Adamawa CDTI project annual project technical report submitted to technical consultative committee (TCC): from December 2005 to November 2006

ADAMAWA CDTI PROJECT _ ANNUAL REPORT. ORIGINAL: English _v2.. __ fo: fll Sit'l c5\ eaP AHE BFP v il I l't't1 ,r'i ,, For lnformotlon To, -\t e A'o ^*[ LItlf COt'NTRYAIOTF: NIGERIA Proiect Name: ADAMAWA CDTI PROJECT. Approval year: MAY, 1999 Launching year: MAY, 1999 Reportins Period: From: December, 2005 To: November, 2006.(Month/Year) ( Month/Year) Proiectyearofthis report: (circleone) I 2 3 4 5 6 (7) 8 9 10 Date submitted: DECEMBER,2006. NGDO partner: Helen Keller International. WHO/APOC, 24 November 2004 ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) DEADLINE SUBMISSION: To APOC Management by 31 Januarv for March TCC meeting To APOC Management by 31 Julv for September TCC meeting AFRICAII PROGRAMME FOR ONCHOCERCTASIS CONTROL (APOC) ll WHO/APOC, 24 November 2004 ANNUAL PROJECT TECHNICAL REPORT TO TECHMCAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: Country National Coordinator Name: .r.trf.r.,.a j.t.\..(.,G,L tr -f )r'\A(i(- Signature: Date: Date Date: ..!.I1. rrylt I La- it Date: .!fl . t.l Z.,Irs+]. )?l Zonal Oncho Coordinator Name: lltTl-i.1l.r]. ...L.G*t, - r't +\ Signature: W**.-.-s,. ry lt aLl -i]-t-' NGDo Representative Name: .:t>...fiwN- 19/*'lr* signature: ll/,Irtb# This report has been prepared by Name , .(*.:/.8A. ftfrlt ts*>'t+ Designatio " S.'iAiE.. Signature t7i2w llt WHO/APOC, 24 November 2004 Table of contents ACROr{YMS............... .............VI DEFIMTIONS......... .............. vII FOLLOW t]P ON TCC RECOMMENDATIONS .......I SECTION 1: BACKGROI IID INT'ORMATION I.I. GSNpRALINFoRMATION 1.1.1 Description of the project (briefly) 1.1.2. Partnership 3 J 3 5 7 9 9 1.2. PopulerroN SECTION 2: IMPLEMENTATION OF CDTI........ 2.1. Tnr,telrNe oF ACTIvITIeS.................... 2.2. Aovocecv..... ...... .. I I 2.3. MostI.zertoN, SENSITIZATIoN AND HEALTH EDUCATToN oF AT RISK coMMuNtles 12 2.4. Courvttxny INVoLvEMENT.............. ............... 14 2.5. Cepecrrv BUTLDTNG ......................15 2.6. TnperueNrs................ .................17 2.6.1. Treatmentfigures............. .....17 2.6.2 What are the causes of absenteeism?............. ............20 2.6.3 What are the reasons for refusals? ................ ............ 202.6.4 Briefly describe all known and verified serious adverse events (SAEO that ...20 2.6.5. Trend of treatment achievementfrom CDTI project inception to the current year22 2.7. ORoeRrNG, sroRAGE AND DELIvERy oF IvERMECTIN........... .................23 2.8. CoulruNrry sELF-MoNIToRING eNo SrarrHoLDERS MeenNc ...........25 2.9. SuppRvrsroN............... ..................26 2.9.1. Provide aJlow chart of supervisionhierarclry. ..........26 2.9.2. Whot were the main issues identified during supervision? ...........26 2.9.3. ll'as a supervision checklist used? ......... ....................27 2.9.4. What were the outcomes at each level of CDTI implementation supervision? 27 2.9.5. Was feedback given to the person or groups supervised? .............27 2.9.6. How was the feedback used to improve the overall performance of the project? 27 3.1. 3.2. 3.3. 3.4. EqureueNr FnaNcInI CONTRIBUTIONS OF THE PARTNERS AND COMMUNITIES.. OTgpR FoRMS OF COMMUNITY SUPPORT E>cpNoITuRE PER ACTIVITY 27 28 28 28 SECTION 4: SUSTAINABILITY OF CDTI ..............29 4.1. [NrpRNel; INDErENDENT nARTICTIAToRY MoNIToRING; EveluertoN ...................29 4.1.1 Was Monitoring/evaluation caruied out during the reporting period? (tick any of thefollowingwhich are applicable)............ .......,29 4.1.2. What were the recommendations? . ..........29 4.1.3. How have they been implemented?....................8rror! Bookmork not delined. 4.2. SusreNasILITY oF PRoJECTS: PLAN AND sET TARGETS (MANDAToRY AT ...............30 30Yn 3)............. tv WHO/APOC, 24 November 2004 4.2.1. Planning at all relevant levels....... 4.2.2. Funds.... 4.2.3 Traruport (replacement andmaintenance) 4.2.4. Otherresources..... 4.2.5. To what extent has the plan been implemented................ 4.3. IurpcReuoN 4.3.1. Ivermectindeliverymechanisms 30 30 30 30 30 30 30 30 3t 3t 3t 4.3.2. 4.3.3. 4.3.4. 4.3.5. Troining.... Joint supervision and monitoringwith other programs. Release offunds for project activittes .... Is CDTI included in the PHC budget? 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements?............. .................. J/ 4.3.7. Describe others issues considered in the integration of CDTI. .....31 4.4. OppnerroNAl RESEARCH.. ..................31 4.4.1. Summarize in not more than one half of a page the operational research undertalren in the project areo within the reporting period. ...... 31 4.4.2. How were the results applied in the project?....... .... 3 I SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, A}[D oPPORTIINITIES....... ............32 SECTION 6: UMQUE FEATURES OF THE PROJECT/OTHER MATTERS ...........32 v WHO/APOC, 24 November 2004 Acronyms APOC ATO ATrO CBO CBBI CDD CDTI CSM LGA MOH NGDO HKI NGO NOTF PHC REMO SAE SHM TCC TOT I.JNICEF UTG wHo African Progtamme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Community-Based Organ ization Community Based Bamako Initiative Commun ity-Directed Dishibutor Community-Directed Treatment with Ivermectin Community Self-Monitoring Local Government Area Ministry of Health Non-Governmental Development Organ ization Helen Keller Intemational Non-Governmental Organization National Onchocerciasis Task Force Primary health care Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Stakeholders meeting Technical Consultative Committee (APOC scientific advisory group) Trainer of trainers United Nations Children's Fund Ultimate Treatment Goal World Health Organization vt WHO/APOC, 24 November 2004 Definitions Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). (ii) Eligible population: calculated as 84%o of the total population in meso/hyper- endemic communities in the project area. (iii) Annual Treatment Objective: (ATO): the estimated number of persons living in meso/hyper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. (iv) Ultimate Treatment Goal LUTG): calculated as the maximum number of people to be treated annually in meso/tryper 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'd year ofthe project). (v) Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) Geographical coverage: number of communities treated in a given year over the total number of meso/hyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). (vii) Intesration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) through CDTI (using the same systems, training, supervision and personnel) in order to maximise cost- effectiveness and empower communities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTI. (viii) Sustainability: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future, with high treatment coverage, integrated into the available healthcare service, with strong community ownership, using resources mobilised by the community and the govemment. (ix) Community self-monitoring (CSM): The process by which the community is empowered to oversee and monitor the performance of CDTI (or any community- based health intervention programme), with a view to ensuring that the programme is being executed in the way intended. It encourages the community to take full responsibility of ivermectin distribution and make appropriate modifications when necessary. (i) vlt WHO/APOC, 24 November 2004 FOLLOW UP ON TGG REGOMMENDATIONS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session 23 (Please add more rows if necessary) Number of Recommendation ln lhe Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCAAPOC MGT USE ONLY 6 Final izes the determi nation of the number of endemic communities, so that this remains consistent between future reports The determination of the number of communities has been finalized and they remain 2,784. Integrates Ivermectin supply in the routine MoH drug system (ifexisting) Integration of Ivermectin supply in the routine MoH drug system is yet to be fully implemented. Carries out training for CSM and SHM and introduces these Arrangements are being put in place to continue with CSM and SHM training in 2007 since the state government has released its counterpart funds for 2006 for the project. This will be reflected in the next report. Trains more CDDs and increases the CDD to population ratio Additional CDDs (242) were trained in 2006, giving a total of 2,63 l, giving a ratio of l:402. More will be trained in 2007. Continues advocacy to LGAs to sustain support to CDTI Advocacy visits to the LGAs have continued during the year. WHO/APOC, 24 November 2004I Executive Summaqy Prepare an Executive summary otthe report ln not more than Wpaga Adamawa State is located south of Borno State at the north eastern part of Nigeria and shares international border with the republic of Cameroon. The State has a total population 2.14 million people (1991) National Population Census (figure), 2l Local Government Areas (LGAs) of which l7 LGAs are Onchocerciasis endemic. The State is multi-ethnic with varied cultures, languages and dialects. Their rural settlements are in large and small satellite gtoups, which are often than not along socio-cultural, and language lineage. Some of the ethnic groups include Higi, Chamb4 Vera, Yandang, Bacham4 Lunguda, Kilba, Hausa and Fulani. The main occupations of the people are farming, caffle rearing and trading. The distribution of Mectizan commenced in 1992 as a pilot project in nine LGAs but later expanded to the l7 LGAs. tn 1999 a new approach called Community Directed Treatment with Ivermectin (CDTI) was developed to make the community a major partner in the implementation of CDTI. In 2006 a total of 2,784 communities with a total (census) population of 1,237,434 of which 1,058,074 people were treated. The project's ultimate trcatment goal is 1,085,352 and the ATO for 2006 was 1,085,352. The geographic and trcatment coverage of 100%o and 85.1 o/o respectively was achieved. A total of 2,631 CDDs were trained from a target of 2,949 for the year trained. Also, 1,259 out of target of 1,378 Health Personnel were trained for programme implementation, thereby achieving annual training objective of 89.8Yo and 91.3% respectively. Some of the challenges/constraints of the project include: Follow-up and treatment of absentees by CDDs after distribution; little response by some LGAs to provide financial contribution towards the project and commitment to the programme by some of health workers and the LGA and community level. These challenges/constraints have been systematically addressed through encouragement of CDDs to be going back to treat those who were absent during distribution; requesting the FLHF staff to ensure frequent visits and effective supervision of CDDs during distribution; advocacy and sensitization visits to endemic LGA executive was intensified to solicit for rclease of funds for CDTI activities. 2 WHO/APOC, 24 November 2004 SEGTION {= Background information '1.11. General lnformation 1.f.1 Description of the project (briefly) - Geographical location, topography, climate Adamawa State, created from the defunct Gongola State in August 1991 is located at the northeasternpartofNigeriaand"liesbetweenlatitudef 28t and tf 55tandlongitude Il% o and I4 %o East:. Adamawa State has 2l Local Government Council areas (LGAs) spread across two notable vegetation zones, the sub-Sudan Savannah with slnrt grasses and sparse trees in the northern part and the Guinea Savannah marked with tall grasses in the southern zone. The Stote shares international border with the Republic of Cameroon and from the border run three major rivers. Their sources have given the land undulating landscape as the water courses with their tribularies have traversed and turned almost the entire land orea into arable place for agricultural activities and suitable breeding sitesfor the Similium Damnosum. There are two seasons, the dry and the rairgt seasons. The rainy season begins in April and ends in mid October with averoge rainfall of 759 mm in the northern parts and l0l Imm in the southern part, particularly around Ganye and Toungo LGAs. The wettest months, which signfy the period of heaviest rainfalls, are August and September. The dry season startsfrom the end of October to April, with the driest montlts being January and February when humidity is as low as l3%. - Population: activities, cultures, language The State is multi-ethnic with varied cultures, languages and dialect groups with a population of 2.14 million people (1991 National Population Censusfigures). Their rural settlements are in large and small satellite groups, which are often than not along socio-cuhural, and language lineage. Some of the ethnic groups include Higi, Chamba, Vera, Yandang, Bachama, Lunguda, Kilba, Hausa and Fulani. The main occupations of the people are farming, cattle rearing and trading. Communication systems (roads. . .) Hausa andfulfulde are widely spoken, however, English has been adopted as the fficial medium of communication. Otherforms of communication, includefairly good road networkfrom the state headquarters to most LGA headquarters. Most of the communities are hard to reach due to bad tetain, rivers or rocks. The only means to reach such areas is either by boat, bicycle orfoot. Even 4 wheel drive vehicles can not reach them, especially during the rainy season. - Administrationstructure There are three levels of administrative structure in the project state. These include the state, LGA and community. The Executive Governor is the Chief Administrative Oficer of the state. There are lhree arms of government that run the state affairs with the Executive Governor as the head. These are Executive, Legtslative and the Judiciary. 3 WHO/APOC, 24 Novembcr 2004 At the LGA level, tlere are two arms of government, i.e. the Executive and Ingislattve who ntn the afatrs at this level with the Executive Choirman as tlu Chief F,xecutive Ofricer. The community level comprise tlrc district, villages and/orwards. The Lau,arc (Hakimis) are tlrc heads, while the Jauros or Mai Angwas are the leaders at tlu communit ies or villages. - Health system & health care delivery (provide the number of health posts/centers in the project area if the information is available). Heakh care is delivered at two level in the project state, i.e. the state and LGAs. The state provides secondary care where there are the General Hospitals and Comprehensive health centers. The local level has the primary health centers, clinics, and dispensaries. There are 179 health Districts; 882 health centers/clinics and a total of 2,208 stafi. Onchocerciasis is prevalent in 17 out of the 2l LGAs in the State. There are nine hyper- endemic LGAs and eight Meso endemic LGAs. In some of the Meso-endemic LGAs only few heauyfoci have been noticed. The number of communities receiving Mectizan since the commencement of CDTI implementation are 2, 784 as against 1,392 who were under treatment before APOC support. 4 WHO/APOC, 24 November 2004 Number of health staffin project area and number of health staffinvolved in CDTI activities. Table l: Number of health staffinvolved in CDTI @lease add morc rows if rucessary) District/LGA Numbcr of hcelth slrlf lnvolvcd ln CDTI rctivltlcs. Totrl Numbcr of hcelth strlf in thc cntirc projcct rrcr Bl Numbcr of hcrlth stelTinvolvcd ln CDTI Br Perccntrgc Br=Brl B' rl00 Madagali t29 63 18.8 Michika 123 67 54 Maiha 195 73 37 Hong 230 92 40 Gombi r6l 90 55.9 Song 120 83 69 Girei 67 66 98.s Yola South 156 67 42.9 Fufore l12 67 59.8 Demsa t52 73 48 Lamurde 88 7t 80.6 Guyuk 198 87 48.9 Mayo Belwa t42 75 52.8 Toungo 6l 6l r00 Ganye I 15 74 64 Jada t40 82 58.5 Shelleng 6l 6l 100 Totel 2,2s0 t,252 55.6 1.1,2. Partnership - Indicate the partners involved in project implementation at all levels [MoH, NGDOs (national/intemational), communities, local organizations, etc.] The partners iwolved in project implementation include: the endemic communities; LGA Health Departments (LOCTsNutrition Offcers); Community Based Bamala Iniliative Committees (CBBI); State Onchocerciasis Control Unit and; Helen Keller International. Describe overall working relationship among partners, clearly indicating specific areas of project activities (planning, supervision, advocacy, planning, mobilization, etc) where all partners are involved. 5 WHO/APOC, 24 November 2004 (l) Communities: The community members are iwolved in mobilization of themselves for Mectizan uptake; selection of the dtstributors; collection, storage, safe kceping and distrtbution of Mectizan; monitoring and superttision of tlrc mectizan distributton. (2) At the LGA level, the LOCTs and Nutrition Oficers are irruolved in the planning of activities in collaboration with the state team, mobilization of endemtc communities; training of community distributors; collection of Mectizan and Vitamin A from the state and delivery at the collectton points; provision of storage facilities and storage of Mectizan (vitamin A; monitoring and supertision of the distribution; and collection of treatment reports. (3) The State Onchocerciasis Control Team draw up plan of activities to be carried out in collaboration with the LGA teams and NGDO partner (HKI); conducts the TOT training for the LGA offcials; carry out advocaqt visits to the endemic LGAs to solicit the LGA Executives support to the project; collection of Mectizan/Yitamin A from the NGDO for the endemic LGAs; Monitoring and supertision; collection and analysis of treatment reports, provision of the necessary data to the NGDOfor re-application of Mectizan. ft) The NGDO provides technical assistance by training of state team as trainers; re- application of Mectizan for the project; high advocacy visit to the state MOH fficials and LGA Executives. Advocacy visits to paramount community leaders, CBOs and influential community members to solicit their support. CBBI Committees are an organized community Development Organization involved in self help progrommes. This could be in the area of health, agriculture and other social activities. In the area of health, they do raise funds to run clinics such as drug revolving. Part of their activities include mobilization of community members for Mectizan uptalce, entertainment of CDDs during training, collection of N20 per household during Mectizan distribution to support the CDDs. State plans, if any, to mobilize the state/region/districttLcA decision-makers, NGDOs, NGOs, CBOs, to assist in CDTI implementation. The project will continue to intensify advocacy visits to the LGA officials to solicit their support for the programme. The support from the State has been oppreciable in-terms of provision of personnel, logistics and funds. There is need to continue with advocacy visits in order to sustain the good working relationship. The project will conduct advocacy and mobilization workshops to the CBBI committees so that they will assist in mobilization of the community members. 6 WHO/APOC, 24 November 2004 j aN a ! oE E -Dri -o = t,J IA't6 lo ls> oo tr oU'p 5o !oE p o 0t E tnr t(D (D Et (D Et o ot" D:t otr{ (D ort o o, (D (D A' o a. o o rErt oq (D o!o :r 0a !(D oo s R s o il Et4 r{ CFU frj oc eX (n oz o a trj -t- rr,z o g r9r.Ad :i a;!e1E3 ;'* a'6q. D fr,t-{ U rn a ozo Eo * x o o ED o Flrj 41 ed oF frj -loC 2, o o E CE I3 i€ 3 -Eg.ts U E'T. .dare =' \o L'I N)o{ (,r(,r N){ o\ {6 N)o5 o\{(,(, o\\o N 5 Ur5 N)5 N) (..ts o\ o\lJt Lrr @ \o Lrl{ { o\5Lrl o\I(])\o N) s@ o\ Lrl { N)\ts{ s Jo{r,{ (.) o\ o(n 55 o\ l I 55 N)os N)(, 65 o(, 5r.rl II I I (Jt I o(, oN)UJo {{ I oo5 { o\{ N)s (J) o N)o@ o\ @\o 55 o\ { o\\t o\€ N)o5 t\JL,I o\\o oUJ (./to oN) N o o o(l a o (t o(! a D (l !t z (D Et o oo isF .:. it o a :.i :;*g;E. ,l o o!c e'g NCo> o,i(i T t 5{(, t\) Lrr L..t tJ{o\ o\ ;JNso\ a{ u)9r I I N) s\o o\(, UI @ \o u{ (r)PootJ o\ o\ t/J\o N) o(JI 56 t 5\o{(rr{ 5\t 6 oo o\ I o \o Lrl6 ! 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GGo sF ilSoSG\b ho 00I €s C) oo G S T soI ag (\\ d(! o la o \$G(!tGo G\ o\(! o c) s,(!r N CI G G\ ,o G a.\<(\ s ,o G\\ (\ o IDt, ct o(D ttc ct, aFt o Ft &.(D o o. o o o.trf. 0q o r|(D ,o o + ='oa !oI.oa (D U2 X z *E z "9 <a1SEEkt'8a' ....4t >dliEo H9 EI Isooot5atnJco ,adlo,ts l1l:tl(Dls'6 6- A)fo o5 u.e U IX I I I I I I 9 oI ootrFt o .o (/) -o (D 9.a H, oC A'Io E cn (rEt (D (D oo t oFt p, (rct o o-o ;a (D{ A' oo ta (D U) o oo Y oI D) oa(D -l U'{ (D .o o-(DFt TA A, o (D ! a :fi o o (D ! &.,oo ti's E +g Eoo-A(!g,P r< If o(.ltg8(!Ft a J o) o oH, 5 oEt o u't F)(t o o fo o A: o !, o 'o .4.oo A'Io D) t V)o ='o o-(D ot(D { o 'go "ot\)5 zo o 3r t\) 85 oo SEGTTON 2= lmplementation of GDTI 2.1 . Timeline of activities Fill in table 3, timeline of activities for areas treated in current year, indicating when the key activities were implemented by the month they began and the month they ended. 9 WHO/APOC, 24 November 2004 I o o 3 o ta -l 3o o oFn oto ott, o'Ft (D p, Io 0t(n Eo D' (D o. (D oE x(D ot o il\o € A) U 6 o F o o o E o z o o r U o t- - CFU rr, o z rr, ..t oe zoo U IE rrjt. U rr, C') ,7, EI oF lr, o - a o -l o F frj cn o z o 'loFl 5: -t a rI' -t.rtz o oC c x \ \ \ 41 rr, Ed o6 c96!E, FliiE\ \ \ \ \ \ \ \ \ \\ \ \ =v oo o 33OE =o o a 3 og N!l o a o o o 3 3 e = oo \ \ \ \ \ \ \ \ \ \ \ 1'vI -a6P =4\ \ \ \ \ \ \ \ \ oo, o o33ott =o o) 4 a =o \ \ \ \ \ -a3Sf4El 5Jto\ \ \ \ \ \ \ LCz o o, \ \ \ \ \ \ \ \ \ LCz o o, o -9 =)o!is o = oo5oc o C!, CLtl o \ \ \ \ \ \ \ \ \ \ \ \ \ LCt- oo -a5P54 rto \ \ \ \ \ \ \ oo{ o o, o -93E =o o a o allt o(. s.6c o = \ \ \ \ \ \ \ Lcz oo -a3srdEtt\ \ \ \ oo I o -9a3o!, =otE! o a otroo 3o o a o o o "oN5 zo o r N 85 2.2. Advocacy State the number of policy/decision makers mobilized at each relevant level during the cunent year; the reason(s) for undertaking the advocacy and the outcome. Describe difficultieVconstraints being faced and suggestions on how to improve advocacy. The number of policy/decision malcers mobilized at relevant level during the current year are asfollows: Slate Level: Advocacy meeting with four (4) senior government officials in MOH o Hon. Commissionerfor Health o Permanent Secretary, MOH o Director, Disease Control and Public Health Sertices o Director, PHC, Local Government and Chieftatncy Affairs. Reason: To maintain the good working relatiorchip with the state MOH decision malrers and ensure continuous material, logistics andfinanctal support. Outcome: The state has continued to release her counterpartfinanciol contribution. LGA Level: Advocacy meeting with four (4) LGA top officials on the need to support the programme by the State Co-ordinator and HKI representatives for every LGA. Those met include: c Chairman o Councilorfor Health o PHC Director . Deputy PHC Directors Reason: The support by some LGAs hove been very minimol, thus, the need to continue to visit and encourage them to slep up theirJinancial support to the ProSramme. Oulcome: The LGAs have responded by making somefinancial contribution towards the programme in the areos offueling and repairs of motorcycles usedfor supervision. Communitv Level: The followings were visited at the community level: o Community Leaders . Opinion Leaders o Religious Groups o Development Association leaders Reasons: o To embrace the programme , (take ownership of the programme). o Encourage them to support the CDDs o Provide storage and safety of Mectizan tablets and Vitamin A capsules. o To monitor and supertise the distributors. ll WHO/APOC, 24 November 2004 *'*$ .s#ii-ilu"p.,':' i'," ,.-:r.r. " rd . "i.",rs, +r.,=p .i5g{ffi1,qt,9*+"ritr-,rtfq"r !.}3',''. -*ffil ,-" r) Odcome: *ttt' 'i:r iirr All the commtmttles have acceptedtlrc prograntme andane gtvtngsome tokcnto the CDDs as a sign of apprccidion of tletr commitment tou'ards tlp distrlbution TTu CBBI committees in some LGAs continue to provi& refteshment to tlrc CDDs &tringtraining. Some CDDs were provided with writing materials by their communities. Difficulties/Conslroints k carmlne od the Advocaq: Most of the difricalties and corctraints are seen d the LGA and Community Levels. While tlp LGA Executives will promise to support tlu project through the release offundsforfueling, maintenance of motorcycles, and some allowances to LOCTs when contacted during advocacy visits, few of tlum always lanour their pledges. How lo Improve on Advocact: . Apart from visiting tlv LGA Executives, advocacy workshops will be organize to enlighten them on the gravity of the problems in their areas and solicitfor support. o The communities will be encouraged to continue to support their CDDs. 2.3. f,lobilization, sensitization and health education of at risk communities Provide information on: The use of media and/or other local systems to disseminate information o Radiojingles and TY spots about the disease and needfor control were done- periodically. o Town criers were used to disseminate information and to call community gatherings where tlu members were health educated about the disease and need for treatment. o Announcements are done in the churches, mosqlues, during community associations or cooryrative societies meet ings. o Healthworkers and CDDs have been trained to health educate community members. Mobilization and health education ofcommunities including women and minorities In areas where there were womenfellowship groups, tlrcy are mobilized, but where there are fane, tlrcy were mobilized with other community members or development association Response of target communitieVvillages Most of tlu communities are supporting tluir CDDs through token contribution ofN20 by each household. Treatment coverage lus improved. Entertalnment of tle CDDs by some communities during tratning. a o o a o a -$ ,i t2 WHO/APOC, 24 Novcmbcr 2004 ?+ 6 1:. *i-". tt{r}+d 'a*"f-- *,*."fiflni{iFHr:4$SF.+frFqqrt1i' 4.-#s+{r- rr *rOq ,tr Accomplishmens o Mobtltzotton and health education of 2,784 endemlc communltles. o Tleatment of 1,058,074 communlty numberx o Organlzation of stake holders meetingwherc LGA PHC Coordinators/Deputies, LOCT leaders, Nutrition Ofricers attended. Suggest ways to improve mobilization and sensitization ofthe target communities. o Encourage PHC staf at community level to visit their community members morefrequently. o More advocacy visils to the LGA executives by tlrc state team to solicit their support to the programme. o Community to be errcouraged to conduct community self monitoring regularly. #, :ff l3 WHO/APOC, 24 Novembcr 2004 , . ,"Y,rr!|fi .+ lt"fiT#Sli'+r* Incentives provided by communities for the CDDs t4 .'q#[lt#q+ r n.5trr5,1rpr*,*gffifi 'tf ..* 'rts.'* "' 24. Gommunltlr Table 4: Communities participation in ttre CDTI (Please add more rows lf rccessary) Information on the female CDDs will be reported in the next report. Comment on: - Attendance of female members ofthe community at health education meetings - In general, how do you rate the participation of female members of the community meetings when CDTI issues are being discusses (attendance, participation in the discussion etc). Culture and religion is a barrier in mobilizingwomen in Moslem communities. The only way employed to mobtlize them was through tlu use offemale CDDs. In other communities, they are mobilized through theirlellowship meetings andwomen ossociation meetings. .i ,5. u s' t, Nunbcr of cor'nunltlcs/vllbgo wlth communlty ncubcn rs rupcnkon Numbcrof CDDs rnd ttc communltlcs lnvolvcd Nuubcr of conmunltler /vlltrgcr rlth fcmrlc CDDr Totrl no. communltlcs ln thc cntlre proJcct ercr Br Numberwlth communlty nembcn rs rupcrvbon Bs Pcrccntegc Br- BJB..l00 MrlcCDDg Br Fcmrlc CDDs Br Tobl B-r& Numbcr of commonltlcs wlth fcmrlc CDDg Bto Pcrcentrge Brt= B'.'/3.'1(Xl IiIADAGALI 3lt 155 49 269 269 MICHIKA u6 ?25 50 237 237 MAIH,A 204 150 73 246 246 HONG 189 95 50 r89 189 GOMBI t7t 86 50 t7l t7t SONG 150 76 50 6l 6l GIREI 67 37 55 6l 6l YOLA SOUTH 30 30 100 30 30 FUFORE 68 35 5l n0 il0 DEMSA 6t 32 52 60 60 LAMURDE 69 35 50 98 98 GUYI.JK 103 52 50 98 98 MAYO BELWA 208 ll0 52 2t5 2t5 TOIJNGO 183 r83 r00 96 96 GANYE 183 92 50 165 165 JADA 297 150 50 415 415 SHELLENO 102 98 96 ll0 It0 Totrl 2,784 r,64t 58.9 2,949 2,949 WHO/APOC, 24 Novcmbcr 2003 DlstrlcULGA ",., ."*:".,qi*ntltr1}'srP!'* ,j ,',{-,..,il,r,-r}r.f.'ar ,'1,,^,.r' r;,1."$"fit114i":"'r "'*-qI}Yf ft'Y'-*'' Atfiition of CDDs. Is attition a problem for the project? Ifyes, how is it addr€sscd? Ihe pruJect tntends to advlse the commtmity members to lroolve tlp rctlrud clvll senants wlo lo'e retunpd ln tlp dtstrtbution of Mecttzan The use kin*ed rystem would be employed in tlp selection of CDDs. Other issues 2.5. GapaclQr bullding - Describe the adequacy of available knowledgeable manpower at all levels. Tlure is available louwledgeable manpower at tlu State level. However, at the LGA and community levels, not all the available manpower has been trained in CDTI implementation 1,204 Front Line Health Facilities staffhas so.far been trained and efforts are being made to train more. - Where frequent tansfers of trained staffoccur, state what the project is doing, or intends to do, to remedy the situation. The Project hove rnt experierce any ccrses offrequent transfer of trained stafi, 'i!' *dil '.I { 1{ .Ji l5 WHO/APOC, 24 Novcmbcr 2004 .t ,F, s (D o H e5 o (! u, o oU .:l s R so il tst c, I o $EG 6 s d I s I Fs s- ooInt:$ ,i o s oIs s tr 5 o\ o 'Uop t.J5 zo o 3r Noo(, t Cx U rn o z # dc2 o o t Lta S o H oH F U o E EI rri x oz o C) o EO (n oz o o 7Ir' ,tt e4 oFf!, ot cn oc -, U rr, (n (A rrJt.t'rtz o o EO fr,t- U o 't a N) l.J N) l.J N N t.J N N l\) N N N N N(,5 ].J N z E Eo -l oxl t?E5.(l+taE F o a t, E B s aI 6 (l E(D E oc (,5 (, 5 N N) N N) N N l\) N N N TJ N N) N 19 N) hJ N) N hJ N N l.J tJ tJ hJ }J N) N N hJ },J 19 N o Is o I T;; t ba(, {o\ ooo {o\ o5 \o@ 6o {o {N {N) { @5 \oo (,l@ \tl.) {\o {5 o\5 o d6 l*l*z EF l3i nEl egc= o Er. s at(t oE o E \o (,\o a(, NIo5 l.J UJ (j){ o\o o\5 TJ UJ 5 l.J(l) 5{ {o oo\o N)(,J o\ o\ hJ(, o\5 6{ tJ(.J { @o N UJ 5qJ o\ o\ 5 N UJ o\5 o\5 hJt, 5 h.)t, 5{ {o tJ(, 5 o\ @ 65 Nl.J o\ NqJ t)(, t, oo {t\) t'J(, 5\o nJ UJ 9r o\ {\o |.Jt, 56 { Nt, t,t, u € o I:r. St 3d TIE -l o '.ta -t -t ----i ----i .----l o + oI rl ot s, rq I'r z I sHc,r ='oE3Q* -;HEToeJdg3' o a o b.r\a o\ t, o\\o tJ{ N5o\ (,5o { 5o o\ o t,o o\o \oo \o6 o hJlJr 5tr o\lJt \oo\ O'lo6s a .l o E(D E 6 9c co }.5t\) o\ N o\t, No\\o N(,{ N)(, lr) N5t, N5 o\ ;6\o 6\o { { o\ ; o\ o\ 5t, 6 ..1 ol (, o (, o o\ IJ5 o\o \o6 \o € \o6 \o € o c t,(, 6|.) N Ut oo t", r.,r 5 t, o\trr o\lJr \o o\ \o o\ ot {oaoToI eq s$ l= IE IE etoll o|rl o UUta ;,i(tt "".k. oC c ^ s a (t oE(t E oo eud**; # I* $ +'*i'f'- --'?t?tii!'{t' (Tick the boxes where specific trainlng wai carled out &trtng the rcponing pertod) . .*,.rrro.,i{ldi Trainees Type of taining CDDs Other Community members e.g Community supervisors Health Workers (frontline hedth facilities) MOH staffor Other Political Lcaders Others(speci&) Program manasement Howto conduct Healttt education Management ofSAEs CSM SHM Data collection Data analysis Report writing Others (speci&) Any other comments 2.6. Treatments 2,6.1. Treatment figures The project was able to treat I ,058,074 people out of ATO of I ,085,352 with 2,791 ,62 I Mectizan tablets If the pdect is not achieving 100%o geographical coverage and a minimum of 65% therapeutic coverage or the coverage rate is fluctuating, state the reasons and the plans being made to remedy this. The project has achteved 100% geographical coverage and 85.5% therapeutic coveraSe. The coverage rate is fluctuating because of some of these reasons: Some CDDs dofeel reluctant to go backto treat absentees. Other CDDs treat more than one community ond sometimes do rnt visit all the communtties because no incentive ts given to them by the communities. # t7 WHO/APOC, 24 Novcmber 2003 3 o x B o F >9.ha >d' UF' (r) 1l o\1 Fln HF ot lr, (n o zo oo tr ozo (r, lrlFFlr,zo U o 2 # 'JoC 2,oo EF Id a cx F c7U rr, Horl F oo a7r)Imo A! o\ u) "ilBEE a BT F[* o\\o o\ o\@ N o\\t o { @\o t\)o5h,-t65 otJ t\)\o{ @(, o No@ ot, v E$r ='9 g o:i 6 € hJ o\ -t o { 6\o N)o5 55o\ irto}J t\)\o{ 6 o t\)o@ o o\\o o\t\)-Io5 tJ o\{ o { @\o N)o5 55o\ tJ F 9za<atc' e =t e a'6 g,{ A Y'r h, -I €5 ot\) l.J\o{ @ (,,o t\)o@ o o\\o o\ o\@ oo oo s t .{ tl, rllt oB EE oo E E,i E o IA p ,e(!0 oo oo oo oo oo oo oo oo oo oo oo oo oo oo oooo o t,, -J -@\o\o i.J 5jo -t{ \o iJo{ o\o\ \otJ -t o\5 t\){ o\ 5 o\ \o{ FN)5}J 56 o\ o\\o 19 5 {@ 'L, o5 o\ co o\{ 6oo\(, o\ P [E *B EE " iar g tJ -t5 5 -J19{5 -,1 55 o o\ {o\ t\)o t tgs ='!t lLo* € o\ 6(,t t\) t.) o\5 \o\oi,\oo { 5 UJ\o -,1 €@ 6Po o\5 -Jo\ co '.o{{ 5 o\ 5{ 5 6\o}J \t @\o 5 io\o TJ 5I o\{ 19 I\o \o { o\ N) }J A5 19t) 5 @ \o { \t o\ \o\o\o 5N{@{ {t\) o\ P rEI o( € o -t5 N \oI -to\ o\\o N o\ \o €{ @ 5 € o\ \o o\\o € o @ 5 66 5Pt\) {{@ s\o6 t'J ru o IE t9 o E €(^ l^ { ir. 6)J @:J o\ {\o 6{ \o 6 @ {5 \o @l- \o19 -t\o \o \oIo\ o:, I \co\ E EYt J e# 5{o(tco d'.o EH-EI tJ6L{o {t\) o5 N) o\@ I Ii, t\,t\)o{ ].)\o\o t,t\) o\ o {-t o\\oo 19No t\,UJ6o o \o t,C'\6 nz rE5<r fr1 t t I I t t t t t t t I t t I t t zIo od4= ffiF t I t t t t I I I t t t I I t I zfl E*HErHf, FJ(!pg (D5 o t, Ft o r{o l, A' p o D'IA o, t,F S *I oil B € V)@ fio ro o r) N5 zo 5 r N 85 '/tti vEI EIo ;l ^E53. oo (! !t OQo il*o oI oa tsGB o\ =' -E oo (! 0t(rtl o{ o,(! tJ o .)o R6vol&o il o s crl o A'ofo oo 4lzo lc' E.IE.;,ltE l'r5lod l,{)(i lEl .r taDg13 'E lil8l+ sl8olR 5lo r11+loAloq, & 5otn o > Eo ?oiiog 6' sI(! oIt =.itE' oE .4.(1 o oth(a o ,l o gH i El Islt ssi ;!F ELG.$ TRE F{! E F! =i* +i$ $[REsB g\+ :lrtorm[P i- -r- l$ $tE3S { $E $ =rl Et3sil EB ie.S Ut$ s s F$B O\s!e. tas E\ soiTt:st .Es S|lPr-iRRSFS\E €oo$$FTrl e.C R. il I ET tllE tsE oo s €t EI E f, \o E a ru o "(')N,5 zo(t 3r N E llI - l- 4lZ. -t-r lo g lE-(rl(,l p 13iil.: ;H Ftx € E: Et8o ='loo Yl =19s. tH5 ta, " E.lE ;t1olo?ta(rt . (..(4d XE t'o ooj 6' oo I) J eJ 3:(D v, s.+) 5' + Jo ! .d.oo+ F'tt! F' t.) F, 4lZ,dH B155" -ldX EIErlobal?o g18 c; lEE, 13rte d li. $l$glHI I;ir'tia(Dt(! ala ^, 6. l+5 EIAs t.tB " to.8lx 5IHglo3loc J a:o(/, A'th d(D J+ soo C' Ffr, o J a (D E .4.o() a sli(a F' >tz5lc ABfli 3lEo lct =l(D elil slE <lx(Dl- lolo olo ELB iT IF x oo I \o{\o 6\ ",-,,,- , -i-' "'.fiurcu*ge*r***-,. il , - {, y { hls - .nt#n"r*r!(F+*i' "-iy{tfiir .-'*rb dtr' l '*iU(ftsW*'"':+r$$1,1dififfi,Cf*''r+.ttr'tE#"+i{r+rt*l rr'-'}r*^'4"''" ' "r:t{,'l,r-' *ffi 2.62 What are thc cruses of absenteelsm? Somc of the causes for absenteeism are as follows: Some CDDs hove been wwiUing to go back to fieat those wla werc absent during theirfirst visit, ond rccording tlem as absentees. Remedv: T'lu commtmity leaders have been eruouraged to appoint mone community members to supertise tluir CDDs during distribution and report such cases to them in order to address tlum. The FLHF staf hove been empowered by giving them adequate training in monitoring and supentision, and have been requested to visit the communitieslrequently to supertise the CDDs durtng distribution 2.6.3 What are the reasons for refusals? No cases of refusal have been recorded as community members have accepted the programme. 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. No serious adverse events (SAE| have been identified so far in the proiect. In case the project did not have any cases of serious adverse events (SAE) during this reporting period, please tick in the box. I No SAE case to report ,,!r x 20 WHO/APOC, 24 Novcmber 2004 l-llotd l(! loo ;Dt,(D o o t,o o =CAp o. (D (r, o o E (h C') frjt, 7 A' oooIt tDo oE =. =lOQ 7o t!!o :t oclI,(!f.oo e(t tr G s R s oil Et u, si :tGoG4 u,S\:s- zo o 3s(\ € s * k s- S Tqt o\ .o G\S Gs t\) 4 o iu ooL5 zo (D 3r t985 U' 2i OQ(! v)o x 9< E.F o o H) ETF rE' oavr-E EX6=OH E-oo3 U) Et o 3o $F$H s HilFE ===.oq-E.q o a 5 F+*UiiOoO =5 5 o .a :r 6'o - g g- t zaF =, !ra e3F i'e,6fi q EO €Eil36.oq Egr FBE irE ka+*-"'" t\,o o l\JI\o NI oo N 8{ N)oo o\ NoolJr Noo5 t\, 8l, N 8N NI t\)ooo \o\o\o \o\ooo \o\o\t HF N\t @5 N{ €5 hJ\o6o N @(r o N oo rao Nb,oo hJ(,to5 N o -to q- g '*dsZd '8fi r gi & oo 3 3c o6 tr ooo0 hJ -l65 N{ €5 N \o €o t\) -t({^ N 6oo TJ t,o5 N(,o5 N ooo E$B tt N\t65 N{ oo5 t\) t/rt,{ N N)6N N{t,{ N r,o5 h.) lrro5 6 o\t, odZ TEBT n#gE*8 a: ooD E' oo oo @(, 6o \o6 \oo\ oo \ot, E BE'}{Y8 $ sEE SE \o{ \o6 6(, \o(,6 \oo\ oo oo \o(, 'E E e E{t NqJ{ 5 rJ)5 {O 5 \o(.J(,{(, N) o\ \o(, o UJo N 5 \o o\ o\ N \o \o 5r, { UJo @ 6 g- !tFE E .Ei*[s o 006 oo( N^ 'o o5lJ( o^\ o t, \o5 \ot, .9 8o €Ur .9Io \o o\ (a {6t, o\ (.r! I F$sF o(, 6b{5 \o o\r, Et, "j0 O\ ='N=.vo Sno5ni o a\o t,o6 6(, tj o\Nt, -t\t o\ 6 t, \ttJ o\ lJr o\l/r o\ t, rcQ- #_ Hq!ao6xr E' 6r, t, 6N 6o {\o 6o 6 {(,,rt^ \t\t Ftot/oo 3 6,8 v!. (to(tto tr'.a E It E F ,it \o\t \oo\ \o(, \ot, @ \o6 65\t \C'N a rf; E EtrFi1t s \oo\ \ot, 6\0 6t, ta {N o\ {P o\ (^I6 9- 85 H ts ; *'t, r E l'.1 E'ls u, lo 3.tr xaIlin E g;8HA *(DErB? elp:iF{x ea;ga:3 3$E;ts3 Ersga.h 6' aB6 H I+E!?u 3,Fs 3- €r =,6i$'9Ho6al-{(,lif- t9(Dr- a(DEE UEt, *4tD ='cigld?' ;.E s !n€. E'0Q(D(2E(?(D ,r .'+ rE,(!D+. BE9 l'ii 3.E p r! G-O EFg3q.= Isso Eu ;.Fgeil =srE HE.o\R$ x€rl s oeo aD tt F o ai-/ zo (D J o ! e o o ,; ! u D t 5 oc -oo s o o oe it! 6' o o o .t T !oI J o t o D ..olII -lot .rl i o c o! a aa , o t E 3tt ort ot o o 3 3 E = - o o ,, .t ti o o 3 3 I aa t 3 o 3 t! o e 3 orl o rt , Df -{ o oo o0 A o r+ Itc .+i €{ o I o o o =o 4 o{ og D o o oEI il a. o o o 3 3 Ef o o E = t o .t o{ D o .t o o{ o .a o o 3 3 EI €- ot o{ , o eEl( o oIllr; oI o{ o a 3!c o aj E o o fo D a, oaj D o .a N{o5 o o 3 3 Et o o J aa -o E o o o ,a o 'UooL5 zo (l 5 r N 85 hJ N) #t*.o-,,".ri},d6s"ib'*.;Mfrii*4r*I\*#r#i,..'"mia;*ii.,*,*,,*.,:'.',,*,.q{frr.;rrr&+ar.,.,as'{*,-"t*g'..l,.l";* ..r. ,,*1ijt,,J,".'r+rr.rr i -!+.rk ,.- f"hr=":-{FfiGjsif i+1' ,-,Lr q- +.I:+ryqPr',r *fllF}u1,,fi\-1. r r6rrxlr 2.7. OJderlng, storage and delivery ol lvermectln Mectizan@ ordered/applied forby -@lease ri*rlp approprlate onswer)MOHX WHOEI UrUCrrtr Other (please speciff): _SOCT TIIROUGH NGDO TO NOCP Mectizan@ delivered by - (please tick the appropriate answer) MOH tr wHotr t]NIcEFtr Other (please specifr): TO NGDO, TIIEN TO SOCT NGDOtr NGDO X Please describe how Mectizan@ is ordered and how it ges to the communities Ordering of Mectizan begirufrom the communitywherc after community registration, (census) have been conducted and number of eligible people obtaitted. These are sent through the LGAs and the state to the NGDO (HKI). HKI then used those information to applyfor tlrc Mectizan. Where distribution has been going on the information is obtaircd from the treatment reports from the community summaryforms. On the other hand, when Mectizan reaches the port of entry, HKI will collect it to her store. The state now collects from HKI and later distribute to the various LGAs who deltver it to the designated PHC centers which are collection pointsfor the CDDs to collectfor distribution. Irwentory process was maintained at every level of tlu drug transfer. Table l0: Mectizan@ Inventory @lease add more rows if necessary) 23 WHO/APOC, 24 Novcmbcr 2004 r !r,n ,/. n.. 5+rril..ls;- ,\.{k {# ,.wfrfos#E{lifit"qqpffi;r*++,,5"'i-x{:+qst'-rr"}" 't.t -,Strte/DistrlcU LGA tablefr Rcqucstcd Rccclvcd Uscd Iast Westcd Erplred Renrlnlng MADAGALI 210,000 210,000 20/,,U5 555 5,000 MICHII(A 388,000 388,ooo 379,452 48 500 E,000 MAIHA l50,0oo 150,000 149,549 5l 400 HONG 210,000 210,000 207,148 E52 2,000 GOMBI 165,000 165,000 149,553 47 15,400 SONG I25,000 125,000 t20,547 53 4,400 GIREI I19,000 I19,000 I t8,413 87 500 YOLA SOUTTI 50,000 50,000 48,09E 2 1900 FUFORE 105,000 105,000 104,319 8l 600 DEMSA 140,000 140,000 t30,973 27 9,000 GI.IYI.JK 150,000 150,000 149,335 5 660 LAMURDE 150,000 150,000 145,484 5r6 4,000 SHELLENG 141,000 141,000 13E,284 465 2,251 MAYO BELWA 195,000 195,000 191,805 95 3,100 JADA 270,000 270,A00 264,438 562 5,000 GANYE 191,000 191,000 190,085 44 871 TOIJNGO 100,000 100,000 99,882 l0 l0E ONCHO. OFFICE TOTAL 2,E59,000 2,859,000 2,791,621 101 3,903 63,375 How are the remaining ivermectin tablets collected and where are they kept? The remaintng lvermectin tablets are collected during retrieval of treatment reports and are kept at the state Onchocerciasis office store. List and briefly describe the activities under ivermectin delivery that are being carried out by health care personnel in the project area. Health care personnel are involved in the following activities: Collection of tlu required Mectizan/Yitamin A Capsules from the state. Deltvery of MectizailYitamin A to tle designated PHC centers which are collection points. Provision of storagefor safe keeptng of lvermectitr/Yitamin A. Ma intain prope r iwe nto ry fo r t he m. Collection of treatment reports and left over tablets/capsules and return to the state. Any other comments J 24 WHO/APOC, 24 Novcmbcr 2004 .>s*+i{8.+^:-*i-{ \F"5r-r !il!.' $v - -.'."ifi;+1,,t1,'r.n+Utt+*Wgtf,F#i4H:'d4il}}'ct''' -"'' "'l r, , **r^-fE.*&, q 2.8. Gommunt$r self*nonltorlng and Stakeholderc teetlng Has any training (of nainers) for community self-monitoring been done in the project area? No tratningfor community self-monitoringwas conducted in 2006. Arrangements are beW mode to do tlat early tn 2007 since the state government have just rcleosed its c ountetpart tinanc ial contribut io n If so, When? Table I l: Community self-monitoring and Stakeholders Meeting (Add rows if needed) Describe how the results of the community self- monitoring and sakeholders meetings have affected project implementation or how they would be utilized during the next heatment cycle. Wtry the project did not conduct CSM and SHMwas that the state dtd not release its counterpartfunfu and the little that was available was usedfor treatment acttvities. Now that the state lns released.funds, it will be dorc and would be retlected in the rcxt report. -,t District/LGA Total # of communitieVvillages in the entire project area No of Communities that canied out self monitoring (CSIO No of Communities that conducted stakeholders meeting (SHfvI) TOI.JNGO 130 GAI{YE 183 JADA 297 N,I/BELWA 208 DEMSA 6l GIIYI'JK 103 SI{ELLENG t02 YOLA S. 25 F['FORE 68 GIREI 67 SONG 150 GOMBI t7t HONG 189 MAIHA 204 MICHIKA 446 LAMT'RDE 69 MADAGALI 3ll TOTAL 2,784 25 WHO/APOC, 24 Novcmbcr 2004 {- rh-..'.-+;:'! i-f".-:.a1?'''r n,1ffi 2.9. Supervlslon 2.9.1. Provlde a IIow chart of supervlsion hierarchy. NGDONOCP STATE (SOCTS) LGA (LOCTS) DISTRICT SI.JPERVISORS CLINICS i/c COLLECTION POINTS COMMI.'MTIES/ CDDs 2.9.2. What were the main issues identified during supervision? - Needfor more CDDs to reduce tlu burden ofwork on some CDDs. - Non release of counterpart contribution by the LGA executive. - Unvillingness of some CDDs to go back and treat those who were absent during distribution I I ,, rl 26 WHO/APOC, 24 Novembcr 2004 ..< ---qri${dl(r,Y,i' - \ rrri! ,lr' ,.r:+*r,r:,..ra! :.r$r!:t4$r.4++r*!i.!q+",iEill!t' .. q,.'!# 2.93, Was a rupcrvlslon checklist used? T'he rcvlewed supertisory checHist based on tlu report of evalualon was ued dwlng supervlslon at all larcls. 2,9.4. \ilhat were the outcomes at cach level of CDTI lmplementation cupervision? - LGA execattves were requested to befueling the motor-cyclesfor tlu LOCTs to enable them carry out effecttve superttision -Communities were requested to select more CDDs. -ITu community members wene encouraged to continue with the support they are giving their CDDs. -They were also requested to select or appoint some members of the communtties to superttise the distribution to rnalce surc tlat CDDs were going back to treat absentees. -Tlrc Front Line Health Facility stffwere requested to increase their superuisory visits to the communities to etuure compliarrce. 2.9.5. Was feedback given to the percon or groups supervised? Feedbackwas gtven to the supertised and necessary comections and action takcn to put in place what was deficient. 2.9.6. How was the feedback used to improve the overall performance of the project? Some LGA Executives saw the need to support their staffwith logistics during superttision More CDDs (36) were selected and trained. Additional (404) healthfacilities staffwere trainedfor effective superttision. SEGTION 3= Support to GDTI 3.{. Equipment Table 12: Status of equipment (Please add more rows if necessary) *Condition of the equipment (F=Functional, CNFR=Currently non-functional but repairable, WO=Written off). How does the project intend to maintain and replace existing equipment and other materials? The project intends to naintain and replace existing equipment and otlpr materials with the counterpartfunds{rom the State government and some supportfrom HKI. 27 WHO/APOC, 24 Novcmber 2004 MOH DISTRICT/ LGA NGDO OthersAPOC No. Condition No. Condition No. Condition No. Condition No. ConditionType of equipment Source 2 F 2 F I Fl. Vehicle 2t F2. Motor cycle(s) 4 F2 F 4. Printe(s) 2 F I F5. Photocopier (s) 2 F I F6. Fax Machine(s) I I F 7. Others I F I Fa) Telephone b) Bicycles 2t0 F c) rrI IIII 3. Compute(s) r',{r*i p\" i ri'|ilr' .xr t-.' #,r!!ry,-Y,"dfrtJFs# *F" -?.,"11,* €! ; -,-r,'rrX"nffi 9,2. Financlal contrlbutlons of the partnenB and communltles Table 13: Financial contributions by all parhers for the last three years If there are problems with release of counterpart funds, how were they addressed? Advocacy visit to the Chief Executive of the state have been intensified to solicitfor tlu release offunds. - Additional comments 3.3. Other forms of communiQr support Describe (indicate forms of in-kind contributions of communities if any) Prayersfor CDDs 3A. Erpenditure per activityr Indicate in table 14, the amount expended during the reporting period for each activity listed. Write the amount expended in US dollars using the current United Nations exchange rate to local currency. Indictate exchange rate used here Contributor Ycr,t 5 (May, 2M3-lprtl 204) Ycrr 5 (Mcy, 2004 - Aoril.2il)5) Yanl(Dcccnbu,2005 - Novcnber,2(N6) TOTAL Cash Budgeted rus$) TOTAL Cash Released rus$) TOTAL Cash Budgeted rus$) TOTAL Cash Released rus$) TOTAL Cash Budgeted (Us$) TOTAL Cash Released rus$) MOH (Cental + ProvinciaUState) 39,682.s3 39,370 39J70 74,871 76,87t MOH @istict/LGA) 472.44 472.44 Local NGDO(s) ( if any) NGDO parme(s) t6,740.6 t6,740.6 t5,580.94 t5,580.94 t6,455.74 16,455.74 Others a) b) Communities APOC Trust Fund 62,856 20,000 2s,l2l 25,tzt TOTAL 1t9279.19 36,740.6 55,423.38 55,423.38 11t,447.74 11t,447.74 28 WHO/APOC, 24 Novcmbcr 2004 ',{llryid&f(fT: 's ^:i Y1f.f'-j 'rF,F'1-"-' ""{4m M!el4: Indicate how much the project spent for each activity listcd below during the rcporting period Any comments or explanations? SEGTION 4: Sustainability of CDTI 4.1. lntemal; lndependent participatory monitoring; Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable) There was no Monitoring/evaluation carried out during the period under review. Year I Participatory Independent monitoring Mid Term Sustainabi I ity Evaluation 5 year Sustainability Evaluation Internal Monitoring by NOTF Other Evaluation by other parhers 4,1.2. What were the recommendations? ActivtB Erpenditure ($ us) Source(s) of fundine Drug delivery from NOTF HQ area to central collection point of community 1,700 HKI Mobilization and health education of communities 6,227 APOC/HKY MOH Training of CDDs 29,544.40 APOC/HKY MOH Training of health staffat all levels 23,271.75 APOC/HKY MOH Supervising CDDs and distribution 9,368.65 HKIA,TOH Internal monitoring of CDTI activities 6,937 HKIA,TOH Advocacy visis to health and political authorities 7,579.40 APOC/HKI/ MOH IEC materials t7,253.50 HKIA,IOH Summary (reporting) forms for teafrnent 1,505.76 HKI VehicleV MotorcycleV bicycles maintenance 4,891.48 HKIA,IOH Oflice Equipment (e.g computers, printers etc) 719.80 HKI Others 9,449 MOH TOTAL 118,447.74 Total number of persons treated 1,058,074 29 WHO/APOC, 24 Novcmber 2004 .-.5,pd*_'s.**, . -. -t$"'**S*,i**"Sl1rg14.$,rr.: r'... -- - ",r},+rgr ' { rfq/,/rq+w- , *t'ffiffi;:: id. '* , rr1i "* ,+1'11r''f,,r'1 42. Sustalnabtltty of protec{s: plan and set targets (mandato4y at Yr t) Was the project evaluated during the reporting period? /Vo Was a sustainability plan written? Written in 2005 When was the sustainability plan submitted? 2005 What arrangements have been made to sustain CDTI after APOC funding ceases in terms of; 4.2.1. Planning at all relevant levels A work plan was drav'nfor all the levels which is being use for CDTI implementation All plan of acttvities are writtenfor every year at all the levels. 4.2.2. Funds The state and LGAs did not releasefundsfor activities early enough The just released her counterpart conffibution during the last month of the year 2006 when all activities hove been completed with support of the NGDO. The funds released will be use d for 2 0 07 act iv itie s. 4.2.3 Transport (replacement and maintenance) Maintenance is being done at the state level. 4.2.4. Other resources 4.2.5. To what ertent hes the plen been lmplemented The implementation of tlu plaru is on course. More advocacy visits are being canied out at the state and LGA levels; and more CDDs are being selected and trained. 4.3. lntegration Outline the extent of integration ofCDTI into the PHC structure and the plans for complete integration: 4.3.1. Ivermectin delivery mechanisms PHC stafinow talces resporcibility of Mectizan and Yitamtn A. The LOCTs who are *af of the PHC Department now collect Mectizan ond Vilamin Afrom the state. Also the District superyisors do collectfrom tlp LOCTs and deliver them to Front Line Health Facilities which are collection centersfor the CDDs. 4.3,2. Training - The SOCTs and Orchocerciasis Co-ordinator attends worlcshops on other health programmes strch Lcprosy, NPI etc. - SOCTs are irwolved in NIDs. - All the CDTI personnel hove been trained in Cataract screenirtg, identification and referral. - They have also been trained on Vitamin A supplementation. t 30 WHO/APOC, 24 Novcmber 2004 ii,,..b.{4i4i*! '- q. " +q+F#{ffi#*^*r' h"'+,tfF?,t-1 ?r,-tr4ry I ..i4.33. Joint cupervislon and monltorlng wlth other progrsns Supeniston of Mecttzot distrlbutlon Vttontn A wpplementalon Catoact saeenlng and tdenrifrcdton oe corled at the sone tlme wlnn the LOCTs, Dtstrtct Supenisors and Front Llne Health Facilities stfiarc carrying out otler PHC acttvities. 4.3.4. Release of funds for project activities The routirc procedwes oefollowed in the rclease offunds just like other projects at the state and LGA levels. 4.3.5. Is CDTI included in the PHC budgef At tlu LGA level, it is ircluded in the gewal budget items, while at the state level it is in tlu Department of Disease Control Budget. 4.3.6. Describe other heatth programnes that are using the CDTI structure and how this was achieved. What have been the achievements? - The CDTI stntcture is being used to deliver Vitamin A to the communif members. - It is also usedfor screentng and identification of Cataract cases. This was achieved by mobilization and education of community members to see the need for Yitamin A supplements and Cataract extraction. The CDDs have been trainedfor these activities. These have motivated many CDDs to be more committed resulting to high coverage in both Mectizan and Vitamin A supplementation. Theyfeel hapW to be referued to as doctors in some communities as they assume more responsibilities. 4.3.7, Describe others issues considered in the integration of CDTI. Other issues considered in the integration of CDTI is that through its implementation communities have been motivated to carry out other health and developmental activities such as establishing drugs revolvingfunds, constntction of roads, marlrets and so on. 4J. Operational research 4,4.1. Summarize in not more than one half of a page the operational research undertaken in the proiect area within the reporting period. None hos been conducled ln the proJect- 4.4.2. How were the results applied in the project? .,( 3l WHO/APOC, 24 Novcmbcr 2004 . - .11. 8...4+rr+r,, ". +Yilt$r{Il*1f-,r' a a 2, o .*4,d.ild;.r.,, y:1" +, :. r, ;, ri +a rr+rfi?qri|fir *'-- 'qf** SEGTION 5: Strengths, weaknesses, challengcsr and opportunities - List the sfengths and weaknesses of CDTI implementation proc€ss. STRENGTIIS: STAIIIIIYG: CDTI personnel derive satisfaction in the discharye of tlwir duties now as a result of tlrc addora such as Yitamin A and Cataract because they are gaining more lmowledge through the implementation of tluse other programmes. Iwolvement of nutrilion fficers and CBBI committees in the progrom activities have strengthened the staffcapacity and program reach by ofering assistance in the area of community mobilization, program self monitoring etc. LOGISTICS: Partners such as tlu Ministry of Health and Helen Keller International have continued to support the project in various ways including technical, managerial, logis t ics and fi nanc i al as s is tance. I 3 SASTAINABILITY: . The program reach and mectizan coverage are quite inspiring. . Ihe state and some LGA have continued to release counterpartfund to the project. o The inclusion of add-ons in the structure has enable the personnel to be trained in other programmes and keep them busy all tlrc time. WEAfr,{ESS: LGA CONTRIBUTION: Even though some LGA have begun to make some financial commitment not many of them are releasing the funds. Time and resources will be required to continue with odvocacy visits and sensitization of the LGA executives. List the challenges and indicate how they were addressed. The most challenges/constraints of the project include: The release of funds by LGAs to support the programme; willingness of the CDDs to return to treat absentees; commitment of some of the health workcrs iwolved in CDTI activities at tlp LGA and community levels. These challenges/constraints have been systematically addressed through conttnuous advocacy visits and sensitization of LGA leaders in order to release fun* fo, the activities; eroouragement of community leaders and members to appoint monitors to be monitoring the distribution; and the FLHF staffto intensify superttision of activities during distrtbution. SEGTION 6: Unique features of the proiecUother matters 32 WHO/APOC, 24 Novembcr 2004 I