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

POC I RESERVED FOR PROJECT LOGO/HEADING ORIGINAL: English COUN Y/NOTF: NIGERIA Pro Name: IMO CDTI ,4.pproval vcar: 1998 Launching vear: 1999 Ilcportin g Pcriod: From: January/2007 To: DecemberlZ00T Pro icct ycar of this rt: (circleone) | 2 3 4 5 6 7 (8) 9 l0 [)ate submitted: Janua ry 2008 ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) EADLINE ISSION l'o APOC Management by 3l January fbr March 1'CC meeting 1& To APOC Management by 31 Julv for September TCC meeting So 1 fr -i-o, .brR ffv:#, fl.GoftoneAFRICAN PROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) : Global 2000NGDO Partner 'l 'I '' WIIO/APOC. 24 .lanuary 200tt 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: f.me taft C.ftau Signature: .. (* Date: ..1.?.-.Q.2,-.he... Zonal Oncho Coordinator Name Signature Date NGDO Representative Name: NC €' €rnu"tL4+ Signature Date: .t.T..:..T..:...9< T? This report has been prepared by Name , ..f.t.:., r>1\2Il.W.*.7 Designatio n, {*..,.. 6.*., ffe Signature L,- b( (_g Date u L WHO/APOC, 24 January 2008 Table of contents ACRONYMS V DEFINITIONS VI F'OI,I,OW UP ON TCC RECOMMENDATIONS I.]XECUTIVE SUMMARY .... SEC'I'ION I : BACKGROUND INI,'ORMATION l.l. Grurnar.rNFoRMnrroN................ l.l .l Description of the project (briefly1.... 1.1 .2. Partnership 1.2. Popur,Rr-roN SEC'I'ION 2: IMPLEMBNTA'IION OF CD'I'I....... ...................82.1 TIMELINE OF ACTIVITIES ..........9 2.2. ADVOCACy .................. l02.3. Motltt,tz.R'l'toN, SENSIT'tzA'noN AND HEAr-r'n EDUCATIoN oF- nt RtsK ('oMMuNrrrr.s I I2.4. CouuuNrry TNVoLVEMENI'............ ............... 132.5. Cnpncrrv BUTLDTNG ...................... I _52.6. TRrarrracNrs................ ................. lg2.6.1. Treatntentfigures............ .......18 I,Vhal are the causes o/'absenteeisnl? .......... ............... 22 ll'hat are the reasonsforrefusols?................ .............22 Briefly describe all known and verified serious adverse event.t (SAEs) rhut occurred during the reporting period and provide (in table 8) the recluiretl inforntation when aveilable. ............ . ...... ..ll 2.6.5. Trend of teatnrcnt achievement.from CDTI prolect inception to the curuent yeur ..... .21 2.7 . ORoI.,ITINc;. SI.oRAGE AND DEI-IVERY oI. IvDRMECTIN .........252.8. CovrrauNrly sEt.F-MoNlroRrNC AND STAKEHoLDERS Mr.n-rrNc ...........262.9. S(,lr,riRv1sroN............... ..................2g2.9.1. Provide aflow chart of supervision hierarchy. ...........2g 2.9.2. lYhat were the nruin issues identified during supervision?..............................29 .9.3. Was a supervision checklist used?......... ................ 292.9.1 Whal were the outcontes at each level of CDTI intplementation .snpervi.rion'?.2g).9.5. LI/as feedback given to lhe person or groups supervised? ...... ......302.9.6 How v,as the.feedback used to improve the overall perfornrunce o.f rheproject... ... .. . .. j l SECTION 3: SUPPORT'I'O CDTI... ) .3 .3 3 .1 ,.6 2.6.2 2.6 3 2.6 1 3. t 3.2 3.4 EeurpunNr FtnaNclRl coNTRTBUTIoNS oF THE pAR'tNERS AND coMMUNITTES. Ornen FoRMS oF coMMUNtry suppoRT ExpeNprruRE prln AC'rrvt'ty ............ .30 .30 .32 .JJ .JJ SECI'ION 4: SUSTAINABILI'IY OF CD'I'I.. ....34 IN't'e nNnl; TNDEpENDENT pARt'tctpAToRy MoNI'roRrNG; EveLun.r.toN...................34 lilas Monitoring/evaluation carried out during the reporting period'? (tick uny of the followingwhich are applicable)............ ...........3J lVhot were the recomntendations?. . . J j 4.t. 1.t.I 1.1.2 lll WHO/APOC. 24 .lanuary 2(X)E z1.1.3. I{ou, have they been implemented? .............. ........ ..... Jj 1.2. Srrs'r'nrNRstLrry oF pRo.rECTS: pt,AN AND sETlARGE'rs (MANDAloRy A I ...............35 Ytr 3)......... 1 2.1. Planning at all relevant levels..... ............ Jj 1 2.1 Fund,y ................ . Jj 1 2.3 Transporl (replacement and ntaintenance)....... .......... Jj 1.2.1. Other resources ..................... J5 1.2 5 To what extent has the plan been implemented................ ........... . JJ +.3. IN'mcRnTroN ............... ....... .........36 1.3.1. Iverntectin delivery mechani.sms ............ .36 l.-1.2. 7.raining..... ..........36 1.3 3 .loint .supervision and ntonitoring wilh other programs . .......36 1.3 1 Relea:;e offunds for project activities.... ................... 36 1.3 5 ls CDTI included in rhe PHC budget'?...... ..................36 1.3 6. Describe other health programmes that are using the CDTlstruclure and hoty this was achieved. Whal have been the achievements? ............. ... ...............37 1 3.7 Describe others issues considered in the integration of CDTI. .....37 .[.4. C)t,t:nn'ftoNAl RESEARCH .....37 I 1.1. Suntmarize in not more than one half of a page the operational research undertaken in the pro.ject areawithin the reporting period............................ 37 1 1.2. How were the results applied in the pro.jec't?............. ...................37 SEC.I.ION 5: S'I'RENGTIIS, WEAKNESSES, CIIAI,LENGES, AND OPPORTUNIl'IES .. .....37 SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS.........38 lv WHO/APOC. 24 January 2008 Acronyms APOC Afiican Programme for Onchocerciasis Control A1'O Annual Treatment Objective A'l-rO Annual 1-raining Objective ('BO Comrnunity-Based Organization ('DD Community-Directed Distributor Ct)'ll Community-DirectedTreatmentwithlvermectin ('SM Cornrnunity Self-Monitoring l.CA l,ocal Government Area MOH Ministry of Health NGDO Non-GovernmentalDevelopmentOrganization NGO Non-Covernmental Organization NO'f F National Onchocerciasis Task Force l'llC l)rimary health care ItlrMO l{apid Epiderniological MappingofOnchocerciasis SAL Severe adverse event SIIM Stakeholders rneeting l'CC 'l-echnical Consultative Cornmittee (APOC scientific advisory group) fo'l- Trainer of trainers tiNl('EIr L.lnited Nations Children's Fund ti'1.(; Ultirnate Treatment Goal WllO World Health Organization GRBP Global 2000 River Blindness Programme llKl Helen Keller International SSI Sight Savers International NOCI'} NationalOnchocerciasisControlProgramme NO'l'lr National Onchocerciasis Task Force SMOII State Ministry of Health I-Cl Lions Clubs lnternational LGAI-lD .Local Government Area Health Department VllW Village Health Workers I)llS District Health Supervisor llPS Hcalth Facility Staff WHO/Al')Oc. 24 .lanuarl 2()0ll Definitions ti) Total population: the total population living irr meso/hyper-endemic communities within the project area (based on REMO and census taking). (ii) Illieib-Lc -p.qpulalton: calculated as 84%o of the total population in meso/hyper-endemic communities in the project area. (iii) Annual T ent Obiective: (ATO): the estimated number of persons living in rneso/hyper-endemic given year. areas that a CDTI project intends to treat with Ivermectin in a (iv) Ultirnate Treatment Goal (UTG): calculated as the maximum number of people to be treated annually in meso/hyper endemic areas within the project area. ultimatcly to be reached when the project has reached full geographic coverage (normally the project should be expected to reach the UTG at the end of the 3'd year of the pro.iect). (v) -l-Islapsuuq coverase: number of people treated in a given year over the total population(this should be expressed as a percentage). (vi) Geographical coverage: number of communities treated in a given year over the total number of meso/hyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). lvii) Intcgration: delivering additional health interventions (i.e. vitamin A supplernents. albendazole for LF, screening for cataract, etc.) through CDTI (using the same systems, training, supervision and personnel) in order to nraximise cost- eff-ectiveness and empower communities to solve more of their health problems. l-his does not include activities or interventions carried out by commurrity distributors outside of CDTI. (viii) Sustainabilit.v: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future, with high treatment coverage. integrated into the available healthcare service, with strong community ownership, using resources mobilised by the comrnunity and the government. (ix; Comrnunity self-monitorins (CSM): l'he process by which the community is enrpowered to oversee and monitor the performance of CDTI (or any community-based health intervention programme), with a view to ensuring that the programme is being executed in the way intended. It encourages the community to take full responsibility of Ivermectin distribution and make appropriate modifications when necessary. VI WllO/APOC. 24 .lanuar'1 2001t !FOLLOW UP OII TGG REGOMMENDATIONS lJsing the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. 'l CC session 25 Numher ot Rec'omnrcnlnlktn in lhe Reporl TCC RECOMMENDATIONS 232 'I'hc diffelence in the number ol'persons treated reported in thc text (pages 2 and 5) and table 7 should be addressed. Provide inforrnation on the placc of storage of Mectizan. (Pleu.se add ntore rows if necessary) ACTIONS TAKEN BY TIIE PROJECT The dilference in number of persons treated on pages 2.5 and table 7 last year was a typographical error. The correct figure is 499.416 as appeared on page 2 andtableT and not 499.422 as contained in page l5 of2006 report. The Mectizan drug at the state level is stored in the state central store. while at the local government level. each local governrnent area has drug store where Mectizan and other drugs are stored. At the health facility level. the quantity of drug is so srnall that it does not require a store but the Ieft over is kept where other drugs in the facili are FIIR TCC/AP(IC MGT USE ONLY The timeline should be ploperly presentcd in the Iogical order. lrrtirlmation on the irnplcmentation ot' activities should be provided. The timeline is presented in the logical order ofthe project activities Period of activity implernentation as specified in the timeline provided. in the 2007. see 9 9See Infblmation on community t'csponses. rate of attrition of CDDs should be provided. l'able 9 should be complcted and data provided tbl year 2005 lnforrnation on cornrnunity responses on the CDTI implementation has been provided in the appropriate section. These included community supports to CDDs. On the issue of attrition. a 12.34% CDD attrition was recorded Table 9 is cornpleted, data frorn 1999 to 2007 are provided in rable l4 24 in 2006. See 9. See WFIO/n POC. 24 .lanuary 2(X)tl !Executive Summary Prepare an lixecutive summary of the report in not more than one page. Inro State was approved along with Abia State as a project in September 1998 for CD'l-l irrplenrentation ( I 998/1999) l'hc project has completed its 3rd year of sustainability activities (Jan - Dec 2007) after its lilih year evaluation in 2003. The project was also monitored for the implementation of sustainabilitv plan in 2005. l'heprojectareahasatotal of 1,647 villageswithall l,64Tvillagestreatedforthisfiscal year. Jan - Dec. 2007. The total population of the area was 747.168 persons with an ATO and Ul-G o1635.09 I persons. I lowcver. the project was able to treat 537.924 persons (72o/olherapeutic coverage). Population movement within the project area is dynamic with rural urban migration arising liom cnrployrnent. occupation and educational pursuit. ln ternrs o l' train ing, a total of 144 District Health Superv isors and Health Cenrer Staff and I 92 Health Facility Staff were trained out of 144 and 429 targeted respectively, and I .008 CDDs were trained out of 3,294 CDDs targeted for 2007 llowcvcr. a nlass transfer of health workers tiom CDTI to non CDTI local government areas is al'lL'cting the prograrnme. The project is rnaking efforts to conduct training to the affbctcd slatl'so as to restore the structure previously established in the State. One of the rnajor constraints that faced the project was inability of both the State and local government areas to release budgeted fund for CDTI implementation in their respective areas, despite series of advocacy visits carried out in the State. Other chal lenges include (a) lrnproving community involvement through community self monitoring.(h) lrrcrcasing the nunrber of CDDs in the project area. I'hc pro.icct tricd to meet up with these challenges through intensive rnobilization and advocacy visits to different cornmunities and groups, so as to sensitize them towards greater participatiorr in the programme. 2 WHO/APOC. 24 January' 2008 !SEGTION {: Background information 1.1. General informatlon I)escription of the project (briefly)l.l.l lrno State is located in the southeast region of Nigeria. The state lies between latitude 4"45' and 6"15'North and longitude 6n30'and 8o09' East. Abia and Anambra States border it on the North. on the South are Rivers and Bayelsa States. East is Abia State while Anarnbra State is on the west. lrno state has an estimated population of about 3.4 million people with over 747.168 persons at risk ol- Onchocerciasis in these 16 local government areas. The State has 27 Local (iovcrnment Areas with APOC supporting in l6 LGAs. Irno State has a lot of fast flowing streams and rivers which favour the vector for Onchocerciasis, such streams/rivers include Imo River. Otarniri. Nbaa, Ogochie. Oranririukwa, Njaba river etc. ,\dministratively. lmo State has a well developed administrative system in each of the auton()r.l'rous community with the traditional ruler or the "eze" as the head of traditiorral aclrrirristration. Each village has a representative in the eze's cabinet, known as the village lread. l-hc rlost popular systern of Government is the democratic systern of Government litrowrr as "Ogbako umunna", here important decisions are jointly taken, which usually hold in a village squares, markets, or the premises of the leader, there both men, women, a times children gather to take a decision that affect the entire village or community. hno State has a good nurnber of social, cultural and religious activities. There are a number of age grades. youth organizations, women groups etc. Cultural festivities are used to mark some important landmarks, like the yarn eating festival (lri Ji) which signifies the beginning of farrn harvest. ['hc rnascluerade festival, Owu festival which rnark the beginning and end of farming period. otlrers includc lwa Akwa, Egwu Onwa and traditional wrestling which are organized fbr p lcasu re. lhc pcople are rnainly Christians with different denominations with Rornan catholic and Anglican ChLrrches dominating. The major languages spoken in the State are English and lgbo languages. l'he State has a good road network for easy communication, though most of thern are in a dilapidating state. begging for attention especially f'ederal roads in the State. I'hc clinratc is partly dry (Novenrber- March) and wet (April - October). The people are nrainlv lhrmcrs. fishermen and traders which cxpose them to the bite of the blackfly'. Cornrrul-rity leaders in consultation with the elders and community members mainly take dccisions that affect the people. This is usually in a central place, like the market square, comnrunity halls, village heads. Infact the people are democratic in nature. lmo State has both primary, secondary and tertiary health facilities, with primary health care scrvices rrot well developed. Most of the villages are without prirnary health care facilities. the available ones are not well equipped. In some areas. the patronage to these facilities are not cncouraging. Governrnent emphasis appears more on secondary and tertiary levels, neglecting rhc prinrary liealth care level. The number of health staff involved in Onchocerciasis control r5 rcllected on table 5. 'l'hc project has completed its phase I of CDTI implementation, which ended in Septernber 2003. arrd is currently in its second phase or the sustainability phase. 3 WHO/APOC.24 JanuarY'2008 -'fhe project has enjoyed a good working relationship with APOC, NOCP, Global 2000, the l.ions Clubs international district 404 Nigeria and other stakeholders in the control of Onc lrocerc iasis. l-abl-c-l: Number of health staff involved in CDTI (Please add more rows if necessary) District/LGA Number of health staff involved in CDTI activities. Total mber of health staff in the entire project area Bl Number of health staff involved in CDTI B2 Percentage B3=B2/ Br *100 Aboh Mbaise 79 29 36.7 Ehime Mbano 93 3s 37.6 Ezinihitte 77 38 49.4 Ihitte Uboma 86 30 34.1) Isiala Mbano 89 34 38.2 lkeduru 86 35 40.7 Ideato North 62 29 46.8 Ideato South 73 30 4l. t Mbaitoli 87 29 JJ. J Nwangele 6s 28 43 I Ngor Okpala 94 4l 43.6 Orsu 63 25 39.7 Obowo 73 28 38.4 Okigwe 69 30 43.5 Onuimo 54 l8 33.3 Owerri North 94 28 29.8 Total 1244 487 39.1 1.1.2. Partnership Indicate the partners involved in project implementation at all levels [MOH. NGDOs (rrational/international), communities, local organizations, etc.] Describe overall working relationship among paftners, clearly indicating specific areas of project activities (planning, supervision, advocacy, planning, mobilization, etc) where all partners are involved. State plans, if any, to mobilize the state/region/district/LGA decision-makers, NGDOs. NGOs, CBOs, to assist in CD'l'l implementation. 4 WI-IO/APOC. 24 .lanuary 2008 I-fhe partners involved in project implernentation; l. African Programme for Onchocerciasis Control (APOC) 2. National Onchocerciasis Control Programme (NOCp) 3. Lions Clubs International District 404 (LCI) 4. The Carter Center River Blindness programme (TCC) 5. State Ministries of Health (SMOH) 6. Local Governmenr Area Health Department (LGAHD) 7. EndernicCommunities. The partners have a harmonious working relationship and are working towards the successful irnplementation of CDTI in the project area. Spccilic Areas Advocacy: Advocacy is a continuous process. weak communities and Local Government Areas are targeted and during advocacy visits. Issues pertaining to their roles and responsibilities are stressed for the purpose of sustaining the programme. Issues like fund release to the programlne are stressed . Organizations involved in the advocacy include NOCP, CRBP, LCI and SMOH. Funding and Technical Support: The major partners which have provided funding and technical support to the programme are APOC, The Carter Center (Global 2000) and Lions Clubs International. With the funds released, the project has been able to carry out a number of CDTI activities in the project area. Mobilization and Supervision: Partners involved in mobilization and supervision include TCC, SMOH and LCA health department. At the state level, The Carter Center has been a great asset in assisting the project to reach the state executives and their supervisors. though not much has been released but the messages have been passed. I'ra irr ing: 1-he project organized targeted training for weak and new personnel. which were jointly carried out by GRBP, SMOH. LcA health departrnent while the endemic communities assisted by selecting the CDDs and health committee members for training. In view of the frequent changes involving political office holders and executive arms of the Ministry, the state is planning to organize a stakeholder forum ro enable them to be sensitized and mobilized toward CDTI concepr. This will take place immediately after the local government election in 2008. 5 WHO/APOC. 24 .lanuary 2008 !I 1., ! o! 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Timeline of activities F-ill in table 3, timeline o/ aclivitiesfor areas treated in current year, indicating when the key activities were implemented by the month they began and the month they ended. 8 WHO/AI'}OC. 24 .lanuary 200tt !l- lFo lal- a .D .D o -+) DJo =. 3. o e rD - .D FO a .D A) .D o- =rD o = - -rD k rD - f\ h { r{ =G a1(\ 1q o o 3 o I > o =N D' 5' = a' FD oo o (, ox .D o q (D (D o Jp J'(D - (D 6' o =N A) =.o =FD (D (D o - o o oC' o A] (D ED U) F) o o o =. o o- o o rD N o a-o o- of 4a =o ='6a; o-N oc0o ='. taJ zO<o aD ;+ J= eta FDaF5o= (D0q 'oo-c caoa5?Q ak5(D(.DCD sf t:. .D(D'o oo oo- coq(DY o).D +aDX.t .i o- O: A: .Do- A-E(D -OaD9 ='a6.!o-O ar i, .D ox oo =.$E. r(};" rl .D= o-g ='th 5J '!D o .D -s. ? 2. o(D ) t9! D c l9 6 Fl oll F o{(D =.z o! o = o o d6'I(D o(t o o oa U) z oc - oF FD FO z{ F' oao 6- 6 F) o = o- o t0 o U) o J o- op) o z o CD h p FD F) o (D A) rr1N (D m o z cr c) I o A) a'(D U) .) -o I D t\) \.| U) a oc z oo trD,5+ lha z o ;o{ o NJ \t z s t-.J{ o r, NJ -.1 a(D NJ{ .) o 9! o T](D ; { I TJ(D ; { a'l @ ; { -Tl .D ; -1 'rl r!g l..J -.t a oa -.1 D9 oq o(D o a C EO .D g) -o i =. NJ { FO -o l.J { ID l9 c -.1 e ct i ? o NJ { D)k tJO{ 7 p) o NJ -J o) o N) \,1 =N)o -J - (lro =o l..J -.t (o 5$O- -ra -Tl (D 19 \t TI(D ; { o l= o,i o =. -{ ID o NJ { o IJ -.t G IJ{ -a ro oa (a) o t9 \t z o s l'J -a (D o l.J { z s NJ l o .+ 19 { z 3 N) --t z :. N) { o l5 9= o D N) { _(n +='0e a (! ttz o k-, H o s) NJ O -J oo3r9:o 6' 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. [,evel State Promises were made for the release of counterpart funds. Surprisingly only few amount was released for the fueling of vehicle LGAs LGN Constraints The rnajor constraint faced by the project was inability of the state government to release funds to carry out advocacy visits to the LGAs. Lack of political will by policy makers especially at the level of Hon. Commissioner and Permanent Secretary. State and LGAs appear not to see Onchocerciasis as a "serious" health problem as cornpared to HIV and AlDs. Suggestions of Advocacy Improvements: t oii ,ery long time now, most of the advocacy visits carried out by the project has not yielded the expected result, we are soliciting for integrated advocacy by all partners - APOC, NOCp. Clobal 2000 and Lions in the state, especially with the incoming of new adrrrinistration in 2008. This we believe will do the magic in fund release to the project' To mobilize LGA officials for release of funds to LGA Oncho teams. A few LGAs actualized their promises and released little funds despite promises 2007 was better than 2006 in terms of fund release by the LCAs. 2 1J Purpose OutcomeI I I I No. of visits No. of policy makers itate Officials for the release of counterpart funds. 5 l6 32 72 8837 10 WHO/APOC. 24 .lanuarY 2008 2.3. illobilization, sensitization and hcatth cducation of at risk communities Mobilization A totalof 88 policy and decision makers were mobilized during the current yeat atboth State and LGA levels. The reasons for sensitization was to enable them fully understand the programme with a view of rendering adequate support. in terms of fund release and other logistic support. (a) The lmo project carried out an intensive mobilization for effective CDT-l implementation using the following strategy: (i) Macro level - where State and LGA officials were mobilized. (ii) Micro level - where community leaders and village members were mobilized. 'l-he mobilization was conducted using: I. The mass media: o Radio/television discussions: The programme makes use of radio programme *Nduka .4ku" to speak to our people on Onchocerciasis in local language. o J ingles o Press releases o News talks 2. Face to face discussions (Community forum in villages) 3. Correspondence with States, LGAs and communities ln addition. we identified some important traditional mobilization channels in all the villages suclr as: ( l) Use of village heads and chiefs including the opinion leaders.(2) Groups and associations such as age-grades. women organizations, schools, clubs, and women in health programme..(3) Town criers - who are the news disseminators or local radios of each village. have proved to be the most effective means of communication and mobilization. Town criers announced the arrival and commencement date of distribution to the villagers.(4) Church announcements - we have utilized most churches to send messages especially during the Onchocerciasis day celebrations. Church services were held to rnark the day and otTered opportunity for people to be made aware of the CDTI and Oncho control efforts in the State and the l6 LGAs.(5) The project produced posters written in local languages to sensitize the people. A total of 1647 villages in the project area were mobilized. Field experience reveals that dilflcult villages require more efforts at mobilizing them. Hence more time was devoted to the problernatic and hard to reach villages, to ensure their full participation in CDTI prograrnrnes and activities. ll WHO/APOC. 24 .lanualy 20011 E!,l -A ^^^^ 5 () A = .a.' rr/ ',a]'O' -q'po H 5 t9 la O .=iiJ', *. + xrq36>. s,g:= 3 = = g C) < =CD 1. O orl=A: ; 3 r€= Ifr=06' < e 5t,ia;g i strr8= is? Eilg;,a : Fr€gE ra8 3 =dsir E tEqsi =_*i :';Z€--6 e ,=9troF F=.ro x1i9E 2 q?EdqB 'r32= =rii* e 3?3FE IFt = Eaj-e s fqaii *ee= Z =EF: 3 Zd?i',A io= .t?' =i = 3#3s= ;F= ie;oq 3 ai:I+ =?2 =ld38 = Eg=?+ 1g-A i- 57i u:l L u, E - c -i tr = ri?=E= 2 rEfS qur n?at; z i=ai i8Eie-A 2 tg n :3? =3fF = Efi g E:€N--o)4CD=5:-Isfi S lf ? 3;s? =a:: = frE 3 3AA =gi'f 9 a 3aHA€qH o E =A;rEsr ; fi [;a aH'"a-- =i=P A S g:F<17.- '! ? AgUiH'<d = 6 3L-xs*a E e s:+ t x a:a j ^ X oF 6'a:. - i_- Q.atta = Fi U 6Ug[dH x i €Fg-6= H s-l+ e, a 8-B-3 fXE 60)oa F^-U =o aH 6E =:'oo2' 3= al: -= oE-X o - .io; s= Uai) -d - = -oro^= A Zo > 36 o-3P f n u,'ot Eq F.o == ;at_ ' = 6FoI eo q=.Fp a? = 5 Q-.) 550oo< rD(Dx Oqn aatDX(!(D= o- o- -- oo.D o-Psgv'0'Q i.o3 aFD* =ota-0) o-OcC =NC'A A) \ro o_ oa aA$Xi< r;60-O oFD ^lg{=' Al ^' CD= at0 io (!5 OE) D'5FraaDA o5 q5 co ro ?a =6Oq ^Dr a)* OFDo=(!o_ ()Y. D)-6u) ch O- o6' +O -(D =* f-(D=(roiso69 i: o U) t\) = = i IJ D) Di l.J co loI o o 1 3 E a t I o o 3 o3ri o @ 5 o o 3 6'q 5' o o -l t % \ 4 G o(\ 4 o d F)(, @ - iJ o d o F) rn N J CD trJ J J(D ? dp) o r(D pD o z oF1 7((Dp- Ft th po p0 z ct pD o z{ FD 0a(D o d Do o ro ID o a o o5 UA{(D o oI o Ft U) ,z ,ao :l -5 tD tD "l D oI(D >-tFt z oFt o ) o o\{ \oUJ (r){ tJ{\oo\ \o(/) N)\oo\{ UJ{ \oo. s@LA 5NJ (^ {{o\5{ N) Ur UJ LA l+) N)5(^ N){ \o tJ@ o\tJo\ lJ)N.) u)l+) (r.)N)UI -l t.J\o (, (J)L/l N)(, 'tJ z a D 0q @ +I .63-l EE : i.g 23V DJ 6=DG 2327!3i= E uEi==2 a 2,2 4 5 L^ @ t.J oe ! +ll t9 5 N) \ (JJ(, b N)I\o tJ(, U\ 5{ bo NJI tJ)lJ) L^, s(/) L^) NJ 9o (, b s I UJI UJ!{^ (J.) 5 lJ) UJ bo N)\o {\o \ou) \o\o -, 6 - \o L'I@L'I u) 6s \oo\ \o@ o\ oo \o l+.) { @l+) (JJ.E €\o Lal (JJ \o o\(, N)N) so\ N)s u) E UIUrra6'-J NJu.) NJ 5\o @€\o(, \o (, (+)\o 'z o dD -= N) u.) N)\o5 N) NJ u)\o tJ N.) UJ II + tJ N)(,\)N) (Jr5 N)(U^J @{ l.Jo\N) \oNJ NJ (,(, €tJ oo\o oo NJ(+) N) ! @{ !\o 6'= -- g= a a3-E J6 a ar\ o\\oO, s @s o\u.) @ o\{ 5 !tJ @(Jl{5 o,(JJ (JJ UJ ! -J 7. 6': E! al. ao oa o\Ul b\(r) {J F o\p @ s5 \o 9l UA bo LA io -lI UJ 5 o\(j) ir.. o\ 1.., NJ ooi (/t lf o- ';-e; *il =OmO6 o\ lrt(,(, s \)I tJ \) 90 Ur{ o\I\o o\ -lp NJ N) o\ \o o\ L^, a l.J A FT $ tJ 6 it;9srE€[3 i[AB3e3=.<38 7 -o ='=A'3 - o'-16' :{ = 5'*e.= 3?a9 -. a f: fd =, I'o u'Ftt;enEsYr' I +.v'Y>f = et sriiaaEig =siiqF_*xEdta='= oT; ! Z' iEEE =6s=EaFri: o= 6 E =[ " 3 ff P i =; ;'il-t= 4 -1 ;i@ i3:EY*a333j-EjF=Ti=.9 H aiAa: +rtii33=3Egg ='P V+);- - $ -.6r U A=3'r -=aafq=iE3: H f E Y ye * u = +5FAi-HxporD ='o-=.8 = 6-ry 3 = rgF 1q3+i rat;E=51i ^iA(,!'i(Ja=3,r' pq !1 . 1H 4 ;gfIgini+=- YpEt^o{3.*eYZasr0o-;=' +iBifsFiE si;gifgra - -.+ =O Ei,i5 P I =E - F)Cr _.) -; = FD 5 +D)O o O:i i: =.00 rD'=.De=_n.D:,*=eOa-i.s= ,9 g 6 - B 5 Rg =a " 6-g a 6 o e 3 3 =E aE x u=:€ $1.= efs=ixigr - -; "-J *, o- q O *^ JJH A! iIgE ri; .E 3a 8xd H 3 a <-J ^t!/.y't_;=5iirrf;66=-= a;EiEE iEF ;$s++*Hg1 o6^='i= +)+rc s t^. tJE = NJ € 2.5. GaPaciQl building - Dcscribe the adequacy of available knowledgeable rnanpower at all levels' 'fhcrc is an adequate manpower available in the project areas, however' the problem is frequent tranifers affecting the trained health personnel especially at the local governmentlevelfromtheCDTIareastononCDTIareas. I-lowever, manpower available at the health facility Ievel is weak due mainly to the caliber ol- ituffut the level. The solution to frequent transfers is to train all health workers on CDTI concept. Strategy of training CDDs at kindred level has been adopted in the state, but the main constraint here is funds to implement the strategy' - Where frequent transfers of trained staff occur, state what the project is doing, or intends to do. to remedy the situation . (The most importont issue to describe is whut nleasures v,ere taken to ensure adequate CDTI implementation where not enouSlh knowledgeable ntanpow"r rros available or if staff are frequently trun.sferred during the course of the cantpaign)' . Training has been targeted at new personnel and weak ones. . The project has decided to train all the available health staff in the CDTI concept' It will be carried out Local Government by Local Government to ensure adequate and proper information to trainees . The project also met with the authority of school of health technology to introduce GDTI concept in their programme since they produce most of this middle level manpower in the state. . Trained health staff in 2007 will facilitate the kindred selection and training of CDDs in 2008 especially if fund is made available to them' l5 WI-IO/APOC. 24 .lanuarY 2008 o- i D) D) .D o- (a' .D = 6- t.D G a U -l o (D o \ 4 a\ 6 r\, - ac =p0 U) .D l, a (D FO rrJN o F1 = (D F0 o- o A) z o t o o- 9. DD 6- Cp)) o z{ D' (rq @ tD ? P. o g (D O) o a o oct{ o -o z oqo o g FD { CDt =.z o = (J o 4 0q{ @ Fl -t l- \o -t o \o \o\o \o \o\o \o \o\o \o \o55 \o \o 6 o\(, z tD D)o .lo t!r) - I ) z = ,.+ao' (i .-i 5 5 s \o F-. + .o o\ \o rl NJ \o I o. \o { -l a o\ \o I -l I --t Ur 55 o. \o o, \o I 5 \o I \o "l trl -l : s o (D (D \o 5 N.)\o -taoN)\o tJtJo\ N ON)6 N.)o\ t'JN NJ\o 1..)l.J}J NJ \o 6 1 r) itg z tD +=D' -' tDi.j Dlai= lDa o.(D (D qt.J o. +.E 5 oo 5 { rl 5 = I @ I ._t f-- { € 6 \o 5 o\ \o Or 5 *l -l = ,-l \,! o\ \c t! 5i -Io\ s \ot) € .: \o t_ N) { o\ \o l-- N 5 m o\ o\ = 5 a5 UJ A UJ (JJ u)(JJ (, (J) tJ.) UJ (,)UI 5 5 '/. 6 o :r! -.1 -r -a)l0 ='l6 lo la19.l=l6l6l- ^l All ! = r) o 2 UJ A NJ I UJ UJ N) (, tJ l..J 5 l.J t-- UJ (, u) (}J NJ (, NJ (JJ NJ (, (j) u.) r-t tJ NJ A I N) (JJ \o9 t'J s 'a A { t- NJ (JJ (,) (, 5 @o, t9 -J5 NJ 5 o\s -toA A NJ{ oo NJ N) 6 \oNJ @o\ tJUJt.)\o5 -.I oo5 NJ z r! o q !D r! oo 1..)6 o\ o, NJ\.1 { @ 5 { N) N) -l E { NJ * o. -.1 \o s N) \o t z h ; \U 6 6 o\ \v F Ul b.) 5\o o\ ca - 5 N) 5 tJs --l o\ =l _l -i l.J{ t9 NJ +. NJ5 o\\o NJ{ \o s o\ 55 5A @ m l.J{ NJ ? = > \l\1 s a a d s _a o1\ o ni a\ >l = ? c a ci a o q o fi o\ o a o ci ! tr E tJ - 7. q -a:i!20 Di =.G *-D cp= -)c103) '2|rc=/ -7'a'-i,:__ =a9a-c.^ g o-6 'a at C- =4 -i 9- = )ad --c, c -c .toa=- zGd ae- - "= a)a ,2* GCo- =>zo =-a a'cc i )- E'^a l-. z=- o-3 a, :; 7: o Aa =oD'-t- - 6V,:CG.JC -4.-, o -!' D 4.',/i Tt = :.,., 'd?., --7" c =*-f*9 -4at -tl; F- '" rr- -' ) -(F=- io --= =- '3 -adc \t IJ +- =p l.J 6 'l'abtq6: Type of training undeffaken ffir[ tn, irr*u, *her, ,iecrfic training was carried out during the reporting period) -f rainees ]-ype of training CDDs Other CommunitY members e.g Community supervisors Health Workers (frontline health facilities) MOH staff or Other Political Leaders Others (specify) Progratn managelTlent { l-low to conduct llealth cducation d Management of SAEs CSM { SHM Data collection Data analysis Iteport writing I I Others (specifY) Any other comments 2.6. Treatments (a) 2.6.1. 'I'reatment figures - If the project is not achieving 100% geographical coverage and a minimum of 65% therapeutic coverage or the "ou"rug"1utJ is fluctuating, state the reasons and the plans being made to remedY this' During thc period under review, a total of 537,924 persons were treated from a total poprrlation of 747.tOt persons in th^e^]! local government areas within the project area' This givesageographicat .ou.rug.of l00Toandth-erapeuticcoverageofTZVo' Itwill berecalled that our treatment has not b,-een steady, especially in 2004.and 2005' when the project was starved of firnds. These two years *ere irard for the project but in 2006' we made slight progress in geographical and therapeutic coverages' 'l'he reasons tbr low coverage were due to: ln 2007, the following LGAs (ldeato North, Ezinihitte, orsu, Ehime and owerrt North) had unsatisfaJory coverage. rates because most of their old staff were transferred,andnewonesputinplace.Thoughthenewonesweretrainedand integrated into the C;ii implementation, the[ could not work assiduously and supervise adequately like the old ones to ensure good coverage' we are hopeful that they will be better in subsequent years, especially if funds were made available to l8 WFIO/APOC. 24 .lanuarl' 2008 thern for supervision and training. (b) Some CDDs after collecting Mectizan from the health facility delay treatment due to non appreciation of their (CDDs) services by their villagers for the previous year. (c) Sonre health workers delay cornmencement of CDTI activities while waiting fbr firnds release from the local government. (d) Some CDDs after treatment, refuse to submit their returns with the hope of prompring the communities for compensation or motivation. Plans to remedy the situation: ( l) 'l'he project has concluded plans to organize stakeholder meetings both at state. local govcrnment and community levels, especially with the incoming administration at the[,ocal Government level. t2) Selection of CDDs at kindred level is hoped to solve the problern of compensation. However, the training of the selected CDDs by health *oik.r, is envisaged to be aproblem because health.workers still require funds to carry out the trainin! activities, which is not readily available ro them. The project ensured that adequate fund was budgeted for CDTI irnplementation in 2008 and is working hard towards the fund release. (3) t9 WHO/APOC. 24 January. 2008 l-.1 lF)to-t-lo It! -J o = tD u U) ttl o o- a' =.C) t- L] i DO -o A)lr) FD =.a - -t\ 6$ r!\ s \i. (! a 44 t tD =.z o a F) F) (ncro{o z z\J 3 o tll 3o 7 A) o rrjN (a CD e 3 A) (h A) D) 7 p o-(D DD z - o-(D !o o ao 7 q t0 o = o o. c o 7 A) U)o _U\a' o\A\t \o o\ oo(a u){5NJ o\\)Ur \t{ o\A{ \oo\oo(.,l (,\]ANJ o\-JUr {{ o\A -I \o o\ oo(rt U){AtJ o\{L,r {\) \oo\ \oo\ O 6\ a \oo\ .o6\ \oo\\o \o6\ o o 3 o U) !) oao U) s 6tJo\ NJ{UJ ()){N)\o \oUJo\{ A ootJ \o o. NJ{\o(J) -J N)\o \o (j)o\\) 5 ooN)o\ NJ{\ou) UJ{N)\o \ou)o\{ -oo\ oso\ \o\ao\ \oo\\oo\ \oo\\o :o2<. === -J "HHE i E-Nf-'=o,l==+g J -^+39 -i.:G\3 a .3-G > c== :j= ,ON o rj==(! =i j6E 5 X *h = ^ov tr -u,vjil O o ^@ ^:oa -o.d =o.-: 0p= a; N)S N) NJ N.) o\A \o6@ {5 -I o\6 (j) o\{(, u) A oo u o\ A (, 6 NJ (,(Jt A\o @ \o oo UJ o\ 6 \j (JJ L'Ii,A(, A NJ oo (}J "NJ Ao o\ (,l \o tJ UJ (, oo { @(, o\ Ur ! UJ N)(/) "N) s NJ (, o\s N)F{\o N) UI(, -I\oNA ! (}J oo NJ(, u.) (lt \o oo NJ(, o\ NJU) o\ { !'-) { ir) o\ :J {I UJ oo\, LA -J:- ! 90 -J o\(rr (J, !(,\ o I \) (Jr 5\o (, u) (JJ \) o\ L,I NJ\o A\o oo o\ o\\o N) s oo A NJ f.J oo(, u)\) oo 5 A \o o\N) NJ(, s(, u) NJ\o5 (Jr{{ o\ A) o A { NJ LA (^) 9o LA(,.t NJ s _6 oo(JJ (j) Lar{ A{s (JJs o\ o\ \o ! UJ -t.{ o\\o A NJ "s oo oo N)\o (a o\ (JJ {(+)s -J O. 6(,o\le{ o\iJt { :J o\ UJ io { u) -. {I (J) oo oD 5 @ Ot JI dQ *,. -ri,: g i+riE! " = * xf o * ll = -lo=oo -od so\rEvD Orrc= o a1 i .6a,> =orci :o= DuiC= O Y 'C A\o NJNJ l.J ootJ(l) u.)(J) tJ \o s (-al N) N)(}) .N \) o\ (JJ N)5! (JJ \.t tJ UJNJ NJ NJ 5 (rr -Ea.i9Z o =,a, =D;OIi3.;fi +i l -63+ bJ N) UJ \o o\s NJ \o o\ NJs "oo \ostJN) o\5\o oo{5 NJ t9t, sZ5C 65 aq a z 3d o )o l:1 - B ?,: -D a) l! + D IJ - E=t1c-'-t IT o' - t- .D - o lo[a - <f a > lz 1lz 4t7 =ls 9ls ql. =13 A)lj D)lq= lF -l- -l::lE =lE EIE-'lo lo 'o lodl+Jl+-115tE ils nh'dlE "l= 013 tJt-Ala i t= -. I- .Eld qli =ia(Dli: VlrD ,=13o M -il@ ue I(,D?l? ;la =13"l= 9lr 3l-Its Effi gt8qia a5lA) -olP q 3lx g ilo h' -) Jt1A: .) rDO "')noiq3 L 9='J-. rD =qroto_ i. =J 4 r,.l aD -VA -- ='ro a)+ aoB EA -P €.(DI -(D e\1o!!o\OAt-ilfl'-i \\AssL.)GG :a-.)is.=rr. :i =' =i i X!s I o-s: i =-* Fr.S \t.s a\ r- ^t' .qG iI-'€ EiF G II3s =i-l\ oe\rFN : JI= *s e sllE= "S =IE!= E l^:D S *t+ :-R s E18sx i e,{8si i -o 15-lc a- o l-Ii : €.lEiI I IE!: s -lxsS l' 5l=Gr' r\ gl=GEJIDIVis i Bq.l \ o- sF S =tg-\ { 3li.i (D sS. = o dF * Cl: = > \.i - Ess : ESl R ,i' s= I o-E'r S. g9.s s =. !\6 ctdNPIa :di,E s'{ G=ii s,E. lsErSi-o '! l- €-o ae SN4 :-tS^ iv Oe G ta B + i i Oe -JrD= ^iOovoc:Iail€ :gP l^ 0aLor:U st s3 Rfiv v B <-fioao(D1 -A)HrD .D lE l=. la) DO o I.) +- a 1 : ,: 2.6.2 What are the causes of absenteeism? fhe major causes of absenteeisnr have been the rural urban rnigration of the productive sector in search of jobs. Also, some youths attend boarding schools. outside their communities and hence maynot be there during the treatment period. The high rate of unemployment has forced a greater percentage of the population t9 leave the home in search of employment. 2.6.3 What are the reasons for refusals? sonrc people think they are cured and hence had no need of the drug. orher.s refu.re bu.sad,rt their religious berief.' such peopre require irore heoih educution. 2'6'1 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. The state has monitored Mectizan treatment for a long tirne and has not recorded any severe adverse event (SAE) ln case the project did not have any cases of serious adverse events (sAE) during thisreporting period, please tick in the box. No SAE case to reporr 22 WHO/AlrOC. 24 Novcmber. 2(X)4 li lDcto-t- trDl- o (.D a rD =.o = o- rD - .0 r0 o a m o .) = - - .Do o- C - (ro rD - .D -o o - (ra 'o .D - oot - -: a = cc !4 .,t "-^'(!- (\\ ,o NJt! I o t N)A z a G 3 o l9 -f z I ?<;2o -;;oN -.- rN..o5:l !=N a= a = -o o = 8 +E 3 6' iri0o o o = E = -E =l p -\l 6 @ o-_ J-@vO -'= D 1Y -.o -) a O = (1, dr-N C'O Oodo E 99o6 q= 9.o !I E3e @=N DJ !J ='; ='oag'fr 9. =' o'a> - 7o?nio "=do- U) o '/ oao a '2. o oL- =. E; oa 0oZ' t" a l l l I l-l N)lA)L la- !hl.o i --t =+ -tD s- oaD cl= o4 .Dtt oalD !(, 3kllr, .D l6 tsl-3 (D \)qY o' c3 tDa .D= (D5 !9 .D '.) =!- S/d G :$6 =00 s G (\ -a (\\ s tD!r a,(! a A' (D r! -l o' (D (D a o lo\(, UI \p a a! lo oe .D D]a (D tD D) o -l a (D D) 0q(D a .) D9 ta s t\ (! I oo!s sniGb '\J SS\ t s a s G G > r! G e t a G \ o o\ s\ o s G o st S G l.Js I ) IJE =E N 6 N) NJ O\o NJ o6 i.J -.1 NJo o\ NJ t\)ooA NJ N 19 19 NJ o \o\o\o \o 6 \o\o{ rrl s{ c\s{ a5..,1 o\5{ o\s{ o\F{ ;s -J o\A -J 5\.1 ooo= $g e E iP: >5 = !1 --<=o*HE;3So. b= oo o = E -='. a 5 =rroo o\5{ o\A--I o\A{ o\5 -.t o\5 -J o.5 -J o\5\) o\A{ o\5\t a\ -l;e > o=io== =e!Lo3 f! as{ ocNJ \c ENJ\o os\| c\-s\t 6A{ 6.A{ 6oo boZ oH: o U=a lr o \o 3 s^6t\) -JI ol OO O oo F:aO r,rFG5 no? _trr.96=E:m! \o9 A. t.J -JI o. o e ^< J>\oo J d6vo It, r', tr, rll {s: a6 {{ NJ { TJ)J\o5 o. -Jt)j s o, \IN ie6 \t 9 \oA \)\oi\t @ 65s\o5A oo5 .: 55 6- 6'9 !Io-=-lI'; i: B-i 3N* l:r o- Fo t o\ \o o\t9 .9s NJ o\ .6 \t(, o\ -6\: o\ 9s\oO o\s }J\o 5 c\ -lli o\ { NJ \) NJ { N) i NJ ^J .o-G P =6= x{c?Eer-a,_ l! { 'ao NJ5 5\o '5 N) N) oo oo N) \o i.JtJOl oo\ -.1 "co \I N NI\o{A s o\ -ts{ A o\ "s \olu 6a> 9E 6'6 G'o t", { NJ o\ oo l..J :j I5 o\ : {(/r ca o\9 I io=co -ori Do\aEvo o0qcc= t!r- F' F' ooI{ o\6 o,P@ 6 {oa 6i o. o G5 a d6vo t! ooI{ o\oo o,Poo 6 \o!r,){ 6i.r {I\t \t:J'5 ao- Srt =:-= -( 0a .D 6 2.7. Ordering, storage and deliveqy of lvermectin Mectizan@ ordered/applied for by _ Qtlease tick the appropriate answer) MOII WIIOtr UNICEF tr NGDOOther (please specify) Mcctizan MoII St* tclDistrict/LGA Aboh Mbaise I:hirtrc Mbano l-.zrnihitrc [siala Mbano ikcJLrru Idcato North lcle'lto SoLrth Irl b.r itoli Il',r:tngclc )tgor Okpala {.) r's .r Obi,w,o Ol..ig',ve Orr rr irr-r ct [ )vvcrri North by - Qtlease tick the wHon appropriate answer) UNICEF D NGDO er (please specify) Please describe how Mectizan@ is ordered and how it gets to the communities 'lhc order of Mectizan commences with th.e census update and determination of ATos byrocar governmenr areas u:g tl. stut. fro;..t. The totar requisition isconsequently routed to the Mectizan aonaiion programme (MSD) through theGlobal 200o.(supporting NGDO). The bulk Jrrg, ur. procured by Global 2000to their zonal office from where ttr. pro;..iir'irrr"u with their requisition afterproper documentation' consequently, various local government areas come tothe State to collect their shares, at thl Iocal gorernment level, each district andhealth facility tevels collect theirs, while tfre communities collect from theirnearest health facilities' based on their targei poputation to be treated. [)uri,g the Mectizan transaction, health care personnel ensures that accurate Mectizan tabletsare released and delivered to each level based on requisition. They also ensurethat Mectizan tabrets are kept in safe rrorug.iJ.iri,i.r. 'l'ablc l0: Mectizan@ rnventory (prease add more rows i/.necessary) Number of Mectizan tablets Requested Received Used Lost Waste Expired Remaining I 84.000 r 84.000 I 80.000 U l5 0 3985 t00.000 r 00.000 100.000 0 0 0 0 140.000 I 40.000 139.997 0 J 0 0lhilrc Uboma 85.000 8s.000 80.000 0 0 0 s000 135.000 r 35.000 t32.787 0 103 0 2|0 125,000 I 25.000 t22,48s 0 l5 0 2500 85.000 85.000 80.000 0 4 0 4996 90.000 90.000 87.962 0 38 0 2000 t 60.000 r 60.000 t59.971 0 29 0 0 100.000 I00.000 97.t95 0 5 0 2800 I40.000 r40.000 139.977 0 0 0 zs 80.000 80,000 79.997 0 3 0 0 100.000 r 00.000 98.779 0 0 0 t22t 125.000 I 25.000 124.455 0 0 0 545 60,000 60,000 59.83 I 0 0 0 t69 8s.000 85.000 80.000 0 0 0 5000 1,794,000 1,794,000 1,763,436 0 215 0 30349 '[o'I'AL 25 WHO/APOC. 24 November 2004 i i - How are the remaining Ivermectin tablets collected and where are they kept? ' The received tablets are kept in the state drug store before they are reissued to the LGAs,who use thenr as opening balance for the next treatment cycle. - List and briefly describe the activities under Ivermectin delivery that are being carriedour by health care personnel in the project area. Health personnel ensure that accurate Mectizan tablets are given to the local government and also ensure that Mectizan returns are collected. - Any other cornments 2-E- Gommunity serf-monitoring and gtakehorders Meeting llas any training (of trainers) for community self-monitoring been done in the proje ct area? If so' when? -The training was conducted between August - october 2007, weare expectingthe resulr in 200g. 'f-able I l: comrnunity self-monitoring and stakeholders Meeting (Add rows if needed) ,\boh Mbaise tlhime Mbano I.,zinihitte Ihitte [.Jbonra lsiala Mbano I lied uru lc'leato North lcleato South Mbaitoli Nwirng_ele _ 'lgqr ()9ill . )rsu -)bowo treyg.--_ _ )nuimo ,.)werri North l'otal 93 l)cscribc how the results of the community self- monitoring and stakeholders meetings haveaffected project implementation or how they'would be utilized Jr;i;; the nexrtreatment cycle. Sadly' there were no reports on community self.Monitoring (csM) and stakeholders meeting(sHM) conducted during the period under ieporting, we u."'.*p""ting reports from 200g. District/ LCA Total # of communities/villages in the entire area No of Communities thii carried out self monitori No of Communities that conducted stakeholders H 82 127 137 93 167 129 96 t04 96 t37 67 77 I 15 42 85 1647 26 WHO/APOC. 24 January 2008 The LGAs anributed the lack of funds as being the reason for the non organization of theseactivities, we are hoping that once fund is rnadl available by both the state and localgovernment areas, the stakeholder meetings will start. 27 WHO/APOC. 24 lanuary 2008 2.9. 2.9.1 $upervision Provide a flow chart of supervision hierarchy. SUPERVISION FLOWCHART PROJECT ADMINISTRATOR STATE CO-ORDINATORS/ STATE PROJECT OFFICERS STATE ONCHOCERCIASIS CONTROL TEAM MEMBERS (SOCTs) LOCAL GOVERNMENT ONCHOCERCIASIS CONTROLTEAM MEMBERS (LOCTs) DISTRICT HEALTH SUPERVISORS (DHS) HEALTH FACILITY STAFF (HFS) COMMUNITY DIRECTED DISTRIBUTORS (CDDs) 28 WHO/APOC, 24 lanuary 2008 F,. 2.9-2. what were the main issues identified during supervision? The following issues were identified during supervision and are being addressed as follows: ( l) Most of the cDDs and even health workers are not conversant with the newtreatment reporting form and require adequate training on them. (2) Frequent inter/intra LGA transfers: The quality of supervision of some LGAhealth workers were low especially those iransferred from non cDTI areas toCDTI areas, hence more training and retraining is U"ing orguriz-ea for them. (3) Inadequate number of cDDs: During supervision, we discovered that there isneed to increase the number of CDDi asCDDs.cover long disiaices resuttingin low treatlnent coverage.. Effort is being made to select cDDs at kindred ,".HLt against the village level, as"wetl as training oi irror. already (4) Low motivation of cDDs: The selection of cDDs at kindred level will addressthe issue of cDD motivation, as supervision revealed, that mostcommunities do not motivate their distributors. Efforts are being made toensure that cDDs are included in other health programmes that have financialreward. especiaily the Nationar programm" on i*,i'rnirutio" iNpil. 2.9.3. Was a supervision checklist used? Supervisory checklist has been developed by the project and used in the course ofsupervision. 2-9.4. what were the outcomes at each rever of CDTI imprementation supervision? At thc state level, the project was able to discover why it has not been easy for healthconrmissi.ner to release funds to the project. It was because the state *u, nlt using theLreasttring system in fund release. At ihe-local governmeii ter.l. tn" same syri", urr..t.atheir fund release' At the community level, theie ir ";;; number of leadership problemsaffecting the villages, especially with the creation of nJ* autonomous communities. Theseatfected the cDTl implementation in the project. The issue of supervision was used toidentify areas of weakness that needed to be converted to strength. was feed-back given to the supervised, and how was the feedback used in improving theovcrall perf<rrmance of the project z\t State Level: The supervision at the State.level.by the project Administrator empowered theState Coordinator and SoCTs to do targeted supervision. Thotlgh'supervision was inadequate because of limited funds for transportation, we ire grateful toGlobar 2000 and Apoc, for providing the funds to the project. I'QA -L€yqli ldentification of difficult communities and CDDs with poor records. onceagain this was inadequate because the LoCTs could not move to problem areas. 29 WHO/APOC, 24 lanuary 2009 c_qrn4q4_rq1lqygL In the few villages supervised. the cDDs returned their summaries in time and treatment coverage was impressive. In villages where there are noCDDs, they were sensitized and mobilized into selecting a CDD that distributed for them. 2-9.5- was feedback given to the person or groups supervised? Supervisory reports were given to the groups supervised. 2'9'6' Ilow was the feedback used to improve the overall performance of theproject? (a) -l'he fbedback made a great impact on the overall project performance. When theproject performance in terms of geographical and therapeutic coverages of 2006 and2007 are compared, there is an improvement in 2007 performance.(b) A good number of villages with low treatment coverages went back to carry out a moop up activity to increase their coverage.(c) Villages without CDDs during supervision, decided to select new or encourage the old ones to collect their Mectizan drugs.(d) Health facility staff who were properlytrained were re trained and empowered totunction without much supervision.(e) villages without adequate Mectizan suppry were suppried enough. SEGTION 3: Support to GDTI 3.{. Equipmcnt -l-a-ble.l2: Status of equipment (prease add more rows i/'necessary) Sr - I'CC 1'','pc oI ec urplTrent I. 'r/ehicle 2. \{r)tor c Ie 3. ' onrputers -1. l'jrirrtcrs i. I a>. Machines ,i. t )thcrs ii) ri ic vc le lrl , lr_\ (r ) '[rc,tocopiers *Condition of the equipment WO:Written otf). (F:Functional, CNFR:Currently non-functional but repairable, IIow docs the project intend to maintain and replace existing equipment and other matcrials? ( iC I rrt |il tot APOC MOH DISTRICT/LGA NGDO Others No Conditron No. Condttr No Condrtron No Condrtron No Condrtron 2 F -CNFR 32 I6F,I6CNFR 2 l-F I-CNFR 2 l-F I-CNFR 85 CNFR I CNFR 2 l-F t-wo 2 l-F l-wo 30 WHO/APOC. 24 January 2008 I l I l i I I 'l-he"State will maintain. the-existing equipmentr. iirougr, release of fund from theonchocerciasis control budget. Though,'not much has been reieaded from the budgeted funds.our efforts will be to ensure that suci funds are r"r"ur.o'irtture. The State is iware of itsresponsibilities towards these capital equipments. 3I WHO/APOC. 24 .tanuary 2008 j 'ii1 Fl "l E 'Uoo J - (h L) C o- oo =3 =5' U) 6 p0 tDrlt) z o lg - o 0 =CJiz a, z o -7\Ji a'(J 6' - l'u z lo A 9.4Y-o A=3 A)s) tavt o o N{ a5 { A \o{ O O €6 'p o\ 6{ a E-odoa F9 -ls3it}- NJ - la ^.<bn-Fi';CE.=F l^lcag1 t-la\ lol\ \J \< (a-$r s !' o\tj o\p{ Ai{ p 6\o \o 6 p o ,N) 6@ 5 6 o\ p N o\ N (,r 6 p \o { "|.) sN @{ :.{ N o\ @ wJ CE.(1O cr0a P -l(,9+> l^It)lcl: tv Sr'\J6, D c/1 r\ $ S o\ UI i.JA a. 6 o 5{p A .F'NpN o i! o. Wr caoocroe P -+(,g+> -o -o-\ p p Itt o { _{ O :J o\{ € WJ caooCrOq P -l €ag+i o- t^tq \J R< ls Sa, S '{{t5\o ie F t.J{o N {o\P N p ^? -J -(e ^/1gfi +i d- I- N\o UI UtJ -l t)p a\ @ p € @ 56. N { o, N -{o\\o N o\ l@Jl€E-oci(,0a P -l .e?g+> ^( NJ2o ^/.alt P -.1fj_n3> o-r \S R< UTR- \J o\ 5 p N o A N A,' H6 a. o o 6{ u p 6 A N -O. \o6 A UJjE.odEBI@- o- \j R< roiE Io \JS\ p Utp N3 t'.J € 6 6{ N o .o \o o, 6 ^P -l -!Y-r-^gfi Biii r- l-J(,IDD ilo- N16- 'l- It r ] =Brr .) ) =D!f5o;-a+.o d =o5'O =, rlo!v:r =E ,lTl -.Foo =l:6oAo :tt;lr e-o r!'aD ;lit3oxeqD a- B o o 3 3 Ef t 6' o N) IJ +- z a Gf T o N s - lf there are problems with release of counterpart funds, how were they addressed? In Itno State. the issue of counterpart fund release by the State and local government has been a problem. 'l'he project ensures that funds are budgeted at both state andlocal government lcvcls brrt to release has been the problern. Duringthe period under review. the-Director Southcast Programmes of Global 2000 visited the State and had discussions on the issue of cottnterpart ftrnd release. The project remain grateful to Global 2000 and ApOC for making itpossible for us to carry out CDTI activities while hoping that the state will release funds to theproject in future, especially with new policy makers in place of the out gone on"r. 3.3. Other forms of community support - l)escribe (indicate forms of in-kind contributions of communities if any) Olher jams_s f s q mluu[ity_Supp ! rr Sonre of our communities are cornfortable in motivating their CDDs in kind. Such rnethodlnclude: i) Exerlrption fiom some community levies and dues.ii) Arranging labour to assist CDD in his /her farms.iii) Special recognition in cornmunity gatherings.iv) conrmunities also replaced old horisehold [gisters as well as providing measuring sticks to new CDDs. 'v') Some cotnmunities involved themselves in actual monitoring of CDTI activities.fhcse are motivations that are not easy to quantify. 3.4. Expenditure per actiyity lndicate in table 14, the amount expended dur ing the reporting period for each activi tylisted. Write the amount expended in US dollars using the current UnitedNations exchange rate to local cu rrency. Indicate exchange rate used here $l :126_ 33 WHO/APOC. 24 Novcmber. 2004 l'abJe l4: Indicate H[ffi:Jhe project spent for each activity risted berow during the - An,u comments or explanations? il?r"r:J*ir::.rli8f urt u r.. the money came late, we could only utitize $8. APoc fund were rnainly for training of hearth workers, production of IEC materialsadvocacy visits. whire.funds from c]Juizooo una stai"'*1ll-fo. rup"ruision andnraintenance of capital equipments_ ---' I 03.2. the and SECTtOil 4: Sustainabitity of GDTI 4'1. rnternar;independentparticipatorymonfiodng;Evarua*on {'I'l was Monitoring/evaluation carried out during the reporting period? (tickany of the foilowing which are applicabt;i-.- -Year I Participatory Independent monitoring Mid Term Sustainabi lity Evaluation 5 year Sustainability Evaluation Internal Monitoring by NOTF No nronitoring was carried out during the reporting period. Expenditure Source(s) of fundin 8,732.03 8, 103.2 3,015.9 396.8 2,091 .g Global 2000 MOH Community/ LGAs Global 2000 APOC $22,329.73 Mobilization and health education of cornmunities 'l'raining of CDDs 1'raining of health sraff at all levels Supervising CDDs and distribution Internal monitoring of CDTI activities Advocacy visits to hearth and poriticar authorities IEC rnaterials Summary (reporting) forms for treatment Vchicles/ Motorcycles/ bicycles maintenance treated Drug delivery cornnrunity from NOTF HQ area to central collec tion point of fllo ce u entEq e.pl't] c( 0b. n tersomputers, etcpil orsOth lectiCol ofon ent 'l'otal number of I'O'TAT, 537,924 34 WHO/APOC. 24 January 2008 ) 4.1.2 What were the recommendations? Nit 4.1.3 How have they been implemented? Nit 4.2. Yr 3) sustainablllty of profcctr: plan and rct targctr (mandatory at Was the project evaluated during the reporting period? NO Was a sustainability plan written? - August When was the sustainability plan submitted? August What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.2.1. Planning at all relevant levels 'f he process of planning is very relevant to the success of CDTI sustainabitity. Joint planning of activities will continue between the project office, the State Ministries of Health and the LGAs. Planning at the community level will equally continue between CDDs and their community members. 1.2.2 Funds Efforts to ensure that various tiers of Government release budgeted funds will continue. Increased and sustained advocacy meetings at varlous levels will continue. Also involvement of key officers - Finance officers, planning Officers and Mobilization Officers will be ensured. 1.2.3 4.2.4. Transport (replacement and maintenance) Both state and local government areas are aware that it is their responsibility to fuel and maintain all the vehicles, motorcycles and other capital equipmenti. Other resources covernment has been adequately informed that it is their responsibility to rnaintain these equipments, as well as plan for a replacement in case of aging. 4.2.5. I'o what extent has the plan been implemented The project has not fully irnplemented the plan because funds were not made available. with the new executives, we are hopeful they will release funds to irnplement the plan. Global 2000.has started gradual provision of funds for the project to implement the plan 35 WHO/APOC. 24 January 2008 3 other aspects of the sustainabirity pran being impremented incrude:(a) Both State and local Govirnment ensure ihat onchocerciasis control isbudgeted for in their overall work plan.(b) communities now serect the cDDs at kindred revers.(c) communities initiate community serf monitoring bf selecting their monitors(d) communities coming to the nearest health facilities ro collecr their drugsfor distribution.(e) f"4!t facility personnel are empowered to take up their responsibiritiesin CDTI implementation. 4.3. 4.3.1 lntegretlon outline the extent of integration of GDTI into the pHC structure and the pransfor complete integration: Ivermectin delivery mechanisms Ivermectin delivery has been fully integrated into the pHC structure with statescollecting their drugs from the ,on.s u-na rto.ing them in the state drug stores.Likewise' LGAs collect the Mectizun rrorn the States and distribute themthrough the PHC structures to the health facilities. In the state, we havecommenced distribution of vitamin 'A' using CDTI structure in three LGAs. 4.3.2. Training ,!ii[ll: Training on GDTI is carried out by workers who are an integrat parr of the pHC 4'3'3' Joint supervision and monitoring with other programs 'l'here has been an improved joint supervision with GDTI catalyzingthe integration. This isexhibited in occasions where other health programmes such as nutrition. mental health etc.piggy back on the cDTI vehicle. This integration is at the state level. we u." *o.kingtowards developing a common checkrist fo-r various h;;il;;;grammes in the state. 4.3.4. Release of funds for project activities Irttnds for the control of onchocerciasis are part of the entire pHC budgets. But in mostcases' budgeted funds by government are not released. This is not only in onchocerciasis butin other programmes. 4.3.5. Is CDTI inctuded in the pHC budget? CI)'fl is fLlly inregrated in the pHC budget. 36 WHO/APOC. 24 January 200g 4'3'6' Describe other health programmes that are using the CDTI structure and how this rvas achieved. what have been the achievements? other health programmes using existing CDTI structures include leprosy control where somel'oCl's are utilized in carrying out leprosy control activities. Some CDDs.are used to coverI)o'fs treatlnents, community mental health etc. Some Onchocerciasis control LGACoordinators are also leprosy control coordinators. malaria focal persons in different localgovernment areas. The addition of Vitamin'A'to onchocerciasis in three local government areas of the state, added a new impetus to the programme. 1.3-7 - Describe others issues considered in the integration of GDTI. An issue towards which efforts are being made to improve are joint planning sessions with other programme Ieaders/coordinators for better coordinated action. 4.4. Operational rGaearch 4'4'l' Summarize in not more than one half of a page the operational research undertaken in the project area within the ieporting period. None was conducted 4.4.2. [Iow were the results applied in the project? N/A sEGTloN 5: $trengths, weaknesses, challenges, and opportunities l,ist the strengths and weaknesses of CDTI implementation process. S'I'ITENGl'I{S: (l) Good working relationships between Ministry of Health, Global 2000, LocalGovernment Areas and communities. Cornrn itted health staff. Cotnrnunity awareness of the magnitude of Onchocerciasis problem in their areas. WEAKNESSES (2) (:l) (l) (2) (3) (4) Poor funding of the programme by government at all levels. Communities not motivating their CDDs. cDDs preferring cash motivation to other kinds of motivation. creation of more autonomous communities left some villages without cDDs. 37 WHO/APOC. 24 lanuary' 2008 il d'jl r, , ". iri , ',ii,i.,t), "i (l) (2) (3) ['ist the challenges and indicate how they were addressed. To improve community invorvement through. community serf rnonitoring byconrmunities - more communities were mobirized to orginine community serfmonitoring. Training of trainers were carried out for,rr""fr.por.. Though latein August - October 2007, we expect result in 200g. '| r ' To increase the number of cDDs in the project area - The strategy of serectingCDDs at kindred rever has been embaiked upon by the proj..r, hoping rhatwhen completed, this wirr reduce the quest for motivation uvLoor.To increase funding for the programme -.consultation is on to see if it will bepossible to deduct at source fund from tocal gor..nrn.n, areas fbronchocerciasis contror before rereasing the rnoney to" tt e icas, especiailywith incom ing administration. sEGTtoN 6: unique features of the proiecuother matters Irno project is located in an area where its citizenry are highly mobile. The people arecotnmercial oriented. This mobility affects consistency of treatment. Again, the project haslasted up to l0 years, some people are now drug fatigue. The addition of Vitamin .A. toonclrocerciasis contror has added new impetus to ihe pr-ogram. 38 WHO/APOC. 24 .tanuary 2008 f_" \\ , ',.',').r