KEBBI STATE COMMTTNITY DIRECTED TREATMENT WITH IVERMECTIN PROJECT ORIGINAL: Enelish t l COUNTRYAIOTF: NIGERIA Proiect Name: KEBBI STATE CDTI Approval year: SEPTEMBER 1999 Launchins year: DECEMBER 1999 Reportins Period: From: JANUARY 2009 To DECEMBER 2009 (Month/Year) (Month/Year) Proiect vea r of this report: (circleone)l 2 3 4 5 6 7 8 9 10 Date submitted: April 20f0 NGDO Partner: SIGHTSAVERS INTERNATIONAL i t. )i I L,-- r.t03 for Tot S Ri) tlr il <;.*a.anfe*r.- R 6 I { TEN YEARANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE I COMMTTTEE (TCC) AFRICANPROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) RECU LE Jig.w. Nigct Ogua Ondo APrJc/DlR, Yob. Bruchi Kedunr Bcnuc Trrrbt n I II I I ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) DEADL FOR SUBMISSION: To APOC Management by 31 January for March TCC meeting To APOC Management by 31 Julv for September TCC meeting AFRICAN PROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) t I , I ll tI t .l I I ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICBRS to sign the report: Country: NIGERIA National Coordinator Name: DR, YEMI FAYOMI Signature Date Zonal Oncho Coordinator lrlame: Signature: .. Date NGDO Representative Name: Mrs, Anita Gwom Signature Date This report has been prepared by Name : Isah Argungu Designation: Project Coordinator Signature: ... Date llt Table of contents Acronyms vi Definitions vii FOLLOW UP ON TCC RECOMMENDATIONS 1 Executive Summary 3 SECTION 1: Background information 4 1.1. GpNeRar- INFoRMATroN............. .........4 1.1.1 Desutption of the project ftrieJly). ..............41.1.2. Partnership ............... 7 1.2. Popu1arroN............... ..... l0 SECTION 2: Implementation of CDTI ll 2.1. Trvelrup oF ACTrvrrrES ............ .......12 2.2. Aovocecv ........ ..... ...... 13 2.3. MoarLtzerroN, sENSrrrzATroN AND HEALTH EDUCATToN oF AT RISK coMMUNrrrES 14 2.4. Couuunlry INVoLVEMENT........... ..................... 16 2.5. Capecrrv BUTLDTNG.. ......17 2.6. TRpntrrapNTS.............. ..... 19 2.6.1. Treatment.figures ..................... 20 2.6.2 What are the causes of absenteeism'? .......... ... . . ....... 22 2.6.3 What are the reasons for refusals?................ ............... 222.6.4 Briefly describe all known and verified serious adverse events (SAEs) that ... 23 2.6.5. Trend of treatment achiet,ement from CDTI project inception to the curuent year 242.7. ORoeRmc, sroRAGE AND DELIVERy oF TvERMECTTN ...........25 2.8. CouvurNrry sELF-MoNrroRrNG aNo SrersHoLDERS MeprrNrc ............27 2.9. SuppnvrsroN............... ...................... 28 2.9.1 . Provide a.flow chart of supervision hierarchy. ............ 29 2.9.2. What were the main issues identified during supervision? ................ ...........:. 29 2.9.3. Was a supervision checklist used? ............. 29 2.9.4. What were the outcomes at each level of CDTI implementation supervision? 29 2.9.5. Was feedback given to the person or groups supervised?................................ 292.9.6. How was the feedback used to improve the overoll performance of the project? SECTION 3: Support to CDTI 30 3.1. EqurureNr FrNaNcral coNTRIBUTIoNS oF THE pARTNERS AND coMMLrNITrES.. Orupn FoRMS oF coMMLfNrry suppoRT ............... 3.4. ExpeNorruRE PER ACTrvrrY . SECTION 4: Sustainabitity of CDTI 4.1. INreRNer-; TNDEeENDENT pARTrcrpAToRy MoNrroRrNc; EveluerroN.......... ..........32 4.1.l Was Monitoring/evaluation caruied out during the reporting period? (tick any of thefollowingwhich are applicable)............ ...........32 4.1.2. What were the recommendations? ............. 33 4.1.3. How have they been implemented? ............. .. . . . ....... 35 4.2. SusrarNasrI-lTy oF IRoJECTS: ILAN AND sET TARGETS (rranNonroRy AT Yn 3)...... 35 4.2.1. Planning at oll relevant levels.. .................. -iJ 4.2.2. Funds....... ............... -tJ 4.2.3 Transport (replacement and maintenance) . . . .. . . .... 35 4.2.4. Other resources ...... 35 4.2.5. To what extent has the plan been implemented................ .............. 36 4.3. INrpcRarroN............ ......36 4.3.1. Ivermectin delivery mechanisms............... ................... 36 4.3.2. Training.... ..............36 4.3.3. Joint supervision and monitoring with other progroms.... ............. 36 ? 3.2 J.J 32 v lv ............ 30 .....32 4.3.4. Release of funds for project octivities ........ 364.3.5. Is CDTI included in the PHC budget? .............. .......... 37 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements?............. .................... 37 4.3.7. Describe others issues considered in the integration of CDTI. ..... 37 4.4. OpenarroNAl RESEARCH .....37 4.4.1 . Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period. ........ 37 4.4.2. How were the results applied in the project?.... ........... 37 SECTION 5: Strengths, weaknesses, challenges, and opportunities 38 SECTION 6: Unique features of the project/other matters 39 I v Acronyms APOC ATO ATrO CBO CDD CDTI CSM FLHF IEC LF LGA LOCTs MOH NGDO NGO NOTF PHC REMO SAE SHM SOCT TCC TOT UNICEF UTG WHO African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Commurtity-Based Organization Community-Directed Distributor Community-Directed Treatment with Ivermectin Community Self--Monitoring First Line Health Facility Information Education and Communication Lymphatic Filariasis Local Government Area Local Onchocerciasis Control Teams Ministry of Health Non-Govemmental Development Organization Non-Governmental Organization National Onchocerciasis Task Force Primary health care Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Stakeholders meeting State Onchocerciasis Control Team Technical Consultative Committee (APOC scientific advisory group) Trainer of trainers United Nations Children's Fund Ultimate Treatment Goal World Health Organization I , vl ! Definitions (i) Total population: the total population living in mesoftryper-endemic communities within the project area (based on REMO and census taking). (ii) Eligible population: calculated as 84o/o of the total population in meso/hyper- endemic communities in the project area. (iii) Annual Treatment Objective: (ATO): the estimated number of persons living in meso/hyper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. (iv) Ultimate Treatment Goal (UTG): calculated as the maximum number of people to be treated annually in meso/hyper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage (normally the project should be expected to reach the UTG at the end of the 3'd year ofthe project). (v) Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) 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). (vii) Integration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) through CDTI (using'the same systems, training, supervision and personnel) in order to maximise cost- effectiveness and empower communities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTI. (viii) Sustainability: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future, with high treatment coverage, integrated into the available healthcare service, with strong community ownership, using resources mobilised by the community and the government. (ix) Community self-monitoring (CSM): The process by which the community is empowered to oversee and monitor the performance of CDTI (or any community- based health intervention programme), with a view to ensuring that the programme is being executed in the way intended. It encourages the community to take full responsibility of ivermectin distribution and make appropriate modifications when necessary. vll Number of Recommendation in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT ASE ONLY FOLLOW UP ON TGG REGOMMENDATIONS Using the table below, fill in the recommendations of the last TCC on the project and describe how they hove been adllressed. TCC session : The for 2008 was not submitted to APOC (Please add morevows if necessary) a 8 Executive Summary Prepore an Executive summary of the report in not more than one page. ./ Background on treatment and population data - Total comntunities, communities treated, total population, urc, ATo and persons treated. '/ Background on population movements. ,/ Training data - cDDS, health workers, Total population (community) per CDD trained. { Challenges and hov, they v)ere overcome. Executive Summary Kebbi State is located in the North-western Nigeria with an estimated population of 3.2 million people (2006 population census). Onchocerciasis controi p.ogru1n-" commenced in the state in 1995 with Community Based Ivermectin Treatment (CBIT) with support from Sightsavers International while the implementation of Community Directed Treatment with Ivermectin (CDTD with support from the African Programme for Onchocerciasis Control (APOC) commenced in 1999. Out of the 2l administrative LGAs Onchocerciasis is meso-endemic in 6 and hypo-endemic in 3 local governments. APOC supports the project in the 6 meso endemic local governments of Bagudo, Ngaski, Sakaba, Danko Wasagu, Zuru and Fakia, while Sightsavers International supports control activities in the 3 hypo-endemic local governments of Bunza, Suru and Shanga in addition to the 6 meso endemic local goverlments. The project completed its thirteen years of CDTI implementation in December 2009. The state provided a counterfund $5,000 as supporl to oncho activities during the year. The African Programme for Oncho Control (APOC) donated a four wheel drive to the prograrnme in the year under review. The project treated 195,537 persons out of a population of 23g,033, using 537,33g Mectizan@ tablets in 204 endemic communities, thereby attaining 82yo tierapeutic and 100%o geography coverage. 500 Posters and 200 MIS forms were supplied to the state and LGA in February by the NGDO partner for mass distribution in communities, awareness creation and timely reporting of programme activities. 9 The State Onchocerciasis Contro Team (SOCT) and Local Onchocersiasis Control Team (LOCT) were retrained on data collection and colliation to horn their skills on data management. The state MoH appointed a new data manager to the progralnme and he was trained by sightsavers on data management. The programme leadership at the state was found to be weak. In order to improve and strengthened the leadership and government' support to the programme, a joint advocacy visit was undertaken with Sightsavers and National Oncho Control Programme to the state policy makers to address this issue. At the end of the year. the State Cordinator resigned his appointment with the state. Sightsavers, SOCT, LOCT team and FLHF health staff conducted monitoring and supervision of programme implementation. The challenges were attrition of CDDs due to poor incentives from their communities and non use of measuring sticks. During monitoring visits measuring sticks were produced using local materials for those communities found without measuring sticks. SEGTION {: Background information 1.1. General information i. Description of the project (briefly) J (t)(i, (iii) (iv) (v) G e o gr aphi c al loc ati on, topo gr aphy, c I i mate Population: activities, cultures, language Communicatton systems (roads...) Adm inis tr at i o n s tructur e Health system & health care delivery (provide the number of health posts/centres in the project area if the information is available). Number of health staff in project area and number of health staff iniolved in CDTI activities. (vi) Kebbi State is located in the Sudan and savannah grassland of north-westem Nigeria covering a landmass of 36,229 square kilometres (almost same size as Guinea Bissau -36,120 sq. km, or half the size of Sierra Leone -71,740). The state is made up of twenty-one (21) administrative local government areas with an estimated population of 3.2 million people based on the 2006 population census. It borders Niger and Benin republic both francophone West African countries to the northwest and Niger State to the south. It shares its northeastern borders with Sokoto State and its eastem borders withZamfara State. The state was created out of the then Sokoto State in 1991 from the 4th century Kebbi Empire, a remnant of the historical Songhai Empire (which covered northern parts of present day Nigeria and Ghana), which was founded by Muhammed Kotal Kanta a famous warrior of the Kabawa descent (an ethnic group now living in the northern parts of the state). Relative to its geographical location, the climate in the state is characterised by two seasons. Rainfall begins in April and ends in October and heaviest in July and August. The dry season is from November to March with dry Harmattan winds between November and February. The mean annual temperature is 100'F/40oC, while annual rainfall is 500mm. Most of the roads leading to the local government headquarters are a l0 motorable, but the roads to the communities are mainly laterite roads, which become inaccessible in the rainy season. Access to these communities is usually by bicycles, motorcycles, four wheel drive or foot paths. The existence of many rivers in the state particularly "Gulbin Ka" (River Ka) and River Niger along with their tributaries provide fast flowing rivers for breeding of black flies, which transmit Onchocerciasis. The predominant tribes in the state are Hausa, Fulani, Kabawa and Dakarkari with Islam being the dominafit religion. The tenets and laws of Islam as practiced in Sharia Law guide the people of the state. The main occupations of the rural people are farming (subsistence farming), fishing, trading and animal husbandry and nomadic herdsmen. The state and local governments provide formal employment. 80oh of the people live below $l a day which makes services such as health and other social services unaffordable, and thus puts the people at the rural level at a disadvantage. The significance of this is that services have to be free or highly subsidised for them to afford. About 70%o of the population live in rural communities with poor accessibility particularly in most of the rainy season, while 30oh live in urban and semi urban centres (Birnin Kebbi, Argungu, Yauri, Jega and Ztru). During the dry season there is a high migration of male youth to urban areas to engage in petty trading and other unskilled professions to earn a living. They however return to their communities in the rainy season for agricultural activities. There are two main tiers of govemment operating in the state - the state and local govemments. An elected Executive Governor, state house of assembly members, and elected Executive Chairmen and Councillors at the local governments governs respectively. There are also the traditional and religious institutions of leadership, which have an influence in the administration at the state and local government. The Kebbi State Ministry of Health is structured in line with the Nigerian health structure which is based on the concept of the Alma Ata declaration of 1978 which states: - "Primary health cqre as essential health care based on practical, scientifically sound 'and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can affird to maintain at every stage of their development in the spirit of self relionce and self determination". Based on the above the national health care delivery system is structured into primary, secondary and tertiary levels of care assigned to the local, state and federal governments respectively. There is a Federal Medical Centre in the state at Birnin Kebbi, which is supported by the federal government and provides services to all the citizens of the state. The state goverrment through the Ministry of Health is responsible for'secondary health care and supervision of primary health care delivery. The local governments provide primary health care in their respective areas. The Ministry has the following 8 departments: Administration, Public Health Services, Primary Health Care, Pharmaceutical Services, Nursing Services, Planning, Research and Statistics, Finance and Supplies and lnspectorate Services. Other parastatals under the ministry are School of Nursing and Midwifery, Birnin Kebbi, School of Health Technology Jega and Hospital Health System Management Board. The state has twelve secondary health facilities in Birnin Kebbi, Argungu, Yauri, Zuru, Koko, Zuru, Dandi, Ribah, Maiyama and Jega. There are 57 front line health facilities in the six 1l endemic local govemments and all serve the endemic communities. All these health workers in these health facilities have been trained with the special initiative fund. The activities of the State's Ministry and health services provided are funded from budgetary allocation from the state government. The eye care and the onchocerciasis control progralnme have budget lines at the state level, while Onchocerciasis control is under the PHC budget in the local governments. The state and local governments have supported the prograrnme with $330 this year. One cannot discuss Kebbi State without considering the traditional structures, which play a very important role in the development and lives of the people. The extended family system is the basic unit of the community structure in the state. A household head that is usually the eldest male family member i.e. the father or grandfather heads each extended family. The population in these households ranges from 5 to 40 persons per household. The head of the household takes all decisions, including finance and health issues in households while the mother ensures implementation of domestic issues. The poor and women are disadvantaged and marginalizd. Most women in the state are in purdah and are not involved in decision-making. A group of households form a community in Kebbi State as in most part of northem Nigeria, which is headed by a community leader known locally as Maiunguu,a (Head of community, names vary depending on tribes). The "Maiunguwqs " (village or community head) govern their communities in consultation with and assistance from heads of households, religious leaders (Imams) and opinion leaders like "Magajiya" (head of females) and "Sarkin Samari " (head of male youth) in the communities. Kebbi State has four emirates - Gwandu, Yauri, Argungu and Zuru, headed by emirs. The community and religious leaders report to them, while general communal activities.are carried out under the coordination of the village development committees. a t2 AI..GIE AreINGU GVI'ANDU XEE AUrcKAIGO -EGA DAI\IDI MAIYAMA fol(o/ FPSTF YAI.R MAPOF hE STAIE SI{OWNG CDII lGAs I Arcc srpporbd f NoN-Arcc s.rpported t l3 Table I : Number of health staff involved in CDTI (Please add more rows if necessary) DistricULGA Number of health staff involved in CDTI activities. Total Number of health staff in the entire project area B Number of health staff involved intlrl B, Percentage Br=Brl B' * 100 Bagudo 64 64 t00% Danko Wasagu t37 t37 r00% Fakai 38 34 100% Ngaski 57 57 100% Sakaba 55 55 100% Zuru 31 3l 100% Total 382 382 l00o/" 1. Partnership (, Indicate the partners involved in project implementation at all levels IMOH, NGDOs (nationol/international), communities, local organizations, etc.J(ii) Describe overall working relationship omong partners, clearly indtcating specific areas of project activities (planning, supervision, - advocacy, planning, mobilization, etc) where all partners are involved.(iii) State plans, ,f ory, to mobilize the state/region/district/LcA decision- makers, NGDOs, NGOs, CBOs, to assist in CDTI implementation. The partners involved in the project implementation at all levels were l. Kebbi State Ministry of Health 2. Kebbi State Ministry for Local Government and Chieftaincy Affairs (representing the endemic LGAs) 3. African Programme for Onchocerciasis Control (APOC) 4. Federal Ministry of Health (lt{ational Onchocerciasis Control Programme) 5. Endemic Communities 6. Sightsavers lnternational ! Kebbi State Ministry of Health, Birnin Kebbi, Nigeria The Kebbi State Ministry of Health and its structure including function and responsibilities had earlier been described under background. [n addition it provides the project staff and infrastructure for the programme. The staffs are involved in all aspects of the project implementation from planning, advocacy, Mectizan@ procurement, training, monitoring/supervision, community health education and mobilization (as observers) and reporting. The Ministry pays staff salaries and allowances and has consistently contributed counterpart funds since the inception of the programme, but unfortunately in since 2006, the state could not release , l4 counterpart funds budgeted by the project due to misappropriation of funds by SOCT and resumed some support to the prograrnme in 2008 and 2009. Kebbi State Ministry of Local Government and Chieftaincy Affairs All local govemments' activities in the state are under the supervision of the Ministry of Local Government and Chieftaincy Affairs. The Ministry is headed by u Commissioner who liaises with the Local Government Service Commission in the employment, posting, promotion and discipline of staff of the local governments and monitoring of utilization of statutory allocations from the federal government. It also sets up general guidelines for staff matters, including human resource development and serves as an appellate body for local government issues. The Ministry is involved in planning and ensures that the local government releases counterpart funds for implementation of project activities. In each of the 6 endemic local govemment area there is a local Onchocerciasis control team headed by an Onchocerciasis Coordinator, which is mainly responsible for training of Community Directed Distributors, ensuring that the communities collect and distribute the Mectizan@ and community health education and mobilization. The 6 Onchocerciasis control teams also monitor the overall distribution in the communities, ensuring that records are kept at the first line health facilities and communities. They treat cases of severe or mild adverse reactions and reporting. African Programme for Onchocerciasis Control (APOC) The African Programme for Onchocerciasis Control (APOC), which is a WHO ojgan, was established in 1995 with the sole objective of supporting the control of Onchocerciasis in sub Saharan Africa using the Community Directed Treatment with Ivermectin (CDTI) strategy. APOC has supported the project with funds and capital equipment since 2000. A team of independent monitors appointed by APOC carried out an independent monitoring of the project in 2004. A management plan was developed from the recommendations of the report, which was used for the implementation of the project in 2005 and 2006. A team of evaluators was appointed to evaluate the project for sustainability in2006; unfortunately two of the participants lost their lives as a result of a plane crash thus resulted to suspension of the evaluation. Federal Ministry of Health (National Onchocerciasis Control Programme - NOCP) The National Onchocerciasis Control Programme (NOCP) is an organ of the Federal Ministry of Health, which is responsible for overall implementation of the prograrnme in Nigeria. NOCP is a unit of the department of public health and is headed by a National Coordinator. There are four zonal offices - Zone A (Enugu), B (Ibadan), C (Kadtrna) and D (Bauchi), which are headed by Zonal Coordinators and have the responsibility of monitoring CDTI activities in their catchment states. The NOCP on behalf of federal government endorses all MoUs with APOC and states and receives support from APOC. The zonal offrce in Kaduna is responsible for monitoring the implementation of the programme in Zone C, where Kebbi State falls under. The office also provides technical support to the project. Endemic Communities A community or village in Kebbi State refers to people in either small or large groups, who live in the same place, share the same culture, customs and traditions with a l5 common leadership. In the project area there are 204 endemic communities, which fit these descriptions. These communities have been receiving Mectizan for between 9 - 13 years. The traditional structure and decision making process as explained earlier is what is found in these communities. These communities play a major role in the implementation of CDTI in their various commturities, and these include selection of volunteers to distribute the drug, actual collection of drugs from central collection point, distribution of the drug, provision of incentives and reporting among others. Sightsavers [nternational Sightsavers International has supported onchocerciasis control in nine local goverlments (Sakaba, Zuru, Ngaski, Danko Wasagu, Fakai, Bagudo, Suru, Bunza and Shanga) since 1995 using community treatment with Ivermectin. With the commencement of CDT[, this was introduced in all 9 local governments with APOC supporting 6 and Sightsavers International continued support to the programme in the other three LGAs (Suru, Shanga and Bunza). They have provided logistic support (vehicles, spares, transportation of Mectizan@ etc), technical support - planning, advocacy, monitoring, provision of IEC materials and reporting forms. support training of health workers and CDDs on primary eye care etc. In general the relationship existing between the partners mentioned above has been cordial and where necessary, roles/functions are cascaded for effectiveness of project implementation. Support is still being solicited for commitment to CDTI activities at the grass-root. Communities were re-mobilized on their responsibilities as partners based on CDTI principles, so that at the end of APOC support the project can be sustainable. t6 I-*E HE;;(EtrGiici ooeo0) = o-(,# .EE; - -.E E >.q E *, B.Er t eii E -c ooc)t Q H! -*EHEE Ir E s e il E *HE n S >E.E5r = ts a.I a.l 5'r.9 gg E€= hl I .Y' o o El= Es:xE &l u #:;=EEl -q cs ^. =6lF -ct 6;9El .FS'- E " UI P iEEE;Fl= .e ^-:;5El Pi!%oq EI a *Sfr€ rtl a 8^.; t g5l'E o ! bt't EI E HS:€3 EI E ;FEg,.' l 3 3'\:oe 6 =lo cB r-.I cdEl; E i€ cr # g; EIHE; E s: EjTEE a, ir ! *gi= EfEg i:E;r*EU Eo .=S'E H ts9 tdnr td oOB o0ij& - -t-E€8lE E $?: =EEai fliEErEEqE gb;EEEEHE tSeEs x,- C H at cd ()UE33 TSXE.3 EgEE $€;E: # ?Es * l E 3"u a2t .. al "EEi6 lScEx.^ o !? tr - o;- ii gq;tIEiIEc gE- 3HEI Ef,; I q) a) U q)\ q) ^aio! ax Sp .sis\ r-s! u!u q\ E "''us v\:\-\o,q)r Fq) .i$ -s *r >B q) F.- B! q 1 r\ \)\ trN q)q Bq) o t{() a. bo ti (l)L q) oo tr rr o o (d(.) Lr 0)l<(t >.(.) Lo () B Gq) L GI Io lra q) Lr (l) 0) }Zt') L d o d)ao o. 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Timeline of activities Fill in table 3, timeline of octivities for areas treated in current year, indicating when the key activities were implemented by the month they began and the month they ended. Table 3: Timeline of activities for the areas treated in the current year (Please add more rows nece, All these activities took place as planned in2009 with support from the NGDO partner. Please indicate if all activities were undertaken as planned, and if not, please explain. 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 dfficulties/constraints beingfaced and suggestions on how to improve advocacy. As a result of the need to sustain the programme at all levels after post APOC support to the project, the need to advocate to stakeholders is considered necessary, hence the LOCTs as reported from the six endemic LGAs carried out advocacy early in the year before actual commencement of CDTI activities and subsequently during implementation of CDTI activities. This was done to ensure that the project gets the needed support toward sustainability. The advocacy objective was to solicit for early approval and release of funds, and gain political support to programme implementation. Advocacy visits were made to policy/decision makers in the six endemic local government areas. Persons mobilised to support CDTI implementation include Chairmen of the six LGAs, Directors of Primary Health Care Services at the LGAs, Councillors for Health and Information Officers at the LGA level were visited. The outcomes of the advocacy were; all the policy/decision makers at the LGA level and most of the community/traditional rulers promised to ensure that communities were distribution Completior month May July Aug July July Septembe Mobilization of communities Training Census/Update District/LGA Startingmonth Completion month Starting month Completion month Starting month Completion month Starting month Bagudo March March July July January February May Danko Wasagu March March July July January February May Fakai March March July July January February August Ngaski March March July July January February July Sakaba March March July July January February July Zuru March March July July January February August TOTAL 18 compliant to treatment. There was high compliance to treatment as the number of refusals has reduced as seen in the table 7 . The state also supported the project office with monthly stipend of $333. 2.3. Mobilization, sensitisation and health education-6f at risk communities Provide idormation on The use of media and/or other local systems to disseminate information Types of IEC materials used Mobilization and health education of communities including women and minorities Response of target communities/village s Accomplishments Suggest ways to improve mobilization and sensitisation of the target communities Information on CDTI was disseminated to the endemic communities through the use of posters and use of distributors (CDDs) in collaboration with community leaders during community meetings and town criers. Religious leaders and Islamic scholars were used to mobilise the people in mosque and Islamic schools. IEC materials (500 posters and 50 flip charts) were also used extensively to disseminate information, health educate ahd mobilise communities. Endemic communities were mobilized and health educated annually based on need. During the year under review, targeted community mobilization was carried out to address problems identified during monitoring/supervision by front line health workers. The communities have continued to demonstrate good knowledge and awareness of CDTI and response during mobilisation, which has been encouraging. This is demonstrated by the performance of their roles and responsibilities and the request for their drug for annual treatment. The response in the provision of incentive for CDDs has continued to be poor despite the repeated mobilisation and sensitisation. However some communities have duly supported their CDDs. The programme has not use the radio jingles for sensitization yet but plans to do that. r9 icULGA Number of communities/villages with community members as supervisors Number of CDDs Number of communities /villages with female CDDs Tota! no. communities in the entire project area B. Number with community members as supervisors B{ Percentage Be= BJ B. *100 Mate CDDs B? Femele CDDs B, Total Bn= Bz*B' Number of communities with female CDDs B, Percentage Brr= Bt,t/8.* 100 Bagudo 30 17 57% 2t0 6 216 6 t8% Danko Wasagu 83 29 35% 330 t2 342 12 t4% Fakai l4 ll 79% 99 2 l0r 2 t8% Ngaski 37 21 73% 240 3 243 3 8% Sakaba 30 25 83% 110 8 ll8 8 21% Zuru 10 8 70% 't6 4 80 4 40% Total 204 116 57.h 1,065 35 1,100 3s 17"/" 2.4. Community involvement Table 4: Communities participation in the CDTI (Please add more rows if necessory) Comment on: - Attendance of female members of the community at health education meetings - In general, how do you rate the participation offemale members of the community meetings when CDTI issues are being discusses (attendance, parttcipation in the discussion etc). - Incentives provided by communities for the CDDs - Attrition of CDDs. Is attrition a probletnfor the project? If yes, how is it addressed? - Other issues Female attendance to community health education has not improved. This is due to the lslamic norrns and culture that prevents women from freely mixing with males, though few old women and young girls attended meetings. Loudhailers were used to ensure that the females in purdah are informed about the programme during mobilisation and sensitisation. Also health workers sensitised the women when the attend antenatal and post natal visits in the clinics. Attendance and participation of women in the discussion and implementation of CDTI continue to be poor again due to the Islamic way of life that does not allow free mixing of opposite sex. Compensation to distributors has continued to be a problem in some communities. These incentives are not provided in some communities and where they are provided, they are not regular. The project will continue to sensitise communities on the need to provide incentives. t 20 CDD attrition was an issue of concem too; this was as a result of non-incentives to the selected distributors and migration to urban areas to seek for menial jobs. However there are CDDs who have been in the programme for quite a number of years and have continued to serve their communities without asking for any form of incentives. The project has continued to request communities to select new CDDs in a situation where attrition is found. Local goverrunents are also encouraged to use CDDs for all health and development prograrnmes in the communities. For example they should be use as guides during National lmmunization Days so that they get some incentive. The provision of incentives for other community based health prograrnme like the National Immunization Programme while none is given for GDTI is not helping incentive issue. a t 2t 2.5. Capacity building - Describe the adequacy of available knowledgeable manpower ot all levels - Where frequent transfers of trained staff occur, state what the project is doing, or intends to do, to remedy the situation. (The most important issue to describe is what measures were taken to ensure adequate CDTI implementation where not enough lmowledgeable manpower was available or if staffarefrequently transfen'ed during the course of the campaign). Since the inception of APOC support for CDTI activities in Kebbi State a good number of human resources have been developed to meet the needs of the prograrnme and ensure success towards the control of Onchocerciasis. In 2008, all health workers in the endemic LGAs were trained on CDTI so that transfer of staff will not affect the activities in the area. In the year under review, two coordinators were transferred and, the programme lost one Coordinator. These were replaced and trained and programme activities continued in these areas. i t 22 ca c.l l\.t\ \l(-) 4q) \ q) a)\ I $J' > ! B a) a)4 q) \) \ q)\q): Iq q) q) \ o' 9L L s) : S- bo o -\ !q 4q) uq) ? r* a)L t q) CJq) U o (s () tr-(,) o. F Q +< o (/) (,) o C)L .() q-l o (B bo (dLF .iir ,l -ol(dl FI o s s E o B o bo -i o *p t oU t o\\ o Bt .\. o< ." z ; ah (J! lr q) -E! z (ll + - S.!qv N al a] al c..l N N C\ ON O(..l c.l O(\ N a'l r-- al al : l,a st-r- q) q) 0) o <l -tst?r, al c.) (..l o.l a..l c.l ia\o o ah 0) 'e rqa 6JF 2az *U =l- z * Gll v S,iqv zv UF O o t----. O s 0) o q,) (,) o o 0) OEC)q) dL6)- !ij 0,) z E.r?F-u' U0< z O O O rl t N I 0) o c) (J \o in F-U c\ O t o Fl$z(Jc) ;'e +.EOG 6o& z E,rfF-(j * .t, q o O O ia t sta € I q) o) QJ c) s UF \o J o n oE bo(! ca oo0 -iz (!a0ESAf !cdfrr !o(o 00 z d -o cdv(! a L N -l F o Fr
ra) C\ W1 a) \i(.) u q a) :\ .L l$itu': t]\ I o q) -o q)\ U. B q)\ \ L \q): a)q) o\ o I -a >uq) U\ q) SP$CSc) LH\trBo hO \oq)-c Qrj qi -l o tr Itl q, "j 'i*(] ? .>. 9'A =9 ?3 .9oa,t o q,)0.J €llgEo ,ta €5o ao ?E IEoE)ar^ -eq ==.9!EEI e'a .ts l)o 6bF ql' rF7)oEtEq) 9OEg >)() Etr5slo 6?Q.3 -P .sIxf 0 I EI OF FO q() o 6l F C) t= o)cd O0 FoE9E =rjE3 XE -o)o- }Eo0) FIr A (ts c) o oo(d?)trr!s<Zu) z v) O 2 a o o 0) oo d d a a (! d (d (d oo L B E oq 0)& E C) (d G, o ooo(t aLo rLl V) .* t'. Lq) bo \ v s. -p' bo L \ o\q) LL c) q bo s\ () c':..'0)x _vxs+L^. €s =:hOatrq; cd .S liPQ) o\ o+l >. F,tF.- .i:r ol -ol(dl FI 2.6. Treatments 2.6.1. Treatmentfigures If the project is not achieving 100% geographical coverage and a minimum of 65% therapeutic coverage or the coverage rate is fluctuating, state the reosons and the plans being made to remedy this. In the period under review the project attained 100% geographic coverage with a therapeutic coverage of 82oh. The project in the past year reported having 202 communities, but during entry of community names as a basic parameter for the new APOCBase software for data entry, 204 communities were verified to be the total number of communities in the six endemic LGAs, this is as a result of some sections of communities are now treated as communities having their own community household treatment registers. 26 tr-N tqJ ts\$!J OO ,s\\q,t U\ a E .s ts q) 's \LSa-Xs) s'stJ->s bo '{l -a -t .iu a{ !\ Sqrt.a:s!- = _q);-' ' =Y :N) P: -sdl Olr(,6i E S qJH E!'P6 S8r .g .s'n'S o' h =t--li x *s'o- '*! r o E: St \s i: IEr'ot .= I.E")ol -C - * c) ;l E isi d r i:!El S/ %':! qrgI I E€* rlE s iigl 6 S RIr': :l r Ii: €lg st rEts xti ''')--SJqjE $IH.E E:Sll d U,SrsI E$sI S ^-vAu r.iEe +t $H. T:E. E E. i sS6E S.SS =b €EE9€ 8sE o = ss:ts: rr rr So;r E s9 !sf, \s8 (n c)tr Io() 'a .!(g 0.)Lo) €9()e().= .F LV6 \-l2() r'l €a - =-oI U - a.; 0)P- .= c) LV -a EU) ^()oe .e 'E)E OI E(l) ol =-o -l EE "l 8 * El.c o- dttr .n ggA olC,at x olo olol o.r oll ,r ol :l E sl E -l crJ.= Il X ,:l .=9l oo 3l= gl U EI 5 :EI E EIH9l .! rl - !l v o.rl - =l tr ol tEIE EIh EIU ot .= trt : ot tr8lH 8tE rlE rxl = q-l * t-l Iol p. ol E ol- rl O rl !f ul 'ol o- ol c ol= -ol _ -ol - -ol ::EIE EIS EIE =lO =lo =1trzt? zt? zt< 0)l hrl EI 0)l el ol -tdlol .cl ol cdll<lb{ ot c)l s trl cdl ,.r I EI (t)l ol cdlkl(Dl -al9l hd cl !l =tol EI ol :l €l .gl)l EI ol r&l -:\ qq q) Qq) 4i o\ t q)q q) 5 J4(/) Lr (d V)d(l) li(B o Fl o Lr u) E >. .o U) rl] a (c C) (! 0) liF r'-l orl -olcllFI o(! L obod^bs></ oo F o L o)bo(B (.) oo Ua .- \-E- cdk00 o() o o G! q) oo(o L 0) oo t-E5o o.dL(l) F .= : O-ij -6a.^^-!.i\r=?Ij-{E;!*{ C e Et B-E€5 I E 6 3q P;z Y= e 4)a tr o< ! (/)Z EH =voz-o N\or) \o$ €C. N c- (\l 6 ,:-acE*5ei,.Y o\ ra o (s ao O. I ll *\o o POJooo(€oL oo -EoF o\(-.l oo -o o\ ca oo o\ oor- \o @ t-- o\ .+ oo .o o\\o @ s6t € o =! -o;o LO:Y , o.gZ* to @(a) \i6l \o \o^ oo(r) o\tr) co tr) oo c'r oo ca F- \o tr-\o c.l tr-(t) ra ia o\ =od o.= < 9PFU o\q \o N ca ta) c\ o\ ra, r-$ o\ ca\o c\ $ (\ oo o\rn car-$ ca €\o6l € o\ 5 9oEEgXES -oE;=g IF o-o; E dK ooE r-s 6i c-) Ot c.) ra) r- o\ oo oo ao6l ol$ ca Ir- rn co -+ ?o ra 6(n(\l lr) c) b0(d (/) o t oO ll-.- =o,, EoOA6F'b 50> doo \o \o 1.Oo\ \oo\ o\ o\ o oO o'= E}E =E!z oo ca N oo $ cr a.) ca t N ?a d o.= c d.: < 9P'F\J ca c.) oo + r- ca ca t (\I (Hocko'E.; x.9+ tr u o Z,E H _c = so€<g 9ali tr-= 9: d Ltr=Oo oE ca ca oo .+ (-- ca ca t 6l .9< av o a bo(€ EA o bI) *3HSA* d&(d T! J4 U) cd b0 z (€ .od J4(d U) Lr N Fl lr oF oa a a 2.6.2 What are the causes of absenteeism? There is always a high migration of male youth and some heads of households to urban settlements during the dry season to engage in petty trading and other unskilled professions to eam a living. They however retum to their communities in the rainy season for agricultural activities. Kebbi state is home to most Fulani herd. The nomads around endemic communities do move southwards annually for pasture for their animals during the dry season and return in the rainy season, which of course they may settle in the initial point or make a change. This is rampant in Bagudo LGA. There are also people who have to go to schools in other towns/communities and only come back to their communities during vocation. 2.6,3 What are the reasons for refusals? Religious belief and norms, but this is now minimal 2.6.4 Briefly describe all known and verified serious adverse events (SAEs) that occurred during the reporting period and provide (in Jable 8) the required information when available. In case the project did not have any cases of serious adverse events (SAE) during this reporting period, please tick in the box. No SAE was reported 28 o\N q) !\ q) o'\ "a \ q * z L's ta\i S a1 $\ s \ ti q,r a_ Lq) u0 L q) L q) bo L q) LL o() G v) f-l a t) q) q) (l)0liq) G ra Lq) ra thq) uh Q 6l ol .al clltrl =Eeo'= k9;o <.E E L ;30BE.= c .-=(d(goi,^ 6:f 5iEcr! U'6 o ot .2E2oEg9p =\)L,, o- O+ q.o ^ 6.= 0)o-c tr&.3 ; dGq-l;o- o 4< al e E EE cB@OoO E,hq9 o ';6! vaEL' o'=== ^9ud obO S* c@.: (c -c (.).NE€ B; o<i .Jt-oz o o. a trE;:o _YL o =o l-.1 o cU (d N ()E o()>*9-(o(€aB o)':1,oo.:!(!r ao X c)a 0.) bo * 4 V)
F = o() r 66 r r rr d t a-a F U.\-<3- r 66 6 oo 6 s 6 r6 rr F I r 66 66 r rr i=2- ro r6 € 6 6 @ a r ro 6 6 aN. E9 F=q -Fo o o^ N- r r oo = a o r o o. o h o 6 r o I r oo- co s =oo : nc s:o>,, -o d<< =d a 3:I EE o a- r a @\ro o_ 6 o d-r r o 6 o) ar o) o- 8 I Sa 6 o 5 a r o g a- Ig oo oo o oo oo 6 a6 ro soI oo oo !=sE ; E? ! z3d I o 6 o o o N E;!r oo o o o oN 9 9p E (.) ?t; +* = = c< =@E?893 a o =N o o d d r66 6o 6 o o oo N o o a oo o roo N o 6 8 oo D C € o ( t> o € st * € D o 6 E d o. ES L:T =\ EO :o AL EL o-: irE r\ o cglEStL=lLEI E5l >oou 6> -OEo EL o-L' Far ';rl.i ol .1 _€tdFt a 6
2.7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - Qtlease tick the appropri, MOH tr WHOtr UNICEF N ate answer)NGDO f] / Other (please specify) Mectizan@ delivered by - Qtlease tick the appropriote answer) MOH f] WHOtr UNICEFtr NGDO f] / Other (please specify) Please describe how Mectizan@ is ordered and how it gets to the communities Each of the LGA Coordinators compiles the Onchocerciasis treatment report and Mectizan@ used in their various endemic communities and submits it to the State Onchocerciasis Office. The quantity of Mectizan@ tablet required by each community for the next year treatment round is based on total population of that community after the previous treatment round (distributors do update census while distributing) and multiplied by three (x 3). This is then collated at the local government level and sent to the state level then to the supporting NGDO (SSI) which in-turn places order Mectizan@ to the project through NOCP to Mectizan@ Donation Programme. After approval by Mectizan@ Donation Programme, UNICEF thereaftqr takes charges of the Mectizan@ clearance after arrival from the airport and its storage before collection by the supporting NGDO (SSI). The state then receives its own allocation based on the total number of people to be treated likewise the local governments and all the endemic communities at agreed points of collection. At the community level the first line health facilities receive and store the required drug for communities within their area of supervision. Communities are then informed to send their distributors/representatives to collect their Mectizan@ allocation after pre-distribution activities have been concluded. 33
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