Bauchi State CDTI annual project technical report submitted to Technical Consultative Committee (TCC): January to December 2005

RESERVED FOR PROJECT LOGO/IIEADING ORIGINAL: English ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATTVE COMMITTEE (TCC) For Tol Tcc9s1 DEADLINE FOR SUBMISSION: To APOC Management by 31 January for March TCC meeting To APOC Management by 31 JuIv for September TCC meeting Tor \ H. AFRICANPROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) I Proiect Name: BAUCHI CDTICOLTNTRYAIOTF : Nigeria Launching year: 2000Approval vear: 1999 Reportine Period Month/Year)t JANUARY- DECEMBER 2005(circleone) 1 2 (3) 4 5 6 7 8 9 10 NGDO partnert UNICEFDate submittedz Jan 2007 3iH csb CllP httBffi tu A ) ' : {l I;o 0 I JUIN 2007 Al*rJLfDlR WHO/APOC, 24 November 2004 t: I t I ffi $ fi r: ti ti I ft I} tI f\ u L, IZ fior Lil t f, F m i. t ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: t] rl tI n II t; Country: NigeriaNational Coordinator Name: Princess P. Ogba-Pearce ! rt Signature: . oate: .I.[ Jnr)"pAT c-a- I Zonal Oncho Coordinator Name: ...Sheh Jibrin S Date This report has been prepared by Name : Abdulkarim Daniebu Designation Coordinator Signature Date .?.Y.ft 7hv 2 WHO/APOC, 24 Novernber 2004 * ?f+ It t] i. t Et t; Table of contents l.l. GBlmnu rNFoRMATIoN 1.1.1 Description of the project (briefly). 1.1.2. Partnership 1.2. PopurerroN SECTION 2: IMPLEMENTATION OF CDTI ......... 14 2.1. TruBr-msoFACTrvrrrES.............. .................... 14 2.2 Aovocacy..... 16 2.3. MostlIzefloN, sENSrrrzATroN AND HEALTH EDUcATToN oF AT RrsK corrauuNrrrps 16 2.4 Couuuury nwoLVEMENT ................... Capectry BUILDTNG... TnrarNaeN"rs ................ 2.5 2L 2.6 23 2.6.1. Treatmentfigures............. .....23 2.6.2 What are the causes of absenteeism? ................ Etor! Bookmark not delined. 2.6.3 What are the reasonsfor refusals?.................... Error! Bookmark not defined. 2.6.4 Briefly describe all lorcwn and verified serious adverse events (SAEs) that ... 27 2.6.5. Trend of treatment achievementfrom CDTI project inception to the current year29 2.7. ORoERING, sroRAGE AND DELIvERv oF IVERMECTIN 2.8. Couvur.urysELF-MoNIToRINGAND STAKEHoLDERs MBerrNc 2.9. SupeRvrsroN 30 .9 10 t0 ..12 .................31 .................31 2.9.1. 2.9.2. 2.9.3. 2.9.4. 2.9.5. 2.9.6. Provide aflow chart of supertision hierarchy... Error! Bookmarh not defined What were the main issues identified during superttision?............................. i2 ll'as a supervision checkltst used?......... .................... 32 What were the outcomes at each level of CDTI implementation supervision? 32 Was feedback given to the person or groups supervised? ............ i2 How was thefeedback used to improve the overall performance of the project? 32 SECTION 3: SIJPPORT TO CDTI.. 3.1. Equrruevr. 3.2. FrN.clrrctar coNTzuBUTIoNS oF Tr{E pARTNERS AND coMMr.rMTrEs . 3.3. Ornpnronus oF coMMtrNrry suppoRT 3.4. ExpBworuRE PER AcTrvrry SECTION 4: SUSTAINABILITY OF CDTI.. ............35 4.1. INreRNer; INDErENDENT pARTICIpAToRy MoNITonrNc; Eve1uATIoN................... 35 4.1.1 Was Monitoring/evaluation catied out during the reporting period? (tick any of thefollowingwhich are applicable)............ ....... 3i 4.1.2. l[hat were the recommendations?. .......... 36 4.1.3. How have they been implemented?................. ........... 36 4.2. SusrnrNestt,lTy oF IRoJECTS: ILAN AND sET TARGETs (uervoeroRy AT......... ......37 33 33 34 34 34 3 WHO/APOC, 24 November 2004 t] ri t] ti ti r'!t, tI fi lr II tI i I I r Yn3)... 4.2.L 4.2.2. ;; ;;;i; ; ;; ;;,it ; ;i; ;;, i ;;; i; Funds, ........37 ........ 37 ,......, 37 4.2.3 Transport (replacement and maintenance)....... 4.2.4. Other resources 4.2.5. To what q,tent has the plan been implemented............. 4.3. IxrecRauoN 4.3.1. Ivermectin delivery mechanisms ...,,..',,., 37 ,.,..,....., 37 37 38 38 4.3.2, Training.......... 38 4.3.3. Joint supervision and monitoring with other programs ............... 38 4.3.4. Release offunds for project activities.... .................... 384.3.5. Is CDTI included in the PHC budget?...... ................. 384.i.6. Describe other health programtnes that are using the CDTI structure and how this was achieved. What have been the achievements?.............. ................. 38 4.i.7. Describe others issues considered in the integration of CDTI. .... 38. 4.4. OpBnauoNAL RESEARcH ........ ..38 4.4.1. Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period. ...... 38 4.4.2. How were the results applied in the project?............. .................. -r8 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AlrlD OPPORTUNITIES SECTION 6: UNIQUE FEATURES OF TIIE PROJECT/OTIIER MATTERS........... 39 4 WHO/APOC, 24 November 2004 t: rI r: ft ti ti II tI TE il tl n I,J |J 0 tI t; il rI I} rI tI ft .u ,nJI .E :I .l .l I I Acronyms APOC African Programme for Onchocerciasis Control ATO Annual Treatment Objective ATrO Annual Training Objective CBO Community-Based Organization CDD Community-Directed Distributor CDTI Community-DirectedTreatnentwithlvermectin CSM Community Self-Monitoring FLIIF Front Line Health Facility FOMWANFederation of Muslim Women Association in Nigeria LGA Local Government Area LOCT Local Onchocerciasis Control Team MDP Mectizan Donation Program MOH Ministry of Health NGDO Non-GovemmentalDevelopmentOrganization NGO Non-Governmental Organization NOTF National Onchocerciasis Task Force PHC Primary health care REMO Rapid Epidemiological Mapping of Onchocerciasis SAE Severe adverse event SHM Stakeholders meeting SOCT State Onchocerciasis Conhol Team TCC Technical Consultative Committee (APOC scientific advisory group) TV Television TOT Trainer of trainers UNICEF United Nations Children's Fund UTG Ultimate Treatnent Goal WHO World Health Organization 5 WHO/APOC, 24 November 2004il II I I Definitions Total population: the total population living in mesoftryper-endemic communities within the project area (based on REMO and census taking). (iD Elieible population: calculated as 84o/o of the total population in mesoftryper- endemic communities in the project area. (iii) Annual Treatrnent Objective: (ATO): the estimated number of persons living in meso/h1per-endemic areas that a CDTI project intends to treat with ivermectin in a given year. (iv) Ultimate Treatrnent Goal (JTG): calculated as the maximum number of people to be treated annually in meso/trlper 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 of the project). (v) Therapeutic coverase: nurnber of people treated in a given ye.u over the total population (this should be expressed as a percentage). (vi) Geosraphical coveraqe: number of communities treated in a given year over the total number of meso/tryper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). (vii) Intesmtion: 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 coilrmunities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTI. (viii) Spstainability: CDTI actMties in an area are sustainable when they continue to frrnction 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) Commun8 self-monitorins (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. (DI t} ri t!Ir T} II t?tt i 6 WHO/APOC, 24 November 2()04 il U II 3 II II U U I u il f- ! I 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 (Please add more rows if necessary) ti t; fi ti Ii t ] t 7 Number of Recommendation in the Reoort TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCAAPOC MGT ASE ONLY WHO/APOC, 24 November 2004 ritE ) I) r I tr rIi 1 I] Executive Summary Bauchi State is located in the Northeastern part of Nigeria. It shares borders in the North with Kano and Jigawa States, to the East by Gombe and Yobe States, while Kaduna and Plateau State border it to the West, and Taraba State to the South. The State has a total population of 3,896,468 according to 1991 census, and is made up of 20 LGAs. From the national prevalence survey of Onchocerciasis and the result of rapid epidemiological mapping of Onchocerciasis in 1999, 13 out of the 20 LGAs were envisaged to be endemic for the disease. These are Ningi, Kirfi, Alkaleri, Toro, Warji, Darazo, Dass, Jama'are, Gamawa, Zaki,ItaslGadau, Tafawa Balewa and Shira. The project has however received indications that following the REMO refine in 2003, some of these LGAs may not be CDTI definite, and some LGAs currently not being covered fall under the definite CDTI zone. The Bauchi State commenced CDTI implementation in Decernber 1999, but funds were disbursed in March 2000. Shortly after the second year of CDTI implementation, funding was suspended to the project on account of bureaucratic hiccups and improper accounting of some funds spent. From that time till end of 2004 the project was, as it were, in limbo. For those years the project just managed to ensure that Mectizan tablets were distributed to community members as there was little or no funding both from the State or UNICEF. It was the commitment of the CDTI personnel with minimal contributions from LGAs that saw the project through that dark period. Treatments commenced in the State since l99l with UNICEF assistance and number of persons teated fluctuated in the initial years, but since 2001 treafinents have been on the rise. Total number of target communities is 633, and all of these were treated resulting in a 100% geographical coverage. 642,337 persons were teated out of a total population of 966,146 grving a therapeutic coverage of 670/o, and a l0l%o and 7 8Yo achievement of the ATO and UTG respectively. Most of the inhabitants of the State are normal settlers, but in recent years there are some movements of immigrants from the neighboring States of Nasarawa and Plateau States due communal clash. These immigrants have settled in Toro, Bogoro and Tafawa Balewa LGAs. Also there are movements of the nomadic Fulani who come to the State during rainy season, and seek grcener pastures elsewhere during the dry season. Moreover, after the farming season, youths from the communities tend to migrate to thd townships to get involved in commercial motorcycle business popularly called okada, as a means of getting extra income. The project has conducted a series of training in order to build capacity at LGA and Community levels. The haining sessions conducted involved 39 LOCTs, 208 Health facility staffl and 1,768 CDDs, who were either newly trained and re-trained. Overall, 78%o and l}0%o of ATrOs of health workers and CDDs were achieved for the year reported. With a population of 966,146 persons living in the entire project area, CDD/population ratio stands at l:547. Challenges facing the project include lack of census update, poor counterpart funding by both State and Local govemments, as well as inadequate mobilization of communities. t ( ti ti l'lil I: rl IJ tl 8 WHO/APOC, 24 November 2004 r t l SEGTION {: Background information 1.11. Genera! lnformatlon Bauchi State is located in the Northern Eastern part of Nigeria. The State is sharing borders in the North with Kano and Jigawa States, to the East by Gombe and Yobe States, while Kaduna and Plateau State borders to the West, and Taraba State to the South. The State lies in Savannah region ofNigeria with variation in ecological conditions. The South and Western part are Sudan or Guinea Savannah, while the Northern part of the State is Sahel Savannah. The settlement pattern varies in different parts of the State from nuclear settlements with surrounding farmlands to dispersed settlements. Agriculture is the chief mainstay of the people of the State. Farming season is May to December The State is made up of 20 LGAs with the headquarters at Bauchi. The State has more than 40 ethnic groups and different cultures. The major ethnic groups include the Hausas, Fulanis, Jarawas, Gerawas, Sayawas, Kanuris, and the Kare-kares. Islam and Christianity are the major two religions of the people of the State. Communication is mostly by road and trunk A roads exist linking the State with the capitals of all neighboring States. Other road networks are available linking the various towns and villages but some of the nrral areas are difficult to access during the rainy season. The health system consists of Primary, Secondary and Tertiary levels. The Primary Health Care facilities are at the LGA level where the health clinics and dispensaries are found, while the secondary Health Care facilities consists of the general hospitals located in some of the LGA headquarters and tertiary is the referral hospital located in the State capital. From the national prevalence survey of Onchocerciasis and the result of rapid epidemiological mapping of Onchocerciasis in 1999, I 3 out of the 20 LGAs were envisaged to be endemic for the disease. These are Nngi, Kirfi, Alkaleri, Toro, Warji, Darazo, Dass, Jama'are, Gamawa, Zal<t,Itaslcadau, Tafawa Balewa and Shira. The project has however received indications that following the REMO refine in 2003, some of these LGAs may not be CDTI definite, and some LGAs currently not being covered fall under the definite CDTI zone. Mass Ivermectin dishibution started in l99l with UNICEF's assistance. The distribution strategy was Community based Ivermectin distribution (CBIT). Communities, under this system, had limited authority in project design and implementation. With the adoption of CDTI by APOC as the control strategy and following the approval of submissions made to APOC Management, the Bauchi State commenced CDTI implementation in December 1999, but funds were disbursed in March 2000. Shortly after the second year of CDTI implementation, funding was suspended to the project on account of bureaucratic hiccups and improper accounting of some funds spent. From that time till end of 2004 the project was, as it were, in limbo. For those years the project just managed to ensure that Mectizan tablets were distributed to community members as there was little or no funding both from the State or UNICEF. It was the commitnent of the CDTI personnel with minimal contributions from LGAs that saw the project through that dark period. Ii fi []l; t; 9 WHO/APOC, 24 November 2004 t ! .t il tI IJ il tI U u u E II U ti It' I; l.LI Descrtpion of the project (brietly) Geo graphical locqtion, topography, cltmate P opulation : activities, cultures, language Communication systems (roads...) Adminis tr ation s tntcture Health system & health care delivery @rovide the number of health posts/centers in the project area if the information is available). Number of health *af in project area and number of health staf involved in CDTI activities. Table 1: Number of health staffinvolved in CDTI (Please add more rows if necessary) DistricULGA Nrrmbcr of hcrlth strlf involved ln CDTI rctivitics. Totrl Number of hcdth strlf ln thc cndrc prolect rrer Br Numbcr of hcrlth strlflnvolvcd in CDTI B, Pcrccntrge B'=&/Br rlfl) ALKALERI 30 t7 57 DARAZO 24 l6 66 DASS 20 l6 80 GAMAWA 22 l6 73 ITAS/GADAU 20 16 80 JAMA'ARE 18 16 90 KIRFI t8 16 90 NINGI 25 l6 64 SHIRA 24 l6 66 TAFAWA BALEWA 20 l6 80 TORO 40 16 40 WARII 22 16 73 ZAKI 24 t6 66 TOTAL 307 209 68Yo 1.1.2. Partnership Indicate the partners involved in project implementation at all levels [MoH, NGDOs(national/international), communities, local organizations, etc.l Describe overall working relationshtp among partners, clearly indicattng specific areas of project aclivities (planning, supertision, advocacy, planning, mobilization, etc) where all partners are involved. State plans, if any, to mobilize the state/region/district/LGA decision-makers, NGDOs, NGOs, CBOs, to assist in CDTI implementation. Par[rers involved in CDTI implementation are the National Onchocerciasis Control Programme (NOCP), UNICEF, Ministry of Health, endemic LGAs and endemic communities. I l.l ti I tl t t l0 WHO/APOC, 24 November 20M ti Ii II IJ II m -I The NOCP through the zonal office in Bauchi supervises control activities, facilitates delivery of mectizan to the State, conduct advocacy visits to policy makers at State and LGA levels, assists in training of State personnel, and gives other forms of technical support. UNICEF has been the supportive NGDO partner since 1991 and provides support in the areas of capacity building and logistic support. However, for some time now no support has been received from the organization. The Ministry of Health and LGAs provide the supportive staff as well as logistics for the implementation of the programme right down to the community level. They conduct relevant training for field personnel, supervise activities at their levels, manage Mectizan, deliver these tablets through the various established channels to the communities, and keep records of CDTI data and report same to the appropriate levels. The community selects the distibutors, plans the distribution schedule, makes decision as to mode and period of distribution, and provides some support for distribution and CDD training. Working relationship between these groups has always been cordial. There are plans to identiff and sensitize local NGOs and CBOs in the State, and involve them in the CDTI process. il I ft t!ll I: t] rtil II li(i I J 1l WHO/APOC, 24 November 2004 r---: I II I u u u .+ooc\ tu) .oE q) oz .+(\.l doO{ so ;trB ) I t il II 3oL P o s E B d o oA b0 E oE 0)Lr C) tJ o0 tr Lr 15 otr tsio Eo cl(Dli oF. 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Tlmeline of actlvltles 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.Ii il itti rI(; ) i , I t t4 WHO/APOC, 24 November 2004 ! , fi tI II Ii l] U u U lI l"t il $o c\ G) -o Eo oz .+ c..l rioOr oE B ! l va u, A c) E Eoq) liq) li f*I a, .d E oo o C,)(l) E o o0tro J1oo r/) ig so *5X-ou EE6tx E€ G(, oF1EO lr f ) Hep t:EEIBEEIGl raa: a*ctx - t) Q) q) .ri o6t'E c)'5 ,E, OE(E5a) c)thtr;3 U,d .95 .E(, .L .sa otrGl .= 6lO != qlqr3 E.9c)E) .E€ 9,2df(l)q) TO -:. R. B4 V)q)(J q) .\ s e q)L o t B q) U) Bq) ea li cl C) okk o o tJ Ei .o (.) cl G)E .t) do CI C) lr -o ./)(D '5 o GI(ri o o o F c.ir ol -ol(ll FI I I t1 I ti ti t1 fi tr Il U tI I 0 fl II ! 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C) lU a L 0.) .o E(1) oo a k() -o E o)ooA ko -o oooo k 0) -o E 6)o C)o 0.) -o Et)o c) a L 0.)3 Eooo o k(l) -o o)oo a op H C)oIt)A t)& E0)o C)o L{o -o E c)oo o k C) -otr (l) o 0) a L0)5 E C)o A -HcPtrl9aa b cl atl k slttr GIh h GI d b GI a GI h GI q cl b(lt a cl t cl cl B cl 5d cl h sl E x g cl erg GIh bd EI RIl- I Ft q) L(t o L(.) dJ oN rd dA .A .a GtA d > c,tr d o a G! €((! o G, ok cl s, E GI IE V ootr z GI > C) GI ta H oL{ot- :a (l, B ,!a GIN GIL ,EI V) ! I ti H I t 2.2. Advocacy As one of the components of CDTI programme the project has conducted several advocacy and mobilization visits to policy makers at various levels. These were aimed at sensitizing them to support the CDTI implementation. At the State level the project sensitized the Honourable Commissioner of Health, Permanent Secretary and Director Public Health. They were informed of the factors affecting the implementation of CDTI, and the need to provide counterpart funding. The Honourable Commissioner promised to do everything possible to see that the State Counterpart was released. The Director of Public Health was also directed to make available any vehicle in the Primary Health Care Sector to the State Onchocerciasis conhol team if the need arises. The State team paid advocacy visits to the Chairmen of the 13 LGAs, their Primary Health Care Directors and Secretaries. The issue of inegular payment of counterpart funds and support for CDDs were raised and discussed during such visits. Some LGAs have already started paylng some meager amounts to their LOCTs for the repairs and fueling of their motorcycles. LGAs like Toro and Alkaleri paid the sum of N10,000 each to their LOCTs. Ningi, Kirfi and Warji LGAs provided between N200 to N500 to their CDDs during distribution of Mectizan. WeaknesVConstraints & Recommendation: The major constaint to advocacy is the frequent change of policy makers in the LGAs. Moreover, most of the policy makers - particularly the LGA Chairmen - are not easily met on seat, especially as preparations gear up for the general elections in2007. At the State level, it is only the Executive Governor that has powers to release funds. It is therefore suggested that a high-powered advocacy team visit the Governor 2.3. toblllzatlon, tensltlzatlon and health educatlon of at rlrk communltler Provide inform ation o n : The use of media and/or other local slstems to disseminate information As effective means of disseminating information the State CDTI project is using electronic media like the State Radio and Television through jingles and TV spots to pass information on CDTI to the populace. The media have been used to cover some key CDTI activities particularly at the State level with the help of the information officer of the Ministry of Health. Informatiron ofEcers of the LGAs also assist in ensuring coverage of some CDTI activities, and reports of these are sent directly to the State Radio for broadcast. Other local strategies used in Community mobilization include: -Use of traditional and religious leaders -Face to face discussion with community members -Town announcers mobilizing community members Frontline Health Facility staffhelped the CDDs to mobilize the Communities. They also mobilize women during ante-natal care services. I ; ti flti ft I} ti I t t6 WHO/APOC, 24 Novernber 2004 t U m Ii t I tl ft l''t iI fi tI I] Mobilization and Health Education of Communities including n)omen and minortfies The CDDs and health facility staffmobilize communities through ftaditional and religious leaders, face-to-face meetings with community members and the town announcers. Due to religious and cultural reasons females are rarely mobilized along with the men. Women are mobilized at clinics for those who attended health talks during pre natal visits. Some got CDTI messages through listening to the public address systems or reading the posters made available at community level. There are efforts to involve taditional birth attendants and women religious leaders on mobilization and distribution of Mectizan. The project has tained 35 female CDDs in order to reach the women under purdah. Advocacy has been paid to women religious groups in some LGAs like Federation of Muslim Women Association in Nigeria (FOMWAI\Q so that they can assist mobilize women on CDTI activities and to allow their members to participate during mobilization and distibution of mectizan. Types of IEC materials used Posters, hand bills, pocket and table calendars, t-shirts, where available, were used during mobilization. Resp onse of target communities/villages The various communities have responded by keeping faith as far as intake of Mectizan is concemed. Accomplishments The project has been able to reach out to some women $oups many of who appear willing to be involved in CDTI implementation. The project also tried in mobilizing the endemic communities and getting them to comply to Mectizan treatrnent. Suggest n'ays to improve mobilization and sensitization of the target communities. There is need to identiff and mobilize more CBOs to get involved in CDTI implementation. IEC materials need to be redesigned to meet local challenges. More time and resources are needed for greater interaction with community members. I t tI (I U tI lr t7 WHO/APOC, 24 November 2004 I] il Oo!0r sq .E IJ !r3tra =lt5C := L} a)a E az o I tr i lt tr a) ODt o o Cr GI o o \o € @ o o 6l r-N \o € $N \o tr E .F, ! t6; siiOEIU E.E *eEi - EA o N o o N co F- o O c.l $ m ca l.nra oAU o oEE z dttr Id a o Fr @ ol cq o\ $o t o\ Na o € t oo $ $ \oa $6l tt'- \oo oc(a tr 2n!nElootifI.v N o o N t?) r-- o o c.l $ co cn ra(t) F le oAaU t) ta a \oN c.l o\ .t o C.l o\ o\o\ cOr- .too $ a.l ot-t oN F- or-- l.a\o cl 0 t)E E9 E >r '= e E Eoo Ep}E 8'FSI >0I: a a E E ot) 0 o4 E z oo II re Et >tr o uaa o otr o o o o o o o o a o o a o o tr sisI'Ef €E*2 Ez E c o o o o o o a o o a o o o tr ir ea EUE !.E EolrF-Eg Eg OE99 c.l € oo(7l \otl (.)cO o\co €c.l €N c.lF-. cOr 6$ r- €c.t $\a (r) tfi\o () B a 'tr 0) cl Jr1 ? oNftlli cl a (r,q(! a cC B cl Ed(5 d € G,o o G' oL GId dh rtr L M b0 tr z clL -q(a cl B o) cl cq lr okot- L ct B J4 GIN ql oti r- t, c.tooC\ Eq)s E o) oz$ cioOr o r! ft fi ti u tt ti Ii Q ooo : sL)4 $r q) h P q)L o E B q) a4 cts$. t< AU C)!t€Lo.=Etrba)o'E)EI*o'5t'EEE 'tv)TQ) - -.= -a?eLHEFo-(r: {81ci *l I It tI t1 il il I] tl I I I I I Ir I I tl fi ii t] Comment on: - Attendance offemale members of the communily at health education meetings Due to socio - cultural practice women do not normally attend meetings with men but where it is allowed a few of them do attend. In general, how do you rate the participation offemale members of the community meetings when CDTI rbszes are being discusses (attendance, participation in the discussion etc). Women hardly attend community meetings, and where they do, they make little or no contribution until called upon to do so. Incentives provided by communitiesfor the CDDs Minimal incentives are being provided by communities to CDDs. ln a few places LGA authourities have give financial support. It is hoped that with intensive and consistent mobilization things will change. Attrition of CDDs. Is attrition a problem for the project? If yes, how is it addressed? CDD attrition is a recuning issue but with current mobilization for communities to select more CDDs and to support them we are anticipating little or no effect where and when attrition dccurs. Other rlsszes I Il I I r I I 20 WHO/APOC, 24 November 2003 I I il II I iJ tl fi U [It u u t- t; ti fi 2.5. Gapacltyrbulldlng - Describe the adequacy of available knowledgeable manpower at all levels. There is availability of knowledge able manpower at all levels. These include the eight SOCTs at the State level. There arc 39 LOCTs at the LGA level and the project has conducted the series of naining that reached 209 Health Facility Staff. The project have trained and re-trained 1,768 CDDs, though by the end of the year attrition had reduced it to about 1,300. There is more manpower existing to be tapped at each of these levels. - Where frequent transferc of trained staff occur, state what the project is doing, or intends to do, to remedy the situation. (The most important issue to descibe is what meesures were taken to ensure adequate CDTI implementation where not enough htowledgeable manpower was available or if staffarefrequently transfened durtng the course of the campaign). In order to solve the issue of frequent tansfer of health facility staff the project has hained 209 and plan is under way to train the remaining health facility staffin the future. The project has mobilized the communities to select more CDDs in order to reduce the workload on existing CDDs and to solve the problem of payment of incentives to CDDs. ti tI l ti t; Il ti II t IJ t] 2l WHO/APOC, 24 November 2003 tll ll ,] U II I I ti tI -)oo c.l q)j E(D oztot Ci .o or\o = F oI A .Ao oL L 6)E A6l (D L cl q) oA! E 6, axo (l) .o 6loq E €) E qlL Q)L(l) B IU'oq) E clL o ahLq) E GI rr Lq) o 6E o s o .i"I o * B 8 ast e a. oE sst * + A \3 U24q) Qq) .S bt o\ q) o tB q) V1\lq) ea o GI o o o.A F oU +r o ch (;, (.) tr C) .c)tr .1, o (! oo tr tr c!Lr F< .iir o:l -ol'ctl FI l} tI II J .tl fl u I u I il Ii 60 .s s oq oR .t s 6t6l I t lt (J t oF I + (J b ,.j lr *o \o cA :. a \o c.t \o c.t : o \o c.l \o f.t .: \o co .: o \o rO :-- \o cO :.. o \o cO : o \o cO \o cO : a \o cO o \o cO : \o c.t : \o c.t :_ \o c.) .1- o \o c.t :. \o c.l :_ o \o(o :- \o cO :_ o \o(O \o m _1 a \o cO \o ca : o \o c.l \o c.) .: o €\or- 6\oF o o E clL an n eU o Lo!E z Itd \oc.) \ot?) \oc.l \ocO \oc.l \oc.l \oc.l \ocA \o(.t \oc.l \ocO \oc.l \oc.l €\orr (D (u o () \c o\ oo Otl (.) 3o +(, Sd l. *s o OLq) .=Gdfr!b r. tr(l): 90o9r-9 r-i(l)h E z U?tr c Q) i) (D '= o G o\ UtUaoF +I U .L\.q ,!t * r- \o \o \o o \o .: \o .: o \o o \o :__ \o : \o -: o \o ': \o .: o \o :_ \o :- o \o o \o :... \o \o a \o : \o : o \o : \o .: o \o : \o : o \o : \o a g\ oN €o(\l !o s.EEalotlrc)- !g €€ zE oo (J?ti o rO $ol oN NN oN oo \o \aN oN os oN Na.l $N ro €ct Eo (D (D (f s (n F s a( ie E,\+ \r| c.l c{ $ co \r co $ c.l $ c.l .: ,: :. : tt (.I $ co (\l :. cO : (.l $ cn $ fo !c ra o\(?, to tsc 0 O () Fl3-()o)g'; e+. o L(l) 2 a z Q ? Fi \a s $ $ $ t t \t .q rn s $ $ l+ lA (JJ (,) O o 'tr 0) ctA( oN cd cl a oo Gl o G, > cl E G'(, a GI € c! o E c) d G! E GI tElr u ho 2 CI > G) cl ta GI B .Gl clF oliaF t- cl B GIk E U) jd ctN c oti (l) o q) AI s oo ti tI 1t II Table 6: Type of training undertaken (Tick the boxes where speciJic training was carried out duing the reporting period) Any other comments 2.6. Treatments 2.6.1. Treatment figures The project was able to cover the entire endemic communities, thus achieving 100% geographical coverage. However, the project was only able to achieve 67% therapeutic coverage. This relatively low coverage was due to inadequate mobilization of communities, inadequate number of Mectizan tablets requested by FLIIF stafl poor supervision and inability to conduct mop up treatnents to cater for those temporarily ineligible or absentees. The project plans to lay more emphasis on census and data management during training of CDDs. The project has also trained health facility staff on supervision and data management. If the projecl is not achieving 100oi geographicol coverage and u minimum of 66% therapeutic coverage or the coveruge rate is fluctuating, stole the reosons and the plans being made to remedy this. Il ti I1 lil IilIJ tI U U tI u B I Trainees Type of hainine CDDs Other Community members e.g Community supervisors Health Workers (frontline health facilities) MOH staff or Other Political kaders Others(speciff) Program managerne,nt { How to conduct Health education ,v { Management ofSAEs ./ CSM ./ SHM ./ ,V Data collection ./ Data analysis ./ Report writing Others (specifu) { ./ 23 WHO/APOC, 24 November 2003 r t ! il ii ti I i t 2.6.2 What are the causes of absentism ? Causes of absenteeism include the following : a. The movement of nomadic fulani cattle rearers during distribution time to other places in search of pasture. b. Some youngmen in the communities move to the townsfor AchabalOkada (commercial motorcycling) business. c. Some of the eligble young women maried moved far away from their communities. Arrangement is on process to track and treat the nomadic fulanis. The women are being mobilized to get registered at any community they married in order to continue with the treafrnent. 2.6.3 What are the reasons for refusals : Reasons for refusals were as follows Fear of reactions combined with inadequate health education. Some of the clinical features of onchocerciasis in some people have been cleared, they assume it is no longer necessary to continue teatnent. Poor community mobilization and health education especially on long term compliance to Mectizan teatnent a. b. c.Ii I1 II t1 iJ rl 24 WHO/APOC, 24 Novernber 2004 II IJ U tl tl il H A€E gH€?EEfl a o a o o a a o o a a o O o E32z o o a a o o o o o o a o o o o3bc5EtEga,.o>d a .f \o$ \.|i c?l rr @ \o a r- $ orn o\ tr-(\l EE-EE (\l a o o o N o o ca GI a o GI AoA o Ahs o '4, o ,bood AEooFOtr oot- oor- c.tr- (?)t-. Nc- rac- o\t'- (\ll't \ot-- $t-- a.t r\o (nr- F\o d Eer @(ao CA\a \ao ra r- o\o oo cO €(?) N CAt \o Fr\a cO$ $N6l 6(.l o\\oq 6l$ \f+ oo^ 6$ 6l C.l \a ro\ft ot a r € o\ o\ N o\ o\@(\l \f,$ $(.l co$ rrta! Nt\o EEg rn $ \o$ @\a €- cot ra\o 00- N rn rr| 00 r a(?) o\\ot o\fq cOo c{ N c.t (-- t-- € cn co \\r|in \ot ri$ .+s o\ .t\a $ a c.l\o a\a c.l$\o- \o sf \o r \o cO \o ra\o r-(a\o .E .,pE. EH Bf €.96-=OE E - st @ o\ o r-. r-N@ rr|\o ooao(\t 16 \o o\ r $N c.I o\o c.loc{ ra oq cO\a c.t(\l 6\o oo cl r\\o o\ oo\o €oo cO co c.I ra c.lN o\\o 6 r GI t'-\r) \o! \o\o o\ .1, o ot) ct tIA o t E Eo() 6o I A il o ? 'H 9" = d^gEr 8E() oo oo oo oo oo oo oo oo oo ao oo ao oo ae A E.g.- 3 E S:tr EI= OI E'5 ll AO o c.l € € c") \o r7l rn cO o\ rr) €c.l 66l c.tc- c.lr o\$ c- @cO $(n (r) ta\o nE5g cO € oo cO \o c.t cO cO o\ cO oo c.l €N cOt-- c.lr 6$ t-- @c.l t\a ra ?t)\o EEE€€^ ctl@ 6c.l \oc.l cOcO o\C7) €co ooN cOr\ c.t\n o\.+ Fr €tl =fla) (a ta\o .9< uvo\ {.)6lJI oN c,k cl a rnOdo (t B(l E Rto t CI,E CI o o Gl 0)k GI sl Ed rElk u '6 c z dH u) (!Gl}B -cl1 0) dCUFla oHo t< d ldftlN c o t< *oo ol k c) .o tr C) oz .+ 6l doA. b rl; > I t: t] {} Ii tI r6l -s I:. B U2 B()q) .b ? s o\ q) o tB q) U2 s)g '51(n Lr cl tt) CIoL.d =cl o do E an E >'s t, rI] CN E (l Q)tr Rto F r-l ol .ol cllFI II tJ il I IJ II II U U u 0 n l I ti ! t t- Formula for computins therapeutic and geoefaphical coverages ti IJ Therapeutic coverage rate Geographical coverage rate (%) ATO coverage rate (%) 642,437 xl00 966,146 633 x 100: 633 il2,437N 637,656 :67% :100% : t0t% t I t I %UTG achieved 642,437 x 100 820,655 :78% ATO = The estimated number olpeoplc Eving in madhyperendemic ucas that a CDTI proJect inlends lo lreat i,ith ivcrmectin in a given year. UTG = Thc muimum number of peoplc to bc treatcd ln madhypcr-endanic areas wilhin thc project area, ultlmalely to bc reached when the project has reachedlull gcogaphlcal covaage (normally the proJect should bc upcclcd to rqch thc UTG at the end ofthe t' year olthc project). ! tl 26 WHO/APOC, 24 November 2004 I-I t1 II I lr tl II U U I r I 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. . In case the project did not have any cases of serious adverse events (SAE) during this reporting period, please tick in the box. No SAE case to report ) t 1I fi fi ti Il tJ il T tJ t] I J { 27 WHO/APOC, 24 November 2004 tl u U i I .+ooC\ 0) -o C) ozsol t,o o. o rlr B tl I li a B a, q) ,s o' Lq) ,o a Lq) va * :I' BV) UJq)() q) S ?1tp q) o \\ B aV)ll 0)g €o koa o0 tr Lroa(Dlr (D o0 L € Eo E)ooo (rl I ttt E] U) (t tr C) o o a,r, o € cl rr) o Lro an o .1, o .t) cl() cidt orl -oldtt-l u tI ti tl t} tl U I t! II U H u 0 I n I t I , t l oo ol o zEq -Eah8E E <.E E *q H E'Es.9 e EEE (t o qr .9E2OEgB0 \J CL g €3 ;EBo-c tr&9d =dts.Bsa o c tr= doo()OEE.E o!='5 >\v@Ei' s!=l:Y oO H -E,E tr N o() €.99PgEfE o E o ot 5. U) aE F;E E dtt< = ^A*l-to6Gt E* ES B o c)o0cS'e ao x C) v) C) bo * U) *oo(\l a E(.) oz .t o.l U oA o B I I I o\6l (J tr cl E Lo cl A Eo E(l) o ah GI lt E c) ah ia 6l €)L 6l q) L € rh H Q)E (D clI rd tr o) ahc Q) A st\ a)L. 's Ar T!q)!)t E.SFHi\aE o -\)EE o EP .siGl El.eo()()e ;E. .g s) L+jEl.E -€)h() Fle(.) x od -li O)r: >r : r,lE€I6 ipl ool -dxc)slclo rlAOtrcd9b irxg; +.tr lH cl !irtro(DdLHtrE !)rrl rI\o ci o\l a)l EIt-l Ii t t 'rl t, t { t} Ii il )t I iI tI 1 IJ tI fl U I tl I n s$s a \o (\t \o o\ s r-ra ol\o cnr* @r-- tL{ tri rrl H eHs< B- @ei nN rn NF- oi o.l9r- N .! o € (.) oi c.l c.l c.l (\lq(a F.. o co I ri ri I rd o 't3 0 ,u0O dA s.b s 38ts .'!oo \o9 r..(..1 o c.i@ N $o\ +! o\ \o F- $\ ca @ o\\ \o F-\o ri ,B odL9OC'Er 2E a ro @ o\o oo!a €\o oo(a oi o\sf oo r r.lt- (.) oo \O- tf(o ro t--r- .o. @\o * t-o o !.) oo r- Or r-(oq (..l\l\6 o\oN c-{ o\oN r- * EIEEg o\oN F- $ o\o c{ rr sf o\ool r- \t o\oo! r- $ o\oc\ r- \t o\o c\l t-- sf \o \o" t'- co\o o 6l aooA ts AH - E EH EE€98, ' a 8^9& EE F- o\o o\o\o l-.o\o o\o\o r- o\o oio\o c- o\o o\ \o r- o\o o\o\o l,- o\o o\o\o r- o\o o\o\o \o$ \o\o o\ \o$ \i\o o\ o6 I ri f.l il a t) PHs< B-o soo soo soo soo \o 5\oo soo 6\oo soa sao soo 6\oo 50!rol)= FE E8'5t()orrl 6\oo soo soo \o 6\oo \o o\oo soo \o 6\oo ri qoo:g 8- E E PT 'd E= IB ET E > Ovl rrr ci\o (-) f.)\o cn ro\o (fl co\o cn co\o ro m\o t)(O\o dr(?l\o rO CO\o EiEE$ co C.l\o co(?)\o ra CO\o c.t cO\o (A(n\o co ?a\o (.r(r)\o c.l ca\o CO(.)\o o() o06l =t6l) tra E Eoo *' ,pite E't E.E E €.E,5 € E O Ef I ra ca\o t)(?l\o ro(o\o (O ca\o (.} tI\o (7) r)\o rOfa\o cO(.)\o cnCO\o & EI r.. o\o\ @ o\ o\ 6o\o\ ooo ol oo c.l 6looN (Ooo c\l $ooN oo c.l \ooo c.l r-oo ol @ooN o\ooN o oN I I t il 2.7. Orderlng, storage and delivery of lvermectln Mectizan@ for by - Qtlease tick the appropriate answer)WHOtr UI\IICEil speciff): MOH Other Mectizan@ MO by - Qtlease tick the appropiate answer)WHOtr T]NIICEil NGDC NGDC fi ti tI t ti t speciff): Please describe how Mectizan@ is ordered and how it gets to the communities The State compiles population figures and determines total number of tablets that will be required for the next heatnent cycle. It provides this information to NOCP HQs who fills the re - application forms and submits to MDP. On receipt of the drugs, the State collects the Mectizan from Zonal office which had helped in getting the drugs from NOTF stores. The LGA Coordinators pick the consignments from the State while the health facility staff get their mectizan consignments from the local government headquarters. These then inform the CDDs of the availability of Mectizan. The CDDs pick their consignments and distribute to the community members. Table l0: Mectizan@ Inventory (Please add more rows if necessary) ! LGA Number of Mectizan" tablets Numbe rin stock Requested Received Used Used/ Person treeted Lost Wasted Explrc d Remain ing Alkaleri 0 0155,000 134,500 134,500 m 0 0 0 0 Darazo 0 140,000 128,5000 128,500 m 0 0 0 0 Dass 0 105,000 80,500 79,500 ffi 0 0 0 0 Gamawa 0 121,000 102,0fi) 102,000 t 0 0 0 0 Itas Gadau 0 I10,000 103,000 103,000 tn 0 0 0 0 Jamaare 0 100,000 90,000 90,000 m 0 0 0 0 Kirfi 0 130,000 102,500 102,000 m 0 0 0 0 Ningi 0 140,000 120,000 120,000 m 0 0 0 0 Shira 0 140,000 124,000 124,000 ffi 0 0 0 0 Tafawa Balewa 0 150,000 120,000 120,000 m 0 0 0 0 Toro 0 250,000 204,000 204,000 m 0 0 0 0 Warji 0 130,000 91,000 91,000 ffiI 0 0 0 0 Zal<t 0 125,000 105,000 105,000 ffi 0 0 0 0 Total 1,796,000 1,505,000 l,5o5,ooo ilffi 0 0 0 0 30 WHO/APOC, 24 November 2004 , ! I I t ft it II tI ! tl ti I 4 Iti tI fi tI How are the remaining ivermectin tablets collected and where are they kept? If there are any remaining tablets, they are retrieved by FLIIF staff and handed over to LGA Coordinators for onward transmission to the State. - List and briefly describe the activities under ivermectin delivery that are being carried out by health care personnel in the project area. 0 Request for Mectizan r Collection of Mectizan o Delivery of Mectizan to lower levels o Storage & management of Mectizan - Any other comments 2.8. Gommunl$l self-monitorlng and Stakeholders illeeting Has any training (of trainers) for community self-monitoring been done in the projectarca? If so, When? Table 1l: Community self-monitoring and Stakeholders Meeting (Add rows if needed) CSM and SHM not conducted during peiod of reporting Describe how the results of the community self- monitoring and stakeholders meetings have affected project implementation or how they would be ufilized during the next heatnent cycle N/A 2.9. Supervlsion 2.9.1. Provide a flow chart of supervision hierarchy. I t] II NlcP SOCT LOCT FLIIT'S District/ LGA Total # of communities/villages in the entire project area No of Communities that carried out self monitoring (CSIO No of Communities that conducted stakeholders meeting (SIIM) TOTAL CDDs 3l WHO/APOC, 24 November 2004 tl t.lt-t II { U I I I i lr t -t t 2,9,2. What were the main issues identified during supervision? The main problems identified during supervision include the following : i. CDDs overburdened by work. ii. Some level of CDD attrition iii. Inaccurate census figures. iv. Lack of motivation for CDDs by communities. v. Low participation of women in CDTI activities. vi. Non release of counterpart funding by some LGAs for CDTI. 2.9,3. Was a supervision checklist used? Checklists were rarely used. The State has developed a check list for LOCTs and will be put to use by them in subsequent years. 2.9.4. What were the outcomes at each level of CDTI implementation Steps have been taken by the Honourable Commissioner of health to ensure that counterpart funds by LGAs are paid through the departrnent of LGA administation. Some of the problems identified like poor census, poor record keeping, are being followed up and addressed. Communities are being encouraged to select more CDDs and to motivate their CDDs. Some LGAs have come out with some form of compensation for the CDDs. This, the project will discourage as it is not sustainable. 2.9.5. Was feedback given to the person or groups supervised? Yes feedback was given to the CDDs, LOCTs, FLIIFs and the PHC Coordinators. 2.9,5. IIow was the feedback used to improve the overall performance of the project? Assurances given by Chairmen of LGAs on support of CDTI activities in their areas have boosted the moral of LOCTs and FLHFs leading to improved performance. Many communities have taken up the issue of incentives to their CDDs during distribution but definite actions are yet to be taken. Some LGAs have even begun minimal support to CDDs during dishibution. This has boosted their morale and motivated them to ensure all eligible community members are treated. Some LOCTs have been able to follow up on problems identified during supervision with the release of minimal funds by LGAs for motorcycle fueling and repairs. tl rI fi tj II ti t1II tt tJ II { t J l s il 32 WHO/APOC, 24 November 2004 t tfl t] { r- It, SECTION 3: Support to GDTI 3.{. Equlpment Table 12: Status of equipment @lease add more rows if necessary) *Condition of the equipment (F:Functional, CNFR:Currently non-fimctional but repairable, WO:Written off). How does the project intend to maintain and replace *isting equipment and other materials? It is the expectation of the projecl and this is contained in the plan submitted and incorporated in the health budget, that funds will be made available by the State to maintain existing equipment and other materials. Though not much was released in the year reported, efflorts will be intensified to convince govemment to release counterpart funds for maintenance of project equipment and purchase of various materials. At the LGA level, most LGAs are releasing some minimal funds to the Oncho Coordinator for the maintenance and fueling of their motorcycles. In the meantime, the project has requested APOC to provide replacements for most of the old equipments supplied. APOC MOH DISTRICT/ LGA NGDO Others No. Condition No. Condition No. Condition Source Type of equipment No. Condition No. Conditi on 1. Vehicle I Functional 1 functio nal 2. Motor cycle(s) 13 Broken down I funct ional 3. Computer(s) 1 functional 4. Printer(s) I Broken down 5. Photocopier (s) 1 functional 6. Fax Machine(s) I functional 7. Others a) Television I functional b) Vidoe player 1 Broken down c) Video camera I Non servicable IIIIII IIII II 33 WHO/APOC, 24 November 20M '! I 1l rl 1i II tl I I} IIll I_| t] I { iJ il tj tt I I 3.2. Flnanclal contrlbutlons of the partnenr and communltles Table 13: Financial confributions by all partners for the last three years Actually there are problems in the release of State and LGA counterpart funding. At the State level the team has met with the Honourable Commissioner over the iszue of non release of Counterpart funds in block. He promised to look into the matter and discuss it during the executive meeting with His Excellency and the Finance Commissioner. The outcome of the meeting is that the Government has promised to release as requested in 2006. The project has also met with the Permanent Secretary of the Deparhnent for Local Government Affairs who assured the state team that the possibility exists of LGAs counterpart funding being deducted at source. If this happens, the funds will be handed over to the Directors of PHC of the affected LGAs. Additional comments 3.3. Other formr of communlQl suppoil - Describe (indicate forms of in-kind contibutions of communities if any) The in-kind contributions of the community are as follows: t Provision of venue for CDD training t Foodstuffto CDDs a Refreshment to CDDs during distribution or during CDD training t Occasional support to collect Mectizan ntltr il rlil tl "tt I Contributor Yclr I ('provide rte period') Yerr 2 ('provide the period') Yet 3 ('Jan- Dec 20O5) TOTAL AMOUNT (cASrr) Budgeted rus$) TOTAL CASH Released (us$) TOTAL AMOUNT (cASH) Budgeted (us$) TOTAL CASH Released (us$) TOTAL AMOUNT (cASlr) Budgeted rus$) TOTAL CASH Released (us$) MOH (Central t ProvinciaVState) 40,000 2,000 MOH (District/LGA) 40,000 3,000 Local NGDOG) ( if any) NGDO partrrer(s) Others a) b) APOC TrustFund 82,640 30,000 TOTAL 162,90 35,000 3.4. Expendlture per actMty 34 WHO/APOC, 24 Novernber 2004 ll li l-} LI I] r IJ U tl u I tII tI I II I E T T I I ! t Indicate in table 14, the amount expended during the reporting period for each activity listed. Write the amount expended in US dollars using the curent United Nations exchange rate to local currency. Indicate exchange rate used here Table 14: Indicate how much the project spent for each activity listed below during the reporting period. Any comments or explanations? SEGTION 4: Sustainability of GDTI 4.'1. lnternal; Independent partlclpatory monltorlng; Evaluatlon 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable) _Year 1 Participatory Independent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation Intemal Monitoring by NOTF t Activity Expenditure ($ us; Source(s) of funding Drug delivery from NOTF HQ area to cental collection point of community 565.54 APOC Mobilization and health education of communities 227.45 MOH Training of CDDs 5,000 APOC Training of health staff at all levels 2,000 APOC Supervising CDDs and distribution 2,000 APOC Internal monitoring of CDTI activities 3,200 APOC Advocacy visits to health and political authorities 3,250 APOC IEC materials 3,250 APOC Summary (reporting) forms for treatment Vehicles/ Motorcycles/ bicycles maintenance 3,200 APOC Office Equipment (e.g computers, printers etc) Old vehicle maintenance and fueling t,772.55 MOH LGA fueling and Staff Allowances 3,000 LGA Others TOTAL 27,465.54 Total number of persons treated 6/,2,437 35 WHO/APOC, 24 November 2004 ( l I tl tI tl u r II I- t tl il t { I I Other Evaluation by other partners None was carried out during the reporting period 4.1.2. What were the recommendations? Although no monitoring or evaluation was done during the reporting period, the project is reporting the recommendations of the mid-term evaluation. i The state and other parbrers should joinfly develop a comprehensive costed and sustainable 3-year plan for CDTL The plan should be realistic, based on govemment resources and other sustainable sources t SOCT and NGDO should empower the lower levels through fraining on HSAM o CDDs should be trained on record keeping, census update, and recording of treatnent i Supervisory visits should be targeted and integrated with other health activities o The communities should be encouraged to incorporate CDTI in their usual festivities and use opportunities provided by community gatherings for appraising and recognising those who contibute towards the CDTI promotion in the locality. The CDDs could be honoured during these gatherings in order to motivate them I LOCTs and health facility staff should be empowered to manage problems t Update and reliable census of all the communities should be undertaken t There should be evidence of requisition of drugs based on census t There should be deliberate campaign to stop the purchase of drugs from medicine stores t The PHC deparhnent of the LG and the FLIIF staffshould fully involved in retrieval of reports from the lower levels with a view to over come the difficulties involved in one-time allocation of Mectizan to LGAs t Every community should have sufficient Mectizan in line with each community request o Facilities for CDTI and other health programmes should be used in an integrated manner o There should be clearly developed budget tied to definite activities t Advocacy should be undertaken to ensure the release of budgeted funds and counterpart funds for the funding of CDTI activities 0 There should be plans for replacement of capital equipment t Human resources are good with respect to number and commitnent to CDTI but they lack necessary skills especially on record keeping, report writing and planning. The staff thus needs training in these areas a There should be mobilization of communifies with therapeutic coverage rates of less that 6 5o/o to increase treatnent. t Every community should be listed and registered for treatrnent 4.1.3. How have they been implemented? 1. A Comprehensive sustainability work plan was developed wittr the parhrers and submitted by the project. 2. CDDs were adequately trained on census update, mectizan safe keeping and proper record keeping. 3. Advocacy and mobilization visits have been carried out at the State and LGA levels in order to secure the release of LGA and State Counterpart funds. 4. Mectizan requirements are being requested and distributed based on total populations of target communities. I t II I t 36 WHO/APOC, 24 Novernber 2004 t it t-t; I FI ti t] r] fi r tI 5. APOC Management has been approached through the sustainability plans developed to replace capital items initially procured. 6. Efforts are being made to re-mobilize most communities, not just those with low coverage rates, to ensure that they fulfill their roles and responsibilities. 7. The National and State offices are continually using all means particularly through health education to discourage purchase and sale of Mectizan. Improved Mectizan management through inventory keeping is being promoted. 8. Once funds are available there are plans to do comprehensive taining of all CDTI field workers in 2006. 9. Though health workers and subsequently CDDs have been reminded on the need for census updates annually, a comprehensive census update sponsored by UNICEF was undertaken late2004 and results collated in 2005. This was used to commence the process of community listing by LGA. 4.2. Sustalnablllty of prolects: plan and aet tatgets (mandatory at Yr 3) Was the project evaluated during the reporting period? No Was a sustainability plan writt€n?_ Yes- When was the sustainability plan submitted? 2004 I :tI What arangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.2.1. Planning at all relevant levels A five year post APOC sustainability plan was drawn and has been integrated into the Primary health care developmental programme of the State and LGAs. It is expected that this plan will provide a blue print for sustaining CDTI in the State after APOC withdrawal. 4.2.2. Funds Funding is expected to be done according to budget built into the sustainability plan which has been designed to be an integral part of the health system. 4.2.3 Transport (replacement and maintenance) This has been taken care of in the sustainability plan where vehicle maintenance and replacement has been budgeted for and it is to be taken care of by the government, butnow complemented by APOC until the 5 years of support expires. Some of the replacements are to be taken care of by APOC Management. 4.2.4 Other resources NGDO partrer, CBO and philanthropic organizations are expected to contribute towards sustainability. Mobilization and advocacy are being stepped up to prepare grounds for this purpose. 4.2.5 To what extent has the plan been implemented The sustainability plan is being integrated into the State primary health care development plan. 37 WHO/APOC, 24 November 2004 iitt rl Il I tu .e rl I{i t tl{r tl II fi tI r fi 4.3. lntegratlon Outline the extent of integration of CDTI into the PHC stnrcture and the plans for complete integration: 4.3.1. Ivermectin deliverymechanisms At the state level mectizan is collected by the State Coordinator from Lagos and down loaded at the PHC store where all PHC supplies and vaccines are kept. LGAs collect their mectizan supplies directly from the store as they collect other PHC materials. Any designated officer can collect mectizan for his LGA. 4.3.2. Training At the state level the SOCTs were tained on various components of PHC and are participating in the NPI exercise some as consultants, supervisors and other as; independent monitors. At the LGA and health facility levels LOCTs and FLHFS are involved in all training activities for the various PHC programmes. Likewise CDDs are hained as guides or vaccinators during most of the immunizationcampaigns in many LGAs. 4.3.3. Joint supervision and monitoring with other programs Presently there is no joint supervision with other programmes, and there are no plans for this at the State level. At the LGA level, occasionally when LOCTs are on other PHC assignments like routine immunization they check on CDTI matters. The conscientious health workers at the FLHF level integrate a lot of their activities in visits to the communities. 4.3.4. Release of funds for project activities The CDTI project is one of the programmes under the PHC departrnent, and funds for CDTI are released in the same manner other PHC support funds are released. 4.3.5. Is CDTI included in the PIIC budgetz CDTI or Oncho contol prograrnme is 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? Presently there is no programme that is using the CDTI stnrcture. 4.3.7. Describe others issues considered in the integration of CDTI. 4.4. Operatlonal research 4.4.1. Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period. None was caried out during the reporting period 4.4.2. How were the results applied in the project? N/A I !tt t_ 38 WHO/APOC, 24 November 20M tI tI tl tu E II i i ! tI n ti II SEGTTON 5: Strengths, weaknesses, challengcsr and opportunities Streneths l) There is a great deal of integration at most levels. 2) Availability of some committed health workers at State level and in some LGAs. 3) Willingness of a lot of CDDs to continue despite the lack of incentives. 4) Awareness of the control effort by most policy makers at both State and LGA levels Weaknesses: Inegular payment of counterpart funds by LGAs. Inadequate involvement of women in the CDTI prograrnme. lnadequate logistics for LOCTs Challenees and opportunities : data management. on to train more Frontline Health Facility Staff and have them involved in CDTI activities. being identified to assist in mobilization. been poor. The State project has printed more copies and distributed them to the LGAs and urged them to reproduce. SEGTION 6: Unique features of the prolecUother matters a. b. c. 39 WHO/APOC, 24 Novernber 2004 t]