Yobe State project 8th year annual project technical report submitted to Technical Consultative Committee (TCC

'-" -1 I YOBE STATE PROJECT COT,NTRYAIOTF: NIGERIA Proiect Name: YOBE STATE Approval year: 1999 Launching year: 1999 Reportins Period (JANUARY- DECEMBER :2006) Proiectvearofthibreport: (circleone) I 2 3 4 5 6 7 (8) 9 10 Date submitted: JAI\IUARY 2007 NGDO partner: CBM JOS ORIGINAL : English 8,h YEAR ANNUAL PROJECT TECHNICAL RBPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) Hz DEADLINE FOR SUBMISSION: To APOC Management by 31 January for March TCC meeting To APOC Management by 31 Julv for September TCC eEt Btn C^$ Co? fiEAB F, TccJ4 i ,! I\,q Aoi I tl-P"[u6 i i ! ! 0 8 FFV ?I}fl? AFRICANPROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) ANN[]At, I',RU.tl',( 't' I u(lllNl(lAL l{[]l'oR'l' 'l'o 'l'lr('l tNl('u\l ('( )NSt ll I A I lVl', ( ( )MN'll'l'l'llli ('l'(.(') IiNDORSIiMIINT' Please confirlll You ltave reatl this report by signing in the a lt[)t'ol)l'ia tc sltacc. OIrFI(ll,lRS to sig n the re;lttrt: Country: N ieeria N ational Cloord intttttr ) Niunc: l.*.t Aq c. .i. 6.. . .[.G ri. !- .*Llt,lca Sigrralure .p*^rg(- ql lza;:v.n. Zonal Onclro C'oordiluttttr Narn.,f,t-, e-1t-( t\\ . C G*'=Uot*trc' [)atc: . ].c.1 Signature: -4,I)atc: .).V. c{- '2,<:.P.r. -@^,n -l lris re;rort hus bcelt prel)al'e(l by Nlarne. [.] .Sara (tvlrs) I )csigrrirl itttr : C't,ttt'tlittlttot Signatul'e' ffil+-s-.-, l)ate ,)'r' .lAN i(x)7 ii Table of contents ACROITYMS .............v DEFINITIONS YI FOLLOW UP ON TCC RECOMMENDATIONS..... 1 EXECUTTVE SI]MMARY SECTION l: BACKGROUND INFORIVIATION....... ......................4 3 SECTION 2: IMPLEMENTATION OF CDTI ..............9 1.1 . 1.1 1.1 t.2. 2.t. 2.2. 2.3. 3.1. 3.2. 3.3. 3.4. GeNeRar- INFoRMATToN ............. I Description of the project (briefly). 2. Partnership PopularroN ............... TtunlrNe oF ACTrvrrrES............. .........9Aovocncv ...................... l0 MostI,tzetloN, SENSITIzATIoN AND HEALTH EDUCATIoN oF AT RISK coMMuNnIes 10 2.4. CouvcrNrry rNVoLVEMENT............ t2 2.5. CnpncnvBUrLDrNG.. ......14 2.6. TReanrrnNTS.............. .....16 2.6.1. Treatmentfigures............. Enor! Bookmark not deJined 2.6.2 What are the causes of absenteeism? .......... .................19 2.6.3 What are the reasons for refusals? ................ ............... 192.6.4 BrieJly describe all lmown and verified serious adverse events (SAEs) thot Enor! Bookmark not defined 2.6.5. Trend of treatment achievementfrom CDTI project inception to the current year20 2.7. ORoenrNc, sroRAcE AND DELIVERy oF IVERMECTTN 2t 2.8. CoupruNrry sELF-MoNrroRrNG eNp SrnreHoLDERs MeerrNc ............22 2.9. SuppRvrsroN ...................23 2.9.1. Provide aflow chart of supervision hierarchly............. ..................24 2.9.2. Wat were the main issues identiJied during supervision? ..............................24 2.9.3. Was a supervision checHist used?......... Error! Booknark not deJlned 2.9.4. What were the outcomes at esch level of CDTI implementation supervision? Enor! Boohmarh not delined 2.9.5. Was feedback given to the person or groups supervised? Enor! Boohmarh not deJined 2.9.6. How was thefeedbackused to improve the overall performance of the project? Error! Bookmark not deJined SECTION 3: SUPPORT TO CDTI EqunvreNr FrNnNcrnl coNTRrBUTloNs oF THE pARTNERS AND coMMUNrrrES............. ..............26 OrHsn FoRMs oF coMMUNrry suppoRT ............. Ennon! Booxuanx Nor DEFTNED. ExpENottuREpERAcTrvrry......... .....Ennon!Booxlr,LRr(NorDEFrNED. ,................,....25 SECTION 4: SUSTAINABILITY OF CDTI .................28 4.1. INrnnNel; INDEnENDENT pARTrcrpAToRy MoNrroRrNc; EveluerroN ......... ...........29 4.1.I Was Monitoring/evaluation carried out during the reporting pertod? (tick any of thefollowingwhich are applicable)........... ............29 4.1.2. What were the recommendations? ..............29 ttl 4 4 5 7 4.1.3. How have they been implemented? .................... Enor! Bookmark not defined 4.2. SusrerxngrLrry oF eRoJECTS: ILAN AND sET TARGETS (MANDAToRY AT..... ...........29 Yn 3) 29 4.2.1. 4.2.2. 4.2.3 Planning at all relevant levels.... Funds Transport (replacement and maintenance) ................... 29 ................... 29 ................... 30 ................... 304.2.4. Other resources 4.2.5. To what extent has the plan been implemented............... ...............30 4.3. INrecRenoN............. ......30 4.3.1. Ivermectin delivery mechsnisms................ ...................30 4.3.2. Training... ...............30 4.3.3. Joint supervision and monitoring with other progroms .... ............. 30 4.i.4. Release offundsfor project activities... ......31 4.3.5. Is CDTI included in the PHC budget?............... ...........31 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What hove been the achievements?............. ....................31 4.3.7. Describe others issues considered in the integration of CDTL.........................31 4.4. OpenerroNAl RESEARCH .....31 4.4.1. Summarize in not more than one half of a page the operationsl research undertaken in the project area within the reporting period. ........ 31 4.4.2. How were the results applied in the project? ........ 3 I SECTION 5r StRnncTHS, WEAKNESSES, CHALLENGES, AhtDOPPORTI]NITIES .....31 SECTION 6: UMQUE FEATURES OF THE PROJECT/OTHER MATTERS. ERROR! BOOKMARK NOT DEFINED. IV Acronyms APOC ATO ATrO CBO CBM CDD CDTI CSM FLHF LGA LOCT MOH NGDO NGO NOCP NOTF PEC PHC REMO SAE SHM SOCT TCC TOT UNICEF UTG wHo African Programme for Onchocerciasis Control Annual Treatrnent Objec tive Annual Training Obj ective Community-Based Organization Christoffel Blinden Mission Community-Directed Distributor Community-Directed Treatnent with Ivermectin Community Self-Monitoring First line Health Facility Local Govemment Area Local Govemment Oncho. Control Team Ministry of Health Non-Governmental Development Organization Non-Governmental Organization National Onchocerciasis Control Programme National Onchocerciasis Task Force Primary Eye Care Primary health care Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Stakeholders meeting State Onchocerciasis Control Team Technical Consultative Committee (APOC scientific advisory goup) Trainer of trainers United Nations Children's Fund Ultimate Treatment Goal World Health Organization v Definitions (i) Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). (ii) Eligible population: calculated as 84o/o of the total population in meso/hyper- endemic communities in the project area. (iii) Annual Treatment Objective: (ATO): the estimated number of persons living in meso/hyper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. (iv) Ultimate Treatment Goal (UTG): calculated as the maximum number of people to be treated annually in meso/hyper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage (normally the project should be expected to reach the UTG at the end of the 3d year ofthe project). (v) Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) Geographical coverage: number of communities treated in a given year over the total number of meso/hyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). (viD Inteeration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) through CDTI (using the same systems, training, supervision and personnel) in order to maximise cost- effectiveness and empower communities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTI. (viii) Sustainability: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future, with high treatment coverage, integrated into the available healthcare service, with strong community ownership, using resources mobilised by the community and the government. (ix) Community self-monitoring (CSM): The process by which the community is empowered to oversee and monitor the performance of CDTI (or any community- based health intervention programme), with a view to ensuring that the progrcmme is being executed in the way intended. It encourages the community to take full responsibility of ivermectin distribution and make appropriate modifications when necessary. 4 FOLLOW UP ON TGG REGOMTIENDATIONS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session 2t Number of Recommeudation in the Repoil TCC RECOMMEIVDATIONS ACTIONS TA"KEN BY THE PR.OJECT FOR TCC/APOC MGT USE ONLY The Therapeutic coverage and involvement of health staff in CDTI The involvement of health staffis gradual however, all health staffwill be involve after their training in CDTI Involvement of women in advocacy and mobilization. CDD/population ratio is still low with poor supervision This is still maintained. It is difficult to change CDDs ratio because community select and support their CDDs however, the project has embark on intensive mobilization of community on this. Train all staffon CDTI The project has not achieved this. There is a plan for training all health staff by next year. Integrate drug delivery into PHC to reduce cost and ensure sustainability. Drugs delivery will be fully integrated by 2007. Continue sensitization, health education and mobilization of communities to improve awareness on community roles and responsibilities. Sensitization was done and will continue. Communities are now aware of their roles and responsibilities. Review training objectives for CDDs to attain a ratio of 2:250; esellect and train additional CDDs. This is diffrcult because communities see a burden of supporting even one CDD talk less of increasing their number. Communities were mobilized to select more CDDs to be train 2 IIIrn /a nA^ a, \r^..^-L^- ann / to meet a ratio of at least l:250. Improve integrated supervision At the course of PHC activity, health staff do supervise the CDDs and make necessary intervention. The sometimes help in collecting results from CDDs.. Update census in 6 LGAs with therapeutic coverages over84%oto ensure correct denominator. Although Census has been updated using CDDs census update. There is still incorrect population figure in some LGAs. This will be address next year. Continue integration of CDTI into PHC. Already plan has been made to try the distribution of mectizan together with Immunization campaigns in some LGAs. (Please add more rows if necessary) 3 IIIIn /l tai aA lr^.-^-L^- ann, 2 I Executive Summdty. Yobe State was created out of former Borno State in August 1991. The river Yobe is of particular mention as it cuts across six (6) LGAs and it serves as breeding sites of the black flies. The project is in its I lh treatment round but in its 7tr year of CDTI implementation under APOC. A total of 247 communities are undergoing treafinent in 12 LGAs' of the state out of whichT are Meso - endemic & 5 hyper endemic zones. The population of the communities under treatment is 606,376 people. The ultimate treatment goal for the programme is 520,000 persons. In the year under review, a total of 465,ll0people were treated using 1,126,386 tablets of Mectizan glving 77 % therapeutic Coverage, 100% Geographical coverage and89o/, Ultimate Treatment Goal. Most of LGAs have Nomadic Fulani cattle rearers' whose movement is determined by climatic factors. Also, in Bade LGA there are populations of fishermen who move in to settle towards end of rainy season and move out in the drier parts of the year. Targeted refresher training was conducted at all levels to various categories of staff. 370 CDDs and 184 health workers were ftained and retrained respectively. With this, the project achieved 77%o and 90.5o/o of its ATOs for CDDs and health workers respectively. Ratio of CDD to total population is l:1081. Major challenges include lack of support by LGAs, which led to decrease in monitoring and supervision at that level. Also community support to CDDs is low, this led to high rate of CDDs attrition. The project is encouraging CBOs in the various communities to support especially where there are indications that the CBOs will be responsible for giving CDDs some stipends. With respect to LGAs support in terms of counterpart contribution plans are put in place for LGAs to increase their contributions for OncholBlindness prevention activities . The project will identiff few women groups that will assist in the mobilization and health education of women and bring some degree of pressure to bear on the male dominated traditional stnrctures to allow increased participation of women in CDTI, especially women participation as CDDs. CDTI is integrated into PHC stnrcture in Yobe State. In the reporting year, A total of 400 persons were operated for cataract freely, and 38 lid surgery carried out. Free Cataract operations were conducted by the following organizations: 400 Patients by the Project in collaboration with CBM, Diamond bank 100, Machina and Yunusari LGAs carried out 100. Already, the State Government has empowered FLHF staff through capacity building using health system development funds, to improve the performance of FLHF. The State approved and released 3.2 Million Naira for year 2006. Yobe state project vehicle is obsolete. There is need for its replacement. 4 rlflrn /^nn^ a, \r^-.^-L^- ann, SEGTION 1: Background information 1,1. General information 1.1.1 Description of the project (briefty) - Geographical location, topography, climate Yobe State lies in the Northeastem region of Nigeria. It was carved out of the old Borno State in 1991. It derives its name from the river Yobe that runs across the entire State. It occupies a landmass of 47,153 sq km. The State shares National boundaries with Bomo to the East, Jigawa to the Northwest, Bauchi and Gombe States to the West. Yunusari, Machina, Yusufari LGAs lie along the international boundaries with Niger Republic to the North. The metropolitan city of Damaturu is the administrative headquarters of the State. The State is characteized by savannah vegetation with evident desertification that makes most areas sandy (and muddy in the rainy season) as a result of which the terrain is mostly difficult. The topography is varied with hard-to-reach areas in Gulani, Yunusari, Geidam, Yusufari, Karasuwa, Machina and Jakusko LGAs. Fika and flrne LGA are hard to reach dwing the rainy season. Yobe state is in its 7th year of CDTI implementation in 12 LGAs of the state. Machin4Yusufari, Giedam, Yunusari and Damaturu LGAs are not endemic however, passive treatrnent is given in these LGAs. Population: activities, cultures, language Yobe state has a population of 3.2 millioru with rich cultural activiteis among which are farming, fishing and animal rearing. The major languages spoken are: Kanuri, Bolewa, Ngizim, Karai-karai, Ngamo, Bade, Manga,Bwa fulani and others. Most of the endemic communities are multi-ethnic and multi-lingual with population speaking several languages. Postural Cattle herders such as Fulani groups Koyam and Shuwa Arabs live interspersed with settled agricultural communities. The State has 17 LGAs and 129 health districts and 178 political wards with structures for health care delivery services at all levels. - Number of health staff in project area and nunber of health staff involved in CDTI activities. 5 rrnrn /ln^i au lr^,.^-L^-^nn, Table 1: Number of health staffinvolved in CDTI (Please add more rows if necessary) DistricULGA Number of heelth strff involved in CDTI ectivities. Totel Numbcr of heelth stelf in the entirc projcct erca Br Numbcr of herlth steff involvcd in CDTI B2 Perccntege f,.=f,2l 81 *l(X) BADE 32 2l 6 BURSARI 32 l9 59 FIKA 38 20 53 FI.JNE 45 40 88 GUJBA 3t 2l 67 GULANI 29 l5 66 JAKUSKO 28 l6 57 KARASUWA 25 l3 52 NANGERE l8 9 50 NGURU 42 29 69 POTISKTIM 5t 33 57 TARMUWA t9 9 47 Total 397 245 6l 1.1.2. Partnership The Partners involved in CDTI implementations are MOH, endemic LGAs, NGDO (CBM), NOCP, and local CBOs. These CBOs include 32 Community Developmental Associations in Fune LGA and 31 in Fika LGAs, 6 in Bade, 8 in Jakusko LGA, 7 in Gulani LGA, I in Potiskum LGA, and 14 in Gujba that are assisting in CDTI implementation at community level. Others are Damagum Development Association, Fune development Association both in Fune LGA, Bubaram Gakoko in Potiskum LGA Relationship with partnerc There is a very cordial relationship between the NGDO (CBM) and the State Government. A Memorandum of understanding was signed in 1995 between Yobe State and Christoffel Blindness Mission (CBM) to last as long as the Parfirers agree & it was also renewed at the end of the Project's 5ft Year for Post APOC Years. The NGDO (CBM) usually assist in advocacy, provision of IEC materials for training, provision of funds for various activities, and in training of State teams where necessary. The State performs such functions as training and re-training of LGA health workers, Mectizan procurement and supply to LGAs, 6 rrlrn/ a nnn a/ \r^-.^-L^- ann, monitoring and supervision of Mectizan distribution, formulation of operational guidelines in order to ensure good implementation of the programme, and community mobilization and education. The LGAs are responsible for training and re-training of health facility staff and CDDs, Mectizan procurement and supply to communities, community mobilization and education, monitoring and supervision of Mectizan distibution. The endemic communities collect their yearly Mectizan supply from the health facilities, ensures distribution of Mectizan to eligible persons, selects distributors and determines times and methods of distribution. They also minimally monitor and supervise the distribution exercise. The NOCP through the Zonal office provides technical and moral support to the progftrrnme, supervises the activities of the state of Oncho Control Programme, and pays advocacy visits to policy makers to solicit for support to programme implementation. The Local CBOs assist in advocacy, support of CDDs duriqg dishibution and cornmunity mobilization. Mobilizatiotr There is a plan for an intensive mobilization in some LGAs and communities that are yet to prove evidence of ownership of CDTI project. 7 lrrrrn/ a nn^ n, tr^-.^-L^- ann, z z o E]F rn ,( F a L. (< Xea Xo o t- z o r< EU Ffl -2 rn \1 X EE\-Fa E EU U trj s rB .|ArJ -. 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Et +&8P9{5:+e9 ='rit, -E5!rEl.(D B!-r r, (D -oDrlo:l{*r-5 ts =(D iFH.E gt-.8 Pqj !t ->-ur 3LD-P 'xEr +3 ^.(D FDAE t* Elt tl*8;EFtiB785a :+'x uF sE'h.Fl (DE .ot s (D Ft D) C)3. 3. E+.(D(, !0 U) D))(D 3. (D -\o rJr o "oN)5 zo (D d(D Fl N)o s 2.2. Advocacy All chairmen of the care taker commiffees and the district heads in each LGA were mobilized. Mobilization was done both at LGA and community levels with different target groups. Chairmen of the care taker committees were advocated to grasp CDTI and release their support. It was clearly explained to them that CDTI is the LGAs' project and it their responsibility to keep it going. Although all chairmen have shown commitnent, some of them failed to execute their responsibility of supporting the project in terms of cash. Advocacy should be done at state level where all stake holders will be brought together and be sensitized. I.3. ilobilization, sensitization and health education of at risk communities A targeted mobilization was done in all the LGAs, having in focus those communities with difficulties in CDTI implementation. Community members were sensitized and Local NGOs were also educated on community self monitoring and supervision. Posters were used to disseminate information. Most communities seem to be aware of the projects however, it is still diffrcult for them to support the CDDs in terms of cash or kind. Intensive mobilization and sensitization in all the CDTI communities will be of paramount importance by use of medi4 and frlm show at community levels. 4t rrITn / A nn - a, tI^-.^-L^- ann, DistricULGA Nu mber of communities/villrgcs with community mcmbers rs supcrvisors Numbcr of CDIh Number of communities /vilhgcs with fcmrlc CDDs Total no. communitics in the cntirc projcct eree B. Number with community mcmbcrs as supervisors B( Perccntege Bg BJB. *IM Male CDDs E, Femelc CDI)s B. Total h=Bb+& Number of communities with fcmalc CDDs Bro Pcrccntege Brr= 8,./B,*l(X) BADE l8 ll 6l 26 0 26 0 0 BURSARI 4t 9 22 55 0 55 0 0 FIKA 3l 5 l6 47 0 47 0 0 FLINE 45 28 62 59 0 59 0 0 GUJBA 2l 5 23 28 0 28 0 0 GULANI 36 l7 47 47 0 47 0 0 JAKUSKO t4 6 43 29 0 29 0 0 KARASUWA 5 5 100 l5 0 l5 0 0 NANGERE 9 4 u ll 0 ll 0 0 NGURU 8 3 38 t4 0 t4 0 0 POTISKUM 9 4 44 l9 0 l9 0 0 TARMUWA l0 3 30 22 0 22 0 0 Totd 12 247 100 40 370 0 370 0 0 2.4. GommuniQl involvement Table 4: Communities participation in the CDTI (Please add more rows if necessary) Comment on: - Attendance of female members of the community at health education meetings - In general, how do you rate the participation of female members of the community meetings when CDTI issues are being discusses (attendance, participation in the discussion etc). - Participation of female members of the community at health education meetings and other meetings related to CDTI has been difficult in some Muslim dominated communities. Despite the health education mobilization done efforts proved abortive. Efforts will still be made next year. 42 IlrLIr\ / a DNr a, rI^,,^-L^- ann, Incentives provided by communities for the CDDs Incentives provided by the communities to CDDs is not something to talk of since some communities claimed that the CDD is their son, so incentive is not necessary for the CDD. This has brought about a high CDD attrition rate in the project. Attrition of CDDs. CDDs attrition has been a problem for the project however; there is a plan for all CDDs to be incorporated in some of the health intervention programmes, e.g. IPDs and NIDs. Moreover bicycles will be distributed to some CDDs with the aim of tying them to be committed. 43 lrrrrn / a Dnn a, \r^,.^_L^_ ann, 2.5. GapaciQl building The project has enough manpower to carry out the project activity at all levels o CDTI implementation. A targeted training was organized, to update the knowledge of some staff and also to train those staffthat were transferred newly to the project area. New CDDs were also trained however this does not meet a ratio of 2:250 The project has a plan to train all existing health workers on CDTI activities across the state in addition to the frontline health staff(in charges of health clinics) that were previously trained. This scheduled to hold next year. 14 IITLI^ /A r)f\tavl/l rI^.,^*L^- rnn, s a (D (D EI(! E \o(, \oo\ -lo -l l- -l Fz e FU o -l a X z oeFC z z o rnF trJ X F(a 7( (r) Xo o L* - z O EO EJ 2 rn FI, ,( EUF(A F w Uln g O r.a F o o\ (, (i (.,l (,t (^ (Jt (,l Flo z E E(Drt o c9 =' 'ioara. F o (D (a EB (, a\ (,l o\ o tJl tJr o UI o UJ lJ) o (,l (Jr o u) (r) o (, o (, (Jr 9r o (,r (rl o (,r o (Jr (^ o (, 3 sq F ^.'l:ii B_ rC c\ a (D (! (D 6\o s (, an @ o o o\ o\ N o f.J()) o\ N -lt o o tt(D "t= <.E EF, +rt 0OA E: Ii =H;.iEc= EFoE b')c \.) o 6 @ o o o o \o \o a o\ o\ o o\ Oi o \o \o \o \o o 6 @ o N)o No o o\ o\ o o o o \o F + tii 3 o s (t4 (D (D o €6 s a 6 Fi a o z SHCrt =Fii5o(a .+ ':o Erl YEIHteI -a'(!rt O o o -I -t o -J -I SF6€ !\ o +;'o AII D : o \c a t,D (! (D 6\o s 5bJe N)N N)o s (])UI (,h.) N)@ {hJ L'I5 o\o\ (r)N Orlia z q (Drt o o a{E oa (, (,tt -t (, -tc o N N) N)N o No tJo o s 5 o o o o lJr o tJ\o NJ\o UJ 5s ;\t o t96 t.J@ N (lr -I \o (.) 5s ;\t t.J (, t, (,(, (r) t..)(]) t.J o\ $Fr{ A!;' s, !^:+ ;'o .1llE- a la IDl6 lo l,r, ; r_t t0 0a !0 or H{tI' o (D (D (A ol*) o U -l 5! (D ts(D g o e(\ q(! S * o\(\\ =Va (\ a(\ V1 V) \J 4AZito AaD -vXEFI:. H ra,rnD..E-=> E I E')-P aU)Oo-tr s.dggFiri F: t5'A 6 -Fx9td(D v aaj ,i5;J.. +EE*SE&siioQ s]{ o 9l-sO H, FiJsIl<a+S qEHS i'<a'A!tse.e! <sdR' <LE ; !:.F .d888 P 9.-:dx<:,k e &E$ nlr- = eroq -!:.c =\l=, i+* r-l r. z i-ii5 t op99 9BC) tI'- s. 5$ i+ d'! 5 IiiD la s.X trE+ o-:x 8.$JD -.6:r lja +I JA(Dtsr 5$tr6-Es+s oia: 690 -lo -l o r t'J 9)d o o o s) 9.o' o rd =(? D' 6' Ur ti o FU "o N)5 z o o q (D I N)o U) \o Table 6: Type of training undenaken Qick the boxes where specific training was carried out during the reporting period) Trainees Type of training CDDs Other Community members e.g Community supervisors Health Workers (frontline health facilities) MOH staffor Other Political Leaders Others(specifo) Program management How to conduct Health education { { J Management of SAEs \1 { CSM { ,/ SHM I { Data collection { Data analysis { Report writing Others (specifr) PEC 16 It/un /A Dr\rr a, \I^,,^-.L^- .tnn, rl F C ru oH v)XCz zo FC z zortF fd X v (, C XCaho o t- z o TE tl z rn Fd X ED F U) IE U rr, \f, 6S >d' l.)5 -t \o @ \9 5 o\ h) 5(, 5 6 I = S.R "*ggEEPrd 5 :i.^$ $ f {+ NIt\t \o € \o 5 (r) o\ N 5 l]) 5 6 Edr9EE ='9 p-(a* h)5 -{ \o 6 \o 5 o\ N) 5u lr) 5 6 6v -82q<-3E(D =ts iE# E E*E 3: o olt oo oo oo oo oa oo oo oo oo oo aQ 6o oo \oo\ r(_ FPallt oQ :caADj drro6' 0) oo P (D U) p) 0ao TA o\o o\t, -to\ 5o(, o\o (,) u)5(,)\o (J) lJ) o\o N)55 hJ 1..) N\o NJ N so NJ6 o\6oN)\o U!(]) o\6 u) \o @o{ o\ -)o o\ € {(r.) 6sN 5 (Jl\o(, T9a i FE ^ ETit o :r-! o (i :rEHE'TBr 6' 5(,ro e o (]) oooo N(, ooo u)oooo 6aoo t])oooo 1..) ooo oooo s(/r ooo @oooo o\oaoo (, oooo UJoooo U ^-l;e >t'ts =.)3= :' in F)(D=. 5 o\Ut o UJ N) UJo o\ t\) t'.) o N (, -t N) h,)U) o\ 6 UJ t.J (, Urt\)\t (,\o hJ o\(Jr (r) o o\t') { o\s i.J o\ (,{\o @ o\ 6 u) o N) NJ\o\ost.) t $EI -l -l 6o o\o\ o\s \o o\(, {\o @{ (, -J {6 €t\) @o\ {t\) + o 1 -lo=Oo sEtvt0 Ooatr(r c'.a ru or,t D)+ o { -t o No\ u)5 o o o o o tJ{6 -l\o o o\UJ IB.rf E 3r; q+5 :1, o\ € -l N u) o\ o\ l..J u) 5\o UJo\ t^J hJ5 o\ { o,o\ t,)o N (r) N)66 (JJ (,.) oZ6C833d5'qo^ +) o o o o a o o o o o o o o az ai E* N ao a {I o Dr; - -) o3a o ;Ft tD o) o o) o 0 ln V) a. U) t() t- o 8D H(D s)(n s) tst V)7f G S(\ ss lt \G\o q (! o(\ V1 .d e9O f:!.i Z SaHB+H5o e. o-^ ni t'(tt.eafEEis +1,1 B ooooooooooooo Li. E(DH +E(D aio ts-rftso9e.i+ Of xA)0!E HE fliO *Jo'(DFrA Oo Ei. ad<Fo tno.{!' roO. o\ o.6 s5tri,(DQ rr<iDoH!l o)!i oat-p iJ E. ,-Q(Doqo EE.!+ o. do A) Ft C'tr o o. o (! C)g U)trq) ill oo ,.t .D { o o i .o o() v) (D o X o o, o (D (n o il a oE! D) 'clo o() o oht F 0a(D Ft O) (D lz,Itr ldl(! t:l+) tt,lolo tct l5' tr-t Iralpt+ltalo- Ixt-lolo { u t=FE -o N)5 z o (D cto N)o 5 soo o oar-t -e '\o ir96'p o o oFt F) oq(D rt A' o rl oo -<xevoj oe(D >t A' o SH i I Bll ll Fl €s s cjtS B x!F St !r Es. H *{s E xb--P R$ $s! .: .ES FRS E.s= (! [ *i!* ss s.\G. SSG ea!h3N ! stzrI E S15 Fi $ il[s.> s El9 SE $ qla t$ [ ilfl ^-X E ilx s3 3 *l=ss I BGE ! :I!s .E =EE5;ES6s t€FSEtF $tF(Di*s -Psx6'FI exEEES.U)S:.=E\s$$E.EuGaTE €\s3IEi{+ :r.$,E6i0,G-s'.i6(- *.i 's' cj\v F OAG E E E(: G h € a c t= "r)tJ5 zo (D d tDI NJo 5 >lZ 4lZ -l =lc olc oE13 slE s = ld -16 =l(D 5 l(D 'orlFr c l-r o =lo il lo ro oi l+, = l"t tBl8 E18 [6lE old a316' llE ia\ls = 15 =' = ld ;X la' ).Elts gla E5.14" € l> Ei';E EI+ 3t8 dffi E5l(/) (J slA tz :J ID? 'd6'lE +8lx gHl* o- =lo (D5 r) 5() +t) o(JaI )tr)5U') o-=(?=. =o J O. ='6=- FaErl 6 I\J €. ='(D)() ++rH oHre €.oo+ A'Fl o F) il I2.6.2 What are the causes of absenteeism? Absenteeism is as a result of travels and farming activity 2.6.3 What are the reasons for refusals? The reason for refusals is still not very well known. However some still claim that it is for family planning. In case the project did not have any cases of serious adverse events (SAE) during this reporting period, please tick in the box. No SAE case to report 1g llIrn / l Dar a, L]^-.^-L^- ann / l..Joo o\ t\)ooUr t.Joo5 NJ o()) NootJ N)oo Naoo \o\o\o \o\o 6 \o\o -t frl v tJ5{ l..J5{ N5{ h.)5 -.t t.)5 -I tJ5{ N5-J tJ5{ l.J5{ N5-J oo o5 *B e E, -3 q=.?.S ::Y d.o:lt HE d te,u' = p 0q oo p t5 (D @t o)@(Do N)5{ t..)5{ N5 -l N)5{ t'J5{ N5 -I N5(JI \oo (r! o No o=l- .d.i Pt'E eo5= :'o P o= It' l..J5 -J l.Js{ N5{ b.)5{ N5o\ N)5q NsN) @6 UI@ N) o-ooZ ET >f E!P =51[fi'E flU s.o o ts+) F' oo oo oo oo \op() \oI \orJ\o -l9 o\(r)io 5 90\o !t,oO irsfig€ =ftr,t5oit oo oo oo oo \oI \op \o90{ \o6io o(.jt oI@ oo- ro td l-reEo (a It Elq *r itt 6o o\ u){ o\ s\o5b oo o\ 5 l.'J .i- \o -t 5 t\J -J -tN) UJ\o 5\o -J (j) 6(Jr\)tJ\o ()) u)N -\o oo N\o "9(,){\o N6 -t.J 5\o 6\o (,l{ b.) g- E:iij oa'q E -E=.>:i!e o 'o€ o F.sE! 5 -gT q IEloloc lD) o 5(, oooo 5 UrPooo UJ Iooo tJ) o oo (/) fr)o o o (, N)Pooo N{Ioao N o o N(J) -ooo \otj ooo ^-l;e >6'8, =c3E:'a o)(D= E' 5 o\(n o 5 UJ{ o\{ N) (, o\6 's{s (,(rr N)s u) s \o \c) (JJ (rr UJ N@ o\ -o u)o N) o\ "5 65 b.Jt/) u)\o\o € o\ 5\o Q-r o95I@7? 3t}airpo o'!,o E' -l{ @90UI 696 69 oo{io @lr' 6(ltb @Ni.r 66i.J \o90UJ -lo:'Oo 6€0ro0qtro g'. o 1O F' E' F' '* 'flt o(j) \o -Ii') o(Jr o o5 \o{ o(Jr oA oPOr \o b\ oo- ^< D>Re -l "do(D { t! sr ,lilt 6\o N(/r { o\6 o\o\ o\o o ss t)o\ o ,-< \-5$ d0a(D FU l-l N)6' lP:. b\v, lFhg. l.o f =ra pE'5i iB3'1 *(DHErpaGAHCn:tsFIPEa::+ei IEt(Dtr. :!oPJ6q30EreE €.t;B 6 lq: Hasltsa.plxB;tFclE l' (D- utlo* N)FIHornxbHe.OdO:e'3t(Dbt18 - It.6S. l.0ExErI=Oa G:. Ot(D+ '.t f) lf,(D-;a BBoiDr!-c,gED'(Dt.D5 cLEi+g s"$ tQE'GE' :hp= ti. rtB ='s-(!Pr =tSt4 t HS.AN9,sE€E 0qo tltr a F o 0i/ N) o t- ,U o _o NJ5 z o o ct(DI N)oo5 2.7. Ordering, storage and delively of ivermectin Mectizan@ ordered/applied for by - Qtlease tick the appropriate answer) MOH N WHON UNICEFI] Other (please specifu): NGDOd NGDO f]Mectizan@ delivered by - Qtlease tick the appropriate answer)MoH Efr wHo tl rjrrrcEF fI Other (ilease specify) : Please describe how Mectizan@ is ordered and how it gets to the communities - Mectizan is ordered by FLHF to LOCT to State Ministry of Health. - The State compiles all LGAs requirement and orders through NGDO Partner. - Ministry of Health receives Mectizan from NGDO partner. - Ministy of Health distributes to all LGAs - LOCTs deliver drugs to FLHF. - CDDs collect drugs from FLHF. 2l II[rn /aDnn a, lI^-.^_L__ ann, Table l0: Mectizan@ Inventory (Please add more rows if necessary) State/DistricUlGA xumuer of Mecfirnu iabteii Nunber in stock Requested Received Used Used/Person treated Lost Wasted Erpired Remaining BADE 70000 70000 68806 , 0 0 0 rt94 BURSARI 145000 145000 140'ts2 t 0 576 0 3672 FIKA 150000 150000 142194 2 0 357 0 7M9 FUNE 193000 193000 189949 2 0 1495 0 1556 GUJBA 88000 88000 87000 , 0 1000 0 0 GULANI 140000 140000 138400 I 0 376 0 1224 JAKUSKO 70000 70000 65558 I 0 830 0 3612 KARASUWA 40000 40000 39200 t 0 310 0 490 NANGERE 64000 64000 58026 ! 0 678 0 5296 NGURU 65000 65000 6372t t 0 473 0 806 POTISKUM 65000 65000 54728 , 0 0 0 10272 TARMUWA 8s000 85000 78052 t 0 232 0 r7t6 TOTAL 1170000 ll7fi|00 1126386 I 0 6327 0 37287 Mectizan are kept with the LOCT in charges of various LGAs after collection from the state office. At the cause of mectizan distribution, health do identifu some patients with cataract. Other activities include health education on general condition of living. Other activities carried out by health care personnel are sport checks on distribution of mectizan. Some include PEC activity e.g. screening of client for cataract surgery. During mectizan delivery, health workers carry out a supervisory roles and make necessary correction to CDDs, they also mobilize and educate the community on need to support CDDs. NOTE: Mectizan is always stock at state level. 22 II[rn /A n^f aa rT--.^-L^- ann, 2.8. GommuniQl self-monitoring and Stakeholders Meeting Training for CSM and SHM was done in all the LGAs. However not all communities carried out CSM. Table 1 1: Community self-monitoring and Stakeholders Meeting (Add rows if needed) Community self-monitoring and stakeholders meeting has contributed to the project as many policy makers and community members are aware of their responsibilities. District/ LGA Total # of communitieVvillages in the entire project area No of Communities that canied out self monitorins (CSIO No of Communities that conducted stakeholders meetins (SHM) BADE BURSARI FIKA l8 41 31 t4 t2 9 t4 t2 9 FUNE 45 13 l3 GUJBA 2t 7 7 GULANI 36 t4 l4 JAKUSKO t4 8 8 KARASUWA 5 5 5 NANGERE 9 5 5 NGURU 8 6 6 POTISKUM 9 5 5 TARMUWA l0 4 4 247 97 97 23 IIII^ /A Dnn a' \]--,^-L^- ^nn, 2.9. Supervision 2.9.1. Provide a flow chart of supervision hierarchy. DIRECTOR DISEASE CONTROL MOH I PROJECT COORDINATOR CDTI I SOCTMEMBERS I LOCTMEMBERS I PHC UC / FLHF ICBO COMMUNITY \/ \/ CDDs 2.9.2. \ilhat were the main issues identified during superuision? 1. Improper documentation of treatnents data. 2. Inability of the LGA to play their parts as needed. 3. Late distribution by some CDDs sometimes due to unsteady support for CDDs by some Communities. 4. The supervisory checklists are not properly utilized for all supervisory visits. 2.9.3. Was a supervision checklist used? Supervisory checklists were used at all levels of supervision. 2.9.4. What were the outcomes at each level of CDTI implementation supervision? On the job training to the first line health facility staff on the proper way of documentation was carried out. Communities were also reminded through CBOs to assist the CDDs. These intervention measures resulted in ensuring coverage of all endemic communities and maintenance of high therapeutic coverage rate for the project. 2.9.5. Was feedback given to the person or groups supervised? There is feedback of information at State / LGA levels during supervision. 2.9.6. How was the feedback used to improve the overall performance of the project? Feedback of information are used for future planinig. Other informations are used for corection during subsiquent trainig. 2+ IIIrnlaDnn a, lt^-.^_L^- aAA i SEGTION 3: Support to GDTI 3.'1. Equipment Table 12: Status of equipment (Please add more rows if necessary) *Condition of the oquiprnent (F:Functional, CNFR{urrently non-firnctional but repairable, WO:lWritten off). How does the project intend to maintain and replace existing equipment and other materials? The agreement signed with a consulting firm, which maintains all existing equipment using State counterpart funds is still in place. At the LGA level, some firnds are being released for maintenance of motorcycles. In terms of replacement, efforts are still being made to secure a budgetary provision from the State or LGAS. Moreover, the Project is still expecting NOCP Management to arrange a date for the collection of the equipment donated by APOC management. Meanwhiler, the project vehicle is obsolete. The project is especting its replacement soonest by APOC management. Materials like; IEC materials, flip charts in local dialects & pictorial tally sheets were provided by the NGDO Partrers (CBM). Source Type of equipment APOC MOH DISTRICT/ LGA NGDO Others No. Condition No. Condition No. Condition No. Condition No. Condition 1. Vehicle I F I NF 0 4 F 0 2. Motor cycle(s) l4 CNFR 0 6 NF 0 0 3. Computer(s) I F 0 0 0 0 4. Printer(s) 1 F 0 0 0 0 5. Photocopier (s) I NF 0 0 0 0 6. Fax Machine(s) I F 0 0 0 0 7. Others a) b) c) 25 rI[In/a Dnn a, lI^-,^-L^- ann, Contributor Yerr 6 ('2004') YcrrT ('2005') Yeert QN6') TOTAL AMOT]N T (cAsH) Budgeted (US$) TOTAL CASH Released (us$) TOTAL AMOUN T (cASH) Budgeted (us$) TOTAL CASH Released (us$) TOTAL AMOUN T (cASH) Budgeted (US$) TOTAL CASH Released (us$) MOH (Central + ProvinciaVState) 20,000 18,fi)0 20,000 20,000 25,000 25,fi)o MOH (District/LGA) 20,000 t 8,518 20,000 7,000 7,500 7,500 Local NGDO(s) ( if any) t,000 1,000 200 1,000 2s0 NGDO partner(s) 5,000 3,000 5,000 3,000 5,000 3,000 Others a)Communities 600 600 7,000 7,000 7,000 APOC Trust Fund 0 0 70,000 0 r50,000 99297 TOTAL 45,000 4t,l l8 r 15,000 37,000 195,500 t42,M7 3.2. Financial contributions of the partners and communities Table 13: Financial contributions by all partners for the last three years Released of firnds is not timely and difficult by all parfrrers especially APOC management. The is yet to be addressed. Additional comments APOC management to please release all outstanding funds allocated to the project from its inception to date. Our NGDO (CBM) usually assists the project always with vehicles during mobilization, distribution and supervision. MOH releases counterpart contribution excluding Personnel cost. The Local NGOs are the CBOs like Damagum Development Association, Fune Development Association both in Fune LGA, Bubaram Gakoko in Potiskum & others newly identified that released the amount above in temrs of Mobilizatioq Supervision and paying stipends to the CDDs 26 IIII^ /lDn^ ar lr--,^_L^-nnn, 3.3. Other forms of communi$r support The communities support to CDDs in kind by giving them some measures (mudu) of grains or units of other farm products in appreciation of their work is still encouraged. During farming some communities assist their CDDs by mobilizing some members to work on their farms. Some of the communities simply pray for the CDDs and wish them well. Some assist them with loans for their private business or enterprises. Some communities support the CDDs in running for political positions e.g. councillorship. Some communities make available transport (bicycles or motorcycles) to CDDs to enable him pick Mectizan, attend training in a nearby community or submit reports of treafrnents. Some others provide refreshments during CDD training. Few LGAs stil do employ some CDDs as a means of motivation to others n rl[rn /aDn^ ai l]^-,^-L^-ann, 34. Expenditure per activiQl Indicate in table 14, the amount expended during the reporting period for each activity listed. Write the amount expended in US dollars using the current United Nations exchange rate to local currency. Indicate exchange rate used here l$ US : N128. Table 14: Indicate how much the project spent for each activity listed below during the reporting period. The project is spending close to N2 million to take Mectizan from Lagos to the communities This could be due to over expenses on part of the state and LGA. There is a plan for the integration of drugs delivery into PHC. Activity Expenditure ($ us) Source(s) of funding Drug delivery from NOTF HQ area to cenhal collection point of community Mobilization and health education of communities Training of CDDs Training of health staff a! all levels Supervising CDDs and distribution Internal monitoring of CDTI activities _Advocacy visits to health and political authorities (SHM &_CSM) IEC materials Summary (reporting) forms for treatrnent Vehicles/ Motorcycles/ bicycles maintenance Office Equipment (e.g computers, printers etc) Others 15,000 14,000 3,000 38,0+l to,ooo 10,000 35,000 8,000 1,000 7,000 1,000 0 MOH,LGA,CB ;M MOH,LGA/ ,CBM .MOH MOH, APOC _MOH,!9.1 COMMUNITIE S MOII,APOC MOH MOH/CBM MOW LGA MOH TOTAL 142047 Total number of persons treated 465,110 28 IIIIn /ADn^ a' \r^-,^-L^-ann, SEGTION 4: SustainabiliQr of GDTI 4.1. lnternal; independent participatory monitoring; Evaluation Was Monitoring/evaluation carried out during the reporting pcriod? (tick any of the followingwhich are applicable) 4.1.1 4.1.2. _Not applicable _Year I Participatory Independent monitoring _Not applicable_ Mid Term Sustainability Evaluation Not applicable_ 5 year Sustainability Evaluation Not applicable_ Internal Monitoring by NOTF Not applicable _ _ Other Evaluation by other partners What were the recommendations? Not applicable 4.2. Sustainability of proiects: plan and sct targets (mandatory at Yr 3) Was the project evaluated during the reporting period?_No_ Was a sustainability plan written? When was the sustainability plan submitted?_last four What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.2.1. Planning at all relevant levels The 3 year sustainability plans developed based on basic CDTI activity earlier are still being followed up. The plans were fine tuned and draft submitted to the policy'makers and was used in the execution of the 2006 CDTI activity. 4.2.2. Funds The State & L.G.As have accepted firlly their roles in CDTI and have demonstrated this in the release of counterpart funding. To enhance continuous release and improve the level of funding at the LGA level there is a policy to centrally deduct funds from Ministry of LGA Affairs for CDTI implementation. Meanwhile the State counterpart contribution has been on the increase since inception of the project. The State released the sum of 3.2Million for its counterpart funding. 29 Il[rnla nM a, \r^.,--L^- ann, 4.2.3 Transport(replacementandmaintenance) Funds from the Counterpart contributiomr are still used for maintenance of equipment as has been highlighted in previous sections. However, as stated earlier the project expects APOC to arange for the collection of new capital equipments allocated to the project.. The state received approved phase II budget from APOC but replacement of Vehicle still not done. 4.2.4. Other resources other resources like motorcycles belonging to other programmes in the PHC department, were used during mectizan distribution. 4.2.5. To what extent has the plan been implemented About 85% of the planned activities of the reporting year has been implemented. 4.3. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3.1. Ivermectin delivery mechanisms Mectizan is being delivered through the normal Health centers. Also mectizan is delivered through other PHC activity e.g. routine immunization and distribution of Vitamin A supplementation has been a good means of Mectizan delivery to some LGAs and communities. 4.3.2. Training Targeted training was done in all the LGAs however, few commturities were targeted. Health Staff do give some on the job training during their supervisory roles on other PHC activities e.g. Immunization. This is not fully integrated. At the course of CDTI training, some components of PHC are also discuss. 4.3.3. Joint supervision and monitoring with other programs CDTI activities were also supervised by other health offrcers from within the PHC deparfrnent of the ministry during other health activities. 30 llnrn ra DM a, \r^-,^_L^- ann, SEGTION 5: Strengths, weaknesses, challenges, and opportunities STRENGTHS o Yobe State Government has been financially committed to the Programme The Project has dedicated SOCT members implementing the Programme. The Project has enjoyed tremendous support of the assisting NGDO and NOCP. Their back seat support system to the State is highly appreciated as it makes the Project to take full ownership of the programme right from the onset. Acceptance of Programme by Communities is a success indicator. The project in collaboration with her counterpart parbrer was able to conduct free cataract surgery to people that are cataract blinded (400 eyes were operated). WEAKNESSES . Lack of constant and regular funding from partners o Untimely financial support from APOC management. o Poor supervision by LOCTs at community level due to lack of adequate frrnding. o Unable to meet the dateline for the submission of result and annual report for TCC meeting. CHALLENGES . High ratio of CDD to population o Non participation of female in CDTI activities CHALLENGES ADDRESSED o Continuous health education mobilization. a a a a 3',1 rrITn /l nnn ^, lr^.,^_L^- ann / SEGTION 6: Unique features of the proiecUother matters Dedicated and commlftcd staff at statc level. Gontlnuous support from the government and other partners. Abillty to talntaln the Profcet vchlcle for ovcr the 6 ycarr. This needs urgent replacement for smooth runnlng of the profect. THANK YOU FOR TAKilG YOUR TITE TO READ. 3L IIII^ /A nM a' \I^-,^-L^- ann,