Ekiti State CDTI/APOC project annual project technical report submitted to technical consultative committee (TCC): from Jan 2007-Dec 2007

II I I 1 I EKITI STATE CDTI PROJECT I COUNTRYAIOTF: Nigeria Proiect Name: EKITI STATE CDTI/APOC PROJECT Approval vearzl999 Launching year: 2000 Reportine Period Month/Year):JAN 2007- DEC Z0O7 Proiectyearofthisreport:(circleone) l2 3 4 5 6(7) 8 910 Date m itted : January 2007 NGDO partner: UNICEF ORIGINAL: English rlz 1 lC( llo a I rl cs-b b? AHe Bft Fo otq *- . ,-n .)'n Aor A{ttrS . rl. S^tco^a tl i, I '.. I i! i t t t t I ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) DEADLINE FOR SUBMISSION: To APOC Management by 31 January for March TCC meeting To APOC Management by 31 July for September TCC meeting AFRICANPROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) I 2 I I I I I I I I I I I I I I I I I ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) E,NDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: Country: _NIGERIA National Coordinator Name: ...Mrs.. P. Ogbu-Pearce Signature: . Date: .3P* 5gr*r.'. .?o-o / NGDO Name:. Designation Signature:... Date Zonal Oncho Coordinator Name: Otunba A O Jaiyeoba Signature: . Date 3L3"('tl This report has been prepared by Name : Mrs C. O. Ogunbiyi Designati on :€TIF-€ . .m ^b t NF DR Signature : Date . 3#..4.O..v .:*p> Table of contents Acronyms Error! Bookmark not defined. Definitions FOLLOW UP ON TCC RECOMMENDATIONS Executive Summary Error! Bookmark not defined. SECTION 1: Background information l0Ll. GeNBRal rNFoRMATroN................ ................... l01.1.1 Description of the project (briefly) ..........101.1.2. Partnership .........121.2. PopularroN ............... 14 SECTION 2: Implementation of CDTI 162.1. Tnaplnrs oF ACTrvrrrES .............. .... Ennon! Booxuanx Nor DEFTNED.2.2, ADVoCACY Ennon! BooruaRx NoT DEFINED.2.3. MosrLlzatloN, SENSITIZATIoN AND HEALTHEDUCATIoN oF ATRISK coMMuNIrrps l92.4. Couvtxlry rNVoLVEMENT............ .................212.5. CapactryBUrLDrNG............ 7 8 2 6:4 Briefly describe all known and verified serious adverse eyents (SAEq that....30 2-6.5. Trend of treatment achievementfrom CDTI project inception to the curuent year322.7. ORoERtNc, sroRAGE AND DELIvERy oF TvERMECTIN ......... 332.8. couuuNrry sELF-MoNrroRrNGaNo SrargHoLDERS MpprrNc ...........362.9. SuppRvrsroN................ ................. 3g2.9.1. Provide aflow chart of supervision hierarchy. .......... jg2.9.2. Whot were the main issues identified during supervision? ........... -rg2.9.3. Was a supervision checklist used? .......................... ....................392.9.4. What were the outcomes at each level of CDTI implementation supervision? 39 2 9 5 Was feedback given to the person or groups supervised?............._... .............402.9.6. How was the feedback used to improve the ovirall performance of the project? 40 SECTION 3: Support to CDTI 403.1. EqumurNr ...........40 ...........41 .,,.....'..43 ,......,...43 3.2. FrNaNcral coNTRTBUTIoNS oF THE pARTNERS AND coMMuNrrrES 2.6. TnnarupNrs...... 2.6.1, 2.6.2 2.6.3 Treatment figures ........... What are the causes of absenteeism? What are the reasonsfor refusals? ... What were the recommendations? . How have they been implemented? SusraNagILITy oF pRoJECTS Planning at all relevant levels Funds........ Transport (replaceme nt and maintenance) 24 30 30 30 Error! Bookmark not defined. MoNrroRrNc; EvaluarroN ............ ........ 44 out during the reporting period? (tick any 3.3. OrHpR FoRMS oF coMMUNrry suppoRT....................3.4, ExppNoIruRE PER ACTIVITY SECTION 4: Sustainabitity of CDTI 4.1. IuroRNar-;TNDEeENDENTpARTTcTpAToRy 4.1.1 Was Monitoring/evaluationcatied of the following which are applicable) ............ 4.1 .2 4.1 .3 4.2. Yn 3)... 4.2.1. 1)) 4.2.3 4 4.2.4. Other resources... ..................454.2.5. To what extent has the plan been implemented......... ...................454.3. INTEGRATToN ............... .................454.3.1. Ivermectin delivery mechanisms .. ... .......454.3.2. Troining ..............464.3.3. Joint supervisionandmonitoringwithotherprograms..... . .........464.3.4. Release offunds for project activities ......464.3.5. Is CDTI included in the PHC budget? .....464.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? ............. ..................464.3.7. Describe others issues considered in the integration of GDTL .....46 4.4. OppnarroNAl RESEARCH ...................46 4.4. L Summarize in not more than one half of a page the operational research undertoken in the project area within the reporting period........ ..................464.4.2. How were the results applied in the project? ............. ..................46 SECTION 5: Strengths, weaknesses, challenges, and opportunities4T sECTroN 6: Unique features of the project/other matters Error! Bookmark not defined. 5 Acronyms Treatment ective ective Distributor Directed Treatment with Ivermectin SM IEC Inform Education and Communication Government Area Onchocerciasis Control Team MDP Mectizan Donation of Health DO on-Governmental Deve National Onchocerciasis Control Team ational Onchocerciasis Task Force health care id of Onchocerciasis adverse event SHM takeholders OH of HealthState SOCT tate Onchocerciasis Control Team echnical Consultative Committee scientific TOT Trainer of trainers LI-NICEF United Nations Children's Fund UTG Ultimate Treatment Goal wHo World Health 6 APOC African Programme for Onchocerciasis Control ATO ATrO CBO Community-Based Organization CDD CDTI Community Se lf-Monitoring LGA LOCT MOH NGO NOCP NOTF PHC REMO SAE ICC Definitions (i) Total population: the total population living in meso4ryper-endemic communities within the project area (based on REMO and census taken). (ii) Eligible oopulation: calculated as 84%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 tobe treated annually in mesoftryper 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 i.d year ofthe project). (v) Ther4pqutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). 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). (vi) (vii) Integration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) through CDTI (using ih. ,ur. 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-monitorins (CSM): The process by which the community is empowered to oversee and monitor the performance of CDTI (or uny .o.runity- based health intervention programme), with a view to ensuring that the programme is being executed in the way intended. It encourages the community io tut" frtt responsibility of ivermectin distribution and make appropriate modifications when necessary. 7 FOLLOW UP ON TGG REGOMMENDATIONS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session 25 Number of Recommend ation the in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY Ensure good record keeping through training and supervision of CDDs as well as provision of good registers - CDDs were trained and re-trained on record keeping. - CDDs were supervised by health staff at various levels. To improve supervision more FLHF workers were trained and involved in the CDTI process. - A few LGAs provided good registers. At an appraisal meeting it was agreed that SOCTs and other external persons are to be used to advocate to LGA policy makers for the production of registers, reporting forms and posters. - The assisting NGDO, UNICEF, will be approached for the of more Identify an effective stratery for ensuring regular and timely release of State and LGAs funds to CDTI Activities. - Advocacy visits were paid to both the State and LGAs Policy Makers on regular and timely release of funds to CDTI Activities. This is routine. - Letters were written by the Zonal office to both the State and LGAs for the release of funds for CDTI activities. -The Project plans to seek support from members of State house of assembly who will put pressure n the executive arm to release funds. - There is also an intention for a high-level advocacy visit by LTNICEF and NOCP officers originally scheduled for 2007 but now rescheduled for 2008. For this an advocacy fact sheet is being prepared in collaboration with intensified to NOCP HQs. - Efforts are 8 sensitize and mobilize the policy makers in the department of Local Government & Chieftaincy Affairs that have oversight of the LGAs. Focusing on training new and many CDDs. The current ratio of I CDD per 661 peopte is unacceptable. - A total of 1,083 new CDDs were trained in2007 making a total of 2,677 CDDs. The current ratio of CDD to population is now 1:400. - An additional 1,600 CDDs is expected to trained in 2008 with support from LTNICEF. (Please add more rows if necessary) Executlye Summa4y Prepare an Executive summary of the report in not more thsn one poge Ekiti State is one of the States in the southwestern part of the country and is located in the B Health Zone.It has a population of 2,384 212 [according to 2006 census]. There are 16 LGAs in the state, all of which are endemic and implementing CDTI. The main indigenous population that constitutes overwhelmingly the major ethnic group in the State is the yoruba. Individuals from other ethic groups such as the Fulanis, Igbiras, Agatus, Hausas and Egedes have migrated into the State and are cohabiting with the indigenes. Christians form a high percentage of the population of the State, so population movements always take place during religious activities or celebrations like Christmas and Easter. Moreover, there are population movements during Muslim celebrations and during the farming / harvesting season. Closure and commencement of school periods also brings about some population movements in the State. During these periods, there is a seasonal migration of people from one place to another. The prevalence survey of 1988-1990 and the subsequent REMO of 1994 and 1998/2000 revealed that the State is endemic for Onchocerciasis. The total at-risk/ target population with the recent census update is 1,070,681 in 422 communities with an UTG/ATO of 899,357- Treatment commenced in the project area when it was still part of the old Ondo State with assistance from IINICEF and NOCP using the CDTI approach initiated in 1999. The project trained and retrained 8 SOCTs, 32 LOCTs, 858 Health workers and 2,677 CDDs through assistance from both APOC and LINICEF thereby achieving 84yo overall for its training objectives. 422 communities were mobilized to select their CDDs and collect 9 mectizan from designated points. Current CDD to population ratio stands at I CDD to 400 persons. A total of 805,578 persons were treated in 422 communities with 2,223,852 mectizan tablets for the year under review, thus giving a geographic coverage of l00o/o and therapeutic coverage of 75%o. The number treated represented 90%o of the ATO and UTG. Major policy makers, NGOs/CBOs representatives and community leaders at State, LGA and community levels were mobilized in various advocacy meetings to support CDTI implementation in the State. However, only a few LGAs released counterpart funds. The major challenges that faced the project were inadequate release of funds both at State and LGAs levels, poor census update, inadequate numbers of CDDs for distribution of Mectizan, inadequate numbers of health workers involved in the CDTI process, demand for incentives by CDDs in many communities, inadequate number of motorcycles/bicycles for supervision as well as inadequate, and/or ineffective, supervision particularly by the frontline health staff. The challenges were addressed through training of more CDDs and health workers, delineation of areas of supervision for all LOCTs and FLHF staff trained, collection and collation of community data with support by APOC and building of a data bank at the State level, mobilization of more CBOs/lrlGOs to be involved in the CDTI process, sensitization of some community leaders by SOCTs, LOCTs and UNICEF and continuous advocacy with policy makers. SECTION {: Background information 1.1, General information 1.1.1 Description of the project (briefly) Geogrophical locotion, topogrophy, climate Ekiti State, located in the southwestern part of Nigeria, was carved out by presidential fiat from Ondo State on October 1996.It covers an areaof approximately 5,500 square kilometers while it has a bio-climate of rain forest in the southern area and Guinea Savannah in the northern parts. A greater percentage of the landmass is made of rocks and mountainous regions. The rains commence in April and end in October, while the dry season starts from October ending by March. l0 Populatio n activ ities, c ult ures, lang uage The Yorubas constitute overwhelmingly the major ethnic group in the State and it is mainly the indigenous population. However, individuals from other ethnic groups such as the Fulanis, Igbiras, Agatus, Igbos, Hausas and Egedes have migrated into the State and are cohabiting with the indigenes. With a current population of about 2,384,212 according to the 2006 census, the State is divided into 16 LGAs. Settlement pattern is compact with population densities of between 280 - 350 persons/ square kilometer. Farmsteads exist but are seasonal. Communication qtstem (road.. ) Roads between major cites are in good condition, but access roads to most of the endemic communities are very poor. Some are not accessible during the rainy season. Despite this, transport by road remains a major means of communication among the communities. The electronic and print media are also veritable channels of communication. Within the communities the town announcers and announcements in churches / mosques communities meetings are preferred means of communication. Administratio n str ucture The State is made up of l6 administrative units known as local Government areas. Each LGA is headed by a Chairman, usually elected, whom career officers assist. There is a legislative arm made up of elected councilors from the various wards that make up each LGA. Beneath the ward levels are the communities. At the State level, the Governor is the chief executive, assisted by an executive council made up of commissioners in charge of various ministries. There is also a legislative arm comprising elected persons from the LGAs. Health system & health care delivery (provide the number of health posts / centers in the project orea if the information is avaitable). There is an official PHC policy and structure in the project area. It is a system of health care services where community participation forms the mainstay with support from the State, Local Government and NGOs. Levels of functionality however vary across the State. Scattered throughout the State are various health facilities ranging from health posts to hospitals. There are 552 health facilities in the proje ct area. t1 Number of heolth staff in project area and number of health staff involved in CDTI activities. Table l: Number of health staff involved in CDTI (Please add more rows if necessary) District/LGA Number of health staff involved in CDTI activities. Total Number of health staff in the entire project arca Br Number of health staff involved in CDTI B2 Percentage Br=Bzl Br *100 ADO 137 50 36% EFON 7l 56 79% EKITI EAST l3r 49 37% EKITI SOUTH WEST I 5 I 66 44% EKITI WEST 84 63 75% EMURE 9t 30 32% GBONYIN 97 53 55% IDO/OSI 93 40 43% IJERO 219 84 38% IKERE 210 76 36% IKOLE 105 54 5t% ISE/ORLIN l0l 35 35% ILEJEMEJE 143 59 4t% IREPODUN/ IFELODUN 75 4t 55% MOBA 138 54 39% OYE 106 69 65% TOTAL t 952 879 45Y" 1.1.2. Partnership Indicate the partners involved in project implementation at all levels [MoH, NGDOs(national/international), communities, local organizations, etc.J The partners involve in the CDTI project are MoH, Apoc, wHo, Nocp, UNICEF, LGAs, COMMTINITIES. t2 Describe overoll working relationship among partners, clearly indicating speciJic areas of proiect activities (planning, supervision, advocacy, planning, mobitization, etc) where all partners are involved. The State and LGAs through their various teams are involved in training of field personnel, community mobilization & health education, planning and management of project implementation, supervision and monitoring, Mectizan procurement and delivery, and report writing. APOC funds the training, mobilization and Advocacy, production of programme materials, and procurement of capital equipment (Generator, Photocopier, motorcycles, bicycles). The WHO helps in procurement of capital equipment while UNICEF assists in the training of Health workers and CDDs, sensitization and mobilization of NGOs and CBOs, and supervision. LINICEF also assists in the clearance of Mectizan from the sea port. The Zonal and National Offices assist in supervision, monitoring, training, advocacy, distribution of capital equipment, Mectizan procurement and evaluation of the programme. LGAs help in provision of health personnel and some counterpart funds for the programme activities. The communities play such roles as selection and remuneration of CDDs, collection of Mectizan, determination of mode and period of drug distribution, census update, Mectizan distribution, recording and reporting of treatments. State plans rf any to mobilize the state /region / district /LGA decision -makers, NGDOs, NGOs, CBOs to sssists in CDTI implementation. Policy makers at State and LGA levels were mobilized during the course of the year. Some market women associations, National Union of Road Transport Workers (NURTW), and some NGOs/CBOs, were also sensitized and mobilized to support CDTI in the State. Such NGOs/CBOs mobilized with support from UNICEF were Environmental Development and Family Health Organisation (EDFHO), Prevent AIDS Society (PAS), Society for Women and AIDS (SWA), Business and Professional Women, Justice Development and peace Commission (JDPC), Center for Environmental & Community Development, Family Heritage International, Life Center Foundation, Kid & Teens Concerns, Life and peace Dev. Organisation, and Busy Bees. 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H I >L.,1 =e -^-- -sPPE!'-v-^E< E H#f sE9, P3H= I EX qHrH< - o)A _ .r, _y, LJ'- () o =B E =- o':-E u?:i i E sd -!l -^ O.r -7 Ef$ 4 o>6i .= tE€ o .= u, =-6 (dA."-iI I=EX< s =eoE^ Pt*rr ig^Av*E -E eX-<tE o-'= F.= .. c --E t'E I EE O HE Oi B E:5E E b 3,EE e B'E F * qpl'E ILv9^ .iHva Et3:zOf!€>s 98 E Ecl \Fl^r =E :"35-8ETH! ==>,oe = c*tsd' o o.ti512lraA.-4o d b{)5 -} -J.2i; 6{c 9 €,) J a arE .E EJE E, € €gBs(,)EdOo)GI=C)Etr = sE 95CI!.EE(:(, = ;HEbE6) -BRo9E .e.= I3 E .i EsReE .E EEU s Ic) iF.cs 9ft EEE.:E + E E # €q (-) rl.] o U E] o (J tr.l ! a o. Lo U r o UI! Oul ! rF Od z Qd 2 L)& z J D J D E] zD r! zD q.l zD o z -z z J e -.] J & F O z Od z O& z D z & D z d D z z) o I z \J e& ca z ql 2.2. Advocacy State the number of policy/decision mahers mobilized at each relevunt level during the current year; the reason(s) for undertaking the advococy ond the outcome. Describe dfficulties/constraints being faced and suggestions on how to improve advocacy. The top functionaries at the State level were mobilized by NOTF/APOC/LTNICEF representatives during this reporting year. The Hon. Commissioner for Health, Permanent Secretary and the Director of Disease Control mobilized the Commissioner for Finance, Commissioner for Local Government Affairs and the Honorable members of the State Assembly, so that each LGA can contribute N250,000 for CDTI by opening an account for Oncho programme as a first step towards counterpart funding and N10,000 for monthly imprest. 155 The LGA policy makers, 6 officials of the Ministry of LG and Chieftaincy Affairs, and thel6 Chairmen, Local Government Service Commission were also mobilized to support CDTI activities. The 4 LGA Zonal supervisors also followed up on this and it has resulted to the release of counterpart funds by the following LGAs: Ilejemeje (N5g,000), Gbonyin(N20,000), Ido/Osi (N100,000) and Ekiti South West (N100,000). The tunds were used to support training of CDDs and production of some treatment registers. Other LGA Chairmen promised to release some funds in 2008 Meanwhile, despite all efforts made in the reporting year, the 1 million approved by the State government was not released. At the community level these groups of people are mobilized: LGA Traditional Rulers Opinion Leaders Religious Leaders Market Women Grps Other CBOs Ado Ekiti 9 8 7 t2 J Efon 6 J 4 5 Ekiti East l5 l2 7 20 5 Ekiti s.w 9 t4 6 9 Ekiti West 8 7 9 l0 Emure 5 5 l3 8 I Gbonyin 7 8 l5 l0 2 Ido / Osi 8 t2 6 9 [ero t2 23 8 l2 Ikere 7 6 6 il Ikole l0 t2 7 t4 Ise/ Orun 6 7 5 aJ Ilejemeje 18 1l 5 t4 Irepodun i Ifelodun ll 9 6 t2 Moba 58 24 J 6 oye t2 6 7 8 Total 201 167 lt4 163 t2 l8 WHO/APOC, 24 November 2003 With the mobilized figures above, there is still a problem with the provision of tangible incentives to CDDs by the community leaders thereby leading to continuous request of incentives by CDDs. Even the traditional leaders are expecting incentives from the Government. The major constraint in achieving desired results is the rapidity in changes of policy makers at the LGA level. At the State level, substantial funds can only be released by the chief executive. Though several memos have been written on the need for counterpart funding, a face-to-face meeting advocating for such has been lacking. To improve advocacy a 4-year workplan and an advocacy fact sheet have been developed to be presented to the Executive Governor during a planned high-level advocacy in 2008. This plan will also be presented to the Hon Commissioner for health or other policymakers in the State so as to ensure the approval and release of funds, and secure commitment possibly for a 4-year period. The project will continue to seek for influential persons (members of the State legislature, retired policy makers, etc) who can intercede on behalf of the project to the State's chief executive. Additionally, there will be continuous advocacy visits to the prominent traditional rulers and policy makers at the Local Government level in 200g. 2.3. Mobilization, sensitization and health education of at risk communities Provide information on: The use of media and/or other locol systems to disseminate information Radio has been an effective medium to reach large numbers of the target population. The high literacy rate in the State, broadcast in local languages, the compactness of the State making radio coverage even in very remote communities effective, and availability of radio sets in almost every home makes this medium irresistible in dissemination of information. This was supplemented with face to face meetings with community leaders by health workers. At the community level, information on CDTI was disseminated through community announcers, in churches and mosques, and during community meetings. A few posters were also distributed. Types of IEC materials used Some posters were used but the number was inadequate. APOC approved some funds for the printing of IEC materials but this was not accessed till almost the close of the year. 19 Mobilization sensitization and health educotion of women and minorities - method and response Within the project, there is an active participation of female members of the community at mobilization meetings and during health education sessions. Some of the women have volunteered as CDDs whenever serving CDDs expressed unwillingness to continue due to lack of incentives. Some women have met with community leaders over incentives for CDDs while some gave out money from their personal purse to support cDDs. Response of target communities /villages Communities have responded by coming forth to collect their Mectizan tablets. Members have expressed willingness to comply with Mectizan treatment. Some of the communities have fulfilled only part of their responsibilities under CDTI by selecting additional CDDs. Accomplishments o There is an increase in awareness of the communities of the benefit of Mectizan, and its continual intake over a long period of time. o Coverage has improved. o More NGo/cBos are involved in the implementation process.. o There is an increase in awareness of the roles of partners / communities in CDTI o More females are interested in CDTI programme, and are participating as CDDs. o Support of CDTI project by some LGA policy makers. lVe aknesses / constraints o Inadequate funds to have more interactive sessions with communities. o CDDs and Health workers are demanding for incentives r Perception of some sections of the community that the programme is heavily funded and the community is being denied its fair share. o comparing GDTI programme with NpI on payment of incentives. Suggest woys to improve mobilization/ sensitization of the target communities. o Follow up on the mobilization of additionalNGOs/CBOs, and actively involving them in the CDTI process. There is a plan to do a joint SOCTAIGO monitoring of CDTI implementation in 2008 with support from LINICEF. 20 a Equipping local NGOs, market women, religious leaders, road transport workers and other community based organizations with necessary mobilization skills will help a great deal in improving mobilization of the communities. Inadequate funding to the project by partners have constrained the implementation of this recommendation. Front line health facility staff will be encouraged to hold regular meetings with the communify leaders. The project intends to collaborate with relevant sections of the ministry of information and culture in order to make use of appropriate staff with skills in community mobilization. Efforts wil be made to initiate and expand community self-monitoring and stakeholders, meetings. There should be a continuous sensitization and mobilization of the Traditional rulers, Opinion leaders and the communities. There should be airing of jingles on CDTI project on Radio and Television. Such jingles will emphasize support for CDTI and compliance to Mectizan treatment even in the absence of symptoms ofthe disease. 2.4. Gommunity lnvolvement Table 4: Communities participation in the CDTI (Please add more rows if necessary) a a a a a Num ber of communities/villages with community members as supervisors Number of CDDs Number of communities /villages with female CDDsTotal no. communities in the entire project erea B4 Number with community members as supervisors Bs Perccntage Bc= Bs/ B1 *100 Male CDDs B7 Female CDDs Bs Total Be= Br+f,t Number of communitics with female CDDs Bro Percentage Brr= B,o/B.*100 ADO 22 7 32% 40 69 109 22 100, EFON ll l0 9t% 124 9t 215 ll 100% EKITI EAST 27 9 33% 150 88 238 27 r00% EKITI S WEST 27 7 26% 93 104 197 27 100% EKITI WEST t6 15 94% 80 85 165 t6 100% EMURE l0 9 90% 46 27 73 l0 100% GBONYIN t7 4 24% 71 42 I l3 17 100% IDO/OSI l3 5 38% 92 46 138 t3 100% IJERO 57 49 86% 245 99 344 57 100% 2t DistricULGA IKERE 36 24 67% 125 38 163 36 100% IKOLE 20 5 25% r05 40 145 20 100% ISE/ORI.IN 23 6 26% 43 37 80 23 100% IEJEMEJE 52 48 92% 68 83 1 5 I 52 100% IREPODUN/ IFELODT'N t5 7 47% 83 88 17t l5 100% MOBA 59 53 90% 129 100 229 59 100% OYE l6 l3 8t% 97 49 146 t6 100% TOTAL 421 271 64"/o 1591 1086 2677 421 1000h Comment on - Attendance offemale members of the communigt at health education meetings Female members of the community are allowed by men to attend health Education meetings and are allowed to participate and give suggestions in the meetings. The active participation of the female folk is reflected in the increased number of them that are CDDs. More than 40yo of the total number of available CDDs are females, and as seen in the table above there is no community that does not have a female CDD in place. - In general, how do you rate the participotion offemale members of the community meetings when CDTI issues ore being discusses (attendance, porticipation in the discussion etc). Women are always allowed to participate and even contribute to the decisions during general community meeting. But on special or key decisions on community matters, elderly men are usually the decision makers and women do respect them. - Incentives provided by communities for the CDDs Usually, incentives to CDDs are in kind due to the poverty levels. Some communities give cash since there is comparison with other incentive-giving community-based programmes such as the immunizationprogramme. Some communities are however yet to give any incentive to their CDDs. - Attrition of CDDs. Is attrition a problemfor the project? If yes, how is it addressed? Attrition of CDDs occurs within the project, but the rate is not alarming. Some of the younger CDDs secure admission to higher institutions; a few leave the job due to lack of incentives as 22 they compare the CDTI project with immunization; some few elderly CDDs die; while some CDDs secure jobs and therefore abandon the distribution. Sometimes, the community leaders were mobilizedto select new CDDs and the State presented umbrellas with CDTI printed on them as incentives to each CDD. Other issues 23 2.5. Gapacity building - Describe the adequacy of available knowledgeable manpower at all levels. The available manpower for CDTI implementation is enough with many of them knowledgeable about the CDTI strategy. 351 new Health staff were trained, and made to see CDTI programme as part of their routine daily responsibility.l,0S3 new CDDs were trained to replace those that went away and reduce the workload of the existing CDDs thereby reducing demand for incentives. The current ratio of CDD to population is 1:400 but the project plans to train more CDDs in 2008. - ll/here frequent transfers of trained stoff 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 implementationwhere not enough knowledgeable manpower was available or if staffare frequently transferred during the course of the campaign). Staffs are not always stable. During this reportin gyear, some staff were transferred due to establishment of new health facilities and demands by some communities. As reported earlier in the preceding paragraph, health staff were trained from health facilities to ease the problem of transfers. Replacements were effected and reduction in the area of supervision by each staff ensured. More health workers will stilr be trained in 200g. 24 WHO/APOC, 24 November 2003 e) G U) (.) c) z 6 -= +Fe_i .r o- r-qv ir zv o\ \o v+ c{ cel N @ c.l o\ o\ F- o\ : \o c.l ca \o t F- \o st F- e.l co a oo co F- 00\o +st € coN \o \o c.l\o st + s @ F-(n t-- co o\ OlN c\l F-F- N \ooo caF- e.l Q a.l N N N c{ c{ co € oo \o oo e.l 0 q) .=G cttFr Ltr(ul oq)lH9 r-G6'L z o ,: + *'rqv dl6t IF q) dL =s TH E --- zy 6)I E ,'lt Y { .g'U UE + oo c.) \o \o .+ oO\o F--- $ : *N t----- a.l F- €$ +N c{+ c.l 00 c.l \oI h st e.l \o : c.) + \o F- c.) <t $ N C.l s co + ca a.l r. a.l c.tC.l c.l <f ca I \o \o € € t m c.t .+ @ 00 + N + \o cl U) 0 j 9(u iic q) z iu+ : ,L &,Q U = el c.l c.l c\l N t----. N c{ c.l c.l c! c.l N N N c.t c.l N a.l cl F a'l (\ c{ C.l N a-l N e..l e.l N 6l e.l (\ c.l c.! -] ! z H Fa F vr! Fa trl a F Vr! Fa rr.l F u E] ql & z r! z z F a o L] -& r! E]dr! v E] ..] v z & o E]a trl r! z rrl ql -.] Zz 'JDAOoo+Jf rr)/,8 ca co N L(.) -o Eo o z $N *(J ta) a..l 4q q) Iq) S q: \ \)L o t ! q) aa S o C) c) o F (-)(* 0 (.) () C)L ,9)qi (.) (d oo F ,Hr o)l -otdtFI \o N H U U) c) L L() E oL cl () B GI ,11o q) O clq) o 6lL q)Lq) B ph() o GL .t2Lq) clL L() lbb o: € € o G s $ o tr o oo t *p\ t \ lo ,a g = \o * c.l o\ r-r-\o FI rf o\in o) o () EI s g\ t (.) 6 \o ra ra o\ N 4) c) o o\ 6ia6 Eq) €) () s o\ $ F. ra ta(.) in o\ c.l 6l ?a) () €) c) -\ o 6I al N al?a) l! j tr oF Trainees Type of training CDDs Other Community members e.g Community supervisors Health Workers (frontline health facilities) MOH staff or Other Political Leaders Others (specifo) Program management How to conduct Health education x x x Management ofSAEs x X x CSM SHM Data collection x x x Data analysis x x Report writing x x Others (speci&) Table 6: Type of training undertaken (Tick the boxes where specific training wqs catied out during the reporting period) Any other comments 27 WHO/APOC, 24 November 2003 : EEE;2vA ss * EuTE.E=E I O I rl s_4 =u)AO I I I I I bsstrtq z6 t-r@ co ao o\ oo co F-N \o co trr ra) Nr- $ =f+ NN o\ o\\o N Ee'eE ca \o \ot- I \o coN a-N o\ (r)r- an oo N .+oN +o lt a!o500a d^O-!ro(6 Sro\ oo F E -_EEU E lr-ijj a!z =odo E H.gT .l .Q .o'FU t9 ,H doyE o f E1€ -?.g o.:oE G YE ots o\ cor- o\\ot- o\ o\\o o\ .+ t-r \oo\\otr o\ o\ t-- o\ o\t-- \o 6\ c.l oo -oo\ 00 .o o\ t-- tr- o\ t'- \o o\$Fr .o o\ c{ oo o\ ca t-r t- \o ra) lr) ao 00 aa €+ + o\ ol t F- .+ o\N o $rn aoo\o NF- t ooin r* o\I-r € co co ooo tr- sor- oo$ o\ ra) co ca ct oo 6 o\q € c.t 6 00o o\tr) r- rn \o+ (a) o\ co N co o\ rn $la) o\ oo oq .+\o o ca$ 6 r,- tr- o\ \o col N \o^ $ 00 c..l(a) .{ tn r) +\o\ co \or-t- t.r o\ eo € lr) * =f+ ca otr N$$ ra) \o\o € c.) s o\ !f,\o o\ .+ NF-tr o\ o\co o\ 00 oo s o\ co$ t-- t- F-trr\ rr)\o s co\o^ \o cn lt :Etrt;==*I EE$EE a>'6 .90 -M = 6^ iI 9e\.oo<- doU tsB -q.ts f,i E € EE"fi = E >$ AO o tso d o.= =EElr= o4 93' FL) ar') ar.) o) () o\ \o \o o \o O \oo\ .\ o\O o\ .o o\o \oo\O \o o .o o\ o \o otN t-N rrN \o (-- co rrrn a-ca N caN N1r) N c.l r-N F-N \o F- ca F- F-ca c.l aoc.l N N e{ trrc.l Fc.l \o o t-- ao r- r-co oC\ coN a't ()j ;v o o z trr TJ.] t-Fiav<El frl a F v s.l F MH I! D zH z zoa U) o n o& rI.] rl.]& rqv ir.lJo E zD& rr.la rr.l o rll r.l E] + N () 0) z <f e.l {o ooN -:\ 9qq q) u s) q: L q)\ o t q) Fi sj< 0 rr (o (t) cB() (g \J .l o L t) .o a E,] U) E a0 () € C)t-F r-f ,l -.ol -cnlFI ofl E o Efl G oLF .i N I o\N I I I I ao Nt-- c\l N$ co fa\o o\ 6 o\ c.t o\ \o =ia fa .o o\ co\o \o t-t'r \oo\(n t-- sia r-. t'- oos F-tr t-\o oo c.) co (r) €r-ia ia 6 €\\f]\ol lat € c.) ar o\ co F-1r) F-ia(.) o\ o\6 ra) c.l l1ltrF- co N o\t'r € cnN co@\o 6\o F- \o o o\ \oo\ o ra) o\ \o N6It |r) o\tn \o GINt o\ \o 6lNv Jlrltl. q.ld ca o r! o :] F F Formula for computing therapeutic and geographical coverage Therapeutic coverage rate Number of people treated x 100(%) Total population living in meso/hyper-endemic communities within the project area Geographical coverage rate Number of communities/villages treated x 100(%) Total number of meso/hyper-endemic communities as identified by REMO in the project area ATO coverage rate (%) Number of treated x 100 Annual Treatment Objective %UTG achieved Number of people treated x 100 Total number of people to be treated in meso/hyper-endemic areas within the project area (UTG) ATO = The estimated number of people living in meso/hyper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. UTG = The maximum number of people to be treated in meso/hyper-endemic areas within the project area, ultimately to be reached when the proiect has reachedfull geographical coverage (normally the project shoild-b, "tp"rirrd tu reach theIITG at the end of the 3'd year of the project). 2.6.1. Treatment figures ' If the proiect is not achieving 100% geographical coverage and a minimum of 65% therapeutic coverage or the coveroge rote isfluctuating, state the reasons andihe plans betng made to remedy this. The project geographic coverage is 100% and therapeutic coverageisT5oh 2.6.2 What are the causes of absenteeism? Some of the members in the communities might have gone to their farms or trading places during treatment periods. Unfortunately the absentees are not treated later after the initial treatment. Some non-indigenes travel down occasionally to their hometowns, especially during functions and are missed out during treatment periods. 2.6.3 What are the reasons for refusals? Refusals are not common because the community leaders always intervene. Some of the community members are even eager to use mectizan twice annually because of the benefits of the drug, which they have experienced. however, refusals were recorded because of initial reaction to ivermectin in some individuals such as itching, swelling and pains. 2.6.4 Briefly describe all known and veri/ied serious adverse eients (SAEs) that occurred during the reporting period and provide (in table 8) the required i nformatio n w h e n av ailab le. No report ofany serious adverse event. 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 30 WHO/APOC, 24 November 2004 $ e.l () () z + c.l O - aa q.) !\ q) Lq) -a S L -qJq J+ i- tl r-\ qq q) Qq) %: \ q) L o *S q){SqJ A.v o Lo a. oo t- o a.orr 0) bo l< E E() L ooo a IJ.] a t) C) 0)()(n L C) a o 9zIEUL raO()trL -Egl) a6 .. !rool t()l q) El o?lz o E09E"o= r9;o4CE I Ss.E 60b5.- F 9Eg rI] 5'5 or .9 E^ 910)Y \J O- O* c*Q ai ^ o,= ()()-.c trd3a I I ;6(lri;()- o-6EO() tr E= doooOEa:qE o v qEi' O H-EE I C, €-9oo.N =58tr;flEETE I E a ar9 U L-l ooGl =oNi= 'E.lJ .9!2- o> x o oh.o c =o0?o I xo a (.) oo * U) t I I I I c.l c.) an I CEI o) AD 6l L.q) q) t'r cl tr clt q) q,) ar) cl q) L a0 a, q) an Frin(a o\ o\6 cl 4)L cl q) o) tr o L t'r q) q) c,I q) ah CEq) Pr * F.. o.l >= rl.]= \o rlJO >=[!* F- E] FO .: >\o -: c)\ E = 5-C 9 o!i o-* nE E885S6 H3 € E] bo L .h o-y >xF o;-DQ c.r oo(! LA(Dy> FO\o(O oA (dol.. iE-is.s F O.L, cd;J x ?r?6.s!i qd!a (l)ZoE Fo €! o\ N .o o\ coN -o o\\o co \o o\ =l \o o\ \oo\ oo \o o\\o € \oo\ o\ oo o\\o oo o\ o\ oo 1Oo\ o\ \o o\ c.) .o o\ $ -o o\6 o\N \o o\ € \0 o\ oo \oo\ o\ € .o o\ o\ oo \o \o oo \o A\ o\ oo .o o\ o\ o\N co \oo\ co \oo\ €(-- -o o\s o\ -6 o\lr) c- \o =tt- 6\ F- 1Qo\ ra) tr- o\ ral t-- o\l/.) F- o\ t-- \ot.) o\ .+ oo N oo oo c.) co t- at 6 o\+ ra) ca o\ o\+ ra)+ ral |r) o\(n $ c\ t--+\o o\Ota) Fr co tr- o\\iF-F- oo F- l{-) lr) oo o o$o *o ra) o c.l\o" \o lr_) co ra tr-\lr) +$ o -i: c.l\o rr) t- o\q o\ \o co o\\ot-\o co Fr C.tt- \o rn €^ € € t-- n+\o^ \o\o oo tr- c-) oi o\ oo o\o o o \o € =lvI *N$ €\o o c.t c.) € la) ol\o\o t-- o\q t-- coF- co\o ,rI @ o\r- r-+ oq(r)\o oo !f, o\ c.) o\ Nt- coO €\o or-o * c!r!\o IJ] O * Qo lJJ- c.) E] elI! ,o o ! o ).,YcE Yo {E =LdOO4x E E.3E 3_F 3>>E Efi Hr! h-6E E> 8oEtrE()c6: AOotr>i5 bo AOy> HA\Ot(j,i co 9p bD(€ k a'= < \o\J O-o o;i o(!E: =d o)ti=69 oQ \o o\ t--t- \oo\ c.t 00 \o co o\ .o o\\o oo \oo\ ^\o \oo\ \oo\oo \o o\o \oo\O o\r- r-- \oo\ caa \o o\ c.) o\ .o o\\o oo o\o \o6\ o o\o \o o\ 1Qo\ o \oo\ o\ ra)\o N \o t-.N Nco ra) o\ c.l N $ ta)N!+ al c.l .+ C.l(\ + NNt (\ c'l$ o.lN .+ ++ ca $$ co $ =lco s$ ao N sl a.ts c..lN$ o.lcl+ (\ N+ c'lN\r NN =l $s co $$ co $$ ca =l$ ca N =f, ra) c{$ a.lN+ NN+ c.l o..l+ N C.l .+ NN$ il ri t-o\o\ € o\ o\ o\ o\ o\ N N c.lo 6l coo N so(\ la) oN \o oN r-o (..t 00O c.l o\o ol c.l a €\\) tr!q) q) .s \\ a,)E39e A.P\i(.) :rr G! =q)Ocl Oe -q (.)Pq) .- L ots5S) 0)+r()Etro) :q>o-q()P 'a: LEa. I|rCB -()hh;: LIl,/ cBlEItrtr|ool(li (gt !olEi{ 09"iuE '= c)ti o EE(,)trEdPq e|e olELC) qrtr Et.o o- .LF O\l ,.; qlq€l o.t Fl Other (please specify) Mectizan@ delivered by - Qtlease tick the appropriate answer)r/uoril wHo tr UNICEF tr NGDO tr Other (please specify) Please describe how Mectizan@ is ordered and how it gets to the communities The State provides population data and numbers of Mectizan tablets it believes it will require to NOCP who processes the data after receiving similar information from other LINICEF- assisted States. The population data comes from the census update conducted, which flows from the communities to the LGAs (LOCTs). These are compiled and forwarded to the State. NOCP submits a re-application for the UNICEF - assisted States to MDP. On approval, the drugs are shipped to the country and UNICEF facilitates clearance and storage. The State collects from NOCP while it releases to the LGAs. LOCTs release drugs to the district health supervisors or the health facility staff who in tum make them available to the communities. FLOW CHART OF MECTIZAN DELIVERY 2.7 . Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - Qtlease tick the appropriate answer) r/uog wHo UNICEF STATE DISTRICT TH FACILITY COMMUNITY NGDO UNICEF/ NIGERTA- ZONAL OFFICE. \[ JJ WHO/APOC, 24 November 2004 st (\ Lo -o (.) o z t c.l s ca %qpIq) q: \ q)L t I q) F5 U 5 h (l) @ N (-)() =a .^., -Iot -oldlFI lr) ca u0 r! oil o x TI] o hB HG>a) o D & o o 6) c! B oJ €) €) o €) (l) o c)il tr o! z en q) atl N c) C)tstz o) z oo r- + N o\N $$ o\ @ o\\t + F-\o o\+ +F- \o ca c.t o\ !a o rat- o\ ia l,a(.I\o o\ al or- € ia(f)(f) 6(r)(7) c.) € c.l ?a\o ?a) 6N \o (r)\o o\ 6fa I ca \o F- o\ \o o\t \o F- o\ I ro F- I oGI ?a) N F- \ot GI t \otN r+ o\ coF- t-- \o|r) ra) co oo co oo+ s o\N s r-o+ o\ al o $la) cno\o rn c{l-. $ oo n t-- o\t- oo co ca oo t-- + F-o .+ o\ o co r-6 .+ t-trhr-\o € ao co aF- ra ra 6 6F- rn iac € o\ t'- @ 00 o\ crN + o\F-@ \o oo € o\ N € c.) r+ oa o\ F- c.l t'- o\ c{ e.l $ + + @ NN F- c.l F- c-sl o\ \o\t a- c.l c..l N $ 6lia € ?alN al N GIia6 (f) N6l N O € € + o\ € m t <t o €\o c.l € o\ r.. o.t + c.l \o €\o t-i(n cl ra Nt\ o € t O + O F- o $ N F- t'- c.l F- s o c- 6(o N raNN F..@ 6 o\ o\ ca @ c\l NF- o\! \ot) G{ o\ r{ 6l =o\ 6(')s F] (.) L .2 Q c) 6l a o! zotup Fa r! F vq.l Fa trl a F v E] Fa r! F v sl rJ.] zql Z z a a o o & rl] ll] d,t!g E]J(J v z & r U) r! IJ.] 2 F] ElJ zD IJ rlr! E. zD t-.1oAr!& o - z F] -] F F f.l(J Ir t o Ht- Fa tI F oF z & I A total of I,438,940 mectizan tablets were carried over from year 2006. An additional 1,225,000 tablets were receivedin200T treatment year making a total of 2,663,940 tabs. How are the remaining ivermectin tablets collected and where are they kept? The remaining tablets are sometimes kept with the LOCT leaders who utilize them for the next treatment cycle. The quantity retained is subtracted from that which will be required for that treatment cycle. At other times the drugs are returned to the State, where they are kept for the next treatment cycle. List and briefiy describe the activities under ivermectin delivery thut are being carried out by health care personnel in the project area. The health personnel at the various levels have been responsible for the following: o Collation of at-risk eligible population data o Collection of Ivermectin from NOCP/Zonal office o Storage of ivermectin o Distribution of Ivermectin o Record Keeping of drug distributed - Any other comments: The facility staff do demand for little incentives/imprest for the running round during supervision. 2-8,. GommuniQl self-monitoring and stakehotders Meeting Has any training (of trainers) for community self-monitoring had been done in the project area? No If so, When? 36 WHO/APOC, 24 November 2004 Table 11: Community self-monitoring and Stakeholders Meeting (Add rows if needed) Not done due to insufficient funding by all partners during the reporting period. But there is a plan to train them in the coming year. Describe how the results of the community self- monitoring and stakeholders meetings have affected project implementation or how they would be utilized during the next treatment cycle. DistricV LGA Total # of communities/villages in the entire project area No of Communities that carried out self monitoring (CSl\O No of Communities that conducted stakeholders meeting (SHIvt) TOTAL 37 WHO/APOC, 24 November 2004 2.9. $upervision 2.9.1. Provide aJlow chart of supervision hierarchy. NOCP ZONAL N.O.CP AKURE STATE ONCHOCERCIASIS CONTROL TEAM (SOCT) LOCAL GOVERNMENT ONCHOCERCIASIS CONTROL TEAM (LOCT) 2.9.2. COMMUNITY - CDDS What were the main issues identified during supervision? Inadequate supervision and poor oversight function by FLHFs The CDDs were demanding for incentives or payment partly because they are aware that other programmes such as the NPI programme give incentives to their distributors. Improper and incomplete registration of households in the register. 38 WHO/APOC, 24 November 2004 Exercise books were used instead of printed registers. Lack of interest in CDTI project by both the Health staff and CDDs because of no incentive. The total number of the health workers involved in CDTI presently is still inadequate. The CDDs that are working with the project are still not sufficient. This inadequacy makes the work load to be too much for the existing CDDs. Inadequate logistics at all levels 2.9.3. Was a supervision checklist useil Yes, but not at the LGA/community level. 2.9.4, What were the outcomes at each level of CDTI implementation supervision? l. An appraisal meeting with LOCTs supported by UNICEF in collaboration with NOCP was held, and several decisions were reached. These include: a. Supervision should be carried out at least thrice ayear, during mobilization, training (health workers/CDDs) and treatment. A minimum of 3 days to be used during each supervisory visit. Appropriate checklists are to be used during such visits. b. LOCTs are to have specific wards as areas of oversight. In the same manner, the FLHF staff involved in CDTI implementation are to be given communities to supervise. The SOCTs are to monitor implementation of this using the list submitted by the LGAs. c. LOCTs are to be re-constituted in all LGAs. PHC Coordinators or assistants or those senior in rank to LGA Oncho Coordinators are to be excluded as members. This does not however exclude them from being used for mobilization or supervision as need arises. Oye and Irepodun/ Ifelodun LOCTs will need to be constituted. d. Where LGA Coordinators have problems of securing commitment of FLHF staff with regards to CDTI implementation, the intervention of PHC Coordinators orland other levels should be sought. 39 WHO/APOC, 24 November 2004 2. Informal, one-on-one, training was done on areas of deficiency. 3. The community leaders were sensitized again on giving incentives to the CDDs. Some agreed while some did not. One of the LGAs (Moba) was mandated by the Traditional rulers to give the CDDs at least N2,000 after 2007 distribution. 4. The health facility staff that refuse to participate were encouraged to continue and those transferred were replaced. 5. Community Leaders selected more CDDs who were trained. 2.9.5. ll/as feedbach given to the person or groups supervised? Yes on the spot. 2.9.6. How was the feedback used to improve the overall performance of the project? Given the feedback provided, the intervention measures put in place, additional healh workers and CDDs were trained and overall number of persons treated increased in2007 Targeted mobilization of traditional rulers in 4 LGAs where some indicators of community participation are weak has been planned for early 2008. This is being supported by TINICEFA{igeria. SEGTION 3: Support to GDTI 3.{. Equipment Table 12: status of equipment (Please add more rows if necessary) Source Type of equipment APOC MOH DISTRICT/ LGA NGDO Others No. Condition No Condition No. Condrtion No. Condrtron No Condrtion 1. Vehicle 1 F 1 NF 2- Motor cycle(s) 15 F 3. Computer(s) 1 F[old] 4. Printer(s) F 5. Photocopier (s) 2 F 6. Fax Machine(s) 7. Others a)Bicycles 60 CNF b)TV set I F 40 WHO/APOC, 24 November 2004 c)vcR 1 CNF d)Generator 2 F *Condition of the equipment (F:Functional, CNFR:Currently non-functional but repairable, WO:Written off). How does the project intend to maintain and replace existing equipment and other materials? 8 New motorcycles, 1 Generator, 1 Photocopier and 10 Bicycles were donated by APOC in this current year. The project repairs and maintains all capital equipment with the inadequate funds provided by the State and Local Governments. Efforts will be intensified to convince government to release counterpart funds for maintenance of project equipment and purchase of various materials. 4t WHO/APOC, 24 November 2004 $ N Lo C) o z + c.I () o o.{ o > N$ o 6Pb'o > _sl 0) ZEFF ,;9otsoo.i (l(Jix tr-(Jo() .l.<P9r (,) ,\ C,)\-/ =OoOro<E -d,\-Pc)!H 6)ra )r(tc) o-C6.* L- QaA.tr- Essb- LqiNo- N 3*so, e'6 6T BE;PE:E\) rr ; (.)1fPio E'II - ItE:3 *rE u€r* itF(, .8 33 Eb-A:\acdii F.E E.E -.5 -C OOI(|,o !)Str=;B 81 5 vHo!\- ll tr c'1S'E6E arJ-V; o'- qrr; .r 0) c/)Sr=€ E eJveL.L ar (J P -6oo)E E=€s6 q) H(,) k oESo€^ ar-UA{P c)= .Q E Cv^ s.h,Es9E oZE'o I q= ..cdP(.,IaIo..r$cdX(,S }.hEb g E-E9rt -4d!*-r('9€ U) l-r(! C) >. ooL th d o l-r € U)Lro ti(cq d >\p v) -o L oo (€ o cl3 tu c.ir -t ,l -ol cdlFI t- Od f- & q.l f.l(h <E!-f5?daFQE(= F-GI \o a.l(\ +6 F-+\o \o\ot F al -ts .> _= L9glA-bEf,5qF<:1 E= o\r- \o -tt-- € a.l € F- ia \o\o 6 N; x El >l tl a F(DJ:O<!iq?.a&= $ \o o(.l 6l L!c .2 _= <=i!(J ,vq)A-bEI5qF<:1ce= o\F- \o $ \o + o\ ra ra =ta N & r.l t{(n <EiF(rJ- o<rdgt-Qcl= c.l c.l oo oo ol al6a Ntr) Lts . z _i_; <xi!c, ,l)q)A-b>x5qF<YcoZ ! 6l t El rda r.l 4 F7)J:O<hrq?-AC= -ts .2 _!: <=i!(J?9V)A-bEI5qF <:Aca = \o F-\o a{ € € o\ c.l 6\o = .I ra aoo c.l :ldl sl li(h <Ei5?dalaOilZ @+ € c..t F- al\o iao- <rQA -E 'r<ir<=(J b==F<ce *+ (\ oo\o r- oN o\ -o oO L ,^o dcd Ei^'c <: o= :/6 *.E uo2tu J .9 -.2 =Az= o o z^ 6tro6Oa Lr!O z) ^=riE AO. o o tu F O o A. J F oF Additionul comments 3.3. Other forms of communlty support - Describe (indicateforms of in-kind contributions of communities tf any) Word of appreciation is the main in-kind contribution. Some traditional rulers gave money to the CDDs from their personal purse. 3.4. Expenditure per activity - Indicate in table 14,the amount expended during the reporting period for each activity listed. Write the amount expended in US dollars using the current United Nations exchange rate to local currency. Indicate exchange rate used here Nl26 Table 14: Indicate how much the project spent for each activity listed below during the reporting period. Activitv Expenditure ($ us) Source(s) of funding OTF HQ area to central collection point of Mobilization and health education of communities Alvgcqcy*v-i q!1s_ _to -!qalt!r ad pol i_!!cql Summary(r9pg_4!!g) {glms g1 tryqlment. _ Vehicles/ Motorcycles/ bicycles maintenance IEC materials Others authorities distribution* Intemal monitoring_ gf CD! activities Oflge PqUtgq-{,I .(a g computers, etc) Supervising CpDs q1{ Drug delivery from N community of health staff at all levels !ag!.ng g_fqQDs_ 2,729 soo - 1,191 1,19f 1,270 3,523 9,263 7,279 APOC/ LINICEF APOC/ UNICEF/ LGAS APOC/ tl,rgcEF IDIICEJ {foc Aloc{LGA APOC MOH LGAS TOTAL 29 466 43 WHO/APOC, 24 November 2004 Total number of persons treated 805,578 SEGTION 4: Sustainability of GDTI 4.1. lnternal; independent participatory monitoring; Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable) Year I Participatory Independent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation Internal Monitoring by NOTF N o ne *u. ca.ri@r:;H1f*l "luati o n b v o ther p artners 4.2. sustainability of profects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period? No Was a sustainability plan written? Yes When was the sustainability plan submitted? 2005 What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.2.1. Planning at all relevant levels After the evaluation of the State project, a planning/debriefing meeting was conducted during which a draft 3 - Year Sustainability Plan was developed. Present at the meeting were representatives of the LGAs (policy makers and health workers) and the State representatives. The Plan was fine-tuned and submitted to the MOH for inclusion into the Yearly health plan. A new four-year work plan has been developed and submitted to the NOCP for their input before presenting it to the Commissioner to release funds for sustainability of the project. It has been planned that at the close of each year, a review of the succeeding year's plan will be undertaken and where necessary amended. 44 WHO/APOC, 24 November 2004 4.2.2. Funds At the State level, there has been some counterpart contribution, but these have been neither adequate nor regular. With the evaluation of the project, the State Government has renewed its commitment to funding the CDTI project and encouraging the LGAs to do likewise. Advocacy visits will continue to ensure that LGA keep on releasing at least minimal amounts for CDTI implementation. In the year, there was some financial assistance that came from LINICEF for training of health workers and CDDs. There is a promise that such support will continue in the next2 years. 4,2.3 Transport (replacement and maintenance) APOC has approved one vehicle to replace the existing one. Some capital items were also supplied.These include Generator, Photocopier, motorcycles and bicycles. At the LGA level, the National Primary Health Care Development Agency (NPHCDA) occasionally, procures motorcycles for NIDs, which are distributed, to the LGAs. Sometimes, these are being used for CDTI activities especially when they are not in use by the NID project. With respect to maintenance, a few LGAs released minimal amounts for the periodic maintenance of the motorcycles. In the meantime, a system of strict control of transport has been put in place. Every trip and every expenditure on (fuel, tyres and repair) a logbook and monthly reconciliation of trip authorization and logbook entries has been institutionalized. 4,2.4. Other resoarces With regards to IEC materials, the project is sensitizing the Government on the need to produce some with the withdrawal of APOC funding which is already in the plan before the end ofthe year. 4.2.5. To whut extent has the plan been implemented Most of what was planned under the initial sustainability plan have been achieved despite the inadequacy of government counterpart funding. Coverage rates over the past 4 years have been stabilized, and total number of those treated has been on the increase. A new 4-year work plan has being developed, and will be submitted to the State authorities and shared with LGAs. 4.3. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3.1. Ivermectin delivery mechanisms The Mectizan delivery process occurs within the existing PHC structure. Communities pick their Mectizan requirements from the health facilities, except in few cases where the drug is taken to them during NIDs, for instance, the LGA iPHC staff who come to pick up their vaccines also use the opportunity to collect Mectizan. 45 WHO/APOC, 24 November 2004 4.3.2. Training Currently, CDTI training is not integrated into any other health programme training activities 4.3.3, Joint supervision and monitoring with other programs At the State level, there are no plans for joint supervision and monitoring at present. A few members of the SOCT participate in other health programmes like Malaria and immunization. On some occasions they take opportunity of their visits to the field for these activities to briefly look into CDTI issues. At the LGA level, some of the LOCTs are also involved in other programmes and sometimes use the opportunity of visits to community/ health facilities for one programme to look into other programmes, which they are handling. 4.3.4. Release offunds for project activities Where there are releases of fund, imprest is released for PHC activities and is controlled by the PHC Director. At both State and LGA levels, proposals for the release of funds however must pass through the DC Director and PHC directors in LGA under normal channels. 4.3.5. Is CDTI included in the PHC budget? At the State level, there is a budget for CDTI in the Disease control budget. At the LGA level, CDTI activities are under a general PHC budget. 4.3.6. Describe other health programmes that are using the CDTI structure und how this was achieved What have been the achievements? None at the moment 4.3.7. Describe others issues considered in the integration of CDTI. 4.4. Operational research 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 None was undertaken during the reporting period 4.4.2. How were the results applied in the project? Not applicable. 46 WHO/APOC, 24 November 2004 SEGTION 5: Strengths, weaknesses, challenges, and opportunities List the strengths and weaknesses of CDTI implementation process. Strengths o Increasing interest shown by more NGOs/CBOs in the CDTI process o Dedication of the LGA Onchocerciasis Managers. o Quite a number of communities are fulfilling their roles under CDTI. o Counterpart contributions by some LGAs. . Availability of more health staff trained in CDTI. . Availability of committed SOCTs. . High rate of CDD retention in several communities despite inadequate motivation o Support from both APOC and UNICEF o Constant monitoring from the UNICEF, NOCP and APOC through several means. Weaknesses o Lack of commitmentbyllaziness of Health Workers o Indicators of community participation weak in a few places. o Some CDD attrition o Lack of effective planning when training activities are to be carried out by SOCTs and LOCTs. Challenges o Inadequate release of fund both at State and LGAs levels o Poor census update o Comparing CDTI project with Immunization programme by the CDDs on remuneration. o Inadequate numbers of CDDs for distribution of Mectizar,. . Only a few communities are giving incentives to their CDDs. . Inadequate numbers of health workers involved in the CDTI process. . Inadequate number of motorcycles/bicycles for supervision. o Demand for incentives by CDDs in many communities o Inadequate, andlor ineffective, supervision particularly by the frontline health staff Challenges were addressed through: o Training of more CDDs and health workers. o Delineation of areas of supervision for all LOCTs and FLHF staff trained o Collection and collation of community data with support by APOC and building of a data bank at the State level. o Mobilization of more CBOsA{GOs to be involved in the CDTI process o Availability of 8 new motorcycles for supervision. 47 WHO/APOC, 24 November 2004 oo A letter from the zonal office to the commissioners for health, Secretary to the State government, and Local governmenVChieftaincy affairs lead to the release of counterpart funds for 4 LGAs. Sensitization of some community leaders by SOCTs, LOCTs and UNICEF. 48 WHO/APOC, 24 November 2004