Evaluation of sustainability of Kwara state CDIT project, Nigeria: December, 2004

1 World Health Organisation African Programme for Onchocerciasis Control Evaluation of Sustainability of Kwara State CDTI Project, Nigeria December, 2004 Margaret A. Mafe Wade Kabuka Uche Enyinnaya Pius Mabuba Philip Sankwai David Sang Nigeria Chad Ethiopia D.R. Congo Cent Af Rep Cameroon KenyaUganda Rwanda Burundi Tanzania M oz am b i qu e Malawi Sudan Eq Guinea Gabon C on g o Angola Liberia 2 TABLE DES MATIERES Abbreviations/ acronyms ................................................................................................................ 3 Acknowledgements ............................................................................................................................ 5 Executive Summary ........................................................................................................................... 6 Introduction and methodology ...................................................................................................10 1. Introduction .......................................................................................................................................10 1.1 Background .............................................................................................................................10 2. Methodology......................................................................................................................................12 2.1 Sampling .................................................................................................................................12 2.2 Levels and instruments .........................................................................................................20 2.3 Protocol ...................................................................................................................................20 2.4 Team composition .................................................................................................................21 2.5 Advocacy visits and ‘Feedback/ planning’ meetings ....................................................22 2.6 Limitations ..............................................................................................................................22 3. Evaluation Findings and Recommendations..........................................................................................23 3.1 Sustainability at the State level ...............................................................................................23 3.2 Sustainability at the LGA level ...............................................................................................31 3.3 Sustainability at the FLHF level .............................................................................................39 3.4 Sustainability at the Community level ..............................................................................43 3.5 Sustainability at all levels .........................................................................................................50 4. Conclusions ...........................................................................................................................................51 4.1 Overall sustainability grading of Kwara State CDTI Project ...........................................51 5.1 Advocacy activities and feedback/planning workshops ..................................................53 5.2 Two levels feedback/Planning meetings ...............................................................................53 5.3 Way forward ...............................................................................................................................57 5. 4 Lessons learnt on use of the Instrument ...............................................................................57 Appendix 1 FEEDBACK/PLANNING WORKSHOP ..............................................................................58 Appendix 2 SWOT ANALYSIS (STATE) ....................................................................................60 Appendix 3 Identified Resources...............................................................................................................62 Appendix 4 SUMMARY OF FEEDBACK/PLANNING MEETING FOR LGA LEVEL .......................66 Appendix 5 : SWOT ANAYLSIS AT LGA LEVEL ................................................................................74 Appendix 6 : LIST OF DOCUMENT CITED ...........................................................................................76 Appendix 7 : LIST OF THOSE MET........................................................................................................77 3Abbreviations/ acronyms AG Acting APOC African Programme for Onchocerciasis Control ATO Annual Treatment Objective CBIT Community Based Ivermectin Treatment CDD Community directed distributor (of ivermectin) CDTI Community Directed Treatment with Ivermectin CEHO Community Environmental Health Officer CSM Community Self-Monitoring DD(H/E) Deputy Director, Health Education DD,PHC/DC Deputy Director, Primary Health Education Care and Disease Control DD,MCH Deputy Director, Maternal & Child Health DF Director of Finance & Supplies D(F&E) Director, Finance and Establishment DHU District Health Unit FLHF First Line Health Facility FMoH Federal Ministry of Health HF Health Facility HMIS Health Management Information System Hon. Honourable HQ Headquarters HSAM Health Education/ Sensitisation/ Advocacy/ Mobilization IDP Ivermectin Distribution Programme IEC Information, Education, Communication KWECP Kwara Eye Care Programme LGA Local Government Authority LOCT Local government Onchocerciasis Control Team M&E Monitoring and Evaluation MoH Ministry of Health NGDO Non-Governmental Development Organisation NGO Non-Governmental Organisation NOC National Onchocerciasis Coordinator NOCP National Onchocerciasis Control Programme NOTF National Onchocerciasis Task Force NID National Immunization Day ONCHO Onchocerciasis ONCHO Coord. Onchocerciasis Coordinator PHC Primary Health Care REMO Rapid Epidemiological Mapping of Onchocerciasis SHM Stakeholders’ Meeting SMoH State Ministry of Health SOC State Onchocerciasis Control SOCP State Onchocerciacis Control Programme SOCT State Onchocerciasis Control Team Super. Supervisory SSI Sight Savers International 4SWOT Strength, Weaknesses, Opportunities, Threats TCR Therapeutic Coverage Rate UNICEF United Nation’s Children’s Fund UTG Ultimate Treatment Goal WHO World Health Organisation ZOTF Zonal Onchocerciasis Task Force 5Acknowledgements We thank the following persons for their help: * The staff at APOC Headquarters in Ouagadougou : Dr. Seketeli, Dr. Amazigo, Mr. Aholou * Dr. Jiya, NOCP, Nigeria * Staff of the State Ministry of Health in Ilorin, Kwara State: Dr. Bola Olaosebikan, Commissioner for Health, Alhaja Ayinke Saka, Permanent Secretary, Dr. (Mrs) A.P Folorunsho (DPHC/DC), Mr. Yemi Ajayi (DD Epid), Mr. G. D Adeseko DD (M&E), Mr J.S.B Asonibare DD H/E, Mr. Oye, DF&S * Dr. K. O. Ogundimu, Sight Savers International * Members of SOCT * Members of LOCT of all LGAs especially Asa, Ekiti and Kaiama * Chairmen, Vice Chairmen, Councillors, Directors for PHC/DC and all other key staff of all LGAs especially Asa, Ekiti and Kaiama * Health Workers and Community members of the Health Facilities and Communities visited in the 3 LGAs. * Secretarial Support: Miss Veronica Okorodas, Miss Cecilia Okorodas and Mr. S. O. Alao. 6Executive Summary Community Directed Treated with Ivermectin (CDTI) was introduced in Kwara State by the African Programme for Onchocerciasis Control (APOC) in September, 1999. The Kwara State CDTI project is in its fifth year of APOC support (September 1999 – August 2005). Its fifth year was adjusted from 2003 to 2004 (September, 2004 to August, 2005) because of the State’s late submission of previous budget proposal to APOC. The State’s CDTI project which was in the 3rd month of the 5th year of APOC support was evaluated between 21st November and 6th December 2004 by a team of six Evaluators of mixed expertise which included three individuals from outside Nigeria; one from Kenya and the other two from Tanzania. The Evaluators were mandated by APOC headquarters: to evaluate the sustainability of the Kwara CDTI project; to give feedback about the findings of the evaluation (in relation to project sustainability) to decision makers and pay advocacy visits to decision makers to encourage them to play their part in supporting the State CDTI programme. The following are the findings of the evaluators: - Planning: The state has no overall written yearly health plan but has written plans for individual health programmes. A detailed yearly plan for onchocerciasis control exists although there is no specific planning for sustainability. There is neither an integrated health plan at LGA level nor a written plan for CDTI, as is also the case at the FLHF level. - Leadership: The leaders are exercising effective leadership for CDTI at their levels. There are focal persons for CDTI at all levels. In some LGAs the LOC takes full responsibility for CDTI implementation. In others, initiation of activities is dependent on the state level. - Supervision and Monitoring: This is routine. At the State level, this is limited to the LGA level although occasional spot checks are made to the FLHF. There are supervisory checklists but these are not being used. When problems are brought to the SOC’s attention, appropriate actions are taken. Treatment data and reports on CDTI are readily available, and are clear and detailed. - Training & HSAM: Training is usually routine, but has recently been targeted in view of recent add-on of Vit A supplementation and eyecare and there is efficient use of personnel. SOCT trains only the LOCTs but are also usually present as observers at training of lower levels to add authority to the training. LOCTs train right down to community level i.e. CDDs and training reports are not available at the LGA level. HSAM is targeted, particularly when there is change of personnel/policy makers. At the State level, HSAM is usually integrated with other health programmes and conducted by key MOH officials and programme officers. - Mectizan Supply: Distribution of Mectizan to LGAs and communities is done within government system. Supply is timely and adequate and, there are no shortages. There is good stock control. LGAs collect their drugs from the state level. The SOCT does not calculate their Mectizan requirement – it is done by the NGDO. The LGA’s mectizan need is also not calculated at this level, neither at the HLHFs level. Ordering and procurement of Mectizan is done by the NGDO (SSI). 7- Finance/Funding: There is some release at the LGA level although this is inadequate. There is however generally no specific written budget for oncho at this level although CDTI is recognised as a priority health issue. As such there is no budget allocation for it. Rather, 3% of LGA budget is for health services from which oncho needs are supposed to be met. There is an effective financial control system in place. At the State level, there is a detailed onchocerciasis budget but no actual release of funds in any year. There is no budget containment from year to year. There is a good control system for APOC funds in the State. There is no involvement in financial input at the FLHF level hence no records of either budget or expenditure. - Transport and Equipment: These are inadequate and some of the equipment are too old and non-functional. They need to be replaced. Maintenance is based on needs and not routine. A vehicle log-book is maintained. Costs of repairs and maintenance are met by APOC and Government funds. At the lower levels, suuh as LGA the motorcycles are maintained through personal funds. - Human Resources: Staff are very stable, they are skilled and knowledgeable in CDTI activities and are capable of meeting training needs of new personnel. They are happy, committed and contented to do CDTI work. Salaries are paid regularly. Those at the LGA receive financial incentives from the LGA. There is however lack of secretarial support for SOCT. - Coverage: Overall this is good. At the State level, geographic coverage was 100% in 2004, 89% in 2002 and 86.7% in 2001 and therapeutic coverage was 88.5% in 2003, 84.4% in 2002; 86.0% in 2001. At the LGA level, geographical coverage is 100% and therapeutic coverage is above 65% each year. At the community level coverage is generally good. Therapeutic coverage is satisfactory in all the communities. Concerning the overall situation with respect to the aspects and critical elements of sustainability, the team’s findings are the following: Integration: Integration is present but needs better planning and coordination. Resources: There are highly qualified human resource at all levels performing good work. Although there is an approved allocation of funds at State Level, it has never been released. Transport and other equipment are available but are inadequate, not routinely maintained and are aged. There are no plans for replacement. Training materials are adequately supplied at State Level. At the LGA level, there is release of some financial support to CDTI but this needs to be improved. Motorcycles are available but there are no funds for routine maintenance. NGDO partner provides spareparts yearly for the motorcycles. Training materials are inadequate at this level. At the FLHF level, there is no financial provision. Staff at this level are skilled but not fully empowered to carry out CDTI activities. Efficiency: There is need for improvement through targeting and integration of activities. Poor empowerment at FLHF in particular prevents the health staff at this level in performing effectively. 8Simplicity: Project has been running in a simple uncomplicated manner. Health Staff Acceptance: High acceptance and commitment to CDTI is shown by all staff at all levels. Community ownership: There is high level of community ownership evidenced by Communities selection of CDDs and provision of materials support and making decision on time and mode of Mectizan distribution. In some communities, Community Leaders are also involved in Community Self Monitoring. In most communities, community leaders provide solutions to problems when they arise. Effectiveness: Good coverage rates are being achieved at all levels even though personnel at all levels do not determine these rates as the NGDO partner has been responsible for doing this. There is a need for all levels to estimate yearly Mectizan requirement. On the five aspects of Sustainability, the situation is as follows: * Money: At the State level, there is a problem as there is no release of funds in support of CDTI activity. Some LGAs release arbitrary funds occasionally which are not tied to specific budget allocation. There is no provision for financial release at the FLHF Level. The Community mobilises itself to meet its needs and provides incentive to the CDDs. * Transport: Motorcycle spare parts are provided annually by NGDO. Repair of available vehicle is met from APOC funds while repair of motorcycle is met by State/LGA/personal funds. * Supervision: At the State level, supervision is routine while in many LGAs, it is targeted. At the FLHF level, there is hardly targeting when there is empowerment. * Mectizan Supply: Mectizan supply system is dependable, but State should use Government means of collecting State’s supply from the zonal office. * Political Commitment: There is political commitment resulting in some support which needs to be improved upon particularly at the State level. There is a high level community ownership of the programme. Kwara State is seen as a special situation in that it had been subjected to a peculiar political administration in the recent past (1999 – 2003). The administration adversely affected the functionality of the Ministry of Health amongst other State organs. The evaluation of this project should therefore be considered in this light. 9Detailed recommendations were made, based on the findings of the evaluation. These recommendations were prioritized, and indicators and deadlines were suggested for each. The most important recommendations concern: - The need for the release of funds in support of CDTI activities most especially at the State level - Targeting of activities such as training, monitoring and supervision at all levels - Full empowerment of the immediate next levels (LGA and FLHF) - The need for all levels to determine their yearly mectizan needs and calculate their coverage rates. - Integration of activities as far as possible - Improved documentation including maintenance of vehicles and equipment at all levels above the FLHF. Advocacy activities were carried out at the State and Local Government levels. Two feedback/planning workshops were held: one for the State and the other for the LGAs. Participants at these meetings were briefed of the preliminary findings of the evaluation for them to analyse the implications in terms of strengths, opportunities, weaknesses and threats. Thereafter, they were guided into developing 3 – year sustainability plans (2006 – 2008). 10 Introduction and methodology 1. Introduction 1.1 Background Kwara State lies in the Middle-belt zone of Nigeria. It has 16 administrative Local Government Areas (LGAs), namely: Asa, Baruten, Edu, Ekiiti, Ifelodun, Ilorin East, Ilorin West, Ilorin South, Irepodun, Isin, Kaiama, Moro, Oke-Ero, Patigi, Offa and Oyun. Each LGA is divided into 3-9 districts. All the headquarters of the Local Government Areas are well connected with all season roads. Most of the inter community roads are very accessible through out the year except those of Baruten, Kaiama, Moro, Asa, Edu and Patigi Local Government Areas which are often impassable during the rains. The state capital, Ilorin is 346kms North of Lagos and 594kms South of Abuja the Federal Capital of Nigeria. It is located on Latitude 8º and 10º 31’ North and Longitude 2º 45’ to 6º 10’ East. The state has an area of 32,500sq.kms and shares an international boundary with the Republic of Benin to the West, and boundaries with five other states, Oyo, Osun and Ekiti to the South, Kogi to the East and Niger to the North. The projected population (1991 Census) is 2.6 million people made up of the following five major ethnic groups namely: Yoruba, Nupe, Baruba, Hausa/Fulani and Bartonun. The main occupation of the people are farming, fishing and trading but farming is the predominant occupation. Farming activities is carried out during the rainy season (March to November) and in the dry season (December to February). Fishing activities are at a peak in the dry season. The state has two main climatic variations of wet season (March – October) and dry season (November – February) with cold and dry harmattan from December – January. The terrain is mountainous with prominent land forms. The major rivers that transverse the state and confirmed as the breeding sites of the blackfly include: Kampe, Osin, Asa, Oyun, Ero, Oyi, Nano, Oli, Moro, Awon and Awere and the tributaries of River Niger. All the 16 LGAs in Kwara State are endemic for onchocerciasis, 4 of them are hyper- and the rest 12 are meso-endemic. Mass distribution of Mectizan in Kwara State was initiated by an NGDO (Africare) in collaboration with the state Ministry of Health in 1989 using Community Based Ivermectin Distribution (CBIT). Following the withdrawal of the NGDO from the state in October 1997, Sights Savers International (SSI) was invited by the National Onchocerciasis Control Programme to support Mectizan distribution in the State and has since then being the NGDO supporitng Mectizan® distribution in the state. Community Directed Treatment with ivermectin (CDTI) is being implemented in all the 16 LGAs of the State and it is in its 5th year of APOC’s support (Sept. 2004 to August, 2005) There are 1,069 endemic communities. (518 hyper and 551 meso-endemic) in Kwara State. Since the inception of the project, 805,143 persons have been treated with 2,040,768 mectizan tablets in all the 16 LGAs in the State. The annual treatment objective (ATO) for the year is 750,000 with a total population of 895,711. The Ultimate Treatment Goal (UTG) for the project is 752,448. 11 Partners that are involved in CDTI activities in the state include the State Ministry of Health and all the 16 Local Governments. 1069 endemic communities, the CBO/Development Associations, Sight Savers International and APOC. The NGDO (Sight Savers International) is regularly involved in training, planning, monitoring, supervision, supply of Mectizan® and other materials and in carrying out advocacy and giving support in mobilisation at all levels in the state. Reports of Mectizan treatment are compiled by each LGA coordinator and submitted to the state coordinator. Each LGA reports the quantities of Mectizan® required by each community for the following year and this information is compiled as the State report and the request forwarded to Sight Savers International supervising the project in the State. The NGDO orders and delivers Mectizan® to the State. Government Structure There are 3 tiers of Government in Nigeria and political figures are therefore found at these levels: * Federal UTG = 752,448 * State * Local Government Treatment is still ongoing. Politically, the President, Vice President, Senators, Members of the House of Representative and Ministers are found at the Federal level while at the State level, the Governor and the Commissioners and the Members of State House of Assembly are the key political figures. At the LGA level, the Chairman, Vice Chairman and the Supervisory Councillors are the lay politicians found at this level. The CDTI is operational along the health system structure which recognizes the following levels of health care: * State * Local Government * Health Facility (District) and • Community level 12 2. Methodology 2.1 Sampling Onchocerciasis is endemic in all the 16 LGAs of Kwara State. All these 16 LGAs were therefore randomly sampled to obtain 3 LGAs following the procedure as detailed in the document: ‘Guidelines and Instruments for Conducting and Evaluation of the Sustainability for CDTI Projects. The selected 3 Local Government Areas are Asa, Ekiti and Kaiama (Table 1). For each of these selected LGAs, a listing of all FLHF supporting CDTI was made in a tabular form which provided for details on therapeutic coverage rates, the level of endemicity, geographical location and accessibility status (Tables 2a-c). Purposive sampling was further applied in selecting two FLHF from each LGA, one far and the other near to the LGA headquarters. For each of these selected two FLHF, all villages in the catchment area of the FLHF were listed and their primary and secondary criteria computed in a table (Tables 3a(i)- 3c(ii). These criteria were used to select two villages per FLHF: one near and the other far from the FLHF. Four villages were therefore selected from each LGA. Effort was made to include at least one isolated community in the selection. A total of 12 villages in all were selected from the three LGAs. The FLHF chosen in each LGA and the selected villages are given in Table 4. The 12 villages selected and evaluated were Ogele, Oloko Igorese, Bakase and Sosoki in Asa LGA; Inihun, Ilemo, Oke-Ado and Koro in Ekiti LGA; and Kango Lamisa, Hamdallahi, Miku and Tungan Maje in Kaiama LGA. 13 Table 1: List of endemic LGAs in Kwara State CDTI Project by Primary and Secondary Selection Criteria S/NO. LGAs Primary selection criterion, therapeutic coverage rate % Secondary selection criteria Selection (Yes/No)Endemicty (hyper/meso/ both) Geographical situation (north, south, east west, central) Accessibility (easy, moderate, difficult) 1. Asa 88 Meso West Easy Yes 2. Baruten 85.9 Meso North Difficult 3. Edu 87.7 Meso North Moderate 4. Ekiti 63.2 Hyper East Easy Yes 5. Ifelodun 84.1 Hyper Central Moderate 6. Ilorin East 94.3 Hyper Central Easy 7. IlorinWest 93.8 Meso Central Easy 8. Ilorin South 93.1 Meso Central Easy 9. Irepodun 93.4 Mesoo East Easy 10. Isin 89.7 Meso South Easy 11. Kaiama 90.1 Meso North Difficult Yes 12. Moro 94.7 Meso North Moderate 13. Oke-ero 88.1 Meso East Easy 14. Oyun 68 Meso South Easy 15. Offa 95.5 Meso South Easy 16. Patigi 84.1 Hyper East Difficult 14 Table 2a: List of Health facilities (FLHF) supporting CDTI Activities in Asa LGA S/N Health Facilities Therapeutic Coverage Endemicity Level Geographical Location Accessibility Selection (Yes/No) 1. District Health Unit Ofon N/A N/A East Easy, Near 2. Ogele H/F N/A N/A West Easy, Near 3. Enyenkorin H/F N/A N/A West Easy , Near Yes 4. Alapa H/F N/A N/A North East, Far 5. Odegiwa H/F N/A N/A North Easy, Far Yes 6. Karajo H/F N/A N/A North Easy , Far 7. Sapati – Oko H/F N/A N/A Central Easy Near 8. Okeso H/F N/A N/A Central Easy Near Table 2b: List of Health facilities (FLHF) supporting CDTI Activities in Ekiti LGA S/N FLHF Health Facilities Therapeutic Coverage Endemicity Level Geogra- phical Location Accessibility Selection (Yes/No) 1. Osi Health Office N/A N/A West Easy Yes, Near 2. Obbo Ayegunle H/C N/A N/A South Moderate 3. Isolo Open Health Office N/A N/A Central Easy 4. Etan Health Center N/A N/A West Moderate 5. Isapa Health Center N/A N/A North Moderate 6. Koro Health Center N/A N/A East Moderate Yes. Far 15 Table 2c: List of Health facilities (FLHF) supporting CDTI Activities in Kaiama LGA S/N FLHF Health Facilities Therapeutic Coverage Endemicity Level Geogra- phical Location Accessibility Selection (Yes/No) 1. C.W.C. Kaiama N/A Hyper Central Easy 2. School Clinic Kaiama N/A Hyper Central Easy 3. Asoki Health Clinic N/A Hyper South Moderate 4. Gwaria Health Clinic N/A Hyper South Difficult 5. Moshe-Gada Health Clinic N/A Hyper South Difficult 6. Kugisi Health Clinic N/A Hyper West Easy 7. Woro Health Clinic N/A Hyper North Moderate Yes 8. Kanikoko Health Clinic N/A Hyper South Moderate 9. Bani Health Clinic N/A Hyper South Difficult Yes 10. Adena Health Clinic N/A Hyper South Difficult 11. Kemanji N/A Hyper North Easy 16 Table 3a(i): List of communities covered by Eyenkorin Health Facility, Asa LGA S/N Communities Therapeutic Coverage Endemicity Level Geographical Location Accessibility Selection (Yes/No) 1. Ogele 88.8% N/A West Easy, Near Yes 2. Pampo 88.2% N/A Central Easy, Near 3. Oloko/Igorese 75% N/A Central Easy, Near Yes 4. Arowo Saiye 84.2% N/A Central Easy, Near Table 3a(ii): List of communities covered by Odegiwa Health Facility, Asa LGA S/N Communities Therapeutic Coverage Endemicity Level Geographical Location Accessibility Selection (Yes/No) 1. Ode – Giwa 88.8% N/A North Easy , Near 2. Bakase 90.2% N/A North Easy, Far Yes 3. Sosoki 87.1% N/A North Easy , Near Yes 4. Onire 88.9% N/A North Easy. Far 5. Nasirin 76.7% N/A North West Easy Far 17 Table 3b( i): List of communities covered by Osi H/Office, Ekiti LGA S/N Communities Therapeutic Coverage Endemicity Level Geogra- phical Location Accessibility Selection (Yes/No) 1. Itakete Osi 82.4% N/A 2. Inihun Osi 91.1% N/A Yes 3. Odo – Ohoo Osi 90.6% N/A 4. Oke-Ole Ayin Osi 87.3% N/A 5. Igbeyin Osi 77.9% N/A 6. Ilemo Osi 94.1% N/A Yes 7. Ile Ajide Osi 91.1% N/A 8. Idoji Osi 75.2% N/A Table 3b(ii): List of communities covered by Koro Health Centre, Ekiti LGA S/N Communities Therapeutic Coverage Endemicity Level Geogra- phical Location Accessibility Selection (Yes/No) 1. Odolomu 90.2% N/A 2. Oke – Ado 86.5% N/A Yes, Far 3. Ogbua 62.3% N/A 4. Oke – Ogi 79.6% N/A 5. Koro 91.6% N/A Yes, Near 18 Table 3c(i ): List of communities covered by Bani Health Facility, Kaiama LGA S/N Communities Therapeutic Coverage Endemicity Level Geographical Location Accessibility Selection (Yes/No) 1. Labelabe 81.7% Hyper North Difficult 2. Fonlo 77.8% Hyper South Moderate 3. Kango Lamba 98.3% Hyper North Moderate Yes 4. Rioji 81.6% Hyper North Difficult 5. Bani Zango 87.8% Hyper Central Easy 6. Kagbona II 82.4% Hyper South Difficult 7. Famini 76.2% Hyper North Moderate 8. Leere 83.3% Hyper East Difficult 9. Kagbona I 86.4% Hyper South Difficult 10. Hamdallahi 75.9% Hyper West Difficult Yes 11. Olori 90.1% Hyper South Easy 12. Ossa 88.8% Hyper North Difficult 13. Avode 88.1% Hyper North Difficult 14. Darusalam 86.6% Hyper North North 15. Welewele 89.4% Hyper South Difficult 16. Alenje 89.7% Hyper North Difficult 17. Tunga-Juiti 90.5% Hyper West Moderate 18. Olokotintin 91.1% Hyper South Difficult 19. Ga-Eleure 85.4% Hyper West Moderate 20. Bade Bani 84.8% Hyper Central Easy 19 Table 3c(ii): List of communities covered by Woro Health Facility, Kaiama LGA S/N Communities Therapeutic Coverage Endemicity Level Geographical Location Accessibility Selection (Yes/No) 1. Worumakotu 92.2% Hyper West Easy 2. Miku 94.4% Hyper West Moderate Yes 3. Tungam Maje 91.0% Hyper West Easy Yes Table 4: Selected Communities by LGA LOCAL GOVERNMENT ASA EKITI KAIAMA FLHF 1. Eyenkorin health facility (west, near, meso – endemic) 2. Odegiwa health facility (north, far, hyper – endemic) Osi health office (west, near) Koro health centre (East, far) Woro health clinic (north, moderate) Bani health clinic (south, far) Communities 1. Ogele (west, near, meso) 2. Oloko Igorese (central, near, meso) 3. Bakase (north, far, hyper) 4. Sosoki (north, near, hyper) Inihun (far) Ilemo (near) Oke Ado (far) Koro (near) Kango Lamba (north, moderate) Hamdallahi (west, difficult) Miku (west, difficult) Tungan Maje (west, easy) 20 2.2 Levels and instruments Table 3 Level Instrument Project/ State 1 Local Government Area 2 FLHF 3 Community 4 2.3 Protocol  Research question: How sustainable is the Osun State CDTI project?  Design: Cross-sectional, descriptive.  Population: The Osun State CDTI project, its NGDO partner (UNICEF/IFESH); its LGAs, Health Facilities, with all staff involved in onchocerciasis control in them; the project communities, with their leaders and CDDs.  Instrument: * A record sheet, structured as a series of indicators of sustainability. The indicators are grouped into nine categories/ groups. These groups represent critical areas of functioning of the Programme. * The instrument assesses sustainability at four levels of operation. * The instrument guides the researcher to collect relevant information about each indicator, from a variety of relevant sources.  Sources of information: ∗ Documentary evidence and observations. ∗ Verbal reports from persons interviewed.  Analysis: * Data from all sources is aggregated, according to level and indicator. * A qualitative summary of the situation regarding each indicator at each level is made. This is aggregated and summarised for each category of indicator, for each level. * Based on the information collected, each indicator is graded on a scale of 0-4, in terms of its contribution to sustainability. * The average ‘sustainability score' for each group of indicators is calculated, for each level. * Finally an overall assessment of sustainability is made, by considering the 7 aspects and 5 critical areas of sustainability.  Recommendations: ∗ These are strictly based on the findings of each area of research. 21 2.4 Team composition The core team members were the following: Team Members 1. Margaret A. Mafe, Team Leader Public Health Division, Nigeria Institute of Medical Research, 6, Edmond Crescent, P.M.B.2013,Yaba, Lagos Nigeria. Tel. 2341 4938945; 08034082690 Fax 2341862865 E-Mail: margmafe@yahoo.co.uk 2. Dr. David Sang MOH, Division of Vector Borne Diseases, Box 20750, Nairobi, Kenya Tel: 2716934; 0722819165, 08038082588 Email: sangdvbd@yahoo.com 3. Dr. E. Uche Enyinnaya Carter Center Global 2000 Imo/Abia Project, Plot R60 Owerri Tel: 08034718708/083231090, 083-231883 (256-77)587098 Email: enyiuche2003@yahoo.com 4. Mr. Phillip Sankwai Onchocerciasis Control Unit State Ministry of Health Kaduna Kaduna State. 5. Dr. Wade Kabuka Ruvuma Focus CDTI Project, P. O. Box 5 Songea, Tanzania. Tel: (255) 252602048 6. Dr. Pius Mabuba Sight Savers Int. P. O. Box 2513, Dares Salaam, Tanzania. Tel: (255) 222701098 Email: pmabuba@sightsavers.or.tz Team members were grouped into three sub-teams, for the purposes of fieldwork. Three SOCT members: Mr. Yemi Ajayi, Mr. Ganiyu Kareem and Mr. F. O. P. Oyinloye who acted as guides and facilitators (and translators) accompanied each sub-team. 22 2.5 Advocacy visits and ‘Feedback/ planning’ meetings Advocacy visits were to be paid to relevant persons at each level, as many as possible, and officials were debriefed at the end of the field visits where possible. Finally, feedback/planning meetings were conducted for relevant officials at the State and LGA levels. During these meetings the evaluation team gave feedback on its findings, and the State and LGA teams were guided into developing 3 – year sustainable plans, based on the findings and following the guidelines provided by APOC Management. 2.6 Limitations 1. The timing of the evaluation coincided with the National Immunization Days (NIDs), and all key health officials in all tiers of Government were involved in this exercise. This seriously affected the timetable of the evaluators. 2. The absence of most Honourable Chairmen of LGAs on official assignment to Abuja prevented their participation at the feedback LGA meeting. 3. The sudden posting and transfer of key LGA officials just before the feedback meeting affected the full participation of the LGA at the feedback meeting. 23 3. Evaluation Findings and Recommendations 3.1 Sustainability at the State level Planning (2.3) Findings: • The state has no overall written yearly health plan but has written plans for individual health programmes. • A detailed yearly plan for onchocerciasis control exists although it does not show much variation over years except the Vitamin A supplement add-on in the present year 2004. • All partners, State, LGAs & NGDO (SSI) contribute to the routine yearly planning of oncho project and each one is clear of its role. There is documented evidence in the form of minutes of the planning meetings. Sustainability at State Level 2.3 3 3 2 2.6 1.25 2 3 3.3 3 0 1 2 3 4 2.2 5 4 24 • There is no specific planning for sustainability. • Reason why there is no specific funds: Government has not -released funds in support of oncho activities that would warrant such planning. Recommendations: Planning Implementation 1. State should develop an integrated yearly plan for all the health programmes 2. State should integrate the 3 year sustainability plan developed into the overall State health plan Priority: 1: MEDIUM 2: HIGH Indicators of success: 1: Integrated yearly State plan available 2: Sustainability plan available and in use Who to take action: 1: Director, PHC 2: SOC/Director PHC Deadline for completion: 1: Immediate and yearly 2: December 2004 Integration of Support Services (3) Findings: • Vit A supplementation integrated in oncho control in 2004. • SOCT members are programme managers such as the State Malaria manage, Schistosomiasis Desk Officer, Health Education Officer, etc so they integrate activities and combine tasks e.g. monitoring, HSAM, etc. Leadership (3) Findings: • The leaders are exercising effective leadership for CDTI at their level. • Written evidence is available to support CDTI progress, but there is no documentation of successes from lower levels. • Different members of SOCT are assigned specific duties such as Mectizan ordering, inventory and M&E. All are fully informed on CDTI activities and have quarterly meetings which are targeted. 25 Recommendations: Leadership Implementation 1. There should be recognition and documentation of successes as this is motivating and contributes to sustainability. Priority: 1: MEDIUM Indicators of success: • Reports on successes available Who to take action: SOC/DPHC&DC Deadline for completion: April 2005 Monitoring & Supervision (2.2) Findings: • Treatment data and reports on CDTI are readily available, and are clear and detailed e.g. LGAs’ Treatment Records, Inventory of Equipment, Financial Records, Mectizan Inventory and Annual Technical Reports. • Monitoring and Supervision is routine • Limited to the LGA level although occasional spot checks to the FLHF are done. • There are supervisory checklists but are not being used. No visitors’ books. • Other programmes such as NPI sometimes help transport mectizan to LGAs while delivering vaccines, M&E programme collects oncho reports while out on other activities. • The supervision checklist was introduced to them after the 2003 distribution and the lack of funds in 2004 as a result of the change of the CDTI project’s new financial year has hindered them from supervising/monitoring • Supervision is done once a year to the LGA level, but because of the new add-on of Vita A supplementation, it necessitates the SOCTs going as far as the community. • When problems are brought to the SOC’s attention, appropriate actions are taken. However, LGAs level rarely provide feedback on successes or on some funding issues. • Most of the recommendations of the 2001 monitoring exercise have been addressed. 26 Recommendations: Monitoring & Supervision Implementation 1. Carry out targeted supervision to problem LGAs 2. Institute use of supervisory checklists and empower LOCTs/FLHFs to do the same Priority: 1,2: HIGH Indicators of success: • Reports on LGAs with problems visited. • Integrated Supervisory checklists developed and in use at all levels. Who to take action: SOC, DPHC&DC, Zonal NOCP/SOC/ Deadline for completion: 1, 2} January 2005 Mectizan Distribution and Procurement: (2) Findings: • Ordering and procurement of Mectizan is done by the NGDO (SSI) and not within government system. • Distribution to LGAs and communities is done within government system. • The SOCT does not calculate their Mectizan requirement – it is done by the NGDO. However, there has been no shortage, and there is good stock control. • The presence of the NGDO’s country office in same area (Kaduna) as the Zonal NOCP Office facilitates collection of mectizan by NGDO Recommendations: Mectizan Distribution and Procurement Implementation 1. State should determine yearly mectizan requirements and empower lower levels to do the same 2. State should explore use of government channels for collecting the yearly supply of mectizan through Zonal NOCP office. Priority: 1, 2: HIGH Indicators of success: • State yearly Mectizan need determined by SOCT. • Government channel used for State’s Proocurement of Mectizan Who to take action: 1,2: SOC/DPHC&DC, Zonal NOCP Deadline for completion: 1, 2} January, 2004 27 Training & HSAM (2.6) Findings: • SOCT trains only the LOCTs but are also usually present as observers at training of lower levels to add authority to the training. • The training is usually routine, but has recently been targeted in view of recent add- on of Vit A supplementation and eyecare. • There is efficient us of personnel. Training is done by 3 SOCT members at most convenient sites (3 zones) • HSAM is targetted, particularly when there is change of personnel/policy makers. • HSAM is usually integrated with other health programmes. HSAM is also conducted by key MOH officials and programme officers. • Examples of Impact of HSAM are available e.g. successful releases of funds for oncho at some LGAs e.g. Asa & Baruten, programme being allowed independent use of project vehicle, requests from the programme being processed by higher officials. Recommendations: Training & HSAM Implementation 1. LGA level should be fully empowered to carry out training of FLHF staff 2. Training of LOCTs should be targeted. Priority: 1, 2: HIGH Indicators of success: • Report of training indicating limitation of training to LGA level • Evidence of targetted training Who to take action: SOC/DPHC&DC Deadline for completion: 1, 2} December 2005 Finance (1.25) Findings: • There is a detailed onchocerciasis budget but there is no budget containment from year to year. • SOC is not aware of government funds that will be available in the coming year, but only the approved amount which has never been released so far. • Inadequate government budgeting for CDTI although there is increase from previous year; • No actual release of funds in any year 28 • There is a good control system for APOC funds in the State, with joint signatories from the NGDO (SSI), State MOH and SOC. Returns are audited by the NOCP and APOC Accountant. Funds are spent as budgeted and virement is disallowed. However, the system entails SOC/Accountant travelling to Kaduna to obtain necessary signatures Recommendations: Finance Implementation 1. There should be budget containment from year to year. 2. High level advocacy: By APOC Managements to sensitize the State Government to release counterpart funds By MOH officials to Health Committee of State House of Assembly for release of funds Priority: 1, 2: HIGH Indicators of success: • Evidence of cost reduction from year to year • Evidence of release of funds Who to take action: 1: SOC, DPHC&DC 2: Permanent Secretary & Commissioner for Health APOC Deadline for completion: 1} December 2004 2} April 2005 Transport and other material resources (2) Findings: • Some of the equipment are too old or non-functional and need replacement. • A lap top computer bought for the project is being used by the NGDO (SSI) • Maintenance is based on needs and not routine. A vehicle log-book is maintained. • Costs of repairs and maintenance met by APOC and State funds. • Available transport is used only at the State level and in support of the next level, but also occasionally up to the community when need arises. There is a vehicle log book in use but not fully completed at times and is not regularly reconciled by SOC. • No plans for replacement by the government. 29 Recommendations: Transport and other material resources Implementation 1. State should make plans for replacement/additional equipment 2. There should be provision for routine maintenance/servicing of motor vehicles and equipment 3. APOC should consider providing/ capital equipment/replacing non- functional items including the following: (i) 2 Motor vehicles (ii) 2 Desk Top computer with UPS (iii) Printer (iv) Lap-top computer (v) Air conditioner (vi) Motorcycles for FLHFs instead of bicycles Priority: 1, 2,3: HIGH Indicators of success: • Written commitment for replacement/additional equipment • Maintenance schedule available and in use • Capital equipment are replaced Who to take action: 1: SOC/Director PHC & DC 2: SOC 3: APOC Deadline for completion: 1,2} December 2004 3} September 2005 Human resources: (3.3) Findings: • Staff have been stable since 1999 • There is opportunity for exposure of health cadres and students to CDTI activities through industrial attachments, etc. • There is lack of secretarial support for SOCT • Lack of equal opportunities for training and primary assignments of some of the SOCT members sometimes affects commitment to oncho activities • Inadequae computer skill. 30 Recommendations: Human Resources Implementation 1. Most of the staff at this level should be trained in computer use and information management. Priority: 1, 2: HIGH Indicators of success: • Most SOCTs with high level of computer skills • High quality data management. Who to take action: SOC, DPHC&DC Deadline for completion: 1, 2} May 2005 & subsequently Coverage (4) Findings: • Geographical coverage was 100% in 2004, 89% in 2002 and 86.7% in 2001. • Therapeutic coverage was 88.5% in 2003, 84.4% in 2002; 86.0% (2001) Recommendations: Coverage Implementation 2. Maintain and improve upon the current good geographical and therapeutic coverage 3. Ensure proper calculation of therapeutic coverage taking full consideration of non-eligibles and absentees, etc and empower all levels to do this. Priority: 1, 2: HIGH Indicators of success: • High geographic and therapeutic coverage rates achieved • High quality data management. Who to take action: SOC, DPHC&DC Deadline for completion: 1, 2} May 2005 31 3.2 Sustainability at the LGA level Planning (1) Findings: • There is no integrated health plan at LGA level • There is no written plan for CDTI but LOCs aware of all the different CDTI activities that need to be implemented • LOCTs only recently made aware of the need for having written plan through a training conducted. Sustainability at LGA Level 1 2 2.33 3 2 1 0.5 3.5 0 1 2 3 4 1.5 4 32 Recommendations: Planning Implementation 1. LOCTs should consolidate 3-year sustainability plan developed, reusing them to reflect variation based on needs. 2. Sustainability plans should be integrated into the overall LGA health plan. Priority: 1, 2: HIGH Indicators of success: 1: Annual CDTI workplan available showing variation of activities from year to year 2: Overall integrated LGA health plan available reflecting CDTI plan and in use. Who to take action: LOCs/HOD Health/SOC Deadline for completion: 1, 2} December 2004 Integration: (1) Findings: • Implementation of some activities is integrated with CDTI, such as immunization, family planning and M&E., but this is not very effective as there is no integrated work-plan Recommendations: Integration Implementation 1. There is need for development of integrated health plan at LGA level Priority: 1: HIGH Indicators of success: 1. Integrated health plan available and in use Who to take action: HOD Health Deadline for completion: January, 2005 Leadership: (2) Findings: • There is a focal person for CDTI in all LGAs – the LOC. • In some LGAs e.g. Asa, HOD Health and LOC take full responsibility for CDTI implementation. In others e.g. initiation of activities is dependent on state level. In Ekiti there is little interaction between LOC and higher officials. 33 Recommendations: Leadership Implementation 1. HOD – Health should be fully involved in implementation of CDTI activities Priority: 1: HIGH Indicators of success: HOD Health fully responsible for CDTI implementation with LOC. Who to take action: SOC Deadline for completion: 1} January, 2005 Monitoring & Supervision (2.33) Findings: • Data are transmitted through government channels and transport facilities. • However, apart from mectizan treatment reports (LGA summary forms and community summary forms reports , there are no other implementation reports available e.g. for training, finance • No documentation of problems or successes • LOCTs supervise down to community level, usually by-passing FLHFs 34 Recommendations: Monitoring & Supervision Implementation 1. LOCTs should be empowered to produce regular implementation reports on mectizan distribution, training, coverage, expenditure, etc. 2. Supervision should be targeted, and limited to FLHF level. Supervision checklists are to be used. FLHF are not to be by- passed to reach the communities. 3. There should be documentation of successes and addressing of problems at all levels. Priority: 1, 2: HIGH 3: MEDIUM Indicators of success: • Number of LOCTs writing reports. • Evidence of targetted supervision and monitoring limited to FLHF level. • Number of FLHFs independently supervising and monitoring the CDDs • Checklists in use • Reports on problems and successes. Who to take action: 1: SOC/LOCTs 2: SOC, LOC 3: LOCTs Deadline for completion: 1: January, 2005 2,3: May 2005 Mectizan Procurement & Distribution (3) Findings: • Procurement is based on population of endemic communities; however, the LGAs’ mectizan need is not calculated at this level, but at higher levels. • Supply is timely and is adequate - there are no shortages • Mectizan is stored in the government pharmacy at that level. • For 2004 Mectizan was brought to the LGA by the State level; in previous years, LGAs collected the drugs from the state level. • There is record of drugs collected by the FLHF/communities. 35 Recommendations: Mectizan Procurement & Distribution Implementation 1. LOCTs should be empowered to determine the mectizan requirements for their LGAs and complete mectizan order forms Priority: 1: HIGH Indicators of success: • Evidence of LOCTs estimating their annual mectizan requirement • Mectizan order forms available and in use at the LGA Who to take action: SOC, LOCTs Deadline for completion: June 2005 1, 2, 3} Training & HSAM (2) Findings: • LOCTs train right down to community level i.e. CDDs. • Training reports not available. • Measuring sticks, treatment forms and flip charts are available. • Training of LOCTs is routine – not targeted, and always done at LGA headquarters – which is not always cost-effective • Training of CDDs takes place at sites close to the communities. Few staff are involved in the training of CDDs, and training is for one day (approximately 6 hours). • HSAM is targeted e.g. when there is new leadership like the Chairman. • Impact of the HSAM is seen in commitment and support given to oncho activities by the LGA. In some cases however, this is not well planned or documented. 36 Recommendations: Training & HSAM Implementation 1. LOCTs should limit training and HSAM activities to FLHFs – not training the CDDs. 2. Training needs should be identified and the training targeted. 3. There should be proper planning of HSAM activities Priority: HIGH Indicators of success: • No of FLHFs conducting targeted CDD training independently • Evidence of training based on needs • No of LGAs with proper plan for HSAM activities. Who to take action: SOC, LOCT Deadline for completion: June 2005 Finance: (0.5) Findings: • No written budget for oncho although it is recognised as a priority health issue. • No budget allocation is given to oncho, but 3% of LGA budget is for health services from which oncho budget is supposed to be met. • In 2004, there was release of N50,000 in Asa and N20,000 for Kaniami. • There is in place an effective financial control system for the LGA. Recommendations: Finance Implementation 1. LGA should budget and release funds for CDTI 2. LOCTs should have a budget for CDTI and be aware of the LGA budget for CDTI Priority: HIGH Indicators of success: • Evidence of increased release of funds for CDTI • LOC aware of budget provision for CDTI for the year Who to take action: 1: LGA Chair/DPM/HOD Health/Treasurer 2: LOCTs Deadline for completion: December 2004 37 Transport and other material resources (1.5) Findings: • No routine maintenance – rather based on need. • The NGDO (SSI) provides spare parts for motorcycles maintenance annually. • LOCTs maintain motorcycle using personal funds as government is not providing funds. • When there is break down of official transport LGAs hiring and use of public transport are alternatives. • No written authorization for use of transport, however, transport use is sometimes integrated. • No immediate plans for replacement of transport. Recommendations: Transport and other material resources Implementation 1. There should be provision of maintenance schedules and funds provided by the LGA for this Priority: MEDIUM Indicators of success: • Maintenance schedule in use • Running costs are being met by government Who to take action: HOD Health Deadline for completion: June 2005 Human Resources (3.5) Findings: • Staff are stable; they are skilled and knowledgeable in CDTI activities. Capable of meeting training needs of new personnel. • Ministry of Health and LGAs from time to time provide opportunities for further training for staff e.g. staff users take programmes in public health, etc. The CHEWS can also undertake Community Health Officers training. • Staff are happy, committed and contented to CDTI work. They do receive financial incentives from the LGA. Salaries are paid regularly. 38 Coverage: (4) Findings: • Geographical Coverage is 100% or almost so • Therapeutic coverage in has been above 65% each year: • Summary training sheets are available. • REMO records not available. • In some cases, calculation of summary treatment sheets does not take proper consideration of non-eligibles and absentees • Therapeutic coverage not calculated at the LGA level, but above records are from SOC Recommendations: Coverage Implementation 1. LOCTs should be empowered to calculate therapeutic coverage & retain such records Priority: HIGH Indicators of success: • LOCTs calculate therapeutic coverage • Records on theraputic coverage available at the LGA Who to take action: SOCTs Deadline for completion: January 2005 39 3.3 Sustainability at the FLHF level Planning (1) 1. No written plans 2. No evidence of integration into overall plan Recommendations: Planning Implementation 1. FLHF staff should prepare detailed, written annual workplans for CDTI and integrate it into general workplan at that level. 2. FLHF staff should be trained on how to prepare annual work-plans for CDTI. Priority: HIGH Indicators of success: 1. Availability of detialed annual work-plans with CDTI integrated into it. 2. Availability of FLHF training reports. Who to take action: LOCTs, FLHF In-charge Deadline for completion: January 2005 Sustainability at FLHF 1 2 2 44 0 1 2 3 4 2 1 3 2 40 Leadership (2) 1. No year plan present 2. Dependence on District Supervisors who is a member of the LOCT Recommendations: Leadership Implementation 1. FLHF staff should be empowered to take full responsibility for CDTI activites in their areas. Priority: HIGH Indicators of success: • Evidence of a schedule for CDTI activities • No. of FLHFs initiating all CDTI activities Who to take action: LOCTs/FLHF In-charge Deadline for completion: January 2004 Integration (4) Monitoring and Supervision (2) 1. No report or data available at this level 2. LOCTs bypass FLHF to collect data directly from communities 3. Data within government system 4. Supervision conducted but without supervisory checklist 5. Problems were addressed, solutions provided but no records kept Recommendations: Monitoring and Supervision Implementation 1. FLHF staff should be empowered to produce and keep regular implementation reports on mectizan distribution, training, coverage, etc. 2. There should be targeted supervision using checklists. 3. There should be documentation of successes and addressing of problems at all levels. Priority: HIGH Indicators of success: 1. Availability regular implementation reports LOCTs calculate therapeutic coverage 2. Availability of fully-completed supervision checklists following visits 3. Availability of reports/other documentation of successes Who to take action: LOCTs/FLHF In-charge Deadline for completion: May 2005 Mectizan (2) 1. Insufficient Mectizan Records 2. Coordination of Mectizan ordering from State 3. Mectizan distribution is within government system 4. Drugs adequate and timely 41 Recommendations: Mectizan Implementation 1. FLHFs should be empowerd to determine the mectizan requirements for their area 2. FLHFs should keep records on mectizan collection and distribution for their areas. Priority: 1: HIGH 2: MEDIUM Indicators of success: 1. Availability of mectizan ordering forms at FLHFs 2. Availability of inventories for mectizan collection and distribution at FLHFs Who to take action: 1: LOCTs 2: FLHFs In-charge Deadline for completion: 1: July 2005 2: December 2005 Training and HSAM (2) 1. Training not targeted 2. Training plan need by District Supervisors who are members of LOCT Recommendations: Training and HSAM Implementation 1. Training needs of CDDS should be identified and the training targeted to meet these needs. 2. Training of CDDs should be conducted by FLHF staff, not LOCTs or District Supervisors. Priority: HIGH Indicators of success: 1. Report of training needs assesssment carried out 2. Availability of CDD training reports carried out by FLHF staff Who to take action: FLHF/LOCTs Deadline for completion: May 2005 42 Finance (-) 1. No involvement in financial input hence no records of either budget or expenditure Recommendations: Finance Implementation 1. Health staff should budget for CDTI activities, which will be taken into account in the overall LGA CDTI budget. 2. The LGA should provide a vote to the FLHF for assembling all reports concerning CDTI activities (coverage reports, distribution reports, mectizan statistics and traing reports). Priority: HIGH Indicators of success: 1. Evidence of budget documents (LGA) 2. Records of disbursement and expenditures Who to take action: FLHF In-charge, LOCT Leader, HOD Health Deadline for completion: March, 2005 Transport and Materials (1) 1. Available transport insufficient 2. FLHF at times transport self within private funds 3. Inadequate posters Recommendations: Transport and Materials Implementation 1. Adequate posters should be provided for FLHFs 2. There is need for advocacy for provision of motorcycles or bicycles to large FLHFareas. Priority: 1: HIGH 2: MEDIUM Indicators of success: 1. Availability of adequate training posters at each FLHF 2. Documentation of advocacy/official memos requesting for this provision. Who to take action: 1, 2: SOC/ LOCTs/HOD Health Deadline for completion: 1: May 2005 2: December 2005 43 Human Resources (3) Coverage (4) 1. Coverage generally good. 2. No record or distribution summary available 3. Inability to calculate therapeutic coverage Recommendations: Coverage Implementation 1. FLHF should be empowered to calculate therapeutic coverage for communities in their areas and retain copies of the records. Priority: HIGH Indicators of success: Existence of therapeutic coverage summary forms at each LGA. Who to take action: LOCTs Deadline for completion: January 2005 3.4 Sustainability at the Community level Sustainability at Community Level 44 2.67 2 2.5 3 3.33 0 1 2 3 4 3 44 Planning & Management (4) Findings: • CDDs chose times and routes which will make the work less burden some • There was no report of any problems • CDDs update the census while distributing Leadership & Ownership (2.67) Findings: • Village head has overall responsibility for mectizan distribution, and if any problem comes up he is the one who handles it. However in one community (Bakase in Asa), the CDD seems to carry all the burden as a result of leadership problem in the community. • Coverage is satisfactory and there has never been any problem in this regard. • In one community – Oke-Ado in Eko LGA, there has been a problem with the Apostolic Church whose adherents do not swallow any form of drugs. The councillor for the area promised to discuss with the church leadership to ensure compliance. The Chief also promised to follow up the issue. Recommendations: Leadership & Ownership Implementation 1. Encourage greater involvement of community members in CDTI 2. Inform communities of long-term need for taking mectizan Priority: 1, 2: MEDIUM Indicators of success: • No of communities with greater involvement of community members in CDTI • No of communities aware of long-term intake of mectizan Who to take action: FLHF Deadline for completion: 1, 2} April 2005 45 Monitoring (2) Findings: • In many communities CDDs are supported by the communities to go to the FLHF • In some cases, FLHF staff go to the community to examine the records, hence it is unnecessary for CDDS to go to the FLHF. Recommendations: Monitoring Implementation 1. Communities through CDDs should be encouraged to submit treatment figures to FLHFs Priority: 1: MEDIUM Indicators of success: • No of communities where CDDs go to the FLHF to submit treatment records Who to take action: LOCs/FLHF Deadline for completion: April 2005 Obtaining and managing Mectizan (2.5) Findings: • Generally speaking, the right amount of mectizan is received, and some is left over for absentees to take on return, and temporary non-eligibles. Treatment registers are up to date. • The LGA/FLHF delivers drugs to the community making, transport requirement unnecessary for the CDDs. In a few communities, CDDs are empowered by the community to go to the FLHF to collect the drug. • Many LGAs/FLHFs do not seem to be aware that the communities are required to fetch the drug from the FLHF. • The village leader (with CDD in one community) makes decisions about timing/mode of distribution. Community members especially women are just carried along. • Decision about what/whether they should give in appreciation to CDDS is left to individual household. • Village leaders are monitoring CDTI activities, but the community members especially women have no idea about this. • In most communities there is no formal self-monitoring. • Community members expressed willingness to continue taking the mectizan as long as available, but many are not aware of how long they must continue taking it. • In focus group discussions community members mentioned the benefits of Mectizan such as de-worming, improved eye sight and less itching. 46 Recommendations: Implementation 1. Communities should be encouraged to fetch their annual mectizan supply from the FLHF, and LOCTs should cease from delivering the mectizan to the communities 2. Empower communities to carry out self-monitoring Priority: 1: HIGH Indicators of success: • No of communities collecting their annual mectizan supply from the FLHF • No of communities carrying out self-monitoring Who to take action: LOCTs/FLHF Deadline for completion: 1: February 2005 2: August 2005 HSAM (3) Findings: * CDDs provide health education; village leadership arranges for announcements in churches, mosques etc. However, in one community - Bakase, it was only the CDD trying to provide HSAM – community leadership was not involved because of leadership dispute. Finance (3) Findings: Some communities give financial incentives, and/or prayers and expression of gratitude e.g. in Ogeele and Bakase communities. Recommendations: Finance Implementation 1. Communities especially those not doing so should be encouraged to provide financial incentives to CDDs Priority: 1: MEDIUM Indicators of success: • No of communities providing financial incentives to their CDDs Who to take action: LOCTs/FLHF Deadline for completion: 1} April 2005 47 Human Resources (3.33) Findings: • Majority of the communities sampled far exceeded the ideal ratio of 1 CDD to 250 population. In a few communities such as Oke-Ado in Ekiti LGA, there is a good ratio of 3 CDDs to 253 persons maintained. • Average walking distance of CDDs is about 0.5 kilometres or about 15 minutes, except in a few communities with satellite areas where they have to travel longer distances. • The majority of CDDs are quite competent and use the measuring sticks. However, in two communities (Bakase and Sosoki), the dosage was based on the CDD’s perception – not using the measuring stick, which made the dosage incorrect. • In some communities, CDDs have assistants. • Communities expressed preparedness to replace CDDs in the event they were to drop out or become un-available. • All the CDDs express strong willingness to continue with their work as long as required, seeing this as an opportunity for community service. They are highly stable. Coverage (4) Findings: • Therapeutic coverage is satisfactory in all the communities e.g. for 2004: Sosoki: 82%; Bakase: 88%; Oloko: 75% • However, actual coverage calculated on the basis of the community treatment registers was at variance with the summary treatment reports given by the LGA. The LGA treatment summaries are generally much higher. 48 Recommendations: Human Resources Implementation 1. Communities should be informed about the ideal CDD ratio and select optimum number of CDDs 2. All CDDs should us measuring sticks to determine correct dosage Priority: 1,2: HIGH Indicators of success: Who to take action: LOCTs/FLHF Deadline for completion: 1} May 2005 2} February 2005 Coverage: Findings: • Therapeutic coverage is satisfactory in all the communities e.g. for 2004: Sosoki: 82%; Bakase: 88%; Oloko: 75% • However, actual coverage calculated on the basis of the community treatment registers was at variance with the summary treatment reports given by the LGA. The LGA treatment summaries are generally much higher. In most communities Census and Distribution are done during the same visit. Visiting times and routes are the CDD’s preference for ease of distribution. Where problems exist community leaders work closely with CDDs to manage them. Leadership & Ownership (3.3) The community leadership has put in place reliable channels of information to reach all the members when Mectizan is available. There is willingness to motivate CDDs because community members acknowledge several benefits associated with taking the drug: expulsion of intestinal worms, general well being, cessation of troublesome itching, improvement in eyesight and of skin condition (Smooth Skin, Leopard skin cleared). Only a few people expressed their awareness of the duration of the treatment. Monitoring (4) Reports are usually delivered on time and are often made in triplicate – one for FLHF, one for LGA and one for the State. In some communities leadership expresses willingness to provide transport fare. There are no complaints about facilitation to deliver reports especially where the health facility is close by. 49 Obtaining & Managing Mectizan (4) There was enough Mectizan available for all the eligible community members. Some was reserved for absentees for a month after which excess was returned. Quantity of Mectizan needed for each community was determined on the basis of population figures in all communities sampled. LOCTs deliver mectizan to the FLHFs. These in turn make it available to the CDDs who come to get the drug from the near-by facility. HSAM (2) Community leadership has put in place very efficient information channels to ease drug distribution. CDDs also provide information on management of side effects. There is little effort to encourage community members to provide resources to offset local cost of distribution. Recommendations: HSAM Implementation  Community members must be sensitized on the need to provide resources to offset local costs of distribution Priority: High Indicators of success: Community members contributing for CDT implementation Who to take action: Community leader, FLHF In – charge Deadline for completion: February 2004 Finance (2) Community leaders often provide funds for transport to collect Mectizan, deliver reports, and attend training programs. Some communities have also made plans to provide financial incentives to their CDDs. Some others do not encourage their CDDs in any form. Reason why financing appears problematic: There has been no real effort to motivate the community members to contribute towards meeting CDTI needs at this level. Recommendations: Financing Implementation  Community members should be mobilized to take decisions on appropriate form of CDD compensation. Priority: High Indicators of success: • Number of CDDs compensated • % attrition rate 50 3.5 Sustainability at all levels LEVEL GROUP OF INDICATORS Pl an ni ng Le ad er sh ip M on ito rin g & Su pe rv is io n M ec tiz an Tr ai ni ng / H SA M In te gr at in g A ct iv iti es Fi na nc es Tr an sp or t/ Eq ui pm en t H um an R es ou rc es C ov er ag e A ve ra ge Fo r t he Le ve l STATE LEVEL SCORES 2.33 3 2.25 2 2.6 3 1.25 2 3.33 4 2.58 LGA LEVEL SCORES 1 2 2.33 3 2 1 0.5 1.5 3.5 4 2.08 FLHF LEVEL SCORES 1 2 2 2 2 4 - 1 3 4 2.44 COMMUNITY LEVEL SCORES 4 2.67 2 2.5 3 - 3 - 3.33 4 3.06 AVERAGE STATE SCORE 2.51 51 4. Conclusions 4.1 Overall sustainability grading of Kwara State CDTI Project 4.1.1 Aspects of sustainability Aspect Judgment: To what extent is this aspect helping or blocking sustainability in this project? Integration: Integration is present but needs better planning and coordination. Resources: At all levels, highly qualified human resource is available and performing good work. Although there is an approved allocation of funds at State Level, it has never been released. Transport and other equipment are available but are inadequate, not routinely maintained and are aged. No plans yet for replacement. Training materials are adequately supplied at State Level. At the level, there is release of some financial support to CDTI but needs to be improved. Motorcycles are available but no funds for routine maintenance. NGDO partner provides spares for the motorcycles. Training materials are inadequate at this level. At the FLHF level, there is no financial resources available. Staff at this level are skilled but not empowered to carry out CDTI. Efficiency: There is need for improvement through targeting and integration. However, poor empowerment at FLHF in particular, prevents the health staff at this level in performing effectively. Simplicity: Project has been running in a simple uncomplicated manner. Health Staff Acceptance: High acceptance and commitment to CDTI is shown by all staff at all levels. Community Ownership: High level of community ownership evidenced by communities selection of CDD’s and provision of materials support, deciding on time and mode of Mectizan distribution. In some communities, Community Leaders are also involved in Community Self Monitoring and providing solution to problems when they arise. Effectiveness: Good coverage rates are being achieved at all levels even though personnel at all levels do not determine these rates as the NGDO partner has been responsible for doing this. There is a need for all levels to estimate yearly Mectizan requirement. 52 4.1.2 Critical elements of sustainability * Money: At the State level, there is a problem as there is no release of funds in support of CDTI activity. Some LGAs release arbitrary funds occasionally not tied to a specific budget allocation. There is no provision for financial release at the FLHF Level. The Community mobilises itself to meet its needs and provides incentive to the CDDs. * Transport: Motorcycle spare parts are provided annually by NGDO. Repair of available vehicle is met from APOC funds while repair of motorcycle is met by State/LGA/Personal funds. * Supervision: In State, Supervision is routine while in many LGAs, it is targeted. But at FLHF, there is hardly targeting when there is empowerment. * Mectizan Supply: Mectizan supply system is dependable, but State should use Government means of collecting States supply from the zone. * Political Commitment: There is political commitment resulting in some support which needs to be improved upon particularly at the State level. There is a high level of community ownership of the programme. Kwara State is seen as a special situation in that it had been subjected a peculiar political administration in the recent part (1999 – 2003). This administration adversely affected the functionality of the Ministry of Health amongst other State Organisation. The evaluation of this project should therefore be considered in this light. Based on the above, the evaluation team concludes that the project is making satisfactory progress towards sustainability. 53 5.1 Advocacy activities and feedback/planning workshops Advocacy Towards the end of the evaluation and advocacy visit was paid to Dr. Bola Olaosebikan, the Honourable Commissioner for Health, and Alhaji Ayinke Saka, the Permanent Secretary of the Ministry of Health accompanied by the Director, Primary Health Care and Disease Control, Dr. (Mrs) A. P. Folorunso and Mr. Yemi Ajayi, State Oncho Coordinator. Dr. Mrs. M. A. Mafe, the team leader, briefed the Permanent Secretary on APOC vision of sustainability. In essence, at this stage of the Oncho Programme activities, SUSTAINABILITY requires a firm commitment of the State to provide the necessary resources, especially Government Counterpart Contribution (G.C.C.), for the continuation of CDTI activities. In his response the Honourable Commissioner for Health, Dr. Bola Olaosebikan thanked the Evaluators from Nigeria, Tanzania and Kenya for their hard work and contribution on assessing CDTI in Kwara State, Nigeria. He stated that Kwara State is undergoing reorganization following mismanagement by previous Government. He expressed his fear that the performance of the Kwara State CDTI must have fallen short of expectation and thereby requested for special consideration for APOC funds for certain key activities of CDTI. He assured the team that the State new political reorganization will emcompass players particularly from International Agencies such as UNICEF, UNDP, WHO, APOC and others, so that they can work in partnership for the improvement of the health of the people of Kwara State. In conclusion, he pledged the willingness of the State to put resources according to APOC’s recommendation on CDTI. At the different LGAs visited advocacy visits were paid to policy makers that were present at the time of the visits. Debriefing was done at the feedback and planning meetings. 5.2 Two levels feedback/Planning meetings One feedback/planning meeting was held at the State level while another was for the 14 LGAs. 5.2.1 State Level Feedback & Planning Meeting This workshop was held from Monday, 29th November to 30th November 2004, at the Data Bank Hall in Ilorin, the State capital. In attendance were members of the evaluation team; the State Onchocerciasis Control Team members, other representatives of the MoH, the deputy director, PHC, Director PHC&DC and the Permanent Secretary, State MoH. The de-briefing/workshop commenced with an opening ceremony chaired by the Permanent Secretary for Health, (Alhaji Ayinke Saka), supported by the Directors for Finance, Personnel, Primary Health Care and Medical Services and Training. The State Coordinator introduced the team. The Director, Primary Health Care gave her speech and introduced the programme to the Permanent Secretary. The Team Leader, Dr. (Mrs) Mafe later informed the Permanent Secretary that the team visited various level, gave the processes and activities that were performed adding that APOC hopes that sustainability would have been achieved in all affected project by the fifth year of APOC funding. The 54 Permanent Secretary responded by thanking the team and that the government appreciates their coming and promised that in areas the State is not doing well, these will be looked into to meet APOC’s expectation. She promised that the issue of counterpart funding would be looked into. Opening prayers said by Pastor F. O. P. Oyinloye. This was followed by self introduction of all participants. The State Oncho Coordinator, Mr. Yemi Ajayi introduced the workshop. He stated that APOC activities started in the State in 1999, and was now being evaluated for sustainability. He further stated that the team had completed the field evaluation – data gathering from Asa, Kaiama, and Ekiti LGAs – and the findings would be presented at this workshop. He then invited the team leader – Dr. (Mrs) Margaret Mafe to make her remarks. The team leader who welcomed all participants, conveyed APOCs goodwill to the gathering and emphasized the importance of the workshop. She enjoined SOCT to be very attentive as they would serve as facilitators during the LGA Feedback/Planning Workshop. Her presentation covered the APOC’s philosophy, the objective of the evaluation, definition of sustainability and detailed description of how the 3 LGAs Asa, Ekiti and Kaiama were randomly selected. She further stated that 2 FLHFs were selected in each of the LGAs and 2 communities from each FLHF giving a total of 4 communities per LGA and 12 communities selected overall from the 3 LGAs. She showed a copy of the four instruments used during the data gathering processes and concluded by saying that the results of these findings would be follow immediately. She drew participants attention to the scoring of the different indication of sustainability stating that a score of 2.5 to 4 indicate that there is satisfactory performance on that indicator. Findings at the different levels (Community, FLHF, LGA and State) were presented by the other evaluators. The presentations were followed by discussions.  The full programme and report are given in the Appendices. The following is a summary of the workshop process: ∗ Introduction. ∗ Methodology and the workshop process. ∗ Presentation: Background to evaluation and definition of sustainability. ∗ Presentation of evaluation team’s detailed findings at the community, health facility, LGA and State levels. ∗ Discussion on presentations on findings ∗ General discussions on the findings and their implications. ∗ Group work (done in plenary due to the small number of knowledgeable participants): Discussing the findings & doing a SWOT analysis; proffering solutions for all the levels. ∗ Presentation on issues in formulating a 3 - year sustainability plan. ∗ Group work (also done in plenary): ‘Planning for sustainability at State/ project level’. The major task was the development of the 3 – Year post – APOC plan taking into consideration issues from the preliminary findings and the format given by APOC Management. ∗ Open discussion: The way forward. 55 Discussions on the findings: An SOCT member said there should be a conscious effort to actualise counterpart funding at different levels and that the State level should stop going to community to collect reports. Another comment from another person was that drugs should be in government system right from the State. Dr. Uche highlighted the need for proper record keeping. Another person commented on the financial aspect of the programme since certain finances are no longer going to be met by APOC, thus a solution has to be made. Since the Local Government Level is doing better than the State Level, Advocacy has to be put in place constantly at the State level. On the issue of monitoring and supervision, an SOCT member sought further information on targeted monitoring and supervision and was informed that this should not be a routine affair but rather tied to need. Another participant raised the issue of giving incentives to CDDs to which a response was given that this is the responsibility of the communities. The participants were divided into groups (2) for group work, after which each group made presentations. During the presentation, the secondary group was asked to comment on the first group’s presentation. Issues raised: * Why is training below LGA level a threat? Response, By this, the LOCTs are not being empowered making the process unsustainable. * Why training only LOCT? Response. Targeted * How do we solve by passing FLHF? This is done by empowering LOCTs and informing them to fully empower the FLHF to deal with the directly with the Communities. * Why is unawareness of mectizan requirement? State is expected to calculate the yearly Mectizan requirement in order to correct this. What do you have in the State to sustain Oncho programme? Response – There is budget line for this programme, what is required is release of funds in support of CDTI.  A three – year Sustainability plan for the State level now exists. Its implementation is primarily the responsibility of the State Coordinator and the top officials of the MoH. Support and supervision will however need to be provided by the Nigerian NOTF and APOC management to ensure that the project achieves sustainability. Way Forward In the session on the way forward, participants were asked what they intended to do with the sustainability plan they had developed. They stated that it would be presented to the authorities through the Director (PHC/DC) and the Permanent Secretary to the State 56 Government. The State also plans to hold internal review meetings to ensure that they keep to the plan. The state Ministry of Health gave an assurance that the sustainability plan developed during the feedback workshop will be supported and implemented. MOH should monitor the implementation of decisions reached to address the deficiencies identified by the evaluation team and the overall sustainability plan should be given prompt attention. APOC and the Nigerian NOTF should follow closely the implementation of decisions and activities of the sustainability plan. The detailed workplan would be presented to the Ministry of Health authorities through the DPHC. Also copies of the workplan would be made available to the NGDO partner (SSI) and Zonal Office, NOCP Kaduna. The workplan would be integrated into the State health plan which had been drawn out at the recently held Kwara State Health Summit. The MOH through the H/C, PS and DPHC would present the detailed workplan to the Health Committee of the State House of Assembly for political support and financial allocation during the budget approval and allocations. Finally, the detialed workplan as agreed at the workshop would be forwarded to APOC through the NOCP immediately by 31st Dec., 2004. Monitoring of the implementation of the workplan would be assured through regular State Oncho. Task Force (SOTF) meetings and quarterly meetings of the SOCTs and LOCTs. Departmental meetings would be held to harness integration of other health programmes with active involvement of Zonal Office of NOCP and the NGDO. Regular briefing of partners: MoH authorities through DPHC, Local Government Service Commission and Ministry of Local Government. 5.2.2. LGA Level Feedback & Planning Meeting This workshop was held for all the 16 LGAs from Wednesday, 1st December to Thursday, 2nd December, 2004 at Federal Secretariat Hall, Ilorin. Those expected at the workshop from the Local Governments include the Chairmen, Supervisory Councillor for health, Director of Finance (Treasurer), Director of Personnel/Administration, PHC Coordinator, and the Onchocerciasis Control Coordinator. Many did turn up in spite of mitigating factors such as NID days, AIDs day, etc. All but 2 of the LGAs were represented by technical officers and policy makers.  The full programme and report is given in the Appendices. The following is a summary of the workshop process: ∗ Introduction. ∗ Methodology and the workshop process. ∗ Presentation: Background to evaluation and definition of sustainability. ∗ Presentation of evaluation team’s detailed findings at the community, health facility, and LGA levels. ∗ General discussions on the findings and their implications. ∗ Group work: Discussing the findings & doing a SWOT analysis; proffering solutions for all the levels. Group report back and discussion followed this. 57 ∗ Presentation on issues in formulating a 3 – year sustainability plan. ∗ Group work: ‘Planning for sustainability at LGA level’. Groups had two tasks: making a sustainability plan for 2006 – 2008, and identifying resources for each of the 3 years. Again group report back and discussion followed this. ∗ Open discussion: The way forward.  Three – year Sustainability plans for the LGAs now exist – but these will need further modification taking into consideration the amount of funds that will be available to the programme from all sources. Their implementation is primarily the responsibility of the PHC Coordinators and LOCT leaders, and these persons need to be supported and supervised by the SOCTs. 5.3 Way forward All the LGAs gave assurance of adhering to APOCs requirements. They promise to process the 3 year (2006-2008) sustainability plan they had developed and utilise them. They unanimously proclaimed that the plans will be forwarded to the political Heads of their LGAs (the Chairmen) though the appropriate channel. Some of the Councillors and Directors of Personnel and Management present promised to obtain the needed political backing. 5. 4 Lessons learnt on use of the Instrument TOOLS: 1. Assumes all systems are the same – health structure, integration etc 2. Expectation of resources available at lower levels especially transport is too high (vehicle at Health facility). 3. Political structure differs e.g. there is no political leader at the level of the FLHF. 4. At FLHF level, implementation is what is expected and not planning. MANUAL: Performance suggested in the manual might not be easy to achieve in a day’s training. ADDITIONAL ISSUES FOR CONSIDERATION The time allowed for the feedback/planning workshop is rather short for the full achievement of the objective of drawing up a 3 years sustainability plan especially where the no. of LGAs exceed 10 as was the case with Kwara State with 16 LGAs. 58 Appendix 1 FEEDBACK/PLANNING WORKSHOP STATE LEVEL 29TH – 30TH NOVEMBER, 2004 VENUE: DATA BANK CONFERENCE HALL, MINISTRY OF HEALTH, FATE PROGRAMME DAY 1 29TH NOVEMBER, 2004 1. Opening Prayer - SMOH 9.00a.m – 9.05am 2. Introduction of Participants - Mr. Yemi Ajayi 9.05am – 9.15am 3. Welcome Address - SMOH 9.15am – 9.25am 4. Presentation *The Workshop Programme - Team Leader 9.25am – 9.35am *Administrative matters - Mr. Yemi Ajayi 9.35am – 9.40am 5. Presentation: - Dr. (Mrs) M.A. Mafe 9.40 am – 10.10am *The objective of the evaluation *What is sustainability? *The evaluation methodology BREAK 10.10am – 10.30am 6. Presentation of the main findings: Community Level - Mr. Philip Sankwai 10.30 – 10.40am FLHF Level - Dr. Wade Kabuba 10.40 – 1050am Local Government Level - Dr. Uche Enyinnaya 10.50 – 11.00am State Level - Mr. Pius Mabuba 11.00 – 11.10am 7. Open Discussion - Dr. (Mrs) M. A. Mafe 11.10 – 11.40am 8. Group Work: SWOT analysis – ‘What is the situation regarding sustainability in our project’ & “What could be the solutions to the weaknesses regarding sustainability in our project? (State Level) - Dr. Uche Enyinnaya 11.40pm –12.40pm 9. Group work: ‘What resources are we likely to have, at the State Level for the next 3 years? - Mr. Philip Sankwai 12.40pm -1.40pm LUNCH 1.40pm – 2.40pm 10. Presentation: * Guideline for Developing three yearo sustainability plan - Dr. Wade Kabuka 2.40pm – 3.10pm * Open Discussion - Dr. Wade Kabuka 3.10pm – 3.30pm * Format for Work Plans - Dr. David Sang 3.30pm – 4.00pm * Open Discussion - Dr. David Sang 4.00pm – 4.30pm 11. Development of 2006 sustainability plan - SOCT 4.30pm – 6.30pm 12. Closing DAY 2 – 30TH NOVEMBER, 2004 13. Presentation & Discussion of 2006 Sustainability plan - Mr. Pius Mabuba 9.00 – 10.00am Tea Break - 10.00 – 11.30am 14. Amendment of 2006 sustainability plan - SOCT 10.30 – 11.30am 15. Development of 2006 & 2007 susstainability Plan - SOCT 11.30 –1.30pm LUNCH 1.30pm – 2.30pm 16. Open Discussion on the 3-year Sustainability Plan - Dr. David Sang 2.30 - 3.30pm 17. The way forward - Dr. M. A. Mafe 3.30 – 4.00pm 18. Narrative Justification of Budgets & Development Of Background Information of Sustainability Plan - Dr. Uche Enyinnaya 4.00 – 6.00pm 19. Closing 59 Participants S/NO NAME RANK/ DESIGNATION STATE 1. Mr. Bukola M. D. CEHO SOCT State 2. J. O. Adeoti SOCT State 3. F.H.Lt. (rtd) Asonibare J. S. B Asst. Director SOCT State 4. Mrs. V. T. Ashaolu SOCT State 5. Ganiyu Kareem SOCT State 6. Yakub Omotosho SOCT State 7. FOP Oyinloye SOCT State 8. D. O. Opawoye SOCT State 9. R. A. Olanrewaju SOCT State 10. Yemi Ajayi SOCT State 11. Dr. K. Ogundimu NGDO NGDO 12. Akanbi D. A. B. (Mrs) SOCT State 13. Dr (Mrs) A. P. Folorunso DPHC/DC State 14. Mr. J. K. Oye DFS KSMoH 15. Hajia Saka Ayinke Permanent Secretary KSMoH 16. Dr. Fagbayi DMST KSMoH 17. Dr. Giwa Epid Unit KSMoH 18. Dr. Wade Kabuka Evaluator Tanzania 19. Mr. Pius Mabuba Evaluator Tanzania 20. Dr. Uche Enyinnaya Evaluator Owerri, Nigeria 21. Dr. David Sang Evaluator Kenya 22. Mr. Phillip Sankwai Evaluator Kaduna, Nigeria 23. Dr (Mrs) M. A. Mafe Evaluator Lagos, Nigeria 60 Appendix 2 SWOT ANALYSIS (STATE) Group 1 Indicator Strengths Weaknesses Opportunities Threats Solutions to Weaknesses & Threats PLANNING  CDTI plan integrated into State Health Plan  A CDTI detailed plan exists  Planning is participatory  Each partner is clear about roles  No variation in plans  No written sustainability plans  CDTI plan integrated into State health plan  Concept of targeted planning is new  Planning is participatory  Each partner is clear about roles  Review of past years’ activities and introduction of innovative ideas into future plans  Strict compliance with planned activities  Development of realistic plan for a sustainable programme MONITORING & SUPERVISION  Checklist used in supervision  Monitoring system identifies problems and successes  Leadership is keen about solving identified problems  Inadequate awareness on targeted supervision  Supervision activities not integrated  Frequent supervisory visits  Presence of joint monitoring and evaluation unit  Some awareness on targeted supervision  SOCTs’ supervision should be integrated into other PHC activities  Supervisory visits should be more purposeful  Invigorate M & E unit  Develop joint checklist  Provide logistics for supervisors TRAINING /HSAM  State trains LGA staff  Training reports available  Training is sometimes targeted  Training is routine  Number of trainers unjustifiable  SOCTs go beyond the LGA level  Oncho Day used for HSAM  HSAM activities are not integrated  Involve LOCTs in training at community level. SOCTs should not go beyond the LGA level. MECTIZAN SUPPLY  Mectizan supply system within the government set up  Stock controls exist  Supply based on demand from LGAs  System largely dependent on APOC funds  Obtain written commitment for regular supply of drug for the next 15 years from the donor agency  Provision of logistics by the State Govt. for collection, distribution and delivery of Mectizan tablets 61 GROUP 2 INDICATOR STRENGTH WEAKNESS OPPORTUNITIES THREAT SOLUTIONS TO OPP & THREATS FINANCE Good internal auditing of funds. Timely submission of financial returns. Oncho budget line item Approved budget without cash backing. SOC is unaware of Govt. funds that will be available in the yearly budget. Favourable government Using of influential people for advocacy support No release of fund by government Advocate for the release of Govt. funds TRANSPORT & OTHER MATERIAL RESOURCES Integrated use of transport resources. Provision of IEC materials Obsolete equipment No routine maintenance of existing transport facility and equipment No plan to replace existing transport and equipment Advocacy to Govt. to replace existing old vehicles and equipment. HUMAN RESOURCES Highly skilled and stable staff No computer operator in the team Computer operator within M.O.H COVERAGE Good coverage Calculation of geographical coverage and therapeutic coverage SOCT, LOCT, FLHF 62 Appendix 3 Identified Resources GROUP 1 S/NO EQUIPMENT 2005/6 2006/7 2007/8 COST 1. Computer Sets 2 - 1 2. Laptop Computer 1 - - 3. Toner for Computer 6 6 9 4. Computer Printing Paper 12 12 12 5. Diskette 5 5 5 6. Photocopier 1 - - 7. Toner for Photocopier 10 10 10 8. Generator - 1 - 9. Fax Machine 1 - - 10. Air Conditioner 1 - - 11. Standing Fan 2 - - 12. Scanner 1 - - 13. Calculator 12 - - 14. Toyota Hilux Van 1 - - 15. Motorbike 1 - - 63 GROUP 2 S/NO STATIONERIES 2005/6 2006/7 2007/8 COST 1. Computer Paper 50 50 50 2. Photocopier Paper 50 50 50 3. Biro (Pkt) 5 5 5 4. Ruler (Dozen) 2 2 2 5. Flip Chart Papers 2 2 2 6. Marker (Dozen) 2 2 2 7. Pencil 3 3 3 8. File Jackets 5 5 5 9. Eraser 2 2 2 10. Sharpener 2 1 1 11. Stapler (Big and Small) 3 - 1 12. Staple Pins 5 2 1 13. Tippex 5 5 5 14. Cellotape 3 3 2 15. Paper Clips 2 2 2 GROUP 3 I. E. C. MATERIALS S/NO I. E. C. MATERIALS 2005/6 2006/7 2007/8 COST 1. Posters 2,000 1,500 1,500 2. Handbills 4,000 3,500 3,000 3. Flip Charts (for Training) 100 100 100 4. Mega Phone 2 1 1 5. Projector 1 - - 64 COST IMPLICATION GROUP 1 S/NO EQUIPMENT 2005/6 2006/7 2007/8 COST 1. Computer Sets (Printer, UPS, Stabilizer) N400,000 - 200,000 2. Laptop Computer 200,000 - - 3. Toner for Computer 75,000 75,000 - 4. Computer Printing Paper 7,200 7,200 7,200 5. Diskette 4,400 4,400 4,400 6. Photocopier 250,000 - - 7. Toner for Photocopier 40,000 40,000 40,000 8. Generator 9. Fax Machine 10. Air Conditioner 11. Standing Fan 10,000 - - 12. Toyota Hilux Van $25,000 - - 13. Motorbike $4,000 - - STATIONERIES 65 GROUP 2 S/NO STATIONERIES U/P 2005/6 2006/7 2007/8 COST 1. Computer Paper N600 60,000 60,000 60,000 2. Photocopier Paper N600 60,000 60,000 60,000 3. Biro (Pkt) N300 2,000 2,000 2,000 4. Ruler (Pkt) N150 1,000 500 500 5. Flip Chart Papers N2,500 10,000 10,000 10,000 6. Marker (Dozen) N1,000 2,000 1,500 1,500 7. Pencil (Dozen) N120 500 500 - 8. File Jackets N360 3,000 3,000 3,000 9. Eraser Pkt (100) 2,000 - - 10. Sharpener Pkt (100) 1,000 - - 11. Stapler (Big and Small) 1,500 - - 12. Staple Pin (50) 500 250 250 13. Tippex (5) 500 500 - GROUP 3 S/NO I. E. C. MATERIALS 2005/6 2006/7 2007/8 COST 1. Posters N 20,000 20,000 15,000 2. Handbills 15,000 15,000 15,000 3. Flip Charts 25,000 25,000 25,000 4. Mega Phone 10,000 5,000 5,000 5. Projector 66 Appendix 4 SUMMARY OF FEEDBACK/PLANNING MEETING FOR LGA LEVEL Agenda: See below FEEDBACK/PLANNING WORKSHOP LGA LEVEL 1ST – 2ND DECEMBER, 2004 VENUE: FEDERAL SECRETARIAT HALL, FATE ROAD, ILORIN. PROGRAMME DAY 1ST DECEMBER, 2004 6. Opening Prayer - SMOH 9.00a.m – 9.05am 7. Introduction of Participants - Mr. Yemi Ajayi 9.05am – 9.15am 8. Welcome Address - SMOH 9.15am – 9.25am 9. Presentation *The Workshop Programme - Team Leader 9.25am – 9.35am *Administrative matters - Mr. Yemi Ajayi 9.35am – 9.40am 10. Presentation: - Dr. (Mrs) M.A. Mafe 9.40 am – 10.10am *The objective of the evaluation *What is sustainability? *The evaluation methodology BREAK 10.10am – 10.30am 6. Presentation of the main findings: Community Level - Mr. Philip Sankwai 10.30 – 10.40am FLHF Level - Dr. Wade Kabuba 10.40 – 1050am Local Government Level - Dr. Uche Enyinnaya 10.50 – 11.00am 7. Open Discussion - Dr. (Mrs) M. A. Mafe 11.00 – 11.30am 11. Group Work: SWOT analysis – ‘What Is the situation regarding sustainability In our project’ & “What could be the Solutions to the weaknesses regarding Sustainability in our project? - Dr. Uche Enyinnaya 11.30 – 1.00pm * Group 1: Community level * Group 2: FLHF level * Group 3: Local Government Level LUNCH 1.00 – 2.00pm 12. Presentation of group work and Plenary discussion - Dr. Wade Kabuka 2.00 – 3.00pm 10. Presentation: * Criteria for further APOC support - Mr. Pius Mabuba 3.00 – 3.15pm * Open Discussion - Mr. Pius Mabuba 3.15 – 3.45pm * Format for Work Plans - Dr. David Sang 3.45 – 4.15pm * Open Discussion - Dr. David Sang 4.15 – 4.45pm 11. Development of 2006 sustainability plan - SOCT 4.45 – 6.45pm 12. Closing DAY 2 – 2ND DECEMBER, 2004 14. Presentation & Discussion of 2006 - Mr. Pius Mabuba 9.00 – 10.00am Sustainability plan - Mr. Yemi Ajayi 10.00 – 11.00am 14. Open Discussion - 11.00 – 11.30am Tea Break 15. Group Work: Amendment of 2006 Sustainability Plan - LOCT 11.30 – 12.30pm 16. Group Work: Development of 2007 & 2008 Sustainability Plans - LOCT 12.30pm–2.30pm LUNCH 2.30 – 3.30pm 17. Presentation of three-year sustainability plans - Mr. Philip Sankwai 3.30pm – 4.30pm 18. Open Discussion on the 3-year Sustainability Plan - Dr. David Sang 4.30 - 5.30pm 19. The way forward - Dr. M. A. Mafe 5.30 – 6.00pm 20. Endorsement of LGA sustainability Plan - Mr. Yemi Ajayi 6.00 – 6.30pm 21. Closing 67 Participants: S/NO NAMES ADDRESS DESIGNATION 1. F. A. Abifarin Irepodun LGA HOD Health, CNO 2. Kadiri Ajiboye Irepodun LGA Oncho Coordinator 3. Sule Saka Femi Ekiti LGA Oncho Coordinator 4. Raheem Atanda Asa LGA Oncho Coordinator 5. Idowu S. B. Oyun LGA HOD (H) PMOT 6. Haliru M. A. Kaiama LGA Oncho Coordinator 7. Alh. I. L. Zarumi Moro LGA HOD Health 8. Hajiya Fatima Idris Kaiama LGA DPM 9. Prince Yusuf L. A. Asa LGA LGT 10. Olasehinde M. O. Oke – Ero LGA Oncho Coordinator 11. J. A. Babalola Isin LGA HOD (Ag) Health 12. Alh. Ibrahim O. Shehu Asa LGA Chairman, Asa LGA 13. Abdulfatai Babatunde Ifelodun LGA HOD, Health 14. Dr. S. A. Olaegun Ekiti LGA HOD (H)/CMO 15. M. O. Babatunde Ifelodun LGA HOD, Health 16. Barr. Isiaka M. Amude Ilorin South DPM 17. Alh. Azeez Ahmed Ilorin South LGT 18. Umar Hussaini Edu LGA Supervisor 19. Alao Yekeen Isin LGA Oncho Coordinator 20. Mohammed A. Kawu Edu LGA Oncho Coordinator 21. Hajia F. Zubair Asa LGA HOD, Health 22. Sulaiman Yabata Ilorin South LGA Supervisor for Health 23. Hajia K. B. Kareem Ilorin South HOD/Health & M 24. Prince A. O. Ogundeji Asa LGA DPM, Asa 25. Saidu A. Yakubu Ilorin South Oncho Coordinator 26. Hon. Ayisat Olaniyi Oke Ero LGA Supervisor 27. Hajj. Khadijat K. M. Ilorin East PHC Coordinator 28. Mr. Kola Gobir Ilorin East Supervisor 29. Hon. Gbenga Ajayi Irepodun LGA Supervisor 30. R. I. Ibrahim Ilorin North LGA HOD Health 31. Hon. Lateef Oloyin Asa Supervisor 32. Abdullahi S. Umaru Kaiama Treasurer 33. Okanla W. Saka Moro LGA Supervisor 34. Hon. Ayisat Ibrahim I. Ilorin East Supervisor 35. Sammy Oyeleke Offa LGA Oncho Coordinator 36. Hajia Ramat Oganja Ilorin West LGA Supervisor 37. Alh. S. A. Ahmed Ilorin West LGA DPM 38. Alh. Ahmeed Issah Moro LGA Oncho Coordinator 39. Adeniyi B. Ayowola Ifelodun 40. Okorodas Veronica Irepodun 41. Alice Fayemi Ekiti 42. Jide Abogunrin Isin 43. Samuel Usman Patigi 44. Oba Edun Ilorin – West 45. Abdulraham Omomeji Ilorin – South 46. S. O. Alao Ilorin – East 47. Oloruntoba S. Asa 48. Oloyin Saka Ilorin – West 49. Bio M. Yakub Kaiama LOC 50. Lattah A. Alhaji Patigi Coordinator 51. Jimade Salihu Patigi LOCT 52. Bukola M. D. SOCT Facilitator 53. Adeoti J. O. SOCT Facilitator 54. Asonibare J. S. B. SOCT Facilitator 55. Ashaolu V. T. SOCT Facilitator 56. G. D. Adesoko SOCT Facilitator 57. Olanrewaju R. A. SOCT Facilitator 58. Akanbi A. B. SOCT Facilitator 59. Ajayi Yemi SOCT Facilitator 68 60. Ganiyu Kareem SOCT Facilitator 61. FOP Oyinloye SOCT Facilitator 62. Yakub S. Tosho Accountant Facilitator 63. D. O. Opawoye SOCT Facilitator 64. Margaret A. Mafe Yaba, Lagos State, Nigeria Evaluator 65. Wada Kabuka Dares Salaam, Tanzania Evaluator 66. Pius Mabuba Dares Salaam, Tanzania Evaluator 67. Uche Enyinnaya Owerri, Nigeria Evaluator 68. Philip Sankwai Kaduna, Nigeria Evaluator 69. David Sang Nairobi, Kenya Evaluator 69 Summary Proceedings: Feedback/Planning Meeting For LGA Level DAY 1 15 LGAs were present with some chairmen, supervisory councillors for health, DPM, DPHF, HOD Health, Oncho coordinators and their assistants. - There was a welcome address from both the DPHC MoH, and words of encouragement from the LGA. - The objectives of the workshop were spelt out - There was presentation on the preparation for the evaluation. - Presentation on road to sustainability., - The summary of finding/graphs were shown on slides. - Ten indicators used were shown to the participants. - Discussions - Concept of SWOTS analysis was introduced and the participants were grouped into 3 for SWOT exercise. - The SWOT was applied in developing the work plan for year 2006. - Presentations made on each LGA SWOTS analysis by the participants. - Necessary corrections were made. Report of day 2 workshop – LGA - Presentations made on correction of SWOTS analysis. - Each of the fourteen LGAs developed the year 2006 sustainability plan. - Presentation of year 2006 sustainability plan was made. - Generation of questions that were duly answered by the facilitators about supervision of lower level and cost reduction. - Discussion of sustainability plan. - There was amendment of 2006 sustainability. - The 2007 and 2008 sustainability plans were developed. - The financing aspect of the three-year sustainability plans were presented and amended. - The way forward: questions were answered by the top functionaries and the participants. - Draft 3 years sustainability plans were signed. The started with an opening prayer said by Alhaji A. F. Subaru, the H.O.D. Health from Asa L.G.A. This was followed by self introduction of the participants beginning with the L.G. LOCTs, SOCTs and then the team of evaluators. The welcome address was given by Mr. Yemi Ajayi, the State Oncho Coordinator. He briefly gave a general introduction on the purpose of the meeting, that APOC activities started in the State in 1999, and was now being evaluated for sustainability. He said the business of this meeting was purely L.G.A. affairs and as such every participant must be attentive. He further stated that the team had completed the field evaluation, which was data gathering from the randomly selected LGAs of Asa, Kaiama and Ekiti LGAs – and the findings would be presented at this de-briefing. Finally, he gave administrative matters, that participants at this de-briefing/ workshop would be given tea breaks and lunch on each day, transport allowance and per diem. He urged every participant to register their presence. Ten LGAs were present on the first day and they included Kaiama, Asa, Isin, Oke Ero, Edu, Ifelodun, Ekiti, Ilorin East, Irepodun and Ilorin West. Mr. Yemi Ajayi then invited the team leader, Dr (Mrs) M. A. Mafe to make her remarks and presentation. The team leader welcomed all participants, emphasized the importance of the workshop gave APOC philosophy, Acronym and APOC objective. She also talked on what sustainability is all about and the objective of the evaluation, instruments used at the different levels. She gave a detailed description of how the three LGAs were randomly selected. 70 Similarly, she showed a copy of the four instruments used during the data gathering processes. She concluded by saying that the results of the finding on the field would be shared with the participants at the workshop. Presentation of findings on the Community Mr. Philip Sankwai gave the report on the findings at the community level starting with the overall scores for each indicator. He said there was no report of any problem with regard to community level planning, the coverage was very satisfactory, mectizan distribution was well planned and okay, while in monitoring women were left out instead of them (women) to be part of the monitoring team. Management of Mectizan was well done. Some communities gave some financial support and prayer to the CDDs. The human resources was good in most of the Local Government visited while the coverage was satisfactory in all the communities visited. Mr. Philip further said that they found out that first line health facilities staff go to the community to examine the records, hence it is unnecessary for CDDs. He said that they found out that in many communities, there are 3 CDDs to 253 people which is a good ratio. And the CDDs are ready to carry on with the distribution. Finding at the FLHF level: This finding was presented by Dr. Wade Kabuka. The chart showing the scoring was not good. He said there was no written plan in the FLHF visited, Supervision was left with the LOCT and LOCT did not properly carry out Supervision activities. Dr. Wade Kabuka said that there was insufficient Mectizan records. Training was not targeted, no record of budgeting or expenditure, while transport and materials available were insufficient. Finding at the L.G.A. Level Dr. Uche Enyinnaya gave the findings. He said there was no integrated health plan, no written plan for CDTI and no coordination. Integration with other programmes was done but not efficient, and training which was supposed to be conducted by LOCT was carried out by SOCT which is not good enough and no record of training. Transport was not sufficient and as well as inadequate posters plus funds. At this juncture, the representative of the State Ministry of Health led by Director, Primary Health Care, Dr. (Mrs) Folorunso came in. she apologised on her inability to be fully present at the workshop due to many programmes of the primary health that is taking place/holding simultaneously this week, most especially the World Aids Day in which Her Excellency, the wife of the Governor of the State is fully invited. Dr. (Mrs) Folorunso enjoyed all participants to work for the success of this workshop and this will help in reducing Oncho level in the State drastically as such no longer posing as danger to the people. The evaluators leader responded by thanking the representative of Ministry of Health and she believed that other five LGAs will soon join the meeting. She further emphasised and solicited for the LGAs cooperation on sustainability plan. Open discussion was moderated by Dr. (Mrs) M. A. Mafe. She requested all the LGAs present to go through their file to see the performance level of most of the LGA reported and react to some of the problems facing their L.G.A. Kaiama LGA Coordinator (Mr. Haliru) said that they usually plan but not on record but agreed to correct this. Mr. Haliru said further that there is no separate budget for Oncho, its only when the need arises that the HOD writes to the Chairman for financial support. Irepodun LGA HOD said they use to plan, that is have work plan before the financial crisis in the LGA especially the case of Zero allocation which really affected their finances. The response of the other LGAs is almost the same but with little or no difference. Kaiama DPM (Ajiya Fatima Idris) said that there is cordial relationship between her HOD Health, LGA Oncho Coordinator, DPM and the Chairman which help in the presentation of Oncho programme in her LGA. She said there is 71 need for proper record keeping, there must be a plan chart which must be discussed with the DPM to plan the financial implications of it. The group work was coordinated by Dr. Uche Enyinnaya. He talked on what the situation is regarding sustainability in our project and what could be the solutions to the weaknesses regarding sustainability and the threat to this project, at community level, FLHF level and Local Government level. The participants were divided into three groups, after which each group was asked to present their group work. Comments from participants:  The Oncho Coordinator should get themselves familiar with their DPM so that in time of need the DPM will assist him on her.  Local Governments are not to carry the drug to the FLHF, it should be the other way round. Somebody should know what is expected of him or her at their level to move things forward. At this point, there was modification of the group works. That is each group was to correct and rewrite their group work. Furthermore, another presentation by Mr. Pius Mabuba was done on the criteria for further APOC support. He said after the fifth project years, APOC would not support programmatic activities such as:- Salary Top-ups, routine CDTI activities such as CDD training, monitoring and supervision and distribution of Mectizan e.t.c. Similarly, APOC could provide more support for up to three additional years of CDTI implementation if the projects meet certain conditions. The format for work plans was presented by Dr. David Sang after which each Local government was asked to developed and write out the sustainability plan for year 2006, 2007 and 2008. Two Local Government Areas, Irepodun and Ilorin West were asked to present their sustainability plans after which comments were passed on each of them. Fifteen Local Government Areas were represented. 72 DAY 2 Comments from the LGAs - Planning done but not documented - Finance – major problem, budgets are made, approved but not released. - Planning is done - integrated - Budget – major problem, done but money not released. - CDDs integrated, used to find Cataract cases in their areas. - Used to plan in past but because of lack funds for implementation we stopped two years ago. - No proper documentation in all CDTI activities aimed down - With proper record keeping transfer of staff would not affect project performancy. - Each LGA should record proper year planner which reflect all CDTI activities Ekiti LGA - Planning is carried out with the HOD Olasehinde - Planning is carried out together with the supervisor - Major areas is finance has not collected any Kobo uses his personal finance to carry out finance Ibrahim - Planning is carried out with his supervisors. A written plan - Oncho is integrated into primary eye care - CDD trained for detection of eye people. CDD use to trace cataract cases - Support financially through the funds are inadequate - Metazoan is adequately from SOC Mohammed, Kaiama - Planning is carried out yearly. Workplan is in the plan but for the past two years he had no plan - Integration exist - Leadership HOD called LOCT’s to present problems to LOC management - Finance nothing comes out - M/S is carried out with our little money Ilorin East LGA - Planning is vital there is planning due to lack of finance - Leadership, political, religion, chiefs etc are carried along - Coverage wide range all nooks and corners are covered - Monitoring and supervision is carried out but marred by finance. - Manpower-Transfer here and there Asa LGA - Planning in some years back but now no planning due to lack of support. But HOD, supervisory councillor etc are involved M/S is carried out - Training we now know that FHLF will do it - Finance only this year we were able to get something - Transport. There is support in that area Ilorin West - All in the same line no documentation - Training in reality on coordinator & supervisor do the training - Finance, Government assistance in this years distribution - Transport , Government assisted 73 DPM, Kaiama Chairman directs to me and I direct to HOD. There is cordial relationship between the HOD and myself. We write the coordinators and we discuss - With proper record keeping there will be no problem - Finance, we do not have any special allocation for CDTI. There should be additional funds for health - There should be cordial relationship in the health sector Plan and discuss with DPM so that it could be included in the LGA budget The way forward In the session on the way forward, participants were asked what they intended to do with the 3-year (2006-2008) sustainability plan they had developed. They unanimously proclaimed that the plans will be forwarded to the political Heads of their LGAs (the Chairmen) through the appropriate channels. The Directors at the workshop pledged to act promptly and promised to put obtain the Chairmen’s approval for provision of adequate funding. 74 Appendix 5 : SWOT ANAYLSIS AT LGA LEVEL INDICATOR STRENGTH WEAKNESS OPPORTUNITIES THREATS SOLUTION Planning LOCTs aware of all different in CDTI activities - No integrated plan - No written plan for CDTI LOCTs recently made aware of the need for having written plan. Advocacy to political traditional & Religi leaders. No budget allocation Proper planning and proper Documentation Integration Integration with programme like Immunization M&E No Integrated Work Plan Integration with others existing partners Lack of documented Plan. Presentation of documented integrated plan. Leadership Focal person for CDTI HOD’s Health LOC takes full responsibility for CDTI Little integration between Local and higher officials Involvement of staff of other department Unwarranted transfer of programme officer’s There must be proper interaction between Local and higher official of L.G.A. and other staff of other department. Monitoring and Evaluation Data transmitted through government channel, and transports facilities - No Implementatio n deports for training and finance. - No document of problem or successes LOCTs by – passing FLHFS. We can make use of others units to trans for our reports to the rights quarter. E.g. M&E unit, NID, FP. E.t.c. Lack of adequate transport and finance. There should be proper implementation report for training and finance and mobility. Mectizan Procurement Distribution. Timely collection of metazoan from the state. Adequate supply of mectizan from state. Good storage facility at L.G.A. Collection of metazoan by FLHF from LGA stores. 1. Metazoan need is not calcvalted at L.G.A. level. 2. No record of metazoan collected. Metazoan collection through L.G.A. transport system. Non- provision of training on metazoan by OCT. Empowerment of LOCTs by SOCTs. 75 Training HSAM LOCT trained down to community level. Machined sticks and treatment form, H chart are available. Training report unavailable Training of LOCT not targeted and therefore not cost effective HSAM is not well planned and documented. We can integrated HSAM into other PHC programmes e.g. immunization, FP. No proper documents and planning of HSAM There should be proper recording of training and HSAM activities. Finance Fund is released for the programme No written budget for Ondo programme 3% of L.G.A. allocation is too saved for Health Financial assistant from N.G.O. e.g Rotary club, Lion club e.t.c. Unstable political Environment Effective Financial control system by the L.G.A. Transport and others materials resources. No routine maintenance rather based on need. Hiving of public transport. The NGDO (SSI) provides spare parts for motor cycles maintenance annually. Dependence on N.GDO (SSI) for vehicle on transportation Provision for motor cycle and vehicle for programme sustain Routine maintenance Human Resources. Quality personnel are available for C.D.T.I MOH train LGA Staff from time to time. Unstable Health personnel through transfer also recruitment. Routine training of LGA Oncho Team by MOH and retaining of LOCt. Coverage Geographical coverage is 100% Therapeutic coverage is = or grater than 65% REMO records are not available 76 Appendix 6 : LIST OF DOCUMENT CITED 1. Independent monitoring of Community Directed Treatment with Ivermectin in Kwara State, Nigeria (2001). A report submitted to African Programme for Onchocerciasis Control by P. E. Ogbu-Pearce 2. Sight Savers International support for Mectizan distribution, Kwara State (2003 – 2005) Kwara State Project Document {March, 2003) 3. Kwara State reporting format for LGAs 4. Monitoring and Supervision Checklist 5. Mectizan Record Book 6. Annual Work Plan 7. Report on training 8. Report on mobilization 9. Report on distribution 10. LGA Report 11. Training materials 12. Report from Ekiti LGA on State Coordinator’s observation on Year 2003 treatment report. 13. Report on Mectizan distribution on Oke – Ero LGA 14. Report on Mectizan tablet distribution and Vitamin A Supplementation Year 2004 from Kaiama LGA (dated August, 2004) 15. Field report on 2004 distribution of Moro LGA in September, 2004 16. Training and mobilization report. 77 Appendix 7 : LIST OF THOSE MET STATE MINISTRY OF HEALTH Dr. Bola Olaosebikan - Commissioner for Health Alhaja Ayinke Saka, - Permanent Secretary, Dr. (Mrs) A.P Folorunsho - (DPHC/DC), Mr. Yemi Ajayi - (DD Epid), Mr. G. D. Adeseko - DD(M&E), Mrs Kudabo - V.I DD MCH, Mr J.S.B Asonibare - DD H/E, Abdulraheem Atanda - SOCT Mr. Bukola M. D. - CEHO SOCT J. O. Adeoti - SOCT Mrs. V. T. Ashaolu - SOCT Ganiyu Kareem - SOCT Yakub Omotosho - APOC Accountant FOP Oyinloye - SOCT D. O. Opawoye - SOCT R. A. Olanrewaju - SOCT Yemi Ajayi - SOC/DDPHC &DC Akanbi D. A. B. (Mrs) - SOCT Dr (Mrs) A. P. Folorunso - DPHC/DC Mr. J. K. Oye - DFS Dr. Fagbayi - DMST Dr. Giwa - Epid Unit Dr. K. Ogundimu - Sight Savers International Officer & Zonal Officer ASA LGA Alhaji Ibrahim O. Shehu - Chairman Hon. Lateef Oloyin - Supervisory Councillor for Health Hon. Jimoh AbdulSalaam - Supervisory Council for Agriculture Hon. Zakariyau Mukadam - “ “ “ Works Alhaji Saadu S. Ajelanwa - Secretary of the Local Government Hajia A. F. Zubair - PHC Coordinator Mallam Raheem Atanda - Oncho Coordinator Prince A. O. Ogundeyi - Director of Personnel Malam Lazees Yusuf - Local Government Treasurer Malaam Issa Ajape - EPI Manager Kareem Magaji - Olooko/Igborese Alhaji Aliu - Village Leader, Sosoki Ayodeji Salumanu - CDD, Sosoki Shehu Akanji - District Head Supervisor, Onire District Alhaji Oba-Ajadi - Village Elder, Bakase Mrs. Idowu Babatunde - CDD, Bakase Mrs. Hajara Yusuf - Community Member, Bakase Alhaji Kusumu Taiye - “ “ “ Hajia Musa - “ “ “ Haliatu Hassan - “ “ “ Salimata Babatunde - “ “ “ Babajoko Amosa - “ “ “ Adama Jimoh - “ “ “ Mamicina Ambal - “ “ “ 78 Nofisatu Nuru - “ “ “ Batuli Jimoh - “ “ “ Mrs. Ramat Kolawole - Community Member, Sosoki Mrs. Fatima Ayodeji - “ “ “ Alhaja Madina Aliyu - “ “ “ Mrs. Saratu Salamon - “ “ “ Mrs. Rabiatu Abeje - “ “ “ Mrs. Seliatu Abeje - “ “ “ Mrs. Moramo Ayodeji - “ “ “ Mr. Alao Jimoh - “ “ “ Mr. Tunde Ahmed - “ “ “ Alhaji Aliu - “ “ “ Alfa Isiaka Salahudeen - “ “ “ Mr. Sheu Atolagbe - Community Member, Bakase Mr. Babatunde Abdulrahoof - “ “ “ Jimoh Ayinla - “ “ “ Jimoh Akande - “ “ “ Sheu Giwa - “ “ “ Alfa Kabiru - “ “ “ Mohmad Bello - “ “ “ EKITI LGA Oba Elijah Adegoke Oyun - Olukoro of Koro Hon. Adeniyi Daniel - Councillor, Koro Ward Mr. Sunday Joe Ajere - Chairman, Koro Ekiti Hon. Olufemi Ajayi - Councillor for Oke-Ado, Eruku-Ekiti Samuel E. Aremu - CDD, Igbaye Compound, Koro S. O. Abejide - CDD, Oke-ogi Compound, Eruku-Ekiti F. A. Aina - CDD, Oke-Ado Compound, Eruku F. O. Adesoba - CDD, Oke-Ado Compound, Eruku Bosede Ayeni - Health Educator, Health Office, Osi Racheal Adegoke - “ “ “ “ Chief Adebayo Ogungbe - Community Chief, Inihun-Osi Ammond I. O. - CDD, Inihun-Osi James Oladele - Community Member, Ileme-Osi Emmanuel Adesoye - CDD. Ilemo-Osi Olajide Inawole - CDTI Supervisor, Koro Health Centre Mrs. Abayomi Josephine - SNO, Koro Health Centre Fabiyi Omolola - Student on practical, Koro Health Centre Abu Florence - Student on practical, Koro Health Centre Ester Abioye - CDD KAIAMA LGA Hajia Memunat Mohammed - Supervisory Councillor for Health Mallam Hassan Ibrahim - PHC Coordinator/HOD Health Mallam Haliru M. Ahmed - Oncho Coordinator Mallam Abubakar Seriki Nuku - Village Head, Nuku Mallam Abubakar Ismaila - Village Head, Tunga Maje Alhaji Abdulrahman Kango Owode - Village Head, Kango Owode/Lamba Alhaji Musa Hamdalli - Village Head, Hamdalli Mallam Abubakar Alhassan - Oncho District Supervisor, Kaiama/Woro Health Clinic 79 Mallam Abubakar Musa - Oncho District Coordinator, Bani Abdulraham Mohammed - CDD, Tanga Maje Mallam Sefiu Idris - CDD, Nuku Mallam Abdulateef Ashiru - Health Facility, Woro Abubakar Hammed - Nuku Community Mallama Adsat Nuhu - “ “ Hassan Umar - “ “ Mohammed Koro - “ “ Jubril Suleimana - Tunga Maje Mohammed Tunga - “ “ Alhassan Hammed - “ “ Hajia Senab Mohammed - “ “ Sukura Hamdallahi - “ “ Umar Alhaji Ibrahim - “ “ Alhaji Hamed Kango Owode - Kango Owode Ibrahim Kango - “ “ Issa Ibrahim - “ “ Hajia Medinat Hammed - “ “ Sikirat Abdullahi - “ “ Sule Afolabi - “ “ Jubril Hamadallahi - Hamadallahi Garuba Musa - “ Abubakar Abdullahi - “ Hajarat Hamadallahi - “ Hammed Abukadri - “ Jibrula Alhassan - “