Imo CDTI annual project technical report submitted to Technical Consultative Committee (TCC): January 2006 to Dec. 2006

@.yvtt\ i I ! i RESERVED FOR PROTECT LOGO/HEADING ORIGINAL : English F r i-'i ii{-u-,^,1 Ei!l csL c* *ilE/ cu*rr) ffi" 2 I rEu. fr}ilI . i - _ .tr Jre -ffffi T COUNTRYAIOTF: NIGERIA Proiect Name: IMO CDTI Approvalvear: 1998 Launching vear: 1999 Reportins Period: From: To:January 2006 (Month/Year) Dec 2006 (Month/Year) Proiectvearofthis report: (circleone) I 2 3 4 5 G (7) 8 g l0 Date submitted: January 2007 NGDO Partner: Global 2000 WHO/APOC, 24 November 2004 I I I I I I I I I I ir ANNUAL PROJBCT 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 Julv for September TCC meeting AFRICANPROGRAMME FOR ONCHOCBRCIASIS CONTROL (APOC) I I I ii WHO/APOC, 24 November 2004 AIINUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFIUCERS to sign the report: Country: NIGERIA ?E, Zonaloncho Coordinator Name: :A{t"'t ' 'C'i'"iir'lA' sis,.tdG-$ Date: .. ....{::.1.;=[.>1. NGDO Representative Name:D(-'€""f$''d**'l This report has been preprred by Name : ... .. ...9.NYENAMA.J,.Q- P?le__,r.._.1..=5,.1.1.,J.4-,1r=.1+gry?'99.7,,r.-,:-..-. lll WHO/APOC, 24 November 2004 I I DEFINITIONS F',OLLOW t P ON TCC RECOMMEI\DATIONS..... ....................1 EXECUTIVE SUMMARY ........2 SECTION 1: BACKGROUIID IIYFORMATION ........3 1 . 1 . GnNBR qr- rNFoRMATroN ............... ....... 3 1.1.1 Desuiption of the project (briefly). .......................3 1.1.2. Partnership .......................4 1.2. Popur.RrroN ......................6 SECTION 2: IMPLEMENTATION OF CDTI ...........8 2.1. Tnraelnre oF ACTIvITIES.............. ........8 2.2. ADvocACy .....................10 2.3. MosILIzeTIoN, SENSITIZATIoN AND HEALTH EDUCATION oF AT RISK COMMTTNTTTNS ... IO 2.4. Covttr,tullry INVoLVEMENT................ .................I2 2.5. CapacrrvBUrLDrNG... .....13 2.6. TRrarueNrs................ ..................... 15 2.6.1. TreatmentJigures............. ..............,.. /5 2.6.2 Wat are the causes of absenteeism? .......... ........19 2.6.3 What are the reasonsfor refusals?................ ...... 19 2.6.4 Briefly describe all known and verified serious adverse events (SAEI that............... l9 2.6.5. Trend of treatment achievementfrom CDTI project inception to the cutent year.......21 2.7. ORornruc, sroRAGE AND DELIVERy oF IvERMECTIN .............22 2.8. CoNaMUNItrv sELF-MoNIToRING AND STAKEHoLDERS Mpenxc ...............23 2.9. SupeRvrsroN............... ......................25 2.9.1. Provide aflow chart of supervision hierarchy. ...................... 25 2.9.2. What were the main issues identified during supervision?......... .............. 26 2.9.3. Was a supervision checklist used?......... ..............26 2.9.4. What were the outcomes at each level of CDTI implementation supervision? ............26 2.9.5. llas feedback given to the person or groups supervised? ...... 26 2.9.6. Howwasthefeedbackusedtoimprovetheoverallperformanceoftheproject?........26 SECTION 3: SUPPORT TO CDTI 3.1. EeurpupNr .....................27 3.2. FINeuCIar CONTRIBUTIONS OF THE PARTNERS AND COMMUNITIES..............................28 3.3. Ourpn FoRMS oF coMMLTNITY sLIPPoRT ...............28 3.4. ExpEuorrunr pER ACTIVITY ............... .................29 SECTION 4: SUSTAINABILITY OF CDTI ..............30 4.1. INreRNx.; INDEpENDENT PARTICIPAToRY MoNIToRING; EvaI-uattoN.......................30 4. t . t Was Monitoring/evaluation carried out during the reporting period? (tick any of the followtngwhich are applicable).....,...... ............'.30 4.1.2. What were the recommendotions?. ...............'...... 31 4.1.3. How have they been implemented?.............. ....'...31 4.2. SUSTaTNaSILITv OF PROJECTS: PLAN AND SET TARGETS (MANDATORY AT................... 3l Yn 3) .....................31 4.2.1. Planning at all relevant levels....... ......'--...........'.31 vII 27 IV WHO/APOC, 24 November 2004 4.2.2. Funds .....'...31 4.2.3 Transport (replacement and maintenance)........ -................... 3l 4.2.4. Other resources .............. 31 4.2.5. To what extent has the plan been implemented.......... ............ 32 4.3. INreoRArtoN ............... .-.................--32 4.3.1. Ivermectin delivery mechanisms ........ 32 4.3.2. Training..... ...........--..-.....32 4.i.3. Joint supervision and monitortngwith other programs -.----...32 4.3.4. Release offundsfor proiect activities.... .--........... 32 4.3.5. Is CDTI included in the PHC budget? ...... ........'.. 32 4.3.6. Describe other health progrommes that are using the CDTI structure and how this was ochieved. What have been the achievements? .......'.. ...... 32 4.3.7. Describe others issues considered in the integration of CDTI. ............'... 3-l 4.4. OppneuoNAl RESEARCH .....33 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. """' 33 4.4.2. How were the results applied in the project?.......-..... ...-.-...... 33 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AI\D OPPORTT]NITIES .......33 SECTION 6: IIIIIQUE FEATURES OF THE PROJECT/OTHER MATTERS...........34 WHO/APOC, 24 November 2004 Acronyms APOC African Programme for Onchocerciasis ControlATO Annual Treatment ObjectiveATrO Annual Training ObjectiveCBO Community-Based OrganizationCDD Community-Directed DistributorCDTI Community-DirectedTreatmentwithlvermectinCSM Community Self-Monitoring LGA Local Government AreaMOH Ministry of Health NGDO Non-GovernmentalDevelopmentOrganization NGO Non-Govemmental OrganizationNOTF National Onchocerciasis Task ForcePHC Primary health care REMO Rapid Epidemiological Mapping of OnchocerciasisSAE Severe adverse eventSHM Stakeholders meetingTCC Technical consultative committee (Apoc scientific advisory group)TOT Trainer of trainers UNICEF United Nations Children,s FundUTG Ultimate Treatment GoalWHO World Health OrganizationGRBP Global2000 River Blindness ProgrammeHKI Helen Keller InternationalSSI Sight Savers International NOCP NationalOnchocerciasisControlProgramme NOTF National Onchocerciasis Task ForceSMOH State Ministry of HealthLCI Lions Clubs Intemational LGAHD Local Government AreaHealth DepartmentVHW Village Health Workers DHS District Health SupervisorHFS Health Faciliry Staff VI WHO/APOC, 24 November 2004 Definitions (i) Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and censui taking). (ii) Elieible population: calculated as 84Yo of the total population in mesoftryper-endemic communities in the project area. (iii) Annual Treatment Objective: (ATO): the estimated number of persons living in meso/tryper-endemic areas that a CDTI project intends to treat with Ivermectin in u jr.n year. (iv) Ultimate Trealmqnt Goal (UTG): calculated as the maximum number of people to be treated annually in meso/tryper 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 ofthi 3.d year ofihe project). (v) Therapeutic coverage: number ofpeople treated in a given year over the total population(this should be expressed as a percentage). Geoeraphical coveraE. number of communities treated in a given year over the total lyTbgt of meso/hyper-endemic communities as identified by nEUO in the project area(this should be expressed as a percentage). (vii) Intesration: 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 e.po*.i communities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of GDTI. (viii) Sqstainabilitv: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future, with high treatment cor".age, integrated into the available healthcare service, with strong community ownership, using reso,ices mobilised by the community and the govemment. (ix) Communitv self-monitoring (CSM): The process by which the community is empoweredto oversee and monitor the perforrnance of CDTI (or any communiiy-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 iesponsibility o-f Ivermectin distribution and make appropriate modifications when necessary. (vi) vll WHO/APOC, 24 November 2004 FOLLOW UP ON TGG REGOMMEilDATTONS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session 20 Number of Recommendation in the Reoort TCC RECOMMEND ATIONS ACTIONS TAKEN BY THE PROJECT FOR TCUAPOC MGT USE ONLY 39 To improve geographical and therapeutical coverage There is an improvements in both geographical and therapeutic coverages (see page t7) ,, Increase number of CDDs No. of CDDs increased. (see page t4) ,) Increase advocacy for the release of govemment funds Both number of advocacy visits and government officials mobilized during the period under review increased. See pe. l0 Intensify mobilization for continuous suppoft to CDTI. More time was devoted to reach problematic villages to ensure their full participation in CDTI activities. Also plans have reached advance stage with traditional rulers to initiate stakeholders meetings in their respective communities. ,t (Please add more rows if necessary) WHO/APOC, 24 November 2004 Executive Summa4y Prepare an Executive summary of the report in not more thon one page. Imo State was approved along with Abia State as a project in September 1998 for CDTI implementation (l 998/1 999) The project has completed its Znd year of sustainability activities (Jan - Dec 2006) after its fifth year evaluation in 2003. The project was also monitored for the implementation of sustainability plan in 2005. The project area has a total of 1,647 villages with only 1,582 villages treated for this fiscal year, Jan - Dec. 2006. The total population of the area was 737,002 persons with an ATO and UTG of 626,452 persons. However, the project was able to treat 499,422 persons (6sYotherapeutic coverage). Population movement within the project area is dynamic with rural urban migration arising from employment, occupation and educational pursuit. In terms of training, a total of 4l District Health Supervisors and Health Center Staff and 38 Health Facility Staffwere trained, and 829 CDDs were ffained, the shortfall in CDD haining was due to targeted haining. However, a mass transfer of health workers from CDTI to non CDTI local government areas affected the programme, the project is making efforts to conduct training to the affected staff, as soon as fund were made available. One of the major constraints that faced the project was inability of both the State and local govemment areas to release budgeted fund for CDTI implementation in their respective areas. Other challenges include (a) To improve community involvement in community self monitoring.(b) To increase the number of CDDs in the project area. WHO/APOC, 24 November 2004 SEGTIOil {: Background information 1.1. General information 1.1.1 Description of the project (briefly) Imo State is located in the southeast region of Nigeria. The state lies between latitude 4o45, and 6o15' North and longitude 6o30' urd 8o09' Eist. Abia and Anambra States border it onthe North, on the South are Rivers and Bayelsa States. East is Abia State while Anambra State is on the west. Imo state has an estimated population of about 3.4 million people with over 737,002 at risk of Onchocerciasis. The state has2T local govemment areas and 16 are supported by APOC in the implementation of CDTI strategy. The state has a lot of fast flowing stiiams and rivers such as oLmiri, Maa,Imo river, Ogochie, Oramiriukwa Rivers, etc. the climate is partly dry (Nov. - March) and wet(April - October). The people are mainly farmers, there are arso fishermen and traders. Community leaders in consultation with the elders and community members mainly takedecision. In 1998, a proposal made to APOC for Onchocerciasis control in Imo and Abia States was approved, with Global 2000 Nigeria as technical partner. Tl: p.j".t has completed its phase I of CDTI implementation, which ended in September 2003; and currently, is in its second phase or the sustainability phase. The project hasLnjoyed a good working relationship with Global 2000 and other jtuk.holdr.s in Onchocerciasis control. WHO/APOC, 24 Novernber 2004 1.1.2. Partnership - fndi.cate the partners involved in project implementation at all levels [MOH, NGDOs(national/international), communitiei, local'organizations, etc.] - Describe overall.working relationship among f,artners, clearly indicating specific areasof project activities (planning, suplrvisionl'advocacy, planning, mobilization, etc) where all partners are involved. - state plans, if any, to mobilize the state/region/dishict/LGA decision-makers, NGDos,NGOs, CBOs, to assist in CDTI implementation. The partners involved in project implementation;l. African programme for onchocerciasis contror (Apoc)2. National Onchocerciasis Control programme (NOCp)3. Lions Clubs Intemational District 40I GCI) '4. Global2000 River Blindness programme (GRBP)5. State Ministries of Health (SMOH) Table 1: Number of health staff involved in GDTI (please add more rows if necessary) District/LGA Number of health staff involved in CDTI activities. 'I'otal Number of health staff in the entire project area Number of health staff involved in CDTI Percentage Br=Bzl Br *100 Aboh Mbaise 8l 26 32.10 Ehime Mbano 93 34 37 Ezinihitte 76 JJ 43 Ihifte Uboma 86 27 31.4 Isiala Mbano 98 26 26.5 Ikeduru 89 3l 35 Ideato North 62 22 3s.5 Ideato South 73 25 34.2 Mbaitoli 87 26 43 Nwangele 6t 26 43 Ngor Okpala 93 38 4t Orsu 63 2t 33.3 Obowo 72 25 35 Okigwe 69 27 39 Onuimo 54 l6 30 Owerri North 92 26 28.3 Total 1249 429 34.3 WHO/APOC, 24 November 2004 6. 7. Local Government Area Health Department (LGAHD) Endemic Communities. The partners have a hymoligus working relationship and are working towards the successful implementation of CDTI in the project area. Specific Areas: Advocacy: Advocacy is a continuous process, weak communities and Local Government Areas are targeted and during advocacy visits, issues pertaining totheir roles and responsibilities are shessed for the pu.por" of rurt irirgit"programme, issues like fund release to the programme are stressed. organizations involved in the advocacy includE Nocp, GRBp, LCI andSMOH. Funding and Technical Support: The major partners which have provided funding andtechnical support to the programme are Apoc, GRBP ura rct. Mobilization and Supervision: Partners involved in mobilization and supervision include GRBP, SMOH and LGA health department. Training: Targeted training for weak and new personnel were carried out by GRBp,SMoH, LPA health department while the endemic communities assisted by selecting the cDDs and health committee members for training In view-of the frequent changes involving political office holders and executive arms-of_the Ministry, the state is planning to organize a stakeholder forum to enable them to be sensitized and mobilized toward CDTI concept. WHO/APOC, 24 November 2004 1.2. Population ,ffit f;H::i:::f"::::,:1i, at risk in the entire project area whether they are treated or not during the reporting period'lease add more rows CDTI Districts/ LGAS in the entire project area Total population in the entire project area Number of communities/villages in Population ofMeso-endemic zone in the project area Ar Hyper-endemic zone in the project area Az Total in meso/hyper- endemic zone A; = Ar-F Ar IVIeso-endemic zone in the project area A4 Hyper- endemic zone in the project area A5 Total in meso/hyper- endemic zone A6= A4+ A5 Ultimate treatment Goal (urc)Aboh Mbaise 66,609 82 0 82 66,609 66,609 56,619Ehime Mbano 49,gg4 0 0 127 127 49,994 49.984 42,496 52,300 Ezinihitte 61,529 137 137 61,529 61,529Ihitte Uboma 33,314 0 93 93 33,314 33,314 28,317 Isiala Mbano 52,472 167 0 0 167 52,472 52,472 44,601 Ikeduru 49,933 129 t29 48,933 48,933 41,509Ideato North 38,552 0 93 93 38,552 38,552 32,769Ideato South 40,725 96 0 0 96 40,725 40,725 34,616Mbaitoli 70,549 r04 104 70,549 70,549 59,967 Nwangele 25,129 96 r37 0 96 25,129 25,129 21,360Ngor Okpala 64,977 0 t37 67 64,977 64,977 55,231 Orsu 35,499 67 0 35,499 35,499 30,173Obowo 40,590 77 0 77 40,590 40,590 34,493Okigwe 46,565 0 115 115 46,565 46,565 39,580 Cpq3 Onuimo 18,933 0 8 42 42 18,933 18,933Owerri North 42,753 0 85 42,753 42,753 36,340 TOTAL 737,002 1040 607 1647 489,125 248,977 737,002 626,452 WHOiAPOC, 24 November 2004 urc=caldldedsi*ncinen'a^nbe'ofe*Ltobe,Eateda,ualbinneso4rpe?.n& b arc.o withtn ttp poject area, uldnat lr to be rcactEd wtpn rtp rqicct tw,eactqdh eeos.qtd. coyens. ("o dbiL iond lhutd t" ry"a"a o n*t rii'&A ;il,a q p r ,Eo ot * wj.cr. was a census for the project done during the reporting period? yes { No If No, what is the source of the data in the table above? * Source:National census CDD _ Other source, specifr:Year : - Ifyou are using the term community or village, define what constihfes the community or village. This will help undefstand the profile ofthe Foject illlr"i'J* * "f kindreds while a community is made up of differeft villages wirh a kaditional mler. At the village levet, rhe.€ is no Is there any other information ofinterest about the population in the projea are&? Ifsq include it herE. In Imo stat€, population is quite dFamic with constaot migration fiolr rural to urban areos due to €conomic atrd educatioaal pursuits. WHO/APOC, 24 November 2004 SEGTION 2: tmplementation of GDTI 2.11. Timeline of activities Fill in table 3,.timeline of activitiesfor areas treated in cunent year,indicating whenthe key activities were implemented by the month they began and the month they ended. 8 WHO/APOC, 24 November 2004 Table 3: Timeline of activities for the areas treated in the current year (please add more rows if necessary) - CommentsrMobili attended to. initial mobilirution Districtll,GA Completion month Completion month WHO/APOC, 24 November 2004 Mobilization of communities Completion month Starting month Jan.2006 Starting month 9 Completion month TOTAL 2.2. Advocacy State the number of policy/decision makers mobilized at each relevant level during the currenty.:11; tlg reason(s) for undertaking the advocacy and the outcome. Describediffrculties/constraints being faced and suggestio^ o, how to improve advocacy. To mobilize State Officials for the release of counterpart funds. Promises were made for the release of counterpart funds. But surprisingly the fund was not released till the time of this To mobilize LGA officials for release of funds to LGA Oncho teams. A few LGAs actualized their promises and released little funds despite promises Constraints: l. Lack of political will by policy makers.2. State and LGAs appear not to see Onchocerciasis as a o'serious', health problem as compared to HIV and AIDs. Suggestions of Advocacy Improvements: Integrated advocacy by all partners - Apoc, Nocp, Global2000 and Lions is required in the state, especially with the incoming of new administrat ion in 2007 . 2-3- Mobilization, sensitization and health education of at risk communities Mobilization 4 tgtal of 80 policy and decision makers were mobilized during the current year at both State and LGA levels. The reasons for sensitization was to enable them fully understand the programme with a view of rendering adequate support, in terms of fund release and other logistic support. l0 WHO/APOC, 24 November 2004 (l) (2) (3) (a) The Imo project carried out an intensive mobilization for effective CDTI implementation using the following strategy: (i) Macro level - where state and LGA officials were mobilized.(ii) Micro level - where community leaders and village members were mobilized. The mobilization was conducted using:l. The mass media: o Radio/television discussions . Jingles a Press releases t News talks 2. Face to face discussions (Community forum in villages)3. Correspondence with States, LGAs and communitiei In addition, we identified some important traditional mobilization channels in all the villages such as: Use of village heads and chiefs including the opinion leaders. Groups and associations such as age-grades, women organizations, schools, clubs, and above all women in health and family support programme. Town criers - who are the news disseminators oi local radios of each village, haveproved to be the most effective means of communication and mobilizationl Town criers announced the arrival and commencement date of distribution to the villagers. Religious organizations. Church announcements - we have utilized most churches to send messages especially during the Onchocerciasis day celebrations. Church services were held to mark the day and offered opportunity for people to be made aware of the CDTI and Oncho control efforts in the State and the 16 LGAs A total of 1647 villages in the project area were mobilized. Field experience reveals that difficult villages require more efforts at mobilizing them. Hence more time was devoted to these problematic and hard to reach uillag"s, to ensure their fullparticipation in CDTI programmes and activities. (4) (s) ll WHO/APOC, 24 November 2004 2.4. Gommunity involvement Table 4: Communities participation in the CDTI @lease add more rows if necessary) District/LGA Number of communities/villages with community members as supervisors Number of CDDs and the communities involved Number of communities /villages with female CDDs Total No. communities in the entire project area B, Number with community members as supervisors B. Percentage Be= B./ B. *100 Male CDDs B" Female CDDs B. Total Bo= B+B* Number of communities with female CDDs B," Percentage Brr= R_^/R _*f nn Aboh Mbaise 82 32 39.02 94 t27 221 69 84.15 Ehime Mbano 127 29 22.85 97 119 216 79 62.20Ezinihitte 137 30 21.90 9t 142 233 87 63.50 Ihitte Uboma 93 25 26.88 77 119 196 7t 76.34Isiala Mbano 167 60 35.93 t22 155 277 85 50.90Ikeduru 129 24 18.61 89 r33 222 72 55.81Ideato North 93 t4 l5 91 104 195 4t 44.09Ideato South 96 25 26 84 105 189 67 69.80Mbaitoli 104 40 38.46 109 139 248 81 77.89 Nwangele 96 28 29.17 85 100 185 63 6s.63 Ngor Okpala 137 3l 22.63 t25 tt7 242 84 61.31Orsu 67 32 47 83 69 152 4t 61.19Obowo 77 26 33 70 100 t70 6l 79.22 Okiewe 115 30 26.09 93 135 228 77 66.96Onuimo 42 15 35 68 48 116 33 78.57 Owerri North 85 29 34.t2 78 106 184 63 74.t2 Total 1647 470 28.540h 1456 1818 3274 1074 6s.33% Comment on: In.Imo proj-ect, thele was an active particiPatiotr ofwometr in CDTI activitie$ evea dudtrg health education and mobilizatiotr atrd this is refl€cted in theselectiod ofcDDs where morE commrmities nominate female cDDs as their disnibutors. During the year, a total ofg29 cDDs were tained with 612 as new cDDs while 217 werE old ones. These new 612 CDDS were added to the alEady existing-Cotis in the oom.*iti* - t2 WHO/APOC, 24 November 2003 2.5. Gapacity building - Describe the adequacy of available knowledgeable manpower at all levels. There is an adequate manpower available in the project areas, however, the problem is frequent transfers affecting the trained health personnel especially at the local govemment level from the CDTI areas to non CDTI areas. Though manpower available at the health facility level is weak due mainly to the caliber of staff at the level; (l) The solution to frequent transfers is to train all health workers on CDTI concept.(2) Strategy of training CDDs at kindred level has been adopted in the state, but the main constraint here is funds to implement the strategy. - Where frequent transfers of trained staff occur, state what the project is doing, or intends to do, to remedy the situation. (The most important issue to describe is what meosures were taken to ensure adequate CDTI implementation where not enough lcnowledgeoble manpower was ovailable or if staffarefrequently transferred during the course of the campoign). o Training has been targeted at new personnel and weak ones. o The strategy of training CDDs according to kindred level has been adopted, but lack of follow up by LGA personnel is hampering the progress. It is envisaged that with an increased number of CDDs, agitation for compensation will reduce. o Training of health staff has mostly been that of on the job training, which is inadequate especially for the new ones. 13 WHO/APOC, 24 November 2003 Table 5: Training at the different levels of GDTI implementation (please add more rows if necessary) District/LGA Number of Districts/LGAs staff trained Number of Health center/nost steff frrined Number of other trainerc of trainees ( TOTs) Numberof CDDs trainedATrO C, New Cz Refr C, Total Cr= C+ C. C. fvw ixelri lotalilCe= ccic,ic*c. ATrO c. New i n"t 9ro i c,, Tot l Crz= Crn* C' ATrO C,. New cu Refr Total Cre= C,,+ C,CxAboh Mbaise 9 0 4 4 l5 0 4 4 J 0 2 2 t64 38 7 45 9 0 4 4 2t ui4 4 4 0 2 2 254 27 t2 39Ezinihitte 9 0 2 2 t7 U ') 2 J 0 I I 274 186 50 l3 63Ihitte Uboma 9 0 2 2 t4 0 2 1 ) 0 I Ifciqlq l\rlLo-^ 9 0 2 2 l5 27 l4 4tU 3 J J 0 I I 334 39 l8 57Ikeduru 9 0 J J 20 U 2 2 2 0 I I 254 39 6 45Ideato North 9 0 2 2 13 U I I J 4 0 I I 186 49 t3 62 Ideato South 9 0 2 2 t2 0 2 2 0 2 2 192 38 t7 55 Mbaitoli 9 0 2 2 18 U J 3 2 0 I I 208 49 7 56Nwangele 9 0 J J ll U z 2 2 0 2 2 192 42 l0 52 Ngor Okpala 9 0 J J 29 t0 0 J J 2 U 2 2 278 30 l6 46 Orsu 9 0 2 2 U 3 J J 0 2 2 134 38 9 47Obowo 9 J 3 t4 0 2 2 J 0 2 2 154 -1Q!!gwe 9 0 2 2 l8 5Z IU 50 U 2 2 J 4 0 3 3 230 46 t9 65Unulmo 9 0 J J 6 0 I I 0 aJ J 84 tn 30 lt 4t Owerri North 9 0 2 2 23 o i2 2 2 0 2 2 TOTAL 144 0 4t 4t JU 27 65 256 o i38 38 45 0 28 28 3294 612 217 829 7o Achievement 28.47Yo 7o Achievement i 14.84o/o 9o Achievement i Al.lqyo 7o Achievement i. 25.17o/ototal only. Make surecorresponding nihot thniffiuw*g. NB: some commuaities have started selectiug their cDDs at kindred levels, but due to non-release offunds, by botb the state and looal govemment,it was oot possible for their aaining to bi canied *t. orrv .-a.""rr* iiirrg was ca.ied out for health worke^ due to the same reason. t4 WHO/APOC, 24 November 2003 Ehime Mbano 0 'ReJr' : U detail not available Table 6: Type of training undertaken Qick the boxes where spectfic training was carried out during the reporting period) Any other comments 2.6. Treatments 2.6.1. Treatment figures - If the project is not achieving l00Yo geographical coverage and a minimum of 65%o therapeutic coverage orthe coverage rate is fluctuating, state the reasons and the plans being made to remedy this. During the period under review, a total of 499,422 persons were treated from a totalpopulation of 737,002 persons in the 16 local govemment within the project area. This gives a geographical coverage of 96.lYo and therapeutic coverage of 6g0/o. The reasons for low coverage were due to :(a) The inability of the local govemment authorities to release budgeted funds to LOCTs to enable them carry out effective supervision of the CDTI activities, because the programme was not effectively supervised, it becomes difficult to monitor the activities of the CDDs, even when the CDDs complete their distribution, retuming the treatment summaries to the project becomes a problem due to funding at that levei. Trainees Type of trainine CDDs Other Community members e.g. Community supervisors Health Workers (frontline health facilities) MOH staff or Other Political Leaders Others(speci&) Program management { \i { How to conduct Health education { { { { { Management ofSAEs ,v CSM { SHM { { Data collection \i Data analysis { { Report writing { { { Others (specifu) t5 WHO/APOC, 24 November 2003 (b) (c) (d) Some CDDs after collecting Mectizan from the health facility delay treatment due to non appreciation of their (CDDs) services by their villagers foi the previous year. Some health workers delay commencement of CDTI activities while waiting for funds release from the local government. Some CDDs after treatment, refuse to submit their returns with the hope of prompting the communities for compensation or motivation. Plans to remedy the situation: (1) Efforts is being made to ensure that both state and local government authorities release funds budgeted for the programme, especially with incoming administration.(2) Selection of CDDs at kindred level is hoped to solve the f,roblem of compensation.However, the training of the selected CDDs by health *oikers is envisaged to be aproblem because health workers still require funds to carry out the trainin! activities, which is not readily available to them. t6 WHO/APOC, 24 November 2004 Table 7: Treatment and SAEs by district/LGA in all areas at risk (Please add more rows if necessary) District /LGA Communities/Villages Population Number of persons who refrrsed the heatnent Number of absentees Number ofSAEs Number of serious adverse events (SAEs) referred to the health post/hospital Total # of communities/ villages in the meso/hyper- endemic areas Dr Annual Treatrnent Objective Dr Nurnber of communitieV villages treated D3 Geographical coverage(n D4= Dy'Dr*lfi) Total population of the meso/hyper- endemic areas D, Affrud Treatnent Objective D5 Number of persons treated D? Therapeutic coverage (Y,) Ds-- Drl Dsr100 Aboh Mbaise 82 82 82 100% 66,609 56,619 42,456 46,399 70 5t 222 rt23 743 0 0 Ehime Mbano 127 127 103 8t.t% 49,994 25,469 804 0 0Ezinihitte 137 137 t37 r00% 61,529 52,300 46,099 75 611 431 0 0 Ihitte Uboma 93 93 93 t00% 33,314 28,317 22,333 67 322 202 0 0 Isiala Mbano 167 167 137 82.1% 52,472 44,601 35,504 68 tt4 464 0 0Ikeduru 129 t29 129 100% 48,833 41,509 32,389 66 3t2 833 0 0 Ideato North 93 93 93 r00% 38,552 32,769 20,756 54 t073 1247 0 0 Ideato South 96 96 96 t00% 40,725 34,616 59,96: 24,I78 59.4 n l2tt 1695 0 0 Mbaitoli t04 t04 104 t00% 70,549 49,237 754 t002 0 0 Nwangele 96 96 96 100% 25,129 21,360 17,609 70.r 413 412 0 0 Ngor Okpala 137 137 r37 t00% 64,977 55,231 49,620 76.4 1032 ls98 0 0 Orsu 67 67 67 t00% 35,499 30,173 25,010 7t 817 1732 0 0 Obowo 77 77 77 t00% 40,580 34,493 29,176 72 393 628 0 0 Okigwe 115 115 105 913% 46,565 39,580 33,379 72 1248 t42t 0 0 0 Onuimo 42 42 42 100% 18,933 16,093 13,557 72 67 1204 403 t8n 0Owerri North 85 85 t4 q,5 t00% 42,753 36,340 28,714 1054 0 0 TOTAL 1647 1582t$j 96.1o/o 737,002 626,452 499,416 68o/n 11584 15756 0 0 t7 WHO/APOC, 24 November 2004 TherEpeutic colllage rate = Number ofp€opte tneated x IOO(V,) fotat popGtion living in meso/hyper_endemic coEmuaities within the Eoject arca Geogap_hfu€l cov€rage rate = Numb6 ofcoEmuities/villaaes treafEd x IOO(v") torl numb". of oEo,4rFiiemic comm-*rities as identilied by FEM9 in the project arca ATO cov-erag€ rale = Number ofp€opte treded x IOO(Y") Annrdroeito loE ;;- %UTcachieved - Number ofpeople treded x IOO Total nunb€r ofp€ople to be tr€€ted in meso/hyper-endemic areas within the project arca (UTG) ATo - ?h.^tirred rumba otp.opr. dnq i^ aaalrrrpetad.ll,tc ara, thd acDTr pdanirr.n b b ttdet,Iisrn c,h,in a gi?n,e. *'Tmfrm,"'"ffi8#trf #[1trhryWtffi,ffi;'^'qbberuddvha"h'prol'dhateh.d!,ase,qrbdcMas. l8 WHOiAPOC, 24 November 2004 2.6.2 What are the causes of absenteeism? The major causes of absenteeism have been the rural urban migration of theproductive sector in search of jobs. Also, some youths attend boarding schools, outside their communities and hence may not be there o*ingit. treatment ;..i;. What are the reasons for refusals? somefelt that they were cured and hence h1d no need of the drug. wile others refusebased on their religious belief, Such people re{uire more health education. Briefly describe all known and verified serious adverse events (sAEs) that occurred during the reporting period and provide (in table 8) the required information wheuavailable. The state has monitored Mectizan treatment for a long time and has not recorded any severe adverse event (SAE) In case the project did not have any cases ofserious adverse events (SAE) during this reporting period, please tick in the box. 2.6.3 No SAE case to report t9 WHO/APOC, 24 November 2004 E Table 8: cases of serious adverse events (SAEs) that occurred during the reporting period @lease add more rows if necessary) 20 * Serial n *t", oJtn" pott"il I WHO/APOC, 24 November 2004 Date Mectizan was taken Results of tests (thick blood smear) 2'6'5' Trend of treatment achievement from cDTr project inception to the current year Table 9: Treatments and coverage by calendar year for the entire project area. (pleaseJill in the required data) Plc{s€ itrdicate the urc for the proJec' srca: 626.452 (use thi! ffgure.s the detromi'rlor ir all urc coveruge calculrtioD!.) YEAR Communities/Villages Total # of communities/villag es in the meso/h5per- endemic areas Er Annud Treatment Objective 8,, Number of communitie s/villages treated E. Geographi cal coverage vt E{-- Ey' Er*100 ATO coverage (Y.) Er tr-/ r'-*lnn population of the meso/tryper- endemic areas Annual Treatnent Objective Number of persons treated Therapeutic coverage (Y") f,g= n-/ ['-*inn ATO coverage (Y.) Ero= En/ E"*100 UTG Coverage ('/o) 1997 1998 720,752 t999 1647 1647 1368 R? 847,944 847,944 794,793 466,492 55 65 75.4 2000 2001 1647 1647 t647 1647 1647 1647 100 100 100 100 720,752 462.1s7 54.5 64.1 74.7 675,565 526,974 66.3 78 85.2 2002 2003 2004 200s 1647 1647 1647 1647 1647 t647 1647 1647 1229 100 r00 74.6 100 756,394 642.934 573,872 75.8 89 92.7 100 74.6 725,293 727,946 616.490 501,106 69.1 8l.l 80.9 618,751 395.226 54.4 63.8 63.8 68 68 2006 1647 1647 t582 96.1 96.1 737,002 626,452 499,422 682007 2008 2009 2010 2t WHO/APOC, 24 November 2004 Population 83 2.7. Ordering, storage and delivery of lvermectin Mectizan@ ordered/applied for by - (trtlease tick the appropriate answer) MoH El wHo Other (please speciff): MectizanG}-d:Iilered by - Qtlease tick the appropriate answer)MOH l! | wHo n uNrcEF tr OthE(please specif,): tr TTnrrCEF tr NGDO E NGDO Please describe how Mectizan@ is ordered and how it gets to the communities The order of Mectizan commences with the census update and determination of ATOs by local government areas and the State project. The total requisition is therefore routed to the Mectizan donation programme (MSD) through the Globai 2000 (supporting NGDO). The bulk drugs are procured by Global 2000 to their zonal office from where the iroject is issued with their requisition after proper documentation. Consequently, various locai government areas, come to the State to collect their shares, at the local government level, eachlistrict and health facility levels collect their, while the communitieJ collect from their nearest health facilities, based on their target population to be heated. During the Mectizan transaction, health care personnel ensures that accurate Mectizan tablets are released and delivered to each level based on requisition. They also ensure thatMectizan tablets are kept in a safe storage facilities. Table l0: Mectizan@ Inventory (Please add more rows if necessary) How are the remaining Ivermectin tablets collected and where are they kept? 22 WHO/APOC, 24 November 2004 State/District/ LGA Number of UectDano taUlets Requested Received Used Lost Waste Expired Remainins Aboh Mbaise t47,000 147,000 146,987 0 0 0 l3 Ehime Mbano 82,000 82,000 77,000 0 0 0 s000 Ezinihitte 144,000 144,000 143,894 0 0 0 106 Ihitte Uboma 66,000 66,000 66,000 0 0 0 0 Isiala Mbano I 15,000 I15,000 109,550 0 0 0 5450 Ikeduru 100,000 100,000 99,976 0 0 0 24 Ideato North 65,500 65,500 65,496 0 0 0 4 Ideato South 73,000 73,000 73,000 0 0 0 0 Mbaitoli 153,000 153,000 152,909 0 0 0 3r Nwansele 57,000 57,000 56,256 0 0 0 7M Ngor Okpala 145,000 145,000 l44,ggl 0 0 0 t9 Orsu 80,000 E0,000 79,987 0 0 0 13 Obowo 92,500 92,500 92,390 0 0 0 120 Okigwe 101,000 101,000 100,987 0 0 0 l3 Onuimo 44,000 44,000 43,995 0 0 0 5 Owerri North 85,000 85,000 85,000 0 0 0 0 TOTAL 1,550,000 1,550,000 1,538,399 0 0 0 11542 The remaining Mectizan tablets have been received as opening balances and will be re-issued back to the LGAs for the next treatment cycle since they areyet to be expired. - List and briefly describe the activities under Ivermectin delivery that are being carried out by health care personnel in the project area. Health personnel ensure that accurate Mectizan tablets are given to the local government and also ensure that Mectizan returns are collected. - Any other comments 2,8. Gommunity self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? If so, When? Table I l: Community self-monitoring and Stakeholders Meeting (Add rows if needed) 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. Sadly, there were no reports on Community Self Monitoring (CSIO and stakeholders meeting (S[IIV[) conducted during the period under reporting. District/ LGA Total # of communities/villages in the entire proiect area No of Communities that carried out self monitoring (CSllO No of Communities that conducted stakeholders meetins (SHM) Aboh Mbaise 82 Ehime Mbano 127 Ezinihitte 137 Ihitte Uboma Isiala Mbano _93 167 Ikeduru 129 Ideato North 93 Ideato South 96 Mbaitoli 104 Nwangele 96 Neor Okpala r37 Orsu 67 Obowo 77 Okiewe ll5 Onuimo 42 Owerri North 85 Total 1647 23 WHO/APOC, 24 November 2004 The LGAs athibuted the lack of funds as being the reason for the non organization of these activities, we are hoping that once fund is made available by both the state and local government areas, the stakeholder meeting will start. 24 WHO/APOC, 24 November 2004 2.9, Supervision 2.9.1. Provide a flow chart of supervision hierarchy. ST,PERVISION FLOWCHART PROJECT ADMINISTRATOR STATE CO-ORDINATORS/ STATE PROJECT OFFICERS STATE ONCHOCERCIASIS CONTROL TEAM MEMBERS (SoCTs) LOCAL GOVERI\MENT ONCHOCERCIASIS CONTROL TEAM MEMBERS (LOCTs) DTSTRICT HEALTH SUPERVISORS (DHS) HEALTH FACILITY STAFF (HFS) COMMTINITY DIRECTED DISTRIBUTORS (CDDs) 25 WHO/APOC, 24 November 2004 2.9.2. what were the main issues identified during supervision? The following issues were identified during supervision and are being addressed as follows: (1) Frequent inter/intra LGA transfers: The quality of supervision of some LGA health workers were low especially those transferred from non CDTI areas to CDTI areas, hence more training and rehaining is being organized for them. (2) Inadequate number of CDDs: During supervision, we discovered that there is need to increase the number of CDDs, as CDDs cover a long distance resulting to low treatment coverage, effort is being made to select CDDs at kindred levels ai against the village level, as well as training of those already selected. (3) Low motivation to CDDs: The selection of CDDs at kindred level will address the issue of CDD motivation, as supervision revealed that most communities do not motivate their distributors. Efforts is being made to ensure that CDDs are included in other health programmes that have financial reward. .9.3. Was a supervision checklist used? Supervisory checklist has been developed by the project and used in the course ofsupervision. 2.9.4. What were the outcomes at each level of CDTI implementation supervision? The issue of supervision was used to identiff areas of weakness that needed to be converted to strength. Was feed-back given to the supervised, and how was the feedback used in improving the overall performance of the project At State Level: The supervision at the State level by the Project Administrator empowered the State Coordinator and SOCTs to do targeted supervision. ihough supervision was inadequate because of limited funds for transportation, but we are $at;fuI to Global2000, for providing the funds to the project. LGA Level: Identification of difficult communities and CDDs with poor records. Once again this was inadequate because the LoCTs could not move to probiem areas. Community Level: In the few villages supervised, the CDDs returned their summaries on time and treatment coverage was impressive, hence there is need to supervise all the villages. 2.9.5. Was feedback given to the person or groups supervised? Supervisory reports were given to the groups supervised. 2.9-6. IJow was the feedback used to improve the overatl performance of the project? 26 WHO/APOC, 24 November 2004 The overall performance of the project was far better this period, when compared with 2004 both in terms of geographical and therapeutic coverages. SEGTION 3: Support to GDT! 3.1. Equipment Table 12: Status of equipment (Please add more rows if necessary) *Condition of the equipment (F:Functional, CNFR:Currently non-functional but repiirable, WO:Written off). How does the project intend to maintain and replace existing equipment and other materials? The state will maintain the existing equipments through release of fund from the Onchocerciasis control budget. Though, not much has been released from the budgeted funds, our efforts will be to ensure that such funds are released in future. The State is aware of its responsibilities towards these capital equipments. Source Type of equipment APOC MOH DISTRICT/LGA NGDO Others No. Condition No. Condltr No Condition No. Condition No. Condltion l. Vehicle 2 l-F I.CNFR 2. Motor cycle 2t 5F,I6CNFR 3. Computers 2 l-F I-CNFR 4. Printers 2 l-F I.CNFR 5. Fax Machines 6. Others a) Bicycle 85 CNFR b) UPS 1 F c) Photocopiers 2 l-F 1-WO Generator I CNFR 27 WHO/APOC, 24 November 2004 3.2. Financial contributions of the partners and communities Table 13: Financial contributions by all partners for the last three years - If there are problems with release of counterpart funds, how were they addressed? In Imo State, the issue of counterpart fund release by the State and local government has been a problem. The project ensures that funds are budgeted at both state and local govemment levels but to release has been the problem. During the period under review, the Director Southeast Programmes of Global 2000 visited the State and had discussions on the issue of counterpart fund release, also, the Project Administrator Global 2000 made efforts on this regards. The project remain greatful to Global 2000 and APOC for making it possible for us to carry out CDTI activities while hopingthat the state will release funds to the project in future. 3.3. Other forms of community support - Describe (indicate forms of in-kind contributions of communities if any) Other forms of community support Some of our communities are comfortable in motivating their CDDs in kind. Such method include i) Exemption from some community levies and dues. ii) Arranging labour to assist CDD in his /her farms. iiD Specialrecognitionincommunitygatherings. iv) Donating food to the CDDs 28 WHO/APOC, 24 November 2004 Contributor Year 4 (Oct. 200 I - Sept. 2002') Year 5 (Oct.. 2002 - Sept. 2003) Year 6 (June 2004 - May 2005') Year 7 (Jan 2006 -Dec. 2006') TOTAL Cash Budgeted (US$) TOTAL Cash Released rus$) TOTAL Cash Budgeted rus$) TOTAL Cash Released rus$) TOTAL Cash Budgeted rus$) TOTAL Cash Released rus$) TOTAL Cash Budgeted rus$) TOTAL Cash Released rus$) MOH (Central + Provincial/State) 6,000 656.1 4,608 0 9,230.4 r,520 7,692.3 115.4 MOH (District/LGA) 16,473 2,884.8 35,7t2.6 3,255.6 10,153 769.2 9846.2 1,769.2 Local NGDO(s) ( if anv) 0 0 0 0 0 0 0 0 NGDO partner(s) 98,260 118,321 58,570.35 42,222 37,367 1200 4,019.2 4,019.2 Others 0 0 0 0 0 0 0 0 a) 0 0 0 0 0 0 0 0 b) 0 0 0 0 0 0 0 0 Communities 51,917 1,589.9 73,242 1,547.2 57,000 270 1,322.3 APOC Trust Fund M,714 42,175.2 38,129.4 r 8,000 7,500 4,000 8,000 4,000 TOTAL 217,364 165,627 210,262.35 65,024.E 121,250.4 7,759,2 29,557.7 11,226,1 These are motivations that are not easy to quantiff. 3.4. Expenditure per activity - Indicate in table 14, the amount expended during the reporting period for each activity listed. Write the amount expended in US dollars using ihe current United Nations exchange rate to local currency. Indicate exchange rate used here____-$-1_:_l-30 29 WHO/APOC, 24 November 2004 Activitv Expenditure (S US) Source(s) of fundins Drug delivery from NOTF HQ area to central collection point of community 115.4 Global2000 MOH Mobilization and health education of communitie_q Training of health staffat all levels _" 3,091.5 Community/ LGAs Supervisine CDDs and distribution Intemal monitoring of CDTI activities Advocacy visits to health and political authorities 4019.2 4,000 Global2000 " APOC IEC materials Summary (reporting) forms for treatment ? Vehicles/_Motorcycles/ bicycles maintenance - Office Equipment (e.g. computers, printers etc) / Others: Collection of capital equipment 11,226.1 TOTAL s7,759.2 Total number of oersons treated 449,422 Table 14: Indicate how much the project spent for each activity listed below during the reporting period - Any comments or explanations? The cost of capital equipment purchased by APOC for the State totaled $47,500 which sum was retained by APOC management. SECTION 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 { Other Evaluation by other partners 30 WHO/APOC, 24 November 2004 No monitoring was carried out during the reporting period, apart from Global 2000 coverage survey and APOC treatment complianceiuruey carried out in two localgovernment areas of the state. 4.1.2. What were the recommendations? The result are being awaited. 4.1.3. How have they been implemented? Yet to be implemented as the result is still awaited. 4.2. sustainability of proiects: plan and set targets (mandatory atYr 3) Was the project evaluated during the reporting period?_\q Was a sustainability plan written? prqviously When was the sustainability plan submitted? August 2003 What arrangements have been made to sustain CDTI after ApoC funding ceases in terms ofi Sustained advocacy to convince State and Local Govemments to redeem their commitments. 4.2,1. Planning at all relevant levels The process ofplanning is very relevant to the success of CDTI sustainability. Jointplanning of activities will continue between the project office, the State Minishies ofHealth and the LGAs. Planning at the community level will equally.ontinu. betweenCDDs and their community members. 4.2.2. Funds Continued efforts to ensure that various tiers of Government release budgeted fundswill continue. Increased and sustained advocacy meetings at various "levels will continue. Also involvement of key officers - Finance officJrs, Hannin! officers andMobilization Officers will be ensured. 4.2.3 Transport (replacement and maintenance) Both state and local government areas are aware that it is their responsibility to fuel and maintain all the vehicles, motorcycles and other capital equipments. We have received the letter inviting us to come and collect ih. ,.ruirin! t r (eleven) motorcycles and a generating set as requested in our last year,s plan. 4.2.4. Other resources Government has been adequately informed that it is their responsibility to maintain these equipment. 3l WHO/APOC, 24 November 2004 4.2.5. To what extent has the plan been implemented Govemment has not fully implemented the plan but. With the letter we have just received, APOC has released all the capital equipment in the sustainability plan, though the cash aspect has not been fully released. Global 2000 has also started gradual implementation of their part. 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 Ivermectin delivery has been fully integrated into the PHC structure with states collecting their drugs from the zones and storing them in the state drug stores. Likewise, LGAs collect the Mectizan from the States and distribute them through the PHC structures to the health facilities. 4.3.2. Training Training - Training on CDTI is carried out by workers who are an integral part of the PHC structure. 4.3.3. Joint supervision and monitoring with other programs There has been an improved joint supervision with CDTI catalyzing the integration. This is exhibited in occasions where other health programme such as nutrition, mental health etc. piggy back in the CDTI vehicle. We are working towards developing a common checklist for various health programmes in the state. 4.3.4. Release of funds for project activities Funds for the control of Onchocerciasis are part of the entire PHC budgets. But in most cases, budgeted funds by government are not released. This is not only in Onchocerciasis but in other programmes. 4.3.5. Is CDTI included in the PHC budget? CDTI is fully integrated in the PHC budget. 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? Other health programmes using existing CDTI structures include leprosy control where some LOCTs ure uiilirid in carrying out leprosy control activities. Some CDDs are used to cover DOTs treatments, community mental health etc 32 WHO/APOC, 24 November 2004 4.3.7. Describe others issues considered in the integration of cDTr. An issue towards which efforts are being made to improve are joint planning sessions with other programme leaders/coordinators for better coordinated aition. 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 conducted but Global 2000 carried out a coverage survey while APOC carried out treatment compliance survey, we are still expecting the results 4.4.2, IJow were the results applied in the project? The results are yet to be applied. SEGTION 5: Strengths, weaknesses, challeng€sr and opportunities - List the strengths and weaknesses of GDTI implementation process. STRENGTHS: (l) Good working relationships between Ministry of Health, Global 2000, Local Govemment Areas and communities.(2) Committed health staff.(3) Community awareness of the magnitude of Onchocerciasis problem in their areas. WEAKI\ESSES Poor funding of the programme by government at all levels. Communities not motivating their CDDs. CDDs preferring cash motivation to other kinds of motivation. - List the challenges and indicate how they were addressed. (l) (2) (3) (1) To improve community involvement in community self monitoring by communities - more communities were mobilized to organize community seif monitoring. To increase the number of cDDs in the proje ct area - The strategy of selecting cDDs at kindred level has been embarked upon by the project, hoping tha-t when completed, this will reduce the quest for motivation by CDDs. To increase funding for the programme - consultation is on to see if it will be possible to deduct at source fund from local government areas for onchocerciasis control before releasing the money to the LGAs, especially with incoming administration. (2) (3) 33 WHO/APOC, 24 November 2004 sEGTloN 6: unique features of the proiect/other matters Imo project is located in an area where its citizenry are highly mobile. The people arecommercial oriented, this mobility affects consistency ortrlaiment. Again, the projecthas lasted up to l0 years, some peopre are now orug zuigu", th"refo.e, there ii everyneed to add a new programme toonchocerciasis con-trol tI #r. their interest again. 34 WHO/APOC, 24 November 2004 BT'I' vEA R sUSTAINABILITv IILAN grog.,IB,f o srATE (yt En 3) JAI\UARY _ DECtrh{BER 2fi07 Flip charts Hanc.ibills I GAI I I I 1,000 I\fcr I GAs I 7 irlllilt i ss,oco I iiliri___.i SiN ACTIVITY PERSONNEL RESPONSIBLE DURATION INEICA.TOR OF SUCCFSS REGUIREMENT f-__t_____I srnrr SOURCE I NGDo T APoc I Lc[ 1 etanning rD dts -- coordinator & LOCTs for I DPH/PHC & other i Jan ZA}t review of previous years I Programnre I distritrution & updating of j Oflicers I information for 20AG12007 I I distribution year. I i 2007 produced Plan rlf Action Stationeries - Paoer - Biro - File Jackeis - Hrring of Hali - Lunch - Perdiem for LGA siaff Sub-Iofal N3,000 N 17,000 N30,C00 N50,000 i-- I I I I I I I N2o,ooo I I I I xzo,ooo -T--l I i Nioo,ocoi i (DSA r rI I 16 L As i I ttrr)li;iilitI I N*a,,,,,,,aaZ -t Collection of census update, I SPO, I ian. ZOOZ supp!.v of drugs to 16 APOC I SOCTs I Z wks l-GAs & sstimation of drug I i.OCfs I iequirement for 2A07 I Idistribuiion I I I - Ce,rsus fig,r;'e obtainecl - Drug availahle at the LGAs Frre! Sub-total t{ 15,0c10 N15,000 3 Procui'ement of crugs frcm I SPO I Jan. - Feb.A.buja/Lagos lDriver lSOays - Drug collected/ available in the state Perdiem SPO Driver Fuel Sub-total N24,000 N7,5CO Mf,50A -_r-lliltt N2s,ooo i I N25,000 i i4. I Advocacy visit to 16 LGAs I Director public II lHeatth, lOweeks I I Hon. Commissioner I June - JulVI lseo II I socrs Iltt I Productton of IEC materiais I SpO I 2 weeks I for HSAM I socrs I Visits carried out EC materiais - vehicle fueling - vehicle maintenance - Posters N 120,000 l$1o,occ N50,000 I $s,0c0 I I I I I I I I I Sub-tofa/ N120,000 N50,000 $15,000 rratntng 0I Heatm workers due to ,'etii'ement and new recruitment DPHiPHC P.A SPO SOCTs LOCYs Feb. - Mar. 12 weeks Fiealth Workers trained for CDTlactivity IEC materialS, \ Fueling for training Suh-total N220,000 N220.000 N85,000 N85,000 $6,000 $6,000 6 Training of 6000 CDDs using Kindred level structure SOCTS, LOCTs DHS, FLHT 12 weeks Mar. - June 6000 new CDDs trained at kindred level CDD treatment guide, Posters, Handbills etc Sub-tofa/ N95,000 N95,A00 N30,C00 N30,000 $8,000 $8,000 N800,000 (at the rate of N50,000 per LGA) N800,000 ;upervston/monttofl ng o1 drug movements, distribution (twice a year per LGA) and retrieval of treatment. tJPO, SOCTS 8 weeks Feb. - Nov. Drugs available at LGA, Districts, H/Facility & communities - Distribution in progress Fuel Perdiem: 5 SOCTs SPO Driver Perdiem for NGD0 staff Sub-tofa/ N64,000 N32,00C N24,000 N 19,000 N139.000 N500,000 N500,000 Kep0n r//nfing SPO SOCIs Monthly & Quarterly Monthly, Quarterly, 6 monthly Technical Report and Annual Report Paper (10 reams) Biro (2 pks) Printer ink Toner (2 pks) Stapling pin Developer File jackets Binding Suh-total N12,000 N1,200 N20,000 N 10,000 N200 N10,000 N600 N5,000 N59 000 I I Vehicle & Equipment maintenance SPO 2 months Vehicle & equipment in good condition -Servicing -Replacement of tyres -Change of spare pans (NGDO) -Copier servicing -Generator repairs Sub-total N48,000 N 120,000 N27,000 N30,000 N 18,000 N243,000 5 7 E R;\, re w;eetr n gs qi,A. rly, ZOIF 6 monthly technical repon, Global 2000 assisted reviev; rneetings, SplC meeting SPO, SOCTs Drivers, DPH/PHC lvlcnihly/ Birnonthly/ Quarterly 7 months Jan. - July Annually lmpro'red performance by ail staff concerned. lmproved therapeutic & geographical c0verage -Awareness created -Appi'oval& release cf fund -lmproved pei-fornrance by state officers Fuel Perdiem: ' Review meeting SPIC meeiing 'lechnical Review Meeting Sub-total Hiring of halt EniertainnrenU Lunch Sub-fofai P.A, SPO, SOCTS, DPIi/PHC, Perm. Sec. Dir. of Accounts Dir. of Planning Other program officers L__l _- i,, I Renevralof insuraG I '" I ' ;vuursiltsilr ut d Lilp lopI I Compuier for easy i____ I ?ccessibiiity of informationI IA : tr..rr:--r:- --l--i--- N430600SPO Vehicie insurance renewed Fund New Equipment Procured i iTc !l GRAND TOTAL ry!q!-_l Stakeholders meeting at stare level (twice a year) to create awareness & solicit support for CDTI implementation N66,000 N 18,000 i{35,000 N100,000 Nl19,000 N100,a00 Ni 8,000 N25,000 I I I $2,500 I $3,500 t'J1.134.500 N810,000 $38,000 Nrnr.- D' L(' A'/J YA'i^')'::': (' / arz- ft.*g"J 5 N , Date: Position: Sign-.: , )Iinistrv of Fleeltlt GIobel l0Cil River ElinCi:ess Progran:n;e 9 Zci46 f.v7 1V^ -^ la u-8- t- oe 6 I zl/s /au i '-l t' t1 'J -..r 5 .t -H.a*-' , i -=>