Plateau/Nasarawa CDTI annual project technical report submitted to Technical Consultative Committee (TCC): June to November 2002

9gp 99 gp s d g I gg gg 9g ',fr 9g g 9g g o g g dg p o90fr 90 g gd g g g g g F NATIONAL ONGHOGERGIASIS TASK FORGE, NIGERIA SIX MONTHS TEGHNIGAL REPORT SUBMITTED TO: AFRIGAN PROGRAMME FOR ONGHOGERGAISIS GONTROL (APOG) MARGH 2OO3 rl"\*rt For lnformotiorr 1o, I rrL ,'|,r 1 t g frFiIItfig o oFiI ofr o oFfr ; o frigtfrFg ,Ii ,p t, nfi vFp fi .1 It1, rill 'u fr$ , ,g n , oit t COUNTRYINOTF: NIGERTA PROJ ECT: P LATEAU/NASARAWA Approval year: { 997 Launching year: { 998 Year being reported: (5t*) FIFTH Period being reported: JUNE - NOVEMBERT 2OO2 Prepared on: JANUARY 2OOg NGDO partners (s): THE GARTER GENTER. GRBP F..'. A. '.r -,1 J..L!_r I'o; rltr,r,.l .-:ra. r'f., r:i '\P1 a \ r,,, ' ,r', J l'( f t l'1-, . i' L. r:r \D /:c ,, 9 f, 9 9 ts g p g s s g s g I o g g g g I 99 99 F I g g 0 g I gFggg g gg fr Rg Table of Contents LIST OF ACRONYI\4S FOLLOW UP ON TCC RECOMMENDATIONS SUMMARY SECTION I: BACKGROUND INFORMATION I.I GENERAL INFORMATION 1.1.1 1.1.2 1.2 Description of the project (very brie/ty) Partnership POPULATION AND FIEALTH SYSTEM SECTION 2: IMPLEMENTATION OF CDTI PERIOD OF ACTIVITIES ORDERING, STORAGE AND DELIVERY OF IVERMECTIN ADVOCACY AND SENSITIZATION MOBILIZATION AND I{EALTH EDUCATION OF AT RISK COMMUNITIES COMMUNITIES INVOLVEMENT IN DECISION-MAKING CAPACITY BUILDING Training Equipment and human resources TREATMENTS Treatment Trend of treatment achievementfrom CDTI prolecl incepfion to the current year SUPERVISION Supervision of health personnel achieved Supervision of CDDs and distributions was achieved Quality of records was ensured The results of supervision were utilized 2.1 2.2 2.3 2.4 2.5 2.6 2.6.1 2.6.2 27 2.7.1 2 7.2 2.8 2.8.1 2.8.2 2.8.3 2.8.4 SECTION 3: SUPPORT TO CDTI3.I FINANCIAL CONTRIBUTION OF TI{E PARTNERS AND COMMLINITIES3.2 OTFIER FORMS OF COMMLINITY SUPPORT3.3 COST PER ACTIVITY SECTION 4: SUSTAINABILITY OF CDTI4.1 INTERNAL; INDEPENDENT PARTICIPATORY MONITORING; EVALUATION4.2 COMMTINITYSELF-MONITORING 4,3 SUSTAINABILITY OF PROJECTS: PLAN AND SET TARGETS4.4 INTEGRATION SECTION 5: DISCUSSION, CONCLUSIONS & Rf,COMMENDATIONS APPENDD( I APOC CDDs CDTI DHS GRBP LOCTs MOH NGDO NOCP NOTF PA PHC SOCTs SVE SPC LIST OF ACRONYMS African Programme for Onchocerciasis Control Community Directed Distributors Community Directed Treatment with Ivermectin District Health Supervisors Global 2000 River Blindness Program Local Onchocerciasis Control Team Members Ministry of Health Non Governmental Development Organi zatron National Onchocerciasis Control Programme National Onchocerciasis Task Force Project Administrator Primary Health Care State Onchocerciasis Control Team Members Sentinel Village Evaluation State Project Coordinator u RESPONS TO TCC 13 & 15 COMMENTS ON PLATEAUNA WA PROJECT 1. COST PER PERSON TREATED IN US $ FOR THE YEAR 1998/99 _ 2OOI/2002 * YEAR ENDS 3 1 MAY 2OO3 2. NATURE OF 9 LGAS NEWLY PROPOSED FOR INCLUSION FOR APOC SUPPORT. These LGAs have scattered pockets of hypo-endemic villages and with as few as one (1) to twelve (12) villages that are mesoendemic for onchocerciasis. They have been on Clinic Based treatment (passive) with ivermectin while the mesoendemic foci have been on mass treatment for 7 to 8 years now. These LGAs are also lymphatic filariasis co-endemic and have been on mass combined treatment with Albendazole and Ivermectin for the past 1 or 2 years. We are therefore, withdrawing these 9 LGAs from the Oncho list since they are adequately covered under the Lymphatic Filariasis Elimination Programme henceforth 3. EXPLANATION OF RETREAMENTS This activity was necessary to harmonize treatment period with the "choice time" of the communities. They were treated with a lot of difficulties suffered by the clients/CDDs and supervisors because the Iast treatment was in the peak of the rainy season. We also thought it wise rather than to delay their treatment by six months, they were retreated six months earlier to the date of the next treatment. During the year 200112002 things went quite smooth in these villages when we treated them in the dry season. YEAR E)(PENDITTIRE PERSONS TREATED COST/PERSON IN US$ APOC (A) GRBP (B) TOTAL (A+B = C) (D) (c/D) 199811999 216,348 86,319.41 362,667.41 657,211 055 199912000 94,576 46,322.77 l40,8gg 77 788,939 0i8 200012001 90,829 38,418.90 129,246.90 967,690 0.17 200112002 85,069 54,073.90 139,742.90 917,160 015 2002/2003+ 50,000 45,949.71 95,949.17 ..ON-GOING'' NOT AVAILABLE lll 4. REVISED ATO OF THE 9 LGAs ARE To REMAIN UNDER APOC LIST In the light of #2 above all demographic data in respect of the 9 new LGAs are being reported to the Lymphatic Filariasis Elimination Programme (LFEP) 5. THE IMPACT OF LF/SCHISTO PROJECT ON CDTI The combined treatment for Lymphatic filariasis, Schistosomiasis and Onchocerciasis in Plateaua.{asarawa project has shown synergistic benefits among which are: - Increasing enthusiasm by community members and LGA officials - High level of participation and ownership of the project by LGAs and endemic villages - Improved treatment coverage - Integration of PHC activities and horizontal capacity development of various health workers. 6. ANNUAL TREATMENT SINCE INCEPTION YEAR TARGET V!LLAGES COVERED VILLAGES TOTAL POP. ATO POP. PERSONS TREATED 1992 502 502 335,540 271,909 217,299 1 993 888 809 643,234 514,597 484,175 1 994 960 939 665,747 532,599 449,521 1 995 960 951 675,204 540,1 63 536,427 1 996 960 960 735,460 650,000 564,731 1997 960 960 7gg,g01 650,000 699,254 1 998 885 885 876,250 685,000 653,909 1 999 885 885 915,993 700,600 657,211 2000 885 885 986,174 699,960 788,939 2001 885 885 937,572 711,030 761,690 2002 885 832 1,146,450 1,103,763 917J60 lv 7. REPORT ON SPECIAL ADVOCACY WORKSHOP/RETIREMENT OF FUNDS This was sent to APOC Headquarters through NOCP Nigeria, immediately after the workshop by Dr. K. Korve. 8. INTENSTFY ADVOCACY FOR STATE/LGA COUNTERPART FUNDS RELEASE. Several advocacy visits were made to remind the States/LGAs communities to contribute their counterpart funds as per their budgets/agreements but were met with a constant problem, because most' funds went to security maintenance as the two States had a long period of unrest during the year 200112002 However the communities still supported CDTI with N411,822.00 in 2OO2 as against N517,392.00 in 2001 9. EVIDENCE OF INTEGRATION WITII CDTI: o CDDs are involved in other programmes - LF/Schisto, EPI activities o APOC vehicles/equipment are occasionally made available to other sister project and similarly other projects do augment CDTI activities at peak time or during brief breakdown etc. o Monitoring & Evaluation officers work hand in hand with oncho field staff (LOCTs/DHS/FIFS) on collection of field summaries and census up dating. Oncho field staff are also involved in EPI/LF & Schisto activities. Other health staff at the community level helps with health education and mobilization for CDTI during anti-natal visits/clinic sessions. v EXCECUTIVE SUMMARY The implementation of CDTI in PlateauA.lasarawa States started when APOC's letter of agreement was signed in April 1998 The CDTI project in the fifth year still maintained the old 12 LGAs initially approved by APOC (Plateau: Bassa, Bokkos, Jos East, Kanke and, Pankshin. In Nasarawa state' Akwanga, Karu, Kokona, Lafra, Nas/Eggon, Toto and Wamba) with a total of 885 mesoendemic villages Activities carried out in the six months under review are * Advocacy visits to LGA chairmen and community leaders * Mobilization and Health education * Mectizan distribution * Monitoring and Supervision, submission of treatment reports and drug balances. * Training The project in the first six- months of the year treated 404,593 persons (39.3%). A total of 340 villages completed treatment from June to November 2002 Also, the project received 1,635,330 tablets of Mectizan from Global 2000, The Carter Center Nigeria Jos, and used 1,192,107 tablets in the CDTI villages Training was carried out in only one village on request by the community. Five CDDs were trained at that training by Health facility staff in Jos East LGA of Plateau State, while Nasarawa state trained 100 HFS on CSI\{/SHM. The project intends to conduct more training in the second six month of the year, however, these trainings will be focused on those joining the programme for the first time. Mobilization was carried out in 340 villages this represent 38.4Yo of our target of 885 villages in the fifth year of CDTI The villages (3a0) showed high level of commitment to the programme by giving incentives to 1990 CDDs amounting to N378,334.00 an average of N3 l7 90 per CDD. Mobilization, health education and advocacy activities in the next six months of the fifth year would be intensified on sustainability effort, ownership and self-monitoring of CDTI. Major constraint during the period was lack of payment of counterpart fund by both the states and Local governments, towards the implementation of CDTI in the states. VI SECTION 1: Background information 1.1 General information 1.1.1 Description of the Project Plateau/I{asarawa states are Iocated in the Middle-Belt of Nigeria and bounded to the South West are Kogi State & Abuja FCT, while to the North and North East are Kaduna and Bauchi states respectively. Benue and Taraba states are to the South and South East respectively. The people of the state are predominantly farmers living in scattered rural settlements with most of the roads leading to such areas mostly un-tarred, rough and sometimes not motorable due to flood and lack of culvert and bridges. Also, the rocky nature of some LGAs has serious impediment to effective transportation. The state enjoys two types of seasons, the raining season, (May - October) and the dry season (Nov. - April). Most treatment/distribution activities in the state are preferably carried out during the dry season when most farmers have less to do in their farms. APOC financial assistance to the state CDTI Project started in April 1998. Presently, the project is in its fifth year (June 2000 - May 2003) of APOC assistance. In the fifth year, the project targeted to treat 911,278 persons in 885 villages (Table 6), to train625 personnel for CDTI activities and to mobilize and carry out health education in 885 villages. Other activities included registration for ivermectin treatment and village participation meeting. During the months of June to November2002, the project's 340 villages (out of 885 villages) were undertaking their 10ft round of treatment. Number of uiUug.s that have treatment summary forrn, at the end of Novernber were 340 and shows that 404,593 persons have been treated out of a total population of 7,049,734 persons. The state ministries of health/LGAs have been supporting the programme, staff salaries are paid and efforts to ensure that counterpart fund for the project is released is being pursued. 1.1.2 Partnership The principal external partners to the project have been APOC, GRBP and MSD. Other partners are, NOCP, PlateauA,lasarawa States, the twelve LGAs, and the 885 Meso-endemic villages. The States are the Implementing agencies and their major roles include Planning, Manpower development, Advocacy, Procurement of IEC materials, Mobilization and health education. APOC/ GRBP provides funding/technical assistance to the project, advocacy to high government functionaries, procurement of ivermectin tablets from MSD and development of Health education materials. Other partners in CDTI are community base organizations e.g. Road transport Workers Union, Churches and women organization e.g. women fellowship (Matan Zumunta), their roles range from transportation of ivermectin to Mobilizationof the people. I 1.2. Population and Health SYstem The plateauA.{asarawa States' project operates within two autonomous states with a combined total landmass of 58,585 square kilometers and an estimated population of 4,449,2.34 persons The two states consist 30 locai government councils (LGCs)/local government council areas (LGCA$ (see *rpl Twelve LGCA5 i,ith ags villages .onriitrt. the CDTI project area. The estimated population ori[ere villages stands at 1,049,734 persons. Plateau and Nasarawa states, which prior to 1997 were one state (Pliteau), have been on mectizan treatment since 1992. The plateauA.{asarawa states health system is structured in such a way that each LGA has five primary healthcare districts usually referred to as referral centers, and is headed by District health ,rp.*irorr. within each district aie health post or centers headed by health facility staff (F{FS) who or.rr.., the activities of certain number of boos within their catchments areas. See Tables 2 &' 3 ' on population of CDTI LGAs 2 -l D9 o b,J EE A'0 o l- D' F} A' o FU o D] (D r? F} D'oa(!(a(t) r N) r+=Er iri CDq! .{=o=iJ a) (D5 s)HO H) o -l o o (D U) F:. Fe oq(D U) Fl o ets pD o 0) o ot o -l (n H C) U) r<c (r) N ory doE+) d9o)Hr-r 6. U) o o (D (D a- d o H € oo (D o3 l+r O) >ir\ t{A5\J o'r.to(DH a E.H)8"o Fl a.(, o U) L (, p0 a CD a. o Fl o(+ E) d o t o. v) o -o l/) N)\o{ LIJ5 t\)\o\)(,5 I oa I.J E. r''. E fy (D NJ -c U) (f) trc (n z ort s 'Ut- -l rn e z V) F c Q(D { D] F} o (}J SECTION 2: Implementation of CDTI 2,1 Period of activities. This report of CDTI implementation is from June 2002 to November 2002 (six Months). (See table 3.) The project in the fifth year targeted to treat 911r,278 persons, trah 625 Personnel for CDTI activities in PlateauAiasarawa and to mobilize and health educate 885 villages. Other activities included registration/census population, community self-monitoring of CDTI and stakeholder meeting. Most of these activities are usually carried out between January and June when farmers are less busy. 2.2 Ordering, storage and delivery of lvermectin Mectizan ordered/ applied for by MOH{ } !vHO{ } LTNTCEF{ } Mectizan delivered by MoH(e) wHo{}rrNrcEF{} Quantity of Ivermectin Required for year 2002 NGDo (o ) NGDo { } Cr Number of ivermectin tablets required for the period reported 2,270,000 Cz Number of ivermectin tablets received by the Project 2,270,000 Cr Number of communities/villages which collected drugs from designated point of collection 885 Villages Mectizan tablets are usually ordered by the NGDO and collected by the state for the twelve LGAs Mectizan requirement is being estimated based on eligible population from the census figures. When mectizan tablets are received by the states, each LGA is informed either by letters or Radio Messages to come and collect their allocations based on their eligible population. 2.3. Advocacy and Sensitization The Project Director, Administrator and the State Coordinators carried out advocacy visit to all the CDTI LGAs. The main focus was on the issue of sustaining CDTI in their LGAs by paying their counterpart fund. Most of the chairmen promised to contribute their quarter by paying counterpart fund when their financial position improves. Directors PHC at State & LGA levels were also sensitized and mobilized to own CDTI as a primary responsibility. The DHS and FIFS were all involved in the mobilization at village and district levels. 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Mobilization and health education of at risk villages The annual objective of the project is to reach and mobilize all the 885 villages through face-to-face discussions with the entire villages e.g. Men and women both old and young. etso Uy the use of Posters, Radio Jingles, Pamphlets and Brochures. The project used brochures, Oncho posters and pamphlets for the purpose of mobilization and Health education. During the 6 months (June -November 2OO2), the project was able to mobilized 340 villages, which represent 38.4o/o of our target in the fifth year. The out come of the mobilization was impressive at the village level, as quite a number of them were aware of their roles and responsibilities in CDTI. A total of 340 provided various incentives to their CDDs. Financially a total of N378,334.00 was provided to 1990 CDDs as incentive with an average of N317.90 per CDD. However, all the LGAs are yet to pay counterpart fund, which is a serious handicap for sustainability. After the Carter Center review meeting in Jos, all counterpart fund due from the State government from 1998 to date was compiled and sent to the government for necessary considerationind action. The project is yet to have a feedback from the governments. 2.5. Involvement of Community in decision-making All the 885 villages are aware of their responsibility in CDTI activities. They now take decision on various issues like selection of CDDs, CDDs incentive, where to collect their drugs, and method of Mectizan distribution. Also decision on how to treat absentees is done by the villages. During the period under review, 100 % of the villages had selected their CDDs, and 340 collected Mectizan from Health post of their choice. See (table 6a and 6b) on community involvement. 9 rl -l F FU 2, X CA 2 X 2X[n Lfc(, FN (r) Fl ED XXc CA aa an n t1 O F v, b.J\o o\ o\(r) -l o\ UJ a(Jf -IO Fl o B \o O s o\ o\ o\ \oo\ \oo\ {! =22 tD5= 3 E'ra<-: oE:i -ao UqB .JD I' tJ\o o\ { UJ @q) -t Fl o DT \! .o o\ o\ o\ o s s !t.)<o oe=_ai 4 --5 = Vr. 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UUl, (.) :,\o s (Jr o\ N) oo N)N A s {lz EIBol> o) 17 *l= t>oloaol{3l> =l{Elm a o o 4 e. o o o{ -t(D(t o O)g f o o o 3 3cf o'a) o? o o- ='o- o o. a. of 3 ID5 ol o o -t 0)o _z: =.oo d od F d 0) tl o o z rrl oa oqo t- p) Xo7fo X F) x A' oa!, I -al-r eH{ (rro(o o(Jl (o(o @(rl \lN 5\ (o(o Jo N) -lo o) oo J oo s -too s oo s Joo s Joo s Joo s J oo s s sq =9t32XGI I tr5oi= -J ai#5 E-\-ltV1 Oro @ O)(o \o \l(o O)(, 5(n oo (o.l -loID @ Ps o J I \l 9) \,1 (o N(o @ :.t(rl (o !n! @ 9) @ (o 90 N) s ooo ^o 3irig 3 zo=.tr tr+ra- --.aJaA u.Jq;il'B =oq. laB=q -.o5(o o {(rl{ I o(, J !(o N) @(o (, !! !@ NN J N) @o Q< #* N(.t N) N N { s (,l oilg=\J 0)U,6' {oo -Ao(, .A @ N(o .l o) @s JoN N)\l O) N) @ J o qr_ z c =ETo .t o{r og o o No N) N) l9 s s (rl J -{o 9r_ N(, s No s I N) s sn(rl s P(, s s,o s I(o s s ao =.3 =JZo== aroog$i !/o H8 a a F cr -lo o z E oq oco tr A) ;l D' 7ox o X F !o oa A) I o =.o t-o (o J N N J -lo 0) (o J s N G) N) ! s N) ! s N J s b s I(o s s ooo. oo P -r'3:.:.ii:== 3 *== 5 =t o =qe P =6'9 *+5 Ssi -.Jrr. J-J_GI 'D A' =Gl { J N) G) Cr) (, G) N o0) I., @ @ s J J No }.J !J }. N) s s,o A io s oo =odr =f; +I =H 8 ==Ei 3 aq E 5.1 e' E."$o (,(, o (, o () o (, o (rlo (rlo (rlo (rlo BE-tIA (, o \,1 O) ! N)o s (o (rt -{o 0) s,Ns P\l s PN s N(, s !n J s N J s Sr) N) s J \.l s s ouO- +a=oo5 -=Er € 8.qO.+O +d: ; ,X-Eli5r =.*{O^5sE o -:-. 5 =GI 2.6, Capacitybuilding: 2.6.1 Training Training strategy in the fifth year will be focused and targeted. Only those that will be involved in the program for the first time would be trained. The project-training objective for the fifth year rs 625 personnel. The trainings are necessary because of the frequent transfers of health staff and high CDDs attrition rates. A total of 33 5 persons for Plateau and 290 for Nasarawa State. See table 7 for breakdown, Within the period under review, the project trained 5 new CDDs in a village in Plateau State and 100 FIFS on CSNI/SHM in Nasarawa State. See table. 7 More trainings are expected to commence within the next six months of the fifth year (December to May 2003,) when the remaining villages will be ready to commence Mectizan treatment and distribution. Health education materials and training materials had already been acquired they included: The content of the training was quite explicit and easy to understand. CDDs were trained on the cause of the disease, signs and symptoms, drug administration using height, exclusion criteria and the management of side reactions. Target for training could not be met because more trainings are expected in the second six months of the fifth year (December to May 2003). 2,6.2 Equipment and human resources. In addition to the Office equipments, vehicle and Motorcycles provided by APOC, The Carter Center - GRBP/LF programme also provided seven Motorcycles and twenty-seven bicycles for supervision to the project. However, some Motorcycles provided initially by APOC in the first year have broken down and need replacement. (See table 8). Capital equipment and vehicles usage is to be properly integrated within the health system such that maintenance can be done within the Ministry of health's budget. Also motorcycles provided to the LGAs are to be maintained by the LGAs with their counterpart funds. See table 8 for Capital equipments within the Project. Both the state and LGAs have adequate trained and experienced staff in the programme. At the state level, there are 8 SOCTs and 2Data clerks assigned for CDTI programme only, while in each of the 12 LGAs, there are 35 Primary Health care staffs trained for CDTI activities which are integrated with other health related activities. Some have been in the programme for more than six years. However some of them are frequently transferred to none Onchocerciasis endemic LGAs. The Project intended to reduce this by training all health facility staff on CDTI and to introduce the CDTI programme in the curriculum of Schools of Health TechnologyAlursing in the two states. t2 EE oXX o V) Ed aa U O o F o O Ft oFl F >d z X2 'li2 X z X E1 o U) FJ a -l N N) tJ N N) EFJc Gz rg9 EP(,+ s a (D o E(! c O ItlJ!t Ete z o o F.l l, .:6 ="ioa F a 0 0 tt *s o O UI O r:rl atr I Gz or9c o qF \oo\ a (! o o Itl oi !r+3 EDT z g(! 0O "+* lir 6 .! .\c i!' o oos o O (^ Lar (Jr Lar ;d Fl\o .tbJUI Lrr O O a1 Z odo o O EFcl? \oo\ .) (! t! (! O al Yo' El !) z E (! o o G Fl oFt a It (Ds a Lar e>ta\.)UIo (,O (j (rr (-,t Qz eJlt) Ulr EE 'f iDc)? s (,) o a! (! tr o O O t?, t!, ED 5 z (t(!rt o o E'ta t9 tD N\o Ur O Ut -F ad d F' r.l !] G J rt D9 -| G Frt oE F| o o 0 oLt o L,irl - EJ o F| A'Fl. o lJ { m UFA' { A) d Ho o z Hgq 0eo - OJ Xox o FO X D) ,f FO qs .) '^) -. .\.igz G, \OQ. o- o\ ^P -65tJ o\ o\ o\ o\ O O €e o\ o\ o\ ;d ae.tJ5 o\ o\ x:l3$3ilE z o o '-l U -:a ='H(!.)a<F o o O t,tJ5 o\ O o\ (.)(,l L'I Ur ^l -6 O arv< Ur EFN tj O\E +x zt o o ;i Ae o.lat! tD oO O F9 b.J b.J N.)(^ h.J(JI NJ ^Pe= -6 tJ(JI tJ t.) pUr tJ(Jl ].J ez 9{-IUt l.J O OO ].J t.) NJ N) o:i a l)t fD olrI(! l0 Gt! 0ea 1l EI o (! Fl o F.l0 DI (! 00 oo Ut tJ\o u)@5 ootJ l.J -Io\ NJ@ ^Di'f{r6-I€ o\ 5 5 iz e{qJ5 o O t.J -l -IN) N) -.1l.J NJ -) -I {r+\o\oo\ z EI(' o o o U 0 D' E tD l..J\o 0|o N) l.J -lo\ t.J oo 5Fl +3 Ul \o(r) o\ 5 t/J NJ \o oo { o\ 5 u) N) ez o o o A) o ,l qL o o F] q (/) A) Fo Fo = 0ao 0) o -to oE o (D P(u q o oo (Dt ID o o 'P 'U og o o ,U o o o a! o () o ? o o o o o o HB Itl? = I I I I I NJ Lrr ta1 !l :E o O o -HstoH I I I I I I I I I I I I I lrztroIr i, o E \o o\ I I N) I I I I O ll fl, E o D o bJ I I I I I I I I I I I I I 4zEO tr 19 (f,) oo I I I I I I a1 o DT z I I I I I I I I I I I 4Ztro 19 I I I I I I I I I I I I I E o t9 oFl F' t) I I I I I I I I I I I I I I ,-1 zEO D \o @ N) (,) El tr E -l -lPF I I I I I I I I I I I I I 4ry o E 19 I'E b,.)l!elFl hJ IE'l>rE€I'f =.lP rElr'l FrlFr 5o Fl! A, L D9 Et ooo ioo(r) -.1 A) or a E] o or{r 5 I I I I I I t I I I I I I lz t>ta t>F { 0 H € Ef Ur o\ 5 UJ l..J O \o oa ! o\ 5 uJ NJ a z o (! o A) - (D r.l led o o 0) o a 9)(, No 0) 'lo o o .D P @ a o Q.)o o A' o o -l oI o oI >Ut o o o tr o ID o c, o ? o () o o o o -dl!7r. I I I I I UJ a1 c o t9 I I I I I I I I o\ 5 ll a1 zEOt, It o as :E oo \o N) I I I (r.) ll rrj tr E !1 I I I I I I I t I o\ 5 I 4t2 Ett o ED b.) (Jt \o I I I I I I I at EIt oIt!r I I I I I I I I I I I I 4Ztro !9 ?t o I I I I t I I I t I El It 19 I I I I I I I I I I I 4ZtroIr t, oI !9 o H trlFtt) \o o\ (j) Etr lrp I I I I t I I I I I I I o\ 5 I 41 ry Ac oItD Fl -.1 F a o eFot! I I I I I I I I I I I I I I 2.7. Treatment 2.7.1 Treatment figures Coverage 39.3% 38 4% 1,029,734 971,278 persons 404,593 persons 885 340 (See table 9 for details) The PlateauA.{asarawa State CDTI project was able to achieve the following during the first six months of the fifth year thus:- 2.7.2 Comment on coverage period falls between Decembers to May 2003 farmers are exhausted after coming back from their farms and therefore, they prefer to be treated at home either in the mornings or afternoon. that completed treatment to ensure that they are treated. 2.7.3 Trend of treatment achievements (See table 10) l6 Fj ot-l F !e ,fa X o) ,f(D t-r (/, rn Fia ED 7f ,f o V) F0aa S9 Lld>i. -< hJ\o o\ o\(}) -t o\(,) 00UJ -J ^l E-r H +gE E gH 3€ F-+6'! @ S.o(u-hl- o b,J\o o\ o\ UJ -) o\(JJ m(,) -t a-l .6"i f(aE.Ee5E7'o F'de- oN) t.) o\ t\)5 \o o\ -I 8- c'<EfA;Xa *E.E H. o. o ='-At.Ag+ o(,) 5 !r, Ut s Q @ s 1...) :c5 o\ (}J ;- o\ -t(,) 5 s NJi N) s ooo(D ^ra.ASE 8E oa r5CDi' o :\ O {rl IF (/) hJ(,J t.)(,(,) @ N) Ur -l NJpo rj -)(, 5 9o\o -T\o 00 ,N o\ -.I\o oo 5(JJ H i5*$ao5 b,J(/J{ gJc6 j-J N) b.) UJ l.Jj.J 00\o { "ro{@ 9o -)5 j, o\5 Edr ?EE(Dts o (.) o o\ b,J (l) oo @ -) I UJ -t 5 5 o\5 5N\o N.) o\ 9os\o oo o ax { =r5id?drE q 6 o o\ (,r(,t\o o\ o\I\] -o6\ .NJ s UJ co s -.t i.r s UJ UJ 'tJ s a) 'l -<-(DxE 5'ts oa(a(Dt o H{8d * (.){5 N) u) mt9 |..J -l (JI trJ il-*rFB5niiii.3(a(D0xiD :r5 xe E-q UI6 N.J N.J t\) t\) (j) N) oo oo tJ N) N) 5 m BzE"E B.E' {56 (j) UJo\ 5Oo N) -t UJ o\ H eE f,B * ? z F z t- z t- z t- z t- z - z )6 ot o()t o o r5 e a $6 o B. EgAFgfi =,.+-v (D E va t.J o{ Hrl o D?Fl.IIJ(D IJFl. b.J -I -.1 Ft (D DT F| tr o Fl\ ET 0q :t (D(a rd F r.l trl F.l t, r! P Ft (! E' (! A' 0 o G e O F o e tr G I z (! Eg t! hJ !.J --l lz t>la t> IF IF -l EEF tr, P Fl (D D) (! 19t, 0 (D(! e r!'a O c 0 a F o n o I z (! Grt NJ bJ F o " H rE - a: *i+r=E 3UB E.g "H E; ., o 5 3.ol(D- o 93> H3E ='o D;E- o BFE+ " E.q o c_ o x P. $) ^Rrsx: (!a o 6 +!iE lt ==t-Y r s g!e ia o 3r> 3tsE ='(! !e o z+'rf Ets9e ts q 6 A -J o!oo \co Dc-IrEvD 6ME $-t*sf, o-l 3BE(t 9o aE.A -*7 E i E g* ,o&B-i, i, Z, x,g,BB5$:g !D5FD €tr€ffJs€E uJS(,),50loUJ -tC,UtUrC+o. s i.r bo 'oo Lrr $ 1O 10 qO qO 1O yO 6\ o\ o\ o\ o\ o\ o\, J\r\):1-o\ i, \: = 'N "N.l >.r1' +', & ; ^ U:our=;ur lr}), ul uJ NJ' 5 -l{ uJ co, \o o -l Ut -l NJ 9t, (Jl \c zzzzzzzz =-rN)uJN)5tJ-i C I' NJ o\, ur, s(,r{O-l -l(,.}, N)I Oa I do D) (j) -t, oo(Jr ;J 00 0|o -J (JJ bo t, Ur 00 NJ Ut I T (JJ i.J 5 o\ UJoo lrJ9(.) s I I @N) z zz N) N.J -1tJ o\tJ o\ co\oi t.) 5 -t -oo oo -l O UJ f.J tj N) : \o 5(JJ 5 o\ o\ b,Jg\ a\o f,.) -I(.) \oa N.J -ut tJ ". (}J L,T -o. -I5 \o 5(JJ (JJ(, \o (^)i ,t qq e8 oo; o\ o\ -to\o .F oo, 0|o 11, L^;i J., Y' oo5r ur IQ UJUJr {\)' o\OUJoo oo ..JI 5{'] te 'oo 'oo{o Ul ziz"zz .1....., Y Lr -! "1, \NJ' ! o\' Eg$crEi oo N) b.J b,J (.j * r+ b.J hJ N tJ }J \o\o\o hJ \o\oa \o\o\o o D9rt 0|o oo @ @ 00 € tJl 0|o oo m@ o(D +95x= ga idl3E+ HEE - oo @ @ 0a oo 00 00 00 co oo NJ sH'> EB= ,'5 Bde- 0lo@(Jl 00@9l 6@9r -]], oZO ryig=-rqatrHg?-)_ cE.Eo;+ E.t* (,) oo@Ul 0lo@ Ut 1O \o o\ s 1Oo\ 8PE€A) a,iq3E -o C)o\ D) (, * OO o\ O o\ O \e O rO ^\ O o\ o -? >x$ d oa(D oo E t Fl t!(o D' xaoa -,-) f.J -lo\5 rH g$-Bt \o\)F o\o co u)5 5 -l -T @\o5 (, "|.J m)o6 UJ \o 1..) -J 00 u) (j) 00 -l I N) 6 UJ o\ o\ oo -I ga> EeE .iZ- -ljo o\ -t@ \o5(.) "co \o -) -t j-J @ m m UJ "u, O o\ j.J tJ 'I@ a! Z sg"E iD Y ,do.a| q u) 90\o s @ UJ 'N) s oo 't) s o\5 o\ s 5 !c -I\o^\ 8+<J(D.D pr a) oa 'd(D(D :/^ o *@ 'lo\ l+ 5 O. s \o 't, s \oi\o s @ i.J 't, s \o o\ s o -? >x$ 3 oa(D oo { * I o A) o tr l:gF l>ta IF'l> tz l>ta t>IF t>l{ t> t.J -l b.J drt o tr oHf -|rt G A' F| o Fl. D)(.) o tD o J F| l{rF! o J o -\J -l E no o .)Fi ao FI o tr .;o C} ID .) rt rt o EFl o A'Et -l D' tD iEt o E9 o DT D) oo F| o o .)p tD D)Fl :l IC * 2 rrj rl z o ln CD rnF tJO tJ \o oE! o -lo te \J (D o o (D o r+ a'zi1 o JaaEE tr5qo UC:,xo i30 o q {o CO -lo A) N) lt (,) o .t+ O 3'7 {E =aG E' E' 't ^ ='aE'i Ed'* a o(!EE slEl E=1:E'_E 8 qi5* ,, t.Fxoe rl o a.| s 5 il (]) ,F z ,tr =Ea9 o2-EBA EEEi.< = d99.28 a!< a;= -- a, a 0[B O ru ord uiii o qz *Q =oi X=ogo.(D s -llt o\ +{ a r! F' (! oo do(D (D o0 \o Fo :n 0 q fu o E) t!l)(! lrE IE Ittl l3 B IF ri A' o )r oo (D o {o tD !, o'rl F9 o rt' o (D (r)o .: o o(r, Q')lr z EE tr o'Ft g, o a oEt D] oq tD Frr{o o DT - oFt reEt o L (n p(o o D'(o(o rl o D) o a o o o oa o Errrt o E?o NJ 2.8. Supervision 2.8.1 Health Staff: LGA Level The plateauA'{asarawa CDTI project is so designed that at each level there are experienced staff to carry out supervision. At the state level, the SOCTs supervise the activities of the LOCTs while the LOCTs supervise those of the DHS and FIFS. Atl the LOCTs are provided with Motorcycles to facilitate supervision. Community Level The DHS are assigned Five PHC centers, which serve as collection centers for Mectizan and these collection centers are headed by FIFS who supervises the activity of the CDDs. During supervision Community registers are checked to ensure proper recording, drugs are checked to ensure that they are adequate, also questions are asked about CDDs incentives. 2.8.2 CDDs Each CDD collects Mectizan from a Health facility of his choice after Community registers must have been updated. Eligible population multiplied by three estimates total Mectizan required. Each CDD has community register where information on households are entered. Community leaders/flealth Committee members monitor/supervise the CDDs on daily basis. 2.8.3 With close supervision at each level records were properly kept and mistakes were avoided. Results of supervision are used in addressing problem areas to prevent future occurrences. 2t ->'- )> ^pl-1 (, i-, Q |-!o O) o -l (n al a. o o (D @ U) H o - (/) -l t-{ oo zvczUCCU]J \J PU) 9a) og oo Fl\Ft EtFl\oEt @ O o\\o o\ @ u @ bo NJ @ (.,l O z - @ oo 90 oo i o D9 CwAE s1 0- -oq(D oa @\o "oo N) oo @ (, oo bo N) @ (J.) o\ '(r) o\ @(]) oo s oo boO @ (g)J u.)9(, o\ -l o ^D Aoa= -L;t, oo o D' qJ o z !e a Nooo b,.) o q oo Lh (.ll \o oo N) @ oo z H @ O\o 'o )''l o D' EEEV)Eao- -oo(D (Da a N) :c\) o\ @ oo(.,t o\\o @ NJ \o\ o\ @ oo oo NJ g UhF \) UJ \oo z rr o E' 5 qr o o ?r- D b,.) o t..Joo\.J Fl o ^1, @d@= Dtu(D @ o\ u) "o. N) Ur @ Lh -I@ .O {t @ { LIJ :c(, g) 5)o(j N)\o 5 oo 94{ u)\o 't) o Fl o DT Coat Y9 0- -oeo oa @ Lh @(j -)00 .^ z ri @ N) N) \os :, zr rlo ^F ad cE' t, oa o F] t,l !:r (D o zt- D No \,J b.J e(, H I:E!e lFgl> tl lr,i - lta,r'J l>tcl\tzl>la5lLJ1,,Jr)l>Et{E' t> ; E' o a o tT (.r) X 7A o (r) l-{ o I zo 3 NJ NJ 19tr .: o0 o' o DTO (,J NJ l.J IFU IE Ilrjl> t; IF El> B o !+ o oa F} FU tDrt f) F}rl -l F a- o o cDo at) q) + (D pD A) o op) Fe r+ oFt (Dt) (D r.t o) o + o -1 0a ot o -J p0 o o cn O 'o(D ? U) o o U U(a F0 o. U' r-t d o -lF..l F) 0a o>i o F) r+ t/) a) +g, + FD o (D (A -l r_1p, 0a o ts+) o U V) 7 od Npo o o) o- (D F o a- o F) o !J o+) oo (D CA CJt.l HL5dq =o- =o o zo -lFfj a FoFt (D o) o c)(D r-l 0o C)o (D o IJ o ot g9 b,J UI (J) g @(,5 Ul N) g\o UJ(j i7. g9Fs N)9 u)(^ eN A :J @(,.) z g N@9tI\o(Jr z F'(t lr5 ra o .)o ar, e a I o t.tF EE I r.d oo F Ed ts oo oF Ud FO ts C) oF EU FU ts o oF td FU E oo Ed ts o oF EU ts oo oF Ed FU 0o rt .) CD u) o oe l.J SECTION 3: Support to CDTI. 3.1 Financial contributions of the partners and communities. During the period under review and the past years, Support to CDTI by APOC and GRBP has been quite satisfactory. But the State and LGAs are yet to release their counterpart fund due to lack of fund. In Plateau State, a memo of 2.5 million was sent to the Governor for approval but this is yet to be done, while in Nasarawa state government has taken steps to deduct at source counterpart fund for LGA. A total sum of N378,334.00 was contributed by 340 communities to support 1990 CDDs in the twelve CDTI LGAs. (See table 12) The projects need strong advocacy to the governors of the two States by NOCP and GRBP for the State to release its counterpart fund to the Project. 3.2. In both States most of the incentive for CDDs are in Cash except for some communities who during the distribution period provided food and some drinks to CDDs. 3.3. See Table 13 24 d oFl F FU z, X(r) z X z, x rd o0 tn C,) -l EUcXXcC' w (n(r) U O rt a F o b,J\o o\ o\(, { o\(, oo(J) \) Ito(!5 <E' 'r!!B .! aD, E *+I Fo =.q8 -?aa DE0G z -F z l- z H z ts zr zrr o\z5.o &q e3L= aD= rr= =.! =.a3.r 0e UI u) N) LP (JJ s ?z roErraa) g3H ='P. Eoe 6 :i' ZO FF -tD, rd -l!' o'tErEio F} cE o og =GI o o 3tr = o c.? 3 o = o -t =GI 16 EDa FJ< o o a c) .Dr CD oq o c) (D (D o o z a F 4 F NJ -l c -.1 F D) C' F) -lo o z E re oco F te tD X o x-o F0 XgeFt ,r{ A) oq Fe a a F o UI €\o oo(Jl \o\o oo(Jr {N) s{ \o\o ON) EoOE <El ; Ei. !,; (s E i:ltI Fo E.B -?r4 aG I t I I I I I I \zf.o&q E9 (!5 =.! =.09ii ... D] 0a (J) bJ I l I {N) 5\) \o\o ON) Qz cotrir .)a g3E E'P EIQ6:T =(! *s -l D) SECTION 4: Sustainability of CDTI 4.1. Monitoring and Evaluation The project is making steady progress toward sustainability. This is indicated by the commitment of various communities e.g. provision of incentive to CDDs, collection of Mectizan from collection point of their choice and selection of CDDs. The evaluation of the Project in the fifth year to determine it sustainability is yet to commence. 4.2. Communityself-monitoring Most villages are yet to carryout community self-monitoring of their programme, however community members especially village development chairmen and village heads do supervision on regular basis. Stakeholders meeting were held in 15 PHC district with the hope that each village will hold their own stakeholders meeting. The attendance at such meeting was quite encouraging. 4.3. Project sustainability The plateau CDTI project is in its final year and plans are in top gear to insure that the programme will continue after APOC funds cease. These plans include high-level advocacy by the NGDO and NOCP to persuade the government to release fund for programme activities at both state and LGA levels to this end a meeting was schedule with LGA chairmen by the Commissioner Ministry for Local government and chieftaincy affairs on how to get counterpart fund deducted from source. 4.4. Integration The CDTI programme is fully integrated in the health structure of the state ministry of health and that of the Local government. This is evidenced by the fact that all staff involved in the Programme combine other activities with CDTI e.g. immunizatron and treatment of minor diseases, and provision in the health budget are made but not released due to lack of funds. 26 SECTION 5: STRENGTH, WEAKNESS AND CONSTRAINTS. 5.1. Strengths The CDTI activities in Plateau/Ilasarawa state wishes to observe the following strengths of the project during the fifth year of its activities:- workplan. despite the strike action and lack of payment, of salaries for months by their LGAs. improve supervision. 5.2. Weakness / Constraints month facility staffat the LGA level. posed a serious treat to CDTI sustainability in the state. 5.3. Assistance Needed a. State Government/LGAs LGAs. makers and governors of the states to press for the release of counterpart fund in the years ahead. b. NOTF/APOC Management NOTF Zonal Office. c. Conclusion/Future Plans:- 27 ?C ?. o TI T F -t mb (] Lry :-! CO Iri rn a a]i f: i) N I 1) o = o at o o5q o 3. o 0og Ct o o 3 @ tr1 o TDgl lz lat 17lr l0 l:cl> l-.1 ;.Ulz -,la -) w, a.t'l\l l=t\- l= li-" ,-r\ ! ld lJ :. l'tr 'l-FZr=TIT ,='r=.alF4 =2tZz=. ItJC}=IL z= I !(!tJ-lZ l).C'?T\ = t -: , |il ==l>--- t-l:|r' ElF1-\\JV'aF 'g tr- { m o =c \,,J O J](J rFtJJ ,,,t' (:I' ilI ,ll l I I ,lJ. 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