Annual NOTF secretariat technical report to Technical Consultative Committee: January- December 2005

z'*nop./r. *9 \ffii NOC HQs ORIGINAL : English ANNUAL NOTF SECRETARIAT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) tcc s3 To ApOC Management by 31 January for 14 TCC meetin{ i by 3l Julv for SSplember TCC meetin$ i, I i , t I To APOC Management i:c'i.,1: f To, .\ R A i l-he AFRICAN PROGRAMME FORNF4* " oNcHocERcrASIS CONTROL (APOC) NOTF: NryerdaCOUNTRY/z Nigeria Approval vearz 1997 January - December 2005rti ear 2 3 4 s 6 7 (8) 9 10 11 t2 t3 t4 Proieet (circle) IYear this rt: July 2006Date submitted: e.r u Eir t csA CoP 6\rr'c 2 4 A0lJr 2006 ta ANNUAL NOTF SECRETARIAT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: Country z NIGERIA National Coordinator Name: Mrs. Patricia Oghu-Pearce Signature: Date: June 20,2006. NOTF Chair Name: Dr. S. Sani Signature: Date: June 20,2006. This report has been prepared by Name: C. Okoronkwo' Designati on: Tech nicol Oflicer/Data Manager Signature Date: June 20,2006I t WHO/APoC, 3 October 2004 TABLE OF CONTENTS 1.1. GeNpRel- INFoRMATIoN............. 1.2. PopulnrtoN AND Hee.lru sYSTEM..... SECTION 2: SUMMARY OF CDTI IMPLEMENTATION 2.1. DtsrntsurtoNPERIoD 2.2. AovocncY e.No SeNsnlzATIoN 2.3. INTORUETION, EDUCATION AND COMMUNICATION STRATEGY AND MATERIALS DEVELOPMENT........... 2.4. CouvuNtrles' INvoIvEMENT lN DECISIoN-MAKING... .... 1l 4 7 9 9 2.5. 2.6. 2.7. 2.8. 2.9. Cnpncttv BUILDINC.. OnoeRrNG, sroRAGE AND DELIVERY oF IvERMECTIN ............... TRenTuENTS.............. SupenvtsloN ............... ColluuNtry sELF-MoNIToRING nNo StereHoLDERS Meermc r0 l4 15 l9 2l 29 .... 3 I SECTION 3: OTHER ACTMTIES OF THE NOTF..."""""" ""' 34 SECTION 4: SUPPORT TO CDTI """"""" 37 4.1 FrNeNctn l coNTRtBUTIoNS oF THE PARTNERS ........... 4.2 OrHEn FoRMS oF coMMUNlrY suPPoRT....... 4.3. Resounce MoBILIZATIoN EFFoRTS.... 4.4. ExpENotruRE PER AcrlvlrY BY THENOTF SECRETARIAT """""" 4.5. EeulPunNr SECTION 5: EVALUATION FOR SUSTAINABILITY OF CDTI, INDEPENDENT MONITORING AND OTHER REVIEWS 59 62 63 63 64 5.1. INoppeNoENTPARTICIPAToRY MoNlToRlNc/evatuatloN.... 5.2. 5.3. SUSratNaglLlTY OF PROJECTS: PLAN AND SET TARGETS (MANDAronv er Yn 3) INTecRnrtoN ............ 66 66 69 70 7l5.4 OpenertoNAt- RESEARCH...... SECTION 6: STRENGTHS, WEAKNESSES, CHALLENGES AND OPPORTUNITIES 73 i t Acronyms APOC ATO ATrO CBBI CBO CBM CC CDD CDI CDTI CM CSM DHS DOTS FCT FLHF GCR GIS GRBP HFS HKT HMM HSAM HQs TDP TEF IFESH IT African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Community Based Bamako lnitiative Community-Based Organization Christoffel Blinden Mission Carter Center Community-Directed Distributor Community-Directed lntervention Community-Directed Treatment with lvermectin Community Meeting Community Self-Monitoring District Health Staff Directly Observed Treatment Short-course Federal Capital Territory Front Line Health Facility Geographic Coverage Rate Geographic lnformation SYstem Global 2000 River Blindness Programme Health Facility Staff Helen Keller lnternational Home Management of Malaria Health Education, Sensitization, Advocacy & Mobilization Headquarters Ivermectin Distribution Programme lntemational Eye Foundation lnternational Foundation for Education & Self Help Information TechnologY a ITN lnsecticide Treated Net KAP Knowledge, Attitude & Practice LF Lymphatic Filariasis LGA Local Govemment Area LOCT Local Government Onchocerciasis Control Team MDP Mectizan Donation Programme MIS Management lnformation System MITOSATHMission to Save the Helpless MOH Ministry of Health NEEDS NationalEconomicEmpowermentDevelopmentStrategy NGDO Non-Govemmental Development Organization NGO Non-Governmental Organization NOCP National Onchocerciasis Control Programme NON Newsletter on Onchocerciasis in Nigeria ll WHO/APOC, 10 April2003 INOTF NPHCDA NPT o/R PATHS PEC PHC REMO SAE SHM SMOH SOCT SSI TBA TCC TCR TOT UN UNICEF UNIVA UTG VAS wHo ZOTF National Onchocerciasis Task Force National Primary Health Care Development Agency National Programme on lmmunization Operational Research Partnership for Transformation of Health Systems Primary Eye Care Primary health care Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Stakeholders meeting State Ministry of Health State Onchocerciasis Control Team Sight Savers lntemational Traditional Birth Attendant Technical Consultative Committee (APOC scientific advisory group) Therapeutic Coverage Rate Trainer of trainers United Nations United Nations Children's Fund University Village Association Ultimate Treatment Goal Vitamin A Supplementation World Health Organization Zonal Onchocerciasis Task Force lll WHO/APOC, 10 April2003 tDefinitions (i) Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). (ii) Eligible population: calculated as 84o/o of the total population in meso/hyper- endemic communities in the project area. (iii) Annual Treatment Objective: (ATO): the estimated number of persons living in meso/hyper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. (iv) Ultimate Treatment Goa[ (UTG): calculated as the maximum number of people to be treated annually in meso/hyper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage (normally the project should be expected to reach the UTG at the end of the 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) Integration: The bringing together of two or more health programs, removing barriers between/among them, in order to maximise cost-effectiveness and permit free and equal association. For example delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) through CDTI (using the same systems, training, supervision and personnel) in order to maximise cost-effectiveness and empower communities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTI. (viii) Sustainability: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future, with high treatment coverage, integrated into the available healthcare service, with strong community ownership, using resources mobilised by the community and the government. lv WHO/APOC, 10 April2003 FOLLOW UP ON TCG 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 21 (Please add more rows if necessary) I Number of Recommend ation in lhe Report TCC RECOMMENDATIO N ACTIONS TAKEN BY THE NOTF SECRETARIAT FOR TCC/APOC MGT USE ONLY 4 (i) continue advocatingfor Federal government, state and LGA cash contribution This is being done with tremendous help from APOC Mangement, some members of TCC, members of the Steering Committee, and NGDO partners. We have seen Ekiti, Oyo and Nassarawa giving some counterpart funds for the first time for CDTI activities. Delta State during the reporting period increased its counterpart contribution significantly 4 (ii) encourage training of many CDDs in every community The NOTF is encouraging this. Ebonyi State has applied for support from APOC Mgt for selection and training of more CDDs along kindred lines. Their proposal has been approved, and implementation is expected to commence from 2006. The NOCP intends to submit a special proposal for selection and training of CDDs in selected States. 4 (iii) where women are accepted, should encourage their selection as CDDs This is the stand of the NOTF. However, some States complain of lack of funds for proper mobilization, and even where new CDDs, including female CDDs, are selected the funds are not there to do a thorough training. a (iv) where a project has more than one state, information for each state should be provided This has been done in the current report. WHO/APOC, 10 April 2003 Executive Summary Nigeria is made up of 36 States and the Federal Capital Territory with a population of over 120 million p...onr. Total population at risk for Onchocerciasis is about 28 million persons. In 2005 treatments increased slightly with a total of 21, 166,922 persons being treated. This represented aTS%otherapeutic "ou"rug. rate, and achievements of 90% of both the ATO and uic - slight reductionJover what was achieved in 2004. overall, the national therapeutic coverage lias been over 65Yosince 1999. Details of treatments show that27 States (8a%) of the totil 32 States and FCT covered (a3% increase over 2004 figures) achieved >65% therapeutic coverage rate. 31,883 communities were treated out of a total of 36,162 communities targeted, representing an 88 % geographic coverage rate. Projects like Kebbi, Kwara, Niger, Gombe andZamfa* huu. experienced coverage fluctuations on account of CDD attrition, inadequate number of CDDs, poor census update, inadequate supervision, late supply of Mectizan through the LGAs to the communities and lack of follow up on treatments due to dearth of funds. Poior performing States in the last two to three years in terms of coverage have been Benue, 6yo, Imo and Abia. Reasons for this include withdrawal of extemal support, poor counterpart funding, poor managerial skills by State teams, inadequate commitmeni by h-ealth workers and improper mobilization of communities. During the reporting period a total of 10,601 health workers and 59,642 CDDs were trained or re-traiied, r.fr.r.niing achievements of 81% and 78% of their ATrOs respectively. These represent slight increaies over numbers trained/retrained in 2004. The CDD/population ratio stands at about 1 CDD: 472 Persons. Extent of integration of CDTI into PHC varies from one project to another, and from State level to the fiUF level. Generally, Mectizan processes and funding are within the govemment system. Joint monitoring/supervision and joint utilization of logistics/transport 6."u. more aithe peripheral level than at the project or national levels. CDTI has been used as a vehicle for VAS, PE'C, schisto and LF control programmes to the benefit of all the programmmes. In the course of the year, the NOTF conducted advocacy campaigns, participated in targeted training of programme staff, coordinated procurement of Mectizan and capital items, organiied *p.-*irory and monitoring visits to selected projects, and overseen transfers of eiOC fundJto projetts while ensuring that expenditures are in line with approved budgets. The NOTF tras atso conducted routine programme review meetings and sensitizationl mobilization of target populations. Strengths of the programme in-country include increasing level of integration of CDTI into the pHC structure, -p..r"r,." of trainid staff at all levels of CDTI implementation, good commitment by healih staff especially at the State level to the CDTI process, and effective coordination, networking and collaboration at national and State levels. Moreover, mectizan processes, apart from procurement, are well established within the govemment system, and are working perfectly. The CDTI structure is also being used as a vehicle for the delivery of other health "*. p.og.ummes such as VAS. This has strengthened the CDTI structure. Weaknesses are absence of appropriate skills at national level for the mobilization of resources for CDTI implementation in the country, poor coordination of research activities resulting in ineffective utilization of outcomes in projects, poor supervision at all levels, inadeqtilte involvement of the FLHF staff in the CDTI process, low CDD to population ratio and inadequate record keeping at the LGA and FLHF levels. 2 WHO/APOC, l0 APril 2003 tOpportunities for strengthening the CDTI process abound. These include availability of human resources for COtt lmplementation at atl levels, increasing recognition by stakeholders of CDTI as a vehicle for the effective delivery of varied health interventions at the community level, early receipt of Mectizan consignments at the national level, and increasing involvement of local NGOs, CBOs and associations in the CDTI process. Mass and indiscriminate transfers of health staff; the creation of the Ministry of Environment in the south westem States and subsequent deployment of environmental health officers to that Ministry; inadequate counterpart funding for project activities at State and LGA kevel; weak levels of community owneiship in some of the projects; and payment of community based workers by other programmes constitute some of the threats to effective programme implementation in the country. Additionally, there is a general feeling of well being among some target populations resulting in non-compliance to Mectizan treatments. To address the chalenges and threats the NOTF embarked on advocacy visits/campiagns to policy makers, .r,ru..J the reconstitution and training of teams at State/LGA levels, and inititia moves for the mobilization of resources from the public and private sector for CDTI. It also encouraged projects to request inclusion of CDDs in incentive - paying programmes at the community levil, Lnru.. selection of more CDDs along kinship or ward lines and have a rethink of IEC strategies to deal with non-compliance to annual treatments. J WHO/APOC, l0 April2003 \SEGTION {: Background information {.'1. General lnformatlon l.l.l. Description of the country program -CDTI and vector elimination (briefly) Status of National ptan implementation, population at risk, number of proiects being impleminted, othei relevant activities, infrastructure (eg. Adequate healthfacilities, is system decentraliZed or not, etc), logistics, administrative structure. Nigeria is made up of 36 States and the Federal Capitat Territory with a population of ovir 120 million persons. Nigeria operates a federal system. There is a central govemment withihe president at the top, supported by executive, legislative and judicial ipparatus. Each Statohas its own govemment with the Governor as the chief executive. fi. ir "o.plemented by the same type of structures at the federal level but on a State basis. The State consists of a number of LGAs with each LGA being administered by the Executive Chairman supported by its miniature legislative and executive structures. The country is divided into six geo-political zones. There are however 4 health zones for the onchocerciasis control programme. Each health zone comprises eight to ten States and has a Coordinator for the Onchocerciais Control Programme. Latest information on PHC facilities indicates that there are 22,895 different types of facilities in the country. Of the number 14,203 are public health facilities while 8,692 are privately owned. lg, 745 are PHC facilities white 2,970 are secondary health facilities. The remaining 33 facilities are of tertiary level. The total number health care facilities is still considired grossly inadequate and accessibility (physical access and economic access) is a big p.obl.*. A majority of the rural populace is emasculated from adequate health care. presently Nigeria has 28 projects (27 CDTI projects covering 33 States, including the Federal -Capital Territory, and the National Headquarters Support Project. About 28 mitlion persons are at risk of the disease. Heatth system & heatth care delivery $tate any problems related to health system that imp e de p ro g ram imP le me ntation). primary Health Care (PHC) is the strategic policy, central function and focus of Nigeria's national health system, and to this is tied the overall social and economic development of the communities. This policy, according to the document on Revitalization of primary Health Care in Nigeria - A Blue Print, recognizes that the physical, biological and social environment of a community constitutes the cesspool in which diseases=thrive and from where they can be effectively controlled or eradicated. Currently, Health Care Delivery is the responsibility of all three tiers of government, with each tier taking care of its level. Ideally, at the LGA level PHC is the first level of contact of the community members with the health service, and referrals are made upwards from that level. Problems: roles and responsibilities of the State and the Federal are not clearly spelt out. minimum health care package to citizens of the country. Policy makers and programme managers within the health sector has faited to agree on or work 4 WHO/APOC, l0 APril2003 towards an integrated minimum package of PHC services, preferring rather the execution of gigantic and expensive vertical programmes for each component without commensurate impact. economically inaccessible to the rural populations and the poor. by inadequate logistic support and poor communication. or institutional support for community participation and co - management in PHC. little or nothing for capital development, drugs or supplies. [n some areas, there is a problem with the payment of salaries of health workers leading to low morale and abandoffnent of work for other means of livelihood. Provide map locating all projects (CDTI and Vector Control, tf any) within country, Yobe Kano Bomo lGduna FCT Niger Taaba Benue Shaded areas indicate the combined projects 1.1.2. Partnership Indicate the partners involved in project implementation at all levels (MoH, NGDOs - national, inte rnatio nal) 5 Name of CDTI Project Partners Adamawa HKI, NOCP, State MOH, endemic LGAs, target communities, CBBI committees. Akwa Ibom HKI, NOCP, State MOH, endemic LGAs, target communities, Bauchi UNICEF, NOCP, State MOH, endemic LGAs, target communities, Benue UNICEF, NOCP, State MOH, St. Monica's Hospital Adikpo, WHO/APOC, 10 April2003 rr'ffi ri ', t"r -) ta) endemic LGAs, target communities, Borno HKI, NOCP, State MOH, endemic LGAs, target communities, Cross River LINICEF, NOCP, State MOH, South Eastern Nigeria Outreach Eyecare Services (SENOES), Ogoja Catholic Eyecare Services, Cross River National Park, Cross River Forestry Commission, Tulsi Chanrai Foundation, Great Friends of Obudu, Pacesetters Klub Exclusive of Calabar, Calabar Leo Club, Catholic Nurses Guild, endemic LGAs, target communities, Youth Care, Opthalmology Dept of University of Calabar, Cross River University of Calabar. Edo Global 2000lCarter Center, Lions Club International District 404, NOCP, State MOH, endemic LGAs, target communities, Delta Global 2000/Carter Center, Lions Club Intemational District 404, NOCP, State MOH, endemic LGAs, target communities, Ekiri UNICEF, NOCP, State MOH, endemic LGAs, target communities, Enugu Global 2000/Carter Center, Lions Club lnternational District 404, NOCP, State MOH, PATHS, endemic LGAs, target communities, Anambra Global 2000/Carter Center, Lions Club International District 404, NOCP, State MOH, endemic LGAs, target communities, Ebonyi Global 2000/Carter Center, Lions Club Intemational District 404, NOCP, State MOH, endemic LGAs, target communities, FCT CBM, Dept of Health, Area Councils, target communities Gombe UNICEF, NOCP, State MOH, endemic LGAs, target communities, lmo Global 2000lCarter Center, NOCP, State MOH, endemic LGAs, target communities, Abia Global 2000lCater Center, NOCP, State MOH, endemic LGAs, target communities, Jigawa CBM, NOCP, State MOH, endemic LGAs, target communities, Kaduna SSI, NOCP, State MOH, endemic LGAs, target communities, Kano CBM, NOCP, State MOH, endemic LGAs, target communities, Kebbi SSI, NOCP, State MOH, endemic LGAs, target communities, Kogi SSI, NOCP, State MOH, endemic LGAs, target communities, Kwara SSI, NOCP, State MOH, endemic LGAs, target communities, Niger UNICEF, NOCP, State MOH, endemic LGAs, Agric. Cooperative Groups, Trade Unions, Age Grades, target communities, Ogun IFESHruNIVA, NOCP, State MOH, the Baptist Church, Anglican Church, endemic LGAs, target communities, Ondo UNICEF, NOCP, State MOH, Progressive Club, Elite Club, Cordat Club, Union of Friends, endemic LGAs, target communities, Osun UNICEF, NOCP, State MOH, endemic LGAs, target communities, oyo UNICEF, IFESH, NOCP, State MOH, endemic LGAs, Boys'Scout, Girls Guilds, Lydia Groups, Man O War Groups, target communities, Plateau/ Global 2000lCarter Center, NOCP, State MOH, endemic LGAs, target communities, Nassarawa Global 2000lCarrer Center, NOCP, State MOH, endemic LGAs, target communities, Taraba CBM; MITOSATH, NOCP, State MOH, endemic LGAs, target 6 WHO/APOC, 10 April2003 communities, Yobe CBM, NOCP, State MOH, DAMAgUN Development Association, Fune Development Association, Bubaram Gakoko, endemic LGAs, Zamfara SSI, NOCP State endemic LGAs Describe overall working relationship among partners, clearly indicating speciJic areas of project activities where all partners are involved (planning, supervision, advocaiy, resources mobilization, endemicity mapping / assessment, development of IEC materials, studies or surveys etc). Generally, the relationship among partners is cordial though there are occasional frictions over the extent of roles being played by some partners. The NGDOs assist in resource mobilization, advocacy, endemicity assessment, Mectizan procurement, monitoring and development of IEC Materials. The State and Local Governments are engaged in mobilization, plaruring, supervision, Mectizan delivery, and training. NOCP's role includes advocacy, training, supervision/monitoring, ffid technical support. The communities select their distributors, determine type of incentive to be givin to such distributors, decide mode/period of distribution, fund local costs of distribution, and supervise the distribution programme. Where operational local NGOs and CBOs assist in community health education and mobilization, supervise and part - fund the CDTI process. State plans d any to solve any issues arising as regards CDTI implementation. There are no plans to solve any issue as it relates to partnership in CDTI implementation, as none is outstanding. 1.2. Populatlon and Health system Table 1: Projects and population at risk in the entire country whether they are treated or not during the reporting period. (Please add more rows if necessary) 7 Name of CDTI Project Total communities in meso/hyper- endemic zone Total population in meso/hyper-endemic zone Ultimate Treatment Goal (UTG) by 2010 Adamawa 2,784 1,178,45 1 989,899 Akwa lbom 13 17,682 14,853 Bauchi 675 914,000 767,760 Benue 3,473 2,957,600 2,484,384 Borno 1,429 745,109 625,892 Cross River 930 1,008,897 847,474 Edo 530 687,029 577,104 Delta 470 562,439 472,449 Ekiti 344 1,091,000 9r6,440 WHO/APOC, 10 April2003 Enugu 1,373 922,475 774,879 Anambra 1,062 735,153 617,529 Ebonyi 973 594,000 498,960 FCT 559 297,491 249,892 Gombe 966 1,617,452 1,358,660 lmo 1,940 955,208 802,375 Abia 684 522,920 439,253 Jigawa 158 352,832 296,379 Kaduna 2,597 1,283,274 1,077,950 Kano 977 600,738 504,620 Kebbi 287 241,415 202 789 Kogi 2,544 1,572,168 1,320,621 Kwara I , 1 09 973,054 817,365 Niger 2,745 1,632,079 1,370,946 Ogun 881 300,274 252,230 Ondo 579 1,212,406 1,018,421 Osun 997 814,030 683,785 oyo 2,269 r,244,463 1,045,349 Plateau 296 354,799 298,031 Nassarawa 589 868,751 729,751 Taraba 1,533 l,ogg,823 923,851 Yobe 247 594,486 499,368 Zamfara 134 160,231 134,594 TOTAL 36,162 28,L56,752 23,651,672 Source: From Oncho Project reports: National census: Other source, speci Year source: UTG: Calculated as the maximum number of people to be treated annually in meso/hyper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage (normally the project should be expected to reach the UTG at the end of the 3'd year of the project). 8 WHO/APOC, l0 April2003 SEGTION 2: Summary of GDTI lmplementation 2.1. Distribution period Chart the actual distribution period for each CDTI Project in the country in the table below. Overview of distribution undertaken rows as BrieJly note any problems/issues (one paragraph). Quite a number of projects still distribute Mectizan during the rainy season. This is at variance with the NOTF policy that distribution should take place in the dry season. It has however been noted that several reasons account for this development, and these include late delivery of Mectizan to projects/LGAs, non-provision of logistics by LGAs for drug collection, unwillingness by some CDDs to distribute due to lack of incentives, poor commitment of health staff, community decision on time of treatment and late release of funds. 9 Distribution PeriodProject Name Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Adamawa { { { Akwa Ibom ./ ./ ./ Bauchi ./ ./ { ./ ./ Benue { ./ { { { { { ./ ./ { ./ ./ Borno ,v { { Cross River { ./ { { { { { { ./ ./ ./ { Edo { { { { { ./ ./ ./ .i Delta ./ { { { { { ./ ./ Ekiti { ./ .J \i \i Enugu ./ ./ ./ ./ { { Anambra ./ { ./ { ./ { ./ ./ { Ebonyi { \i \i { { ./ ./ ./ ./ .i FCT { { Gombe ./ ./ { ./ { { { { lmo ./ { ^/ ./ ./ { ./ { { ./ ./ Abia ./ { { { { { { ./ ./ ./ { Jigawa ./ { ./ { ./ ./ Kaduna ./ ./ ./ ./ { Kano { \i ./ .i { .i { \i { Kebbi { { { { Kogi \i { { { { { { Kwara ,v \i { { { ./ Niger ./ ,v ./ .i ./ { ./ Ogun ./ { Ondo ./ ^/ ./ { ./ { { { { Osun { ./ { ./ { { { { ovo { { ./ { ./ { ./ { { Plateau { { { { { { { ./ ./ { ./ Nassarawa ./ { ./ { ./ { { { Taraba { ./ ./ ./ ./ Yobe { .i ./ ./ Zamfara \i { { WHO/APOC, 26 September 2003 2.2. Advocacy and Sensitization a) State the number and type of policy / decision makers mobilized at the national and lower (state and district level) during the current year; the reasons for the sensitization and outcome. b) State progress made towards internal resource mobilization. Partners are making more efforts to encourage State and Local Government policy makers to provide counterpart funding for CDTI activities. Given the changes taking place at the LGA level several State projects have tried to get approval for the deduction of LGAs contributions before allocation. These have met with varying successes. There is an increasing number of Level No & Type of Policy makers mobilized Reason for Sensitization Outcome of Mobilization National 17 (Minister, Permanent Secretary, Director, Public Health, some policy makers at State level - PHC Directors, Commissioners for Local Government & Chieftaincy Affairs); 13 senior officers in the FMOH and other federal ministries. a Enablement of senior policy makers, national coordinators of community-based programs, the NGDOs and donor agencies supporting or financing control programmes in Nigeria, to dialogue on different programme- designed support and sustainable approaches; o lntegration of approaches and analysis of factors that constitute barriers or promote integration of community-based interventions; a Sensitization on the benefits of the community-Directed lntervention (CDI) approach a Increase knowledge on CDTI and the sustainability process The Onchocerciasis control programme has been incorporated into the NEEDS document, and the presidency has given a positive nod to increased funding of communicable diseases. It is expected that in the coming year more funds will be made available to the programme for direct control activities. State 160 (Commissioners for Health, Permanent Secretaries, Directors for Health, Members of the House of Assembly (in Kaduna State) Nassarawa State has released 5.5 million naira deducted from LGAs allocations for CDTI. This is the first time the State is making funds available for CDTI implementation. Oyo State released over 400,000 naira for CDTI. Again this is the first time this is taking place. Delta State increased significantly its counterpart contribution. LGA 1,213 (LGA Chairmen, PHC Directors, councilors, other policy makers at this level) lncreased recognition of the need for sustained control of the onchocerciasis disease, and increased financial support for CDTI. A number of LGAs are supporting CDTI even though levels differ. In Oyo State nearly all LGAs are giving monthly imprest to the Onchocerciasis Coordinators. l0 WHO/APOC, l0 April 2003 States where the direct deduction is being effected. As stated above, Nassarawa State was among those that joined this group. Projects are also being encouraged to identifu and mobilize local CBOs, NGOs, socio - cultural groups and religious organizations at various levels to contribute to the CDTI process. Meanwhile, the NOTF has set up an ad-hoc committee to come with proposals on private sector participation in the implementation of CDTI in the country. c) Describe any policy-related constraints being faced by any particular project and describe what was done to cssrsf the project (outcome). Explain any plans on how to improve advocacy. Incessant transfer of health workers at LGA level has been a recurring factor, particularly in the south western States. State Coordinators in collaboration with Zonal Coordinators and NGDO partners have made appeals that CDTI staff be retained in their positions or transferred to CDTI LGAs. Some States have given heed to this appeal while others are yet to respond favourably. The creation of the Ministry of Environment, again in most South westem States, and the transfer of all environmental health officers, most of whom make up the LOCTs and SOCTs, have also been a source of great concem. In Oyo State, the entire SOCT members, being environmental health officers were transferred out, and it took the intervention of the national and zonal offices for them to be reinstated. To improve advocacy, the NOTF in collaboration with APOC Management intends to send high - powered teams to selected projects, targeting the chief executives of such States. States being targeted are Ekiti, Oyo, Plateau and Nassarawa in the interim. Other States that are yet to release counterpart funding are being targeted in the nearest future. In addition, the NOTF is still looking at modalities of having national and zonal goodwill ambassadors for the control of onchocerciasis. This is yet to be conclusively discussed. 2.3. lnformation, Educatlon and communication strategy and matertals development Briefly describe the IEC strategt being used in the countryfor CDTI. At the inception of CDTI in the country, the NOTF raised a sub - committee on [EC. Its' main mandate was to come up with prototype IEC materials and possibly coordinate the mass production of such materials for projects in order to maximize economies of scale. The sub - committee came out with several prototype materials ranging from treatment registers, CDD brochure and different posters. The NOTF initially assisted projects to produce what they needed, but later projects were allowed to produce, and develop others on their own sometimes with assistance from other partners. Currently, it is the policy of the NOTF to allow projects to develop and produce their own IEC materials relevant to their needs. They are advised to utilize existing local channels of communication for the dissemination of information on CDTI. However, in recent times the NOTF is requesting the projects to develop materials that emphasize sustainability and long term compliance to Mectizan treatment even in the absence/ regression of the disease manifestations. Note if ony neu, IEC materials were developed or revised, the type of the material, the message and target audience, and where they were distributed. We are not aware of any new IEC materials developed or revised during the reporting period. - How were the IEC materials developed ? N/A ll WHO/APOC, l0 April 2003 a- Are the materials reviewed to address upcoming issues (like decreasing refusals, s ustainab il ity, maintain ing co mp liance to lo ng-term treatme nt, SAEs) ? N/A - Report d any KAP surveys have been done and how their results were used? At the inception of CDTI some projects conducted KAP surveys but the results were not shared with the NOTF Secretariat, neither was it aware of how the results were used to translate existing IEC materials or develop new ones. The NOTF is not aware of any recent surveys. S ummarize info rmatio n o n : - The use of appropriate and innovative media and/or other strategies to disseminate information among the projects; To disseminate information among the various projects, the following strategies/channels of communication were utilized: o Radio and televison messages/programmes . Posters/Handbills t Bill boards o Community meetings a Announcements in churches and mosques o Health workers sensitization meetings o Local Town criers o National HQs newsletter, NOly' a NGDOs'Newletters To disseminate information TO the various projects, the following strategies/channels of communication were utilized: Onchocerciasis in Nigeria (NOIU). but for the past two years it has been made annual. per zone) - Mobilization and health education of women and minorities - method and response Different approaches are being used in various projects, particularly in the northern part of the country where involvement of women and minorities constitute an issue. [n some States like Zatnfara and Kebbi Muslim teachers are used in reaching women. Projects like Yobe make use of local NGOs. Generally where women are in seclusion, the public-address system, female health workers, traditional birth attendants (TBAs) and family heads constitute means of health educating and mobilizing them. [n some other projects especially those in the south- western part of the country, trade women associations and faith-based women societies are effective means of reaching the female folk. In the southem part of Nigeria, involvement of women and minorities in the CDTI process is not much of an issue. They are part and parcel of the community that is mobilized and health educated by health workers and CDDs. Response in most projects is quite encouraging. Where the women participate, particularly in the south, they make vital contributions and some are selected as CDDs. [n some south- eastem States like Imo and Abia, there are as many female CDDs as there are male CDDs; and sometimes more. In the north, participation to such a degree is still not existent. There is t2 WHO/APOC, 10 April 2003 however an increase in the level of awareness of women in CDTI issues. In a few of the States like Yobe, Adamawa and Gombe there are attempts to select females as CDDs. - Majoraccomplishmentsl The major accomplishments include: State some women groups have taken it upon themselves to give incentives to CDDs selected. even though overall amount being made available tend to fluctuate in the CDTI process. As earlier stated, in some projects a good percentage of existing CDDs are females. CDTI. [n some parts of the north, VAS coverage is higher when distributed by CDDs than when distributed by health workers during the immunization campaigns. Additionally, in some communities where oral polio was rejected when administered by health workers or other vaccinators, it has become accepted if the CDD is seen to be participating. Weaknesses/Constraints I implementation is cumbersome. health workers, and develop appropriate IEC materials education of target communities by health staff. signals to communities that CDTI is only for men. This further constrains mobilization of female members of the community. members do not possess the means to move around. Suggest ways to improve mobilization of the target communities among projects. I . Selection of more CDDs along kindred lines and utilization of same to mobilize the populations. 2. lnvolvement of communities and CDDs in planning and implementation of other health-intervention pro grammes. 3. Greater involvement of existing frontline health workers particularly in community mobilization. 4. Greater interaction of knowledgeable implementers with communities. When CDTI was initiated, sufficient time, and maybe funds, was not devoted to this activity. 5. Targeted training of health workers in the implementation of CSM 6. Identification and mobilization of more local NGOs, CBOs, age grades, religious/ cultural groups, women groups etc for community mobilization. A situation where there is some form of competition among several community based groups in the CDTI process will dramatically improve not only community mobilization and health education but also ultimately enhance community participation and ownership. t l3 WHO/APOC, l0 April2003 a7. Mobilization of community representatives at the LGA level to identifu more with the programme and assist in the mobilization of their constituencies. 8. Increased emphasis and efforts towards integration of health care delivery programmes, particularly at the lower levels. This will translate in part to an integrated approach to community mobilization. 9. Capacity building on mobilization skills for health workers. 10. Review of IEC materials to address emerging issues from the community level. 2.4. Gommunitiest involvement an decision.making Comment on community participation making comparisons among proiects Community participation has been limited to selection of distributors, collection of Mectizan from designated points and announcements of times of treatment (following anival of Mectizan). This occurs in all the projects. However, only in some projects do communities determine period and mode of treatment, mobilize resources for CDTI at that level, compensate CDDs, conduct self - monitoring and follow up on refusals. Cross River State Project remains an outstanding example. [n this project community enthusiasm in the implementation process is legendary (maybe except in Akamkpa LGA). Most communities are so well mobilized that they are even prepared to be collecting their Mectizan and returning reports directly to the State capital even though for some communities this could as well take a whole day's joumey. Projects such as Taraba, Kogi, Kaduna, Ebonyi, Ondo, Ogun and Yobe are making great efforts to ensure adequate mobilization of their communities and increasing level of community participation. However, self - monitoring, follow up on refusals and mobilizationof resources still appear to be weak in these States. The FCT project appears the weakest with respect to community involvement and mobilization. This is not entirely surprising given such confounding variables as the urbanization of the local communities with the attendant heterogeneity of the populations and the constant interaction with the seat of government that has monetized all issues and gradually eroded time-honoured community principles and morals. In Plateau and Nassarawa States, the problem of low community participation is an offshoot of inadequate attention given to the programme by the health staff, a development arising from low morale due to non payment of staff salaries and allowances. The low level of community participation in other projects is mainly more of a result of inadequate interaction by health staff with the communities, occasioned mainly by dearth of funds and poor commitment. Participation of female and youth members of the community at health education meetings; This varies from one part of the country to another. In the southem part of the country (most sections) females and youth have the freedom to attend health education sessions with other community members. In some of these parts they can be more vocal than the men. However, in some sections of the southem eastern part of the country, the youths, though free to attend and participate, do not attend as they see the programme as belonging to the adults. Moreover, the youths believe they will be more rewarded for their time if they are engaged in some activity that will bring ready cash. [n the middle belt, they can be present but deference is given to the men with respect to participation. In most of the northern parts of the country, women are never allowed to attend with the men any gathering, including health education sessions. The male youths may be allowed. However, in some communities the women can be organized separately for health education sessions by appropriate persons, and their participation in such sessions are uninhibited. a t4 WHO/APOC, l0 April 2003 t ,In general, how do you rate the participation of minority groups andfemale members in community meetings, decision-making, (attendance, participation in the discussion etc,) other issues. See comments above. Suffice it to reiterate that in most communities across the country (except Benue State where females can become traditional rulers, or hold high traditional positions), women are not part of the decision - making apparatus of the community. However, as in the south they can contribute but the final decisions lie with the men. There have been no reports of marginalization of minority groups. In most parts they become assimilated into the host community and play the roles expected of all community members. 2.5. GapaciQl bulldlng Training of national, district level staff in CDTI and general management skills (computer applications, project planning, etc.) Brietly describe any training done by the NOTF for specilic CDTI or Vector Control Projects (O bjectives, partic ipants, o utco mes, any follow-up needed). Officers of the NOTF at national and zonal levels have been involved in training of project staff, but no training programme was organized on a national basis by the NOTF. One of such training activities in which NOCP officers partook in was a targeted training of some SOCTs of UNICEF-assisted States in technical report writing and organization of CSM. This was followed up with a one-day training of LOCT leaders in the UNICEF-assisted States on CSM. There was a capacity building workshop on operational research proposal writing for key project staff in FCT, Taraba, Plateau & Nassarawa States. This workshop, organized in collaboration, with APOC Management, was sequel to proposals submitted on usage of the kindred system for CDD selection to be carried out in the affected States. The objectives of workshop were: o To strengthen the capacity of participants in conducting community research that will enhance CDTI implementation. o To improve the capacity of participants to design and write good research proposals through clear problem identification, development of research tools, data collection, analysis and the use of research results for program re- orientation. o To enhance the participants' use of community meetings for development work related to CDTI activities. o To revise and finalise an Operational Research proposal submitted to TCC. This training covered the following topics: methods, data collection, handling/entry, analysis and interpretation); activities; and how it relates statistical trends l5 WHO/APOC, l0 April2003 t, The O/R proposal was finalized, submitted to TCC, approved and funds released. However, the study is yet to be concluded due to late release of funds. Table 3: Type of training undertaken at national level by the GTNOAtrOTF (tick the boxes where specific training was carried out during the reporting period) Type of training Project staff MOH staff Opinion Leaders Others(speci!) Program management ^/ How to conduct Health education Management of SAEs CSM ./ ./ SHM Data collection ^/ Data analysis Report writing ^/Others (Operational Research) { ^/ Briefly describe any technical assistance provided to the CDTI projects. Technical assistance has been extended to projects in the following areas: o Preparation of technical reports using the revised reporting format o Preparation and production of sustainability plans o Rendition of accurate financial returns. This is applicable to projects that have new accountants or have problems in usage of the WHO imprest system. Such States include Kwara, Gombe, Akwa [bom, and Ekiti. o Definition of 'definite' CDTI areas using the health mapper software o Review of technical reports, progress reports and budgets Fill in table 4 on the next page. l6 WHO/APOC, 10 April2003 c.t o o{ op o a() t/) \o(\.l t, o o. Ff. = f- q) -a € o C) \ q) U) q) "\t t q) v s bo \q) 41q) *.$' 3< S l q) R s q)\ 41 lr1 d s 4.)t4 a)(.) a) q: o a) t B q) U7 Gq) s cn()(.) 'a tia >.p otro .o oo (t H (l o >.Li(d a +r d)l _ol(!t FI rt € o. co o\ $ ca :. s c.t €\o$ : c.l c.t$ :. \o tft ca o\ c- c.t : o{\o t6 a.l \o c.l co c.l $ \o € (\.l tt c..l o\ o\ cr c.l(" : € c..l\o or- c- o : o c- c- c.l e- c\ co co c.ls c..l c-tli c.l cn o\ c.t ci :. o.l c- o\ o\ c- € : $ e.ls c.l $ co :. c\l ...l c- o\r- elt-. c.t\o C-l\o r- oo .: o \o € o\ : co o\$ 6' +. q .U o r: =v or* € $ oo o\ c- a.ttts rn o\ € co \o$ o\ oc.l c-- o € c..l c.t o.l c{ o.l cf) c.tc.l (,) ctL erl e eq) o L 4)E z ?!FQ o\so\ c\l c..lo\ oo\o o \o \o c-r- t $ € o6 o I E6 Gll v trO'e Su: c- c- \o € € c.lt- o at o\ o \o € \o o6 I I I o b0 .='o'c!trtr ;^ r-H9- .ob L$t35 z (J o F c- I € € ol o\ o.l o\ c.l o\ :. c.tt :. \o t-- : o\ : $\o o\ c.l o\ c.l o c.l : o c\l o co c..l o o € : ca c.l : C..l c..l \o .:. \o oa< U"a E,q?F-u' $o$ tt : o\ $ I o c.l c-.1\o c.t c.ltt c{ c-s c- ca (\.l o\ c.l € : I €N s\o : t\o I o oo .: t\o \o € co € c..l o € o@ o€$ o\o c.t $ c.) o c.l o c.t(\.l \o q) -E 6tF f;E =s9ah .rE E: zi. o(J (.) o F" $c.t o\ oo \o o\ c-.1 €(\l s\o t I o\o \o t c- : € t (\.l c.l c.t o\ € € o{ \o o\ \o o\ (rl r- s c.t c- I I I I 6+.q 6i* .n E.l+F-d t ca s c.l COtr- c.l I I I c 6lL 6t ah oq) oL Fr Lo& z O o F $ cn $6 I I \o $ €t s \o o\ tt + a)& oo o tr CI -o + (6 3(6 o0 (u 6t q)(,) o e. (g B(B 6! + op (d 3}4 + C) (B m + o) o m + o li o m +t<o & U) cn ot<O oEH (g o n &rrl o0 H (g t<p (rl >r op H FO& I I I I I I c- c.) cO I I I I I I I I coO c-.1 a o Ci o O. o oo oi) q) a) .a € Ur AJ\ a,)e a.rL c4 a){t .s\ qJ \t:a:s3;\\r*!\9Sst)|-qr$\ $P ;llioo '5Sts \bstS,It\re< 9*. .sS tq9t\.q) =>SC\ !rt13qr'* B q.l .a L.\){L!.:r ta60SCH+* \o o\q \o o\ o\ \o(\.l \o c\l I t-. €\o r \o c-.1 rO o o^ .:. ss co :. \o \o olo c..l alo|/I N $ : srr : ossf \o € \o € c.t c.t : € : c- o c.l o\o : alt-. F- rn €\o c.t :. € 1 o\o$ $\o cr c.l .: at tt c.t o\ o\ c.t s c.l c- c.l o\ to$ o\s CA$ c.t cn$ c.t al$\o o\ r.) a\ ra \o .:. ta6i(.! 6t- o o o) q) \c sa .d \ool ooo-$ c- o\ o{ oo € o\ \o$$ c..l cr tl o ct c.lr- \ot- c- c.t I coo €o : I I s ot o $ c.l altl : a.t € I I I co : € c.l o c- c- I I t- o\\o t-ia\o oto o GI q) 4) (u q) \cc\ coo €o I o{s I o oo c..l \o o\ o.t o,6 rn o\ ?a ra 6 c- € .:. tt : cot o.l \o c.l$ c- o\ : o\ a{ t r-. € : \o $ €s :. c.t c.t €\o I €\o c-.1o\o oo o\ : $o c.t o : o ca a ott : c.ls : c.r (\l c- : € : o\ o.l \o o.l N$ : t € t-. c- \o o\ ca \o o\ c.t o\ o\ o\ o\ : s to $ :. t €t-. o\ .a6 ca \o ta o\ GI cr o € OJ Q,) (u q) \c \o c- co C'. o\ c.t o\o\o c- c-l ota\o o\o o s c-- so{ $ rn I ra o\$ (\.l : \o : \o a-\o t-\o I $ €$ :. cft c.t I I I I \o c.l c.t o\ o\ : cn c-.1 I I I I I I I I I I I (a GTi o\ o\o ! GI ?a o\ q) rl) (lJ q) \co\ o^l c.t c-\o \o €$ o o{$ I r-.iaia C! !(! v o GIv + ,op ov '50 ov + (o L ct ' v H(l) oo z + @o oE o + crt o + o >.o (l, o(! A (! 3 Ctk(! cnt) cl z + c,!(B t<(llF +o o (U .(!g (6 N Fl F otr I I a I I I I a I I I I I aI aI I I I I I I I a 2.6. Ordering, storage and dellyety of ivermectin Please describe how Mectizan@ is ordered and how il gets to the communities. The assisting NGDOs usually completes the re - application forms for Mectizan needed based on data/requests collected and collated from the projects, and forwards same to the NOCP HQsNOTF Secretariat. For the UNICEF - assisted States this function is performed by the national office based also on population and treatment data/requests from the States. The National office/HQ compiles, reviews and endorses the re - application forms and forwards to the Mectizan Donation Programme (MDP). On approval MDP forwards consignments through LINICEF who clears the dugs. From the NOTF store, operated currently by UNICEF officers, the drugs are lifted by the assisting NGDOs, or Zonal offices or by the States. Where the former applies, the States get their supplies from the NGDOs or Zonal offices and make them available to the LGAs. The LGAs in turn make the required quantities to the health facility centres/collection centers from where the communities pick up their drugs. [n some cases the LGAs make the drugs available to the communities directly. Please comment on whether ivermectin delivery has been integrated into the essential drugs delivery system at the national and lower levels or not. State activities under ivermectin delivery that are integrated into the national health care system in the country. Nigeria is yet to have a national integrated essential drugs delivery system. Several agencies responsible for health care delivery such as the NPHCDA and the NPI have set up drug supply/delivery channels to cater for the services that they render. lvermectin delivery at the national and zonal level operates independently of these channels. However, at the State and LGA level there is some form of integration although the extent or degree varies from one locality to another. Generally, when States and LGAs receive their ivermectin supplies they are stored in the PHC store where vaccines and some other essential drugs are kept. [n some places the same inventory is used for all the drugs kept in such stores. Some State projects however keep their Mectizan supplies separately. [t must be emphasized that all the Mectizan processes except procurement are within the government system. Moreover, there are several instances where LGA personnel utilize the opportunity of vaccine collection at the State level to pick up their Ivermectin consignments, and vice versa. Please state where any remaining Mectizan@ rs stored after the distribution cycle. This differs from State to State. [n some States the remaining Mectizan after distribution is retrieved and stored at the State level. [n some other cases they are left at the LGA level and whatever is left is deducted from the number requested for the next distribution cycle. Attention is however paid to expiry dates to ensure that expired drugs are not distributed to community members. It is the policy of the NOTF that all expired drugs be retrieved and forwarded to the NOTF Secretariat where they are properly disposed of. l9 WHO/APOC, 26 September 2003 o Eo oN o Eo oN o E C) oN o E OO o E(J O o Eo oN o E OO o E OO o z (J O o E ca(.) o Eo oN o OQ o E Q(J o E cq O o E aa Jr o E caQ o E a U) o E U) c/) o E aa o e C)troN o z, ahtr o) (,) e o E v o E v o o oN o o E v o o E trrr!(J z o EtlrH(J z o t\ rr.lO z) o z l&r! O z o ler! 9 3 o trrr!Q z o z IL rI](-) z Etl E] 9 3 o Eh rl]O z o E 14r! 9z o Et!HQ z o Etl. 14O z o E E rr.l 9z D o E tJr rl]O z o et\ ru 97f qh q)L o a o Et\ rJlO z o Eh rl.1O z o El&r!(J z o EEr r! L) zL o Efr rr.l9 z D o Etr rr.19 z) o Eh rrl 9 zf o EE. rr.l 9 z3 o E fJ. rqO z o E tJ.HO z o Et\ rr.lU z o hHO 7f aa acr) U)a o t\ z rJr o trr o af! o E v 14 o l* v o2 frr () Q QO o tJ. (,)(J OQ QO caO o 2t\ OQ (J O mO U)a caQ o,oo1' o46.9qzs rrEfrl q)Q> Zo ,bt AE!/ .aEI>: rr€ A€)vE >9 F ar2t-q) L o v $ c- o\ o\ \o rat Ot1 €s c{ o\$ o\ \o € c- e- oo(r| c- $ o\q s € c.l o oos ot o\o lat c.l e.t c.l o\ c-t$ a.l oo c.t o\@$ !f, cor- o e.l ar 6t o& e.t efl c.l I s c.t c-. e- c.l$\o c.l$ I I o o o$ os \o\o I II I I I c- o\q o\ e.l o\ c.t I ! a * rd I I I I I N c.l I o\ € $ \o I I $c'I c.t € o\s e.lc\ c- o\ c- I $ I o ih 6l B $ c.t\o sco c.to\ c.t \o I I o\ I o\ c- rn II I I s c- \o o\ c.t \o e- ct\o c.l c.t I I qh o Fl o € oo I I \o € c.t c.l c-$ oo I I c.t €o o cn o\ oo rat cn C-l c! .f € rat c.l c.t \o o c- 6l \.l c\ € or- o\ € o\ $ cls $ c-$ c.t co e- o € o co e.ts s c.t c.l \o e.t oo \o(n C'I c--s r-- o\(-- c.l o c-o ca c.t$ $ rat c-l oo cl(n o c- c.l\o eo c.t o\c\ c.l r- o\ o\ al € o\ \o € € 6l c.l \o\o c.l €\o o\ o\ o\ € c\ () o D co\o c.l cn o\ c.i \o € o\ o\ o\ r-o\o c.t o\ o\ c.l a o o cn c- $o o\ o\ o\ o\ c*.@(rl oo c.l(n I o o\$^ c.t$ c- ooo c.l c.t co c.l cn $\o rn \o o c.I 6l c- € co o\ o\ c.l c.t o \o cl oo s e- ooo co c-tr| co c- er('- c..l c..l \o cnq o\ € c-- o(n o@ o$ a.t c.t o\ oo c.l o o c..l o o (n ct €) 4)q) q)il ooo \o c\ ooo o c.l oo o c.t cn(n o\o oo c.t o\VI c.t c.to c.l ooo € € o tr) c.t s $\o o^ €t c.l o o\ e- c.l ooo e\o c- o\ € o\ $ c.ls o(rl c.t e.lt1(*- oo(n\o c.t oorn o\ e- c.l € s e- oo rr| o\ aa e- c- r- crto o.l \o c.l o\ o\ oo c- c.l o € oo c.t c.l ooo oo c.i oo oort e\ oo o \o 6t ooo ooo c.l oo ooa c.l c.t o\ oo tt o\tat c.t cno cl ooo € € o(rl c.trn$ ooo o c.lC\ c.t oo o\l'- c.l c.lo e- o\ € o\ I e.l$ ooo" or-r- o rn cn e.t co c.l o(r) c.t s\o \o eh q) E 6lt- @ GN I €)Eia o Lq)E z o ehq) ct c)il oE o tr .t) o o o k(u & U) U) o O o! 14 d (u n &rI] o{ rr.1 (! l-ip (d op H FO trr o& oo o (s 5 C, B(E o0 (n E(\l v o GIv 5!q) v 'a oV (g (d BV t<(l) o0 z o[ c)q)otr oGt!z (!l 3(! tr(gE op c, B}Z o (s ca c) tr(l) ca o L o ca cooo c.l ro -o E(u Aoa \o o.l q, o O. o o c.l u')i o\ q)\ t a) % !q) @ (ll N () o,) a; (l) !(6F I I ca O c..l kq Q oA o C.l Ei GiHS -gAo0 od 'P5 >rOA a.O gF g, €i g A,E .9ElE.: al-9 E E*L- €flEN6(,u.= =F-rE6,s)hi r5aNe.io. <() E€ 9< .t) 6!to ^ '(B >a (!C) ?, .2fut -vr(D r.(6 q.1 fogEZ €;J6X >c=(l)* <Eo'5J(l)\o. EE '- crt!J o) a-(d aa(Bc) AF(.) ! e(dH6(.)c) -c +i>o dE(D= oN -9 o-r otJ(J- 9-a((l>\ o(E eo -()'6X(gcVog8 A..l cri O L,,,6A t-A9H au) Pa6s a-a\) cr) .54 .i orhEO ,n .z & 308 =€ 60i;Pi 9€E&a\)- >\(!q)ar tr-{ o=E.E H T(D(B\E C -(D , <€ o I o € f=I Lo(- at q) cl(,) L q) E E oI L € cr2 c) E GI A 6lN Iq) Era * o E QQ o (J O o F c/) oF o E ca O o a(r) o Et\ El 9 3 o ErlH 9 zD o E 14 tc 9 3 o EIL E] 9 3 o EIL rI](-) z (-) O (J O a oF ca(J av) rat rr)$ c-. o\ c.l r- o\('- o\ oo c- c-(n c.l € c.l o\o $ \o aa c.t e.t o ct)cl €6i cl oo c.t("\o I I a\ot-$t\cl o I I I e-tr| o r?)t(A6l I I I r?l6\o t rr) c.t coo rn r- sf c.t o\ c.l $ cn $ (..l € c.to o\lr) o^ c.t c.ls a,a\a rnr- cr)r- cl\o rn rr| €\o(n rrl c.l c--N en c-$ rt C{ \€) o\ c.ls e.l o € rato \o\o e.fs$ \o6lc(a ra\o $o €\o c.l € c- afi cr $ t.| c.l\o o\ C.r$ c.l o € \o\o ci$s €6l o\ cGI(n \o\c t6 (l(l) ((I or *(! ; CILr(( U) cr)(€ z d&(g l-r6F o)p o I 6 ,d A(! N ct) rl Fotr I z zz z z zz z z zz z z zz =z K EE E s e B6:€ a E E* 2 H 3;Z HE E z z z zz z z zz z z zz z z z E?Ea zz I z z z o cotrl c.l c.l\o .f, \o c.l€o\$ c-c\ $ c-- o\ o\ c- \o rn €@ (t. c.l € o\ c.l$ o\o c- z c.t c.l c- c.l b93CE8a.o z<4 c-s c-oc\ o\ z z z (rl o\ o\ z coc.t a.tc- € C.l$ o \o(.l o\ cn N € t-tltrl $c\ c.l c-$ z ts. -Pt !a;EE >oJ .o o\ €@ .o o\ c-\o s o\ c.t s c.l ca -o6\$ € s oo c-. -o6\$@ .o o\o o\ so@s\o$ -o6\ e- € -o6\ aa € s(Ao-o6\c.l € s$$ s c.lr- € c{ c- \o c.l \o c.t cfi € -sf o6s €\o c.t o\$ c\ rr|\o o6 o\ o € \os € c-. c- c.t e- o\(n\o sodI \o r-. <f € €$ $\o $ c.t ol c.t oo ci c- ca € c- € r.1 c.l s('-$ €$q €\o o\ o@ c- c- s c.lq \o \o \o cn $$ c.t d\O oo rato la oo $ co\o $ €q o\ cnt o o o( o\ e- € sc- c- a.l €$ c.ttrl\o \o € \o c.ls c.l\oc\ \o\o c.l o o \o oolrl c.l € c-\o (n C.l ca o sl' cos c.t o co € o oo c.l \o 6l $oo €ocl rn rr.) o\ o c.lq c.l e.l rr1 a.lra (r) c-- o o $ o\ o\$ c-. o\ c.l c.l(n$ e- \o o\cl o^ e- €\o o\ cn$ crl\o ooo o\ rrt t--$ c.l c.l o\ o $ o\ oo\o^ c\(r| o\ (tl o\o $(" c- o\ € ooo (n$ € c- c.la\o t-. d .:.dE. &H45.?.eK:b E? - q€6 EEF lt e o '5 q) =aoO 6^$bs()o EOF o 0_ c69 EtsE , o.-z =o6 C).= lEoE=oti8 .o o\ e- -o o\ €$ .o o\oo soo so soo -o o\ o\ o\ -o o\oo .o o\ soo \oo\ s e-$ soo soo soo .o o\ c\ o\ o\ (.l \oo\ c-o cl c.t o c-$ $$ ca c.l c-- c.t c.t\o c.lr- o\ c.l\o o\ c{$ oao o\ otl $ €\ c.l c.l o\ e-\o !B E'- O Y -r 5 sHtr tr= o =l>-AOa )9.,3q o= i oo.E c EH+ E'r_?g E E$EE lt o I cr) q.) o C) E .9 c)Fm .:- 6'^Ebs604-83 o =o? 6.2286 588 $€\o c.t\o c.t c- o\ o\ (rl \o\o o\ o$ o\o c.t c-s t$ cn cn c- c.to\c-\o co c*$ en o\ c.l$ cn o\ s €('- C.l ca o\tr| \o\o o\ o$ o\ $oo\o o(-.s $$ c.t c.l c- c.l c.l\oo c.ltr- o\ o\ e.ls oca o\ cnrn s € e- c.l co o\t--\o cn c-s cn o! o(? o (E ! bI) r! (l -o (E o -o rl] FO fJ. an, .hAo> O& It oE rrl (! oa J(H (E- *E c) (! ca o q) ca o oa (B ,(6 (B ! ao 'a A c.t ot a O (J o or o c.t C-l a4l o\ a)\ NB q) U7 s a)\. J( cA L d cr,(t c)Lrd cl U) o(.) U,H a .o (ll (.) (B c)t<F c.to c..l ka o d oA coN q) q) q) "a L s U2 q) U) q q) a. c') "ao U) .j o .o \o o\ o\ oo S 9 €lI]\ \o o\ oo q) u5 a) B\) q) (J oo U) U'2q) P a) oo v\I oa v q) a- 9 a) t4 a.) q a q) \ -\)tq 4q) oo() a) a) o$ u') q) q)\ q) a4 V) o' I U) a C1q) bo\ a) vq) q) c'1 \' Bq) L t., It- \oG\ N t\\ V) o E!r N v') tl) cj E s 8 UFF{ hJf${! A. td !\H rr\ F;z td\FFr NFF( s!\HU\ Nl\\i s t\4 { Ha hJ\)Uz\ L\ F.lzfri\ t<Fr NFFi ci €lr s \ o a I s E z z zz z z zz z zz z z zz z z z zz z z zz z zz z z zz z =z z o o\ ot €o\o \o $ rat o c.t Z c.l$ r--$ O cn o\ c-\o c.l z \o c- o\ $ \oO co rn €$ os rn c\ o c.l s oo o\\o c.tr o\ \o $ € ca o c.l c.l \o € c- c.l oo o\ z o\ c.l c.l e- co rat o lrlc-in z z s o\ o\ cn rn c.l e.l € z c.ts o\$ o\ c- oo € s c.t €(*. s c- tr- s rat--oo\ o\ c- -o6\ o\ s\o € s c.l oo s € -o o\ c! € s\oo -o6\ €rn .o o\ e.t c- s o\ € s c- c- s c.l € .o o\ c-- € s € € s c.l € \otrl c.l c.t c\ al ar o\\o\o CI \o c- c.t co C-l cl\o c{ o\ c- o$\o$ o\ e.l c.t o\ €s t- c-. c.l$ c.l cn c.l \o o\ o\ \o\o o\ oo o\\o tn c.l c- rn\o o\ c- c.l \o c- c.t \o € \o c.l c.l rr) c.t o\o d o\ c.l s €oa cOrf1 o\ o.ltrl o o\ @ o\ oo \o \o\o \o^ o\ c.l \o o\ a.t c.l c- c-s \o r- o\ oo o(.l $ o otn oo o c- c- o o o(al c.t s o\ c- ooo € oo oo c.ltrl ra \o c.l o €o cno € oo$ oo o^ o c- c..l o o oo c.t \o €$ s o\ e.t c.l o\o co\o$ $$ e.l o\ o\t-- $trl c.t \@\o € c.t c.l co o\ o\ s c-c\ oo c.l \oo$ c.l cl coo s € $ s c.l @\o c.l e-tr| s o co c- o\ o\ c- cl c.l\o ctttl oo cltr} co s c- c.l c.t € c.l € aa e- oo\o -o o\oo sca(-- sa6 -o o\ € o\ s\o o\ soo soo soo -o o\oo se-f- sct e- s o s € s € € -oo\ O .o6\ o\ o\ soo € o\ t?)o o\ c.l c--\o rat c.t c.t c--$ c.l o\t'- ral (*. o\ o\ ca c-o\o\ € € s c.t €a rr|\o(n c.l cr c- o\ c-oc! $$tat cl € r,1 e-$ c.T $ ca 6l\o o\\o c.l ol \o o\ c..l o\ € c.l ca(n co oo o\ c-(r) c-. o\ o\ c- € C.l $$tn c.l o\ $ c- c.l € e- o\(n o.l c-c\ o\ o\ €rn a.l ca(n c-$ c.l s c.tr-o\ o\ o\\o crl c..l \o o\ c.l o\ s\ c.t € € o\F-c-c- o\ c- oo c.l sf$ a{ € c- o\ (.l oIo (!lre (d N rl tr o - o o €o (€ or GI 7(! (q ano6 z (! ! c,rr(gFooo oE o l+ tt) o 5!() v '5o ov CIlr(B Bv L 0)bo z (l B(l .9 ct (q v o 6 v cnooN L.a Q oA o $ C.l olol -l crxl >El * sl udt '= sl6 ol =oI q)ol trot 5OI ct tslt 3lE El c zl< Y E * $ $ OO E e)t Gi-' $\./ \ ,el_- qr){ v ctt(I).:.LS' :\u.s9'S s*^e oSl €.:R c,ooi .-Qg :rd .-\ >- 'S sE i:E !To.iE '=ci o1-E;-Ic!.E:E *€ EF-.iI t \.E E SS : R SRE E 'ii =lg A EF;ls ! iSpl I ; Si' gIE I Ei E? t E!EtE i EEol E $ .se .El! E 5S EIE ! EE s :iE uS '' SEEI tF\. sib {: .O E:s st t !:E t it# E I$ € s, !=(, s trs.FrrllS) o 9!s \ ss. (6 C)L cl eoo 'a L(Eq9e(u btro'ao L-q2. cr fr.l €& .= -o €9 '= 0.) ,lE .l) {j()tr 'Eo L )6tr(o dcttro)o.5o.; .eit ot trHAIHJi =I Ee, xl9? Tl ;Yl .-I El trx 9l 6i PI E\ 6lC EI E SH xl : =l *EI; BI€6l c iJt (,) sl:= El E8; Elt EIE A.EHa EI E d a .Hi?l= El s zlE ztP il q) 6 C) ooFa 9Soo oF o GI o)boG (l) o c) d .Y roEo- e.v cl o0 oq)(7 o (€ o o0(0 Lo o C)(),^ Eo\ dv (l (l) F lr - If the projects are not achieving 100% geographical coverage and minimum of 65% therapeutic coverage rate or if coverage rate is tluctuating, state reasons and plans being made to remedy this. Projects like Kebbi, Kwara andZamfara that did not reach 100% geographic coverage in 2005 had problems of CDD attrition, inadequate number of CDDs, poor census update, inadequate supervision and lack of follow up on treatments due to dearth of funds. Other States like Gombe and Niger had fluctuations in coverage due to lack of knowledge of the exact number of endemic communities to be treated, poor census update, inflow of migrants during treatment periods, and late supply of Mectizan through the LGAs to the communities. Projects such as Benue and Oyo are having poor geographical and therapeutic coverage rates as a result of leadership problems, presence of communal crises in some LGAs, poor funding, poor commitment of some health workers at LGA and health facility levels, and mass transfers of health staff resulting in those not appropriately trained being saddled with management of the control effort at the peak of the distribution season. Other reasons include poor census update, lack of knowledge of the exact num ber of endemic communities to be treated and presence of bureaucratic bottlenecks. Akwa lbom's case has to do with the slow pace of treatment for fear of possible SAEs as well as poor census update. Imo and Abia States are still experiencing poor therapeutic and geographic coverage rates due to the withdrawal of funds by both APOC and the assisting NGDO and lack of counterpart funding by the State governments. The problem of Plateau State has to do with communal crises yet to be resolved and poor motivation of health workers whose salaries are being delayed. To address these various issues the NOTF is doing the following: 1. Shared the updated REMO map for the country within the health mapper software with projects and highlighted the definite CDTI areas. However, projects need training on the utilization of the software. 2. Ensured the recall of entire SOCT that was transferred out in Oyo State. It is trying to further to strengthen the structures that will ensure effective implementation of CDTI in Benue State with the change in project leadership. 3. Where counterpart funding appears to be the main reason for low or fluctuating coverage the NOTF is stepping up advocacy, sometimes in collaboration with APOC Management. 4. During review meetings encouraged States through participatory methods to identi$ reasons behind the low coverage rates and to address them. 5. Has encouraged projects to plan for increase in the number of CDDs. The NOTF intends to approach APOC to support the training of more CDDs preferably along kindred lines. Already, Ebonyi State has applied and received approval for this. Implementation will be carried out from 2006. 6. Advised that opportunities available be utilized to ensure that persons in conflict/crisis areas are treated, and follow up treatments ensured. 7. Encouraged projects to step up supervision and monitoring through integration with other programmes and usage of appropriate checklists. 8. Plans to approach APOC Management to support training of more CDDs and health workers to achieve a CDD/population ratio of l:120 and ensure better supervision of endemic communities. 25 WHO/APOC, l0 April2003 2.7.2 In general, what are the causes of absenteeism and refusals and how is the NOTF dealing with them? Refusals have occurred as a result of a feeting of wetl being by at - risk populations following years of Mectizan treatment and on account of fear of reactions which took place in in. purt after Mectizan treatment. [n very few communities refusals are due to rel i gious/cultural reasons. Absenteeism occurs mainly due to tack of adequate mobilization of communities. This leads to lack of community decision on time/period of treatment. When Mectizan arrives and the community commences treatment some members would have traveled to their farms or to seek for seasonal employment. In Cross River State, the high non- indigent nature of communities in the southern senatorial district led to lack of community decision on treatment. This subsequently led to a high rate of absentees. In a few places, absentees have been reported when actually it had to do with shortage of Mectizan which was not discovered and remedied on time. Additionally, absentees have been reported in cases of communal crises where populations were displaced and could not be treated during the year. To deal with these, the NOTF: l. Has advised projects to rethink their IEC strategy, and highlight the need for continuous compliance to Mectizan treatment in their IEC materials. 2. Has requested projects affected by fear of reactions to intensifr community health education and usage of testimonials. Where need be it has advised that community stnrctures be mobilized to deal with refusals using the traditional system for sanctions. 3. dnsured that Mectizan is applied for early and that the consignments arrive in the country in sufficient time to enable timely delivery to endemic communities. 4. Advised projects to ensure adequate mobilization of the endemic communities so that they can request for and collect their Mectizan as at and when due, as well as make appropriate decisions on period of distribution. 5. Encouraged effective supervision during treatments, and greater involvement of the health facility staff in the CDTI process. 6. Requested projects to do targeted training of CDDs on record keeping, where funds allow. 2,7,3. Brielty describe all known and verilied serious adverse events (SAEI) and provide in table 7 the required information when available. The NOTF Secretariat has received no information on any known and verified serious adverse events. 2.7.4. In case the country has had no case of serious adverse event (SAE) during this reporting period, please tick in the bon No case to report ./ 26 WHO/APOC, l0 April2003 Number of deaths Number of cases with sequelea Action takenNumber of verified* SAE cases reported Name of project ! Table 7: Cases of Serious Adverse Events (SAEs) that occurred during the reporting period 'lease add more rows neces, * SAEs should be verified by proiect coordinator Sequelea is defined as those cases that have not recovered fully from the SAE and are left with lasting neurological or other debilitating effects. 27 WHO/APOC, 10 April2003 fl aN c.t o c.l a o Ci o or o ,,, q) do o) cn(r) CIa(t< o C) U) o cr) o bI)E o (g olrF ral zt h tro c,(! o Gt !o (g o () (rr o tno (6 cr)o o (ll =Aoq oLrd t) 0)k ooii L.)+ e ,go qt a B S triq.r qJ S' \FFr sl) q3 s € q) t .i € -is CJ I a.r\S *+ha04)q -\Lt9EL\Ls =o9qt €) c)ES9\e.f 9\ eqlo)E .4ll9Ea\ L -'=h&UTE.Stii -tr .= v\EE .- eJE3(9 q.r .E€ Atrcto9t- LrrFGl 9990 oq) .F N'Fa qeb tea .o-5 e.nEA Nq) 9 6.oE E.€ .9 tqYA9. erv(q ct(l)!,) r .!>t a9LlE E€IE eElE EEI; :.Bl; E^s" a w6r E9e E8 = cBrrE TEh gE LddG EEE .EEE EHA qr.9 *i t< ' .9 ool r sEl q,) (.l e- c- €;@ q c-l o\ cl o\ cl o\ (.! os ,a1 c-$ q o\ rr) s c- q) oI)I Es/O () 9 cn(-- q c-- 9 o\ (t. e\o (t. cl (-- € cl c.l\o q t*-\o \ € o oO € o>ooo o G lL'-E9tlt'l oa o. El € (.) F r- ca o\ € \o \o o\ct o c-o o\ cn o\ r.1 c.i cos o c-l $ o\(rl c- o c.l c! c.l o\ \o\o c..l cn c- c.l \o\o € € $ \o(n$ \o\o €\o c.l o\ c.t \o €$ rn O -o 4A ITJS B(rl<6 ootrFa.F c{(n co s o\ o c\l ('- (rl o c-$ c.t c.l (.l € $o rr1 € c- \o c- o\ c.totr) tr- c{ o c{ rat$$ € c..l\o o\ Eo? 6.2 lEtr rE E.gr{ < g€'FIJ c.l o\(n r--\o k1 c{ o\ eo c! co \o e.l c..ltrt c- ..d € c.l It e- (n € \o t--so $ oo ca o\ c.l(*- c\ o\\oa € c-\o(r) \o @ c.l c{ \o crl s $ c.l 2,:^ E 8.8E hk B?;NoE€ EPE F * c.t c.t $ €6 c- qj oo o ca ,a1 \o o\ q c.l o\ q cn o\ c] o\o\ () o0 c, q) io6o E G IL*- .9 t> i r.lE Htd oO oo tr)o ca c.l € € c.l \o c- c- \o c.t tt\o ca c.t $$ ca co c.l cn o\ c.l$ ca =EE+t c- -aq €E$ . o= $ cn c.l\o \o c.t rat c..l c.t co o\ o\$ c.l c.l c.l o \o ca c.t Irltat $ cn c.l c.l $ c.t dqa OE '-6 'E c).9 E-O F--E-E [i grd = sb +'- >r -.82E E o\oo c.l o o c.t soo c.l oo c.l \ooo c..l r--oo c.l €oo c\ ooo c.t C.l cttoo c.l c.to c.l c- o\ o\ € o\ o\ o\ o\ o\ 2.8. 2.8.1 Supervision Note the supervision that was undertaken by the NOTF (Proiect supervised' date' by whom, objictive of supervision mission, outcome,follow-up needed) Table 9: Supervision undertaken by the NOTF (Please add more rows if necessary) Project Name Supervisor Date Objective of supervision Outcome/follow-uP needed Plateau Mrs. P. Ogbu- Pearce May 3 -9 To assess extent of CDTI implementation & integration of programmes Use of hamlet sYstem -zuriYa - to select CDDs; more HSAM needed to be carried out; State & LGAs to be encouraged to give counterpart funding oyo C. Okoronkwo Aug/Se pt To assess steps being taken by the project to address the issues raised bY the evaluators, determine what further needs to be done to put the project on the sustainability track, & assist the project to develop both transitionaland sustainab Deatailed workplan for quarter of2005 & transition 2006 workplans produced; 2004 treatment data reviewed and poor performing LGAs identified; follow up mechanisms/actions to be taken charted. Follow Up: LGAs with insufficient Mectizan to be supplied; LGAs with low therapeutic coverage to be closely monitored; LGAs to develop/revise sustainability ptans; NOCP to monitor through monthly reports progress of activities in the project. Treatments have commenced in lporoo o o o communitY Most of key recommendations have been addressed but there is need to consolidate State contribution is minimal, but a starting point Sustainability ptan being prepared, to be finalized soonest Ekiti Dr. Y. A. Saka Juty To determine whether treatments have commenced in Iporo community, & assess extent of implementation of recommendations of evaluators eross IRiver I Mrs. P. Ogbu- Pearce August To assess extent of implementation of sustainability plans o State & LGAs to be encouraged to give counterPart funds o Supervisory visits inadequate due to lack offunds; need to steP uP supervision o CDTI Training integrated with prevention of blindness; integration to be Ogun Otunba Jaiyeoba To assess extent CDTI implementation of but LGA contribution not good Supervision is weak at all levels; there is need to upscale supervision using appropriate checklists. Documentation poor at the FLFIF level Need to intensi! communitY mobitization to assure they fulfilt all their roles Project well funded bY the Stateo a a a 29 WHO/APOC, l0 APril2003 Nassarawa Mrs. P. Ogbu- Pearce May 3 -9 To assess extent of CDTT implementation & integration of programmes Need for communities to select more CDDs and to appreciate the work being done by existing ones; distances covered by existing CDDs are much; more HSAM needed to be carried out; State government to contribute to CDTI imP lementation Osun Otunba Jaiyeoba To assess extent of CDTT implementation o Counterpart funding at State level still problematic; need for high level advocacy to the governor o No APOC funds for the last two years, therefore activities are low-keyed o Need for community mobilization to ensure increase in therapeutic coverage and ision of incentives to CDDs 2.8.r. lUhat were the main issues identiJied during supervision? Poor supervision by health staff, partty due to inadequacy of funds Low commitment of some LOCTs to CDTI implementation. This resulted in late Mectizan supply (or non-supply) to some target communities' Mass transfer of health *orkiri, particularly at the LGA level. This led to experienced LOCTs being moved to non-endemic areas and untrained health workers appointed as LOCTs. Oveiall, treatments in affected areas were delayed considerably and in some communities not carried out. Poor govemment counterpart funding in several LGAs and States. Inadequate implementation of CSM & SHM lnadequate support for CDDs by communities Insufficient health education materials in most sites Inclusion of several communities that are outside the definite CDTI area in mass treatment with Mectizan lnadequate levels of ownership of the CDTI programme by some communities, due to insufficient understanding of their roles and responsibilities The FLHF level not sufficiently involved in the CDTI process Most CDDs are still willing to work despite lack of support, but CDD attrition a problem in some Places. 'Community awareness and acceptance of the drug, Mectizan, remains high Sufficient Mectizan available in most communities visited 2.8.2. lhas a standard supervision checklist used? No 2.g.3. What were the outcomes at each level of CDTI implementation supervised? o Training of some health workers at project level in selected States on CSIWSHM . Management orientation of project teams in some States such as Oyo & Benue o Some LGAs started releasing counterpart funds o Mobilization, and in some cases training/orientation, of FLHF staff for CDTI o Mobilization of CBOs & religious groups to provide incentives to CDDs o Sensitization of communities to select more CDDs' 30 WHO/APOC, 10 APril2003 2.8.4. ll/as feed-back given to the sapervked, and how was the feedback used in improving the overall pedormance of the proiect? The NOTF Secretariat usually encourages that feedback be given to those supervised. This is done in two ways: o Debriefing of project personnel and State policy makers after the exercise. o Provision of a copy of the supervisory report to the project staff In some projects implementers made corrections and improved on record keeping, started mobilizing communities to select more CDDs/replace CDDs or give incentives to existing ones, increased level of participation of FLHF staff, and conducted a re- orientation for some health workers. [n some places some local NGOs and CBOs were mobilized and became involved in the CDTI process in several ways. These led to befter coverage - geographic and therapeutic - in a number of projects. The effects of the management orientation given and training on CSM will hopeful be seen in the 2006 treatment cycle. 2.9. GommuniQl self-monitorlng and Stakeholders i[eeting Table 10: Community self-monitoring and Stakeholders Meeting (Please add more rows if Adamawa etwilUom 0 (0.0%) 0 (q._0%) __ I Q.oYrL- q(q0%)_ t9 2 13 22 t2 l4 0 (0.0%) Bauchi 0 (0.0%) 0 (0.0%) 0 0:/0_ 0 0Yo)_ t4 t00% 0 Benue B9T9 0 (0.0%) t4 (100%)Cross River Edo t2 9 16 0 (0.0%) Delta e (l0o%) 9(oZq) 0 t6 100% 5 r%) Ekiti 0 (0.0%) Enugu 16 16 (100%) Anambra l6 16 (100%) Ebonyi FCT Gombe i.o Abia Jigawa Kaduna 10 10 (100%) p(lq0%r 0(0 2 Q9Yv) 0 0 0:/t g @!%.) _ 0 0 0 .0% 0 .0%) 6 l0 0 (0.0%) 4 (40%) 20 t2 8 0 (0.0%) t6 0 (0.0%) 0 (0.0%) 0 (0.0%) Kano 18 0 (0.0%) Kebbi 9 0 (0.0%) No. and % of LGAs or districts that conducted stakeholders meeting (sHrl{) No. and % of LGAs or districts that carried out self monitoring (CSM) Total# of LGAs or districts in the entire project area Project Name Kogi 2l 31 0 (0.0%) WHO/APOC, l0 April 2003 0 Kwara Niger oEun Ondo Osr.- oyo Plateau Nassarawa Taraba Yobe Zamfara 16 2t 8 t4 t4 t6 5 7 t2 -_ t2 6 0 (0.0%) 10 (48%) 0 (0.0%) t4 (r00%) i4 (rbOxl o to.o%l 0 (0.0%) 0 (0.0%) o (o.ov.i-- 0 (0.0%) 0 (0.0%) 0 (0.0%) l0 (48%) Q (0.,92d_ 14 Goq%) 14 (100%) q_(9.q%) ) 0 (0.0%) 0 (0:0olo) 0 (0.0%) 0 (0.0%) TOTAL 409 107 (260 ) 85 (2lo ') Describe how the results of the community self- mon'toring and stakeholders meetings have affected project implementation or how they would be utilized during the next treatment cycle. It has been observed that there is a decline in the number of communities and LGAs implementing CSM and SHM. Various reasons have been attributed to this and these include dearth of funds, difficulties in implementation, and lack of understanding of the concepts. For this reason training for SOCT and LOCT leaders in UNICEF-assisted States was conducted. The NOTF is contemplating making a special proposal to APOC for the implementation of CSM in some States. Where CSM and SHM are being implemented the following have been observed: all that are eligible for treatment are treated. In a community in Cross River, community members must show a card from the CDD indicating they have been treated before being allowed to go to their farms. workers who are not alive to their responsibilities. This has led to some of the health workers living up to their tasks. commence and for agreement on other health -related or developmental projects. adequate supply have been subsequently made and this has resulted in increased therapeutic coverage some stipends to motivate CDDs. PHC programmes. be more forthcoming in supporting the CDTI process. and this has led to increase in community participation identifr problems and proffer solutions, and this has resulted not only in the solution 32 WHO/APOC, l0 April 2003 of identified problems but also in communities feeling a greater sense of belonging and ownership of the programme. 2.10 Compliance to long-term treatment with Ivermectin Mention specific activities in the Table ll that the NOTF has done to ensure that CDTI projects comply with long-term mass treatment with ivermectin? (For projects 4 and above years old) Table I 1: Activities of that promote compliance to long-term treatment with ivermectin Obiective Specific Activities Project targeted 1. Promote Integration of CDTI with other health care services Holding of a special meeting on community directed interventions at national level All projects 2. Maintain high therapeutic (>65%) and geographic(100%) coverage Supervision & intemal monitoring Review meeting for States The review meeting targeted all CDTI States. Some States were monitored internally while 5 others were independently assessed. See appropriate sections 3. Promote strong community ownership One-day training of SOCTs and LOCT leaders on CSM Cross River, Ondo, Niger, Osun, Oyo, Benue, Bauchi, Gombe & Ekiti. 4. Promote high government commitment Advocacy visits Special meeting on CDI For both the advocacy visits and te CDI workshop States with history of poor counterpart funding were targeted. 5. Support strong partnership 6. Put in place a strong IEC strategy that encourages continued treatment Other JJ WHO/APOC, 10 April2003 SEGTION 3: Other activities of the NOTF Describe any additional activities undertaken by the NOTF (REMO, RAPLOA, KAP studies, vector elimination where applicable, etc). 3.t Other activities undertaken by the NOTF are: 1. The periodic publication of NON was produced. 2. Fact-finding ,irit to Ekiti State to ascertain extent of implementation of recommendations of the sustainability evaluation team' 3.2 llthat was done to coordinate CDTI Project activities? The following was done as part of efforts to coordinate CDTI Project activities: o Conduct of Review meetings for all assisted States where status of implementation was assessed and suggestions made. o Review of reports, treatment and training data; and feedback is provided to projects. o Visits to some projects and on-the-spot assessment of situation of things and provision of corrections where needed. o Periodi c zonal meetings where status of CDTI implementation and issues therefrom discussed and addressed. Significant issues are brought forward to the NOTF meetings for further deliberation. Feedback is given through the zonal office. o Zonalcoordinators' visits to projects within their areas of oversight. Issues they cannot address or that needed more input are referred to the national office. o Correspondence (by emait or courier) with projects on salient points 3.3 Note meetings convenedfor the NOTF. (objective of meeting, isszes addressed, date, participants, outcome, constraints faced follow-up needed) l. A meeting of the NOTF was held to review CDTI implementation inthe country. participants included members of the NGDO Coalition, Zonal Coordinators and NOCpofficers. The meeting was held in April 12,2005. The following key resolutions were taken at the meeting: . The Zonaloffices Programme Managers in-charge of CDTI should be assisted in terms of manpower development and training to make them relevant at all times. o As a result of the confusion arising from not sending funds for CDTI implementation after the end of a project's financial year which has resulted in delay of project implementation for the following year, APOC is requested to speed up the approving process ofbudgets from projects' o The lack of support for Onchocerciasis control was noted with concem. Continuous and intensified advocacy visits was advocated to projects that are not doing well and for the release of counterpart funds by the State Governments. o The need for a training/re-training of project personnel on health mapper was noted. This is to enabG them define appropriately the definite CDTI areas, and use this information to target and report Mectizan treatments. o Members agreed to contact General Yakubu Gowon and some other notable Nigerians to be appointed as ambassadors and advocates for onchocerciasis control Programme in Nigeria. 34 WHO/APOC, l0 April2003 A review meeting for ApOC - assisted States held 6th - 7th June 2005 also to review CDTI implemen[tion with some emphasis on extent of implementation of sustainability plans. Participants were State/Project Coordinators, NGDO partners, NOCP Hq ofncers, Zonal boordinators, and some accountants. The meeting was also used to gdtnrougtr the technical reporting process. Coordinators commented on the difficutiies usin[the format and diicussions were held on the best way to develop annual reports. fn NOCp HQs Accountant and the WHO Finance Assistant used the forum to ieview financial returns and highlight areas of concem. On-the-spot training of Project Accountants on problem areas was also done by them. Other issues highlighted at the meeting include the following: a. Where iunds allow, NOCP should invite the TCC Chair and Chair, Steering committee, to such meetings to add value to discussions. b. State projects, particularly Ondo, were advised to use the REMO map in the health *ippe, io delineate their definite CDTI LGAs. NOCP promised to circulate the software as soon as possible. c. States should take serious thought over what will happen post - APOC' d. NOCP was encouraged to follow up on the replacement of the Ogun State project vehicle. There were concerns over UNICEF's current role in the funding of CDTI, as assisted States may not receive funds till2007. NOCP was requested to follow up on this and to veriff who should endorse sustainability plans on behalf of that organization. Some participants expressed concern over seemingly different parameters used to judie technicat repons and noted that it appears some issues depend on the pe.rpitiues of the reviewer. Dr. Elhassan explained that-there is a format for i"uii*, and certain things acceptable in the early years of a project may not be acceptable when reported in the later years. 3. A review meeting for UNICEF - assisted States was organized and held 16th - 17th August 2OO5.FaJititators using participatory techniques got the participants to identiff their areas of poor performanci and analyze reasons behind this. The participants also made suggestions as to how the issues behind the poor performance could be addressed. As a follow up on the resolutions of the meetings, NOCP: o Has requested informal contact with notable Nigerians as Onchocerciasis ambassadors while seeking ministerial approval o Intends to conduct further advocacy visits to needy States in collaboration with partners to assure counterpart funding a Has made the health mapper available to States that requested for it. A proposal for training of State personnel on it has been submitted to APOC o lncreased collaboration with the national programme on prevention of blindness is being promoted at national and zonal levels a Has been assisting projects having difficulties in using the format for technical rePorting. 2 e. f. 35 WHO/APOC, 10 APril 2003 Place/Proj ect/CountrY Responsible Pelqq4_ CDI Tanzania Dr. J. Y. Jiya Regional review meeting of the Carter Center Ethiopia Dr. Y. A. Saka Prevention of BtindnessA/ision 2020 Several places Dr. J. Y. Jiya Evaluation of MDP activities Kwara State C. Okoronkwo Meeting with TCC Ouagadougou Dr. J. Y. Jiya International Review meeq4g - Atlanta, USA Dr. J. Y. Jiya Partners France Dr. J. Y. Jiya of Health Workers Kenya C. Okoronkwo Training of Health Workers Rumbek, South Sudan C. Okoronkwo J.5 Briefly state any administrative duties undertaken - Number and type of reports reviewed (technical, financial), Technical reports and financial returns from all projects were reviewed, and forwarded to APOC Management. - Reports forwarded to APOC management, 3.4 Note meetings attended to provide technical input to other proiects, other countries, or other sectors. See above - Administrative assistance or trouble shooting for projects. A fact finding visit was undertaken to Ekiti State CDTI project 3.6 Insert the Plan of Actionfor the NOTF activities for the current year indicating activities by month, which were implemented' See attached. The activities not done are clearly marked X' 3.7 Insert the Plan of Action for next year. See attached 36 WHO/APOC, 10 April2003 Meetiney'Mission c.t o c.l a ri oA b rJr c\ cn ia Nil ola z FlIYil o B n{I o z 4 q:, oo(\t LU(9o =co (J o(L oo|r, (9 z.6 z. =II Oo o- l-o UJd. a ooo- ooo C\l o(o o- c.) t oo(9 z. oo <\l o, I ooo- (?) ooo- < T J-o =lJ- ooo ooo- oos- (f) a ooo- ooo- <f) ooo- oo Or- CD oolr, oo rr) o at, UJoo =U' l!o E,o s2 cl = at ..2xo c -go- -!9 -os(E G, o) ! (J o €(D C, .s)(n o oo 'a o(J aaD .E'i .Y (Do-oo) -aE:g(Do- =oo(o(J .= &.e -9 -cts(u (! ctt(o Lo(o = o o Loo-q) E.U .9, Q)oc G,9-IF(D drF><(l) U' .tt )<o E -go- oE _g '6 (! o) !o o €(l)c .9a -qo -g'6 C, .tt (E Lo(o = oo(! U) >r -o U' <,C = L C,g o) oo o oU'(o -!P(D E, ar, € c, L(Eg(l) q o <) oo o(Do=(E:yQA(D-t-a o)E o Loo-(l) E. .9 (Do L G,9-L-g9 <o -!9 -os G, <o U'E L o)(5 = =, I(l)l aDI(Elol E ID E o) .=6 =o-8Eb'o eu, d '-?O I(J c) 'o o- E9cb (r, --cbEE-e .9q =EgE o.Ega EE H8 *= p1 e .5-Q--o bE8HE $g*FE & E AH.E 8.fi -o-'=O-'.= ==o9U'(E5"a oE a.c-#.32 = EEE ctI E, !.lJ o- soo6l(,(l)o c(E - c(E ? .oolJ- -o o)lJ- -oolJ- o d(! =d(D lJ- -ie(5 =fdl.Io o z. a ot c)o I ! e c, = (DE - c)o I L C)q(I, = oo I -co(o = o z. E e(o =o ! = co Eoo C) (o z. >h =o- u)oC)ON ;(,(J c) .!9. e o- al, tto .d E <, .ajc, uto(D <'E -;(EEE'o8 o- <n EEOG (o c)ZN art an at .E EE U' oo (Jo 'o (L (J ('C) (D<'E -;(E8E'o8 o- cn .-E Eo)8=OO;O(t,o-z.< ah _E EEOE(, c)ZN E9-i50 .o t6(9z.z jj .)ooo)<'E -(E8E 'oE o-(/) bo EEEctoP .!l (L .ao s= (D o EEEdo9 .!l (L .ea oED.I-s= =o olEl(Jl clo1 (U co (E z. (t)E o olc E CI E Lo c Gld6, -O ahEc o o art G, -!pE o ah LU <.i e o o); .9(! = .E o =U, .9, 05 aho)c(l) o --oo(Ir c.i U' Ed) =E'(l) Eo(D C, E()o o- + U' '6 .g e(l)ooE,oCo GC .9 (E z.(l) o CDc E C, =erri O o CIoo E'(E o c -go- @ U'E L) o q) att(E -tc E E U'c ul l'- at Eo =o o) =,ooc d) =c, e o- X cd - --lrJ od o o o >ro(tl C'o E'(E (D -g .9) -ow.9r\ (E oia al, .9)(o o- E(EO >o(Eq) o E' o .!l o o- o G, <r) o U'o-o ! .1, =o =oG'oo E4ct xgj(E := .1, .q o-o- U' o)C) o o co Ed) (J e o- c.i E(l) eoo-(o o q) at(o 4) ./D EE o5'o =O.EeE at)EE 8.9o-E.E .o.(o G, e(, o '6 o o) =,c(o q)o C,Eo q 'Ge Eo) o.= -o-hb5-ho-E c5* +o FC) LU o ut coo <a toEE Co ZHPEsF E-H3.tsFEts,^FOE A E,= P- Hi 6'r .E E EE =EE.BE EG olb P.= .9 SEe Ec-e E P-**EEbBE a cao cl a C) oA o > a co a loooGI !.ll(9o =CO C)o o- I I ooo- ro (9 z.6 z. -)t! oo o- FOlU E.6 (9 z.6 z. =lJ- oo(L FO lrJ G,6 (9 z.6 z.) LL oo o- F C) ul E,6 oo(9 z. ooq.(.) -o II oorr, ooto ooo- * ooo-(.) ct, aD !.lJ c,o =(r, Lr-o E,o !2 ct = = =:o(D L C, .co E'C(E ar, .o .^XE:oo dB. coo Eo- eo =Co E o ..2 9.o(t)=69 coocD ==,(!o 'r= CO =Ye oo(/)(Eq)O) '..>'dE ol8EE -!P -o -q(U (! Lq) !o =o E'(l) c .9') <n (n c o) E =g at .E E'C(! l2 or(Ea '5E E(E =e =U' ao .9, a o)o-)(n Eq) e-Ob(E ee (DE -g'6 (g @, Loo-oE, CDC o .=co = E'oL C, !o .o, Loo-(DEeq(D o-t EAE-c>.= r-lJ = = =E o)(u 6 o ll) e(JO(D O. 'F(t) o-b o> ^q120z. <) U, ah '= o Loo- E <,oN (EE .= = =,(l)(o)6c>G'o-o9> <J .=o= .-! P(Ea.EEg o=z. <t) U' al, 'i oEoo-oE, oc(E *o69EE6e _q)bE L.E EE ts8 *= o 8.9 =(u e6 eg EEe..-6 -U--SO.EE EE >= =>E5(!(o E8q'6' ao- --ut .i 3=. E.PEEEEP G Elr qr* S.iEE€E@ F-9. E a d:O=OO-- <.E.d C (o o oO ->- au E 3.8 EEET E.E x EE dOE oo E, ul o- >r(o =I -ool! (o =I4toII E>. <5 CD) I - ol = I - o z. I o- o-o <n I - ciq)o I o-oU) >. C, =I c(o - (! =I E(E - I P;s: oz a q)C - L o- =o - =o .oE Esoc) -:Oau o-z.< E=, ooAO C5o;ci(Eq)z.a e(D(J io9Eo .!:OF ri EZ,F jj(J o o(D o o- o<) al, -3 H{8E.= '=c, EE (DE'o-<n< -Peae6 EE -oG,o .91 C) L_ -c (!(,C ooFN ER-q8 16(9 z. z. c E6,8=()() -;OiE o-z.< E";o'1, ,s2 6rFoOO -cEocooFN eoop(J= aEooc) -cGc)cooFN O. .t(l)p sr -cE85FN 6rts =8OOO-;o-(E <. z. 6rts =8ooO-;o-(E <. z. oo CDc Lo =co E i '3e .EE o'-o-E =o.tr sO OF:5tsE o-= .Glrr, > -(D eo C, G [! od eo .E o =>\ .E (DI <t EC G, e(l)cE(E o- =e *€ .9€ =>2(l) tse 5€F-9 -E U'EE o o) v, cl -!Po) o .tt L UJ cd at6 Lo C,c! ar, oa €gE5 E.E3e,o^= o-= orE -.E co .J' .Yoo o oo- an bo .9, e(l) o- u, AEd'o(\l o. (r,q,bE o) cI) .c=o,bb.s '= \-t a =o(o2 -:Lqtr€.>E (U= E EE X-E.E . o-ah -e=(\rSC/) o at c, EE 'O "dLEE€ c)Zo- EEQEfisX'EE N Bg o o = -o L ..tt U,OE "oBa(D6(r Ea taEi5= .C,d)>(\i uJ !o, Loo-o c .9 (E E UJ o .9, ar, (uC +(\I .DC o-9to- cB cnEsi6(q.E(/) -gag q<n8E(o- ato '-3=e <€ trig(\l o. bE cDo .E ci) -9E@ '=a.E :BE €EEo ='=Xo (E EbE R E.; Eg9gc.a t6 91 8-V e5 -96;E SH .ahNU) t'.J < LU o LrJ too 5t6(trk e (g(D .b=>ur=o EEE.E Os E EF O.= O- b E B,c BEE EgE .E -E FE fr e"E.g Bi;EE r=-EEEeO!+: = (D oFq) (E.no.tt od >\(u= = :x .:J e= ([ HE-E E.EE E PHB=s I a ca c-.1 H Q oA o o\ ca LU(9 ct =o Oo(L I oo|r)- I a oo(9 z. a I I a oo]f) I -o =II I ootr) I ooo- oo|r) I C"(t, LrJ Lt(, =ta lJ-o E,o slo = at .c2.x(D C(Ed .9x(l) an(l) =o E o e(t) -rp o U' .tpo-oO E -9o E(D ato(E U' o- Loo L(u E o o z. Lo >rE(E o) al, o- Loo 6.9 E(! .q.o e= o= .2. o. -!c -os(o (o oEo o ooc .gra =t(l) c) E' e o. o @ o.oo ooo- E o)o- -9o) o)E ctt(D o)(Eoo(D E o .aJ -!c -os(o (o (D C))o oo .g',(n -!c -ct _g(o (o tn =aD ah Eo- o o z. coo o) o- c o) E ah attq, atto(E o Loo- o)x -rp -o -g '6 (o Eoo-oE. t, .9x(l) tt c G, = =atcoC' o at = o6s(E (E (l)E C) o E'(DC .s) U) EE H8 *= E- "EE EEso E HE uECEgEEEE c) (o E O-O (O tr o5O =(JL.ox *EE rtEe.=(I) E o-'.=68ar (D Eo'ii € i: .1,drEC)d) E !2 _ E.= ,TLLE-Eg E€ = Eco(l)c -E ESaE clo E, uJ o- +oo6l (Jo +oo <\ oo ooola- 6=oi< I$oo6t o_o E,P -cto!J- oolJ- c(o - c(u - -ctq) lJ- (l) c - (r, = CD) -.;o-(D U) =o - =o L(D o(! q(o =(o (oo b .o,E(E !?(E6=;S(E(Ez.a (D CD G,c(E =(U (Ea oo)(E E' -r s5(€(o(Eoz. rtoo oq) 'o o- oO)(oc(o =C' (Eo e(Do o io(D F -joo oo 'o (L anON ii ooo (5 z. IIFo z. tJ-Fo z. Pooo +t(o z. !too oo 'o (L =(J o) o6 =o)C, Lo L -go- <ri(f) oc .e = -o L coo Lo al,(D oq) E. c.i c.) -9,(u L(D (E E o) -goo od o -goo +(f, al, o- Loo C G, = .s2Eul rri(f) ahEc o oU'(t, -r9 E o =ahc UJ @ c., o)F -!9U' =oc o co o E e o- F- <.) >\ .sl6o- o U'o CD(E al, ato E o- -eo oOu) xg ci9<oE al,E'c = o o al,(! -tcE E anc UJ X o, <f, U' =,1,U'(Dg o- o o o E e o- X C;$ (D -os C,(! o U' .noE o) L U' an(D U'C'4ut Xg .an -O<f o- o) a)o o Ecoo X c.is alt c(E = =art Loo :> .E L(D =X c.js .1,E = o(l) U'(o -go E =oC ITJ X +sf LU (, u, oo s=H€€EteeEEE* o z.6 z.J lJ- oo(L FO tTJ E,6 ooo- <f) oolr) oot\ I ooo- c! oo$- U, ,9xo Loo-oE. -9 -o -g'6 (E Loo o)E. ob(E Q) =ui =ar, q) o LOu,cL.=Q) .tE'= o e(E q) .F ui =att o o L &.EQ) .tE'= -6CO(Ec _(E 9E -o->tr o-!P =E.= O) >r(E = o z. I >\(u = j o z. I = - CD = I .> - E,CDts =8C)c)O;o_(5<2. dq) C) o G .s2c *,ni5(JFN 6 art6< c,<.E E3o'-t= 6U'5<(-' <.E a3o'-t= 6 8-eF(E =cn(E.= ssEc. oINC 'F(t)(EE O, U,5E .o@th6r< oO c .9(u =G UJ o U' .= ..2, o-3 I =9o.=to1r-'= ot.9(\ra Eo(J -!coU' .E c .9 .g o o(J c) c)o c)<) at<.9dg(t U) ta9 C(E(ECOEc E8 <.i c)Y(l) rrr 'O-* IE€ P6U) :EE.8ExEFFO;5(9(o CO od E E=a9rnqdE6 6(qE E e; cao c.l La O () o o< o or+ e looo(\l !.lJocl =o ooL ooto- (f, oolrr- oolr)-(o I I I ooo- o(\I oo(9 z. I ooo-(o a I I I -o =lJ- I oolo oo c., ooto ooo- @ (r, U, LU()(J =U' lJ-o E,o s2a = att :2xo Loo- E .9, o)oc(! E'c o) o .9,x(D Eoa E (h:(l)o q(EE g) ah U' '= o Loo- E .e ooC G, =,cq) atI at xld) Eo o-l(DL jj .9 o)oc(E Ec(t) E(D Co E -!9o. .E c -q(L €(!) .= .E eo(u .= (J(5 o (l) -oE z. ahI xt(l)t atLd) jq co (E .= .E o aD .!Po.oO .9,x c) e(l)E -!Pco (E .= .E o o .!9 o.oO ah a 'i o) 1=oo- E .e (D oc C, <,co E' o)L C,E(r, oo o .9,x(D Eoo.oE EE H8 *= HE a e = or=-:-o P 9E =b E o a; P9 Eg56E5 = 3g .E 5.= oIu ul o- -o o)II I c(E ? -o(l, lJ- I c(E - >\(g =I L o- e c, = Lo (! =I L o. (E = (! = o)c) - (uc)? =o - =dt CD =oo(L CD =oo o- OO o- o)E. e C oo o) =c)o o- a oo 5o .Coq) F tsooO +j(o z. tooo -j(tl z. Eg ooO +j(! z. lJ-Fo z. eoo 5o (,oF =c) co Eo aD o) a.f, .J, (J(E o-cLO -L.EO -'aol: 'E(l)(t o.O- r^r .9f,r d(Jd- o_:< r()O bc F,O6u)FO BEEP6aot .=(5 -o) =c,.:z o)60o-(tr - -oho{i .:l '.=6t6EtE8 3 o*.E =.!9 (DgLO'EEco) .9OEagr E E.E cv ='=co '- ahv = qb . .= o -E.E Eo (E-', 6h o) r u.g(Y) s U)|froG, C'I .F oo E oOF .E c .9 (E o. c) .: L(o(L +lr) o) .E o o) =6 C) o c -g .L rri r.c) eo(6 ='6(! lJ- E o =(o lf, eo (E ='6(u lJ- o =c F. rr) tt c(o o. '6 L GI(L o =s cd(, o:C oo =6o o E C,oo o, r() eD .E oo E 6o o tsoo.oE, oo Eo(L o(O lr! o u.t @o E E-aE sEgEU.E;93 O(D=*(JE*El- -o.= o Gl .= Ir ut I I ooo- oolf, I a oo]f) ooGI I oo@ (D EG'(, EiJ rlt -o)(l)o' =o-Eego o- -cr - (tt9E2e E .= = =,o (E at o (o -g -ct -g'9e (o(D s(Eo- o. -!P -o -g '6 (! o o) c) =oUt o ah) ah U' '= (D at .!c CDo (Eq U' o (rt = -!P -os(o (o (l)Eo =o Eoc CD6 EI ts6U,xd) o-c =(Ect o- FCOEoE 8rx €= EHpo 916E.= u) o- o5x"a- :EEE:A E He*gE +joo :L o- I -oolJ- ol I o)c - CD o)) o z. I - lJ-t-o z. .-€ EE()6 E,€ Eo €a 16(9z.z lJ-Fo z. io C) oq) 'o L <hoot9x c4a=. N€c> = bo(E 00- z. L) <. 8e .N6E6EoS=U,EE EE!P e(l)E E8E -6 s.e(D >\ dr EEEI3Elr)oo<co c) .C, o o c .9 (E 'Ee OE'ec .9E 6E(Lt] coo <U' t, Q)I oth (J(E oo 06 > 'acoI F-sf ItI(l)l '6rl ol (E U' Co (o .N 4to E o- -9o (t)o X cds I oE'c o o an(o -!qo) o)g IDc t-rJ X o,$ cn .EE' C, .O *? C'To: EH .=s =ob(, =6xS{JO boo-Eo-o aEXE 3s o6 -> ut^ E E gE Efi= E EE €EEEE I cooo C.l a o d oA o sf oo o- oor() oo(9 z. oo(o oo rr)-(\l oo(f) oo 1.c, oo(\l 6 roooN UJ(9 ct =to -o =lJ- oo6l q) -oE c o co (Eo EoC' E(D o,6 at .o(o o c .9 c)Eoo:> .LE9 Eo)o)>EC,(D'- -oE'(Do=cs6) :l lU) = o oz ut -!9 .o(o o) .EE' (E eo (D uolJ o o) .zq)o E ah -o(o Eo (E oo-)bo C(D C U' 'i o eo -!9co([ = .E o U' .!9o-oo -o,os(E (E Go =Eo (D(J ol>tct- a 'i(l, attq) o(D L o e -g -!9 -U)oo !)$ ^(l)o)o--c lo.E E(l) =.q o) oc(! E'o oo o) Lo (E .92E-o(o ou o o -oE =z. th EoU'U' LU(,o =U' lJ-o E,o s26 = EE(u-PU6-=ut_ € Es ar .E (D5rc Eq, o ir q arr:: o o;g:..= e € .8'E = 's,6E€ E d a5 5 8E EEfi8o-Eild C,q,o I oz C,oo o z. I oo doo I oo o, I) - j o z. I c)o o z. I i C)o ->) -I (D C, = - = -I(l, q - oI E, LU o- :- C, = c cl =C(o N (Jo = = =tsooO Glz c(E =c(o N (Jo = o)Lo U) Gl =ctsSE oo)o> =E EooO Gl z. = = ;(E z. t!uJ-() t: =8O ii(D o-oo -- Q- 6= i(o =c(E N (J(D = C(o =c G,N oo = =o J. = co =ehSE <J O)(D> =c U' -!9 -o(E o E o-xo o GU'oo- .9.o X c;t- o c.(E N o(l) =o a o) .z d)o cd(O anoo(9z ct(l)coN ao (E a c,(l) .c =at o)E(! E' c,L o-x(l) o (E .9 orlE=lfY S 1.(6lcD >l(0 (o c, GlN c) o) =o (D CD(E o a <c;(O (J -r96o o eq) tr L(ELU' oaDcE .9(q(EC .= (t >N -(J -'(l)G= .9(o .s2 -o-o-(E (D E, C CIN (J o =o =.!P oE. c.i(.o an Eo (D E. c C,N (J(l) =o c .9 an .9 E -o U) + <,o Lo =o tt ELo c(o N C' o) =o cq) E E =(Jo o- rri(o (O o eO '= 6tE. €EU'O e5EEcro PO- EB. e(D EE, cr (E(l)NE=u --j q)io= o co E (E(D co CI .s2 o- o- CI o G, (! .N o(D =o q .9 -goo 6i(o o Eo=q, UT =() LU @o g.g.E.t6 o .oE s Ee€tgEeaE I I a I Ithl(hl -'idro al-, o- o, 9l -goE:(!=E6o.-i(l) o -cl >(E 8e cno (\.l l<a o C) oA o o.tt @ raloo(\l ut(9o =o OoL I <t)FO ul?oE(L =oE,l! Oo o- U)F() UJ -o E. o- =o E.II oo o- U)FOul -o E. o- oElJ- c)o o- aFO[l -oE o- =otlJ- oo = oo C, z. oo(o- F a J-o =lJ- oo(o oo(o oo <! oo <o t oo(\t (r, U'tu(J() =(t, l!o E,o s2 ct = U' at 'i q) L -go- -!P -os(5 (g o Lo =o =,o)c .g(t) Q) .c, o Loo o)E, jj ..4 ooCGt61 !lc(D.El=(s<.= o .c o Loo-oE .e (l)oc €p o.=1=(E<E o) .c, o Loo-(D G. .9 oo €E (D .sE(E<t: (r, ..2xo eo -t9 U'o o o) o o .qo-oO _!P -os(o (E(t L o- E o o z. o tt x o) C -g(L -!9 -os(! (E (r, o(o ='6(E o tn = o) -o(E (! (g Lq, o o E(Dc .9ra o) =oo -o o .gooo E. -!P -o -g'6 C, atG L o) (E (l) ! agE(E 8.8EE :;OgE oo9Z.o s gi.E =.= c6.E -ts =Ea (D ! ogE(E 8_8 ea .- o- .s2 b(Do2z ^e,<o irlE!2 C'=b:=EE(o=<tsu) .9,x(!) eo -!P lho) cr E o U' .!9 o.oO t,o oo o) .9,(E al,oo. e o. o o z. oc(E o(l) .=(D o E att6C'oo-gE =o) --=o.!p2a EE H8 *5 E >,_ -l= l- E8 !E or ..s'= o,f.EEo irr.E5aB Lo o)c Loo-o E' o) o-LLo-'^ -UEO >6F .= aD Efr E-EEOEo- (EE.E E oog 'Y .ho. (Ei! 9 E= .=.^ :Ee€eE H5I6.9 o Po EeE€ EEE cto E, !.lJ o- E, e(u = C) (o = ) -I e(u = o z. I L c)(g = I(Jo i(E = o)c) - ;o- o) CD I - I 9: Eoa +)o.(l)a ioo ;(Jo <joo L o- o z. ci) .iiolJ- o, I -clq) lJ- o, e(E = =o - =dt e o)o oio(l) F ; C)o o(D o o- U' U' H(Doo8E 6-ccoooNF eoo!s -c ,.1 E9 ittt aD5< c)<.E e tJ_ .E.oo'-&= (hLoo o .Coq) F U' o C' 5o -co o)F .ii 2-q8 t6(9 z. z. Ei ooO (E z. rioo (J .!P. e(L C' a aD i .E E U'(l) L(o Eo o)a 1!Fo z. o _(o(5c OE 'EO(EO z. <) =iooO (E z. al, al, at i .E o Eoo 0,c Loo a =q) att .:c = C)(o cn .E '6 o G,(L -r- q)o C, -tuoL(tt E o) att LrJ 6it\ troq) o(rtF C)oU) =oc o CD .Ec '6 F c.jt\ oF 6Eac50o- ol? 'Ee Eo)(D-E3 od 'E P5 .=o '6=to) =ct\O EI ol U'I atlpa F?P FEio-'-E? 5= (E= =og6s e= .c)R€ o oco Lo at c L o-ol<n oc, E .!P3(Jou,(l)eE*. \r/ .^=t-. tP6 ILoo E alt c 'E-.gq aoL(E5'-otz a(D =(J'E !2(6! -EEFeXccio >1 5l:sr*O o oFooU) 3,E 'E= t= ll, :8hedo .8,R6 U' o (E = (J(€ o .= ; :> 'F_ Lo =otr\ (l) cn(o -!u E attE'c = E)o ul o@ q) =Co o =oo co -@ ottt o U,6 L o)(tl E o) oo c 6i@ E- E'.e ; ou- c<do-oPE oEgEErHbt6 E '6 U) z.(E- GlJ'(5();?q) .- k(o (D+ @ (,'tI E^ o o U'FOoabg, CD.Ec'E :==(E (,)iE ' attxe +e@o- I(E al,oo- eo- o U' o) =oq) E. rri @ .9,(E al,oo- eo. E. o o C .9 -go(J cct@ (rt6U'oo-o o- E. o o =.!9 oE. l'-@ LU oul @o 6 .99 9bE EEP >,(,, (D O- =?_- c c, E (E OJLgd P SEB AE E-BEEEE a a coooN .F O oA o co$ a gil oo(\l ul(9o =!o OoL a I oo|rr- oo(9 z. ooo-(o -o =lJ- I oolr)- oo(\I oo|r) oo <\t a a !J-o E,9A < !-r.r c)C'6si =qt o E(E ah =,c(6 lJ- o tlJ at= '-x z.(l)= (5=(L= oE(J o Eq) L .ga Loo-q, E.ji .e(l)eo()L>(5O PoES <o '() -oosegb <O g-EulP!2 az,E= c .9 (E .= .- (rt hx .Eeo- o)OFo -!q !t(u E= EO *E .!yo(, ap.oE(!aDe >'.= 2EE ..2x(D Eoo-o o b G, E E)a o crcE(Do)oJO)Eo- u, aD .!9 !9 i+6dE eul(EC -coQEiJ'= .E.E d.nE€O(oz.e Epg o (t)o,'=EE ?eobEFo=o-i EE -i .EaE.- s#ef E 6o.E= e b'68E E EE H8o-Eild (Dc .o *-EEq'E -6r u (!.= = =-oo--F(h ut o- ><. z, = E*,9-EEsE E= EfiEEfic -a E.= E -!9 .E b - al,>o.)vg- =49EEEB=e E o'. ':6 gEEE;982-.nZE=-!9bE-stsE9E H C (l) +E ctI E, uJ o- al,)ol ;oo ooo <Jo C,q)o C'oo I -o(DII C)q,o I -o o)lJ- ctoo I -ct(D LL +oo!J or o=o5 ooo L(E - ooo q(E - oq)a a (! - =o ! =dt E rr-k r.x rld S2 b .^z t) Q-_oI ur-()E E(u0E z<)L +) C) C) o .9ro(L O =6 = .!2 etso-c) a)E.q)oo- -C O-od', lJ-F[l oq)F PoOU,ob -io(uE2.6 E(Eo tsooO -: jEg CD =(o(!o o) =(o (go ! C)(D F tsoOU,ob -:oaEE2.6 uibtic) (JE<9ts.!p-EEFL (l)og,E (l)F(D= a<) al, ah @ C .E =, E o =aoE o(E cr, cnC,_ .EH Pi -eE ET6rtg l.tJ €()qrz, .== #= E3 q) ct(E -!9E .J' EC o)t,c UJ o CD @ =-<D oo 2oa9,(J iu EC/) PE ':c.a a)oEU'E<e^.Efr aL) ;2. cJ> ) =l6El 06(l, =9a<.thbs2 -- Z.c, -rE-oE-(i)Cdro5'E s€>o)OF TEGIE cD .= E e (E C'og r- (Dbtroh L(f. €6 60g(9 o€odd.g c,iEau) Eo tt .!2 al, (E al, tro c) o c .9 o -9OU,og -. (o 3d6 E e o .!l alt 'a(o o troO o o _g6oOE ,ri g ctt u) Ec9t .EA16=E;o-fp6 =0 €aqE =.n6.C CE, E .-o(o= ct, U) E'Iel(ol E1(., .E E.o o) at ai otso)=E6 -o< -9b EA(u- :(E E'E .(Et\cCD l= E G,6 .s2c .coo u; o)o)E la -E =o =o'=G(D'iE. E, .(E@CO, i= o utOgt Eo .Os1 o6 EO 5Ac) (J B.F '3e .s2 6 E8 ,n'E EE LU oUI coo BeEagEg E .EEG PX ..9GSP o=; EE€EPTE E=s.geEEEa o; c--- ts= (us oF o.= .= o-.= o- o-=, I .9,g>( ego.9-gr8 .E q,a-L(6= =6o.-:(D o -cr>-s+'63e ci, o GI = U' th Lrt c .E !, o .9(E U'oo- e o- G, o o L .9 ah .9. Eo = a\Q6 ET c.too c.l a (-) A o $$ q u,oo(\I uJ(9 cl =6 C)o o- I I I oo|r) I ooo- oGI oo C9 z. ooo-(.) ooo-(o -o l! oo(f) ooo^ ooto I oo|r) ct, at, !.u C) C) =aD u-o E,o s2o = st Loo-(D G '69 c$a(EY <o6= .s2 --co) -c ol()E'(D=F-o ah .!9o-o(J o o,(Jo tsoo o :> =-os(! t, E =o)L U' .- oo 'o o- Foi9oio-.= EE j-- .2 utXCo =-=(D O.r =6q)P PEEE =trQJ4OE RO .9 .=-t E= >E t6b'o Ioz 6 c(l) at E o- q(o o_ U' x(l) eo(!E (E o at J -!P -o -g'6 (u (D !o o Eo L CD6 .tto .E EcCO !? (E9: .ofEObo-E6bP -(Eof th= == att .9,xq) c -g(L aD ..2x(l) eo (U =o(E o U' = .c2x(D e _9 -rc o .t) .tPo-o(J CD .E -ooo o o- 'iD ooE. o -os(g (E .tto .9 cDo -u,(E L(t)(! = (D o Loo- o) G, jj .e (DoE(tt n o., -EE(E<.b EE H8 *5 F.Eoi61c o) Q)ut -c >iE (D E ts'F'E . ==.=GlE aEH= E e8 g9'E[!cD o o c g.-E 'E P 9c) EE$EE EEBEE -Zurh() .q.s E .E.u6 ==oEEH;oQo;i o eE'€ E.P:O E s€E=()i56= E ggE-BoEE. : =EEE =EE B$ gH,E=-c E AE 5€.o oo E, !.rt o- o ^q)rOooc\t t Es .:$>QOa- c, >io=o5 ooo I (g - C,oo Ii(o - ) - CD) o, o z. I oq) <D (E = C, = (u = ;o-o </) r)(Jo +tC'o rjoo =o - =6 ij-:(Dc)ooE<o5 -c q,8'oFO- oq)9.E (l)Fg6 a<) ;o(J c)(l) 'd (L +;o c) (J(l) 'o o_ Eooo (5 z. Eooo (! z. ioo oq) 'o (L ctLo(!p6 ts..o= 8=', .(o(o(!z.a tsooq) (o z. +)o(-) o(l) 'd (L ;(!z >\EEcLo(l)oOO (r,o .d E =, ia) utoo) <'E -G,EE'o8 o- cl) E Es eg do-a< = Fo U' --. to oCL(D (D @= o-.qo92OEz. c, '=Ee6Coo'=gb(s(Do--C, uiO- ar) . t,OE'o=F4l i(D olE') -o -2 rac) c) 9E *o 3E(.) rt BEE.E =E 'a oo 'o CL o =.!c oEu, ooE o-= .iD Eo-(l)(Ed'Ei .c <\l (EC'C Fi= G '6 c(E c ia rr(J ,-1(D^- 'ot O-6 Oa .;= U'. '=o d* co= =E .= .9 (Ep (E att at, Lq)o €o orIc(E '=6 (EE' :(Dr6 +ooo F (,) eo(op (! o co (E o .E C,q, E X lrio (l) U'(!o E o:o C o ahc ul X @o t6 d)(! !, *oJO) 3E 2<n8EE8 EE(o.= E'_E9>q)X6 .(D5'O -O oo-o-(E = -c, =(U(l) J- !o ED:CC '= o)gb eo) ox -6(oE do adSo: _06 E o) .Eg (t) -o o 2o(o ='ii(E :x .E Eo =X oto oU'(E -!uo U'E'c E ctc ul X c, ahooc '6 od eo (UE c)(E o '= s X - o =co o (D CDc(! LL X <.i o(J .9, <no .9(E o (E E Lo (l) CDc(E L X d =(Eo I LoPro6OEu) a) =B =(E;=c(E c(E .Gi E F06 xg +8 :> LU (, u.t oo EP o= Ig (Eg b€.o e EEEEE,E €TEEEE >c =ogEE tr== alr': > .n ='FsEtEtr=P;8 : eGtH,b EeSE E 'c.e'*'3 5E.E= E E EE EE E 6= 3 € 9 E.EtD E .:= -^ E SE H o .EE€BE a I a 6 loooGI LrJ(9o =@ c)o o- a ooo-t ooo- GI ooo- 6J ooo- <\l ooo z. oo(o- c.) a oola) ooo- 6l ooo-(\l ooo^t\ ooo6i Io =lJ- I oo6{ a oos-6t I oo@ a oo(o oo(o oolr) oo|r) oo|r, !!o E, ?E <uJci(J6q =U, ah ..4,xq, c -go_ eg) -!9c .9 (E =s o .t)(D a- u, EE -!p -cts(E (g q) o =o .rc @c .9,a os o Lio .DA:€ a=ts=(!= I :i h.=g FE<(r ts att(/)E cDb .cq(Dig.c :oo-o5(E 6!UE6 eoE -!Pc .9 (E '= L =ot,o o- u, EE -!9 -os(E (E Lo -co o EoC .s)a Eoocd'E &E .- EEp gE €Eq)Ei= o Loo-(l, E. .ij .9, RP -'EEE 8q<! o EoooE jj ..2 oqo-EF6i5 !uch9q<L o Loo-o E. .2 s8 =iDi5 !uCE9q<! CDc o(l) E(l)E, o 1=oo-q, E. LU =o(J =o ct LU (J Ln o-xut bo-ge .E= ETBi i3s 3=E EE e xelloEoI N= CL atO6(J-(E d)(l, U}.E E .OE EEEE-o- o)te 9 9E e.E ag3=E E(=o>E =(/)Po)xE O-O-O E.E.E :(! .E 5eoE i5 !P .zr0b8o- o-'=ECE ao E, UJ o- i, 'E>o-o <, z, i, 'E>o-o <2. iD = 'E>o-o<z 6 = 'E>o-o<2. +j(Jo L o- ioo -C, = {oo -(E oo -(! = o z. f(E = >(E = o z. (Jo doo I oo =o J- =@ ttEooO (E oN .1,Eooo (5EoN (r, oo oo 'o o- (r,E oo(J (!coN o -j ,i2Ea = Et Lt- o-oEo o(Jaoz. e ts 6.. :^?-4 =ELLo-oEo o(JaC)z. *)oo oo 'o (L -.:'6oc) €s6(9 z. z. =iE8Oc -i (E(E -Cz. L) -.=ii5E €€Hi6 h(9z.Nz. Eo.. EB -a Z.z.= EE 3e 5,4 =o FlJ-oN o o, L .E (o6i o- .=iE FE artolc q)q) E FLLoN o C .9 (E = q -t\ (l) aD(o -!co ah =,L E)tt,c LU €i -o3U' lJ-l- utr-r CDNEEEU'Fc- €EOE -'EoiEFO -C, CDC L EgAc,tr6 FO'OE?=6.!U CD (DcE .=\ E(Dtsg o-'E otsc\lo -(J O)C L EE, ch .=trE6Ez.= e.9 5& EE '=E LE .F T5 (l) att(u(l) E .tt!,c E (r, L UJ <.i(\l -o =.tt lJ- L ,^ U, >? -'Eo(D -(D()E =r(l)c(DOE(J'E(oE6lo -c) (D orI o=(DEi;8 o.o a) at =(l, =(Du,b.E PO EE -JC(DNb9 -(JE .n o) .E(l,(D c. attso) =t6-@ i; o!,LO) o..2 eU,aJ .t) =(uEd ER tri< S"E o)e ': U)aDogF!a Ea a:3 *u)o(E c) = tJ-9 t-ub!2 c) z. ..; =SE Eg o gF ioeo o) fn CZ(EL E.eeg4.c o NE8 - E(/) u.t oUI oo rE= i_ Et<)o - .Eoi 'ila8e.aE€6 E H:= b=EE;oZi-c:E-9bEO-F G 6 OP 6 o = o oo -qE9. 7 cn 9.9'= !h c o <n.E = -8.g E SgEf;EE.€EEEfi€l-- o € E o- jJ (o (l) o (u .C o- s $= Es aE; co c-.1 Lr& o d o Or o B r$ o z. I c)o e _ote eb (E (E oo -c)o(g o, U) :EE(EE -(D --E -)c ==oe =(DfiEXEdE :E a I I a co o C.l tra o Q o0. o rJ< > \o$ e> rooo(\l ul(9 ct =CO (J o o- oo <o- (f, oo Or-6l ooq. oo(o- t\ ooo- <\l o(o(\l 3d CD oo(9z oo@- $ I oo @_ to al,l, -o =lJ- oo6td - o(\lt\ oo|r) oo(o- oo(.) o6tlr, o LLo E,?8< u.rci q)69 =(t q) o =9o E€C-: .q)g(,(E E= 5Ha9) =; a -E.E EA E & Hg E= AHa9) .'ib a 6Es e ag c .9(o C' Eoo E'a) arr. .gr.=cn 'oi 5E.E p€c) o_: EHHC:E,Z B*E q) C) =o>o) oE(D(E .ag(/) 'E E o- .EHg 3F-r>(D= EE E .E,g FCD(6O. U' o uJ =oo =o o LU oul o-xul oU c,oU) Bs =b^ Oz.9DEEgE9.9=tsCCcH eEqr '=leF5 88E -o.E(l)=3e EEgE e. o .!,ECq) E +:E _L Cr()JCr(O +l!OFoO -l', -(Do *olE Y oN.a HEEEti d.= .c drE >=L(Do)vt >=66_=(D ts o'= o .E &'OH 8F (E OE< oI E, uI o- ooo I i(E - (J o)a Ii G, - d o)o I (! - C'oo I (E - ctoo I i(o - doa Ii(E - C)(l)o I c(o - =o = m i(J(, (Jo 'o o- iioO.tC)=E -JEo:€E +)EE3-*r -(trEO)5,€tF +joo o c) 'o o- ct o) L Gl o ooU) ;oo oo 'e- o- ioo oo .6. (L =() cgO o'Eb(u(Do aD'=6=a= --E ,ndtlE o=C,Y AE o'6) cr 89 A E:ngE REE.FE/l :(o Eutdrg :E!l 6(E= Eg -L <: sg cra(ooF(n oE E8q >.= t8aE.g9ibd .r,Etr(D (,) =o(o- >b .L -=(f)o -() o E .q oo o (D oC(Eco C '6 =<.i(f) tt(D .sl o o e '6 o-o E. q)oc Gl o c '6 =c.j(f, att (-)(D 'o o- o (D aD(E -!co =tc lJ- +(f, ttto CD(o o .Yc(o -o o q o E >r(E o- ,ri <f, ul o ut oo LCO e - E= E.E ,.E E ,E.E.= E = E E5+ Ef E o <rrP =_ e .r,@G,6?i^c) 6 .E E .E..EoE-E P QF o.= o-.:l eEe ' sEE EEE ooo- lr)(\I o .o .gc) EEq o^LQ5E(DEEg(l)q) ooo .C, (t, o .--PTo:-6g 5S lJ- - o ooc(E E'ce8 <.E -; (DF(9 -E heiE -co a I a 4 @oo6t ttJ(9o =dl oo(L I oolr) (9 z.6 z. =tJ- c)o(L FO^llJ lrE<.6e ooo- ooo-(\I oo(9 z. ooc.{ <o I ooo- <o ooo- (f) -o =lJ- ooo- ooo- oo$- <f) ooo ooo-(., ooo- ooo- ooo- cD al, u.t()o =(t, t!o E,o s2a z, at al, 'i o c -go- -!c -o -q(5 (g Q)Eo)o ooc .9a o(r, .!Qo-oo o) a/, .E'i =(DOLo(DE'Eg(Do- E-.9(l)(E o.=d)>t..= -!P -cts(E (E .9.(E L o) (E = Q) o Loo-(D E, jj .a o)o Gl9-ECq) arF;<o .rt .9,xq) c(! E -rP -o -g(! (E q)E(-) o ooc c,6 -!P -cts(E (u -9,(g L o) (E = aD =,c E(og (D c oC' ou7 ooat=(E19 -9. U)&a arto L(Eg (D c)o(J ou)ooaD=(!J9 -9, cn(D-t6 ar, at '= q) L(Ild -rc -o -g'6 (o q) o o =,oC .9U) o aD .!9o-oo O) ar) .E'= -- o)o-oo) -oEg(l)o- -c =o(D(g(J .=(t)>tv c. -!9ll -g'6 (o .9 G, Lo(o = o o Loo-(1) E, jj .al, (l) oc(E9- -s6id -o =blrEob E E-Ei4Bxo.rh EE H E Lg,E c)J-(E== z. d-- ES H8 *5 EiH-Eefi='g9e= EE*EEES;c & EaP Ee+dq oo E, uJ o- ltr,ooC! ooo (I, - L cl - -oolJ- -o(D lJ- -oolJ- c,) L Gl =dolJ- .c e G, =ri o)lJ- o)c -I o- oo o (E = c(u - c(E - oolJ- -co (o =a -o(l) lJ- c cl = .ci(l) tJ- I c)-(r= =<- =o =dt Eoo C) (E z. :x o- s)o(JON *)(Jo oo '6' (L (r, at aD C .E E jj() u,o(D<'E -(56E '= c)Y(D o- u) tt =, E.g 3e(I, o)ZN U' U'U' L .E o an oo o .!P. e(L 6,no(D<'E -(g8E 'o8 o-a .-E tscD8=O();O(E0_z.< EE3sE€ EooO (E z. ,)oo oo '6 (L aD atU' .E E jja)aoo)<'E -(E8E'o8 o- c/) Etg t6(9zz. E' ooo (E z. =o o c)co (oc .9 Clz o -c o olc E G, E o C -go-e -O ar,Ec o(l) at(E -!cE E =ttcul <\i e -9 o) co (o = .E o ID .9, oo U'(D)co o .Yoo co c.i ah E(l) .= E'ooo(l)c o =oo .L + .t) '6 .g eooo oco (oc .9 C, z. o, o o)E E(! =erriO o G,oo o(E o c -go- <ci U,E) o c) at(E -!9o E =al,cul F- al, E(l) = =,ooq) o)c E C'o(L €i eg eE Ee 9=EfrEc6= .-g, ETat -(Eo; z, al, .9)(o o- E(E c) >\o(!(Jo E' o 6o co o- =IolJ- o CD .E r=(o E o C6(!E,L6 i(D:E v, =,q = o q) U' c,(D E o ah L UJ <ri c .9(! '= .E o t, .9, 06 .t) o) =qo Lo -voRe =o an E(D =EoE' @q)C E c)o o- + E CD .f, ,n(l)G,q'6tsE 60 o_6 b(.2 3< =B:Y-; (!LE= EAE6bo-()g tri.9 -U) Gc .9, a(EoCE .oBEP E-OHE o(E 9=bE oo16sc. o) '= o) =(Ell c)z.o(o E, -(E !.lJ C) !.lJ mo <f) laEE <.) E -EEH9E H-'69= EE-E(JsHEEi=*9* F.E 8 E AUfidE t caOo c-.1 t<a ci oA o \o N & ofr z Fl Fr vil o B A Q o z r\$ I I cnoo c{ a o C) oA o >! €+ 4 (ooo(\I ul(9 ct =o Oo(L ooo- lr) oood o o(9 z. I a -o lJ- I oo1r) oolo ooo- s ooo aa, CD at, lJloo =ct, lJ-o E,o s2o = E .= =!,oL(oE,U' =,c(E o '*e(l)o o-- 8- o ,1, o) o- eo .=co E o .9, P. ut(D=5p cq)oo)(!(I) '== co e ot(/, (o q)(l,.--> '6-6 q) EEE -!9 -os(o (! o o o =,(l)C .9)U) U' co E e at ;c GI .T, Q)(E=bEi6a =6 =U' eo .9. a(D o- =CNEo vA5(! &it EE H8 a5lrl O beagEE -R(Eg P#Er8E -g--SO.=E ao G uJ o. (! =I -oq) lJ- (E =I -o(t) lJ- E>. <5 o, ! (-) L c, = CD I E, P(E = o z. I L o- =o - = o pE EsOC);O(E0-z.< tstsooAO c) \J;cicl(l)z.a eo(J Eio9Eo .s2OF EE jj oo oo 'e- o- th a) alt -3 H{ BE.E 'a-O EE (DEL(/)< -Pe98E 6ts -o(EO .s2 o -c(E(JC(l)oFN E C) oO olc Lo .= o E 5, '-6 O '= q:, (l)E o- o- .tt O €.E EELG -(D atlLo(! 6 ul o5 eo .E o =:> .E LoE <\i Ec(E eoCE(o :oe(60 o(E36 =eEEcO 6E c.i E anoE = o (Do Cl -!co o att lIJ + al,G L o) 6e9 EEi5pd.)Ec,9 61 .EEor o.EOE o-6 tr).= Co tt =o(D !o oo- at eo .9. a99q at =i5(/)'6.(c, O- E o a3(t, UT () u.I 6o .a t6E E_e(Eo s?_ 6 a, E 5 E-^EO* c EF o.= o- I o(o o- (f) I o(o ro ad I a I oo(\l (D oo r.c) oO or- O) oo|r) oo|r) oo@- CA(\t o)oCg CLE8et 9"oq)= -J t- -!Pots(l) ar, = -o(D.= c, !+ o- (!E 3e -!P -os(E (s -9.(E L o) (E = 'o(l) U'(o -!uo, (t E o) =(E .=o-(O !-()E E'Ofr? Io(l) 'o o- E9os(D bEE.E .gq =E -qE9'6gE Ego-'= ==c)eu)Gl .i"u eE S4.E(E= i E6E (l)C - I g o- (Jo I -oq) lJ- (Jo I .c,o (E = o z. I c, (E = o L(l) .9cEs c(goo II p a) at(J (D <'E .-(E EE '= (JYd)o-a bo EEEooe .!l (L .!2 0CDT _9= L o) C) EEEoo9 .!l (L .9, OTDTs= 6e.O .o6EEE a/to6E E4 RE EEot,cOoo -o) -> (tooo-= <oH t\ =, -G, E o -ct tt, ah .g o-o-)U' o)o Go o c o) E(D o e o- - 1'(l) eo- o-(E o o u, E+pp.E ro .otsEo9;ECEb o-o(! o-'A .(o6t c, o .= Clo-(l) E'c(E (D c)c(Ec(l) .EosbEE €_aEE!?oEEa? .o(Y) o E o -ct =U, 5-oG o h 9tc q)zr.= E.- E H RE'H'*= E E o5#qq,Qgt6l- u, o.=llq) o-c t I a coo C.l ka CJ o o. o FJ< o\+ II a lJ- o lJ- o a oo|r) oo1r) oo -a- ootr) oot\ oo(\I ooo- (f, ooo (Y' I oolf) ooq) ooo-(.) oo|r, oo ooo- <\l oolr) oOtr) oo@- @ oo|r) ooo- oo ro- oos- oorfJ oEs(o (u !r, Loo-(l) E. CDc Lo =co = E-:t, Cr, e=0()ao ET <E6U'E .E8 6.E 6€ d. tt -!9 -o _q '6 (! o o o E'o .9)U) q) o- o '.4 )e >.92 H6 .E€ (l)o o- cr =(Du)!b jli o.gz. u) o5 -ruo -g '6 Eeq9, =E6-(Ed) o. --ccD.= .E= o=, .= o.) tsq =b E E(EE(r, oEoo- &,e 6(Do5 s8E-c>.=uJ= -c, = =,o) (E =(o <Dg oot< o.dc)'o; o-; =o -EEz. <) ah ..2x(l, Eoo- E o(l)N .>(E L '= E o) (E Gc>(!(D -69>.c, .=(D= .-! BEEg o= z. u) o e Gl o .E = ui .= .9 o oEQocL.=4) .tE'= o -(\t oC o .= .9 oE oEQutcL.=(trDU'E'= bE >r -= E6(E(E tr8q'd ao- a:aEts si3E#E@ E9, E ts- d:o=oo_; <.ts.d.E (! 0 oEC(J(Ec _(E 9E oo->tr o-!P =E.= O) o-o CD I - (! =I Lo CD I .> - +)oo I o) = o(l)o o, ci(Do I o-oU) (,oo I o-oU) doo o z. I;(Jo j o z. I - oc -I >\(o E €e 16(9 z. z. E' ooo +j(E z. EooO +)(E z. E2-q8 i6(9 z. z. =,oo c) +)(gz ctso)8=C)C);O(50_z.< e.o(l)po=iE ctoc) -cGoc(l)oFN g. .r,op ,!2 558 -EG()C(t)oFN E,;op €Eoo -cEoc(DoFN 6U'6< c)<.E etr .E- oo-Ii= 6U'6< c)<.E eLLEo 'd- o-= tr UJ !2 z. =ob=or.9 orO .E S .Eo q.<nEE EE .E EL6 SHE.B EE€TECCE bEft: o- (/);<;Ea> lu, o(D>e (!_ .EE _E >cL.- =xEor ,qb -6 .(! qDaoq)A cll*o rngE (D € or$c. c,aS.Eor (E- 6tF.q Eooo-a o o9 CC .='E(l)F atlEe6.E(r(o .o't '64 -oeo3 6.i C) a =U' =o)6g6o '6F o)Eo-'-cn 9. o'E c'd o.L bso-.= 6.E ;.E o e.ooq)t6gZU)(l) (\r EN .!9.c *aEC .:-soo. tD >. hEE(r' '=-L-= €s =, uD rr)(n ang (E U) Eo -o e= 8o5 'd=dil o.= c>o.= .:ilE5E s'Eu6 <0 <t E o -ct)U' o .9) -o 69i5b "dBcEo- o .:z -{u tda= c)(E - llJ U,Eoo-o Lo (E -=(E UJ o ctt '6 (gc C\i (nE(E ord E= EE(E'6 cD6 ea8u s6aD'A 'a9{E(f)o- E o !l =U, E o) ooq, al, .E c .9 .g '6 Coo E c oa) t,(-, (D <i6 - (l) o o) 'o o- O .tteb -= cr:c(u .EE o)1,1tlog 4o cDc .EgEC . B F() .oN< E o -cl)U' oo(oE 9a or-F.2 = oi66 92 6.E (!iEfiEF.E 6(J .E -E FE fr eE.g BliEE H=-EEEqO1*: = o oF(J (E U'7"" E EEA9oo s-e O6-g E 'aE9 3sEF c,= I a :t u.I(9 a =aD ooL I I oo ao- I a oo .ar- I ooo- oo(9 z. I I oolr, ooro ooo a I -o =lJ- a oo|r, ooo- oo1r' ooto oo rr) c.i a oo(\l oo@ U,q, ul UTo J aD l!o E,o !2o = tt .9,xo L -go- .aJ,xo t,(l) =o E o e .E -!9 o a.rt(D o.oo E -r9 -o Eoo U)(u o o- o ah c G, E o o z. o >,E(u(Dq U' o- Loo 6.o E(E .E .s2(., : ^g2e -!9 -o -g'6 (o LoEo =o =,oc E' o)o JE' eo- al, .!co-oo ooo- =,(l) o. -9o o =,(rtq, o:(E ch aDq) E o U' J -q -cts(E (tl o o Jo ooE .9')a -!9 -cts(E (E U, .=I ahU'o o- o o z. co a.rt E o- c(l) Eooo(n U'(o oEoo. o)E. -!P -cts(! (E Eoo.q)t att .9,xq, v, (E = =al,co(J o art = (l) -o -g '6 (E (l) o o E(D L .9U) (l) EG'(, G(J(/' .!u-oo' =o-Eego) o_ -ct =-QY'6:e .= =E o) (EEo Ec(o -r9 -o _g 'Ee (Eq, d8. -!9 -os(o GI o o)o =o a.D o .9.J art ..2x(l) tt .!pq o e tn o .9,J -9 -cl -g '6 (E Lo o =o t,oE .9U) E e Euo-c =(Eatt o- hEOE EPo)^ =r=EH Po)Pt66r.= ao- EE H8 *= L(l)o EEIEp E H E uE e E gEEE€c) (g E O-O (E tro5OpOEbF- (,!h.=E (DfEEE(l)Eo-= -ho=oqJos,(g E(D E *E.s E !2 _ E.= Hg E€ = EC(,(l)E -E ESaE o EEEEEe ao E, !.ll o- rr)oo6l (Jo |r)oo <\l c)o oq)o ls1 8R Ilr, (ooooo6r (\lQ-o E,E -oolJ- -o(D lJ- c(E - c cl - .cioLL +:o.(Da ;o. o)U) ;oo(n ;(Jo >.(E =I oolJ- o) I oc) - c,) o.Q)C) o z. I o-q) CN =o - = GO ool(Ec(o (u (Eo E ooO{(E z. g(l) o)(o c, =G, G,o (l) CD(E E' d9 =E(EGl(oaz. *:oo oo '6' (L ool G,c G, =GI(oo eoo Go !o(DF +)oo oo 'a o- oON ii ooO i(E z. lrFo z. lJ-Fo z. EooO i G, z. i,oo oo 'g o- lJ-Fo z. ._8 EE()G 5,8 Eo €s t6C9 z. z. lJ-Fo z. +;oo (J(l) 'o (L t,oo a9=C4=, €s6 = bo(tl OO-z.o<. E o o -t9(rt =o o C _g o- - U'C .9) -o L coo o al,o o(l)E 6i .9,(5 L o)(6 E o -g6o oO o -!9oO c.i .1, o- L(J tl, =q(o = .s2E IIJ + q, Ec) o q) ah(E -!uE E)(r, c[l d -g -!9aD =q,c o c .9 o E'o o- <, e o) --(E E .s26o. o al,oo(oo @o E o.o6 oo F- (toE = o ottt(5 -9(D L o) =at IJJ <t att = -g o .tto o- o C .9 C) =t, e(L oi -!9 -o -g '6 (E o oo o)c E cn L ,1,U'oah C,{E .U'oo -O o) z) .tt (.)) =,coO - ID c(o = =U'coo > .F co =cri U'EC) o o) aD(E -!9E d) .J' L t.rJ <.i =o)L =,oNCPb(E€ EED EEEq!C. E:ft Eg: + e65cE> T+(o E 8:e 9EO - CLc) E o tr =C" o(l) <-) oo (l) -c o o .9(! .N -oo E ho:rEC c€(ocE.P FO o o)(,)o(tt (J(o co(J od > .E c o) =6i tt .g o,o E U' C .9 C, .N -oo E o-o(l, (l,o c.i al, €c J o oo(E -!9og E attC uJ + o) L €C o d.t -o)be(oO .) u, =o €E €: r-O Pt6 =N 6oo d= lrJ o UJ clo s=H€EEteeEtE* od -> ur^Ea.OXo) -EE gE,e .:: -o o o.=aOU)g*F E EE H I cooo c-t H (J oA ,Jr otri I a I I I 6 (l'oo(\t u.l(9 cl =o C)o(L oo(9 z. oot\ ooo- (f) oo@ -o =II ooro ooro oot\ oolr, oo oo oo|r) ooo- @ U'U' UJC'C' =t, lJ-o E,o !2o = ah ,9,x(l) Loo- E .9, o(Jc c, =,c(D t, .9.xq, Loo-(l) .9, €)oc(E =,co C" ,9,x(l) Loo-(D jj .9. o(Jc(E E'c(D U' ..2.xq) Loo- Eji ,a o)(Jc(! !,C(D =EE c.E .-E .E95E Pr.s 'E oocr- Ed)arb.= E(/)g (o EaE =u a =,oo(o -9c =oo)EE(n (gFEEE c. .t)o(l)E'E .sr EEe<c, >'o-oC) Ec(E E -g .E -o =q)(a .S2 5EEi .9. o o- ut <o5 E(J 5o .E th(t) =c .E (D Gt* 'e..r,o-x9a)o- u)o-o<E .9.xq) a 0) -!9E .9(! .= .E o atto o.oo o lh 'i o Loo. E .9 (l)oc(ooco E E(E !o od o .9.xo Loo-o E. EE H8 *= HE a e =a:rE-o P 9E -b E 6 -a eE € B5 EE5: E-E.e "= E cto E, uJ o- o z. I c(u - ..ootJ- I c(E - >\ G, =I q o- C)(l, = L o- >r(E =I L o- oc -I >r(o = (D = - CD o) =o .J- = co o) =C)o(L o c) o-oE, b c =oO CD =Oo o- eo C) o oq) F =ioo c) +;(E z. Ei ooO (E z. g oo() +t(E z. tsoo C) (E z. lJ-Foz eq) C) o E c)oF =C' 6(E *,nEC =.9o(E o- o) =o. =O -9 c)60:o- 6o 'a= i5- tu(-,c 'z utfg - ttt -{ E = .9.E3EOo- o-ooq) o_ Er -(E.=o .U'bE =-(E(Eo-c '7i o rddJEo-& criO (r,g (E66 EE '= .9.o) ut!oEI .EHi6(9c.z s'6 .s2 .!u E-.E C) (JE(E(E :-o-5do (n o (tt o)c (D(D- cl- -6 .EO COo=(E- .*b Fa56=o- 6' .=s.= Eo = -(Eb.g o.=q, cDOgE.9o;) o_=IIJ g(9q =E!- .= t-3b o,s)o 9EE 6q) --:(D ya(D = ts'a .(tt=tr, = tt o (E .E E -o -9(9 o o .=(rt -o(D =ah atq)(,o @ G -o -9(9 (l) L(l) =,c =ar,E L = o >.o =>r+(E <t .E ;.E Eo o,e q) o E6 Eo .= E.E E(SSE)tr o) @.= U' c(E o. oE(!(L o .= E o, o (E cno .; o ol q .E @o =o E'CoO ci co o, .E oo E o Loo-q) E, oa)e JO sr(odh .(l) ul o UJ oo d, .:: u) h o., -Y == (D g, =(U g tY'a'= / .tEg EU.E Xs2 Soc)=-oElEt- .o.= o (E.E EL a, oo rrr- oo !ai, 6t oolr) oolr) oo r.c, oolr, oo ooC! oo(o^ 6t o q) att (g atoo-oL o- E'C(E o .9,xo(J -ERL< ,ni9b =(J3e,o.L5E* z*6 E a'gJo cl< c.= o o.!2 ==t ># &b -.= Pb!a6 9HE' U' .9.xo C(Ed E'o F= 8E g:= a6 o- (u{E HE d = HH EI(D lJ- I c(E - o-(l)a I o)cf - -= - >\ - ii oo C) i(E z. ii oo() ';(o z. iiLoo C) (E z. ii ooo (o z. PEsi6 cn a5o- oP .=ogE - art .Oct6'; .N q) ^.r= >2= flE5 r-lJ -2.EOd(9 _t@< z.oI<og16 €! eZA.,a u, J Y,) '= p= 5e == =: 'HgEEEE .xot\(Do (L[!(L z. o U' '.4 c .9(! N '6 q oq, o L -go- d (L UJ(L z. o .= .9. q) (Uq o -cl -go c) o; E o -ct at, I ca o c..l Lr (-) o o. o (n II cooo C.l La O d oA o C.lta oo aa, t oo CD. o E o -ct =C" e (0 oo6t LUoo =o () o o- I oo(9 z. I oo|r) I oola, -o =lJ- oo6t ooc! I oo r() oolr)6i oo(o oo(o ooot U' ct, UJC'o =C" t!o Eo s2o = U' 'i(l) arto cr(D o eo -!p *aho -!uo.= .!9 qro--c O.E at tso c .9 .ug o- d) se(b-E.PE6gE(t)(D -o>E'i5 -(J29. U' .9.gXge iD o. q,'g .E(DE:(!=E6o.-l(D O!l>so-'=8ii -t9 -os(E (E o-o =Eo (D .slo c Eo(o <,o-) ao c(D U' 'i q) clt o) -!P co (E .= .= o(tt .9o-oO - q .9 C) -!9oc) >, .LE9 go)(D> (D'- -=, =rod., = rD !i .-qu)= o o z. o9oE9 o, g2 .= o)ELtse =ftE; s(D@.=Eo.oxJO) (D -oE =C o LoE8E8r- o.i5 .e2OE oat(D -ctc(ECD€ u)6 EEfi8 *5ulO E(l) >. (DEa E= -a- 'E = = E.e =eS.H E E 3 ESE EE :ERUa= .t2. _Eirg$*t oI E, u.I o- (u = = - I (D C) - ) - I (D L - CD) I - j o z. I oo j o z. I oo o z. I oo doo I oo C,oo I o z. (,q)o =o - =@ = =- >\L E.E g ..:i e (5ooc(D>(E = c= C C, =c>SE(J O)o)> =s C(E =c>(E=NE oo)(D> =s Ei oo() (E z. 5 = +J(E z. lJ-LU-OE =E=o L'(l) o-q) o) --9- 6= c(E =c>SE oo)(D> =s cSE F E'g .EC(DgEs c(5 =c>(E^Ni= o(Dc)> =s = =ts'ooO -)(gz =o c(E N 'E tto= .gb -,E EE =-u, <o e8e:(l,o E .tt(Ec o-.9 EE =-o(1)=EE -d c .9 c, .sl -o-o-(o aoE, L Gl .N o(D =o c .9 -g i5E 6i.9 Co (E .sl o- o-(E (t) E, E(! .N(,(l) =o =.tpdqEE c., € Iq) E. (Eo- .No6>(l)- >os (r)OE .E€ tl, e .!2 5 =(g =c)J:u) o- .o-s(E (! .N oq, =o co E E(, e o- d c C, .N(Jo =o (D o)(E o U) <ci o -!9oo o eocE(E o-l4 s(DoE c(E (u6 .=N cc) -(l)F-= CI'oo(9 z. o c(E .!J oo =EE >,c 9N: al,ooot6 @A o o =U, -!u -o(E E .g o-xo o (E Ior 'E -O6(o(r'6 or(E U' -!P -oc, =,(D .= o-xo o6U'oo- .9o o E o -ct3 u, ll! =C) ut dto qgFH o <sE E€EEfiEa'-Hl:6ES5iD.tsEE t CO c.l La o C) o o. o > ca(a 4 (4,oo(\I u.I(9o =o Oo o- I I oo|r, II o I I I I (/)Fo UJ -o E,(L =o&l! Oo(L aF C) IIJ -o E, o- =o E. lJ- C)o(L aFo UJ -o E, o- =otl! oo(9 z. I I I oo(o I -o =lJ- I oo(o oo(o oo<o oo <! oo(f, U'U' UJ(,(J =U' t!o E,o g o = art U' x o) c -g(L -!9 -os(E C, oco o Eq) c .9,a o o Loo-(l) E. .9. (l)oc(!n €F' o-=E(E<E (l) o Eoo-oE. .9. (l,o Gt g; o, -=E(E<E o o Loo-(l) E. ..4, (Do GlxEF' o) -sE(!<5 -!P .s atCo e(l) o- E(D .E L(l) =o ..2J 't6 -!c -o(oPE6e 6e E# .Et e * (Jr=O FE EEgb'R oc) 62 tt .9.x(D c =ooo(Il o o -o E) z. -!P -o -g'6 (E U' o) c = aD .9,xo atLq) -!p aho =o E o o .!9o-oO o -o -g(E (u tt C L o-o o o z. U' ..2xq) C(Ed -tc -os G, G,(r, Lo G,E '6 (E o .9J -!u -o -g '6 Gl gq) -c(J)o Eoc .9r U) cn .E .Yoo -o o .g(l,o(l) E. o) -o -q.G (o .9,(! L(D(! = E o) F_C o-o b(/, o- ah&E .^ o. .ea boo P_2. €F o^EE(E<.= E= s8 *= o >_ ^l= L E8!8 oreCuth'E.e E E.E <D -tr, 'E(9dE co o)C Loo-o E o) o- -UEc) (D FEqE5(E5 E-9EEECL (EEC E 2e, '16 EE E= 7e ,*HE 9=.E I;e XEeE'Ov-c- cL, E o6 g 6 o or 9o E$EEEE;EEE= FE-E oI E,!! o- t e(E = .c e(E = = -I c,(! = o z. IE e C, = +;oo *(E = !o C, =I -oolJ- IEp(D(trE =€ o. Q)a o) (l)q = - -)ooC) I) - o- I o (u = 9;o.(D U) +;oo +joo ;oo o z. I oo =o - =@ e(Do o ooF *)C'o (J o) 'o (L ut u) ts(Doo EE G-ccooo)NF eoo!e E8FZ, ; .t) at)6< c)<.E -tr .E- oo'It= ii ooO *) GI z. C) -(Lo ;oo oq) 'o o- e(D o o .C(J o)F eo(J o i c) o)F tsR-q8 t6(9 z. z. ELooO (E z. +Jo(J oo 'o (L art aht, .E E U'o L(E Eo o) c/) IIFo z. =(, o .!P = C'(E cn .E .Eg o C _(E o- - o al,(o -!co atEC E)U' ut <ri tro c) co ttF()oa = (t)c o CDc c '6 F c.i ol-tir (E OEao oo) or.ECE '=o .= o-(Eo oclE .S2 "oEP8 'Fa F:c .c$o Eo o o 'a *. i5q 'o.E o-o E=Oei60?9 .E=OE &e .orr,< o -9 .E Eo() E,o o c .9 (E €e =(D(l)=EE -o -E e0,o!p'a =(!E 'ii HE oQo+3= !J O) Eq€E'(EE EEE C (E(J .9 c-ci6qe .E: E "Ep E,oo o(! (l, o-oth(o o CD .E o= ^*O\J c) .c)(f)(E O E.oo (D .C o o o) L .E o) o) + E, o o oco co an C L o- o) g (1, €.E -U' C,!P.qqdqr-Et .olr)+ o U'tsoo- E U' .c. u, =, .n o-.E:eoo -ot .:/ -cEE 'ao Ee.boL) E. .dd E. o co anFOo CN o ol '= eJ,(!= 5=F(E C, U,(EO -otPr\ O. eo CI ='6(o o:= s od .E (l)I d o(r, C,(D o) al, EC = c))oc UJ o; o =Co o --oo co ci o) att o .9,(E Lo (E E E oo(L - Lo E. o co o) .E ==.t -o o) .b(q '-o cbPodE9Ec\lo F(, ul C) UJ dlo 5 .999bE EEP >.s) (l) o- =.=- c c) E-B E= 6.I e s'98.g s E-EEEEE > I I coo C.l t<q (J o o. o Jr $(n q (l'oo6{ lr!(9o =o c)o(L I oo(9 z. I ooo^ (f) I ooo(,' I -o =lJ- oo ,.cr- oo6t oo ootr) oo6l CD CD ur()() =al, u-o E,o s2o = .= =E(D(!EU' 1' L(E o .4,, 6!u c!2<s7(L= o) !o o Ed)G .91 <D o o Loo-oE, jj .9. o)oc(E 9-EC -9o <q) lJ- LU !2 z. = .E -r9 -ct _g (E (E Looo-o(l)E(rb ahq(t) o c .9 c, .= .E o U'(D o- at6E .8 EE -u,Gl- -cF -oEOFE@P E(E ;E .axq) Eoo- E o -(5 E E) <D U'o =cr E o -9 o)J o at c. .!P o)o- qlA o.)C5E (l) E' c, E (E E U'fro .-o E., o,-..t oeoe2.6 Ico E ooE a C)q) 'o o- Fo;s!ao EE EE ts8 *= ouo 3a =; E.E 8; EgE Ag!E E E #Es g#Es Loo= .F_ - =.EE P; E E AEE E EHEE€-=.EE€Eq=o k:- (D =oE tsE E.EO ctI E, LU o- a.tt =o) = *j(Jo ooo (Jo doo doo I -oolJ- o(l)o I -o(l) lJ- oq)o I -o(l) lJ- <;8!?o :E(D=o5 o(l,o I c(! - o(Do I c GI - =o I = co E€ 9'E',qo- qOU-NUJ -(JGZ,z.= +;oo (Jo 'o (L II uJ S2 z. =yro)6 ,SroiEEoq6 -coE'OFo- !ooF E' ooy,o6 -:,9 .E iEz.o (u (EoiiooO -;d:g t- o) =(o(!o o) =(E (Eo C)oF tsoO.t(Jb -iC)(E!F2.6 Eu;(J (JE<o€ -() -c(l,O'a-C,EFO- oo u .E Eoo o,c Loo ct) =C' =8B5(Eua Po .= -g6 .a/,EU, E,EL I d, I -b lJ- .n lJ-J E= O) -tL E=dl; -06 oU,(E -!Po) atto L E atC UJ cri @ .E =IU) od >E@696OE' or -19CUt '='6(,.)U' -c<P'id, llJ <D. =(.)J =T(E6'6 oo .g) =<U) lJ-c) uJc!2oZ -- -tH6 85 .EE oFpiD >EY(D o- E- <.= E o -ct =(r, E e (o cl sD "br-ciiE58bo =oE9 6bo(D(ri6 -A E e at .s2 at (u(t troO o c .9 oq) :UD o(Doi6 6I CD E e U'o tt (o U, troO o Co (o :UDoo()t6 (tA =,6E .bEi6etspo-t(D5. aE .90 fr2 =at(1)F(rE + (/) 'tr,c(E 6 .s2 q C)(t) ^ att .,, C,q)=96 =s-o p,bE _qbE 'E- ao.g6PO6 .L!o r= o C, Gl (g .!2cEo o) ui o cDE,a =s;E .!9 E> 'ti(t)=(r6 .L(.o i= ul () llJ oo <u .=oA E.3 EL-ar!': E H E Ea= =E e686=E3E=E P.E.E;U 6 8 E 8 E.E o.E oxBEse ;EE E E E fi Es E i 3.8 gSeEaE*.E:'-EEEF (D.=.= (E g.= (E O-<' E ooL aF C) UJ -o E,(L =oE.lJ- I I oos oo r.c) oot I oo(o ooc! ool{a c.i q, =o9E(! 8-8 ea .- o_ .eE oo?z= .:9 CD EH.E .E6.= -akPa .9.x(l, e(D o oq) oo o o .!p o.oO !, o, .=oo o) .9,(o aho o.o o o o z. E(D =.tu E .9,(E(too.o o o o z. tn .9, u)(ge iD o. e'g -L O)E-(E= Eoo.- =q)o-o>(E+'6(5e o z. cn ii(D l! c, = I ..ct(D lJ- o)) !o (E o) = c) (E = o _(I,q.E OE 'EO(Il0 z. L) Eooo (o z. aD o art L .E E EoC) cnc Loo ct) ah at .D E .E !, E. o co U'FO Eeb.Eqr= .io 'F3tre c.i e -O .9.(o(t oo. e o. Lo U'o =cr(l) E. + .9,(E(t oo.o o. E, o o C .9 -goO d .9.(E ahoo. e o. E. o o =.!c q) E. @ o -9,(E U'oo-o o- t o o c .9U' .9, E -o = a\cn6 iL;< G o ll =cr, !. I I cooo C-l La O o o. > (n(n q <,ooGI ul(9 ct =dl Oo(L oolf, oolal, oo(9 z. ooq.(.) ooo- CO -o =II oo(f) oo(r1 ooo- ooo oo|r) oo|r) aD(r, uJ C'o =aD l!o E,o s2o = iLoo-(D L G'p8 E9 <o6=(J- c(D -c cn()E' o)=F-o C,' .!Po-o(J Eo()o tsoo o :x = -os(! o E) o) o oq) 'o o- Foi9oio-.= EE jj .9oxco =>(l) (D= -LL6q)P g€p Ql4o Eg?b ts= =b td5:g co aD o) o- c -gL ,9xq) eo(5p G o (r, = -!9 -o -g(5 (o o .c C) =o =,(Dc .9 CD ah .!P .=c EcEO !/ (s9: .edEObo.P6bs -(Eo- v, =. == att ..2xo c -go- .tt .tt '= o) eo (E: '6 (E o .tt = .9xo at)Lo -t9 o .t)o 'a oo o)c .Yoo -cl o o- '6 ooE. -r9 -os(E (E at .!l .9 crl -9i(E Lo (E = EE H8 *= FE\J (E d) Q)o -C >\E O)b EEE =oFaiob a'= (op Ee H E E +8 q9'EuJ(, o o c g.-E = e Hg=SEtt s EEBEg -Eurho .IP.Y E .=(Ui6 =?oEEH;oQoiii o eE'€ P.P:O 6b E6> .3EE€ G, U'C" =CJC -ij 6= = =, =RG,-(DE.LY+cC) )/ > C (D s6 €EtI=PE E3=HPFE E B$ He,g:Fc E aE 5€.o ctoE ut o- o _otrrooo-c!t Es 'lL()>89Gt- <rio=o5 dq)o I (E - c,(l)o I L(E - o: = o: = o z. I o- Q)U) (E = (! = G, = (t) q = - oc = - =o - = m ii -.i(l)oc)oE<o6 -c (D8'oFO- o(l)qr.E (l)Fg6 a<) ;oo C)o 'd L(L ;o(J C)o 'a (L =iooO;(!z =iooO (Ez ioo o(D 'o o_ eo(op (o ts..o=8= -E(o(!z.a Ei oo C) J(E z. ;o(J o .t9. e o- J G, z. >rEEo-o(Do o(J U' aD ._i E <t =q) ui o cD =,) -o .U' o(l) Aq, 68-op)z.= 5(Eo'6 ;i(5 E=G' (Eo- c)(D'=rE i@ g(l) CDE -cl -'n u)dEoo ra 8EZ. c. *(Eo.E =-<o)(u '= .s2ocE,E <.,i g E o -ct (rt 'cn oq) .6. o- o =.q a.t(rE "aE -o '6G o'ticr=EE .L -lF Eoc(E c .= C) 'aOxo-6< 'do *oo6-s3g- '-at oal, =B9 JLa= c.i E E o ll =cD .E c .9 Glp (E ar, =a.l, Lo9,n6.9 ?6 'Eo e(D(E?i o_ -!P .o -(n eo (Ep C, o L .9 Glo .E L(D =, Gi o ah Clo E atE'c = E artc r! c.j t6 fi# *6gE(t <)c(De6eu, oc -'= =o)'€a =r-F8 -'o +o- E o tl) ct, od oo-o G, =.E =(DHtsiE E8 eD= .= !p IE iEE EDLGIOch(E EC(EE a- (! .(o -:O E o) .Eg (D -o o eo G' =o(E > .E L o) =6i o) att(E -g(D t, =tc o) =attc ul c.i ooo .E oU eo(5 .= o(E (D .= s + o co o o o:c(E E ,rt LU =() uJ too 6pe- E0l b..e.o E E E E "P?-a;*EEE8F g.= o- o-=, .>F :9gEE o== .a E'5in ='FsEtRfr €:U : €C'E,E E .ss5,.EE.g E.F = *.s2 E iD E EE EE E 6= 3 € 9 E.EcD E .:= -^ E EE E gt 3 -E.E E.Ets->,vcnu, oo ro- oo ao- a oo t, .9gX(l)(l, (l)o. eg -s o)P:(E=E6o.-ic) o-o >(E+'66e ooo I c c,? CN U'o .d EE' ";96Y8a .Ee F (/,OEgOoo. 'E o) =L8E>9 -oh cc .9(= .8!c(E>(-,+l'= a=u r-g E o -o)(r, , a a I a cooo c-.1 Lra o Ci o O. o \o lat @ (oooGI UT(9o =o C)o o- ooo- s oo(9 z. I I oo@-(o J-o =lr I oo6{ I oos-(\t at,(t LUoo =(r, lJ-o E,o sl ct = tl, .9x o) C(o E al,Lo -tP o (o .= ;o ato o- s)o'=O6D o -o -g(o C, g o -co Jo E o)c .9')U) E'IC oo E o o ij ut(,)(D:- o)=P=(E=EECOoo.E(D<.8 U' .9.xq) c -g(L EE H8 *E 3*;E E rgIE EE 3,eE Eco<E =NEO: L qLl2(l)Fo)J- O-= O- -FO) ,-r e(Jo- -oo at c.R.9 ii(E EE>F eipo- o.E.E oI E,!! o- ci = 'E>o-o<2. 6 'E>o-o <. z. 6 = 'E>o-o <2. 6 = 'E>o-o <2. .c, c) (E =I -oolJ- =o I =6 af, =,oo C) E oN (t)E ooO E oN ttt C)C' c)o 'o o- .J'Poo(J (E coN =igooo (E z. =() U'o,c oo E FlJ-oN o CD .E LC -g(L - at CDc oo E FlJ-oN o c .9 (E .= s ci (D U'(E -!c(D oE E oc UJ c.j o) o)E E Eo C) o)U' lJ-FoN o 9a '= ollJc96 +E CDc q)(t) E (l, Eo -o U'U' eo s'= a(D6odg ,rr'= LU o uJ oo b -EE .o ft';8;F€ 3 E HEEEEEEE8e85E ooo- lr) ooo- oolf, ooo- oolr) oo(f) oo(o cd ooo- <\l ooo-(o I oot\ oo|r) oolr) oo\@ ooo- oo6r oolf, ool.c, oolf, oo@ oo rt'il a o ! o 1=oo- o)E, i, .9. o)oc(E61 (D-E E(E<-= (E (o E .E E'oc '6 a-L-8E o;ia=EE O(Ez. e. E o) E "o It6(EPh(EE .b <o Aau8; 8.85>o6o>2.9 .lt a/, xo E(o(L -!9 -os cl G q,(, o E(u L .9) U) (l) os(t, G, a.tt .s2 ..2 CDoJ -9 -ooS :Eg>(o >\ 1=xo =0!P ii3gttt a) oo 9E o .tt(! -ct(! (o E' <,c C, E(D .(o -^E6g s.889 ..2xq) o o) = E E(E U' oo !,oo =U)Ego-EF(U6o.o--c(D.=G= (E I(EaC <r_ 6 (g E EPf; <)92oa.tAEETB c(/) e (D-sg €sEEe *t 9 s.8 _9-(D(5(5(J.= =, =, c oc) - .> - CD I .> - (E = q)c = - - o z. I) - d o)o I o z. o z. C'(l)o +t .J ar,oo) <'E -(o8E '- c,EO) o- u) E Es:g uo_o< e _(DE.PP6 Lo cn C,c G, = (o (Eo +;oo o .tP. e(L E*o.t o .o oDFLE88E o cn(EC(u E (! (oo b o) -(E ES L Q) o:(uc(o E (o(!o at .!2 .9. CDo =I(o Lo(o E o oo, L(E ts @ E(E E _oO(Eg c(l) .9+(oC' €E oJ2-c E HE€ o=c PE E '=oo .FE8 'o(EF-g= s# €d6 et,og P8 ,E3 F'- o-c =9Eg6qlrE <,E (E(! =tFoO at(E o- o C .9 o -!9oogO .9=;= EE .(EOrc U'E'c o q) .t)(E _9 E c, =aD Ltrl o .9.(o Lo(o E .J' .s2 ..2 CD -9 E =(, e(L - c .9(, -!9oo (E (E E o c .9 .9 a(l)-. o- )x 6'A .(t.)(\x F(l) op =c .9 C, (u G, =,o co(! EO d Gl(o E' Lo o) L 'ao(D F(D e()oxE)<u) q)al, -s.Eut -.<6 .:so -c) (E (oE coEoo-(D <D =, -=oe aO EEoL EAA.=&E .:lr)o F(, E o lt =aD ! cooo C.l A o () o o< o c-(.| 6 @oo(\t UT(9o =o (J o(L oo(9 z. -o =lJ- lJ-o E, ocnFU' < r-rJc) (J a- sl =.n tu =o(, =o o LU C' UJ o-x uJ aI E, !.r.1 o- =o ! =@ =o ul o ut oo lJ- o ooot' a ooo- 6r ooo-(\t ooo- 6l oood I a ooc\l ooG' t I oo|r, ooo- GI ooo- C\t ooo-t\ ooo- <\ oolo(.' ooo ooo- oo|r, oo (O oo@ oo(O oo(O oo r.c, oolr) oolr) ooo-(,(\l oo ra, Gd6t -!p -os(o (o (l, =o =o E'oc .g@ o att .!9 o-o(J Or a, .Ex -- (D Og9(l)E'Egd)o- =oO.,(E(J .=o>E.= o -o -g.G (! .9,(E L(D (E = -9 -o -s(5 (t, CDC (t)(D E o Loo-oE. o c -go- oo ..2x(l) eo .= o=' E'E -o=66 JE .E (D -o -g'6 (! t, o)c 6)(l) E €nt (E() o-- 5 eq) -!Pco (E =s o th(D o,--at -9x(J O) (D -o -g '6 (E o) -co)o E'oC cD CN Eoroc6-= EE U'A gE €EOEk= (l) oEoo- Q)E. .9 Q)(,C(EqE-s ;i o)E!U<E o o Loo-oE. jj e o)oc(gq) !r.= ;i d)i=(l) <E oE o Loo-q) E, jj ..2 o(J Ee,PEgE <E TDc oo E o .c, oEoo-ou o o -q) .qC E EoS2otc 8_6dr O.)E,E .E C(Da .9.>.= oo(D = ocoEr= -l-=,a(,-o)o .E EE= :=ts5 a E =f e oCoE8 -84eE o- O 5 E.E oE =(,)OEE:Y(D-c(l,(E C):='d E 'E t!.> E d)F i6 E P:a!€ u x.E :(o .E 5e(J.g -C6!Qca AEEo- o-'FECE : o. I e(E = >r(E =I L o- L o- (E = q) C, - ;(Jo L o- ;oo -G, = ,;oo -(o = oo -(E = o z. *(E = (! = o z. I oo (,oo I oo o o)o ,)o(, o .!9. e o- al, tt at, .a Et, jjou)oo)<'E -(E8E'o8 O. CD PooO ':(E z. Eoo c) +;(! z. C) <n lJ-Fo z. o d(l)a c)(n lJ-Fo z. o do(n +)oo o .9. e o- .= tsEo(J €si6(9zz. E E8O,: -J'6(E-C z. <) -.E.H 5,3qorH 5,€ I Eo,.6g i52.z.= EEOE 16bZN =(go .--EEo:- -a iDez; 5S c, =,c o(l) U'(o -!c(D (D =ttC UJ @ o al, .9, oo al,oZe(l)o) >Eg(D *.9 o(o 1'Et\ .= ah Eo .= oo:o(l,(D c o (,o o- €; CDc o)q) E q) Eo -o(r, U' eo =oJ- o; E C,g o)c L .eQut:I(EEE E(E :ab -e'E .eE EaooUJts =E E o -ct =at, (n .Eo69)(D.=gE FLo=7(l) q)oo -EPb .=oqe G'EdE .o e() CDc. ut 'E c, o) .c 8E LLE EA1> e& .eE(E.= >=ch -o6i C) (l)t,(E -!cE ah =,c E U'c UJ c.j (D o) .E Eoo -ct) ctt lJ-Fo z. o (J = attE8R6 +E ooc o o) E oo =,CDE .EE oo(t)o -u, -o olQ EE =r.=CEo=c)51rro E o -o U' E U' o)c o)oEo a8 '= u)9o -o)6 -9, -E €qC r\o)< a\ (J:o- -{ o o)C EEc(6 =cn ..D P> .:4,aut;'s (Jl = -.'Eho(J 1 6t -) oo)c Ea e6 BEru, ofil(D(68lsoEO -g(9 <: c., € al, o) =o,o E lJ- -o ooc(5oc o) + E o .ct =(r, (l) .S2 .-ch:(trEr +i EE h r ab di o6 = E oE EgE €EE E E b =, E ts-EE O (lJ 6';8;E€; AfiEEEEE € E t P 8€E i cooo C\ Ha (-) oA o > oo(.l I oo(o- (f) oo o)- 6r oor.) ad ooo- oo(o- t\ ooo- <\l oo @-(D o(Ct u)|fi ro oo@- + oo@ t I I I Go(c'|ft ro I oo6l o oGIt\ o(\t CD. o ootr) oo@- oo(f, oo ---(\l o(\t(C) ed Lo o =o>(DEE(D(E .oEs).E E= 6HAQ) =b a EE€p as E= .E,Ha9) =b a -iE Ee 6 E Eg c .9 G,o EL @o =,(Dul =,.92'6',6 5-E.E ro€ EHEoE?- B*E q) !o =o>o) oE(D(u =(s5'e o o- *H€E5r>(l)= EE E =<E >\. '> (E(r(EO. u, s o oU C,oa E-* -(Ja-oz @ EEEECcERE=E= .= EE E _s o o=J o-Ct O -(Do.g(D=3e aho .i=E=e. @ .t,E EE .E.=.> _s cr (JJ(D(5 slrOF oO -Y, -(l)o - o BE Y urN,a!PE CEfri EE E @b.:9 d)tt >=L(D(rv= >:5E-=o ts o'= o .E oo'O H 8F ct 0-E< (,oo I c(E - (,oo I i cl - d o)o I i(6 - (,(Do I (o - doo Ii(o - ct o)o I L(E - o o)a I c(g - ;oo (,o 'o (L tsoO.D 3eEE€E '):. (-'E€8-*r -(EE(l) 5F5E- *joo oo 'o (L ato L(E Eo o) CD ioo o(D 'o (L i(J c) o(D 'o (L c .9 gGloo (l)=6=(!E(DF66;,lE ,t .= ei:e. =qro. c)- ;.l F"6 =F.td6EcFo)q Eg, -EUl EP3; BF(-) =Eg EE(E .s2 =a.oGT U! Ec o6E?crc EuD o8 E*'Eoo o) '"etr(E q)COcr o-EE '6 .!p ==.oc., c, E o -ct JU' co Eo- '= oo o oo L(E c o) C '6 = - U'(D(JE(D o .9(o o- @E.(l) oC C,c(D .E C, =6i vt C)d) 'd o- o o(t(E -!uE Ec lJ- - aD(l) TD(oco .Yc(u -ct o E(D E>'(E o- c.i E o tt C" :5o 'F-e 8E E'E E = E B PE*EfE ah - .!2oz;E gB !a(llo?<b.EE.E.oE-EPF od o- >-iE6 5Lh '- 'EL-aE,^ H'aEEt€ - !r €'F o- (I,O Cb E Csl- (o o o-.= o t ltz il Gti Gz q) U) Gq) q)L I .v U) H c) L o o o o +. E L oU att o o I a I oJ .9 ar', E ooo(.l F- c.l o orn$ oo ON ooo OO cn o o$c- o\ ooo l.i o\cl oo o c-.1 oo O co oo(rl OO rr|\o c\ \U) co .:OE dtr()Eqb o (cA o o o z \at c.l co \o € co ra (n cn co\o € o tn c\ C.l$ o\o c\ <f, \o car- C.l co t o\ co\n oOq C.l C.l\o (ll o (H o L t) a o o O o(n $so rr| st oo o o\ c.l o\o c- \otn c.t ooo (n sf + ooo O o o o lat o o ca\o ooo oo t.) oo 'a l.<a o o tr (n z d B(o (6E o! (d 3J/ o (d ca o () m o Lro ca l<o & U' .r) oliO o €H (\l (l) a jt rI] o0 H ((lkp tr GI >. o!t! coo N Lro o O o o< o o\rn bo4 '5tr o&oh l-r()E F) Lr(lI(l) >r o - e k € (r) e() o 'a L{A F nO (! o € o2LiDotrEEEH.G=c(!OBIE? hh.9'^oE Ei\o9,EL=g.9E tFge -fl-(tL ! ';-io'EdczH .LE-H rVL -rt;^o:; rr6HtfEE ..EH3atoE.,, r!!l- E c{l!Ft(r.ol lll q €lfati#l 0 I c.t O(\.l Lra o d o o. o \o a I I I I a o O o $ o o o\o oo o o\oO$ oor\ ooo ooO o{ ooo(n c.l$ oo o^ C-l co o o o\.r\o ooO \o € ooO oN rar ra1 €$ o \o o\ r(n ooo (rl C-l ooo € o\n r+ ca o t ?a ?a ttN ooo (.r c..l oo c.lor- C-l (\t ol 6r- tr t\ ooo oo ( oo c.t oo o^ N c- oo rn c-.1 o o @ C.I ooo Oo o^ ooo o (n o o C-l o ot €q \o o\c\ oO o c-n o o oo € ooo r- co t)6r- r- o\ €(a ?a F() r! op o o (65 (C 3d oo CI aEdv o (l v 5p oV 'a ov (! l-{(l Bv o o0 z o0 o o tro U) o o >.o (o(.)(! o. (R B(o 6(h t)(6 z ds(o li(oF (l) !o (o l<d tr(! N 6: oF t 3 a c.toON Ha (J o O. o rJr \o o U' o ! t< oo cr)(0(J o o0 li oaol-r o .rt o o F >. o Fo(J k € u) hi .9dEs =aru o\os dB t) c^(o qi o'Fbs9{trC) ,v,H\ tl, Ic.ac\HS'4p Y)1s .;\ (J\,/ s €I cla sqjsaa()te9.nZqes l.r So.S crs(L)\J2qrdo";SrE<\ rh G'ui;6 s€A=,< ! aIf there are problems with release of counterpartfunds, how were they addressed? - Comments The issue of counterpart funding is one of the greatest challenges facing CDTI implementation in the country. To address this, the NOTF has done the following: 1. Organized a CDI meeting at national level which targeted among others States with low counterpart funding. 2. Had the Director, APOC, meet with top officers of various agencies and ministries of the federal govemment including the Hon. Ministers of Health and Finance. 3. Organized and encouraged advocacy visits at both State and LGA levels by the Zonal offices, the assisting NGDOs and the national office. 4. Published the status of counterpart contribution by the different States in the newsletter, NON. State the number of projects that had nofundingfrom APOC Trust Funt? 17 projects State the number of projects that had no funding from any outside source? 2 All other projects had some funding from their assisting NGDOs, but the degree varies. State the number of projects that are late in submission of the Jinancial reports to APOC?_10 projects_ 4.2. Other forms of community support Describe (indicate forms of in-kind contributions of communities if any) Communities make in-kind contributions in the following ways: o Purchase of hard cover note books for registration of community members o Provision of venue for CDD training and hosting of CSM/SHM o Provision of refreshment during CDD training or visits by health workers/ extemal persons o Provision of foodstuff/farm produce to supervising health workers o Provision of motorcycles/bicycles to pick Mectizan, submit treatment report, attend training o Provision of in - kind incentives to CDDs. These in-kind incentives are reflected in the following areas: o Free land allocation for cultivation o Loans for private business or enterprise o Nomination for appointments/election as Councillors/LGA Chairmen o Exemption from community levies o Exemption from communal labor o Gifts of fairly used clothes o Food during distribution o Gifts of yam, rice and other food items particularly after harvest o Nominations to represent the community in duties where monetary compensation is given o Special recognition during celebrations or festivals in the community o Assistance in farm work o Prayers o Appreciation such as "Thank You" 62 WHO/APOC, l0 April2003 a4.3. Resource mobilization efforts Describe activities undertaken by the NOTF to raise funds or mobilize in-kind resources and the outcome of those efforts. Fund raising activities has been limited to advocacy programmes (visits & workshops) and approach to NGDO partners for resources needed. Outcome of these efforts has been described in various parts of this report. 4.4. Expenditure per activlty by the NOTF secretarlat Indicate the expenditure on activities below in US dollars using the current United Nations exchange rate to local curre,ncy (=[\=--------.00 to l$) Table l3: Indicate how much the NOTF secretariat project spent for each activity listed below the f Amount used in the production of NON *This represents top up allowances paid to project staff Comments Activity of NOTF secretariat Expenditure ($ US) and Source(s) of funding APOC MOH NGDO OTHER s00.00 700.00 24,502 400.00 9,891 Drug delivery from NOTF HQ/entry Monitoring and supervision of CDTI Training of Project officers, TOT, NQIEgeft-elc. Advocacy visits to health and political authorities at national level IEC KAP studies, materials _d91el9p41eqL _B i qqnqal N_O- TF__meeting_s !9e_! and mqiryqqg4pe_ qt vetrlgles,-___ JVlaintenance-gf g{!-qe eqlrip{ngqt _ pglnllg_proj9-qF, Annual review districts, etc telio:tqtv Others* 6,048.40 1,280.85 1,229.97 1,526.57+ 3,886.82 2,493.21 15,636.24 2,179.51 2,404.67 15,634.63 2,000.00 1,500.00 1,010.00 5,550.00 1,900.00 TOTAL 52,320.87 12,460.00 35,493.00 Total number of persons treated 21,166,922 63 WHO/APOC, 10 April2003 l4.5. Equipment Table l4: Status of equipment of NOTF Secretariat Project (Please add more rows if *Condition of the equipment (Functional, Currently non-functional but repairable, Written off). How does the project intend to maintain and replace existing equipment and other materials? The NOCP HQs Support Project intends to maintain and replace existing equipment through the following means: l. Requesting further support from the Trust Fund to replace vehicles and the copiers. 2. Seeking the central government increased support for the maintenance of the equipment and replacement of computers and printers. 3. Approaching the assisting NGDOs and UN Agencies involved in Onchocerciasis control or prevention of blindness to support replacement of equipment. Other members of the NGDO Coalition (SSI, CBM & HKI) have given a desktop, two printers and a fax machine to NOCP to complement the donation of a desk top and printer by the country office of WHO. This is sequel to a fire incident which engulfed part of the Federal Secretariat where the NOCP HQs is located and burnt practically every office item. Describe the adequacy of available knowledgeable monpowter at all levels. The country is blessed with more than sufficient manpower. The problem, particularly at the health facility level, has been the under - utilization of the manpower available for CDTI implementation. Affected projects are however being encouraged to ensure that staff at this level are well utilized. lYhere frequent transfers of trained staff occur, state what project is doing or intends to do to remedy the situation (The most important issue is what measures were taken to ensure adequate CDTI implementation where not enough knowledgeable manpower was available or staff often transferred during the course of the campaign). Projects are advised to either train as many of the available health staff present so that transfers will not hinder project implementation or reach agreement with the poticy makers in 64 WHO/APOC, 10 April2003 Other donors NGDO PrivateAPOC MOH Type of Equipment Source Condition of the equipment * Please state l. Vehicle 2 (F) 2. Motor cycle I (F) 2 (F)3. Computers 2 (F)4. Printers l (NF) 1 (F)5. Fax Machines 6. Others a) LCD I (F) I (F)b) Copier c) Generator I (F) charge to ensure that trained staff are not arbitrarily transferred. where transfers result in the removal of trained personnel and emergence of those outside the CDTI cycle' the replacement, ur. uruuily trained by the assiiiting NGDO personnel in collaboration with the Zonal office or the national office personnel, particularly if this is at the State level' Some times the SOCT/State Coordinator provides ihe needed orientation. At lower levels the immediate higher level ensures a quick orientation or training. 65 WHO/APOC, 10 APril2003 l a$EGTION 5: Evaluation for sustainability of cDTl, lndependent monitoring and other reviews 5.,1. lndependent particlpatory monltoring/evaluatlon 5.1.1 Was any independent Participatory monitoring and/or evaluation carried out during the reporting period? Yes Table l5: Overview of when monitoring and evaluation undertaken (Please add more rows if *Internal monitoring bY Partners with monitoring of implementation of Project Name (AfterYear l) participatory independent monitoring Mid-term sustainability evaluation (3'd year) Independent monitoring after 4th year Evaluation For sustainability (5th year if necessary) lnterna I monito ring by NOTF Other evaluation by partners & monitoring implementation of sust. Plans Adamawa Akwa lbom Bauchi Benue Borno Cross River September Edo Delta Ekiri Enugu Anambra Ebonyi FCT Gombe lmo October Abia October Jigawa Kaduna Kano Kebbi Kogi June Kwara November Niger Ogun Ondo Osun Oyo Plateau* June/ May-Dec Nassarawa* June/May- Dec Taraba Yobe Zamfara sustainability plans combined 66 WHO/APOC, l0 APril2003 5,1.2 In general, what were the recommendations? 1. High-powered delegation advocacy team to the state policy makers with the paiicipation of AP|C management is urgently needed to solicit for release of funds for CDTI activities 2. lntegration of CDTI in the Nigerian Federal Ministry of Health should be pursued to "nrur. that CDTI activities are integrated into all PHC activities. 3. ApOC management should consider supporting core CDTI activities like targeted training, monltoring and supervision, health education and advocacy for some projects. This is crucial consldering ih" fu"t that there has been mass transfer of health staff across the LGAs and somi of the staffs are not knowledgeable on CDTI. It is also apparent that government cannot at this time train these staffs because of the high cost involved and the poor funding as all local governments 4. NOTF Nigeria should hold stakeholders meetings with the Commissioners and Directors of pUC from the States' Ministry for Local Government and Chieftaincy Affairs. 5. SOCT should empower the lower levels to carry out CDTI activities and estimate their ivermectin requirements to ensure adequate supply of Mectizan. 6. State should provide effective and targeted supervision of LGAs and should promote the use of integrated checklist for monitoring and supervision. 7. Develop a plan for empowerment of Local Government health staff especially those at the frontline health facility level to enable them carry out their responsibility of health education, advocacy and general mobilization of communities. 8. Top level p.og.u-rn. planners should recognize the pivotal role of the FLHF in CDTI and empower it to perform its responsibilities.g. Instituti plans for motivating community and health personnel and partners (especiatiy at the community level) who perform credibly' 10. Increase the number of CDDs per community. The assisting NGDO or APOC can be approached to support the training of those selected' 1 1. Re-mobitize targli communities to make their roles and responsibilities clear to them. 5,1.3 In general, how have they been applicd/ implemented? In the projects evalluated/monitored the following have been implemented in various degrees: . High powered advocacy visits have been planned at national level for Plateau, Nassarawa as well as Ekiti in 2006. A stakeholders' meeting in the form of a CDI workshop was held in Abuja for Commissioners of Locul Gou.rn,nent & Directors of PHC in selected States. Major issues addressed were counterpart funding and integration' Onty the Cross River State project has developed and is utilizing an integrated . supervision checklist. Othei projects are ensuring targeted supervisions especially with funas being inadequate. Project implementers have started imbibing the culture of targeted su-pervision, although there is still the feeling that the presence of SOCTs and LOtfs areneeded often at the community tevel to ginger activities. Most LGAs have been empowered to initiate key CDTI activities, including estimating the number of tablets they need annually. There are plans by the projects to increase number of CDDs, but the execution is being hindered Uy aea.t-t of funds. The Plateau State project has however with assistance from the supporting NGDO gone ahead to utilize the hamlet system, 'zuriya', to get more CDDi ietect"a and trained. The NOTF intends to seek assistance from APOC to train more CDDs in some States. 67 WHO/APOC, l0 APril2003 a o a o aa Communities are being sensitized again to their roles under CDTI, but this is being constrained by lack of funds and adequate involvement/empowerment of FLHFs to do this. In few projects attempts have been made to increase the number of CDDs through community mobilization and sensitization. Nassarawa State started the deduction of funds at State level to assure LGA contribution to CDTI activities. 5.1.4 Any other comments? a a 68 WHO/APOC, 10 April 2003 5.2. Sustalnablllty of proiects: plan and set targets (mandatory at Yr 3) What arrangements have been made to sustain CDTI after APOC funding ceases in terms of : 5.2.1. Planning at all relevant levels. Following sustainability evaluations, States and LGAs have developed 3 - 5 years work plans of action. This development is a departure from what obtains in the past where little or no attention was paid to planning or where planning is routine, unrealistic and unreliable. lmplementers have at these levels have become empowered to plan taking into consideration the likely resources that will be available to them. All the projects in the country with the exception of Akwa lbom have developed sustainability plans. The work plans are being revised annually by the projects. At the federal level there is an annual planning of activities. The weakest level as far as planning is concerned is the first line health facility level. The reason is 3 - fold: lack of adequate empowerrnent, low levels of commitment, and inadequate educational background of staff. 5.2.2. Funds Counterpart funding is still a problem in most projects at both State and LGA levels, although there is some level of improvement. States such as Nassarawa and Oyo which hitherto had never made counterpart contributions have started releasing funds. There are however some projects that are doing relatively well. These include Ebonyi, Yobe, Cross River, Adamawa, Bomo, and Gombe States that have been consistent in the financial support of programme implementation over some years. To promote counterpart funding, partners have paid several advocacy visits at all levels. High-level advocacy have been planned in collaboration with APOC Management. To ensure availability of funds for the LGAs, State level staff have started seeking approval for deduction of funds at source for CDTI activities. This has been successfully implemented in some States such as Cross River, Gombe, and Borno. Nassarawa State has joined this group. To further cement this development and ensure continuous funding at the LGA level, a conscious effort was made to involve Commissioners of Local Government & Chieftaincy Affairs. At the federal level, counterpart funding is a still a source of concern. There was an improvement during the reporting period but a greater part of the funds was released almost at the close of the year, and to avoid lapsing they were used to procure materials. At the initiative of APOC Management the control programme has been integrated into the NEEDS programme. An adhoc committee in the NOTF has been set up to propose ways of seeking private sector participation in the funding of CDTI activities on a national basis. The NOTF is also considering the appointment of Goodwill ambassadors for Onchocerciasis control in the country. 5.2.3. Transport and equipment (replacement and maintenance) ln several projects, maintenance of existing transport and equipment is gradually being sourced from Govemment funds, but APOC Management has been requested to replace logistics where necessary. This replacement for some projects has been effected. Some projects like Adamawa, Cross River, Bomo and Ebonyi have replaced some capital items from govemment counterpart funding. Most SSI and CBM - assisted States have benefited from replacement of motorcycles and bicycles by the supporting NGDO. The same is true of Taraba that has some assistance from MITOSATH in addition to what was received from CBM. At the federal level, replacement of such items as computers, printers, and fax machine has been effected with support from FMoH and the NGDO Coalition. Maintenance of logistics is still dependent on APOC funds. 69 WHO/APOC, l0 April2003 5.2.4. Human resources There is enough human resources at all levels. In fact several projects have had to rationalize their State and LGA teams to make for more cohesion and effectiveness in programme implementation. In some projects, staff at the FLHF level are yet to be adequately mobilized and utilized. 5.2.5. Which proiects have submitted sustainability plan? By the end of 2-003 all projects except FCT, Kebbi and Akwa Ibom have submitted sustainability plans. 5.2.6. To what extent have the plans been implemented? In most of the States implemeniation of plans is reasonably on course. Generally it is being hampered by inadequate funding and late releases of approved funds. From the assessment of the implementation tf sustainability plans in 4 States the following issues were highlighted: o Non-receipt of the capital equipment approved for it from the APOC Trust Fund. . Implementation of CDTI activities is still dependent on assisting NGDOs and activities sometimes initiated by either the State or the NGDO. O At the LGA level, CDTI sustainability plans are available but not used for implementation due to delayed and inadequate funding. o At the FLHF level, massive transfer of health workers has disrupted timely implementation of CDTI activities in some LGAs. o Record keeping was poor in all the LGAs. . HSAM is weak at all levels. . Low therapeutic coverage (<650/o) & dwindling geographic coverage (75%) in a few places o lnadequate and poor quality monitoring and supervision o Little or no training activities conducted in recent times due to funding constraints . High CDD attrition rate 5.3. lntegratlon Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration. 5.3.1. Ivermectin delivery mechanisms In several projects, LGA Oncho teams (LOCTs) take the opportunity of picking their vaccines for immunization to collect their Mectizan tablets. At State and national levels, ivermectin delivery stands separate, but all the processes are within the government system. It has already been statedthat the country does not have a national drug delivery system. 5.3.2. Training Some projects have utilized the opportunity for CDTI training to train personnel on schistosomiasis, LF, primary eye care and VAS. [n a few States other health programmes such as guineaworm eradication & malaria control programmes use CDTI training activities to highlight relevant aspects for the trainees. 70 WHO/APOC, 10 APril2003 I5.3.3. Joint supervision and monitoring with other programs ln many States, project personnel take o-pportunity.oi iniolvement in other programmes such as immunization, .unitution, to monitor und tup.*ise CDTI activities' What is more common is the sharing of transport in programme moniioring and supervisio-n' [n some instances other p.ogru,,'." ituff r"quist CDTI personnel to collect imponant data for them when they are out on field activities, and this is vice versa. Where vnS is being integrated into CDTI efforts have been made to utilize trips for one to supervise and monitor the other' At the national level, no joint monitoring exists nor is one being planned' 5.3.4. Release offunds Fund releases at all levels follow normal channels within the Primary Health Care/Public Health department. 5.3.5. Is CDTI included in the PHC budget? At national and State levels, CDTVOnc-hocerciasis control is reflected in annual budget estimates. At the LGA level, some LGAs reflect CDTI in budgets but in majority of cases CDTI is subsumed under a general health line item' 5.3.6. Describe other heatth programmes that are using the GDTI structure and how this was achieved. What have been the achievements? we are not aware of other health programmes using the GDTI structure' However, in few northern States there are attempts 6V NPI to utilize community registers for routine immunization of children under Syears' 5.3.7. Describe other isszes considered in the integration of GDTI 5.3.8. Describe the integration of other programs into CDTI in your country and the results of this inigration-on CDfi @.5. It Vitamin A supplementation integrated and what are the isults, is screening fir cataract of primary eye care interventions integrated in all or some proiects, if io integration has taken place, are there plans to pilot test a strategy, etc?) , - -r rL^ In 7 States VAS is being in6g.utei with CDTI. tn PlateauA"lassarwa project, there is some pilot testing of integratiig LF-and schistosomiasis control into CDT[. [n most SSI and some cBM - assisted states, .Ifort, are on-going to integrate simple primary eye care (e'g' screening for cataraciti in,o CDTI. Inlormation auailuble to us indicate that over 93'000 persons ire being reached under VAS. Funds accessed for VAS have been used to boost CDTI. There are plans to integrate some elements of reproductive health into CDTI on a pilot basis in some States. 5.4 Operational research 5.4.1. summarize in half of a page the operational research undertaken in the country area within the rePorting Period' Operation research in the'fotto*ing areas was commenced within the reporting period: a The usage of the kindred .yrt.rn for the selection of cDDs in FCT, Taraba and Nassarawa States . lntegration of Reproductive Health into CDTI in Enugu, Ebonyi and Cross River State a Complianc" to und perceived benefits of lvermectin (multi-country study) o Effectiveness of the cD[ process for the delivery of interventions with different degrees of complexity, i.e. Ivermectin treatment, Vitamin A, Insecticide Treated Nets (ITNs), 7l WHO/APOC, 10 APril2003 Directly observed Treatment Short-course (DOTS) and Home-Management of Malaria' (multi-country studY) 5.4.2. How were the results applied in the proiect? The exercises are yet to be completed. The first phase of the multi - country study on the effectiveness of the CDI proce.r fo. the delivery of interventions with different degrees of complexity has however been completed. At a review meeting with stakeholders, the following issues were highlighted: o All partners especially the Ministry of Health (MoH) partners noted that the CDI research is useful and are prepared to participate in it' o MoH will ensure supplies to these sites o The distribution should be according to community timing o Drugs for home management of malaria currently used in the State/LGA will be used for the studY o Drugs for HMM witl be pre-packaged by the LGA in collaboration with the Research Team . only treated nets should be supplied to the Study sites o Research Team will ensure the first treatment before supply to the communities o Each team should make provision in their budget for this activity o Access of communities to re-treatment kits will be facilitated by MoH o The study will continue to use CDI in ensuring case detection regarding DOTS o Research Team should take advantage of the changes in the DOTS strategy to accommodate community DOTS and allow CDI implementers to handle drugs o Advocacy/debriefing meeting should be encouraged for the future 5.4.3 Note the isszes that have been identified by the NaTF for future operational research. Some of the issues raised by APOC Management as O/R priorities have been noted by the NOTF for future operational research. These issues include: o Causes of CDD attrition o Best ways for CDDs ComPensation o EnhancingCommunityparticipation o Reasons for poor sensitization of communities o The role of CBOs in sustaining CDTI . Causes of poor participation of females in CDTI o The role of add-ons as a form of motivation of CDDs 72 WHO/APOC, 10 APril2003 a a$EGTION 6: Strengths, weaknesses, challenges and opportunities Lkt the strengths, weaknesses, opportunities and threats of CDTI implementation process' Strensths Increasing level of integration of CDTI into the PHC structure Presence of trained staff at all levels of CDTI implementation' Lower levels empowered to plan, initiate and implement CDTI activities Good commitment by health staff especially at the State level to the CDTI process Mectizan p.o..r."., apart from the procurement, are well established within the I government system, and are working perfectly' . Utilization of the CDTI structure as a vehicle for the delivery of other health care programmes such as VAS. This has strengthened the CDTI structure. o Effective networking and collaboration among partners at national and State levels. o Community awareness and acceptance of the Mectizan drug remains high o Effective coordination of CDTI implementation at national level Weaknesses r . eUsence of appropriate skills at national level for the mobilization of resources tor CDTI imPlementation in the country o poor coordination of research activities resulting in ineffective utilization of outcomes in projects across the country. . Potr supervision at all levels, partly due to inadequacy of funds o Inadequate involvement of the FLHF staff in the CDTI process. o Low CDD to population ratio. o Lack of skilG Ly State personnel to address several operational issues using the appropriate mechanism set in ptace by APoc Management/TCC o lnadequate record keeping at the LGA and FLHF levels o Advocacy campaigns appear not to be yielding the desired results Opportunities -.A',uilubilityofhumanresourcesforCDTIimplementationata1llevels o Increasing recognition by stakeholders of CDTI as a vehicle for the effective delivery of varied health interventions at the community level o Early receipt of Mectizan consignments at the national level. For the past few years Mectizan consignments for most programmes are received in country 2 - 3 months before the beginning of a treatment cycle' o lncreasing involvement of local NGOs, CBOs and associations in the CDTI process' ta Threats -. Mass and indiscriminate transfers of health staff' . The creation of the Ministry of Environment in the south western States and subsequent deployment of environmental health officers to that Ministry o Inadequate counterpart funding for project activities at State and LGA kevel o Late release of appioued funds by both APOC Management and government. Several projects had theii financial years revised as a result of this. 73 WHO/APOC, 10 APril2003 a.t . Weak levels of community ownership in some of the projects o Payment of community based workers by other programmes o Some CDTI activitiei, particularly training and supervision, are yet to be properly targeted to achieve desired overall objectives. o Low commitment of some health staff at lower levels to CDTI implementation o Poor response to CDD incentive by communities o General feeling of well being among some target populations resulting in non- compliance to Mectizan treatments. Lkt the strengths, weaknesses, opportunities and threats of the vector elimination proiect (where applicable ). N/A Indicate how challenges ntere addressed. o Advocacy visiis to policy makers and appeals to ensure that some staff redeployed or transferred are recalled. . Appointment and training of 'new' health staff on the CDTI process. In some cases LOCTs had to be reconstituted. o Focused advocacy campaigns targeted at States not performing well o Initited moves for the mobilization of resources from the public and private sector for CDTI. o Encouragement of projects to request inclusion of CDDs in incentive - paying programmes at the communitY level o Encouraged selection of more CDDs along kinship or ward lines o Called for institution of awards to best performing CDDs and communities o promoted integration of cDTI with other community - based programmes o Suggested escalation and initiation of CSM in order to improve community participation. This is however being constrained by dearth of funds. o Management orientation of some State level officers in order to empower them deal with outstanding issues on CDTI implementation' o Advised projecis to rethink their IEC strategy to address issues of continuous compliance. Indicate how opportunities can be utilized to improve CDTI. There is need tolncrease the number of health peisonnel involved in the CDTI process. Given the increasing levels of integration it is ideal that all heatth staff are trained and empowered to implement CDTI. Invariably, this will lead to: o Better supervision of treatments and increased coverage o [mproved mobilization and sensitization of communities to participate and own the programme o [ncreased usage of CDI as a means for improved community health interventions If Mectizan can be made available early enough at collection centers and communities are aware that the drug is available all year round, it will facilitate the following: o Community decision on period of distribution o Early treatments, timety collection and collation of data, giving opportunity to impiementers to follow up on refusals and generally on areas of low coverage o Reduce proportion of absentees a 74 WHO/APOC, l0 APril2003 a{ t o Further enhance confidence in communities in the heatth system to respect their decisions o Sensitize LGA policy makers early enough to commit funds for CDTI before overwhelmed by competing demands from other sectors lncreased involvement of NGOs, CBOs, religious and socio - cultural associations in CDTI will result in the following: o Better community mobilization leading to increased community participation and ownership o Increased/better support for CDDs resulting in lower attrition rates o Decreased proportion of refusals as a result of increased health education and greater compliance to Mectizan treatment by community members o Quality community supervision of the CDTI process o [mproved funding of the local costs of Mectizan distribution and other community health interventions aa D 75 WHO/APOC, 10 April2003