Enugu/Anambra/Ebonyi project first bi-annual technical on CDTI implementation): October 1999-March 2000

SECOND YAAR rIRST BI.ANN UAL Tfl CHNICAL REPORT ON CDTI IMPLH,MENTATTON OCTOBER 1999 - MARCH 2OOO #'o# NOTF/APOC-WHO IN COTLABORATION \ryITH GLOBAL 2OOO NIIGERIA ENUGU/ANAMBRA/EB ON^YI PROJE C T rSrH APRrLrzooo 4/!rrr\l-:ii a J i'r,-.i i,'..i El' o '.l t_<q -.. Ja K O O rlo. F- ,JlJ\. EXECUTIVE SUMMARY The implementation of CDTI in Enugrr/Anarnbra/Ebonyi states Project commencedinoctober,lggs,eventhoughAPoCmoneycameinJanuary, lggg. Before this date, Global 2000 was the NGDO providing the operating fund for all the activities. This bi-annual report covers activities between October lggg and March 2000' Theprojecthasanestimatedpopulationofabout3'65millionpersonsliving in communities, villages and hamlets' However, village is the focal point of all the GDTI implementation' hence thenarreispreferredandmorecommonlyusedinthetext.CDTI implementation started with macro-level advocacy to the states and local govemmentareas.Theobjectivewastosufficientlyeducateandmobilize gloupstoprovidethefinancial,logisticandhumanresourcesforCDTI activities. The project undertook a total of 49 advocacy visits to24 LGAs' 388 trainings were conducted at three levels namely; state, LGA and community.Atotalof14ToTs[SoCTs],110LoCTs110DHS,469}trS and3,36gCDDswereffainedonCDTI.Atotalof2,}3}villageswere mobilizedandhealtheducated.Eighteentls]Ministryofhealthstaffand one[1]NGDOstaffwereinvolvedinthemobilizationexerciseatLGA level. Treatment has been concluded in3l2villages that collected drug' Activetreatmentwasthecaseinallthevillagesandatotalof|36,279 eligible persons were treated out of a total [census] populatio n of 2'920 '787 g,vi.gacoveragerateof4.66%andcostpertreatmentof0.llUS$. Judgingfromthecooperationreceivedfromcommunitiessofar,thereare practicalindicationsthatCDTIapproachwillbemoresuccessfuland sustainable than CBIT' 4 2In conclusion, the project is being saddled with some problems which need immediate attention and these include, provision of new field project vehicles,moremotorcyclesandbicycles.Theprojectalsorequestsforthe elevation of the three states into full fledged autonomous APOC project with separate budget allocations' & SECTION I reacpi*KqeffiqffiJNTKSffi Enugu,AnambraandEbonyiStatesareamongthesevensouthEastern StatesofNigeriaformerlybenefitingfromtheLionsClubs/Global2000 Project_drivenRiverBlindnessProgramme.Thethreestateshavethree separateprojectswhichwerecompletelyindependentofoneanotherbothin operationandbankingactivities.Eachprojectthereforehasaproject numberandabankaccountofitsown.Unfortunatelythethreesister projectswerecombinedintoasingleprojectunderoneprojectname: NorF/ApocAMHo-NGEN pRoJEcr. The combination of these tt*ee projects into one has put the project into a disadvantaged position in equipmentandfundallocationandsupplybyAPOC.Inaddition,provision of information based on the three states has become more diffrcult taking into cognisance the amount of information generatedby each state' The threestateshavealotincommonandbelongtothecountry,sPrimary HealthCaretNoCP]ZoneA.Forpurposesofclarity,someofthe information provided in this paper may be presented as they relate to individualstateswhileothersmaybegeneralizedwhereandwhen necessary. INLTGU STA'IH,: EnuguStateislocatedbetweenTol0,andl"45,N.Itisboundedonthe NorthbyKograndBenueStates,onthesouth,byAbiaState;ontheEast byEbonyiStateandontheWestbyAnambraState.Thetotalcensus populationofthestateisabout2.Smillionandmadeupofl7local .) .> 4Government Areas, pGAs] sixteen [16] of these seventeen LGAs are under CDTIspreadoveralandmassofoverzs,zoosquarekilometers.The registered[census]populationofthoseresidinginthesixteenendemic LGAS stands at 1,320,220. The bio-climatic zone is rainforest in nature withannualrainfallbetween|52cmand203cm.Theclimateis comparativelyequableandthetemperaturerangesbetween22.2.Cmd 36"C. It is the humidity rather than the temperature that causes discomfort to newcomers, and this is between 78% and950/o' It is generally cool during the rainy season, while the mean temperature in the hottest periods of February and April is about 36"C. The topography has two marked zones,hillyormountaneousandflatzones.ThehillyZonesffetches through A*go, Udi, Ezeagu, oji River, Uzo Uwani and part of Igbo Etiti LGAs. The hilly nature glves rise to rapids and water-falls that exist in mostriversespeciallyoji,ogurugu,Anambra,AjaliandDuuwhichform conducive breeding sites for Simulum damnosum' ANA-S{BRA STAT'S: AnambraStateisboundedontheNorthbyKogiStateontheSouthbylmo State,ontheEast,byEnuguandontheWest,byDelta.Itislocated between 543', and648',N and has a population of approximately 4 million andmadeupof2lLGAs,outofwhich16areunderCDTI.The[census] registeredpopulationofendemiccommunitiesisgl0,530.Thestate derives its name from the placid Anambra River which is a tributary of the River Niger. The land has an undulating configuration and generally slopes fromtheNorthtothesouthandfromEasttoWestintotheRiverNiger whichisthemajordrainagechannel.Thehighestlevelisabout400mefres above sea level. The state falls within the south equatorial rainforest region lA 5which passes through the tropical forest and great oil palm belt of Nigefra' then thins out into the savannah area with dumps of ffees' The rainfall is relatively high at about 2050mm average. The highly fertile ureas of oji and the Mamu rivers are also established breeding sites for simulium damnosum. EBONYI STATE: EbonyiStateislocatedbetweenT45,ands030,N.Itisboundedonthe NorthbyBenuestate,ontheEast,byCrossRiverStateandonthesouth, byAbiaState'Thestatehasatotalofthirteen[13]LocalGovernment Areas, out of which 10 are under APoC. It has an approximate population of 1.85 million based on the 1991 National Population census Estimate' However, the total population [census] residing in endemic communities is 689,987 persons. There ire over six different dialect local languages in the state. The topography consist of undulating elevation of approximately 500m abovesealevelintheSouthandextendstotheruggedterrainofthe central. The Northern part is charact eirzedby uniform landscape with intermittent escapement. The cross-River terrain is mainly an alluvian table land which favo*rs most agricultural activities. ThevegetationalTangementconsistsofmangroveforestsparsely distributed around the cross-River basin of the boundary of the state, with a mixture of the decidious and evergreen types of ffees' THE APOC P-ROJECT; The project can be said to be located between 5"43,and 8o30,N with a combinedpopulationof8.65millioninhabitantspnugu2.Smillion, Ebonyi 1 .85 million and Anambra 4 millionl ' It has a total of 51 LGAs out of which, 42 uehyper/meso endemic for onchocerciasis' ThiscombinedprojectreceivedAPoCfundinJanuary1999but commenced operation in october 1998 with a project offtcer for each state directing the operations in the state' However, it is noteworthy that after six month into the second year of operation the next installment of APOC fund forthesecondyearhadnotbeenreceivedbytheprojecttilldate. L tU The total number of communities in the hyper and mcso-endemic districts/LGAs The total number of villages in the hyper and meso-endemic LGAs is 3'466 [Enugu:|,3ll,Ebonyi:|,I2landAnambra:|,0627.However,the number of villages is not stable because of creation of more states' LGAS and the up grading of some hamlets to the status of villages' 1 tiil Hot+, mony villages were receiving ivermectin before and hout 'ttflt'y ote not4' included in APOC Prqiecr? All the 3,466vi11ages have been receiving mectizan tablets before the inffoduction of the community Directed Treatment with Ivennectin [CDTI] approach. Now they are all included in APOC project' I liiiy The number of times the comrnunitie*trillages in the Proiecr atea have received treatment.Anydheraitditionalinformartonwillbehelpful {iii} The project - driven IDP commenced graduatly in 1995 hence all the villages did not start receiving mectizan tablets in the same year ' Treatment therefore, started in some LGAS of Enugu and Anambra States in January 1995 whereas it took offin Ebonyi state in 1996 and extended to other LGAs later. Therefore, while some villages are in their 6ft year' othersareeitheronthe5ftor4ftyearoftreatment. e 1 1iv; Ijyou are using the term community or village, d,efine what constitute the comrnunityorvillage.ThiswillhelptheTCCreviewerunderstqtdtheprofile ofthe Proiect area' Thoughtheprojectrecognizesthedifferentadministrativestructuresofthe alea,thebasicoperationallevelisthevillage.Hence,theterm.village, will be more often used in the report except where the application of the term'community' becomes more relevant' Villageistheimmediatesmallerfunctionaladministrativeunitofa communitylargerthanahamletwithavillageheadandmadeupofmany households. Yl Administrative Structures in the Project Areal TOWN OR COMMUNITYTOWI\ OR COMMUNITY VII",LAGfl HOUSEEOLDS I SECTION 2 The overall strategy for the confrol of onchocerciasis through chemotherapy revolve around the implementation of community based sustainable programmes for the distribution of mectizan tablets to all individuals either infected or at the risk of infection. Emphasis is therefore placed on establishing Ivermectin Delivery Programmes in which the primary responsibility for obtaining the required mectizan tablets' disffibuting it to the at-risk population, supervising the activities of the cDDs and keeping relevant record will be devolved to the communities themselves' In addition, the communities are responsible for taking decisions on selection of CDDs, method of distribution, month[s] of fieatment and remuneration of disributors. Training: Training of staffinvolved in CDTI implementation was conducted at three separate levels: [a] the state level - for training of SOCTs tbl LGA level - for fraining of LocTs and District Health supervisors IDHSI and Health Facility Staff [ISSI' tcl Community level - for fiaining of CDDs' In view of the number of community drug distributors to be Bained in the project atea,CDD fiaining is done at the community level. Each LGA is divided into five districts and each with a Disfiict Health Supervisor and a number of Health Facility Staff. The number of trainings vary according to the number of persons to be trained' 3 TABLE 1 : TRAINING OF THE DIFFERENT LEVELS OF STAFF INVoLVED It'l cDTl IMPLEMENTAT|ON [ocroBER i999 To ililARcH 20001 IIII ENUGU'AHAMBRAJEBOI{YI CDTI 9 TOT = SOGTS LGA staff = LOCTs, DHS and PHC Health Centre/Post staff = HFS I STA,Tfi NO. OF TRAIHIIIG UHtrEHTAl{EfrI trl$ OF SOGTS TRATIIHU IrlO. OF LGA BTAFF TRA]NHS OII CbTI ilo. or HfiALTI.I SENTftHP6ST$TAFF NO. OF CDDB TR*INSD A H G D H Enugu 124 5 65 173 1,187 Anambra 108 4 80 136 535 Ebonyi 156 5 80 160 1,647 En/An/Eb. 388 {4 225 469 3,369 IIIIII. 7 TABLE 3: TRAINING OF THE DIFFERENT LEVELS OF STAFF INVOLVED [IS, OF CT}D$ THAlttlfI) :J#)X#'MY*Effi NO, OF NO. OF HEALTfT BENTHHIPOST $TAFF TRAlttIEb cttrtur*2#flEr*3r :1u**?iir NO. OF T.O.T. TRAIIiIHDUNDERTAKEN I x*x:.*,".ffi l**r*r*r*: NS. OF tGA NO. OF L€A STATF TNAINfiD ON TbTI hrrrB*f ft **Lt6*t* *il:i* : 1;, NJIKOKA IN CDTI IMPLEMENTATION IN ANAMBRA STATE d 108 ilo^ sr YRAINII{G AL TABLE 4: TRAINING OF THE DIFFERENT LEVELS OF STAFF INVOLVED IN CDTI IMPLEMENTATION IN EBONYI STATE .'gg - MAR. | :t :,,i,1,:l:,t:,:,:,: iii::::EsA ,, i so.os l I,NUHR KEN T,O1lt: TRAIf{ED NO. OF CDD$ TRA]NEO A B C U :,E ISHIELU 17 1 10 2A 159 EBONYI 13 0 10 14 126 IKWO 27 1 10 27 305 IZZI 28 0 10 31 202 OHAOZARA 15 1 10 2A 219 AFIKPO N. 12 0 10 10 197 EZZA NORTH 19 1 10 14 203 ONICHA 25 1 10 24 236 rvo 0 0 0 0 0 EZZA SOUTH 0 0 0 0 0 TOTAL 156 5 80 f60 1,647 " CDTI ACTIVITIES FOR THE YEAR NOT YET COMMENCED $ I IIIIIII'ITIIIIIIII NO. OF LGA STAFF TRAINED ON CDTI NO, OF HEALTH CENTREIPO$T STAFF TRAINED ON ODTI TABLE 5 : |ililPLEMENTATION OF CDTI {OCTOBER 1999 - IIIARCH 2000} IN ENUGUIANATTTBRA'EBONYI STATES' CDTI J \ III'IIIIIIIIII-IIII t"{o. oF V*-LAGES WHICH SELEOTEP cobs NO. OF VILLAGES PAYINS CDDS IN CASH OR KIND A rli:il B lilllGlli llllllll .l l riiriiiiiii E :NUGU 1.377 766 603 603 603 603 176 \NAMBRA 1,062 412 322 412 412 322 41 :BONYI 1.027 854 854 854 854 854 e45 :N/AN/EB. 3,466 2,432 1,779 1.869 1.869 1.779 562 iiiii i i iiiii]ii :ii riiiii ]liiiiii A. B El Fr G 1 ENUGU EAST 31 31 31 31 31 31 10 2 UDI 172 172 108 108 108 108 40 3 EZEAGU 120 120 72 72 72 72 2A 4 NKANU WEST 142 142 142 142 142 142 31 5 NKANU EAST 120 12A 94 94 94 94 26 6 UZO-UWANI 80 80 60 60 60 60 34 7 IGBO-ETITI 101 101 96 96 96 96 15 I AWGU 145 9 ANINRI 70 10 OJI RIVER 58 11 UDENU 76 12 NSUKKA 88 13 tst-uzo 59 14 IGBO.EZE NORTH 39 15 IGBO-EZE SOUTH 72 16 ENUGU NORTH 4 TOTAL 1,377 766 603 603 603 603 176 TABLE 6: IilJIPLEIIIEHTATIOil OF CDTI {OCTOBER, 1999 - MARSH 2000} IN E}.IUGU STATE \^Y III'IIIIIIIIIII--II ,..'.NOl ,OF ,1'11,'1,,lllEl:G Wlfrl fr,:r TABLE 7: IMPLEMEF.ITATION OF CDTI {OCTOBER, '99 - MARCH 2000} I}I ANAMBRA STATE riii:iiiiiiiiiiiillllsrloFii i .,,..ii. .,11,,,,..l-'--il,,,.., NO OF VILI.ASE8 ... WHICII .COLLEGIED .,: .DRI,G$ TO OF VIL ln Lllril{ til o AJIiI rt ,1' B !JIKOKA 45 45 42 45 45 42 21 HIALA 42 12 12 12 12 12 12 qNAMBRA EAST 24 14 14 14 14 14 7 {GUATA 90 1 1 1 1 1 1 }RUMBA NORTH 90 90 80 90 90 8o 0 SRUMBA SOUTH 65 58 58 58 58 58 0 AYAMELUM 54 54 0 54 54 0 0 AWKA NORTH 73 73 65 73 73 65 0 qWKA SOUTH 65 65 50 65 65 50 0 cYt 50 0 50 0 0 50 0 DUNUKOFlA 43 0 0 0 0 0 0 EKWUSIGO 26 0 0 0 0 0 0 IDEMILI NORTH 115 o 0 0 0 0 0 IDEMILI SOUTH 80 0 0 0 0 0 0 NNEWI SOUTH 105 0 0 0 0 0 0 ANAOCHA 76 0 0 0 0 0 0 NNEWI NORTH 19 0 0 0 0 0 0 TOTAL 1,0s2 412 372 412 412 372 41 \ I I I I I I I I I,I I I - T I I I I I .il t E Iii..::::.::rt:r:.i:iilliil rl iii;:::t::i t: |::i:ii t;:iiii i t:iii::ii:l *o.: sI 'F VILLACES NO..OF VIttAGES WHICH 6OI.LECTED DRUGS NO Wlri C T AGES -.tnFn IL'IJ trII]T B $: Ftr F At., SHIELU 104 104 144 144 104 104 59 BONYI 96 96 96 96 96 96 39 KWO 130 130 130 130 130 130 59* IZZI 104 104 104 144 144 104 60* OHAOZARA 96 96 96 96 96 96 62* AFIKPO N. 90 90 90 90 90 90 66* EZZA NORTH 120 120 120 124 120 120 0n ONICHA 114 114 114 114 114 114 0* rvo 50 0 0 0 0 0 0** EZZA SOUTH 123 0 0 0 0 0 0** TOTAL 1,027 854 854 ES4 854 854 345 "* CDTIACTIVITIES :OR THE YEAR \,loT ED * TREATMENT IS ON-GOING TABI-E 8: IMPLEIT,IENTATION OF CDTI {OCTOBER, {999 - MARCH 2000} IN EBONYI STATE rI- \ I-IIIIII'IIIIII'III TT TABLE 9 : DETAILED BREAKDOIIUN OF TRAII{|NG ACTTVTTIES {OCT. {999 - MARCH 3000) ,,,, :,, .,,,,: ,.,::.,. ,,.,,:,, : : .. .,. .,.,,,, ....*e* *E.........,.CAERE ENUGU SOCT 5 5 lAAo/o LOCT 80 30 37,5% PHC COORDINATOR 16 5 31.25o/o DHS 80 30 38% HFS 240 173 72% CDDS 4,131 1,187 29o/o SUB.TOTAL ,1,553 1.430 3l06 ANAMBRA SOCT 4 4 lOOo/o LOCT/PHC COORDINATOR 96 4A 41,670/o DHS 80 40 50% HFS 240 136 56.670/o CDDS 2,286 535 23Yo SUB.TOTAL 2.706 755 27.90% EBONYI SOCT 5 5 lOOo/o LOCTIPHC COORDINATOR 45 40 88.9o/o DHS 45 40 88.9% HFS 90 160 177.78o/o CDDS 2,960 1,647 55.64% SUB.TOTAL 3,{45 1,892 60.{5% EN/AN/EB SOCT 14 14 100o/o LOCT 221 110 49.77Yo PHC COORDINATOR 16 5 31.25o/o DHS 205 110 53.66% HFS 570 469 82.28% CDDS 9,377 3,369 35.93% GRAND TOTAL '10.403 4,O77 39.19% I I T * This actual grand total includes the 14 SOCTs trained at state level. 4( ,,,,,,,,,TARG,ET:' IJ uJzz oot ul o. 10,000 9,000 8,000 7,000 6,000 5,000 4,000 3,000 2,000 EI TARGET NACTUAL 1,000 0 PROJECT ,43 tnnpr-rtlarhtrATloru tocr. tgsg * URRCH rO0ot tN eNt*N,EA. cnT 10 2g hoiect's armual training obiective utd the percentage of the obieAive achieved The percentage of the objective achieved is quite high in some areas' but it is expected that alo}%achievement will be recorded in all sectors by the end of SePtember 2000. TRATNING MATERIALS: 2gty Types of materials developed and usedfor training health staff anil CDDs' Materialsweredevelopedbytheprojectandusedintraininghealthstaffand CDDs. These materials include: [a] Post antl Pre-test: They are used to assess the effectiveness of communication of trainers on the course of fiaining, and also an insffument for evaluating the knowledge of the fiainees before and after training sessions' tbl Pocke-t Treatment Guide: This is used as a reference material for LOCTs, DHS, ADHS and CDDs with a view to understanding: til What onchocerciasis is tii] Their roles in oncho control tiiil The CDTI concePt tM The difference between 'c' above and the system formally in place tv] Community mobilizationsffategies tvi] The new 3mg mectuanformulation tvii]Treatmenttechniquesandmanagementofsidereactions lcl Flin Chart: This is a ffaining material diagramatically designed to ease teaching - /?-w 11 learning process. td] Samples of measuring stick and village fieatment registers. tel Radio and television jingles tf] Audio-visual materials - TV and radio tgl Hand bills in local languages thl Mectizan tallYisummary sheets 25lly The p*formance of the CDDs, does the perfonnance of the CDDs indicate they received and understood important informalion ubout their roles? The use of the above materials were significantly result oriented. The outcome of the performance of health staffand cDDs in the pre and post tests indicated a significant difference between the pre and post fraining knowledge. This therefore, means that CDDs understood their roles in the implementation of CDTI. 21ivy Wat needs to be done to improve the quality of training of health staff and CDDs? The following need to be sfrengthened to improve the quality of training of health staffand CDDs: tal use of local languages during training to clariff issues tbl Provision of adequate training manuals tc] Use of posters printed in local languages te]ProvisionofadequateandqualitytrainingtoToTs. 2 tt If the annual obiective was not achiaed, suggest whot should' be done to imprwe the performance of the proi ecl? Though achieving the training objective is obvious by the end of the second technical year of operation of the project, there is still need for the 7r 12 following measures to be taken to improve the performance of the project: tal Continuous community mobilization should form an integral part of every IDP comPonent. tbl More realistic training targets to take care of CDD attrition and community non-compliance in appointing one CDD to 250 persons per village should be taken into consideration' tcl There is need to provide CDDs and IIFS with bicycles to enable them attend training and participate in drug collection exercises' 2.I. MOBILIZATION AND EDTICATION: Successful mobilization and health education were crucial activities which created awareness of the problem of onchocerciasis at the state, community and village levels as well as solicit support and pafronage of the entire citizens towards effective implementation of the conffol programme. The ultimate aim was to have a sustained high demand for mectizan tablets for prevention of blindness due to onchocerciasis' Advocacy visits were made to top state and LGA goveflIment officials to acquaint them with the problem of onchocerciasis and the need for the government at all levels to support the programme in various ways. Communities were mobilized with the help of District Health Supervisors and their Assistants [Health Facility Staf[], the CDDs and members of VHCs using all available avenues both formal and informal and appropriate health education messages conveyed by use of a variety of culturally - relevant media' 2.11i! Provide information on the use of media ond/or other local systems to di s s emi n al e inform ati on ? Informationir said to be effectively disseminated when the message relayed or fiansmitted has been coded [heard, accepted] and the u- t13 receptor [villager] elicits a positive response. The channels used for disseminating information in the project varied from community to community and village to village' The methods used were: Electronic media: Radio j ingles, radio discussions/interviews/broadcast' Radio j ingles were prepared and aired constantly, especially' during the onchocerciasis week observed by the project in February 2000' Radio stations in alt the states and the National radio stations were involved in the mobilization activities. During this period, radio messages were relayed to the public as news insert or during important programmes. The use of radio proved very effective because the project was getting feedback from a large number of people. Information released through the radio fiavels very fast and gets into the nooks and corners of the project area' Atii] Television: The television was also widely used, but coverage was limited by lack of electricity in most of the communities and villages' Fortunately, most of the community leaders could afford to own television sets and radios' During training of trainers, TvA/ideo films were used in some LGAs that have elecfficity while some communities provided generating sets to enable the fiainers use the equipment during training of CDDs' oncho messages were also given by way of slide presentation, prepareddocumentaryandoverheadtransparencyprojection. B. Print Media: Those used include posters, brochures, newspapers publications, picttrres or photo graphs, flipcharts, handouts, handbills and calendars. {A} Atil u t4 C. Local Systems: These are the traditional methods applicable to different communities and villages and relate to varied fraditions' The local methods include: c{i} Town criers-These ale persons chosen by the community for the purpose of moving round the villages or market squares with metal or wooden gongs or drums disseminating information to the people' They are usually compensated by the village or community through their common purse. These move around the markets during the day' but around the villages at dawn or at night. This method was very effective. C{ii} Church announcement: The main religion of the inhabitants of the project area is christianity. There are churches in all the towns and are built through communal contribution. They are usually centrally located and important messages disseminated through the churches reach every household' c{iii} Announcement in the school: Education is one of the valuable assets recognized in the project afea. Each family, no matter how poor, makes effort to educate its children. Messages passed through school children get to the households very fast' c{iv} Yillagelcommunity Heads/f,zes - The village head is a good channel for message dissemination. As the head of the village or community, he is entitled to call meetings of his cabinet chiefs or other members of the community or give oral directive to his subjects through the village chiefs or sectional heads like ward heads and heads ofhouseholds' C{lt/}VillageMeetings/GroupMeetings_Theseareveryeffective channels of information and were very much utilized by the project' LL\ 15 The project team usually collects the dates of villages meetings or' launchings, or group meetings and usually assigns the District Health Supervisors, the Assistant District Health Supervisors, the LocTs to communities in order to talk to them at the meeting sessions' The VHCs and CDDs who are now much more in number than before were very useful in this asPect' c{vi} use of Theatre Group or Drama: This was widely used in schools and during fiainings. The drama method was generally useful in attracting people of all age grades' 2 .I {i\ Are you satisfiedwith the results of the mobilization efforts? Theuseofmediaandotherlocalsystemofdisseminatinginformation were very effective and gave satisfactory results from the target villages. The effectiveness is reflected by the increased commitment of the community leaders and distributors and the high degree of involvement of the communities and their willingness to commit available local resources to the distribution process. Furthermore, there were increased responses from isolated hamlets which hitherto were not reached in the Past' 2 .l {n1\ oia turget communities/villages respondfavourably? A significant number of target communities responded very favourably, though our efforts will be directed towards making remaining communities resPond' 2 .l {iv} szgg est wuys to imprwe mobilizstion of taryet communities WaystolmproveMobilizationofTorgetCommunities: Li 16 {a} Increased logistic support particularly motorcycles for LGA staff participating in CDTI implementation' tb) Provision of bicycles for health cenffe staffinvolved in the CDTI implementation to enable them cover the villages more effectively' {c} Use of mobile public address system for better outreach of the poPulation. L6 rll iril|Et TEll Nld. Lrli TARGE VILLABT UI'HICH nrctvr H:e. nBo tMFr}Rr^t lii!i!:!l iiiill::;iiiiiii i?:r,,:rt.. -:.: l r!!E i,,ii,i,..i *8... ',:i:: iHHilriii:iiiill illliii'ii,E:iiiiill l.vtr ,Iriiir! l OF EXII fREA- ,TION ,:::. ]iiii.|, ..i o ENUGU 766 766 17 6 1 ANAMBRA 412 412 16 5 1 EBONYI 854 854 16 7 1 EN/AN/EB. 2,032 2,432 49 18 TABLE {0 : MOBILIZATIOId AND HEALTFI EDUCATION OF TARGET COilmUillTlES, VILLAGES lN ENUGUTAIIIAMBRATEBOHVI STATE$ IDP [OCT.'99 'MARCH 2000 IIIIIIII-.IIITIIIII # C^\ sruo NO, OF M.OHSTAFF . INUOLVED IH :MOBTL T ON I.1.IO. OF NGI}O STAFF INVALVED IIII MOtsILIUATION ,. A' l B t\\, D E 1 ENUGU EAST 31 31 2 6 1 2 UDI 172 172 3 6 1 3 EZEAGU 120 120 3 6 1 4 NKANU WEST 142 142 2 6 1 5 NKANU EAST 120 120 3 6 1 6 UZO-UWANI 80 80 2 6 1 7 IGBO-ETITI 101 101 2 6 1 8 AWGU 9 ANINRI 10 OJI RIVER 11 UDENU 12 NSUKKA 13 rSl-UZO 14 IGBO.EZE NORTH 15 IGBO-EZE SOUTH 16 ENUGU NORTHm 7S6 768 17 TABLE {T : MOBILIZATION AHD EDUCATION OT TARGET COIfifIIIUNITIES tN EiltuGU STATE [OCTOBER TO MARCH 20001 \o bJ rII'IIIIIIIIITI-III oF.,., , , - 88. ,, ,*r. TABLE {2: MOBILIZATION AND HEALTH EDUCATION oF TARGET COMMUNITIES IN ANAMBRA STATE IOCT. '99 . MAR. 2OOOI ..' 1 ,.,,., I ,,... li li.ii ii ii .. . ll'Il I :'::::::;lllll lll;l..ii ,.l.;ii. iiR ii :ii : Htt : .lMF OF iET GE8 31.1 ,ED louT RNGE :NDED II'ENT iiii:ii::::iri r::::iiiltltil . lil ,i:!l iiiiiu*** iiiiiriiiiiri r::iiiii :ri:i;iiii :il:ilililrluBl iir;illl,;1.i, ;;ll,; ;, )ir,'OF i,i |@fllr:; :'1 I illl li ,.ii.....i,'' ::,:::::,: NEi,,,Of; :,,,,, ,,,' , , ltllgo.$lnrF: : illltol ED '.ii....... , ..,. ...,....,.... m iii. .,,.'., .,.",.... ' .. MOEILIZATIOiI , :,:': ',:.i,. i .. ". ::: A . ..., ..,,.,E i.t, ::,,::,:,.,, irl I iiiiii:ii:i:iii i:::: {JIKOKA 45 45 2 5 1 IH]ALA 12 12 2 5 1qNAMBRA EAST 14 14 2 5 1 {GUATA 1 1 0 0 0 SRUMBA NORTH 90 90 2 5 1 )RUMBA SOUTH 58 58 2 5 1 qYAMELUM 54 54 2 5 1 {WKA NORTH 73 73 2 5 1 \WKA SOUTH 65 65 2 5 1 oYt 0 0 0 0 0 DUNUKOFIA 0 0 0 0 0 EKWUSIGO 0 0 0 0 0 DEMILI NORTH 0 0 0 0 0 DEMILI SOUTH 0 o 0 0 0 INEWI SOUTH 0 0 0 0 0 {NAOCHA 0 0 0 0 0 INEWI NORTH 0 0 0 0 0 TOTAL 412 412 't6 s1 c,-j i IIIIIIIIIIIIIIIIII :l, or OGACI TS ITO POtICY ,l :RSTPHC ,,i :'.: : , iii.,,.,.iLGA,i,!i:,, i,! !iil l:ii8l]F iiiiiirirtilE A B il'/ D .;..l:ll llll ll.:.l. ..':ll;H ISHIELU 104 104 2 7 1 EBONYI 96 96 2 7 1 IKWO 130 130 2 7 1 lzzl 104 104 2 7 1 OHAOZARA 96 96 2 7 1 AFIKPO N. 90 90 2 7 1 EZZA NORTH 120 124 2 7 1 ONICHA 114 114 2 7 1 rvo 0 0 0 0 0** =ZZA SOUTH 0 0 0 0 0** TOTAL 854 &54 16 YABLf; 'tr3; FflOB|LEATIOH Alrf,D l-tEA[-TH EDUSATtCIf.fi SF TARGET COML|UNInES tilt EBONyt STATE [OCT. '99 - MAR. 20001 o r.r) I IIIIIIIIITITIT'III fl:: ::::!!! l.r QP'rr , )GAGY rs lro roLlcY RSlpt{C :'1.: l NO! \IGOI lNt oi .ll oEtLti TI t I t I T t T I T I T I T iI t T T IIfrOBILIZATION AND HEALTH EDUCATION OF TARGET COMMUNITIES lN Elt/ANrrB. cpll 3500 3000 2500 z o F Jf o- o o- 2000 1500 1000 500 0 PROJECT 5t 17 SECTION 3: ACHIE,VE,MENTS: aJ ti ) Treatment coverage rate The total number of people treated was 136,279, Bnugu 29,945,Anambra : 30,007, Ebonyi : 76,327]. The projects' t reatment coverage rate was 4.660 , [Enugu : 2.26oh, Anambra : 3.29Yo, Ebonyi : 11.06%l a, J {ii} Total [censusJ population Total [census] population was 2,92A,787 persons lEnugu : 1,320,270 Anambra : 910,530 Ebonyi : 689,9871. ,l J {iii} Eligible population Total eligible population was 168,901 [Enugu :37,A37 Anambra : 40,078,Ebonyi : 91,786]. Elie$le population figures are available for villages that have completed treatment. The State team fransports the mectizantablets to LGAs prepared for freatment. The LGAs then inform the District Health Staff at the Health centres located within the communities that the drug is ready for collection. The district health staff submit requests for mectizan based on the census figures collected from the CDDs. The LGAs move the drug to the District Health Staffwho in turn move them to the health facility based in the communities. The endemic communities then go to the health facilities to collect their drugs and from then take responsibility for storage and allocation to the CDDs from the villages. The CDDs dispense the drugs 3?-- 18 grving appropriate health education messages with the assistance of Village Health Committees [VHCs]. Methods of distribution vary from village to village. Whereas some villages prefer house-to-house distribution, others go for cenfalized distribution. Mass treatment was applicable in all the hyper and meso endemic villages and the CDDs were jointly supervised by the state, LGA and district health staff. The VHCs enswe follow-up of absentees, refusals and ineligibles who later become eligible within the period of freatment in the area. aJ {iv} Descibe briefly whether the proportion of viltagelcommunity members who were absent daring trealment is higher than expeded. The proportion of absenteeism and refusals is lower than expected in most of the project areas. This situation is atfibuted to the aggressive mobilization of the communities, perceived benefits of ivermectin and the high demand for it in many of the endemic villages. In addition, the ability of the communities to recognize problems with distribution methods and modifu the methods accordingly contributed to low absenteeism recorded so far. aJ {v} Stae the most common reasonsfor absenteeism- For those that are absent during freatment, the most common reason given by them is "trading/travelling activity" which keeps them away from the community during distribution period. aJ {"i} Suggest what actions need to be tahen by the project to reach absentees and fufaulters ilring ilte nqt treafrnent and if any constraints might pret ent their inclusion. Arrangements should be made to keep drug at the nearest health facility to take care of absentees. Where this is not possible, arrangement will be made 33 19 to treat them in the farrn. This arangement is bound to be very successful and the project suggests that it should be applied in other projects. The issue of defaulters is more diffrcult to handle. Defaulters should be traced back to their residents for treatment if they are still within the project area. But where they have left the area for far away cities, it becomes very difficult to follow them up because of constraints of transportation cost involved. There are also some people who refuse the drugs for sorne reasons. For this goup of persons, continuous education and mobilization is suggested. 3t^ TABLE4: ACHIEVEMEHTS IOCTOBER {999 - MARCH 20001 IN EN UGI.'/ANAilIBRAJEBOf{YI $TATES' IDP \ 0^4 ii s1;,, [Iq. sF TARSFTED vrrtlgH$ THSATHD }IUIIIEER OF =tIGIBtEFHR$StrtS TREAIEB SO$T PER F#R$AFI TREATEE uss TIIT'TBER OT VILINGT$ WHEfiH gEB IS A HEALTI{ WORKER T{UT{EEft OT PISTRIBUTION$ $I,JFERV!$HD H.Y I{EALTI{WORKEH ]$UMBEH ST THHATHS VIL[- ASHSWTHSTItfi- lilARY F0f,iltl$ A E c D E F ENUGU 61 29,945 0.10 2 61 61 ANAMBRA 69 30.007 0.12 NIL 69 69 BONYI 222 76.327 4.14 NIL 222 222 TOTAL 352 { 36,279 0"1'[ 2 353 352 * TREATMENT is still ongoing in all the villages that GOLLECTED drugs. TABLE {s : ACHilEVEMENTS [OCTOBER 19gg - MARCH 2000X IN ENUGU STATE SDTI \o t'1 sll*o, tsA TARGETEE VILI-AGES TRHATf;U ELIGIBLfl FERSONS IfiEATHb FHR$ON TREATEb u8t YITLAGSS I,l,}THftH cBo rs A ITHAI.Y}IWOf,KER EtsTRl$U?ISNS $UPEHWSGD BT }IHALTHWOf,KER TRHATES \IILLAGfS TVTTH SUMMAHY IORM$ A s s D H F 1 ENUGU EAST 31 21.837 0.10 NIL 31 31 2 UDI 30 ltx ongoing 8,108 Pending 2 30 30 3 EZEAGU Tx ongoing NIL NIL NIL 4 NKANU WEST NIL 5 NKANU EAST NIL 6 UZO.UWANI NIL 7 IGBO.ETITI NIL 8 AWGU 9 ANINRI 10 OJI RIVER 11 UDENU 12 NSUKKA 13 lSt-UZO 14 IGBO.EZE NORTH 15 IGBO-EZE SOUTH 16 ENUGU NORTH TOTAL 61 2$,S4S 0.'! 0 2 61 6t TABLE '16: ACI-NIHVEtuIENT [OCT. 'NS9S - MARCH 2{1CICI1 IN ANAMBRA STATE GDTI r\-rf T*IJTBER OT EI$TRIBUTISII$ stJP*tilIrsEs BY HEALTH WORKER8 HUIiHER gF TRTSTTP UttAqHS VSTH $UMilNRY FORhlE EfATE Bg. SF TARGHTEil VILI-ABHS TR=*TED EL}SIBhE FHR$SNS TREATHP PHRSOITI JnE*rsp rJ$ f V}tLACE$ TIIHERE SDtr I$ A HEfiLTI'I YI,ORI(HR A B, G D E F NJIKOKA 42 20043 0 0 42 42 IHIALA 12 5,493 0 0 12 12 ANABRA EAST 14 4,305 0 0 14 14 AGUATA 1 166 0 0 1 1 ORUMBA NORTH 0 0 0 0 0 Tx on going ORUMBA SOUTH 0 0 0 0 0 Tx on going AYAMELUM 0 0 0 0 0 Tx on going AWKA NORTH 0 0 0 0 0 Tx on ooing AWKA SOUTH 0 0 0 0 0 0 oYt 0 0 0 0 0 0 DUNUKOFIA 0 0 0 0 0 0 EKWUSIGO 0 0 0 0 0 0 IDEMILI NORTH 0 0 0 0 0 0 DEMILI SOUTH 0 0 0 0 0 0 NNEWI SOUTH 0 0 0 0 0 0 ANAOCHA 0 0 0 0 0 0 NNEWI NORTH 0 0 0 0 0 0 TOTAL 69 30,007 0 0 69 69 TABLE {7: AC}IIHVEMENT [OgT. {99s - fillARGhl 2000] IN EBONYI STATE CDTI Oo tl l ii l,', ** lsF IETED hers [TED EL}GIBLE FER$ON$ TREATEB FERSON TREATEE IJS $ VIl.I*fiP9$ WHERE sBs r$ A HEALTH TIIIOR}ffiR NU$BER OT EI$TRIHUTISTS$ suP#nff]$EE BY HEAI.TH I'VORKERS TIUMBER OF TR=*TED VlL[AOf;$TrIITtl SUfrtIITXf,fiY FORMS iiliiil ,i i,' j I B c D E F SH ELU 104 42934 4.14 0 0 104 BONYI 96 27,296 0.16 0 0 96 KWO 5 2,218 0.11 0 0 5 tzat 17 3,939 0.15 0 0 17 sHAOZARA 0 0 0 0 0 0 \FIKPO NORTH 0 0 0 0 0 0 EZb, NORTH 0 0 0 0 0 0 ONICAH 0 0 0 0 0 0 tvo 0 0 0 0 0 EZZA SOUTH 0 0 0 0 0 0 TOTAL 222 76327 0.14 0 0 222 N"TREATMENT IS STILL ON.GOING *CDTI ACTIVITIES FOR THE YEAR NOT YET COMMENCED TABLE 18 : TREATMENT [ocToBER 1999 To MARCH 20001 |NENUGUJANAMBRAIEB0NYISTATESGDTI s-l(\ * Treatment does not include'passive'. * Eligible population based on the communities where treatment is concluded * POPULATISH THHATED TX. COVHRASG TATE fiTATfi l*o.0F VILTAGES TNEATEP TOTAL [OEltl$U$l POFUI*TISN ELIemi-fi** psputATlOH 0 D EA B ENUGU 61 1.320.270 37,037 29,945 2.27% 40,078 30,007 3.30%ANAMBRA 69 910.530 91,786 76,327 11.060/oBONYI 222 689,987 168,90,| 136,279 4.67%EN/AN/EB. 352 2.920.787 TABLE 19 : TREATil,IENT IOCTOBER 1999 TO MARGH 20001 IN ENUGU STATE GDTI O J $THO. $TATE NO. OF TAHGETED VILL*BE$ T*EATEH TOTfit *[gEH$USI pspuL[flsH ELIGIELH POPUTATIOH poFut-ATIoill TREATED TX. COIfHRnSE RATE A B s il E 1 ENUGU EAST 31 52,089 23,094 21,837 41.92% 2 UDI 30 ttx ongoingl 104,287 13,943 8,1 08 7.77o/o 3 EZEAGU Tx onooing 96,867 4 NKANU WEST Tx ongoing 99,778 5 NKANU EAST Tx ongoinq 101,914 6 UZO.UWANt Tx ongoing 98,662 7 IGBO.ETITI Tx ongoing 56,036 I AWGU Tx ongoing 110,374 I ANINRI 75,046 10 OJI RIVER 66,710 11 UDENU 76,968 12 NSUKKA 87,904 13 rsl-uzo 99,561 14 IGBO-EZE NORTH 92,839 15 IGBO.EZE SOUTH 68,575 16 ENUGU NORTH 42,660 TOTAL 61 1,320,270 37,037 29,945 2.27% * CENSUS EXERCISE STILL ON-GOING IN 15 LGAS STATT ftto. or VILIAGES TREAYEE ?OYAI lcsN$usI PSPUI-*TI#N HU6[HLE POPULATffiIE FEPULATloilI TftEATEU TX. COVSfiAeE NAIE A E G s H NJIKOKA 42 45,201 24,541 2A,A43 44.34o/o IH]ALA 12 48,710 8,495 5,493 11.28o/o ANABRA EAST 14 31,412 6,841 4,305 13.70o/o AGUATA 1 65,611 201 166 0.25o/o CRUMBA NORTH 0 61 ,1 09 0 0 0.00% CRUMBA SOUTH 0 59,806 0 0 0.00% AYAMELUM 0 47,770 0 0 0.00% AWKA NORTH 0 59,892 0 0 0.00% AWKA SOUTH 0 52,554 0 0 0.00o/o oYl 0 42,400 0 0 0.00% DUNUKOFIA 0 38,593 0 0 0.00% KWUSIGO 0 29,762 0 0 0.00% DEMILI NORTH 0 107,116 0 0 0.00% DEMILI SOUTH 0 68.485 0 0 0.00% NNEWI SOUTH 0 91,108 0 0 0.00% ANAOCHA 0 58.336 0 0 0.00% NNEWI NORTH rOTAL 0 32,665 0 0 0.00% 69 940,530 40,078 30,007 3.19o/o TABLE 20: TREATMEHT [OCT" '99 TO MARCH 20001 IN ANAMBRA STATE CDTI J TABLE 21: TREATMEHT IOCTOtsER {999 TO MARCH 20001 IH EBONYI STATE CDTI J S STfiTE lfo, sF XTILLAOES TREATEE TOTAT loEr{su$x FQFUI*ITION EL!OIBLE FSPUL"ATffif'l* POPUTATIO}I TNEATED TX. SpVfrRAeH NATE A B s t) E zzl 17 89,778 5.377 3,939 4.39o/o SHIELU 104 60,618 52.700 42,934 70.83% VO 0 31,250 0 0 0.00% KWO 5 110,573 3,177 2,218 2.01o/o f,HAOZARA 0 1 10.573 0 0 0.00% =BONYI 96 43,223 30,532 27.236 63.01% AFIKPO NORTH 0 37,524 0 0 0.00% =ZZA NORTH 0 50.990 0 0 0.00% f,NICHA 0 107,394 0 0 0.00% EZZA SOUTH 0 51,770 0 0 0.00% TOTAL 222 693,683 91,786 76,327 11.00% * BASED ON COMMUNITIESruILLAGES TREATMENT IS GOING ON TREATil'IENT {OGTOEER 19 : MARGH 2OOO} IN ENUGU'ANAIIf, BRAJEBONYI GDTI z o FI =e, o o- BTARGET POPU1ATION flPOPULATION TREATED PROJECT q3 zIFIf o- o o- TREATIITENT {OCTOBER :! 99 - ITARCH 2OOO} IN ENUGU'ANAhilBRA'EBONYI GDTI @TARGET POPULATION NPOPULATION TREATED PROJECT k\ 250,000 200,000 150,000 20 SECTION 4: srRtrNGTHs AND WEAKNESSES or CDTI IMPLEMENTATIONT 4ll Hottt did CDDs chosen by the committees perform their tasks? From the progress made so far, there are indications that the CDTI approach is bound to be more successful and sustainable than any other distribution sfategy ever applied before. The wave of perceived success can be noticed from different angles. [a] The CDTI approach gave the communities the opportumty to choose the type and number of CDDs they required. So far, most of the CDDs chosen have demonstrated competence in the performance of their tasks. There is marked increase in coverages achieved and the CDDs demonsfrated apparent adherence to exclusion criteria and use of appropriate dosing. There is, therefore, need to emphasize on the provision of guidelines to the communities for selection of CDDs in the first instance. 4 gy willingness or not of communifies to participate in GDTI process -to collec't the drug and to take charge of distribufion and its There is increased willingness and involvement of many communities/villages to commit available local resources to the CDTI process. These communities happily plan and collect their drugs. The increase in the number of CDDs has reduced the area and population covered by one person. The use of more CDDs definitely accelerates the time of distribution and coverage is enhanced. However, the level of community input in some communities/villages is still very low even though ^{ 2t they were brought into the picture at the planning stage. There are still complaints about increased burden of compensation on the entire community as a result of increase in the number of CDDs involved in the process eventhough they were informed about the implication of the increase. Furthermore, there is already growing rivalry and leadership problem among the multiple CDDs now being used per village. In terms of mectizan management, CDTI sfrategy provides for appropriate and accurate mectizan tablets inventory down to the household level and the communities feel more sense of fulfillment as they now participate more actively in the planning and execution of the distribution process. They now determine the quantity of their own drugs and willingly collect them by themselves. They also determine the method of disfibution. However, there is increased distortion of data, because they now have to pass through multiple hands for verification. There were no difficulties in sending reports/records back to the ivermectin collection points since the points are closer to the CDDs. The communities are happy to take custody of their drugs, but the safety cannot be assured in times of community clashes. Although supervision is done by the health staff, the village health committees assist in this component since the CDTI approach provides participatory opportunity to all segments involved in programme implementation. Monitoring of village registers are among the tasks performed by the VHCs. 4 gtly Describe the level of involvement of the regional/stale and d.istrict/ LGA governments in the anivities inchding involventent of Sectorc aatside health infacilitating distributiott" If any level of gwerument prwidedfunils [aaual cashl and/or materials ta ryards Implementation of CDTI. It is important to state so utd hant much. q6 Qesfon.. tf any level of govemment provided funds [actual cash] and or materials towads implementation of CDTI it is important to sfale so and how much. TABLE LEI/EL OF FINANCIAL INVOLVEilENT OF STATES, LGAS, BEtrlEFlTlNG VILLAGES AHD OTFIERS [OCT. 1990 - MARCH 20001 * The sum of N750,OOO which was the balance of N3m counterpart fund for the year 1999 was released between October and December 1999. rt- J COfilTftIHUTCHS Aft{OUN? NE.[SASEE IN EIIIUGU SIATE AMOI.IHT RELEASEB IN ANAIIE*ASIAfS AMaililT i ftELEASEfrIH EBOHYI&?AliE TOIAL .STATE 0 0 750.000 750,000.00 GA 70.100.00 104,000.00 411,040.00 585.140.00 VILLAGE 21.000.00 15,000.00 73,910 109.910.00 TOTAL 91,{00.0 1{ 9,000 1,234,950 1,445,050.00 22 Mobilization of states, LGAs and benefiting villages for acceptance, ownership and involvement in onchocerciasis confiol has been an integral part of the project's routine activities and has yielded some useful fruits. Auached herewith is a summary of the financial involvement of the states, LGAs and benefiting villages within the project area for the period under review. The states and Local Governments apart from approving and releasing fund for CDTI activities, also release their personnel whom they pay salaries and other benefits. However, despite the fact that the various partners are aware of their expected inputs to the implementation of CDTI, there is still very low govemment counterpart funding at state and LGA levels. Other community-based NGDOs like the Sudan United Mission ISUMI of the Netherlands and local radio stations at state level however, support CDTI in training, community mobilization and monitoring of distribution activities. 41i"1 Wat you consider the major achievements of the project {a} A solid foundation is being laid atthe village level for sustainability of CDTI. Communities now appreciate their roles in ivermectin delivery. More than640/o of eligible population are now receiving teatment with ivermectin. This level will definitely improve with time. Adequate sensitization of endemic communities on CDTI project. Increased awareness in the states on Ivermectin leading to increased demand. tf) Increased involvement of women in CDTI {b} {c} {d} {e} qg 23 {g} Less probability of drugs getting expired since more hands are involved in the disfribution hence less time is spent. {h} Monitoring of side reactions, recording and reporting are more effective and efficient as a result of proper and longer training. 4 {i The constraints and the challengesfor the next treatment qtcle. {i} Attrition of CDDs which is affecting coverage in some communities. {ii} Villages have added responsibilities by involving more than one CDD because the burden of compensation is increased. {iii} There is the tendency for struggle for leadership amongst the CDDs, leaving the job to suffer. {iv} Unstable political situation can lead to changes in political powers. {"} The greatest challenge for the next freatment cycle is to increase the coverage rate and level of involvement of the state and LGA in the programme. {vi} To keep the level of sensitization of endemic communities on CDTI high. 4t"it Clearly what types of help you needfrom: [aJ the goventment tbl APOC Management [cJ other parties to be ablc to imprwe the CDTI process nert ye&n A From Government: {i} Make as a matter of policy, annual budgetary provision and actual release of funds towards onchocerciasis control. B From APOC: {i} Improve the status of funding to projects {ii} To separate the project into three APOC projects to cater for each of the states. During the preparation of the proposal, the states were t^g 24 freated together thinking that the budgeting by APOC would be done separately. The three states are highly endemic and should maintain separate status in terms of operation and budgeting. {iii} APOC should provide new vehicles to the project as a maffer of urgency because the vehicles supplied by the Lions are too old and are susceptible to constant breakdown. {iv} More motorcycles and bicycles are needed to improve grass root mobilization and supervision C Other Parties: ti) To assist in community mobilization at all levels {ii} To continue assisting the programme 4 1viil : Pleasewritefreely on any other aspects of CDTI project implementdion thaf might nd have been cwered abwe The aim of CDTI is to establish effective and self-sustainable community based ivermectin treatment throughout the endemic areas in the three states. Ivermectin distribution has been going on in the project since 1995 under the former funding partners [Global2000 and Lions Club International]. CDTI implementation started with macro-level advocacy to the states and local government areas. This was necessary to elicit support, cooperation and active involvement of the functionaries at both levels of government in the programme. The strength of CDTI in the project area lies in the commitment of some of those involved in the project. Also, training and skill transfer to CDDs by health staffand the active participation and involvement of the health establishment in CDTI management at the district level has been properly put in place. However, there is need to address the problem of transportation. New project vehicles should be supplied to the 5o 25 project in order to meet up with the challenges of training and mobilization. There is also, urgent need to provide more motorcycles for field staff to enhance their mobilization efforts. On sustainability, the state and local govenrment have demonsfrated their interest in the implementation of CDTI. They have continued to bear the burden of payment of salaries and allowances to all those staff involved in CDTI activities. None of these workers was disengaged from service like their counterparts in other projects. The incumbent governments have sincerely pledged to release counterpart frrnds for CDTI activities this ffeatment year. 5t