NGNIG5 CDTI annual project technical report submitted to Technical Consultative Committee (TCC): January to December 2006

unDATED f' yn,nR ANNIIAL TECHNICAL REPORT FOR C OMM(TNITY D IRE CTE D TREATME NT WITH IVE RME CTIN GDTD PROJECT IN NIGER STATE. ORIGINAL : English II I i, COUNTRYAIOTF: Nigeria Pro Name: NGI\ilGs Approval veart 1999 Launching vear: 2000 Renorting Period: From: January 2006 To: December 2006 (MONTrr/rEAR) ( MONTTT|TEAR) Proiect Year this renort: (circleone) I 2 3 4 5 6 (7) 8 9 10 Oate *oUmitted: 13th Februa ry 2007 NGDO nartner: UNICEF t:t i, ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTBE (TCC) DEADLINE FOR SUBMISSION: To APOC Management by 31 Januarv for March TCC meeting To APOC Management by 31 Julv for September TCC meeting AFRICAN PROGRAMME FOR oNCHOCERCIASIS CONTROL (APOC) Lro FH F tf, t II tlI I :{ Cll u dil V* ;T I =.a I *tBed orusT1o aa *f /002 llnr 0 z IrL ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: Country: NIGERIA National coordinator Name: Mrs. P. Ogbu Pearce Signature: =ililzo'7Date Zonal Oncho coordinator Name: Dr. Fayomi Signature Date NGDO representative ne Gana This report has been prepared by Name : Hajiya Rakiya.y.Datri Designation : Onchocerciasis coordinator o+ Signature,&***6 Date ;r;J 9r l*.I ACROTWMS. V Tahle af content FOLLOW UP ON TCC RECOMMENDATIONS. I EXECUTIW SAMMARY SECTION l: BACKGROUND INFORMATION...... .......... J , I 1. 1. Gzttrntt TNFqRMATTzN 1.1.1 Description of the proiect (briefll) 1.1.2 Pmrtvonsntp.. 1.2 POPUL,4TION SECTION 2: IMPLEMENTATION OF CDTI 2.1 )) 2.3. 2.1. 2.5. 2.6. 2.6.1. 2.6.2 2.6.3 2.6.1 2.6.5. 2.7. 2.8. 2.9. 2.9.1. 2.9.2. 2.9.3. 2.9.1. 2.9.5. 2.9.6. TIMELINE OF ACTIVITIES Aot'ocitct' MowuzertoN, sENSlrtzATIoN AND HEALTH EDLicATIoN oF AT NSKCOtvItttLtNITIES...., C o tvt,vt ti;urt ilv t'olrEt t ENr.............. .. C',-t p lc ry B(,t LDIxG ... Tnetrutyrs Treatment ./igure,s............. What are the cause,s of' absenteeism?.......... What are the reasons./br refusals? ................ Briefly describe all known and veri/ied seriou.s adverse events (SAEs) that . Trend ol'treatment achievement.from CDTI project inception to the current year Onoeanrc, sroRAGE AN D DELIT' ERl oF It' EF.*IECTIN C o tut u u twr t' s EL F- tv ro N IT o N N G,l w o S r,q x EH o to rps M rrrwc . _ . Sttpr,at tstol Provide a.flow chart of supervision hierarchy.. What were the main issaes identified during supervision?.............. . Was a superttision checklist used? ........ Wat were the outcomes at each level of CDTI implementation supervision?....... Was.feedback given to the person or groups supervised? ............... How was the feedback used to improve the overall performance of the project? .. .............3 .,.....,,.3-6 7_8 ....... 9-l t .........12 . ... t2-13 ....,. t1-15 ........... /i ...... t6- 18 .. .. t8-22 .,.....,..,22 .,...,.....25 ...........26 ...........26 . . 26-27 ...........28 ......29-3 t ......31-33 ,.....,.... -r3 .......... -3-' ,.....33-33 ..........31 .....31-35 .......... -r5 .....35-36L& lll SECTION 3: SUPPORT TO CDTI, EgunurNr Fm.qNcut :oNTRIBWIoNS oF THE PARTNERS AND coMMUNITIES..... Ornnn FIRMS oF coMMUNITt'suPPoRT Exp rt t otrunr P ER ACTIYITY 37 3.1. 3.2. 3.3. 3.4. ..37-38 ..39-40 .......40 ..40-4t ! SECTION 4: SUSTAINABILITY OF CDTI 41 1.1. IurrWtL; INDEPENDENT PARTICIPATzRY MONITzRING; Eyetulrtott ...................41 4.1. t Was Monitoring/evaluation caruied out during the reporting period? (tick any oJ'the followingwhich are applicable)............ .......--..-....... 11 4.1.2. l(hat were the recommendations? ...............41 4.1.3. How have they been implemented?............. ................-.- 12 1.2. Susr.uy.taLrrt'oF zRIJECTS; zLAN.4ND sET TARGETS (u.,tNo.tronY AT t'R 3) . . . .. ... ...12 1.2.1. Planning at all relevant levels..... ..........'..'... 42 1.2.2. Funds........ 12-13 1.2.3 Transport (replacement and maintenance) .....13 1.2.4. Other resources.. ...... 13 1.2.5. To what extent has the plan been implemented................ ................13 1.3. IurrcntrtoN............... 43-44 1.3.1. Ivermectin delivery mechanisms................ ... .... . ..,...,.11 1.3.2. Training.... ....................14 1.3.3. Joint supervision and monitoring with other progrums.... ............... 15 1.3.4. Release oJ-Junds.for project activities .. . .... ........ 15 1.3.5. Is CDTI included in the PHC budget? .............. ............. 15 1.3.6. Describe other health progrommes thqt are using the C'DTI slntchtre and hov, this v,crs achieved. lllhat have been the achievements?............. ..............15 1.3.7. Describe others issues considered in the integration of CDTI .. J5-16 4.4. Orcnertox.tl RESEARCH .............. 46 4.4. I. Summarize in not more than one halJ'of a poge the operotional research undertaken in the project areawithin the reporting period.. ................ 16 4.4.2. How were the results applied in the project?.... ............. 46 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AND OPPORTWITIES 47-50 SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS I *. rr- L ;; lv 5G5T Acronyms APOC African Programme for Onchocerciasis Control ATO Annual Treatment Objective ATrO Annual Training Objective CBO Community Based Organization CBS Community Based Supervisor CDD Community Directed Distributor CDTI Community Directed Treafrnent with Ivermectin CSM Community Self-Monitoring DHS District Health Supervisor DPHC Director Primary Health Care FOMWAN Federation Of Muslim Women Association Of Nigeria HSAM Health Education, Sensitization, Advocacy, Mobilization LGA Local Government Area LOCT Local Onchocerciasis Control Team MIS Management lnformation System M&E Monitoring and Evaluation MOH Ministry of Health N/A Not Available NGDO Non-Governmental Development Organization NGO Non-Governmental Organization NIDs National Immunization Days NPI National Programme on Immunization NOCP National Onchocerciasis Control Programme NOTF National Onchocerciasis Task Force PHC Primary Health Care REMO Rapid Epidemiological Mapping of Onchocerciasis SAE Severe Adverse Event SHM Stakeholders' Meeting SOCT State Onchocerciasis Control Team (The State Programme coordinating team) TBAs Traditional Birth Attendants. TCC Technical Consultative Committee (APOC scientific advisory goup) UNICEF United Nations Children's Fund UTG Ultimate Treatment Goal wHo World Health Organization t t 5. v Deftnitions (i) Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census aking). (ii) Eligible population: calculated as 84o/o of the total population in meso/hyper-endemic communities in the project area. Annual Treatment Objective: (ATO): the estimated number of persons living in meso/hyper- endemic areas that a CDTI project intends to treat with ivermectin in a given year. (i ii) I (iv) (v) (vi) (vii) (viii) (ix) Ultimate Treatment Goa[ (UTG): calculated as the maximum number of people to be treated annually in meso/hyper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage (normally the project should be expected to reach the UTG at the end of the 3'o year of the project). Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). Geographical coverage: number of communities treated in a given year over the total number of meso/hyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). Integration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) through CDTI (using the same systems, raining, supervision and personnel) in order to maximise cost-effectiveness and empower communities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTI. Sustainabilily. CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future, with high treatment coverage, integrated into the available healthcare selice, with strong community ownership, using resources mobilised by the community and the government. Community sel.f-monitoring (CSM): The process by which the community is empowered to overs€e and monitor the performance of CDTI (or any community-based health intervention programme), with a view to ensuring that the programme is being executed in the way intended. It encourages the community to take full responsibility of ivermectin distribution and make appropriate modifications when necessary. I- ,* =tF vl FOLLOW AP ON TCC RECOMMENDATIONS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session 25 I Number of Recomm endation s in the Report TCC RECOMMEN DATIONS ACTIONS TAKEN BY THE PROJECT F'OR TCC/APOC MGT USE ONLY (D Focus on Stale and LGA financial contributions. Concerted effort was made both to the Ministy for Local Government to obtain the proposed mandate for central deduction of counterpart contribution for the 2l CDTI LGAs as well as to the Ministry of Finance for release of US$30,000 approved counterpart fund for the State. US$20,000 was released to the State but no mandate was obtained for cenffal deduction of LGA contributions. Only 2 LGAs released the sum of US$650 to their LOCTs despite intense advocacy visits to all of the 21 LGAs (ii) Replace and repair project equipment. Some project equipment were repaired and maintained at State level, however, repair of LOCT motorcycles has been difficult due to absence of counterpart funding at that level. (iii) Recruit more new female and male CDDs. Communities are continuously mobilized for inclusion of women as CDDs, but this is still difficult to achieve because of religious and socio-cultural belief of the people especially the Moslems who happen to be the majority. There is a plan to collaborate with an islamic group known as FOMWAN, with the hope of improving women participation. Absence of female CDDs does not however seem to have any negative effect on treatment of females. There is severe CDD attrition due to lack of motivation, and new ones are being selected both at ward level and along family lines. CDDs are to be trained for integrated disease surveillance and it is hoped that this would create ,opportunities for them to be motivated also thereby threat of attrition. (iv) lmprove supervision at all levels. There has been concerted effort by NOCP, UMCEF and the SOCT to ensure that communities are adequately supervised, and these effiorts have been quite revealing! The LOCT are highly demoralized and hardly supervised the lower level, therefore, drugs were not released to the communities on time and even when released, distribution was not properly supervised and dattwas not collated from the community register. WHO/APOC, 24 November 2O06 , !Executive Summary Niger State has 25 administrative divisions known as Local Government Areas (LGAs), out of which 2l are approved by APOC for implementation of CDTI. The population of the State is 3.9 million based on the recent Q006) national census. There are 2,872 affected communities with a registered population of 1,821,090 people at risk of infection and blindness from Onchocerciasis. At the time of submission of this report 1,427,870 people were reported treated in 2,600 endemic communities, representingTsYo therapeutic andglYo geographic coverage respectively. One LGA (Mashegu) had not submitted any report and all effort made by the SOCT to obtain it failed. The Ultimate Treafinent Goal (UTG) for the project is 1,529,716 therefore UTG coveragewas93Yo. The population in over 40Yo of the project area is highly migratory because the State shares boundary with several others in all directions, as well as with Benin republic on its' westem border. Commonest among the migrant ethnic groups are Gwaris, Kambaris and nomadic Fulanis. Due to the socio-cultural beliefs and practices of the aforementioned, they migrate annually both within and outside the State in search of virgin (fertile) land for growing cash crops such as yams, guinea corn, maize and millet, while the nomadic Fulani migrate in the dry season in search of water and fresh fodder for their animals. The above phenomenon is responsible for the nucleated and highly dispersed settlement pattern, as well as highly dynamic community and population figure that prevails in over 60% of the State. Niger is the largest of the 36 States in Nigeria, occupying l0o/o of the total area. 5,356 CDDs were trained/retrained out of an ATrO of 14,263 representing 38%o, while 702 health personnel were trained/retrained to increase capacity for supervision of CDTI. This achievement represents 122% coverage. The challenge the project experienced within the period of report was achieving its' ATO of 1,529,716 people in spite of very poor funding at LGA and community level. Only two LGAs released firnds to the LOCT, therefore most of the teams were demoralized and commitment declined. Because of inability of most LGAs to collect Ivermectin from the State, it had to be conveyed to them, either by the SOCT or during distribution of vaccines for mass immunization. Involvement of persons other than CDDs during NIDs further demoralized them and led to severe dropout and delay in treatment. In order to ensure that drugs were released to all eligible communities, a comprehensive list of these communities together with their drug allocation was compiled by the SOCT and then distributed to the LGAs as a guide. The acceptance of Mectizan and its' popularity, together with opportunity provided by the NfDs, helped to ensure fairly good coverage and distribution was integrated at all levels. ln spite of the difficulties encountered, the commituent of some of the LOCT and frontline health facility staff ensured training/retraining of CDDs as well as supervision of treatment. Intensive advocacy and mobilization visits were made to LGAs by the SOCT and supervision was intensified to ensure adequate coverage. Frequent tansfer of the heads of the PHC deparfinent at LGA level was a major set back to ensuring timely reporting from the LGAs, despite the effort of the SOCT.UNICEFS' renewed commitment to the programrne provides a ray of hope and its' funding for focused intervention in Borgu LGA(November/December 2006) helped to improve treahent coverage at the border with Benin republic. {* iI 2 WHO/APOC, 24 November 20O6 SECTION 1: Background information 1.1. General information l.l.l Description of the proiect (brielly) Geographical location, topography, climate Population: activities, cultures, language Communication systems (roads. . .) Administration structure Health system & health care delivery (provide the number of health posts/centers in the project area if the information is available). Number of health staffin project area and number of health staffinvolved in CDTI activities. 1.1.1. Description of proiect Niger State is geographically located within the middle belt of Nigeria and it lies between latitude 3 20' East and longitude llo 3'North. It is borderedby Zanfara State on the North, Kebbi State on the North West, Kogi State on the South, Kwara State on the South West, Kaduna and Federal Capital Territory of Abuja at the North East and South East respectively. The State shares a common boundary with the Republic of Benin on the westem border i.e. at Babanna district of Borgu Local Government Area. The location of the State gives rise to cofllmon inter-border trade with it in all directions. The topography of the State is highly undulating, while the land is traversed by several fast flowing rivers such as Niger, Oli, Kadun4 Kontagora, Gurara and several tributaries that flow into them. As a result of the topography, the major rivers of Niger and Kaduna have been dammed for production of electricity, therefore, the State houses the largest number (3) of hydro electric power stations in the country thus eaming itself the title, 'Power State'. Prominent among the dams are Kainji, across river Niger at New Bussa in Borgu LGA, and Shiroro, across river Kaduna at Shiroro LGA. Despite its' meso endemicity, the State is surrounded by hyper endemic foci on its' northeast, southeast, south and southwest. These foci are in Kadun4 the FCT, Kogi and Kwara States respectively. The vegetation of the State is mainly of the guinea savanna type with forest mosaic savanna especially in the south and south-western parts. The climate is of distinct dry and wet season with rainfall ranging between l,l00mm in the North and l,600mm in the south. The wet season ranges from 150days or more in the northem part to 210 days or more in the southern part. The dry season commences in October and humidity could be as low as 140' between December and February.*- aJ WHO/APOC, 24 November 2006 t) {- a, .: Temperatues rise as much as 90T between March and June, wittr the lowest minimal temperatures usually in December and January. Most of the Onchocerciasis endemic communities are located within the abundant flood plains of the rivers that traverse the land, thus the population is agrarian in over 80% of the State. Among the large ethnic groups, the Gwaris', Kambaris' and nomadic Fulani have a socio-cultural habit of moving from place to place in search of virgin land for their crops, and in the case of the Fulanis, for water and fresh fodder for their animals. Common cash crops produced by the farming groups include yams, rice, maize, millet and guinea corn. Nupes' are one of the major ethnic groups in the State, and they are more stable in settlement, forming very large clustered populations that reside within the marshy alluvial rich valleys, which abound in the State. The Nupes grow mainly rice as both food and cash crop while they are also very good fishermen. While the settlement pattern n 40% of the State is dense and clustered, over 60% is sparsely populated and hig$y nucleated with distances of up to 40 kilometers between some communities. Niger is in fact the largest State in Nigeria, occupying about 12 million hectares of land, which represents about one tenth ofthe total land area ofthe country. There is a fairly good road network in about 40o/o of the are4 however, due to the riverine nature, about 40% of movement is by water, using local tug boats, engine boats, and ferry for movement of goods, vehicles and humans across the rivers, especially between communities and from the State to neighboring Kebbi State. Heavy flooding, as a result of overflow of the hydroelectric power darns especially after the rains, is a major threat to communities that reside along the large rivers of the State, therefore several communities are often either submerged, dispersed or are displaced. The administrative structure is typical of what obtains all over the country, i.e. with a politically elected executive Governor at the State level and 25 local administrative councils headed also by politically elected LGA chairmen. The peculiarity here is that the administrative councils are further subdivided into 43 units with 18 of them known as developmental area councils each with a separate leadership which makes coordination of activities quite difficult especially where there is poor collaboration between the adjoining LOCT coordinators. There are several traditional institutions headed by Emim and chiefs of various hierarchies, who oversee the districts and communities wtrile the kingdoms are grouped as emirate councils. The communities within the emirates are headed by traditional rulers who pay allegiance to the top hierarchy as is typical of the ancient feudal system of government, while all Emirs are accountable to the Executive Governor. The State govemment basically comprises of three arms i.e., the executive,legislative and judiciary. 4 WHO/APOC, 24 Novemb er 2006 *& The health care delivery system comprises of three levels i.e. Primary, Secondary and Tertiary, all of which are quite well interlinked. The PHC system has been put fairly well in place, and is becoming more functional. There are over 2,400 health postslhealth centers in the State out of which about 1,000 exist within the CDTI project area. There are 3,239 PHC staffwith796 participating in CDTI. Out of 2l CDTI LGAs, l7 are old (i.e. have implemented CDTI for at least 4 years), while four, narnely, Suleja" Tafq Gurara and Agwara (which came about as a result of the REMO update/approval of year 2004) have implemented CDTI for three years now. Western Borgu shares border with Benin Republic at Babanna district and was also approved for CDTI in year 2004.It was only in year 2006 that concerted effort was made to ensure total coverage of over 200 communities in that sector. 5 J+ WHO/APOC, 24 November 2006 Table 1: Number of health staff involved in CDTI District/LGA Number of health staffinvolved in CDTI activities. Total Number of health staffin the entire project area Br Number of health staff involved in CDTI Bz Percentage *100 Kontagora 150 13 9 Rijau 123 50 41 Magama 216 36 t7 Mariga 202 34 t7 Mashegu tt4 27 24 Agaie r32 23 t7 Lapai 137 67 49 Mokwa 182 48 26 Rafi 185 61 33 Wushishi 150 50 33 Borgu 113 69 61 Lavun 18s 23 t2 Shiroro t20 60 50 Gbako 69 2t 30 Katcha 65 45 69 Munya r93 18 9 Bosso 230 36 16 Suleja r66 2l 13 Gurara 187 37 20 Agwara t& 24 r5 Tafa r55 JJ 2t TOTAL 3239 796 25 6 T' a- F WHO/APOC, 24 November 2006 1.1.2 Partnership - Indicate the partners involved in project implementation at all levels MOH, NGDOs (national/intemational), communities, local organizations, etc. ] - Describe overall working relationship among partners, clearly indicating specific areas of project activities (planning, supervision, advocacy, planning, mobilization, etc) where all partners are involved. - State plans, if any, to mobilize the State/region/district/LGA decision-makers, NGDOs, NGOs, CBOs, to assist in CDTI implementation. Partners involved in project implementation are:- - The National Onchocerciasis Control Programme, of the Federal Ministry of Health, - The State Ministry of Health and LGA/PHC departments - UNICEF, APOC, WHO - 2,872 Onchocerciasis endemic communities with their CBOs. These CBOs are mainly agricultural cooperative groups and trade unions for both men and women, as well as various youth (age grade) associations which often double as agricultural cooperative groups. The overall working relationship among the partners is quite cordial and encouraging. Generally, all are involved in HSAM at various levels. UNICEF has renewed its' commitment and is involved in planning for conduct of CDTI activities like planning, training, HSAM and supervision/monitoring. The focused intervention at Borgu LGA (December) was an outcome of the intemal advocacy/monitoring visit paid to the State by the new UNICEF consultant in October in company of NOTF offrcials. Two review meetings for the 9 assisted States were also sponsored by UNICEF in the year under report. The Ministry of health solicited for piece-meal release of funds from the US$23,809 approved and wzls successful in acquiring US$15,873 which was utilized for HSAM, supervision and monitoring among several other activities. i- i* 7 WHO/APOC, 24 Novemb er 20O6 aVarious groups like media organizations, the Nigerian Red Cross society, Jama'atu- Nasril-Islam (JN! the predominant muslim organization, as well as National Union of Road Transport Workers also pledged to continue to assist with HSAM activities. There would be a new democratic government in2007, and there is a plan for high level advocacy visit involving UNICEF, NOCP and possibly APOC to the State in the middle of year 2007 to advocate for bulk release of funds (for 3 years) from the newly elected democratic govemment. Advocacy visit would be paid to the 21 new LGA councils by the SOCT to also solicit support for long term release of funds for LOCT/CDTI activities. A comprehensive list of active local NGOs and CBOs is being compiled for sensitization and collaboration in the on-coming year, of special interest is the Federation of Muslim Women Association Of Nigeria (FOMWAN) which would be engaged for collaboration to mobilize women for active participation in CDTI at community level. L 1- T 8 WHO/APOC, 24 Novemb er 20O6 lxr lilS i" IR.15, ! rA. .SLrt} S= S :I. l!v, tr \ .S\l F S ItF s. G(\ G! .S G G GE =s. Gs G Ii .(\E G $E l\\ s Oe s G s o Oe\ G S a Ed o ar) lr) o ct 7( A: o p od 0,tfo a oEt o rrE EUor-t 0c 4 U) V) Fp o ,f{g, t- E '6 F) oc B.o E)(, (D oa A,r-t oc F' pt @ F' F) F D'c 7(o F' oa oFt F FOAU 'E>l ='q -E- -. Ft .Dlr=?a -o H3aElq =' (! o\{ \oUI@ (.,r\o { o\s{ \o so t\) @ L'IU)(Jl oo u) tJ) r.rr 0a5(]) t) r-rt o oo -Io o\\o(/r 6 o\ at]) @ N)t) UJ o\ u)tJ Ur\o UJ -Ioo{ UJ o\ (,{ -Io5 N -J t.)5 \o N) (,l{ (, t'J UT N){ ooF{\o\o E' EI6 'e d: s -a9+s E ='E^'lo E' rjs 5o o\o\ o\ t.J a(]) \otJ 5o tJ) t, hJ6 5L,T NJ t)a(,l at) tJ{ (J1N) 5N) {NJ :sFE.=r o a g.i P iBgBE. z E(t orl oHt a o E E .Db\ lt9 oqota Itr I t NO-t*r!< E(!D-? 1=d)s(!E =6 .dB E'a' (,r 5 5 o\o\ o\tJ o UJ \o l..J 5 tJ.) UJ N)6 5(n NJ t)o(, tJ N){ (,|rN) 5l.J {N) Flo OD :a'8 NO rDt (! I ll + o\{ \o(i @ (/r \c) -l o\s{ \o 5P N) 6 (.rl UJ @(,) (])(,| 65 UJ NJ(Jro { o\\o 6 o\ (J) € tJt\) UJ o\ ttJ \o l+) { -oo{(,) o\ (/t{{ 5 t){ tJ5 \otJ(rr -J Ur l-.) (.,1 tJ{ 65 -J\o\o :sFE.= o agE E *g o r5 er o E ora! I I I I I ! ! I E.H s "PA:gH D-i.:l A TA '!9 '" o\{ \o Lfr oo Ur\o { o\F{ \o 5o "N oo (,r UJ(/t @(r) (j)(^ "€ 5U) t.)Ulo o {P o\\o(, 6IO u) € N) N) tJJ o\ (+) tJ L'T\o u) { €{ tJ) o\ (,r J-J{o5 t){ N)s \oN Lh -I Uh _tJ(, N){ @s{\o\o *8'lH e.3 -. ll D9 NrE ='o(Dr ET I + L'I{ o@(Jr 5)o -Io5 LhF UJ o\5 t,(, -I@ UJ 5tJr o o (, o o6 t) -9ooo 9r Jo(, 65 {l.) 'N,{N) otJ{6 UJ u) -t@ o\ o\ (r) 6 5 € 5 -I aI €6 N) { J-J{ o\o tJ6 N)t, { N UJ sIFeFle \o Iio\ to o "c)tJ5 zo g ct(D:.i N)ao o\ & &r $r t I t \oo ot l-.o .oA() o z t o.l d oA L,,, A > q< u)oE k()#EF_26Hv) EP d(l) U'g .sH at< € Lotr ! rd t<s H&(€=6 a.hotrYAo =,r(L) H BEHE3 ti ,\ ;^G)rtE S 3eil .E -EEI+J t 9.2 o \YJ'Lt E fi€ .8 3€Eh * EEt 3H Ep oE.2s tca EEx}iE .$ E;i\.EE€qrHtcgs ; IE .S 1tr tr\u .S.Bgi t!^ $ EEH\FLtr\)ts98S e2EiE H5 E € g HEE 9 E Es E6 kEg'=E'+{Lt'.q r; € E3E -!)F b gOEE i3 e .{v- L a t= 6$!(Jc)t € E-8 a., V E.gE ;7 ES F HE : -qE EH'F() t< C)E () (dIo .d CdL{ cg € Gt 0) bI) CB (D dtr) o Io o ot, o l< troo Gl bo cd a € o c)q)to qr o o. o '1, Cd E 0) Eoog +io a ok bo v))o o bo Eo thd 0.) C) -q (n o) a () L oq(l)ti r/) tr € o)a U)(l >. l-r tro(,) tro ' (l) F ri Ps uq) .P \ \)s s' q) S'L\ a)s \S El sq)\ sq)s st\ qj EO B \ a b S() q) _tt u,q) U) Sq B .s 3 q) +' q) bo \S >. Sa Lq) q) .s 60 u, q)\ a s h, L GI() I I I .h o()o ah otoL3 a |-r(-) I -,l Io l-lU u) aa o)() d o (rt 4() C) 3 oa * o -o 0.) .o(B o tr c, (ttE o) +ro() C)Lr ot) (;) t) d B oz +{ o l'{()g b0 li o o.oli o b0 tr)E (l) tro .o oo 'a kq () I li € (n)a (l)() Gt (nd z (+-{ o t<3$ PV 6e clP .Ets =E *tq)(l)-c l'{ +J((re +,d8o 'aF ti e-Et+r c'l -( .=o -d cdPG) 'S ri?o v)PSB cg t)oP tix6c) €c)trp(D€ li-00.)=O.Oh-c -.c a -\eratro'HaidO" 'r q)5€ tr(g C\, EEO(l)tr Egoec6 Pb ooPC)go o- 'E8tr TJT L +r bO98600 -oE= trio (l)H€ =(strE) Xt^cg(tl ai)S0) 6O' U9 cdeEtr ^(l)8 FEil E.F!J€ A -Rlo)\C)-d k+J ao \o C\o" .rf \r1 $s cil\o \o F- or+ ooo c.l €+ ia r* o\Nl,n F- c,I $\o ooq co c- (n c..l ral od+ r-rr) o\ N6 I I F- c.t $\o € o\ cnr- c.l ra) oot (a) F- r.1 o\ GI € o\ ooc.t \o C.lt-- cl t-r6 cl o\ 6co r\o c.ltr- clr-6 N F- ca s\o oo o\ co t-- r otla) €s o lr) r-\ o\ GI € GI o cn clL6lLr o ql d B b0 ,E clF Fl tr oH D tE,*(t)^ H H 8EiKE=E .? ts H;flFE g =:oa bi o.6 ilE's =.O14oSHSFilgrsE'8RE3ts E EB9Egi+d.e:i € 8E.HH.Fli++ B 3 i+ E$ gExPaEHE; -:. o' o- <liL.t+'aOSrSd Ev)i5'8 Fl BqIEG o9';u)Uot Xg x*H Hd6E'.')+ dH tii o $ai@>. ;F)9*tr8;P9.8I5o)'oot .? [P HE'ES9 2 5 fr i ndfrgq qd{T 4.#*EEa(,6LHqrF'0cq.E N EsEs;H B.} Ets @ E rV) u. Fl 'HOU) H Fl r>qP E6'j.g H.;H'# dP.od FHT tI o o -o Ir.J5 z o (D do N)oo o\ fE t- E o ahtoq a o o: QO EIE (J- fro3 trooo os E o) o z o) .o o o z o) -o o o z o ,E o o z ts(os o) ao U) 0) €E 6) o z (Ds tr 0) o z os o) o z tro! H q) oo o k c)s E c)o(D a os o o z os (l) o z ko € og() cl) .B'.eir. tr 6t= li o)E o o z h t t, bo >r l- >. =l- .r)3 o0 >r =E 3 tros Eo o z h C\, GIb (D l- h) Lro. Ec E tr o al L n 6E ooEEo- lros Eooo a lr(l)s Eo o z o -o E(l) o z C) -o Eo o z 0) -o oI z q) -oA C) oz 6) -o () o z o)D o o z l-() ..otr o o z Lo -oc o)oq) a ri o)p E(l) c)o o o -o o o z Hos o) o z C) ,a o) aoa l'+ ir rt 6t=i\E (l)s tr o o z >r a >t rn o0 a >r >\ an bo a = L C)str o o z b((l (! o a = q q) clE Po o E e)(J EEqoEE $n li(.)p tr o)o d) o o .o E 0) o z Lro3 o() o L It)5 Eo o z l<op C) o C) o Ho -otr o o z H3 o o() t/) li 0) .od o) o z L3t q) o z Lop ooo lios (l) oo n lio .o o o z o) -o o o z C) .o E c) a a)a Err .l|.tr cl: ri) - 1.. C) ,o o o z l- l- o =bo a, u0 a tros Eo o z H trdl- o =l- h a Lq AT EI cL t'{ o EEEOEE ,Jr L o)soIoo (n 5 bo) .t) bI) Lq)3 tro Aoa a bI) t) h0 >r I t- C)s ooo n (t) =bI) an oo S* iJE c=i\tr kos o oo U) 00 >. h h l- tt)360) I I L ad (! I = () l- 0 0) tr o c)tt o tr o 6l N ! ot=a o c)rEE EE U h 0,)p E C) o z o 'o o) aoa .t) bI)) o3 E o) aoa aroso oo rn) bI) a () 3 C) aoo oI Eq) &oa tr(l) -o q) o(D a Lr C)s o aoa o -o o aoa Er* *JE ct= o! o o z >. =l- >t l- ) >, >r at) bD >t 5 L GI =tr(1l >r a (, rI () L t, n ct o m Crl o v )q, & GI E cl oo GI GI oo G' u0 o) thql o GI o0 d o. GI Fl d B .vo rEcd& E ah .r1 o0 oa tr GI Fl o ok o ox clp o \ooo o.l k(l)E E() oz t C.t o o O. o Jr > (\l \) AJ q q)a \ SJ I v)tr a.r 13 q)s .S la S) g o' t) aJ R TI 'Sl *l €t!isv L Cd bI)() -o >r(.) *I * Itr o tr a € >. ,o EoI4 ,(.) tr c)g 4F rl() *r Gi) ? U)(l) .t I .l !l9o(t >. o) J1 c) -i! !() * - bI) tr .t € cd C) .tEg .< L cllox I E C) EJo d .l to! cBoLrI ct) CI,oL!\td FiLn€\,) u)a- q.) EP A .:t-*EAHE.EtsS S EEiJ=o) * b eES P €PS--.f(\t$3 =;i5+i\) F{ 'Gt EN ;E9'1 trFEINH9u)Nl\u I I I I I Fl oFl F Hp p' Ia{ !0r-i D' o ht Dtst A: at ,o !r-' ED o .A v,o trtr pt Xs c) F' Li tr 0qtt, 0a u) oedo oo odoFt LiI (D a(D tn do t oa t, c,t)(D (D 3d(D O oE o dor-t zo (D do 0e rJ) t (D 5 @ oa U'+ c 0at an 0a (r) rr o - oq o zo (D d(Dit t oa v) Lr o I o tr 0et U) tr(rcl F U) t 0a(, o o6oFt t (D z o (D d(DFt z (D 5d(DFt z o o doE a(D\, o q (D I Uooo 5oFt z o (D (t(DE oo odo o 0a tt) oc U tr 0e tn oo o6 o5 o zo (D d(D Fl U(D o(D croit z o o tscroit a(DE o Ed(D U(D oo dort zo (D !J6or-t oo od(D >t (D 0e U) oa V, 0qE(t) oo o6o (r d (! zo o do -t Uo c)o d(D >t zo (D Cor-t (A oEg r Uooo CoFt (, (D (D =d(D oo ocro I o o E E(Dt o E ? UEE d'9Hd0)xE.oo=;+(DF+=AllE8ggH;g ,rg-Bvr'iEl P:iFolDAF?YEgleB +(D:riD FFE 6X(! +iEa1'P?x tsH.+ 650\ a?8' =LJC)E APg3-tA4(D58ts 9d?LEI &q+ up)5(D(DoEF?a.o;FOad6-lE.u)od e.9v)g=- '6o- r't EtO.O ei5.oiJooq5 I ftoO* P4 r!f ,].(Da ='au)sg6 +:ioXo dUqg 6- r)i] +Re v, d. =' h' 30. t< Ft PHd@5U) NH ii. a)oHE (D a t1 F3.=S.o++H.gF t*Eg, HdHa 9Ptaq)2,H 'd 6'Lr O.O-r ,ry".oiHEHaf-F3{f s)+-L V,d(J !t(D L'h\r qF.pai I5'ProB N.1E ? Eg'e'e '+6FUdE7 ts o g3F u1 fEsE9 * FYb? Fr D)(D+ H'tsfiEo) iJ.i+H(D=a.6 r_t1s .DAJ5s 7"* E5p Ho o-E X' nl rr5 r_l !)AA;,()(n$g3.8o(D5 BE: d -. ;+ ut+ -{dts. rrC)A \-./ t^la(DE d11 €# (r, ,d LJoiDc) it-g8 30rB6 a F.(D5()HF)d,aEo9.4N ;i-s?: ii. (Itoai,7r a sBi '8 0 36BE gPE:E t'-*FH = eqHg* th !t El H- "ar;io188ts6'. E =a5'a H S&nE6 9)5 =9.'TEv'-gd g PY 5 H.-E a rdsH g 8.BE 6 B8,8 E Ol-4;JH-s'6'P-XTDi'H ase' =:'(D (a5Ep eL 9.fr+F+(9tsEo-6cdig *b*. i\i oi.+3. ooB6!'I g.gFnSs :no'5ts450r,o--tsr9Y5o)-oaS+ '96'8 dE d-(Do-oDL+)I' l-oo=I'V)CritsEE EB*(D o3'Brts g. El*Ft95 S18IBE8.4P )+ +LJo5(Ddts: d(D(D(Du)=cr(DOEEh+Pa (,9HtaoBlFt tl lrRrdd'IsBSniL d+ -)5 tsts u) * '!o Fru o -o N)5 zo (D d(tEt NJoo o\ tr & r- *ts a- !- iE l! 2.2. Advocacy State the numhr of policy/decision makers mobilized at each relevant level during the current year; the reason(s) for undertaking the advocacy and the outcome. Describe difficulties/constraints being faced and suggestions on how to improve advocacy. State level. 10 Policy makers were mobilizedat this level i.e. within the Ministry of healtb Finance, and Ministry for Local Government, to inform the leaders on the current status of the progamme especially as regards funding, as well as the need to ensure sustained yearly funding at both State and LGA level. The UNICEF representative visited the State in company of hvo members of the NOCP, but was unable to meet with most of the policy makers. The Director PHC was however met and the concern about the project, especially as regards funding, was expressed to her. She pledged to convey the message to the relevant administrators- The advocacy to the Ministry for local Government was to follow-up on the promise by LGA leaders during the stakeholders' meeting of December 2004, to give a mandate for central deduction of funds necessary for conduct of CDTI activities at that level. While the effort at State level yielded some result, same could not be said of the Ministry for local govemment. The difficulties being faced at both State and Local Government level is due to the current political environment where funds are hardly released for activities. The local govemment funds are alleged to be mostly withheld by the State government thereby frustrating conduct of activities. Therefore in spite of several efforts, little achievement was made because no mandate was given. lt is thercfore suggested that a high powered advocacy team comprising of WHO,.A,POC, UNICEF as well as other NOTF personnel be made to visit the oncoming newly elected State government in June or July 2007 with the aim of helping improve on the current situation LGA Level A total of 632 policy makers and traditional leaders were mobilized to solicit for both moral and financial support to the prograrnme. The situation at Borgu, Wushishi, and Bosso LGAs was given special consideration in view of low coverage as well poor compliance by both prograrnme implementers and communities. Several stakeholders' meetings were held with traditional leaders and the LGA policy makers in attendance for ensuring improvement during the next treatment round. t4 WHO/APOC, 24 November 2006 l* q- = Communitv level. Communities were mobilized for self monitoring and stakeholders' meetings in order to check/address problems of CDD attition, as well as poor heatment compliance, which is currently the problem in some LGAs. It would indeed be appropriate for APOC to sustain frrnding for conduct of such an activity in order to check the above threat 2.3. Mobilization, sensilization and health education of at risk communities Provide information on: - The use of media and/or other local systems to disseminate information - Mobilization and health education of communities including women and minorities - Response of target communities/villages - Accomplishments - Suggest ways to improve mobilization and sensitization of the target communities. A documentary was produced on Onchocerciasis control in Niger State, by the initiative of the National Television Authority, Minna network centre, free-of-charge, and aired both locally and nationally in several slots which lasted over five days and this helped to increase awareness on the CDTI. Demand is high for Mectizan and we are informed that acceptance of Mectizan enhanced acceptance of polio immunization in some communities which u,ere initially non compliant. Large numbers of posters and other IEC materials produced since year 2005, were distributed to affected communities through the LOCTs. A total of 1,331 villages were mobilized in 15 LGAs, especially in Mariga, Borgu, Bosso, Rijau, Mokwa and Katcha where new cofilmunities were added. The mobilization activities were conducted by the SOCT, LOCT and peripheral health care staff. Mobilization and health education efforts Lrave ensured good compliance in about 620/o olt of the 2l CDTI LGAs. There is however need for adequate release of frrnds at LGA level in order to ensure better supervision of activities by the LOCTs. l5 WHO/APOC, 24 November 2006 fD a- 1'E Community involvemenl W: Communities participation in the CDTI * - Only partial reports were received. N/A - Not Available. No reports received. Comment on: - Attendance of female members of the community at health education meetings 16 wHo/Apoc,24November2006 District/LGA Number of communitiesfuillages with community members as supervisors Number of CDDs and the communities involved Number of communitics /villages with female CDDs Total no. communitie s in the entire project area Br Number with community members as supenrisors Bs Percenta ge Bo= By' Br *100 Male CDDs B7 FemaIe CDDs Bg Total Bq B7+Bt Number of communities with female CDDs Bro Percentage Bu= Blo/84*100 Kontagora 72 72 100 ts2 152 0 0 Rijau 142 142 100 292 0 292 0 0 Magama 52 52 100 104 0 104 0 0 Mariga 271 270 100 s64 0 564 0 0 Mashegu + 102 N/A N/A 216 0 216 0 0 Agaie 205 205 100 427 0 427 0 0 Lapai 211 2rl 100 s96 596 0 0 Mokwa* 145 136 94 537 0 s37 0 0 Rafi 128 128 100 203 0 203 0 0 Wushishi 130 130 100 130 0 130 0 0 Borgu* 403 324 80 470 2 472 2 0.5 Lavun+ 92 8l 88 235 0 235 0 0 Shiroro 103 103 100 136 4 140 2 2 Gbako 62 62 100 96 0 96 0 0 Katcha* 166 145 87 257 0 257 0 0 Munya 140 140 r00 283 0 283 0 0 Bosso 154 154 100 218 0 218 0 0 Suleja t9 l9 100 60 0 60 0 0 Gurara 138 ll1 80 114 2 116 ) 1.4 Agwara* 65 48 74 130 0 130 0 0 Tafa 72 72 100 128 0 128 0 0 TOTAL 2,872 2,600 9r sr48 8 5,356 6 o.2 aire f,- - In general, how do you rate the participation of female membeni of the community meetings when CDTI issues are being discusses (attendance, participation in the discussion etc). - Incentives provided by communities for the CDDs - Attrition of CDDs. Is attrition a problem for the project? If yes, how is it addressed? - Other issues Attendance of female community members at community meetings constitutes about 50% of the total gathering in about 50% of the project area i.e. where purdah (i.e. seclusion of women indoor) is not the practice. Where purdatr is in practice the attendance is zero except where a separate meeting is held exclusively for the women. However, even where attendance is adequate, the participation of the women in discussion is passive, because culture inhibits them from being vocal in public. However, as earlier explained, when separate meetings are held for the sexes, the reverse is the case, and the kind of issues that are discussed are quite revealing. Such issues give indication as to community compliance with teatment, coverage, CDD performance, attitude of supervising FLHF staff, adequacy of Mectizan@, awareness on the programme, as well problems on payment of CDD incentives. More often, the scenario in over 50% of the project area i.e. Moslem dominated areas, is one where only the elderly women are permitted to participate and fully contribute to discussions at public meetings. The female elders are expected to debrief the other women in the community, at another separate gathering of women. The elderly women are often the TBAs in the community and they double as mobilizers, since they are the women group leaders. The issue of provision of incentives varies with different socio-political areas of the State. In areas where the commtrnity leadership is good, there is a system of communal contribution either in cash or in kind which is usually handed over to the CDDs at the end of distribution. Most communities contribute between US$0.1 to US$0.4 per household treated, with a result that CDD incentirzes could be as much as US$37. Other CDDs are assisted with farm work while other communities contribute foodstuff such as grains (millet, guinea com, rice), yams, fish and several others. Generally, all are supported with prayers. CDDs have often been elected into political posb, while others, because of their hard work, were offered government paid jobs by their LGA cotrncils. The incentives paid to CDDs during the period of reporting was barely quantified by the LOCT, however, the amount reported on from 5 LGAs was U.S.$1,025 in cash. However, in over 50o/o of the project area, especially where CDDs are selected along family lines, or at ward level, incentives are not paid as a rule. This is because the communities view the CDDs' role as one of the t7 WHO/APOC, 24 Novemb er 20O6 The usual responsibilities expected from a family member towards his kindred. Such CDDs are quite contented with this position, and appreciate the fact that their communities vest trust on them. The community leaders and CBOs also assist with mobilization and supervision of treatment. CDD attrition was a major problem this year however and this resulted in incomplete geographical coverage of some of the affected communities. Reporting was delayed as a result of which about 28% of community data were not received at the time of compilation of this report. Several CDDs dropped out because of lack of incentives especially in view of the fact that other members of the same communities benefited from participation in Polio eradication activities while they were not incorporated. Because of attrition, the current CDD to population ratio is l:340 in contrast to l:271 ofyear 2005. Meetings have been held with the community leaders with the aim of addressing such concems. The communities have been mobilized to either select distributors along family lines or if possible at ward level in order to overcome such unfortunate developments. They have also been advised to identifr a sustainable source of funding for long time treatment. 2.5. Capacity building - Describe the adequacy of available knowledgeable manpower at all levels. - Where frequent transfers of trained staff occur, State what the project is doing, or intends to do, to remedy the situation. (The most important issue to describe is what measures were taken to ensure adequate CDTI implementation where not enough knowledgeable manpower was available or if staffs are frequently transferred during the course of the campaign). Generally there is 65% knowledgeable manpower at State and LGA level, however in some LGAs where it is inadequate for facilitation/supervision of CDTI, school head teachers are trained to complement the efforts of the district health supervisors. This is typical of Borgu and Bosso LGAs. The school head teachers are residents of the communities and their inclusion complements the role of the health supervisors since there are extremely few PHC facilities within these LGAs. The Ministry of health has made efforts to discourage frequent transfer of staffthrough holding of meetings with the LGA/PHC directors as well as with the LGA policy makers, and Ministry for Local Government, however this has not yielded positive results since these transfers occurred even during the last quarter of year 2006. The directors themselves were transferred and this has greatly frusfated achieving meaningful impact especially concerning checking the negative auitude of some of the LOCT. {e ,l* l8 WHO/APOq 24 November 2O06 ir' Three of the 8 participating State staff (SOCT), were also transferred, therefore, the supervision schedule was reorganized to ensure that no LGA was neglected. Furthermore, new personnel would be identified and trained on the job in order fill up the gap created and to reduce the workload of the available staff. Frequent transfer is a common phenomenon in some LGAs like Bosso, Rafi, Gurara and Borgu, and this created a lot of problem with supervision, especially because such staff are replaced by newly employed ones who have no training on the prografilme. The project therefore intends to train all PHC staffwithin these LGAs as well as to institute CSM and SHM. Seminars will be held for final year students of the schools of health technology from where such personnel are produced in order to prepare them for supervision of CDTI wherever they are posted. Meetings have already been held with the LGA policy makers to address such problems with the hope that such transfers would be controlled. LOCTs were highly constrained in movement and the district supervisors were mainly vested with responsibility of overseeing implementation of CDTI activities within their locality. In view of cross border concerns with Benin republic, it is necessary to point out that although Borgu LGA has about 6lYo of its' staff participating in CDTI, most of these personnel are concentrated within the southern and south eastern axis, whereas the portion of that LGA that immediately borders Benin republic, i.e. Babanna district, located in the western portion has only 13 health facilities and 15 trained PHC staffi.e. despite its' large area and long distances of up to 20 or 30 kilometers between communities. It was in view of this critical situation and the need to ensure adequate supervision that school head teachers were trained and incorporated as supervisors since year 2004.It will indeed be necessary to sustain this tempo in order fill in such resource gaps, i.e. by retraining those on ground and training new ones. The funds for the special initiative from APOC will help to achieve some of these objectives. l9 WHO/APOC, 24 November 2006 tr to Xs o 9' od A'ro (, r-t oFt o li F' d tr or-t 0e d(A v, F A: ? o}({ D) t- O) ,cl pt oc tD o E'(t))(D oa It @ E 0) 0e D) F' F F' F o A) oaoEt Dt aa rl 6 F o I I I I B a o z rort o iq (!Aoa. F o lu O DB I I I I I I I I F a b .G\1, ,0^-+1.'3 AIIP .s t9 oo l+) u) t9 tJ 00 @ t)o\ N)o\ N\o 5N) 5 l.J (Jr5 o t')oo 5 o5o a .D =*z -<E E* r+ ;i3.-H{ rlroiiE (! (+) (,t @ o a 5 { tJ l..J 5 q\ LA (,r NJ o\ s(J) 6\o t^ - (j) (Jl (rto 5t) 5(j) a { -'l 5 (JJ o\{ o ;(,l N)(Jr o o UJ (fJ UJ (, o\ 5 5 o\ t, IJJ 2 a .(\\ ; o E s) o\ aOO '+ll I t)(-rl I I I OEoI z irDi 6-i(Dc AD+ Hq YrlHFc3' Grt o o I I 5 s I I 2(\' e sq o9,O trop6 -+ll D n S 5 -tUJ (n @ u)t)t) 5 t.J tJL,I\o NJoOs 5{6 o\{L {t.)o\ o\ o\u) 5o\N) @ {s N) N)o o\{ € Flrt o o z a ET(! Et o U Uo rt D E'(Do o N6 u) NJ6 u) o i\)(,r{ N) L'I{ tJth { \o o\ t..) -t)o 5o (,lr(, @o NJ(])(rr 5 o\ lJ) N) o\ s\ttJ u)o lJ)o tJ UJ t\)o UJ oo s \o tJ! u){ o\(, s lJ) (Jr\o o\ \o UJ u)(, 5 5 N) -l - o\ tJ o\ { o\ 5 oo @ Lrl o\s oo \o o\ o5 u) N) €\o N)\o N) o (,r tJ (rrt) 2(\' < b .(\+ o.o9 t -56at -+lt g (1 s IFlS. lR' l,-, lra S 0,4 tr sl\ sG' t\ G'(\ .S SH (\ (\ t..) Jr o "o\)5 z o o d(DI Noo o\ lr r?' tb t? .;t# I I II II I I I I I I I I I I I I I I I I I I I s .) (D (D o;t H oH F Fl F'+ O)' 0q{ A) ,.t F o EtpFt A) atr e.p EDo(t) t)o I I I I I I I I I I t s o .D t! t! N(, UI -It, 5 lJ) hJ6 5 (.) hJ UI 5\0 -t { l'.) I \o \J \o N.) t)5 N)5 Lrr N) (, N) tJs t)5 a t, o\ (r) e\ s .) 6 (D (D o\5 tJ UI I I I I 5 ; I I I I a s a o o (D (, € 5 I.J o\(, (j{(n tJ)€@ (Jrs{ (Jr(, (i(it.J @{ 5 tu o\\o Ut t UI o\ N) € o N6 (+) o o UJo o o\ o\ t) 5a o\o ; oo t'J a * zo{ Fo + H)r(D .+ 0) E,o A) s) A)d JD EFt o r(D (D oo E(D(A rd o p. i, 0q o6p) o!, :<? FO ,t(D U)tr-t(D p) (DB(D v) 5 a-o d o oo 5 ge NJ { tso Frtr op N)5 z o g (t oI Noo o\ ig {! t- t; I I I I Table 6: Type of training undertaken eir*in, boxei where speciftc training was carriecl oul during the reporting periocl) Trainees Type Of training CDDs Other Community members e.g Community supervisors Ilealth Workers (frontline health facilities) MOH staff or Other Political Leaders Others(specify) Program management How to conduct Health education ,/ ,/ ,/ Management of SAEs ,/ \/ CSM ,/ ,/ SHM ,/ ,/ Data collection ,/ \/ Data analysis ,/ \/ Report writing \/ Others (speci&) - Any other comments At State level - Training was done on the job, and 4 SOCT members were equipped with knowledge and skills to improve on their report writing skills. At LGA level - FLHF staffwere tained/retrained by the SOCT and LOCT. CDDs were trained/retrained by the FLHFS. 2.6. Treotments 2.6.1. Tre atment jigures - If the project is not achieving l00o/o geographical coverage and a minimum of 650/" therapeutic coverage or the coverage rate is fluctuating, state the reasons and the plans being made to remedY this.lL & fll : it, 22 WHO/APOC, 24 November 2003 I* Based on the data available at the time of submission of this report, the project acltreved 78%o therapeutic coverage, 93o/o geographical because reports for 272 communities out of the 2,872 targeted were not received. Late commencement of treatment as well as poor attitude of sorne LOCT to ensuring early compilation and submission of treatment reports are the responsible factors. The report for Mashegu LGA could not be incorporated here because the LOCT leader was unavailable and the other LOCT members could not assist. All effort made by me to obtain the reports proved abortive and this situation has become a recurring one, therefore there is the plan to reorganize that team and to ensure that a more coflrmitted one is put in place. The SOCT will also intensifr supervision of the activities in order to avoid such reoccurrence. The report for 79 new CDTI communities of Borgu LGA were also not received among others indicated on table 7, and are being awaited. However the LOCT are generally demoralized because they do not receive any moral or financial assistance from their leaders, therefore some of them resist collecting the drug from the SOCT and others collect but do not care to release it to the communities. The poor attitude of some supervising PHC staff had a negative effect on coverage because activities were not supervised in some areas, while some PHC staff did not even care to inform the communities on availability of Mectizan. This is particularly true of Borgu LGA. CDD attrition was a major concern because several communities could not replace those that dropped out early enough and even then these CDDs distributed the Mectizan only at their convenience i.e. after farming activities which greatly delayed reporting. Non motivation of the CDDs by communities coupled with their non involvement by the village heads in incentive giving activities like mass immunization of children greatly compounded the problem! Meetings were held with the policy makers of such LGAs and they promised to ensure better supervision of drug distribution through imposition of sanctions on defaulting staff. They also pledged to ensure release of funds for LOCT travel during supervision, as well for conduct of other CDTI activities. The need to integrate activities in PHC was again emphasized and the heads of health pledged to ensure that is done. Meetings were also held with the traditional leaders of defaulting communities, and they expressed concem that they were not earlier informed about such problems. They then pledged to ensure that all communities in their domain were always treated. Communities were also mobilized to select CDDs along family lines or at ward level in order to check the problem of attrition and low coverage. l t- 7 23 WHO/APOC, 24 November 20O6 Ir-lls'ls. IN l;,r l\) l\a (\ FaA Fr9) .+ * GtaN oA Gi ?1 v) * t F) F F' o Fs * odpxo a Ei oEt o -0, p * w o r_t oa * i U) (t) F E' ? o ,f{ t0 * rr s)r3pr oe At (D s) v) (D oa + ?A tgFt oq F: ?p 0c o, F' F rE: F' noE FO oa or-t !o -(J5a >6' 5o q\q\ o\N a(, \otJ 5O(, UJo N)€ s(, N) t'J(,r oIJ tJ{ (/rN) sl\) {tJ "H t$-f= *- 6'E IF: qr-a oI Bt !J (D o o) 0aoq so o\o\ o\tJ (r) \o tJ so(]) tJ)o tJoo 5L,I tJ N (,l oIQ t) -t (,l t.) 5N {tJ Ess?'s E(DB 5o 5(,l 6tJ ot, € (JJ tJ5 (,) N) oo t, o\ tJ t)o(,,r z t){ ()tJ 5tJ -IN $EtIU oo 6 -l a @ oo @o o \o(, o Oo z o a a o _o^(DLtocYE o\O Ai -Bg0a =.(.DC) D) E' *ll e Lrt\o { o\F{ \o 5o N o€ Lal(.) L,I oo(,J (,(,! "oo5 N)(Jr o o { o\\o(,T 6 o\ u) oo t'J t'J UJ o\ (, tJ Lrr\oU) -1oo{(J) o\ (Jt -I{ 5 NJ{ t.)5 N (,l -J L'T tJ(j N){ oo5{\o\o 9s Eag Eit o - =-t =.>=l.D) o"(Z.e =.O)HH 5 -E? Oa- FU o!tr o, op 5\o\o5 (,lF(J) o\s u)(j){ oo(J) 5(n o lr) a oo tJ o (,t)o(j) @A -J -pN){t) l'.J{@(^) UJ-Ioo o\ o\ (J) oo s oo 5 -l o\ € oo N) {{ -Jo\ tJ@ tJ UJ -I tJ UJ Egs =.E:Io=. 6 N) t))\o\o 5 N) "A o\\o t,(/) 'N.l s\o 55 "o\ oo{ l.J -l\o{ -1UJ\o\o o\P -Jo o\ -l u) -) o\ o\{\o o o\ "5 o\\o -lt) (,l 2, (, -l(,r ooF6(,(,| t.J{ tJ(, \t -No\(J1\o $Hi{ a\o o\o\ €u) €UJ \t6 o\\o *o\ @N) €{ € \ot) z, \o \otJ €(Jl 6o\ R-lVJGf =.9o\t o !, -& E(!tr U -1 -v --b- tto {t) so 5 o oo5lJr -l \o o o z 5\o (]) (n{ oI 4>7 Fst 5 ts" g E' (! (! Ol o tJ) -I( (,to\ oo \o oo(/r {5 o\ tjt N)t) -t9 tJa (r) @\o o\\o oo \o oo '5 \o N) z t= \](, o\ (,t o\\o \o(j) \o o\ &z9oE EE o o o o a o o o o o z o o o o ory aA >P rr, 6o4 a o o o o o o o o o z t- o o o Egfu$rHf N)5 o t= o _o N)5 zo (o 6(D ts Noos fa. 7''t' ir, Flr * H oH F -l A' S:' 0q{ o)H Pr * o Et r-t c, r/) .o gt EE o(r, IAo b.J 6 -lbJ -ItJ q\ (,l UJ6 \o r-^s i.) 6 -IhJ {tJ oLA (j)a \o t/rs bJ o\ { N) 5@ \o (/rs \o o {5 oao oo o € bJ \0 (Jl\) (,l o 5 -6(,,r t)(Jr -J(,) \o @ o .l u){ o\ -J\o(i oo UT bJ\o -t (,I 5 oo UJ @ 5I{ o\ o\ J'J 5s (,FotJ o\ (Jr{ oo(j 5h) -t € -I 5{ N) oo o\ tJ o\@ UJ Lar ;J o\\o\o (, u) 5 (n tj -{ (i\o -t6 0,oN) 5LA {@ 6u) oa5 b.) o\ UI Llt(rr o 5os -i.J-Io tJ) UJ\o a 5(, UI 6 o\\o o\ -to\ oo 5\o (, 5 (Jl\oo\ o o o a a o o o o o o z+ * rtt r.l oFl o) 'da(D\oEo\+ -5' c)o (D DD 0ao r_t o) (D o(D a oaFt ODaiJ o\ =-vb tD o o oFl t0 0a(D D) o il -lo o ^Oro{O\(D .vH c, oa(D n A)4(D E'q L S(/) -l -tAO O E!Dlllln$-r n il(DSfi)o.o(DFr?ts s E'B)d;.E E' &(DF{O)8e Hil5=!-2 eatsH!.flb5e-D)dxrD I.:oH-lloo!? -!i;' Efi€ 'i )v; q g BIE0 I ?' ;laI a i' EIEE o oa Elo = q =' ct l'-) g) !-r F.t lOrE. E qE BE EtIIsg E #l:E+ g Hl8Hg6'Pea H &A (U aEH i EaFD'rl(DGEPfA -o+ox : :<-; i cl.?H 1. qERH = ?Alr"dEIH € T ='da=.ai (,Lr/ E. HBii 6 e#+EF)59lo'u)3H ? sJv- d)FLI +H' ts *FB ,5(DBi'E "i€ =.E._<6 5 gHB' E E.qd fl $ odE'= 'o o- ,/.Ft A) L) €.{;\i(DFH. t9Eg '+) Itvod fdP Ft €. oo t9(,l € o F! o _o t.Js zo t! doH Noo o\ z2,ooo5}E; :IOFJ =x3.F9, g' hD6<,! i- .,3,9 exou)9.,5so.(D Ft(D o 9. oP p) A4lz.olc slH ElqEls D, lcl1L looloElIO H ltD i.tE rlBEIA =lxJIf-D lHr,l-Al5 j o r_l I(D 5 o-o o oo Ht5 o U){ Po EFtg. (D o D]Fl(D FD 412.o lc' Et3EHE l''rEloe l,+)t1loF,r lO olE tsl=fiE > lia €R-ri l<(Dl=? lEiaftiJ t(D F11 EIH 6'tts e 18- ilx 5l- Elts 3.o(, F)(A a(D Ei (Do d Er? ='3 (D r3 Fl €.(D t1 o)Hop) >lz BIE Etf -r lE;-, lodi lr+,p lct3l.DBlo(D lEl eh' 8lr slE <lxol-loIO rr" + a- ti il 2.6,2 What are the causes of absenteeism? Absenteeism is due to either poor cornmunity mobilization for treatment or selection of inappropriate treatment time, whereby some community members would have traveled out of home either for farming and other vocations. 2.6.3 What are lhe reasonslor refusols? Refusal is often due to fear of reaction to the drug or suspicion that the drug is for birth control especially in inadequately mobilized communities. 2.6.4 BrieJly describe oll known and veriJied serious adverse events (SAEs) that occurued during the reporting periocl and provide (in table 8) the required informotion when avoiloble. In case the project did not have any cases of serious adverse events (SAE) during this reporting period, please tick in the box. I No SAE case to repoft ,/ ari r{ n f& 26 WHO/APOC, 24 November 20O4 v) * 0q(D (/) (D X 9<J. E.da=5'g(D ot fi 6Y FN5r o@@HE EXR E(D5 6-*o.B (a E o o ?sq3!dFSilB& H.d66@+ D' E)!'N l-lP a iLla €53o,F.- o Eb+gUhOiaA) =5 5 (D,9 = 6'o -ss*' 3 3 :'iD(D ='o - alo 9 9,, P(D @ 0 ,d^ dE568Ei;'o oFt 9.a F' EE 6 @c)iDgBs 867 I E'> e a5 AEE lslS. IN loo 6 Ca(\ la, ,S 4,(\ S a4 F (\ :r G(\(\ Sr s K ttj s S(\(t (\ te =G I ,a\G *(A (D Fl g) d5 doFl o F+) (D E o: (D N){ € o ttr o -o t.J5 zo o EC(!Ft N)oo5 S1' I fa, Ef' ? t- Noo o\ N)oo(a Noo5 N)oo()) NootJ Noo b.)ooo \o\o\o \o\o 6 \o\o -l F' F N6 -IN tJ{5lJt N)(rt(, N t\)(, oo UJ {\o()) o\5\o Lrr\o N)€u) @u) t9 I = =9 *ggEP s! *ql tt, o o oa\. B 0e(D a N @{t\) N){s(n -t.)(,(, tJ 1..) 5\o (..ro o\ (JJ oo L,I {(.) O (,l 6{ \o6t, N) 9 ioa. eiQ*3=i-dir ot, l!H "t,6oo tJ 5 € t-.)(,r tj N) N) t.Jo UJ {{ o\ o\(J) 5 (,l N) t'J 5os o\{t) UJo O BOFE -T \o @@ @(,l \o\o \o\o 5(,l u) Lar\] l.)t, at9) E*rsfr E5 \o @e a oo 00 \) { o\6 @0|o o ^? >rc(D I "#o(DEfr talp t 6 N) b\oo o\(JJ NJ o{\o (Jl5 UJ \o o\o o\@\t \o o\ "o tJF o\o5 \o o\ Jo(})(a \o L,I N) \otJ \o(-llo(, \o 5 UJ a \oo o rE =o "88 E-,F',E *g*3.e !A , ,i: FU oIE E p o h,) -l{ U){ \o UJ o\ t.)\o o\ 65 5{(,{N) 6 o\{ oo oo -Ft\) L,I5 (j)(Jl o\ \o(, t) 56 tJl 5t,5 o N) o\\o N) o\ E$r FT{ '5 N{ €{o tJ(n tJ 6oo 'N) 5 l.J{t) o\ \otJ o o\\o \)\o o\ @ o\(n {6 _@ \o(J) UJ 5 "s oo5 tJ\o oo o l.J ooI5\o6 N.){I@ u) NJ z6E EACE Fg rata o FT6 {6 {{ 6a o\(, {6 {\o (,) -t UJ UJN tr) 8H aZ (DS9;'Evtg EUQ(DGE + F' R_ t! E,a9r. ll e \o u) \o \oo\ \oo\ \ot) \o()) 6@ o\tJ o\o\ o(J) ^€ oSE H 'do lq6 rrr [!{ia 'j ll \o u) \o \oo\ { -J * o\ (/r\o N)5 t)UJ N)N) N) Fl o o o ort D 0q os FIS hl\o Htrxo.\\:!.\'-t"da.E $q *s$ AvtSl -s:ta N.s33REtSsi G\R.HG EEGls .E. lg s(! lo ,'a3lL\IG- SPl\- lissi t$tiOEU lBd\tfg .q 'SL-r i. .Il* iEG\.ar\Sz $E+d=.d' \ =F*.s -^q =).i.sdsG relS,"5s + =rrs:. E .=.E SE =a\B\E'* Bi. *ExS =' (! Et =t -i. -ta\ .a$ (! \-rt te oeo o P.tt F o E'oi-, N)6 * o IUo -o f.Js zo (D croF! b.Jooo\ Ir r: 5t F til \/ 2.7. Ordering, storoge and delivery of ivermectin Mectizan@ ordered/applied for by - @lease tickthe appropriate answer) MOH wHotr UNICEF f] NGDO N Other (please speciff) Mectizan@ delivered by - (please tick the appropriate answer) MOHtr WHON UNICEF' NGDO tr Other (please speciff) Please describe how Mectizan@ is ordered and how it gets to the communities The Federal Ministry of HealthA.{OCP office orders for drugs while UNICEF takes responsibility for its'clearance on arrival at the Nigerian port. It is also responsible for its' storage prior to collection. The quantity of Mectizan@ required by the project is calculated based on 84Yo of the total census population and that figure is multiplied by 3 to obtain the accurate drug requirement for the project. Approval to collect drugs is obtained from the NOCP zonal offrce at Kaduna" and the State collects its drug allocation from NOCP National office at the Federal Ministry of Health. After collection, release is made accordingly to the LGAs. LOCTs release drugs to district health supervisors, while the communities collect their requirement from the district health facility within their locality or from other agreed collection points. In the case of very distant communities, drugs are deposited at the nearest frontline health post/facility for convenience of collection. It is pertinent to note that all drug requirements are determined through the same calculation procedure as employed for drug requisition by the State. The delivery process is as follows:- DISTRICT/WARD HEADS COMMUNITYtE t-i tr iT' '} \/ NOCP HEADOUARTERS FLHFs COMMUNITY SOCT LOCTs DHS COMMANITY 29 WHO/APOC, 24 November ZOM W.l!!: Mectizan@ Inventory - Only partial reports were received - No reports were received - Not yet Available. * + N/A B [-!r L r How are the remaining ivermectin tablets collected and where are they kept? - Remaining Ivermectin tablets are collected from the communities through the FLHFs and submitted to the LGA Oncho. coordinators through the district PHC supervisors. The LGA coordinators submit all remaining tablets to the State coordinator and such drugs are kept at the project office for the next distibution round i.e. if the explry date is not close. However, if StatelDistricU LGA Number of Mectizan' tablets Requested Received Used Lost Wasted Erpired Remaining Kontagora 238,000 238,000 173,103 136 0 0 64,761 Rijau 386,000 386,000 250,667 1,715 0 0 l33,6lg Magama 233,000 233,000 215,760 3,886 0 0 13,354 Mariga 329,075 329,075 320,306 I46 I 0 0 7 )308 Mashegu+ 143,000 143,000 N/A N/A N/A N/A 143,000 Agaie 193,000 193,000 180,075 I ,83 1 0 0 12,093 Lapai 337,000 337,000 310,979 399 0 0 25,622 Mokwa 226,976 226,976 224,026 1,587 0 0 1,363 Rafi 213,000 213,000 200,819 702 0 0 11,479 Wushishi 164,000 164,000 l5l,4l9 49 0 0 12,532 Borgu* 480,000 480,000 363,285 208 0 0 116,507 Lavun* 89,000 89,000 74,604 38 0 0 14,358 Shiroro 134,500 134,500 lll,223 1,406 0 0 21,877 Gbako 90,000 90,000 81,930 t2 0 0 8,058 Katcha* 164,000 164,000 115,860 1,619 0 0 46,521 Munya 155,000 155,000 145,285 55 0 0 9,660 Bosso 177,000 177,000 157,547 455 0 0 18,998 Suleja 140,000 140,000 130,144 70 0 0 9,786 Gurara 175,000 175,000 156,784 1,710 0 0 16,506 Agwara* ll 4,000 I14,000 74,143 83 0 0 39,774 Tafa lll,612 lll ,6 1 2 lrl,4l7 159 0 0 36 TOTAL 4293,163 4,293,163 3,549,376 17,581 0 0 727,206 30 WHO/APOC, 24 November 2006 U. they are required for urgent utilization by other projects or are almost expired, they are tansferred to the NOCP Zone C, officer for further action. The remaining tablets are retrieved from the LGAs during submission of treatrnent summaries and kept at State level for subsequent utilization. List and briefly describe the activities under ivermectin delivery that are being carried out by health care perconnel in the project area. Healthcare personnel hold regular meetings with communities and their leaders to ensure effective conduct of CDTI activities. They sensitize and mobilize the communities (through health education) for ownership of CDTI. They train the CDDs, and supervise yearly Ivermectin distribution. They supervise distribution in order to ensure that communities receive drugs, the drugs are properly managed, and that there is good treatment compliance, as well as ensuring that CDDs keep accurate treafrnent records. They provide feedback on Ivermectin distribution to the district health supervisors, LOCT, SOCT and all other partners. Health care personnel facilitate conduct of CSM and SHM through training and supervision-. Any other comments Low morale, caused by poor funding of activities by government, is a major reason for poor attitude to work which is exhibited by some health care personnel. Any other comments 2.8. Community self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project trea? If so, When? In years 2002, 2003, 2004. t& j I rF 3l WHO/APOC, 24 November 2006 aTable IL: Community self-monitoring ond Stakeholders Meeting Describe how the results of the community self- monitoring and stakeholders meetings have affected project implementation or how they would be utilized during the next treatment cycle. Pilot CSM and SHMs conducted in these LGAs revealed that some CDDs were discontented about not being paid incentives by their communities, while members of communities who had never served as CDDs were incorporated into programmes like polio-eradication and guinea worm surveillance. This informed the decision to work towards formulating a PHC directive such that, wherever committed CDDs were present they were also integrated into other PHC ir. t.-- l- '{ * DistricU LGA Total # of communities/villages in the entire project area No of Communities that carried out self monitorine (CSM) No of Communities that conducted stakeholders meeting (sHI\O Kontagora 72 18 t8 Rijau 142 24 36 Magama 52 t7 l4 Mariga 270 34 46 Mashegu N/A N/A N/A Agaie 205 34 38 Lapai 2tt 26 36 Mokwa 136 N/A 0 Rafi 128 18 0 Wushishi 130 20 0 Borgu* 324 29 38 Lavun* 8l N/A N/A Shiroro 103 t7 52 Gbako 62 l6 2l Katcha* 145 24 18 Munya r40 23 JZ Bosso 154 20 t2 Suleja t9 6 8 Gurara 1ll l8 t4 Agwara* 48 N/A N/A Tafa 72 l8 28 TOTAL 2,600 362 4tt 32 WHO/APOC, 24 November 2006 progfilmmes, especially where financial or material rewards would be derived, in order to encourage CDD retention. This action is already being applied in at least 5 LGAs and the benefits are obvious since the treatment coverage is quite good and there is very good CDD retention. These LGAs are Magam4 Kontagora, Agaie, Lapai and Gbako. Information from some SHMs revealed that the communities had preference of a treatnent period, which did not conform with the period when drugs were usually released to them, and this information helped to plan for Mectizan delivery at preferred treatment periods. In the Kambari settlements (camps) there is distrust in a CDD from the same cofitmunity administering drugs to its' members, so the CDD from the main village is relied upon to visit the neighboring wards (settlements) to administer drugs and this causes a lot of delay in completion of treatment and reporting. These CDDs have to travel over distances of sometimes 20 to 30 kilometers apart and require assistance with bicycles from APOC. 2.9. Supervision 2.9.l.Provide aflow chort of supervision hierarchy. 2.9.2. What were the main issues identiJied during supervision? The main issues identified include :- (l)Drugs were being allowed to expire. (2) There was no documentation on treatment of some communities (especially those that are far and hard to reach) for example, those at the border with Benin republic. a 3 i,. 6r l NOCP SOCT LOCT DS CDDsFLHF CSMs, Communilies,Villoge heods 33 WHO/APOC, 24 November 2006 (3) Geographical coverage was low and therapeutic coverage for some LGAs like Borgrr, Bosso and Wushishi were far below 65%. Drugs released to some LGAs were also not adequately accounted for. (5) Late submission of treatment reports to the State. (6) Inconsistency in Mectizan inventory records at different levels / Poor census 2.9.3. Was a supervision chechlist used? Yes. One was developed by the SOCT to address specific issues of concern while the standard checklist was utilized by the combined team of NOCP and IINICEF. 2.9.4. What were the outcomes at each level of CDTI implementution supervision? State level (l) The outcome of NOCP/UNICEF supervision indicated that there is need for adequate supervision of the LOCT by the SOCT since drugs released for 6 months had not been distributed in some LGAs, while year 2005 treafnent report indicated that some LGAs had very low coverage. (2) Absence of counterpart funds at LGA level was having a severe effect on conduct of CDTI activities. LGA level (l) High CDD athition/Some CDDs were not adequately trained and data entry was poorly done- Height/dosage calibration was also inaccurate. In one of the communities, drugs were received by the CDD, but not distributed. (3) Highly demoralized LOCT. There was hardly any release of counterpart funds at the LGA level and the health statr (LOCT) did not supervise the FLHF staff in most of the LGAs. Records were poorly kept at all levels and there was no duplication of those forwarded to higher levels. (4) There was frequent trans r of trained health staff leading to lack of supervision of sorne communities. (5) The directors PHC were not giving the necessary moral support to the LGA coordinators. 34 WHO/APOC, 24 Novernber 2006 tL {J E. * TI Communitv level (l) Treatment fatigue was observed to be the problem with many of the communities. There was a feeling of good health and the communities no longer had the urge to comply with treatment. (2)The health staff were not adequately communicating with the traditional leaders, therefore the leaders were not aware of release of Mectizan to the CDDs. 3) Mectizan was not released to the communities by the FLHF staffand when they requested they were informed that there were no drugs because the programme had come to an end. (a) Opposing political parties were exploiting the issue of payment of incentives to CDDS as a tool against the incumbent government, by insisting that the payment should be done by government rather than the people since healthcare is a social service that is their right. 2.9.5. llosfeedback given to the person or groups supervised? Yes, feedback was given at all levels. 2.9.6. How was thefeedback used to improve the overall performance of the project? (1) Reminders were written to both the State Ministry of Finance and the Ministry of Local Government in request of release of counterpart funds. Advocacy visits were also made to both Ministries to sensitize the leaders on need to release funds. LGA policy makers were sensitized on the urgent need to release fimds to the LOCT, and pledges were made to support with frrnds- That promise was not actualized in most LGAs but is still viable and could be redeemed. Meetings were also held with traditional leaders in Wushishi, Borgu, Bosso and Gurara amorrg several other LGAs and pledges were made for improvement. (2) The State Ministry of Health released the sum of U.S.$15,873 for HSAM, supervision, as well as for retrieval of outstanding treatment reports and drug balances that were not submitted. (3) Meetings were held with the LGA authorities to inform them on the poor attitude of sorne health workers, and action was taken to ensure that drugs were immediately released to the benefiting communities and treatrrent corlmenced imnrediately. This was particularly so for Bosso,Borgq Wushishi,Mashegq Mokwa,Agwar4 Lapai, and Agaie LGAs. 35 WHO/APOC, 24 November 2OO6 o(4) In order to ensure l00o/o geographic and at least 84% therapeutic coverage of communities, the SOCT compiled a comprehensive list of endernic communities and their projected population and released Mectizan accordingly to the LGAS. This effort also helped to control wastage. (5) Adequate capacrty was provided (for supervision of CDDs) through training and retraining of health staff and other community supervisors like teachers (in Borgu LGA) where long distance between communities makes supervision very difficult. (6)The SOCT supported the LOCT to mobilize the communities for better compliance with CDTI objectives and especially the need to sustain yearly treatment through both moral and financial support to the CDDs. (7) Communities were mobilized to select new CDDs i.e- where attrition had affected distribution and all were trained, by the FLHFs and LOCT and treatment followed immediately even though some as late as in December. (8) Communities that had never been treated were mobilized for participation and treatnent is ongoing. There is promise of 100% geographical and 84% therapeutic coverage in year 2007. l, : a fIIg iE 36 WHO/APOC, 24 November 2006 *L f- & IF ,I jI SECTION 3: Support to CDTI 3.1. Equipment Table 12: Status of equipment *Condition of the equipment (F:Functional, CNFR:Currently non-functional but repairable, WO:Written off). How does the project intend to maintain and replace existing equipment and other materials? This will be done tluough the normal government system, i.e through the vehicle maintenance pool. Furthermore, the project intends to intensifr request for monthly standing imprest (running cost) from the State approved budget line for recurrent expenditure which if provided, would serve .rs a source of firnds for equipment maintenance as well as for maintenance of other iterns. The budget line for overhead i.e. State counterpart fund would also be intensely exploited for ensuring sustained funding of project activities by government. Even though funding at LGA level is currently very poor, there will be sustained mobilization of the relevant authorities for the necessary fund release, the LGA coordinators have been responsible for maintenance of project motorcycles attached to them and will continue since this DISTRICT/ LGA NGDO OthersAPOC MOH No. Condition No. Condition No. Condition No. ConditionType of equipment Source No. Condition I wo I wol. Vehicle 1 F t6 wo2. Motor cycle(s) 22 l0F 6CNFR 6WO 2 lwo 1F3. Computer(s) 2 lwolF4. Printe(s) I CNFR5. Photocopier (s) 1 F6. Fax Machine(s) 7. Others a)Megaphones 10 F b)Writine board I F I Fc)Overhead projector 1 FVideo player 50 woBicycles 65 20wo T.V. set I F Manual typwriter 2 F FIn-focus projector 1 I woUPS IIIII IIIII II II I II 37 WHO/APOC, 24 November 2O06 it is the usuat practice over here- LGA administrators will also be encouraged to purchase motorcycles and bicycles for the programme i.e where ever the need arises. Furthermore, efforts will be made to ensure integration of the CDTI with viable projects like HIV/AIDS control, NPI, malaria control etc. so that there would be central maintenance of all participating PHC vehicles. APOC management has also been requested to replace some capital equipment before its'final disengagement. 38 WHO/APOC, 24 November 2006 ls$ ISHlh; E ={.rs'tT8t* f:SSI+s'Ya\,S =.\ss ,,GsEi$Eille(\! :r 'i. .Y, hESq!Sr= si.H. E' s.(\ G\< Gtr; GqtaFSS il :h \)g Fi oFl F -l> =ti8 E o o o IJ 5t oa FB>zB6 oH x\ia 2? -iO ,Hgo F<oo >E a< $\J(D*. s< Eq \oO -I N6 \o u)o u) o5 NFooo o o o t\JN{No 2EdOd Eo*iF Ftr (D tr S oo tt o\(, oooo 6 5(, { otJ(]) 9o tr) 6 N) N) -JN(A AEOH EFAS a!- hJ5 -Itroo o "9{oo (,t -F@oo N)5 o o 5\o o o eEsE o oD b.l o (I5\o (,I 5(, -o oo N5o I @ o\ -t o ergOFi EFA9 a!- \oo 5 hJo o\(,r ooo IQ5 o o I o(, -J 5q) oo eEaE a (D E(, oe e6 \o o\ t, o 5 o\ 6 [t)(, 6 -l.N @{ 2oEOFld Fegr6> (DF \oo 5bJo o\tJ N)o z (/) UJ( Ns oo z 5 tj)o OEEOJ EE*E (! !o 5 ooo ,t3\o6 t6Ut -Jo o NJj-r u)5 o\ {os o 2EOlEFA9 (!ts o.L \o € Ul o\(, (j) (,l o l..J N NJ o\ \t N) (, o\ 6 OEEOI eguE .D lg rrt bJ E{(n UJ -t(, (,(, o -(D ONuJo.o"F 9; ^|io\lr*5rEs tJ NJ t.J uiE eEFiH A E - = A H'"^5>E K j-l{{ t.J 2NO-1A9E Q aD- € o\ Ur 5 "(r, \o -l o z tJ(,) "N) 6 o\ N.J t.J N) b,.Jt\) oEgOFl EEEE b<go,E!- 'rQor il!i *E6s UI (, t,o\o o -c) (D^H -9 ah'i-Fi 106 -Ib3 x E'.'!o uJ5g9,Ag o z 8c&ta (, t- o o s6 2FO-) EFAS (D- rrt6 bJ -lI.J c N6lJr 5i., o z t,\o o\6 N J},6o\o OEEOFI CEAE a<(r, (! t0!- ,rQ-t Ip *EiE96 (,\o O ur t,() HgFE $98 "F'i - Eo o\ i.) N)N z O^(/r5 N-tir.6eo o L'I "oo{(,) 2EOH EFAS (Di-4\ ())\o o ru o _o N)5 zo g d(D Noos iL Tr :1IT rr;l $ (2) If there are problems with release of counterpart funds, how were they addressed? While the State released funds, there were indeed severe problems with release of counterpart funds at LGA level. All effort made to ensure release at LGA level was futile. - Additional comments It is recommended that advocacy visit be maa.e to the newly elected government between June and July 2007 by a high powered team of APOC, UNICEF and NOCP to solicit for bulk release of funds, possibly for 4 years duration. 3.3. Otherforms of community support (3) Describe (indicate forrns of in-kind contributions of communities if any) In-kind conkibutions by communities include assistance with farm work, prayers, supervision by village heads and CBOs, support with community mobilization, giving of food stuff to CDDs, provision of transport or transport fare to collect Mectizan@ from agreed points, nomination of CDDs into politically elected posts such as local councillors or LGA council chaimren, employment into government paid jobs, and recommendation for inclusion of CDDs for other incentive giving social services like polio eradication and guinea worrn surveillance. 3.4. Expenditure per activity (4) Indicate in table 14, the amount erpended during the reporting period for each activity listed. Write the amount expended in US dollars using the current United Nations exchange rate to local currency. Indicate erchange rate used here US$1.00 to #126. Tsble 14: Indicate how much the project spentfor each activity listed below during the reporting period s tr tt- it, ,t Activity Expenditure ($ us) Source(s) of funding Drug delivery from NOTF HQ area to certral collection point of community 2,000 Gov't Mobilization and health education of communities 5,000 Gov't/Unicef Training of CDDs 6,000 Gov't/Unicef Training of health staff at all levels 11,000 Gov't/APOCAJnicef Supervising CDDs and distribution 4,500 Gov't/APOCAJnicef Internal monitoring of CDTI activities ? Gov't/Unicef Advocacy visits to health and political authorities 6,000 Gov'UAPOCAJnicef IEC materials Summary (reporting) forms for treatment 40 WHO/APOC, 24 November 2004 Vehicles/ Motorcycles/ bicycles maintenance 1,587 Gov't Office Equipment (e.g computers, printers etc) 100 Gov't Others (Travel to meetings) 2,500 Gov't/Unicef TOTAL 38,687 Total number of persons treated 1,427,870 (5) Any comments or *planations? The support for field activities from UNICEF was for focused attention to Borgu LGA in view of consistent low coverage and the need to address cross border concems with Benin republic. This was an outcome of the monitoring visit by both UNICEF and NOCP to the State in October. SECTION 4: Sustainability of CDTI 4.1. Internal; indepenelent participatory monitoring; Evaluation 4.1.1 Vl/as Monitoring/evaluation cunied out during the reporting periocl? (tick any oJ the following which are applicable) _Year I Participatory Independent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation lnternal Monitoring by NOTF Other Evaluation by other partners 4.1.2. What were the recommendations? The recommendation of the intemal monitoring by the NOTF was that:- (l) The LOCTs should be constantly supervised. (2) More CDDs should be selected in the larger communities in accordance with CDTI guidelines. I(3) Communities should be better supervised in order to ensure good &eatnent compliance. (4) Census up date should be completed in parts of the project where it had not been done. (5) The State and LGAs should be adequately frrnded for sustainability. ,/ lL {Tat Ir t 4l WHO/APOC, 24 November 2006 4.1.3. How have they been implemented? (1) Monitoring and supervision is being intensified to ensure compliance with CDTI objectives. There is plan to develop and produce integrated checklists for use by the PHC department in order to promote the required integration. (2) The State PHC department holds regular meetings with policy makers and informs them of developments. The LGAiPHC directors have been sensitized to ensure feedback on conduct of CDTI activities through holding of regular review meetings together with the district and FLHF staff. Problems should be identified at all levels and successes commended. (3) The State and LGA policy makers will continuosly be mobilized for release of counterpart funds. (4) Communities are being mobilized for adequate support to CDDs and would continue to be, in order to ensure good retention as well as selection of more CDDs at ward level as well as along family lines. 4.2. Sustainability of projects: plan ond set targets (mandatory ot Year 3) Was the project evaluated during the reporting period? No. Was a sustainabiliry plan written? Yes. When was the sustainability plan submitted? July 2005. What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 1,2.l.Planning at all relevont levels This will be done at all levels as an integrated PHC plan with clear objectives towards sustaining the strengths, improving on the weaknesses and taking advantage of opportunities presented through implementation of an integrated action plan. Integrated planning will be done annually within the PHC departments at State, and LGA level as reflected in the post-APOC/CDTI plans. Plans and budgets are already available for year 2007 activities. 4.2.2.Funds Government would be aggressively mobilized to release counterpart funds based on the activities on the sustainability plans. A realistic budget is already available at State level and this has received approval of the State government. The LGA budgets are also ready and awaiting release of f,rnds. SHMs will be held at all levels, and the Ministry for local govemment will be continuously 42 WHO/APOC, 24 November 2OO6 .L IF4: IL pressurized to ensure central deduction of flrnds for Oncho. activities in accordance with the resolution made at the State level stakeholders' meeting held in December 2004. Unfortunately efforts so far made have not yielded much benefit. At State level, high level advocacy visits will be made to the Ministry of finance as recommended by the evaluation team. Moves will be made to obtain release of monthly standing imprest as was the past practice, as this will assist the project to carry out minimal repair/maintenance of project vehicles and equipment as well as for general running of office. 4.2.3 Tronsport (replacement and maintenance) This will be done centrally in the MOH i.e. if counterpart funds are not available. The LGA project motorcycles will be repaired and maintained with their own counterpart funds. LGA administrators will be encouraged to purchase motorcycles and bicycles for the programme whenever necessary- At State level, efforts will be made to ensure full integration of CDTI into active projects like AIDS control, NPI, malaria control etc. so that there would be central maintenance of all participating PHC vehicles i.e including the CDTI project vehicle. APOC manager.nent will however be requested to replace some capital equipment. 4.2,4. Other resources UNICEF has renewed its' commitnent to the project through appointment of a new schedule officer Govemment along with other NGOs would have to sustain support in the absence of additional external funding. Because of the current situation at LGA level, there is a serious funding gap but it is hoped that other sources would be identified that will help to ameliorate the constraints being experienced i.e. pending the arrival of a new government that might satisfy the hope for financial release by govemment at all levels. 4.2.5.7o what extent has the plan been implemented The plan was written in year 2005 and its' full implementation is expected to be by end of Decernber 2008 since it came into effect only in the year under review. Most activities especially at LGA level were conducted in an integrated marurer taking advantage of opportunity provided by the Polio eradication pro grarnme. 4.3. Integration Outline the extent of intcgration of CDTI into the PHC structure and the plansfor complete integrotion: ry * 43 WHO/APOC, 24 November 2006 Planning and budgeting is done in an integrated manner and the SOCT members have other schedules (in PHC), which enables them to integrate CDTI activities with others. Integration of vitamin A distribution was initially proposed by the project, but because UNICEF had already integrated it with the intensified polio immunization campaign, it was not realized. Vitamin A is also a part of the on going routine immunization package. Polio and measles eradication activities are the current atEactions, and moves are being made to hain CDDs for integrated disease control as a part of the routine CDD training/retraining progmmme. A workshop has been held and laminated photographs have been provided by WHO for distribution to the CDDs. The special initiative from APOC will provide opportunity for orientation of the CDDs. While deliberate efforts are being made to ensure complete integration of activities at State level i.e starting from planning to joint supervision, it is very strong at LGA level, because all healthcare staff at that level are given schedules that compel them to participate in campaigns such as rnass immunization, disease surveillance, malaria control and several other services, because these personnel are also in charge of the health facilities within the project area. 4.3.1. Ivermectin clelivery mechonisms The Ivermectin for LGAs when not collected on schedule, is distributed from the State through the LGANPI managers when they come monthly to collect vaccines for immunization or through other personnel when they come in for other PHC activities. - Ivermectin meant for communities is delivered through already established channels like M&E offrcers' outing, or collection/delivery of NPI vaccines to districts and communities. The M& E officers are members of the LOCT, and their position provides opportunity for visiting the district health facilities on a monthly basis i.e. while out on AFP surveillance. 4.3.2. Troining This activity is yet to be frrlly integrated, however several SOCT do participate in the NPI campaigns and they utilize these opportunities to support targeted training on CDTI. Training will however be integrated with other add-on activities such as primary eye care outreach prograrnmes and malaria control. Training is proposed for PHC managers and NGOs at State and LGA level to empower them for better collaboration and networking as well as for joint supervision and monitoring. The proposed integrated training of CDDs for integrated disease surveillance has already been mentioned above - 44 WHO/APOC, 24 November 2006 b Ir$IL t 4.3.3. Joint supervision and monitoring with other programs During the year under report, most of the SOCT and LOCT participated in PHC campaigns like vitamin A distribution, malaria control, polio eradication etc, at State and LGA level, therefore supervision of CDTI was integrated with such activities. Joint supervision and monitoring with other PHC programmes is the current approach and these activities are already reflected in the 3-year CDTI sustainability plans submitted. Integrated supervision checklists will also be developed for use. 4.3.4. Release offundsfor proiect activities Already there are approved PHC budgets with allocation for Oncho control for the current and subsequent years. Release of funds will be effected through continuos strong advocacy meetings with policy makers and traditional leaders. Efforts will be made to ensure that Oncho. budgets are continuously integrated within existing PHC budgets in order to effect release of funds. 4.3.5. Is CDTI included in the PHC buclget? Yes. 4.3.6. Descrihe other health progrommes that are using the CDTI structure ond how this was achieved. lYhat have been the achievements? The WHO coordinated routine immunization progftIrnme is making effort to utilize a slightly modified CDTI structure, for ensuring adequate service delivery at community level. Traditional leaders are now involved in routine immunization activities, and health management teams are being instituted at ward and community level to ensure self-monitoring. 4.3.7. Dncribe othen rsszes considered in the integration of CDTI. Other issues considered are that of conducting several more CDTI tasks at a time while out in the field for PHC activities. There is a proposal to involve CDDs with all community based disease control prograrnmes like polio eradication, community mobilization for HIV/AIDs control, home treatment of malaria, as well as for distribution of insecticide treated bed nets. A major issue of concern with disease control is the evident compartmentalization which is exhibited strongly right from the top hierarchy of healthcare delivery. What often obtains is that different progfitmmes engage separate personnel at community level instead of the available CDDs for the various activities, especially where incentives are involved without taking cognizance of the available CDTI structure. In order therefore, for CDTI to serve as a vehicle for integration at community level, there is the need for programme planners/implementers like WHO and other a! fi at r=5t Itl 45 WHO/APOC, 24 November 2006 agencies, to make conscious effort through policy formulation and advocacy for utilization of existing resource personnel at community level. 4.4. Operational researc h 4.4.1. Summarize in not more than one holf of a page the operational research undertaken in the project area within the reporling period. None yet but there is the intention to undertake one, based on assessing the impact of Islamic associations on women participation in social service delivery at community level. This proposal is aimed at identifying viable and effective means of ensuring better women involvement in healthcare service at the peripheral levels with the aim of improving, as well as sustaining Mectizan delivery to the end users for the long duration of time required. 4.4.2. How were the results appliecl in the project? Not applicable. rs Tr iL t 46 WHO/APOC, 24 November 2006 It trT iL I SECTION 5: Strengths, weaknesses, challenges, and opportunities - List the strengths and weaknesses of CDTI implementation process - List the challenges and indicate how they were addressed. State level. Strenstlts (1) Availability of adequate Mectizan and its' popularity. (2) Opportunity for integration of activities with other PHC progmmmes like immunization campargn. (3) Availability of State counterpart funds in the year of report. (4) Renewed commitment of UNICEF. (5) Sustained support from APOC lYesknesses (l) Very poor funding at LGA level and generally unfavourable political environment. (2) Late commencement of treatment, due to slow response by the LOCT. Drugs had to be conveyed to most of the LGAs before treatment commenced. (3) Late submission of treatment reports. Only 1l LGAs submitted complete reports while 4 LGAs did not submit any report. The SOCT had to pay several visits to the LGAs before the current report could be obtained. (4) Inadequate institution of CDTI at Borgu LGA which shares border with Benin republic. The area is very large and communities very hard to reach. Human resource and transport logistics are very inadequate. (5) Poor attitude of some LOCT leaders to integration. Poor supervision by the FLHFs. 47 WHO/APOC, 24 November 2006 Er tr t LGA Level. Strengths (l) Adequate Mectizan. (2) Fairly good commitment of PHC staff in about 55% of LGAs (3) Fairly good integration of CDTI with PHC Vleaknesses (1) Very acute funding gap in all LGAs/ No release of counterpart funds. (2) Delay in submission of treatment reports. (3) Poor attitude of some PHC staff, therefore CDTI is not being fully integrated with other activities. Wastage, due to expiry of unused drugs that were not returned after distribution. (4) Poor supervision of FLHF staffby LOCT. (5) Inadequate trained personnel in some LGAs e.g. at Babanna area of Borgu LGA. (6) FLHFs not adequately training or supervising CDDs. (7) Inadequate transport logistics especially in border LGA like Borgu where distances from LGA headquarters to some communities takes 8 to 10 hours due to extremely bad terrain. (8) Frequent transfer of staff in some LGAs. (9) Several motorcycles are broken down and are yet to be repaired due to lack of financial release by the LGAs. (10) CDTI is not adequately instituted along border areas with Benin republic. (l l) Inadequate 2-way feedback to State and communities. Communitv level. Strensths (l) Good awareness/acceptance of Mectizan. (2) Receptive communities. (3) Evidence of good ownership in over 55% of project area. 48 WHO/APOC, 24 November 200,6 (2) Good commitment of some fraditional leaders (3) Committed CDDs in some parts. lVeaknesses. (l) Inadequate CDDs. High CDD attrition. The much funded National immunization programme had a negative effect on the CDDs since only few do benefit from participation despite their long time commitnent to distributing Mectizan to their people even when they not being paid any incentives. (2) Reduced commitment of some community leaders to ensuring support for CDDs (3) Reducing community treatment compliance due to fatigue. (4) Inadequate community geographic coverage. (5) Poorly mobilized communities in 45olo of project area. (6) Inadequately trained CDDs. Inaccurate transfer of treatment data from registers. C hal lenses/ Oooortunities (l ) Mectizon deliverv Activities like training, Mectizan delivery, advocacy and supervision were largely integrated into the polio immunization activities at LGA level, some SOCTs participated in training and supervision, thereby utilizing the opportunity for conduct of targeted CDTI activities. All LOCT were integrated into the National Immunization Days (NIDs) activities. (2) Advocacv to Stote Policy makers Ministerial management meetings were employed to sensitize the new Honourable Commissioner of Health for release of funds for oncho. control activities while the involvement of the State director of Budget in PHC project monitoring helped to facilitate release of State counterpart firnd during advocacy to the Ministry of Finance. L TT b il .r :f t* 49 WHO/APOC, 24 November 2006 aa (3) Public awareness for imoroved drug occeptonce Collaboration with the State unit of the National Television Authority (NTA) produced a documentary that was produced and aired free-of-charge for further creating awareness on the progftmme. (3) Motivation of CDDs/ recluction of CDD attritioto; Some CDDs from communities that did not give incentives were incorporated to participate in mass immunization activities from where they received some cash benefits. Communities with strong family affiliation were encouraged to select CDDs along family lines thereby increasing number and reducing demand for incentives. (4) Extremelv delaved reoortine bv LGAs/ collection of reports bv SOCT Funds released by the State was utilized by the SOCT for travel to defaulting LGAs for conduct of several activities like collection of outstanding treatment reports/drugs, advocacy to LGA leaders, meetings with the PHC team, 'spot-check' monitoring/validation of treatment, as well as Health education/Community mobilization SECTION 6: Uniquefeatures of the project/other matters Cross-border concerns with Benin Republic This project is one of the largest, and this makes conduct of activities very difficult and demanding, especially in view of gross under funding by government, coupled with the funding gap caused by inability of the LGAs to sustain support to the project since year 2005. Borgu LGA is of special reference here, because of cross border concerns with Benin Republic. The support from UNICEF as well as that of the State government helped to address several of the concerns about that LGA. 403 commtrnities are currently listed with over 200 in the border district of Babanna. Treatment commenced in several communities only in December and most of the treatrnent reports are yet to be received to determine the outcome of the effort made. To give an insight into the enormity of the problem, it is necessary to explain here that Borgu LGA is the largest in Niger State occupying about 25%o of the total land area while the region of concern - Babann4 comprises of 50Yo of the whole LGA. The distances between communities range frorn 30 t 50 WHO/APOC, 24 November 2fi)6 to 40kms on an average. There is the need to boost (strengthen capacity for training and supervision at that level, while there is need to support the LOCT with 2 motorcycles and provide at least 40 bicycles that will help to facilitate movement by CDDs during conduct of CDTI activities. While sincerely appreciating APOC's support, it is our sincere hope that it can assist (as a special intervention) with the necessary funds and logistics for addressing the cross-border concerns. t i t b .tl r! * 51 WHO/APOC, 24 November 2006