NGNIG5 annual project technical report submitted to Technical Consultative Committee (TCC): March 2005 to February 2006

II iI sIxTH YEAR AFINUAL TECHIYICAL REPORT FOR I COMMI,MTY DIRECTED TREATMENTWTII VERMECTIN PROJECT IN NIGER STATE. I i I I AI{NUAL PROJECT TECHNICAL REPORT SUBMIITED TO TECHNICAL CONSULTATIVE COMMITTEE DEN)LINE FOR SU-BMISSION: To APOC Management by 31 Januan for March TCC meeting i To APOC Management by 31 Julv for Seotember TCC meeting AFRICAN PROGRAMME FOR oNCHOCERCTASTS CONTROL (APOC) &ntl es) bP AHBBA tu I I I ! I I ,t fiiE6u I 6 A0llr 2006 Aroc/Dlt ORIGINAL : English Proiect Name: NGNIG5COUNTRY/I\IOTF : Nigeria Launchins vear: 2000Aooroval vear: 1999 From: March, 2005 To: February 2006 (MONTE/YEAR) (MONTE/YEAR) Proiectvearofthis renorfi (circleone) I 2 3 4 5 (6) 7 I 9 l0 Date submitted: JuIy, 2006 NGDO oartner: LJNICEF IANFIUAL PROJECT TECHMCAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENIDORSEMENT Please conlirm you have read this report by signing in the appropriate space. OFFICERS to sigu the neport: Counfiry: NIGERLA National Coordinator Name: Mrs }.Ogbu Pearce signatnre,W*- Date: 2810712006 Zonal Oncho CoordinatorName: Dr NGDO Representative Name: Dr Catherine Gana Signatue: @,.^p Date: 2810712006 This report has been prepared by Name : Hajiya Rakiya .Y. Datti Designation : State Coordinator Sinatur$ry.-*y Date 1710712006 t 2 Table of contents FOLLOW UP ON TCC RECOMMENDAIIONS.....r....o.................... .........,..7 EXECUTM SIIMMARY..r...............r..................e ...................................t SECIION l: BACKGROIIND INFORMATION.............r.........,.....................9 l'l' GENERAL IIIFORMAIION.......o..o....'.......'........o.............................9 L 1. 1 Description of the project (briefly).. .. ... . ..g_tz 1.1.2 Partnership ti,.:ll 1.2. PopurarroN.. ....14-16 sEcTroN 2: TMPIJMENTATTON oF crlrr..'...'.......,r...........,......r............17 2.1. TnffirNsoFAcTTWrrES............... l7_lg 2.2. AovocAcy.. ...19Srarsr,EvEl" B_Zo. 2 . 3 . MoBILIzATIoN, sENsITIzATIoN AI{D HEALTH EDUcATToN oF AT RrsK coMMUMTIES . . . . 20 2.4. CortnnxrryINVoL\IEMENT ...............21-23 2.5. CepecrryBrlrlDrNc ..............n-n 2.6 TREarmnns...... .........27 2.6.1 Tremment figures.. ... ......21-30 2.6.2 Whatarethecaus€sofabsenteeism?.......... 3l 2.6.3 What are the reasons for refusals? ..."......."... ....,...31 2.6-4 Briefly describe all knoqm and verified serious adverse wents (SAEs) that ocarrred dtring the reporting p€riod and provide (in table 8) the required information when available... ......31-32 2.6.5. Trend oftreament achievement fiom CDTI project inception to the curent year.....33 2.7. ORDERI.Iq sToRAGEA]tDDELrvERyoFIvERMEcrrN............ .....34=J_6 2.8. Cornllwrry sELF-MoMToRINGAND STAIGHoI^DERSN{EEmNG 36.38 2.9. Suprnusorrl ..39 2.9.1. Provideaflowchartofzupervisionhierarchy.. ..,..................39 2.9.2. What were the main iszues identified during zupervision? ............... ........39 2.9'4. What were the outconrcs at each level of CDTI irnplementation zupervision? ..........40 2.9.5. Was feedback Sven to the person or groups supervised? ............... .........40 2-9.6. How was the feedback used to improve the overall performance ofthe project?........41 SECTION 3: SUPPTORT TO CIITI.o...e .o,o.....r,.o.......,...................o.r...........,.....41 3.1. 3.3. 3.4 EaurPr\rm\n ,41-43 Orrmn ronus oF coMMUNITY SUPPoRT 44 .44 . ._*. E:em.tomrng pER AclTvrry SECIION 4: SUSTAINABILITY OF CDTI....r.................................................{5 4.I. INIERNAT; INDEPENDENT PARTICIIATORv r\TONITORING; EVALUATION .. ... ... ....45 4.1.1 Was Monitoring/evaluation carried out d#ngthe reportLrg p€riod? (tick any of the following which are applicable)............ ..............45 4.1.2. What were the recommendations?...... ..................45 4.2. SusrarueBILITYoFpRoJEcrs: rLAI-IAt{D SETTARcETS (lvneuoeronv ATYR 3)......45-46 4.2.1. Planning at all relevant levels........ ......46 4.2.2. Funds. ...........46 4.2.3 Transport (replacement and maintenance)...... ........46 4.2.4. Other resourees.. .................47 4.2.5. To what eirtent has the plan been implemented ............. .........47 4.3. hrrs'cneuoN .......47 4.3.l.Ivermectin delivery mechanisms...... ...47-48. 4.3.2.Training.... 48 4.3.3. Joint srpenrision and monitoring with other programs .........48 4.3,4. Release of funds forproject activities".. .................48 4.3.5. Is CDTI includd in the PHC budget? Yes. .......". .................48 4.3.6. Describe other health progammes that are using the CDTI structure and how this was achieved. What have been the achievemerts?...... ................48 4.3.7 . Describe other issues considered in the integration of CDTL ... .48-49 4.4. OpnneuouarREsEARCH. .....4g 4.4.1 Summarize in not more than one half of a page the opermional research undertaken in the project area within the reporting period. ..............49 None yet, but there is the intention to undertake one basd on knowldge, attitude and practice of Muslim uromen in endemic communities i.e. as regards acceptance of social services vis' a vis' the way they fulfill their roles and responsibilitiee in accordance with Islamic injunctions .......49 4.4.2. How werethe resrlts applied inth€ project? .........49 SECf,ION 5: STRENGTHS, WEAKNESSES, CIIALLENGES, AhtD OPP'ORTLINITIES....49dI SECTION 6: IIMQIIE IEATIIRES OF Tm PROJECT/OIHER MATTERS...........S2 Acronyms APOC African Programme for Onchocerciasis Control ATO Annual Treatment Objective ATrO Annual Training Obj ective cBo Community Based Organization CBS Community Based Supenrisor CDD Community Directed Distributor CDTI Community Directed Treatmert with Ivermectin CSM Community Self-Monitoring DHS District Health Supervisor DPHC Director Primary Health Care HSAM Health Education, Sensitizatioq Advocacy, Mobilization LGA Local Government Area LOCT Local Onchocerciasis Control Team MIS Management Information System M&E Monitoring and Evaluation MOH Ministry ofHealth N/A Not Available NGDO Non-Governmental Dwelopment Organization NGO Non-Crovernmental Organization NIDs National Immunization Days NPI National Programme on Immunization NOCP National Onchocerciasis Control Programme NOlT National Onchocerciasis Task Force PHC Primary Health Care REMO Rapid Epidemiological lvlapping of Onchocerciasis SAE Severe Adverse Event SHM Staheholders' Meeting socr State onchocerciasis Control Team (The State Prqgramme coordinating team) TBAs Traditional Birth Attendants. TCC Technical Consultative Committee (APOC scientific advisory group) I.JMCEF United Nations Children's Fund IJTG Ultimate Trqtment Goal wHo World Health Organization 5 IDefinitions (D Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). (iD Eligible population: calculated as 84%o of the total population in meso/tryper-endemic communities in the project area. (iii) fuinual Treatment Objective: (ATO): the estimated number of persons living in meso/tryper- endemic areas that a CDTI project intends to treat with lvermectin in a given year. (iv) Ultimate Treatment Goal GITGI calculated as the maximum number of people to be treated anrually in meso/hyper endemic areas within the project area, ultimetely to be reached when the project has reachd full geographic coverage (nonnally the project should be expected to reaph the UTG at the end of the 3" year of the project). (v) Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a p€rcentage). (vi) Geographical covera$e: number of communities treated in a given year over the total number of meso/hyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). (vii)Integruion: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) through CDTI (using the same systems, training, zupervision and personnel) in order to maximise cost-effectiveness and empower communities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTL (viii) Sustainability: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future, with high treatment coverege, integrated into the available healthcare service, with strong community ownership, using resources mobilised by the community and the government. (ix) Community self-monitoring (CSM): The process by which the community is empowered to oversee and monitor the pcrformance of CDTI (or any community-based health intervention programme), with a view to ensuring that the prograrnme is being executed in the way intended. It encourages the community to take full responsibility of Ivermectin distribution and make appropriate modifications when necessary. FOLLOW TIP ON TCC RECOMMENDATIONS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session 21 Number of Recomm endation in the Reoort TCC RECOMMENDATIO NS ACTIONS TAKEN BY TITN PROJECT FOR TCC/AP OC MGT USE ONLY (D Keep planning and monitoring State and LGA financial contributions. Planning and monitoring is being done at all levels and the financial contribution$ are documented on an annual basis. (ii) Train more new CDDs in every village. Communities are continuously mobilized for selection of CDDs at ward level as well as along family lines, but the response is poor as evidenced by reduced number of new trained (1,440), over that ofyear 20O4 .Q,345>. In view of the significance of CDDs to zustainability of CDTI effort will be intensifid to ensure that more are selected and traine{ especially in view of curent CDD attrition. (iii) Find acceptable ways of enhancing women's involvement as CDDs and community srpervisors. This is still a great challengg in view of religious and socio-ctrltural attitudes. The project nevertheless plans to oontinuously €ngnge Islamic religious organizations with the aim of achieving better involvement of women. (iv) Mvocate for Community-directed approach as a vehicle for health care integration. Sweral health care progams are already riding on the vehicle of CDTI. Availability of CDDs as well as other struchues d community level have proven to be a major attraction for activities like guinea wonn zurveillance, distribution of insecticide impregnated bed nets and pre-packed drugs for malaria control, environmental sanitatioq mass immunization activities and othens. There are already moves to train and €Nrg4ge these CDDs for such activities. Of particular interest is the on-going routine immunization programme which is adopting the community directed approach at ward level. 7 Executive Summary Niger State has 25 administrative divisions known as Local Government Areas (LGAs), out of which 2l are approved for implernentation of CDTL The projccted poptrlation for the State is prt at 3.8 million based on the 1991 national census. There ue 2,745 atrected communities with a r€gist€r€d poprlation of 1,632,O79 people at risk of infectisn and blindness from Onchoccrciasis in the CDTI area. A total of 1,252,800 people were treated in 2,418 mdemic communities, represefiing 77o/o the,rapeutic and 88% geographic cov€rage respectively. The Ultimate Treatment Goal (UTG) for the project is 1,370, 946, therefore UTG coverage was 9lo%. The population in over 40oZ of the projea area is highly migratory becruse the State shares bounduies with several others in aU directions, including Benin republic on its' western border. Commonest among the migrant ethnic groups are Crurarig Kambaris and nomadic Fulanis. Due to the ctrltural beliefs and practices of the aforementioned, they migrate annually both within and outside the State in search of virgin (fertile) land for growing cash crops such as yams, guinea corn, maize and mille, while the nomadic Fulani migrate in the dry season in search of water and fresh fodder for their animals. The above phenomenon is responsible for the nucleated and highly dispersed settlemefi pattenq coupled with fluctuation in numbers of communities as well as population figure that Gatures in over 60% of the vast land are. Niger State is the largest of the 36 States inNigeria" occupylng l07o ofthetotal area. 6,014 CDDs were trained out of an ATrO of 12,923, representing oriy 46Yo, while 295 health personnel were trained/retrained for increased capacity for supervision of CDTI, represurtitrg9lo/o coverage of AtrO The challenge the project orperienced within the period of report was achieving its' ATO of 1,370,946 people in spite of poor government funding at Stae and especially LGA level. The system of financial contrcl instituted by the State government severely atrected release of funds to the LGA councilg therefore in spite of the pledges made at yar 2004 SIINI funds were mostly not released to the LOCT. The above situation was compounded by total absence of donor funds, and because of inability of most LGAs to make timely collection of Ivermectin from the State, the SOCT conveyed it to therq either personally or during the NIDs, and then supervised its' distribution to the benefiting communitieq thereby ensuring that treatment commenced immediately. The acceptance ofMectizan dueto its' popularity, as well as oppornrnity provided by the NIDs was utilized to integrate CDTI in PHC at all levelg while the commitment of most of the LOCT and frontline healttr facility sta$ensurd retraining of CDDs and supervision oftreatment. Sustained high level advocacy visits will be made to bottr the Ministry of finance and Ministry for Local Cr,overnment affairs in order to ensure release of the necessary counter part funds. SECTION l: Baclrground informrtion l.l. General informetion 1.1.1 Description of the project (briefiy) - Geographical looation, topography, climate - Population: activities, cultures, language - Communication systems (roads...) - Administration stnxcture - Health system & health care delivery (provide the number of health postVcenters in the project area ifthe information is available). - Number of health statrin project area and number of health staffinvolved in CDTI activities. 1.1.1. Descrintion of oroiect Niger State is geographically located within the middle belt of Nigeria and it lies between latitude 3 20' East and longitude I lo 3' North. It is bord€red by Zamfara State on the North, Kebbi State on the North West, Kogi State on the Soutlu Kwara State on the South West, Kaduna and Fde,ral Capital Territory of Abuja at the North East and Sotrth East respectively. The State shares a coilrmon boundary with the Republic of Benin on the western border i.e. at Babanna district of Borgu local government area. The location of the State gives rise to cornmon inter-border trade with it in all directions. The topography of the Stme is highly undulating while the land is traversed by several fast flowing rivers such as Niger, OIi, Kaduna, Kontagorq Gurara and several tributaries that flow into them. As a rezult ofthis topographS the major rivers of Niger and Kaduna have been dammed for production of electricity, thereforg the Sate houses the largest number of hydro electric power stations in the coutry thus earning itself the titlg 'Power State'. There are two prominent hydro electric power dams at Kainji across river Niger, and Shiroro, across river Kaduna. Despite its meso endemicity, the State is zurrounded by hyper endemic foci on its' northeast, southeast, south and southwest. These foci are in Kadun4 the FCT, Kogi and Kwara Sttes respectively. The vegetation of the State is mainly of the gulnea s&vanna tlpe with forest mosaic savanna especially in the south and south -western parts. The climate is of distinct dry and wet season with rainfall ranging between 1,100mm in the North and l,600mm in the south. The wet season ranges from 150days or morie in the northern part to 210 days or more in the southern part. The dry season commences in October and humidity could be as low as 140'between December and February. 9 Temperatures rise as much as 90T benveen March and June, with the lowest minimal temperatures usually in Decernber and January. Most of the Onchocerciasis endernic communities are located within the abundant flood plains of the rivers that traverse the lan{ thus the population is mainly agrarian in over 80plo of the State. Among the large ethnic groups, the Gwaris', Kambaris' and nomadic Fulani's have a cultural habit of moving from place to place in search of virgin land for their crops, and in the case of the Fulanis, for water and fresh fodder for their animals. Common cash crops produced by the farming groups include yams, rice, maizg mille and guinea corn. Nupes' are one of the major ethnic groups in the Stde, and they are more stable in settlemen! forming very large clustered populations that reside within the marshy alluvial rich valleys, which abound in the State. The Nupes grow mainly rice as both food and as cash crop while they are also very good fishermen. While the settlement pattem in 4ff/o of the State is dense and clustered, over 60% is sparsely populated and highly nucleated with distances of up to 40 kilometers between some communities. Niger is in fact the largest St*e in Nigeria, occupying about 12 million hectares of land, which represents one tenth ofthe total land area ofNigeria.. Niger State has a fairly good road network in about 4U/o of its' area" however, due to the highly riverine nature, about 40% of movement is by water, using local fug boats, engine boats, and ferry for movement of goods, vehicles and humans across the rivers, especially betrveen communities and from the State to neighbouring Kebbi State. Heavy flooding as a result of overflow of the hydroelectric power dams especially after the rains, is a major tkeat to communities that reside along the large rivers of the State, therefore several communities are often either submerged, dispersed or are displaced. The administrative structure is typical of what obtains all over the country i.e. with a politically elected executive Governor at the Stue level and 25 local administrative councils headed also by politically elected LGA chairmen. These administrative councils are further subdivided into 43 units with lE of them known as developmental area councils. There are several traditional institutions headed by Emirs and chiefs of various hierarchies, who oversee the districts and communities and the kingdoms are grouped as emirate councils. The communities within the emirates are headed by traditional rulers who pay allqgiance to the top hierarchy as is typical of the ancient feudal system of government, while all Emirs are however accountable to the governor. The State govwtment basically comprises of ttree arms i.e, the executivg legislative and judiciary. l0 The health care delivery system comprises of three lwels i.e. Primary, Secondary and Tertiary, all of which are quite well interlinked. The PHC system has been put fairly well in place, and is becoming more functional. There a.re over 1,400 health postJhealth centers in the State out of which about 1,000 orist within the CDTI project area. There are 3,520 PHC staffl, out of which, 849 are participating in CDTL Out of 2l CDTI LGAs, 17 are old (i.e. have implemented CDTI for at least 4 to 5 years), while four, namely, Suleja" Tafa, Gurara and Agrvara (which came about as a result of the REMO update/approval of year 2004) were recently added, and have implemented CDTI for only two years. Westem Borgu i.e at Babanna which shares border with Benin Republic is also severely atrected by this phenomenon. t1 IIgE!S-[r Numbcr of heelth stalf involved in CDTI DistrictllGA Number of health steffinvolvcd in CDTI actMties. Totd Numberof health steffin the mtire project areo Bt Numbcr of health stafrinvolvd in CDTI Bt Percentage Br=Brl Br x100 Kontagora 125 32 26 Njau t23 50 4t Magama 216 36 t7 Mariga 202 34 t7 Mashegu tt4 27 24 Agaie 132 39 30 Lapai t37 67 49 Mohrya 182 48 26 Rafi 185 6t 33 Wushishi 150 50 33 Borgu ll3 72 & Lavun 185 23 t2 Shiroro 150 32 2t Gbako 231 23 l0 Katcha 165 45 27 Munya 194 28 t4 Bosso 230 36 t6 Suleja 180 36 20 Gtrrara 187 52 29 Agwara 164 24 l5 Tafa 155 34 22 TOTAL 3,520 849 24 1.1.2 Partnership - Indicate the partners involved in project implementation at alt levels MOH, NGDOs (nationaUinternational), communities, local organizations, etc.I - Describe overall working relationship among partn€rs, clearly indicating specific areas of project activities (planning zupenrisioq advocacy, planning mobilizatiorl etc) where all partners are involved. t2 State plans, if any, to mobilize the State/region/distrist/LGA dwision-makers, NGDOs, NGOs, CBOs, to assist in CDTI implementation. Partners involved in project implementation are:- The National Onchocerciasis Control Programme, of the fderal Ministry of Healttr, The State Mnistry ofHealth and LGAIPHC departnrents UNICEF, APOC, WHO 2,644 Onchocerciasis endemic communities with their CBOs. These CBOs are mainly agricultural cooperative groups and trade unions for both men and women, as well as various youth (age grade) associations, which also often double as agricultural cooperative groups. The overall working relationship among the partners is quite cordial and encouraging. Generally, all are involved in HSAM at various levels. UNICEF, the zupporting NGDO partner was very much involved in yearly planning for conduct of CDTI activitieg advocacy, HSAM and supervision/monitoring but has not been much involved since year 2005, and we are (at present) not clear about its' position. The Ministry of health solicited for piece-meal release of funds by vray of monthly standing imprest of at least US$300 from the approved budget line for rocurrent orpenditure allocated to the Oncho. progremme. US$1,470 was released for supervision and monitoring in December, 2005. Various groups like media organizations, the Nigerian red sross society, Jama'atu- Nasril-Islam (JM) the predominant muslim organizatioq as well as National union of road transport workers also pledged to continue to assist with HSAM activities. Yes, there are plans to mobilize NGDOs, CBOs, policy makers and others in the coming year since these are core activities which have been listed within the 3-year CDTI sustainability plans written by both the State and LGAs. 13 1.2" Popdrtiotr I!trh.2: Commldtica md populrttor rt ritk h fbc Gf,tirc projcct rr.r rhcthff th.y rrc lrc.tcd or mt durirg thc rcportirg pcriod. CDTI Districts/ LGAs in the entirc project enea Total population in the entirc project nrea Number of communities/villases in Population of Meso- endemic zone in the proicct rrea Ar Eyper- endemic zonc in the prciect lnea Az Total in mero/hyper- endeuic zone Ar = Alt Az Meso- endemic zone in the project area A4 Eyper- endemic zone in the projcct arGe AJ Total in meso/hyper- endemic zone A6= Aal A5 Ultimate treatment Goat (uTG) Kontagora 84,187 72 72 84,187 w,187 70,717 Njru 150,050 175 175 150,050 150,050 126,M2 Magama 92,571 52 52 92,571 92,571 ?7,760 ldariga 127,241 271 271 127,241 127,241 106,883 lvlashegu 57,704 102 t02 57,704 57,704 48,471 Agaie 76,999 205 205 76,999 76,999 64,679 Lapai 132,593 2tt 2tt 132,593 132,593 I I1,378 Mokwa 90,744 145 145 94,744 w,7M 76,224 Rafi 94,415 128 128 84,415 84,415 70,w Wushishi 59,708 130 130 59,708 59,708 50,154 Borgu* 140,000 275 275 140,000 140,000 117,600 Larnrn 32,313 92 92 32,313 32,313 2?,142 Shiroro 50,269 103 103 50,269 50,269 42,225 Gbako 36,178 62 62 36,178 36,178 30,389 Katcha &,719 174 174 64,719 &,719 54,364 t4 I Munya 56,026 140 140 56,026 56,026 47,M2 Bosso 68,958 131 13l 68,958 68,958 57,925 Suleja 64,317 24 24 &,317 &,317 54,026 Gurara 69,431 tt7 tt7 68,431 68,431 57,482 Agrvara 48,525 65 65 49,525 48,525 40,761 Tafa 46,131 7t 7t 46,131 46,131 38,666 TOTAL 1,632,079 2,145 2,745 1,61t2r079 1,632,079 lr37Or946 IIIG - odculgtod rs tho maximum aumba ofpcople to b€ ts€dcd amually ia mcro/hyper edemic areas within the projcct srEq uttnD dy to be reachcd whcn thc pqiect has reachcd full g€o$ehio covcragc (nrymally the projott ould be €xpected to r€scrr thc L/TG !t ths €nd ofthe 3d year ofthe project). Was a census forthe project done during the reporting period? Yes- No-{ IfNo, what is the source of the data in the table above? * Source:Nationalcensrs CDD-{- Other source, speciry: Year : If yo[ ]r uirS thc tcrm corrutrltll or y bgr' d.trrr. wh.t col'tlffic' th. commuDlty or vllhga Thb f,i[ hdp ud.rrtrrd th€ pnfils ofthc proj.c't rrcr. The wod co8llnrtrity er u!€d b this rc?ort, caodifittes the l€Est honrcganous group ofpcople made up ofhousehoftls haviag a common socio- cnlursl hgitESp 8nd 8 tradhionat leader. Ir thGr ily othcr i oru.tbn of futGrctt rbort thc popdrtion ir thc ploJcct rrtl? If ro, itrdudc lt hcrl. Yes. The numbers of cotrur.lDitiB tend to incr€ase ronrally becaure ofinflux ofpopulation acro*s the bordcr u€as ofthe Stdc. t5 Tbe poprlation ofBorgu I,GA which sbrr€s bodcr with Benin rcpublic u BEbEtrtr! dfutsict, ir highly dyosBic in populdioq size std trumber of cotrttrutrities, bcc€us€ of irfenrc tr$r-bqd€. EoveBetr by thc nornadic Fulanis ard Kanrbaris. Ttcr€ groups ofteo oI y form hasietrt rctl€deds (canps) arwod Oc lrgrr pruaaem s€ulemeffs, thrrdy le{ding rometimcs to wide fluctuation in yearly population rurnbeG. l,Iotritoritrg by tlt€ SOCT hrs IEEIed that tt€ oomrnunities ofBabanrE distsic* ofiltlt LOA ar€ incorr€Gdy li*d because several rrc oluetercd urd€f I fclv viltage arcas thereby mrliry it difro{t to mo[itor cov€rage. Efort was thercfore mrdc to hrv€ s comEchensive list of thc communities in order to obtsin thc aecessary brreline inbnnation tha will con[e proper iastitutioa ofCDlfI in that uc4 espocialty in vicw of oo$-borda cotrcertrs. l6 SECTION 2: Inplcncntlim ofCDTI 2.f. Tindirc of ectlvit's Filt in table 3, tinelbE d Ntivilies lo qe6 teoted in cToren yeo', irdicatirg when the key acivities wcre funpleoflted by th. modh ihey b€gan 8rd the rmth th€y erdcd. IlUq!: Tlndine ofrctiviairr for thc.rGG tt tcd itr ttc ctlnrrt ycrr Dtutrict/LGA Mobilizetion of communities Training CensusAlodete Drue distribution Supervision Starting month Completion month Sterting month Completion month Sterting month Completion month Starting month Completion month Starting month Completion month Kontagora March Se,ptember Ivlarch Atrgust March September March September lvlarch September Rijau March September ldarch August March September March September March September ldagama tvlarch September March June March September March September March September ldariga March Se,ptunber March September March September March September I\[ashegu March Septenrber May Septe,mber Ivlay September May September Agaie Ivlarch Sepember July September Iuly September July September Lapai March Septernber IVIarch July Iuly September July September Iuly September Mokwa March Septunber April July April Octob€r April Octob€r April October Rafi lvlarch September March July March September lvlarch September March September Wushishi March September April June April Septe,mber April September April September Borgu tvlarch Se,ptember April June April September April September April Septe,rnber Lavun IWrch Se,ptember June fune June September June September June September Shiroro March September April Ivlay April September April September April September Gbako ldarch September lvlarch August lvlarch August tvlarch August t7 I Katcha IVIarch Septernber Ivlarch August March Atrgust lvlarch A*rgust Munya Ir{arch Septunber August December August December Angnst December Bosso lvlarch Sepunber fune July June October June Octohr fune Octob€r Suleja January July June July January June January June Iaruary June Gurara Ianuary July June July Ianuary June Ianuary Iune January June Agwara Ianuary August March May January June January June Ianuary June Tafa January August June July January June Ianuary fune Ianuary June TOTAL -Conn.[tr TI|G project cmtplctcd its' fifth y€ar ofAPOC tunding c the end ofFcbruary 20o5 while no furdg wcre available from Uniccf Thc only turds avaihbb Aom the St6te gov€mmcd was the balance of US$,om conicd over tom US$7,,107 rcleagcd ir yw 2(M, and this fuld wns utitized by the SOCT br'ryot-clt€ok' srpcrvisior of Mectizan distibution in 4 aewly sddd LGAs of T8&, Sutcjs, Gur&a rd Agwarq rs wel as in Rijur Katchr, It okwr, Borgu ltd Bo38o l,CiAs wl!€rB r€y€rsl tr€w communitics wcrc Edded rs s r€{rh ofRcmo fimlizdion ird approvat ofyear 20O4 (s€c RGrDo rrport). Geoerally, $pcwision was done by thc heahh staffc LGA level althargh tho quality of rrpcrvirion by the I,oCT w'! inadequate becarse of v€try tow funding st thst level. Mo$ r&v.l was thdcfore irdegr8tcd itr to th€ Natioorl Polio Eradicaion activitics which s€t-up spccial orss immunizrtion days lnown as NlDs. r8 2.2. Advocacy State the number of policy/decision makers mobilized at each relwant level during the currqrt yeax; the reason(s) for undertaking the advocacy and the outcome. Describe diffrcultieVconstraints being faced and suggestions on how to improve advocacy. State lcvel. l0 Policy makers were mobili?d atthis level i.e. within the Ministry of health, Finance, and Ministry for Local Government, to inform the leaders on the current status of the progamme especially as regards funding as well as the nmd to e$ure zustained yearly funding at both State and LGA level. The advocacy to the Ministry, for local Clovernment was to follow-up on the promise by LGA leaders during the stakeholders' meeting of December 2oM, to give a mandate for central deduction of funds for zustaining of CDTI activities at that level. The diffrculties being faced at both Sate and Local Govsnment level is due to the current political envirounent where funds are hardly relased for activities; The local government funds are alleged to be mostly withheld by the State government thereby frustrating conduct of activities at that level, therefore, in spite of several efforts, little achievement has been made, because no mandate has been gtven. It is therefore suggested that a high powered advocacy team comprising of WHO/ApOC as well as NOTF personnel be made to visit the State government in year ZO07 inorder to help improve on the current situation. LGA Level A total of 432 Policy makers and traditional leaders were mobilized to solicit for both moral and financial zupport to the programme. The situation at Borgu, Wustrishi, Bosso, Grrara and Rijau LGAS was given special consideration in view of low coverage as well poor compliance by both programme implementers and communities. Several stakeholders, me€tings were held with traditional leaders and the LGA policy makers for ensuring improvement during the next treatment round. Communitv level A total of 1,331 villages were reported to have been mobilized in 15 LGfu, i.e including the 4 new ones added after Remo finalizatiorL as well as in old treatment LGA' like Rijau, t9 Mokwa and Katcha where new communities were added. The mobilization activities were conducted by some LOCT and peripheral health care staff There is urgent need to mobilize the communities for Community Self Monitoring and stakeholders' meetings in order to check/address problems of CDD attrition, and poor treatment compliance, which is currently the problem in some LGAg. It would indeed be appropriate for APOC to give consideration to funding conduct of such an activity in order to check the above tlreat. 2.3. Mobilization, sensitization and health education of rt risk communities Provide information on: - The use of media and/or other local systems to disseminate information - Mobilization and health education of communities including women and minorities - Response of target communitie$villages - Accomplishments - Suggest ways to improve mobilization and sensitization ofthe targEt communities. - Advocacy visit was made to the State Television house during commemoration of Oncho. day, for purpose of creating awareness on the disease as well as availability of Mectizan, free-of-charge for its' heatment. - Radio discussion programmes were held in 4 major local dialects. - Bill boards were produced for placing in strategic locations in the State for sensitization of policy makers. Large numbers of posters and other IEC materials produced since year 2005, were distributed to affectd communities through the LocTs. - Mobilization and health education efforts have enzured good compliance in a1n,ut 670/o out of the 2l CDTI LGAs. There is however need for adequce fund release at LGA level in orderto emure betts supervision of activities by the Locrs. 20 2.4. Communityinvolvement Table 4: Communities participation in the CDTI - Incomplete daa Comment ont - Attendance of femele membcrr of the community et health education meetings 2t District/LGA Number of com munitiewillages with community memberu rs supenieoru Number of CDDs and the communities involvd Numbcr of communities /villagec with female CDDs Total no. communiti Number with community members as superuisors B. Percentage Br BJB, T1OO Malc CDDs B" Female CDDs B Totd BlF Br+8. Number of Percentagr Brr= B.JB.*100 s in the entire project aree B, s with female CDDs Bro Kontagora 72 72 100 144 0 t4 0 0 Rijau 175 ll3 65 292 0 292 0 0 Magama 52 s2 100 104 0 104 0 0 Mariga 271 271 100 564 0 5& 0 0 N4ashegu t02 98 96 2t6 0 216 0 0 Agaie 205 205 100 402 0 402 0 0 Lapai 2tt 2tt 100 &6 0 il6 0 0 Mokwa l4s 145 lm 537 0 537 0 0 Rafi 128 128 100 203 0 203 0 0 Wushishi 130 tI3 8V 130 0 130 0 0 Borgu 275 85* 3t a7 I 548 I 0.6 Lawn 92 92 100 235 0 235 0 0 Shiroro 103 101 100 194 4 198 2 2 Gbako 62 62 100 96 0 96 0 0 Katcha 174 174 100 257 0 257 0 0 Munya 140 t40 100 300 0 300 0 0 Bosso 13l 109* 8l 2tE 0 218 0 0 Suleja 24 24 100 490 0 490 0 0 Gurara tt7 90 77 tt4 2 It6 2 2 Agwara 65 65 100 130 0 130 0 0 Tafa 7t 68 96 88 0 88 0 0 TOTAL 2,745 2,418 88 6,M7 7 6,014 5 0.2 * the CDDs role as one of the usual responsibilities exp€ctd &om a family member towards his kindred. Such CDDs are quite contented with this position, and appreciate the fact that their communities vest tnrst on them. The community leaders and CBOs also assist with mobilization and supervision oftreatment. CDD attrition was a major problem in 4 LGAs namely Wushishi, Borgu, Bosso and Gurara and this resulted in incomplete geographical coverage ofthe atrected communities. Several CDDs dropped out because of lack of incentives especially in view ofthe fact that other members of the salDe corlmunities benefited from participation in Polio eradication activities while they were not incorporated. Because of attritioq the current CDD to population ratio is l:271in contrast to l:238 of year ZCf,,A. Meetings have been held with the community leaders with the aim of addressing such conc€rns. The communities have been mobilized to either select distributors alorg family lines or if possible at ward level in order to overcome such unfortunate developments. 2.5. Capacity building - Describe the adequacy of available knowledgeable manpower at all levels. - Where frequent transfers of trained staff occur, State what the project is doing, or intends to dq to remedy the situation. (The most important iszue to describe is what measures were taken to ensure adoquate CDTI implementation where not enotrgh knowledgeable manpower was available or if staff are frequently transferred during the course of the campaign). Generally there is 65% knowledgeable manpower at State and LGA level, however in some LGAS where it is inadequate for facilitation/supervision of CD1L school head teachers are trained to complement the efforts of the district heahh srpervisors. This was the cose when the REMo was updated for the Stue, and there was need for manpower in the western part of Borgu as well as parts of Bosso LGA. The school head teachers are residents of the communities and their inclusion complements the role of the health zupenrisors since there are extremely few PIIC facilities within the districts. The Ministry of health has made efforts to discourage frquent transfer of staff through holding of meetings with the LGA/PHC directo,rs as well as with theLGA policy makers, and Mni stry for Local Crovernment. Three of the 8 participating Stane $atr (SOCT), were ransferred, therefore, the zupervision schedule was reorganized to ensure that no LGA is nqglected. Furthermore, new personnel would be identified and trained on the job in order fill up the gap created and to reduce the workload of the available staff. Frequent fiansfer is a common phenomenon in some LGAs like Bossq Rafi, 61*ara and Borgq and this created a lot of problem with zupervision especially becurse srch staff are replaced by newly employed ones who have no training on the programme. The project intends to train all PHC staff within these LGAs as well as to institute CSM and SHM. Seminars will be held for final year shrdents of the schools of health technology from where such personnel 8f,e produced in order to prepare them for zupervision of CDTI wherever they are po*ed. Meethgs have already been held with the LGA policy makers to address such problems with the hope that such transfers will be controlled. Unfornrnately, because of the poor financial stafi,rs of the LGAs, training snd supervision suffered a set-back because the tOCTs were highly constraind in movement, the district supervisors were therefore mainly vestd with responsibility of overseeing implementation of CDTI activities within their locality. In view of cross border concems with Benin republic, it is necessary to point out that although Borgu LGA has about 640/o of its' staff panicipating in CDTI, most of these personnel are concentrated within southern and south eastern oris, whereas the portion ofthat LGA that immediately borders Benin republic, i.e. Babanna districq located in the western portion has only 13 health facilities and 15 trained PHC staffi.e. despite its, large area and long distances of up to 20 or 30 kilometers betrreen communities. It was in view of this critical situation and the need to ensure adequate zupervision that school head teachers were trained and incorporated as supervisors in year 20M. It will inde€d be necessary to sustain this tempo in order fill in such resource gaps, i.e. by retraining those on ground and training new ones. 24 Table 5: Treining at the difierent revers of crlrr implementation District/LGA Number of Districts/LGAs stafrtraincd Number of Eealth _lgElgrlpost stalf trained Numbcr of other treiners of trainees ( TOTs) Number of CDDs trainedATrO Cr New Cz Refr Cs i TotaliCri cr*ic, ATr o Cs New Cc ReIr Ct Tota ICr Ccr Ct ATr o Cq New i Retr Cru i C,, Total Cu= Cro+ Cu ATrt) Cr New in* iTorali i Cre=cu icrt icrdi ;Crs Kontagora t4 15 t7 32 586 4 i140 i t44 Rijau 35 4 46 50 tz00 3 289 292 I\dagama 10 3 33 36 741 8 96 104 I\{ariga 54 0 0 0 1018 76 i488 564 Mashegu 20 0 0 0 462 0 216 216 Aeaie 4t 0 0 0 616 0 402 402 Lapai 42 0 t4 t4 t06l 165 i48l 646 Mokwa 29 U 7 7 726 u8 419 537 Rafi 26 I 42 43 675 0 203 203 Wushishi 26 l5 35 50 478 0 130 130 Borgu 35 I 3l 32 lt20 286 362 648 Lawn 18 15 0 15 259 155 80 23s Shiroro 2t )U 45 95 402 52 146 198 Gbako t2 0 0 0 289 3l 65 96 Katcha 35 0 0 0 518 448 o i2s7 22 t278 2s7 300 Munya 28 0 0 0 25 Bosso 26 0 36 36 s52 0 2t8 2rE Suleja 5 24 0 24 515 3ffi 124 490 Gurara 23 52 0 52 547 0 116 l16 Agrvara r3 24 0 24 388 130 0 130 Tafa t4 92 92 369 24 @ 24 TOTAL 527 204 398 602 12.970 lr44g 41574 6,014 7e Achievement l14 Ye Achievemcnt 7o Achievement 46 * 'New', 'Refr': If detail not available, provide the corresponding total only. Make sure that there is no double counting 26 Table 6: IYpe of treining undertaken (Ticlc the boxes where specific ffaining was csrried out daring the reporting Wrid) - Any other comments At State level - Training was done on the job, and 4 SOCT membens were trained to improve on their report writing skills. At LGA level - - FLItr staffwere trained/retrained by the socT and LocT. cDDs were trained/retrained by the FLIIFS. 2.6 Treatments 2.5.1 Trrcatment figures - If the project is not achicving 100% geographical coverege end a minimum of 650/o therapeutic coverage or the coverage rete ic fluctuating Statc the reasons and the plans being mede to remedy this. Trainees type of training CDDs Other Community members e.g Community supervisore Heafth Workerc(fiutline heelth facilities) MOH stalf or Other Politicd Leeders Others (snecifv) Program management Howto conduct Health education .l { Managemen t OfSAES csM t/ SHM { Data collection { { Data analysis ./ { { Report writinc ',i Others (specifu) 27 While the project achieved 77o/o thenpeutic coverage, it only achieved 88% geographical because 327 comaunities out ofthe 2,745 targsted were not reared. 2 communities were said to have lost their treatment registers in a flood disaster and did not procure nsw ones up to the end of the y@rs' distribution perioq white the re,sraining 325 did not collect Mectizan either because the CDDS had dropped out and neu, ones were not selected orthey were not aware of availability of Mectizan. The poor attitude of some supervising PHC staff had a negative effect on coverage because activities were not supervised in some aroalt, while some PHC staff did not even care to inform the communities on availability of Mectizan. This is particularly true of Borgu and Bosso LGAs. Meetings were held with the policy makers of such LGAs and they promised to enzure better supervision of drug distribution througtr imposition of sanctions on defaglting staff They also pledged to ensure release of funds for LOCT travel during zupervision, as well for conduct of other CDTI activities. The need to integrde activities in PHC was again emphasized and the heads of health pledged to ensure that is done. Meetings were also held with the traditional leaders of defaulting oommunities, and they orpressed concern that they were not earlier informed about such problems. They then pledged to ensure that all communities in their domain were always treated. Communities were also mobilized to select CDDs along family lines or at ward level in order to check the problem of attrition and low coverage. 28 Table 7: Treatment and sAEs by district/LGA in all anees at risk Iristrict ltfrL _ Conmunities/Villager Popul@ Number d pGrumE who rcfwed the trcatment Number of ebsenteeg Nunher of SAEg Numberd serimr adversc eyents (SAEs) rcferedto the health poct/hmpftal Tdd # of communitied viltagu in the meso/hyper- endemic arelt I)' Annual Trcffiert Objrrtive D, Numbersf comnunitieg lvillegu treffi lr" Geograpnicat cwcmgg(w Ilr- ID3/ IDlr100 TdrI populetion of the meso/hyper- endemlc aretf D. AnnuaITreffi Objoctive ID5 NumDer d penmNs treated D, Therapeutfic coyierage ("/") Dr= Ilzl Ds*Ifi) Kontagora 72 72 72 100 84,1E7 70,717 73,274 E7 9l 294 0 0 Rijau t75 175 l13 & 150,050 126,M2 l02,Eg6 68 83 385 0 0 lvlagma 52 52 52 100 92,571 77,760 79,574 t6 0 2,242 0 0 Mniga 27t 271 27t 100 127,241 l06,gE3 t12,562 89 67t 356 0 0 Lfashegu toz 102 9E 96 57,7M 48,471 41,593 72 3 4 0 0 Agaie 205 205 205 100 70,999 64,679 6t,573 t9 0 s55 0 0 Lapai 2lt 2tl 2tt 100 t32,593 I I 1,379 76,224 103,944 7E 0 ,16 o 0 Mokua t45 145 145 100 g),744 75,W t3 0 4,624 0 0 Rafi l2r 128 128 100 E4,415 70,909 63,692 75 I 4ffi 0 0 Wushishi 130 130 113 E7 )9,7UU 50,154 6,glo 79 l15 22s4 0 0 Borgu 275 27s 85 3l 140,000 I17,600 62,144 44 3,E7t 4,132 0 0 Iavun 92 92 92 100 32,313 27,142 2E,4E5 E8 0 453 0 0 Shiruo 103 103 101 9E 5$,269 42,225 41,213 fi lE5 2014 0 0 Gbako 62 62 62 100 Jb,l7E 30,3E9 29,Otl 80 0 l5 0 0 Katcha 174 174 174 100 64,719 54,364 56,E04 EE 2t tn4 0 0 Murya 140 tfi 140 100 56,026 47,M2 49,W 87 109 183 0 0 Bosso 13l 13l 109 83 68,95E 57,925 32,767 47 0 1743 0 0 ,o Suleja ffi 24 90 65 68Tafa 24 24 u' tt7 Agrran 165 65 7t TOTA, 12,7t5 2r745 utTO cotrer4ge rate (%) 96 UTGachievrd --- 2AIE - = !'umber of people treatrd x l0(! Annual I'reatment Obje*ive = Irumber of peoplc_lredrdx-l.@- Ilormula for corrputing theraprutic anl geogrrphical coveral;gg I'herape rtic cor erage r rte = (%) (ieogralhical coverage rate = (%) Sumber rfpeople treatrd x l0(1 Total populatior living .n meso/hyper-endemic communities within the project area Ir'umber of conununitiely'villasr:s treded x 100 Total nulnber of meso/hyper-erdemic communities as identified by REMO in the project area Iotrl nrmber of people to be tlstrd in E€3o/hypcr-€odcmio are83 within the project area @TG) rlTo = 'tlrc cdimaod rumbcr ofpeople livitrtt in rneso/hypcr-eodeoric arcas thd a CDTI project irlteods to tred with ivermectia in a givcr year. IITG = rte naximun ruober ofpeoph to bc u€alod in rr€ldhyp€r-enrteinic areas within the project arEa ultinarcly to bG rc!.ted xlheo thc troject hss reached fuu geographicsl coverage (normally thc projeot slnuld be ogeacrt to rerch the I;TG 8t thc eod of the 3d year of thc proj€ct). 00 6t,317 54,{26 59,i67 9t l8l 205 0 0 6:i,431 57,t'$2 49,t24 73 1896 5,516 0 0 w 4ii,525 40,',t6l 39,354 79 M 9,765 0 0 6 4;,131 3E,(li6 37,725 EI 677 2t4t 0 0 t Gn$7'!t - 1r52-&m r370946 77 rr2s 40,4t5 0 0 30 I l tl 2.6.2 What are the causos of absenteeism? Absenteeism is due to either poor community mobilization for treatment or solection of inappropriate treatment timg whereby some community members would have ffaveled out of home either for farming and other vocations. 2.6.3 What alrc thc reatons for nefusals? Refusal is often due to fear of reaction to the drug or suspicion that tho drug is for birth control especially in inadequately mobilized communities. 2.6.4 Brielly describe all known and verified serious adverse events (SAEs) that occurred during the reporting period and prcvide (in table 8) the required information when aveileble. - In case the project did not have any cases of serious adverse events (SAE) during this reporting period, please tick in the box. No SAE case to report{ 3t Table t: Cases of serious edverse events (SAEs) that occunrcd during the reporting period * Serisl rumber of tlre paient 32 Village of origin Date Mectiza n was taken Symptoms IHealth status before taking Mectizan Date of admission in health facihty or linvolve complicating lment or circumstances lnot Date I sympto ms appeare d Date of dismissal from health Outcome of prognosis 2.5.5. Tnend of trcatment achievement from CDTI pnoject inception to the current year Table 9: Treatments ard coverage bv calendar yeer for the entire projcct erea. (PleasefiIl iathe reqaired daa) Pleese indicate the UTG for the project area: 1137O946 use this figurc as the denominator in all UTG coverrge celculations.) YEAR Communities/ViIegcs Populrtion Total # of communitieV villages in the meso/hyper- endemic rreos Er Annuel Treatment Objective F- Number oI communi tiedvitleg es treated Eh Geogrephic al coverage f/"1 El= Ey' F4*100 ATO coverSge ("/"1 Es= E'l F4*100 Total population ofthe meso/hyper -endemic [reas E. Annual Treatmcnt Objective 8,1 Number of persons treated F,r Thrapeu tic coverlgc(/ol E= w Ec*lfll ATO coverege P/"1 Ero= W Eztl00 UTG Coverag e f/"1 t997 l.l?t l.12l 300 23 88 900,000 269.260 276.E32 3l 103 2l 1998 1.183 983 672 57 68 904,300 434,000 286.498 32 66 22 1999 1,283 567 4M 31 7t 950,500 490,500 298,000 3r 62 23 2000 .l5e 730 s22 45 7t 952,592 356,942 314.4U 37 88 24 200t t.@9 1.3E5 1.634 99 118 969.350 8t4.254 76E.t93 79 94 59 2002 t.793 1,506 1,776 99 llE r.024.664 860,719 796.M5 7E 92 6l 2003 2,583 2.149 2,203 85 ll0 1.687.596 1.417.572 1.092.069 65 96 77* 200,4 2.s52 2,552 2.5s2 100 100 1.543.960 l,296,g4l t.242.726 80 96 96 2005 2.745 2.745 2.418 8E 8t r.632.079 1.370.946 1,252,900 77 9l 9l 2W 2W7 2008 2009 33 2.7. Orderin& storage end delivery of ivermectin Mectizan@ ordered/applied for by - Qtlease tick the appropriate ans:wer)MOEm WHO tr rrNrCEF D NGDO Other (please speci$): Mectizan@ delivered by - (please tich the qpropriate answer) NGDO tr tr rygH E wHo U uNrcEF mOther (please specifu): Please dcscrlbc how Mectizen@ [r ordered and how it gets to the communities The Federal Ministry of Health/t''{OCP offrce orders for drugs while UMCEF takes responsibilrty for its' clearance on arrival at the Nigerian port. It is also responsible for its' storage prior to collection. The quantity of Mectizan@ required by the project is calculatd based on Molo of the total oensus population and that figure is multiplied by 3 to obtain the accurate drug requirement for the project. Approval to collect drugs is obtained from the NOCP zstaloffrce at Kaduna, and the State collects its drug allocation from NOCP National office at the Federal Mnistry of Health. After collectioq release is made accordingly to the LGAs. LOCTs release drugs to district health supervisors, while the communities collect their requirement from the district health facility within their locality or from other agreed collection points. In the case of very distant communities, drugs are deposited at the nearest frontline health post/facility for convenience of collection. It is pertinent to note that all drug requirements are determined through the same calculation procedure as employed for dnrg requisition by the State. The delivery process is as follows:- DISTRTCT HEADV WARD HEADS { \ COMMI.JNITY 34 IeD!910: Mectizen@ Inventory Stete/DigtricU LGA Number of Mectizen' tablets Rcqueste d Recc\ted Used Lost lYasted Expircd Remainin o Kontagora 175,000 175,000 156,351 t49 0 18,500 Rijau 280,000 280,000 266,473 2,607 0 10,920 Magama 222,500 222,500 lg7,62l 5,520 0 19,359 Mariga 330,000 330,000 315,9I5 1,010 0 13,075 Mashegu 140,000 140,000 110,425 42 0 29,533 Agaie 245,000 245,000 189,934 2,lol 0 52,965 Lapai 272,436 272,436 266,325 361 0 5,750 Mokwa 2r0.000 210,000 188,0I8 5,I98 0 16,784 Rafi 2r0.500 210,500 176,671 249 0 33.580 Wushishi 160.000 160,000 l3l,716 602 13,540 14,142 Borgu 250.000 250,000 155,432 532 0 94,036 Lawn 95.000 95,000 83,695 16 0 l r.289 Shiroro 105.500 105,500 102,727 455 0 2.318 Gbako 70"000 70,0m 66,M8 17 0 3.535 Katcha 175,000 175,000 156,543 2,2ffi 0 t6.t97 Munya 107.500 107,500 106,693 39 0 768 Bosso 150,000 150,000 91,954 60 2.500 55.486 Suleja n2.400 122,000 106,640 602 0 14.758 Gurara r40.000 140,000 l3l,48l 549 0 7.9?0 Agwara 235,500 235,500 121,563 I31 50.000 63.806 Tafa 90.000 90,000 89,261 127 0 612 Chanchaga Clinic Based 4.000 4000 NIA 0 4000 TOTAL 3,7t9,936 3,7t9,936 3rll,8t6 22,G21 66,040 489,383 How arethe rcmeining Ivermectintabtets coflected and where arethey kept? The remaining tablets are retrieved from the LGAs and kept at State level for zubsequent utilization. Remaining lvermectin tablets are collected from the communities through the FLIIFs and submitted to the LGA Oncho. coordinators throtrgh the district PHC supervisors. The LGA coordinators submit all remaining tablets to the State coordinator and such drugs are kept at the project ofEce for the next distribution round i.e. if the explry date is not close. Howwer, if they are required for urgent utilization by other projects or are almost expired, they are transferred to the Nocp zone C, officer for further action. 35 - List end bricfly dcscribe the ectivities under fvermectin delivery that are being cerried out by health care peruonnel in thc project area. - Healthcare personnel hold regular meetings with communities and their leaders to ensure effective conduct of CDTI activities. - They sensitize and mobilize the communities (through health education) for ownership of CDTI. - They train the cDDs, and supervise yearly Ivermectin distribution. - They supervise distrihution in order to ens.rre that oommunities receive d*gr, the drugs are properly managed and that there is good tremment compliance, as well as enzuring that CDDs keep accurate treatment records. - They provide feedback on Ivermectin distribution to the district health supervisorg LOCT, SOCT and all other partners. - Health care personnel facilitate conduct of CSM and SHM through training and zupervision.. - Any other comments Low morale, catrsed by poor funding of activities by government, is a major reason for poor attitude to work which is exhibitd by some health care personnel. 2.t. Community Self-Monitoring and Stakeholderc Meeting [Ias any training (of trainers) for Community Self-Monitoring been done in the project area? Yes ffso, When? In years 2002, 2003, 2OO4. Table 1l: community selGMonitoring end stakehotderc Meeting DistricU LGA Totel # of communitie#village in the entirre pnoiect arrce No of Communities that caried out gelf monitorinq (CSM) No of Communities thet conducted Stekeholdcrs Meeting(sHno Kontagora Rijau Magama 72 t75 52 20 33 l6 20 JJ l6 Mariga 271 0 0 ldashegu rcz 0 0 ASaie 205 0 0 36 Lapai 2tt 0 0 Mokwa t45 0 0 Rafi 128 4 4 Wushishi 130 0 0 Borgu 275 ll ll Lawn 92 20 20 Shiroro 103 35 35 Gbako 62 0 0 Katcha 174 0 0 Munya 140 0 0 Bosso t3t I I Suleja 24 0 0 Gurara tt7 3 3 Agwara 65 8 8 Tafa 7t 0 0 TOTAL 2,745 151 151 Describe how the recults of the Community $etf-Monitoring end Stekeholders Mcetings heve affected pnoject implementation or horv they would be utilized during the next treatment cyele. In year 2002 pilot CSI4/SHM was instituted in 20 communities of Borgu and Mokwa LGAs In year 2003, tlrere was training of 321 LGA/PHC as trainers of trainers, for facilitation of CSM in the 2l LGAs. In the same year (2003), the SOCT supported the LOCT in ensuring that CSM was instituted in at least l0 hst performing CDTI communities in each of 17 participating LGAs. In year 2004., CSM and SHM were major topics within the training 4genda for supervisory capacity building supported by Unicef In spite of these efforts, very few documented reports have been received i.e in spite of prEssure exertd on the LGAs in rquest for such feedback. Interaction with affected communities however gave some evidence of ongoing Cslvt and such evidence are presence of selected monitors wlro gave verbal feedback on their findings to community leaderdvillage members. 37 The pilot CSM and SHIvls conducted in these LGAs revealed that some CDDs were discontented about not being paid incentives by their communitieq while members of communities who had never served as CDDs were incorporated into programmes like polio- eradication and guinea worn surveillance. This informed the decision to work towards formulating a PHC directive zuch that, wherever committed CDDs w€re present, they were also integrated into other PHC programmes, espeaiatly where financial or material rewards would be derived, in order to encourage CDD retention. This action is already being applied in at least 5 LGAs and the benefits are obvious since the treatmeut cover4ge is quite good and there is very good CDD retention. These LGAs are Magama, Kontagor4 Agaie, Lapai and Gbako. The pilot CSIWSHM held in Borgu LGA in year 2002 revealed that because payment of incentives by household i.e. prior to fieatment was imposed on some communities, several members rejected treatment as a mark of protest of that decision. It was then advised that payment should only be voluutary, and based on coilrmunity consensug otherwise, it could have a negative effect on compliance. On another occasion the CSM and SHM revealed that CDDs were disenchanted with their work because the bicycles provided by APOC were allocated to some favored CDDS in two selected communities, possibly where the LOCT leader of that LGA is native of, therefore a directive was immediately given that the bicycles be retrieved and kept at the FLIIF of very remote and hard to reach communities for use at random (i.e. when needed within those catchment areas), either for collection of MectizarU zupervision of CDTtr, or other pHC activities. This revelation made the Stme to make a policy directive that all such bicycles be kept only in custody of resident zupervising pHC personnel. Information from some SHIUs also revealed that the communities had preference of a treatment perio4 which did not conform with the p€riod when drugs were usually released to thern, and this information helped to plan for Ivlectizan delivery at preferred treatment periods. 38 2.9. Supervision 2.9.1, Provide a flow chart of supervision hierarchy. 2.9.2. What were the main issues identifrd during supewision? The main issues identified include :- (t) cDD attrition which resulted in non treatment in some communities. (2) Some CDDs were not adequately trained and distribution was not being supervised. (3) There was no documentation on treatment in some communities (especially those that are far and hard to reach) for example, those at the border with Benin republic. In one of the communities, drugs were received by the cDD, but not distributed. (3) Drugs received by some LGAS were not released to communities for 6 months, because the LOCT insisted on releasing the drugs only when funds were released to them by the LGA authorities. (a) The health staffwere not adequately communicating with the traditional leaders, therefore they were not aware of release of Mectizan to the CDDs. (5) There was hardly any release of counterpart funds at all levels of CDTI implomentation. 2.9.3. \tas e supervision chocklist uscd? Yes. This was developed by the socr to address the issues of concern. 39 2.9.4. What were the outcomes et eech level of CDTI implementation supervision? State level (1) The outcome of NOCP nrpervision indicated that there is need for adequate supe,rvision of the LOCT by the SOCT since drugs released for 6 months had not been distributed in some LGAs, therefore this activity was intensified in the LGAs of concern. (2) Absence of State oount€rpart funds was having a severe effect on conduct of CDTI activities - Reminders were written to both the State Ministry of Finance and the Ministry of Local Government in request of release of counterpart funds. Advocacy visits were also made to both Ministries to sensitize the leaders on need to release funds. LGA Level (l) A meeting was held with the LGA authorities to inform them on the poor auitude of some health workers therefore dnrgs were immediately released to the benefiting communities (2) There was training of health personnel at LGA level for added capacity to srpenrise CDTI, while the SOCT supervised the LOCT to ensure that communities were adequately supervised. (3) Communities were mobilized to select new CDDs and all unskilled CDDs were retrained, by the FLItrs and LOCT. (4) Policy makers made promise to support with funds. That promise was not actualized in some LGAs but the pldges made are still viable and can be redeemed. Meetings were held with traditional leaders in Wushishi, Borgu, Bosso and Gurara LGAs and pledges were made for improvement. The State Mnistry of Health released the sum of U.S.$l,4gl for supervision as well as for refiieval of outstanding reatment reports and drug balances that were not received. (5) Several communities were health educated and mobilized for programme ownership. Communitv level (l) More CDDs we,re selected by the community and that reduced the work load of the existing ones, hence threat of attrition was reduced. (2) Communities were better mobilized and there was improvd compliance with treatment as well as better supervision of CDDs by the community leaders. 2.9.5. Was feedback given to the pcrton or gnlups supervised? Yes, feedback was glven at all levels. 40 2.9.6. How was the feedback used to improve the ovcrall performance of the project? - The respective policy makers and traditional leaders in the affected LGAs were mobilized for better commitment to the prografime, as demonstrded through advocacy and release of funds in some LGAs that prwiously did not release any. - Adequate capacity was provided (for supervision of CDDs) through training and retraining. - The SOCT zupported the LOCT to mobilize the communities for better compliance with CDTI objectives. - There is promise of 100%o geographical coverage in year 2A06. SECTION 3: Support to CDTI 3.1. Equipment Table 12: Status of equipment Source type of equipment 2. Motor cycl{s) * Condition ofthe equipment (F-Functi t repairable, Wo=Written offr. 4t I F 22 l0F 12CN FR 2 wo I wd-l I CNFR I F l0 F I F I F ffi I tioo l. _llioo r wo I Eow does the project intend to maintain and replace existing cquipment and other materials? This will be done through the normal government systen\ i.e through the vehicle maintenance pool. Furthermorg the project intends to intensiS request for monthly standing imprest (running cost) from the State approved budg* line for recurrent expenditure which if provided would s€rve as a source of funds for equipment maintenanoe as well as for maintenance of other items. Even though funding at LGA level is currently very poor, there will be sustained mobilization of the relevant authorities for ttre neoessary fund release, the LGA coordinators have been responsible for maintenance of project motorcycles attached to them and will continue to, since this is the usual practice over here. LGA administrators will also be encouraged to purchase motorcycles and birycles for the prqgramme i.e where ever the need arises. Furthermore, efforts will be made to ensure integration of the CDTI into viable projects like HIV/AIDS control, NPI, malaria control etc. so that there would be central meintenance of all participating PHC vehicles. APOC management has also been requested to replace some capital equipment before its' final disengagement. 42 3.2. Financid contributions of thc partners end Communities Table 13: Finencial contributions by ell paftncrc for the lest thrcc years - If there arrc problems with release of counterpart fundq how were they addrrssd? - Indo€d ttere wtre sevene probtcms with rclease ofmuntcrprt futrds at both Stde ald I.GA kvel. All €ffoft made to €o&rc release st LGA level was fisile while !t Stat! levcl, fird was releas€d when there vas scvcre dclay end ditrorlty in obtdniag t€atm€nt rrTons fiom the l,GAs couplcd with the darm rsir€d sbot* imminer ergiry of&ugE which werr in o.rgody ofthe LOCT. Tlrere ir a proposert advocacy virit by thc Itroaourable mmmirsiorm ofHealth to the lfitrishy offinarce. - Additiorul cornmems Year s(2ffi',) Year 1 (2W') Year 2 (210/0[') Year 3 ('?,/0i0l2') Year4 (2N3') Year 5 (2004) Year 6 (2005)US$ f.00 =#135TOTAL Cash Budgete d (us$) TOTAL Crsh Rdeese d rus$) TOTA L Cash Budgct (us$) TOTAL Cesh Rehased (us$) TOTAL Crsh Budgete d (us$) TOTA L Cash Release d rus$) TOTAL Cash Budgete d (us$) TOTAL Cash Released (us$) TOTAL Cesh Budgete d rus$) TOTAL Cash Released (us$) TOTA L Cash Budgpt ed rus$) TOTAL Cash Released (us$) MOH (Stat€) 22,720 22,7?5 49,000 0 43,0m 0 4,3m 0 3l,6lg 7,772 22,222 l,4El MOH GGA) 10,000 9,139 15,000 E,675 10,371 7,2t7 N/A 704 6,720 1,654 (fromt LGAs onlv) 23,296 455 (5 LGAs onlv) Iocal NGO(s) 3,566 from 3LGAs mainly women group contributions N/A N/A NGDO parhe(s) IJNICEF 24,0W 7,023 24,000 0 24,M 18,259 24,N0 27,346 25,225 25,225 0 0 Communitie s 13,041 9,145 58,800 1,240 1,416 N/A 335 2,156 documented from 13 LGAs 1,373 (documented for 346 comms of l l LGAs) APOC Trust Fund 128,940 I10,000 100,7m 45,000 65,000 35,000 62,120 70,w 35,000 35,000 40,597 0 TOTAL l9E,70l 156,031 247sm s4Brs n,42O 61,961 n,42fi 98,rgs 9E1563 75,373 86,105 3Joe I 43 3.3. Other forms of community support - Describe (indicate forms of in-kind contributions of communities if any) In-kind contributions by communities include assistance with farm work, prayers, supervision by village heads and CBOs, support with community mobilization, giving of food stuff to CDDs, provision of transport or transport fare to collect Mectizan@ from agreed points, nomination of CDDs into politically elected posts such as local councillors or LGA council chairmerq provision of appointments into government paid jobs, and recommendation for inclusion of CDD for other incentive glving social senrices like polio eradication programme and guinea worm surveillance. 3.4 Expenditure per actMty - 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 rat€ to local curremcy. Indicate exchange rate used here US$1.00 to #135. Table 14: fndicate how much the project spent for each activity listed below during the reporting period Activity Expenditure ($ us) Source(s) of fundins Drug delivery ftomNOTF HQ area to central collection point oT community Mobilization and health education of communities Training of CDDs Training of health staffat all levels Supervising CDDs and distribution Internal monitoring of CDTI activities Advocacy visits to health and political authorities IEC materials Summary (reporting) forms for feafinent Vehicles/ Motorcycles/ bicycles maintenance Office Equipment (e.g computers, printers etc) Others 222 455 1,195 700 0 4t 0 State/LGA LGA Comms. LGA LGA State,LGAs State 0 0 State 0 TOTAL 1,936 !qlq! numberof persons treated 1,252,800 - Any comments or explanations? 44 SECTION 4: Sustrinability of CDTI 4.1. Internal; indepeudent prrticipototy ffiitoring; Evaluation 4.1.1 Was Monitoring/cveluation cnrried out during the reporting pcriod? (tick any of the following which ane rpplicrble) .Year I Paticipatory Independent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation Internal Monitoring by NOTF Other Evaluation by other partners 4.1.2. What were thc nocommendations? The recommendation of the internal monitoring by the N0TF was thatr- (l) The LOCTs should be constantly supervised. (2) More CDDs should be selected in the larger communities in accordance with CDTI guidelines. (3) Communities should be betten zupenrised in order to eruure good treatment compliance. (4) Cenzus up date should be completed in parts of the project where it had not been done. (5) The state and LGAs should be adequately funded for sustainability. Supervision checklists were distributed to LGA staffand they were retrained (hands on) on how to utilize them. Monitoring and supervision is being intensified to exrsure compliance with CDTI objectives. There is plan to develop and produce integrated checklists for use by the PHC department in order to promote the required integration. The State PHC departnrent holds regular meetings with policy makers and inforrrs them of developments. The LGAIPHC directors have been sensitized to ensure feedback on conduct of CDTI activities through holding of regular review meetings togcther with the district and FLIIF staff Problems should be ideutified at all levels and successes commended. 4.2. sustainability of pnojects: plen and sct targets (mendatory at yr 3) Was the project evaluated during the reporting period? No. Was a sustainability plan written? Yes { 45 When was the sustainability plan zubmitted? July 2005. What affangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.2.1. Planning at all relevant levels This will be done at all levels as an integrated PHC plan with clear objectives towards sustaining the stre,ngths, improving on the weaknesses and taking advantage of opportunities presented through implementation of an integrated action plan. Integrated planning will be done annually within the PHC departments at State, and LGA level as reflected in the post- APOC/CDTI plans. Plans and budgets are already available for year 2006 activities. 4.2.2. F'unds Government would be aggressively mobilized to release counterpart funds based on the activities on the sustainability plans. A realistic budget is already available at State level and this has received approval of the State government. The LGA budgets are also ready and awaiting release of funds. SHMs will be held at all levels, and the Ministry for local government will be continuously pressurized to ensure central dedustion of funds for Oncho. activities in accordance with the resolution made at the Stme level stakeholders' meeting held in December 20O4. Unfortunately efforts so far made have not yielded much benefits. At State level, high level advocacy visits will be made to the Ministry of finance as recommended by the evaluation tean. Moves will be made to obtain release of monthly standing imprest as was the past practice, as this will assist the project to carry out minimal repair/maintenan@ of project vehicles and equipment as well as for general running of office. 4.2.3 Transport (replacement end meintenance) This will be done centrally in the MOH i.e. if oounterpart funds are not available. The LGA project motorcycles will be repaired and maintained with their own counterpart funds. LGA administrators will be encouraged to purchase motorcycles and bicycles for the progrffirme whenever necessary. At State level, efforts will be made to ensure full integration of CDTI into active projects like AIDS control, NPI, malaria control etc. so that there would be central maintenance of all participating PHC vehicles i.e including the CDTI project vehicle. APOC management will however be requested to replace some capital equipment i.e. before its final disengagement. 46 4.2.4.Other resourceg UNICEF was unable to provide support for year 2005, and government along with other NGOs would have to zustain support in the absence of additional external funding. Because of the current situatio4 there is a serious funding gap but it is hoped that oth€r sources will be identified that will help to amelioratethe constraints berrg experienced. 4.2.5. To what ertent hes the plan been implemented The plan was written, in year 2005 and its' full implementation is expected to be by end of December 2007. However in spite of absence of APOC and Unicef funds, most activities especially at LGA level were conducted in an integrated manner taking advantage of opportunity by the Polio eradication programme. 4.3.Integretion Outline the extent of integration of CDTI into the PHC strucfirre and the plans for complete integration: Planning and budgeting is done in an intqgrated mann€r and the SOCT members have other sohedules (in PHC) which enables them to integrate CDTI activities with others. Integrmion of vitamin A distribution was initially proposed by the project, but because UMCEF had already integrated it with the int€nsified polio immunization campaigrq it was not realized.. Malaria and leprosy control activities are the current attractions and moves are being made to actualize these plans. While deliberate efforts are being made to ensure complete integration of activities at State Ievel i.e starting from planning to joint supervision, it is very strong at LGA and community level, because all healthcare staff at that level are grven schedules that compel them to participate in campaigns such as mass immunization, disease surveillance, malaria control and several other services, and this is because these personnel are also in charge of the health facilities within the project area. 4,3.1. Ivemectin delivery mechenisms The Ivermectin for LGAs when not collected on schedule, is distributed from the State through the LGANPI managers when they come monthly to collect vaccines for immunization orthrough other personnel when they come in for other PHC activities. - Ivermectin meant for comrnunities is delivered through already established channels like M&E officers' outing or collection/delivery ofNPI vaccines to districts and communities. 47 The M& E officers are members of the LOCT, and their position provides opportunity for visiting the district health facilities on a montlly basis i.e. while out on AFP surveillance. 4.3.2. Training This activity is yet to be fully integrated, however several SOCT do participate in the NPI campaigns and they utilize these opportunities to $pport targ€ted training on CDTI. Training will however be integrated with other add-on activities zuch as primary eye care outreach programmes and malaria coffirol. Training is proposed for PHC nnnag€rs and NGOs at State and LGA level to empower them for better collaboration and networking as well as for joint supervision and monitoring. 4.3.3. Joint supervision and monitoring with other pnrgrems During the year under report, most of the SOCT and LOCT participated in PHC campaigns like vitamin A distributioq malaria control, polio eradication etc, at State and LGA level, therefore zupervision of CDTI was integrated with nrch activities. Joint supervision and monitoring with other PHC programmes is the proposed approach henceforth (i.e. during the post-APOC era) and these activities are already reflected in the 3-year CDIfI sustainability plans zubmiued. Integrated supervision checklists will also be developed foruse. 4.3.4. Release of funds for project ectivities Already there are approved PHC budgets with allocation for Oncho control for the current and subsequent years. Release of funds will be effected through corfinuos strong advocacy meetings with policy makers and traditional leaders. Efforts will be made to ensure that Oncho. budgets, are continuously integrated within existing PHC budgets in order to effect its'release. 4.3.5. Is CDTI included in thc PHC budget? yes 4.3.6. Describe othcr heelth pnogrammes that are using the CDTI structure and how this was achieved. What have been the achievements? The routine immunization programme is making effort to utilize a sligtrtly modified CDTI structure as adapted by WHO, for enzuring adequate service delivery at community level. 4.3.7.Deocribe other issues considercd in the integration of CDTI. Other iszues considered are that of conducting several more CDTI tasks at a time while out in the field for PHC activities. There is a proposal to involve CDDs with all community based 48 disease control programmes like polio eradication, community mobilization for HIV/AIDs control, home treatment of malaria" as well as for distribution of insesticide tre*od bed nets. CDDs would also be trained for disease surveillance on AFP, guinea worn, leprosy, schistosomiasiq and Hw/ AIDs at community level. A major issue of concern with disease control is the evident compartmentalization which is exhibited strongly right from the top hierarchy of healthcare delivry. What often obtains is that different progranunes engage separate personnel at community level instead of the available CDDs for the various activitieq especially where incentives are involved without taking cognizance of the available CDTI structure. In order therefore, for CDTI to serve as a vehicle for integration at community level, there is the need for programme plannerVimplementers like WHO, to make conscious effort i.e. through policy formulation and advocacy for utilization of such structures, where available. 4.4. Operetional rcseerch 4.4.1 Summerize in not mort than one hdf of a page the operationd research underteken in the project erea within the reporting period. None yet, but there is the intention to undertake one based on knowledgg attitude and practice of Muslim women in endemic communities i.e. as regards acceptance of social services vis' a vis' the way they fulfill their roles and responsibilities in accordance with Islamic injunctions. 4.4.2. How were the results applied in the projcct? SECTION 5: Strengths, weaknecses, challenger, and oppoftunities - List the strengths and weaknesses of CDTI implementation process. - List the challenges and indicate how they were addressed. State level. Strencths (l) Availability of Adequate Mectizan. (2) Integration with other PHC activities e.g. NPL (3) Good leadership / committed SOCT. Weaknesses (l) Delayed release of fundilInadequate funding. (2) Inadequate zupervision of LOCTs. (3) Poor political will of policy makers which resulted in poor release of LGA funds by State government. 49 (4) Inadequate institution of CDTI at Borgu LGA which shares border with Benin republic. LGA Lcvel. Strencths (l) Adequate Mectizan (2) Fairly good commitment ofPHC staffin about 65% ofLGAs. (3) Integration of CDTI with PHC. Weaknesses (l) Very acute funding gap in all LGAdNo release of countopart funds. (2) Severe delay in submission of treatment r€ports. (3) Poor attitude of some PHC stafl the,refore CDTI is not being fully integrated with other activities. Wastagg due to orylry of unused drugs that were not returned after distribution. (4) Poor zupervision ofFLI{F staffby LOCT. (5) Inadequatetrained personnel in some LGAs e.g. at Babanna area ofBorgu LGA.. (6) FLHFs not adequately training or zupervising CDDs. (7) Inadequate fiansport logistics especially in border LGA like Borgu ufuere distances from LGA headquarters to some communities takes 8 to l0 hours due to extremely bad terrain. (8) Frequent transfer of staffin some LGAs. (9) Several motorcycles are broken down and are yet to be repaired due to lack of financial release by LGA. (10) Incomplete census in LGAs like Borgu, Mariga, Katcha, Agaie and Mohrya which led to wide fluctuation in population figures. (l l) CDTI is not adequately instituted along border areas with Benin republic. (12) Inadequate 2- way fbedback to Stde and communities. Communitv level Streneths (l) Good awarenesVacceptance ofMectizan. (2) Very willing communities (3) Evidence of good oumership in over 75o/o of prqect area. (4) Good commitment of traditional leaders (5) Committed CDDs in some parts. Weaknesses. (1) Inadequate CDDs. (2) InadequateGeographical coverage. 50 (3) Poorly mobilized communitiesin25Yo of project area. (4) CDD attrition in I lo4 of communities due to lack of motivation. (5) Absence of CSM in most communities. (6) lnacctrate transfer oftreaunent data from registers. (7) Inaccurate censuV no update of comnrunity census records. (8) Inadequately trained CDDs. (9) CDDs are not adequately incorporated into PHC. Challenses/ Oooortunitics (1) Mectizan delivcry - Activities like training Mectizan delivery, advocacy and supervision were largely integrated into the polio immunization activities at both State and LGA levef some SOCTs participated in training and supervision, thereby utilizing the opportunity for conduct of targeted CDTI activities. All LOCT were integrated into the National Immunization Days (NDs) activities. Some political ward councilors were involved in Mectizan delivery to communities in their catchment areas. (2) Advocacv to State Policv malrers Ministerial management meetings were employed to sensitize the new Honourable Commissioner ofHealth for release of funds for oncho. control activities. - P,ublic awarrcncss for imoroved drus acceotrnce Advocacy visit was made to the State media houses (i.e. television and radio) during commemoration of Oncho. week in February and this was aired, thereby further creating awareness on the programme. (3) Motivation of CDDs/ reduction of CD.4 attrition: - Several CDDs from communities that did not give incentives $/ere incorporated to participate in mass immunization activities from where they received some cash benefits. - Communities with strong family affiliation wer€ encouraged to select CDDs along family lines thereby increasing number and reducing demand for incentives. (4) Ertrtmetv dclaved reoorting bv LGAs/cottection of rcoofts bv SOCT US $1,481 released by the State was utilised by the SOCT for fiavel to 13 defaulting LGAs for conduct of several activities like collection of outstanding treatment reports/drugs, advocacy to LGA leaders, **fJgr with the PHC team, 'spot-check' monitoring/validation of treatment, as well as Health education / comrnunity mobilization. 5I SECTION 6: Unique ferturts of the project/other matters Cross-border concerns with Benin Republic This project is one of the largest in Africq thus making conduct of activities very diffrcult and demanding especially in view of gross under funding by Governmen! coupled with the funding gap caused by UMCEFs' inability to strstain its' support to the project since year 2005. Borgu LGA is of special reference here, because of cross border concerrxr with Benin Republic. Because REMO was not finalized until year 2004, there was no approval nor justification to expand of CDTI into the area. Unfortunately Government assistance was also not forthcoming when approval was received for expansion, therefore ooverage remains very poor since only treatments that had been on going since commencement of mass Mectizan distribution was maintained. To give an insight into the enormity of the problenl it is necessary to explain here that Borgu LGA is the largest in Niger State occupying about 25o/o of the total land area while the region of concern - Babanna" comprises of 50p/o of the whole LGA Already 135 communities have been listd for CDTI and the distances between these communities ranges from 30 to 40kms on an average. There is inadequate capacity for training and supervision at that level, while there is need to support the LOCT with 2 motorrycles and at least 20 bicycles that will help to facilitate movement durfury conduct of activities It is our sincere hope that APOC management can assist (as a special intervention) with the neces$ary funds and logistics for addressing the cross-border concerns. 52