Abia CDTI annual project technical report submitted to Technical Consultative Committee (TCC): from January 2007 to December 2007

M RESERVED F OR PROJE CT LOGO/HEADI]VG Proiect Name ABIA CDTICOUNTRY/NOTF: NIGERIA Launching year: 1999Approval year: 1998 From: JAN. 2007 To: (Month/Year) DEC. 2007 (Month/Ycar) Brpqrlrus feriad: Date submitted: January 2008 OI{IClNn L: Englrslr Proiectyearofthisreport: (circleone) | 2 3 4 5 6 (7) 8 9 10 NGDO trartncr: Global 2000 so__ I .-: ;:Iun rJeflt It( Bt FO B i'.lr i..', );,; :ilon rc, AiR AO 4A^lS#, l1-fuNz:ta ,r 'i !r, '+' i t I E i II I ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) DBADLINE F'O II SUBMISSION: To APOC Management by 31 January for March TCC meeting To APOC Management by 31 Julv for September TCC meeting AFRICAN PROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) t tl ANNUAL PRC).IECT TECHNICAL REPORT 1-O 'fli('l INICAL CONST IL'l'A.l'lVl: ('OMMI'f't'tlt1 ('l'('(') ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFl,-lCEltS to sign thc rcport: Country: N GERIA National Coordinaror Narnc: PXCgtr^.A...g. ). G..B-t-t 4=ftive Signatr"rrc Zonal Oncho Coordinato zsfaa lit :IA:r Date: r NarnTS si-rn,,g[. 'l \r . . .c{F. hNK NGDO Reprcsenrarive No,r"',}Q .q..'. €*Vl\.A il Signalurc | ,)arc: . I 'l'l',is reporl l-ras becn preparcd by Namc :(fu*S.....ND..t6^l*l r,f.. I l)csignatit)n : . . . ,S.f,r;.O..:......:..:...,..: . Signaturc D?t..'LZ =eA-OB (_ l/4i O-c,u I lll WI lO/z\l'()('. 24 .lanulr_r lt)()l( Table of contents ACRONYMS .............. DEFINITIONS ......... FOLLOW UP ON TCC IIECOMMENDAI'IONS EXEC UTIVE SUMMARY ........ SECTION I: BACKGROUND INFORMATION l.l. GsNgRer_ TNFoRMATToN ............... l. 1.1 Dcscripticttr qf tlrc projcct (ltrit,/\1,) ...1.1.2. Partnership 1.2. PopularroN SECTION 2: IMPLEMITNTA'I'ION OF CDTI.......... 2.1. Tlrraet-tNeoF ACTIVrrtES.............. 2.2. 2.3 2.4. 2.5 Capactry BUILDII\c .... TRenrueNrs............... . Treatntent figures 0 0 2 J 2.6. t l_5t-!2.6.2 LYhat arc tlrc causes of absanlccisnt?........... .............. t92.6.3 lYhal are tlte rcusons Jbr ra.fusuls? ................ .................. t92'6'4 BrieJly describe all known tuul verfied serious adversc events (SAEs) rltat occurred during the reporttttg period and provide (in table 8) the required irtfoltruriott when available............. ....... lg 2'6.5. Trend of treatment achievementfrom CDTI project inceptiort to tlrc currettt yeur.2l2.7. OnoeRtNc, sroRACE AND DELIVERv oF- Ivpm,tgclN .........222'8. coruuururry sELF-MoNrroRrNc AND STAKETToLDERS MEprrNc ...........23 2.9.1. Provide a/low chart of supe n,ision hierarchy. ....... ..... J42.9.2. Ll/hat were the nruin issues iclentified c)uring supervi.siott? ...........252.9.3. Was a supervision chccklist usetl?......................... ..... . ... ......lj2'9.4. lI/hat were the outcontes at eaclt level of CDTI inplenterttaliort strpcrt,isiou? 252.9.5. L[/as feedback given to lhe person or groups sttpervised? .............262'9'6. I-Iow was thcfeedbuck u.tccl to ittprove tlie ovirall pctfortttctttcc o.f'tlta preftc/'/ 26 SECTION 3: SUPPORT TO CDTI........ ..26 EqutrurNr ...........r...... FINaNcTeT CoNTRIBUTIoNS oF THE PARTNERS AND CoMMUNITIES OrgeR FoRMS oF coMMUNtry suppoRT................ ExpeNortuRE pER AcTrvrry THE SUM oF $17,000 R-ELEASED BY APOC MANAGEMENT wAS USBD INCARRY ING OUT THE MOBILIZATION NND HEALTH EDUCATION OF THECOMMUNITIES' TRAINING OF HEALTII WORKERS, CDDS, COMMUNITY SUPERVISORS, ADVOCACY VISITS TO POLITICAL AUTHORIBS ANI)PRINTING OF' IEC MATERIALS............. ERRORI BOOKMARK NOT DEFINED SECTION 4: SUSTAINABILITY oF CDTI 29 3.1 3.2 3.3 3.4 26 27 21 28 T 6 7 I 2 3 3 -) 5 6 tv 4.1. IN'l'ettNnl; INI)11t,t,Nl)t!N1'I,n t('n('l,n 'tot{y N{oNI't ot(rN(;1 l,,tzAl.r.t,^t'toN. . l() 1 l.I l'Vu:; 14ortitttt'ttt{/avultrttltotr t'ru't'icrl orrl tltrt'rtt,t, tlrt t't'1tot'lut.\ ltt't'ttttl ) (tt( l\ (utr ol tltL, /itllott'ittg t,ltrt lr ut t' trltltlr< ultlc) .. -)t) 4. I .2. I4/ltat x,erc lhc recorttrtrctttluliott.s I .10 4.1.3. l-low hut,a tlta.t, bacrt intltlatttcttlatl'/........ _10 4.2. Sus't'nlNRurt.n'\'or; r'RoJtj(''r's: I,t.AN n Nt) SI:'r"l'AI((,I:.'l's (MANDn 'r'or<\' ,\'r 30 . Yr< 3) . .t0 4.2.1. Planning ut ull rclavattt lat,cls . ... -104.2.2. Funds........ -j04.).3 Trattsporl (raltlucenrcrtt ctrttl rnuinlururtca) ......... . ... . -10 1 2.4. Otltar rq;out'L'cs'... _j0 4.2.5. To wltat extant ltas tlrc platt beut intpletnuttcd ............ . -i I4.3. INrncnnrloN............... .ll 4.3.1. lvcrrttectitt clalivar.l, ttrcclturtisttts ............ . .. _l I 4.-1.2. Traittittg il 4.-1.-1. .loirtt.suparvi,siott uttrl rtrottrlot'irt! ryillt olltct'l)t'o{t'(uu.\ .l-r 1.3.4. llclcu.ye o.f'.f uttds f ot' 1.tt't.t1ct t Lt( tivtttL,.\ -i_) 4.-1.5. l.s CDTI ittc.ludad itt tha l,llC'bttdgat'/ -ll 4.3.6. Dcscribc olltar haultlt prosrunutlas thut ura tt.tittg tlrc CD'l-l ,\'lt'u(ttu'('ttrttl ltov, lltrs tt,us aclticved. I4/hul have been tlte ucltievenrcrtts'/............. ....... . -l-r 4.3.7. Describe olhcr isstrcs consielered in tlrc integratiort of CDTI . ... .....iJ 4.4. Opene,rroNAl RESEAtrcn.. ......32 4.1.1. Sunnnarizc irt rtot tnorc lhatt onc hulf o.f a puge tlta opcrcrtittttul t'a.tt,ut"t'lr uttderlakert in llte projccl urau v'illtirt llta reltctrting pariod................ .....: ... ...... . -i-r 4.4.2. How y,cre tltc resLtlts ctppliad in thc projcct/............. . -jl SECTION 5: STRENGTHS, WBAKNESSIiS, CHALLBNGES, AND OPPOtITUNITIES.... SECTION 6: UNIQUII FBATUI{BS oF'l'IlE PROJBCTiOTHBR NIAT'triRS ....33 ....33 V y.!. Acronyms APOC ATO ATrO CBO CDD CDTI CSM DHS LGA GRBP I.IFS I-{KI LCI LGAIID MOI] NGDO NCO NOCP NO'l'll PIIC REMO SAE SHM SMOH SSI TCC TOT UNICEI,- UTG VHW wHo African Programme for Onchocerciasis Control Annual Treatnrent Obj ectivc Annual Training Objcctive Comrnunity-Bascd Organization Cornmunity-Directcd Distributor Commuuity-Directcd Trcatment with Ivcrrnectin Corlnrunity Scl l'-Mouitori ug District I'lealth Supcrvisor Local Govenrr-nent Area Global 2000 River Blindness Programme llealth F'acility Staff l{clen Kcller Intemational Lions Clubs International Local Govemurent Arca I'[calth DcparLmcut Ministry oI Ilealth Non-Govemmental Dcvelopmcnt Orgauizatiorr Non-Goverlmental Organization Na tiortal Orrchoccrc iusis ('<lntrrr I I)rogra nrnrc National Onchoccrciasis'l'ask l;olcc Primary health carc Rapid Epidemiological Mapping of Onchocerciasis Scvere adverse event Stakeholders mecting State Ministry of i-Iealth Sight Savers International Technical Consultative Committce (APOC scientific advisory group) Trainer of trainers United Nations Childrcn's IjLrnd UItinrate Trcaturcnt Goal Village Healtir Workers World Health Orgarrization '9't Vi Definitions Total nopulation: the total population living in rneso/hyper-endemic communitics u,ithin the project area (based on REMO and census taking). (ii) Eligible population: calculated as 84o/o of the rotal population communitics in the project area. ln treso/hypcr'-c nclcr.n r c ( iii) Annual Obiectivc: (ATO): the estimated nuurbcr of pcrscins ln'rng ur Ir Ivcnlcctrir ut a gtvcnmeso/hyper-cndemic arcas that a CDTI projcct ir-rtcnds to trcat rvit year. (,u) IJltrnrltc 'frcirlrlctrt Coul (tJTG) cltlculatcd as tlrc r.nu.tiruur.n nuntbcl ol'lteoltlc to Ite (v) treated annually in meso/hyper endemic areas within the project areet, ultiuratelv to bc rcachcd when thc projcct has rcaclrcrl [ull gcogralthic covcragc (norntalll, thc ;'r'o.1cel should be expected to reach thc UTG at the end of the 3'd ycar of thc project). 'l'ltcrapetttic covcrage: nutnbcr ol'pcoplc treatcd in a given ycar ovcr thc total pripulatron (this should be expressed as a perccntagc). (vi) Geographical coverage: number of cornmunities treated in a given year over the total number of meso/hyper-endemic communities as identified by REMO in thc projccr arca (this should be expressed as a pcrcentage). (vii) Intesration: delivering additional health interventious (i.e. vitamin A supplcnrcnts, albcndazole for LF, screcuing for bataract, ctc.) through CDTI (using thc sarnc systcn-rs, traiuing, supervisiou and personnel) ir-r order to maximise cost-elfectiveness and curpo\\,el' cot.tlrlrunities to solvc ntore of thcir hcalth problcms. This docs not inclrrdc ilctlvlltcs ot' itltcrvct.ltions carricd out by cornrnunity distributors outsrdc ot'CD]'I. (viii) Strstainability: CDTI actrvitics in an area are sustainablc whcn thcy c6ntinuc to lLrnctrog effectively for the foreseeablc futurc, with high trcatmcnt coverage, intcgratctl into thc available healthcare scrvicc, witlr stt'ong conununity ownership, using resour-ccs mobrlrsccl by the conununity and the govcmment. (i^) Community self-monitoring (CSM): The process by which the community is emporvcrcd to oversee and monitor the performance of CDTI (or any community-bascd health intcrvention progran-rme), with a view to cnsuring that tlre prograulnte is bcrng cxccr,rrccl irr thc way intcndcd. It cncouragcs tlrc comrlunity to takc hrll rcsponsibilrly o['lvcrnrcctrn distribution and makc appropriatc rrodiIrcations whcn ucccssary. vu ts (.i) FOLLOW UP ON TCC RIJCOMMENDATIONS Using thc tablc bclolv, llll in tltc rccomnrcndatious ol'thc lasl.'l'CC on thc ltrtlcct untl describe how they lrave been addressed. 'l'CC session 25 Thc Statc scn"^itizcd 564 conrnrunitics during thc implcr.nentation oI thc spccial country initiatrvr: wlrich lacilitatcd thc sclcction of CDDs and cor.unrunil.y su1'lcrvisols along kinclrccl Ilncs. A total of 2726 CDDs and 1205 comnrunity supcrvisors rvcrc traitrccl. This is a 60"1, and ii09l, incrcasc ol'tlro nunrbcr ol' CDDs and supcrvlsors vc availablc in 2006. ( I ) I c us c u tl tl r t t o t' a r o t,s' i /' r t t' t' t,,s.s u t'1, ) Nuuber of Recommendatiott in thc Report TCC RECOTTilTENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/,,IPOC MGT USI] ONI-Y 235 To incrcusc thc scnsilizir(ion and mobiliz.atron ol thc conrnrurritics and to incrcasc thc uumbcr of CDDs through kindrcd sclcctic-ru 'I'o rcinlbrcc thc add-otr iutervcntions in ordcr to raisc thc population intcrest lor Onchocclciasis control activitics. 'fhc Statc intcgratcd vitanrin 'A',supplcmcntation during thc child hcalth weck programme. A total of 491 15 childrcn from 6 months - 59 months and postpartum mothers werc immunizcd at 3 LGAs. Othcr iutcrvcntions likc ITN distributions (ctc) arc yct to takc olf in thc St.atc is Executive Summary Preparc un Excctttivc suntmut),oJ'the rcport in not more than one pugc. Abia State project is I conrlrorteut ol Inro/Abia-NOTF-wLlO-CDTI projcct rvhrch ri,as approved by APOC irt Septcrllbcr 1998 for thc first ycar CDTI inrplcprcprarierr(l9eri/te99). Currently, the project has corr;tletcd its cight ycar of'CDTI in-rplcnrcntation (lbur.tlr ycar post APoc sustainability plan) spanning January 2oo7 - Decenrber 2007. Out of a total of 564- vtllagcs, tirc project treated 549 villages giving a gcographical coverage of 97o/o. Of a total population of 405175 persons with an ATO ind-UTCj ot' 356,701 persons, the projcct treatcd 331,288 persons giving a therapeutrc covcrage of 81.6% and an ATO/UTG covcrage rate of 93oh.In addition, a total of tO+,OOZ per.sops were passively treatcd clLrring tirc reporling pcriod. Aclditional data wcrc strli bcing expected at the time of subttrission tlf this repoft. Population nrovenrellt withrn thc pro.;ccr area is dynamic with movcr-ncnts towards the urban areas. Itr tcrurs of traiuing, the projcct trarncd aud rctraincd 59 LGA statlTLOC]'s,412llcalth Facility Staff,2726 CDDs and 1205 Conrmunity Supcrvisors in U AITOC l-CjAs ot'Abia Statc. By these, the projcct achicvcd 92"/o, lll%o andglo/o of ATrOs for LGA stal'l', hcalth workers and CDDs respcctively. With the present number of CDDs thc pro.ject has achieved a CDD/populatiort ratio of l: 149, a considerable improvement ovcr that ol'200(r which r,vas l:366. A rnajor challengc, which afl-ectcd the project's perfomrance, was inadequatc tuld r-clcasc front the State and Local Govcnrntcnts. This demonstration of poor poiitical wrll by rhc policy tnakers, particularly the LGA chairmen has adversely afl'ected key colrpolclts ol' CDTI implementation. Thc State Project intensified efforls to ensure thelinrelyrclcasc of the couutctpart funds by the State and the LGAs, but nothing much was rcalrzccl. I-lowcver, Abia Statc Flealth Dcvcloprncnt Projcct II (nBIISDP II) assisrctl in 1r-ainirrr: /r'cl'rrtittrrtg ol'additiorral l()2 FLllliS ancl I70 CDDS f}opt t5c acLivr: arrcl ltassrvc l,(iu\s. Otlier challcnges faced includc CDD attrition due to inability of sonre courrlunitics to trlotivate theur, poor attitudc to work by sonrc hcalth stafl, and poor mouitorilg apd sttpcrvision of CDTI activitics by hcaltli lacility stalf. To arlclrcss thcsc thc pr-ojcct mobilized communities to select additional CDDs preferably along kindr-ed lircs who were trained using funds providcd by APOC and the Abia State Llcalth DevclopnclL Project II. The project also utilized the opportunity of the special country initiaiive to train and involve more health staff thus decreasing the wort load and requiring thcnr to ensure effective monitoring of their areas. The Statc CDTI project intcgratccl vitanrin'A'supplcurcntation during thc child Sclltir week programme supported by UNICEF Zone'A'. A total ol 4g,Tlichilclrcn lirnr (r tlronths - 59 lnonths arld postpartuu.t mothcrs wcrc givcn vitantin A i1 3 l-(iAs ol'thc State. 2 $t l.l.l SEGTION {l Background information 1.1. General information Description of the pnrjcct (brictly) Abia State is located in the southeastern region of Nigeria. The State lies bctr,vcen latitude 4o45' and 6ol5'Nor1h and longitude 6o30'and 8o09'East. It is bordered on the north and noftlteast by Ar-rantbra and Enugu Statcs whilc on thc casL by Cross Ilivcr auil Akwa Ibom States. Its southcrn bordcr is shared by Rivcr.s State. l'licrc arc two clintatic scasons - dly scason spanning Octobcr [o iVlarch anrl tlrc nrrny scasou Iiont Alrril to Scltlcnrltcr'. Abia State has l7 LGAs with a population of 2,883,399 rnillion peoplc accor.cluru ro 2006 census out of which 405,175 persons are at risk of contactirrg Onchoccrciasis in li hyper and meso endenric LGAs. The pcople of Abia State arc vcry dynamic peoplc who are predonrinantly lal1crs, traders, artisalts and civil servants. The people are unitcd and lrave Igbo as a coprprol language The road netrvorks within the project are very bad with difficult terrarns rvhrch urc particularly problcrnatic during thc rainy scasoll. This makcs conru-tunicatron clil'flcLrlt as most of the rural areas lack telephone services. Thcrc arc basically two lcvcls of adurinistration -- thc Statc ancl thc LGA. At thc Statc lcvcl thc chicf cxecutive is an clcctcd Govcrnorsupportcd by his cabinct, a singlc htiusc of legislature and thc judiciary. At thc LGA levcl, an clcctecl Chairnrcn is iu clrar-sc supporlcd by an equally clcctccl council. Thc LCA is diviclcd into cornrrrunrtrcs. Traditional leaders (Ezcs and Chiefs) head the communities. Councils ol eldcrs assist the Igrvcs. At the kindred or village level, the elder in the family presidcs ovcr a council of elders where decisions are collectively rnade. Tlic hcalth care system in the State follows the pattern of the Fedcral Ministry of I-lcalth in the State Ministry of Health. Primary health care is thc bedrock and thc cnLry point for thc conttnunitics. Referrals are nrade to the secondary health carc centcrs. l'lrc primaryhealth care is the responsibility of the LGAs while the secoldary is that of thc State govenlment. The Comnrissioner for health is the political heacl at the State lcvcl; followcd by thc Pcrtrrartcnt Sccrctary of thc Ministry (who is thc accounting of-liccr.. f)nc ol'thc importaut functions ol'thc Statc ministry of tlcalth is to lbrtnulatc tlrc Statc hcaltlr policics, translation and execution of Federal Health policies etc. For the Local Govemment level (Department of Health) the most significant development is the reorganization of Health Services in Nigeria whicft ,o* tn o,., expanded role of local governments as regards primary health care serviccs. The local govenlments are directly responsible for organizing and rcndering PFIC Services to thc comnlunity people through the administration of primary lrcalth carc centrcs within thc local governtttent area. There are two divisions at this level that deals dircctly with health: the primary Hcaltl-r carc and the environmcnl.al Division. Thc political lrcad ol' the unit is the supervisory coutlcilor for health who is rcsponsible to thc Chair-rnan oIthc local govemment. 3 !7r Organogranr chart of Hcalth Systcrn in Abia Statc. Mcdical offrccr of I Icalth PIIC coordinator LGA PIIC dcvelopn-rcnt Comrnitl"cc Expcricncc conrnrun i ty Ilcalth Ol-llccr' llon. Comm. lrt-rr I-lcalth Statc {l'l lC lnrltlcntcntatiorr Committec Perurancr-rt Sccretary Drlcctor ol l'l IC (Statc I'l IC Co- ord tnatot') Asst drrcctor NI'l Ntrtr ttron, I lc.rltlr lrrlrrc.rtrorr [:ss l)r rrgs clc Asst. drrcctor I)rvrsron ol'I'llC 'l'nrrnrrrg & M,ttr1>orvcr n sst (lrrcctor tlrvrsron t,1' l'l lC l'lrrrrrrrrrg. tttottrlor rntl ,trrrl LGA Chairrnan Supervisory Colrnsclor for llcalth Asst. coor tlr rr rrtrlr t\,4cH t;t) Asst Coortlrrrator NI'l/ I)iscasc Cor)trol Asst. coo[dlniltor ltsscntral tlr rrgs ct;Lrr;.r & Srrl;pltcs Asst. coordrnalor I Icalth Dtluct(rorr & Sch. Ilcirltlr l) rr rrr ra rn nrr' Ass(. eootdrtt.rtor pl,rrrrrrntg rnonrlot tnrl ,rrttl ll r,;r I r r,r I r r rr District/LGA llr Total Nunrbcr of Itcalth slaff in (hc cnlirc projcc( arca llr Nurubcr of Ircalth sta[f involvcd in cr)1'l Pcrccutage li.r=llrr,r, *tn,, Unrunncochi ti5 43 50.5 Isuil<rvuato 118 54 15.1 148 69Bendc Ukr.va East 82 38 16.6 46.3 Ukrva West 79 31 46.8 Ikwuano 86 35 40.6 Ohatia 74 39 52.7 Arochukwu l0l 44 43.5 I: Number of health staff involved in CDTI se add tnlre roy)s i tlcccs.\'( r.l') It r', 'l'otal 773 359 4(t.41'1, NB Tltouglr number truincd t'cre tnorc, lhc uhove nunthcr antl pcrccntage rcflact rhosa slu./J'purticiltutirtg itt CDTI.. 1.1.2. Partnership - Indicate thc pafltrors involved in project irlplcmentation at all lcvels [Moll, NCDOs(national/intcrnatronal), conrr.ntrnitics, locul organ izations, ctc.l - Describe overall working relationship alnollg paflncrs, clcarly rndicatrng spccrlic arcas of project activities (planning, supervision, advocacy, planulng, nrobilizltiop, ctc) whcre all partncrs arc involvcd. - State plans, if any, to mobilize the state/region/district/LGA dccisron-rnakcrs. NGDOs, NCOs, CBOs, to assist in CDTI irnplcurcn(ation. The partners involved in project irnplcnrcrrtatiou; o African Programmc for Ouchocerciasis Control (APOC) o National Onchocerciasis Control Programme (NOCp) o Lions Clubs Inremational Districr 404 (LCI) o Global 2000 River Blindncss Prograrr.rr.r.rc (GIf.Bp) . Statc Ministry of I-Icalth (SMOI t) . Local Govemrnent Alca Ilealth Dcpartrnent (LGAIID) . EndcuricCourrtunitics. . ABI-ISDP Il o Girls guide, Girls Bngadc, Boys Br.igade and Boys Scout. The partners have a good working rclationship and are working torvards thc succcsstirl irnplementation of CDTI in the projcct arca. NOCP, GRBP, LCI, and SMOH are involved in advocacy gearcd towards cnsuring support by stakeholders for CDTI implcmcntation and sustainability. APOC, GRIll, an<t LCt proviclc funding and technical supporl. SMOH, GRBP, LGAs and enden-ric comnrunities are involved in mobilization, training of CDTI personnel and supervision. The endemic conrnnrnities provide the CDDs who carry out the actual Mectizan treatment. Thcy also nrake decisious with respect to time and mode of distyribution. Due to changes in the administrativc pcrsonnel and policy ntakers at thc, Sratc and LGA levcls, therc is a need for a fresh nrobilization and the State plans to orgauizc a stzrkcholrlcrs mecting to intimate thcm about thcir rolc in thc sustainability of tl-," CDTi stratcgy. 5 T Ft tJ - trr o ,f * c o !o FD ,f A) o C 7+ A) rD a (- 7f 1 o) FNp0 @ EU .D o-(D a 2t c Fo (- o o -ooE >qdv,4 tD=- D)aD+ igsq =. ii (D A (rt{ -IUI o\(n o\ {Ol.Jt\) N) OA o\ o\ (! @ \o o\ F L,'I5 -J AO o\ oo o\ o\(,t\o L}J()J ci-o!'rE :r 66D= a: = r.i1r 3.o D)d- El6' E.5 0R(!A ; ='5H 1r6== UJ\o o\ o\6 Ur o\5 o\ oo o\@ O I O (, O (, @ oo a (,l a LA t-at O (^ (Jr o o\ o\ o\ NJ tJ N 5Ji6,< E-:r '7=aD'iEg *3 "'lE a-3 -.=D Nti =.o6- 6r il P + z .D +t r) fDq rc oO A UI{ -l(,l i.J6\o N) o\ o\\tA\o (,rt L' o\ o\ t! a O LA ! I.J N) { NJ NJ NJ oo o\ o\ NJ oo o\ o\ O (}J oo(^ \c) o\ ()J oo(,l\o O J\(Jt 5 -lO A +\{O O LAA (n5 o\ O O@ o\ (,| O oo o\ o\ \o UJ(}J o\(,l\o(,(,) o :NF -.= o661 - =@ O :N e.3 3:r * 6 0 0..< ,r3='EE D-!.: lF^lE6' O.6 rOO5 \+;'€ s NE ='o6r 6r II + (+)(,I { u J}J Fo J\ m { N o\(Jr @ UJ NJ oo (jJ co 1..)OJ- s\) so\{\o o\o 5 Lar Fl Ii) feAiri =:' ;+ =' J6 .l N T ! oE tr ql ,.i of 1lJ\ I,'r\ tu !l.D .! INJs^ s*o (\= J(.DSmq FDa t0() o a U) o' >1 o H €. rD() o .D o. I 0a o ta o Fl oa rc(a Fl o o a DJ o- o ID o I aF o lD ID Fl it a) F.i rD r'. .l) o I .0 rD -(.o t rD F) rD o- C CL = ( l'! ('g ta o - 0a .DEt a o- Q OJ a\ lat- - \o ll cj Ri :_ d- .n-'\\E. RS oQ= 'HES=' =.- a= nis a\ :! <-\ \d a): .i* oQE= :-i{ENbi .:: \i = .i= .*o\i :\ d! =-fSF 6: ni. Io\) \ j=. -\R 6\ QQ. '-i :f! :- =-\= :tr A6 a .\ s G a* :-(\ a\ r\ a) i *F zp 1a1 co- o Fr 3a' zoDA =Hiouo r:O(D+) -O lo) It!t-.t, IJlrDl*lO),d !.1 fD9, ,UEl<lo1.9 I I I I I I I I I (, oI o H .) JD q (.D =.<' l2_ z $j u ot Ca t a UA .D .D: o o = c -1,) ( t'a !, c- r) rD p r) o .) r) c ot (IQ I *J (-D -o C C- o - DJ c- - .D O .D "oE o oo DJ .D P {/l O) o FD oa .D a aH c0 o- o. rR Io o +r 7l =o-a cD o-a .0 'oH €.(D o D)t(D FO CD 0qFl o @ O o) rra .Dq F .D .) o - ('t a =a dCD coCD N YL:16-=il.D 6' tsl ao' ,-oI =' A)b3. o C)o'{A .)Ci =o5t,foda' !FtL =D)o=' * ci5 Fr(.D !D: u.nov(^) tsriHO) DOl-aP,3 o- o6 OErl+ ;i .D J- ro .) DJ o- (D o- op) o 13 I a +l !_" t' 2.1. SEGTION 2: lmplementation of GDT! Timeline of activities Fill in table 3, timeline of uctivitiesfor areas treated in current year,ind,icaLLng rvherr the key activities were implemented by the month they began and the mor-rth tliey ended. g T Fl H t- x' c DO I oo ,f{ o 0) 0) x.I A) o x' A) Lu A' (D (D ,l s o (! oo a, a I{ ,1 O@ -(n ri UA -, o O6 o OE ;r! 7 s o @ _a 5-l -oo -l D) Iq ao 1' :-+ @ o =) 'n a) m Lr) 5-l -rq o .D a C t! o m o Ou +6 ,|) O) ca a =+ oo 0q oo O6 - ,n o 6 -v) 5j -oo a 6 Uoo O @ l-r IDJ l\J l.D IUJ ; .D (D o o =.3a i =(D -fi t p o o- .l) .) = --l .D .D - \ ri la a l* o a: rl r: avq .- o o ? -l .D o a DT .) (.0 A)H(D o DOF,lt.(} o- o a 3 .D o a D) .D rr LI rD c) A) ao (D 'oI €. rD .) o- .D io o (DE .D o - ^ o PD -t o o <FJ;'3 @j. ;f- .DOa -o' r=aoAr- =A ).@ o- ,t .D= rDaDx^(Dki. ri</. U)Eo+) t rD o DJ o ot l0 lJ() o .D -O a O)tst .0 a .D rI) e) rD o- rD Il- a Fl oq oo rD Y -J CD LN .D rD FD s !,, Level/Statc Abia No. of visits 4 No. of policy nra I<cl's ti To rnobilize State Olficials for thc rclcasc of counterpaft funds Purposc Abia t2 34 l'o mobilizc LGA officials fbr rclcasc of funds to LGA Oncho teams, t6 42 2.2. Advocacy State the nunrber of policy/decision makers mobilized at each relevant level during thc currcnt year; the reason(s) for undertaking the advocacy and the outcome. Describe difficulties/constraints being faced and suggestions on how to improve advocacy. Outconrc Promises wcrc madc lirr thc rclcasc oI corrrrtcr'ltirrt lunds. Thc Statc rcleascd fund for Zonal l{eview Meeting, and thc Abia Health Developrnent Project releascd soure lunds lor trarning ol- sornc ltcaltlr workcrs. LGAs A fcw LCAs actualizcd their prourises and relcascd littlc lirnds. Constraints: l. Inability to meet with policy makers at the LGA level 2. Policy makers having too many engagenlents at the State and Federal lcvels, making it difficult for thcm to focus on such issues as onchoccrciasis conLrol.3. Inadequacy of funds to hold advocacy workshops that will involve thc top ltolrcy rrrakcrs at both Statc and LGA levels. Suggcstions of Advocacy lmprovcmcnts: l. I,tcgratcd advocacy by all part"rcrs - ApOC, NOCI), Clobal 20002. Organizing Advocacy mccting with nrernbers of Abra housc oIAsscntbly3. Thc Statc Tcanr will continuc visiting thc policy ntakcrs at thc LGA lirr. sensitization and awareness creation on CDTI activitics 4. Utilization of the Department of LocalGovernment to advocate to LGA Chairnrcn5. Identification and utilization of prominent people and NGOs who have access to the State's chief executive. 2.3. Mobilization, sensitazation and health education of at risk communities Mobilization During Iltc rcltortittg pcriod, rvith thc bcncfit of thc lunds nradc availablc uudcr thc spccral country initiative, the project did a comprehensive mobilization of target communitics. Irrrst, the health workers al1er being trained wcut ou nrobilization of their arcas. Thc Statc tcarp e1 observing deficiencies in the mobilization process cmbarked on an aggressivc coururuniLy l0 ..lu mobilization and utilized the opportunity to train LGA health workers on eflbclivc w'ays o1' mobilizing cornnrunity n.rcnrbcrs. Thc nrobilization was conductcd using: L Thc nrass nredia: o Itadio/tclevision discussions o Jingles i Prcss roleases o News talks 2. Face to lace discussions (Conrmunity forum in each village) 3. Correspondence with Stal.c, LGAs and cornr.trr.rnitics 4. Postcrs and l-randbills, somc ol r,vhich were produccd uuder thc, spccral couutl')' rnrtra[ive. I-Iowcver, the numbcrs wcre not adcquatc. In addition, the projcct utilizcd othcr inrportant traditional nrobrliz-ation chartucls in all thc vrllagcs to rcach thc targct pollulatious, anrl thcsc wcrc: ( l) Village hcads and chicl.s including thc opinion lcadcrs.(2) Groups and associations such as age-grades, won-leu organizations, schools, clubs, aud above all women in health and family support programllte.(3) Torvn criers - who are the news disseminators or local radros of each villagc, havc proved to be the most cffectivc means of comrnunication and rnobilization. CDt) training activities are announced by the town criers as well as commenceuteut ancl end of distributions.(4) Girls Guide, Girls Brigade, Boys Brigade and Boys Scout.(5) Rcligious organizations.(6) Church announcements -utilized especially during thc Onchocerciasis day celebrations. Church services rvcre held to mark the day and offered opportunity for pcople to be rnadc aware of thc CDTI and Oncho control efforts. A total ol'564 villagcs in thc llrojcct arca wcrc fully urobilizcd. Thc various vrllagcs shou,cd willingncss to kecp on participating in CDTI, although most had problcms witli giving incentivcs to CDDs. This unwillingncss is more pronounccd in the LCAs whcrc oil is bcing produced. One good thing is that all conmrunity membcrs pcrceive the drug as a good thing, and arc willing to take it whenever it is available. To combat the issuc of incentive s to CDDs and also hclp enge nder l.norc awareness, health workers in some areas like ir-r Ukwa East focuscd ou tnobilization of wollrcn dLrring their mectings at thc community levcl. This maclc for greater involvcment of the wornen, and this translatcd into increascd coveragc. Therc arc still, howcver, some difficult villages that require more efforts at mobilizing thenr. To improve the mobilization process, more funds need to be provided for lace-to-lacc meetings with community members, production of adequate number of revised or new IEC rnaterials, production and airing ofjingles on television and radio. More time will need to be dcvotccl tt-r thc problcnratic villagcs. llaving cxpcricnccd thc input ol[raclitioual rvontcu groups a[ thc comnrunity levcl, efforts will be made to mobilize thcm specially to inrprovc cournrurrity participation. T ,fi IrNINlo' 5 l.ll+- ^o(l oEit 3J d{ (Dri ID -)3.O =.oo ='O"= =lro -) \J -l \ aq(\ a\ = -:($ o =q ='-J a .i 4 ') .-: -l D PFl o .) 2f o PD F) ,f) D) o Cx' ID rD a 7i{ FO ln A)a Ed .D o a x c A] o (D o .) a' I t- o Ut o\A (/) b.) (,I(, (,l s co T\)@ 5 (rt IJ\o oo oo IJ J- 5 t..) o\ (..t N-) (,| l.J\o u) L,l o\@ Lar\o o\ o\ UJ Ol LA O t-) Or l.J oZ If =6 =r lo 6J E6oq 9ot)@ oa -='q; =aGO ==lo 3.5 o' aiai=P - ='r.e,. "\ ? .Z D 0q6 ID 6a .=a 6J ud 1* '^ -_. a tll AA o\\o o\ oo N)NJ 5NJ o\oo (,)s N)\j IOCOi a ,:- 56 oE -.F =0op a= = D 6 o .J E! I EE + (,I @ h.J b.J{[.J o\ @(^ UJ(rl A t.J o\ UJ oo l.J NJ{ Lar N.) -J! t.J UJ5 UJ t..) t..) ! tJJ\o(,l NJ o\ UJ l\) UJ L,)(n{ A UJ UI J>\o At)J UJ5 s(, 55 oo LA(}J ooN.) EAtnoTo5--;. = = o' 6' !. @ I l ,=? ,6=i tr9e319= 5: = 6'o OQ @ E t lt -J{ ^\ ! NJ A @ o\ Lar @;- \o oo !UJ 6 ,r, oo L^, o co H9 :1 E+ :,1 r. o5-l;: <ta " .D3 r.63.< ='rD,o)0c ,:a Ooo v r.| 5u * r=r5-l ^NJ:l o, 5- =\J7a ro .iaa '(D H FJ o o- NJ{ CD{ o .D o- 5 o\ o- o Ua .D1r .D :': (D P EJ o o CD N) ! rD o l,DI rD A) o- o-o u o \$o i$ Conrment on Attendance of female ntembers of the cornmunity at health education mectings In gcncral, how do you ratc tlrc participation of lcuralc nrcrlbcrs ol- thc colnr.nr.ult), meetings when CDTI issues are being discusses (attendance, pafticipation in tlie discussion etc). Parlicipation of female members of the community at l-realth education nrcctiurrs apd other nreetings related to CDTI Incentivcs provided by comrnunities 1br tirc CDDs Attrition of CDDs. Within thc project thcrc is vcry activc participation ol'thc wol.lleu lblk in all rssucs p.rcr.l.liprrrr-1 to thc cotlltnuttity. Iu somc cascs, including hcalth cducation scsslous lhcy arc llol.c lrctryc and more in numbers than their male counterparts. In some places, as eirlier highlrghtcd. community wolren meetings have become thc fulcrum for CDTI implcmcntation, ancl Llrrs will be further improved on and expandcd. As could be observed froli the table abovc. thcr.c are tllorc f'emalc CDDs than male CDDs in the project area. In fact, in sor.uc corpprulitics all the CDDs are females. In a fcw places the lead CDD is the spouse of the cornmunity leaclcr. This is an attestation to the effective involvernent of women in the CDTI process. Some comnrunities provide cash incentives to their CDDs while others providc in-kin,l contributions. For some others words of appreciation are the only incentives providecl. A f'erv others do not give incentives, bclieving that it is tlie responsibility of thc govcrnmcnt ro givc incentives, since they are the ones providing health care services. Attrition is not much of a problcnr. Sornc CDDs lcavc thc prograulr.lc lor grccncr pusturcs, to attctld schools or for inadequatc motivation. One of thc bcncllts olinvolvcrlcnt oi'wonrcn as CDDs has becn their tendcncy to bc rnorc availablc at thc comnrunity than thcrr rrralc coullterparts. To address attrition, and reduce demands for iucentiv"r, it" pro.jcct lrcgun rnobilizatior-r of the communitics to sclcct cDDs along kindred lines. 2.5. Gapacity building - Describe the adequacy of available knowledgeable manpower at all levels. There is an adequate availability of knowledgeable manpower. Howcver, thc problcnr, rvhiclr is expericnced, is that of frequent transfer of traiqed manpower from CDTI to non CDTI arcas and lack of interest and commitment to CDTI activities. Also, ,ranpowcr availablc in so'rc hcalth facility lcvcr is wcak. - Whcrc li'cquent transfcrs of trained stalf occur, state what the project is doing, or intcnds to do, to remedy the situation . (The nto.sl itnportant issue to describe is witar tye lsurc.t were taken to ensure adequate CDTI intplementation where not enouglt ' knowledgeable manpower was available or if staff are ft'equently traisfert ccl clLrrittg the course of the campaign). With the benefit of the special country initiative, the project trained additional health workers including the unskilled health workers so that they provide back-up services. With the suppo( of the Abia State Health Development Project II, some health workers werc traincd not only in CDTI LGAs but also in non-CDTI LGAs. T 43 6\ 6 (D 6 \o 19 Fl -, - H (1 x' .I o FOir FJ Pf{ p) o - ,f{ (D U) r1)({ TD E lDa E! o o. o a F c o t (D o o\5 oo co oo 6 @ oo .l- E oo co oo co 'laI z (i -; - q oo A rJh\o IJ o\ m IJ o\ 6 O lJ o\ 6 @ t9 +. o\ t fpi olr f 6 o\ G4G o 6\ 5p Ul o\ LJ A -Ih.) @ { IJ\] NJ @ \l o\ co 5 5 N)5 s co TJ tJ Ji 6 3Z qZ a! -l _- _l !^r o o tJ AA tJ .! (D r! o\ o\ o\ o\ tJ NJ tJ N) N) t-.J t tJ NJ IJ tJ N tJ IJ NJ N) t) N) N) tJ N IJ N) i A1 o : A- 9"g o o z ^l .D q= EJ fD -' D- .D - N) l.J 6\ a! o rD \o A p\o € hJ tJ{ A rrt o\ p -Ip \o \,1 o\ t.J TJ J\ 01 N) a tJ{o @\o o\ l'.-) N\]{ UJ s oo \o A 5 @N tJ \o { \o t\) -J 6 tJ { a) -l -a rn b or A-l Qll a r) (a z rt o D' t! l-'l lD)Idt- lanl- ; - 0a OJ C! @' -C! o C9 o o ,l .D a a! o =a ri -ri s * G CJ Q C) a '-la - >; \ a o a rS A$ \ o o:\ a\ 0a o a ; b E- c s ot 0! (n o (D o o oa U)o oo (D .D H o t-l 0 7f a-Fi(D o (D o. a o o oO a FO a- .D F)Fi o o ,f FD o cD X oa oU ? 6 T Trainees Type of training CDDs Other Community members e.g. Community supervisors Health Workers (frontline health facilities) MOH staff or Other Political Leaders Others(specify) Program management { { { How to conduct Health education { { { { { Management of SAEs ./ CSM { SHM { { Data collection ./ Data analysis { { Report writing { Others (specifv) Table 6: Type of training undertaken (Tick the boxes where specific training was caruied out during the reporting period) Any other comments 2.6. Treatments 2.6.1. Treatment figures If the project is not achieving I00% geographical coverage and a minimum of 650/o therapeutic coverage or the coverage rate is fluctuating, state the reasons and the plans being made to remedy this. The State achieved a geographical coverage of 97oh and 81% therapeutic coverage. More data were being expected from Bende and Ilaryuano LGAs as at the time of compiling this report. A 100% geographic and better therapeutic coverage rates could not be achieved due to the following reasons: 1. A critical component is that of supervision by the LGA health workers. There was grossly inadequate supervision due to the inadequate fund release by the LGA authority. This reduced the ability of the LOCTs to reach out to villages with problems or villages which had delayed in collecting their Mectizan. 45 Also some LOCTs delayed in carrying Mectizan to the health facilities even after collecting it from the State. They claimed to be waiting for funds tr-our the LGAs and this delayed treatment. Some CDDs after collccting Mectizan delaycd in carrying out thc actLral treatment due to complaints of non-appreciation from their communities. T|err due to the inability of the LOCTs/DHS to visit such placcs, [hc issuc lingcrcd with the subsequent delay in treatment. Even after cornplcting trcatment, some CDDs refused to rcturn thcir trcatnrcnt data hoping that this would prompt their conimunities into supporting them. The way forward: Though the project is still expecting more data, the project in order to forestall situations as reflected above did the following: o Trained more health facility staff, and is requesting LOCTs to ensure they are assignerl to specif,rc communities to supervise. It is expected that a health worker will be having an average of I - 2 communities to supervise and collate treatment reports. o Continued mobilization of cornmunities to sclect CDDs along kindred lincs, or through any other acceptablc lneans. This will bc continucd. o Conducted advocacy visits to LGAs to release funds for LOCTs supcrvision and CD'l't implementation. In the coming year, the project intends to collaboratc l-uol'c wrth tftc department of Local Gover.rtment: 2 3 4. I,J *8 A6 + \ (! o)Lr 6o a(6H()H0)(tId !!oo.= 'aA LV Hz0.) r'lEP, t '= -o I v ati aa .;i(.)= .iLP a E3EB ojrEitr at tro ol =E *l HI xl Ib El go- bltrF gIE A al t=,al ; ol() otol 0) oQ.r ol '-1tr Sl6 -l $ fla El$ rlBl tl:t El E sl()l ol - ll H orlEI E5 EIE Eol Xl 'E ll u Hl =l El € 5l q HlOl t*l = <..1 * q-lsq ol p. ol E olF,l pl O ul Jxr oro- orc bl Hl EI= €l= ElEl zlt zlP 2l cdl a-: I €l5l Bl ililil(dl!l C:)IEIel .YodgF .EI E ; =l o-looEI F' E A5l g B Ecllooc)bl 3^ E^ F':l is E8 I -l C)*O =l af9oEl E S e6l -E6F E;€csEEg= O rrl a<Ea zz O O bs -occo zd oo $ c..lN cO co\ot oo ca $ c.lr- \o @ \o\o rn o.lO oo o\ =t E- E eE, EEOTTE€;e 9'e UATL co 6l @ \o c\t N co$ -d. N co \o v c-l F- o\ rn F- ca o oA ll *s o PO =boo6 F9 oo <oF s n o\ sr-@ n$@ s .t r- o\r- co \o F- \ @r- q \or- \o 6 ?poe59EEEf o.!z \o tr*N \o N co$$ \o\otr) .f, $ o\\o ca ca t-*@$ ca ca oo N N o\ .ttt co$O tn 6 €6t t)t) !o d o.a =E6E .gT <.eA' Fv ra) .t\o \o o\ t--\o$ ca \or-$ $ N oo co ca ooN rn co 00 (n c.l r- la) 00s .t \o or-\o l,o(+) GA ^.rd-:1o ts€ o c!€< = ' d. 3sX Etro ca ca o\ rr)\o \o @ rn \o rr) $(n Ot,-$(r)$ \o o\(n @ ca \o\o[r) oo6l otN r-\.} \o c.lla)\o rat-t'-iAo = ah C) b0(! t) C) oU e ll rdd\o E .9oibo o- s5r!650i oe \J O o\@ O O tr-o\ O sr-o\ E.9 .- 3 = gfl tr tr= ii = E'trz6 o N \o N (.}\ (.} \or.) rn @\o o\tf,l,o -E.od o.= =tr'oE E.ST < g*'F9 c.l \o\o rn ( rn (n I @(.) \n @\o v\oia \oa@-.r6 =.9E 6IIE;.$8.g EE,EE- o>*6 c-lO \o\o (a) r.n(n ( 00tf1 ( oo\o $\oia .9< iaY H o o C) o CB BJI a 0) C) pa rnd E] cd J4 U7(.) B cl -V o B}1 (g (! o = J () olr Fl t-r ti ! 6qj(J q) o\ q) o ! a) V') q) E Ji(/) li Cd a(€()tr 63 63 L' F.l o L (n t ! (n rq a (.) cd C) LrF Sr o-r I -ol(dt FI \o o\ -lqJ N>eo :-- (D .D o- -j r) A) O og oo {il a lz. (D t.-t al.D 'n lrid lo6l+o l-'gto c) IJJ -tu -t"ol: -llo li')Dl^ a 1.. .D o .Dt I .D o-o :J .) A) o >. .o e. oo IDE(D - -Jo c\ cj eiIlr ^s sI'G Gqr Df,F s,.ai. I!>: :is \ \=tr:: =Er V\:^i$F =d *r* Ints ;'{s,E RS I =t fi1 3iir .s3X X 'l\ ci I FC =xN s EGq =* :-cS S oi. qn; s .s: i \:! A . {=: { -=rs- i!F Q-\E a,3s. =.tB rE.+ *s: 3t-d si. s;G.:GT iS r.6= 3. r.s6 \s .o F GE :. t Oa € E. s1\S OE hh T 2.6.2 What are the causcs of absclrtecism l Causes of Absenteeism: Migration Registration of those not resident in the arca. 2.6.3 What are the reasons for refusals? Reasons for refusals Religious beliefs People feel well misconception Briefly describe all known and vcrified serious adverse events 1sans1 tnat occurred during the reportiug period and provide (in tablc 8) the requircd inforntatiorr whcl available. Not Applicable In case the project did not havc any cases of scrious advcrse cvcnts (SAE) during this reporting period, please tick in thc box. 1 2. I 2 J 2.6.4 I No SAE case to report { 41 ,* E I I I :oE *>s ooe <.E E b qpE oo.= 9 .=6d 6.= o oEti x V.=El"o E o TJ IJ o o0 o o. @ .Et o6e;^(r= L-O-o c! -yP =otr & Q6O A -E C : d O d:-6 E,L o oA O* F 6u.<-a .o A E{-H HiLH ;'- l i I -l 5 s I9S #sErg o o <n o O-o:YEF IAi] e* z I u.N I cEg:t o o.r .tr oo bo6.F x(.) U) oo U' A EJ N q.) a. eJ aJ q ,6 -\ 4\)(.) q) S h a\ qJL \ \J 4Bq) 5 o Hoa o0 tr q q) L< o o0 L =.o' E c) E aoo o o r! a 0 0) o) o U)Lr C) ac(d t/) o L 0)th({< a 0) rn O cicir orl .ol *!lFI is I / \| b) N .o ?\ c ! q t\ i !o .c i q aO ?: \ =^' :! i: s: >=qt so \; t== Ee :.hr !.. :! <,h E! :! Ss a\ ts (, o c( (.) GI q) oI t'r cll Lo 6l o c) q) 0 cq a, ot-\o rrl ra q, GI I o) q) .o () t< D 0) C) Gq) E q) t, 6l C) a(:\ \J trq) L a{ 8N eSJ =sI6lGi ocE :q) 6)l* trT oq) '= 6r L= cL, .o t-t (nUE trpl o +il +r El c cqloolE5l qJ OO '=(n a, 0) !Otro6Ja)rC ctl ao)e e (.) (dE9oF< ti oir ta -:l ri #l u o\F) obo rg() o O o\ v1 co\o Y 00 \o @ \o od F-. q 6 q c.t r: co oo Gi o\ o drI] E] o ^ bI)(J d^ i Oo\ -o o r- tr- r.-r- r;co \o@ \ @ F- n @\o c.i ca \ @ oo 6i o 3d) O da3bs ooFeF ll + L.I E] 91 r- \o\o @ ri\o q \o\o r\o a rcol r- \t? @ l{ o6 .o6E 4q =A!6zb o. -l: .i- m o\vI o{ \o \d\o c{ cl t- o\\o c.l oor vi$ ot F- a] =t m od € if ol \o c.l @ @ N td *a d O.=2E*o < Ee'F9 o\ .f t-- a-l o\ +F- e.l \oc\ N 6 e.l o\$ \ooo $oo m\o C.l Or- \o c-' I (! AoA GA e :ri; _ A B66.= ". >r -- 'o 6.E<'=II)I<= - O E' a 3s o € ol$ GI @ a.ln cO c.t $$q $ $ v \o \o\o o\ oo \o\o o\ €oo v1 Nt-. r\F- $ Il r kl r.1 t{ o ^h0P EG. - Oo\ -o a @ \or- o oO rc C.l ci rJ- r- co ci o. ddd- 6a,r I HoU 9-r.itr OaH @ co \o F- co c.l t..it o\ t-r o\ t,l o'i .!? e 5 ffg , E.. Ez3' o\@ .f 01 o{ <t\o Fl\o \c) r- <t t\ c.l \o ol ti 6 o.=AE' b=o < g€'F9 s .<l\o .f\o .:i\o tf,\o v\o <t\o \o $\c) @ 6) o0 cg .9 =E E o(J bod =atI g IE +h.9 t, b ;; _ =.= c +.'= rd E E s EEE *U o v\o v\o v\o +\o *\o $\o .f\o +\o $\o & gr r-. o\ o\ & o\ o\ o\ o\ o\ o GI 6l o.l c.l e.l $ (\ c.l \o c.l r- c-l m C'l N GI 2.7. Ordering, storage and delivery of lvermectin Mectizan@ ordered/applied for by - Qtleose tick the oppropriute answet) MOH wHo DNTcpE NGDO Other (please specify): Mectizan MOH o by - Qtlease tick the appropriate answer) DNIcrcr ase specify): tr NGDo r Please describe how Mectizan@ is ordered and how it gets to the communities The order of Mectizan commences with the determination of the ATOs by the various LGAs and states. Collectively the total requisition is routed to the Mectizan@ Donation Program (MDP) through tlie supporting NGDO i.e. Global 2000. The bulk clrugs arc procured by Global 2000 to the zonal office from where the states are issr:cd with their requisition after proper documentation. Subsequently thc LGAs go to tlic statc nrinisrr.ics of health to pick their consignmcnt of drugs from there they are issucd to the various District Health Centers and Health Facilities. The Communities send to their CDDs ro the health facilities nearest to them to collect their requirement, also based on tlieir target populations to be treated. Table 10: Mectizan@ Inventory (Please add more rows if necessary) Number of Mectizan tablets llcrnainin 8t42 How are the remaining Iverrnectin tablets collected and where are they kept? The remaining tablets have been reissued as opening balances for the next treatmcnt cycle since they are yet to cxpirc. The tablets are kcpt in the LGA store aftcr thcy have been verified by the SOCTs. ry StatelDistricU LGA Requested Received Used Lost Waste Expired Umunneochi 184726 184726 175489 I 095 0 Isuikwuato 134692 134692 130763 731 0 3 I l9it Bende 164699 164699 r 3880 l 916 0 24982 5983Ukwa East I 15696 tt5696 109002 7tl 0 Ukwa West 9282t 92821 91629 481 0 1l Ohafia 154834 154834 132428 654 0 21152 Arochukwu 16317 I 163t7 t 146869 825 0 t5417 Ikwuano 872s2 87252 I 65671 524 0 21057 TOTAL 1097,891 1097,891 9906s2 0 5937 0 101302 WLL Statc activitics undcr lvcrtrtcctin dclivcry that arc bcing carriccl out by hcalth carc pcrsonnel in thc projcct arca. Healtltcare personnel issue drugs to the ncxt levei, nronitor their usc irntl rcccryc treatntont data frorn CDDs. Any other cornrneuts 2-a. Gommunity self-monitoring and stakehotders Meeting llas any traitlirtg (of traincrs) Ibr conrnrunrLy scll'-rnonilorirrg [rccn clonc in tlrc l)r'olcct arca'/ If so, When? Table ll: Courmunity self-monitoring and Stakeholders Mccting (Acltl rovts i/'naalcd) Dcscribc how thc results of tlie coulnunity scll'- monitoring ancl stal<choldcrs rlrcctmss Itavc affcctcd projcct implcnrcntation or how tlrcy woulcl bc utilizccl dur-inu thc pcrl trceltnrcut cyclc. Sadly, thcre were no rcports on Community Self Monitoring (CSM) and stakcholdcrs rneeting (SHM) conducted during the period under reporting. The LGAs attributed the lack of funds as being the reason forthc non organization o1- these activities. District/ LGA Total # of cournrunitics/viIlagcs in thc cntirc projccI alcir No of Contrtrunitics that carricd ouL scll' rurttnitorirrg (CSM) No of Conrnrunitics that conductcrl sLlrl'cholrlcr s nrcctrnr (SIINI) Umunncochi Isuikwuato Bcndc t02 66 ll5 Ukwa East 55 Ukwa West 50 Ikwuano 58 Oliafia 50 Arochukwu 68 Total 564 HLl Y 2.9. Supervision 2.9.1. Provide a flow chart of supervision hierarchy. PROJECT ADMINISTRATOR STATE CO-ORDINATOIIS/ STATE I'ITO.I ECl' OFI?ICI'IIS STATE ONCHOCERCIASIS CONTROL TEAM MEMBERS (SOCTs) LOCAL GOVERNMENT ONCHOCERCIASIS CONTROL TEAM MEMBERS (LOCTs) DISTRICT HEALTH SUPERVISORS (DHS) HEALTH FACILITY STAFF (HFS) COMMUNITY DIRECTBD DISTRIBUTORS (CDDs) 2? 2-+ Ivtlr 2.9.2. what were the main issues identified during supervision? o Low commitment by some liealth workers to CDTI implementation clue to absence of or inadequatc incentives . Inadequate mobilizatiorl of communities . The non-involvement of sonre traincd health workcrs by thc Locrso Growing participation of f'erlales in the CDTI process, leading to increase ir-r nuntber of fernale CDDs o Payment of some incentives by Ukwa West local government to solrc CDDso Some communities elected not to select additional CDDs citing the problenr of incentives as the cause o The appointment of old CDDs as community supervisors by health workcrs instead of allowing the comnrunity to takc that d-ecisio, o Inadequate IEC materials at the community level o Sonte the health staff trained were unskilled staff (liealth assistants, healtS attendants and ccmetery kecpers). 2.9.3. Was a supervision checklist uscd? Supcrvision chccklist has bcen devclopcd by thc project ancl this is uscd cluring t6c co1l-sc of supervision' The supervisory checklist was ineffectively used at all levBls. 2'9.4. What were the outcomes at each level of CDTI implementation supervision? State Level: l. State team ensure that proper mobilization/scnsitizatron excr.cisc wils done at Ohafia LGA 2. Tlley equally cnsurcd that thc FLI{FS arc dcvotccl/committccl to CD'l'l programme 3. The State team revised the Health Education mcssagcs to cover socro- economic effects of thc discase. 4. Thc Abia Statc I-lcalth Dcvcloprncnt Progranrnro was approachcd uptl they releascd funds for training of additional hcalth workc,ls. Local Government Level: l. The LOCT allowed the communities to detenninc the criteria for selection of CDDs and community supervisors (whom to select) 2' Heads of Disease Control and Primary Health Care were sensitize6 to effectively monitor the activities of their health staff. 3. The LOCTs encourage the communities leaders and women leaders to motivate their CDDs in as nruch as thcir work is voluntaril)z Com Level l. Community leaders were enc ouragc to select rnore CDDs at kindred ievel 2. womcn groups wcrc scnsitizcd to support CDTI ancl crcatc a\,val-cncss. 'r'19 ?'!t 2.9.5. Was feedback given to the person or groups supervised? In areas where supervision was carried out, feedback was givcn, eitlicr orally or through supervision reports. 2.9.6. How was the feedback used to improve the overall performance of thc project? The fcedback facilitatcd thc sclcction of adclitional CDDs, ancl PIIC C'oorclinators becatrre lllore aware of the issues being encountered in CDTI inrpicnreutation r.incl hclpcd gcnerate commitnrcr-rt by health staff. The CDDs trained participatcd fully and sorne of tlrc conrrnunity lcadors cornpensated their CDDs aftcr distribulions excrcise. Thesc all lcd to improved treatment coverage - geographically and tlierapcutically SEGTION 3: Support to GDTI 3.{. Equipment Table 12: Status of equipment (Please add ntore rows if necessary) Source Typc of ,cquipurcnt APOC MOFI DISTRICT/LGA NGDO Others No. Conditron No. Condrtr No Condrtrorr No. ('ttndtItorr No L 0r(lrltorl l. Vehicle 2 Repairable 2. Motor cycle t6 8 functional 8 groundcd 3. Computers 2 I set functional I w.o 4. Printers 2 One Functional 5. Fax Machinos (r. Othcrs a) Bicycles 80 40 functional 40 w.o b) Photocopier 2 One Functional c) UPS I w.o d) Generator 2 Functional e) Office Safe lf:f 2.Y -t /UO *Condition of the equipment (F=Functional, CNFR:Currently non-functionalbut rcparrablc, WO:Writtcn ofl). l-low docs thc projcct intcnd to maintain a4d rcplacc cxisting oquipnrcnt and otlrcr. materials? In view of the State and LGAs inability to replace capital equipment previously, thcy will be pcrsuadcd to nraintain the cxisting oncs from the oncho control budgct. The support of APOC will be sought for the replacenrent of capital equrpnrcnt. 3.2. Financial contributions of the partners and communities Table I 3: Financial contributions all ers for the last three rS - Ifthere are problems with release of counterpart funds, how were they addresscd? In the Abia project, the issue of countcrpart fund release by the State and Local Goventments has been a problern. However, this problem was addressed through the use of continuous high-level advocacy to the various ticrs of govenrrnent by officials of Globai 2000 and zonal co-ordinator. Sadly, the promises havc not really materializccl. 3.3. Other forms of community support - Describe (indicate fomrs of in-kind contributions of communities if any) 2* L+ Ycar 6 (.lutte. 2004 - ,Sapt . 2003) Contributor TOTAL Cash Budgctc d (uss) 1'OTAL Cash Rclcascd (us$) Ycar 7 (.lun.. 2006 -Dcc 2006) l'o'fAL Cash Budgctcd TOTAL Cash Itclcascd Ycar tl (Jau. 2007-Dcc. 2001\ TOTAL Cash Buclgctcd TOTAL C'ash Itclcasctl (us$) MOH (Ccntra[+Provrn cial/Statc) 7,692 923 1,692 300 I I.1il.il 10,080.07 MOH (Drstrict/LGA) 6,153 3,076 6,1 53 865.4 il,lil.ll 2143. 51 Local NGDO(s) ( rf any) 0 0 NGDO partncr(s) 24,91t l 000 ) ')\\ /. 2,255.4 1147 .56 7141 56 Othcrs 0 0 0 0 a) 0 U b) 0 0 Communitrcs 32,000 t53 0 4 I 3.98 APOC Trust Fund 1,640 1,000 4.500 r 7,000.002,250 17.000.00 TOTAL 72,396 6152 20,600.4 5,670.8 46369.182 36,785. r 8 T{ i) ii) iii) ir) v) vi) 3.4. Exemption from some community levies and dues. Arranging labour to assist CDD in his /her farrns. Special recognition in cornmunity gatherings. Giving fbodstuff to thc CDDs. Sorne comrnunitics givc varicd alnouuts <lf moncy to thc cDD. Using the villagc town cricr to nrobilize pcoplc cluring trcatmcnt Expenditure per activity Indicate in table 14, the amount expended during the reporling period for cacS activity listed. Write the amount expended in US dollars using the current Unitcd Nations exchange rate to local currency. Indicate exchangc rate usedhere S I :N130 Y'L$ s Table l4: Indicate how much the project spent for each activity listed below durirrg the reporting period Activity Expenditure ($ us) Source(s) of funding Mobilization Training at CDDS Training of I-Iealth Staff at all lcvel Supcrvising of CDDS Intcnral Mountitrg Advocacy IEC Materials Sumrnary report fonns and treatment Vehicle maintenance Office Equipment e.g. colllputcr etc Collections of APQS Equipment 850 I 1,550 6,750 1,500 4,0(x) 3,500 3,500 0 2,189.04 1,000 794.50 TOTAL 35,632.54 Any cornments or cxplanations? SECTION 4: Sustainability of GDTI 4.1. !nternal; independent participatory monitoring; Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting ;reriod? (tick any of the following which are applicable) Year I Participatory Independent monitoring Mid Tenn Sustainability Evaluation 5 ycar Sustainability livaluation Itrtcnral Monitoring by NOTIT Othcr Evaluation by other paftners No monitoring was carried out during the reporting period under review APOC APOC, GRBP, MOH, ABHSDPII APOC, GRtsP, MOI-I of LGA, ABIISDPII GI{I]I' & MOII GRI]I' & NIOII APOC, GRBP & MOII APOC 0 GRBP, & MOII GRBP & MOI] MOI I \ ?? L5 *s 4.1.2. What were the recommendations? N/A 4.1.3. How have they been implenrcntcrl? N/A 4.2. sustainability of projects: plan and set targets (mandatory at Yr 3) Was tlie project evaluated during the reporting period? Nq Was a sustainability plan written? Previousl August 2003_ When was thc sustainability plan subntittcd? Aueust 2003 What arrattgemcnts have bcen made to sustain CDTI after APOC funding ccascs in tcrrns of: 4.2.1. Planning at all relevant levcls The process of planning is very relevant to the success of CDTI sustainability. Joint planning of activities will continue between the project office, the Statc ministries of Health and the LGAs. Planning at the community level will cqually continue between CDDs and their communitics. 4.2.2. Funds Ilffbrts to cnsurc that various ticrs of Govcrntrcnt rclcasc budgetcd lirnrls rvill cotrtinue. Iucreased and sustained advocacy nrcctings at various levcls tvill continue. Also involvement of key officers - finance Officers, Planning Officers and Mobilization Officers will be ensured. 4.2.3 Transport (replacement and maintenance) Thc State would want the APOC Managernent to corrtirtrc assisting thc Statc in replacing the Capital equiprnent rvhile the State and Local Govenrment u,ould take up the responsibility of maintenance 4.2.4. Other rcsourccs T 2 30 The computers, printers, IEC nraterials available are in working ordcr. Nonc wirs replaced or required maintenance by the SMOII during the year undcr rcvicw. The project howcvcr needs to replace its written off UpS provided by ApoC We would like APOC to rcplace thc UPS and provide us with Laptop which ivill help us in data managernent. Furthermore the State will take up the responsibility oI ntaintaining the cquiprncnt 1.2.5. 'l'o what extcrrt has thc plan bcelr inrplenrcntctl 1'ltc govcrntncnt has failcd to ltortour thcir conruriturr:ut torvarcls tlic succcsslirl ittrplcnlcntatiorl of tltc sustainability plan, but AI)OC has rclcasccl approvccl nloney accrue to thc State fbr implernentation SCI and yearly supportcd programme and hars equally rclcascd a uew Toyota IIilux The state budgeted about N8 million for thc sustairrability of the prograrnrnc lbr thc three vear period, however this amount was not adcquately releaiccl ancl this harnpered the implernentations of thc project,s plans. Tlre state planned to train 8357 CDDs and I155 FIIrS in five years (2003 -2007). The project howevcr trained 3615 CDDs and 879 iil.-S in the samc pr:r-rod, ri,fticlr represents 43.2% and I 6u/o respectiveiy. The project planrtcd to trcat a targct population of l,(r03993 pcoplc l|tpt 2(X)3- 2007. The project was able to trcat a total of 1,194808 pcople for tho sar.r.rc pcrrod representin g 7 4.4%. The project expected to make 2272visitsto the 564 ender-nic villages irr fiye years as part of commuuity rnobilization. The project made l8l3 visits fbr conrnruirity nrobilization and trcatment in this period which is gOs%. Supervisory visits both at the state and LGA level was fairly concluctccl Supervisory checklist was effectivcly used at all levcls. 4.3. lntegration Outlinc the cxtcntof integration of CD'l'l rnto thc PIIC structurc and [hc plaps lirr. cornplete integration : 4.3.1. Ivermectin delivery mechanisms lvermectin delivery has been fully integrated into the PHC structure with states collecting their drugs fronr the zones and storing them in the state drug stores. Likewise LGAs collect the Mectizan from the states and distribute them throuqh the PHC structures to the health facilities. KJ 9L !{ 4.3.2. Training Training on CDTI is carried out by workers who are an integral part of the PIIC structure. 4.3.3. Joint supervision and rnonitoring with oflrer programs Joint supervision has been initiated with other progran'rs as exhibited by thc sharing of information. 4.3.4. Release of funds for project activities Funds forthe control of Onchocerciasis are part of thc cntire PI-IC budgcts. But irr rrost cerscs, tho dil'flculty is thc rclcasc ol'thosc lirnds. 4.3.5. Is CDTI included in the PHC budgct? CDTI is tully integratcd in thc PI-IC budgct. 4.3.6. Describe otlter health programmes that are using the CDTI structurc and how this was achieved. What have been the achievements? The other health programmes that are using the CDTI structures arc disease surveillancc, and Nutrition unit. The disease surveillance officers selected by WHO in each LGA fbr Surveillance activities, search for new cases of Onchocerciasis at the endemic LGAs. The Nutrition unit collaborated with thc CD'l'l unit during the irnplenrcntaliorr ol'child Health week at 3 UNICEF LGAs namcly Obingwa, lsuikwuato and Bcndc. A total ol' 49715 childrcn and postpartum mothers were given Vitamin A Supplementation. Tliis activity was sponsored by UNICEF Zoie A. , 4.3.7. Describe other issues considered in the integration of GDTI. An issue towards which efforts are being made to irnprove arc joint planning sessions with other programme leaders/coordinators for better coordinated actjon. 4.4. Operational research 4.1.1. Sunrmarize in ltot ntorc than onc half of a page the opcrational rcscarclr undertal<en in the projcct arca within the rcporting pcriod. The project did not carry out any operational research during the period uncler review. 4.4.2. How were the results applied in the project? s 2< 3L (l) (2) (3) (4) (5) (6) (7) SEGTION 5: Strengths, weaknesses, challenges, and opportunities I. List the strcngths and lvc:rl<Ircsscs of CDTI irnplemcntatiou proccss. STIIENGTHS: Selection of CDDs along kindred lines lncrease in the uumber of CDDs available and involvcd in CDTI intltlcntcntatron Availability of more traincd health workcrs for CDTI Increase in the nurnber of community supervisors Fligh level femalc iuvolvemeut resulting in increased number of fcnralc CDDs Colnmitted staff at the Statc levcl Usage of the CDTI structurc for othcr intervcntior-rs WEAI(NESSES L Poor mobilization of communitics by FLIIFS 2. Poor attitudc of health workers towards CDTI prograntnle 3. Unwillingness of some conlmunities to incrcasc thc numbcr of thcir CDDs4. Non release of counterpart funding by Governmcnt 5. Inadequate record keeping and reporting List tlre challenges and indicate horv they we're addrcssed. (l) Non release of counterpart funding at all levels of government(2) CDD attrition due to inability of somc communities to motivatc their CDDs(3) Poor monitoring and supervision of CDTI activities in some LGAs/ Conrnrunities. fo addrcss the challengcs tlic projcct did thc following:(l) Mobilizcd thc comt.uunitics to selcct nrqrc CDDs, prcfbrably along kindrccl lrncs(2) Traincd and rctraincd hcaltlr workcrs to bc involvccl in CDTI inrplcnrcntation ancl to assurc all attitudinal changc.(3) Paid advocacy visits to the policy nrakcrs at Statc and LGA levcls towarcls rclcasc of counterpart funding. SEGTION 6: matters Unique features of the proiecUother (l) (2) I{igh level of awareness of the CDTI programme at the comurunity levcl Cood interscotoral collaboration bctwcen all paltncrs. ?3 ,34 (3) High number of Female CDDs that are more committed and stable to carry out their function effectively.(4) Good rapport of the SOCT, LOCT with the governrnent authorities 33 3+ T q Oto c\l c)- C) Lr)N .-((, ._. I O C) c) a..) c) U)(D (:) Q C) o CJ tr) OOO.(r) z. 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