at all level,sJor the procurement oJ needed re.\ources and approctch some local NGOs to assist in providing materials needed. ........36 4.2.5. To what extenl has the plan been implemented................ 36 4.3. INrEcrarroN............... .................36 1.3.1. Iverntec'lin delivery mechanisms are known to other units in the deparlntent. 36 1.3.2 Tnrining' ... ......16 Joint training ac'ln,ittes adopted in the Depcrrtntent.for progrumme stcfJ to be myolved .s'ut'h a:; RBM, NPl, HIV/AIDS, TB/LEPROSY und Health Educcrtion Programme....... 36 1.3.3. Joint :;upert,ision and nonitoringu'ith olher progrum.s is implemented. T'here ure plans to use ('DDs Jor vitarnin A supplementation ancl intmunization................... .. 361.3.1. Release o/'fundsfor project activities in the State and Local Government......36 1.3.5. Is CDTI included in the PHC budget? ... . ... .36 1.3.6. Describe other health programmes that are using the CDTI structure ...-... ...37 1.3.7. De.sc'ribe other,s issue,s considered in the integration o/ (DTI. ... .. ... -17 4.4. OprnnlroNAr- RESEARCH. N1L........... ......................37 1.1.1 ,Suntnrerrize irt nol ntore lhetn one hul/'oJ a puge the operationctl re.sectrch ttrtclertaken m the pro.jecl urea wilhin the reporting pertod .. ..... ..37 11.2. Hov,v'cre the results applied in the pro.lect'?.. .... ... ...........37 WEAKNBSSES .......... .........38 OPPORT'UNITIES..... 38 SECTION 6 : UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS............39 lv WI IOtA POC. 2.1 Novcnrber 2007 Acronyms APOC African Programme for Onchocerciasis Control ATO A'frO CAN CBO CDD Based Organization ederal Government of N la al Treatment Ob ective ommun Christian Association of Nigeria ectiveal 'Irainin Directed Distributorommun Directed T'reatment with lverrnectinmunl mun ity Self-Mon itoring CDTI CSM FGN FLI-{F GCCC IEC II.-ESH overnment Cash Counterpart Contribution nformation. Education and Communication nternational Foundation for Education & Self H Line Health Facili LF Lymphatic Filariasis LGA Local Government Area MOH NGDO NGO NOCP NOl't NPC NPI OGRUMED PHC & DC RBM REMO SAE SHM fB/L Stakeholders meeting alth Care and Disease Control Bgp i d E p i Qe41q!_ogr99l-Yt epp i Onchocerciasis Tuberculosis and Lgplgsy Programme Severe Adverse Event Roll Back Malaria TCC Technical Consultative Committee (APOC scientific advlsory group) Mini of Health on-Governmental Devel ization on-Governmental ational Onchocerciasis Control P t9€I9lrl tre ational Onchocerciasis Task lrorce ational ulation Census ional Pro mme on lmmunization State Rural Medical Scheme 'rainer of trainers UNICEf'_ I]NIVA UI'C WHO nited Nations Children's Fund Il_n iygrslly Vi I la-ge Assocjgliol - U ltimate l-reatment Goal World Health izalion WI IOTAPOC. 24 n-or,ember'2007 m Definitions (i) Total population: the total population living in rneso/hyper-endemic commuttities within the project area (based on REMO and census taking) (ii) Eligible populationl calculated as 84oh of the total population in meso/hyper- endemic communities in the project area. (iii) Annual Treatment Objective: (A1-O): 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) Ultirnate.Ireatment Goal (UTG): calculated as the maxirnum number of people to be treated annr.rally in rnesoihyper endemic areas rvithin the project area, ultimately to be reached when the project has reached full geographic coverage (normally the project shoLrld be expected to reach the UTC at the end of the 3'd year ofthe project). (v) Therapeutic coverage number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) Geographical coverage: number of communities treated in a given year over the total number of nreso/hyper-endemic communities as identified by REMO in the pro.iect area (this shor"rld be expressed as a percentage). (vii) lntegration: delivering additional health interventions (i.e. vitanrin A supplentents, albendazole for LF, screening for cataract, etc.) through CDTI (using the sante 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 comrnunity distribr"rtors outside of CDTI. ( viii) Slflalf3blliIy: CDTI activities in an area are sustainable when they' continue to lunction etl-ectively for tlre fbreseeable future. rvith high treatment coverage, integrated into the available healthcare service, with strong commr:nity ownership, using resources mobilised by the community and the government. (ix) Community sell-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 rnodifications when lrecessar). vl WHO/APOC. 24 November' 2007 FOLLOW UP ON TCC RECOMMENDATIONS Using the table below, fill in the reoommendations of the last'fCC on the project and describe how they have been addressed. TCC session 25 No of recommendatto n rn llte 5 year technical report 282 TC C REC O M 1I,T EN DAT I O I{ S ACTIONS TAKEN BI'THE PRO.IECT- FOR TCC ,lPO(' MGT USE ONLI' 'fhe project has achieved high geograph ic and therapeuti c coverage, and the report is well written. However, there is not explanation why geographical coverage is 9l?o in the District of Obaferni/Owode whereas it is I 00o o in all other Districts. In 2005 and 2006. some communities were merged when reporting treatments by the Front Line Health Facility staff. However in 2007, the communities were dernerged and recorded separatell' which lead to a l00o/o geo coverage. 283 The report wos uccepled with the following recommendation for irnprovement of future reports: - Tltc use of'thc remuiurttg drugs should be c'learll' arned The following recornmendations were made for project improvernent: - The plantttng of ecttvtltes should be better desrgned, uttd the tttnttlg.for dr/ferent dctn'tltcs should ba carelulll' udclressed - The ntunber oJ' tratnees rs tdentical rn all Districts/LGA (Table 5), and do not take into account the population size, etc - E/Jbrts shoulcl be made on str,ttutnabtltty,, CSI( and Dtle grLttt otl - Left-over drugs are retrieved by LGAs from FLHFs. 'Ihese are retrieved by the state. - The unexpired left over drugs are distributed first in the following year before the new consignrnent (first expirl' - first out basis) - There was an improvement in the planning and timing of CDTI activities in 2007 . - Information on the identical number of staff trained is noted and the issue has been addressed in 2007. - CSM and SHM was carried oul in 2007 and will further be expanded in 2008 with availability of funds. Efforls are being rnade to irnprove i ntegration. 7 WHO/APOC. 24 November 2007 283 4' year technical report TCC accepted the report with the following recomrrendations. Improve mobr lizatt on o/ APOC.furtds - Provide tn.fulure rcporls t nform a tr on on ./i n anc'r n g r n the previous ),ears 283 This has been done in 2007. Information on fi nancing by partners fbr the last 3 years provided in table l3 in this reporl. 8 WHO/APOC. 24 November 2007 Executive Summary Prepare on Executive summary) of the report in not more than one page. Ogun State is one of the 36 States in the Federal Republic of Nigeria. Located in the South Western part of Nigeria, it is made up of 20 local government areas with a population ol 3,728.098 (NPC 2006). The greater proportion of the State lies in the tropical rain forest zone with a sizeable feature of Guinea Savannah in the northern part. 'fhe people in the State are predominantly Yorubas of which there are ljebus, Yewas, Egbas. Aworis, Eguns, and Remos. The prevalence survey of 1994 and the subsequent REMO refine of 1997 and 2000 revealed that the State is endemic for Onchocerciasis. Mectizan distribution in the State started in year 2001 with support form IFESH and APOC. CDTI is being implemented in952 communities in 8 LGAs. The total population of the endemic areas is320,215. Population movements occur with the migration of young ones from the rural areas to urban centers in search of greener pastures. There are also movements rvhen farmers and parlicularly' fishermen move temporarily to new areas during parlicular seasons. Festive seasons (religious or traditional) provide opportunity for movement of persons from community to community and from urban areas to the communities. and vice versa. During the period being reponed 952 communities were covered and 254,783 persons treated thus achieving 100%o Geographical coverage and 80% Therapeutic coverage. The treatments also meant a coverage rate of 95%o of the Ultimate Treatment Goal of 268.980 and 96%o of the Annual Treatment Objective of 265,620. 620 health workers (332 new and 288 refresher) and 2.430 CDDs (430 new and 2,000 reliesher) were trained during the reporting period thus achieving 100% of ATrOs fbr both health workers and CDDs. 153 State and LGA Policy makers were mobilized as well as 326 Village [{eads. 189 Women Leaders and263 Religious Leaders to support CDTI. 'Ihe strengths of the implernentation process include the involvement of religious organizatiorr and churches in the CD'fl process, high community awareness of the benefits of Mectizan treatment, willingness of community members to comply with annual treatment, availability of trained health staff at all levels, willingness of most CDDs to continue with Mectizan distribution despite Iack of or inadequate incentives. presence of a committed supporting NGDO. and release of funds by the State Government annually since Programme inception. Weaknesses experienced are non-release of counterpart funding by LGAs especially during this campaign period preparatory to the general elections, non-institution of community self monitoring and inadequate involvement of the FLFH staff in the CDTI process Challenges facing the project inclLrde instability of politioal appointees/caretaker/transition committees at the Local Government level, unsatisfactory quality in record keeping, and inadecluate number of CDDs in some communities. 9 WHO/A PO('. 24 Nor,ember 2007 1.1 SECTION 1: Background information General information f .1.1 Description of the project (briefly) - Geographical location, topography, climate Ogun State, otherwise known as the Gateway State, was carved out of the defunct Western State on 3'd February, 1976 by the Federal Military Government of Late General Murtala Rarn at Mohammed. It lies within the tropics. It is bound in the West by the Benin Republic; in the south by Lagos State and the Atlantic Ocean: in the East by Ondo State and in the North by Oy,o and Osun States. Ogun State occupies a total areas of 16.409.26 square kilometers. The climate follows the troplcal pattern with the rainy season starting about March and ending in Novernber. followed by the dry season. - Population: activities, cultures, language. The population for the State is 3,728,098 (NPC 2006). The major ethnic groups are the Egba, Yewa, Awori, Egun, Ijebus and Remol they belong to the main Yoruba ethnic group. Nigerians from other parts of the country as well as expatriates also live in the state. The languages spoken are mainly Yoruba (Language of the predomirrantly rnajority) and English lofficial language). There are several dialects including I.iebu. Remo, Egba. Yerva, Awori. Egun. Ikale and Ilaje. The major occupations of the population are fanning and fishing, weaving of cloth (-Aso-Oke), tie and dye (Kampalu and odire) are practiced. Settlement pattern is largely dispersed. - Communication systems(roads...) Roads between majorcities are in good conditions, but access roads to most of the endemic communities are in poor shape. Some are not passable during the rainy season. Despite this. transport by road remains a major means of communication among the communities. The electronics and print media are also veritable channels of communication. - Administration structure. 'I'he State consists of 20 Local Government Areas with the political appointees as Chairmen. The legislative arm is made up of elected Councilors from various wards. At the State level, the Executive Governor is the Head of administration. There are the Legislative and Judicial Arms. The capital of the State is located in Abeokuta. - Health system & Health Care Delivery (Provide the number of health posts/centers in the project area if the information is available). 'l'here is an official PHC policy and structure in the Project area. It is a system of health care services where community parlicipation fbrms the mainstay with support from the state, Local Government and NGOs. Level of functionality however varies across the state. The health facilities in the State are spread and located in various LGAs, ranging from Health Posts to Hospitals. There are 426 Health Clinic/Centers/ Posts and 8 Hospitals in the Project Area. l0 WHO/APOC. 24 November 2007 TablS_t: Nurnber of health staff involved in CD'll (Pleuse add more rov's if neces,san') District/LGA Percentage Br=Bzl Br *100 Abeokuta North Abeokuta South 200 156 't8% 270 249 920,o + 140 t29 929/o 170 l6t 95 uro 150 200 Ervekoro llb lnreko-AIbn Obat'emr-Orvode Odeda l'eu l-North 200 t82 9 lo,o 'Iotal I {90 1329 890 1.1.2. Partnership - Indicate the partners involved in project implementation at all levels (MOH, NGDOs (National/International), communities, local organizations, e.t.c). Paftners involved in project implementation in Ogun State are: IFESH/UNlVA, IrGN, NOCP- {National &Zonal Oflices}, State Government. the endernic l.ocal Government Areas and the endemic communities. local CBOs such as, Marketers Association. Union o1'Road 1'ransporl Workers, Landlords association. and Okada Riders (ACOMORAN) and Religious bodies such as CAN. Bible Society of Nigeria, NASFAT, DAWAH. YOLJBAS, NAWA-RU-DEEN are also partners of CDTI in the state.. - Describe overall working relationship among partners, clearly indicating specific areas of pro.iect activities (planning, supervision, advocacy, mobilization, e.t.c) where all partners are involved. Communities have shown commitment in the implementation of CDTI by mobilizing members to take their treatment during the distribution period. Also, they select their distributors and participate in CSM and SHM. The CBOs pass on information (time, date. venue) of distribution to their family members and other community members in their vicinity to be available during the treatment period. They also mobilize communities in other ways. The LGAs provide Health workers. local government PHC staff and others who train the CDDs on CI)-l'1. plan activities especially mobilization of endernic areas. lltanage side eff'ects fiom the use o1'Mectizan and keep treatntent data. WIIO/APOC. 24 November 2007 Number of health staff invoh'ed in CDTI activities. Total Number of health staff in the entire project area Number of health staff involved in CDTI B t25 83% t9t 96% 160 ri6 859 o il The state oversees and supervises the CDTI activities at the LGA and community levels. Stepped down advocacy visits are paid to the LGA chainnen. 'l'hey also report all state activities to the Federal and APOC. IFESH/UNIVA is mainly involved in planning, occasional advocacy and also assists in providing technical experts in Training, community mobilization, co-financing Programlne activities, monitoring, encouraging in Mectizan treatment. l-he NOCP zonal Office supervises CDTI in Ogun State. Paflners are working together in hannony to achieve a successful implementation of the Programme. Religious groups of [Moslems & Christians] propagate gospels and campaign on health infbrmation i.e. Onchocerciasis messages for compliance to the fiee drug. The Christian Corpers Fellowship is also involved in organizing Community Rally in some LGAs. t2 WtIOiAPOC'. 24 Nor cmber 2007 t-- at U -c o 'Z -'t al aa q) p U) 0 o(.) re dq) ,; '5ogE ;E A(Ji() Lq) --O0 Lq) o<) r).v * c.. a 'oEl Y €>l : o,) .' o alJa lvu !t *rt(.)v - €\, q) ! d(! i=l ;:9 Lt S aa v I ':r,L9V Iu - : LLV ve-rY v/(u^E(Jzx * -tr q) LL;i HJtV' =oq,.Ea> e --9Z- ,. El ri ! a) oi a- ! ;;: ^a S a:' :.J {> :$* -]il\ !i{cuv \= l, U =\t:-Irls I ux I!vvule z o-s IhulU\I rl Ll :3 b =Y .9:2lu ^ : -i 5ir:\ E i=L x\6 ^-- o qr.Y (,\\;3 oosv\\ .- r-5) c! :l!JO-{=; t ^. Pir-.Ons' a <! \, \.ru U-.Js: -c 3$ ! >LrY <o6 =Y4 -- := 6:\_U il; d a\\AX: sii: t UUU %: s- ! i,J - U at, -o 0) o- oo L o o- c.)L o bo L o L a.) (.)! C)!(! 0) L() 0) q) q) q) () u -Ya o o- o o- () E tr o(, cit orl -l -tFI tr .9{a!5c oE "iF CO ri$ \o tf, olai O @ rJ a.) a o\ €\o Nf UE = e99 O c.I @(-.l \o cO +' CN sj- \o N ooON ol c{ (^.1$ c'} r-- c.) o t-- + CO ca tr- c'f CO oo nO c.) t-- t--$ cn s +$ \o \o I oo C.)\o $ I I I II C.r- ca ca oo \o .{- oo .f, cat F- t-- $ c.) ns$ \o \o t-- + ca r- $ r- $ V) (\l (\T ?a ra (\l N ?f) I -= o-N !\ E L OE 46.=E-:>.! q o -iJ.E:9' N= oF! -f II o. O oo oo O N \otr- v af) 0 c) OI U)o I Lq) z I I -o ON o.= ctO F .YOE9 io (.rE; +E 'EgE 9t E ?oU ux! 2 +_ il o\ co @ No. \o F- $ aa at raa I N rn o\ (! FO) .YEcg Ja9 d = qr.:- X *o 9'YU-I L^-^ tr- '1 aa C' oo C'\o $ oo$ a.) r-|'- +C. s. s :f, \o \o o\r- + co Ir- $ in 6t (.I l+) '!i()(J .YE () 9;Y-O-tLU 6,r: *i -< E N z o c a € = I o o o e € a o q '6 o ,u I !oE t Z rl 3 F- I I I I I If you are using the term community or village, define what constitutes the community or village. This will help understand the profile of the project area. A Contmunity is clefinecl as group.\ oJ people who live in a purltcular place i.e. have u common geographicol boundary ond y'ho .shore u c'ontmon inte rest in v'hal happen,s lherc Is there any other information of interest about the population in the project area? If so, include it here. - People always migrate to the community at their own convenience, either to farm for festivity or vacation. t4 WHO/APOC. 24 November 2007 U) q) U) trt (, a) -o c U o z ,o E O c z ! a) ,o a P oZ a ,o E a z ! EI oZ o -o Ea a z D -o E 1) c z LU -o 6 Z bn -t litr L ! -oo f& L ()L (6 .a 0)ll- d ot! = -c L L ad =L o L6 L -o0)t! CE ,o(JL a ox *o trts (, a) -o Eo o z o E9 cZ !o ED C Z o -o Eo o >rd o -o EU aZ o EU oZ o E2 7. o -o ED o Z, ;r 2 a0trE a- >\ z, cC CE z o) p q q (,) U *oEE U 7. Z Z Z z =Z Z Z a0FE 1itr a- z z zzz z z z o( F EE (, o- Lc- o z. c- oLoL c- c- o cd2 I C o (g o0iE :tr a- o!6 -co! 2 G= tr c)a *o trE U = -o .) !L -ct L (d c! L -c .) >'Ld -cO LL .i -oo r- Ld .d c =! -cD ! cc cJ ,c ut* ! c3 L -oD L ci = 4.0 a- d ci a J a Z 6 :z o! o a o .o fl Ir] = € J ,a E? C tr e !C L z. o F- -ot , -.c t u Z -t c.l C T () q.) Z rrq) q, q)a q) q) q) c) a a q) U) z. -x (.) E E o() I U - bo() -o (.) I -cI o E (.) d I -o -o() 9 - G) F d o- E () L(.) l\ a;G); .= qj -U eS(.) \-c! ._) u= ,:ZO Q)L !U9;\ -O()s -E\ ooB LqJ .E?bdtr oqJ \ U\ .= L .. (d =()^^a - _(J\!q)L \J\cr\ UC) \!\ qr\rto ^P ,-PcsA:E --USre(-Lc, JLv \.- C) 0l,\,c 'Eoa; LSgiJ.='je Ar-!9 =s:'=EO.o'; .9t!5'5Elr!2 - o sH d: o E! o --Ld)LriAt==l' o -'A c)Z E '''= E = E :- !E=e .all-_c r) . .L E ulv-_-L !-rt!J4)=la N i-I 5 Fl 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. Below are the Tables showing: Number of Policy and decision makers mobilized at State and LGA levels WOMEN LEADERS 34 40 20 t5 t5 20 30 r89 LGA RELIGIOUS LEADERS l5 JJ 4l 263 ADVOCACY AT STATE AND LGA LEVELS Honourable Commissioner for Health Chairrnan. House Cornmittee on Health Pcrmanent Secretaries: a Health 2-, 3. S/N LGA VILLAGE HEADS Abeokuta North 80 Abeokuta South 74 Ewekoro 23 Ifo 22 l5 2 J 20 50 50 4 30 5 Imeko/Afon 30 Obafemi/Owode 3l 24 6 7 8 Odeda 40 Yewa North 26 TOTAL 326 N/s STATE # # I Chairman Local Government Service Commission. Chairmen of t,GA Director; General Services and Administration. Treasurers Supervisory Counci lors for Health. Oncho Officers. I 8 8 _s--_- 8 I 2 b. 4 a. Hospital Management Board Director: 7 l4 8PHC & DC. Department PHC Coordinators b d e Training !o.tp ital Services Dept. Nursing Services Department PIanning, Research & Statistics Depart District Coordinators WES Coordinator 40 8 f. Phannacy Department ob Finance and Adm inistration 5. Principal: a. b d. _!r!oo_E rlxll!|ns. _ Schools of Midwi School of Health Tec!t_ology._ Centre.uctive Health Programme Oflicers: NPI unit 3 3 I ll6. a b. Roll Back Malaria unit TB/L unit.U. d HIV/AIDS unit. e. f. Health Education unit. School Health Service unit. 16 WllOir\I'}(X.'. 24 Nor cmber' 2007 I I C o Reproductive Health unit Monitoring & Evaluation unit Women - In - Health unit. I 30 Total 103 Environmental & Health Total Reasons for the sensitization: o To remind them on their responsibilities for CDTI execution and sustainability. o To participate in Community Self Monitoring and attend Stake Holders Meetings. o To share ideas and encourage participation of the decision makers. o To determine appropriate incentive to be given to the CDDs. o To improve women involvement in CDTI activities. 0utcome: Communitl, - Community leaders promised support to CDDs and support the CSM and SHM initiative. Government - State government approved some funds but these are yet to be released. - The following LGAs give monthly imprest: i) rfb LcA - N25.000 ii) Odedal.GA-N10.000 iii) Abeokuta North N 10,000 iv) Abeokuta South - N5,000 v) Imekafo LGA - N 10,000 - Obafemi Owode LGA only sponsors the coordinator to nreetings and state organized programmes - Aparl from monthly imprest, some LGAs have approved but not released counterpafi funds. Ewekoro LGA gives neither counterpart funds to the programme nor monthly imprest for the coordinators partly because there is a constant change of coordinators to head the programme. Constraints: - Bad road and poor terrain experienced by the State and [,G Supervisors especially along the smuggling route in lmeko-Afon and Yewa North and collapsed bridges in Odeda and Obafemi - Owode. - Perception by the stakeholders that the programme is a WHO funded one and therefore believe that the support is enough. - Change in political leadership in the Ministry of Flealth. - C,'hange in budgeting procedures at the state level. Recommendations to improve advocacy: o Need highly placed and respected persons from the Federal and NGDOto be paftof a high level advocacy team to the state policy makers. . Sponsor programme segments in media houses such as Radio, Television. Media Chat and Press Conference to solicit for support and create awareness.. o Mark of Onchocerciasis Day at various levels. . Show documentaries of people affected with terminal cornplications of the disease. t7 WHO/APO('. 24 Nor,'ember 2007 h. I Organize Drama and Song groups to give orientation to top policy officers for moral and financial suppoft. Production, Printing and Distribution of Souvenirs such as Face-Cap, Stickers f-Shirts (vests) and Pocket Calendars. 2.3. Mobilization, sensitization and health education of at risk communities. Provide information on - The use of media and / or other systems to disseminate information. Use of Media Houses: The State Ministry of Health organizes regular Programme tagged OGRL-JMED for various health activities to be implernented in the rural community. Airing of this in GTV, GBC. NTA and F'M News was regularly done. The Onchocerciasis Programme was aired in the following Media Houses ,/ 'Eto Ilera ni Ipinle Ogun' in Paramount FM 94.5. '/ GBC -'Healthy Living Segment'. ./ Mid-day News on Health and Environment [Oncho Day]. GTV/NTA News in Yoruba, English and Egun. To mobilize comnrunity members lor treatrnent after the day has been llxed, town criers. loud speakers in mosque and churches are used to disseminate infbrmation after prayers or church service. Posters on onchocerciasis are also posted in clinics during treatment. Also in each community. there is a person in charge of mobilizing the community to participate in health related activities include onchocerciasis control. Mobilization and Health Education of communilies including women und minorities '['hese are aimed at ensuring community involvement and participation. Health workers rnobilized community' r.nernbers during community' meetings or hcahh education session. Mobilization meetings were also held with Religious Leaders, Community Development Associations and Landlords Associations who further mobilized community members to cornply' with treatment and/or to support CDDs. Women are specially mobilized through market women associations and through religious organization during market days or religious functional meetings. Regular rreetings with Chrrstian Association ot'Nigeria {CAN} and led to sor.ne ChLrrches choosing CDDs on behalf of'the conrmunily in Abeokr-rta North and South. 28 Churches are currently involved, and a total of distributors have been selected and trained. Registration and treatment were carried out and completed during the l{ealth Week commemorated in various churches. Health Education sessions in Churches and Mosques are regularly held. Response of target communities/village: - CIDDs are now'enjoying rnotivation from cornmunitl, rnembers in some communities. - CSM and SHM initiated in some communities. - Number of CDDs increased with voluntary participation in drug distribution. a a t8 WHO/APOC. 24 Novcrnber' 2007 Women participation improved Accomplishments: - Level of acceptance by the opinion leaders and women fbld is high - Increased women participation in the CDl'l process - lmproved therapeutic and geographical coverage Ways to improve mobilization and sensitization of the target communities: - Involvement of ward representatives at the LGA level. - Encouraging participation of women organization and faith based groups. - Formation of Village Cornmittees on Mectizan Dlstribution. 2.4. Gommunity involvement Table 4: Communities participation in the CDTI (Please add ntore rows iJ neces.sary) Comment on: Attendance offemule mentbers of the community ut health educotion meetings. - Attendance is on the average. It is fairly satisfactory In general, how do you rate the participation of female members of the community meetings when CDTI issues are being discussed? Some women are community title holders and are opportune to raise issues i.e. Iyaloja/l1,alaje in tneetings. l-heir opinions are sometimes allowed on some issues. ln sonre cases lbrnale participation at community nreetings depend on decisions of elderll male members. Attrition o/' CDDs. Is attrition a problem for the project? If yes, how is it addressed? - Attrition is not a problem in the state - Other issues District/LGA Number of comm unities/villages with community mcmbers as supervisors -t -f Nrrnn".wittt communities community in the entire members as projectarea supervisors Percentage Bc= BJ B. r Bs/ Br *100 Abeokuta North I t9 l l0 88 lt0 92 300 100 400 28 )-l9o ,I I o.o i.si;,, 2.1 0zo ' li% - I li,u 219'o Abcokuta South Irvekoro I tir Iureko-Afbn Obat'emr-Orvode Odeda 245 r05 350 45 t'73 l-s_5 111 87 2(r0 7_s 2i0 88 265 --. .-t .-._64 255 51 230 33 25 i5 2t)176 I9I 104 t73 25 !ewa North 153 204 96 300 28 t8% Total I 952 l.6l 8 6'12 2.290 239 25 o'u 19 WHO/APOC. 24 November 2(X)7 Number of CDDs and the communitics inl'olvcd Number of communities /r'illages n ith lcmale ('DDs CDDs pernoie -- f -rot,ri CDDs Number of com m unities n'ith female CDDs Pc lce ntage Bn= B * 100 ___ _+,____ 2.5. Gapacity building - Describe the adequacy of available knowledgeable manpower at all levels. Adequate trained staff is available. Where frequent transfers of trained staff occur, state what the project is doing, or intends to do, to remedy the situation. (The most importunl issue to describe is whul meusures were tuken to ensure adequute CDTI implementulion wltere not enough knowledgeable manpower was uvtriloble or iJ'staffs are.frequently transferred during lhe course of the campuign). Where transfers occur, the project intends to train the new staff on CDTI implementation. The project intends to train all health staff in the endemic LGAs to ensure that transfers do not affect programme implementation. 20 WI IO/APOC. 2-l Nor,emhrer' 2(X)7 I lt Q Q,] Q Q U LJ L rr 6 F +. q = z q) a (.) o z $ N N O oo on c\ O a.l N N at cn N O c.l o ?a)iN al (-)t s o\ .f O O oo a.t o{ O cl (-)t6l dll v :.i, F v.: qv >v (,LF .=6FF (Jl o0) .0) Lc! a,L z (\ Fl t-l c\ al o - E,, JE,T +F-(,- U ! e< = LF 6J !sluol a! 2l!xl tr'>i z;l q) m \o st C € CN {6 at sN OF- $ OF- + r-- O ca \o +s .o \o ca t c.l € \o + <f rl € € al (\l te cl o\ o sO .o F- oo \o oo ",, d o.'+F-d' U, Q (./ q F qJ (! 0 o J OJ z oo al oN r-t \o F- € + a- \o + € o. \o o \o O\o c € ot \o a\ oo \o at r-O \o t-- -t €r-r- €$ a o\FI F- € s o\ € o\ N Oo (\ J N -v, _ !L <z = <l ,; o ! t! € c € o o tro .o -(j -E,oo 6EIEC L z o Fl F F a-CCcl -c Ct Z J cl c (-.l 04 =o a € o I : o o -G a *p o t/ o t a t ts ? a aa\)U AJ a .= aL U t qJ % qJ a_ .9 () E() o- E FcU o I o :q o L .a)F E (.) (! bo =LF n1 OI -l -ol FI Table 6: Type of training undertaken (Tick the boxe.s where specific training y,tts carrrcd oul during tha reporling period) 'l'rainees Type of training CDDs Other Community members e.g. Community monitors I-{ealth Workers (frontline health faci lities) MOH staff or Other Political Leaders Program management How to condr-rct Health education Management of SAEs CSM SHM Data collection Data analysis Repofl writing Any other comments 2.6. Treatments 2.6.1. Treatment figures If the project is not achieving 100% geographical coverage and a minimum of 65%o therapeutic coverage or the coverage rate is fluctuating. state the reasons and the plans being made to remedy this. The project is achieving 100% geographical coverage and more than 65%o therapeutic coverage. 22 WHO/APOC. 24 November 2007 -tc CI t -c c! Z -j cl C : c.,l CN() L O(.) 'a L o. 0.) o z rr'l _o -o() TE '.: C(-) =a () tr E o .O E() -a u I qJ o. -C o () E(ts o !() -o E -= oF q)L C! O G) 'a ! o. OJ .C .= ,c '= (.) 'E =E E oo .9Eo()O .r -o CL cd XoJ9# c't o0 ?, )= Cq o- 6) FZ. OO x O d C) o o o() o (! o L 6) -o E Z o L 4) -o E (. ( I C = =C 0 c () 5 L ,o =E L C 'L c L (.) L u CIJ () o F (J d a) bo sj() oU GU.: .- \" bo o() () d 0.) oJ.) L !) o()^ 9^\ 0) o. cO() F c z os E =Z o ;y = u6-?a i z P !€ o(: o2uO Z Z Z z Z z 7. Z z z z 7. z z o trl *4 2cn /-o z z z z Z -J z Z N z ,!y ia u ll LE^-OEziEEtrH}OE ;b z z Z z z z Z Z z \o €r s 6 foo O..L\o ao F o\ oo r-. o\ € o\ r \o € \o rr o\ r \or c- CI \c aa6 FT{ rt1 al ? n,_ trlu Z a.l + \c +N aN \o\o + =j- v :o dO= a6:r99' -v $ € r- al OF- cor\ al c.l Oo @ on t-- oo o. -J F-\o 0a a.| + r- al [n N o cg o. r = = l;i: x! a= a'. 6 1lE oF r- '1 oc \o -f € -J- r-r- + J + f \o \o F- -$ F- -t Vt al 6l 2u o!!- -" ao\ oIJa- (, o\ \o \o o\ ^\ o\ \o o\ \+ =,r ! c aLJ3f(E ==-L LA 0 € ao c N o\ \o F- t = 6t Ui doa =: o ron --o ao ca O c.l o\ \o t-- $ a.lta (J bQ =l- a C) E E (-) \Oa '- U= l:;; d - O> -/=q):,lEJadYto v>u ao ca N \ot'- :f, rn alra brr o\ :z? _ts2 d 3-E ^=Ern o jz() a ,o Ioc -Yo(JqE< -(D ,oo c) c t-Cd+ iz t] F 3 &h L ad(.) cd J o L E () (.) F r- CI ! O -o E o oZ -+ al ; 5o\ sI bo OO \ ! s' \4. S= 'io :-!1 .==F!YL I.a .tsn !\I:sS$ \is =>!! I '==:. F lY! *.< S' .S: a. lu:\ '=€t\ L- f-t : S'u ls b':.. i *.!! ib .! 1's = \s b !a! S' =lB =u3 Ss ': rxboUUI 'Q\ * Elsav! !Y: a-* s ia = \ j : q.= \ S:'r: =i: t'=i 'ris da-qi sf u uts>-:t\ s='il il= ^ ,- tL l\C (, F o!(6 (,) o 'd o. o =.: a) c0 E() -o () L(.) o- o o .E () (! ^, 0-)9l LOi e -l o.r ,12 9. Ul o- -l uol o (JL oluql ! Ol - -ol -trl 6il l<ZI; (-) .9 .:o l,F o\ (.) .E() 6) c o E o LF J a.l 2.6.2 What are the causes of absenteeism? The health facility did not adequately report absentees. The pro.iect team is however aware that sorne rvorkers were transferred. lrew u,ent forcommunity'assignment in the city. Sorne religious members traveled to represent churches at Conferences, Retreats and Camps during distribution time. Although some absentees took their drugs later. others were not properly followed up or drugs had been retrieved by the time they came back to the country. 2.6.3 What are the reasons for refusals? Refusals are mostly wanderers. Not staying in the community for subsequent Rounds. 2.6.4 Briefly describe all known and verified serious adverse events (SAEs) that occurred during the reporting period and provide (in table 8) the required information when available. In case the project did not have any cases of serious adverse events (SAE) during thisI reporting period, please tick in the box. 25 WHOi,APOC. 24 Nor ember 200-l c-- at O -c C D oUe \o cl : \oN q) U ql qJUj aa tJ '! -i r- qJ r. \ a U a_ o L() o- co L o o-() (J CO .I = OLL O O o t! a () (.) (J a! o E a o L C)a o 0.) (, #1()I =lFI otr- i>c Y> - aC= -,q ilUdl-9 .-=6 (loo aa) l^rL! 6'5 a.2 C-,)C 2. cl) 6-Q ^ 6.= O d,=d Ah-)O a.=,L,G o e6-c.P A Y Y,Cg rli I i It z d : ,. I o0.i n=,'.-! -ih-A::Z- .-L!Y -C .N*9?-dudo>, c a o- E a a oOOr6.- = .org>6 2(a (J 50 * a t I 1 l I I F- at o _o Z -t CI c a ao F ON (, ccr- € ccF- o\ o\\o o\ o ,.& ll * !Ja- ii kl o ^ oll(rF- - o6\ I 6\ oo Ir- o\\o oo 6\ co o\ r- o\ ol € F- o\ o\ o\\c I *- r.i r.l Ii a bl) o. !: ;> -E9F .\ F-\o o\ c F- \o oo € o\O@ rI] ,a ON OE9- n'FE o € € r{ rn (-- o GI & t-- cl o, + O CI F F- di -t CI oo c.t @r- + CI c) Ei> r 1)9' FU +F- cld al ol + .<. CI c.J c\ cl a.l cl c.l .'l 5l c CI r; .o c.l -fr\ a\ CI $F-6t C -t F- cl $ a- ol 5 F- cl \o -1. : o.l ^t o oo = O .E E Eo(.) l* trlQ t L]G^ - o6' 'o o\O o\ c\c O o\ c\ EO= oo!= L - L.o !'_PU91di't O o rr') o\ ca € \o -f t-- o\Oo o\ o\ o. o\ € o\ 9) -=aa u = Y, 7ca, r- \o Ot- N o' al o. oo oo r\ c\ n tl 2uGU> r .ao -'-ic r- \o t\ c\ al o. € @ o.l o. c.l d =rzli;i -?? e aE 6=aAi - = o 2i EO -f, -t € al cl at o. al o. CI o. cl rJ t-- € c.l c.l o.lO c{ an <- (\ ON a1 r- CI oo c\ (\ a.l t-- c.t -U)t U ! I -I q) bo LSe - -so -c,NO .= Fr;,-\:l B- i= v- L!,) i -rLe.:O r\)9;-=i\.= uNo i\IAVet1 E A ! oio 'EGcq A!q) o(JLC)q)=tr'=oo Ll- O*0 .:9E ALJ l- .-a,ra Q=. l-(.r- !vbr6f r L AvtrarLA .i ii c-l ->r!lCEtrEl !,o.)-l 6-el z > cdl 0J0, ol E'E .) -Ol O. U! 9U,-tr>o !-q UU()L9 :=F -(!JYA VLItroe !, )-. G) Lr -(dc!-orA f/)+;- v N e-l G)(Jl o _t _.ol :',1 -lvr-l A. 2.7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - Qtlease tick the appropriate an:;wer) MoH tr wriOtr UNTCTNtr IFESHruNIVA I Other (please spec ify') Mectizan@ delivered by' Qtlea,re tick tlte crppropriule an.nrer)MoHtr wHOU UNICE!-X IFESH/UNIVA Other (please specify) Please describe how Mectizan@ is ordered and how it gets to the communities IFESH /UNIVA forwards completed Mectizan application form to Mectizan Donation Program through the NOTF. The completed forrn is based on drug requirements calculated based on total populations received fiom the community level through the Ft.HFs and LGAs to the State. On approval. consignment is received through UNICEF and supply is made to the State Ministry ol' Health by the assisting NGDO. How it gets to the communities. State Coordinator collects Mectizan from IFESH Field Officer to replenish state store. LG Coordinator applies for total required by the Frontline Health Facility Staff, and makes these available to them. CDDs finally collect the needed number of tablets for the communities. T'abte l0: Mectizan@ Inventory 6'r' Year. State/District/ I,GA Number of Mectizan'u tablets Reques ted Receive d Usetl Lost Wasted Expired Remaining AbeokLrta North 100.000 120.000 85,000 140.000 r r3.000 1s0.000 100.000 80.3,12 0 5 t9.653 0 I t4.80 r 0 .1.682 () .l l9.ti6i 0 l I l 9..198 9.980, AbeokLrta South Ewekorcr rlb Imeko/A f on Obaf'emr/Orvo de r 20,000 1 05.1 98 80.3 r885.000 1.10.000 103.200 150.000 120.r33 103..t98 I .t0.01 2 Odeda r 00.000 t00.000 85.228 0 I 14.771 Yeua North r 30.000 129.337 r r 0.348 0 19.652 TOTAL 938,663 938,663 825,077 0 l7 112,906 '/ How are the remaining ivermectin tablets collected and rrhere ale thel,kept? LG Coordinator retrieve left over tablets and distribute to other communities, but state distributc to static centers for clinic base. Lefl-over drugs are retrieved by LGAs frorr FLHFs. These are retrieved by the slate.The unexpired left over drugs are distributed first in the following year before the new consignrnent (first expiry - first out basis) 28 WHO/AI'O('. 26 Septerrber 2007 l I l I 0 ./ List and briefly describe the activities under ivermectin delivery that are being carried out by health care personneI in the project area. - Requisition, Collection and supply to endemic communities. - Keeping of Mectizan [nventory. - Updating Registers and supply of Mectizan. - Notification to the community of availability of drug. - Monitoring and supervision of Mectizan distribution. '/ Any other comments Nil 2.8. Gommunity self-monitoring and Stakeholders Meeting Has any'training (of trainers) Ibr communitl,ss;1'-,.r.r.,-ritoring been done in the project area? If so. when? Table I l: Community self-monitoring and Stakeholders Meeting \Add row^s if needed) District/ LGA Total # of communities/villages in the entire project area No of Communities that carried oLrt self rnonitoring (CSM) No of Communities that conducted stakeholders rneeting (SHM) Abeokuta North ll9 110 67 61 42 50 55 27 78 44 25 Abeokuta South 48 54 6l -1 -1 ti9 52 3l Ewekoro Ifo Lneko Afon Obaf-erni Owode Odeda Yewa South 88 il0 92 176 104 153 TOTAL 952 435 382 Describe how the results of the communify self- monitoring and stakeholders meetings have alTected project implementation or how they would be utilized during the next treatment cycle - The CSM and SFIM have helped to improve treatment coverage - It has created more awareness and compliance to Mectizan - Cornmunity members have shown ownership ol-the prograrrlne 29 WHO/APOC. 24 Nor ember 2007 2.9. $upervision 2.9.1. Provide a llow chart of supervision hierarchy. COMMUNITY DI RECTED DISTRI BUTOR 2.9.2. What were the main issues identified during supervision? CCDs complain of lack of logistics Increase awareness on Mectizan benefit Members are very familiar with dates set for distribution Some who experience side effects confessed never to use the drug. Intermittent posting of staff at health facility level resr"rlted to lack of continuity There is low level of integration of CDTI activities lnto PHC in some LGAs Late submission of summary fonns to LG coordinators by' FLHF staff. 2.9.3. Was a supervision checklist used? YES DIRECT OR PHC &DC STATE COORDINATOR & SOCT, LG COORDINATOR & LOCT 30 WHO/APOC. 24 November 2007 FRONTLINE HEALTH FACILITY STAFF 2.9.4 What were the outcomes at each level of CDTI implementation supervision? LGA Level:- - FLHF Staff shown interest in CDTI Mectizan delivery to CDD. - CDD now report to FLHF Staff at appropriate time. - Empowerment of the LOCT Staff for proper recording of summary forms and submission at the right time. - 8 Local Government PHC Coordinators were sensitized and improved on CDTI monitoring. Community Level: - - High commitment towards Mectizan distribution by opinion leaders. - CDDs are ready to update their registers. 2.9.5. Was feedback given to the person or groups supervised? YES. 2.9.6. How was the feedback used to improve the overall performance of the project? Total number of people treated increased over 3RD Round Treatment. FLHF Staff develop interest in CDTI activities. Improvement in submission of summary forms by FLHF Staff. State received report during the monthly meeting with LG Coordinators. 3l WHO/APOC. 24 November' 2(X)7 SECTION 3: Support to CDTI 3.{. Equipment Table l2: Status of equipment (Plea:;e add more rows if nece,\sary) Status of equipn-rent (Plea,se add more rot',s iJ neces',saty) *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? Source Type of Equipment APOC MOH DISTRICT/L GA IFESH/ UNIVA Othe rS Condition of the equipment * Please state 1. Vehicle Functional I ord 2 Nil Functional 2 2. Motor cycle Functional 8 Nil F unctional 8 F unctional J 3. Computers Functional I Functional I Nil 4. Printers Written off 1 Functional I Nil 5. Fax Machines Functional I Nil NiI 6. Air Conditional Functional 2 Functional J Nit a) Lap Top Functional I Nil Nil b) Generator Functional I Functional I Nit c) Bicycles Functional Nil Functional Nit d) Public Address System Functional 4 Nit Nil Nit e) Television 20" Functional I Nil -014s!rqy!u&--g) Refrigerator h) UPS Functional Functional Functional I Functional 2 Nit I NiI Nil 2 Nil Nil i) Stabilizer Nil 2 Functional Nil j) Photocopier Functional I Nil Nit Nil Nilk) Slide Proiector Functional I l) Storage Boxes Functional 4 Functional I Nil Nilm) VCR Functional I Nil n) Over Head Proiector Functional Functional Nil I Nil Nil Nil Functional o) Writing Board p) lnformation Board I Nil Irunctional 2 32 \ /llO/APO('. 24 Nor,cnrber"20()7 The project intends to maintain and replace existing equipment with the State Counterpart Contribution and support by IFESH/[INVA. 3.2. Financial contributions of the paltners and communities Table l3: Financial contributions by all partners for the last three years '/ If there are problems with release of counterpart funds, how were they addressed? Sonie funds have been approved but yet to be released. A follow up will be done to ensure thc release. Additional comments - APOC should not hesitate to release fund promptly 3.3. Other forms of community support '/ Describe (indicate forms of in-l<ind contributions of comrnunities if'any) - Release of members of the community as CDDs. - Purchase of registers for registration of the population. - Venue allocated fbr training i.e. Palace, Town Hall. - About 35o% of communities give incentives in kind to their CDDs Contributor Year.{ (Jan-Dec. 2005) Year 5 (Jan-Dec, 2006) TOTAL Cash Budgeted (us$) TOTAL Cash Released (us$) TO]'AL Cash Budgeted (us$) TOTAL Cash Released (us$) 'IOTAL Cash Budgeted (us$) MOH (Central + Provincial/State) 60.340 I 5,680 9.319 9.319 2,200 2 ,200 36.000 23.000 5.700LGA 20.560 r0,200 Local NGDO(s) ( Church Society) Nrl 0 0 IFESH/UNIVA Others 25.4t5 I i,250 Nrl Nrl I6,020 It 6.020 Nrl Nrl l 4.500 a) b) -q)Communities APOC Trust Fund Nrl Nrl Nrl Nrl N rl Nrl Not quantrfred Not quantrtled Nrl Nrl Nrl Nrl Nrl Nrl 50,000 I 1,200 l2,l_50 82,030 52,44-s 2_s.465 98,000 19,533 .I'OTAL 188,315 rl,tro lt0,0J{ 61,261 15 7,000 5l ,88J JJ W'l IO/APOC. 24 Nor ernbcr' 2007 3.4. Expenditure per activity '/ Indicate in table 14, the amount expended during the reporting period for each activity listed. Write the amount expended in US dollars using the current United Nations exchange rate to local currency. Indicate exchange rate used here $ r:N126 Table l4: Indicate how much the project spent for each activity, listed below during the reporting period Activify Expenditure ($ US) Source(s) of funding (2007) Drug del ivery from NOTF HQ area to central collection point of lcommunity Mobilization and health education of communities Training of CDDs Training of health staff at all levels Supervising CDDs and distribution Internal monitoring of CDTI activities Advocacy visits to health and political authorities IEC rrraterials Summary (reporting) forms for treatrnenl Vehicles/ Motorcycles/ bicycles maintenance Maintenance of Office Equipment (e.g. computers, printers, Photocopier etc) 3s0 8.1 45 I I ,481 4,0s2 4,000 4.182 2,000 6,1 50 4.352 I.-5 l8 4.005 IFESH/UNIVA IF'ESH/LINIVA .MoH APOC APOC LGA MOH,IFESH MOH.LGA LGA LGA N,IOII.I,C,A.II'E SH/UNIVA. MOH.APOC. IFESH/TINIVA TOTAL 50,235 Total number of treated ,/ comments On the expenditure table, the MOH supported some activities in the year. The fupds used were from the 'bulk release' for CDT'I and other health programmes under tt. pUC & DC department for joint activities. The amount released for the programmes sum up to $22, 467. 34 WHO/APOC'. 24 Nolemher 2007 254,783 SECTION 4: Sustainability of CDTI 4.1. lnternall independent participatory monitoring; Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable) Year I Participatory Independent monitoring Mid Tenn Sustainability Evaluation 5 year Sustainability Evaluation Internal Monitoring by NOTF Other Evaluation by other partners 4.1.2. What were the recommendations? Many issues were observed on data collection and most of them were attributed poor data collection The following recommendations were made: - The monitoring activity on data collection should be redone using the oppoftunity provided by the training of health workers as approved in the 2007 budget and LGA data should be collected from registers or available summaries at FLHF or LGA levels. - Some indicators such as number of CDDs available/trained collected so far can be retrained and used later. 4.1.3 How have they been implemented? - All 2007 treatment data were collected at the LGA and FLHF levels - A total of 2,430 CDDs were trained and retrained and are involved in the distribution of Mectizan. 4.2. sustainability of proiects: pran and set targets (mandatory at Yr 3) Was the project evaluated during the repor-ting period? No Was a sustainability plan written? Yes When was the sustainability plan submitted? _July 2005-_ What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.2.1. Planning at all relevant levels. 3 year workplan was developed for both state and LCA levels. The annual workplans are refined for each year which was submitted and approved. 4.2.2. Funds Some LGAs have been releasing funds but others have not. Efforts are made to use the LG department and forum of LGA chairmen to lobby those that are not releasing funds. The team will 35 WHO/APOC. 24 Noi.,enrbcr 2(X)7 keep encouraging LGAs to continue paying imprest to coordinators and counterpart funding for continuous CDTI implementation. 4.2.3 Transport (replacement and maintenance) Old vehicles in the depaftment are released to the CDTI unit and IFESH/UNIVA is supporting with 2 vehicles. Maintenance of these vehicles will continue from the funds that will be released to the state project by its government yearly. 4.2.4. Other resources The project intends to mobilize funds from government at all levels for the procurement of needed resources and approach some local NGOs to assist in providing materials needed. 4.2.5. To what extent has the plan been implemented About 70%oof plans have been implernented. 4.3. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: CDTI is being integrated into PHC system through the following means: I Reflection of CDTI activities in the health plan for the State and LGAs. J,. UsageofProgrammelogisticsforotherhealthactivitiesandusageofNPl motorcyclesfor CDTI supervision.{ Awareness of health staff at various levels that CDTI implementation is part of their routine [unctions. .|. Usage of PHC staff for Programme activities. 4.3.1. Ivermectin delivery mechanisms are known to other units in the department. 4.3.2 'l'raining: Joint training activities adopted in the Department fbr programme staff to be involved such as RBM, NPI, HIV/AIDS, TB/LEPROSY and Health Education Programme. 4.3.3. Joint supervision and monitoring with other programs is implemented. There are plans to use CDDs for vitamin A supplementation and immunization. - Usage of programme logistics for other health activities and usage of NPI motorcycles for CDTI supervision are the vogue within the project area. This is more pronounced at the LGA and FLHF levels. - Advocacy and monitoring visits was carried out jointly by the CDl'l programme and some other health programmes in the PHC department. 4.3.4. Release of funds for project activities in the State and Local Government Funds release follows the normal channels within the Ministry 4.3.5. Is CDTI included in the PHC budget? Yes. CDTI activities are reflected in the health plans for the State and LGAs 36 WHO/APOC. 24 Nor,ember' 2007 4.3.6. Describe other health programmes that are using the CDTI structure i) Roll Bacl< Malaria[RBM] ii)TB/L and NPI iii) Vitamin A Supplementation What have been the achievements? Involvement and participation at the community level. Awareness on the sustainability of Mectizan distribution at the community level. A total of 219,900 children 5 years and below were administered Vitamin A Supplernent in the 8 endemic LCAs using the CDTI structure. 4.3.7. None Describe others issues considered in the integration of CDTI. 4.4. Operational research. l{lL 4.4.1. Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period. NIL 4.4.2. How were the results applied in the project? 37 WHO/APOC. 2.1 Nor enrber 2007 SECTION 5: Strengths '/ The encouragement received from the communities based organizations - Christians, Muslims and road transport workers union. '/ The continuous awareness heard on the state radio '/ APOC assistance in terms of capital equipment and training '/ Availability of trained staff at all levels '/ CDDs willing to continue with drug distribution despite inadequate of lack of incentives. '/ High cornmunity awareness of the benefits of Mectizan treatment, and willingness to comply with annual treatment. Weaknesses '/ Lack of manpower at the LGA level ./ Lack of record keeping and reporling ./ Late submission of report '/ Sonre LGAs are yet to release counterpart funds ,/ Inadequate involvement of FI,HF staff in the CDl-l process Challenges '/ Frequent reposting of health workers '/ No financial support from the state '/ Some chairmen feel onchocerciasis control receive so much funding from UN agencies. '/ Number of CDDs reducing in some cornmunities. ,/ Quality of record keeping is poor. Opportunities '/ Retraining of all health workers in both endemic and non-endemic areas '/ High powerful advocacy by the zonal office to the state and LCA stakeholders ./ Regular advocacy and sensitivity to the decision makers '/ Targeted training of personnel '/ Intensify mobilization in the community. 38 WHO/APOC. 24 Novenrber' 2007 SECTION 6: Unique features of the projectiother matters Churches being household congregation accept Mectizan distribution by health committee. Distribution of Mectizan in churches at Abeokuta North and South by the Church Health Committee made the project achieve more in 2 CDTI LGAs. OCRUMED Scheme in the State Ministry of Health was established to bring specialist care to enhance a healthy and economically productive life for rural populace. 'Ihis had led to an increase in Therapeutic Coverage in 2 CDTI LGAs {Odeda and Yewa North} 39 WHO/APOC. 24 November' 2007