NGNIG4 annual project technical report submitted to Technical Consultative Committee (TCC): from March 2004 to February 2005

-'l I I I YEAR FIVE AA{NAAL TECHNICAL REPORT ON THE C OM M (TNI TY DI RE C TE D TREATM E NT WI TH IVE RM E C TI N ANNUAL PROJECT TECIINICAL REPORT SUBMITTED TO TECHNICALCoNSULTATIyECoMMITTEE(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 ONCHOCERCTASTS CONTROL (APOC) I I 2 6 rurt. zoos OzuGINAL :English Proiect Name: NGNIG4CountrvAtoTF: Nigeria Launching vear: 2000Approval vear: 1999 : March 2OO4 To: FebruarY' 2005 -{Monllr/Yeer) ( Month/Yea on")r234(5)678910 NGDO nartner: UNICEFDate submittedl 1510712O05 For TA AL 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( Si ZonalOncho Coordinator Nam.$L YF-..*.Yo.nzt t . Signature: Date: .\k.= 96'-2fr9.9... \_ NGDO Representative Name: .U".. C=11*-"**' ("*"-' Signature; ' '@' ''-*s Date: .p+{:1. . .$.:.y,s. . .4sps- This report has been prepared by Name : Hajiya Rakiya .Y. Datti Designation : State coordinator. Date 3110512405. ii Table of contents ACROI\IYMS................ V.VI DEFIMTIONS Vtr FOLLOW UP ON TCC RECOMMENDATIONS EXECUTIVE SUMMARY .................5 SECTION 1: BACKcRouNrlrNroRlIATroN........-... """""""""""6 1.1. 1.1.1 1.1.2. 1.2. GENERAL INFORMATION .......G8 Description of the proiect (briefly)-.- """""" G8 Partnership """' 10-11 PoPULATION .12-14 SECTION 2: IMPLEMENTATION OF CDTI.-. """"""15-16 2.1. TIMELINE oF Acr[vrilEs.................. ""' 15-16 2.2. ADvocAcY "'17-20 2.3. M0BILZATION, SENSITZATION AND HEALTH EDUCATION OF AT RISK COMMLJNITIE ..........20-22 2.4. Cotr,orururvINvoLVEMENT """"""""'23-25 2.5. CapacrrvsuILDING...... "'26-29 2-6. Tnslmmvrs.--.....-.......-. "30-31 2.6.1. Treatmentfigwes """""""""' 30-31 2.6.2 What are the causes of absenteeism?....-...--..--- """"""""""i2 2.6.3 What are the reasons for refusals? ...-- """"""' 32 2.6-4 Briefly describe all lmown and verified serious adverse events (SAEI that...------ 32-33 2.6.5. Trend of treotment achievementfrom CDTI project inception to the current year-...--..---..34 2.7. OuDENvG, sroMGEANDDEIf,wRYoFIWRME:uN- ...-..--....""""35-37 2.8. CouuuNttv yELF-MzNITINNG AND STAKEHuI^DERyMEEmNG----- -.--.-'-""""""37-39 2.g. Suprnw$ou. """40 2.g.1. Provide aflow chart ofsupervision hierarchy- """"""""""40 2.g.2. What were the main issues identified dwing supervision?.-.....-..... """"'40 2.g.3. Was a supemision checklist used? -.-.-.....- """"41 2.g.4. ll/hat were the outcomes at each level of CDTI implernentation supervision?............41 2.9.5. Was feedback given to the person or groups superuised? -......."-"""""" 41 2.9.6. How was thefeedback used to improve the overall performance of the project? ....-.-----------.-41 SECTION3: SUPPORTTOCDTI- -.*-*42 3.1. EOUIPMENT. -.'...-43 3.2. FINANCULCONTRIBUTTONSOF THE PARTNERS ANDCOMMUNITIES. .........................44 3.3. Onun ronus oF coMMtNITr suPPoRT--...- -------.-....-.-.- 45 14 iii 3.4. SECTION 1: SUSTAINABILITY OF CDTI 4.1. INrnnN.nt; NDEPENDENT PARTICIPATORY MONmORING; EUltUlnON ...........-----.--.47 4.1-l Wrc Monitoring/evaluation carried out during the reporting period? (tick any of the followingwhich sre applieable). """""""""""'47 What were the recommendations?..-....--------.. 47-54 How hove they been implemented? 54-56 4.2. SusmNesILTry oF PRoJECTS: PLAN AND SET TARCETS (MANDATORY AT YR 3).....56 Planning a all relevott levels """"'56 Furds---.-...- 5657 Transport (replacement mdmaintenance)-..-....-. ...."""""""57 Other resources.-.- ."""" 57 To what extent has the plan been implemented.....----.-... """" 57 4.3. INTEGRATIoN -------.-.-57 Ivermectin delivery meclnntisms 57-58 Training...... ...---......."""58 Joint supervision and monitoringwith other programs -.-.....'58 Releose offwdsfor proiect activities -......-..-.....'58 Is CDTI included in the PHC budget? ...... ......-.-.58 Describe other healthprogrammes thot are using the CDTI stnrcture snd how this was 47 4.1-2- 4.1.3. 4.2.1. 4-2.2. 4.2.3 4.2.4. 4.2.5. 4.3.1. 4.3.2. 4.3.3. 4.3.4. 4.3.5. 4.3-6. achieved. What hove been the achievements?..---......-.. """'58 4.3.7. Describe others issues considered in the integrotion of CDTI..--- ......-.-...59 4.4. OpsRenoNatRESEARCH.. ........59 4.4.1. Swnmorize in not more thqn one half of a page the operational research undertaken in the project meawithin the reportingperiod. ....-.......-.-...-.-.-59 4.4.2. How were tlrc results applied in the proiect? .....-59 SECTTON 5: STRENGTHS, WEAN {ESSES, CHALLENGES, AIID OPPORTIINITIES .--.---59-62 SECTION 6: UFiIQIIE IiEATIIRES OF THE PR(UECT/OTHER MATTERS .6243 iv IAcronyms APOC African Programme for Onchocerciasis Control ATO Annual Treafinent Objective ATrO Annual Training Objective CBO Community-Based Organization CBS Community Based SuPervisor CDD Community-Directed Distributor CDn Community-DirectedTreatmentwithlvermectin CSM Community Self-Monitoring DHS District Health SuPervisor DPM Director Personnel Management DPHC Director Primary Health Care GTZIPHC German Technical Agency For PHC HSAM Health Educatioq sensitizatioq Advocacy, Mobilization KAP Knowledge Attitude and Practice LGA Local GovernmentArea LOCT Local Onchocerciasis Control Team Members MIS Management Information System MDP Mectizan Donation Programme M&E MonitoringandEvaluation MOH Ministry of Health NIA Not Available NGDO Non-GovernmentalDevelopmentorganization NGO Non-Governmental Organization NIDs National Immunization DaYs NPI National Prograurme on Immunization NOCP NationalOnchocerciasisControlProgramme NOTF National Onchocerciasis Task Force N/R Not Ready Perm. Sec. Permanent Secretary PHC Primary Health Care RBM Roll Back Malaria REMO Rapid Epidemiological Mapping of Onchocerciasis SAE Severe Adverse Event SHM Stakeholders'Meeting T V T SOCPAC State Onchocerciasis Control Programme Advisory Committee SOCT State Onchocerciasis Control Team (The State Programme coordinating team) TBAs Traditional Birth Attendants- TCC Technical Consultative Cornmittee (APOC scientific advisory group) TOT Trainer of Trainers UNICEF United Nations Children's Fund UTG Ultimate Treatrnent Goal WHO WorldHealthorganization T Vi Defmitions (D Total population: the total population living in meso/hyper-endemic communities within-the project area (based on REMO and census taking)' (ii) Eligible poputation: calculated as84o/oof the total population in meso/tryper-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 Treafinent Goal (UTG): calculated as the maximum nurnber 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' year of the project)- (v) Therapeutic covemge: number of people treated in a given year over the total population (this should be expressed as a percentage)- (vi) Geoeraphical coverage: number of communities treated in a given year over the total numbei of meso/hyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage)- (vir) Inteeration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) through CDTI (using the same systems, training, zupervision 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 stong community ownership, using resources mobilised by the community and the government. (ix) Community self-monitoring (CSM): The process by which the communrty is empowered to oversee and monitor the performance of CDTI (or any community- based health intervention programme), wittr a view to ensuring that the programme is being executed in the way intended. It encourages the community to take full responsibility of ivermectin distibution and make appropriate modifications when necessary. vii FOLLOW t]P ON TCC RECOMMEI\IDATIONS Using the table below, fill in the reoommendations of the last TCC on the project and dessribe how they have been addressed. TCC session 18 Numbe rof Recom mendat lons tn the Reoort TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROTECT FOR TCAAPOC MGT USE ONLY 173(i) Efforts to obtain State and local government commitnent to the project be intensified, to ensure the release of counterpart firnding. In response to TCC 17&18 recommendation, a resolution was made by the ministry of health, that would facilitate release of approved funds by request for piecemeal release from the ministry of finance. It was recommended that the issue of US$36,765 approved by the State since year 2001 be first of all revisited, and the option of request for an initial US$l1,029 out of the whole sum be pursued i.e.,as an altemative to bulk request which could be reason for non release of the said funds. A memo was then resubmitted accordingly and fortunately, release of US$7,353 was effected during the advocacy visit by the CDTI sustainability evaluation team to the State ministry of finance. The SOCT made advocacy visits to all2l LGAs in order to mobilize the newly appointed policy makers for support to the Oncho. programme. In spite of the good political will of the leaders, the system of financial confol instituted by the State government made very meager amounts of money available to them, therefore they could hardly give the necessary financial assistance. I WHO/APOC, 24 November 2004 Furthermore, as a follow up on the request for financial support to the project a state-level SHM was held in December,2004 for the purpose of debriefing the LGA policy makers on the weaknesses identified by the sustainability evaluation exercise principal of which was funding. A major outcome of that meeting was expression of deep concern and a resolve to ensure sustainability of CDTI through adequate funding. Meanwhile, efforts are being intensified to obtain a mandate from the LGA chairmen in order to deduct at least US$1,900 from source (i.e. beginning January, 2005) when hopefully the constaint on their funding would have been lessened. 173(iD UMCEF should ensure prompt release of APOC funds as and when due This time around, UMCEF was very supportive. The bottle-neck encountered however was at the level of the State and NOCP. (iii) Community education be intensified to enable the participation of women in the project There are ongoing radio jingles for HSAM all over the State and women groups, especially those in the participating rural communities are being sensitized especially through radio.The response is yet slow in about 40% ofthe project area because it is a religiouVsocio-cultural problem which is not peculiar to Niger state alone, but a common feafure in most northern states ofNigeria. Efforts will however continue to be intensified to sensitize and mobilize women for full participation. (iv) Picture charts be made available for use by illiterate CDDs. Picture charts have been in use since year 2002, and are very abundant, they will continue to be distributed for use by the illiterate CDDs 2 WHOiAP@, 24 Novembr2ffi4 (v) Number of CDDs be increased in the face of attrition and large land mass Communities are continuosly being mobilized to select CDDs along kinship lines as well as at ward level. In areas where CDDs are not selected along kindred lines, and have to be paid incentives, the communities are hesitant to add new ones since they vest more trust in the ones already on ground because they are committed and also for the fact that they cannot bear the cost of paying of additional incentives which would k the case if new CDDs ane selected. On the other hand, the old ones feel threatened by addition of new ones because they believe that their income would reduce if the same arnount previously available is distributed among them all, thus the issue is quite complicated. While the number of CDDs increased for the year under report over that of 2003, the ratio of CDD to population is still at about 2:470, as opposed to the 2:250 ratio recommended by APOC. Haven said that, it is pertinent to note that CDD retention is extremely high in this project (as confirmed also in the sustainability evaluation report of year 2004). Most CDDs have been on ground for over 5 -7 years and several have expressed the wish to continue to seroe their community voluntarily, even in the absence of incentives! The mobilization of communities will however be continued in order to ensure that there is adequate number of CDDs for sustainability. (vt) CSM be up scaled and SHM introduced in this Effort is being made to ensure that CSM urd SHM are being up scaled. In this direction, CSM 3 WHO/AFOC, 24 November 2004 very mature project. was a major topic on the agenda for Argeted training for capacity building/strengthening of CDTI supervisors in 7 old treatrnent LGAs as well as the four newly added LGAs.The feedback for CSM is however poor, and in order to ensure sustainability, the two related activities are integrated within the post-APOC CDTI plans that have already been written by the state and 21 participating LGAs. (vii) Residual distibution data be collected as soon as possible to allow for accurate coverage data and accounting for remaining Ivermectin tablets. Residual distribution data was collected and the project recorded 65% therapeutic and 85% geographic coverage for year 2003 i.e.in the face of expansion to 4 newly added LGAs. Outstanding Ivermectin was also accurately accounted for. (viii) Subsequent reports must be appropriately endorsed. Noted. The final report was endorsed and submitted through NOCP in January 2004, nevertheless, another endorsed report has been submitted- (Please add more rows if necessary) 4 WHO/APOC,24NovemberZ0$4 Executive Summary Niger state has 25 administative divisions known as Local Government Areas (LGAS), out of which 2l xe approved for implementation of CDTI. The projected population for the state is 3.2 million bas€d on the 1991 national census. There are 2,552 affected communities in the CDTI area with a registered population of 1,543,960 people at risk of infection and blindness from Onchocerciasis. A total of 1,242,726 people were treated n 2,552 endemic communities representing 80olo therapeutic and 100% geographic coverage respectively. With finalization of REMO as well as conduct of census update for the mapped out CDTI areas of the state, the Ultimate Treatnent Goal (UTG) for the project is found to be 1,296,841, therefore UTG coverage was 96Vo. The population in over 40Yo of the project area is hrghly migratory in behavior, and the affected ethnic groups comprise of Gwaris, Kambaris and nomadic Fulanis. Due to the cultural beliefs and practices of the aforementione4 they migrate annually both within and outside the state in search of virgin (fertile) land for growing cash crops such as yarns, guinea corn, maize and millet while the nomadic fulanis migrate in the dry season in search of water and fresh fodder for *reir animals. The above phenomenon is responsible for the highly nucleated and dispersed settlement pattern that features in over 60% of the vast land area of the project. Niger state is the largest of the 36 States in Nigeria occupying l0o/o of the total land area. 6,474 CDDs were fained out of an ATIO of 12,923, representing 50olo achievement, while 295 personnel were trained and retrained for ensuring increased crtpcity for supervision of CDTI in 7 old implementation LGAs with newly added communities that arose from the REMO update/finalizrtion of December 2003, as well as in 4 newly approved LGAS, representing 9 l%o cov erage of Atro The challenge the project experienced within the period of report was achieving its' ATO of 1,296,841 people in spite of poor funding at state and LGA level. The system of financial conEol instituted by the state government severely affected release of funds to the LGAs. The approved budget from AFOC was not received until June 2004, while there was delay in submission of proposals to the NOCP zonal offrce, by the state, as a result of bureaucratic boulenecks. Furthermore,64Vo of proposals submitted for approval by the NOCP zonal office in August were not forwarded to UMCEF until end of December 2004. Due to inabilify of most LGAs to collect Ivermectin early from the state, the SOCT conveyed drugs to the LGAs out of their own pocketg and also supervised the distribution of the drugs to the communities, thereby ensuring that tueatment commenced immediately. Opportunity provided by the NIDs was also utilised to integrate CDTI with PHC at all levels. The commitnent of most of the L@T as well as the frontline health facility staffin rehaining CDDs as well as in supervision of treatment was the strength that helped the project to overcome the challenge. Fortunately, however, because of adjustment of the projects' annual financial cycle by APOC, the outstanding activities were reasonably completed immediately after funds were released in January, 2005. The state released the sum of U.S$7,353 in December, as counterpart funds, therefore all outstanding unpaid expenditure incurre.d by the SOCT and L@T were reimbursed. As a result of the weaknesses identified by the last sustainability evaluation, major of which was funding a sustained release of LCA counterpart funds through deduction of at least US$1,900 (per LGA) from source. Sustained advocacy visis will also be made to the ministry of finance to ensure release of state counter part funds. WHO/APOC, 24 Novemhr 2004 SECTION 1: Backgruund information 1.1. General information 1.1.1 Ilescription of the project Oriefly) - Geographical location, topography, climate - Population: activities, cultuieg language - Communication systems (roads...) - Administrationstructure - Health system & health care delivery (provide the number of health postslcenters in the project area ifthe information is available). - Number of health staffin project area and number of health staffinvolved in CDTI activities. 1.1.1. Descriotion, of oroiect Niger state is geographically located within the middle belt of Nigeria and it lies between latitude 3 20'east and longitude 17" 3'north. It is borderedby Zamfara 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 d 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 common inter- border tade 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 topgraphy of the state, the major rivers of Niger and Kaduna have been dammed for production of electricity, therefore, the state houses the largest number of hydro electric power stations in the country thus earning itselfthe title, 'Power state'. There are two prominent hydro electric power dams i.e. that of Kainji across river Niger, and Shiroro, across river Kaduna. 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,l0&nm in the north and l,600mm in the south. The wet season tanges from 150days or more in the northern part to 210 days or motre in the southern 6 WHO/APOC,24November2O04 part. The dry season coilrmences in October and the humidity could be as low as 140'between December and February. Temperatures rise as much as 90F between March and June, with 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 mainly agraian in over 80% of the state. Among the large ethnic groups, the Gwaris', Kambaris' and nomadic Fulani's have a 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? ice,maize, millet and guinea com. 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 as cash crop. They are also very good fishermen. While the settlement pattern in 40o/o of the state is dense and clustered, over 600/o is sparsely populated and highly nucleated with distances of up to 20 kilometers between some communities. Niger is in fact the largest State in Nigeria, occupying about l2 million hectares of land, which represents about one tenth of the total land area of this country. Niger state has a fatrly good road network in about 40o/o of its' area. However, due to its' highly riverine nafure, about 40o/o 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 neighbouring Kebbi state. Heavy flooding as a rcsult of overflow of the hydroelectric power dams 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 govemor at the state level and 25 local administrative councils headed also by politically elected LGA chairmen. There are several traditional institutions headed by emirs of various hierarchies, who oversee the districts and communities. These 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 7 WHO/APOC,24 Novembr2004 system of government. All Emirs arc however accountable to the govemor. The state government basically comprises ofthree arms i.e, the executive, legislative and judiciary. The health care delivery system comprises ofthree levels i.e. Primary, secondary and Tertiary, all of which are quite well interlinked. The PHC system has been put quite well in place, and is becoming more functional, especially with the support it received from the then German government assisted PHC development agency known as the GIZ project. GTZ however ended its'tenure in December 2004.There ane over 1,400 health posts/health centers in the state out of which about 1,000 exist within the CDTI project area. There are 3,444 PHC staff in the CDTI area, out ofwhich, 676 are participating in CDTI. There are 2l participating LGAs and 17 of these are old (i.e. have implemented CDTI for at least 4 to 5 years), while four, namely, Suleja, Tafa, Gurara and Agwara (which came about as a result of the REMO update/approval of year 2003) were recently added, and have implemented CDTI for two consecutive years. WHO/APOC, 24 November 2004 Tabtre 1: Number of heslth st*If involved in CI)TI (Plesse rdd more rows if necescary) Districtll.GA Number of healtt staffinvolved in CDTI activities. Total Number of health staff in the entire project area Br Number of health staffinvolved in CDTI B2 Percentage BrBzlBr *100 Kontagora 125 t7 t4 Rijau t23 32 26 Magama 216 45 2l Mariga 202 34 t7 Mashegu tt4 27 24 Agaie 132 39 30 Lapai 137 49 36 Mokwa 182 28 15 Rafi 145 32 22 Wushishi tt4 14 30 Borgu 113 53 47 Lavun 185 18 10 Shiroro 150 20 t4 Gbako 237 27 t2 Katcha 165 45 28 Munya t94 28 l5 Bosso 230 22 l0 Suleja r80 30 38 Gurara 187 40 22 Agwara 164 26 t4 Tafa 155 30 20 Total 3444 676 20 9 WHO/APOC, 24 November 2004 1.1.2. Partnership - Indicate the partners involved in project implementation at all levels [MOH, NGDOs (nationaUintemational), communities, local organizations, etc.] - Describe overall working relationship among partners, clearly indicating specific areas of project activities (planning supervision, advocacy, mobilization, etc) where all partners are involved. - State plans, if any, to mobilize the state/region/dishict/LGAdecision-makels, NGDOs, NGOs, CBOs, to assist in CDTI implementation. Partners involved in project implementation ar',e:- The National Onchocerciasis Control Programme, ofthe Federal ministry of health, The state ministry of healtlU LGA/PHC deparhnents UNICEF, APOC, WHO 2,552 Onchocerciasis endernic communities with their CBOs. These CBOs are mainly agricultural cooperative groups and hade 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. UMCEF, the supporting NGDO partner, was very much involved in yearly planning for conduct of CDTI activities, advocacS HSAM and supervision/monitoring. This effort became more pronounced when a focal officer by nameo Dr Kenneth Korve, was appointed by that organization principally to provide technical support with project implementation in all 9 IINICEF supported States in the country. LINICEF supported an NOCP official to monitor the implementation of CDTI activities in the state during the period under r€port and the outcome of the visit was quite useful since feedback was given to the State and the weakness observed in one LGA werp immediately addressed by both the SOCT and the LOCT respectively. The above organization also supported conduct of a zonal task force review meeting, as well as that of a national review meeting for the 9 states benefiting from its' support. APOC supported the state with funds for conduct of advocacy, training, HSAM, as well as supervision/monitoring targeted mainly at the four newly added LGAs, as well as some newly added communities of the 17 old implementing LGAs. Four additional motorcycles, 20 bicycles, a UPS and an in-focus projector were also procured by WHO on behalf of APOC, in l0 WHO/APOC,24 November20D4 support of CDTI activities in the four newly added LGAs and the latter for use during conduct oftraining and HSAM activities. Stakeholders' meetings were held in all?l LGAs between May and June 2004 and all partners pledged to give their moral as well as financial support to the programme. In order to consolidate the effort made at LGA level, another meeting was held at state level in December, after the CDTT sustainability evaluafion exercise of the same year. The aftendance at that meeting was very impressive. The objective was to provide feedback to all partners, most especially the policy makers, on the findings of the evaluation exercise, as well as to sensitize them on the need to adequately fund the Oncho. control programme for sustainability of additional 10 years oftreatrnent. The SHM agreed that funding is a major weakness which poses a threat to the sustainability of the project, and therefore rcsolved that funds for LGA level activities be deducted at source, i.e, based on the available S-year post-APOC CDTT plans that were jointly developed with the LGAs. It was also resolved that quarterly PHC reviedappraisal meetings be held at LGA level in order to promote documentation, feedback and integration with other PHC activities. In order to ensure release of state counterpart funds, plans are underway to further sensitize government through strong advocacy to the ministry of finance. The success of this strategy was demonstrated by the successful release of US$7,353, during the visit of the sustainability evaluation team to the state ministry of finance in November2004. The ministry of health also plans to solicit for piece-meal release of funds to the project ie. by way of monthly standing imprest of at least US$300 from the approved budget line for recurrent expenditure allocated to the Oncho. progmrnme. Various groups like media organizations the Nigerian red cross society, the predominant muslim organizatiorq Jama'atu- Nasril-Islam (JNI), as well as National union ofroad transport workers also pledged to continue to assist with HSAM activities. Yes, there are plans to mobilize NGDOs, CBOs, policy makers and others in the comin gyear, since these are core activities which have been listed within the 5-year CDTI sustainability plans already written by both the state and the LGAs. I I WHO/APOC, 24 November2DA4 more tonts CDTI Districts/ LGAs in the entire project area Total population in the entire project area Number of communities/villages in Population of Meso-endemic zone in the project area At Hyper-endemic zone in the project area At Total in meso/hyper- endemic zone A3 = Ar+ A2 Meso-endenic zone in the project area A4 Hyper- endemic zone in the project area Ar Total in meso/hyper- endemic zone A,r= Az-* Ar Ultimafe trcstment Goal (urG) Kont4gora 73,860 72 72 73,960 73,860 62,042 Rijau 150,050 t7s 175 150,050 150,050 126,042 Magama 92,571 52 <, 92,571 92,571 77,760 Mariga 1t2,596 232 232 112,596 112,596 94,591 Mashegu 57,704 102 r02 57,704 57,704 49,471 Agaie 60,357 195 195 60,357 60,357 50,700 Lapai ll4,62l 2tr 2tt l14,62r l14,62t 96,197 Mokwa 98,234 130 130 99,234 98,234 82,517 Rafi 84,176 t29 t29 84,176 84,176 70,707 Wushishi 59,708 130 130 59,708 59,748 50,154 Borgu 140,000 t74 174 140,000 140,000 117,600 Lavun 42,360 92 92 42,360 42,360 35,582 Shiroro 36,197 103 103 36,197 36,197 30,405 1.2. Population Ta.ble 2: Communitles and population at risk in the entire project area whether they are treated or not during the reporting period.(Please add ruw if necessarv) l2 WHO/APOC, 24 November 2004 Gbako 32,627 62 62 32,627 32,627 27,407 Katcha 68,239 t49 1,49 68,239 68,239 57,321 Munya 56,026 140 140 56,026 56,026 47,062 Bosso 68,958 131 l3l 68,959 68,959 57,925 Suleja 46,897 20 20 46,897 46,897 39,393 Gurara 64,921 l7 tt7 64,921 64,921 54,534 Agwara 48,525 65 65 48,525 48,525 40,761 Tafa 35,333 7l 7I 35,333 35,333 29,690 TOTAL 1,543,960 2,552 2,552 1,543,960 1,543,960 1.296.E41 UTG = calcuhted as fte maximum numb€r ofpeopie to be tpa Uo reaohed wheo thc project has ,lached frrll gcogrephic cov€rag€ (aorEElly lhe project should b€ cxpcoied to r€a€h the UTC} at the eod ofthe 3d yeal of the project). Was a census for the project done during the reporting period? Yes_l- No If No, what is the source of the data in the table above? * Source:National census - CDD--_1|- Other source, speciry:. Year : If you are using ole term community or village, dcffn€ trtsl constitubs lhe coEmunity or village. This x,ill help undelsed the profile of ths project arEa. The r ord community as us€d in this r€port constitut s lhe least homogenous group of people madc up of households havilg a cormon sooio. cultual heritsge and I traditional leadgr. Is ther€ any other informrtion ofintErest about the population in the prcjeot arca? Ifso, include it herc. l3 WHO/APOC, 24 November 2004 It would bo noted that there is discrepanoy in the population figues provided for year 2003 whfl oompsr€d wilh that of the currq* r€poftiry period. This is beceus€ (8s e<plsiaed in that rsport), the ffgures utillzed for sreas whsr€ therc lvas project expansioD due to REMO updete wcm estimates bas€d on l99l population oensus projections (sinoe drcrc had dot boen my community crcnsus in such areas), sinc€ ther€ wss the ugent rced to teat th€s€ areas and at tbe same tim€, bave & baseline figule for measuring the years' perfonnance. With applioetion ofRIMO atong widr oonduct of scosus in ell R.EMO approved areas in year 20041005, it becamo obvious thqt som€ ooEmunities €spccially in Kstcha and Rijau LGA tad to be €xcluded like Kodagprq Magam, IlI8shegu, Mokwa and Lavun since they did not fall within the affected arqssr herce the cvident r€duction irl nunb€r of commutrities as wgll in population figurr. In olhers th€ defmition of the communiti€s was read&essed bas€d olr th9 outcome ofthe comproh€miv€ ceDsus up date ofy€ar 2004. t4 WHO/APOC, 24 November 2004 SECTION 2: Inplemcltrtiotr of CDTI 2.1. Timeline of ecaiYities Flll ir tabla 3, tineliae of aotivities for areas teated in gurcnt year, indicaling when the key arrivities were impl€mented by thc month they began and the month they eoded. T!E&rl: fimelire of &ctiviti€r for thc rr.a! trorted ir tho c[rretrt yeer (Ple$e rdd more row! lf leccccrry) District/LGA Mobilization of communities Trainins Census/Update Drus distribution Supervision Starting month Completion month Starting month Completion month Starting month Completion month Startlng nonth Completion month Starting month Completion month Kontagora January June May June May November May November May November Rijau January June May September May October May 2004 Jan.2005 May. October Magama January June May June May Septonber May November Mav October Mariga January June May Septernber May September May October May October Mashegu January June May June May October May October May 0ctober Agaie January June May June Mav October May October May October Lapai January June May June May October May October May October Mokwa January June May September May November May August May October Rafi January June May June May November May October May October Wushishi January June May June May November May October Mav October Borgu January June May Septernber May November May October May October Lavun January June May June May November May October May October Shiroro January June May September May November May October May October 15 WHO/APOC, 24 November 2004 Gbako January June May June May November May October Mav October Katcha January June May September May November May 2004 Feb.2005 May2004 Feb.2005 Munya January June May September May November May October May October Bosso January June May June May November May October May October Suleja* January 2005 January 2005 January 2005 January 2005 January 2005 February 2005 January 2005 February 2005 January 2005 February 2005 Gurara* January 2004 February 2004 January 2004 February 2004 October 2004 December 2004 November 2004 January 2005 November 2004 January 2005 Agwara* January 2005 February 2005 January 2005 February 2005 January 200s February 2005 January 2005 February 2005 January2005 February 2005 Tafa* January 2004 December 2004 December 2004 December 2004 Seflember 2004 December 2004 September 2044 January 2005 December 2004 February 2005 TOTAL - Commcnts Unfortuaiely, CDTI could not b€ firlty institut€d ea y snough in the new I,GAS of sulejs, Tsfa, curara snd Agwara as well as iE 2 old CDTI LGA! (Riiau and IktchE) with s large number ofn€*ly added communities, b€cause whilc Ole State did not lec€ive counterpart funds to enabl€ it commerce activities erdy, fl% ofthc futrds approved by APOC could not b€ acc.ssed because ofdelays at both statr l€vel and at the levcl ofihe NOCP zonal offioc. l6 WHO/APOC, 24 November 2004 2.2. Advocacv State the number of policy/decision makers mobilized at eacfi relevant level during the current yafr, the reason(s) for undertaking the advocacy and the outcome. Describe difficultieVconstraints being faced and suggestions on how to improve advocacy. State level - 30 people, including the deputy governor of the state, Permanent secretary of the ministry of finance, Perm. sec., ministry for local government affairs, Perm. sec., ministry of information, Perm. sec., ministry of women affairs, Perm. sec. Health and director PHC, other directors of the ministry of health as well as other PHC programme managers. The objective was to further create awareness on the progarnme in order to promote integration of CDTI in PHC; to promote inter-sectoral collaboration among the stakeholders of the various minishies, as well as to sensitize the state policy makers especially, those at the ministry of health and the ministry of finance on the need to pay counterpart funds. Of specific mention was the advocacy visit to the state ministry of finance by the sustainability evaluation team. The objective was to sensitize the executives on the need to release funds to the project and the effort rewarded the project with immediate release of US$7,353 out of U.S.$36,765 approved as counterpart funds since year 2001! LGA level-300 policy makers and traditional rulers were mobilized in all 2l LGAs for support to CDTI. Of specific mention was the visit made to Borgu LGA with the aim of addressing cross border concerns that were expressed during a meeting with officials of Benin republic in September 2003. As a follow up of resolutions made between Nigeria and representatives of that countlr, targeted advocacy was made to the policy makers of Borgu LG,{ to sensitize them on the Oncho /CDTI programme as well as to solicit for their financial support toward the success of the control progftunme in order to prevent re-invasion of Oncho. freed Benin republic by infected blackflies, since the LGA shares an intemational boundary with that country on its' western margin. Benin republic raised alarm to AFOC, about reinvasion of its Oncho. freed areas by infected black flies from Nigeri4 which led to holding of the meeting at Porto novo. In addition to Niger, Kwara, Oyo and Ogun states were also participants at that meeting. ,g A+ WHO/APOC. 24 November 2004 The highlight of the advocacy trip to Borgu LGA was that made to the newly appointed faditional ruler of Borgu emirate! The visit was of great significance, because thc appointment of the present ruler marked the end of misery and instability for the people sinoe he had always been their choice and his previous denial of leadership by the state government led to a prolonged legal battle which caused a split of the leadership all over that LGA for overthree years. This division in leadership resulted in disorganization not only ofthe Oncho. programme but all social services with consequent negative impact on development. The coverage forthat LGA was in fact, the lowest in the project area for overthree years! The new leader promised to ensure better compliance and to ensure sustainability of CDTI not onlv in that LGA, but also for newly added Agwara LGA which is also and a part of Borgu emirate. Borgu LGA is historic for the conhol of Onchocerciasis in Nigeria because control efforts began there as far back as 1962 i.e. during construction of the popular Kainji hydroelectric power dam. Advocacy visits were also made to policy makers and traditional leaders of 4 newly added CDTI implementing LGAs of Gurar4 Taf4 Suleja and Agwara to inform them on the significance of Onchocerciasis as a disease, availability of Mectizan free of charge, for its' teahtent, as well as to solicit their support for institution of CDTI in those LGAs. The response from Tafa LGA was quite encouraging because the LGA chairman released the sum of U.S$357 as counterpart fund for implementation of CDTI activities in that LGA. In order to further mobilize the LGAs for support, a state level stakeholders'workshop which comprised of about 120 participants (that included 3 or 4 policy makers each from all 2l participating LGAs, traditional leaders, State policy makers, the NOCP national coordinator, NGDO replesentatives from the State WHO disease surveillance office, representatives of religious organizations, representatives of the Nigerian red cross society, media representatives, and several others, too numerous to mention here, was held immediately after the sustainability evaluation in December 2004. The findings of the evaluation exercise were communicated to the participants and the worrisome iszues were deliberated on. Solutions were proffered (on the way forward), and the highlight of the workshop was a resolution to ensure that CDTI is sustained in all 2l LGAs. )v A1 WHO/APOC. 24 November 2004 The LGA representatives were requested to give a mandate for monthly deduction of the sum of U.S$1,900 (from the Federal govemments' monthly financial allocation that is released to them) by the State rninisty that overseas local government affairq as payment on LGA counterpart funds for Oncho control. The LGA policy makers noted the concerns and commencing year 2005 requested to be given an opportunity to discuss the issue at their quarterly chairmens' forum that was scheduled for March 2005. The feedback is expected to be positive. Communitv level - HSAM was targeted at haditional leaders in Babanna district of Borgu LGA i.e the westem part of Borgu LGA that borders Benin republic) to mobilize them for acceptance of CDTI, as well as to sensitize them on cross border issues concerning recrudescence of infection in Benin republic. They were sensitized to ensure good community compliance with heatrnent in order to achieve optimum treatnent coverage. A total of 39 communities, represent@ 75% of the total, were reached. Others were inaccessible due to heavy floods, and others, because of very long distances over extremely rugged terrain. The Eained CDD supervisors, who are mostly school head teachers and who are residents ofthose areias, completed the mobilization of the remaining various communities. Several meetings were held with haditional leaders in all 21 LGAs to sensitize them and to solicit their full cooperation as well as in providing incentives for the CDDs. They pledged to give their full support and there is good evidence that there was good collaboration at the community level. This fact is further reinforced by the excellent performance that the sustainability evaluators observed at the community level. Kindly refer to CDTI sustainability evaluation final report of December 2004. 2.3. Mobilization. sensitization and health education of at risk communitiS Provide information on: The use of media and/or other local systems to disseminate information Mobilization and Health Education of communities including lilomen and minorities Response of target communities/villages Accomplishments Suggest ways to improve mobilization and sensitization of the target communities. v 45 WHO/APOC. 24 November 20M Radio jingles with Oncho. messages were produced in 4 predominant dialects of Hausa, Nup", Gwari and English and this was aired daily throughout year 2004. Messages were also disseminated in mosques, churches and on market days especially along border communities in Borgu LGA, which are within l5 to 30 km distance of Benin republic. As earlier mentioned, HSAM was targeted at policy makers, traditional leaders and 39 communities that border Benin republic i.e at the western margin of Borgu LGA. Oncho. day (1212104) was commemorated at state and LGA level and there was mass dishibution of T-shirts with Oncho. logo messages as well as calendars also bearing Oncho. logo messages. A contract was awarded to the state cultural troupe for purpose of production of a one hour local drama slot that would be aired on television for sensitization of State and LGA executives as part of efforts to sensitize them for release of countelpart funds. In view of religiouVsocio-cultural barriers that prevent women in ethnic groups like the hausas who form about20o/o of the states' population from participation in public gatherings, megaphones were utilized to amplifr sound for the hearing benefit of women in seclusion (purdah). Various women groups were mobilized for participation in CDTI in the 21 LGAs, and during these occasiong it was revealed that prior to that, the women were actually ignorant about the disease nor were they aware of the availability of Mectizan free-of-charge for its' control. They were neither aware of the need to participate in the programme nor to provide support for the CDDs. They therefone expressed pleasure for being informe4 and pledged to also mobilize other women as well as other members of their communities for compliance. The women also pledged to participate in drug disfibution as well as to provide incentives for the CDDs. Evidence of such support was like in Shiroro, Taf4 Rijau and some other LGAs where women participated in community mobilizatioq drug distribution and even contributed to CDD incentives. In Shiroro LGA for example, women groups confibuted about US$20 cash as incentive to CDDS. Because of Islamic religious fanaticism which is rampant in that area, they aggressively mobilized their fellow women against any effo* to discourage them from accepting Mectizan@ ff eatment. v -t0 WHO/APOC. 24 November 2004 THSAM was targeted to 4 newly added LGAs of Tafa" and Gurar4 Suleja and Agwara and this helped the communities to embrace the CDTI approach. Communities of Suleja and Agwara LGAs could not be mobilized earlier because the project was deprived from utilization of the funds provided by APOC since the Zone C, NOCP Coordinator declined from forwarding the states proposals submitted to him in September, to UNICEF for final approval. Therefore, only barely 25Yo of the funds provided by APOC was utilized between March 2004 which was the commencement date ofthat project agreement and December 2004 ofthe curent reporting period. These LGAS were however mobilized in January 200.5, and because of time constraint due to the need to complete the years' activities, training of CDDs and treatrnent followed concurrently. This was quite easy because the supervisors had earlier mobilized their communities to select CDDs and the CDDs had also had some training in the previous year (2003) when distribution commenced in those new LGAs. All of the efforts made have greatly helped to improve awareness and acceptance of the programme as already confirmed by the findings of the various monitoring/evaluation activities conducted by UMCEF, the NOCP offices as well as the APOC evaluation team. The community response has indeed been excellent. Community mobilization and sensitization could be improved if the radio programmes produced could be transmitted to all benefiting communities. With improved funding, the LOCT could sensitize and further mobilize the communities to develop local drama slots to suit their needs thereby increasing acceptance. Funding is very crucial, since the SOCT and LmT need to travel to lower levels to support them in conduct of HSAM activities. Megaphones and other public address materials are very useful tools for community mobilization and so their use should be intensified. WHO/APOC. 24 November 2O0/l/ JL 2.4. Communitvinvolvement f,g!!g.1l: Communities participatiqn in the CDTI Slease add more rows if necessary) Comment on: - Attendance of female members of the community at health edupation meetings / )1, District/L GA Number of communities/villages with community members as supervisors Number of CDDs and the communities involved Number of communities /villages with female CDDs Total no. communiti es in the entire project area B+ Number with community members as supervisors Bs Percent age Be: BJ Br *100 Male CDDs Bj Female CDDs Br Total &: B/-Bs Number of communi ties with female CDDs Bro Percent age Brr: 816/Ba*1 00 Kontagora 72 72 100 248 0 248 0 0 Rijau 175 175 r00 350 4 354 ') I Magama 52 52 100 t26 0 t26 0 I Mariga 232 232 100 564 0 564 0 0 Mashegu t02 t02 100 216 0 216 0 0 Agaie 195 195 100 402 0 402 0 0 Lapai 2rl 2rl 100 646 0 646 0 0 Mokwa 130 130 100 655 0 655 0 0 Rafi r29 t29 100 255 1 256 I 1 Wushishi 130 130 100 284 0 284 0 0 Borgu 174 174 100 643 5 648 3 2 Lavun 92 92 100 185 0 185 0 0 Shiroro 103 103 r00 212 l4 226 3 3 Gbako 62 62 100 96 0 96 0 0 Katcha 149 149 100 157 0 t57 0 0 Munya 140 140 100 300 0 300 0 0 Bosso l3l l3l 100 245 0 245 0 0 Suleja 20 20 100 400 0 400 0 0 Gurara It7 tt7 100 268 0 268 0 Agwara 65 65 100 110 0 110 0 0 Tafa 7t 7l 100 85 3 88 3 7 Total 2,552 2,552 lOOYo 6,447 27 6,474 t2 0.5 WHO/APOC. 24 November 2004 In general, how do you rate the participation of female members at the community meetings when CDTI issues are being discussed (attendance, participation in the discussion etc). Incentives provided by communities for the CDDs Attrition of CDDs. Is aurition a problem for the project? If yes, how is it addressed? Other issues Attendance of female community members at community me&irtgs constitutes about 5ff/o of the total gathering n 5Wo of the project area i.e. where purdah (i.e. seclusion of women indoor) is not the practice. Where purdah is in practice the affendance 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 often passive because, they are intimidated by the prcsence of the men as a result of the culture, which inhibits women 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 revealed are quite interesting. Suoh issues give indication as to community compliance with treatment, coverage, CDD performance, attitude of supervising FLIIF staff,, adequacy of Mectizan@, awareness on the progtamme, as well problems on payment of CDD incentives. More often, the scenario in over 50% of the project area is one where, only the elderly \vomen are permined to participate and fully contibute to discussions at public meetings. The female elders are expected to debriefthe other women in the communrty at another separate gathering of women. The elderly women are often the TBAs in the community and they also double as mobilizerg since they are often also the women group leaders. The issue of provision of incentives varies with different socio-political areas of the state. In areas where the community 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 dishibution. Most communities contibute between US$0.1 to US$0.4 per household treated, with a result that CDD incentives could be as much as US$37 in some communities! Other CDDs are assisted with fann work while other communities contribute foodstuff such as grains (millet, guinea corrq rice), yams, fish and several others. Generally, all CDDs are supported with prayers. CDDs have often been elected into political posts, while others were, because of their hard worh offered govemment paid jobs by their LGA councils. The community leaders and CBOs also assist with mobilization and supervision ofteatment. However, in over 50% ofthe project area, especially where CDDs are selected along family lines, or at ward level, 24 s) WHO/APOC. 24 November 2004 incentives are not paid as a rule. This is so, because the communities view the CDDs role as one of the usual responsibilities expected from a family member towards his kindred. Such CDDs are also quite contented with this position, and appreciate the fact that their communities vest their trust in them. The incentives paid to CDDs during the period of reporting was barely quantified by the LGAs however, the amount reported on from 13 LGAs was U.S.$2,156 as cash. Most incentives are in form of food given to CDDs during house to house visits as well as prayers/blessings. Athition is not a major problent with this project because most of the CDDs, even where incentives are not provided either financially or materially have continued to serve their communities since inception of CDTI, and some have been retained for over 7 years! Generally, the CDDs in the larger part of the project area are quite contented with their responsibility and they feel honored by the trust vested on them by their communities. Some CDDs even provide registers for community census i.e where the previous one is either filled up or is missing. They also ffansport themselves to collect Ivermectin for yearly distribution, and this might not be unconnected with the fact that several ofthe younger community leaders are themselves the CDDs. There is a slight improvement in number of CDDs for this reporting period over that of year 2003 thus the CDD to population ratio increased from l:500 to I :238 on an average. Having said that, attrition is indeed a problem in communities of about20Yo of the project area. An example is an LGA like Rafi whefl"- HSAM will be targeted to before the next tneatment in order to mobilize them to select additional CDDs to reduce the workload of the existing ones, as well as to prompt them to provide necessary incentives to the existing CDDs. Furthermore, the active women groups in such communities will also be mobilized for better participation as well support to the CDDs. As a PHC policy in the state, LGAs are being mobilized to utilize CDDs as vaccinators and local guides during polio eradication and other PHC campalgn progammes. The ministry of health is also collaborating with the Guinea wonn eradication prograilrme to utilize CDDs for case search. Efforts are also being made to promote utilization of CDDs for the roll back malaria programme, AFP surveillance, as well as case search for leprosy control. With this integrated approactr, it is expected that CDD retention would be greatly improved up to 90Yo Other iszues-: none 2{ r\ WHO/AFOC. 24 November 2004 T2.5. Capacity buildins - 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 staff are frequen y transferred during the course of the campaign). Generally there is reasonably (up to 75%o) adeqtnte number of knowledgeable manpower at state and LGA level, however in some LGAs where there is inadequate knowledgeable manpower for facilitation/supervision of CDTI, school head teachers are trained to complement the efforts of the district health supervisors. This was the case when the REMO for the state was update4 and there was inadequate manpower for CDTI implementation in the western part of Borgu LGA as well as parts of Bosso LGA. A proposal was submitted to Unicef in request for funds for capacity building, and the funds provided was utilized to fain additional personnel. This taining was part of the targeted training/retraining that was conducted in 7 old implementing LGAs. The school head teachers are residents of these communities and their inclusion complements the role of the health supervisors since there are extremely few PHC facilities within some disticts. The situation in one LGA M*yq was an exception because, even though that LGA had been participating since year 2001, the output especially in terms of reporting and supervision, was noted to be very poor, therefore the whole health team in that LGA had to be refiained. CDTI haining was also conducted in the 4 newly added LGAs of Sulej4 Gurara, Agwara and Tafa. Transfer hardly occurs at state level. At LGA level, hansfers are also rare, but where it occurs frequently like was the case in Bosso and Rafi LGAs, effort will be made to train all health workers in those LGAs as TOTs and supervisors. However, the ministry of health has made efforts to discourage frequent transfer of staff through holding of meetings with the LGA/PHC directors as well as with the LGA policy makers, therefore there is a high degree of staff stability. N)5 WHOiAPOC. 24 November 2004 Table SzTrainineatthe differentlevels of CDTlimolementation (Please add more rows if necessarvl District/LGA Number of Districts/LGAs staff trained Number of llealth center/Dost staff trained Number of other trainers of trainees ( TOTs) + * Number of CDDs trained Atro (-. New C, ReIt C" Total Cr= C,+ C AtrO C. New Cd Refi Ct Totsl cs= Cr* Cz ATrO C" New Cn Refr C,, Totol Crf C'n+ C, ATrO c.. New Cu Refr Cts Total Cre= Crr* Crr Kontagora 0 0 0 0 0 0 0 0 751 49 199 24E Rijau 0 0 0 0 35 20 t7 37 1,571 2Et 73 354 Magama 0 0 0 0 0 0 0 0 740 0 126 126 Mariga 0 0 5 49 8 25 JJ 901 148 416 564 Mashegu 0 0 0 0 0 0 0 0 440 0 216 216 Agaie 0 0 0 0 0 0 0 0 483 r0E 294 4U Lapai 0 0 0 0 0 0 0 0 E7E 0 646 646 Mokwa 0 0 0 0 t2 t2 0 t2 786 338 317 65) Rafi 5 0 0 J 0 0 0 0 673 l3 243 256 Wushishi 0 0 0 0 0 0 0 0 57E t20 164 2E4 Borgu 0 0 5 5 35 l3 JJ 46 20 l3 5 l8 1,120 tls 533 648 Lavun 0 0 0 0 0 0 0 0 232 33 152 lE5 Shiroro 0 0 0 0 20 5 9 t4 2E9 124 102 226 Gbako 0 0 0 0 0 0 0 0 261 2 94 96 Katcha 0 0 5 0 32 7 t4 2t 442 0 157 157 Munya 5 0 5 5 2E 9 l3 22 4 4 4 331 22 278 300 ,,A WHO/APOC, 24 November 2004 Bosso 0 0 0 0 0 0 0 0 0 0 0 0 433 126 tt9 245 Suleja f 0 0 0 ll 0 0 0 386 400 0 400 Gurara 5 0 5 5 30 0 33 427 268 0 26E Agwara 5 0 0 0 lo 0 0 0 737 lt0 0 110 Tafa 5 5 0 5 9 0 ,< 25 464 E8 0 88 TOTAL 30 I 25 30 271 74 169 243 24 17 5 22 12,923 2,345 4,129 6.474 7o Achievement 100 7o Achievement 90 o/o Achievement 92 7o Achievement s0 * 'New', 'Refr' : If detail not available, provide the corresponding total only. Make sure that there is no double counting. The others are teachers. zr& WHO/APOC, 24 November 2004 Table 6: TVoe of traininq undertaken (tick the boxes where specific training was carried out during the reporting period) - Any other comments - none 2.6. Treatments 2.6.1. Treatment fisures - If the project is not achieving 100% geographical coverage and a minimum of 65Yo therapeutic coverage or the coverage rate is flucfuating, state the reasons and the plans being made to remedy this. - Not applicable. 2' "g) Trainees type of training CDDs Other Community membens e.g Community suner:visors Heahh Workers (frontline health facilities) MOH staff or Other Political Leaders Others(Teacherc) Program manasement { ./ How to conduct Health education -,/ ./ { .i Management of SAEs { CSM { 1/ { { SHM -,1 { ./ ./ Data collection ',/ ./ { Data analysis ./ .j Report writine ./ { Others (specifr) { Raploa survev WHO/APOC. 24 November 2004 Table 7: Treatment and SAEs bv districtllGA in all areas at risk (Please ad4 more row$ if necessarv) District /LGA CommunitiesA/illages Population Number of persons who refused the treabnent Number of absentees Numb er of SAEs Nrmber of serious adverse events (SAEs) referred to the health post/hospi tal Total # of communities/ villages in the meso/hyper- endemic meas Dr Annual Treafircnt Objective Dz Number of communities/ villages treated D3 Geogaphical coverage (%) Dr= D5/ Drrl00 Total population of the meso/hyper- endemic areas Ds Annual Treatnent Objective Dc Number of persons treated Dr Therapeuti c coverage (o/o) De= Dzl Dsilfi) Kontagora 72 72 72 100 73,860 62,042 60,890 82 3,685 9,285 0 0 Rijau 175 175 t75 100 150,050 126,042 l2l,54l 8l 0 27,610 0 0 Magama 52 52 52 100 92,571 77,760 82,242 88 0 10,329 0 0 Mariga 232 232 232 100 112,596 94,581 101,049 90 u0 11,437 0 0 Mashegu 102 102 102 100 57,704 48,471 54,697 95 0 4,016 0 0 Agaie 195 195 195 100 60,357 50,700 53,261 88 0 7,096 0 0 Lapai 2tl 2tr 2tr 100 l14,62l 96,197 94,553 82 0 20,06E 0 0 Mokwa 130 130 130 100 98,234 82,517 81,839 83 48 16,347 0 0 Rafi r29 129 r29 100 84,065 70,707 68,541 82 2E 15,497 0 0 Wushishi 130 130 130 100 59,708 50,154 55,751 93 0 3,957 0 0 Borgu* 174 174 174 100 140,000 117,600 94,222 67 5,480 40,298 0 0 Lawn 92 92 92 100 42,360 35,582 31,014 73 389 10,957 0 0 Shiroro 103 103 103 100 36,197 30,405 30,191 83 1,456 4,550 0 0 Gbako 62 62 62 r00 32,627 27,407 26,169 80 0 6,458 0 0 )r .lD WHO/APOC, 24 November 2004 Katcha 149 149 149 100 68,239 57,321 55,459 81 l3 12,767 0 0 Munya t40 140 140 100 56,026 47,062 49,509 s8 325 6,192 0 0 Bosso 131 131 t22 100 68,958 57,925 41,4r0 60* 0 27,548 0 0 Suleja 20 20 20 100 46,897 39,393 33,347 7t 944 12,606 0 0 Gurara tt7 rt7 n7 100 64,921 54,534 43,773 67 2,299 1E,E59 0 0 Agwara 65 65 65 100 48,525 40,761 38,354 79 406 9,765 0 0 Tafa 7l 7t 7l 100 35,333 29,680 24,914 7l 343 10,076 0 0 TOTAL 2,552 2,552 2,552 100 1,543,960 l1296,g4l 11242r726 80 15,516 285,718 0 0 Fomula for mmouting theraoeutio and qeoEsphical coveragEs Therspeutia covrrage rate = Number ofpcople b€atEd x 100(W Total population living in mcso/hyper<ndemic oommudties within tfic proj€ct arcs G€og.8phio8l covsrag€ ratg = Number ofcommuniti€Vvillapes treat€d x t00("/.) Tot8l numb€r ofmeso/hypcr+nd€mic communitics as identified by RXMO in the projeot area ATO covcrage rate = Numb€r ofp€oplc teat€d x 100(Vt Arnurl Tr€ltnent Objectivc % UTcachieyed = Nurnb€r ofpeople treat€d x 100 Totrl numb€r ofpeople to be t€ated in mesoihypetrodemic ar€qs Mthin th€ pmjeot arra (JTG) ATO = The estim&t€d numbo ofpeople living ir meso/hyper-€nd€mic aEas that a CDTI project inte s to treat with ivorm€ctin in a given year. UTG = The maximum number ofpeople to b€ t ested ia meso/hyper-endemic arcas within tte project arEa, ultimately to be rc&ched when the Foject has reached full geographical covemge (normally the project slrculd be oeected to r€8ch the I-]"IG at the end ofthe 3d ycar ofthe projeel). I .xg WHO/APOC, 24 November 2004 2.62 lYhat are the causes of absenteeism? Absenteeism results when community members are away to farm or trade in places outside the village, probably because they were not aware of treatnent time nor availability of Mectizan ii the community. Others, especially the youth, engage in other income generating vocations outside the community, especially in the dry season when they go to the townships to eam extrE income by engaging in manual labour at construction sites, seryo as water hawkers, house helps, security guards etc. because there is little or nothing to do in the commumty after crop harvest. Such people rarely give regard to community decision on treatment. However such problems usually occurred when the communities wene not well mobilized on the need for collective decision making. 2.63 What are the reasons for refusals? Refusal is not very signifrcant among the communities here, since they are well informed and they really appreciate the benefits of Ivermecth. However, when it occurs, it is either due to ignorance about the drug and its' benefits, or due to intense itching experienced in areas like Borgu LGA where the parasite load might be high in previously untreated cases (sometimes among immigrants like Ifumbaris and nomadic Fulanis) and there is reaction when taken for the first time. In other cases, religious fanatics interfere with distribution by misinforming the people about Ivermectin treatrnent. They claim that during is meant forbirth control and that the disease manifestation illushated on the red Onchocerciasis health education posters are a warning of the oonscquences that the drug would have on people wtro took it. 2.6.4 Briefly describe all known and verified serious adverse events (SAEs) that occurred during the reporting period and provide (in table 8) the required information when available. Not applicable r ft1 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 / / 3a- WHOIAPOC, 24 November 2004 Ig!!9:ll Cr!€! of lcrlour rdveN€ cvelt! (SAES) thrt occutr€d dudrg ttc reprdrg period (Pl.a!e r dd more now! if rcc.lrarT) !b! applicrbh SAI * Ag e Sex Village of origin Date Mectiza n was taken Date 1s sympto MS appeafe d Symptoms Health status before taking Mectizan Date of admission in health facility Date of dismissal from health faciliW Results of tests(thick blood smear) Outcome of prognosis Extenuating or complicating circumstances Alcohol involvem ent or not * Serial number of the patient ,"{ b\) WHO/APOC, 24 November 2004 2.6.5. Trend of treatment achievement from CDTI project inception to the current year Table 9: Treatments and coverage bv calendar year for the entire project area. (Pleasefttl in the required data) Please indicate the UTG for the project area: 1.296.E41 (use this figure as the denominator in all UTG coverage calculations.) YEAR CommunitieMVillages Population Total # of communities/villag es in the meso/hyper- endemic areas E. Annual Treatnent Objective E" Number of communitie s/villages heated E. Geographi cal coverage (o/o) Er= Ey' Err100 ATO coverage (o/o) E- EJ Err100 Total population of the meso/hyper- endemic areas D. Annual Treatnrent Objective E, Number of persons treated E" Therapeutic coverage (%o) Eg= E"/ E.t100 ATO coverage (%) Eto= fJ E,*t00 UTG Coverage (o/o) 1997 t.l2t t,Lzt 300 23 8E 900,000 269,260 276,832 3l 103 2t 1998 1,193 983 672 57 68 904,300 434,000 286,498 32 66 22 1999 1,283 567 404 3l 7l 950,500 4E0,500 298,000 3l 62 23 2000 1.159 730 522 45 7l 952,592 356,942 3t4.4E4 37 88 24 2001 1.649 1,385 1,634 99 llE 969.350 814.254 76E,193 79 94 59 2002 1,793 1.506 1,776 99 llE t.024.664 860,71E 796,865 78 92 61 2003 2,sE3 2.149 2,203 85 110 1.687.596* 1.417.572 1"092.069 65 96 77* 2004 2.552 2,552 ? {s? 100 100 1,543.960 l,296,g4l 1,242,726 80 96 96 2005 2006 20w 2008 2009 + estimated figures based on l99l projected national census and CDD records. )r:5, WHO/APOC, 24 November ?N4 2.7. Ordering, storage and delivery of Ivermectin Mectizan@ ordered/applied for by - (plgase tick the appropr;lg1le answer) Morr l-l umo E umc-rr f] NGrx) tr Other (please speciff): Mectizan@ deljrcfed by - @lease tick tle appropriate answer)MOII E WHOf] T]NICEF I] NGDOE Other (please specify): Please describe how Mectizan@ is ordered and how it gets to the communities The ministry of healthA.[OCP office orders for drugs while T MCEF 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. A request for approval to collect drugs is made through the NOCP zonal office at Kaduna. The state collects its drug allocation ftom the NOCP national oflice located at Lagos and releases it accordingly to the LGAs. LOCTs release drugs to district health supervisorq 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 helth post/facility for convenience of collection. All drug requirements are determined through the same calculation procedure as employed for drug requisition by the state. The delivery process is as described by the following flow zs 3\ WHO/APOC. 24 November 2004 Table l0: Mectizan@ Inventory (Please add mme rows if necessary) State/DistricU LGA Number of Mectizan' tablets Requested Rccoived Used Lost TYastcd Expircd Remaininq Kontagora 196,817 195,000 152,160 53 0 42,787 Rijau 307,sffi 310,000 259,070 1,267 0 49,663 Magama 222,0N ?22,500 208,674 1,154 0 12,672 Mariga 4(X),0(X) 334,500 303"448 2,018 0 29,O34 Mashegu 138,589 140,000 137,146 176 0 2,679 Agaie 128,500 165,376 158,682 4,694 0 2,000 Lapai 2E7,665 2E7,5W 267,921 952 0 18,627 Mokwa 247,549 200,000 l99,537 463 0 0 Rafi 210,7& 210,500 194,672 r57 0 15,671 Wushishi 162,351 169,000 168,336 6& 0 0 Borgu 382,500 380,000 24l,7gg 77 0 138,135 Lavrm E2,945 105,000 61,712 49 0 43239 Shiroro 252,E29 105,fi)o 104,804 116 0 80 Gbako 6tAts 70,000 61,295 t7 0 8,688 Katcha 327,6N 178,000 150,135 1,403 0 26,462 Munya l27,WO 126,66 126,&6 0 0 0 Bosso 217,408 210,000 115,770 928 0 93,302 Suleja 122,W 122,0w 1o7,437 549 0 14,014 Gurara 140,0fi) 140,000 t23,Otz 1,984 0 15,004 Agwara 235,500 235,5N 121,563 13l 0 ll3,E(b Tafa 70J6s 70,365 64,3ffi 293 0 5,706 TOTAL 4,3211359 3,976,87 3,32&174 17,145 0 63ri568 How are the remaining Ivermectin tablets collected and where are they kept? Remaining Ivermectin tablets are collected from the communities through the FLIIFs and submitted to the LGA Oncho. coordinators through the dishict PHC supervisors. The LGA coordinators submit all remaining tablets to the state coordinator and such drugs are kept at the project offtce for the next distribution round if the expiry date is not close. However, if they are required for urgent utilization by other projects or axe almost expired, they are hansfened to theNOCP Zane C, officer for furtheraction. ?6 35 WHO/APOC- 24 Novemkr 2004 - List and briefly describe the activities under Ivermectin delivery that are being carried out by health caro personnel in the project area - Healthcare personnel hold regular meetings with communities and their leaders to ensuo effective conduct of CDTI. - 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 their drugs, that the drugs are properly managed, there is good treatment compliance, and that CDDs keep acc ur:ate treatment records. - They provide feedback on Ivermectin distibution to the district health supervisors and the LOCT. - They facilitate CSM through taining of CSM monitors and also facilitate SHMs when held. - Any other comments 2.8. Community seH-monitoring and Stakeholders Meeting Has any haining (of trainers) for community self-monitoring been done in the project area? Yes. If so, when? In years 20A2,2W3,2W4 @g-Ll: Community self-monitoring and Stakeholders Meeting (Add rows if needed) t Disfict/LGA Total # of communitieVvillages in the entire project anea No of Communities that carried out self monitoring (CShO No of Communities that conducted stakeholders meeting (sHno Kontagora Rij;u Magama Mariga Mashegu Agaie Lapai Mokwa Rafi Wushishi Borgu 72 iia 52 232 102 195 ztt 130 t29 130 Li4 t4 9 l3 t2 N/A N/A NIA N/A N/A N/A 15 40 98 43 132 60 78 105 45 96 9e 15 WHO/APOC. 24 November 2004 Lavun Shiroro Gbako Katcha Munya 92 N/A N{4 79 48 N/A N/A 103 62 149 140 25 2 N/A N/A Bosso Suleja Gurara Agwara Tafa 131 20 tt7 65 7t 7 N/A N/A N/A N/A N/A N/A N/A N/A TOTAL 2,552 97 915 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 treatrnent cycle. In year 20{J2 pilot CSII/SHM was instituted in 20 communities of Borgu and Mokwa LGAs In year 2003, there was haining of 321 LGA/PHC as hainers of trainers, for facilitation of CSM in the 2l LGAs. In the same year (2003), the SOCT supported the L@T in ensuring that CSM was instituted in at Ieast 10 best performing CDTI communities out of the 17 participating LGAs. In year 2004, CSM and SHM were major topics within the fraining agenda for supervisory capacity building supprted by Unicef. ln spite of these efforts, very few documented reports have been received on conduct of the CSMs i.e in spite of pressure exerted on the LGAS in request for such feedback. Interaction with affected communities however gave some evidence of ongoing CSM. And such evidence are presence of selected monitors who gave verbal feedbask on their findings to community leader#village members. ,x * WHO/APOC- 24 Novembr 2004 The 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 policy such that wherever committed CDDs were present, they were also integrated into other PHC programmes, especially where financial or material rewards would be derived from such participation in order to encourage CDD retention. This action is already being applied in at least 5 LGAs and the benefits are already obvious since the treafrnent coverage are high and there is very good CDD retention. These LGAs are Wushishi, Magam4 Kontagor4 Agaie and Ghko. The pilot CSIvflSHM held in Borgu LGA in yar 2002 revealed that because payment of incentives by household i.e. prior to heatment was imposed on some communities, several membets rejected treatnerrt as a mark of protest of that decision. It was there and then explained that payment should only be voluntary, and it should be based on community consensus, otherwisg it could have a negative effect on compliance. On another occasion the CSM and SHM revealed that CDDs were disenchanted with their work because the bicycles provided by APOC were allocated to some favored CDDS in two selected communities, possibly where the LOCT leader of that LGA is native of, therefore a directive was immediately given that the bicycles be retrieved and kept at the FLIIF of very remote and hard to reach communities for use at random (i.e. when needed within those catchments areas), either for collection of Mectizan, supervision of CDTI, or other PHC activities. This revelation made the state to make a policy directive that all such bicycles be kept only in custody of resident supervising PHC personnel. Information from some SHMs also revealed that the communities had preference of a treatment 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 treatuent periods. 2q 3A WHO/APOC. 24 November 2004 2.9. Supervision 2.9.1. Provide a IIow chart of supervision hierarchy. 2.9.2. Whatwere the main issues identilied during superuislon? The main issues identified include :- (l) Concern over threat of CDD attrition due to lack of incentives in some communities. (2) Some CDDs were not adequately traine4 and dishibution was not being supervised, There was no documentation on treatment in some communitieq especially those that are far and hard to reach, for example, those at the border with Benin republic. [n one of the communities, drugs were reported to have been distuibuted by an untrained CDD, who was also not being supervised. Therefore, the available treatnent register had records only up to year 2N2, after which he was decmsed and no replacement was made until after this intervention (3) Drugs received by some LGAs were not released to communities for 3 months after they had be.en released from the state, because the LOCT insisted on releasing the drugs only when funds were released to them by the LGA autho,rities. There was CDD attrition in some communities of 3 LGAs due to lack of incentives. .N 3,3 WHO/APOC- 24 November 2004 (4) There were complaints in 2 LGAs of Bosso and Marig4 that communities were discouraged by religious fanatics, from accepting Mectizan. 2.93. Was a supervision checklist used? Yes, but only by the S@T. 2.9.4. What were the outcome at each level of CDTI implementation supervision? State level (1) There was training of additional personnel at LGA level for added capacrty to supervise CDTI while the SOCT zupervised the LOCT to ensure that communities were adequately supervised. LGA L,evel (2) Drugs retained were immediately released for treatment. (3) Communities were mobilized to select new CDDs and all unskilled CDDs were retrained. (4) Policy makers made promise to support with funds. That promis€ was not actualized in some LGAs but the pledges made are still viable and can be redeemed. (5) Communities were health educated and better mobilized for programme ownership. Communitv level (6) CDDS were reselected and retrained and there was improved supervision and record keeping. (7) More CDDS were selected by the community and that reduced the work load of the existing ones hence threat of attrition was reduced. (8) Communities were better mobilized and there was improved compliance with treatnent as well as better supervision of CDDs by the community leaders also. 2.9.5. Was feedbackgiven to the person or group$ supervised? Yes 2.9.6. How was the feedback used to improve the overall performance of the project? - The respective policy makers and traditional leaders in the affected LGAS were mobilized for better commifinent to the progftmme, as demonsEated through advocacy and release of funds in some LGAs that previously did release amy. - Adequate capacity was provided for supervision of CDDs through training and retaining. - The SmT suprported the LOCT to mobilize the communities for better compliance with CDTI objectives. - There is improved tneatment compliance and better coverage. As a matter of fact, the treafinent coverage so far achieved is the highest so far attained by the project i.e. even in spite of project expansion as a result of REMO update/finalization coupled with late conduct in some LGAs. !( tqo WHO/APOC. 24 Novembr 20{l,4 SECTION 3: Suonort to CDTI 3.1. Equipment Tabte 12: Status of equipment (Please add more rows if necessary) *Condition of the equipment (F:Functional, CNFR{urrently non-functional but repairable, Wo:Written off). * Donated by GTZ to Borgu LGA 6 years ago. + donated by Unicef in lW2 - 1994. *T WHO/Aro. 24 Novembet2004 q,L Source Type of equipment APOC MOH DISTRICT ILGA NGDO Others No. Conditi on No. Conditi on No. Condit ion No. Conditi on No. Conditi on 1. Vehicle I F I wo I wo 2. Motor cycle(s) 22 16F 2CNF R l6* wo 3. Computer(s) 2 wo 4. Printer I wo 5. Photocopier I F 6. Fax Machine I F T.Bicycles 6s F 50+ CNFR S.Motorcycle boxes l0 F 9.T.V I F lo.vcR I F I l.Overhead Proiector I F l2.Writing Board I F l3.Megaphone & Mic 10 F l4.Photocamera I CNFR l5.Mannual Typewriter 2 F l6.Canoscan scanner I F l7.Garmin GPS I F lSAir conditioners 2 F l9.Money safe 1 F 20.Generator I CNFR 2l.Infocus Droiector I F 22. IIPS I F IIIow does the project intcnd to maintain and replace existing equipnent and other materials? This will be done through the normal government system, i.e through the vehicle maintenance pool. Furtheilnore, the project intends to request for monthly standing imprest from the state approved budget line for recurent expenditure. If provided, that would also serve as a sour,ce of funds for equipment maintenance as well as for maintenance of other materials. The LGA coordinators have been responsible for maintenance of project motorcycles attached to them from counterpart funds and will continue to, since this is the usual practice over here. LGA administrators will be encouraged to purchase motorcycles and bicycles for the programme where ever the need arises. At state level, efforts will be made to ensure full integration of the CDTI into viable projects like HIV/AIDS control, NPI, 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. .y \z WHO/APOC- 24 November 2004 2. Financial contributions of the parhrers and communities Table 13: Financial contributions by all partners for the last three years Contributor Year I ('2000') Yeor 2 ('2001') Ye*3 ('2002') Yeor 4 ('200j') Yerr 3('2004') TOTAL Cash Budgeted (us$) TOTAL Cash Released rus$) TOTAL Cash Budgeted (us$) TOTAL Cash Released rus$) TOTAL Cash Budgeted (US$) TOTAL Cash Released rus$) TOTAL Cash Budgeted russ) TOTAL Cash Released russ) TOTAL Cash Budgeted rus$) TOTAL Cash Released (us$) MOH (State) 22,720 22,725 49,000 0 43,000 0 4,300 0 3 1,618 7,772 MOH (LGA) 10,000 8,13 8 15,000 8,675 10,371 7,287 N/A 704 6,720 1,654 (from8 LGAs onlv) Local NGO(s) 3,566 from 3 LGAs manily women group coolibutions NGDO partner(s) UNICEF 24,000 7,023 24,000 0 24,000 18,25E 24,000 27,346 25,225 25,225 Communities 13,041 8,145 58,800 1,240 t,4t6 N/A 335 2,156 documented from 13 LGAs APOC Trust Fund 128,940 l 10,000 100,700 45,000 65,000 35,000 62,120 70,000 3s,000 35,000 TOTAL 198,701 156,031 247,500 54,9r5 90,420 61,96I 90,40 98Jas 98563 75473 /( l+ WHO/APOC, 24 November 2004 r I t If there are problems with release of counterpart funds, how were they addressed? There were indeed severe problems with release of counterpart funds! Several advocacy meetings were held both in-house i.e. during the state in-house committee (SOCPAC) meeting that oversees the implementation of the Oncho CDTI programme, and in company of representatives of NOCP and IINICEF i.e during their biannual advocacy visits to the state. Fortunately, the CDTI sustainability evaluation team made a very successful advocacy visit to the accountant general of the state ministry of finance in company of the state director of budget and the SOCT leader and release of US$7,353 out of U.S.$35,714 approved was effected. Additional comments 3.3. Other foms of community support - Describe (indicate forms of in-kind contributions of comnunities if any) In-kind contributions by communities include assistance with farm worlL Fayers, supervision by village heads and CBOs, support with community mobilizr;tiolrr, giving of filod 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 councilors or LGA council chairmen, provision of appointments into govemment paid jobs, and recommendation for inclusion of CDD for other incentive giving social services like polio eradication programme and guinea wonn surveillance. 3.4. Expenditure per activity - Indicate in table 14, the amount expended during the reporting priod 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 US$1.00 : #136.00 ,g h Lt WHO/APOC. 24 November 20M Table 14: Indicate how much the project spent for each activity listed below during the reporting period - Any comments or explanations? (l) Only abofi 36%o of the funds released by APOC was utilized between June (when the approved budget was received) and December 2004,W,ause of delays caused by inability of the state in-house committee known as SOCPAC, that vets all Oncho. proposals before submission to NOCP in request for use of donor funds to sit until August 2004. to further compound matters, the proposals (9 out of 14 in number) submitted to NOCp Zone C, in August 2004 were not forwarded early to UNICEF. It was only when the state made a complaint to the NOCP national coordinator, and after his intervention during the last week of December that the outstanding 9 proposalg werc forwarded. Initial delays were however caused by late receipt of the approved APOC budget. Because state counterpart funds were not available at that time, conduct of activities in the 4 newly added LGAs was largely delayed until January 2fi)5 when both APOC and state ,lg L+5 WHO/APOC. 24 November 2004 Activity Drug delivery from NOTF HQ area to cenfral collection point of community Mobilization and health education of communities Training of CDDs Training of health staffat all levels Supervising CDDs and distribution Intemal monitoring of CDTI activities Adlocacy visits to health and political authorities IEC materials Summary (reporting) forms for treatment Vehicle insurance/Vehicle, motorcycles, bicycles maintenance Office equipment (e.g computers, printers etc) maintenance Others:- Census update - Office supplies - Communication TOTAL Total numbcr of persons treated Expenditure (s r]s) Source(s) of fundins 500 ii;i4o 3,676 9.209 7,482 N/A 8,823 14,876 0 4,390 2,794 12,690 State/LGAs APOCruNICEF/LG As APOC/LGAs APOCAJNICEF APOC/State, LGAs UMCEFAIOTF UNICEF/State APOC State/LGAs, APOC vehicle insurance State/LGAs I.INICEF 2,951 APOC. State 3,600 APOC, State (telephone) LGAs (teleohone) 8233t 1242,726 funds were available. The only available source of funds between January and November was therefore, UNICEF. Out of pocket expenditure made at state level for activities such as supervisory visits of the SOCT to old CDTI implementing LGAs, vehicle and equipment maintenance, and several others was reimbursed only after the US$7,352 paid by the state was released in December 2005. The APOC funds released in January was utilized for completion of activitiqs in areas not previousl5r covered as well for prcduction of IEC materials. This was possible because the projects financial cycte was adjusted from January-December 2004 to March 2W4 'Februaly 2005, since the approval of the budget was in Februaqy 2W4. SECTION 4: Sustainability of CDTI 4.1. rnternal; independent participato4r monitoring; Evaruation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable) Year I Participatory Independent monitoring Mid Temr Sustainability Evaluation 5 yem Sustainability Evaluation Internal Monitoring by NOTF Other Evaluation by other partners 4.1.2. What were the recommendations? The recommendation of the internal monitoring by the NorF was that:- (1) More CDDs should be selected in the larger communities in accordance with CDTI guidelines. (2) Communities should be better supervised in order to ensure good treatment compliance. (3) Census up date should be completed in parts of the project where it had not been done. { { ,ff t+6 WHO/APOC, 24 November 2004 Recommendation Implementation Planning:(i) Statr at this level need capacrty building in planning objectively and also be able to identifr resource gaps. Priorily: MEDIILM Indicatorc of success: Policy makers and SOCT staffare capable of planning objectively and identiffing resource gaps for effective and efficient CDTI activities. Who to tohe oction: Dir PHC,SOCT, Deadline for completion January, 2005 Leadenhip:(i) Policy makers at this level and especially SOPAC to be more aware that the donor fundingis finally coming to an end and that the prograrnme is now totally theirs and as such commit more funds to the Project. (ii) PHC Deparfrnent should meet regularly with policy makers and they should be inforrned of developments in the proiect. Priority: MEDIUM Indicators of successz Policy makers take ownership of the programme. Who to toke action: PHC director, SOPAC, State coordinator & State government. Deadline for co mplaio n : Continuous Monitoring and S rqeruision :(i) Statr at this level should empower the level immediately below them. (ii) Achievements and successes should be noted, and rewarded. (iii) Advocacy visits with more pressure should be intensified to ensure prompt release of state counter funds. (iv) Concerted efforts ought to be made to carry out integrated monitoring and supervision. Priority: HIGH Indicdotx of success: SOCT empowers the LOCT for supervisory visits indepth report writing and record keeping. Successes shall be noted and rewarded as a means of motivation. Who to tahe acfion: State coordinator and PHC coordinator Deadline for compldia n: March 2005 lntegration activities: Capacity building workshop should be organized for stakeholders by PHC Departonent. Priority: MEDIUM Indicatorc of success: Programme managers carry out supervisory capacity building workshops. Who to tahe oction: SOCT & Director PHC De adline for co mp letio n : Continuous Training/IISAhI: Adequate and targeted training be provided for newly added places especially the 4 new Local governments. Priori$: MEDIUM Indicators of success.' S@T Provides needed training to the next level below. The recommendations of the S-year sustainability evaluation were as follows:- Recommendations for the State L,evel lg WHO/AFOC. 24 November 2004\r Recommendation Implementation Who to take action: state Oncho coordinator & SOCTs D eodline for c o mp ldio n : January 2005 Training of FLFIF should tzrgetneeded skills and knowledge. hiority: MEDIIIM Indicatots ofsuccess: SOCT empowers LOCTs training needs. Who to take action: SOCT & LOCT D eadline fu co mp let io n : January 2005 Timely meeting of SOPAC to approve proposals of expenditure for onwards passage to UMCEF through the NOCP Zrine C for prompt approval of funds and early production of HSAM materials for action. Priority: IIIGH Indbators of success: Unicef and state government commit more funds for CDTI activities. Who to tohe oction: SOPAC, PHC & SOCT Deadline for completion : 2005 Finonces: Stake holders' meetings involving Political and Traditional Rulers should be organized Strong advocacy visits ought to be made to the ministry of finance. Realistic Budgeting should be in place. Priority: HIGH Indicaot's of success: PHC deparhnent makes realistic budget state provides counter part fund to enhance CDTI activities at all levels Who to tahe action: SOCT, PHC department and PRS deparfinent Deadltne for complaion : March 2005 Transpont and Materials: State government be sensitised to provide adequate funds for the project to purchase a 4 wheel drive vehicle. Priority: HIGH Indicator of success: Provision of Vehicles and materials by the stale, maintenance & repair plans in place. Who to tahe uction: SOCT, state government Deadline fo r co mp letio n : Continuous Human Resources There should be targeted training. Priority: Medium Indicator of success: Skill training for deficient staff Who to take action: Dir PHC, SOCT Dead line for completion: January 2005 .4Y WHO/APOC,24 November2}}4 [l) Recommendations for the Local Govemment Area level Recommendafion Implementation Plnnning: (i) Staff at this level need capacity building in the area of record keeping and report writing skills. Priarity: MEDIUM Indicatorc ofsuccess: LOCT staff capable of keeping record and writing reports for CDTI activities. Who to tahe uction: SOCT, LOCT, PHC Managers Deadline for c o mpletio n : March 2005 Leaderchip(i) Policy and decision makers at this level need to be more sensitised to the fact that donor funding is finally coming to an end and that *re programme now totally in the hands of community and health service; therefore, they should commit more funds to carry out CDTI activities.(ii) Civil leadership be sensitised to seek more sources of funds to undertake CDTI activities hiOriO: MEDIT]M Indicalors ofsuccess: LGA health plan with budget that integrates all disease control programs is available. Who to tohe action: PHC coordinator LOCT Civil and LGA leadership D eadline for c o mpletion : Continuous Monitoring and S upemision: Reporting procedures should be developed: o LOCTs should routinely use a check list for targeted supervision o Supervision calendars should be drawn up and distributed to CDTI implementers o All supervisory visits should result in written reports which should be given to PHC coordinator, SOCT, and feedback provided to FLI{F PrioriU: MEDIIIM Indicaton of success: Check list is being used by LOCT. Supervision calendars being used by LOCTs. Written reports always submitted after supervisory visits. FLHF take action based on feedback. Who to tohe action: LOCT, PHC coordinator Deodline for completion : March 2005 o Efforts should be made to carry out integrated supervisions Priorily: MEDIUM fndicatorc of success: Integrated supervisions are carried out by LOCTs, programme coordinators. lTho to tahe ac.tion: LOCT D eadline fo r c omp letio n : Corttinuous Training/IISAM: LOCT should only hain FLHF staffin CDTI Priarity: MEDIIIM fndicaton of success: Directives to LOCT, training guidelines in place Who to tahe action: SOCT, oncho coordinator Deadline for comp letion : March 2005 Training of FLIIF should target needed skills and knowledge Priority: MEDIT M Indicotors ofsuccess: LOCTs tailor training agenda to training needs. ,p t{3 WHO/APOC, 24 November 2004 Recomhendation Implementation Who to take action: LOCT Deadline for complction : March 2005 HSAM should be properly planned to address issues relating to program implementation and most importantly fund raising Priority: HIGH Indicatorc of success: LGA political and civil leadership commit more funds for CDTI activities Who to take action: L(rcT, PHC, SOCT Deadline for completi,o n : March 2005 Finances: LOCTs should intensifu advocacy towards LGA authorities with regards to funding CDTI activities. Priorily: HIGH fndicutorc of success: LOCT secures financial support for CDTI activities Who to take action: LOCT, SOCT, PHC management Deadline for completion : March 2005 Transporl and Materials: State government and LGA sensitised to commit funds for replacement of vehicles Priorily: HIGH Indicator of success; vehicle and materials available for LGAs,, maintenance and repair plans in place. Who to take action L@T, SOCT, LGA,, state government Deadline for completion: Continuous V WHO/APOC. 24 Novembr 2004 50 Recommendations for the FLIIF Levd Recommendations Implementation Planning: 1. FLI{F personnel should be empowered to carry out planning. 2. They should plan CDTI activities in an integrated marlner with other health prograflrmes. Prioritv: IIIGH Indicqtorc of success: 1. FLIIF personnel capable of planning CDTI activities 2. Plan consisting of CDTI as integrated with other health progralnmes. Who to take action: r. LocT 2. PHC managers. FLTIF staff D eadline for c o mpletio n : 1. June 2005 2. Every year Leaderxhip & Ownership 1. Personnel at this level ought to take the initiative to carry out CDTI activities. 2. Reports on key CDTI activities should be documented. Prioritv: MEDIU Indicatorc of success:l. FLI# personnel's initiative to launch CDTI activities. 2. Documented reports on CDTI activities Who to take aciion: FLI{F personnel Deadline for co mpletion : Continuous Monitoring and Srryentision: 1. Monitoring and supervision need to be planned and carried out on the basis of identified problems and in and integrated manner. 2. Checklists ought to be used for monitoring and evaluation; reports on such activities should be written and kept. 3. Problems identified and successes commended should be documented. Priori$: MEDIUM Indicaton of success: l. Written reports on purposeful and integrated monitoring and supervision, actions taken by FLttr staff based on feedback. 2. Checklists used by FLIIF personnel 3. Reports on identified problems and successes cotnmended Who to take aclion: 1. FLHF staff Deadline for completion : Whenever there is a felt need Training/HSAM: 1. Training needs to be conducted objectively and in an integrated manner. 2. FLTIF personnel should take the responsibility to train CDDs and mobilize other community members for CDTI activities. PriAriO: MEDIT]M Indicators of success:l. Written reports on targeted and integrated training episodes. 2. Written reports on targeted HSAM activities; skilled CDDs; well- oriented and supportive community members Who to take ac.tion: 1. FLHF staff ,/ WHOiAPOC. 24 November 2004 5)L Recommendations !4qplementation Deadline for camplaion : Whenever the need arises Financial Resoutces: l. FLIIFs need to have their own budget, and they should exercise budgeting. 2. Fund allocated for CDTI activities should be clearly indicated alongside with that of other health programmes. 3. FLIIF personnel need to intensifr advocacy to higher authorities in order to secure fund for CDTI activities. Prioritv: IIIGH Indicdon of success: 1. Allocated budget for CDTI activities at FLHF level 2. Budget breakdown for CDTI and other health prograrnmes 3. Minutes of advocacy meetings, and reports on advocacy visits Who to take action: 1. LGA/State Offices ffLIIF staff 2. LGA authoritieV FLHF staff 3. FLIIF staff Deodline fo r co mpla io n :l. April to May (every year) 2. July (every year) 3. Whenever there are needs and opportunities Transport Facilities: 1. Transportation facilities need to be availed for each FLI{F. 2. The running costs for vehicles ought to be covered by the government. Priority: IIIGH Indicalorc ofsuccess: 1. Number of functional vehicles 2. Fund allocated to cover the running costs of vehicles. Who to take action: l. LGA/State/NGOs Deadline for co mplaio n : Continuous 23 52' WHO/APOC, 24 November 2004 Recommendations for the Community Level Recommendation Implementation Leaderchip: Community leaders and CDDs need to resolve the problem of inconsistent treatnent of nomadic Fulanis living among them. Fulani community leaders should be mobilised to accept annual treatment as an essential factor that would protect them from a serious disease (onchocerciasis). Priori0: HIGII Indicuton of success: Nomadic Fulanis are being treated annually. Who to take action: FLIIF, Community leaders, CDDs Deadline for co mp laio n : December 2004 Increase HSAM of nomadic Fulani's leadership to make themselves available during treatrnent rounds Encourage the selection of CDDs from Fulani members to treat their people. Time of distribution should be planned to coincide with the return of the Fulani's to their host communities. Priority: HIGII Indicatorc of success: lncreased participation of the Fulanis in decision making process of CDTI in their host community. Who to take action: FLI#, Community leaders & CDDs Deadltne for conryldion: December 2004 HSAM: Intensifr HSAM among the Fulani's through inter-community meetings to promote annual treatment hiority: MEDIIIM fndicatorc ofsuccess: CDTI is integrated as part of other health activities Who to take action: PHC Coordinator and LOCT Deadline for con pletian: January 2005 Humnn Resource: FI{LF should provide community leaders and members with enough information to select and train more CDDs to lessen the work load of CDDs and improve CDD:Population ratio. Priority: IIIGII fndicators ofsuccess: More CDDs are selected and trained in affected communities. Who to take ac.tion: LOCTs, FLIIF, communiff members Deadline for completion : Continuous 4.I.3. How have they been implemented? They are being implemented since the evaluation was conducted barely 6 months ago. - Planning is now done objectively and resource gaps identified, for efficiency. The Oncho. plans are integrated in the PHC master plans at State and LGA level in order to ensure integration as well as sustainability of CDTI. 54 wHo/ApoC. 24 November 2004 s3 - The state governmelrt released the zum of U.S.$7,353 in December 2004. The remaining available APOC funds was releasd in Jamrary and this enabled the project to produce the required IEC materials as well as to zuccessf,ully conduct the CDTI activities that did address several of the recommendations ofthe sustainability evaluation team. - In order to strengthen the efforts that would facilitate release of government counterpart funds, a state level SHM was held in December 20O4 where a resolution was nrade that would ensure adquate fundtng atl-GLlevel through deduction of at least U.S.$1,900 per each of the 2l LGAs from source ( Federal allocation for the LGAs that comes through the state), by the ministry responsible for overseeing local government affairs. Representatives of the state government, including the state dirrctor ofb,udget w€re present at tlre state level meeting and they were adequately sensitized to ensure release of state counterpart funds. - Successes were noted and best performing LGAS were recognized during the state level SHM held in December 200E., certificates were aurarded to the best two, for consistent release of counterpart funds since year z0ff.. These 2l,GAswere IVlashegu (ts ) and Lavun rz* I - Adequate and targeted training was provided for the 4 new local governments in lanuary 2005. Targeted training was providd for the LOCT, to equip ttrem with needed skills like report writing and record keeping and these activities would be sustained. The LOCT have been retrained and empowered with skills that will enable them to also empower the FLIIFs for initiative driven conduct of cDTr activities at that level. - The LOCT have been notified to ensure that communities are mobilized for inclusion of nomadic Fulanis in their yeady ivermectin distn'bution activities. More CDDs should be selected by the communities and the nomadic Fulanis should be adequately sensitized for optimum compliance. - The L(rcT were ernpowerd to carry out integrated zupervision and monitoring and Mectizan distribution activities were integrated into the ongoing polio eradication programme. Efforts will be made to add on other PHC activities like vitamin A distribution, as well as community €,ye care prograome$. These plans are already reflwtd in the post- APoc / cDTr sustainability plans developed by both the statg and the LGAs. ,3 5lr WHO/APOC, 24 November 2004 - Supervision checHists were distributed to LGA staff and they were retrained on how to utilize them. - Monitoring and supervision is being intensified to ensure compliance with CDTI objectives there is plan to develop and produce integrated checklist for use by the PHC departrnent in order further promote the requird integration. - The PHC department holds regular meetings with policy makers and informs them of developments. The LGA/?HC directors have been sensitized to ensure feedback on conduct of CDTI activities through holding of regular review meetings together with the district and FLItr staff. Problems should be identified at all levels and successes commended. 4.2. Sustainability of projects: plan and set targets (mandatory at Yr 3) Was the projet waluatcd during the reporting period? Yes Was a sustainability plan written? Yes When was tbe sustainability plan submitted? July 2005 What errangcrnerts havc been made to sustein CIITI after APIOC funding eeases in terms of:- 4.2.1. Planning at all reftvant lerrds This will be done at all levels as an ntegrated PHC plan with clear objectives towards sustaining the strengthq 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 departrnents at statg and LGA level as reflected in the post- APOC CDTI plans. Integrated plaos and budgets are already available for year 2006 activities. 4.2.L 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 lwel and this has already received approval of the state government. The LGA budgets are also ready and awaiting release of funds. SHMs will be held at all levels. 56 55 WHO/APO C, 24 November 2004 At state level, high level advocrcy visits will be m* to the ministry of finance as r€coilnme'r# by the evaluation team. Moves witl be made to ot**in release of momhly starding imprest &s was tlre past practice, as this will assist ttre project to cany out minimal repir/maintene*ce of project vehicle end equipnrent as well as for general running ofoffice. This was one of the rcsolutions of the last zo*re C ZOTF meeting held in Tafa LGA in October,2004. 42.3 Transport (replrcment md mahtenance) This will be do{te centrally in tlre MOH if counteryrt funds are no{ available. The LGA proiest motorcycles will be repaired ard maintaired with counterpart fimds. LGA dministratons will be errcoureged to pnchase motorcycles and bicycles for the programrne wknever fiec€ssary. At state hvel, efforts will be m& to €nsure firll integration of CDTI into viable pqiects like AIDS confiaol, NPI, etc. so that tlrere would be cerrtral maintenance of all pa*icipeting PHC vehicles i.e inchding ttle CDTI project vehicle. ArcC msnagement will however be requested to replecs sorne capital equipnent i.e. before its finel disengagement. 4.2.4. (Xter resources UNICEf will provide support for year 20O5, government and IWs would have to cortinue in the possible absence of additio+ral funds because UNICEF is unable to conrmit itself to further funding after year 2005. 4.2.5. To wlat extont hrs the flan been imf,cmcntcd The plan has only recently been written, and its' full implementation is expected to be by end of December 2007. 4.3. Integration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3.1. Ivermectin delivery mechanisms - The Ivermectin for LGAs is distributed from the State through the LGAAIIPI managers when they corne monthly to collect vaccines for immunization. 2r 56 WHO/APOC, 24 November 2004 - Ivermectin meant for communities is delivered thrcugh already established channels like M&E officers' outing, or collection/delivery of NPI vaccines to districts and communities. The M& E officers are members of the LOCT. 43.2. Training - This activity is yet to be fully integrated, however several SOCT do participate in the NPI campaigns and they utilize these opportunities to give targeted training on CDTI. Training will however be integrated with other add-on activities such as vitamin A distribution and primary eye care outreach progftunrnes. 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. 4.3.3. Joint supervilsion and monitoring with other programs - During the year under report, most of the SOCT and LOCT participated in PHC campaigns like vitamin A distribtrtion, m&lsria control, polio eradication etg &t st&te and LGA level, therefore supervision of CDTI was integrated with such activities. Joint supervision and momitoring with othar PHC programrnes is the proposed approrc*r henccforth i.e. during tho post-APOC y€&s, srd ttlese activities are already reflected in the 3-)aar post- APOC/CDTI sustainebility plans. Integrated supervision checklists will also be dev€loped for use. 43.4. Rclease of funds for proiect sctivities Already tlrere are appnoved PHC hdgsts with allocation for Grcho control for the current year. Release of funds will be effected through contimros strong advocacy meetings with polhy makers ard trnditional ffirs. Etrorts will be made toensure that Onc*ro. budgets, are contintrously irregrated within existing PI{C hdgots in order toeftct its' release. 4.3.5. Is CDTI i*ctud€d in thc PIIC Mget? -Yes it is 43.6. Iless{be other hcalth programmes that nre using thc CDTI strw{ure rnd how thlswas actleved. What have been the achl,evements? - Noneyet. However, there are plans to integse distfihtion of vitamin A. i.e. after disengagenrent of th€ poliD €radication prqgraffiine (which has been carrying on this rctivity) by erd of year 2005. 5r 5r WIIO/AP€rc" 24 November 2004 4.3.7. Describe other issues considered in the integration of CDTI. Other issues considered are about the need to combine two or more CDTI tasks at a time while out in the field, as is currently the practice. It is also being considered to ensure that CDTI is integrated in PHC all through to community level therefore thereis a proposal to integrate CDDs with all community based disease control programmes like polio eradication, community mobilization for HTV/AIDs control, home treatment of malaria, as well as for distribution of insecticide treated bed nets. They would also be trained for disease surveillance on AFP, guinea worrn, leprosy, schistosomiasis, and HIV/ AlDs at community level. 4.4. Operational research 4.4.1. Summarizr in not more than one half of a pege the operational research undertaken in the project area within the reporting period. None yet, but there is the intention to undertake one based on knowledge, attitude and practice of muslim women in endemic communities as regards acceptance of social services vis' a vis' the way they fulfill their roles and responsibilities in accordance with Islamic injunctions. 4.4.2. How were the results applied in the project? SECTION 5: Strengths, weeknesses, challengeso and opportunities - List the strengths and weaknesses of CDTI implementation process. - List the challenges and indicate how they were addressed. State level Streneths I. Good integration of support activities. 2. Good leadership 3. Adequate Mectizan supply 4. Adequate human resources 5. High geographical and therapeutic coverage (1 00% and 80% respectively). Wenknesses 1. Poorplanning 2. Non-targeted monitoring and supervision. 3. Non-targeted training and HSAM. 4. Poor financial support from government 5. lnadequate transport and material resources. ,Y WHO/APOC.24 November20O4 5a LGA level Streneths l. Good integration of support acfivities. 2. Adequate Mectizan supply 3. Adequate human resources 4, High geogfaphical and therapeutic coverage 5. (l 00% and >75o/orespectively). Weaknesses l. Poor planning 2. Non targeted monitoring and supervision 3. Non targeted haining and HSAM 4. Poor financial support fnom government. 5. Inadequate transport and material resources 6. Poor leadership FLHFs Streneths l. Adequate Mectizan supply 2. Adequate human resources 3. High geographical and therapeutic coverage (100% and>75o/orespectively). Weaknesses l. Poorplanning 2. Non targeted monitoring and supervision 3. Non targeted training and HSAM 4. Poor financial support from govemment. 5. Inadequate transport and material resources. 6. Poor leadership t( WHO/APOC. 24 November 2004 53 Communitv Streneths l. Very high coverage 2. Good financing 3. Good planning 4. Good leadership 5. Good supervission/monitoring 6. Timely collection of Mectizan@ 7. Adequate Health education and serrsitization Weeknesscs l. Poor human resources 2. Low coverage in some communities 3. Non mobilization of nomadic fulanis 4. Non u€ahnent of nomadic Fulanis Chal lenees/OpDortunities The challenges faced this year were- (l) Collecting Mectizan@ from Lagos and ensuring prompt delivery to benefiting communities in the absence of funds. This was overcome through raising of a loan, which was latter reimbursed. The delivery of Mectizan to the LGAs and communities was synchronized with the period of polio immunization therefore the same resources were utilized. The SOCT also integrated their travel with the travel during the NPI campaign period in order to supervise the LOCT and several of them also ensured that they were assigned in the course of the exercise to at least one of their LGAs of CDTI supervision. Mectizan@ was sent to LGAs along with vaccines, and delivered to the communities also during the polio-eradication campaigns. CDDs in some communities participated in the National Polio Immunization (NPf) campaigns. .fr( 60 WHO/APOC. 24 November 2004 The drugs were taken to the LGAs in April when most of the LOCTs failed to collect them from the state. The SOCT sourced for transport money on their own and delivered Mectizan@ to their respective LGAS of supervision, ensured its' effective distribution to the communities, and carried out advocacy to policy makers to sensitize them for release of funds. The loans were however reimbursed from State counterpart funds when received in December. Several of the LOCT and participating PHC staff exhibited great commitment by ensuring that CDDs were retrained and that distribution was supervised. (l) There was delayed submission of trcatment reports to the State by some LGAs and this issue was addressed at the State-level stakeholders'forum, whero over 100 participants comprising, traditional leaders, LGA council chairmen, LGA directors of personnel and management, LGA treasurers, and DPHCs attended. A resolution was made, as a part ofthe communiqud of the meeting, that the LGA/DPHCs would call for quarterly PHC revieilappraisal meetings in order to establish an avenue which ensures that treatment rcports are submitted to the State latest by the end of September each year. SECTION 6: Unique features of the project/other matters - One of the unlque features of the project that helped to enhance stability and success at all levels is one, whereby, socr are put in-charge of LGAs to which they ate indigenous,(kinsmen) thereby ensuring effective communication with the people since language, religious, and other socio-cultural barriers that could frustrate progress are rcmoved. This stratery appears to ensure better commitment of the SOCT coupled with better leadership. There is cost reduction in terms of requirement for accommodation and feeding since these SOCT do reside with relatives while out on supervision in the field. Furthermore, the SOCT utilize opportunities of visiting home to carry out HSAM, as well as supervision and monitoring activities at very little cost to the project. This therefore implies that, as long as such personnel are on ground CDTI could be sustained for long, i.e. even in the face of poor funding. This same strategy works well and applies with the LOCT, district and FLHFs. The FLHF staff are usually posted to their native locality and are rarely moved away from there, therefore by this, integration and cost reduction is greatly achieved while there is stability and better commitment in most cases. - Another uniqueness about this project is the high retention of CDDs in spite of little or no payment of incentives in most of the project area. This could be because several of the CDDs are selected along family lines, therefore even in the absence of incentives, they are kl 6tv WHO/APOC. 24 November 2004 patient and even willing to commit there own personal resounces for the sustenance ofthe CDTI despite heavy workload of sometimes 750 people to I CDD. Although the absence of female CDDS in over 95o/oof the project area attracts concern, the high level of awareness makes it easy for male CDDs to administer treatment to females in spite of religious and socio+ultural consideration, since in most cases they arc kinsmen, therefole several communities have continued to sustain a minimum of 75-82o/o therapeutic coverage despite the high average cDD to population ratio of 2:477. g 6L WHO/APOC. 24 November 2004